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Chapter 22 of 28
濒湖脉学
Knotted pulse (slow pulse with occasional pauses, resuming after each pause) is characterized by: a slow pulse that suddenly skips a beat, then resumes its beating. This definition originates from the Maijing (Pulse Classic). 🩺
A crucial distinction must be made here: there are three different types of "knotted" (jie) in classical literature that are called the same name but differ in nature: what the Mai Jue (Pulse Songs) calls "coming profusely, clustering and then retreating" — Li Shizhen explicitly points out this is unrelated to true knotted pulse; Zhang Zhongjing's "Yin-knot" (a pulse that feels like successive knots on a long bamboo pole) and "Yang-knot" (a pulse that is full and grand, as vast as a chariot canopy) carry a different meaning; and a Lijing record of a knotted pulse "moving like hemp seeds, rapidly contracting and dispersing irregularly," which indicates death. These three types share the same name but are fundamentally different in reality and must not be confused. 🌿
Form & Substance Poem: A knotted pulse features slowness with intermittent pauses, reflecting the pathological state of predominant yin excess and dwindling or nearly extinct yang qi. A knotted pulse felt with light pressure suggests qi stagnation; knotted pulse felt with heavy pressure suggests accumulation/retention. Treatment decisions — sweating or purging — must be made with discernment and inner clarity. 🔥
Comparative Poem: For differentiation from intermittent pulse (dai mai), see the section on intermittent pulse.
Indicative Disease Poem: The appearance of knotted pulse stems fundamentally from qi and blood congealing and stagnation. Stubborn phlegm binding causes painful groans; internal accumulation (jiju) may form, surface abscesses and swellings may erupt, and hernia-like masses (infradiaphragmatic painful lumps) cause harm — the nature of disease is yin. 💨
Knotted pulse indicates diseases due to yin exuberance. Qin Yueren (Bian Que) stated: greater knottedness corresponds to greater accumulation; milder knottedness indicates only mild hindrance of the qi mechanism. A knotted pulse on light palpation indicates superficial painful masses; a knotted pulse sinking and hidden suggests internal accumulations. 🌊
The clinical essence of knotted pulse resides in the phrase "yin exuberance with yang depletion, qi and blood stagnated."
Pulse beating depends on the harmony between yang qi driving force and yin blood nourishing sufficiency. A normal pulse flows smoothly with even rhythm, embodying powerful yang qi activation and evenly circulate yin blood. When yin cold dominates and yang qi is constrained, movement of qi and blood within pulse pathways becomes slow and impeded; when extreme stagnation builds up, a momentary gap in pulse continuation occurs... pause. Such an intermittent beat occurs as yang labours to recover itself. — precisely the saying "slow and irregular with intermittent return."
Li Shizhen made every effort to distinguish by distinguishing substance. All three varieties of "knot," while sharing name but not significance, reveal commitment to sophisticated theoretical foundations…
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Regarding syndromic translation footnote in classic literature: “Knotted pulses identical phenomenon.”
From modern medical viewpoint, the knotted pulse with parameter slow pulse+ irregular beats overlaps key criteria suggesting pattern-fitting: Modest ranges associating mainly with aruppation echoes having lower-load burdens presenting parameters appropriately paired thereafter again naturally colliding through contact-based but relevant respective main domains addressed widely elsewhere still necessarily emerging main roles … In continued comprehensive and honest alignment modern knowledge emphasizes mod compatible biomedical relevance beyond scope projections but not limiting—transference careful measures focus categorical.
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