Discussion of an excerpt of Mai Jing 脈經 chapter 11,
by Wang Shuhe 王叔和 (180-270 AD)
Geneviève Le Goff, L.Ac.
© 2024 Geneviève Le Goff
象 and the shadow of elephants...
經言脈有伏匿者，伏匿於何藏而言伏匿也，
The classic says the pulse can be concealed or hidden; when it says concealed or hidden, in which zang is it concealed and hidden?
然謂陰陽更相乘更相伏也，
Indeed it is furthermore said that yin and yang mutually invade and hide each other;
脈居陰部，反見陽脈者，
when the pulse is in the yin division, but contrarily one sees a yang pulse
為陽乘陰也，脈雖時沈濇而短，
this is yang overtaking yin, although at times the pulse might be sunken, rough or short,
此陽中伏陰也，
this is yang hiding within yin;
脈居陽部，反見陰脈者，
when the pulse is in the yang division, but contrarily one sees a yin pulse,
為陰乘陽也，脈雖時浮滑而長，
this is yin overtaking yang, although at times the pulse might be floating, slippery or long,
此為陰中伏陽也，
this is yin hiding within yang.
重陰者癲，重陽者狂，
Double yin leads to derangement, double yang leads to mania.
脫陽者見鬼，脫陰者目盲。
Disconnected yang leads to seeing ghosts, disconnected yin leads to blindness.
“The classic says the pulse can be concealed or hidden; when it says concealed or hidden, in which zang is it concealed and hidden? Indeed it is furthermore said that yin and yang mutually invade and hide each other; when the pulse is in the yin division, but contrarily one sees a yang pulse this is yang overtaking yin, although at times the pulse might be sunken, rough or short, this is yang hiding within yin; when the pulse is in the yang division, but contrarily one sees a yin pulse, this is yin overtaking yang, although at times the pulse might be floating, slippery or long, this is yin hiding within yang.”
This short excerpt from Mai Jing 脈經 chapter 11 by Jin dynasty physician Wang Shuhe 王叔和 aims to reveal that which is sometimes hidden to the novice practitioner: the inner physiological relationships which logically connect different, and indeed opposite pulse images. In doing so, it defines binary categories of yin and yang pulses, and understates their physiological commonalities and differences.
The ‘yin’ and ‘yang’ divisions of the pulse can be understood in two ways in the Mai Jing. One refers to the depth of the pulse, regardless of its location, yin being deep and yang superficial, and the other refers to the proximal, yin position of the chi, versus the yang, distal cun position. In this case, the pulse in the yin division refers to the chi; the pulse in the yang division refers to the cun. One would naturally expect the yin, chi pulse, as reflective of shaoyin, to be deeper. If it contrarily displays the effulgence of yang, this denotes pathology. Nothing too surprising so far. The text goes on to say that in this situation the pulse might at times also appear sunken, rough or short, all of which are yin qualities. However, these are pathological yin qualities, not the harmonious, deeper pulse of a healthy yin. Why would a pulse at times display the effulgence of yang and at others weakness and insufficiency of yin? The answer lies in the nature of blood. Blood pertains to jueyin, and is born in the nascent East, of the merging of yin and yang in the North; it is comprised of yin nutritive and yang ministerial fire, which in health circulate together in harmony within the blood. Sunken, rough and short pulses are all pulses which denote an insufficiency of fluids. Indeed in the Shang Han Za Bing Lun 傷寒雜病論 whenever “sunken” is used, it is always in relation to the lack of engenderment of blood and steaming of fluids, with a background of insufficient unification of yin and yang; rough denotes blood stasis, which is the solidification of the fluid aspect of the blood and essentially a loss of yang/buoyancy and a transition into a state of excessive inertia and yin; and shortness reveals insufficient substance. How then, do we get a yang pulse image intermittently with these yin pulses? When the fluids of the blood become insufficient, ministerial fire is no longer embraced by them: following its nature it rises too quickly and strongly, so producing a yang pulse image. The pulse might then turn to slippery, surface, or wiry and forceful. Line 100 in the Shang Han Lun 傷寒論, part of the shaoyang chapter, touches on this apparent paradox. In the latter, a patient who presents like a shaoyang patient has a pulse that is rough. The remedy is then to take Xiao Jian Zhong Tang, rather than Xiao Chai Hu Tang, and to only turn to Xiao Chai Hu Tang if the patient fails to recover. Line 100 speaks of the relationship between ministerial fire and nutritive. When the nutritive is dry, ministerial fire flares: this is actually the core etiology of a shaoyang disorder, which is why it often (but not always) arises after one has lost fluids in a yangming disease. It logically follows that a rough pulse is reflective of the reduced yin which is the background and reason that a wiry (or occasionally slippery) pulse can arise. We can see these intermittent patterns in patients with blood or fluid damage. Commonly in clinic this can be a weak patient with a shaoyang stage cold, menopausal patients with hot flashes, patients with anxiety or mania, metabolic disorders such as diabetes, etc, a myriad different diseases which all fall within the scope of diminished yin and effulgent ministerial fire. Typically these patients will present with a strong, yang pulse, and as they (and their ministerial fire) settle into the calm of their treatment, the true deficient nature of their fluids shows and the pulses move inward, becoming weak and yin in nature; this is the first step to recovery (yang re-internalizing), and is followed by the recovery of fluids and the eventual strengthening of the pulse. The same progression is seen in herbal treatment of jueyin/shaoyin patients with a desiccated presentation, and yet a forceful pulse. The first phase of herbal prescription would entail a background of blood nourishment and reliquefaction, as well as increasing the unification of yin and yang in the North, while also needing to downbear exuberant ministerial fire by using bitter herbs like huang qin or huang lian (as in Huang Lian E Jiao Tang or Gan Cao Xie Xin Tang for example), or sour ones like wu mei or wu wei zi. This is the archetypal jueyin condition, where deficient yin leads to a dysregulation of ministerial fire, and is in keeping with biao ben zhong qi 標本中氣 theory in the Huang Di Nei Jing 黃帝內經, where we see shaoyang ministerial fire as the center of jueyin.
Wang Shuhe also gives us the mirror condition, where a patient presents with a yin pulse in a yang division, the cun. Instead of the pulse having harmonious strength and being found in the more surface level, representing the reaching upward of nutritive and ministerial fire to the southern position, the pulse is deep, faint, or rough. This signals that the nutritive and ministerial fire have failed to reach the surface. This outward movement is the task of the East, and depends on the strength of the newborn yang issued from the union of yin and yang in the North. When heavenly yang fecunds and quickens yin in the North, the process of transformation and steaming begins, and blood, the perfect marriage of water and fire, is born; it starts moving and steaming toward the upper and outer reaches of the body, eventually to reach the exterior as sweat and urine. A weak pulse in the cun therefore signals weakness of the unification of yang into yin in shaoyin North, and the ensuing failure of the outward movement of the East. The latter core reason for this reversal can sometimes be complicated by dryness of jueyin or fluids, as a failure of the unification of yang and yin in the North often causes, as we saw in the previous section, a lack of engenderment of jueyin blood. Sometimes we see a deep and wiry chi in association with the weak cun, denoting water accumulation in the North, bogging down the departure of ministerial fire and dampening steaming and transformation: hence the weakness of the cun. This pulse presentation is logical enough. Yet in the clinic we commonly see the association of a cun rolling upward in a surface or slippery fashion, or buoyantly extending toward the thenar eminence. This is characteristic of yang losing root and floating upward; usually this pulse is seen in association with a sunken or weak chi. Such a pulse image can be felt in Zhen Wu Tang, Fu Zi Tang, Fu Ling Gui Zhi Gan Cao Da Zao Tang, Ling Gui Zhu Gan Tang, sometimes in Ba Wei Shen Qi Wan, all patterns in which we have a water accumulation in the North, giving rise to improper engenderment of blood, and hence upward rising wind, yang losing root. This is a yin condition hiding under a yang pulse. It would be easy to mistakenly think fire is excessive upon feeling a slippery cun, but that is not always the case; in fact it is more common to see a slippery cun in a situation of overall deficiency taxation, and the failure of yang to submerge into yin at the Northern, shaoyin pivot, something often (if a bit imprecisely) commonly called yang deficiency in modern verbiage. The remedy here would be to strengthen yang and its unification into yin with fu zi, and help the transformation and steaming of water, so the green dragon of the East can be born and reach the upper in a harmonious manner. Leaves have to be connected to roots in order to not wither and fly away.
At this point one can see that the two situations offered to our appreciation by Wang Shuhe, a yin deficiency condition presenting alternatively with a yang pulse or a yin pulse, and a yang deficiency condition presenting alternatively with a yin pulse or a yang pulse, are but mirrors of each other, and the fact that the physiology of yin and yang is interdependent. Effulgent yang in the pulse can be caused by deficient yin as well as deficient yang, itself leading to lack of blood because taiyin requires yang to generate nutritive; reciprocally, preponderant yin in the pulse can be caused by deficient yang (lack of transformation) as well as deficient yin (lack of reaching due to insufficient substance), which leads to the terminal separation of yin and yang, a cold center and thence, the formation of pathological dampness. All formulae in the Shang Han Za Bing Lun, whether categorized as treating a yang or yin conformation, aim to reestablish the balance of fluids and ministerial fire, and, precisely, regulate the yin and yang extremes of the pulse highlighted for us in this passage. Understanding the simultaneously inverse and complementary relationships presented by Wang Shuhe can help us understand the composition of formulae with more precision.
This short passage establishes a contrast between the yin pulses sunken, rough or short, and the yang pulses floating, slippery or long. It is worth noting the opposing symmetry of these pulse qualities: sunken and floating, rough and slippery, short and long. Let us first turn our attention to the sunken/floating dyad. Sunken denotes the lack of outward movement of yang qi; this pulse in the Shang Han Za Bing Lun is always found in lines where in addition to yang deficiency, the fluids have also been damaged. The sunken quality reflects weak yang as much as the insufficiency of the nutritive fluids which carry the ministerial fire toward the South. Weak yang contributes to nutritive deficiency because taiyin needs yang to produce nutritive, so creating a vicious cycle. In comparison, a floating pulse occurs when weak yang qi loses root and floats upward; this can only happen if the nutritive is also weak, releasing the grasp it normally has on yang. Both sunken and floating pulse qualities, though reflecting opposite movements, are expressions of dual deficiencies of yin and yang. We see this shared etiology in the rough/slippery dyad as well. A rough pulse is the pulse of blood stasis, of severely depleted fluids. The nutritive has been desiccated to the point of stagnating the blood. As for the slippery pulse, it can show both phlegm and heat. In modern Chinese medicine schools these concepts are often taught as antithetical, as dampness is yin and heat is yang. However, in the classics these two concepts are intimately related. Close study of the character for phlegm (痰 tán) reveals that it contains a double fire component. This etymology offers a window into taiyin physiology and the formation of the slippery pulse. Taiyin’s main function is to produce nutritive, under the impetus of heavenly yang entering the zang to process food, drink, and air. When taiyin does not receive enough yang and is unable to properly process the latter, two things happen simultaneously: on the one hand, nutritive is insufficiently produced, and on the other, phlegm accumulates as the by-product of deficient transformation. In the quintessential taiyin condition, we therefore see the coexistence of dryness and damp accumulation. Dryness can lead to effulgent fire, which can cause an external manifestation of heat, as well as the stewing of the dampness into phlegm, both of which can lead to slippery pulse images. Hence the fire components in 痰 phlegm. In this pathomechanism we see the correspondence between the dichotomous pair rough/slippery: both have their root in fluid damage and yang deficiency. They are, so to speak, two sides of the same coin. Our last yin/yang pair in this passage is the short and long pulses. A short pulse denotes lack of yin substance and weak propelling of the blood by yang; conversely we see long pulses when yang moves rashly in a blood vessel which does not contain enough yin substance, as is typical of the pulses of the Xie Xin Tang family of formulae. Although the expression is opposite, both pulses denote a lack of yin concurrent with a malfunction of yang, albeit a bit different in each of these cases.
It can be argued that the entirety of the Shang Han Za Bing Lun deals with the subtlety of differentiation between the various expressions of the same essential vacuities: vacuity of yang and vacuity of yin. Some of these expressions include symptoms and pulse images which sometimes masquerade as excessive, but really are only localized excesses having their root in hidden deficiencies and malfunctions. Where Zhang Zhong Jing describes these mechanisms with symptoms and the composition of his formulae, Wang Shuhe here describes them in the language of the pulse. All pulses, symptoms, herbs, point choices are but the image cast by the proverbial shadow of the elephant in the word 象 xiàng (appearance): like the changing shadow of the elephant, they translate a deeper, invisible reality at the whim of celestial orientation and the relationship of the sun to the earth, in what the Chinese classics hint is the highest meaning possible for human life. The question of “is there such a thing as excess in the Shang Han Za Bing Lun?”, adjacent to the study of this short Mai Jing passage, can be a further inquiry and a starting point for understanding a greater ancient Chinese cosmological worldview. Wang Shuhe, in preserving Zhang Zhong Jing’s works as well as in describing pulse images in a myriad nuances, is, through the ages, an ally in our ability to deduce what lies beneath the surface from perceiving what is liminal between patient and practitioner.
“Huangdi Neijing.” Chinese Text Project, ctext.org/huangdi-neijing. Accessed 25 Aug. 2024.
Wang, Shuhe. “Mai Jing 脈經.” Edited by Lin Yi, Baoheng Gao, The Library of Congress, www.loc.gov/item/2021667496/. Accessed 25 Aug. 2024.
Zhang, Zhongjing, Craig Mitchell, et al. Shang Han Lun: On Cold Damage. Paradigm Publications, 1999.
Zhang, Zhongjing, Nigel Wiseman, et al. Jin Guì Yào Lüè: Essential Prescriptions of the Golden Cabinet. Paradigm Publications ; Distributed by Redwing Books, 2013.
© 2024 Geneviève Le Goff
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