Professor Fang Mingqian on the Rapid Pulse

All deficiency-tax, consumptive damage and long-standing illness present with a rapid pulse. A rapid pulse cannot be taken universally as heat or as excess. The book Mai Ru states: "The rapid pulse may be yin or yang; later generations have handed down the notion that all rapid pulses indicate heat, but this began with the Nan Jing. One must know that although a rapid pulse may indicate heat, one must distinguish deficiency from excess." In my own clinical experience, whenever I have seen patterns of blazing fire or latent fire, the pulse has conversely not been rapid, but only surging, slippery and forceful, as described in the classics. As for the differentiation of the rapid pulse, there are broadly eight categories; I list them below, and whatever is not covered may be inferred by analogy.

• External contraction may present a rapid pulse. But if the pulse is rapid right at the onset of contraction, the pathogen has not yet passed through the channels - where would the heat come from? Therefore only warm dispersal is appropriate. Even if the pathogen has long passed into the channels, only when the pulse is rapid and slippery can one speak of heat; if it is rapid and weak, it remains after all a yin pattern, and only warming the centre is appropriate. The rapid pulse of external contraction cannot all be taken as heat. Note: in externally contracted cold damage, the pulse is floating and rapid.
• Deficiency-tax may present a rapid pulse. When the rapid pulse arises from yang deficiency, the pulse must be rapid and weak, or also fine, and the pattern presents with cold-deficiency signs; this is then warmed. Note: rapidity normally belongs to heat, but in deficiency-tax it is otherwise; it should be viewed as deficiency, using Baoyuan Tang (Source-Securing Decoction) or Renshen Yangrong Tang (Ginseng Nutritive Decoction). There is also a rapid pulse from yin deficiency: the pulse must be rapid, wiry and slippery, with signs of vexing heat; here, too, cold medicines should be used cautiously, for merely clearing heat will surely lead to spleen diarrhoea. Moreover, in consumptive patients the pulse is invariably rapid; among rapid-pulse disorders, deficiency-tax is by far the most common. The more deficient the patient, the more rapid the pulse; the more rapid the pulse, the more critical the condition. How can all rapid pulses be heat diseases?

Note: For yin deficiency, take Liuwei Dihuang Wan together with Dabuyin Wan and Renshen Yangrong Wan. It is the same rapid pulse, but there are two different routes of supplementation; one must not err. In examining consumptive disease, the hand no sooner rests on the wrist than the rapid pulse is felt. Other people all clear heat, while I alone use ginseng as the chief herb - that is the reason. Again, take fever: when low-grade fever arises in the afternoon, taking more cold medicines will not clear the heat, but once Buzhong Yiqi Wan is taken together with Liuwei Dihuang Wan, it is resolved.

• Malaria may present a rapid pulse. During a malaria attack the pulse is always tight; when the attack stops it is always moderate and relaxed. The stopping merely means the cold pathogen has receded; true heat and true cold are otherwise.

Note: In malaria, upright qi contends with the pathogen in a crevice of the body - the crevice being the shaoyang interstices where the two meet. When upright qi wins, there is heat; when the pathogen wins, there is cold. Hence the alternating cold and heat, and the rapid pulse. Treat with Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Muzei Cao (Horsetail) and Changshan (Dichroa); add Renshen for deficiency.

• Dysentery may present a rapid pulse, but if it is accompanied by wiry, choppy, fine and weak signs, it is a deficient rapid, not a heat rapid; warming the life-gate will not fail once in a hundred. Only when there are clear fire signs, in a person of robust age and strength, may one treat it as a heat rapid - and only when a surging, slippery, forceful, rapid pulse is actually seen is that the true pattern. Note: When dysentery occurs once a year, if there is solid fire, use Chengqi Tang to purge it; if there is extreme deficiency, use Jiangcha Yin (Ginger-Tea Drink) with added Renshen.
• Sores and abscesses may present a rapid pulse. Sores have yin and yang: yin patterns should be warmed and supplemented, yang patterns should be heat-cleared. Of course, the rapid pulse is divided into forceful and weak. The Nei Jing says: "All pain, itching and sores pertain to fire" - this is the fire of the five emotions. The rapid pulse must be divided by whether it is forceful or weak, and distinguished by whether it is fine or not. A fine rapid pulse indicates blood deficiency; a rapid, small, jerky pulse indicates yang deficiency.
• Pox and rash may present a rapid pulse, because the toxin has not yet reached the surface; once it reaches, the pulse is no longer rapid. Note: when upright qi is sufficient the illness does not advance; when the pathogen is spent the pulse becomes rapid.
• Abdominal concretions and gatherings may present a rapid pulse. Whenever there is a mass like a plate below the ribs or abdomen, arising from accumulated stagnation that will not move, the pulse must be rapid. If there are no fire signs yet a fine rapid pulse is seen, it must not be taken for heat. Note: where qi and blood are obstructed between the viscera and upright qi seeks to pass through, the pulse first becomes rapid.
• Pregnancy may present a rapid pulse. The qi of the thoroughfare and conception vessels is obstructed, hence the rapid pulse; there is fundamentally no fire. Here one must distinguish cold and heat by strength and weakness, and must not, because the pulse is rapid, insist on scutellaria as a divine herb. Whenever the pathogen is exuberant, the rapid pulse is invariably accompanied by yang pulses; in severe deficiency, the rapid pulse is invariably accompanied by yin pulses. Thus one can tell whether the rapidity is true heat or not.

Note: Where there is obstruction in the lower abdomen, heat tends to rise. Lay practitioners commonly use scutellaria as a divine herb, but in fact it must not be used indiscriminately; it should be decided according to the pattern.

Zhiyuan's note: This is one of the very few medical essays written by Professor Fang Mingqian himself. Old Fang was busy with clinical practice all his life and wrote little. His understanding of the rapid pulse can be called profound indeed.