Shanghan Lun Pulse Diagnosis

Shanghan Lun Pulse Diagnosis from the Tian-Zeng Lineage


The Treatise on Cold Damage shanghan lun is the oldest surviving clinical handbook in the history of Chinese medicine. Written by Eastern Han dynasty (circa 200 CE) imperial envoy Zhang Zhongjing, it is an integral part of his collective writings once labeled the Treatise on Cold Damage and Complex Diseases shanghan zabing lun. But the contents of the Shanghan Lun as we know it in current day is far from complete. The present versions studied in Chinese medical schools as well as in the West, do not include the original first three chapters of Rules for Pulse Differentiation bianmai fa, Rules on Pulse Assessment pingmai fa and Cold Damage Outline shanghan li. Regardless whatever motivation was behind the historical deletions of these passages, of the aforementioned chapters, the chapters on pulse instructions are crucial for anyone desiring to fully grasp Zhang Zhongjing’s clinical instructions. Especially since the pulse patterns maizheng form the core diagnostic parameters in the establishment of the formula patterns fangzheng by which the canonical clinician categorizes disease and therapy.

The importance of the pulse instructions is best illustrated with the words of the late Beijing Shanghan Lun scholar Liu Duzhou: “The Treatise on Cold Damage comprises of one scroll on Rules of Pulse Differentiation and Rules on Pulse Assessment, which shows that the study of Zhongjing puts great emphasis on regular pulses and pulse differentiation. This needs no further elaboration. The pulse methods of Zhongjing originate from the Inner Classic neijing and the Classic on Difficulties nanjing, while it also has its proper areas of innovation. It uses yin and yang as basic statutes for the classification of the pulse’s floating or sinking; strong or weak; and slow or fast qualities; as well as the [pulse’s] changes through the chi and cun positions. It uses five element theory to assess lengthwise zong and transverse heng, compliant shun or adverse ni [passage] of unseasonal feishi pulses. It stresses that it is imperative to feel chi when feeling cun, and to feel the foot as well as the hand as diagnostic methods. It indicates the importance of the integrated assessment of the radial cunkou, instep fuyang and carotid renying pulse divisions, and especially stresses the ultimate truth that the pulse is rooted in stomach qi and that the presence of stomach qi leads to prosperity, while the absence of stomach qi leads to death. In the discourse on pulse assessment, emphasis is placed on the relationship of nutritive and protective with the abundance or demise of the three burners, spleen, stomach and ancestral qi to indicate that the strength or weakness of the person, and the presence or absence of disease is always intimately linked with nutritive and protective. Therefore, the use of Zhongjing’s rules on pulses rests on the understanding of disease and the decision between life and death. Hence, for mastery of the theory behind the six conformations differentiation, one must imperatively study the pulse differentiation methods for the benefit of one’s six conformation differentiation.”

In the practice of Shanghan Lun medicine according to the lineage of master Tian Heming and his disciple Dr. Zeng Rongxiu, diagnosis is performed with the greatest emphasis on pulse differentiation. Every prescription answers to a limited number of pulse patterns. These pulse patterns maizheng thus form the basis for the identification of the formula patterns fangzheng in a lock-and-key fashion. As such the actual steps taken by the classical clinician to move from clinical differential diagnosis to treatment is always and exclusively decided by the pulse. This is a process for which profound understanding of the pulses becomes a crucial prerequisite of preceding importance over the eventual in-depth mastery of the classical formulas.