Pulse check Cases Collection (1)

Case 1
A 45-year-old man developed multiple red, swollen, intensely itchy mosquito-bite–like lesions on his legs that would not resolve. One week ago, identical swellings appeared on skin areas that had never been bitten. Topical applications and internal heat-clearing, detoxifying herbs had no effect. He also complained of dry mouth with a bitter taste, heartburn, and dark yellow urine. On palpation, both wrists felt weak overall; the right guan position was slightly wiry and tight, the left guan slightly more forceful. Diagnosed as a Jueyin disorder, he was treated with Chai Hu Gui Zhi Gan Jiang Tang. Within three to four days of starting the formula, the redness, swelling, and itching subsided rapidly.

Case 2
A 52-year-old woman suffered from chronic constipation and depended on enemas for relief. Her tongue body was pale with a thick coating. The right pulse was deep, slippery, and strong; the left was superficial, thin, and weak. Treatment aimed to nourish the blood, warm the kidneys, and purge intestinal excess. She was given a combination of Ji Chuan Jian and Cheng Qi Tang for seven days. After treatment, her bowel movements became regular and smooth; she experienced a clear, lasting effect and did not return for further treatment.

Case 3
A 36-year-old factory worker reported long-standing digestive issues, including abdominal distension and acid reflux; gastritis had been diagnosed. His left pulse was relatively thin, only strong when pressed deeply; his right pulse was deep, empty, and weak. He also complained of cold intolerance, lack of morning erections, and low libido. A hospital workup was unremarkable. The presentation was consistent with yang deficiency. He was advised to take the patent medicine Guī Fù Dì Huáng Wán together with Fù Zǐ Lǐ Zhōng Wán. After one month, he reported significant improvement: his libido returned and his cold intolerance lessened. He was instructed to continue the regimen for another month to consolidate results.

Case 4
A 4-year-old boy awoke with bright red cheeks and sudden high fever. His tongue had a white coating with red spots on the anterior portion. His pulse was deep, full, and forceful, and he had a clear, runny nose. This was diagnosed as an exterior cold with constrained interior heat. He was given the patent formula Fáng Fēng Tōng Shèng Sǎn. Two hours after dosing, the cheek redness subsided and the fever dropped to a low grade; he then passed foul-smelling diarrhea, reducing his symptoms by half. That evening, his pulse was again deep, rapid, and dry, and his lips were cracked, so Mài Dōng and Xuán Shēn were added before bedtime. The next morning, one more bout of diarrhea occurred and he was fully recovered.

Case 5
Since the pandemic began four years ago, my mother has seen countless TCM practitioners throughout Beijing for her insomnia and related issues—with almost no sustained benefit. Some treatments worsened her condition after one or two doses, others helped briefly but failed thereafter. When I returned home, I took her pulse carefully and found an exceptionally complex presentation. Aside from the right chi position (Mìngmén) being acceptable, each of the six positions had its own issue. By zang-fu: heart, lung, spleen, kidney, and liver were all involved; by the four levels (Qi, Blood, Fluids, Shen): Qi stagnation, blood stasis, fluid retention, phlegm accumulation, and emotional factors were all present. Thankfully, her Mingmen fire remained intact, preserving her constitutional energy despite years of sleep loss.

Emotional-disturbance patients struggle to build trust with practitioners—or even with their own children. I first explained my pulse findings to her with a diagram, then analyzed every formula she had tried. Most expensive prescriptions had missed her true pathology, targeting only liver-soothing, Qi-regulating, and Shen-calming, which proved ineffective for such a multifactorial case. One renowned insomnia specialist’s formula used Zhizi Chi Tang (for excess heat) on a constitution with a weak cun pulse, producing the opposite effect.

Among all the formulas she had tried, two stood out: a modified Chai Hu Jia Long Gu Mu Li Tang and Wendan Tang, each augmented with herbs to nourish yin, regulate Qi, and resolve blood- and phlegm-stasis. Both provided relief, but she could only take them intermittently—turtle-shell herbs were hard to digest, and subsequent tweaks diluted their efficacy.

After clarifying all her issues, I crafted a comprehensive prescription combining and modifying seven classical formulas—reaching my limit in terms of herbal quantity. In such complex cases, omitting any level of pathology leaves treatment incomplete. Yet combining too many formulas can blunt each formula’s distinct action. Short-term relief is achievable, but full resolution demands prolonged, patient regulation—and the ever-present risk that the patient’s discouragement will cause her to discontinue treatment.

Emotional disorders are the hardest to treat: they challenge the practitioner’s diagnostic mastery and provoke the patient’s own fixations, leading to discomfort with any prescription—even as forgoing treatment is worse. These cases are often the least popular among doctors, compounding difficulty at every turn. Such is the stubbornness of human fate; we can only do our utmost and leave the rest to destiny.