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Do you not consider #2 & #3 choppy?
1) Rough feeling (actual texture of the pulse)
2) irregular speed (changing with breath, or otherwise)
3) ireegular strength. (Hitting fingers at different intensities, at different times)
You have identified a serious nomenclature problem that has been historically confused. The elite of this profession provide no consistent response to the question ‘what is a choppy pulse?’ I entered this question on the list previously with no clear response from any quarter.
The evidence for confusion about the description of a choppy pulse abounds, just read this list:
Jin Wei: this is a pulse that is felt fine, slow, short, scattered, hesitant, and unsmooth, like scraping bamboo with a knife.
Maccioccia: This pulse feels rough under the finger:instead of a smooth pulse wave, it feels as though it had a jagged edge to it. Choppy also indicates a pulse that changes rapidly both in rate and quality
Li Shizhen: “A pulse which feels thin, minute and short and has an uneven flow, beating three and five times with irregular rhythm, is called choppy.....It feels like a knife scraping bamboo, rough and jagged. It is easily scattered like rain falling onto the sand. It also moves very slowly and at irregular depths, like an ill silkworm eating a leaf.”
Wang Shuhe: “a fine and slow pulse, coming and going with difficulty and scattered or with an interruption”
Kaptchuk: irregular in rhythm. In this case it is called the three and five not adjusted sometimes three beats per breath and sometimes five beats per breath.
Wu Shuiwan: The movement of this pulse is felt as rough and choppy. It is not fluent. It is slow and thin. The wave of this pulse is short.
Deng Tietao: it should feel slow and uneven, fine,small,short.
CAM: A hesitant pulse feels rough and uneven; stagnations; produce a hesitant and forceful pulse ........insufficiency;creates a hesitant and weak pulse;
Pulse descriptions are often used to define the choppy pulse that may or may not have bearing on designating a choppy pulse. These include fine, slow, short, scattered, hesitant, changes of rate, thin. Wu Shuiwan and Jin Wei both describe the pulse as short. The famous Yi Tian Ni used this description, it is a wave that halts abruptly as if it has hit a mass. This is very different from a wave that gives way suddenly due to a deficiency of Qi.
The idiosyncratic qualities of Drs Shen and Hammer are derived from many qualities which have traditionally been attributed to the choppy pulse. Macicocia who studied with Dr. Shen describes the choppy pulse similarly to Shen and Hammer –-- a jagged (fixed)edge. However, then he then uses the standard commentary or what Hammer calls ‘changing rate at rest’ to describe a choppy pulse. This important because the pathophysiology ‘of changing rate at rest’ is vastly different from that of a choppy pulse according to Hammer. Interpretation: most of the qualities used to describe the choppy pulse may happen in the presence of blood stasis or essence deficiency. These qualities may be a product of these two processes or they may represent processes that may lead to blood stasis or essence deficiency. If the blood is deficient as demonstrated by the thin, fine, and thready qualities, then the blood is predisposed to stasis due to the lowered circulating blood volume. This does not necessarily indicate blood stasis. Certainly there is an increased possibility of essence deficiency under these circumstances.
Review and comparison of the authoritative passages listed above can create tremendous confusion. My recommended solution is that writers specify exactly what it is they are talking about when referring to the rough quality. In addition, when working with other practitioners in the clinic, it is necessary to inquire about the exact sensation that is being discussed.
Will Morris
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