OK - let's mix our metaphors. The hesitant pulse has a shortened time for automaticity and refractory period. These notes are extrapolated from studies with one of my teachers, Qiu Zhouyi.

The hesitant pulse involves automaticity which is an intrinsic property of some types of cardiac tissues, like the nodes and the conducting fibers. Automatic cells are characterized by the appearance, during diastole, of a slow depolarization which is capable of reaching threshold and generate an action potential. This depolarization may also be called a slow diastolic depolarization, or pacemaker potential. In the hesitant pulse, the automaticity depolarizes more quickly, this gives the sensation of no ramp up in the wave.  

The refractoriness property is defined as the period of recovery that cells required after being discharged before they can be reexcited by a stimulus. This refractory period is reduced in the hesitant pulse, giving the impression of no departure portion of the wave. The electro-phathophysiological mechanisms of the hesitant pulse can be divided into disorders of impulse propagation and the disorders of impulse formation. There are three factors affecting automaticity. They are the maximum diastolic potential, threshold potential and the slope of repolarization.

I think it is important to raise the notion that early Chinese texts on rate do not articulate the difference for a fast pulse between beats per breath and an elevated rate of arrival or departure. The rate of the wave's arrival can be fast - and it is in the hesitant pulse, just as it is in the departure. So this is a pulse that in early times may have been described as fast. If it is without force, it is yin depletion. If there is force, there can be excess heat involved. The problem is that both the automaticity and the refractory period are so short, there is insufficient time to fill the heart with blood, so there is a reduced ejection fraction. This creates a scenario where a forceful hesitant pulse is rarer.  

So - in pursuit of a treatment for the patient with the hesitant pulse, and assuming confirmation of yin depletion,

Treatment principles:
   Nourish Yin, enrich the Kidney and Heart, clear the Depletion-Fire
Formula:
1.“Huang Lian E Jiao Tang” (Coptis-Gelatinum Corii Asini Decoction)
        Huang Lian 9g, Huang Qin 9g, Bai Shao 10g, Ji Zi Huang 2 yolks,
 EJiao 10g.
2.“Tian Wang Bu Xin Dan”(Emperor of Heaven’s Special Pill To Tonify
      The Heart)
      Sheng Di Huang 12g,  Ren Shen 6g, Tian Men Dong 12g,  
      Mai Men Dong 12g, Xuan Shen 9g,  Dan Shen 10g,  Fu Ling 12g,
      Yuan Zhi 6g,  Dang Gui 9g,  Wu Wei Zi 5g, Bai Zi Ren 10g,  
      Suan Zao Ren 10g, Jie Geng 9g,  Zhu Sha 10g.

For severe yin deficiency, add
Mai Men Dong (Ophiopogonis Japonici, Tuber) 10g
Sheng Di Huang (Rehmanniae Glutinosae, Radix) 10g
Dang Gui (Angelicae Sinensis, Radix) 6g
For irritability and insomnia, add
Long Chi (Draconis, Dens) 15g
Mu Li (Ostreae, Concha) 15g
For significant empty heat, add
   Xi Yang Shen (Panacis Quinquefolii, Radix) 8g
   Lian zi xin (Nelumbinis Nuciferae, Plumula) 10g

Electrohysiological study of Dang Gui:
Treating experimental arrhythmia with the alcohol purified extracts of Dong Gui was reported by Dr. Wei Zhong Min (Biejin University of TCM). The results suggest that Dang Gui can slow conduction, increase refractoriness, and depress phase 0 depolarization by increase action potential amplitude (APA), prolong the effective refractory period (ERP), and decrease the rate of rise of action potential (Vmax).

Further, complex patterns of blood stasis, excess heat and phlegm heat are common concomitants with the hesitant pulse, the whole picture must be considered. If there is qi depletion also present, Baked Licorice Combination (zhi gan cao tang) also has Ginseng and Ophiopogonis (Sheng Mai San) in it.

Warmly,

Will


On Fri, Jul 3, 2009 at 6:03 AM, rossrosen <rossrosen@...> wrote:
>
>
> I can definitely understand that. To some degree it is contingent upon perspective. For example, one can see the representative formula for treating Hesitant and HT yin deficient pulse as Sheng Mai San (which also treats HT shock which is almost always found with a Hesitant wave). Sheng Mai San can be analyzed to be a ST yin supplementing formula (Ren Shen nourishes fluids, Mai Men Dong nourishes ST yin; Wu Wei Zi astringes fluids and sometimes referred to as the 5 flavor herb to affect all zang) and indeed HT shock can be seen as affecting the Emperor which impacts the rest or the empire, or, significantly affecting one's center (stability/groundedness) rooted in the SP/ST and source of post-natal qi. It all comes down to experience and clinical success in that regard.
>
> Ross
>
> --- In PulseDiagnosis@yahoogroups.com, "sppdestiny" <revolution@...> wrote:
> >
> > Ross,
> >
> > I appreciate the context you're providing here. Still, I have to stand by my observations over quite some time that the earth element is strongly implicated in the hesitant pulse. Of course the heart radical is the foundation foe the yi and si so there would seem to be an interesting relationship.-Lon
> >
>
>


--
William R. Morris, PhD, DAOM, LAc

http://www.aoma.edu/