A Case Report of Treating Pulseless Disease with Integrated Acupuncture and Herbal Medicine Under the Guidance of Professor Guanhu Yang
Yu Yu¹, Yang Guanhu²
1.White Pine Acupuncture Pain Clinic, 1035 Sterling Rd., Suite 101, Herndon, Virginia 20170
2. Department of Specialized Medicine, Ohio University, USA)
Corresponding Author: Yu Yu, Email: [email protected]
Collaborative Guidance: Yang Guanhu, Email: [email protected]
Abstract
This is the case of a 47-year-old female patient whose primary presenting feature was a completely impalpable left radial pulse (left cun). Western medical evaluation revealed severely diminished ovarian reserve accompanied by uterine fibroids. Under the guidance of Professor Guanhu Yang, an integrated treatment strategy emphasizing “supplementing the kidney and replenishing essence, soothing the liver and strengthening the spleen, activating blood and unblocking the vessels” was implemented using a combination of acupuncture and herbal therapy. Within a short treatment period, the patient’s left pulse changed from completely absent to distinctly palpable, and deep, large fissures on the tongue surface also showed significant improvement. This case demonstrates the notable therapeutic effect of the combined acupuncture-herbal approach in treating “pulseless disease” caused by severe deficiency of qi and blood, offering valuable insights for the clinical diagnosis and treatment of such challenging conditions.
Keywords: Pulseless disease, acupuncture-herbal integration, pulse diagnosis, tongue diagnosis,diminished ovarian reserve, Professor Guanhu Yang
I. Case Information
Patient: Female, 47 years old. Initial consultation: April 15, 2025.
Chief Complaint: Absence of left radial pulse for several months, accompanied by mental fatigue and lack of strength.
Present Illness: The patient reported that several months ago she accidentally noticed the pulse at her left wrist was difficult to palpate and gradually felt a lack of energy. Her past medical history included infertility and uterine fibroids. Between 2020 and 2024, she underwent multiple unsuccessful attempts at assisted reproductive technology (IVF, including using both her own and donor eggs). Current symptoms: Depressed mood, irritability, excessive worry and overthinking, significant mental fatigue and lack of strength, sleep is acceptable but light, normal appetite, normal bowel and bladder function. Menstrual cycle is still regular with heavy flow for the first 2 days, followed by spotting for the next 3 days.
Past Medical History: History of uterine fibroids.
Specialized Examination (July 8, 2025): Gynecological endocrinology showed: Anti-Müllerian Hormone (AMH) 0.07 ng/mL, Follicle-Stimulating Hormone (FSH) 32.5 IU/L, indicating severely diminished ovarian function.
Traditional Chinese Medicine Four Examinations:
● Tongue Manifestation: Tongue body red, no coating, tongue surface covered with deep, large longitudinal fissures.
● Pulse Manifestation (April): Left cunkou pulse completely unpalpable; right pulse deep, thin, and weak.
*(Follow-up on July 8):* Right pulse deep, thin, and rapid; left pulse remained extremely thin and weak, almost imperceptible.
Diagnosis:
● TCM Diagnosis: Pulseless Disease (Severe depletion of Liver and Kidney essence-blood, insufficiency of Heart vessels, combined with Liver qi stagnation and blood stasis); Deficiency Consumptive Disease; Abdominal Mass (Zhengjia).
● Western Medical Diagnosis: Disappearance of Radial Artery Pulse (unilateral, etiology to be investigated); Diminished Ovarian Reserve (DOR); Uterine Fibroids.
II. Treatment Process
Phase One (April – June): Initially, the approach focused on regulating qi and blood. Acupuncture treatment utilized a formula of Dong’s Extraordinary Points for gynecological issues, including Yunbai, Libai, Gynecology, Huannao, Tongwei, Tongbei, Tongshen, Sihua, Menjin, and Sanshen. This was done for five intermittent sessions. During this period, the patient reported no significant improvement in symptoms like fatigue, and the left pulse remained unpalpable. This suggested the disease had a fundamental root that was not being addressed, and conventional symptomatic point selection was insufficient.
Phase Two (Starting July): Subsequently, Professor Yang Guanhu was consulted. Professor Yang reviewed the four examinations, placing particular emphasis on the signs of “complete absence of the left pulse” and “tongue fissures without coating.” He pointed out that the key pathogenesis of this syndrome was “exhaustion of kidney essence, deficiency of liver blood, insufficiency of heart vessels, malnourishment of the vessel pathways, accompanied by qi stagnation and blood stasis.” Treatment must address both the root and the branch, combining acupuncture and herbal medicine. The approach should use large doses to replenish essence and blood as the foundation, while unblocking the meridians and activating qi movement as the function. A comprehensive plan was thus formulated:
1. Acupuncture Formula (Prof. Yang’s prescribed “Unblock Vessels and Revive Origin” needling protocol):
• Elevate Yang and Regulate Spirit: Baihui (GV20), Auricular points (Shenmen, Liver, Kidney).
• Cultivate Original Qi and Fill Vessels: Abdominal points: Qihai (CV6, shallow insertion 1.5 cun), Guanyuan (CV4, deep insertion 3 cun), Zhongji (CV3, deep insertion 4 cun). Aim: To stimulate original qi, strengthen the Chong and Ren vessels, thereby nourishing the source of the vessels.
• Unblock Meridian Qi: Upper limb: Hegu (LI4, regulate qi), Quchi (LI11, unblock the fu organs), Lieque (LU7, connect with the Conception Vessel). The originally used Dong’s points (Gynecology, Huannao) were retained to regulate uterine qi and blood. Lower limb: Zusanli (ST36, strengthen spleen/stomach to generate qi and blood), Yinlingquan (SP9, strengthen spleen and drain dampness), Sanyinjiao (SP6, regulate liver, spleen, kidney), Zhaohai (KI6, nourish yin and benefit the throat), Taixi (KI3, tonify kidney, source point), Taichong (LR3, soothe liver, source point). This formula aimed to establish a qi and blood circulation pathway from the original qi (Guanyuan) to the extremities (Hegu, Taichong), emphasizing “unblocking” to guide “filling.”
2. Chinese Herbal Formula (Prof. Yang’s prescribed “Replenish Essence and Unblock Vessels Decoction”):
• Prescription: Epimedium (Xianlingpi) 10g, Morinda Officinalis (Bajitian) 10g, Ligustrum Lucidum (Nüzhenzi) 12g, Wolfberry (Gouqizi) 12g, Prepared Rehmannia (Shudihuang) 15g, Chinese Yam (Shanyao) 12g, Cornus Officinalis (Shanzhuyu) 10g, Salvia Miltiorrhiza (Danshen) 15g, Peach Kernel (Taoren) 6g, Safflower (Honghua) 6g, Poria (Fuling) 10g, Atractylodes Macrocephala (Baizhu) 10g, Chuanxiong Rhizome (Chuanxiong) 6g, Licorice (Gancao) 6g.
• Formula Explanation: This formula uses Epimedium and Morinda Officinalis to warm and tonify kidney yang, invigorate vitality, and provide motive force for qi and blood circulation. Ligustrum Lucidum, Wolfberry, Prepared Rehmannia, and Cornus Officinalis greatly tonify liver and kidney essence-blood, replenishing the substance of the vessel pathways. Chinese Yam, Poria, Atractylodes Macrocephala, and Licorice strengthen the spleen and boost qi, assisting the source of qi and blood production. Salvia Miltiorrhiza, Peach Kernel, Safflower, and Chuanxiong Rhizome activate blood and resolve stasis, unblocking stagnation in the vessels and collaterals. The entire formula focuses on the root of “essence-blood deficiency” and the branch manifestation of “vessel pathway stagnation and obstruction,” working together to achieve the effects of replenishing essence, nourishing blood, activating blood, and unblocking vessels.
Treatment Requirements: Herbal decoction: one dose daily. Acupuncture: at least once per week. Primary focus of observation: changes in pulse manifestation.
Therapeutic Response and Outcome:
● July 24, 2025 (approx. 2 weeks after combined treatment): Patient reported feeling slightly more energetic. Tongue manifestation significantly improved: tongue body turned pale red, most of the deep, large fissures on the tongue surface disappeared, only a central fissure remained but became shallower. Core therapeutic effect emerged: Right pulse remained deep and thin, but the left cunkou pulse could now be faintly palpated, albeit extremely weak. This was a favorable sign indicating initial recovery of essence-blood and beginning filling of the vessel pathways. The original formulas were continued.
● August 4, 2025: Patient reported deeper sleep. Tongue pale red. Left pulse was now clearly palpable; pulse strength remained weak but distinctly perceptible under the finger.
● August 27, 2025: Left pulse definitively present, appearing deep, thin, and weak, but with stronger pulsation compared to August 4. Tongue body fissures were significantly shallower and fewer; tongue color light red. The patient subsequently discontinued acupuncture due to personal reasons but continued taking the herbal medicine until October.
● October 2025 Follow-up: The patient sent tongue photos. Tongue body fissures were markedly shallower and fewer; tongue color light red. She reported reduction in symptoms like fatigue.
III. Discussion and Insights
This case, with the left pulse going from absent to present as the core efficacy indicator, fully embodies the theoretical essence of the idea that “what is inside will manifest externally” and “to treat the vessels, one must seek their root.”
1. The Cause of “Pulselessness” Lies in the Exhaustion of Essence and Blood: The complete absence of the left pulse, combined with a red tongue without coating and deep fissures, indicates extreme deficiency of liver and kidney essence-blood, which fails to ascend to nourish the heart and fill the vessel pathways. As stated in Lingshu • Jueqi: “Containing and restricting the nutritive qi, giving it no place to escape, is called the vessels.” The filling of the vessel pathways relies entirely on the nutritive blood. The left pulse reflects the heart, liver, and kidney, and governs the nutritive blood. The pulselessness in this case was not due to simple obstruction from qi stagnation and blood stasis, but rather a true “malnourishment” from severe essence-blood deficiency, combined with “lack of free flow” due to weak qi and blood movement. Professor Yang’s use of large amounts of herbs to nourish and replenish essence-blood as the sovereign precisely reflects the principle of “to unblock the vessels, one must first fill their substance.”
2. Acupuncture and Herbs Synergize, Achieving the Marvel of “Tonification” and “Unblocking”:
● Herbs Primarily “Supplement”: Ingredients like Prepared Rehmannia, Cornus Officinalis, and Wolfberry, with their thick, enriching properties, directly replenish the deficiency of essence and blood, addressing the material basis of the empty vessel pathways.
● Acupuncture Primarily “Unblocks”: The acupuncture protocol design is highly ingenious. Deep needling of Guanyuan-CV4 and Zhongji-CV3 directly warms, stimulates, and activates the original qi of the lower jiao and the essence chamber (uterus). This is the foundation of the congenital constitution, the root of essence-blood production. Combined with points on the extremities below the elbows and knees, which are areas rich in qi and blood (e.g., Hegu-LI4, Taichong-LV3, Zusanli-ST36, Sanyinjiao-SP6), it powerfully unblocks the pathways for systemic qi and blood circulation. The “guiding and unblocking” action of acupuncture not only promotes the absorption and distribution of the herbal medicine but, more importantly, acts like a key, opening up the qi and blood circulation that had become stagnant due to deficiency. It effectively transports the essence-blood resources from the “rear” (supplied by the herbs) to the “frontline” (the vessel pathways in the extremities). This embodies the principles of “using needles to move qi, using herbs to nourish blood” and “when qi moves, blood flows, and when blood is abundant, the vessel/pulse returns.”
3. Cross-Referencing Tongue and Pulse to Verify Efficacy: The simultaneous and rapid improvement in the tongue manifestation (deep fissures becoming shallower) provides corroborating evidence that essence, blood, and fluids have been nourished. This, together with the recovery of the pulse, mutually confirms and jointly indicates the restoration of the body’s fundamental material basis. This case vividly illustrates that in complex and severe conditions, tongue and pulse manifestations are extremely reliable objective indicators for judging the abundance or deficiency of essence-blood and the progression of the disease.
Conclusion: Although this patient had a complex gynecological and endocrine medical background, the core symptom for which she sought treatment, and the focus of therapy, was “pulseless disease.” Under the guidance of Professor Yang Guanhu, an accurate TCM pattern differentiation of severe deficiency of essence and blood, malnourishment of the vessel pathways was made. The approach abandoned mere unblocking of collaterals and established the fundamental principle of “substantially supplementing the essence and blood as the main strategy, assisted by activating blood and unblocking collaterals.” It fully leveraged the unique advantages of acupuncture in stimulating the original qi and unblocking and guiding, creating a synergy between acupuncture and herbs. The treatment successfully restored the left pulse within a short period, demonstrating the potential and advantages of combined acupuncture and herbal therapies in treating challenging pulse conditions caused by severe deficiency of qi, blood, essence, and fluids. This case provides a successful diagnostic and therapeutic paradigm and offers profound insights for the clinical management of similar conditions characterized by “pulselessness” or “extremely faint pulse” where deficiency damage is the primary concern.
(This article is dedicated with gratitude to Professor Yang Guanhu for his meticulous guidance and to the patient for her trust.)
杨观虎教授指导针药结合治疗无脉症一例报告
余昱1，杨观虎²
1.美國 White Pine Acupuncture Pain Clinic, 1035 Sterling Rd., Suite 101, Herndon, Virginia 20170
2.美國俄亥俄大學特色醫療系 Department of Specialized Medicine, Ohio University, USA)
通訊作者：余昱，Email: [email protected]
合作指導：楊觀虎，Email: [email protected]
摘要
本文報告一例47歲女性患者，初診以左寸口脈搏完全無法觸及為突出特徵，西醫診斷可見卵巢儲備功能嚴重減退伴子宮肌瘤。在楊觀虎教授指導下，以”益腎填精、疏肝健脾、活血通脈”為核心治法，採用針灸與中藥相結合的方案。治療短期內使患者左側脈象由完全消失轉為清晰可及，舌面深大裂痕亦顯著改善。本案展示了針藥結合在治療嚴重氣血虧虛所致”無脈症”方面的顯著療效，為臨床診療此類疑難病症提供了寶貴思路。
關鍵詞：無脈症；針藥結合；脈象；舌象；卵巢儲備功能減退；楊觀虎教授
一、 病例資料
患者，女，47歲。2025年4月15日初診。
主訴：左側手腕脈搏消失數月，伴神疲乏力。
現病史：患者自述數月前偶然發現左側手腕脈搏難以觸及，且逐漸感覺精力不濟。既往有”不孕”及”子宮肌瘤”病史，曾於2020-2024年間多次嘗試輔助生殖技術（IVF，包括自卵及贈卵）均未成功。刻下症：情緒抑鬱易怒，多思多慮，神疲乏力明顯，睡眠尚可但眠淺，胃納一般，二便調。月經周期尚規律，經前2天量多，後3天僅點滴狀。
既往史：子宮肌瘤病史。
專科檢查（2025年7月8日）：婦科內分泌示：抗繆勒管激素（AMH）0.07ng/mL，促卵泡激素（FSH）32.5 IU/L，提示卵巢功能嚴重衰退。
中醫四診：
• 舌象：舌質紅，無苔，舌面滿佈深大縱形裂紋。
• 脈象：左寸口脈完全無法觸及，右脈沉細弱（4月）；至7月8日複診，右脈沉細數，左脈仍極細弱幾近於無。
診斷：
• 中醫診斷：無脈症（肝腎精血大虧，心脈不充，兼肝鬱血瘀）；虛勞；癥瘕。
• 西醫診斷：橈動脈搏動消失（單側）待查；卵巢儲備功能減退（DOR）；子宮肌瘤。
二、 治療過程
第一階段（4-6月）： 初以調和局部氣血為思路，選用董氏奇穴婦科方（雲白、李白、婦科、還巢、通胃、通背、通腎、四花、門金、三神）進行針灸治療，斷續治療約五次。此期間患者自覺乏力等症狀改善不明顯，左側脈搏始終未能觸及。提示病在根本，常規局部取穴難以奏效。
第二階段（7月起）： 遂請教楊觀虎教授。楊教授詳審四診，尤其重視”左脈全無”及”舌裂無苔”之象，指出此證病機關鍵在於 “腎精枯竭，肝血虧虛，心脈失充，脈道不榮，兼有氣鬱血滯” 。治療必須標本兼治，針藥並用，以大劑填補精血為體，以疏通經絡、鼓動氣機為用。遂制定綜合方案：
1. 針灸方（楊教授擬定”通脈啟元”針方）：
• 升陽調神：百會、耳穴（神門、肝、腎）。
• 培元充脈：腹部取氣海（淺刺1.5寸）、關元（深刺3寸）、中極（深刺4寸），旨在激發先天元氣，培補沖任，以資脈道化源。
• 疏通經氣：上肢重點取合谷（調氣）、曲池（通腑）、列缺（通任脈）；原用董穴婦科、還巢以調胞宮氣血。下肢取足三里（健脾胃生化氣血）、陰陵泉（健脾利濕）、三陰交（調肝脾腎）、照海（滋陰利咽）、太溪（補腎、原穴）、太沖（疏肝、原穴）。此方旨在建立從元氣（關元）到四肢末梢（合谷、太沖）的氣血循環通路，重在”通”以引”充”。
2. 中藥方（楊教授擬定”填精通脈湯”）：
• 處方：仙靈脾10g，巴戟天10g，女貞子12g，枸杞子12g，熟地黃15g，山藥12g，山茱萸10g，丹參15g，桃仁6g，紅花6g，茯苓10g，白朮10g，川芎6g，甘草6g。
• 方解：本方以仙靈脾、巴戟天溫補腎陽，鼓動生機，為氣血運行提供動力；女貞子、枸杞子、熟地黃、山茱萸大補肝腎精血，充養脈道之體；山藥、茯苓、白朮、甘草健脾益氣，助氣血生化之源；丹參、桃仁、紅花、川芎活血化瘀，疏通脈絡之滯。全方著眼於”精血虧虛”之根本與”脈道滯澀”之標象，共奏填精養血、活血通脈之效。
治療要求：中藥每日一劑，針灸每週至少一次，重點觀察脈象變化。
治療反應與轉歸：
• 2025年7月24日（治療約2週後）：患者自覺精神稍振。舌象顯著改善：舌質轉為淡紅，舌面大部分深大裂痕消失，僅中央裂痕變淺。核心療效顯現：右脈仍沉細，但左側寸口脈已可勉強觸及，雖極微弱。此為精血初復、脈道始充之佳兆。守原方繼進。
• 2025年8月4日：患者訴睡眠轉沉。舌淡紅。左側脈搏已清晰可及，脈力雖弱，但指下分明。
• 2025年8月27日：左脈明確存在，呈沉細弱之象但搏動比8/4強。舌體裂痕明顯變淺變少，舌色淺紅。後患者因故中斷針灸，但仍堅持服用中藥至10月。
• 2025年10月隨訪：患者傳來舌象照片，舌體裂痕明顯變淺變少，舌色淺紅。自述乏力等症減輕。
三、 討論與體會
本案以“左脈從無到有”為核心療效指標，充分體現了中醫“有諸內，必形諸外”及“治脈必求其本”的理論精髓。
1. “無脈”之因，責在精血枯涸：患者左脈全無，結合舌紅無苔深裂，乃肝腎精血極度虧虛，不能上奉於心、充盈脈道所致。《靈樞•決氣》云：“壅遏營氣，令無所避，是謂脈。”
脈道之充，全賴營血。左脈候心、肝、腎，主營血。此案無脈，非單純氣滯血瘀之閉阻，實為精血大虛之”不榮”，兼有氣血運行無力之”不通”。楊教授以大量滋填精血之品為君，正是”欲通其脈，必先充其體”的體現。
2. 針藥協同，共奏”補”與”通”之妙：
● 藥以”補”為主：方中熟地黃、山茱萸、枸杞子等厚味填精，直補精血之虧，解決脈道空虛的物質基礎問題。
● 針以”通”為要：針灸方案設計極具匠心。深刺關元、中極，直接溫煦、激發下焦元氣與精室（胞宮），此乃先天之本，是精血化生之根。配合四肢肘膝關節以下多氣多血之經穴（如合谷、太沖、足三里、三陰交等），強力疏通周身氣血運行之通路。針灸的”通導”作用，不僅促進了藥物的吸收與布散，更重要的是，它像一把鑰匙，打開了因虛而滯的氣血循環，將後方（藥物補充的）精血資源，有效地輸送到前沿（四肢末梢的脈道）。此即”以針行氣，以藥滋血，氣行則血行，血充則脈復”。
3. 舌脈互參，驗證療效：舌象的同步快速改善（深裂變淺），為精血津液得以滋養提供了佐證，與脈象恢復相互印證，共同指示了人體根本物質基礎的恢復。此案生動說明，在疑難重症中，舌象與脈象是判斷精血盈虧和病情轉歸極為可靠的客觀指標。
結語：本案患者雖有複雜的婦科內分泌背景，但其就診的核心突出症狀與治療焦點在於”無脈症”。在楊觀虎教授指導下，精準辨證為”精血大虧，脈道失充”，摒棄單純通絡之法，確立了”大補精血為主，佐以活血通絡”的根本原則，並充分發揮了針灸在”激發元氣、疏通導引”方面的獨特優勢，實現了針藥的完美協同。治療在短期內成功使消失的左脈復現，充分展示了針藥結合療法在治療因嚴重氣血精津虧虛所致疑難脈症方面的巨大潛力與獨特優勢。此案例為臨床診治類似”無脈”或”微脈”屬虛損為重者，提供了成功的診療範式與深刻啟示。
（謹以此文感謝楊觀虎教授的悉心指導，並對患者的信任致以敬意。）
