Understanding the Complex Pulse: San Mai (Scattered Pulse), Bu Jing Mai (Non-Static Pulse), Shang Sheng Xia Xu Mai (Upper Excess Lower Deficiency Pulse), and Xia Sheng Shang Xu Mai (Lower Excess Upper Deficiency Pulse)Today we will learn about the Complex Pulse: San Mai, Bu Jing Mai, Shang Sheng Xia Xu Mai, and Xia Sheng Shang Xu Mai.1. San Mai (Scattered Pulse):(1) Characteristics of San Mai:The pulse is intermittently large and small, sometimes appearing and disappearing, and although it may be large, it appears scattered and chaotic. When it disappears, it feels elusive. The San Mai is often floating, large, weak, and chaotic, with a pulse that gradually becomes empty upon pressure, and when pressed heavily, it feels rootless; the pulse rate varies, and the strength of the pulse is uneven.(2) Mechanism and Diagnostic Significance of San Mai:The formation mechanism of San Mai is primarily due to the exhaustion of Qi and Blood, leading to a desire to escape, and the second is the dissipation of Yuan Yang (Original Yang). Clinically, it is often seen in critically ill patients or just before death. If San Mai appears in patients with chronic illness and deficiency, it often indicates a terminal state, where the body’s Zheng Qi (Upright Qi) is nearly depleted, causing the Yuan Yang to float outward, making recovery generally difficult.For example, in acute conditions such as heat stroke, severe bleeding, acute vomiting and diarrhea, or profuse sweating, recovery may still be possible. In cases of severe bleeding, the pulse may show Kua Mai (Hollow Pulse), Xu Mai (Weak Pulse), or even Wei Mai (Minute Pulse), but if San Mai is present, the condition is already very serious, indicating that death is near. At this point, Qi and Blood are exhausted, and even Yuan Yang is about to dissipate.Weak, Kua, and Wei pulses, while not ideal, at least indicate that the patient still has a pulse, whereas San Mai is characterized by an intermittently visible pulse, fluctuating in strength. However, there is still a chance for recovery, such as using Du Shen Tang (Ginseng Decoction) to greatly replenish Yuan Qi or using wild ginseng to sustain life.2. Bu Jing Mai (Non-Static Pulse):According to the Shang Han Lun (Treatise on Cold Damage), it states: “In the first day of a cold injury, if the pulse is static, it indicates no transmission; if there is a desire to vomit and restlessness, with a rapid pulse, it indicates transmission. If after two or three days, the Yangming and Shaoyang symptoms are not seen, it indicates no transmission.” To determine whether there is transmission, one should rely on the pulse and symptoms; if the pulse is static, it indicates that the pathogenic factor is still in the Taiyang stage, and the illness will resolve in six or seven days; if the pulse is rapid and there are symptoms of nausea, vomiting, and restlessness, it indicates that the pathogenic factor has a tendency to transmit inward. Since there are static pulses, there are also non-static pulses. However, Bu Jing Mai is not mentioned in textbooks, yet it is frequently observed in clinical practice and plays an important role in indicating the state of the struggle between Zheng and Xie (Upright and Pathogenic Qi) and the transmission of disease, thus requiring special mention.(1) Characteristics of Bu Jing Mai:Bu Jing Mai refers to a pulse that is slightly rapid and somewhat elastic. A pulse that is slightly rapid means it beats slightly faster, with over 80 beats considered slightly rapid; of course, over 90 beats is definitely a rapid pulse. However, a slightly rapid pulse can be seen in normal individuals, and a slightly elastic pulse can also be a normal pulse for someone with a more irritable temperament.But when both are present, especially during the progression of a disease, it indicates a pathological pulse. In describing the pulse, it can be expressed as slightly rapid and slightly elastic. Some clinically experienced doctors with solid pulse diagnosis skills may describe it as Bu Jing Mai.Bu Jing Mai can indicate that the patient is about to develop a fever; if one understands the classics and has solid clinical experience, they may even predict when the fever will occur.(2) Mechanism and Diagnostic Significance of Bu Jing Mai:1. Zheng and Xie Struggling: The primary cause of Bu Jing Mai is the struggle between Zheng and Xie, focusing on predicting whether the fever can stabilize based on the pulse’s static or non-static nature.The formation mechanism of Bu Jing Mai is mainly due to the struggle between Zheng and Xie, but it is not in an extreme state of struggle; the non-static pulse indicates that the Zheng Qi is “agitated” because the pathogenic Qi has not been completely cleared, thus the Zheng Qi is fighting against the pathogenic Qi, leading to a pulse that is agitated and “non-static.”As indicated in the Shang Han Lun, a static pulse indicates no transmission in two situations: one is when Zheng overcomes Xie, indicating that the pathogenic factor will resolve on its own without further medication; the other is when Zheng Qi can still resist Xie, and the pathogenic factor has not yet transmitted inward, remaining in the Taiyang stage. If the pathogenic factor transmits inward while Zheng Qi is trying to expel it outward, then Yang Qi becomes “agitated,” causing Qi and Blood to become turbulent and rapid, resulting in a non-static pulse.Bu Jing Mai has two main clinical significances: first, it predicts whether the patient will develop a fever during the progression of the disease or after taking antipyretic medication; second, it helps determine if our diagnosis has missed something. If the patient takes sweating and exterior-releasing herbs like Ma Huang (Ephedra) or Gui Zhi (Cinnamon Twig) or antipyretic Western medications like Baifuning or Tylenol, and after sweating, the pulse remains non-static, slightly rapid, and slightly elastic, it generally indicates that the patient will still develop a fever in a few hours; if the pulse is static, it suggests that the disease is about to resolve. On the other hand, if Zheng overcomes Xie and they no longer struggle, the pulse will be static, appearing calm and gentle, or slightly weak, with no signs of agitation, neither slightly rapid nor slightly elastic.2. Internal Heat Evil:If the pulse is non-static, elastic, and rapid, it suggests an excess of Yang heat. If there is a tendency for bleeding, and the pulse is floating and non-static, one must be cautious about the possibility of bleeding. If the patient experiences severe bleeding, and after treatment and medication, the pulse remains non-static, it indicates that bleeding has not been completely controlled, and one must be highly vigilant about the patient experiencing further severe bleeding. When we observe obvious signs of bleeding, it actually indicates that the patient has already lost a significant amount of blood, such as in cases of cerebral hemorrhage, gastric bleeding, pelvic bleeding, or intestinal bleeding, and the pulse has the advantage of rapidly reflecting physiological and pathological changes in the body.Therefore, we can use the clinical manifestation of Bu Jing Mai to make an early diagnosis of bleeding disorders, aiming for early treatment.3. Shang Sheng Xia Xu Mai and Xia Sheng Shang Xu Mai:(1) Shang Sheng Xia Xu Mai (Upper Excess Lower Deficiency Pulse):1. Characteristics of Shang Sheng Xia Xu Mai:The term “upper” refers to the cun part of the pulse at the wrist, including the cun anterior; the term “lower” refers to the chi part of the pulse, including the chi posterior. Shang Sheng Xia Xu Mai indicates that the cun pulse is floating, while the chi pulse is deep, and the cun, guan, and chi parts are aligned in a diagonal upward direction.2. Mechanism and Diagnostic Significance of Shang Sheng Xia Xu Mai:① Pathogenic Qi invades the exterior, and Zheng Qi struggles against the exterior pathogenic factor;② Pathogenic Qi is strong and solid in the exterior, while Zheng Qi is insufficient in the interior;③ Pathogenic Qi is strong and solid in the upper body, including the head, face, neck, throat, chest, heart, and lungs, while the kidneys are deficient in the lower body;④ Yang Qi is floating in the upper body and insufficient in the lower body.The mechanism of Shang Sheng Xia Xu Mai generally indicates that Yang Qi is floating and abundant, which may be due to a cold or flu, while there is also kidney deficiency or Yin deficiency with Yang floating and excess heat in the upper body.(2) Xia Sheng Shang Xu Mai (Lower Excess Upper Deficiency Pulse):1. Characteristics of Xia Sheng Shang Xu Mai:The term “lower” refers to the chi part of the pulse, including the chi posterior; the term “upper” refers to the cun part of the pulse, including the cun anterior. Xia Sheng Shang Xu Mai indicates that the chi pulse is floating, while the cun pulse is deep, and the cun, guan, and chi parts are aligned in a diagonal downward direction. This pulse is rarely seen clinically.2. Xia Sheng Shang Xu Mai is generally seen in individuals with weak Qi and Blood, where there is some pathogenic factor in the lower body, often due to wind evil. It is relatively rare in clinical practice.——————END——————*This article is excerpted from Sixteen Lectures on Clinical Pulse Diagnosis. For further study, please refer to the original text.
