(1) Pulse Characteristics
The main feature of the Xian Mai (Xian Pulse) is that it is straight and long, moving up and down like a bowstring. There are no specific requirements for the pulse position or frequency. The pulse can be superficial or deep, and the frequency can be fast or slow. A typical Xian Mai is characterized by a strong and full pulse, but it can also present as a weak and string-like pulse. The pulse body can be fine or not, or large, but it must be long.
(2) Similar Pulses
The Xian Mai and Chang Mai (Chang Pulse) are often confused because both are long. The main feature of the Chang Mai is that the pulse body is long and exceeds its normal position. Although the Xian Mai is also long, its main characteristic is that it is straight like a bowstring, moving up and down, and its pulse strength is stronger than that of the Chang Mai.
(3) Pulse Theory and Main Diseases
The Xian Mai is a yin pulse among yang pulses. It indicates a constricted blood pulse, lacking smoothness and comfort, thus representing a yin pulse hidden within yang. The gentle regulation of the meridians relies on the warmth of yang qi and the nourishment of yin blood. When yang qi or yin blood is insufficient, the pulse loses warmth and nourishment, becoming constricted, hence the Xian Mai. Alternatively, if the qi mechanism is obstructed by pathogenic factors, preventing the smooth flow of qi and blood, the pulse may also lose the warmth of yang qi and the nourishment of yin blood, resulting in a constricted and string-like pulse. Therefore, Zhang Zhongjing states, “If the pulse is string-like, it indicates deficiency.” The Diagnosis Essentials states: “The Xian Mai indicates the gathering of blood and qi, representing yin hidden within yang, or cold entering between the meridians.”
The Xian Mai can be classified into three types based on the strength of the pulse: normal pulse, pathological pulse, and true organ pulse.
1. Normal Pulse
The Xian Mai in spring corresponds to the liver, hence the normal pulse of the liver is also Xian. In spring, when the cold of yin retreats and yang qi rises, the yang qi begins to sprout but is not yet abundant, and the warming power is not fully developed. The Inner Canon refers to this as “the qi comes soft and weak,” hence the pulse still has a constricted feeling and is Xian. The liver is the organ where yin ends and yang begins, corresponding to spring, where yang begins to grow but is not yet abundant, thus the pulse is also Xian.
The normal Xian Mai should be long and gentle, just as stated in the Plain Questions: Discussion on the True Organs: “The spring pulse is the liver, the eastern wood, the source of all beginnings, hence its qi comes soft and weak, light and slippery, straight and long.” The Plain Questions: Discussion on the Qi of the Balanced Person states: “The pulse of the balanced liver comes soft and weak, like lifting the tip of a long pole, indicating a balanced liver.” The act of lifting the tip of a long pole, which is long and graceful, is a very appropriate metaphor for the state of the Xian Mai.
2. Pathological Pulse
The Xian Mai can be excessive or insufficient.
(1) Excessive: The manifestation of an excessive Xian Mai is clearly described in the Plain Questions: Discussion on the Qi of the Balanced Person: “The pulse of a diseased liver comes full and slippery, like following a long pole, indicating liver disease.” Full and slippery indicates a firm quality. It resembles following a long pole, where the Xian Mai is long and firm, lacking softness.
What causes the pulse to be excessively Xian? It can be due to qi counterflow, obstruction by pathogens, or a deficiency of the root with a false excess.
Qi counterflow: Due to emotional disturbances, the qi mechanism becomes chaotic, or the qi mechanism is excessively vigorous or stagnant, leading to a Xian Mai. When qi counterflows, both qi and blood rise, causing the pulse to be long and strong. When the qi mechanism is stagnant, qi and blood cannot flow smoothly, and the pulse loses the warmth and nourishment of qi and blood, thus becoming constricted and strong.
Pathogenic obstruction: When pathogenic factors obstruct, the qi mechanism is not smooth, and qi and blood cannot be expressed, leading to a constricted and Xian Mai. The obstructing pathogenic factors include a wide range, beyond just emotional disturbances, but also include the six excesses, phlegm, blood stasis, and food accumulation.
Pathogenic factors affecting Shaoyang: Shaoyang governs the pivot, the entry and exit of yin and yang. When Shaoyang is affected by pathogens, the pivot is not functioning properly, leading to irregular entry and exit of yin and yang, and abnormal circulation of qi and blood, resulting in a constricted and Xian Mai. Malaria belongs to Shaoyang, hence the pulse of malaria is also Xian. Spasms are a disease of the muscles, caused by pathogenic factors leading to irregular qi mechanisms, resulting in the muscles losing softness and becoming constricted, which is reflected in the pulse as Xian. Therefore, “the spasm pulse feels tight like a string, moving straight up and down.”
The liver is the Jueyin organ, a firm organ, where yin ends and yang begins. When pathogens affect the liver, the rise of yang qi becomes abnormal, and yang cannot overcome yin, leading to insufficient warming, resulting in a constricted and Xian Mai.
The Xian Mai indicates phlegm and fluid: Phlegm and fluid are yin evils. The formation of phlegm and fluid is due to insufficient yang qi and inadequate warming, hence the pulse is Xian. Moreover, once phlegm and fluid have formed, they obstruct the qi mechanism, preventing the smooth flow of qi and blood, leading to a constricted pulse. This is what Zhang Zhongjing referred to: “If the pulse is偏弦, it indicates fluid.”
The Xian Mai indicates cold and pain: Excessive cold damages yang, causing the pulse to lose warmth and become Xian. Pain arises from obstruction in the meridians. Once obstructed, the meridians must be constricted, which presents as a Xian Mai in the pulse and pain in the symptoms, reflecting the same mechanism.
The Xian Mai indicates masses: Masses are formed by the gathering of qi, blood, and phlegm. When masses obstruct qi and blood, the pulse loses warmth and nourishment, resulting in a Xian Mai. Regarding food accumulation causing a Xian Mai, the principle is similar to that of masses, both due to obstruction of the qi mechanism.
Root deficiency with false excess: The liver is a firm organ, relying on the spleen and stomach to transform and nourish the essence of food and water, and the kidney water to nourish it. If the spleen and stomach are weak, leading to insufficient transformation, the liver loses nourishment, or if kidney water is insufficient, leading to inadequate nourishment, or if kidney yang is insufficient, leading to inadequate warming, the liver will lose its ability to regulate and will become excessive, resulting in a Xian Mai. This Xian Mai can be strong and vigorous, but one should not mistake a strong Xian Mai for an excess condition, as it can also be a deficiency condition. Zhang Zhongjing clearly pointed out: “If the pulse is Xian, it indicates deficiency.” Deficiency means insufficiency. Treatment should focus on nourishing the earth or benefiting the kidneys to allow the liver to regulate.
(2) Insufficient: A Xian Mai that is weak indicates insufficiency, which is caused by true deficiency. True deficiency includes liver qi deficiency, liver yang deficiency, and liver blood deficiency. When yang qi and yin qi are insufficient, the pulse loses warmth and nourishment, resulting in a Xian Mai. In cases of liver qi deficiency, the pulse is Xian and weak, or Xian and unable to withstand heavy pressure, accompanied by symptoms such as dizziness, shortness of breath, chest and rib distension, fullness in the stomach, fatigue, and weakness. In cases of liver yang deficiency, the pulse is also Xian and weak, accompanied by cold symptoms such as cold limbs. In cases of liver blood deficiency, due to blood deficiency often accompanying qi deficiency, the pulse is often Xian, fine, and weak, with symptoms such as dizziness, palpitations, shortness of breath, cramps, and a pale complexion. In cases of liver yin deficiency, the pulse is often Xian, rapid, fine, and may be strong, with few instances of a weak Xian pulse.
3. True Organ Pulse
The Plain Questions: Discussion on the True Organs states: “The true liver pulse is rapid, both internally and externally, like following the edge of a knife, feeling firm, like pressing the strings of a zither.” The pulse is strong and not soft, indicating a loss of harmony, and the stomach qi has already declined.
Among the same true deficiency pulses, some may present as a false excess, showing a strong and vigorous pulse; some may present as a weak Xian Mai, indicating both true deficiency; and some may present as a strong and firm pulse, like following the edge of a knife. Why is this? It is due to differences in constitution and the varying strengths of the true qi. If the true deficiency is not severe, one can still mobilize the qi and blood of the whole body, exerting effort to present a false excess pulse. If the true deficiency is severe, the effort to struggle is also weak, leading to both true deficiency and false deficiency. If the true qi is exhausted, the stomach qi is already depleted. The pulse may be strong and firm, like following the edge of a knife, indicating the leakage of true qi, representing the true organ pulse of the liver.
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