Today we will learn about Hong Mai (洪脉, Surging Pulse), Da Mai (大脉, Large Pulse), and Xi Mai (细脉, Thin Pulse).
Pulse Characteristics
Hong Mai: The pulse is superficial, wide, with a surging quality, resembling turbulent waves.
Surging Quality refers to the pulse feeling like a high and steep wave, full and forceful when it comes, giving a sensation of being both floating and large, hence termed “taotao man zhi” (涛涛满指, full pulse).
Declining Quality is relative to the surging quality, indicating that the pulse recedes like falling waves, slightly slower and weaker than the incoming wave, akin to the ebb and flow of tides.
Da Mai: The pulse is wide, but without the surging quality.
It also gives a sensation of fullness under the fingers. This is a similarity between Da Mai and Hong Mai.
The difference is that Da Mai lacks the floating and strong characteristics of Hong Mai, being relatively gentle.
Xi Mai: The pulse is narrow, thin like a thread, with a distinct response under the fingers.
Some also refer to Xi Mai as Small Pulse.
According to the Bin Hu Pulse Studies: “Xi Mai is smaller than Wei Mai (微脉, Minute Pulse) and is often present, thin, straight, and soft, like a silk thread under the fingers.”
This distinguishes Xi Mai from Wei Mai, which will be introduced later and is commonly seen in critically ill patients.
From the above characteristics,
Hong Mai, Da Mai, and Xi Mai represent opposite pulse sizes.
Comparing Hong Mai and Xi Mai, the two are opposite in terms of pulse size and momentum. Therefore, they are generally introduced together as contrasting pulse types.
Clinical Significance
Hong Mai: Indicates excess heat, commonly seen in summer.
Da Mai: Often seen in healthy individuals, but can appear in disease states, indicating disease progression.
Xi Mai: Seen in various deficiency patterns, and can also indicate dampness; slightly thin and sinking pulses can also appear in winter.
Pulse Analysis
Hong Mai
The excess heat in Hong Mai refers to the extreme stage of an external pathogenic disease. For example, in typhoid fever, there is a Yangming channel syndrome, and in warm diseases, there is a Qi level syndrome.
When the disease reaches this stage, due to excess Yang Qi and internal heat, the righteous Qi is not diminished, actively resisting the pathogenic factors, leading to a vigorous struggle between the righteous and the evil, causing the pulse to expand, with Qi surging and blood flowing, exhibiting the characteristics of “Hong”.
This condition is often accompanied by high fever, thirst, and profuse sweating, commonly referred to as the “Four Great Symptoms”.
Hong Mai is more likely to appear in summer due to the excess Yang Qi, as the body’s muscles are relaxed and open, allowing Qi and blood to flow outward, resulting in a floating and large pulse.
Da Mai
In healthy individuals, Da Mai is often a sign of robust health, especially in young people. However, if the pulse becomes larger during illness, it often indicates a worsening condition.
Thus, the Nei Jing states: “If it is large, the disease progresses.” If the pulse is floating, large, and weak, it indicates a deficiency of the righteous Qi; if the pulse is large and strong, it indicates an excess of internal heat. Therefore, we must assess Da Mai in conjunction with its strength.
Xi Mai
Finally, regarding Xi Mai, it primarily indicates deficiency, and can represent various deficiency patterns.
For instance, if the nutritive blood is deficient, the pulse will not be full; additionally, if there is Qi deficiency, there will be insufficient strength to propel the blood, causing the pulse to become thin and small, giving a weak and powerless sensation.
However, why can Xi Mai also indicate dampness?
As we know, dampness is sticky; when dampness invades the body, it can obstruct the pulse, making Qi and blood flow relatively unfavorable, or causing the pulse to be suppressed, resulting in a thin pulse. Thus, Xi Mai can indicate both deficiency and dampness.
Moreover, in winter, due to cold stimulation, our pulse can also be understood as blood vessels constricting, leading to a thin and sinking pulse.
Modern Mechanism of Xi Mai
Thin and Weak pulses are often due to weakened cardiac contraction and relaxation functions, insufficient blood volume to fill the vessels, or increased peripheral resistance, leading to reduced effective circulating volume and slow blood flow.
Thin and Strong pulses often occur due to the presence of certain vasoconstrictive substances in the body, causing the blood vessels to be in a constricted state, resulting in a thin pulse, often appearing as a thin string.
Summary
Hong Mai and Xi Mai: are two pulse types that are opposite in size and momentum.
Da Mai, while similar in width to Hong Mai, lacks the surging quality and is often seen in healthy individuals or those with worsening conditions.
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