Introduction: Today we introduce the “Xian Pulse”.
The Xian pulse has two main characteristics: it is tense and stable, with a significant degree of tension, hence the term “straight as a string”.
Generally speaking, it represents a pulse associated with pathogenic factors.
Therefore, the “Jing Yue Quan Shu” (Complete Book of Jing Yue) states: “It is due to disharmony of blood and qi, qi counterflow, excess of pathogenic factors, strong liver and weak spleen, cold and heat, phlegm and fluid retention, food stagnation, accumulation, distension, deficiency, pain, and rigidity…”.
Clinically, this is indeed the case; conditions such as wind-cold invasion, accumulation of phlegm and blood, emotional stagnation, hyperactivity of liver yang, and pervasive yin pathogens can all present with varying degrees of Xian pulse. The reason for this is often due to disharmony between yin and yang, leading to mutual rejection.
Thus, the Xian pulse is commonly seen in excess conditions, which is why the “Zhen Zong San Mei” states: “The Xian pulse is the foremost indicator of the six remaining thieves, most commonly seen in diseases of the meridians, hence it is prevalent in cases of cold damage and severe conditions.”
As a result, many medical texts later referred to the Xian pulse as the “forbidden pulse of a hundred diseases”, and Zhang Jingyue also stated, “If this pulse is present in various diseases, it is certainly not auspicious.”
However, can we summarize the Xian pulse in this way?
Not necessarily. For example, the “Jin Kui Yao Lue” (Essential Prescriptions of the Golden Chamber) states: “The Xian pulse indicates deficiency; the stomach qi is insufficient, leading to morning food being vomited in the evening, resulting in stomach reversal; cold is present above, and the physician treats it below, hence the pulse is Xian, thus named deficiency.”
Morning food being vomited in the evening, and evening food being vomited in the morning, indicates a severe deficiency of the original yang of the spleen and kidney. The so-called “cold present above” refers to deficiency cold, not an actual cold pathogen.
Thus, You Zaiqing’s “Jin Kui Xin Dian” (Heart Classics of the Golden Chamber) also explains: “The Xian pulse is not due to external cold added to the pulse, but rather a pulse of cold generated by stomach deficiency; when the stomach is deficient and cold, and the yang qi is insufficient, it leads to morning food being vomited in the evening, resulting in stomach reversal. From this, we understand that the Xian pulse can indicate deficiency, referred to as cold, which is a superficial understanding of the pulse.
You Zaiqing’s opinion is worth our reference in clinical practice.
The Xian pulse not only has both deficiency and excess, but it is not always a pathological pulse; it can also represent the aspect of righteous qi.
The “Shang Han Lun” (Treatise on Cold Damage) states: “If after vomiting or purging in cold damage, the condition does not resolve, and there is no bowel movement for five to six days, up to ten days, with tidal fever in the afternoon, not fearing cold, and speaking as if seeing ghosts. If severe, the patient does not recognize people, feels anxious and restless, has slight wheezing and stares blankly, the pulse is Xian, and if it is Se (rough), it is death.”
In cases of cold damage with vomiting or purging, it indicates significant damage to the fluids; if the pulse is Xian and Se, how can there be a distinction between life and death?
Wang Hu’s “Shang Han Lun Bian Zheng Guang Zhu” (Comprehensive Notes on Differentiation of Cold Damage) explains: “Both Xian and Se are yin pulses; the Xian pulse indicates that yin is not yet exhausted, still carrying nourishment, hence it can indicate life; the Se pulse indicates that yin is exhausted, having become desiccated, hence it indicates death.”
Wang Hu’s explanation is based on Cheng Wujis’ “Annotations on the Shang Han Lun”, which is quite reasonable.
At the same time, Yu Jiayan also explains the passage in which Zhang Zhongjing states, “If the pulse is Xian after purging, with fever and sweating, it indicates self-recovery.” He states: “This means that the pathogenic qi has deeply penetrated the yin aspect, and the pulse should be deep, weak, fine, and Se; suddenly it turns to Xian, indicating the emergence of the lesser yang’s generating qi, which indicates vitality.”
It can be seen that the Xian pulse indeed can represent the aspect of righteous qi.
This righteous qi symbolizes the “emergence of vitality”.
Any Xian pulse that represents vitality generally arises from the following mechanisms:
Initially, the pulse may come as floating and rootless, but as the kidney qi returns to its source, the pulse body becomes quite thick, and at this time, the pulse presents a Xian appearance.
Initially, the pulse may come as deep and weak, lacking vitality, but as the liver and spleen qi become vigorous, the pulse becomes quite strong, and the pulse appearance shows Xian.
Initially, the pulse may come as very scattered and unclear, but as the yang returns and qi gathers, the pulse shape becomes quite firm, and the pulse appearance shows Xian.
Initially, the pulse may come as fine and lacking spirit, with unclear fluctuations, but as the yang returns and qi fills, the pulse becomes quite expansive, with even rises and falls, and at this time, the pulse presents a Xian appearance.
The above types of Xian pulse all represent a transformation from emptiness to fullness, from weakness to vigor, from dispersion to gathering, from obscurity to clarity, indicating a gradual shift from a negative to a positive state, thus its essence represents the trend of evil retreating and righteous qi recovering.
However, it is still in the stage of “initial recovery of yin and yang”; the righteous qi can only fill the meridians, making the pulse shape become tense and strong, but it has not yet reached the state where the righteous qi overflows outside the meridians, making the pulse become smooth, warm, and abundant, which is the pulse of rich stomach qi, hence it is still referred to as Xian.
In 1972, a middle school teacher named Wang experienced a prolonged low fever, underwent numerous tests, and the cause remained unknown, until he was cured using methods to warm yang and tonify qi.
During the illness, his pulse was consistently fine; he took Dang Gui Bu Xue Tang (Tangkuei Blood-Tonifying Decoction) with Fu Zi (Aconite) and Bai Wei (Swallowwort) for over forty doses, and Bu Zhong Yi Qi Tang (Tonifying the Middle and Benefiting Qi Decoction) with Fu Pian (Aconite) for over twenty doses, before the stubborn low fever subsided, and his pulse also became strong.
He had a relative who was knowledgeable in medicine, who said his pulse was Xian, indicating that the disease had retreated but the pulse had not, which was indeed alarming. Upon further examination, it was confirmed that the pulse was rising and falling evenly, quite firm, and it was correct to call it a Xian pulse. I told him this was a manifestation of the gradual internal filling of yang qi.
This was in 1972, and now this person is still teaching in middle school, in good health, and successful in his work. Although the experience is not extensive, it is indeed a practical verification.
I have also realized that in long-term illnesses, a pulse that is tense and strong often reflects the internal encounter of true qi, especially when seen in the wrist pulse.
In cases of more severe illness, the cun and guan pulses may be knotted or sunken, while the chi pulse is full and strong, rising and falling powerfully, often symbolizing that the fundamental aspect has not been shaken, because true qi cannot reach the upper parts, it must accumulate in the lower parts.
Of course, there is a saying that in long-term illness, the chi pulse should avoid Xian, but this only refers to avoiding “isolated and hard” Xian, not avoiding “long and full” Xian. Isolated and hard indicates a lack of stomach qi, hence it should be avoided; long and full indicates the presence of stomach qi, hence it should not be avoided.
The “Su Wen” (Plain Questions) states: “In spring, a slightly Xian pulse indicates balance; a Xian pulse with more than enough stomach qi indicates liver disease, but a Xian pulse without stomach qi indicates death.”
These statements are very important for diagnosing the Xian pulse; the Xian pulse has both a representative aspect of pathogenic factors and a representative aspect of righteous qi. How to accurately distinguish between them requires not only analyzing the situation of the disease but also considering the pulse body itself, whether there is stomach qi, the amount of stomach qi, and this is crucial.
Note: This article is excerpted from “Selected Lectures on Traditional Chinese Medicine, Volume 1”, compiled by the Graduate Class of Traditional Chinese Medicine Research Institute, published by the People’s Health Publishing House, October 1980. This public account is used solely for academic exchange; if there is any infringement, please contact for deletion, and reprint must indicate the source.
The cover image is sourced from Shetu Network.
//////////
You may also like, click to read the original text:
Is pulse diagnosis reliable for pregnancy? What is the pregnancy pulse like?
The correct way to understand Zhang Zhongjing’s “Xian Pulse”.
How to “differentiate pulse” to treat insomnia?
