Library

The characteristic of the **Shi Mai (Real Pulse, 实脉)** is that both light pressure (**Ju**, 举) and heavy pressure (**An**, 按) feel strong and forceful, with a sense of fullness under the fingers. The **Xian Mai (Wiry Pulse, 弦脉)**, **Hong Mai (Surging Pulse, 洪脉)**, **Jin Mai (Tight Pulse, 紧脉)**, and **Hua Mai (Slippery Pulse, 滑脉)** all belong to the category of Real pulses. They do not resemble the Jin Mai which is bursting and urgent without harmony, nor the Hua Mai which flows smoothly back and forth, nor the Hong Mai which comes vigorously and departs weakly. (This passage is from Zhang Lu. Additionally, Li Shizhen states in the *Binhu Maixue* poem on pulse characteristics: "Obtained as large and long in both floating and deep positions; no emptiness felt under the finger, only strength; Heat accumulated in the Triple Burner forms vigorous fire, unblocking the intestines and inducing sweating brings health." In the poem on similar pulses: "The Real pulse is powerful and strong in both floating and deep positions; the Tight pulse moves unpredictably like a plucked string; one must know that the Firm pulse presses against the bones and sinews, while the Real pulse is large, slightly wiry, and longer.") The Real pulse is a sign of internal and external congestion and fullness. If seen in exterior diseases where the pulse is Real and Floating, symptoms such as headache, fever, aversion to cold, nasal congestion, head swelling, limb pain, and carbuncles/toxins can be observed; if the pulse is Real and Deep, symptoms such as abdominal fullness, hardness, and pain can be observed. In interior diseases, if the pulse is Real, Surging, and Slippery, various Fire syndromes, tidal fever, masses (*Zha*), blood stasis, phlegm-fluid retention, abdominal pain, and wheezing/counterflow qi can be observed; if the pulse is Real, Deep, and Wiry, various Cold stagnation syndromes can be observed. By observing these along with other Qi and Blood excess syndromes, the disease condition is within grasp, leaving no room for concealment. However, if the pulse is said to be Real, there is no Deficiency; if there are Deficient signs, it is not called Real. This entirely depends on the physician determining whether the pulse energy is truly Real or not. (The Real pulse has distinctions between Cold-Real and Heat-Real. But nowadays people only know of Heat-Real and are unaware of Cold-Real, which is regrettable. Zhang Jingyue says: "For Real syndromes caused by Fire pathogens, the pulse is Surging, Slippery, and forceful, corresponding to various Heat-Real syndromes; for Real syndromes caused by Cold pathogens, the pulse is Deep, Wiry, and forceful, corresponding to various Pain and Stagnation syndromes." He also says: "The Real pulse has true and false types; the true Real is easy to identify, but the false Real is easily misdiagnosed. Therefore, one must inquire about the cause and simultaneously examine physical signs and symptoms, which is the mark of a skilled physician.")

The characteristic of the **Xu Mai (Deficient Pulse, 虚脉)** is that it appears suddenly large and soft when lightly pressed, and fails to rebound or feel firm upon heavy pressure, feeling like searching for a chicken feather; after prolonged pressing, the root is neither lacking nor scattered. The **Kou Mai (Bamboo-slash Pulse, 芤脉)**, **Ru Mai (Soggy Pulse, 濡脉)**, **Chi Mai (Slow Pulse, 迟脉)**, and **Se Mai (Choppy Pulse, 涩脉)** all belong to the category of Deficient pulses. They do not resemble the Kou Mai which is suddenly hollow in the center and feels gradually emerging upon pressure; nor the Se Mai which is weak and powerless, appearing immediately upon light pressure; nor the San Mai (Scattered Pulse, 散脉) which is scattered without a root, completely undetectable upon heavy and prolonged pressure. (This passage is from Zhang Lu. Additionally, Li Shizhen states in the *Binhu Maixue* poems on characteristics and similarities: "Lightly pressed it is slow and large, heavily pressed it is loose; the pulse shape has no boundary, resembling an empty grain sack; do not treat the Bamboo-slash and Deficient pulses as the same type; the Bamboo-slash comes slow and large like a green onion.") The Deficient pulse is a manifestation of Qi and Blood deficiency. Therefore, if Floating and Deficient, it indicates Qi decline; if Deep and Deficient, it indicates weak Fire; if Deficient and Slow, it indicates Deficient-Cold; if Deficient and Rapid, it indicates exhaustion of Yin fluids; if Deficient and Choppy, it indicates Blood deficit; if Deficient and Wiry, it indicates Spleen Earth deficiency and Liver Wood excess; if Deficient with a faint, small, and thin sensation at the Chi position, it indicates loss of Blood or Essence; if Deficient and Large, it indicates Qi deficiency failing to consolidate. All these require differentiated treatment to avoid errors, which constitutes good medical practice. However, generally, emetic and purgative methods should not be used, lest they exacerbate the Deficiency. (Zhang Zhongjing says: "Those with a Deficient pulse cannot undergo emesis; those with abdominal fullness, a Deficient pulse, and recurrent cold limbs cannot undergo purgation; those with Deficient pulses in all three positions (Yin and Yang) with continuous fever are in a critical/deadly state.")