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[Body Image] The Se pulse (Se Mai, Cymose Pulse) is rough and obstructed, like a knife scraping bamboo; it presents with the three characteristics of Slow (Chi), Fine (Xi), and Short (Duan).

"Se" means not smooth or fluent. The *Suwen: Sanbu Jiuhou Pian* states: "Irregularities in the rhythm indicate disease." This refers to stagnation and an uneven pulse rate. The *Maijue* uses the metaphor of a light knife scraping bamboo because scraping bamboo causes obstruction and lacks slipperiness. Tong Zhenzi uses the metaphor of rain soaking into sand, meaning that while rain on metal or stone is slippery and fluid, rain on sand is rough and does not flow smoothly. Li Shizhen uses the metaphor of a sick silkworm eating leaves, indicating slowness and difficulty.

[Main Pathology] The Se pulse primarily indicates Blood deficiency and also signifies Essence injury. A Se pulse at the Left Cun position indicates Heart pain and palpitations (Zhengchong). A Se pulse at the Left Guan position indicates Liver Blood deficiency causing hypochondriac distension. A Se pulse at the Left Chi position indicates Essence injury leading to fetal leakage (bleeding during pregnancy). A Se pulse at the Right Cun position indicates Qi stagnation (Pi qi) and spontaneous sweating. A Se pulse at the Right Guan position indicates anorexia accompanied by vomiting. A Se pulse at the Right Chi position indicates difficult and constipated bowel movements, abdominal coldness, and cold calves.

The middle jiao extracts essences from food and drink, transforming them into red Blood; this is called Blood. It confines Ying Qi so that it has nowhere to escape; this is called the Pulse. Both share the same substance but have different names. Moreover, Blood belongs to Yin fluids; when abundant, the pulse is slippery and fluid, and when deficient, it is withered and rough, which is inevitable. Essence and Blood both belong to Yin, hence the Se pulse governs both conditions. Blood is what nourishes the Shen (Spirit); when Blood is deficient, it fails to nourish the Heart, causing pain. If prolonged and compounded by fright or doubt, palpitations become severe. The Liver is the Sea of Blood; when Blood is deficient, it cannot nourish itself, causing pain in its associated regions. Kidney injury results in no surplus Essence; men experience dysuria, women experience menstrual blood deterioration and fetal leakage, indicating the loss of True Yang. When Lung Qi is deficient, circulation in the chest is impaired, leading to stuffiness; when it fails to protect the exterior and maintain solidity, spontaneous sweating occurs. Sweating consumes fluids, termed Fluid depletion. If leakage continues, Wei Qi dissipates, leading to cold extremities, termed Yang collapse. With Yang collapse and Fluid depletion, the Se pulse appears. Blood deficiency weakens Spleen Yin, reducing appetite and inducing vomiting; in severe cases, morning food is vomited in the evening, evening food in the morning, or immediate vomiting after eating. Stomach lack of residual fluids and Blood deficiency lead to dry Jin-Ye (Body Fluids), preventing downward lubrication and causing constipation. Abdominal coldness and cold calves occur because insufficient Blood cannot follow True Yang Qi for circulation.

[Combined Pulses] A Se pulse combined with Firm and Large qualities indicates Excess Heat; a Se pulse combined with Empty and Soft qualities indicates deficiency heat caused by rootless fire blazing.

Since the Se pulse originates from Blood deficiency, if it additionally presents as Firm and Large, it signifies rampant pathogenic Fire where Yin cannot control Yang. If it only presents as Empty and Soft, it belongs to rootless fire scorching. It may also result from depression, rich and greasy diet, absence of sweating, or erroneous tonification, causing Qi to surge and Blood to boil, transforming clear essence into turbidity. Old phlegm and retained fluids become sticky and mixed, obstructing the pulse channel, preventing smooth arrival, and presenting a Se appearance. If deep pressure reveals strength and rapidity (Shu pulse), combined with clinical signs and physical constitution showing heat symptoms, it should be treated as stubborn Heat.

Generally, moist objects are slippery, and dry objects are rough. Thus, Slippery pulses govern Phlegm-Fluids, and Se pulses govern Yin decline; this principle is inherent and beyond dispute. The Lung, being an organ with abundant Qi and little Blood, shows a normal diagnostic pattern when a Se pulse appears at the Right Cun. The Kidney, responsible for Essence and Blood, shows a sign of deficiency and decay when a Se pulse appears at the Right Chi. Regardless of gender, a Deep and Se pulse at the Chi positions invariably indicates infertility, confirming Blood deficiency and Essence injury. Therefore, if a pregnant woman presents with a Se pulse, it indicates insufficient Blood to nourish the fetus; if a non-pregnant woman presents with a Se pulse, she faces the worry of Yin decline and Marrow exhaustion. The spurious *Maijue* states: "Searching under the fingers, it seems present; lifting the fingers, it is completely absent." This describes the Micro pulse (Wei Mai), not the Se pulse. Wang Shuhe's description of it as "stopping once then returning" is also flawed. The Se pulse is slow and difficult in its movement; it resembles a stop but is not truly a stop. He also described it as "Fine and Slow, difficult in movement, and scattered." This implies more pulse force at the superficial level than the deep level, resembling the Scattered pulse (San Mai) but not actually being one. One must know that the Micro pulse is extremely fine and soft, seeming present yet absent; the Wet pulse (Ru Mai) is superficial, fine, and soft; the Weak pulse (Ruo Mai) is deep, fine, and soft. These three pulses are all vague under the fingers and seem similar to the Se pulse, but they are distinct. However, a single Se pulse can also arise from external pathogens invading, causing Qi stagnation and roughness; from Wei Qi dissipation, causing Yang deficiency and failure to hold, resulting in deficiency-related roughness; or from intestinal and stomach dryness and thirst, causing Jin-Ye loss and Blood exhaustion, resulting withered roughness. It requires the practitioner to be spiritually agile and discerning.