Wiry pulse: what it means in Chinese medicine
The wiry pulse, xian mai, feels like a taut string under the fingers: long, straight, firm at its edges, and pressing back against the finger the way a bowstring or a tuned string does. It is the pulse of the Liver and Gallbladder, of pain, and of phlegm-fluids, and it is the most common abnormal pulse in a modern clinic, because the Liver's free-coursing is the first thing that pressure and held emotion disturb. A slightly wiry pulse in spring, in an old person, and in a lean and tense person is within the normal; a wiry pulse that is also rapid, thin, slippery, tight, or found at one position alone is a diagnosis.
How it feels
Wang Shuhe's Mai Jing, the classic on the pulse, describes it among the pulse images, and Li Shizhen's Binhu Maixue carries it into the list of twenty-eight that the modern textbook teaches. The wiry pulse is felt in a line across all three positions rather than rising and falling as a wave, and its edges are distinct, as though a string lay under the skin. It is separated from its neighbours by touch. The tight pulse (jin) is also forceful but feels twisted, like a rope turning under the finger, and belongs to cold and to acute pain. The long pulse (chang) extends beyond its positions but is soft, and in a healthy person is a good sign. The leather pulse (ge) is wiry at the surface and hollow beneath, and belongs to loss of Blood and Essence. A wiry pulse with force is excess; a wiry pulse without force, thin and string-like, is the Liver short of Blood, a string with nothing behind it.
What it means
The Suwen treats the pulse of the four seasons, and spring's pulse is wiry: wood rising, the Liver's own image. Out of season or in excess, the same image shows the Liver in disorder. Liver qi stagnation gives a wiry pulse of moderate force with distension and sighing; Liver yang rising and Liver fire give a wiry pulse that is also rapid and forceful, with headache, red eyes, and temper; Liver Blood deficiency gives a wiry pulse that is thin. Pain anywhere tenses the vessels and makes the pulse wiry, so a wiry pulse in a person with no Liver signs is read as pain. Phlegm-fluids (tan yin), the thin fluids that gather in the stomach, the chest, and the limbs, give a pulse that is wiry and slippery together. In the Shanghan Lun the wiry pulse marks the shao yang stage, with alternating chills and fever, a bitter taste, and fullness under the ribs, and calls for Xiao Chai Hu Tang.
The differential
| The pulse | What it shows | The direction of treatment |
|---|---|---|
| Wiry, moderate force | Liver qi stagnation | Xiao Yao San, Chai Hu Shu Gan San |
| Wiry and rapid | Liver fire, Liver yang rising, stagnation turned to heat | Long Dan Xie Gan Tang, Tian Ma Gou Teng Yin |
| Wiry and thin | Liver Blood or Liver yin deficiency | Xiao Yao San with Blood herbs, Yi Guan Jian |
| Wiry and slippery | Phlegm with Liver qi, phlegm-fluids, food stagnation | Wen Dan Tang, Er Chen Tang |
| Wiry and tight | Cold with pain, cold in the Liver channel | Nuan Gan Jian, Wu Zhu Yu Tang |
| Wiry and slow | Cold stagnation, phlegm-fluids | Ling Gui Zhu Gan Tang |
| Wiry and choppy | Blood stasis with qi stagnation | Xue Fu Zhu Yu Tang |
| Wiry and floating | Shao yang stage, or an exterior invasion in a Liver person | Xiao Chai Hu Tang |
| Wiry and deep, weak | Qi bound inward with cold hands and feet | Si Ni San |
| Wiry on the left, weak on the right | The Liver invading a deficient Spleen | Tong Xie Yao Fang, Xiao Yao San |
Position
The Liver is read at the left middle position (guan), so a wiry quality there alone is the Liver; wiry at the left middle with a soft and weak right middle is the Liver overacting on the Spleen, the pattern of abdominal pain relieved by a loose stool. A wiry pulse at the rear positions (chi) belongs to cold and pain in the lower burner, the hernia disorders and menstrual cramping of the Liver channel's course through the groin. Wiry at the front positions with headache is the Liver's yang rising to the head. The reading is made against the person: the Suwen places the ideal pulse reading at dawn, before food, emotion, and movement have coloured it, and a pulse taken after an argument or a coffee is wiry and rapid in anyone. The tongue is read alongside; a wiry pulse with a normal tongue is stagnation, and with red sides it is heat, and with a pale body it is Blood deficiency.