Wiry Pulse (弦脉)

Appearance (体象歌)

弦如琴弦，轻虚而滑；端直以长，指下挺然。

Clinical Indications (主病歌)

弦为肝风，主痛主疟，主痰主饮。弦在左寸，心中必痛；弦在右寸，胸及头疼。左关弦兮，痰疟癥瘕；右关弦兮，胃寒膈痛。左尺逢弦。饮在下焦；右尺逢弦，足挛疝痛。

Combined Patterns (兼脉歌)

浮弦支饮，沉弦悬饮。弦数多热，弦迟多寒。弦大主虚，弦细拘急。阳弦头痛，阴弦腹痛。单弦饮癖，双弦寒痼。

Clinical Significance

The Wiry Pulse indicates liver-gallbladder disease, phlegm-rheum, pain, and malaria. It forms when liver qi stagnation, liver yang rising, or phlegm-rheum retention causes the vessels to become tense and straight like a string. As the liver pulse, it reflects impaired liver qi flow and loss of vessel suppleness. At the left inch position, wiry pulse indicates heart vessel stagnation or phlegm-rheum obstruction with chest pain and palpitations. At the right inch, it reflects lung qi failing to disperse and phlegm-rheum rising upward with headache, chest oppression, cough, and asthma. At the left guan, it points to liver-gallbladder stagnation, malaria, or abdominal masses with rib-side distension, alternating fever and chills, and palpable masses. At the right guan, it indicates stomach cold or phlegm-rheum below the diaphragm with cold stomach pain, diaphragmatic fullness, and belching. At the left chi, it reflects water-rheum retained in the lower burner with difficult urination and lower abdominal tension. At the right chi, it indicates cold in the liver channel or hernia with pain in the lower abdomen and genitals and muscular cramps. Wiry and rapid indicates liver fire; wiry and slow indicates cold congelation; wiry and large indicates liver-spleen deficiency; wiry and thin indicates liver yin deficiency with muscular cramps.

Treatment and Care

For liver qi stagnation with a Wiry Pulse, treatment soothes the liver and regulates qi with Chai Hu Shu Gan San or Xiao Yao San. For liver yang rising with headache and dizziness, subdue liver yang with Tian Ma Gou Teng Yin or Zhen Gan Xi Feng Tang. For liver fire, clear liver fire with Long Dan Xie Gan Tang. For phlegm-rheum retention, warm and transform phlegm-rheum and strengthen the spleen with Ling Gui Zhu Gan Tang, Er Chen Tang, or Wen Dan Tang. For cold in the liver channel with hernial pain, warm the liver and scatter cold with Nuan Gan Jian. For malaria with wiry pulse, harmonize Shao Yang and expel malaria with Xiao Chai Hu Tang or Chai Hu Jie Nu Yin. For liver yin deficiency with muscular cramps, nourish yin and soften the liver with Yi Guan Jian or Shao Yao Gan Cao Tang. Daily care emphasizes emotional balance, avoiding anger and frustration that constrain liver qi; a light diet avoiding spicy, alcohol, and greasy phlegm-producing foods; and adequate sleep to protect yin. Gentle exercises such as tai chi and ba duan jin regulate qi flow, and massage at Tai Chong, Xing Jian, and Yang Ling Quan soothes the liver.