Slow Pulse (迟脉)

Appearance (体象歌)

迟脉属阴，象为不及；往来迟慢，三至一息。

Clinical Indications (主病歌)

迟脉主脏，其病为寒。寸迟上寒，心痛停凝；关迟中寒，癥结挛筋；尺迟火衰，溲便不禁，或病腰足，疝痛牵阴。

Combined Patterns (兼脉歌)

有力积冷，无力虚寒。浮迟表冷，沉迟里寒；迟涩血少，迟缓湿寒；迟滑胀满，迟微难安。

Clinical Significance

The Slow Pulse primarily indicates cold patterns, though it may also appear in excess heat patterns when heat and dry stool are bound in the Yangming bowel. It forms when cold factors cause stagnation or when yang qi is insufficient to warm and move blood, resulting in fewer than four beats per breath. Generally, a slow pulse with force indicates excess cold, caused by yin-cold pathogenic factors congealing in the channels and organs. A slow pulse without force indicates deficiency cold, due to decline of yang qi. At the inch position, slow pulse indicates upper burner cold with chest pain, heart pain, and congelation. At the guan position, it points to middle burner cold with abdominal masses, muscular cramps, and poor appetite. At the chi position, it reflects decline of ministerial fire with kidney yang deficiency, presenting as incontinence of urine or stool, cold pain in the lower back and legs, or hernial pain pulling into the genitals. The Slow Pulse may also be seen in Yangming fu-organ excess pattern, where intense heat binds with dry stool and obstructs qi movement; in such cases the pulse is slow but forceful, accompanied by abdominal fullness, pain, constipation, and tidal fever.

Treatment and Care

For cold patterns with a Slow Pulse, the main treatment principle is to warm yang and scatter cold. For excess cold with slow and forceful pulse, warm the middle and scatter cold with Li Zhong Tang, Fu Zi Li Zhong Wan, or Wu Zhu Yu Tang. For cold congealing in the liver channel with hernial pain, warm the liver and unblock the channels with Nuan Gan Jian. For kidney yang deficiency with slow chi pulse, warm and supplement kidney yang with Jin Gui Shen Qi Wan, You Gui Wan, or Si Shen Wan. If the slow pulse belongs to Yangming fu-organ excess heat, the treatment is to purge heat and unblock the bowels with Da Cheng Qi Tang. Daily care requires strict avoidance of cold, keeping the abdomen, lower back, and legs warm, eating warm foods such as ginger, lamb, and longan, and avoiding raw fruits and cold drinks. Moxibustion at Guan Yuan, Ming Men, and Zu San Li helps warm yang and relieve pain. Local hot compresses can ease cold pain. When deficiency cold is prominent, gradual warming with nourishing formulas prevents further damage to yang qi, and regular monitoring of bowel movement and temperature helps distinguish true cold from heat binding patterns.