Intermittent Pulse (代脉)

Appearance (体象歌)

代为禅代，止有常数；不能自还，良久复动。

Clinical Indications (主病歌)

代主脏衰，危恶之候。脾土败坏，吐利为咎；中寒不食，腹疼难救。两动一止，三四日死；四动一止，六七日死。次第推求，不失经旨。

Clinical Significance

The Intermittent Pulse indicates organ decline and severe exhaustion of qi and blood. It is slow and weak with regular, patterned pauses; after the pause the pulse takes a noticeable time before resuming. It forms when visceral qi is severely weakened, heart qi is exhausted, and the pulse cannot continue its rhythm. The Intermittent Pulse is a critical sign, commonly seen in serious heart disease, severe electrolyte disturbances, poisoning, or the terminal stage of chronic diseases. In traditional Chinese medicine, it often arises from spleen-earth failure with impaired transformation, or from heart-kidney yang collapse and inability to generate qi and blood. Clinically, patients may present with palpitations, shortness of breath, fatigue, pale complexion, cold limbs, poor appetite, abdominal pain, and diarrhea. Classical texts state ominous prognoses such as "two beats and one stop, death in three to four days; four beats and one stop, death in six to seven days," emphasizing the dangerous nature of the Intermittent Pulse. Modern clinical practice requires combined evaluation with modern medical examinations and should not rely solely on the pulse. The rhythm should be confirmed by repeated palpation and correlated with the patient's overall vitality and consciousness, and in modern practice electrocardiographic findings and laboratory values are essential companions to traditional pulse assessment.

Treatment and Care

For organ decline with an Intermittent Pulse, treatment focuses on greatly supplementing qi and blood, restoring yang, and rescuing reversal. Heart-spleen qi-blood deficiency is treated with Zhi Gan Cao Tang or Gui Pi Tang. Heart-kidney yang deficiency with impending yang collapse is treated with Si Ni Tang, Shen Fu Tang, or Ma Huang Fu Zi Xi Xin Tang. Spleen-earth failure with vomiting and diarrhea is treated with Fu Zi Li Zhong Tang or Si Shen Wan. If static blood or phlegm-turbidity obstructs the heart vessels, add blood-activating, phlegm-transforming, and channel-unblocking herbs such as salvia, ligusticum, trichosanthes, and allium on the foundation of supporting healthy qi. Daily care requires absolute bed rest and close monitoring of vital signs; keep the environment quiet and warm, avoiding wind and cold stimuli. Food should be very light, liquid or semi-liquid, in small frequent servings such as rice soup, ginseng soup, and red date soup; avoid raw, greasy, and hard-to-digest foods. The Intermittent Pulse usually appears in critical illness and must be managed in a professional medical setting. Moxibustion at Guan Yuan, Qi Hai, Ming Men, Nei Guan, and Zu San Li may assist in restoring yang and securing collapse.