Knotted Pulse (结脉)

Appearance (体象歌)

结为凝结，缓时一止；徐行而怠，颇得其旨。

Clinical Indications (主病歌)

结属阴寒，亦由凝积。左寸心寒，疼痛可决；右寸肺虚，气寒凝结；左关结见，疝瘕必现；右关结形，痰滞食停。左尺结兮，痿躄之疴；右尺结兮，阴寒为楚。

Clinical Significance

The Knotted Pulse indicates yin-cold congelation and stagnation of qi-blood. It is slow with intermittent stops that have no fixed pattern, like a traveler moving slowly and wearily. It forms when yin-cold is excessive internally, yang qi is insufficient, or tangible pathogens such as static blood, phlegm-turbidity, and retained food obstruct the vessels, causing blood flow to become slow and interrupted. The Knotted Pulse usually belongs to cold and deficiency patterns, but may also be combined with excess pathogens. At the left inch position, knotted pulse indicates heart yang weakness with cold congealing the heart vessels, presenting as chest pain and palpitations. At the right inch, it reflects lung qi deficiency-cold with phlegm congelation, presenting as cough, shortness of breath, and chest pain. At the left guan, it points to cold congelation and qi stagnation in the liver channel with hernia, abdominal masses, and rib-side pain. At the right guan, it indicates spleen-stomach cold-dampness with phlegm-food stagnation, presenting as abdominal fullness, belching, vomiting, and loose stools. At the left chi, it reflects lower burner cold congelation with channel obstruction, presenting with weak lower limbs, difficulty walking, or pain. At the right chi, it indicates kidney yang deficiency with yin-cold internally, presenting as cold lower abdominal pain, weak cold lower back and knees, and difficult urination.

Treatment and Care

For heart yang weakness and cold congealing the vessels with a Knotted Pulse, warm yang, scatter cold, and unblock the vessels with Zhi Shi Xie Bai Gui Zhi Tang, Gua Lou Xie Bai Bai Jiu Tang, or Guan Xin Su He Wan; for severe yang deficiency, combine with Shen Fu Tang or Si Ni Tang. For lung cold with phlegm congelation, warm the lungs and transform phlegm with Ling Gan Wu Wei Jiang Xin Tang or Xiao Qing Long Tang. For cold in the liver channel with hernial masses, warm the liver, scatter cold, and move qi-blood with Nuan Gan Jian or Tian Tai Wu Yao San. For spleen-stomach cold-dampness with phlegm-food stagnation, warm the middle, transform dampness, and promote digestion with Li Zhong Tang combined with Er Chen Tang or Ping Wei San. For kidney yang deficiency with lower burner yin-cold, warm and supplement kidney yang and scatter cold to unblock the channels with Jin Gui Shen Qi Wan or You Gui Wan. Daily care requires strict avoidance of cold, especially keeping the chest, back, abdomen, and legs warm. Eat warming foods such as ginger, lamb, longan, and cinnamon; avoid raw and cold items. Moxibustion at Guan Yuan, Qi Hai, Shen Que, and Zu San Li warms yang and unblocks the vessels. A knotted pulse with obvious palpitations or chest pain should be evaluated for structural heart disease by modern medicine.