Hollow Pulse (芤脉)

Appearance (体象歌)

芤乃草名，绝类慈葱；浮沉俱有，中候独空。

Clinical Indications (主病歌)

芤脉中空，故主失血。左寸呈芤，心主丧血；右寸呈芤。相搏阴伤。芤入左关，肝血不藏；芤现右关，脾血不摄。左尺如芤，便红为咎；右尺如芤，火炎精漏。

Clinical Significance

The Hollow Pulse indicates blood loss and damage to yin. It is floating, large, and hollow in the center, like pressing on a scallion stalk, felt at both the superficial and deep levels but empty in the middle. It forms after sudden massive blood loss when yin blood is abruptly depleted, the vessels lose filling, and yang qi floats outward. The Hollow Pulse is commonly seen after vomiting blood, nosebleed, bloody stools, uterine bleeding, traumatic hemorrhage, or postpartum hemorrhage. At the left inch position, hollow pulse indicates the heart has lost blood nourishment, presenting as palpitations, insomnia, pale complexion, and dizziness. At the right inch, it reflects lung yin damage or damage to both qi and yin, presenting as cough, shortness of breath, dry mouth and throat, and spontaneous sweating. At the left guan, it points to liver blood failing to store, with dry eyes, muscular tension, irritability, and menstrual irregularity. At the right guan, it indicates spleen failing to govern blood, presenting as bloody stools, uterine bleeding, sallow complexion, and fatigue. At the left chi, it reflects kidney yin deficiency below with intestinal dryness, presenting as bloody stools and weak lower back and knees. At the right chi, it indicates yin deficiency with fire flaming upward and insecure essence gate, presenting as seminal emission, yellow leukorrhea, burning urination, and lower leg sores.

Treatment and Care

For acute blood loss with a Hollow Pulse, the first step is to stop bleeding, then supplement blood and nourish yin. For vomiting blood or nosebleed, cool blood and stop bleeding with Shi Hui San, Xi Jiao Di Huang Tang, or Xie Xin Tang. For spleen failure to govern blood with uterine bleeding or bloody stools, strengthen the spleen, boost qi, and stop bleeding with Gui Pi Tang or Huang Tu Tang. For obvious blood deficiency, greatly supplement blood with Dang Gui Bu Xue Tang, Si Wu Tang, or Shi Quan Da Bu Tang. For yin deficiency with fire flaming upward, nourish yin, drain fire, and cool blood with Zhi Bai Di Huang Wan or Liang Di Tang. For postpartum hemorrhage with hollow pulse, supplement qi and blood, restore yang, and secure collapse with Dang Gui Bu Xue Tang combined with Shen Fu Tang. Daily care requires absolute bed rest and avoiding activity that may worsen bleeding. Keep warm, eat warm and nutritious easily digestible foods such as red dates, longan, e-jiao, pork liver, black chicken, and brown sugar water; avoid raw, cold, spicy, and blood-moving foods. During active bleeding, avoid coarse hard food. Moxibustion at Zu San Li, San Yin Jiao, and Xue Hai can supplement qi and contain blood, but stopping bleeding is the first priority.