Scattered Pulse (散脉)

Appearance (体象歌)

散脉浮乱，有表无里；中候渐空，按则绝矣。

Clinical Indications (主病歌)

散为本伤，见则危殆。左寸之散，怔忡不寐；右寸之散，自汗淋漓。左关之散，当有溢饮；右关之散，胀满蛊疾。居于左尺，北方水竭；右尺得之，阳消命绝。

Clinical Significance

The Scattered Pulse indicates dissipation of primordial qi and collapse of organ essence-qi. It is floating, chaotic, and rootless, gradually disappearing at the middle level and absent with deep pressure, as if it has a surface but no interior. It forms in chronic severe illness when primordial qi is exhausted and yin-yang are separating, so that pulse qi cannot remain internally but floats outward. The Scattered Pulse is seen in terminal stages of various diseases, after massive bleeding, profuse sweating, severe diarrhea, heart failure, or shock. At the left inch position, scattered pulse indicates heart qi dissipation with heart spirit failing to anchor, presenting as palpitations, insomnia, and mental confusion. At the right inch, it reflects lung qi escaping outward with insecure wei, presenting as profuse sweating, weak breathing, and pale complexion. At the left guan, it points to liver wood disorder with fluid overflowing, presenting as edema, fluid retention under the ribs, and rib pain. At the right guan, it indicates spleen-stomach collapse with qi distension, presenting as abdominal distension like a drum, poor appetite, and diarrhea. At the left chi, it reflects kidney yin exhaustion with weak lower back and knees, tinnitus, seminal emission, and difficult urination. At the right chi, it indicates kidney yang dissipation and life fire about to extinguish, with cold limbs, edema, altered consciousness, and an extremely poor prognosis.

Treatment and Care

For primordial qi dissipation with a Scattered Pulse, emergency treatment supplements qi, secures collapse, restores yang, and rescues reversal. For yang collapse with sweating and cold limbs, use Shen Fu Tang, Si Ni Tang, or Du Shen Tang. For damage to both qi and yin with profuse sweating and thirst, use Sheng Mai San with cornus, dragon bone, and oyster shell to astringe sweat and secure collapse. For kidney qi exhaustion and yin-yang separation, greatly supplement primordial qi and restore yang with Da Bu Yuan Jian or Shen Rong Gu Ben Wan. For organ deficiency, combine supporting formulas such as Gui Pi Tang, Jin Gui Shen Qi Wan, Zuo Gui Wan, or You Gui Wan according to the affected organ. Daily care requires absolute bed rest and close monitoring of temperature, respiration, pulse, and blood pressure. Keep the environment quiet and warm, avoiding wind and cold stimuli. Food should be extremely 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 Scattered Pulse indicates critical illness and requires immediate emergency medical care combined with modern treatment. Moxibustion at Guan Yuan, Qi Hai, Ming Men, Bai Hui, and Zu San Li may assist in restoring yang and securing collapse, but it is only an adjunctive measure.