Faint Pulse (微脉)

Appearance (体象歌)

微脉极细，而又极软；似有若无，欲绝非绝。

Clinical Indications (主病歌)

微脉模糊，气血大衰。左寸惊怯，右寸气促。左关寒挛。右关胃冷。左尺得微，髓竭精枯；右尺得微，阳衰命绝。

Clinical Significance

The Faint Pulse indicates severe decline of qi and blood and extreme deficiency of yang qi. It is extremely fine and soft, almost imperceptible under the finger, as if it is about to disappear but not quite gone. It forms after prolonged illness, massive blood loss, profuse sweating, severe vomiting or diarrhea, or in critically ill patients when primordial qi is scattered and blood flow lacks propulsion. The Faint Pulse is a critical sign. At the left inch position, it indicates extreme heart blood and qi deficiency with palpitations, anxiety, and pallor. At the right inch, it reflects lung qi collapse with weak breathing, low voice, and continuous sweating. At the left guan, it indicates liver blood insufficiency and cold congelation in the channels with muscle cramps, numbness, and aversion to cold. At the right guan, it reflects stomach yang weakness with cold stomach pain, vomiting of clear fluid, poor appetite, and loose stools. At the left chi, it indicates marrow exhaustion and essence depletion with weak lower back and knees, tinnitus, and forgetfulness. At the right chi, it reflects kidney yang on the verge of collapse with cold limbs, edema, impotence, and a poor prognosis. The Faint Pulse demands immediate attention because it often precedes collapse of yang or sudden deterioration, and skin temperature, level of consciousness, and urine output provide additional clues to the severity of deficiency.

Treatment and Care

For a Faint Pulse due to qi and yang collapse, emergency treatment restores yang and rescues reversal. For yang collapse with sweating and cold limbs, use Si Ni Tang or Shen Fu Tang. For damage to both qi and yin with profuse sweating and thirst, use Sheng Mai San with additions to astringe sweat and secure collapse. For dual qi-blood deficiency, greatly supplement qi and blood with Shi Quan Da Bu Tang or Ren Yang Ying Rong Tang. For kidney essence deficiency, fill essence and supplement marrow with Zuo Gui Wan or Gui Lu Er Xian Jiao. For stomach yang deficiency, warm the middle and strengthen the spleen with Li Zhong Tang or Fu Zi Li Zhong Wan. Daily care requires absolute bed rest, protection from cold, and keeping the abdomen warm. Food should be warm, liquid or semi-liquid, in small frequent meals, such as rice porridge, ginseng soup, and red date soup; avoid raw, cold, greasy, and hard-to-digest foods. Moxibustion at Guan Yuan, Qi Hai, Ming Men, and Zu San Li can rescue yang, but critically ill patients must receive emergency medical care immediately. Family members should keep the patient warm and calm while arranging emergency medical evaluation without delay, and small sips of warm broth or rice water may be offered if the patient is alert and swallowing safely.