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Chapter 23 of 28
濒湖脉学
Overall Paraphrase
The Dai pulse (Intermittent pulse) belongs to the Yin pulse category.
The ancients described the Dai pulse as follows: within the pulse beat, there is a pause; after the pause, the pulse cannot resume on its own and takes a relatively long time before beating again. Zhang Zhongjing said: "When the pulse arrives, it seems to sink into the Chi position (deep section), and it takes a long time before it comes again." Master Wu said: "In a normal pulse, there are five beats per breath, indicating that the qi of the five viscera is sufficient; if there is no pause within fifty beats, this conforms to the 'Great Derivation number' (fifty), and is called a normal pulse." Conversely, if there is a pause, it falls into the category of the Dai pulse. When kidney qi cannot continue, there is approximately one pause every forty beats; when liver qi cannot continue, there is approximately one pause every thirty beats. This is because the qi of one particular viscus is weakened, and the qi of other viscera temporarily substitutes to maintain continuity. The classics state: "The appearance of a Dai pulse indicates qi depletion." Hua Boren said: "If a person without illness is thin and debilitated with a Dai pulse, this is a critical pulse condition; if a person with illness suffers sudden damage to qi and blood, and qi cannot continue, this is a pathological pulse." In febrile disease (cold damage), when palpitations and a Dai pulse appear, the ancients believed that Fumai Tang (Restore the Pulse Decoction) should be used as the main treatment (🌿for study purposes only, not as medication guidance). If a Dai pulse appears during pregnancy, the ancients believed it is related to around one hundred days of pregnancy, and one must distinguish between life and death.
Physical Form Poem: The pulse pauses in its beating and cannot return on its own; because it beats again after a pause, it is therefore called the Dai pulse. When it appears in a sick person, it may still be treatable; when it appears in a healthy person, it relates to the span of life.
Comparison Poem: A rapid pulse with occasional pauses is called a Cu pulse (Abrupt pulse); a slow pulse with pauses is called a Jie pulse (Bound pulse); only a pulse that pauses and cannot resume on its own is a Dai pulse. The Jie pulse mostly indicates life, while the Dai pulse mostly indicates death — their outcomes differ. The pauses of the Cu and Jie pulses have no fixed regularity; sometimes they pause after two or three beats and resume immediately afterward. The Dai pulse pauses with a fixed regularity; it must pause after a certain number of beats, and after pausing, it seems to sink into the Chi section, taking a long time before coming again.
Indication Poem: The Dai pulse fundamentally arises from weakened visceral qi; it can manifest as abdominal pain, diarrhea, deficiency in the lower burner, or damage to the middle burner from vomiting and diarrhea. In women, it can also appear around three months of pregnancy. The Maijing states: "A chaotic Dai pulse indicates death; it also indicates diarrhea and the passage of pus and blood in the stool."
Regarding prognosis based on the number of beats: if there is no pause within fifty beats, the body is free of disease; if a pause occurs within a certain number of beats, one can infer which viscus has depleted qi: a pause after forty beats indicates depletion of one viscus, with death likely after about four years; a pause after thirty beats suggests about three years; a pause after twenty beats suggests about two years; a pause after ten beats suggests about one year; one should also observe complexion, spirit, and symptoms. A pause after two beats suggests about three to four days; after three to four beats, about six to seven days; after five to six beats, about seven to eight days; and so on.
Dai Tongfu said: "When examining the pulse, one must observe at least fifty beats, as stated in the Nanjing; the Maijue five-viscera song uses forty-five beats as the standard, which deviates from the classics." Liu Dongyang said: "The ancients used the number of beats to assess the pulse — this is a crucial point; one must observe a full fifty beats before understanding the deficiencies of the five viscera. People today claim examination is complete as soon as they place their fingers on the wrist — how could fifty beats be a matter of a snap of the fingers? Therefore, students of medicine should examine the pulse, inquire about symptoms, listen to the voice, and observe the complexion — integrating all four diagnostic methods to avoid errors."
The defining feature of the Dai pulse is "pausing mid-beat, unable to return on its own, and taking a long time to come again," with pauses occurring at fixed regular intervals. It reflects weakened visceral qi, where the qi of one viscus cannot maintain continuity and is temporarily compensated by the qi of other viscera. Compared with the Cu and Jie pulses, the key distinguishing features of the Dai pulse are "pauses with fixed regularity" and "inability to resume on its own." The ancients also strongly emphasized the "fifty-beat pulse examination," holding that one must observe at least fifty beats to determine whether the qi of the five viscera is sufficient, and advocated that pulse diagnosis must be combined with inquiry, auscultation, and inspection — the integration of all four diagnostic methods. This emphasis on pulse rhythm and examination duration reflects a notably rigorous aspect of traditional pulse science.
The regular long intervals described by the Dai pulse resemble arrhythmias such as bigeminy, trigeminy, sinus arrest, escape beats, or atrioventricular block in modern medicine, though they cannot be simply equated. The "fifty-beat pulse examination" reflects the ancients' emphasis on sufficiently long examination duration, which shares conceptual similarity with modern electrocardiographic monitoring's emphasis on extended recording; however, using "a pause after forty beats, a pause after thirty beats" to determine visceral depletion and calculate time of death is a historical experiential observation that lacks scientific basis and should not be used for clinical judgment. Statements about the Dai pulse in pregnancy and the hundred-day fetus cannot serve as criteria for assessing gestational age or fetal safety today. Judgments such as "death" or "critical" in the original text should be regarded as records of ancient pulse diagnosis experience and should not be applied directly.
The Dai pulse reminds us of the importance of bodily rhythm and the continuity of visceral qi. From a non-therapeutic daily perspective, one can pay attention to: maintaining regular daily routines, avoiding prolonged sleep deprivation and overexertion; keeping emotions balanced, avoiding fright, worry, and excessive rumination; and practicing moderation in diet, preventing binge eating or repeated vomiting and diarrhea that may damage vital qi. If one notices abnormal pulse rhythm, palpitations, or marked fatigue in daily life, one should seek medical evaluation promptly rather than self-assessing prognosis against ancient texts.
This content is based on classical Chinese medicine texts and is provided for traditional cultural study and research only. It does not constitute any medical diagnosis, medication guidance, or treatment advice. Please consult a qualified healthcare provider if you experience discomfort.