There is a major principle in pulse diagnosis: when the three positions of the pulse (cun, guan, chi) are all floating and equal, it generally indicates a lack of disease, hence it is called a normal pulse. Many women experience this during pregnancy, although it may have a slightly slippery quality. In addition, any disease will inevitably present unique pulse patterns, so the first step in pulse diagnosis is to check for uniqueness:

Pulse Diagnosis

By considering the overall picture, one can identify a special pulse pattern. For example, if eight out of nine pulses are normal and only one shows an abnormality, attention should be paid to that specific pulse, as it indicates that the corresponding organ may have a disease.

The second step is to check for coexisting pulses. A coexisting pulse is one that does not have a pure form; for instance, a floating pulse can manifest in several ways and may coexist with other pulse forms.

The third step is localization. For example, if the cun pulse shows a certain pattern, such as a slippery pulse, it generally indicates phlegm in the throat, and the location of the slippery pulse determines where the phlegm is located.

The fourth step is to rule out other conditions. The state of the pulse reflects the state of Qi movement in the body. Therefore, pulse diagnosis often serves to understand the Qi mechanism of the body. Many individuals may exhibit compensatory phenomena; for instance, some may have a slippery cun pulse but no phlegm, often due to previous surgeries on the lungs or throat, which can only be clarified through inquiry.

Diseases typically begin at the surface. Over time or due to misdiagnosis, the pulse pattern may change. If the disease progresses into the body, it will manifest as a deep pulse.

• What Does a Deep Pulse Look Like?

The “Pulse Classic” states: A deep pulse is felt only by pressing down to the tendons and bones.

This method of pulse diagnosis involves pressing on the cun pulse with some force. (To clarify, traditional Chinese medicine categorizes the force of pulse diagnosis into three levels: three grains of weight, six grains of weight, nine grains of weight, and twelve grains of weight. These levels correspond to different pulse positions and indicate different disease locations.)

When initially holding the pulse, if it feels like three grains of weight, it corresponds to the skin and hair, indicating the lungs. If it feels like six grains of weight, it corresponds to the blood vessels, indicating the heart. If it feels like nine grains of weight, it corresponds to the muscles, indicating the spleen. If it feels like twelve grains of weight, it corresponds to the tendons, indicating the liver. Pressing down to the bone and feeling a quick response indicates the kidneys. Hence, the concept of lightness and heaviness.

Thus, in the “Nanjing” (Classic of Difficult Issues), the information obtained from using different pressures in pulse diagnosis represents different areas, making pulse diagnosis the best method for determining the location of a disease.

For instance, with a headache, if the pulse feels like three grains of weight, it indicates a surface condition, requiring treatment to release the exterior, using wind-dispelling herbs such as Fang Feng (Siler) or Ma Huang (Ephedra). If it feels like six grains of weight, it may indicate blood stasis or hypertension, necessitating blood-activating and stasis-resolving treatments or Qi tonics. If it feels like twelve grains of weight, it may indicate liver yang headache, requiring calming the liver and extinguishing wind. If it reaches a floating pulse, it indicates a Jueyin headache or Shaoyin headache, necessitating a large amount of Yang-supporting herbs such as Fu Zi (Aconite).

A deep pulse may also be described in other ways:

Like sand wrapped in cotton, firm inside and soft outside.

Because a deep pulse requires force to be felt, it can sometimes give the impression of being soft outside and firm inside. In fact, a deep pulse can also be very strong; ancient practitioners referred to a very strong deep pulse as a stone pulse:

Like a stone thrown into water, it must reach the bottom. A deep pulse indicates a well of springs below; in hexagrams, it corresponds to Kan (the Water hexagram), in seasons to winter, and in humans to the kidneys. It is also called stone, and also called nourishment. If excessive, it feels like a stone being pressed, indicating an external disease. If insufficient, the Qi feels weak and fleeting, indicating an internal disease.

If a deep pulse is very strong, it may indicate stiffness in the lower back, which can be understood as an external disease. If a deep pulse is felt in winter, it is generally considered normal, as in winter, the body’s Qi is stored and must be concealed for optimal protection, reflecting normal Qi movement.

• Differences in Deep Pulse Between Genders

There are significant differences in pulse patterns between men and women; a deep pulse does not necessarily indicate disease. A deep pulse merely reflects a state of Qi in the body.

Water flows down, the pulse comes deep, soft and smooth between the tendons and bones. For women, it is at the cun position, for men, at the chi position; this is considered balanced across the four seasons.

For women, a calm and gentle demeanor is the best state, so such personalities are considered normal. Conversely, those who are proud and arrogant are generally viewed unfavorably; thus, a cun pulse must have a certain depth. If it is floating and slippery, it indicates that the woman is proud and arrogant, so a deep cun pulse in women is considered normal.

Additionally, men should exhibit strong will and depth, primarily reflected in the state of the kidney pulse. If the kidney pulse is floating, it indicates ongoing depletion of kidney Qi; if the kidney pulse is deep, it indicates a restrained state, which relates to the Chinese concept of “self-restraint and returning to propriety as a virtue.” Therefore, a deep kidney pulse is generally considered normal, and such men are viewed as well-maintained and vigorous.

• Distinguishing and Differentiating Deep Pulses

Li Shizhen often distinguished various pulses in his writings on pulse diagnosis, which are interpretations developed by later generations. For instance, the floating pulse and deep pulse are essentially the same; the floating pulse is simply a deeper manifestation of the deep pulse.

A deep pulse adjusts the tendons and bones evenly, while a floating pulse pushes against the bones. A deep pulse is fine like cotton, truly weak, while a long and strong pulse is a solid form. (A deep pulse travels between the tendons, while a floating pulse travels above the bones; a solid pulse is strong, while a weak pulse is fine.)

Both the floating pulse and deep pulse require firm pressure to be felt, but the difference is that a deep pulse generally indicates kidney disease or a retraction of Yang Qi, while a floating pulse represents a different disease state, often indicating serious conditions such as tumors, referred to in ancient texts as accumulations. Thus, the “Jin Gui Yao Lue” states:

For all accumulations, if the pulse is fine and adheres to the bone, it indicates accumulation. If it is at the cun position, it accumulates in the chest; if it slightly emerges at the cun position, it accumulates in the throat; if it is at the guan position, it accumulates beside the navel; if it is at the upper guan, it accumulates beneath the heart; if it is slightly at the lower guan, it accumulates in the lower abdomen; if it is at the chi position, it accumulates in the Qi Chong; if the pulse emerges on the left, it accumulates on the left; if it emerges on the right, it accumulates on the right; if it emerges on both sides, it accumulates in the center. Each is determined by its location.

This so-called adhering to the bone pulse is the key to determining if the body has developed something. For example, if a tumor has developed in the lungs or neck, it can generally be felt at the right cun pulse. If it is a kidney stone, it can also be felt at the chi position. Of course, these pulse patterns have many distinctions, some in pulse shape, others in pulse Qi.

In summary, the presence of an adhering to the bone pulse indicates that the disease has progressed deeply, requiring attention or communication with the patient.