2.Deep Pulse (Chen Mai)
Diagram of Deep Pulse
The deep pulse, referred to as “stone” or “ying” in the Neijing, indicates that the pulse is deep and requires significant pressure to palpate. The Pulse Classic, Volume One states: “The deep pulse is not felt with light pressure, but is palpable with heavy pressure.” Zhang Deng from the Qing Dynasty summarized the diagnosis of the deep pulse as: “The deep pulse does not respond to light touch, but is felt with heavy pressure; lifting the finger reduces the response, while pressing harder increases the response, indicating it is not immediately felt. “
【Pulse Characteristics】 Light touch does not elicit a response; heavy pressure reveals the pulse.
The deep pulse indicates that the pulse energy is submerged, and the pulse is located deep within the body. It cannot be detected with light pressure; moderate pressure may reveal a weak pulse, but only with heavy pressure can a distinct pulse be felt between the muscles and bones. As stated in the Pulse Classic: “Light pressure on the skin does not yield a response; moderate pressure to the muscle reveals a response, and heavy pressure to the bones reveals a strong pulse; this is the deep pulse.” The Pulse Classic also states: “The deep pulse travels through the muscles and bones, like a stone sinking in water.” The Binhu Pulse Studies notes: “Like a stone thrown into water, it must reach the bottom to be felt.” This describes the deep pulse’s location as being deep, requiring thorough palpation to discern its form.
【Differentiation】 The deep pulse is similar to the hidden, firm, and weak pulses, as all four are located deep and do not respond to light touch. However, the deep pulse is found between the muscles and bones, requiring heavy pressure to be felt, while the hidden pulse is deeper than the deep pulse, situated on the bones, thus it does not respond to heavy pressure either, requiring the muscles to be pushed aside to feel the pulse. The Binhu Pulse Studies states: “The deep pulse travels between the muscles, while the hidden pulse travels above the bones.” The Pulse Classic states: “The deep pulse is felt with heavy pressure; if it is a hidden pulse, even heavy pressure to the bones will not reveal it; the finger must push aside the muscles to see the pulse.” The Four-Character Essentials states: “The deep pulse is close to the muscles and bones, deeply situated; the deep pulse is extremely hidden.” The firm pulse is similar to the deep pulse but is larger, more taut, and firm, as noted by Li Zhongzi in the Correct Eye of Diagnosis, Volume Two: “The firm pulse is found in the deep category, large and taut.” The weak pulse, while deep, is characterized by being thin and soft, indicating a combination of deep, thin, and soft pulses.
【Main Conditions】 The deep pulse indicates interior conditions, as discussed by medical practitioners throughout history, but the range of interior conditions is vast. When categorized by deficiency and excess, the deep pulse can indicate differences in strength. A strong deep pulse indicates interior excess, commonly seen in phlegm, food stagnation, qi stagnation, cold accumulation, diarrhea, heat accumulation, vomiting, and edema; a weak deep pulse indicates interior deficiency, often seen in conditions of weakened yang qi. The Jingyue Complete Book, Chapter on Pulse Spirit states: “Although the deep pulse indicates interior conditions, one must assess its strength to differentiate deficiency and excess; a strong deep pulse often indicates stagnation and excess qi, while a weak deep pulse indicates yang not reaching the surface and qi not flowing smoothly.” The Binhu Pulse Studies states: “The deep pulse indicates interior conditions; a strong pulse indicates interior excess, while a weak pulse indicates interior deficiency; the deep pulse also indicates qi and water accumulation.”
The Shanghan Lun, Differentiating Shaoyin Disease Pulse and Symptoms states: “In Shaoyin disease, with body pain, cold hands and feet, and joint pain, the deep pulse indicates the use of Fuzi Decoction.” “In Shaoyin disease, the deep pulse indicates urgent warming, suitable for Si Ni Decoction.” These all indicate that the deep pulse signifies interior deficiency and cold, with weakened yang qi. The Jinkui Yaolue, Water Qi Disease Pulse and Symptoms states: “The pulse is deep and slow, with external symptoms of wheezing; the pulse is deep and sinking, with external symptoms of abdominal fullness without wheezing; the pulse is deep and slow, with body heat, chest fullness, and swelling of the limbs and face, which, if prolonged, will lead to pus and abscesses.” “Interior water indicates yellow swelling of the entire body and face, with a deep pulse and difficulty urinating, hence the disease of water.” The Phlegm, Cough, and Pulse Symptoms states: “If there is retained fluid in the chest, the person will have shortness of breath and thirst, with joint pain in the limbs, and a deep pulse indicates retained fluid.” This indicates that the deep pulse or slow deep pulse signifies edema, yellow sweating, and retained fluid. Clinically, to accurately grasp the diseases indicated by the deep pulse, one must be familiar with the deep pulse and its associated pulse patterns.
The deep pulse can also appear in healthy individuals without disease, as noted in the Three-Finger Zen: “Many healthy people have a deep pulse.” The deep pulse is associated with winter and the kidneys, as stated in the Neijing: “In winter, the stomach is slightly stone-like, indicating a deep pulse; the stone refers to the deep pulse.” The Correct Eye of Diagnosis, Volume Two states: “The kidney is the organ associated with winter; all things hibernate, and yang qi sinks, with cold winds, snow, and frost, hence the pulse is deep and yin, residing in the interior.” Overweight individuals or those with a calm disposition may also exhibit a deep pulse, which is considered a normal pulse and not a pathological one. The Medical Treatise, Volume Five states: “Calm and deep individuals often have a deep pulse; overweight individuals often have a deep pulse.”
【Associated Pulse Conditions】 Common associated conditions include deep and slow indicating interior cold, deep and rapid indicating interior heat, deep and relaxed indicating dampness, deep and tight indicating cold pain, deep and slippery indicating phlegm or damp-heat, deep and wiry indicating internal pain, and deep and rough indicating qi stagnation. The Four Examinations, Volume Six states: “Deep and slow indicates chronic cold, deep and rapid indicates internal heat, deep and slippery indicates phlegm or food stagnation, deep and rough indicates qi stagnation, deep and weak indicates cold-heat, deep and relaxed indicates cold dampness, deep and tight indicates cold pain, deep and firm indicates cold accumulation.” It can be seen that the associated pulse conditions are quite broad and complex; mastering the deep pulse and its associated pulse patterns can lead to further understanding.
【Pulse Theory】 When the pathogenic factor is in the interior, the righteous qi is engaged internally, causing qi and blood to be trapped, hence the pulse is deep and strong, indicating interior excess; if the organs are weak, yang qi is diminished, and qi and blood are insufficient to circulate to the surface, the pulse is deep and weak, indicating interior deficiency. Xu Lingtai in the Hui Xi Pulse Studies states: “The deep pulse indicates yin, with the pathogen hidden in the interior; if there is no hidden pathogen in the interior, it is merely qi stagnation.” The Diagnosis of the Three Essentials states: “The deep pulse corresponds to the organs and bones, as the yang qi is weak and cannot circulate qi to the surface; if the pulse shows a deep yin manifestation, it will be weak upon prolonged palpation; if the yang qi is trapped and cannot rise to respond to the defensive qi externally, the pulse will be hidden and deep, and will not weaken upon prolonged palpation.”
【References】
(1) Binhu Pulse Studies: “The deep pulse is felt with heavy pressure to the muscles and bones (from the Pulse Classic). Like cotton wrapped around sand, hard inside and soft outside (Yang’s description). Like a stone thrown into water, it must reach the bottom.”
(2) Diagnosis of the Three Essentials: “If the pulse is deep and strong, it indicates yang pathogens hidden within; if the pulse is deep and slow, weak, and thin, it indicates yin cold without a doubt. … Regarding diarrhea and pulse being deep, cold hernia and pulse being deep, joint pain and pulse being deep, hidden pathogens and retained fluid and pulse being deep, stone water and pulse being deep, chest and abdominal pain and pulse being deep, cholera and vomiting and pulse being deep, qi stagnation and pulse being deep, all are indicative of the pulse corresponding to the disease.”
Compiled by Shi Chaoqi, Shi’s Traditional Chinese Medicine