Theoretical Insights
Discussion on the Deep Pulse by Zhang Zhongjing
Baotou City Xinglin Traditional Chinese Medicine Research Institute Meng Linsheng
Zhang Zhongjing’s discussion on the deep pulse includes 59 entries, with 23 in the “Jin Kui” and 36 in the “Shang Han” (including 3 in the “Bian Mai Fa”, 8 in the “Ping Mai Fa”, and 3 in the “Shang Han Li”). He provides detailed explanations on the definition, nature, main diseases, and associated pulses of the deep pulse.(1) Definition“The pulse that is slow and colliding is called deep” (Ping Mai Fa, Entry 56): The pulse reflects changes in qi, blood, ying, and wei, thus Zhang Zhongjing often interprets the essence of the pulse based on the condition of ying and wei. In this entry, he clearly shows the harmony of ying and wei through the pulse’s calmness and tranquility, stating that “wei qi is harmonious and is called slow, ying qi is harmonious and is called deep.” Slow means wide, gentle, and unhurried; deep means neither urgent nor slow, introverted and hidden. Therefore, the terms slow and deep here do not refer to the pulse names in “sick pulses.” This pulse, which is hidden and not exposed, harmonious and gentle, is called the deep pulse.The deep pulse and the floating pulse are determined by the depth of the pulse.Since the “Nei Jing”, methods to differentiate between floating and deep pulses have included light touch, lifting, floating touch, and heavy touch, seeking, and deep touch, known as “lifting, pressing, seeking” and the three conditions of “floating, middle, deep.” Although the “Mai Jing” states that to obtain a floating pulse, one should “lift with excess and press with insufficient force,” and to obtain a deep pulse, one should “press heavily until reaching the sinews and bones,” the strength used in lifting and pressing and the depth of probing are quite vague. This is particularly difficult for beginners to master. I remember when I was an apprentice, my master, Mr. Dong Haiying, first had me use my thumb, index, middle, and four fingers to pinch small beans, repeatedly probing and rubbing. Initially, I thought it was merely to train the sensitivity of my fingers. Later, I realized that this action also served as a “quantitative” standard for the force applied during pulse diagnosis. Because my master set a time limit, within a certain number of days, I gradually increased the number of beans from one, three, to six. After reading the “Nan Jing · Wu Nan” and “Shang Han Lun · Ping Mai Fa”, I began to understand my master’s good intentions.Thus, the 44th entry of the “Ping Mai Fa” discusses the quantification of the force applied to diagnose floating, middle, and deep pulse positions. Only by repeatedly pinching, probing, touching, and rubbing the “small beans” can one not only enhance finger sensitivity but also achieve a clear understanding of the “force” used during pulse diagnosis.The 44th entry states: “When the pulse is pressed with the fingers, if it feels like three beans, it indicates lung qi; if it feels like six beans, it indicates heart qi; if it feels like nine beans, it indicates spleen qi; if it feels like twelve beans, it indicates liver qi; if it feels like pressing to the bone, it indicates kidney qi.”Here, “beans” can refer to various legumes, generally, small round beans are the best.From this, it can be seen that using a force equivalent to the weight of 3-6 beans is for “floating touch”, also called “lifting”, which can diagnose a floating pulse; using a force equivalent to 7-12 beans is for “middle touch”, also known as “pressing”; using a force equivalent to 12-15 beans or heavier is for “deep touch”, also called “seeking”, which can diagnose a deep pulse and a hidden pulse.(2) Attributes1. “Deep is pure yin” (Ping Mai Fa, Entry 54):According to the attributes of yin and yang, those located below the pulse opening are naturally of yin nature. Zhang Yinan notes: “Deep is pure yin, which is Shaoyin.”2. “Spring is floating, autumn is floating, winter is deep, summer is surging” (Ping Mai Fa, Entry 35): The deep pulse is the main pulse of winter. The “Nei Jing” also refers to the deep pulse as “stone” or “ying”, as stated in the “Su Wen · Ping Ren Qi Xiang Lun” that “the winter stomach is slightly stone, which is called flat.”3. “Deep is the master of bones”, “Deep is the kidney” (Zhong Feng, Entry 4): The kidney is the water organ, which governs the bones and produces marrow, belonging to Shaoyin. The deep pulse is located below, like water flowing down and moistening, its nature is similar. The pulse is deep and gentle, as stated in the “Su Wen · Ping Ren Qi Xiang Lun” that “the kidney pulse comes with a wheezing sound, pressing it feels firm, it is called kidney flat.”4. “Fat people should have deep pulses”, “Thin people should have deep pulses” (Ping Mai Fa, Entry 51): Fat people have thick skin and flesh, and their blood vessels are deeply hidden beneath the flesh, hence the pulse should be deep; thin people have shallow muscles, hence their pulse should be floating. If a thin person shows a deep pulse, it is not due to excess evil but rather a deficiency of the righteous qi, thus it should be investigated in detail.(3) Main Diseases1. “Deep indicates internal” (Bian Mai Fa, Entry 18):When a deep pulse is observed, it indicates that the disease is internal. The “Ping Mai Fa” Entry 37 states: “If there is a disease inside, the pulse should be deep.” The “Shang Han” Entry 148 states: “A deep pulse is also internal.”2. “If the pulse is deep, the ying qi is weak” (Bian Mai Fa, Entry 4):Insufficient ying blood does not nourish the pulse, hence the pulse does not swell and appears deep. Most deep pulses are weak.3. “Deep indicates excess” (Zang Fu Jing Luo Xian Hou Bing, Entry 11):Excess conditions often present with deep pulses, and deep pulses are strong. The “Ping Mai Fa” Entry 6 also states: “Deep indicates excess.”4. “If the pulse is deep, there is water retention” (Shui Qi, Entry 10):Water and qi stagnate in the body, or it may be due to edema, the pulse is often deep. Entry 19 reiterates that “deep indicates water”, Entry 21 also states “deep indicates water”, and Entry 11 states “if the pulse is deep and absent, there is water.”For the analysis of water and qi pathology, Entry 1 states: “The pulse of righteous water is deep and slow”, “the pulse of stone water is self-deep”, “the pulse of yellow sweat is deep and slow”, Entry 5 states “internal water… the pulse is deep”, Entry 26 states “the disease of water, its pulse is deep and belongs to Shaoyin.” The “Ping Mai Fa” Entry 35 states “deep and hidden water accumulation.” If heat combines with water, it leads to the symptom of chest obstruction, as stated in the “Shang Han” Entry 132: “Pressing it causes pain, the cun pulse is floating, and the guan pulse is deep, it is called chest obstruction.”5. “Shaoyin disease, pulse is deep” (Shang Han, Entry 323):Shaoyin disease with internal deficiency and cold symptoms often presents with deep pulses. Entry 94 states: “Fever and headache, the pulse is deep… body aches, should rescue the interior, suitable for Si Ni Tang.” Entry 305 states: “In Shaoyin disease, body aches, hands and feet are cold, joint pain, if the pulse is deep, Fuzi Decoction is the main treatment.” If there is Shaoyin deficiency and cold with concurrent exterior symptoms, the pulse can also be deep, Entry 301 states: “In Shaoyin disease, initially acquired, it causes fever, if the pulse is deep, Mahuang Fuzi Xixin Decoction is the main treatment.” The “Shang Han Li” Entry 90 summarizes: “If both cun and chi are deep, it indicates Shaoyin disease.”6. “If the pulse is deep, there is retained fluid” (Tan Yin, Entry 10):Water and fluid retention that does not disperse, yang qi is obstructed, hence the pulse appears deep. If water and fluid stagnate, it can cause swelling of the skin, and if it rises and obstructs the lungs, it can cause cough and wheezing, as stated in the “Lung Wei” Entries 8 and 9: “If the pulse is floating, Houpo Mahuang Decoction is the main treatment”, “if the pulse is deep, Zexie Decoction is the main treatment.”7. “If the pulse is deep, thirst for water, and urination is not smooth, all indicate jaundice” (Huang Da, Entry 9):Wet heat stagnates and causes jaundice, which can also present with a deep pulse.8. “Abdominal pain, the pulse should be deep” (Fu Jue, Entry 5):Abdominal pain can be seen in various pathologies and pulse patterns, but in cases of yang deficiency or excessive cold, the deep pulse is predominant.1. “Deep is pure yin” (Ping Mai Fa, Entry 54):According to the attributes of yin and yang, those located below the pulse opening are naturally of yin nature. Zhang Yinan notes: “Deep is pure yin, which is Shaoyin.”(4) Associated PulsesDue to the different associated pulse patterns, the diseases associated with the deep pulse also vary.1. Deep and tight:(1) External evil transmitted internally, combined with water, leading to excess heat and chest obstruction, the pulse appears deep and tight, “In Shang Han, after six or seven days, if there is chest heat and excess, the pulse is deep and tight, with pain below the heart, if pressed it feels hard, Da Xianxiong Decoction is the main treatment” (Shang Han, Entry 139). If due to mismanagement of evil leading to internal cold and concurrent vomiting, the pulse can also be deep and tight. Entry 144 states: “In Taiyang disease, if it is purged… if the pulse is deep and tight, it must want to vomit.”(2) Damage to the middle yang, water qi rising, can also present with a deep and tight pulse. The “Shang Han” Entry 67 states: “In Shang Han, if after vomiting or purging, there is fullness below the heart, qi rises and rushes to the chest, if one stands, the head feels dizzy, the pulse is deep and tight, if sweating occurs, it moves the channels, the body shakes, Fuling Guizhi Baizhu Gancao Decoction is the main treatment.”(3) True yang is weak, water and cold rise, the pulse can also be deep and tight. The “Shui Qi” Entry 21 states: “The cun pulse is deep and tight, deep indicates water, tight indicates cold, deep and tight collide, it is stuck at the guanyuan, initially it is still slight, in the later years it is not felt, after yang declines, ying and wei are affected, yang is damaged and yin is excessive, cold is slightly moving, kidney qi rises.”This reveals the mechanism of the occurrence of deep and tight pulses in relation to water and cold. If kidney yang is insufficient, qi transformation fails, the pulse is deep and tight, leading to difficulty in urination, as stated in the “Shui Qi” entry: “Shaoyin pulse is tight and deep, tight indicates pain, deep indicates water, urination is difficult.”(4) Heat stagnates in Shaoyang, when the disease invades internally, the pulse can also be seen as deep and tight. The “Shang Han” Entry 153 states: “In Shang Han, after five or six days, if there is sweating from the head, slight aversion to cold, hands and feet are cold, fullness below the heart, no desire to eat, hard stools… this is half inside and half outside. Although the pulse is deep and tight, it cannot be considered Shaoyin disease, because the yin cannot have sweat, now that there is sweating from the head, it is known to be not Shaoyin, it can be treated with Xiao Chai Hu Decoction.” Entry 267 also states: “If it is originally a Taiyang disease, and does not resolve, it turns into Shaoyang, with hardness and fullness below the ribs, dry vomiting and inability to eat, alternating between cold and heat, not yet purged, if the pulse is deep and tight, it can be treated with Xiao Chai Hu Decoction.”(5) If there is fluid retention in the chest, water pressure on the lungs, the pulse can be deep and tight. The “Jin Kui · Shui Qi” Entry 24 states: “If there is fluid retention in the diaphragm, the person wheezes and feels fullness, below the heart feels hard, the complexion is dark, the pulse is deep and tight.”2. Deep and slow:(1) Yin cold obstructs internally, accumulating in the intestines, the pulse can be both deep and slow. The “Bian Mai Fa” Entry 2 states: “The pulse is deep and slow, cannot eat, body feels heavy, and stools are hard, it is called yin accumulation.”(2) Deep and slow pulse is also a manifestation of water and cold accumulation. The “Shui Qi” Entry 19 states: “The cun pulse is deep and slow, deep indicates water, slow indicates cold, cold and water collide, leading to edema. Among them, Entry 1 also states: “The pulse of righteous water is deep and slow, the external symptoms are wheezing”, “the pulse of yellow sweat is deep and slow, the body is hot, the chest is full, the limbs and face are swollen. If it does not improve for a long time, it will definitely develop into pus.”(3) If the fluids are deficient and the muscles are dry, leading to spasms, the pulse can also be deep and slow. The “Jing Shi Re” Entry 11 states: “In Taiyang disease, if the symptoms are complete, the body is strong, and the pulse is deep and slow, this is a spasm, Guo Lou Guizhi Decoction is the main treatment.”(4) If the ying blood is deficient, the muscles lose moisture, the pulse can also be deep and slow. The “Shang Han” Entry 62 states: “After sweating, if the body aches, and the pulse is deep and slow, Guizhi Decoction with Shaoyao and Shengjiang each one liang, and Xin Jia Decoction is the main treatment.”(5) If the chest yang does not expand, and water retention accumulates, the pulse appears deep and slow. The “Xiong Bi” Entry 3 states: “In chest bi disease, wheezing, coughing, spitting, chest and back pain, shortness of breath, the cun pulse is deep and slow, the guan pulse is tight and rapid, Guo Lou Xiebai Baijiu Decoction is the main treatment.”(6) If kidney yang is insufficient, and water qi accumulates, leading to “righteous water”, the pulse appears deep and slow. The “Shui Qi” Entry 1 states: “The pulse of righteous water is deep and slow, the external symptoms are wheezing.”(7) If water and dampness are internally stagnant, and ying blood is hot, leading to yellow sweat, the pulse can also be deep and slow. The “Shui Qi” Entry 1 states: “The pulse of yellow sweat is deep and slow, the body is hot, the chest is full, the limbs and face are swollen.”(8) If true yang is weak, and virtual yang is externally lost, it is easy to diagnose a deep and slow pulse. The “Xue Bi” Entry 11 states: “The pulse is deep and slow, it is called loss of qi, if the person walks quickly, they will wheeze.”(9) If true yang is weak and exhausted, and virtual yang rises, the pulse can also be deep and slow. The “Shang Han” Entry 365 states: “If there is diarrhea, the pulse is deep and slow, the person has little redness in the face, slight heat in the body, and diarrhea of clear grains, they must be obstructed, sweating will resolve, the patient must be slightly faint, because their face is wearing yang, the lower part is deficient.”(10) If yin is exhausted and yang is lost below, and yang is obstructed above, the pulse appears deep and slow, which is quite difficult to treat. The “Shang Han” Entry 356 states: “In Shang Han, after six or seven days, after a large purge, the cun pulse is deep and slow, the hands and feet are reversed, the lower pulse does not reach, the throat is not smooth, spitting out pus and blood, diarrhea does not stop, it is difficult to treat, Mahuang Shengma Decoction is the main treatment.”3. Deep and fine:(1) If the Taiyin damp earth is affected, both cun and guan can present as deep and fine pulses. The “Shang Han Li” Entry 90 states: “If both cun and chi are deep and fine, it indicates Taiyin disease.”(2) If damp evil obstructs, causing joint pain, the pulse is often deep and fine. The “Jing Shi Re” Entry 14 states: “In Taiyang disease, if there is joint pain and restlessness, the pulse is deep and fine, this is called damp obstruction.”(3) A deep and fine pulse is originally a sign of deficiency and decline, but if it appears in yang heat diseases with delirium, it indicates a pulse pattern that does not match, and the disease is critical. On the other hand, if true qi is exhausted and delirium is present, it also indicates a critical condition. The “Shang Han Li” Entry 111 states: “Delirium and confusion, slight heat in the body, the pulse is floating and large, hands and feet are warm, if the pulse is deep and fine, it indicates death within a day.”(4) If Shaoyin blood is deficient, the pulse can be deep and fine and rapid. The “Shang Han” Entry 285 states: “In Shaoyin disease, the pulse is fine and deep, the disease is internal, sweating cannot be induced.”4. Deep and solid:If there is internal heat and excess, the pulse can be deep and solid. If after Shang Han, yang qi recovers too much, and body fluids are damaged leading to internal excess and accumulation, the pulse can also be deep and solid. The “Shang Han” Entry 393 states: “After Shang Han, if there is further fever, Xiao Chai Hu Decoction is the main treatment; if the pulse is floating, it can be resolved with sweating; if the pulse is deep and solid, it can be resolved with purging.”5. Deep and slippery:(1) If water and dampness accumulate, rising to the skin, leading to wind water, the pulse is often deep and slippery. The “Shui Qi” Entry 3 states: “If the cun pulse is deep and slippery, there is water qi inside, the face is swollen, and there is heat, it is called wind water.”(2) If dampness is internally excessive, leading to heat and diarrhea, the pulse can also be deep and slippery. The “Shang Han” Entry 144 states: “In Taiyang disease, if it is purged… if the pulse is deep and slippery, it indicates heat and diarrhea.”6. Deep and wiry:(1) If wood is obstructed in earth, leading to internal cold and downward pressure, the pulse can be deep and wiry, indicating downward diarrhea. The “Shang Han” Entry 364 states: “If there is diarrhea, the pulse is deep and wiry, indicating heaviness below.”(2) If the kidney is deficient and the liver is excessive, qi rises and blood overflows, the pulse can be deep and wiry, indicating nosebleeds. The “Jing Ji” Entry 5 states: “If the patient has no blood color, no cold or heat, and the pulse is deep and wiry, it indicates bleeding.”(3) If fluid accumulates in the chest and ribs, it leads to suspended fluid, obstructing the rise and fall, causing disharmony in the liver channels. The “Tan Yin” Entry 21 states: “If the pulse is deep and wiry, it indicates internal pain from suspended fluid.”7. Deep and knotty:If blood stagnates and qi is obstructed, leading to dampness and jaundice, the pulse appears deep and knotty. The “Shang Han” Entry 129 states: “In Taiyang disease, if there is jaundice, the pulse is deep and knotty, the lower abdomen is hard, and urination is not smooth, it indicates no blood; if urination is smooth, and the person is delirious, it indicates blood syndrome, and Di Dang Decoction is the main treatment.”8. Deep and minute:(1) If internal cold is excessive and yang qi is insufficient, the pulse is often deep and minute. The “Shang Han” Entry 61 states: “After purging, if sweating is induced again, during the day the person is restless and cannot sleep, at night they are calm, do not vomit or thirst, with no exterior symptoms, the pulse is deep and minute, and there is no significant heat, Jiang Guo Decoction is the main treatment.”(2) If the Taiyang follows the channels, and there is stagnant heat internally, leading to “stored blood”, a minute deep pulse can be observed. The “Shang Han” Entry 128 states: “In Taiyang disease, after six or seven days, if the exterior symptoms remain, the pulse is minute and deep, and it does not lead to chest obstruction, if the person is delirious, it indicates heat in the lower jiao, the lower abdomen should be hard and full. If urination is smooth, it indicates that blood will recover, hence Di Dang Decoction is the main treatment.”9. Deep and hidden:If heat remains internally, qi fails to circulate, and water and dampness do not follow the normal path, leading to overflow and water retention, the pulse appears deep and hidden. The “Jin Kui · Shui Qi” Entry 8 states: “Deep and hidden collide, it is called water. Deep indicates the pulse channels are weak, hidden indicates difficulty in urination, weakness leads to difficulty in collision, water flows to the skin, it is indeed water.”
Verification | Li Huibo
