In-Depth Discussion on the Deep Pulse and Its Associated Pulses (Part One)
【Deep Pulse (Li Mai)】
The deep pulse represents internal conditions, regardless of whether they are heat or cold, excess or deficiency; as long as it is an internal condition, the following pulse patterns will inevitably appear.
【Deep Pulse (Chen Mai)】
1. Definition and Characteristics
To diagnose the deep pulse, one must apply greater pressure with the fingers, as it can only be detected from below the surface. Thus, it is said that “pushing the tendons to the bones is necessary.” The ancients described it as: “like cotton wrapped around sand, firm inside and soft outside.” The deep pulse is smooth and even, representing a normal pulse in winter. The deep pulse often indicates internal diseases, and it is essential to determine the condition based on other associated pulses.
2. Similar Pulse Differentiation
Firm Pulse (Lao Mai): The firm pulse is even deeper than the deep pulse, appearing both deep and hidden, solid and long, with a slight string-like quality.
3. Selected Literature
From the “Treatise on Cold Damage”: “If the patient has fever and headache, but the pulse is deep, if not resolved, with body aches, one should rescue the interior, and the prescription is Si Ni Tang (Four Reversal Decoction).”
From the “Treatise on Cold Damage”: “In Shaoyin disease, if the patient initially has fever but the pulse is deep, the prescription is Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction).”
4. Diseases Indicated by the Deep Pulse
The deep pulse primarily indicates internal diseases, generally representing internal conditions. Any strong pulse indicates internal excess, while a weak pulse indicates internal deficiency. The deep pulse also indicates Qi pulse and is associated with water pathogens. If the deep pulse is combined with a slow pulse, it often indicates chronic cold diseases. A rapid deep pulse often indicates internal heat. When combined with a slippery pulse, one should consider phlegm and food-related diseases. When combined with a rough pulse, it often indicates Qi stagnation.
【Associated Pulses with the Deep Pulse】
1. Deep and Slow
(1) Deep and slow with small, weak, and subtle qualities, especially at the wrist. The deep and slow pulse indicates chronic cold deficiency, but in the context of associated pulses, it suggests: small, weak, and subtle, indicating a deficiency of the Mingmen fire (Gate of Life), and treatment should focus on warming the Mingmen fire and tonifying the middle Qi, addressing the lower source.
(2) Deep and slow, with a soft and moist quality upon palpation. The deep and slow pulse indicates internal cold and chronic cold, and upon palpation, it feels soft, with a larger pulse shape and weak force, indicating a significant deficiency of Yang Qi, with a likely swollen and tender tongue, and a moist and slippery coating. In severe cases, it may indicate kidney deficiency with urinary difficulties, necessitating tonification of the middle Qi and treatment of the Mingmen fire, such as using Ba Wei Di Huang Wan (Eight Flavor Rehmannia Pill) combined with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
(3) Deep and slow with a small, slippery, and spirited quality. On the surface, the deep and slow pulse indicates internal cold; however, upon detailed examination, if it has a small, slippery, and spirited quality, combined with tongue, color, and symptoms, it should be considered as internal heat stagnation, which is trapped and not released. Treatment should focus on dispersing stagnation, opening up, and regulating. Often, practitioners only see the deep and slow pulse and blindly label it as cold deficiency, without noticing the small slippery quality or examining the changes in tongue shape, quality, and coating, which can lead to incorrect treatment.
(4) Deep and slow with a slightly urgent quality upon palpation. The pulse appears to indicate internal cold but is actually a solid manifestation; this indicates heat stagnation or phlegm obstructing the Qi mechanism, with a thin and dry tongue, possibly red in quality, and symptoms of irritability, frequent dreams, red urination, and slightly dry stools, with five hearts burning. This indicates internal heat stagnation, phlegm-heat obstructing, and hindering the Qi mechanism, hence the pulse appears deep and slow. Although it is a slow pulse, the slight urgency upon palpation indicates it is not cold deficiency but rather heat stagnation. Treatment should focus on dispersing stagnation and transforming phlegm, similar to the Zheng Qi Tang (Purge the Pathogen Decoction) in the “Treatise on Cold Damage.”
(5) From the “Golden Cabinet”: “For chest obstruction, shortness of breath, cough, chest and back pain, and shortness of breath, the pulse at the cun (inch) position is deep and slow, while the guan (bar) position is tight and rapid; the prescription is Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes, Allium, and White Wine Decoction).” This passage refers to the deep and slow pulse, while the guan position being “tight and rapid” seems difficult to interpret. In fact, a slow pulse and a rapid pulse cannot coexist; it should be interpreted as a slippery quality at the guan position, with a slight urgency upon palpation. This indicates that the patient with chest obstruction has fullness in the chest, obstructed lung Qi, and internal heat stagnation, leading to cough, shortness of breath, and chest and back pain, hence the cun position shows deep and slow, while the heat stagnation in the chest causes a slippery quality at the guan position, not truly a rapid pulse.
2. Deep and Rapid
The deep pulse indicates internal conditions, while the rapid pulse indicates heat patterns. The simultaneous presence of deep and rapid pulses must be due to internal heat-related diseases, and one must further determine the condition based on other associated pulses.
(1) Deep and rapid pulse with a string-like, small, and strong quality upon palpation. The string-like quality indicates stagnation, and the small size indicates insufficient Yin; the tongue must be red, with dry mouth and thirst, and irritability. This indicates Yin deficiency leading to heat, but it is not purely an excess condition; treatment should primarily focus on clearing heat, using sweet and cold herbs to nourish Yin, with a small amount of heat-clearing herbs.
(2) Deep and rapid pulse with a fine string-like quality and weak force. This internal heat is formed on the basis of blood deficiency. Blood deficiency leads to self-generated heat, and Yin deficiency must be excessive. This type of heat is not true excess heat but rather deficient heat, and one can use sweet and cold herbs to nourish Yin, as harmonizing Yin will naturally reduce heat, and one must avoid purely using bitter herbs to prevent damaging the righteous Qi.
(3) Deep and rapid pulse with a soft, slightly slippery quality upon palpation. In the context of internal heat, there may also be damp obstruction of the meridians and weakened righteous Qi; one must observe the color and examine the tongue carefully. If it is damp obstruction, treatment should focus on transforming dampness; if it is righteous Qi deficiency, one should consider tonifying the righteous Qi.
(4) Deep and rapid pulse, with a soft and slippery quality upon palpation. This often indicates insufficient middle Yang. If the tongue is slippery and moist, indicating heavy dampness and obstructed Qi mechanism, treatment should focus on resolving dampness; if the tongue is swollen and tender with obvious Qi deficiency, one should pay attention to the deficiency of the Qi aspect.
3. Deep and Slippery
From the “Golden Cabinet”: “If the pulse at the cun position is deep and slippery, there is water Qi present, with facial swelling and heat, known as wind-water.”
Li Shizhen stated: “Deep and slippery indicates phlegm and food.”
The deep pulse indicates internal conditions, while the slippery pulse indicates phlegm, representing an excess pulse, which is the Yang within Yin, meaning it belongs to tangible substances of Yin, such as phlegm, fluids, and water pathogens, as well as the fetus in pregnancy. Because of the fetus, it is referred to as Yang within Yin.
(1) Deep and slippery pulse with a string-like, rapid quality upon palpation. The deep pulse indicates internal disease, while the slippery pulse indicates phlegm dampness; the string-like quality indicates stagnation; the rapid pulse indicates heat, and a strong force indicates excess pathogenic Qi. This indicates that there is phlegm dampness obstructing internally, which can lead to heat over time. If the tongue coating is thick and greasy, treatment should focus on clearing and transforming phlegm dampness and dispersing heat stagnation.
(2) Deep and slippery pulse with both guan positions being slippery and strong. The deep pulse indicates internal disease, while the slippery pulse indicates excess pathogens; both guan positions indicate that the disease is in the middle burner, thus indicating gastrointestinal accumulation, representing internal excess. The primary treatment should focus on purging and resolving accumulation, with a likely thick yellow tongue coating. If the tongue coating is slippery and moist, one should consider water pathogens.
(3) Deep and slippery pulse with a slow and weak quality upon palpation. The deep pulse indicates internal disease, while the slippery pulse indicates phlegm; the slow and weak quality indicates insufficient righteous Qi and weak Yang Qi; the weak quality upon palpation clearly indicates significant deficiency of righteous Qi, insufficient Yuan Yang, weak Qi aspect, and possibly cold damp deficiency, which may be due to prolonged illness leading to weakness, and treatment should focus on tonifying the righteous Qi.
(4) Deep and slippery pulse with a soft and even quality. From the pulse pattern, this indicates a deviation of righteous Qi, dampness obstructing, or phlegm turbidity not transforming; if observed in women after menstruation, one should consider pregnancy. In summary, this pulse indicates dampness obstructing and phlegm turbidity accumulating internally, and treatment should focus on resolving phlegm and fluids.
Next Issue Preview: In-Depth Discussion on the Deep Pulse and Its Associated Pulses (Part Two)