Characteristics of the Deep PulseToday, we will learn about the pulse pattern classified as anomalous pulse types—the deep pulse (chen mai).1. Characteristics of the Deep Pulse:“Weak on lifting, strong on pressing.”The sensation of the deep pulse under the fingers is that the pulse is not prominent when taken superficially, but becomes increasingly noticeable with medium and deep pressure. The standard “weak on lifting” refers to the pressure being less than that of a normal person’s pulse when taken superficially; “strong on pressing” means that when the pulse is taken with firm pressure close to the muscle layer, there is a significant resistance felt under the fingers; compared to a normal person, it is “strong on pressing,” meaning that the pulse is more pronounced than that of a normal person when taken deeply. However, there can also be a relative strength, where the pulse taken deeply is stronger than that taken at medium pressure but weaker than that of a normal person.2. Mechanism of Formation and Diagnostic Significance of the Deep Pulse:1. Pathogenic factors invade the internal organs (primarily the interior), leading to stagnation of qi or blood, or the yin and yang being suppressed by pathogens.Throughout history, pulse literature, including current TCM textbooks, generally considers the deep pulse to indicate internal conditions; however, this is not entirely accurate. It can only be said that finding a deep pulse often indicates an internal condition, but to assert that the deep pulse always indicates the interior is somewhat forced.When pathogenic factors affect the body surface, such as the skin, hair, muscles, tendons, bones, and pulse, it indicates a superficial condition that is unlikely to threaten life. When pathogenic factors affect the internal organs, it indicates that the pathogens have penetrated deeply into the core of the body, which may pose a life-threatening risk. The appearance of disease in the six fu organs indicates that the pathogens have penetrated the interior; the five zang organs are fundamental to human life, and if they are affected, the pathogens have penetrated very deeply.In fact, when the righteous qi is suppressed by internal pathogenic factors, the struggle between the righteous and the evil can also present as a deep pulse. The qi of the internal organs, or even the yin fluids, blood, and yang of the organs, will rise to fight against the pathogens. Therefore, at this time, the pulse reflects the site of the battle between qi and blood at a deeper level, thus presenting as a deep pulse. The so-called deep pulse is characterized by: “weak on lifting, strong on pressing,” meaning that the pulse is not noticeable when taken lightly, becomes noticeable at medium pressure, and is even more pronounced at deep pressure, with the standard deep pulse reflecting the site of the qi and blood struggle at a deeper level.However, “when the evil qi gathers, its qi must be deficient,” the result of the struggle between the righteous and the evil will consume the righteous qi, so a deep pulse that is stronger with heavier pressure is relatively rare in clinical practice. If the righteous qi is slightly deficient, the pulse will appear weak under heavy pressure; thus, a typical deep pulse is weak on superficial examination, becomes noticeable at medium pressure, and is also noticeable at deep pressure, but not necessarily more pronounced than at medium pressure.2. Deficiency of qi, blood, yin, or yang.Clinically, deficiency patterns often present with a deep pulse. Qi deficiency, blood deficiency, yin deficiency, yang deficiency, and a certain degree of deficiency of the righteous qi will all present with a deep pulse, whether it is a standard deficiency or a slight deficiency of the righteous qi. The body lacks the driving force or physiological active substances to fill the pulse vessels, leading to a decrease in the amplitude of the pulse, which becomes hidden in the depths. Exhaustion and depletion can also lead to a deep pulse.The qi and blood of the human body primarily serve to protect the internal organs, so individuals with deficiency of yin and yang qi and blood often have cold hands and feet in winter, as the qi and blood prioritize protecting the internal organs and can only give up protecting the body surface. However, only when the deficiency is severe will the righteous qi float outward, known as floating yang deficiency, where the righteous qi and qi mechanism float outward and desire to escape. The so-called internal closure of pathogenic factors and external escape of righteous qi will lead to a floating pulse; while in cases of deficiency or mild exhaustion, the pulse generally presents as deep. Internal deficiency is also an internal condition, and the pulse will naturally be deep.3. Pathogenic factors (mainly referring to cold, dampness, phlegm, and stasis) obstructing the jueyin and shaoyin surfaces, and even partially obstructing the yangming, shaoyang, and taiyin surfaces, can also present as a deep pulse.This point is derived from years of clinical experience in the Yao school. It mainly stems from the Yao school’s unique understanding of “exterior conditions”—all six meridians can have exterior conditions. Some exterior conditions can also present with a deep pulse.Concepts of the Yao school regarding the exterior and exterior conditions:1. Definition of the exterior:The so-called exterior includes:1) Organs and tissues of the body surface belonging to the internal organs;2) Tissues of the body surface (tendons, muscles, skin, bones) belonging to the internal organs;3) Meridians;4) Physiological active substances running in the body surface organs and tissues (tendons, muscles, skin, bones), within the meridians;2. Concept of exterior conditions:Conditions that arise initially on the surface, caused by surface pathogens, and directly lead to changes in the affected area due to the action of surface pathogens are termed exterior conditions.3. Treatment of exterior conditions: Treatment methods include dispersing, penetrating, inducing, and unblocking.4. Key diagnostic points for exterior conditions in clinical practice:① Symptoms and clinical manifestations of the patient focus on the tissues, organs, and meridians of the body surface.② The patient’s history of exposure to external pathogens, mainly including the six excesses of wind, cold, heat, dampness, dryness, and fire, as well as epidemic qi (viruses, bacteria), etc.③ The patient’s clinical manifestations do not show obvious internal symptoms, generally focusing on various symptoms of the internal organs.5. Symptoms of exterior conditions:Exterior conditions often arise initially, but some can persist for twenty to thirty years. Their clinical manifestations primarily consist of symptoms related to the yingwei (nutritive and defensive qi); symptoms of the wei level mainly include: chills, nasal congestion, runny nose, etc.; symptoms of the ying level mainly include rashes, numbness, itching, pain, and redness and swelling of the skin.Except for the taiyang exterior condition and the wind-heat condition of the hand taiyin, other exterior conditions can mostly present with a deep pulse. The foot taiyin exterior condition can show both floating and deep pulses; the yangming exterior condition can present with a deep pulse, but floating pulses can also occur; the shaoyin and jueyin exterior conditions almost always present with a deep pulse, or at least not a floating pulse.6. Examples of relevant exterior condition passages in the Shang Han Lun:300: “In the case of shaoyin disease, if there is a fever after the onset, and the pulse is deep, Ma Huang, Xi Xin, and Fu Zi Decoction is indicated.” (Shaoyin cold exterior condition)278: “In cases of cold damage, if the pulse is floating and slow, and the hands and feet are warm, it indicates a condition in the taiyin.” (Taiyin wind-damp exterior condition)3. Differentiation of the Diagnostic Significance of the Deep Pulse:1. If the deep pulse is due to pathogenic factors invading the internal organs, it will be strong (including pulses that can also be wiry, tight, or bouncing).2. If the deep pulse is due to deficiency of qi, blood, yin, or yang, it often presents with weak pulses (including weak, thin, fine, short, etc.).3. Deep pulses presenting in various meridian exterior conditions often do not show signs of weakness.4. Main diseases associated with the deep pulse (plain language interpretation of the Binh Lake Pulse Studies):The deep pulse indicates internal conditions, cold, and accumulation; strong indicates phlegm and food stagnation, weak indicates qi stagnation; deep and slow indicates cold deficiency, deep and rapid indicates heat accumulation; deep and tight indicates cold pain, deep and slow indicates water retention; deep and firm indicates chronic cold, deep and solid indicates extreme heat; deep and weak indicates yin deficiency, deep and thin indicates damp obstruction; deep and wiry indicates phlegm pain, deep and slippery indicates food stagnation; deep and hidden indicates vomiting and diarrhea, yin toxins accumulating.—Chronic: Refers to diseases that are difficult to treat over a long period.—Fluid/Phlegm: Refers to diseases caused by various evils such as wind, cold, dampness, heat, and emotional or dietary stagnation, resulting in the accumulation of turbid liquid in the body, with the clear and thin being fluid and the thick and turbid being phlegm. This can manifest as vomiting, cough, or stagnation in the chest, or stagnation in the meridians leading to various diseases.—Yin Toxins: Refers to a disease name caused by cold evil penetrating the marrow, leading to stagnation of qi and blood in the meridians, with main symptoms including cyanosis of the skin, severe pain throughout the body, and sore throat followed by redness, swelling, and ulceration.(The deep pulse most commonly appears in three situations: first, internal injury with internal conditions, any disease of the internal organs without external pathogens falls within the scope of internal conditions; second, conditions caused by yin cold pathogenic factors; third, various accumulations that are fixed in a certain area, termed “accumulation,” which can flare up occasionally and cause migratory pain, termed “conglomeration.” When examining the deep pulse, one must first distinguish between strong and weak pulsations: deep and strong often indicate phlegm and food stagnation; deep and weak generally indicate qi stagnation. A deep and slow pulse often indicates a cold condition; a deep and rapid pulse often indicates heat evil lurking within. A deep pulse that is also tight often indicates cold causing pain; a deep pulse that is also slow often indicates accumulation of water qi (i.e., cold water evil). In cases of chronic cold disease, the deep pulse often presents with a firm quality; in cases of extreme internal heat, the deep pulse often presents with a solid quality; in cases of yin essence deficiency, the pulse is weak; in cases of damp evil stagnation (damp evil stagnation), the pulse is deep and thin. A deep and wiry pulse is often seen in pain conditions caused by phlegm; a deep and slippery pulse is often seen in conditions of food stagnation. If the pulse is deep and hidden, it is often seen in cases of yin toxins and accumulation that do not dissipate, leading to severe vomiting and diarrhea.)5. Poems on the Deep Pulse (plain language interpretation of the Binh Lake Pulse Studies):Body Condition Poem:Water flows down, the pulse comes deep, soft and smooth between the muscles and bones; in women, the cun pulse, in men, the chi pulse, this is considered normal throughout the four seasons.(The nature of water is to moisten and flow downward, and the deep pulse also flows downward like water, appearing between the deep muscles and bones. The pulse’s beating should be soft, smooth, and even; in women, the cun position, or in men, the chi position, as long as the pulse beats this way throughout the four seasons, it is considered a harmonious and normal pulse. Men are primarily yang, so the cun pulse is often stronger than the chi pulse; women are primarily yin, so the chi pulse is often stronger than the cun pulse. Therefore, men’s chi pulse is often deep, while women’s cun pulse is often deep.)Similar Poems:Deep helps the muscles and bones adjust evenly, if hidden, one must push the muscles to feel the bones; deep and thin like cotton is a true weak pulse, while a deep and wiry pulse is a firm shape.(Generally, the deep pulse is found close to the muscles and bones, beating softly and evenly. If it is deeper than a typical deep pulse, one must apply firm pressure to feel it, which is termed a hidden pulse; if the pulse is deep and thin like cotton, it is a weak pulse; if the pulse is deep and wiry and strong, it is termed a firm pulse.)Main Disease Poem:Deep and hidden water accumulates in the yin channels, rapid heat and slow cold with phlegm; weak and deep indicates deficiency and qi, deep and strong indicates accumulation and cold.(The yin channels with abundant water qi, or even water retention, often show a deep pulse. If the pulse is deep and rapid, it indicates internal heat evil; if the pulse is deep and slow, it indicates internal cold evil; if the pulse is deep and slippery, it indicates phlegm; if the pulse is deep and weak, it indicates yang deficiency and qi sinking; if the pulse is deep and strong, it indicates accumulation and cold stagnation.)Divisional Poems:Cun deep indicates phlegm stagnation and water retention in the chest, Guan indicates cold pain and obstruction; Chi deep indicates turbid retention and diarrhea, kidney deficiency affecting the lower source.(The deep pulse can be found in three positions, each indicating different conditions. A deep pulse in the cun position often indicates phlegm stagnation and water retention in the chest; a deep pulse in the guan position often indicates cold obstruction causing pain; a deep pulse in the chi position often indicates turbid retention, enuresis, diarrhea, dysentery, and kidney deficiency affecting the lower source.)6. Conclusion:The deep pulse is the opposite of the floating pulse; if the pressure is too light, it cannot be felt. A deep pulse that is soft, smooth, and even is considered normal. In clinical differentiation of the deep pulse, the main focus is on “strength” and “weakness” to distinguish between deficiency and excess. A deep pulse that is strong often indicates excess conditions, such as cold stagnation, qi stagnation, accumulation, and water retention; a deep pulse that is weak often indicates deficiency conditions, such as yang deficiency and qi deficiency.——————END——————*This article is excerpted from “Sixteen Lectures on Clinical Pulse Studies”; for further study, please refer to the original text.
