The ancient texts of Traditional Chinese Medicine (TCM) provide rich discussions on pulse diagnosis. In the Yuan dynasty, Dai Qizong clearly proposed the pulse diagnosis concepts of “fen, he, ou, bi, lei”. Among these, “fen” refers to the understanding of a specific pulse pattern, while “he” refers to the elaboration of combined pulse patterns, known as “xiang jian mai”. However, historical physicians have described single pulses more frequently, while the elaboration on combined pulses is relatively scarce. Through preliminary research, we found that the deep and fine pulse (chen xi mai) has certain theoretical value, but its discussions in ancient texts are relatively scattered and lack systematic summarization.
The deep and fine pulse is a combination of the deep pulse (chen mai) and the fine pulse (xi mai). The Western Jin dynasty’s Wang Shuhe stated in his work “Mai Jing” that “the deep pulse is insufficient when lifted, but excessive when pressed”. The Qing dynasty’s Zhang Lu in “Zhen Zong San Mei” described the fine pulse as “coming and going like hair, clearly felt beneath the fingers”. The combined pulse reflects the characteristics of both the deep and fine pulses. This article theoretically explores the syndromes associated with the deep and fine pulse based on ancient literature, enriching its theoretical connotation and aiming to further broaden its clinical application.
Syndromes Associated with the Deep and Fine Pulse
In the Ming dynasty, Li Shizhen in “Bin Hu Mai Xue” stated that “the deep pulse indicates internal conditions, cold, and accumulation. It indicates strong phlegm and food, but weak qi and stagnation”. Li Zhongzi in “Zhen Jia Zheng Yan” stated that “the fine pulse indicates qi deficiency and various forms of exhaustion”. Qing dynasty’s Chen Xiuyuan summarized that “the deep pulse indicates internal conditions” and “the fine pulse indicates various deficiencies”. It is evident that the deep and fine pulse should encompass the characteristics of both the deep and fine pulses. Reviewing ancient texts, the syndromes associated with the deep and fine pulse mainly include the following three aspects.
Yang Deficiency Syndrome
The Qing dynasty’s Wang Bangfu in “Mai Jue Ru Hai” stated, “If the pulse is seen as deep, it indicates Yang deficiency”. Zhang Lu in “Zhen Zong San Mei” stated, “The fine pulse indicates a deficiency of Yang qi”. The deep and fine pulses can independently indicate Yang deficiency or can be combined to indicate Yang deficiency. The Qing dynasty’s Huang Yunxi in “Mai Que” stated, “The floating fine pulse belongs to Yin deficiency, with much night sweating; the deep fine pulse belongs to Yang deficiency, with much spontaneous sweating”. The fine pulse indicates a general deficiency of qi and blood, with distinctions between Yang deficiency and Yin deficiency. A fine pulse that is floating indicates Yin deficiency, while a fine pulse that is deep indicates Yang deficiency. The Qing dynasty’s Li Yanhe in “Mai Jue Hui Bian” also stated, “Generally, a floating and fine pulse belongs to the Yang aspect… while a deep and fine pulse belongs to the Yin aspect”. When Yang qi is deficient, its driving force weakens, and the pulse qi cannot effectively elevate the pulse pathway, resulting in a sinking and fine pulse.
Cold Syndrome
The Song dynasty’s Xu Shuwei in “Pu Ji Ben Shi Fang” stated, “The deep and fine pulse indicates cold”. The Qing dynasty’s Guo Yuanfeng described, “There are pulses that are fine, which may be due to sudden exposure to cold, causing extreme pain and obstruction in the meridians, leading to the blood being unable to circulate freely, thus the pulse appears deep and fine; this fine pulse should not be hastily interpreted as deficiency, as it may lead to erroneous tonification and solidification of pathogenic factors”. Here, the pathogenic factor refers to cold. The Qing dynasty’s Huang Gongxiu in “Mai Li Qiu Zhen” also stated, “A fine pulse combined with a deep pulse indicates internal cold”. Cold pathogens obstruct the pulse, which may arise from Yang qi deficiency, leading to weakened warming and transforming functions, resulting in the internal generation of cold pathogens; or from external cold directly invading the interior, obstructing the meridians, causing the blood vessels to contract and stagnate, leading to a deep and fine pulse.
Wet Syndrome
Li Zhongzi in “Yi Zong Bi Du” stated, “The deep and fine pulse indicates dampness”. The Qing dynasty’s Yao Qiu in “Shang Han Jing Jie” stated, “The deep and fine pulse indicates dampness”. The deep pulse indicates internal conditions, while the fine pulse indicates dampness; the dampness indicated by the deep and fine pulse is more inclined towards internally generated dampness, or due to Yang qi deficiency, leading to dysfunction in the transformation of fluids, resulting in dampness and turbidity spreading. Dampness is heavy and turbid, easily descending, and the pulse may present as a downward trend; dampness obstructs the qi mechanism, damaging Yang qi, leading to the body’s Yang qi being held back by dampness, resulting in a fine pulse. The Jin dynasty’s Cheng Wuji stated, “The pulse of dampness should be deep and fine”.
From the above, it can be seen that the syndromes associated with the deep and fine pulse mainly include Yang deficiency, cold, and dampness. These three are interrelated; when Yang qi is deficient, its driving, warming, and transforming functions weaken, leading to the generation of cold and dampness, and the cold and damp pathogens further obstruct Yang qi, exacerbating Yang deficiency.
Conditions Associated with the Deep and Fine Pulse
The deep and fine pulse, as a commonly observed combined pulse in clinical practice, often appears in various conditions. In textbooks such as “Chinese Internal Medicine”, “Chinese External Medicine”, and “Chinese Gynecology”, the deep and fine pulse appears frequently, with a wide range of associated conditions. For instance, the deep and fine pulse appears 90 times in “Chinese Internal Medicine”, associated with conditions such as asthma, diarrhea, abdominal pain, edema, urinary retention, and turbid urine; it appears 103 times in “Chinese External Medicine”, associated with conditions such as internal sinking, male infertility, oil wind, frostbite, red butterfly sore, and breast lumps; and it appears 49 times in “Chinese Gynecology”, with conditions including infertility, early menstruation, menorrhagia, dysmenorrhea, amenorrhea, and polycystic ovary syndrome. Thus, the conditions associated with the deep and fine pulse encompass diseases across multiple systems. Ancient literature also discusses “internal accumulation of dampness”, “breast lumps”, “damp obstruction”, and “itching of the Yin” in relation to the deep and fine pulse, indicating its close association with internal accumulation, breast lumps, damp obstruction, and itching conditions.
Internal Accumulation
The deep and fine pulse indicates internal accumulation. The “Jin Kui Yao Lue Zheng Yi” states, “Any yin-cold that condenses and forms gradually is called accumulation. Therefore, all accumulations do not have a single representative symptom, but have a certain deep and fine pulse pattern”. In the Ming dynasty, Wang Huan in “Mai Li Ji Yao” stated, “The deep and fine pulse indicates accumulation” and “the deep and fine pulse indicates internal accumulation”. The concept of accumulation originates from the “Huang Di Nei Jing”, meaning to gather, condense, and retain. Modern medical conditions such as liver and spleen enlargement, proliferative intestinal tuberculosis, and abdominal tumors can be classified under the category of accumulation.
The pathogenesis of tumors is based on deficiency with excess manifestation. Li Zhongzi in “Yi Zong Bi Du” stated, “The formation of accumulation is due to insufficient righteous qi, allowing evil qi to take hold”. Deficiency of righteous qi is a prerequisite for tumor development. When the body’s righteous qi is insufficient, evil qi must gather, leading to pathological factors such as qi stagnation, blood stasis, phlegm retention, cold dampness, and toxic stasis continuously coalescing, causing tumor growth under the stimulation of evil qi; and with insufficient righteous qi, the restraining power of qi weakens, reducing the constraint on tumor growth, thus accelerating the growth rate of tumors. Zhang Yuanshuo stated, “Nourishing the righteous qi will eliminate the accumulation”. Ancient physicians recognized early on that deficiency of righteous qi is the basis for tumor development and gradually developed the academic thought of “supporting righteousness and nurturing the root” in tumor treatment. The deep and fine pulse indicates internal conditions, with insufficient righteous qi unable to invigorate and fill the pulse pathway, often presenting as a deep and fine pulse. The deep and fine pulse also indicates cold; the “Ling Shu: Bai Bing Shi Sheng” states, “The beginning of accumulation arises from cold”, where cold evil reverses upwards, causing qi stagnation and obstruction, gradually leading to accumulation. Zhang Zhongjing in “Jin Kui Yao Lue” stated, “For all accumulations, the pulse is fine and adheres to the bone, indicating accumulation”. Thus, the close relationship between internal accumulation and the deep and fine pulse is evident.
Breast Lumps
The deep and fine pulse indicates breast lumps. Pulse diagnosis is one of the main methods for diagnosing and differentiating diseases in children. Zhang Jingyue stated, “Therefore, when diagnosing children, since they cannot express themselves, one should primarily rely on the pulse, supplemented by observing their shape, color, and voice, to ensure accuracy”. Liu Fang in the Southern Song dynasty stated, “The deep and fine pulse indicates breast lumps”. In children, breast lumps refer to the inability to digest milk and food. In the Ming dynasty, Xue Kai in “Bao Ying Cuo Yao” stated, “The deep pulse indicates difficulty in digesting milk and food, while the deep and fine pulse indicates stagnation of milk and food”. Wang Kentang further simplified it to “The deep and fine pulse indicates undigested milk and food”. The inability to digest milk and food in children, as indicated by the deep and fine pulse, is due to the cold nature of the deep and fine pulse.
In the Sui dynasty, Chao Yuanfang in “Zhu Bing Yuan Hou Lun” stated, “Children with undigested food are due to cold in the spleen and stomach”. Children have a high demand for nutrients from food, but their organs are delicate, and their spleen qi is insufficient to process the fine substances ingested, making it difficult to maintain a balance between these two aspects, often leading to symptoms of undigested milk and food and stagnation. Cold in the spleen and stomach further affects the balance between the normal intake and transformation of food, leading to difficulty in digesting milk and food. The deep and fine pulse indicates cold, which harms the spleen and stomach, leading to undigested milk and food, thus the deep and fine pulse can be seen in cases of breast lumps in children. The condition of breast lumps associated with the deep and fine pulse is often due to the effects of cold on the child’s spleen and stomach, causing dysfunction in digestion, with the core being an extension of the cold and cold syndrome indicated by the deep and fine pulse. Liu Fang in the Southern Song dynasty annotated after “Yong Yong Xin Shu” that “The deep and fine pulse indicates breast lumps, also indicating cold, meaning the pulse is fine and deep”. The Qing dynasty’s Zhang Lu further supplemented in “Zhen Zong San Mei” that “The deep and fine pulse indicates cold milk that does not digest”.
Damp Obstruction
The deep and fine pulse indicates damp obstruction. Li Shizhen in “Bin Hu Mai Xue” stated, “The deep and fine pulse indicates damp obstruction”. The Qing dynasty’s Pan Ji in “Yi Deng Xu Yan” annotated that “The deep pulse indicates internal conditions, while the fine pulse indicates dampness, thus the deep and fine pulse indicates damp obstruction”. The damp obstruction can be understood not only as dampness obstructing and blocking the pulse pathway, leading to a deep and fine pulse, but also refers to the disease of damp obstruction.
The term damp obstruction first appeared in Zhang Zhongjing’s “Jin Kui Yao Lue”, stating, “In Tai Yang disease, if there is joint pain and restlessness, and the pulse is deep and fine, this is called damp obstruction”. Damp obstruction occurs when dampness combines with wind and cold pathogens, flowing into the joints, leading to obstruction and resulting in pain. The Qing dynasty’s Feng Zhaozhang in “Feng Shi Jin Nang Mi Lu” also stated, “Damp obstruction presents symptoms similar to spasms, with a deep and fine pulse, joint pain, and feelings of restlessness”. Dampness obstructs the meridians, leading to joint pain; dampness steaming internally without being transformed leads to fever and restlessness. Damp obstruction as a disease has both dampness as the primary pathological factor and a deficiency aspect. Damp obstruction belongs to modern rheumatic diseases, where glucocorticoids play an irreplaceable role in the treatment of rheumatic diseases. Glucocorticoids can rapidly reduce disease activity, improve patient symptoms and immune function, but excessive use can lead to hormone dependence, damaging Yin and consuming Qi, leading to deficiency of both Yin and Yang. Wu Shengyuan from Yunnan Provincial Hospital of Traditional Chinese Medicine believes that rheumatic disease patients often present with Yang deficiency or cold dampness, considering Yang deficiency as the internal cause and cold dampness as the external cause, with Yang deficiency being the main pathogenesis. The deep and fine pulse indicates Yang deficiency, cold, and dampness, thus it is commonly seen in rheumatic diseases.
Itching of the Yin
The deep and fine pulse indicates itching of the Yin. Itching of the Yin refers to itching in the genital area, with the pathogenesis mainly related to parasitic infections, liver channel damp-heat, and kidney qi deficiency. The Qing dynasty’s Guan Yuheng in “Zhen Mai San Shi Er Bian” stated, “A deep pulse indicates kidney cold, leading to cold pain in the lower back, coldness in the male essence, and blood stasis in females; the deep and fine pulse indicates itching of the Yin”. This discusses the pathogenesis of itching of the Yin in relation to kidney deficiency. The deep and fine pulse indicates deficiency and dampness, with the pathogenesis of itching of the Yin primarily based on kidney deficiency and dampness as a secondary factor, which may flare up upon exposure to wind pathogens. Therefore, the kidney qi deficiency type of itching of the Yin is often associated with the deep and fine pulse. Li Bohua from Beijing University of Chinese Medicine believes that the kidney opens to the two Yin, and deficiency of kidney essence is the main cause of itching in the genital area in the elderly, where those with kidney Yin deficiency present with a fine and rapid pulse, while those with kidney Yang deficiency present with a deep and slow pulse, and those with deficiency of both Yin and Yang may present with both pulse types.
This article is adapted from the China Traditional Chinese Medicine News, compiled from the “Journal of Basic Chinese Medicine” Volume 29, Issue 8, August 2023, a national-level intangible cultural heritage protection project “TCM Diagnostic Methods” series research paper, authored by Chi Haoran, Yang Lei, Yu Qiuhui, Du Song, Liu Zhaihua / Institute of Basic Theory of Traditional Chinese Medicine, Chinese Academy of Chinese Medical Sciences.