The editor says: Regarding the description of pulse patterns, Xu believes that many pulse practitioners either confuse deep pulse with hidden pulse or misinterpret the anatomical position of the radial artery. Only Wang Shuhe has provided a profound summary of deep pulse, stating, “The pulse is deep, difficult to lift, and easy to press.” This classic statement is clearly opposite to that of superficial pulse. It is evident that deep pulse and superficial pulse are determined solely by the depth of the pulse, without the need for additional conditions, which is consistent with textbook descriptions. However, Xu argues that deep pulse is the shallowest among all deep pulses, stating, “In terms of pulse position, the order of deep pulses is deep, weak, firm, and hidden. Deep pulse: difficult to lift, easy to press. Weak pulse: deep yet soft and fine. Firm pulse: a composite of deep, string-like, solid, large, and long pulses, as felt at the tendon of the middle finger. Hidden pulse: extremely deep and hidden.” Regarding the principles of pulse patterns, Xu convincingly argues that they include “constriction of peripheral capillaries, reduced tissue fullness and elasticity, and the radial artery losing its support from surrounding tissues; cold external environment causing skin and tissue to contract and tighten, leading to the radial artery becoming hidden; obesity or edema causing skin and subcutaneous tissue to be submerged; insufficient heart function, reduced cardiac output, decreased vascular fullness, and hidden radial artery; reduced body fluids leading to insufficient tissue fullness; deep pulse can also vary due to different states of heart function, reduced cardiac output, and variations in peripheral vascular fullness and resistance.” Textbooks generally describe the formation of deep pulse as having both deficiency and excess factors. One is the internal accumulation of pathogenic factors, with the righteous qi still strong, leading to a struggle between the pathogenic and righteous qi, causing qi stagnation and blood obstruction, with yang qi being restrained, unable to push the pulse qi outward, hence the pulse is deep yet strong, seen in conditions of qi stagnation, blood stasis, food accumulation, and phlegm fluid; the other is the weakness of the organs, insufficient qi and blood, or yang deficiency and qi exhaustion, leading to an inability to regulate blood outward, hence the pulse is deep yet weak, seen in various organ deficiency syndromes. In obese individuals, the thick fat and rich flesh lead to a deep pulse; in winter, the qi and blood contract and sink, hence the pulse is also generally deep; if all six pulses are deep and fine without clinical symptoms, it is termed as six yin pulses, which can be considered as normal physiological phenomena.” Regarding the question of whether deep pulse can be a normal pulse pattern, Xu states, “Normal individuals can also exhibit deep pulse under physiological conditions, but from long-term clinical observations, those with deep pulse are often in a sub-healthy state.” In terms of the main diseases associated with deep pulse, the two have differing views. Xu believes that “acute fever in the mid to late stages, long-term low-grade fever patients, periodic fever, mid to late stages of infectious diseases, diseases of the digestive system, endocrine system, blood system, malignant tumors, connective tissue diseases, metabolic diseases, etc., can all cause the patient’s pulse to be deep due to changes in the internal environment.” Textbooks are more general, simply stating, “It indicates internal conditions. Strong indicates internal excess, weak indicates internal deficiency.”
Keywords: Traditional and Western Medicine; Pulse Diagnosis; Deep Pulse; Xu Yueyuan; Essence of Modern Pulse Studies by Xu Yueyuan (I) (Edited by Tai Yi)
Author’s Biography: Xu Yueyuan (1955~), male, Hui nationality, from Shouxian, Anhui. Distinguished Professor at Beijing University of Chinese Medicine, Distinguished Expert at Guangdong Provincial Hospital of Traditional Chinese Medicine, Vice President of the Pulse Research Professional Committee of the World Federation of Chinese Medicine Societies, President of the Pulse Research Branch of the Chinese Society of Traditional Medicine, and Professor at the Nanjing New Traditional Medicine Research Institute of the Chinese Academy of Traditional Medicine. Coming from a family of traditional medicine practitioners, he has spent decades integrating traditional and Western medicine and tirelessly researching pulse patterns. He was the first to propose the neurological and blood supply aspects of the cun-kou pulse, introducing the concept of “pulse person” in pulse diagnosis. In clinical practice, he discovered and defined various pulse patterns such as edge pulse, wind pulse, turbid pulse, tide pulse, undulating pulse, odd pulse, and pulse halo points, and attempted to standardize the naming of combined pulses. The discovery of pulse pattern diagrams has provided morphological connotations for pulse diagnosis. He believes that pulse patterns are human signs and advocates for the complementary integration of traditional and Western medicine, emphasizing six diagnostic methods for disease. Mr. Zhang Guangji commented, “The pulse takes shape under the fingers, forming images in the heart, with divine hands and eyes, leaving one in awe”; Mr. Zhu Guoben remarked, “Greatly hidden in the market, three fingers press, revealing the five organs at the cun-kou, if not for the leap of pulse studies by Xu, how could one know the divine heart opens a window to heaven?” He has authored works such as “The Pulse of China”, “The Great Physician’s Pulse”, and “Essence of Modern Pulse Studies by Xu Yueyuan (I)”.
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III. Deep Pulse
(I) Overview
Deep pulse refers to a pulse that is deep in position, difficult to lift, and easy to press.
(II) Research on Deep Pulse
Among the historical pulse studies, only the “Pulse Classic” has been recognized and respected for its understanding of deep pulse. “The pulse is deep, difficult to lift, and easy to press.” This is a profound summary by Wang Shuhe regarding deep pulse. This classic statement is clearly opposite to that of superficial pulse. It is evident that deep pulse and superficial pulse are determined solely by the depth of the pulse, without the need for additional conditions.
Our understanding of pulse position should not be limited to the geometric spatial significance of height and depth. The floating and sinking of the pulse should be understood as the changes in the body’s qi and blood, and the immediate state of function and metabolism.
More precisely, it should be understood as the physiological and pathological changes between microcirculation, the heart’s stroke volume, vascular tension, and peripheral resistance. The floating and sinking of pulse patterns are merely manifestations of the abnormal metabolism between peripheral resistance, cardiovascular function, and the physiology and pathology of the body.
In fact, the deep pulse of obese individuals and the floating pulse of thin individuals are issues of vascular visibility. Deep pulse is due to insufficient tissue fullness in the body, and the lack of buoyancy of the pulse qi causes it to sink within the tissues.
Regarding deep pulse, the “Pulse Classic” states, “Pressing it reaches the bone,” while the “Pulse Classic Errata” mentions, “It is beneath the muscles.” Subsequent scholars have all identified the pulse position through the skin, with some stating it is beneath the muscles and above the bones, as seen in the “Pulse Classic Compilation”.
Some also state, “Deep pulse runs between the tendons,” as seen in the “Essential Readings of Medical Classics”. Others say, “Close to the tendons and bones,” for example, in the “Four-Character Essentials”. The “Binhai Pulse Studies” also believes, “Pressing heavily on the tendons and bones is necessary.”
It is either misinterpreting deep pulse as hidden pulse or misplacing the anatomical position of the radial artery. The “Secrets of Chinese Pulse Diagnosis” states, “Like a stone in water, it must be at the bottom, soft on the outside and firm on the inside.” The phrase “must be at the bottom” raises concerns about the unclear distinction between deep and hidden pulses, while “firm on the inside” suggests excessive pulse tension.
Modern medicine believes that the floating pulse of thin individuals is due to reduced subcutaneous fat, making the pulse pathway more visible. The deep pulse of obese individuals is submerged by subcutaneous fat, with poor heart function, reduced body fluids leading to decreased circulating blood volume, and the radial artery and surrounding tissues sinking, resulting in a lack of buoyancy in the pulse, making deep pulse inevitable, but it is certainly not a displacement of the anatomical position of the radial artery. We may not be able to correct ancient teachings, but we should enlighten future generations with correct understanding.
(III) Characteristics of Deep Pulse
Nature: Deep pulse specifically refers to the single factor of deep pulse position.
Palpation: It is heavy to obtain, difficult to lift, and easy to press. For example, deep pulse can be felt at the lower edge of the earlobe or by pressing the body of an earthworm during summer exercise.
(IV) Pathological and Anatomical Basis of Deep Pulse
Constriction of peripheral capillaries, reduced tissue fullness and elasticity, and the radial artery losing its support from surrounding tissues.
Cold external environment causing skin and tissue to contract and tighten, leading to the radial artery becoming hidden.
Obese or edematous patients have their skin and subcutaneous tissues submerged.
Insufficient heart function, reduced cardiac output, decreased vascular fullness, and hidden radial artery.
Reduced body fluids leading to insufficient tissue fullness.
Deep pulse can also vary due to different states of heart function, reduced cardiac output, and variations in peripheral vascular fullness and resistance.
(V) Modern Clinical Significance of Deep Pulse
Generally, the body undergoes corresponding physiological and pathological changes under the influence of pathogenic factors. When the body’s resistance is still good, and the pathogenic factors are strong, the pulse is deep and strong. When the body is weak and the functions of the affected organs are deficient, the pulse is deep and weak. Normal individuals can also exhibit deep pulse under physiological conditions, but from long-term clinical observations, those with deep pulse are often in a sub-healthy state.
For example, in adults, as age increases, the pulse at the wrist gradually becomes deeper, while the individual’s constitution and physical ability gradually decline. However, this decline is a holistic, balanced, and slow process, and this weakening of balance can make this group of people feel good about themselves.
Clinical observations have found that individuals over 30 years old gradually have deeper pulses, and by the ages of 40 to 50, the deepening of the pulse is particularly evident. X-ray examinations may reveal decalcification of long bones in the lower limbs, and muscle tension and explosive power are also declining, with decreased jumping ability being a significant marker.
Women may experience reduced menstruation, while men may show decreased sexual desire. Common clinical responses include soreness and coldness in the legs, easy fatigue, and poor intestinal function, which is similar to kidney deficiency in traditional Chinese medicine. A healthy lifestyle can alleviate or delay this decline, but the natural laws of biology always have their own limits.
In clinical practice, deep pulse is often seen in the mid-stages of acute diseases and in chronic diseases, which may be related to the reduction of body fluids. Deep pulse is also observed in some febrile patients in the early stages. Traditional Chinese medicine refers to this as “wind-cold binding the exterior, meridian stagnation.”
Generally speaking: acute fever in the mid to late stages, long-term low-grade fever patients, periodic fever, mid to late stages of infectious diseases, diseases of the digestive system, endocrine system, blood system, malignant tumors, connective tissue diseases, metabolic diseases, etc., can all cause the patient’s pulse to be deep due to changes in the internal environment.
Traditional Chinese medicine believes that phlegm fluid, dampness, qi stagnation, blood stasis, food accumulation, and internal cold, all associated with yang deficiency, qi deficiency, blood deficiency, and yin deficiency, can present with deep pulse.
(VI) Modern Clinical Significance of Deep Pulse in the Cun-Kou Division
Cun: Insufficient heart and lung function, decreased blood supply to the heart and brain, insufficient function of the five senses, and chronic organic diseases, hypothyroidism, dizziness, memory decline, chest tightness, tinnitus, and hearing loss.
Guan: Insufficient liver and kidney function, low immunity, liver qi stagnation, liver cysts, fatty liver, poor appetite, chronic gastrointestinal diseases.
Chi: Poor intestinal function, soreness and coldness in the waist and lower limbs, joint dysfunction, menstrual irregularities, and urogenital diseases.
(VII) Combined Pulses with Deep Pulse
Deep pulse is a principal pulse pattern that can combine with middle pulse but cannot combine with floating pulse or pulses that have deep pulse characteristics. However, it can appear simultaneously with floating pulse in the cun-kou pulse.
Deep pulse can combine with middle pulse, such as: deep string pulse, deep slow pulse, deep weak pulse, deep rapid pulse, deep slippery pulse, deep rough pulse, deep fine pulse, deep weak pulse, deep tight pulse, deep intermittent pulse, deep knot pulse, deep rapid pulse, deep undulating pulse, deep edge pulse, deep tide pulse, and deep wind pulse.
It should not combine with floating pulse types such as: floating, weak, scattered, moist, hollow, or leather pulses. It should also not combine with other deep pulse types such as: deep, weak, firm, or hidden pulses.
It should not combine with certain middle pulses such as long or arterial pulses, nor with large pulses that contain deep pulse characteristics, such as combining with surging, turbid, or solid pulses.
(VIII) Modern Clinical Significance of Combined Pulses with Deep Pulse
Deep string: cardiovascular diseases, neurogenic headaches, bronchitis, pleurisy, pulmonary emphysema, gastritis, gastric dysfunction, gastric and duodenal ulcers, chronic hepatitis, chronic pancreatitis, various enteritis, urinary system inflammation, reproductive infections, menstrual irregularities, threatened miscarriage, pregnancy edema, ectopic pregnancy, retained placenta, etc.
Deep slow: neurological, vascular, or infectious headaches, nutritional edema of the liver, kidney, heart, and lung, dysmenorrhea, uterine developmental disorders, tumors, ectopic pregnancy, etc.
Deep weak: chronic nephritis, intestinal tuberculosis, adrenal insufficiency, intestinal dysfunction, chronic liver, gallbladder, stomach, and intestinal diseases, lung, bronchial, and pleural inflammation, urinary and reproductive system inflammation, and lower limb joint diseases.
Deep rapid: various edemas and pregnancy toxemia, hormonal sequelae, diabetes, mid to late stages of infectious diseases.
Deep slippery: cerebrovascular diseases, status epilepticus, mental disorders, pregnancy edema, etc.
Deep rough: lung abscess, lobar pneumonia, lung fluke, liver and spleen enlargement, liver cancer, cholecystitis, stones, menstrual irregularities, reproductive inflammation, cysts, tumors, endometriosis, etc.
Deep fine: chronic wasting diseases, neuroses, recovery phase of mental disorders, chronic gastrointestinal diseases, etc.
Deep weak: gastric ulcers, biliary, esophageal variceal bleeding, spleen and kidney dysfunction, toxic symptoms of infectious diseases, chronic intestinal diseases, etc.
Deep tight: bronchial asthma, pleurisy, gastrointestinal dysfunction, gynecological diseases, etc.
Deep intermittent: heart diseases.
Deep knot: heart diseases.
Deep short: poor blood supply to the heart and brain, chronic gastrointestinal diseases, infertility, etc.
Deep rapid: heart diseases.
Deep undulating: heart diseases, neurological diseases, and nerve compression diseases.
(IX) Traditional Medicine’s Understanding of Deep Pulse
Traditional Chinese medicine believes that deep pulse is due to internal accumulation of pathogenic factors, obstructing the qi mechanism, causing the pulse qi to be strong internally, hence the pulse is deep and strong. Yang deficiency and qi sinking lead to the pulse qi being weak and unable to push outward, hence the pulse is deep and weak.
(X) Differentiation of Deep Pulse
Deep pulse should be differentiated from firm pulse, hidden pulse, and weak pulse:
They share the commonality of being classified as deep pulses, but in terms of pulse position, their order of depth is deep, weak, firm, and hidden.
Deep pulse: difficult to lift, easy to press.
Weak pulse: deep yet soft and fine.
Firm pulse: a composite of deep, string-like, solid, large, and long pulses, as felt at the tendon of the middle finger.
Hidden pulse: extremely deep and hidden.
(XII) Relationship Between Pulse Halo and Deep Pulse
1. Pulse halo deep: This is a change in the “shape” of the pulse, generally related to organ stasis, swelling, and solid changes. Organs under long-term chronic inflammation (toxic accumulation in traditional Chinese medicine) can exhibit a solid feeling of deep pulse halo due to fibrous tissue hyperplasia, chronic granulomas, and chronic calcification.
2. Localized deep: This indicates changes in pulse qi, often suggesting insufficiency in the cun, guan, and chi divisions, indicating insufficient upper qi or middle qi or lower yuan qi.
3. Pulse pathway deep: This is simply deep pulse.
This article is excerpted from “Essence of Modern Pulse Studies by Xu Yueyuan (I) – The Practice and Exploration of Traditional Pulse Diagnosis in Modern Medical Diagnosis: Chapter on Disease Pulse: III. Deep Pulse”, published by China Traditional Chinese Medicine Press, original author: Xu Yueyuan. The title is newly proposed by the editor. Copyright belongs to the relevant rights holders. If there are any improper uses, please feel free to contact us.