Deep Pulse (沉脉)

Appearance (体象歌)

沉行筋骨，如水投石；按之有余，举之不足。

Clinical Indications (主病歌)

沉脉为阴，其病在里。寸沉短气，胸痛引胁；或为痰饮。或水与血。关主中寒，因而痛结；或为满闷，吞酸筋急。尺主背痛，亦主腰膝；阴下湿痒。淋浊痢泄。

Combined Patterns (兼脉歌)

无力里虚，有力里实。沉迟痼冷，沉数内热；沉滑痰饮，沉涩血结；沉弱虚衰，沉牢坚积；沉紧冷疼，沉缓寒湿。

Clinical Significance

The Deep Pulse indicates an interior pattern. It forms when pathogenic factors are retained in the interior, qi and blood are constrained internally, or yang qi is too deficient to propel the pulse outward. Because the pulse is located deep near the bone, it must be felt with heavy pressure. A deep pulse with force usually indicates interior excess, such as cold congelation, phlegm-rheum, water-dampness, blood stasis, or food stagnation. A deep pulse without force usually indicates interior deficiency, especially yang deficiency, with reduced organ function. At the inch position, a deep pulse suggests stagnation of chest yang or phlegm-rheum in the upper burner, presenting as shortness of breath, chest pain radiating to the ribs, or cough with phlegm. At the guan position, it indicates middle burner cold or spleen-stomach accumulation, with abdominal pain, fullness, acid regurgitation, and muscular tension. At the chi position, it relates to the lower burner, manifesting as lower back pain, weak knees, genital dampness and itching, turbid urine, dysentery, or diarrhea. Deep and slow indicates interior cold; deep and rapid indicates interior heat; deep and slippery indicates phlegm-rheum; deep and choppy indicates blood stasis. Accurate diagnosis depends on distinguishing deficiency cold from excess cold through pulse force and accompanying symptoms, since both can present with a deep pulse.

Treatment and Care

Treatment of a Deep Pulse must address the root cause in the interior. For deep and forceful pulse due to interior cold accumulation, warm yang, scatter cold, and unblock the interior with Da Huang Fu Zi Tang or Wen Pi Tang. For deep and slippery pulse with phlegm-rheum retention, warm and transform phlegm-rheum with Ling Gui Zhu Gan Tang or Er Chen Tang. For deep and choppy pulse due to blood stasis, activate blood and resolve stasis with Xue Fu Zhu Yu Tang or Shao Fu Zhu Yu Tang. For deep and weak pulse with yang deficiency, warm and supplement kidney yang with Jin Gui Shen Qi Wan or You Gui Wan. For deep and thin pulse with yin-blood deficiency, nourish yin and blood with Si Wu Tang or Liu Wei Di Huang Wan. Daily care emphasizes keeping warm, especially the lower abdomen, lower back, and legs; eating warm, cooked, and easily digestible food; avoiding raw and cold items. Regular gentle exercise such as tai chi supports qi and blood circulation. Moxibustion at Guan Yuan, Qi Hai, and Shen Que is helpful for interior cold patterns. Long-term management should focus on protecting yang qi and avoiding chronic exposure to cold and damp environments.