Written by/ TCM Medical Theory
The floating pulse resembles a spring that is stuck at its highest point, unable to retract, indicating that the qi and blood are in a state of agitation.
The fu organs (yang) are responsible for the flow and dispersion of qi, while the zang organs (yin) store essence and qi internally. Movement and stillness correspond to each other.
A slow pulse indicates an obstruction in the zang organs, where the essence cannot rise, leading to excessive cold in the lower body, hence the pulse is slow.
The operation of the six channels and the transformation of the six qi can be observed by identifying where stagnation occurs and which channel is affected. What is a Taiyang disease? It is when there is an obstruction at the Taiyang level; a Yangming disease indicates a problem with the Yangming channel, which cannot properly connect. The Taiyang channel is meant to open, and when it cannot, it is termed a Taiyang disease. Each channel has its own responsibilities; it is not aimless to say there is a Taiyang disease, as Taiyang is primarily responsible for opening, so when there is illness, the main issue is its inability to open.
It is also important to emphasize that for each organ and each disease, our approach to treatment has direction and principles, which are not fixed. For instance, why do we often use warming yang herbs? We primarily use warming herbs to nourish and maintain warmth, avoiding excessive heat and dryness, as human beings are fundamentally about growth and survival. This is the guiding principle.
For example, if a man does not exhibit masculine traits, one might think: ‘This person lacks manly vigor.’ If a woman does not appear feminine, she may seem unrefined and restless. These are general directions. In terms of pulse diagnosis, when the qi of the fu organs is flowing outward, it may be insufficient; if the qi of the zang organs is stored inward, it may also be insufficient and unable to express outwardly. Anything in the yin must generate yang; if there is illness in the yin, yang cannot be generated; if there is illness in the yang, the yang qi cannot be contained. Thus, we say, ‘A rapid pulse indicates a problem in the fu, while a slow pulse indicates a problem in the zang.’ This is also a guiding principle. We cannot apply this uniformly to every patient; for instance, if a patient suddenly catches a cold, their pulse may also be slow and tense, but that does not mean the cold has reached the zang organs yet. After an external invasion of wind-heat, the pulse may be rapid, indicating a problem in the fu, and may not have developed to the zang yet. As long as we understand the meaning of ‘A rapid pulse indicates a problem in the fu, while a slow pulse indicates a problem in the zang,’ we are fine.
‘A floating pulse indicates a problem at the surface, while a sinking pulse indicates an issue internally.’ A floating pulse suggests that the qi and blood are surging, indicating that the exterior is obstructed. Our qi and blood should expand outward and then retract; when the outer layer is blocked during expansion, it forces the qi to push outward, resulting in a floating pulse, which is biased towards the yang aspect. When the qi cannot fully expand, it indicates a problem in the yang.
Conversely, when there is illness in the yin or internally, it has not yet unfolded and is stagnated within, indicating a problem in the yin. The distinction between illness in the yin and yang has a standard. Huang Yuan-yu explains this phenomenon regarding the central earth: if the Taiyin and Jueyin of the liver and spleen have not risen, they transform into yin; if they rise, they transform into yang. At this point, there will be a noticeable difference in the pulse. When transforming into yang, there may be insufficient yin essence, leading to excess liver fire, resulting in a floating pulse. When transforming into yin, the pulse is sinking and taut, indicating that it cannot rise and is descending, which may lead to diarrhea or loose stools.
A floating pulse indicates issues in the upper jiao, such as irritability and mouth sores. A sinking pulse, which is sinking and taut, indicates lower jiao issues like abdominal pain, diarrhea, hemorrhoids, or sometimes anal leakage.
If there is not significant stagnation of fire, lower jiao pathologies are more common. Many patients with sciatica actually have cold qi in the lower body. A sinking pulse at the wrist indicates issues in the Jueyin and Shaoyin channels, requiring the dispelling of cold.
The floating pulse, as described in the Pulse Classic, originally means ‘excessive when lifted, insufficient when pressed.’ The strength of this pulse is primarily in the floating layer, with a strong floating quality. What is a sinking pulse? It means ‘insufficient when lifted, excessive when pressed,’ indicating that the strength of this pulse is primarily at a deeper level. From this, we can see that if there is stagnation within, pressing deeply will reveal strength; if stagnation is at the surface, the floating quality will be strong, while pressing deeply will reveal weakness. This illustrates the differences between floating and sinking pulses.