Introduction:When the pulse is strong upon lifting and weak upon pressing, it is termed “floating pulse”. Any pulse that can be easily felt at the superficial level is referred to as “floating pulse”. Any pulse that is easily obtained at the floating level is called “pulse floating”.
Application of Floating Pulse
01
“The Master said: There are diseases caused by wind-water, skin-water, proper water, stone-water, and yellow sweat. Wind-water has a floating pulse, with external symptoms of joint pain and aversion to wind; skin-water also has a floating pulse, with external symptoms of swelling, pressing it leaves no indentation, no aversion to wind, and the abdomen is distended, not thirsty, and should induce sweating.” (“Golden Chamber: Pulse Diagnosis and Treatment of Water Diseases, Part 1”)
“Essentials of the Golden Chamber” (abbreviated as “Essentials”) states: Wind-water, where water is stirred by wind, causes disease due to water. Wind injures the skin and moistens the joints, hence the floating pulse and joint pain; skin-water, where water flows in the skin, internally connects with lung qi, hence its pulse is also floating. It does not combine with wind, hence there is no aversion to wind. The abdomen is distended, which corresponds to the “Inner Canon” meaning not firm. Since the disease is in the skin and does not reach the intestines, there is external distension but no fullness or wheezing internally. Water in the skin should be resolved by sweating, hence it is said to induce sweating.”“Discussion on Pulse Diagnosis”: Wind-water is water qi externally combined with wind evil, hence the external symptoms of joint pain and aversion to wind; skin-water is water dampness on the surface without wind evil, hence the external symptoms of swelling, with no aversion to wind. Although there is a distinction between external evil and no external evil, both are due to water dampness on the surface, hence the pulse is floating, and both can be treated by inducing sweating to recover.Note The author investigated 40 cases of acute and chronic nephritis, all of which had factors of external wind, cold, and dampness; however, simple wind-dampness alone cannot constitute this disease, as there must be an internal factor of deficiency of yang qi in the organism. Only the combination of internal and external causes can constitute the etiology of edema disease. Wind-water and skin-water are due to water dampness on the surface, and the general yang qi has not been severely damaged, so it can be treated by inducing sweating, such as using formulas like Yuebi Decoction (Yuebi Tang) and Minor Blue Dragon Decoction (Xiao Qing Long Tang), which can be selected to induce sweating, leading to urination and resolution of edema.Clinical experience: Wind-water causes swelling of the whole body and face, joint pain, and even the hands cannot be approached; Western medical examinations often indicate acute nephritis. The pulse is floating and slippery, and there may also be a sinking and slippery pulse; the tongue tip is often red with a thin greasy coating, and urination is scant and red. Administering Yuebi Decoction with Atractylodes (Yuebi Jia Zhu Tang) results in urination and resolution of edema after one dose.
02
“Wind-water with aversion to wind, swelling of the whole body, floating pulse, no thirst, and continuous sweating without high fever, is treated with Yuebi Decoction (Yuebi Tang).” (“Golden Chamber: Pulse Diagnosis and Treatment of Water Diseases, Part 2-3”)“Essentials”: This is quite similar to the previous syndrome but has a unique treatment. Ephedra (Ma Huang) promotes yang qi, while Fangji (Fang Ji) is ten times the amount of Huang Qi (Huang Qi) to reduce the exterior, and increase the coldness of Shi Gao (Shi Gao). Why is this? The phrase about floating pulse and no thirst may also be interpreted as floating pulse and thirst. Thirst indicates internal heat, sweating is due to heat pressing, which is different from sweating due to exterior deficiency, hence Shi Gao is used to clear heat, and Ma Huang disperses swelling without solidifying the exterior.”“Discussion on Pulse Diagnosis”: Floating pulse with aversion to wind and swelling of the whole body is a phenomenon of wind evil combined with water dampness on the surface. Because water dampness combines with heat, it leads to continuous sweating, hence Yuebi Decoction can induce sweating, thus removing water dampness and resolving swelling.”Note Wind-water and skin-water, based on the integration of Chinese and Western medicine in nephritis comparison, mostly belong to acute nephritis, with some cases of chronic nephritis having acute episodes. The edema of acute nephritis often presents with floating and slippery pulses or sinking and slippery pulses, with a moist complexion, and the righteous qi is not damaged, making it easy to resolve swelling. This is unlike chronic nephritis, where the complexion is dark and the urine is white, and the righteous qi is weak and cannot withstand evil, making it difficult to resolve swelling, and even if resolved, it is prone to recurrence. Therefore, the treatment of edema in chronic nephritis cannot solely focus on removing water; generally, it must start from warming and tonifying the spleen and kidneys. After removing water dampness, it can often be consolidated.”“Discussion on Pulse Origin”: This section discusses the pulse diagnosis and treatment of wind-water. Aversion to wind and swelling of the whole body indicates that the mechanism is outward, hence the pulse is floating. The absence of thirst indicates that both wind and water are injured, hence there is no thirst, and continuous sweating occurs. The absence of high fever indicates that although there is slight heat, it is not a strong heat. This decoction is used to disperse wind-water.”
03
“For wind-water, with a floating pulse and heaviness in the body, sweating and aversion to wind, Fangji Huangqi Decoction (Fangji Huangqi Tang) is the main treatment; if there is abdominal pain, add Bai Shao (Bai Shao).” (“Golden Chamber: Pulse Diagnosis and Treatment of Water Diseases, Part 2-2”)“Discussion on Pulse Origin”: This section discusses the pulse diagnosis and treatment of wind-dampness and exterior deficiency. The evil is at the surface, hence the pulse is floating; sweating and aversion to wind indicate wind; heaviness in the body indicates dampness. This decoction is used to drive away wind-dampness and consolidate the exterior.”“Discussion on Pulse Diagnosis”: This section discusses the treatment of wind-water with exterior deficiency. The floating pulse and heaviness in the body indicate water dampness on the surface, and sweating with aversion to wind indicates exterior deficiency. Fangji Huangqi Decoction is used to support the righteous qi, consolidate the exterior, and drive away dampness.”Note This section does not mention swelling but indicates that the pulse is floating and the body is heavy, indicating that dampness is retained in the skin surface. In Fangji Huangqi Decoction, Bai Zhu (Bai Zhu) works in conjunction with Huang Qi to perform the function of benefiting dampness, while Fang Ji clears heat and benefits dampness, thus controlling the warmth of Huang Qi and Bai Zhu, making their combination quite suitable. The symptoms of Fangji Huangqi Decoction and the previous Yuebi Decoction are both treatments for wind-water, but the difference lies in exterior deficiency versus exterior excess, and the presence or absence of heat. The Yuebi Decoction is for exterior excess with heat, hence the whole body is swollen, with a floating pulse and continuous sweating; while the Fangji Huangqi Decoction is for exterior deficiency without heat, hence the pulse is floating, the body is heavy, and sweating occurs. Although the external pulse symptoms are similar, the pathogenesis is quite different.
04
“In cases of water disease, the pulse is deep and small, belonging to the Shaoyin. The floating pulse indicates wind. If there is no water but there is fullness, it is due to qi. Water can induce sweating. If the pulse is deep, Ma Huang Fu Zi Decoction (Ma Huang Fu Zi Tang) is appropriate; if it is floating, Xing Ren Decoction (Xing Ren Tang) is appropriate.” (“Golden Chamber: Pulse Diagnosis and Treatment of Water Diseases, Part 2-6”)“Essentials”: A deep and small pulse belongs to the Shaoyin, indicating kidney water. A floating pulse indicates wind, which is wind-water. If there is no water but fullness, it indicates a qi disease rather than a water disease. Qi diseases should not induce sweating, while water diseases can induce sweating; however, the methods of inducing sweating are also different. In the Shaoyin, one should warm the meridians; for wind-water, one should open the lungs, hence it is said that a deep pulse is suitable for Ma Huang Fu Zi Decoction, while a floating pulse is suitable for Xing Ren Decoction. The deep pulse indicates Shaoyin, while the floating pulse indicates wind.”“Discussion on Pulse Diagnosis”: In water diseases, the pulse is generally often seen as deep; however, in wind-water diseases, there are times when a deep pulse appears, such as “… the pulse at the cun is deep and slippery, indicating the presence of water qi, with a swollen face and heat, named wind-water.” This is a clear example. However, if the pulse is deep and small, it belongs to the Shaoyin yang deficiency water disease. A floating pulse indicates wind evil at the surface, which is a wind-water disease. If there is fullness without water, it is due to qi fullness, which is different from water fullness. Wind-water can induce sweating, while Xing Ren Decoction is not detailed but can be used with Yuebi Decoction and similar formulas. A deep and small pulse indicates yang qi deficiency and inability to reach the surface, hence water dampness is not beneficial, and Ma Huang Fu Zi Decoction is suitable to warm yang, reach the surface, induce sweating, and benefit water, thus resolving swelling.Note The differentiation between fullness due to qi without water and fullness due to water with abdominal diagnosis is more reliable; if Western medical examination methods for abdominal water can be used, it is even better. The deep and small pulse in water diseases is different from the deep and slippery pulse; a deep and small pulse indicates yang deficiency and inability to move water, hence it should be warmed and supported; while a deep and slippery pulse indicates wind-heat combined with water, hence it should induce sweating, clear heat, and benefit water. One is cold, the other is heat; one is exterior, the other is interior, and they are different and should not be confused. Water diseases may also present with a hidden pulse, often due to water dampness obstructing and causing stagnation, which is different from a deep and small pulse due to yang deficiency and inability to move water.
05
“For cough with a floating pulse, Hou Po Ma Huang Decoction (Hou Po Ma Huang Tang) is the main treatment; for cough with a sinking pulse, Zexie Decoction (Zexie Tang) is the main treatment.” (“Golden Chamber: Pulse Diagnosis and Treatment of Lung Diseases, Part 8-9”)“Essentials”: This is not detailed in the symptoms, but the differentiation of treatment is based on the floating and sinking pulse.”Note Hou Po Ma Huang Decoction and Minor Blue Dragon Decoction (Xiao Qing Long Tang) are quite similar, as they primarily focus on dispersing evil and eliminating internal fluids, while Hou Po is warm and can also assist the exterior; Xiao Mai is sweet and neutral, thus similar to Wu Wei in calming and stabilizing the righteous qi. Zexie Decoction is primarily based on Zexie and is assisted by Bai Qian, Huang Qin, and Ban Xia, thus having a stronger downward action, although Sheng Jiang and Gui Zhi are only used to descend qi and reduce counterflow, and cannot disperse the exterior. The intention of Zhang Zhongjing is that since cough is due to lung evil, a floating pulse indicates that qi is mostly at the surface, hence it is easier to drive it out; while a sinking pulse indicates that qi is mostly internal, hence it is easier to drive it out from below, which is also a method of leveraging the situation.”“Discussion on Pulse Diagnosis”: Cough with a floating pulse is caused by exterior evil combined with internal fluids, hence Hou Po Ma Huang Decoction is used to disperse exterior evil and drive out internal fluids. Cough with a sinking pulse indicates that internal fluids are retained and counterflowing, hence Zexie Decoction is used to eliminate fluids and reduce counterflow as the main treatment.”Note This section uses the differentiation of floating and sinking pulses to distinguish between exterior and interior fluid evils; for exterior, disperse evil and drive out fluids; for interior, reduce counterflow and eliminate fluids, which is also a method of leveraging the situation.
06
“For lung distension, cough with shortness of breath, irritability, and wheezing, with a floating pulse, indicating water in the heart, Minor Blue Dragon Decoction with Gypsum (Xiao Qing Long Jia Shi Gao Tang) is the main treatment.” (“Golden Chamber: Pulse Diagnosis and Treatment of Lung Diseases, Part 14”)“Discussion on Pulse Origin”: This section has the same meaning as above. Water in the heart indicates cold fluid, and external evil attacks, hence cough and shortness of breath, irritability, and wheezing, with a floating pulse.”Using this decoction warms the cold and resolves both water and heat.”“Discussion on Pulse Diagnosis”: A floating pulse indicates the presence of exterior symptoms, while water in the heart indicates the presence of internal fluids. External evil and internal fluids clash, hence shortness of breath and cough, combined with heat evil causing irritability and wheezing. Minor Blue Dragon Decoction is used to resolve exterior evil and drive out internal fluids, with Gypsum added to clear internal heat.”Note Based on clinical experience, this formula is very effective for acute and chronic bronchitis, where the differentiation indicates the mutual binding of fluids and heat; the pulse is often seen as floating and slippery, and the tongue coating is white and greasy, indicating the presence of internal fluids and heat. However, the dosage of Ma Huang and Shi Gao must exceed that of Ma Huang by five to ten times to exert its heat-clearing and fluid-eliminating effects. Otherwise, Ma Huang, Gui Zhi, Ginger, Ban Xia, and Xiao Xin are all warming and drying herbs, and if the dosage of Shi Gao is small, it cannot control the dryness of the other herbs, and thus cannot effectively address internal heat and irritability, so caution is required when using this formula.
07
“The Master said: If a patient has a floating pulse at the cun, the disease is at the surface; if it is at the chi, the disease is internal. If there is pain in the waist and back, it must be shortness of breath and extreme.” (“Golden Chamber: Pulse Diagnosis of Zangfu and Meridians, Part 9”)“Essentials”: “Front” refers to the cun, “back” refers to the chi; the cun is yang, and the chi is yin; if the pulse is floating at the cun, it indicates that yang is at the surface (the first yang refers to the floating pulse being yang; the second yang refers to the position of the cun being yang). Hence, the disease is at the surface; if the pulse is floating at the chi, it indicates that yang is at the yin, hence the disease is internal; however, although it is internal, if it is connected to the yang pulse, it is at the surface of the interior, and not deep within, hence the disease is not in the intestines or kidneys, but in the waist, back, and knees, and if it reaches that point, it must be shortness of breath and extreme. This is because if the shape is injured and not removed, it will inevitably affect the qi; if the surface disease is not eliminated, it will eventually return to the interior.”“Discussion on Pulse Diagnosis”: The cun refers to the pulse at the cun position, while the chi refers to the pulse at the chi position. A floating pulse at the cun indicates exterior symptoms, while a floating pulse at the chi indicates internal injury. If there is pain in the waist, back, and shortness of breath, it indicates an internal deficiency of the kidneys.”Note A floating pulse at the cun indicates exterior symptoms, while a floating pulse at the chi indicates internal symptoms. In clinical practice, this is often verified; however, it must also be combined with symptoms, such as waist pain, back stiffness, and shortness of breath, along with a floating pulse at the chi, indicating a deficiency of the kidneys. A floating pulse at the cun must also be accompanied by symptoms such as headache and aversion to cold to be considered an exterior symptom. The intention of Zhang Zhongjing is to convey this meaning, and it should not be rigidly interpreted.
08
“If a man has a pale complexion (pale and not rosy), it indicates thirst and loss of blood. If he suddenly has shortness of breath and palpitations, with a floating pulse, it indicates internal deficiency.” (“Golden Chamber: Pulse Diagnosis and Treatment of Blood Stasis and Deficiency, Part 4”)“Essentials”: Thirst indicates heat injuring yin qi, while loss of blood indicates a lack of luster in color, hence a pale complexion indicates thirst and loss of blood. Li’s theory states: “Labor causes both qi and blood to be exhausted; qi deficiency leads to shortness of breath, while blood deficiency leads to palpitations.” Sudden onset indicates an acute manifestation of this disease. A floating pulse indicates internal deficiency, as labor leads to the true yin being lost, solitary yang having no root, qi dispersing externally, and essence being depleted internally.”“Discussion on Pulse Diagnosis”: A floating pulse in deficiency diseases indicates a loss of yin blood, with yang qi dispersing externally. A floating pulse that is weak or large and hollow indicates a phenomenon of blood loss and yang having no attachment. A pale complexion indicates a lack of luster and spirit; thirst indicates yin deficiency and insufficient fluids, but one should not drink excessively, as this is different from thirst due to heat in the stomach. Sudden shortness of breath and palpitations indicate sudden qi deficiency and inability to return to the source. Observing the pulse and symptoms together indicates a loss of yin blood internally, with floating yang qi externally, hence it is concluded that a floating pulse indicates internal deficiency.”Note Zhang Jiebin states: “… Generally, a floating pulse that is strong and spirited indicates an excess of yang; excess yang will inevitably lead to fire, or phlegm may be present internally, or qi may be obstructed above, which can be inferred; if it is floating and weak, it indicates insufficient yin, and insufficient yin leads to a deficiency of water, or blood may not nourish the heart, or essence may not transform into qi, indicating internal deficiency. If these are considered exterior symptoms, the harm is great.” Zhang specifically proposes to differentiate between exterior and internal injuries based on strength or weakness, spirit or lack of spirit, which is of certain help in our pulse diagnosis and differentiation.“Discussion on Pulse Origin”: This section discusses the pulse diagnosis of thirst and loss of blood in men. A pale complexion indicates a loss of moisture and spirit; yin blood is deficient, and fluids are not transformed, leading to thirst; qi is injured and cannot contain blood, hence loss of blood occurs; if it rises and causes sudden shortness of breath, true qi does not gather, hence palpitations occur. A floating pulse indicates that true yin is lost, solitary yang has no root, qi disperses externally, and essence is depleted internally, hence it is said to be internal deficiency.”
09
“If there is cold in the heart, the person suffers from a disease where the heart feels like it is being eaten by garlic. If severe, the heart pain penetrates the back, and the back pain penetrates the heart, like being eaten by insects. If the pulse is floating, vomiting will lead to recovery.” (“Golden Chamber: Pulse Diagnosis and Treatment of Wind-Cold Accumulation in the Five Organs, Part 9”)
“Essentials”: The sensation of the heart feeling like it is being eaten by garlic indicates cold binding externally and heat accumulating internally, causing a sensation of pain that is neither pain nor heat, leaving one in despair. If severe, the heart and back pain will penetrate each other, like insects gnawing. If the pulse is floating, it indicates that there is an opportunity for the cold to exit, and if vomiting occurs, the evil will be expelled and recovery will follow. However, this is also a natural movement of qi and should not be forced with medicine to induce vomiting.”“Discussion on Pulse Diagnosis”: A floating pulse indicates that the evil wants to exit from above, which is similar to “… the pulse of malaria is self-stringing… a large floating pulse can be vomited.” The evidence of recovery through vomiting indicates that there is a tangible evil, such as phlegm, food, or drink; therefore, in this section, the cold in the heart also belongs to cold fluids; otherwise, one would not recover through vomiting.
10
“For those with alcoholic jaundice, if there is no heat, they speak clearly (indicating that the illness is relatively stable, and their speech is clear). If there is fullness in the abdomen and a desire to vomit, with a dry nose; if the pulse is floating, induce vomiting first; if it is deep and wiry, induce a downward action first.” (“Golden Chamber: Pulse Diagnosis and Treatment of Jaundice, Part 5”)“Essentials”: For alcoholic jaundice, there must be heat in the heart; however, if there is no heat and they speak clearly, it indicates that the heat is not concentrated in the heart, and may accumulate from below causing fullness in the abdomen or from above causing a desire to vomit, with a dry nose. If there is fullness in the abdomen, it can be treated with downward action; if there is a desire to vomit, it can be treated by inducing vomiting. If there is fullness in the abdomen and a desire to vomit, both methods can be used. However, if the pulse is floating, it indicates that the evil is close to the surface, hence induce vomiting first; if the pulse is deep and wiry, it indicates that the evil is close to the interior, hence induce a downward action first.”“Discussion on Pulse Diagnosis”: Alcoholic jaundice without heat indicates that the exterior is not hot, while internally there is damp-heat accumulation, and the evil wants to exit from above. A floating pulse indicates a desire to vomit, while a deep and wiry pulse indicates a desire to resolve from below. Treatment must follow the trend of the disease, either inducing vomiting or downward action based on the situation.Note This section can be compared with “For alcoholic jaundice with heat in the heart and a desire to vomit, inducing vomiting will lead to recovery.” In general, when the evil wants to exit from the surface, the pulse is often floating. When it wants to exit from below, the pulse is often deep. Of course, it is also necessary to combine with specific symptoms, such as “if there is a desire to vomit, inducing vomiting will lead to recovery; if there is a desire to resolve, a downward action will lead to resolution,” which is the meaning of this section.
11
“For all diseases of the yellow family, if there is a need to benefit urination; if the pulse is floating, it should be treated with sweating, hence Gui Zhi Jia Huang Qi Decoction (Gui Zhi Jia Huang Qi Tang) is the main treatment.” (“Golden Chamber: Pulse Diagnosis and Treatment of Jaundice, Part 16”)“Essentials”: Benefiting urination resolves damp-heat and jaundice naturally, hence benefiting urination is the general method for jaundice. However, if the pulse is floating, it indicates that the evil is close to the surface, hence it should be treated with sweating. This also indicates that if the pulse is floating, it should be treated with vomiting first.”“Discussion on Pulse Diagnosis”: Jaundice diseases are all caused by damp-heat accumulation, hence benefiting urination is the correct method for treating jaundice; however, there are also cases of exterior symptoms without heat in jaundice, hence a floating pulse without heat indicates that Gui Zhi Jia Huang Qi Decoction should be used to induce sweating and resolve the condition.”Note This type of jaundice must have urination, and the hands and feet must not be hot; it should be noted that “for men with jaundice, if urination is self-benefiting, it should be treated with Minor Building Middle Decoction (Xiao Jian Zhong Tang).” All damp-heat jaundice must have poor urination, as “… for alcoholic jaundice, there must be poor urination, with heat in the heart and heat in the feet, which are its symptoms.” This indicates that the differentiation between damp-heat jaundice and the jaundice in this section should be sought from the presence or absence of urination and heat symptoms. This section uses sweating to resolve the condition, which is a method of harmonizing the nutritive and defensive qi, and does not necessarily indicate the presence of external evil. Gui Zhi Jia Huang Qi Decoction is itself a formula for harmonizing the nutritive and defensive qi, similar in meaning to Xiao Jian Zhong Tang.
12
“The Master said: If the pulse at the chi is floating, the eyes are yellow, and the bleeding has not stopped; when the yellow disappears, and the eyes are clear, it indicates that the bleeding has now stopped.” (“Golden Chamber: Pulse Diagnosis and Treatment of Shock, Vomiting, and Bleeding, Part 2”)“Essentials”: A floating pulse at the chi indicates that there is wandering fire in the kidneys; yellowing of the eyes indicates that there is heat accumulated in the liver. If there is bleeding, it indicates that the blood is not being retained due to the heat from the kidney and liver fire. If the yellowing disappears and the eyes are clear, it indicates that both liver and kidney heat have been eliminated, hence the bleeding will stop.”“Discussion on Pulse Diagnosis”: A floating pulse at the chi indicates kidney yin deficiency, with wandering yang; yellowing of the eyes indicates heat accumulation in the liver, which leads to blood not being retained. If the yellowing disappears and the eyes are clear, it indicates that both kidney and liver heat have been eliminated, hence the bleeding will stop naturally.”Note Based on clinical experience, in asthma cases, a floating and large pulse indicates kidney yin deficiency, with yang losing its storage and rising excessively. Treatment should focus on kidney yin tonification, capturing yang qi to stabilize it. Although the conditions are different, the principles are not contradictory. Studying TCM should be integrated and comprehensive for a better understanding and application.
end
Note:Please follow medical advice for specific treatment and medication!This article is excerpted from “Essentials of Pulse Diagnosis“, edited by Zhang Tangmin and Sun Renping, Chemical Industry Press, July 2007. This public account is only for academic exchange; if there is any infringement, please contact for deletion. The source of the cover image is from the photography network.