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’.
Application of Floating Pulse
01
“The Master said: There are 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 like a drum, with no thirst, and should induce sweating.” (Jin Kui Yao Lue, Water Qi Disease Pulse Patterns and Treatment, Section 1)
Jin Kui Yao Lue Xin Dian (referred to as Xin Dian): Wind water, where water is stirred by wind, causes disease. 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 the pulse is also floating. It does not combine with wind, hence there is no aversion to wind. The abdomen is distended like a drum, which means it is not firm as per the Inner Canon. Since the disease is in the skin and does not reach the intestines, there is external distension but no fullness or wheezing. Water in the skin should be resolved by sweating, hence it is said to induce sweating.” “Pulse Studies: 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 water dampness on the surface, hence the pulse is floating, and both can be treated with sweating.”Note The author surveyed 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 body. Only the combination of internal and external factors can constitute the etiology of edema disease. Wind water and skin water are water dampness on the surface, and the general yang qi has not been severely damaged, hence can be treated with sweating, such as using formulas like Yue Bi Tang (Yue Bi Decoction) and Xiao Qing Long Tang (Minor Blue Dragon Decoction), which can induce sweating and relieve 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 deep slippery pulse, the tongue tip is often red with a thin greasy coating, and urination is scant and red. Administering Yue Bi Jia Shu Tang (Yue Bi Decoction with Atractylodes) results in immediate urination and reduction of edema.
02
“Wind water with aversion to wind, the whole body is swollen, the pulse is floating and not thirsty, and there is spontaneous sweating without high fever, Yue Bi Tang is the main treatment.” (Jin Kui Yao Lue, Water Qi Disease Pulse Patterns and Treatment, Sections 2-3)Xin Dian: This is quite similar to the previous syndrome but has a unique treatment. The Ma Huang (Ephedra) invigorates yang qi, while the tenfold Fang Ji (Sichuan Fritillaria) reduces the substantial effect of Huang Qi (Astragalus) on the surface and increases the cold and bitter properties of Shi Gao (Gypsum). Why is this? The phrase ‘the pulse is floating and not thirsty’ may also be interpreted as ‘the pulse is floating and thirsty’. If thirsty, it indicates internal heat, and sweating is forced by heat, which is different from spontaneous sweating due to surface deficiency, hence Shi Gao is used to clear heat, and Ma Huang disperses swelling without compromising the surface.” “Pulse Studies: The floating pulse with aversion to wind and the whole body swollen is a phenomenon of wind evil combined with water dampness on the surface. Because water dampness combines with heat, spontaneous sweating occurs, hence Yue Bi Tang can induce sweating, thus removing water dampness and reducing swelling.”Note Wind water and skin water, based on the integration of Chinese and Western medicine in the comparison of nephritis, mostly belong to acute nephritis, with some cases of chronic nephritis in acute onset. The edema of acute nephritis often presents with a floating and slippery pulse or a deep slippery pulse, with a moist complexion, and the righteous qi is not damaged, making it easy to reduce 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 reduce swelling, and even if it is reduced, 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.” “Pulse Origin: This section discusses the pulse patterns and treatment of wind water. The aversion to wind and the whole body swollen indicates that the mechanism is outward, hence the pulse is floating. The absence of thirst indicates that both wind and water are damaging, hence there is no thirst, and spontaneous sweating occurs. The absence of high fever indicates that although there is slight heat, it is not a high fever. This decoction disperses wind water.”
03
“For wind water with a floating pulse and heaviness in the body, with spontaneous sweating and aversion to wind, use Fang Ji Huang Qi Tang (Fang Ji and Astragalus Decoction); if there is abdominal pain, add Shao Yao (Peony).” (Jin Kui Yao Lue, Water Qi Disease Pulse Patterns and Treatment, Section 22) “Pulse Origin: This section discusses the pulse patterns of wind dampness and surface deficiency, and the treatment. The evil is on the surface, hence the pulse is floating; spontaneous sweating and aversion to wind indicate wind; heaviness in the body indicates dampness. This decoction drives away wind dampness and consolidates the surface.” “Pulse Studies: This section addresses the treatment of wind water with surface deficiency. The floating pulse and heaviness in the body indicate water dampness on the surface, and spontaneous sweating with aversion to wind indicates surface deficiency. Fang Ji Huang Qi Tang is used to support the righteous qi, consolidate the surface, 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. In Fang Ji Huang Qi Tang, Bai Zhu (Atractylodes) works in conjunction with Huang Qi to promote dampness removal, while Fang Ji clears heat and promotes dampness removal, balancing the warming properties of Huang Qi and Bai Zhu, hence the combination is quite suitable. The conditions treated by Fang Ji Huang Qi Tang and Yue Bi Tang are both for wind water, but the difference lies in surface deficiency versus surface excess, and the presence or absence of heat. Yue Bi Tang is for surface excess with heat, hence the whole body is swollen, and the pulse is floating with spontaneous sweating; Fang Ji Huang Qi Tang is for surface deficiency without heat, hence the pulse is floating, the body is heavy, and there is spontaneous sweating. Although the external pulse patterns are similar, the pathogenesis is quite different.
04
“In the case of water disease, the pulse is deep and small, belonging to Shao Yin. The floating pulse indicates wind. If there is no water but a feeling of fullness, it is due to qi. Water can induce sweating.” “If the pulse is deep, use Ma Huang Fu Zi Tang (Ephedra and Aconite Decoction); if the pulse is floating, use Xing Ren Tang (Apricot Kernel Decoction).” (Jin Kui Yao Lue, Water Qi Disease Pulse Patterns and Treatment, Section 26)Xin Dian: A deep and small pulse belongs to Shao Yin, indicating kidney water. A floating pulse indicates wind, which is wind water. If there is no water but a feeling of fullness, it indicates a qi disease rather than a water disease. Qi disease should not be treated with sweating, while water disease can be treated with sweating; however, the methods of inducing sweating are also different. For Shao Yin, one should warm the meridians; for wind water, one should open the lungs, hence it is said that a deep pulse should use Ma Huang Fu Zi Tang, while a floating pulse should use Xing Ren Tang.” “The deep pulse indicates Shao Yin, while the floating pulse indicates wind.” “Pulse Studies: In water qi disease, the pulse is generally seen as deep; however, in wind water disease, a deep pulse may sometimes appear, such as ‘…the pulse at the cun (inch) is deep and slippery, indicating water qi, with a swollen face and heat, termed wind water.’ This is a clear example. However, if the pulse is deep and small, it belongs to Shao Yin yang deficiency water qi disease. A floating pulse indicates wind evil on the surface, which is a wind water disease. If there is fullness without water, it is a qi fullness, which is different from water fullness. Wind water can be treated with sweating, while Xing Ren Tang is not detailed but can be used with Yue Bi Tang. 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 Tang should be used to warm yang and reach the surface, inducing sweating and benefiting water, thus reducing swelling.”Note The differentiation between fullness due to qi without water and fullness due to water must be more reliable through abdominal diagnosis; if Western medical examination methods for ascites can be used, it is even better. The deep and small pulse in water qi disease is absolutely different from a deep and slippery pulse; a deep and small pulse indicates yang deficiency and inability to transport water, hence should be warmed and supported; a deep and slippery pulse indicates wind heat combined with water, hence should be treated with sweating, clearing heat, and benefiting 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 qi disease 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 transport water.
05
“For cough with a floating pulse, use Hou Po Ma Huang Tang (Magnolia and Ephedra Decoction); for cough with a deep pulse, use Ze Qi Tang (Alisma Decoction).” (Jin Kui Yao Lue, Lung Atrophy, Lung Abscess, Cough, and Shortness of Breath Disease Pulse Patterns and Treatment, Sections 8-9)Xin Dian: This is not detailed in the symptoms, but the distinction between floating and deep pulses is used to differentiate treatment.Note Hou Po Ma Huang Tang and Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction with Gypsum) are largely similar, as they primarily focus on dispersing evils and eliminating fluids, while Hou Po is warm and can also assist the surface; Xiao Mai (Wheat) is sweet and neutral, hence similar to Wu Wei (Five Flavors) in stabilizing and nourishing the righteous qi. Ze Qi Tang is primarily based on Ze Qi, with Bai Qian (Cynanchum), Huang Qin (Scutellaria), and Ban Xia (Pinellia) as assistants, hence has a stronger downward action, although Sheng Jiang (Ginger) and Gui Zhi (Cinnamon) are spicy, they are only used to descend qi and cannot disperse the surface evil. The intention of Zhang Zhongjing is that since cough is due to lung evil, a floating pulse indicates that qi is mostly on the surface, hence it is easier to drive it out; a deep pulse indicates that qi is mostly in the interior, hence it is easier to drive it down, which is also a method of leveraging the situation. “Pulse Studies: Cough with a floating pulse is caused by surface evil combined with internal fluids, hence Hou Po Ma Huang Tang is used to disperse external evil and drive out internal fluids. Cough with a deep pulse indicates that internal fluids are retained and reverse, hence Ze Qi Tang is used to eliminate fluids and descend.”Note This section uses the distinction between floating and deep pulses to differentiate between surface and interior fluid evils; for surface, disperse evil and drive out fluids; for interior, descend and eliminate fluids, which is also a method of leveraging the situation.
06
“For lung distension, cough, shortness of breath, irritability, and wheezing, with a floating pulse, indicating water in the heart, use Xiao Qing Long Jia Shi Gao Tang.” (Jin Kui Yao Lue, Lung Atrophy, Lung Abscess, Cough, and Shortness of Breath Disease Pulse Patterns and Treatment, Section 14) “Pulse Origin: This section has the same meaning as above. Water and cold drinks in the heart, and external evil attacks, hence cough and shortness of breath, irritability, and wheezing, hence the pulse is floating. This decoction warms the cold and advances, resolving both water and heat.” “Pulse Studies: A floating pulse indicates an exterior condition, and water in the heart indicates water and drink in the stomach. External evil and internal drink clash, hence shortness of breath and cough, combined with heat evil and irritability, hence Xiao Qing Long Tang is used to disperse external evil and internally drive out water and drink, adding Shi Gao to clear internal heat.”Note Based on clinical experience, this formula is very effective for acute and chronic bronchitis, where the differentiation indicates mutual binding of drink and heat; the pulse is often seen as floating and slippery, and the tongue coating is white and greasy, indicating the condition of drink and heat binding internally; however, the dosage of Ma Huang and Shi Gao must exceed five to ten times that of Ma Huang to exert its effect of clearing heat and eliminating drink. Otherwise, Ma Huang, Gui Zhi, Jiang, Xia, and Xi Xin are all spicy and dry herbs, and if the dosage of Shi Gao is small, it cannot control the dryness of the herbs, and for internal heat and irritability, it will not be effective, hence caution is needed when using this formula.
07
“The Master said: If the patient’s pulse is floating in the front, the disease is on the surface; if floating in the back, the disease is in the interior, with low back pain and inability to walk, it must be short of breath and extreme.” (Jin Kui Yao Lue, Zang Fu Meridians and Disease Pulse Patterns, Section 9) “Xin Dian: ‘Front’ refers to the front gate, ‘back’ refers to the back gate; the front gate is yang, the back gate is yin; if the pulse is floating in the front, it indicates that yang is in the yang (the first ‘yang’ refers to the floating pulse being yang; the second ‘yang’ refers to the position of the front gate being yang). Hence the disease is on the surface; if the pulse is floating in the back, it indicates that yang is in the yin, hence the disease is in the interior; however, although it is in the interior, it is connected to the yang pulse, hence it is a surface condition in the interior, not a deep interior condition, hence the disease is not in the intestines or kidneys, but in the lower back and knees, and if it reaches that point, it must be short 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 inevitably return to the interior.” “Pulse Studies: The front refers to the cun pulse, the back refers to the chi pulse; a floating cun pulse indicates an exterior condition of surface evil, while a floating chi pulse indicates an interior injury condition; low back pain, stiffness, and shortness of breath indicate an interior condition of kidney deficiency.”Note A floating pulse in the cun indicates a surface condition, while a floating pulse in the chi indicates an interior condition. In clinical practice, this is often verified; however, it must also be combined with symptoms, such as low back pain, stiffness, and shortness of breath, along with a floating chi pulse, indicating a kidney deficiency condition. A floating pulse in the front must also be accompanied by symptoms such as headache and aversion to cold to be considered a surface condition. The intention of Zhang Zhongjing is to convey this meaning, and one should not be rigid.
08
“If a man’s complexion is thin (pale and not rosy), it indicates thirst and loss of blood. If there is sudden shortness of breath and palpitations, the pulse is floating, indicating interior deficiency.” (Jin Kui Yao Lue, Blood Obstruction and Deficiency Labor Disease Pulse Patterns and Treatment, Section 4) “Xin Dian: Thirst indicates heat injuring yin qi, and loss of blood indicates lack of luster in color, hence a thin complexion indicates thirst and loss of blood. Li’s theory states: ‘Labor causes both qi and blood to be consumed; qi deficiency leads to shortness of breath, while blood deficiency leads to palpitations.’ Sudden indicates that this disease appears suddenly. A floating pulse indicates interior deficiency, as labor causes true yin to be lost, solitary yang to be rootless, qi disperses outward, and essence is lost inward.” “Pulse Studies: A floating pulse in deficiency labor disease indicates loss of yin blood, and yang qi disperses outward. A floating pulse that is weak or large and empty indicates a phenomenon of blood loss and yang without attachment, a thin complexion indicates pallor and lack of 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 shortness of breath and palpitations, which is due to kidney deficiency and qi not returning to the source. Comprehensive observation of the pulse patterns indicates that there is loss of yin blood internally and floating yang externally, hence it is concluded that a floating pulse indicates interior deficiency.”Note Zhang Jiebin said: “… Generally, a floating pulse that is strong and spirited indicates excess yang; excess yang will inevitably lead to fire, or phlegm may be present in the middle, or qi may be obstructed above, which can be inferred; if it is floating and weak and empty, it indicates insufficient yin; insufficient yin leads to water deficiency, or blood may not nourish the heart, or essence may not transform into qi, indicating internal deficiency. If these are considered surface conditions, the harm is great.” Zhang specifically proposed to differentiate between external and internal injuries based on the strength or weakness, spirit or lack of spirit, which is of certain help in our pulse diagnosis and differentiation. “Pulse Origin: This section discusses the pulse patterns of thirst and loss of blood in men. A thin complexion indicates loss of luster and spirit; yin blood is deficient, and fluids are not transformed, hence thirst arises; qi is injured and cannot contain blood, hence loss of blood occurs; if it rises and suddenly shortness of breath occurs, true qi does not gather, hence palpitations occur. A floating pulse indicates that true yin is lost, solitary yang is rootless, qi disperses outward, and essence is lost inward, hence it is said to be interior 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.” (Jin Kui Yao Lue, Five Organs Wind Cold Accumulation Disease Pulse Patterns and Treatment, Section 9) “Xin Dian: If the heart feels like it is being eaten by garlic, it indicates that cold is bound on the outside and fire is constrained on the inside, feeling like pain but not pain, feeling like heat but not heat, causing frustration; if severe, the heart and back pain penetrate each other, like insects gnawing. If the pulse is floating, it indicates that there is an opportunity for the cold to exit, hence if vomiting occurs, the evil will be eliminated and recovery will follow. However, this is also a natural movement of qi, and cannot be forced with medicine to induce vomiting.” “Pulse Studies: A floating pulse indicates that the evil wants to exit from above, which is similar to ‘…the pulse of malaria is self-stringent… a floating pulse indicates that it can be vomited.’ However, if vomiting leads to resolution, there must be a tangible evil, such as phlegm, food, or drink; hence this section on cold in the heart also belongs to cold drink, otherwise, it would not lead to recovery through vomiting.”
10
“For alcoholic jaundice, whether there is heat or not, if the patient is calm and speaks clearly (indicating that the patient is relatively stable, and the speech is clear), with abdominal fullness and a desire to vomit, and dry nose; if the pulse is floating, induce vomiting first; if it is deep and wiry, induce purging first.” (Jin Kui Yao Lue, Jaundice Disease Pulse Patterns and Treatment, Section 5) “Xin Dian: In alcoholic jaundice, there must be heat in the heart; however, there may also be no heat, and if the patient is calm and speaks clearly, it indicates that the heat does not concentrate in the heart, and may accumulate from below causing abdominal fullness, or from above causing a desire to vomit, and dry nose. If there is abdominal fullness, it can be purged; if there is a desire to vomit, it can be induced based on the situation; if there is abdominal fullness and a desire to vomit, it can be purged or vomited. 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 purging first.” “Pulse Studies: Alcoholic jaundice without heat indicates that the surface is without heat, while internally there is damp heat accumulating, and the evil wants to exit from above, hence a floating pulse indicates a desire to vomit; if it wants to exit from below, the pulse is deep and wiry, indicating fullness in the lower abdomen. Treatment must follow the trend of the disease, either inducing vomiting or purging based on the situation.”Note This section can be compared with “For alcoholic jaundice with heat and a desire to vomit, induce vomiting for recovery.” In general, if the evil wants to exit from the surface and be resolved through vomiting, the pulse is often floating. If it wants to exit from below, the pulse is often deep. Of course, it must also be combined with specific symptoms, such as “if there is a desire to vomit, induce vomiting for recovery; if there is a desire to purge, induce purging for resolution,” which is the meaning here.
11
“For all diseases of jaundice, if there is a need to promote urination; if the pulse is floating, it should be treated with sweating, hence Gui Zhi Jia Huang Qi Tang (Cinnamon Decoction with Astragalus) is the main treatment.” (Jin Kui Yao Lue, Jaundice Disease Pulse Patterns and Treatment, Section 16) “Xin Dian: Promoting urination indicates that damp heat is removed and jaundice resolves itself, hence promoting 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 resolved through sweating; also, if the pulse is floating, it indicates that it should be vomited first. However, if there is no external wind and a desire to sweat, Gui Zhi Jia Huang Qi Tang should be used to disperse, while also supporting the righteous qi to expel the evil qi.” “Pulse Studies: Jaundice disease is caused by damp heat accumulation, hence promoting urination is the correct method for treating jaundice; however, there are also cases of surface conditions without heat in jaundice, hence if the pulse is floating and there is no heat, Gui Zhi Jia Huang Qi Tang should be used to induce sweating and resolve it.”Note In this type of jaundice, urination must be promoted; if the hands and feet are not hot, it should be referred to “if a man has jaundice, urination is self-promoting, it should be treated with Xiao Jian Zhong Tang (Minor Build Middle Decoction).” In cases of damp heat jaundice, urination is often not promoted, as “… if a person has alcoholic jaundice, there must be no urination, and the symptoms of heat in the heart and heat in the feet are the signs.” This indicates that damp heat jaundice and the jaundice in this section should be differentiated based on urination and non-urination, and the presence or absence of heat symptoms. This section resolves through sweating, which is a method of harmonizing the nutritive and defensive qi, and does not necessarily indicate the presence of external evil. Gui Zhi Huang Qi Tang 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 chi pulse is floating, the eyes are yellow and dizzy, and the nosebleed has not stopped; if the dizziness goes away and the eyes are clear, it indicates that the nosebleed has now stopped.” (Jin Kui Yao Lue, Palpitations, Nosebleeds, and Chest Fullness Blood Stasis Disease Pulse Patterns and Treatment, Section 2) “Xin Dian: A floating chi pulse indicates that there is wandering fire in the kidney; yellowing of the eyes indicates that there is heat accumulated in the liver, and if there is a nosebleed, it indicates that it has not yet stopped. If the dizziness goes away and the eyes are clear, it indicates that not only has the liver heat been eliminated, but the kidney heat has also been eliminated, hence the nosebleed will now stop.” “Pulse Studies: A floating chi pulse indicates kidney yin deficiency, and the wandering yang rises; yellowing of the eyes indicates that there is heat accumulated in the liver (the liver opens to the eyes); if there is kidney yin deficiency and liver heat rises, it forces the blood to rise, hence the nosebleed does not stop. If the liver and kidney heat are eliminated, the yellowing will go away, the eyes will be clear, and the floating chi pulse will also settle, hence the nosebleed will naturally stop.”Note Based on clinical experience, in asthma cases, a floating chi pulse that is large and empty indicates kidney yin deficiency, with yang lost and rising; treatment should focus on kidney yin tonification to stabilize yang qi. Although the conditions discussed in this section are different, the principles are not contradictory. Studying TCM, if one can integrate and understand, there will be a wonderful mastery of the subject.
end
Note:Please follow medical advice for specific treatment and medication!This article is excerpted from Pulse Method Essentials, 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, and please indicate the source when reprinting.
The cover image is sourced from the photography network.
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