Floating Pulse (Fu Mai) is characterized by a strong pulse when lifted and a weak pulse when pressed. It is a three-layered pulse combination. The term “floating pulse” refers to a pulse that is easily felt at the surface level but weak when pressed deeper. Any pulse that can be easily detected at the floating level is termed “floating pulse.” Many historical texts describe what is actually a vigorous pulse as floating pulse. In clinical practice, non-standard floating pulses are more commonly observed.
Classification:
- Floating: Obvious when lifted (+++), insufficient when taken at the middle level (++), even less so when pressed deeper (+).
- Slightly Floating: Obvious when lifted (++), obvious at the middle level (++), insufficient when pressed deeper (+).
- Weakly Floating: Weak when lifted (+), weak at the middle level (+), not obvious when pressed deeper (+ -).
Additional Notes:
- Vigorous Pulse: Obvious when lifted (+++), even more obvious at the middle level (seemingly like a snapping finger) (++++).
- Floating Solid Pulse: Obvious when lifted (+++), even more obvious at the middle level (++++), most obvious when pressed deeper (+++++).
- Floating Soft Pulse: Soft and weak when lifted (++), soft at the middle level (+), soft when pressed deeper (+).
Mechanism of Floating Pulse Formation and Diagnostic Significance
Normal Pulse: The normal pulse of the lung is floating yet short and tight. In the four seasons, the autumn pulse should be floating. Autumn corresponds to metal and is associated with the lungs. In autumn, the yang energy begins to retreat after being abundant in summer, thus the pulse appears floating yet short and tight, indicating a normal state.
Pathological Pulse: Floating pulse indicates that the pathogenic factor is contesting with the body’s righteous qi at the surface, or it may indicate internal wind, internal heat, or deficiency of the righteous qi.
1. Pathogenic qi invades the surface, contesting with the righteous qi at the body’s surface. When external pathogens invade the skin, the body responds by directing qi and blood to the surface to resist the invading pathogens, resulting in a floating pulse. The Taiyang (Greater Yang) syndrome often presents with a floating pulse; the Taiyin (Greater Yin) wind-damp syndrome may show a floating and soft pulse; the Yangming (Bright Yang) syndrome may also present with a floating pulse. Historically, wind attacks often resulted in spleen deficiency, leading to a “floating and soft pulse”; in modern times, adults (except for children) often present with a floating and wiry pulse, which also indicates wind. In cases of cold damage, especially in male patients, even superficial wind often presents as a wiry pulse. Accompanying cold may lead to a floating and tight pulse, while dampness may lead to a floating and soft pulse. Pure floating and soft pulses are rare; when combined with wind-heat, the pulse may be floating and rapid. A floating pulse combined with a slow pulse indicates insufficient chest yang (heart yang) due to wind-cold invasion. A floating pulse that is strong indicates a solid exterior, while a floating pulse that is weak indicates a deficient exterior. Regardless of whether the exterior is solid or deficient, as long as the pulse is floating, there will be symptoms of fever, aversion to cold, headache, and body aches.
Standard floating pulse conditions are relatively rare because the exterior can affect the interior, and new illnesses can impact chronic conditions. Therefore, standard floating pulses are less commonly seen in clinical practice.
2. Internal wind causes qi and blood to circulate at the surface. Internal wind arises from the chaotic movement of qi and blood within the body, especially when yang energy is excessively active and becomes wind. When internal wind stirs, qi and blood rise to the surface, resulting in a floating pulse. Internal wind often presents as vigorous or solid floating pulses. If liver wind disturbs the pulse, it is often floating and wiry, with more strength at the middle level. A small portion may present as a standard floating pulse.
In traditional Chinese medicine, herbs like Quanxie (Scorpion) and Wugong (Centipede) are used to dispel wind and open the meridians, targeting deeper wind conditions compared to those affecting the skin. Therefore, the pulse may also be deep, but the disturbance of wind can still present as a floating pulse, even in cases of liver wind disturbance.
3. Yang energy rises to the surface. Some overly ambitious individuals may have their yang energy floating outward. When yang is not contained, it escapes, similar to qi losing its inward focus. This can lead to issues such as financial instability, indicating deficiency.
A floating pulse due to excessive yang is a virtual floating pulse, which may be large and hollow, or strong and large without being hollow, such as a snapping finger pulse or leather pulse.
By distinguishing the mechanisms of floating pulse formation, we can target our clinical approach: for exterior pathogens, we need to release the exterior; for wind-induced conditions, we need to calm the wind; for deficient yang, we need to tonify and descend.
4. Deficient righteous qi presents as a floating pulse:
- Yin deficiency cannot contain yang; yang floats outward, resulting in a floating pulse.
- Blood deficiency cannot maintain the interior, leading to qi floating outward and a floating pulse.
- Yang deficiency leads to internal cold, causing yang to float outward and a floating pulse.
- Qi deficiency cannot stabilize its position, leading to qi floating outward and a floating pulse.
In chronic illness, a floating pulse may indicate excessive yin damage, leading to floating yang, which is a floating pulse. In chronic illness, the pulse is often deep and thin, but a sudden change to a floating pulse often indicates deficiency of righteous qi and invasion of external pathogens, hence the floating pulse in chronic illness often indicates recurrence.
In chronic illness, a gradually floating pulse may indicate either a gradual recovery of righteous qi or a gradual depletion of righteous qi, leading to floating qi. A sudden floating pulse in chronic illness may indicate a sudden loss of righteous qi, with yin and yang separating, resulting in a violent floating pulse, often a sign of a fleeting recovery.
5. Excessive heat presents as a floating pulse. The six qi transform into fire, the five emotions transform into fire, or prolonged accumulation of qi, blood, phlegm, and food can lead to heat. Excessive heat can invade the exterior, causing qi and blood to surge outward to the skin, resulting in a floating pulse. This type of floating pulse is generally a solid condition.
Floating pulse at the left cun position indicates wind invasion, with symptoms such as dizziness, headache, and phlegm obstruction. A floating pulse combined with a slow pulse indicates insufficient heart qi, leading to symptoms of palpitations, shortness of breath, and anxiety. A floating pulse at the left guan position indicates liver and gallbladder issues, requiring differentiation of deficiency and excess. A strong floating pulse indicates excessive liver fire, with symptoms such as dizziness, red eyes, and bitter mouth; a weak floating pulse indicates fear, fatigue, and insomnia. A floating pulse combined with a rapid pulse indicates liver qi stagnation, leading to chest fullness and obstruction. A floating pulse at the left chi position indicates kidney yin deficiency, often presenting with lower back pain, weakness in the lower limbs, or heat in the palms and soles. A hollow pulse indicates hematuria in men and menorrhagia in women. A slow pulse indicates hernia pain below the navel, while a floating pulse that is weak indicates kidney deficiency.
A floating pulse at the right cun position indicates lung cold invasion, with symptoms such as cough, clear nasal discharge, and headache. If the wind-cold persists, it may transform into heat, leading to cough with yellow phlegm and chest pain. A floating pulse that is weak indicates lung qi deficiency, with symptoms of cough and shortness of breath. A floating pulse at the right guan position indicates spleen deficiency, with symptoms of poor appetite and abdominal distension. A floating pulse combined with a slow pulse indicates spleen yang deficiency, with symptoms of abdominal pain and preference for warmth. A floating pulse at the right chi position indicates lower jiao issues, with a strong pulse indicating excessive fire, while a weak floating pulse indicates deficiency of original qi, often due to chronic illness or congenital insufficiency.
Case Studies:
Case 1: Xu, female, adult, first diagnosed in early September 1962. Main symptoms: chills, nasal congestion, cough, chest tightness, and white phlegm for 3 days, with a thin white tongue coating. The pulse was floating and tight at both cun positions. Diagnosis: Floating pulse indicates exterior syndrome, tight pulse indicates cold; the unique floating and tight pulse at both cun positions indicates wind-cold invading the lung. Treatment: Release the exterior with warm herbs and relieve cough. Prescription: Xing Su San modified. Ingredients: 6g Apricot Kernel, 5g Perilla Leaf, 6g Poria, 5g Cinnamon Twig, 5g Banxia, 5g Zhiqiao, 6g Tangerine Peel, 2g Licorice, 3 slices of fresh Ginger. Decoction for oral administration. After 2 doses, the cold and cough were resolved.
Case 2: Peng, male, 9 years old, first diagnosed in early January 1964. Main symptoms: fever for 3 days, cough with yellow phlegm, sore throat, and poor appetite. Despite treatment with Western medicine, no significant improvement was observed, with a thin yellow tongue coating. The pulse was floating and rapid. Diagnosis: Floating pulse indicates exterior wind, rapid pulse indicates heat; the combination indicates wind-heat invading the lung. Treatment: Release the exterior with cool herbs and clear heat from the lung. Prescription: Sang Ju Yin modified. Ingredients: 6g Mulberry Leaf, 5g Chrysanthemum Flower, 5g Apricot Kernel, 5g Fritillaria Bulb, 6g Platycodon Root, 6g Tangerine Peel, 5g Trichosanthes Fruit, 5g Huangqin, 3g fried Ziziphus Jujuba, 2g Licorice, and a pinch of fresh Mint with 3 slices of fresh Ginger. Decoction for oral administration. After 2 doses, all symptoms resolved.
Case 3: Han, male, 51 years old, first diagnosed in early November 1963. Main symptoms: can only sleep for about 3 hours each night and cannot fall back asleep after waking. Previously took Western sedatives with poor results, hence seeking treatment with Chinese medicine. The pulse was floating, thin, and slippery at the left cun and chi positions. Diagnosis: The left cun pulse corresponds to the heart, and the left chi pulse corresponds to the kidney. The floating and thin pulse indicates heart and kidney yin deficiency, with virtual heat disturbing the heart. The slippery pulse indicates phlegm and heat. Overall, the floating, thin, and slippery pulse indicates a disturbance of heart and kidney. Treatment: Nourish yin, clear heat, eliminate phlegm, and connect heart and kidney. Prescription: Zhen Zhong Dan combined with Er Chen Tang modified. Ingredients: 9g Turtle Shell, 9g Poria, 6g Rhizoma Anemarrhenae, 5g Fried Polygala, 6g Tangerine Peel, 5g Banxia, 5g Raw Dragon Bone, 5g Dendrobium, 5g Fried Jujube Seed, and 2g Licorice. Decoction for oral administration. After 10 doses, insomnia was resolved.
Note: This case illustrates that floating pulse can indicate deficiency. Generally, floating pulses are often seen in exterior syndromes, but in this patient, the floating pulse indicated an interior deficiency. It is important to differentiate between exterior and interior conditions when interpreting floating pulses. If a floating pulse is observed, it is crucial to consider the specific pulse position to determine which organ is deficient. For example, a floating pulse at the right cun position indicates lung qi deficiency, while a floating pulse at the right guan position indicates spleen deficiency. In clinical practice, it is essential to correlate pulse and symptoms for accurate diagnosis and treatment. If a floating pulse is misinterpreted as solely indicating an exterior condition and treated with exterior-releasing herbs, it may lead to damage to yin and worsen the condition.
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