Pulse manifestation: The pulse that can be felt lightly by placing the hand on the skin, and when pressed firmly, it still beats strongly, is called “heavy pressure not empty”.
How did Li Shizhen describe the floating pulse? “The floating pulse only travels along the flesh, like the lightness of a willow catkin.” This is the floating pulse, which can be said to be one of the easiest pulses to feel.
“In the third autumn, knowing no illness, a long illness encountering knowledge can be surprising.” This refers to its clinical significance. If in autumn one obtains a floating pulse, then the illness is very mild; the pulse in autumn is somewhat floating. Why is the pulse floating in autumn? Historically, no one has answered this. According to my research, the floating pulse in autumn is relative to the sinking pulse in winter. The autumn pulse is still more restrained compared to the surging pulse in summer. Why can a long-term bedridden person suddenly have a floating pulse? Because he is a weak person, how could his pulse possibly beat to the skin? He does not have that much strength. Why does it suddenly float? This is because when one is extremely deficient, the original qi is exposed; the more exposed outside, the more deficient inside. Therefore, when you press down heavily, it will be extremely weak. A long-term illness should show a relatively sinking pulse, yet it is floating; this is a sign of poor prognosis.
Main diseases and pulse theory:
1. The floating pulse is most commonly seen in exterior syndromes. What is an exterior syndrome? It is what we call a cold or flu, where the wind-cold has just harmed our skin, causing the whole body to feel cold, with fever and chills, and no sweating at all. At this time, the disease location is very superficial. Exterior syndromes are like this; in a wind-heat cold, when inhaled through the nose, it particularly affects the nose, throat, and pharynx, which are also very superficial areas, and the pulse is also very superficial. Therefore, this is called an exterior syndrome: “floating pulse indicates a yang exterior disease”; it mainly indicates exterior syndromes, whether wind-cold or wind-heat, the pulse is particularly floating.
2. In very rare cases, the floating pulse is not an exterior syndrome, but rather due to yin failing to restrain yang or yin excess counteracting yang. These are very rare situations, like the long-term illness encountering surprise, which belongs to yin failing to restrain yang or yin excess counteracting yang. What is yin failing to restrain yang? It is when yin deficiency reaches an extreme, unable to nourish yang qi; yin and yang are mutually rooted and utilized. When yin is exhausted to the extreme, it cannot nourish yang qi. Yang qi has no root, no support, so it will float to the surface and transiently be lost, then it will be gone, dead. Yin excess counteracting yang is when a mass of yin-cold energy in the body expels yang qi to the surface, so this pulse is also floating on the outside, but it is not a floating pulse because a floating pulse under heavy pressure is not empty; this pulse under heavy pressure is empty.
3. When internal evil exits the surface, the pulse will change from sinking to floating, which is a good sign. In yangming organ excess syndrome, the pulse is initially sinking. After you purge it, the pulse floats up; this is the internal evil exiting the surface, and through sweating, it is cured. However, this floating is not an exterior syndrome, nor is there exterior evil, but rather it shows the trend of the body’s qi mechanism rising and falling, entering and exiting. This is the highest realm of pulse diagnosis. If a patient has had a fever for several days and comes to me, and I feel a very sinking pulse, then I know this person either has weak yang qi that cannot expel the evil outside, or the evil qi has entered inside, with evil and righteous qi contending within the body. At this time, you need to use some heat-clearing herbs or herbs that assist righteous qi, and you must resolve it internally. After using such herbs, the pulse will float up; righteous qi has been restored or evil qi has been expelled, and your righteous qi is liberated, moving towards the surface, still wanting to dissipate heat through the surface. This is your body’s self-healing ability. We must use herbs that align with this self-healing ability; you can use herbs like Mentha (薄荷), Schizonepeta (荆芥), and Perilla (苏叶) to help expel evil outside. You must not use heavy herbs like Rhubarb (大黄), Gypsum (石膏), or Coptis (黄连) in an attempt to resolve internal heat; this is counteracting the self-healing ability. If you look at ancient medical cases, if a fever patient in the later stages uses herbs like Mentha and Schizonepeta, and you say it is re-exposing to exterior evil, you are misunderstanding.
Knowledge expansion:
1. What diseases are indicated by floating pulses in different locations? Li Shizhen has mentioned this; actually, if you follow this pattern to explain to patients, it is mostly accurate. “Floating pulse at the cun indicates headache and dizziness due to wind.” If a person’s cun pulse is very floating and strong, you ask if they have a headache or dizziness; most likely they do. “Or there may be phlegm and wind gathering in the chest,” which also corresponds to the cun pulse, right? As mentioned earlier, if there is phlegm in the chest, it can cause shortness of breath, wheezing, and coughing, which also reflects on the cun pulse. “Guanshang earth is weak, and wood is strong”; if both guan pulses are very floating, then it indicates earth weakness and wood strength. “The chi pulse is floating, indicating urinary issues”; if the chi pulse is very floating, it indicates kidney problems with urination, especially if urination is not smooth, painful, or frequent. Normally, the chi pulse is sinking, which is the physiological state; if the chi pulse is floating, it indicates kidney damp-heat or fire, so its function is abnormal.
2. Clinically, floating pulses are often seen together with rapid pulses and tight pulses, called floating-rapid pulse or floating-tight pulse. How to analyze this floating-rapid or floating-tight? Floating represents the exterior, rapid represents heat. Therefore, floating-rapid together indicates exterior heat. Floating represents the exterior, tight represents cold; floating-tight indicates exterior cold, also called wind-heat exterior syndrome or wind-cold exterior syndrome. If a person with chills and fever has a pulse that is not floating, what is the mechanism? Your diagnosis of exterior syndrome seems incorrect; using sweating herbs may not be effective. Analyzing from the perspective of warm disease theory, this is an exterior syndrome inducing diarrhea. The exterior syndrome is light, while the hidden evil is heavy. The hidden evil is inside, binding the righteous qi within, unable to reach the surface; even with exterior evil, the pulse cannot float, so the heat is very high. Therefore, the treatment principle for hidden evil warm disease is to expel the evil outside, avoiding the excessive use of cold and cool herbs, and always paying attention to the promotion of qi mechanism. Another situation is that if the fever pulse is sinking, there is fundamentally no exterior syndrome, purely an internal syndrome. Sometimes online consultations do not yield good results, largely due to the lack of pulse diagnosis. Your qi mechanism’s rising and falling, entering and exiting, is either excessive or insufficient; without basis, no matter how you treat it, it always feels slightly off.
3. In clinical practice, there are not many truly pure exterior syndromes. For example, many people cannot treat a cold effectively. Why? Because they do not delve deeply into the pulse manifestation. Zhang Xichun mentioned this well, but unfortunately, no one has inherited it. Zhang Xichun said that pure exterior syndromes are rare now; do not look at a person with chills and fever on the first day and say they have an exterior syndrome, then prescribe Ma Huang Decoction without effect, or Yin Qiao San without effect. Because the pulse of an exterior syndrome is floating, but the pressure intensity is the same as a normal person. If you do not know what a normal person’s pulse feels like under pressure, how do you know what a cold person’s pulse feels like under pressure? Zhang Xichun said that a cold person’s pulse under pressure is always slippery, rapid, and strong. This is a simultaneous interior and exterior disease, and from yang transforming into heat, therefore gypsum should be used early. You see, some people use Ma Xing Shi Gan Decoction, Da Qing Long Decoction, or Chai Hu plus Gypsum Decoction to reduce fever, and then praise the classic formulas; however, when they use gypsum, it is much more aggressive than I do. Zhang Xichun also said that taking a single herb of gypsum can also be effective. Do you understand? I have seen four or five people who excessively used Ma Huang, Chai Hu, and Fu Zi without adding gypsum, resulting in all heat transforming into wind. This viewpoint was proposed in the Song Dynasty.
Other links:
Introduction to Sun Shihui’s TCM Studio
My Secret Formulas (Agreed Formulas) Compilation