Exploring the Floating Pulse in Traditional Chinese MedicineFloating Pulse — The Floating and Concurrent Pulse

1. Yang Floating and Yin WeakAccording to the “Treatise on Febrile Diseases” (Shang Han Lun), Section 12: “In the case of Taiyang wind, the Yang is floating while the Yin is weak. The Yang floating indicates spontaneous heat, while the Yin weak indicates spontaneous sweating, aversion to cold, aversion to wind, fever, nasal congestion, and dry retching. The treatment is Gui Zhi Tang (Cinnamon Twig Decoction).”Note:The Yin and Yang of “Yang floating and Yin weak” refer to the pulse position.There are two interpretations: one is that floating represents Yang and sinking represents Yin; the other is that the cun (inch) position represents Yang and the chi (pulse) position represents Yin. How should this pulse be interpreted? If interpreted by cun and chi, this pulse indicates kidney cold with Yang floating above, rather than the Gui Zhi Tang pulse of Taiyang wind. If there is kidney Yin deficiency, one should nourish Yin and subdue Yang; if there is kidney Yang deficiency, one should guide fire back to its source; if both kidney Yin and Yang are deficient, one should supplement both Yin and Yang, with a focus on subduing and restraining.If interpreted as floating and sinking, it aligns with the “Pulse Classic” which states: “When lifted, it is excessive; when pressed, it is insufficient.” This is the floating pulse, indicating the Taiyang exterior deficiency pulse of Gui Zhi Tang. The Yang floating indicates that wind evil invades the exterior, while the Yin weak indicates a true deficiency internally. Such patients are commonly seen in clinical practice, often with a slight deficiency of Yang or Qi, combined with external evil at the muscle surface, resulting in a pulse of Yang floating and Yin weak. The treatment should focus on supporting the righteous Qi and expelling the evil,Gui Zhi Tang benefits the middle Qi, regulates Ying and Wei, and releases the muscles, serving as the foundational formula for supporting the righteous Qi and expelling the evil.2. Floating Weak(1) According to the “Treatise on Febrile Diseases”, Section 42: “In Taiyang disease, if the exterior symptoms have not resolved and the pulse is floating and weak, one should resolve it with sweating, and Gui Zhi Tang is appropriate.”Note:The floating pulse is naturally a light pulse; the weak pulse is certainly a sinking or moderate pulse. This is the floating pulse characterized by “excessive when lifted, insufficient when pressed,” which is consistent with the Yang floating and Yin weak pulse described in Section 12. Weakness indicates insufficient righteous Qi internally; floating indicates the exterior, which belongs to the deficiency of a person with an external pathogen.(2) According to the “Golden Chamber” (Jin Kui Yao Lue) on Jaundice Disease: “If wine-induced jaundice is purged, it may turn into black jaundice after a long time, with blue eyes and black face, a heart feeling like eating garlic, black stools, and numbness of the skin and nails, the pulse is floating and weak, even if black, it is slightly yellow, thus it can be diagnosed.”Note:This section has various interpretations by physicians, some say it is due to improper purging harming the spleen and causing damp-heat accumulation, or improper purging harming kidney blood and causing internal accumulation. What is the reason for this condition? The floating and weak pulse indicates that the righteous Qi is already deficient. Just as the “Golden Chamber” states: “In black jaundice, the abdomen is distended like water, and the stools must be black, sometimes loose; this is a woman’s labor disease.” The labor injury harms the kidney, and the deficiency of the righteous Qi is evident, thus the treatment should primarily focus on supporting the righteous Qi. As for whether damp-heat has not yet dissipated or blood stasis is not moving, it can also be addressed on the basis of supporting the righteous Qi.(3) According to the “Golden Chamber” on Palpitations, Vomiting, and Hemorrhage: “If the patient has no color, no cold or heat, and the pulse is deep and wiry, it indicates bleeding. If the pulse is floating and weak and disappears upon pressing, it indicates bleeding. If there is thirst, it must be vomiting blood.”Note:The floating and weak pulse that disappears upon pressing, along with a pale complexion, indicates the loss of righteous Qi. The bleeding, whether from the nose, lower body, or vomiting blood, is all due to the failure of the righteous Qi to contain the blood, leading to erratic blood flow.(4) According to the “Golden Chamber” on Blood Stasis and Deficiency: “If a man’s pulse is floating, weak, and rough, it indicates infertility, with clear and cold essence.”Note:The floating pulse indicates the pulse position, easily obtained when lifted, indicating the Yang Qi is floating. When pressed, it is weak and rough, indicating the Yang Qi is deficient; rough indicates the pulse is thin, slow, short, and difficult to come and go, indicating deficiency of essence and blood. The combination of weakness and roughness indicates deficiency of both Yin and Yang, hence the essence is cold and infertile. In addition, one may also observe symptoms of lower back soreness, knee weakness, dizziness, and cold limbs.3. Floating and Deficient(1) According to the “Treatise on Febrile Diseases”, Section 240: “If the pulse is floating and deficient, one should induce sweating. Sweating should use Gui Zhi Tang.”Note:This floating and deficient pulse is similar to the floating and weak pulse in Section 42.Weakness indicates fine and weak, with deficient Yang Qi; deficiency indicates floating and large, with deficient Yang Qi and floating Yang.Although both indicate deficient Yang Qi, there is a distinction between floating Yang and non-floating Yang.For deficient Yang Qi, one should warm Yang and benefit Qi; for floating Yang Qi, one should add restraining herbs to prevent Yang collapse.(2) According to the “Golden Chamber” on Spasms and Damp-Heat: “After eight or nine days of febrile disease, if wind and damp collide, the body aches and is restless, unable to turn or side, with no vomiting or thirst, the pulse is floating, deficient, and rough; Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is the main treatment.”Note:Body aches and the pulse being floating, deficient, and rough indicate that the deficiency is due to the invasion of wind and damp into the meridians.Without vomiting or thirst, there are no signs of lesser Yang or Yang Ming.Gui Zhi Fu Zi Tang warms Yang and opens the meridians.(3) According to the “Golden Chamber” on the Five Organs and Cold-Damp Accumulation: “If the lung is dead, the pulse is floating and deficient, pressing it feels weak like a green onion leaf; if it has no root, it indicates death.”Note:The true lung pulse, as stated in the “Plain Questions”, indicates: “The dead lung pulse feels like something floating, like wind blowing through hair, indicating lung death”; the “Plain Questions” also states: “The true lung pulse is large and deficient, like a feather touching the skin.” This section refers to “floating and deficient, pressing it feels weak like a green onion leaf; if it has no root, it indicates death,” indicating that the essence has been exhausted, and the true Qi is floating and scattered outside.4. Floating and Large(1) According to the “Treatise on Febrile Diseases”, Section 30: “If the cun pulse is floating and large, floating indicates wind, large indicates deficiency; wind causes slight heat, deficiency causes cramping in both legs. The disease resembles Gui Zhi, thus add Fu Zi (Aconite) to enhance the Gui Zhi to induce sweating; Fu Zi warms the meridians, as Yang is lost.”Note:1. “The disease resembles Gui Zhi, thus add Fu Zi to enhance the Gui Zhi” indicates the meaning of Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Aconite). The floating, deficient, and rough pulse is consistent with this section’s pulse.2. Why is the pulse floating and large? It is due to the loss of Yang. The Yang is deficient, hence it is large; the floating and large pulse must feel weak when pressed. Gui Zhi Tang plus Fu Zi is used to restore Yang, increasing Gui Zhi to open the meridians.(2) According to the “Treatise on Febrile Diseases”, Section 132: “In the case of chest obstruction, if the pulse is floating and large, it should not be purged; purging will lead to death.”Note:Chest obstruction occurs when heat enters and combines with water, resulting in internal rejection pain, pressing it feels hard like a stone, with shortness of breath and irritability.Chest obstruction should have a solid and strong pulse, but if the pulse is floating and large, it indicates that the exterior evil has not resolved, and the interior has not solidified; the evil still has the opportunity to manifest externally, hence purging is prohibited. Misguided purging of the internal deficiency evil will lead to death.(3) According to the “Treatise on Febrile Diseases”, Section 268: “In the case of three Yang diseases, the pulse is floating and large, the upper pulse is floating, and one only desires to sleep; if the eyes close, sweating occurs.”Note:The floating and large pulse indicates that the Yangming heat is excessive, while the floating indicates that the Taiyang heat is excessive; the upper pulse is floating, indicating that the heat is excessive above, from the guan to the cun, all are floating and large; the long and straight floating and large pulse indicates that the Shaoyang heat is excessive. The excessive heat disturbs the heart, causing a desire to sleep; if the eyes close, Yang enters the interior, steaming Yin and causing sweating.(4) According to the “Golden Chamber” on Malaria Pulse Diagnosis and Treatment: “In malaria, if the pulse is floating and large, it can be purged.”Note:In this case, it is stated: “If floating and large, it indicates that the evil is in the upper division, and the upper should be drawn out, hence it can be purged.”(5) According to the “Golden Chamber” on Blood Stasis and Deficiency: “In cases of labor, if the pulse is floating and large, the hands and feet are restless, severe in spring and summer, mild in autumn and winter, with Yin cold essence leaking out, and soreness and weakness in the bones, it cannot move.”Note:The pulse being floating and large indicates that the Yang Qi is excessive; it must feel weak when pressed. The Yang floating in the hands and feet causes restlessness, and the Yang is not solid, leading to essence leaking out, resulting in soreness and weakness in the bones.5. Floating and FloodingAccording to the “Golden Chamber” on Water Qi Disease: “If the pulse is floating and flooding, floating indicates wind, flooding indicates Qi; when wind and Qi collide, if the wind is strong, it leads to rashes, causing itching; itching indicates the release of wind, which can lead to scabs and leprosy. If the Qi is strong, it leads to water retention, making it difficult to bend and stretch; when wind and Qi collide, the body swells, and sweating leads to recovery; aversion to wind indicates deficiency, this is wind-water. If there is no aversion to wind, it indicates smooth urination, with cold in the upper jiao, and excessive salivation, this is yellow sweat.”Note:This section presents the differentiation between rashes, wind-water, and yellow sweat.1. Rashes: Wind is light and rising; if the wind is excessive, the pulse is floating and large, and the wind invades the skin, causing rashes.2. Wind-water: Wind stirs and water rises, causing swelling in the skin; the pulse is floating and flooding, indicating wind-water. Aversion to wind indicates deficiency, which is exterior Qi deficiency.3. Yellow sweat: Although it resembles wind-water, the pulse is deep, indicating it is not wind-water.6. Floating and FineAccording to the “Treatise on Febrile Diseases”, Section 36: “In Taiyang disease, if ten days pass, and the pulse is floating and fine, with a desire to sleep, the exterior has resolved.”Note:In Taiyang disease, if the exterior has resolved, the pulse is floating and fine, indicating that the evil has retreated but the righteous Qi has not yet recovered, hence the pulse is floating and fine, with a desire to sleep. In this case, one can rest, or adjust diet and nourishment, or slightly use restorative products, depending on the specific situation.7. Floating and SlipperyAccording to the “Golden Chamber” on Phlegm-Damp Cough Disease: “If the pulse is floating and slippery, it indicates injury from dampness.”Note:The floating and fine pulse indicates insufficient righteous Qi, while slippery indicates the presence of phlegm, hence it is termed injury from dampness.8. Floating and Tight(1) According to the “Treatise on Febrile Diseases”, Section 38: “In Taiyang wind, if the pulse is floating and tight, with fever and aversion to cold, body aches, no sweating, and irritability, Da Qing Long Tang (Major Blue Dragon Decoction) is the main treatment.”Note:1. In Taiyang wind, the pulse should be floating and relaxed; why is it floating and tight? The combination of cold and heat, body pain, no sweating, and a floating and tight pulse indicates a typical Taiyang cold injury. Why is it not referred to as Taiyang cold injury but as Taiyang wind? Many physicians interchangeably interpret wind and cold, yet wind is a Yang evil and cold is a Yin evil, with entirely different natures; how can they be interchangeable? This section refers to cold injury, but also involves Yang evil, hence the irritability. The term wind here refers to the nature of the evil, indicating a combination of heat evil as well.2. Floating and tight indicates that cold binds the muscle surface.(2) According to the “Treatise on Febrile Diseases”, Section 46: “In Taiyang disease, if the pulse is floating and tight, with no sweating, fever, and body aches, and it has not resolved for eight or nine days, the exterior symptoms still persist; one should induce sweating… Ma Huang Tang (Ephedra Decoction) is the main treatment.”Note:This Taiyang disease has lasted for eight or nine days; although it has passed the stage, the pulse remains floating and tight, with no sweating, fever, and body pain, indicating that the exterior symptoms still persist, and one should still induce sweating, prescribing Ma Huang Tang. This floating and tight pulse indicates exterior cold.(3) According to the “Treatise on Febrile Diseases”, Section 47: “In Taiyang disease, if the pulse is floating and tight, with fever, and if there is spontaneous bleeding, it indicates recovery.”Note:The floating and tight pulse indicates exterior cold. If the exterior is closed, Yang is constrained and scorched, injuring the Yang vessels and causing bleeding. Bleeding is a form of red sweating, providing an outlet for the evil, hence recovery occurs.(4) According to the “Treatise on Febrile Diseases”, Section 50: “If the pulse is floating and tight, it should lead to body pain, and one should induce sweating to resolve it.”Note:The floating and tight pulse indicates that cold evil binds the exterior, obstructing the Ying and Wei, leading to body pain, hence sweating should be induced.(5) According to the “Treatise on Febrile Diseases”, Section 55: “In cases of febrile disease, if the pulse is floating and tight, and if sweating does not occur, leading to bleeding, Ma Huang Tang is the main treatment.”Note:The floating and tight pulse indicates that cold binds the exterior, and the Wei Yang is constrained. It should have been resolved by sweating, but if it has not been sweated out, the constrained heat cannot manifest externally, leading to bleeding.After bleeding, some may recover due to the bleeding, as seen in Section 47; others, even if bleeding occurs, the exterior has not resolved, and one should still induce sweating, prescribing Ma Huang Tang as the main treatment.(6) According to the “Treatise on Febrile Diseases”, Section 108: “In febrile disease, if there is abdominal fullness and delirium, and the cun pulse is floating and tight, this indicates liver overacting on the spleen, termed ‘Zong’; needling the Qi Men (Liver’s Mu point) is indicated.”Note:1. The five elements interacting, where one overacts on the other is termed ‘Zong’; if one does not overact on the other, it is termed ‘Heng’.2. The liver overacting on the spleen may occur due to excessive wood or deficiency of earth, one being deficient and the other being excessive.3. Why is the cun pulse floating and tight? The floating and tight pulse indicates a pulse spasm.According to the “Pulse Classic”: “The spasm pulse feels tight like a string, moving up and down.” The “Pulse Method” states: “The floating and tight pulse is termed ‘Xian’ (wiry).” The wiry pulse is associated with the liver, as wood overacts on earth.(7) According to the “Treatise on Febrile Diseases”, Section 151: “If the pulse is floating and tight, and if purging is applied, the tightness will enter the interior, leading to distension; pressing it feels moist, indicating only Qi distension.”Note:The floating and tight pulse indicates exterior cold.After purging, the stomach becomes deficient, and the tightness enters the interior, leading to cold entering the interior, obstructing the Qi mechanism, resulting in distension.(8) According to the “Treatise on Febrile Diseases”, Section 189: “In Yangming wind, if the pulse is floating and tight, with a bitter mouth and dry throat, abdominal fullness and slight shortness of breath, fever and aversion to cold, if purging is applied, it will lead to abdominal fullness and difficulty urinating.”Note:This is a case of three Yang diseases, with bitter mouth and dry throat indicating lesser Yang; abdominal fullness and slight shortness of breath indicating Yangming; fever and aversion to cold, with a floating and tight pulse indicating Taiyang. Although it is a case of three Yang diseases, the floating and tight pulse indicates that the exterior cold is heavy.The treatment should first address the exterior, then the interior, or resolve both exterior and interior simultaneously. If purging is applied, the interior will be deficient and cold will enter, obstructing the Qi mechanism, leading to abdominal fullness and difficulty urinating. Although it is a case of three Yang diseases, why is it termed Yangming wind? This disease, although it presents with Yangming symptoms, is not purely Yangming; it is primarily Taiyang, and differentiation is still necessary.(9) According to the “Treatise on Febrile Diseases”, Section 201: “In Yangming disease, if the pulse is floating and tight, there will be tidal fever occurring at times; if it is only floating, there will be night sweats.”Note:Since it is termed ‘Yangming disease’, it must have the characteristics of Yangming stomach heat. Tidal fever indicates a Yangming heat type, indicating that the stomach is indeed full. Other characteristics are not detailed, indicating a concise writing style.2. Since it is Yangming disease, why is the pulse floating and tight? The floating indicates the exterior, indicating that there is heat in the interior manifesting externally. The tight pulse primarily indicates cold; this is only one aspect; tightness also indicates stagnation.The causes of stagnation can be due to evil obstruction or deficiency of the righteous Qi. However, stagnation due to excess evil is caused by obstruction. In cases of excess evil, the pulse may be seen as wiry, tight, deep, fine, rough, small, slow, or even lead to collapse. If the Qi mechanism is obstructed, it may lead to limb collapse, with the entire body feeling cold, resembling a corpse. This tightness, when pressed, must have a sense of restlessness, as Yang heat is internally constrained, leading to restlessness. The floating and tight pulse indicates that the evil is lightly constrained.In clinical practice, how to diagnose whether the floating and tight pulse indicates a cold syndrome or a Yangming organ excess syndrome? Besides the accompanying pulses, one should also consider the four diagnostic methods together.If there is indeed an exterior cold syndrome, this floating and tight pulse indicates exterior cold; if there is indeed a Yangming organ excess syndrome, this floating and tight pulse indicates excess in the stomach.3. “If it is only floating, there will be night sweats.”Only floating refers to floating without tightness.In Yangming stomach excess, if the pulse is only floating, it indicates that there is heat in the interior manifesting externally. At night, Yang enters Yin, and the heat in the interior increases, thus forcing the fluids to leak out, leading to night sweats.This floating pulse must also indicate Yangming heat syndrome.(10) According to the “Treatise on Febrile Diseases”, Section 221: “In Yangming disease, if the pulse is floating and tight, with a dry throat and bitter mouth, abdominal fullness and shortness of breath, fever with sweating, and aversion to heat rather than cold, the body feels heavy. If sweating is induced, it will lead to irritability, and if warming needles are applied, it will cause restlessness and insomnia; if purging is applied, it will lead to emptiness in the stomach, causing Qi to move in the diaphragm, leading to discomfort in the heart, and if there is a coating on the tongue, Zhi Zi Chi Tang (Gardenia and Soybean Decoction) is the main treatment.”Note:1. This is named Yangming disease, and it presents with symptoms such as dry throat, bitter mouth, abdominal fullness and shortness of breath, fever with sweating, and a heavy body, indicating that it is undoubtedly Yangming.However, Yangming disease can have both excess and heat types, as well as Yangming heat stagnation. This section uses Zhi Zi Chi Tang, which is a formula that opens the heat and clears the chest, indicating that the heat is obstructing the chest cavity.Since the stomach is empty, it indicates that there is no dry stool in the stomach, hence it is termed empty. Since it is obstructed by heat in the chest cavity, sweating will assist the heat in damaging the fluids, while warming needles will reverse the heat and purging will harm the stomach, all of which are inappropriate, hence Zhi Zi Chi Tang is used to clear the obstructed heat.2. The coating on the tongue can be understood as having tongue coating.What kind of coating? The text does not elaborate.In the “Treatise on Febrile Diseases”, tongue diagnosis is only briefly mentioned in a few lines.It can be seen that Zhang Zhongjing’s differentiation and treatment do not emphasize tongue diagnosis, but rather focus on pulse diagnosis.In the study of warm diseases, tongue diagnosis is discussed in detail, and it holds significant value in the diagnosis and treatment of warm diseases.Recently, some have used tongue diagnosis as the main basis for differentiation and treatment of various diseases, which is inappropriate.In mixed conditions, more than half of tongue diagnoses do not match, hence using tongue diagnosis as the main basis for treatment will lead to systematic errors.3. In Yangming disease, why is the pulse floating and tight? This tightness is caused by the obstruction of Qi stagnation; the floating indicates that the stagnation is not severe, and there is an opportunity for heat to manifest externally, hence the pulse is floating and tight.However, this floating and tight pulse must feel restless and rapid, and there are symptoms of Yangming disease, which should not be mistaken for exterior cold syndrome.(11) According to the “Golden Chamber” on Wind and Joint Disease: “If the cun pulse is floating and tight, tight indicates cold, while floating indicates deficiency.”Note:This indicates that cold deficiency is colliding, and the evil is in the skin.The floating indicates blood deficiency, and the pulse vessels are empty, leading to the evil not being expelled; whether on the left or right, the evil Qi is slow, while the righteous Qi is urgent, as the righteous Qi draws the evil, leading to stagnation.If the evil is in the vessels, the skin will feel numb; if the evil is in the meridians, it will be heavy and unmanageable; if the evil enters the organs, it will lead to confusion; if the evil enters the viscera, it will lead to difficulty in speech and excessive salivation.(12) According to the “Golden Chamber” on Water Qi Disease: “In Taiyang disease, if the pulse is floating and tight, it should lead to joint pain, but if there is no pain, the body feels heavy and sore; if the person does not feel thirsty, sweating will lead to recovery; this indicates wind-water; if there is aversion to cold, this indicates extreme deficiency, and sweating will resolve it.”Note:1. Wind-water indicates that water is in the skin, located in the Taiyang, hence it is named Taiyang disease.2. The floating and tight pulse is originally the pulse of Taiyang cold injury, but if there are no cold or heat symptoms, no body pain, and no sweating, it indicates that it is not Taiyang cold injury.Water dampness obstructs, and Yang Qi does not circulate, leading to heaviness and soreness in the body.The pulse loses the warmth of Yang, hence it is tight; the evil is in the exterior, and the pulse is floating, but this floating and tight pulse must feel weak when pressed due to extreme deficiency.3. “Sweating will lead to recovery”; is this sweating referring to the narrow or broad definition of sweating? The narrow definition refers to using sweating agents to induce sweating; the broad definition refers to adjusting Yin and Yang, leading to sweating without sweating. This sweating should refer to the broad definition, not the narrow definition. If sweating occurs, it indicates that Yin and Yang have harmonized, hence recovery.This section indicates that due to extreme deficiency and water accumulation, one should warm Yang and benefit Qi before sweating; this is not suitable for the narrow definition of sweating.9. Floating and Relaxed(1) According to the “Treatise on Febrile Diseases”, Section 39: “In febrile disease, if the pulse is floating and relaxed, the body does not ache, but feels heavy, sometimes light, without any lesser Yin symptoms, Da Qing Long Tang is indicated to induce sweating.”Note:1. This section refers to “febrile disease” in a broad sense.Febrile disease has five types, and this refers to the type caused by dampness.The dampness clings to the muscle surface, obstructing Yang Qi, leading to heaviness, as Yang and dampness compete, causing occasional lightness.2. The floating and relaxed pulse indicates that floating represents the exterior, while relaxed represents dampness.3. Dampness clings to the muscle surface, and one should open the Xuanfu to expel the evil; if Yang is internally constrained and heated, Da Qing Long Tang should be used to clear it,resolving both exterior and interior simultaneously.According to the “Golden Chamber” on Spasms and Damp-Heat: “If wind and damp collide, the entire body will ache, and one should induce sweating to resolve it.”According to the “Golden Chamber” on Phlegm-Damp Cough Disease: “If the patient has excessive phlegm, one should induce sweating; Da Qing Long Tang is the main treatment, and Xiao Qing Long Tang is also indicated.” Sweating should not be excessive; it should be mild, as if one is about to sweat, to expel both wind and dampness.(2) According to the “Treatise on Febrile Diseases”, Section 187: “In febrile disease, if the pulse is floating and relaxed, and the hands and feet are warm, it indicates that it is related to the Taiyin; the Taiyin should lead to yellowing of the body.”Note:This Taiyin disease indicates that damp-heat is steaming.The floating and relaxed pulse indicates that internal heat is excessive, while the pulse is floating due to external dampness.Why is the pulse floating and relaxed, rather than being classified as Taiyang wind? This is because there are no symptoms of fever, aversion to wind, body pain, or spontaneous sweating, but rather symptoms of difficulty urinating, yellowing of the body, heaviness, drowsiness, lack of energy, and abdominal fullness with a lack of appetite, indicating that it is due to damp-heat obstructing the spleen.3. The text does not elaborate on the details, indicating a concise writing style.(3) According to the “Treatise on Febrile Diseases”, Section 278: “In febrile disease, if the pulse is floating and relaxed, and the hands and feet are warm, it indicates that it is related to the Taiyin; if urination is smooth, it cannot lead to yellowing.”Note:This is consistent with Section 187.(4) According to the “Golden Chamber” on Jaundice Disease: “If the cun pulse is floating and relaxed, floating indicates wind, while relaxed indicates obstruction; obstruction is not due to wind, and the four limbs feel uncomfortable, the spleen must be yellow, and heat must be circulating.”Note:The floating and relaxed pulse indicates that floating represents wind, which is a Yang evil; relaxed represents dampness, which is a Yin evil, and the combination of wind and dampness leads to obstruction.Obstruction indicates closure, which is due to damp-heat obstructing the spleen.The spleen governs the four limbs; if the spleen does not transport, the clear Yang cannot fill the four limbs, leading to discomfort in the limbs; damp-heat accumulates and steams, causing the spleen to turn yellow.10. Floating and Rapid(1) According to the “Treatise on Febrile Diseases”, Section 49: “If the pulse is floating and rapid, it should be resolved by sweating. If purging is applied, it will lead to heaviness and palpitations; sweating should occur naturally to resolve it.”Note:The floating and rapid pulse indicates exterior heat can be seen, and internal heat can also be present externally.If the floating and rapid pulse feels weak when pressed, it indicates that the righteous Qi is floating externally.The floating and rapid pulse can be resolved by sweating, indicating that it is due to external heat.(2) According to the “Treatise on Febrile Diseases”, Section 52: “If the pulse is floating and rapid, it is appropriate to induce sweating, and Ma Huang Tang is indicated.”Note:The floating and rapid pulse, along with the need for sweating, indicates that it must be floating and tight.Simply having a floating and rapid pulse indicates that it should be treated with cooling and dispersing methods, and Ma Huang Tang should not be used.(3) According to the “Treatise on Febrile Diseases”, Section 57: “If sweating has been induced and the pulse is floating and rapid, with irritability, it is appropriate to induce sweating again, and Gui Zhi Tang is indicated.”Note:The floating and rapid pulse indicates that there is heat externally, and the pulse remains floating and rapid even after sweating, indicating that the exterior heat has not resolved.11. Cun Floating and Guan SinkingAccording to the “Treatise on Febrile Diseases”, Section 128: “If asked about chest obstruction or organ obstruction, what does it look like? The answer is: pressing it causes pain, the cun pulse is floating, and the guan pulse is sinking, indicating chest obstruction.”Note:Chest obstruction occurs when the disease manifests in Yang and is then purged; heat enters and combines with water, leading to chest obstruction.The symptoms include hardness below the heart, internal rejection pain, and even hardness and fullness from below the heart to the lower abdomen, accompanied by neck stiffness, irritability, shortness of breath, and restlessness.The cun position represents Yang, and the floating pulse indicates that there is heat in the chest.The guan position indicates the middle, and the sinking pulse indicates that water and dampness are obstructed below, leading to pain due to obstruction.12. Cun Floating, Guan Small, Fine, Sinking, and TightAccording to the “Treatise on Febrile Diseases”, Section 129: “What is organ obstruction? The answer is: similar to chest obstruction, with normal appetite, occasional diarrhea, the cun pulse is floating, and the guan pulse is small, fine, sinking, and tight, indicating organ obstruction.”Note:The organ obstruction resembles chest obstruction, but chest obstruction is due to excess heat, which is a Yang condition; organ obstruction is due to deficiency and cold, which is a Yin condition.Why is the cun pulse floating while the guan pulse is small, fine, sinking, and tight? The cun position represents Yang, and the floating pulse indicates that Yang Qi is floating; this floating pulse must feel weak when pressed.The guan position represents the middle, and the small, fine, sinking, and tight pulses are Yin pulses, indicating that the middle is deficient and cold, also feeling weak when pressed.Middle deficiency and cold lead to food not being digested, resulting in occasional diarrhea; why is the appetite normal? This “normal” cannot be interpreted as normal appetite; it indicates that the appetite was normal before the organ obstruction occurred.Middle deficiency and cold lead to poor appetite, and the organ obstruction has formed, yet the appetite remains poor, indicating that it is still normal.13. Floating and Moving RapidlyAccording to the “Treatise on Febrile Diseases”, Section 134: “In Taiyang disease, if the pulse is floating and moving rapidly, floating indicates wind, moving indicates heat, rapid indicates pain, and rapid indicates deficiency; if there is a headache and fever, with slight night sweats, and aversion to cold, it indicates that the exterior has not resolved.”Note:The floating and moving rapid pulse indicates that the pulse is rapid and restless, indicating that the disease is progressing.According to the “Treatise on Febrile Diseases”, Section 4: “In febrile disease, if the pulse is quiet, it indicates that it is not transmitted… If the pulse is rapid, it indicates that it is transmitted.”In cases of externally contracted febrile diseases, if the pulse is quiet and the body is cool, it indicates recovery; if the pulse is rapid and restless, it indicates that the evil is excessive, indicating transmission.This floating and moving rapid pulse indicates that the disease is progressing and transmitting.14. Floating and Slippery(1) According to the “Treatise on Febrile Diseases”, Section 138: “In the case of small chest obstruction, if it is located below the heart and pressing it causes pain, the pulse is floating and slippery; Xiao Xian Xiong Tang (Minor Chest Obstruction Decoction) is the main treatment.”Note:Small chest obstruction is a lighter form of chest obstruction.The floating and slippery pulse indicates that floating represents Yang, while slippery indicates phlegm, indicating that phlegm-heat is mutually obstructing below the heart.(2) According to the “Treatise on Febrile Diseases”, Section 140: “In Taiyang disease, if purging is applied… if the pulse is floating and slippery, it indicates that there will be bleeding.”Note:In Taiyang disease, if purging is misapplied, the evil heat will penetrate internally.The floating pulse indicates Yang, while slippery indicates heat and phlegm.If the heat penetrates and presses down, it will lead to bleeding.If the floating pulse is resolved externally, it must also have exterior symptoms; if there are no exterior symptoms, it indicates excessive heat.This floating and slippery pulse must feel strong when pressed.Whether or not bleeding occurs cannot be determined absolutely.(3) According to the “Treatise on Febrile Diseases”, Section 176: “In febrile disease, if the pulse is floating and slippery, this indicates that there is heat externally and cold internally; Bai Hu Tang (White Tiger Decoction) is the main treatment.”Note:If there is cold internally, it indicates that there is heat internally.This floating and slippery pulse indicates that there is heat internally and externally.Bai Hu Tang is a strong cooling formula that can expel heat externally.(4) According to the “Golden Chamber” on Wind and Joint Disease: “If the pulse is floating and slippery, it indicates that the Qi is strong, while floating indicates that sweating occurs naturally.”Note:The floating and slippery pulse indicates that both are Yang pulses, indicating that Yang is excessive and causing sweating to occur naturally.Heat is excessive, causing Qi and blood to be abundant, leading to the pulse being floating and slippery.5. Floating and Rough(1) According to the “Treatise on Febrile Diseases”, Section 174: “If the pulse is floating and rough after eight or nine days of febrile disease, with wind and dampness colliding, the body aches and feels restless, unable to turn or side, with no vomiting or thirst, Gui Zhi Fu Zi Tang is the main treatment. If the person has hard stools and smooth urination, remove Gui Zhi and add Bai Zhu Tang (Atractylodes Decoction).”Note:This indicates that wind and dampness are causing pain, obstructing the Ying and Wei, leading to body aches.There is no vomiting or thirst, indicating that there are no signs of lesser Yang or Yangming.The floating and rough pulse indicates that floating represents the exterior and wind, while rough indicates Yang deficiency and insufficient Ying and Wei.Based on the pulse, this pain belongs to Yang deficiency and insufficient Ying and Wei, with wind and dampness invading externally.Gui Zhi Fu Zi Tang is prescribed, with Fu Zi warming Yang and dispersing cold, while Gui Zhi Tang is adjusted to open the Ying and Wei.If there are hard stools, it indicates that dampness is obstructing the spleen.If urination is smooth, it indicates that the bladder’s Qi transformation is still functioning, hence Bai Zhu is added to strengthen the spleen, eliminate dampness, and promote urination, while Gui Zhi can be omitted.(2) According to the “Golden Chamber” on Floating and Rough Pulse: “If the pulse is floating and rough, it indicates that the stomach Qi is strong, while rough indicates frequent urination; the floating and rough pulse indicates that the spleen is weak, leading to hard stools.”Note:The floating pulse indicates that Yang is excessive, while the rough pulse indicates that Yin is deficient, leading to the spleen being weak and unable to transport fluids, resulting in hard stools.(3) According to the “Golden Chamber” on Vomiting and Diarrhea: “If the pulse is floating and rough, it indicates deficiency, while rough indicates damage to the spleen; if the spleen is damaged, it cannot grind food, leading to morning vomiting and evening vomiting, with undigested food, termed ‘stomach reversal’.”Note:The floating and rough pulse indicates that the spleen and stomach are deficient, leading to the pulse being floating and rough.(4) According to the “Golden Chamber” on Sores and Abscesses: “If the cun pulse is floating and slightly rough, it indicates that blood is lost; if sweating occurs, what if sweating does not occur?”Note:If there are sores or injuries from knives or axes, it indicates blood loss.Blood loss leads to the pulse being rough, as Qi loses its connection, leading to the pulse being floating.16. Floating and Slow(1) According to the “Treatise on Febrile Diseases”, Section 225: “If the pulse is floating and slow, with exterior heat and interior cold, and if there is diarrhea with clear stools, Si Ni Tang (Frigid Extremities Decoction) is the main treatment.”Note:The slow pulse indicates that it is slow and without strength, indicating internal deficiency and cold; the floating pulse indicates that Yang is deficient and floating externally, hence it must feel weak when pressed.This indicates that there is exterior heat, not due to external pathogens, but due to deficient Yang floating externally.This heat can manifest as a subjective feeling of heat, desiring to undress, lie on the ground, or enter a well, with body temperature not high, yet it can also reach 40°C, persisting or intermittently lasting for months. The internal deficiency and cold lead to diarrhea with clear stools, hence Si Ni Tang is used to restore Yang.(2) According to the “Golden Chamber” on Diabetes: “If the cun pulse is floating and slow, floating indicates deficiency, while slow indicates labor; deficiency indicates insufficient Wei Qi, while labor indicates exhaustion of Ying Qi.”Note:This floating and slow pulse indicates that if the pulse is deep and feels weak, it indicates deficiency and labor, leading to exhaustion of Ying and Wei Qi.(3) According to the “Golden Chamber” on Water Qi Disease: “If the cun pulse is floating and slow, the floating pulse indicates heat, while the slow pulse indicates hidden; heat and hidden collide, leading to sinking.”Note:The floating pulse indicates Yang, while the floating pulse indicates the exterior, hence it indicates exterior heat.“Slow indicates hidden” implies that it has the meaning of hiding and descending.The pulse should be sinking.The floating and sinking pulses refer to pulse positions and should not be seen together.This “heat and hidden collide” indicates that exterior heat has penetrated internally, leading to the pulse changing from floating to sinking, and the pulse can also change from rapid to slow.While slow primarily indicates cold, it can also indicate heat; Da Cheng Qi Tang may also present with a slow pulse due to Qi obstruction.If the pulse is sinking and tight, yet strong, it indicates that cold evil is invading internally, leading to the pulse being tight and spastic, hence treatment should focus on warming and dispersing, resolving it with sweating.If the pulse is sinking and weak, it indicates that it is due to Yang deficiency, hence Yang should be restored to save the reverse flow.If the pulse is sinking and slow, yet there is a sense of restlessness, it indicates that heat has penetrated internally, leading to obstruction of the heat.This heat and hidden collision indicates that internal heat has penetrated, leading to the pulse changing from floating to sinking.17. Floating and HardAccording to the “Treatise on Febrile Diseases”, Section 246: “If the pulse is floating and hard, floating indicates Yang, while hard indicates Yin; the collision of floating and hard indicates that stomach Qi generates heat, leading to the loss of Yang.”Note:The hard pulse indicates a floating and large pulse, indicating that the floating pulse is excessive, leading to the loss of Yang.The hard pulse indicates blood deficiency and Yin deficiency, leading to floating and hard pulses, hence the pulse is floating.Yin deficiency generates internal heat, leading to stomach Qi generating heat, which is termed “deficiency heat”.Yang Qi floating and scattering externally leads to the loss of Yang, and at this time, the pulse may change from floating and hard to fine and weak.18. Floating Like a Bean, Pressing It Increases RestlessnessAccording to the “Golden Chamber” on the Five Organs and Cold-Damp Accumulation: “If the heart is dead, the pulse is floating and feels like a bean; pressing it increases restlessness, indicating death.”Note:The “Plain Questions” states: “The true heart pulse is firm and beats like a bean, indicating that it is dead.”This indicates that the pulse should be harmonious and gentle; if it is firm and beats, it indicates that there is no harmony, indicating that the stomach Qi has been lost, hence death.19. Floating and Firm, Pressing It Feels Like a Cup, Clean and Shiny Like a ShakeAccording to the “Golden Chamber” on the Five Organs and Cold-Damp Accumulation: “If the pulse is floating and firm, pressing it feels like a cup, clean and shiny like a shake, it indicates death.”Note:This is the true pulse of the spleen.The “Plain Questions” states: “The dead spleen pulse is sharp and firm, like the beak of a crow, like the claws of a crow.” This indicates that it is firm and has no harmony, indicating that the stomach Qi has been lost, hence death.20. Floating and Firm, Pressing It Feels Chaotic Like a Rolling Ball, Leading to Sinking in the Chi Position Indicates DeathAccording to the “Golden Chamber” on the Five Organs and Cold-Damp Accumulation: “If the pulse is floating and firm, pressing it feels chaotic like a rolling ball, leading to sinking in the chi position indicates death.”Note:This is the true pulse of the kidney.The “Plain Questions” states: “The dead kidney pulse is firm and beats like a stone, indicating that it is dead.” This indicates that the pulse is floating and firm, indicating that there is no stomach Qi, hence death.Summary:The floating pulse can be distinguished from the floating pulse; the floating pulse refers to the disease position, while the floating pulse refers to an independent pulse pattern.Zhang Zhongjing discusses the floating pulse in many places, often referring to the pulse position.In summary, there are five categories:1. Exterior syndrome with floating pulse:The evil invades the muscle surface, and the righteous Qi exits, competing with the evil at the surface, leading to a floating pulse.Just as stated in Section 45: “Floating indicates being outside.”2. Excessive heat with floating pulse:Exterior heat or internal heat manifesting externally leads to the pulse being floating; this floating pulse should also be rapid and large.3. Evil obstruction, blocking Yang externally, leading to a floating pulse:Due to evil obstruction, Yin and Yang cannot connect smoothly, leading to a floating pulse.This type of Yang obstruction is not due to Yang deficiency and Yin excess, but rather due to evil obstruction leading to a floating pulse.The evil can include the six excesses, seven emotions, Qi, blood, phlegm, and food.Although the pulse is floating, it must have accompanying pulses; in clinical practice, one should determine the pathogenesis based on the accompanying pulses and the four diagnostic methods.4. Deficiency with floating pulse:Deficiency includes deficiency of Yin, Yang, Qi, and blood.In cases of Yang deficiency, the floating pulse may occur due to floating Yang; in cases of Qi deficiency, the Qi cannot stabilize its position, leading to a floating pulse; in cases of blood deficiency, it cannot contain the Qi, leading to a floating pulse; in cases of Yin deficiency, it cannot restrain Yang, leading to a floating pulse.Although the pulse is floating, the accompanying pulses differ, and clinical symptoms and signs vary, allowing for differentiation of the cause of the floating pulse.5. Yang recovery leading to a floating pulse:When Yang Qi is weak and unable to circulate the blood vessels, the pulse may be sinking, fine, and nearly absent.If Yang Qi gradually recovers, the pulse will gradually rise, indicating a sign of Yang recovery and improvement in the condition.If the pulse suddenly rises from a sinking pulse, it indicates Yang collapse, which is dangerous!The floating pulse refers to the disease position, easily obtained when lifted, indicating a floating pulse. The floating pulse must have accompanying pulses, and the accompanying pulses should be used to determine the cause of the floating pulse.The independent floating pulse is characterized by being excessive when lifted and insufficient when pressed, indicating the exterior.The floating pulse has many accompanying pulses, generally divided into two categories: a floating pulse that feels strong when pressed indicates excess, while a floating pulse that feels weak when pressed indicates deficiency.However, if the pulse feels strong and beats without a sense of harmony, it is not a solid pulse, but rather indicates a loss of stomach Qi.Excess indicates that the evil is strong, while deficiency indicates that the essence is lost.As for which evil is excessive and which righteous Qi is deficient, there are also cases of both deficiency and excess, which require differentiation based on the accompanying pulses and the four diagnostic methods.

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• This article is excerpted from “The Complete Medical Works of Li Shimao and Tian Shuxiao, Volume 1”

• Authors: Li Shimao, Tian Shuxiao; Edited by Liu Jifang

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