To treat diseases, one must seek the root cause. In Traditional Chinese Medicine (TCM), treatment relies on the four diagnostic methods, analyzes the pathogenesis based on these methods, determines the syndrome type, establishes treatment principles, and prescribes accordingly. Each step is interconnected and essential. The diagnostician employs the four examinations: observation, listening, inquiry, and palpation; the analysis involves determining the pathogenesis and syndrome type. TCM diagnosis began with the Huangdi Neijing (Yellow Emperor’s Inner Canon), developed through the Shanghan Lun (Treatise on Cold Damage) and Jinkui Yaolue (Essentials from the Golden Chamber), refined during the Jin and Yuan dynasties, and completed in the Ming and Qing dynasties, continuously incorporating new diagnostic methods and progressing to this day.
This set of notes is my personal reflection on the university textbook TCM Diagnosis, presented in a different order from the textbook, and contains my personal insights and summaries. I am an amateur enthusiast of TCM, not a medical professional, so any errors in the text are to be expected.
(103) Floating Pulse and Deep Pulse
Floating Pulse
To learn about the floating pulse, one must first understand what “floating pulse” means.
A pulse that is felt at the surface of the body and can be easily obtained is called a “floating pulse”; a pulse that is easily felt but slightly diminishes with deeper pressure is referred to as “floating pulse” in a broader sense. Some people refer to the former as the narrow definition of floating pulse and the latter as the broad definition.
Ancient scholars described the floating pulse as “like wood floating on water,” which is quite appropriate! (See, I don’t always dismiss the ancients.) The mechanism of the floating pulse is due to external pathogenic factors, with the righteous qi resisting the evil at the surface. Since the righteous qi is not deficient, the pulse diminishes slightly but does not disappear with deeper pressure.
Modern medicine believes this pulse is due to the heart expelling an increased volume of blood, causing peripheral blood vessels to dilate, reducing vascular resistance, and resulting in a full radial artery. However, the floating pulse does not necessarily indicate this mechanism.
The broad definition of floating pulse is the most complex among the 28 pulse types. It includes the narrow definition of floating pulse and also encompasses the phenomenon of the pulse simply floating upwards. The causes can be due to the six excess pathogenic factors, internal injuries, emotional disturbances, or both internal and external factors; the disease location can involve one organ or multiple organs; the etiology can be singular or complex; the disease condition can range from mild, new illnesses to severe, chronic conditions; it can be associated with cold or heat syndromes; and it can be either excess or deficiency. It can even represent a normal pulse without disease.
In autumn, when yang qi contracts, the pulse response is not as immediate, resulting in a normal, non-pathological floating pulse, which is the mechanism behind the saying “autumn pulses are often floating.”
The verse for floating pulse is recited from the original text in Binhuh Maixue:“Floating pulse only travels on the flesh, like following the elm pods, light as hair. In the three autumns, if it is present, know there is no illness; if a long-term illness encounters it, it can be alarming.”
The phrase “if a long-term illness encounters it, it can be alarming” refers to a person with a chronic illness whose pulse suddenly becomes very floating, indicating a sign of yang collapse and a portent of death.
Deep Pulse
According to TCM Diagnosis: “It does not respond to light pressure, but is felt with heavy pressure; it is insufficient when lifted and excessive when pressed.” The deep pulse is very straightforward; the most forceful deep pulse is considered a deep pulse.
The deep pulse indicates interior conditions. A strong pulse indicates interior excess, while a weak pulse indicates interior deficiency.
The formation of the deep pulse has both excess and deficiency factors. One is due to internal excess pathogenic factors causing stagnation, with the righteous qi still strong, leading to a struggle between the evil and the righteous internally, causing qi stagnation and blood obstruction, thus the yang qi is restrained and cannot push the pulse qi outward, resulting in a deep and forceful pulse; the other is due to weakness of the organs, insufficient qi and blood, or yang deficiency and qi exhaustion, leading to weak upward movement and inability to push the pulse qi outward, resulting in a deep and weak pulse.Additionally, overweight individuals often have deep pulses due to excessive flesh. The pulse at the wrist is generally slightly deeper than at the cun and guan positions, which is a normal physiological phenomenon, as blood vessels are structured this way; in winter, qi and blood contract and sink, hence the pulse tends to be deeper. People who frequently take diuretics or antihypertensive medications also tend to have deeper pulses.
Modern medicine believes this pulse is due to the heart reducing or maintaining normal blood output, causing peripheral blood vessels to constrict and increasing vascular resistance.There are also two pathological mechanisms to consider: one is emotional depression, which prevents the qi mechanism from moving, resulting in a deep pulse; the other is water qi obstructing the heart, leading to insufficient heart yang, weak beats, reduced blood output, and also resulting in a deep pulse. The ancients said: “A deep pulse is attributed to water.” Some practitioners also refer to the deep pulse as “water pulse.”
I have composed a verse: “A deep pulse is seen with heavy pressure, like a stone thrown into water between muscles and bones.”
Deficiency, excess, floating, and deep pulses all belong to the “six categories of pulses,” which must be mastered proficiently.