Floating Pulse
(1) Pulse Characteristics
The term “floating pulse” has two meanings. One refers to the concept of location, indicating any pulse that can be diagnosed with light pressure, regardless of its size, speed, or strength, as long as it is located superficially. This includes pulses such as Xu Mai (deficient pulse), Wei Mai (minute pulse), Hong Mai (surging pulse), and Ge Mai (leathery pulse). The other meaning refers to a strictly defined independent pulse pattern. To distinguish between the two, the former can be referred to as “pulse floating,” while the latter is called “floating pulse.”
A floating pulse must meet the following conditions:
1. Pulse Location: The pulse is located at the surface of the muscles and can be felt with light pressure. “Light pressure” means that the pulse can be diagnosed with minimal touch, revealing the main characteristics and overall appearance of the pulse. If the pulse can be felt with light pressure but appears different when pressed deeper (either stronger or weaker, larger or smaller, or with a tense or erratic rhythm), it is not considered a floating pulse. The pulse diagnosed with light pressure does not reflect the essence of the disease and therefore cannot be classified as a floating pulse.
2. Pulse Body: Although a floating pulse can be felt with light pressure, its body should neither be too large nor too small, neither too long nor too short. A large pulse would be classified as Hong (surging), Kiao (leathery), Shi (full), or Xu (deficient); a small pulse would be classified as Wei (minute), Xi (fine), or Ru (soft).
3. Pulse Strength: A floating pulse should be easily felt with light pressure but insufficient when pressed deeper, akin to the sensation of twisting a scallion leaf or a piece of wood floating on water. “Insufficient when pressed deeper” means that when the pulse is taken with deeper pressure, it appears weaker compared to when taken lightly. If the pulse remains strong under deeper pressure, it is classified as a solid pulse or a firm pulse. If it is clearly weak under deeper pressure, it is classified as a deficient pulse, which is not a floating pulse.
4. Pulse Amplitude: The rise and fall of the pulse should not be too large or too small. An excessively large amplitude would indicate a Hong or Shi pulse, while an excessively small amplitude would indicate a Xi or Se pulse.
(2) Pulse Theory and Main Diseases
A floating pulse is caused by Qi and blood circulating superficially. Why does Qi and blood circulate superficially? This can be observed in four situations:
1. Normal Pulse: The lung pulse is floating and short. In the four seasons, the autumn pulse should be floating, as autumn corresponds to metal and is associated with the lungs. In autumn, Yang Qi begins to gather after its peak in summer, and the pulse, although floating, shows signs of shortness and constriction, indicating a normal pulse; thus, it should be considered healthy.
2. Pathogenic Attack: A floating pulse in this case indicates a solid condition, commonly seen in newly contracted external diseases. When the six excesses invade, the pathogenic Qi attacks the muscle surface, and the righteous Qi resists the pathogen, preventing it from penetrating deeply. The struggle between the righteous and the pathogenic Qi occurs at the surface, causing the pulse to float, as seen in the pulse of Taiyang disease.
3. Excess Heat: The six Qi transform into fire, the five emotions transform into fire, or Qi, blood, phlegm, and food stagnation transform into heat over time, causing excess heat to invade the surface, resulting in a floating pulse. This type of floating pulse is also indicative of a solid condition.
4. Righteous Qi Deficiency: This type of floating pulse is associated with chronic illness and deficiency conditions. In chronic illness, the righteous Qi is deficient, and the pulse should not be floating; however, if it is found to be floating, there are two possibilities. One is that with appropriate treatment and nourishment, the righteous Qi gradually recovers, leading to a floating pulse, which is a sign of recovery. As stated in the “Treatise on Febrile Diseases” (Shang Han Lun) section 290: “In Shaoyin wind stroke, if the pulse is slightly floating, it indicates recovery.” Section 327 states: “In Jueyin wind stroke, if the pulse is slightly floating, it indicates recovery; if it is not floating, it indicates no recovery.” The other possibility is that the righteous Qi is severely deficient, causing the true Qi to float outward, resulting in a floating pulse. The term “righteous deficiency and floating” includes the deficiency of Yin, Yang, Qi, and blood. If Yin is deficient, it cannot restrain Yang, leading to a floating pulse; if blood is deficient, it cannot maintain internal stability, causing Qi to float outward and the pulse to float. In cases of Yang deficiency, if Yin and cold are prevalent internally, it can also lead to a floating pulse; in cases of Qi deficiency, it cannot stabilize its position and floats outward, resulting in a floating pulse. As stated in “Four Diagnostic Methods” (Si Zhen Jue Wei): “In cases of internal deficiency, there is no pulse that does not float.”
In chronic illness, a floating pulse can present in two forms: gradual floating or sudden floating. Gradual floating may occur as the righteous Qi gradually recovers, or as the righteous Qi gradually depletes, causing the true Qi to float outward. Sudden floating can be seen in cases of sudden loss of righteous Qi, where the true Qi suddenly escapes outward, leading to a violent floating pulse, often indicating a return of light before death. As stated in “Shang Han Lun” section 315: “If the pulse suddenly appears after taking decoction, it indicates death.”
From the above, it can be understood that a floating pulse indicates a pathogen at the surface, or internal heat invading outward, and also indicates internal deficiency.
Deep Pulse
(1) Pulse Characteristics
Similar to the floating pulse, the deep pulse also has two meanings: one refers to the location, indicating any pulse that can only be felt with heavy pressure down to the tendons and bones, regardless of size, speed, or strength, is called deep; the other refers to a deep pulse, which is a pulse with strict characteristics. To distinguish between the two, the former can be referred to as “pulse deep,” while the latter is called “deep pulse.”
A normal deep pulse is insufficient when lifted and strong when pressed, like sand wrapped in cotton, firm inside and soft outside. In addition to being located deep, it must also have the characteristic of being “soft, slippery, and even.” Soft and even indicate a relaxed appearance within the deep pulse, with a smooth and even flow, reflecting the presence of stomach Qi. A deep and slippery pulse indicates Yin (deep) and Yang (slippery), suggesting the presence of Yang submerged in water, which corresponds to the pulse of winter and the kidneys.
(2) Pulse Theory and Main Diseases
The deep pulse is a very important pulse, as it is based on the deep nature. The pulse is defined by the balance of deficiency and excess, and the distinction between deficiency and excess relies on the strength of the deep pulse. Therefore, the deep pulse is extremely important. Why is the pulse deep? Because Qi and blood cannot express outward to invigorate and fill the blood vessels, the pulse is deep. Why can Qi and blood not express outward? There are generally two reasons: one is the deficiency of righteous Qi, leading to insufficient Qi and blood to express outward, resulting in a deep pulse; the other is the obstruction of pathogenic Qi, which blocks the pathway for Qi and blood to express outward, also resulting in a deep pulse.
1. Righteous Qi Deficiency and Deep Pulse: A deep pulse due to righteous Qi deficiency can be seen in cases of Yang deficiency, Qi deficiency, blood deficiency, and Yin deficiency. Yang is active and can stimulate and invigorate the functions of the body. Yang deficiency cannot effectively stimulate and invigorate the circulation of Qi and blood, leading to a deep pulse. Qi is the vessel that invigorates the blood vessels; if Qi is deficient, it cannot invigorate, resulting in a deep pulse. Blood deficiency leads to insufficient filling of the blood vessels, causing a deep pulse. Moreover, blood deficiency often accompanies Qi deficiency, leading to both Qi and blood being insufficient, resulting in a deep pulse. If Yin is deficient, the blood vessels may also be insufficiently filled, leading to a deep pulse. In cases of righteous Qi deficiency and a deep pulse, the pulse is deep and weak.
When a deep and weak pulse is observed clinically, the nature of the disease is undoubtedly deficient. However, to determine whether it is Yang deficiency, Qi deficiency, blood deficiency, or Yin deficiency, one must analyze and judge based on the accompanying pulses and the three diagnostic methods of observation, listening, and inquiry. In cases of Yang deficiency, the pulse is deep, slow, and weak, accompanied by cold limbs, pale tongue, and slippery coating. In cases of Qi deficiency, the pulse is deep and weak, accompanied by shortness of breath and weakness. In cases of blood deficiency, the pulse is deep, thin, and weak, accompanied by a pale complexion, palpitations, and a pale, tender tongue. In cases of Yin deficiency, the pulse is deep, thin, and rapid, accompanied by signs of deficiency heat, a red tongue, and little coating. When discussing floating pulses, it was mentioned that righteous deficiency can lead to a floating pulse; here, it is stated that righteous deficiency can also lead to a deep pulse. Is this contradictory? Not at all. Righteous deficiency can manifest as either a deep or floating pulse, depending on the degree and nature of the deficiency. In cases of Yang deficiency, if the deficiency is not severe, the pulse may be deep and weak; however, if Yang deficiency leads to the rejection of Yin and Yang, causing Yang Qi to escape outward, the pulse may change from deep and weak to large, surging, floating, or scattered. If Yang deficiency becomes more severe, even the floating force may be lost, leading the pulse to change from floating to deep and thin, or even to a pulse that is absent. In cases of mild Qi deficiency, the pulse may not withstand heavy pressure or may be weak when pressed. If Qi deficiency is accompanied by internal heat, the Qi and blood may float outward due to the pressure of the internal heat, resulting in a large, rapid, and floating pulse. In cases of extreme Qi deficiency, the pulse may float and scatter, potentially changing to a deep and thin pulse. Since blood is the mother of Qi, blood deficiency often accompanies varying degrees of Qi deficiency. When Qi and blood are insufficient, they cannot invigorate the blood vessels, leading to a deep, thin, and weak pulse. If blood deficiency cannot maintain internal stability, Qi may float outward, resulting in a large, weak pulse. Especially when blood is suddenly lost, Qi escapes outward, leading to the appearance of a large, hollow, or leathery pulse. In cases of Yin deficiency, if Yang Qi has not yet floated outward, the pulse often presents as deep, thin, and rapid. If Yin deficiency is more severe, and Yin cannot restrain Yang, leading to Yang floating outward, the pulse may present as large, surging, rapid, or as a pulse that is strong in Yang and weak in Yin. Therefore, both righteous deficiency and deep pulse can manifest as either deep or floating, depending on the degree and nature of the deficiency.
2. Obstruction by Pathogenic Factors and Deep Pulse: Internal and external pathogenic factors can obstruct Qi and blood from expressing outward, leading to a deep pulse, including the six excesses, seven emotions, and Qi, blood, phlegm, and food.
(1) External Cold: Cold is a Yin pathogenic factor that constricts and obstructs, preventing Qi and blood from flowing freely, resulting in a deep pulse. As stated in the “Golden Chamber” (Jin Kui Yao Lue) on spasms: “In Taiyang disease, if the symptoms are present, the body feels strong, yet the pulse is deep and slow, this indicates Taiyang disease. The pulse should be floating; why is it deep and slow? This is due to the invasion of wind-cold obstructing the blood vessels, preventing Qi and blood from flowing freely, resulting in a deep pulse.
(2) Internal Heat: Internal heat can obstruct Qi, preventing Qi and blood from flowing freely, leading to a deep pulse. Additionally, internal heat can consume Yin fluids, causing the blood to become thick and sluggish, resulting in a deep pulse. The deeper the heat, the slower the pulse becomes. As stated in “Shang Han Lun” section 208: “In Yangming disease, if the pulse is slow, Da Cheng Qi Decoction should be used.” Da Cheng Qi Decoction is a strong formula for purging heat accumulation, yet if the pulse is slow, it indicates that the cause is not cold but rather heat obstruction. This type of deep pulse must be strong when pressed and may present with signs of agitation and restlessness. Further examination of the tongue will reveal a red, dry tongue with a yellow coating, and signs of internal heat.
(3) Qi Stagnation: Emotional disturbances can lead to Qi stagnation, preventing Qi and blood from flowing freely, resulting in a deep pulse.
(4) Phlegm, Blood Stasis, Food Accumulation: These three can obstruct Qi, preventing Qi and blood from flowing freely, leading to a deep pulse.
In cases of righteous deficiency, the pulse is deep and weak; in cases of obstruction, the pulse is deep and strong.
Slow Pulse
(1) Pulse Characteristics
A slow pulse is defined as having three beats per breath. If only the number of beats is considered, some issues may arise. The slow pulse is categorized into three positions: cun (distal), guan (middle), and chi (proximal). If only the cun pulse is slow, it should have three beats per breath; if the guan and chi pulses are not slow, they should have five beats per breath. The pulse rates of cun, guan, and chi should be consistent and cannot differ. For example, in the “Golden Chamber” (Jin Kui Yao Lue) on chest obstruction, it states: “If the cun pulse is deep and slow, the guan pulse is small and rapid.” The cun pulse should have three beats per breath, while the guan pulse should have six beats per breath. Since the three positions of the pulse are interconnected and move as one, the pulse rates should be equal, and it is impossible for the rates to differ. If one insists on categorizing the slow pulse by the number of beats, it can only lead to the conclusion that the ancient categorization of slow pulses is incorrect, and Zhang Zhongjing’s classification of cun and guan pulses is absurd.
We believe that the determination of a slow pulse should be based on the pulse characteristics rather than the number of beats. The pulse’s every beat is slow, regardless of whether it has three, four, or even five beats per breath, it is still considered slow. In clinical practice, the pulse in all three positions should have consistent rates, while the pulse characteristics may differ. Therefore, the characteristics of a slow pulse should focus on the pulse characteristics rather than the number of beats.
One may ask, how can a slow pulse be distinguished from a rough pulse? Both have the characteristic of being slow and difficult; however, the rough pulse has a smaller amplitude when it beats, while the slow pulse has a larger amplitude.
(2) Pulse Theory and Main Diseases
A slow pulse is due to the sluggish movement of Qi and blood, resulting in a slow pulse. The causes of sluggish Qi and blood movement are generally due to righteous Qi deficiency or obstruction by pathogenic factors.
1. Righteous Qi Deficiency and Slow Pulse: Righteous Qi deficiency, including the deficiency of Yin, Yang, Qi, and blood, can lead to sluggish Qi and blood movement, resulting in a slow pulse.
(1) Yang Deficiency and Slow Pulse: Yang deficiency cannot warm or invigorate Qi and blood movement; internal cold leads to Qi and blood stagnation, resulting in a slow pulse. This can occur in cases of kidney Yang deficiency, spleen Yang deficiency, heart Yang deficiency, and liver Yang deficiency, all of which can lead to a slow pulse. This slow pulse is typically deep and weak.
(2) Qi Deficiency and Slow Pulse: Qi deficiency leads to insufficient force to propel the blood, resulting in a slow pulse. This slow pulse is typically deep and weak.
(3) Blood Deficiency and Slow Pulse: Blood deficiency cannot fill the blood vessels, leading to a dry and sluggish pulse. As stated in “Shang Han Lun” section 50: “If the chi pulse is slow, it is not advisable to induce sweating; how do we know this? It is due to insufficient nourishment and low blood volume.”
Yang deficiency, Qi deficiency, and blood deficiency can all lead to a slow pulse that is weak. The distinguishing features are that Yang deficiency is accompanied by cold limbs and a pale tongue; Qi deficiency is accompanied by shortness of breath and weakness, without significant cold signs; blood deficiency is accompanied by a pale complexion, palpitations, and a pale, thin pulse.
(4) Yin Deficiency and Slow Pulse: A Yin deficient pulse is often thin and rapid, and while slow pulses are less common, they are not impossible. For example, if heat injures the fluids, causing the blood to become thick and sluggish, it can also lead to a slow pulse. In cases of Yin deficiency, the tongue is red with little coating, accompanied by signs of Yin deficiency and Yang excess heat.
2. Obstruction by Pathogenic Factors and Slow Pulse: External and internal pathogenic factors, emotional disturbances, and Qi, blood, phlegm, and food can all obstruct the blood vessels, leading to a slow pulse.
(1) Cold Pathogenic Factors: Cold is a Yin pathogenic factor that constricts and obstructs, preventing Qi and blood from flowing freely, resulting in a slow pulse. As stated in the “Golden Chamber” (Jin Kui Yao Lue) on spasms: “In Taiyang disease, if the symptoms are present, the body feels strong, yet the pulse is deep and slow, this indicates Taiyang disease. The pulse should be floating; why is it deep and slow? This is due to the invasion of wind-cold obstructing the blood vessels, preventing Qi and blood from flowing freely, resulting in a slow pulse.
(2) Heat Pathogenic Factors: Internal heat can obstruct Qi, preventing Qi and blood from flowing freely, leading to a slow pulse. Additionally, internal heat can consume Yin fluids, causing the blood to become thick and sluggish, resulting in a slow pulse. The deeper the heat, the slower the pulse becomes. As stated in “Shang Han Lun” section 208: “In Yangming disease, if the pulse is slow, Da Cheng Qi Decoction should be used.” Da Cheng Qi Decoction is a strong formula for purging heat accumulation, yet if the pulse is slow, it indicates that the cause is not cold but rather heat obstruction. This type of slow pulse must be strong when pressed and may present with signs of agitation and restlessness. Further examination of the tongue will reveal a red, dry tongue with a yellow coating, and signs of internal heat.
(3) Qi Stagnation: Emotional disturbances can lead to Qi stagnation, preventing Qi and blood from flowing freely, resulting in a slow pulse.
(4) Phlegm, Blood Stasis, Food Accumulation: These three can obstruct Qi, preventing Qi and blood from flowing freely, leading to a slow pulse.
In cases of righteous deficiency, the pulse is deep and weak; in cases of obstruction, the pulse is deep and strong.
Rapid Pulse
(1) Pulse Characteristics
A rapid pulse is defined as having six beats per breath. This is based on the number of beats. However, I believe that the rapid pulse should be characterized by the pulse’s appearance rather than the number of beats. A pulse that comes and goes quickly is considered a rapid pulse. The number of beats can be six, five, or seven per breath. The “Inner Canon” (Nei Jing) describes the rapid pulse as “thin and quick.” Thin indicates a sense of urgency, while quick indicates speed. A pulse that comes and goes quickly is a rapid pulse. Clearly, the “Inner Canon” defines the rapid pulse based on its appearance rather than the number of beats. The “Pulse Classic” (Mai Jing) also states: “A rapid pulse comes and goes quickly,” which is also based on the “appearance” of the pulse rather than the number of beats. Even if the pulse has six beats per breath, if it does not feel urgent or quick, it should not be classified as a rapid pulse. Therefore, the rapid pulse should focus on the pulse’s appearance. Otherwise, how can the historical pulse texts explain the classification of rapid pulses? For example, how can the statement “If the cun pulse is deep and slow, the guan pulse is small and rapid” be explained?
(2) Pulse Theory and Main Diseases
A rapid pulse can be due to two main reasons: excess Yang heat and righteous Qi deficiency.
1. Excess Heat and Rapid Pulse: A rapid pulse due to excess Yang heat can be seen in cases of the six Qi transforming into fire, the five emotions transforming into fire, as well as phlegm, dampness, blood stasis, and food accumulation transforming into heat, leading to excess Yang heat. When heat is excessive, it stirs Qi and blood, causing them to move quickly, resulting in a rapid pulse.
Due to the different causes of excess Yang heat, the accompanying pulses may vary. In cases of Qi stagnation transforming into fire, the pulse may be deep and rapid, or deep and wiry. In cases of external invasion of the six excesses transforming into heat, the pulse may be surging and rapid, or deep and solid. In cases of phlegm or food accumulation transforming into heat, the pulse may be slippery and rapid. In cases of dampness transforming into heat, the pulse may be soft and rapid. Of course, aside from the different accompanying pulses, other symptoms and signs should also be considered for differentiation. These rapid pulses are all indicative of excess heat and should be treated primarily with cooling and purging methods.
2. Righteous Qi Deficiency and Rapid Pulse: Righteous Qi deficiency, including the deficiency of Yin, Yang, Qi, and blood, can also lead to a rapid pulse.
(1) Yin Deficiency and Rapid Pulse: Yin deficiency cannot restrain Yang, leading to an excess of Yang, stirring Qi and blood, resulting in a rapid pulse. This pulse is often thin and rapid. If Yin deficiency cannot maintain internal stability and Yang Qi floats outward, the pulse may be floating and rapid but cannot withstand heavy pressure.
(2) Yang Deficiency, Qi Deficiency, and Blood Deficiency: All can lead to a rapid pulse, as the deficiency of righteous Qi causes Qi and blood to become agitated, leading to a rapid pulse that becomes more rapid as the deficiency worsens. This rapid pulse may be deep and thin, or floating and large, but all will be weak when pressed, and treatment should focus on warming and tonifying.