Experiencing wind-cold results in a floating pulse indicative of an exterior syndrome. If a floating pulse suddenly appears after a prolonged illness, it often signifies the symptoms of vacuous yang escaping. This is often accompanied by profuse sweating like oil, dyspnea resembling that of a cow, and a flushed face akin to makeup, resembling a state of returning light. The floating pulse is present, but the sinking pulse is absent, lacking a root. Both floating and sinking pulses can be present in exterior syndromes, indicating a situation where yang qi is surging upwards, blocking the pathogenic factors outside the body. There are differences between strong and weak pulses, rooted and unrooted, vacuous and solid.
Experiencing wind-cold results in a floating pulse indicative of an exterior syndrome. If a floating pulse suddenly appears after a prolonged illness, it often signifies the symptoms of vacuous yang escaping. This is often accompanied by profuse sweating like oil, dyspnea resembling that of a cow, and a flushed face akin to makeup, resembling a state of returning light. The floating pulse is present, but the sinking pulse is absent, lacking a root. Both floating and sinking pulses can be present in exterior syndromes, indicating a situation where yang qi is surging upwards, blocking the pathogenic factors outside the body. There are differences between strong and weak pulses, rooted and unrooted, vacuous and solid.
When palpating the pulse, one must first consider the individual’s constitution. If a person appears robust, one cannot hastily conclude that a floating pulse is abnormal; doing so would be rigid and dogmatic. Observation is the first step; the strength or weakness of the constitution, regardless of gender, age, or body type, all fall within a normal range and state of floating and sinking. A thin and weak individual may have a slightly floating pulse, easily detectable with a gentle touch; one cannot hastily label this as an exterior syndrome, as their thin blood vessels are more easily felt, appearing on the surface. Naturally, if they catch a cold, the floating pulse will be more pronounced. Conversely, a larger individual may have a sinking pulse; it does not necessarily indicate an interior syndrome, as the abundance of flesh may cause the blood vessels to be deeper. It is challenging for them to exhibit a floating pulse unless they are severely ill.
This is a matter of flexible mastery; one cannot adhere rigidly to textbook dogma. With more experience, one will understand the various deviations. It is essential to cultivate personal experience rather than uniformly concluding that a floating pulse indicates a specific illness. The key is to assess whether there is central qi within the pulse, and whether the overall pulse pattern aligns with the principles of qi transformation. An overly large or overly small pulse indicates a problem; the six pulse positions should be relatively balanced. If one pulse position suddenly becomes large or small, it indicates an issue. When diagnosing, one should first palpate the six pulse positions to gain a general impression, noting the states of floating and sinking, rapidity, and slowness, to understand the individual’s physical condition. Then, one can meticulously examine the internal organs according to the floating and sinking pulses and the nine positions, which is the method.
If one is unfamiliar, one should palpate the pulse more frequently and inquire about symptoms without hesitation. Consider the symptoms and the pulse pattern together to see if they align. Over time, one will summarize their own experiences. If the thought process is correct, one can practice based on that; one must have a basis to rely on. Without this method, one may become confused, hastily diagnosing a patient without experience, leading to errors.
Floating pulses are larger during the day and sinking pulses are finer at night; floating pulses are larger during the day and dead at night, while sinking pulses are finer at night and dead. The diagnostician should consider the floating and sinking pulses alongside vacuity and solidity. In patients with prolonged illness, the floating pulse is more pronounced during the day, while the sinking pulse becomes more pronounced at night, indicating excessive yin qi leading to death at night. The hidden bone pulse is even more sinking than the sinking pulse, indicating severe yin excess and insufficient yang qi. Blood flow is impeded; blood is the carrier of yang, and when yang can enter yin, it can transform yin. When it becomes a solid yin pulse, it sinks to the bones, which does not necessarily indicate cancer, but there is certainly a substantial issue present, such as tumors or excessive accumulation of nutrients that cannot be expelled.
A normal person should exhibit a vacuous and agile pulse, where yang qi transforms nutrients into energy. When yang qi is depleted, the intake of tangible substances must transform into intangible yang qi; yang transforms into qi, and yin takes form. Residual waste must be expelled in a timely manner; otherwise, the body cannot function properly. The zang organs store and do not expel, preserving the essence and qi, which are not tangible substances. The fu organs expel and do not store, expelling tangible substances, not essence and qi. The pulse is a reflection of the five phases; a pulse below five beats per breath is considered a slow pulse, while above five beats is a rapid pulse. A slow pulse indicates cold, while a rapid pulse indicates heat, with distinctions between solid heat and vacuous heat. A fine and weak pulse indicates vacuous heat, while a strong and rapid pulse indicates yangming solid heat syndrome, often accompanied by high fever.
The pulse pattern is dynamic, evolving with the progression of the illness. For instance, when one first experiences cold, it may present as a floating tight pulse indicative of the Ma Huang Tang syndrome, where tightness indicates cold stagnation. Without treatment, it may progress inward, stagnating and transforming into heat, leading to the Da Qing Long Tang syndrome. This is akin to current outbreaks of SARS or H1N1, presenting with high fever, cough, and pneumonia. There may still be some cold on the exterior, accompanied by slight chills, leading to a floating and large pulse. Initially, when there is no heat, the pulse may not be overly rapid. If untreated, the exterior syndrome of the floating pulse will dissipate, and everything will sink inward. This transition from the taiyang to the yangming stage results in a rapid pulse indicative of the Bai Hu Tang syndrome. If treatment is not administered, the heat will become excessive, damaging body fluids, leading to a rapid pulse, a sinking pulse that feels empty, and a weak pulse pattern, indicating the patient has entered the Bai Hu Tang syndrome, requiring Ren Shen (Ginseng) to replenish their fluids. If treatment is not given, the patient may develop a fine pulse indicating both yin and yang vacuity, with cold extremities and heart failure, necessitating the addition of yang-replenishing herbs such as Shen Fu Tang and Si Ni Tang.
Vacuous heat is still heat; when the heart beats slowly, blood returns to the heart, fills it, and is then expelled. If the heart beats too quickly, blood may not have time to enter before being expelled, resulting in wasted effort. If the heart contracts without blood, it cannot effectively pump. The pulse method: the Fu Yang pulse is slow and gentle, while the Guan pulse is slow and steady. A slow pulse indicates that yang qi is abundant, while a slow pulse indicates that yin qi is strong; yin and yang are in harmony, and both nutritive and defensive qi are functioning together, achieving a balance of hardness and softness, which is termed strong. A slow and gentle pulse is the normal pulse of a healthy individual, akin to that of athletes. Although the heart rate may be slow, it is rhythmic, and this should not be considered pathological.
It is said: in patients with a rapid pulse, rapidity indicates heat; one should reduce food intake and induce vomiting to promote sweating, allowing yang qi to be slightly diminished, leading to a vacuous pulse. Rapidity indicates external heat that cannot be dispelled, resulting from a cold and vacuous stomach. A rapid pulse indicates yangming vacuity, which should not be hastily labeled as heat. When vacuous heat occurs, blood cannot descend, and the stomach cannot receive blood, leading to an inability to eat. When fire is present above, yang qi cannot descend, resulting in a fine pulse pattern. As a person approaches death, a slow pulse is rare, while a rapid pulse is common. When yang qi is exhausted, the floating pulse appears to be vacuous and wanting to escape, hence the pulse is seen as rapid. Generally, a pulse rate of seven to eight beats per breath indicates an inability to be saved. In cases of vacuous labor, this pulse is most to be avoided. If the pulse rate exceeds ten beats per breath, death is imminent. This indicates the presence of heart failure. When treating illness, observe the pulse’s trajectory; if the pulse becomes increasingly rapid after medication, it indicates that the prescription is incorrect. If the pulse slows down and approaches five beats per breath, it indicates that the direction is correct, and one can observe the development and prognosis from the pulse pattern.
Slippery and rough pulses indicate the interplay of yin and yang. A slippery pulse indicates abundant blood and vacuous qi, while a rough pulse indicates vacuous blood and abundant qi. The liver stores blood while the lungs store qi; hence, the liver pulse is slippery while the lung pulse is rough. The lung’s nature is to gather, while the liver’s nature is to generate; gathering leads to roughness, while generating leads to slipperiness. Metal gathers from above, while wood generates from below; thus, the lung pulse is floating and rough while the liver pulse is sinking and slippery. Gathering leads to qi accumulation, while generating leads to qi dispersion; hence, the lung pulse is short and rough while the liver pulse is long and slippery. Qi is yang, yet contains yin; blood is yin, yet contains yang. Therefore, a slippery pulse indicates yang while a rough pulse indicates yin. When blood is abundant, a flowing pulse is present; a rough pulse indicates a significant deficiency of qi and blood, akin to a light knife scraping bamboo. Sufficient blood is necessary for pregnancy; thus, a slippery pulse is a pregnancy pulse; without blood, the fetus cannot be sustained. Yin and yang are interdependent; one cannot simply categorize where is yin and where is yang. Although the liver pulse governs blood, it is still classified as yang.
The pulse method: large, floating, rapid, moving, and slippery are termed yang; sinking, rough, weak, wiry, and faint are termed yin. The nature of metal and water is to gather, while wood and fire is to generate; gathering leads to sinking and roughness, while generating leads to floating and slipperiness. When the pulse is large, it indicates yang, while a small pulse indicates yin. A large pulse indicates yang excess, while a small pulse indicates yin excess. A large pulse at the cun position and a small pulse at the chi position indicates normal qi; however, if the cun pulse is excessively large, it indicates upper heat, while if the chi pulse is excessively small, it indicates lower cold. Frequent palpation of normal pulses will help one understand what is excessive, necessitating regular practice.
However, a large pulse cannot be hastily deemed as yang excess, nor can a small pulse be hastily deemed as yin excess. “Pulse method”: a wiry and large pulse indicates reduction; a large pulse indicates a hollow pulse; reduction indicates cold; a hollow pulse indicates vacuity; cold and vacuity are intertwined, termed as leather pulse. In women, this may lead to postpartum hemorrhage, while in men, it may lead to blood loss and sperm depletion. This is due to yang deficiency and dampness; when water and fire do not interact, fire becomes excessive and metal is consumed, leading to a floating and large pulse at the cun position; when water is cold and wood is stagnant, it leads to a floating and large pulse at the chi position. A hollow pulse appears very large and firm on the surface, but feels empty inside, resembling a scallion; this pulse does not indicate a solid condition, as there is abundant qi but insufficient blood. An excessive hollow pulse can develop into a more rigid leather pulse, indicating different degrees of severity; leather indicates fire rising without descending, with lung metal being affected. If there is a sudden loss of blood, the heart’s pumping force may become significantly stronger to maintain blood pressure and oxygen supply.
Women experiencing significant blood loss or blood donation may exhibit a hollow pulse, which is a sign of weakness. I once palpated a young man with this pulse; he mentioned he had donated blood a few days prior. Essence and blood are precious substances in the body; although they can be regenerated, they still require the consumption of original qi and yang qi for production. However, excessive blood loss may lead to a sinking and fine pulse, indicating blood loss and essence depletion. At that moment, the heart continues to work harder, as the body has compensatory functions. To claim that blood donation has no effect on a person is misleading. Donating a small amount of blood, such as 200cc, allows the circulatory system to regenerate new blood. This is acceptable; the liver metabolizes waste, and when functioning normally, it can eliminate waste. If the function is abnormal, waste cannot be expelled, leading to thick blood. If blood is drawn, and after half a month, blood lipid levels remain unchanged, it indicates a problem.
After blood donation, one may feel quite well, as it helps filter the blood, leading to a refreshing feeling. This is because the body’s waste elimination function is impaired; one should fundamentally improve liver and kidney function. When the liver is healthy, it can eliminate impurities and waste, while retaining beneficial substances. The body has its own functions; if one continually forces blood donation, it can severely harm the body’s yang qi. This is the reason why blood dialysis is problematic; while it is necessary for life, continual blood donation becomes unsustainable. Using machines for blood dialysis is merely a maintenance measure, but ultimately, it is not a solution. Maintaining liver and kidney function and essence is crucial for longevity and health; relying on external methods is not viable. Utilizing herbal medicine, acupuncture, and exercise to restore liver function will naturally eliminate waste, leading to improved blood quality; this is the long-term solution.
In ancient times, when faced with significant blood loss, what methods did traditional Chinese medicine employ? TCM believes that yang can stabilize yin; after excessive blood loss, large doses of Shen Fu Tang or Du Shen Tang were used to stabilize qi and stop the bleeding. This method was employed to maintain life, allowing the body to regenerate blood. Western medicine may provide quicker solutions through blood transfusions or surgeries, which is a point of superiority. However, the side effects must be considered; ultimately, the priority is to save lives. However, continual blood transfusions are certainly not advisable. It is unnecessary to transfuse blood; everything must be dialectical. If conditions allow, herbal medicine should be used for regulation. TCM historically did not have blood transfusion methods, and surgical techniques were not passed down. Western medicine excels in emergency trauma care, which cannot be denied, but in chronic disease management, TCM often yields better results. The decline of TCM is due to the loss of many classical methods; later generations only learned superficial formulas without mastering the fundamental principles. If TCM professors cannot palpate pulses, how can TCM be revitalized? This is an unavoidable issue.
In summary, when wood and fire leak, the pulse becomes large; when metal and water gather, the pulse becomes small. When yang leaks, it leads to upper heat and lower cold; when yang is stored, it leads to clarity above and warmth below. The pulse of labor-induced vacuity is most to be avoided. If the root of yang is severed, a large floating pulse without return indicates impending death. Therefore, a large pulse indicates disease progression, while a small pulse indicates disease regression. A small pulse cannot support yang, while a large pulse cannot assist yin; one must investigate the source of the size and understand its origins. These pulse patterns reveal the functions of the body, ultimately reflecting the balance of yin and yang. A weak individual fears a large pulse indicating yang escape; if one can treat a large pulse into a sinking and fine pulse, it indicates progress. One cannot claim that treatment is making the patient weaker; many heart disease patients initially present with a rapid and large pulse, which is not a calm and composed normal pulse, but rather a sign of the heart struggling to maintain its function. Treatment that calms the pulse leads to a smaller pulse, and the patient may feel increasingly energetic; this is often observed in clinical practice.
A large pulse may indicate a person lying there unable to move; a large pulse is not necessarily a good sign. A large pulse is a compensatory function of the body, maintaining oxygen and blood supply to the brain and organs, exerting greater force to deliver blood. If the body’s qi and blood can supply normally, the heart does not need to exert such force; a gentle pulse is sufficient. Therefore, a large pulse does not indicate strength; rather, it reflects a deficiency of blood and oxygen in the body. The normal pulse is neither fast nor slow, neither sinking nor floating, but rather calm and gentle, with qi and blood flowing normally. Where there is a large pulse, there is often a deficiency elsewhere. Many people claim their pulse feels strong, but this may indicate hypertension. The pulse of a child is the most normal, soft and balanced.
The warm disease school posits that a large pulse indicates yin deficiency and yang excess, suggesting that replenishing yin may not be appropriate. When yang qi escapes outward, replenishing yin may lead to further solidification of yin and further vacuity of yang. Thus, many theories from the warm disease school are worthy of scrutiny, although their clinical cases are well documented. Western medicine also believes that anti-inflammatory medications are effective for bacterial coughs and fevers, but whether the individual can fully recover is another matter. The warm disease school and Western medicine can alleviate symptoms, but the standards for clinical recovery differ. The warm disease school and Western medicine often leave a gap in achieving full recovery. The classical formula school mobilizes the body’s own qi transformation ability to expel the illness, which is closer to true recovery. The proficiency of the physician varies; once a certain level of medication is reached, the results may plateau, and further improvement becomes difficult. Therefore, continuous theoretical advancement is necessary; the higher the level, the greater the proof of one’s medical skills. All methods can be effective; the distinction lies in how far they deviate from the body’s normal state.
— THE END —
▶ Copyright Statement:
1. Source: “Wang Si Jin’s Lecture on Classical Formulas” reprinted from “Five Flavors of Ancient Method TCM” Edited by/Bai Xiaolin
2. This platform aims to disseminate knowledge of TCM culture; copyright belongs to the relevant rights holders. We respect knowledge and labor; please retain copyright information when reprinting. If there are any improper uses, please feel free to contact us for negotiation. Contact (WeChat): gyzdxueshu
3. We welcome submissions; submission email: [email protected]
