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Let’s discuss the understanding of pulse diagnosis. However, we will not delve into lengthy theories, diagnostic methods, elements, or schools of thought; instead, we will share insights and personal experiences regarding the floating pulse.
The definition of floating pulse in textbooks is as follows: it is easily felt with light pressure, slightly diminishes with heavy pressure but does not disappear, is abundant when lifted, and insufficient when pressed. The characteristic of this pulse is that the pulsation is located in the superficial layer just beneath the skin. Therefore, it is easily felt with light pressure and slightly diminishes with heavier pressure.
Pulse description: abundant when lifted, insufficient when pressed. Main condition: exterior syndrome, also seen in floating yang deficiency syndrome.
In practical learning and clinical practice, I have found that the textbook definition of floating pulse is not entirely accurate or may be misleading. If one immediately concludes that a floating pulse indicates an exterior syndrome and thinks to use dispersing herbs to treat it, this can be quite harmful. Unfortunately, there are many practitioners who make hasty judgments without a thorough understanding of pulse characteristics and indiscriminately prescribe medications.
In fact, simply stating that a pulse is floating does not indicate a specific problem. For example, thin individuals often have a floating pulse, which can be easily felt with light pressure; does this mean they all have an exterior syndrome? Certainly not. The pulse is dynamic and must be understood and assessed in its dynamic context.
Furthermore, a single pulse characteristic cannot determine the underlying issue. A single pulse characteristic only reflects the current state of the individual’s bodily functions. To determine the problem, one must also consider the location of the pulse and whether there are accompanying pulses. For instance, if a floating pulse is present in all six positions of the hands and is accompanied by a tight pulse, this indicates a Taiyang (Greater Yang) cold damage; if it is accompanied by a slow pulse, it indicates a Taiyang wind strike; if all six positions show a floating pulse but with weak or diminished resistance upon heavy pressure, this suggests a deficiency condition. The treatment formulas for these three scenarios differ significantly. A floating pulse with a tight pulse indicates a Ma Huang Tang (Ephedra Decoction) condition, while a floating pulse with a slow pulse indicates a Gui Zhi Tang (Cinnamon Twig Decoction) condition. Lastly, a floating pulse with diminished resistance upon heavy pressure may require consideration of formulas like Jian Zhong Tang (Middle Building Decoction).
If the floating pulse does not appear uniformly across all six positions but is present only in the cun, guan, or chi positions, it should be analyzed more specifically based on the current context; one cannot simply conclude that a floating pulse indicates an exterior syndrome.
So, what exactly is a floating pulse? A floating pulse refers to the pulse that rises towards the surface, indicating an upward movement. It is generally understood to be located in the outermost layer of the skin. However, this can vary from person to person; for example, a floating pulse in an overweight person may be deeper than a sinking pulse in a thin person.
A floating pulse indicates the trend of the pulse’s movement, with its strongest point at the surface layer. It can be easily felt with light pressure; this means that the maximum strength of the pulse is at the surface. However, it is important to note that while the pulse’s energy and strength are maximized at the surface, heavy pressure must not yield an empty pulse; it should still be strong. This is what defines a floating pulse. If the pulse is merely floating but disappears or weakens under heavy pressure, it is classified as a hollow pulse (Kao Mai), not a floating pulse. If the pulse is floating but has its strong point at the deeper level, meaning it is weak under light pressure but strong under heavy pressure, this indicates a solid interior condition. Conversely, if it is strong under light pressure but weak under heavy pressure, this indicates an interior deficiency. A true floating pulse is characterized by being strong under light pressure and not diminishing significantly under heavy pressure. It is crucial not to make blanket assumptions based solely on the presence of a floating pulse.
Next, let’s address the question: why does a pulse float? A floating pulse indicates a certain state of the body; regardless of the situation, as long as the characteristic of being easily felt with light pressure is present, it indicates a dynamic movement of qi and blood towards the exterior. This may be due to internal heat stimulating the pulse, or it may be a response to external pathogens causing the righteous qi to move outward to combat the evil. Another possibility that should not be overlooked is that a deficiency of the righteous qi that cannot consolidate may also result in a floating pulse. Therefore, it is essential to consider accompanying pulses and the location of the floating pulse to make a proper judgment; a floating pulse alone only indicates a state.
How to take a floating pulse? The “Binhai Pulse Studies” states: “Like wood floating on water.” This description is quite apt. We can try to feel this sensation by placing a bamboo stick in water; it will float. When we press it down with three fingers, we can observe the sensation beneath our fingers. This is similar to the floating pulse; when heavy pressure does not yield an empty pulse, the deeper we press, the more the stick will float due to the buoyancy of the water. In the human body, it should be similar; a floating pulse is characterized by heavy pressure not yielding an empty pulse. If we apply strong pressure and the pulse disappears or weakens, it cannot be considered a true floating pulse.
Alright, I have shared some insights with everyone. Below is a discussion from the “Binhai Pulse Studies” regarding floating pulse:
Floating like wood floating in water, hollow and large indicates a hollow pulse. A light tap and it floats indicates a surging pulse, though it may be abundant when it comes and slow when it goes.
Floating pulse is light and flat like twisting scallions. If it is weak, it comes slowly and is empty. A floating pulse that is soft and fine is considered moist, while one that scatters like willow catkins has no fixed trace.
(A strong floating pulse is surging, a slow floating pulse indicates deficiency, excessive deficiency leads to scattering, a weak floating pulse indicates a hollow pulse, and a soft fine floating pulse indicates moisture.)
Poem on main conditions: A floating pulse indicates a Yang exterior condition; a slow pulse indicates wind, rapid heat, tight cold, and constriction. A strong floating pulse indicates wind-heat, while a weak floating pulse indicates blood deficiency.
A floating pulse at the cun position indicates headache and dizziness due to wind, or there may be phlegm obstructing the chest. A floating pulse at the guan position indicates earth deficiency and wood excess, while a floating pulse at the chi position indicates urinary obstruction.
(A floating pulse indicates an exterior condition; a strong pulse indicates a solid exterior, while a weak pulse indicates a deficiency; a floating slow pulse indicates wind, a floating rapid pulse indicates wind-heat, a floating tight pulse indicates wind-cold, a floating slow pulse indicates wind-dampness, a floating weak pulse indicates heat due to exhaustion, a floating hollow pulse indicates blood loss, a floating surging pulse indicates deficiency heat, and a floating scattered pulse indicates extreme exhaustion.)