Abstract: Today, we will introduce three common pulse patterns encountered in clinical practice.
01 Floating Pulse Does Not Always Indicate Exterior Condition
According to the “Shang Han Lun” (Treatise on Cold Damage), it states: “If the pulse is floating, the disease is in the exterior.” This has been the primary interpretation of floating pulse in subsequent pulse literature.
However, the “Jin Kui Yao Lue” (Essential Prescriptions of the Golden Chamber) states: “If a patient’s pulse is floating at the front, the disease is in the exterior; if floating at the back, the disease is internal. If there is low back pain and inability to walk, it must be due to shortness of breath and extreme fatigue.”
Generally, various schools interpret the front and back in terms of the cun (寸) and chi (尺) positions. Due to the different locations of the floating pulse, the reflected pathological changes can vary significantly.
Therefore, I believe that the interpretation of “floating pulse indicates exterior condition” should be revised.
Floating pulse is easily obtained and is located at the superficial level of the body.
The term “exterior” refers only to the location of the pulse; whether it indicates an exterior syndrome, internal syndrome, external pathogen, or internal injury must be observed through accompanying signs, such as floating and slack, floating and tight, floating and slow, or floating and rapid, and analyzed in conjunction with the symptoms presented.
Thus, the “Shang Han Lun, Tai Yang Disease Chapter” states: “If there is fullness below the heart, and the pulse is floating and soft, Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction) is indicated.”
Furthermore, the “Yang Ming Disease Chapter” states: “If the pulse is floating with fever, thirst for water, and difficulty in urination, Zhu Ling Tang (Polyporus Decoction) is indicated.”
The “Jin Kui Xue Bi Chapter” states: “If a man has a pale complexion, it indicates thirst and loss of blood, sudden shortness of breath and palpitations, and a floating pulse indicates internal deficiency.”
Additionally, the “Jaundice Chapter” states: “A floating pulse at the chi position indicates kidney damage.”
All these floating pulses do not belong to the category of exterior syndromes.
As stated in the “Jing Yue Quan Shu, Pulse Spirit Chapter”: “Floating indicates the pulse is at the surface; however, in true cases of wind-cold external invasion, the pulse is actually not floating, but rather tight and rapid with slight floating characteristics, indicating exterior evil. The symptoms must include fever, no sweating, and body aches as indicators.
If the pulse is floating and slack, it is not an exterior evil. Generally, a floating pulse that is strong and vigorous indicates excess Yang, thus fire must accompany it, or phlegm may be present internally, or Qi may be obstructed above, which can be inferred.
If the floating pulse is weak and empty, it indicates insufficient Yin; insufficient Yin leads to signs of fluid deficiency, or blood not nourishing the heart, or essence not transforming into Qi, indicating internal deficiency. If one considers these as exterior syndromes, the harm would be great.
Jing Yue’s discussion is based on certain clinical experiences.
The reason the pulse is floating is primarily due to an excess of Qi rising and not descending, often reflecting a condition of excess above and deficiency below, with strong Yang and weak Yin.
As stated in the “Jin Kui”, “shortness of breath and extreme fatigue” is precisely due to Yang deficiency and insufficient Yin, causing Qi to be forced upwards and not being absorbed.
Floating is indeed a Yang pulse, but there is a distinction between having Yin excess rejecting Yang externally and having Yin deficiency with Yang overflowing externally.
In cases of Yin excess, there is internal cold; treatment should focus on warming and dispersing, either guiding out the fluids, attacking the food stagnation, or moving the stasis of blood and phlegm, forcefully opening the blockages, with slight clearing to assist the floating Yang in internal harmony, such as Bai Tong Jia Zhu Dan Zhi Tang (White Atractylodes Decoction with Pig Bile) (Scallion white, dried ginger, Aconite, human urine, pig bile, etc.).
In cases of Yin deficiency, the Yin is weak and cannot reach the Yang; treatment should focus on warming and nourishing essence and blood, with slight assistance from warming and heating to allow Yang to emerge from Yin and accept Yang Qi back to its root, such as Gui Fu Ba Wei Wan (Cinnamon and Aconite Eight Flavor Pill).
I once treated a young impoverished farmer who had a continuous fever for four days without sweating, working as usual without rest, and not taking any medicine. On the fifth day, he was exhausted and came for treatment, with hot skin, lung Qi obstructed, and shortness of breath. The pulse was leaping on the skin, extremely rapid, and upon slight pressure, it was not discernible. The tongue coating was thin with little moisture, but he was not thirsty, indicating a condition of fluid depletion and Yin-Yang not interacting.
Immediately, I prescribed: Dang Shen (Codonopsis) 18g, Fu Pian (Aconite) 9g, Mai Men Dong (Ophiopogon) 18g, Wu Wei Zi (Schisandra) 3g, Zhi Gan Cao (Honey-fried Licorice) 9g, Gan Di Huang (Rehmannia) 15g, Xi Xin (Asarum) 3g.
After taking the medicine twice, the next morning he began to sweat, the fever subsided, and the pulse was no longer rapid; upon further pressure, it was clear. However, he had intermittent sweating and slight aversion to cold, and the pulse remained floating. I then prescribed Gui Zhi Jia Fu Zi Tang (Cinnamon Decoction with Aconite) for recovery.
The formula was based on Shen Fu Decoction and Sheng Mai San, modified to warm and nourish the original Yang, and support the generation of body fluids, using only a small amount of Xi Xin to penetrate Yin and reach Yang.
This was originally an external invasion, but due to his persistent labor without rest and not taking medicine in a timely manner, it led to internal heat burning, resulting in a deficiency of both Yin and Yang.
If one merely observes the floating pulse and applies sweating methods, the outcome would be unpredictable.
Therefore, my understanding is: Floating indicates the pulse is at the surface, referring to the location of the pulse; one must observe the accompanying signs of the floating pulse, analyze whether it belongs to cold, heat, deficiency, or excess syndromes. It is incorrect to assume that “floating pulse is an exterior disease, and exterior diseases are only seen with floating pulses.”
02 Differentiating Between Soft Pulse and Weak Pulse
Soft, pronounced as “ru”, is a mispronunciation of the character.
Wang Shuhe in the “Pulse Classic” directly refers to it as soft pulse, only noting in the annotations that “soft can also be pronounced as ru”.
Looking at Cheng Wujis’ annotations on the “Shang Han Lun, Differentiating Pulse Method”, it becomes clearer.
In explaining the character “ru” in “blood governs softness”, he states: “Ru is pronounced as ‘ru’, meaning moistening,” and in the same section, he explains “Yang and Yin pulses are large and soft,” stating, “The pronunciation is soft, meaning gentle.”
Therefore, it is essential to accurately pronounce and interpret; they must not be confused.
Soft pulse is weak and soft with little strength; the tactile sensation under the fingers is “like cotton floating on the water surface, light when touched gently, heavy when pressed hard.” Therefore, it appears as a pulse at the floating level.
It is neither like the weak pulse, which is large and powerless, nor like the fine pulse, which is thin like silk, nor like the weak pulse, which is deep, thin, and weak.
Thus, the differentiation between soft pulse and weak pulse begins with the distinction of floating and sinking; soft pulse appears at the floating level, while weak pulse appears at the sinking level, requiring “pressure to discern”.
Secondly, it can be differentiated based on the pulse body and pulse quality; soft pulse is fluffy and soft like cotton, while weak pulse is deep, thin, and weak, ultimately allowing for differentiation.
However, some pulse literature does not distinguish between soft and weak, treating them as weak pulses regardless of their body characteristics or main diseases, which is not in line with clinical practice.
Based on personal experience, I will briefly compare the following:
1.From the perspective of main diseases, soft pulse often reflects an excess of dampness, while weak pulse is commonly seen in patients with Qi deficiency.
Because soft pulse indicates dampness, it is often seen in patients with limb fatigue, skin edema, and conditions like sores and eczema.
As historical records state: “If the pulse feels like mud, dampness combined with heat indicates that the soft pulse leans towards excess evil.” Also, because weak pulse indicates Qi deficiency, it is often seen in patients with shortness of breath, inability to endure labor, and spontaneous sweating or night sweats, indicating that the pulse is weak due to insufficient Qi.
2.From the perspective of pathological changes, soft pulse indicates dampness, and excess dampness can stagnate Qi, so the pulse feels floating and solid; weak pulse indicates Qi deficiency, and deficiency can lead to cold, although the pulse may be deep and thin, it does not necessarily feel soft.
If the soft pulse is floating and does not appear too weak, it must be due to dampness combined with heat, indicating turbid Qi rising; if the weak pulse is deep and thin but does not appear too soft, it must be due to deficiency combined with cold, indicating cold leading to urgency.
There are cases where soft and weak pulses are seen simultaneously, with soft being more pronounced than weak, often seen in cases of dampness invading the liver and spleen, while lung and stomach Qi is obstructed, presenting clinical symptoms of chest fullness, limb aches, etc. Conversely, when weak is more pronounced than soft, it is often seen in cases of true Yang deficiency of the heart and kidney, with spleen and lung Qi deficiency, presenting clinical symptoms of indigestion, abdominal pain, and diarrhea.
However, it does not exclude the possibility of Yin deficiency harming dampness, where the pulse may present as deep and soft, or Qi deficiency harming wind, where the pulse may present as floating and weak.
With countless variations, careful examination is essential.
3.From the perspective of treatment principles,for soft pulse indicating excess dampness, the treatment should focus on aromatic herbs, supplemented with sweet and warm herbs; aromatic herbs are used to transform dampness, while sweet and warm herbs are used to benefit Qi, as excess dampness often originates from Qi deficiency.
For weak pulse indicating Qi deficiency, the treatment should focus on sweet and warm herbs, supplemented with aromatic herbs; sweet and warm herbs are used to benefit Qi, while aromatic herbs are used to awaken the spleen, as Qi deficiency generally requires warming the middle.
For soft pulse that is not too weak, slightly add bitter and cold herbs to clear the heat it carries; for weak pulse that is not too soft, add spicy and warm herbs to transform the internal cold. The mixture of soft and weak pulses often presents in this manner.
Note: This article is excerpted from “Selected Lectures on TCM, Volume 1”, compiled by the TCM Graduate Class of the TCM Research Institute, published by the People’s Health Publishing House in October 1980. This public account is used solely for academic exchange; if there is any infringement, please contact for deletion, and please indicate the source when reprinting.
Cover image sourced from Shetu Network.
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