How to understand this? For example, if there are symptoms like chills, fever, headache, runny nose, and body aches, these are signs of exterior cold, which correspond to the pulse indicating the exterior. Of course, conditions like edema, acne, and eczema also count as exterior symptoms. If the pulse is floating, these conditions also require treatment to release the exterior. Therefore, it is not necessary to use Lian Qiao (Forsythia) and Jin Yin Hua (Honeysuckle) just because there is acne; nor is it necessary to use He Ye (Lotus Leaf) and Huo Xiang (Agastache) just because there is eczema; nor is it necessary to use Chan Tui (Cicada Slough) and Fang Feng (Saposhnikovia) just because there is dermatitis and itching. The pulse must be floating to treat the exterior. If the pulse is deep, slippery, and rapid for acne, then Da Cheng Qi Tang (Major Order the Qi Decoction) with modifications must be used; if the pulse is deep and slippery for eczema, then Fu Ling (Poria), Yi Yi Ren (Job’s Tears), and Zea Xie (Alisma) must be used to transform the interior dampness for effectiveness; if there is dermatitis and itching with a deep, wiry, and rapid pulse, using Bai Shao (White Peony) and Shi Jue Ming (Abalone Shell) to calm internal wind and stop itching will be more effective. Therefore, pulse diagnosis is not only about diagnosing diseases and syndromes but can also be used for prescribing herbs.

Once the floating pulse is established, it is also necessary to determine whether it is slow or rapid, and whether it is strong or weak. A floating pulse that is weak and slow, with exterior symptoms, often indicates a person with Qi deficiency and external cold, which can be treated with Gui Zhi Tang (Cinnamon Twig Decoction) or Huang Qi Gui Zhi Tang (Astragalus and Cinnamon Twig Decoction), or even the later Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If there are no exterior symptoms, but sweating and fatigue are present, it often indicates Qi deficiency that cannot contain, and Sheng Mai Yin (Generate the Pulse Decoction) with modifications can be used. If there is significant Yang deficiency, Zhi Ren (Alpinia) and Bu Gu Zhi (Psoralea) can be added; if Qi deficiency is significant, Huang Qi (Astragalus), Bai Zhu (White Atractylodes), and Fang Feng (Saposhnikovia) can be added. Why is Sheng Mai Yin the best foundational formula? Because Wu Wei Zi (Schisandra) has the effect of containing Qi, which is more effective than a bunch of Yin tonics combined with Qi tonics.

If the floating pulse is rapid and strong, with symptoms of fever, sweating, coughing, and nasal congestion, it indicates a combination of exterior excess and heat, and generally Yin Qiao San (Silver Willow Powder) is more appropriate; of course, if there is an external wind-cold transforming into heat, the pulse may also be floating, tight, and rapid, accompanied by irritability, indicating a Da Qing Long Tang (Major Blue Dragon Decoction) pattern. However, the distinction between the two is whether there is thirst and sweating at the onset of the illness.

Of course, in clinical practice, there are many atypical floating pulses, such as a light floating pulse that becomes slippery when pressed hard. If this is a patient with external cold, it corresponds to the “Shang Han Lun” (Treatise on Cold Damage) saying that a wine drinker has changed to a cold damage syndrome, and Gui Zhi Tang should not be used with it. So what to do? Not treat it! It is not possible to have a situation where Zhang Zhongjing did not provide a treatment method; it is actually not difficult, Gui Zhi Tang combined with Er Chen Tang (Two Aged Decoction) can be used, which addresses both the exterior syndrome and the Taiyin phlegm-damp interior syndrome, and the two formulas can be used together.

Therefore, to learn TCM and become a qualified doctor, or to aspire to be a renowned physician, I believe it is essential to master pulse diagnosis, especially for young doctors. If one does not learn it well and has no patients, they will only be frustrated and may even change careers.

The above content reflects the author’s views. If there are any inaccuracies, I hope colleagues will provide corrections.

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