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A question was asked: Why is a floating pulse considered a Taiyang exterior syndrome? The answer is: When pressed deeply, the force feels insufficient; when lifted lightly, the pulsation is prominent. Hence, it is called "floating." The *Neijing* states: "A floating pulse at the Cun Kou (radial artery) indicates disease located in the exterior." A floating and tight pulse indicates Cold Damage (Shanghan); a floating and moderate pulse indicates Wind Strike (Shangfeng). Both indicate exterior pathogens. If the pathogen enters the interior, the pulse must become deep; how could it be floating? Therefore, a floating pulse belongs to Taiyang exterior syndrome. Another question was asked: Although a floating pulse indeed belongs to an exterior syndrome, if interior symptoms appear while the pulse remains floating, how should treatment proceed? The answer is: An interior syndrome presenting with a floating pulse suggests that the exterior pathogen has not yet been fully resolved. One must first release the exterior before attacking the interior. Medical texts state: "If the exterior is not resolved, do not attack the interior." Zhang Zhongjing stated: "In Jie Xiong syndrome (chest binding), if the pulse is floating, purgation is contraindicated." This demonstrates that a floating pulse indicates the pathogen is in the exterior. However, if the exterior syndrome has already subsided, yet constipation, delirium, abdominal pain, and thirst are present, while the pulse remains floating, one should apply a flexible approach and use purgation. Zhang Zhongjing stated: "When the pulse is floating and there is intense heat, indicating involvement of the zang organs, employ purgation; do not induce sweating." This refers to relying on symptoms rather than solely on the pulse.

A question was asked: Why is a pulse that cannot be felt (hidden/fu pulse) considered an exterior syndrome? The answer is: The vessels are the reservoir of blood. Heat causes blood to flow freely; how could there be a hidden pulse due to heat? Only when cold pathogen penetrates deeply does the pulse become hidden. Inability to feel the pulse in one hand is called "single hidden"; inability to feel it in both hands is called "double hidden." When Taiyang exterior signs are manifest externally, but the pulse is hidden and unfelt, it is due to obstruction by cold qi. However, this is actually a sign that sweating is imminent and recovery is approaching. Medical texts state: "When the weather is hot and muggy, heavy rain must follow; after the rain, the weather clears, just as spirit refreshes after sweating." Another question was asked: What causes a hidden pulse in interior syndromes? The answer is: A hidden pulse in interior syndromes occurs only in direct transmission of cold (Zhi Zhong), also caused by obstruction of cold qi. It is appropriate to use Si Ni Tang (Four Reversal Decoction) added with Porcine Bile (Swinis Fel) and Scallion White (Cong Bai) to warm the body. If the disease transmits through the meridians into the interior, it belongs to heat syndromes. Heat causes blood to flow; how could the pulse be hidden? Another question was asked: There are also Yang syndromes presenting with a hidden pulse; what is the cause? The answer is: In Yang syndromes, a hidden pulse results from extreme depression of heat, which paradoxically presents as false cold. The pulse is extremely choppy and sluggish, appearing hidden but not truly hidden. However, it must be accompanied by symptoms such as cracked lips, dry mouth, desire for cold drinks, and constipation. This is worlds apart from the hidden pulse seen in Yin-cold syndromes. Alternatively, there may be painful areas; when pain reaches its extreme, the pulse becomes hidden, and when pain ceases, the pulse reappears. As for ordinary hidden pulses, they are either exterior syndromes or direct transmission of cold.