Pulse and Tongue diagnosis in TCM
Why does Acupuncturist’s always check our Tongue and Pulse?
It actually feels weird to show our tongue. We never really get used to pull it out at each appointment with a Chinese Medicine therapist. What does he actually see there? And what is he also feeling when taking the pulse with so much focus? Why does he need to take the pulse on both sides?
For many patients, the act of showing the tongue and having both pulse palpated brings a lot of curiosity and intrigue. Here is a short presentation to bring some light to these questions and help you to understand what is going on.
Although the Pulse and Tongue diagnosis are Traditionally very important, they are not the only tools used by a TCM therapist to do his investigation. Tongue and Pulse diagnosis are part of the four methods of examination called “Sì Zhěn Hé Cān” (四診合參): Observation, Listening-Smelling, Inquiry, and Palpation (望, 聞, 問, 切). The four examinations are complementary and are all necessary to be able to make a precise TCM diagnosis.
The speciality of the Pulse and Tongue, is that these 2 examinations are going to allow the therapist to have a deep insight of the internal condition of the body.
So, what does my tongue show?
When observing the tongue, a therapist is going to study the tongue’s body: Color, Shape, Features, Moisture, Coating, Coat Thickness, Cracks, and Root.
These will give important indications on the state of the Blood, Qi, Dampness, Dryness, Heat, Cold, Yang, Yin within the body. A qualified therapist will understand the Patterns or Syndromes that the body is facing and showing through the tongue.
As shown in the photos below, here are some examples of what a tongue observation can reveal:
As we can see in the illustrations, a tongue with teeth marks might indicate a Qi deficiency (氣虛), a purple tongue some Blood stagnation (血瘀), a red tongue might indicate Heat (熱邪), etc. These signs are very valuable information for the choice of the treatment.
By looking under the tongue, the therapist will gain information about the condition of the Blood and how it circulates. Dark Blood vessels will indicate Stagnation (血瘀), paler color will indicate a Deficiency (虛), large vessels will indicate Accumulation (結), etc..
What does my pulse say?
The pulse will help the therapist to gain a deep understanding of the patient's condition. It will also provide immediate and specific information about the Blood - Qi (血 - 氣) quality and quantity, the states of the internal organs (臟腑), and the circulation of the liquids (津液). A proper pulse intake can also help clarify contradictory diagnostic information or symptomatology shown by the patient.
Firstly, a TCM therapist will use 3 fingers to check 3 localisations on both right and left sides. Each localisation will describe the state of the internal organs and viscera:
Secondly, a therapist is going to pay attention to the following 6 big criteria:
Frequency: Fast - Slow (數脈 - 遲脈)
Rhythm: Regular - Irregular (緩脈 - 代脈)
Strength: Full - Empty (實脈 - 虛脈)
Depth: Superficial - Deep (浮脈 - 沈脈)
Shape: Large - Thin (大脈 - 細脈)
Length: Short - Long (短脈 - 長脈)
From here, we can get additional information about the aspect of the pulse: Slippery (滑脈), Choppy (澀脈), Hidden (伏脈), etc. In total, there are 29 standard pulses defined, but in the ancient texts, much more nuance can be found.
Some examples on how to interpret the pulse: ¨Slow¨ might be a sign of internal cold (cold feet, cold hands, etc.), ¨Fast¨ might be a sign of internal heat (fever, inflammation, etc.), ¨Slippery¨ might be a sign of internal dampness (heaviness, bloating, etc.) and so on.
A pulse can also have a combined aspect: ¨Fast + Slippery¨ = Accumulation of Damp-Heat (ex: Gallstone), ¨Slow + Slippery¨ = Accumulation of Damp-Cold (ex: Osteoarthritis), ¨Superficial + Fast¨ = External Heat (ex: fever), ¨Deep + Weak¨ = Qi Deficiency (ex: fatigue), ¨Deep + Slow¨ = Internal Cold (ex: oedema), etc.
The pulse and tongue diagnosis, which represents only a small but very important aspect of the TCM diagnosis method, will help to determine the appropriate acupuncture points, herbs and tools needed to provide an efficient treatment.
The four methods of examination (四診合參) are equally important. Each of them will help to collect clinical data from different angles. With its own unique meaning and vision, one examination method cannot be replaced by another. Emphasizing only one of them and neglecting the others, will not allow a complete understanding of the condition.
* Written by Cedric Mallants / Acupunctuur en Traditionele Chinese Geneeskunde therapist
Huang Di Nei Jing (黃帝內經)
The Foundations of Chinese Medicine (Giovanni Maciocia)