TCM DIAGNOSIS & PULSE DIAGNOSIS

TCM ACUPUNCTURE THEORY – TONGUE DIAGNOSIS

General Theory and Clinical Significance

Why does my acupuncturist look at my tongue?

Tongue diagnosis is an important diagnostic tool in Chinese medicine. It is much easier to learn and less subjective than pulse diagnosis. Generally, it is less channel specific than the pulse, however, the tongue will show the depth and nature (hot, cold, etc.) of an imbalance and it is less effected by short-term influences such as nervousness. The tongue is also useful as a measurement tool to gauge the progress of a disorder.

  • Lower Jiao
    The Base of the tongue corresponds to the Kidney, Urinary Bladder, Large Intestine and Small Intestine Meridians.
  • Â Middle Jiao
    The sides of the tongue correspond to the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patients left side and the Liver on the patients right side.
    The Middle of the tongue corresponds to the Stomach and Spleen Meridians.
  • Upper Jiao
    The Tip of the tongue corresponds to the Lung and the Heart Meridians.

The tongue coat is a good indicator of the state of the Stomach and Spleen. It also shows the strength, depth and temperature of pathogenic factors.

A normal tongue coat is thinnest at the edges, thicker in the center and thickest at the root. It is thin and white, slightly moist and has a root.

Tongue Coat

Coat Coloration

Coat Rooting

TCM ACUPUNCTURE THEORY – PULSE DIAGNOSIS

General Theory and Clinical Significance

Why does my acupuncturist check my pulse?

Pulse diagnosis is one of the more important diagnostic tools used in Chinese and Japanese acupuncture and herbal medicine. While tongue diagnosis provides valuable clinical information, the pulse can be used to gain a deep understanding of the patient on many levels. “Mastering” pulse diagnosis is difficult without the guidance of a skilled teacher. However, even at basic levels, the pulse provides the practitioner with immediate and specific information that can help clarify contradictory diagnostic information and symptomology.

Location of the Pulse: The Guan (Second) Position is found opposite the styloid process of the radius, the Cun Position is found between the Guan Position and the wrist and the Chi position is found at a point equal the distance between Guan and Cun.

Pulse Classic:

Golden Mirror of Medical Traditions:

Alternative view used in China:

  • Superficial (skin level) – generally shows exogenous pathogens
  • Middle – generally shows state of ST/SP Qi
  • Deep (bone level) – generally shows internal conditions
Designation
Sensation
Indications
By Depth: Â Â
Floating(superficial) easily felt at the superficial level
not as significant as you feel deeper
external condition/pathogen
+ empty = yin a/or blood def
+ rapid = wind heat
+ tight/slow = wind cold
Sinking (deep) felt only at the deep level interior condition/obstruction
+ rapid = internal heat
+ slow = internal cold
+ slippery = internal damp/phlegm
+ empty = qi or yang def
By Frequency: Â Â
Slow less than 4 beats per breath (< 60bpm ) cold condition a/or pathogenic factor
+ floating = exterior wind cold
+ sinking/empty = yang def
Rapid more than 5 beats per breath ( > 90bpm ) hot condition a/or pathogenic factor
+ floating = external wind heat
+ sinking = internal heat
+ full = excess heat
+ empty = empty heat
By Quality/Shape: Â Â
Hesitant(choppy) rough and uneven blood a/or jing stagnation
Slippery smooth with a viscous sensation excess dampness, retention of food, pregnancy
+ rapid = damp heat
+ slow = cold damp obstruction
Tight tension with side to side movements (thicker than a wiry pulse) excess cold – interior or exterior, commonly associated with pain
Wiry tension with no side to side movements (thinner than a tight pulse) LV/GB disharmony
By Width: Â Â
Big (excess, overflowing) broad but with distinct edges excess heat, commonly in ST or Intestines
Thin (thready, fine) fine but with distinct edges blood a/or qi deficiency
By Strength: Â Â
Empty(deficient) wide but not strong, disappears with slight pressure, forceless blood a/or qi deficiency
Full (excess) wide and strong, felt with strength at all levels excess condition, often excess heat with rebellious Qi
By Length: Â Â
Short not felt in all 3 positions qi deficiency
Long felt beyond the 3 positions excess, heat, generally considered normal in absence of other qualities
By Rhythm: Â Â
Hurried(abrubt) rapid with irregularly missed beats heat agitating qi & blood
Intermittent regularly skipped beats heart disharmony, exhaustion of zang qi
Knotted slow with irregularly missed beats cold obstruction, ht qi or yang deficiency, general def of Qi, Blood a/or Jing
  • The pulse should be felt in all 9 positions.
  • The quality of the pulse should have “spirit” and not collapse or feel hard or unyielding.
  • The rhythm should be even and balanced and regular beats of 60-90bpm.
  • Age – the strength and quality of the pulse will decline as a person ages.
  • Gender – Men are generally stronger on the left and Women are generally stronger on the right.
  • Seasonal Influences:

·· Spring – more wiry
·· Summer – stronger
·· Winter – deeper