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.
Common Tongue Geography and Meridian Correlations
- 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.
Body Colors and Clinical Indications
Pink
Normal or mild disorder
PALE
Yang, blood a/or qi def
Deficiency Cold
+thin & dry= blood def
+ wet = qi def
+ swollen= qi def
+ swollen & wet = yang def
RED
Heat
+ no coating = yin def empty heat
+ yellow coat = excess heat
+ wet= damp heat
+dry = injured fluids
DARK RED (Scarlet, Cardinal)
Extreme heat
More severe conditions than red
PURPLE
Stagnation
lv qi stagnation is likely
+ pale = cold
BLUE
Severe internal cold
Stagnant blood
Body Shape and Indications
CRACKED
if develops during illness indicates chronic and severe, otherwise normal
location of cracks relates to organ pathology
+ red = empty heat consuming fluids
+ pale = blood & qi def
crack runs from center to the tip = ht disorder or congenital ht problems
horizontal cracks = yin def
SHORT (contracted)
serious conditions
blood deficiency
ht deficiency
+ pale or purple = cold or yang def
+ swollen = damp or phlegm
+ red = heat consuming the fluids
DEVIATED (crooked)
wind
FLACCID
deficiency heat
+ pale = blood & qi def
+ dark red = yin collapse
LONG
Heat in the ht
RIGID
Stroke or early signs of stroke
STIFF
heat in the ht
ht/sp heat
phlegm obstructing the ht qi
+ normal & pale = wind, stroke
SWOLLEN
deficiency
+ pale & wet – yang def
+ teethmarks & pale = qi def or excess fluids
+ dark red = excess heat usually ht/sp
THIN
blood or fluid def
empty heat consuming fluids
+ pale = blood & qi def
+ red = yin def
THORNY (strawberry, granular)
heat
congealed blood
+ on tip = ht fire
+ on edges = lv/gb fire
+ on center = st a/or intestines heat
TREMBLING (quivering)
deficiency heat
+ pale = qi def
+ red =heat prod yin collapse
Tongue Coatings and Indications
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
THIN
normal
exterior condition, wind-cold
THICK
excess damp/phlegm
food stagnation
DRY
heat consuming yin
excess yang or fire
deficiency fluids
MOIST
normal or mild imbalance
WET
excess fluids from yang def
dampness
STICKY (greasy, creamy)
dampness or phlegm
retention of food
Coat Coloration
WHITE
Internal or external cold if coat looks like cottage cheese = ST heat + thin coat & body aches = exterior wind-cold + thin coat & thorny = wind-heat
YELLOW
internal or external heat effected by coffee, tea a/or smoke intake
GRAY
hot or cold internal condition retention of phlegm heat + dry = heat consuming body fluids + moist = damp cold
BLACK
severe condition involving hot or cold + pale = excessive cold from yang def + dry & possible thorny = consumption of body fluids
Coat Rooting
OOTED moss appears firmly implanted
strong st/sp qi
ROOTLESS moss appears to float on the surface
st/sp qi def
PEELED
sp qi def deficient yin or fluids
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.
Common Tongue Geography and Meridian Correlations
Cun (inch) – 1st position
Left Wrist: HT / SI
Right Wrist: LU / LI
Guan (barr) – 2nd position
Left Wrist: LV / GB
Right Wrist: SP / ST
Chi (foot) – 3rd position
Left Wrist: KD / UB
Right Wrist: PC / TH
Alternative Meridian Relationships
Pulse Classic:
Cun (inch) – 1st position
Left Wrist: HT / SI
Right Wrist: LU / LI
Guan (barr) – 2nd position
Left Wrist: LV / GB
Right Wrist: SP / ST
Chi (foot) – 3rd position
Left Wrist: KD / UB
Right Wrist: Mingmen / Lower Burner
Golden Mirror of Medical Traditions:
Cun (inch) – 1st position
Left Wrist: HT / PC
Right Wrist: LU / CHEST
Guan (barr) – 2nd position
Left Wrist: LV / GB
Right Wrist: SP / ST
Chi (foot) – 3rd position
Left Wrist: KD / LI / SI
Right Wrist: PC / TH
Alternative view used in China:
Cun (inch) – 1st position
Left Wrist: HT / SI
Right Wrist: LU / LI
Guan (barr) – 2nd position
Left Wrist: LV
Right Wrist: SP
Chi (foot) – 3rd position
Left Wrist: KD Yin
Right Wrist: KD Yang
Pulse Levels
- Superficial (skin level) – generally shows exogenous pathogens
- Middle – generally shows state of ST/SP Qi
- Deep (bone level) – generally shows internal conditions
Pulse Descriptions, Qualities and Clinical Significance
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 |
Description of a Healthy (Normai) Pulse
- 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.
Influential Factors
- 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: