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

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.

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: