One of the earliest references to pulse diagnosis appears in the Huangdi Neijing, also known as The Yellow Emperor’s Internal Classic or The Yellow Emperor’s Classic of Internal Medicine. A passage in the book notes that, “In diagnosis, observation of the spirit and facial color, and palpation of the pulses, are the two methods that were emphasized by the ancient emperors and revered teachers,” which implies that the practical use of pulse diagnosis existed long before the Huangdi Neijing was written. Pulse and tongue diagnosis are two of the more important diagnostic tools in Chinese medicine. They are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Of the diagnostic tools, pulse diagnosis is one of the more important tools used in Chinese 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. Pulse diagnosis is the ancient art and science of detecting status of a persons body, mind and spirit. Even at basic levels, the pulse provides immediate and specific information that can help clarify contradictory diagnostic information and symptomology .
The pulse can be influenced by factors like age ,in this case the strength and quality of the pulse will decline as a person ages ,or gender , Men are generally stronger on the left and Women are generally stronger on the right. Another factor is the season when you have a more wiry pulse in Spring time ,stronger in the Summer and deeper in the Winter. Tongue and pulse diagnosis are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Generally the tongue, is much easier to learn and less subjective than pulse diagnosis. It is less meridian 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. I believe the TCM is about energy and energy function condition medicine culture, it is more than construction medicine culture, the pulse diagnosis is a energy feeling diagnosis, no only a position touch feeling diagnosis. In an ideal situation, the pulse is taken in the morning while the person is still calm and rested.
In actuality, however, the procedure usually takes place in the clinic during the initial interview. It is important to let patients who have just arrived rest for a while to allow the pulses to settle down. Otherwise, it would be easy to mistake a rapid pulse for a heat condition when it is actually due to the person’s hurrying to make the appointment. This is one situation when sitting in the waiting room is to the patient’s advantage. From my personal experience in the clinic I can say some of the patients find pulse taking strange (on the first session) and also they seem to be a little bit uncomfortable when you ask to see their tongue. The pulse can be felt in a number of locations, the primary location is at the radial artery in the wrist. Each wrist has three positions that correspond to different organs. The left wrist corresponds to the heart, liver , and kidney yin .The right wrist gives information about the lungs, spleen , and kidney yang . In clinical practice, we have to always combine the pulse information with the whole picture derived from looking, listening, smelling, and asking.
Through this process, traditional Chinese practitioners are able to accurately diagnose the patterns of imbalance in their patients without the help of laboratory tests or expensive diagnostic equipment. To make the patient feel more comfortable when the pulse is being take you must ensure you introduce yourself to the patient, explain the procedure answering any questions they may have, ask for their consent and also make sure they are sitting comfortably, with their arm rested. Sometimes what the patient says contradicts the pulse qualities, in which case the acupuncturist will want to ask more questions to get at the truth. Without the pulse diagnosis he wouldn’t have known to ask more questions, to delve deeper, and might have done the wrong treatment. If the patient is taking medication, or just been taking strenuous exercise, pulse taking may not work. If the patient is under the influence of social drugs it may not reveal much. Some patients have arteries that travel on the thumb side of the radial bone so you can’t feel the pulse in the normal position. Some patients have pulses so small (itself a pointer to their health) that they are very hard to take. The pulse quality often changes within a few seconds of inserting the needle in the right place.
As the right treatment progresses, the pulse qualities and strength improve, so that the acupuncturist knows, from pulse diagnosis, that the patient will start feeling better soon. There are three positions a practitioner is looking for, and each position represents a different organ or part of the body. This is the reason we take the pulse on both sides, not just one. By taking the pulse, we can tell if patients eating habits are good, if they have a cold coming on, and if their energy is high or low. We can also take note of how your organs are functioning at that time. The tongue has a special relationship with the Heart, in that the Heart opens to the tongue. The tongue is said to be an “offshoot” of the Heart, or “flowers” into the Heart. The tongue, containing water, electrolytes, mucus, and enzymes, is a very sensitive organ and its appearance changes with many physical changes in the body.
In Chinese medicine, the tongue is a “map” of the internal body. Like the face, the tongue is divided into five-element zones that correspond to your internal organ networks. The tongue reading it’s all about finding what areas are stagnated, which need to be nourished, which are getting too much circulation or too little circulation, too much energy or too little, and how to balance out the body so that everything is in harmony. When we use the tongue as a tool for analysis and diagnosis, we are looking at the shape, shadings, markings, wetness, texture and even the way someone sticks out her tongue. Having this knowledge can help describe the current state of a patient health, as well as his or her genetic tendencies. It is a diagnostic technique, and it can reveal an existing disease process and disclose many things about a person on many levels. All the organs and the entire body can be located on specific regions of the tongue.
The beauty of tongue diagnosis is in its simplicity and immediacy. Benefits of tongue diagnosis include: assesses a person’s current health condition; informs the practitioner about the underlying cause of disease; is an accurate way of determining what is happening in the digestive system: liver, stomach, spleen, small and large intestines; reveals the stage and progression of a particular illness; reflects the quality of the circulation of blood, bodily fluids and essence; mirrors the condition of the bodily fluids, function of the organs, strengths and depth of the pathogenic factors in the body; shows the quality of the individual’s energy production.
A normal tongue should be pink, muscular without tooth marking or discoloration, and have a very thin clear coating that exhibits proper salivary secretions. Tongue diagnosis is more objective than pulse diagnosis, though pulse diagnosis takes a long time to master, while basic tongue diagnosis can be taught in a short period of time. Before examining the tongue for diagnosis, make sure the patient has not eaten pickles, cayenne pepper, curry and other hot things. They will temporarily turn the tongue red. It takes a few hours for the tongue to get its normal coat back after the person has scraped it as well. And smoking turns the coat yellow.
From my personal experience in the clinic I can say it’s common to see thick tongues, purplish tongues, tongues with teeth marks in them and tongues with cracks in various places. I also have noted tongues with coats both white and yellow, sticky and thin. Primarily a preventive discipline, acupuncture, especially through pulse diagnosis, the acupuncturist can detect disturbances in the qi at the earliest possible stage, before disease develops and restores balance through acupuncture treatment and herbs.
Walsh S.& King, E. (2007) Pulse Diagnosis . Churchill Livingstone
Chen, J.X. (2007) Chinese Medicine Study Guide: Diagnostics .
Pulse Diagnosis .Dupler D. In: Krapp K, Long JL (eds.) Gale Encyclopedia of Alternative Medicine. Farmington Hills, MI: Gale Group, 2001
Tongue Diagnosis in Chinese medicine by Giavanni Macciocia
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