One interesting, somewhat enigmatic part of the treatment experience for patients is when the practitioner takes the pulse and looks at the tongue. New patients will often ask, “What are you looking for in the pulse and tongue?” Experienced patients will often want to know, “How is my pulse and tongue today?”
In order for a Chinese medicine practitioner to give a proper treatment we must first figure out our differential diagnosis before selecting our acupuncture points for the session. Before we come up with the differential diagnosis we must obtain the pertinent information from the patient by asking questions, listening, observing and palpating (touching), which includes taking the pulse. While we often only encounter maybe 6 or 7 different pulse qualities in the clinic on any given day, over 28 different pulse qualities exist.
The Pulse: Strength, Depth, Quality
While Western medical pulse taking is basically concerned with the rate of the pulse and if it is regular or irregular, Chinese medicine takes into account not only these factors, but also the strength of the pulse, the depth/level of the pulse, as well as quality of it. For example, one patient might have a slow, deep and weak pulse showing a deficiency of Yang (the warming aspect of the body) and Qi (energy) associated with specific organ systems such as the Spleen and Kidney, and possibly some intolerance due to cold, as well as poor blood circulation. The next patient might have a rapid, superficial and slippery pulse caused from catching a cold. Often the slippery quality will indicate some excess phlegm and mucus in the body, which might mean the patient has a runny nose or a cough, for example. The superficial quality lets us know that the pathogen is of an external nature, and has not penetrated deeper into the body. The rapid quality in the pulse might mean this patient is experiencing more heat signs right now, such as high fever, headache or possibly more yellow colored mucus rather than white or clear. A healthy pulse should be of moderate speed, have good strength and volume, and will fill all of the different finger positions at each depth.
As far as tongue diagnosis goes, we examine the shape, size, color and coating of the tongue. We are also interesting in other abnormalities such as spots, cracks, deviations to one side and also the engorgement of the sublingual veins. One patient might have a very pale colored tongue, swollen tongue body with teeth marks on the sides, indicating some general qi deficiency with potentially a slow metabolism and some edema in the body. The next patient might have a very small tongue with a red body that is dry, little coating and some small horizontal cracks. This type of patient will usually have what we call yin deficiency, often of the Liver and/or Kidney. The yin deficient person might have a frail body frame, dry skin, insomnia, night sweats and hot flashes. It is said that a healthy tongue should be pink-red in color, have a thin, white coat, no cracks in the tongue or peeling of the coat, and the size should not be too small or swollen.
Observation is not limited to the tongue, nor is palpation limited to the pulse. The Chinese medicine practitioner is constantly assessing and prodding to obtain more information. So, we might look at your eyes or the color of your skin to assess the quality of shen (spirit) and specific organ systems. We might observe your gait and your posture to better understand physical problems or areas of weakness. Palpation is often used to feel for the location of acupuncture points, and to find sensitive spots known as trigger points, or “ahshi” points in Chinese medicine. We might palpate the abdomen for masses or pain, and some Japanese styles even feel the abdomen as a diagnostic tool the way we use pulse in Chinese medicine. Palpation is often done along various acupuncture channels in order to assess the overall state of the channel or to figure out which points will be needled during the treatment. So, next time you observe your acupuncturist gazing into your eyes intently, staring at you as you walk, or holding your hand for an extended period, just realize they are actually just doing their job, nothing else.
This piece was written by Michael Dell'Orfano for Marcie Bower's clinic Stepping Stone Acupuncture.