Many acupuncturists use the inspection of the pulse and tongue as a means to assess the health and gather clinical information about the patient. They are part of the four diagnostic methods used during clinical examination, and are often referred to as the “Four Pillars”.
- Inspection – visually observing the patient to determine abnormal changes in complexion, spirit, colour, any secretions or excretions, the appearance of the five sense organs, and most significantly the tongue.
- Listening and Smelling – listening to the patient’s physiological and pathological sounds. Some practioners listen to chest or abdominal sounds, or the sound of the patient’s breathing or quality of speech. A loud voice differs pathologically compared to a weak, feeble voice. Historically there were also certain smells associated with different diseases, but our personal hygiene improvements have made it less used or unnecessary.
- Inquiry – all the questions including discussion about the patient’s symptoms, the cause or predisposing factors of the condition, the history (onset, development, and treatment) of the condition. Questions cover a broad range of topics from subjective temperature, perspiration, defecation and urination, appetite, thirst and taste, as well as sleep. This gives further information to the practitioner to help in differentiating the syndrome.
- Palpation – utilizing the acupuncturist’s sense of touch to feel areas of the body for swelling, temperature changes, hardness, as well as the radial pulse in both wrists.
Feeling the pulse on both wrists is part of the diagnostic of palpation. In Chinese medicine, the pulse arises mainly from the flow of qi and blood in the vessels. Qi is associated with yang, and governs movement, while blood is associated with yin and provides the substance that fills the vessels. Blood depends on Qi for its movement.
The pulse is felt on the wrist where the radial artery throbs. It is divided into three regions, which correspond to the organs. The left side corresponds to the Heart, Liver and Kidney, while the right side corresponds to the Lung, Spleen and Kidney. [Please note that in TCM the organs have somewhat different roles compared to how they physiologically work anatomically] The pulse is differentiated in terms of depth, speed, strength, shape and rhythm. Different conditions of the pulse indicate different conditions.
A normal pulse is smooth, even and forceful. However the pulse may vary due to age, gender, body constitution, emotional state, and climatic changes. It is taken when the patient is either seated or laying with the arm placed approximately level with the heart, with the wrist extended and palm facing upwards. A pulse is best taken once the patient is at rest and not after racing to their appointment. Often it will be palpated again during or post treatment.
In Chinese medicine, the tongue either directly or indirectly connects with many of the internal organs through the meridians. Insufficient Qi and Blood in the meridians or related organs can show as pathological changes in the tongue’s size, shape, colour, and coating.
A normal tongue is of proper size for the mouth, soft in quality, free in motion, slightly red in colour and with a thin layer of white coating which is neither dry nor over moist. The tongue is divided up into four areas – tip, central part, root and border. The tip often reveals pathological changes of the heart and lungs; the border reveals changes in the liver and gallbladder. The central part shows pathology of the spleen and stomach, while the root shows pathology of the kidneys.
Tongue diagnosis helps in diagnosing syndromes of deficiency or excess, heat or cold conditions, impaired circulation of body fluids, presence of phlegm or dampness, and the depth and nature of pathological conditions. It should be noted that the tongue may be affected by food, drugs, or brushing of the teeth and tongue. Coloured candies usually make for some interesting tongue colours and false readings.
Xinnong, Cheng, editor (2009). Chinese acupuncture and moxibustion. Beijing, China: Foreign Languages Press.