I remember the stereotypical long, white beard of the old diagnostician in the traditional Chinese medical hospital in Shenyang, China where I was living in 1998. At that time, and likely still today, there were hospitals in China that only offered Traditional Chinese Medicine, those that offered only Western Medicine, and those that offered both. The combination particularly inspired me. There were diagnostic imaging machines down one hallway and there was the doctor who used the tongue and pulse to diagnose down another hallway. Both were equally valued and led to the next steps in treatment planning.
The old man was trained in Traditional Chinese Medicine and had been feeling patients’ pulses for over fifty years. He would lay his middle three fingers on the patient’s wrist for several minutes, maybe ask a couple of questions, switch over to the other wrist for several more minutes, and maybe ask a few more questions. This doctor would also ask to look at the tongue and the patient would readily stick it out for visual examination. The patient was expecting this. The diagnostician may then recheck both wrists and after ten or fifteen minutes he would share his impressions with the acupuncturist and/or the herbalist.
Simple Diagnostic Techniques?
Observation of the tongue and pulse was considered the “north star” of the treatment plan, the guidance and direction for choosing the points to needle with acupuncture or the herbs to choose for the formula to be drunk as tea. This was the beginning of my training in Traditional Chinese Medicine, so I quickly learned to highly value these two methods of diagnosis as the guide for the rest of the treatment.
In our Western Medicine, dysfunction is understood from presenting symptoms and signs, microscopic examination of the blood, x-ray, MRI, CT scan, ultrasound, etc. We have modern technology guiding us to understand what is happening inside the body. After studying these modern methods and completing my pre-med degree in college, I then found it fascinating when observing in China how the seemingly simple use of the fingers and eyes would give this older doctor enough information to understand the dysfunction and to inform the treatment plan.
Pulse Diagnosis
Since observing in China, then attending Chinese medical school in the US, and practicing in Montpelier for over twenty years now, I have felt quite a few pulses and have seen a lot of tongues in my diagnostic assessments. (Though my beard is not long or white yet.) If you were looking at many different tongues in a day and feeling a variety of pulses, you would begin to see the differences and could then interpret what is felt under your fingertips. The quality of the pulse in different positions along each radial artery tells us about the functioning of the internal organ systems.
Various words are used to qualify the pulse, such as wiry, slippery, thready, tight, tense, superficial, deep, thin, spreading, etc. A forceful, wiry pulse may be a sign that there is internal tension from chronic or acute stress of some sort. You may be used to thinking about the quantity of your pulse, and how many times a minute your heart is beating, but Chinese medical pulse diagnosis is observing the quality of the pulse, and how it feels when pressure is applied. People are often surprised that the pulse may feel differently on the left as compared to the right side. But they can also feel differently at various positions along the same artery. Becoming very aware of these qualities takes a lot of experience which is why the diagnostician at the Chinese hospital had a long, white beard.
Tongue Diagnosis
When we observe the tongue, we are looking at the color, shape, coating, and vessels underneath. There may be red dots or red areas. The coating may be thickened, greasy, or yellow. There may be teeth marks due to swelling on the sides of the tongue. The tongue may be darkened, slightly purple, with enlarged vessels underneath. This may be a sign of poor blood circulation in a specific area or throughout the circulatory system. The front of the tongue gives us information about the upper part of the body, the lungs, and the heart. The middle part tells us about the middle part of the body, the stomach and liver, while the base of the tongue tells us about the lower organs, the kidneys, lower intestine, and reproductive organs.
This is a simple and quick introduction to tongue and pulse diagnosis in Chinese Medicine to let you know of other diagnostic tools that you may not have been aware of. The trained practitioner pays careful attention to these signs, incorporating the symptoms and other information presented, to make a clear strategy for effective treatment using the tools of Chinese Medicine.