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Posted by: Scott Stewart, LAc., Dipl.
When you visit an acupuncturist you will notice two distinctive diagnostic features that differ from a Western consultation. An acupuncturist will feel your pulse for a few minutes or sometimes up to 30 minutes, and examine your tongue for about 10 – 15 seconds. You may say, “Wait a minute! Sometimes my doctor will feel my pulse.” This is true, but in Western medicine they’re only checking your heart rate; that is, is it beating too fast (tachycardia), too slow (brachycardia), or is it a normal pulse. In Eastern Medicine, we gather important information from both the tongue and the pulse that helps us with the diagnosis. First, let’s consider the pulse.
What can we tell from a pulse?
In general, the pulse informs us of the state of Qi, blood and fluid physiology/pathology, and gives us an image of the functional state of the internal organs both individually and as a system. In more advanced systems a skilled practitioner can detect childhood illnesses, mitral valve dysfunctions and other cardiovascular events, ulcers, and other various pathologies.
The pulse can also be used as a preventive measure to detect serious disease and illness before it manifests to a greater extent in the body.
Other arbitrary influences on the pulse include, but are not limited to: stress (including emotional disturbances), lack of sleep, medications, negative dietary habits, caffeine, nicotine, and other stimulants, and sickness; especially the cold or flu.
How is the pulse felt?
The practitioner palpates the radial artery in 3 different positions on each wrist. Traditionally, on the left wrist, the bottom position represents the heart / small intestine. The middle position is for the liver / gallbladder. The upper position is for the kidney (yang) / bladder. On the right wrist, the bottom position represents the lung / large intestine. The middle position is the spleen / stomach. The upper position represents the kidney (yin), San jiao.
You might notice that the practitioner will press down on these positions, this is because there are 3 different levels to a pulse: superficial (qi level), middle (blood level), and deep (organ level). First, the practitioner will feel all three positions at once to get an overall image, then they will palpate each individual position for a more specific image of each corresponding organ.
Why do you have to look at my tongue?
Tongue examination is another important diagnostic tool in the acupuncturist's arsenal. The reason for this is because the tongue has a direct correlation to the visceral organs. As you can see in the image to the left, different areas of the tongue are representative of those specific organs. When we examine the tongue we're looking at the following attributes: texture, coating, color, shape, and mobility. By looking at these different aspects of the tongue we can determine the state of the Qi, blood, and body fluids. We can also determine the state of an illness and where that illness is located. Both tongue and pulse diagnosis are not meant to be used alone, but rather together along with patient observation, and other diagnostic information that is gathered from the patient interview.