Stick out your tongue!

First time patients are often surprised when asked to stick out their tongue. And they are even more puzzled when six pulses are taken on both wrists.

The tongue and pulse are the diagnostic tools that help acupuncturists formulate a Traditional Chinese Medicine treatment plan. The treatment plan includes the choice of acupuncture points, the understanding of the specific meridians that need to be regulated, and whether or not herbal medicine will be used. But before a treatment plan can be established, acupuncturists must first consult the tongue and pulse.

I like to think of reading the tongue and pulse as looking into a window into the internal workings of my patients. Both are good indicators of what is going on internally with respect to the health and balance of the body. This is a valuable way of checking in, and a useful gauge for monitoring the improvements or decline of established patients’ health from treatment to treatment, or to observe clinical manifestations in the first time patient.

Reading the Tongue

The tongue is a map of your body’s organs. There are five zones that correspond to each of the internal organs.

When examining the tongue the color, shape, size, texture, and coating are all important aspects of consideration. A normal tongue appears vibrant and has a light red or pinkish body with a thin white coat. A baby’s tongue is a great example of a normal tongue.

When a person is not healthy, the tongue reflect this change. A deep red tongue can indicate inflammation or heat and, in contrast, a pale tongue can indicate anemia or blood vacuity. And a purplish tongue points to poor circulation, or what is known as blood stasis.

The observation of the color of the tongue body has clinical importance as it most often reflects the true condition of the patient. Reading a tongue can open up a dialogue with a patient and help in gleaning deeper understanding of the disharmonies within the body.

The shape and size of the tongue can give further insight into the health of the patient. For example, a swollen, puffy tongue with scalloped shaped sides can indicate that fluids are not being properly metabolized, and digestion is not optimal. Whereas a small, short, dry tongue can indicate a deficiency of fluids from dehydration or inflammation.

The final indicator is the tongue’s coating and thickness. These reflect the strength of the pathogenic factors as well as the progression and location of disease. For example, a thick yellow tongue coat can reflect a condition that is hot and more acute. Conversely, a thick white coat indicates a cold and chronic condition. A tongue completely without a coat can be indicative of a depletion of fluids, as well as point to a more long-standing chronic condition.

With a simple glance at your tongue, an acupuncturist can make an important and valuable diagnosis.

Reading the Pulse

Pulse diagnosis is another tool that acupuncturists have to help determine the health of the patient. However, reading the pulse is more subtle and subjective than reading the tongue, and may be more complicated to explain.

There are three positions on each wrist that represent a pair of organs. On the right wrist, position one, closest to the thumb, is lung/large intestine, position two, the middle position, is the spleen/stomach, and the third position represents the kidney yin (the yin energy source of the body).

On the left wrist, the first position is the heart/small intestine, the second position is the liver/gallbladder, and the third position is the kidney yang (the yang energy source of the body). 

The strengths and weakness of the pulses are used diagnostically to assess the conditions of the organs systems, as well as any underlying imbalances of the body. To make things even more difficult, there are 27 pulse types – from descriptions such as floating (indicative of a flu or cold invasion), wiry or choppy (indicating stress or anxiety), and slippery (where a patient could be pregnant). All these pulse types have clinical significance and influence the treatment plan and protocol.

So when asked to stick out your tongue or show your wrist, you now know that your internal world is being revealed.