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All lessons   Module 4: Organ by organ   Lesson 9

Module 4   Lesson 9   Jian Bing

Combined patterns

How do you read tongue and pulse when two patterns are at play at once, and how do you see which side comes first?

After this lesson you know the three places where tongue and pulse show a second pattern (body against coating, zone against zone, position against position), you weigh which side comes first, you know the tongue and the pulse of the six most common combinations with their neighbours, you know which combinations are a medical matter first, and you read a picture with two layers from finding to principle.

1 Body and coating root tip body: ground, weeks coating: what lies on top, days 2 Zone against zone root tip root: Kidneys tip: Heart 3 Position against position left right cun Heart guan wiry chi Kidneys cun Lungs guan weak chi Kidneys Liver pushes, Spleen gives way The ground (root, ben) body, strength on deep pressure, chi slow, often a Deficiency What lies on top (branch, biao) coating, pulse shape, the complaint now fast, often an Excess acute: the branch weighs more; chronic: the ground; often you treat both
Schematic. Blue is Deficiency, red and yellow Excess. The three places in the order in which you read them: first the body against the coating, then the zones of the tongue (module 1, lesson 7), then the positions of the pulse (module 2, lesson 6). The bar at the bottom is the weighing rule of step 4.

Know by heart

  • Three places for two patterns. Body against coating (the ground and what lies on top), zone against zone (tip, sides, centre, root), position against position (left against right, cun against chi); mnemonic: underneath and on top, here and there, left and right.
  • Which side first. The body and the strength on deep pressure show the ground (slow, often Deficiency); the coating and the shape of the pulse show what lies on top (fast, often Excess); in acute cases the branch weighs more, in chronic cases the ground, and often you treat both; mnemonic: the complaint names the branch, the body and the deep pulse name the root.
  • Liver invading the Spleen. Tongue normal or slightly red sides, sometimes teeth marks and a white or sticky coating; pulse wiry at the left guan, weak at the right guan; mnemonic: the string on the left, the soft one on the right.
  • Heart and Kidneys not harmonised. Red with a redder tip, little or no coating; pulse thin and rapid, both chi weak; mnemonic: the tip burns, the root dries.
  • Two Yin deficiencies. Liver and Kidneys, Lungs and Kidneys: Red with little or no coating, thin-rapid or floating-empty. The tongue does not separate them; the complaint and the position do: dry eyes and the left guan, or a dry cough and the right cun.
  • Two deficiencies of Qi or Blood. Spleen and Lungs: Pale with teeth marks, weak at the right cun and guan. Heart and Spleen: Pale, sometimes teeth marks, choppy or thin, right guan weak. Kidneys failing to receive Qi: Pale, deep and weak, chi the weakest.
  • Red flags. Short of breath at rest or when lying flat, with swollen ankles; palpitations with fainting or chest pain; coughing up blood, or a cough with night sweats and weight loss; blood in the stools or black stools and weight loss with a stress-related bowel: a medical matter first.

The rest of this lesson is reference.

Three practice questions from this lesson

Case. Woman, 44. With tension, cramping abdominal pain with urgency, then loose stools; even without tension, tired after eating. Tongue nearly normal with slightly red sides, teeth marks and a thin white, somewhat sticky coating. Pulse: left guan taut like a string, right guan soft and weak.
  1. Liver invading the Spleen: string on the left, soft on the right
  2. Liver-Qi stagnation: the abdominal pain comes with tension
  3. Spleen-Qi deficiency: tired after eating, with teeth marks

Answer: Liver invading the Spleen: string on the left, soft on the right. The string at the left guan and the redder sides are the Liver; the weak right guan, the teeth marks and the tiredness after eating are the Spleen. Two patterns, each in its own place: Liver-Qi stagnation does not explain the weak right guan, Spleen-Qi deficiency does not explain the link with tension or the string.

Case. Man, 52. Cannot stay asleep, dreams a lot, palpitations and night sweats at night, nagging lower back, tinnitus. Tongue Red with a redder tip and little coating. Pulse thin and rapid, both chi weak.
  1. Heart and Kidneys not harmonised: redder tip, weak chi
  2. Heart-Fire: the redder tip and the restlessness at night
  3. Heart-Blood deficiency: dreams a lot, palpitations at night

Answer: Heart and Kidneys not harmonised: redder tip, weak chi. The redder tip and the sleep point to the Heart; the missing coating, the weak chi, the lower back and the ears to Kidney-Yin. Heart-Fire has a yellow coating and a full pulse; Heart-Blood deficiency a Pale tongue.

Case. Man, 49, restless, sleeps badly, mouth ulcers, thirst, dark burning urine; no complaints of back or ears. Tongue Red, tip redder, yellow coating. Pulse full and rapid, left cun bounding.
  1. Heart-Fire
  2. Heart and Kidneys not harmonised
  3. Kidney-Yin deficiency

Answer: Heart-Fire. A yellow coating and a full pulse make it Full-Heat. In Heart and Kidneys not harmonised the coating is missing, the pulse is thin and the chi are weak.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 17 case-based practice questions, 17 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 4: Organ by organ.

Try two lessons freeSee Tongue and Pulse