Qi, Blood and Body Fluids

Pale or Pale and dry, Purple or dark red, sticky or dry, a pulse without strength or without filling: what is happening with Qi, Blood or fluids, even before you know the organ?

After this lesson you read the basic language of tongue and pulse that returns with every organ: deficiency, stagnation, Heat, Cold, Dampness, Phlegm and dryness. You know the tongue and pulse of the patterns of Qi, Blood and the fluids and of the six kinds of Phlegm, you read the underside of the tongue, you separate Qi deficiency from Blood deficiency and Dampness from Phlegm, you know which tongues and pulses go to a doctor first, and you read three women with fatigue from finding to principle.

Schematic: Qi deficiency. Slightly Pale, moist.

Schematic: Blood deficiency. Pale, Thin, slightly dry, the sides the palest.

Schematic: Qi stagnation turning warm. Normal, redder sides.

Schematic: Blood stasis with Heat. Reddish-Purple, purple spots.

Schematic: Heat in the Blood. Deep-Red, red points, dry, thin yellow coating.

Schematic: Cold in the Blood. Bluish-Purple, moist.

Schematic: deficiency of fluids. Dry, fine cracks, coating still present.

Schematic: Dampness. Sticky coating.

Schematic: Damp-Phlegm. Swollen, thick sticky white coating.

Schematic: Phlegm-Heat. Red, Swollen, sticky yellow.

Schematic: Cold-Phlegm. Pale, white wet coating.

Schematic, for comparison: Yin deficiency. Red without coating.

Know by heart

The basic language. Pale is deficiency (Qi, Blood, Yang); Red without coating is Yin; Purple is standstill; a sticky coating is Dampness or Phlegm; dry is too little fluid; mnemonic: pale lacks, purple stands still, sticky stays put, dry has run out.
Qi. Deficiency: slightly Pale, moist; empty. Sinking: Pale; weak. Stagnation: normal, red sides when it turns warm; wiry. Rebellion: follows the cause; mnemonic: too little, too low, stuck, the wrong way.
Blood. Deficiency: Pale, Thin, slightly dry, the sides the palest; choppy or thin. Stasis: Purple, spots, full sublingual veins; choppy or wiry. Heat: Deep-Red, points; rapid. Cold: Bluish-Purple; deep, tight; mnemonic: pale, purple, red, blue.
Qi or Blood. Pale and moist with a pulse without strength (empty) is Qi; Pale, Thin and dry with a pulse without filling (thin, choppy) is Blood; mnemonic: Qi lacks strength, Blood lacks filling.
The fluids. Deficiency: dry, coating still present; thin. Dampness: sticky coating; slippery or soggy. Phlegm: Swollen, thick and sticky; slippery. Water: Yang-water floating, Yin-water Pale, wet, Swollen and deep; mnemonic: Dampness lies on the tongue, Phlegm is in it too.
Phlegm with a partner. Heat: Red, sticky yellow; slippery-rapid. Cold: Pale, white and wet; slippery, slow. Wind: Swollen, Stiff, Deviated or Quivering; slippery, wiry. Qi: normal, thin and sticky; wiry, slightly slippery. Dry: dry, little coating; thin, slightly slippery.
Red flags. A Pale tongue with a rapid, weak pulse after blood loss; a Blue tongue with breathlessness; a Deviated or Stiff tongue with loss of function; a Purple tongue with a swollen, painful leg; unexplained bleeding or lumps: see a doctor first, often emergency services (112 in Europe, 999 in the UK, 911 in North America).

The rest of this lesson is reference.

Three practice questions from this lesson

A tongue is slightly Pale, moist and of normal shape, with a thin white coating. The pulse is large and soft and gives way under pressure. What is lacking?

Strength: Qi deficiency
Filling: Blood deficiency
Warmth: Yang deficiency

Answer: Strength: Qi deficiency. A pulse without strength (empty) on a slightly Pale, moist tongue is Qi deficiency. Blood deficiency gives a Thin, dry tongue and a thin pulse; Yang deficiency a wet, Swollen tongue and a slow pulse.

Case. Woman of 36: dizzy on standing up, dry skin, brittle nails, scanty periods, has trouble falling asleep. Tongue Pale, Thin and slightly dry, the sides the palest; pulse thin, halting here and there. Which pattern, and what first?

Blood deficiency; first Hb and ferritin
Qi deficiency; first a week of rest
Yin deficiency; first the thyroid

Answer: Blood deficiency; first Hb and ferritin. Pale, Thin and dry with a thin or halting pulse is Blood deficiency; the pale sides point to the Liver. A Pale tongue does not replace a blood test.

Case. Man of 48: pressing pain in the flank that comes and goes with tension, sighs a lot. Tongue normal; pulse taut like a string. After a month the pain becomes fixed and stabbing, worse at night, and the tongue gets a purple tinge with dark veins underneath. What happened?

Qi stagnation became Blood stasis
Qi deficiency became Qi stagnation
Qi stagnation became Heat in the Blood

Answer: Qi stagnation became Blood stasis. Changing and pressing with a wiry pulse is Qi that is stuck; fixed and stabbing with Purple and full veins is Blood that stands still. Long-standing stagnation congeals the Blood. Heat in the Blood would give a Deep-Red tongue with points and a rapid pulse.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 16 case-based practice questions, 16 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 free See Tongue and Pulse