The pathogenic factors

A pulse that floats, a coating that turns yellow within a few days, a tongue that quivers or dries out: which climate are you reading, does it come from outside or from inside, and how deep has it already gone?

After this lesson you can read the six climates (Wind, Cold, Summer-Heat, Dampness, Dryness and Fire) on the tongue and at the pulse, separate the form from outside from the form from inside, follow one climate from acute to chronic, know the pulse of an acute illness in its variants, know which tongues and pulses must go to a doctor first, and read a summer flu from finding to principle.

Schematic: Wind-Cold. Nearly normal, thin white coating.

Schematic: Wind-Heat. Red tip and sides, thin yellowish coating.

Schematic: Wind-Water. Thin white, smooth and moist coating.

Schematic: warm External Dryness. Dry, thin coating, red tip.

Schematic: Summer-Heat. Red, dry, thin yellow.

Schematic: Summer-Heat with Dampness. Red, sticky coating.

Schematic: Extreme Heat generating Wind. Deep-Red, dry, thin yellow coating, Quivering.

Schematic: Liver-Yang rising to Wind. Red, redder sides, Deviated.

Schematic: Empty-Wind from Blood deficiency. Pale, Thin, Quivering.

Schematic: internal Full-Cold. Thick white coating.

Schematic: Damp-Heat. Red, sticky yellow.

Schematic: Fire. Deep-Red, red points, dry dark yellow coating.

Know by heart

Outside or inside. Outside: acute, chills or aversion to cold, the body of the tongue still nearly normal, a thin coating; the pulse floating. Inside: the body changes, the coating becomes thick or disappears; the pulse no longer floats; mnemonic: outside changes the coating, inside changes the body.
Wind from outside. Wind-Cold: nearly normal, thin white; floating, tight. Wind-Heat: red tip or sides, thin white to yellow; floating, rapid. Wind-Water: thin white, smooth; floating, textbook slippery; mnemonic: Cold squeezes the pulse tight, Heat chases it on.
Wind from inside. Extreme Heat: Deep-Red, dry; wiry, rapid. Liver-Yang: Red or follows the deficient root, Quivering or Deviated; wiry. Empty-Wind: Pale and Thin (Blood) or Deep-Red and bare (Yin); thin; mnemonic: Wind moves the tongue and pulls the pulse taut.
Cold. Full: thick white; deep, tight, often slow. Empty: Pale, wet, Swollen; deep, weak, slow; mnemonic: Full-Cold squeezes, Empty-Cold sinks away.
Summer-Heat and Dampness. Summer-Heat: Red, dry; rapid, overflowing as long as there is strength, empty when the fluids drain away. With Dampness: Red, sticky; soggy, rapid. Damp-Cold: sticky white; slippery, slow. Damp-Heat: Red, sticky yellow; slippery, rapid; mnemonic: Dampness sticks to the tongue and makes the pulse slippery or soggy.
Dryness and Fire. External Dryness: dry, thin coating; floating. Internal: dry, small cracks, coating still present; thin. Fire: deeper Red, dry yellow to brown; rapid, full or overflowing. Empty-Heat: Red without coating; thin-rapid; mnemonic: Dryness cracks, Fire scorches.
Red flags. Fever with neck stiffness, drowsiness or spots that do not fade under pressure; hot and confused after heat; sudden loss of function or convulsions; breathlessness; a rigid abdomen: emergency services (112 in Europe, 999 in the UK, 911 in North America). Fever for more than three days: a GP or primary care doctor.

The rest of this lesson is reference.

Three practice questions from this lesson

With a climate from outside, what changes first on the tongue?

The coating, while the body stays the same
The colour of the whole body, already on the first day
The underside: the veins beneath it fill up

Answer: The coating, while the body stays the same. The coating changes within days and the body stays nearly normal; the body changes only when the pathogen moves inwards. That is why the tongue is often still nearly normal in a common cold.

Case. Man, 28, shivery since this morning, aching muscles, stiff neck, blocked nose with clear mucus, no sweating, hardly any fever. Tongue nearly normal with a thin white coating; pulse superficial and tight. Which form?

Wind-Cold
Wind-Heat
Internal Full-Cold

Answer: Wind-Cold. Chills predominant, no sweating, a floating tight pulse with a tongue that has not changed yet: Cold on the outside.

Case. Woman, 24, sore throat since yesterday, fever 38.5, thirst, slight sweating, a little shivery. She swallows well and is not short of breath. Tongue with a red tip and red sides, thin yellowish coating; pulse superficial and rapid. Which form?

Wind-Heat
Wind-Cold
Internal Full-Heat

Answer: Wind-Heat. Fever predominant, sore throat and thirst, only the edges red and a floating rapid pulse. In internal Full-Heat the whole body is Red and the pulse no longer floats.

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, 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