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All lessons   Module 3: Reading together   Lesson 1

Module 3   Lesson 1   She Mai He Can

Tongue and pulse together

What do you do when tongue and pulse confirm each other, and what when they clash?

After this lesson you know what the tongue body, the coating and the pulse each show best and how fast they change, you recognise the four clashes that occur most often, you resolve a clash in five steps with the history as referee, and you know when the textbooks follow the pulse and when the symptoms.

Tongue body 舌质 clock: weeks to months shows best Blood, Yin and Yang Heat or Cold already present stasis the ground of a chronic picture shows poorly stuck Qi the state of today Coating 舌苔 clock: days shows best the Stomach whether a pathogen is present which: Dampness, Phlegm, food how deep, hot or cold shows poorly the strength of the resistance the Blood Pulse 脉 clock: hours to days shows best full or empty: the strength stuck Qi, pain location: six positions the struggle of today shows poorly Dampness versus Phlegm what has been so for years History: the referee 问 if they agree, the picture carries weight; if they clash, the client's story decides: the symptoms, the course, what makes it better or worse, and since when
Schematic. The division follows the textbooks: the tongue body shows Blood, the Yin organs and the Nutritive Qi (Ying Qi), the coating the Yang organs and above all the Stomach; the pulse shows the location, the nature and the balance between resistance and pathogenic factor. How the book brings tongue, pulse and interrogation together: ch. 24 p. 340.

Know by heart

  • Three clocks. Tongue body weeks to months: the ground. Coating days: the pathogenic factor and the Stomach. Pulse hours to days: the strength, the Qi and the moment; mnemonic: ground, guest, gust.
  • What each shows best. Tongue: Heat or Cold already present, and Blood, Yin and Yang. Coating: what is lying there, how deep, hot or cold. Pulse: full or empty, where (the positions), and whether the Qi is stuck (tension).
  • Four clashes. Red tongue with a slow pulse; Pale tongue with a rapid pulse; full on the tongue and empty in the pulse, or the reverse; a normal tongue with an abnormal pulse, or the reverse; mnemonic: hot against cold, cold against hot, full against empty, old against new.
  • Five steps in a clash. Check the measurement (light, staining, rest, coffee, medication); which clock; look for a combined picture that explains both; let the history decide; record what does not fit; mnemonic: check, clock, combine, ask, record.
  • Following the pulse or the symptoms. Follow the symptoms: clear Full-Heat with a full, painful abdomen, but a slow pulse (stuck Heat). Follow the pulse: cold hands and feet, but a slippery, rapid, strong pulse (true Heat, false Cold). Only in serious, complex pictures.
  • A clash is information. Usually it is two layers (root and branch, Yin and Yang) or two clocks (old and new); sometimes it is the measurement. Rarely is it that "the tongue is wrong".
  • Red flags. Pale tongue with a rapid pulse at rest: anaemia, blood loss, thyroid, infection. Cold hands and feet with fever, a rapid pulse and drowsiness: emergency services (112 in Europe, 999 in the UK, 911 in North America). A slow pulse in an older person: medication first, and with dizziness an ECG.

The rest of this lesson is reference.

Three practice questions from this lesson

Which of the three gauges changes most slowly, and what does it therefore show best?
  1. The tongue body: the ground that is already there
  2. The coating: the pathogenic factor present for months
  3. The pulse: the strength that has been so for years

Answer: The tongue body: the ground that is already there. The tongue body changes in weeks to months, the coating in days, the pulse in hours to days. The slowest gauge shows the ground: Blood, Yin, Yang, and Heat or Cold already present.

You want to know whether the Qi is stuck. Where do you look first?
  1. At the tension of the pulse
  2. At the colour of the tongue body
  3. At the thickness of the coating

Answer: At the tension of the pulse. In Qi stagnation the tongue is often still normal, at most with slightly red sides; the pulse is taut as a string.

Case. Woman of 36, since yesterday shivering, a stiff neck and a clear, runny nose. Tongue Pale-Red with a thin white coating. Pulse superficial and tight. What is going on?
  1. Old against new: the pulse already shows Wind-Cold, the tongue not yet
  2. A measurement error: the pulse was felt too lightly
  3. Liver-Qi stagnation: the pulse is tight and the tongue normal

Answer: Old against new: the pulse already shows Wind-Cold, the tongue not yet. At the start of an exterior pattern the pulse changes first; the tongue is still normal. Tight and superficial with shivering and a stiff neck: Wind-Cold.

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 3: Reading together.

Try two lessons freeSee Tongue and Pulse