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All lessons   Module 5: Going deeper   Lesson 4

Module 5   Lesson 4   Jia Xiang

What masks tongue and pulse

What do medication, lifestyle, a pacemaker and an arrhythmia change in tongue and pulse, and what can you still read then?

After this lesson you ask about drugs and habits before any interpretation, you know for each mask which feature it changes (body, coating, moisture, rate, rhythm, strength), you recognise the red flags that hide behind a mask, and you read what the mask does not touch.

Mask body hue, shape coating hue, thickness moisture wet, dry rate slower, faster rhythm regularity strength and shape tongue pulse Medication beta blocker verapamil, diltiazem digoxin thyroid medication bronchodilator corticosteroids antibiotics iron, bismuth chlorhexidine chemotherapy drug that dries the mouth Lifestyle smoking coffee, tea alcohol staining food, sweets endurance sport Heart pacemaker atrial fibrillation often changes sometimes, or indirectly empty: rarely touches this feature
Schematic, not a measurement: which feature a mask most often changes. Medical action: general medicine; staining of the coating: textbook. An empty cell does not mean it never happens, only that it is not the first thing to look for.

Know by heart

  • Ask first. What does the client take, smoke, drink and train, what was in their mouth in the last hour, and do they have a pacemaker or an arrhythmia? mnemonic: swallow, smoke, drink, train, tick.
  • Rate is masked first. Slower: beta blockers, verapamil and diltiazem, digoxin, endurance sport, too little thyroid hormone. Faster: too much thyroid hormone, bronchodilators, coffee, smoking, alcohol, fever; mnemonic: blockers brake, stimulants speed.
  • Rhythm is medical first. A pacemaker gives an even pulse with a fixed lower limit; atrial fibrillation an irregularly irregular one. Do not name a quality then; newly irregular: ECG; mnemonic: a metronome is technology, chaos is an ECG.
  • The coating stains most easily. Coffee, tea, smoking, turmeric, liquorice and sweets stain; iron and bismuth turn it black, chlorhexidine brown; antibiotics and smoking give a black hairy tongue; inhalers and antibiotics give thrush, which you can wipe off; mnemonic: the mouth first, then the Stomach.
  • Body and moisture. Chemotherapy changes the body itself (red, sore, small ulcers, smooth); drugs that dry the mouth make the tongue dry; mnemonic: dry is only Yin deficiency if no drug explains it.
  • Read what the mask does not touch. With a rate mask: depth, width, strength, shape and the positions. With a coating mask: colour, shape and moisture of the body. And weigh the history more heavily; mnemonic: the mask sits on one layer.
  • Red flags. Newly irregular: ECG. Slow with dizziness: the same day; digoxin with nausea or yellow vision: a doctor straight away; slow with fainting: emergency services (112 in Europe, 999 in the UK, 911 in North America). Fever during chemotherapy: the treatment team straight away. Stopping or changing a drug is up to the prescriber.

The rest of this lesson is reference.

Three practice questions from this lesson

Which questions do you ask before you interpret a tongue or pulse?
  1. Drugs, smoking, drinking, training, the last hour in the mouth, and pacemaker or arrhythmia
  2. How long the complaint has existed and where it is; you ask about drugs only after interpreting
  3. Whether the client has fasted and slept well; habits count only if the pulse deviates

Answer: Drugs, smoking, drinking, training, the last hour in the mouth, and pacemaker or arrhythmia. Each of those questions rules out a known mask. Mnemonic: swallow, smoke, drink, train, tick.

A client takes metoprolol. His pulse is 52 per minute, otherwise deep and weak, especially at chi. What do you do with the rate?
  1. Write it down with 'on beta blocker'; you do read depth, strength and position
  2. Read it as Cold: slow and deep at chi together point to Kidney-Yang deficiency
  3. Leave out the whole pulse: the drug makes every feature unreliable

Answer: Write it down with 'on beta blocker'; you do read depth, strength and position. A beta blocker shifts the rate, not the depth, the strength or the relation between the positions. You do read those; that way the rest of the pulse stays usable.

Which drug makes the pulse faster rather than slower?
  1. Too much levothyroxine (thyroid hormone)
  2. Verapamil (in high blood pressure or an arrhythmia)
  3. Digoxin (especially in atrial fibrillation)

Answer: Too much levothyroxine (thyroid hormone). Too much levothyroxine gives a faster, fuller pulse and palpitations. Verapamil and digoxin make the pulse slower.

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, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.

Try two lessons freeSee Tongue and Pulse