What Happens in TCM Tongue and Pulse Diagnosis

In TCM, the tongue is seen as a visible window into what's happening inside. Practitioners notice:

• Colour: pale, pink, red or purplish. A pale tongue might suggest deficiency; a red one, "heat."
• Coating: thin or thick, white or yellow. A thick coating is linked to "dampness."
• Shape: swollen, thin, cracked, or with teeth marks along the edges. Teeth marks are often linked to Spleen Qi deficiency.
• Moisture: dry or wet.
• Areas: different zones of the tongue are traditionally associated with different organ systems.

Tip before your appointment: avoid brushing your tongue, drinking coffee, or eating strongly coloured foods (like beets or turmeric) right beforehand. They can change its appearance.

Your practitioner lightly rests three fingers on the inside of each wrist, over the radial artery, and feels at shallow, middle and deep pressure. TCM describes many pulse qualities (slippery, wiry, thin, weak, rapid, slow), each associated with patterns. Each of the three positions on each wrist is traditionally linked to particular organ systems.

This is different from a nurse taking your pulse rate. The TCM practitioner is feeling for quality as well as speed.

TCM assessment is thorough. Expect questions about:

• your main concern: when it started, and what makes it better or worse;
• sleep, energy through the day, and when you feel strongest or most tired;
• appetite, digestion and bowel habits;
• feeling hot or cold, sweating, thirst;
• mood and stress;
• for women, the menstrual cycle;
• medical history and medications.

TCM assessment identifies a TCM pattern, such as "Liver Qi stagnation with Spleen deficiency," which guides TCM treatment. It is not a Western medical diagnosis and doesn't replace tests or a doctor's assessment. A responsible practitioner will refer you to a doctor if your symptoms need medical investigation, such as unexplained weight loss, blood in stool or a new lump.

Your pattern guides which acupuncture points, bodywork or advice your practitioner chooses. Two people with bloating, for example, might have different patterns and receive different treatment. Tongue and pulse are rechecked over a course of treatment as a way of tracking change.

TCM assessment is part of every acupuncture visit with a registered practitioner. Acupuncture is currently on the waitlist. Our clinic is in Yaletown, a short SkyTrain ride from Burnaby and close to Chinatown.