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TCM Treatments

Pulse Diagnosis

Pulse diagnosis provides detailed information on the state of the internal organs and reflects the whole complex of Qi and Blood, Yin and Yang, as well as the constitution of a person.

Pulse taking is a subtle skill which requires many years of training working with an expert in practice, and many feel that it has the drawback of being 'subjective' especially when compared to say tongue diagnosis. Nonetheless it provides invaluable information that should never be ignored but assessed together with other diagnostic information (tongue, appearance, case history).  

Unfortunately pulse diagnosis is also subject to external, short-term influences which make interpretation difficult. For example a patient who rushes to an appointment, or who has just had an argument with a spouse, or has been working late hours with very little sleep for the past week, will demonstrate a pulse influenced by these relatively short-term factors. For this reason a practitioner will probably have to learn the predominant pulse pattern for a patient over a several sessions.

Taking the pulse on the radial artery (felt at the wrist) was started by the Classic of Difficulties. The pulse examination is divided into three areas or positions (front middle and rear) and felt at three different levels (superficial, middle, and deep).

Over time there have been many different attributions of organs to individual pulse positions. For example the Pulse Classic by Wang Shu He utilises the following:

  LEFT RIGHT
FRONT Heart/Small Intestine Lungs/Large Intestine
MIDDLE Liver/Gall Bladder Spleen/Stomach
REAR Kidney/Bladder Fire of Gate of Vitality/Lower Burner

 

While the Pulse Study of Bin-Hu adopts the following pulse positions:

  LEFT RIGHT
FRONT Heart/Thorax Lungs/Chest
MIDDLE Liver/Gall Bladder Spleen/Stomach
REAR Kidneys/Small Intestine Kidneys/Large Intestine

 

Giovanni Maciocia does not feel that we should be overly concerned by these discrepancies. He points out that all these schemas share a common thread: the front positions reflect the state of Qi in the Upper Burner (upper body), the middle positions the Middle Burner, and the rear positions the Lower Burner. Since the pulse basically reflects the state of Qi in the different Burners (areas of the body) at different energetic levels, dependent on the pathological condition involved, it is not necessary to attribute too much importance to specific organ or channel positions on the pulse.  

Your Chinese medicine practitioner will feel your pulse at three different depths (superficial, middle and deep) by applying more pressure. The three levels provide an idea of the level of Qi in the pulse and therefore the kind of pathological condition present, specifically:

the Superficial levels reflect the state of Qi and the Yang Organs

the Middle levels reflect the state of Blood

the Deep levels reflect that state of Yin and the Yin organs.

So the pulse provides a picture of the pathology of Qi, Blood or Yin, and the relative state of Yin and Yang.

Yet other doctors use the different levels to interpret the following: the Superficial level: Exterior diseases or the state of the Heart and Lungs; the Middle level: Stomach and Spleen diseases or the state of the Stomach and Spleen; the Deep level: Interior diseases or the state of the Liver and the Kidneys.  These schemas need not be seen as contradictory but can be born in mind by the practitioner.

Over time, your practitioner will be able to form a picture not only of the main patterns affecting your constitution, but also how your pulse responds to acupuncture, herbal treatments, and lifestyle modifications such as diet, exercise, and sleep.

Source:  Maciocia, Giovanni. 1989. The Foundations of Chinese Medicine. Edinburgh: Churchill Livingstone.

Text supplied by Dr Sandra Cattich

Tongue Diagnosis

"Tongue diagnosis is one of the most precious diagnostic methods in Chinese medicine."

(Giovanni Maciocia)

When you visit your acupuncturist or Chinese medicine herbalist you are likely to be asked to show your tongue for the purposes of diagnosis. Ideally you will have not brushed your tongue in the preceding days before the visit, or are not in the habit of doing so, else this will have to be taken into account and your tongue re-examined on your next visit.

Remember that various medicines can affect the appearance of the tongue: antibiotics cause the tongue to peel in patches, corticosteroids cause the tongue to become red and swollen, bronchodilators such as salbutamol cause the tongue tip to become red, anti-inflammatory agents may cause red points to appear, make the tongue thinner and eventually peel. So please let your practitioner know what medications you are taking.

In addition, it is obviously advisable not to suck brightly coloured sweets on your way to your appointment, as well as smoke tobacco, eat spicy hot foods, drink coffee immediately before the examination.

The shape and size of the tongue, its body colour, the coating (its colour, thickness), as well as characteristics in specific locations reveal an enormous amount of information about the condition of your body.

We find written references to tongue characteristics appearing in medical texts such as the Yellow Emperor's Inner Classic as far back as the Warring States Period (403BC–221BC). These continue to appear with increasing systematisation throughout successive dynasties, until the first book devoted entirely to this subject by Ao in the Yuan Dynasty (1279-1368): the Record of the Golden Mirror.

The appearance of the tongue not only provides the practitioner of Chinese medicine with information, but has been closely correlated to various patterns of biomedically-defined diseases, often refining diagnosis in the process.

Let's provide an overview of what the tongue can tell us. Tongue body colour is a reliable indicator of the state of Yin Organs, Blood and Nutritive Qi, of the balance of Hot/Cold conditions and the balance of Yin/Yang. This is because tongue body and coating colours are relatively unaffected by short-term events and changes in the recent past, as compared to the pulse for example. For example a very dark red suggests a condition of intense heat in the body, while a very pale or nearly white suggests Severe Yang or Blood deficiency.

An examination of tongue body shape includes overall shape, texture and any involuntary movements of the tongue, i.e. whether the tongue is thin or swollen, long or short, has cracks, is supple or stiff, whether it quivers, trembles, or curls to the side.  Tongue shape reflects the state of the Organs, Qi and Blood. It is especially useful to help differentiate between Excess and Deficiency conditions.

While the tongue is useful for monitoring an improvement or decline in chronic conditions, the tongue coating is usually more helpful in acute conditions. It reflects Hot or Cold influences more directly than other aspect of tongue diagnosis. The thickness of the coat reflects the strength of the pathogenic factor (a stronger pathogen yields a thicker coat). Similarly thickness and thinness of coating reflect Excess and Deficiency states respectively.

Topography: each area of the tongue corresponds to different organs of the body. Embryological studies suggest that these correlations are by no means arbitrary. So the tip of the tongue corresponds to the Heart, the centre to the Stomach and Spleen, the sides to the Liver and Gallbladder, and the root or base, to the Kidneys. Your practitioner will be looking out for signs in each area.

What is the normal tongue supposed to look like?

Spirit: the normal tongue colour is vibrant and vital

Body colour: the normal tongue is pale red and 'fresh-looking'.

Body shape: the normal tongue is supple, neither flabby nor stiff, neither swollen nor thin. It is not cracked, doesn't tremble or quiver when you stick it out, and it has no ulcers.

Coating: the normal tongue coating is thin and white.

Moisture: the normal tongue should be slightly moist.

Don't be alarmed if you come to the conclusion that your tongue isn't normal! In the absence of accompanying symptoms there is unlikely to be a problem, but ask your Chinese medicine practitioner about any of your concerns.

Start paying attention to your tongue, it can tell you a lot. Also notice how it changes when you eat certain foods. You can start using it to see what agrees with you and what doesn't!

Reference: Maciocia, Giovanni. 1987. Tongue Diagnosis in Chinese Medicin. Revised edition. Seattle: Eastland Press.

Text supplied by Dr Sandra Cattich

Cupping

Cupping is a method of regulating the flow of Qi and Blood by creating a vacuum in a glass cup and placing it over acupoints on the body. Qi and Blood are drawn towards the surface, not only relieving areas of stagnation, but encouraging the elimination of pathogenic factors (Wind, Cold, Damp and Heat) from deeper to more superficial layers of the body's energy system, and opening the pores to eliminate pathogens through the skin itself.

Cupping can be used to move stagnant Qi, Blood, Food and Fluids, drain the lymphatic system,purify the Blood and calm the nervous system. A clinical trial conducted by Ilkay Zihni Chirali demonstrated that cupping drastically reduced the erythrocyte sedimentation rate (ESR) (a blood test used to measure levels of inflammation) in a variety of ailments.

While cupping has a systematic use supported by the theory of traditional Chinese medicine, it is an ancient form of medical treatment found in most studied civilisations, including that of Africa, where the horns of animals continue to be used to draw blood to the surface of the body and eliminate poisons. Ancient Egyptian records describe similar uses for cupping, which the Romans quickly learned to use when the Roman physician, Prosper Alipinus, visited Egypt in the 16th century.

Hippocrates and Galen in ancient Greece actively supported the use of cupping. (Hippocrates is regarded as the father of Western medicine, but if one reads his writings one finds personal, tactile descriptions of working with the energy of his patients in ways which would be quite familiar to any Chinese Qi Gong master, so he was fully aware of the world of energy medicine.)

British doctors such as Samual Bayfield were describing the 'art of cupping' in 1823, and were studying, using and paying official 'hospital cuppers' up until the 1860s. Jewish and Muslim traditions also contain rich accounts of cupping. Today cupping is still practised in Japan, Germany, Poland, Russia, Scandanavia, the Czech republic, Turkey, Greece, Brazil, Portugal, the Balkans and by many Mediterranean peoples.

Traditional Chinese medicine uses cupping to treat abdominal pain, anaemia, asthma, atrophy, back pain, sexual complaints, bed-wetting, boils and skin problems, chest pains, common colds, coughs, influenza, fevers constipation, dysmenorrhoea, hypertension, musculoskeletal pain, stroke, fatigue, and varicose or broken veins, among other ailments.

Cupping is a soothing treatment which usually relaxes patients although it can leave temporary red, circular marks on the skin, as the media noticed when following and photographing Gwyneth Paltrow, who appears to have helped popularise this method of treatment!

Acupuncture

Acupuncture is the insertion of fine needles into the body at specific points which have been empirically proven effective in the treatment of specific disorders.

These points have been mapped by the Chinese over thousands of years. Recently their location has been confirmed using sensitive machines which measure electrical resistance.

Acupuncture is well known to treat many medical conditions.

Acupuncture offers great relief in rheumatic and arthritic conditions such as tennis elbow, carpal tunnel syndrome, painful joints, shoulder, neck, lower back, wrist, pain, hip, knee and ankle problems. Muscle, ligament, soft tissue and all pain producing areas can be treated with great success. Even sports injuries and accident victims experience great relief due to acupuncture treatments. Paralyses, neurological disorders, allergies and gynaecological problems can certainly get effective relief.

Chinese Herbal Medicine

Acupuncture and Chinese Herbal Medicine is based on the flow of Qi in the body.

What is Qi? (Pronounced “chee”)

In the words of Huan Than, 40 BC: “Life is like the flame of a lamp, soon extinguished when the fuel (qi) is exhausted”

There are many forms of Qi. The qi that can be manipulated with acupuncture needling, or restored with a herbal prescription, is called “Jing Qi” - the vital energy circulating in the meridians. It regulates the circulation of blood, the processes of digestion of food, the immunity system of the body, etc.

The body carries a certain amount of Qi at birth. This is depleted by the daily activities of living; it is augmented by intake of food (Ying Qi) and air (Da Qi). This depletion and or reinforcement, if balanced, maintains growth and health.

Imbalance of Qi, its excess or deficiency, is the cause of ill health. The absence of Qi is death. The purpose of Acupuncture and Chinese herbal prescriptions is to restore the imbalance of Qi by puncturing the correct combination of acupuncture points and/or prescribing the correct herbal formula.

 

  • Source: Chirali, Ilkay. 2007. Traditional Chinese Medicine Cupping Therapy. Edinburgh: Churchill Livingstone