A brief and practical introduction to pulse and tongue assessment

Any assessment or diagnostic technique that seeks to make sense of what’s happening inside the human system is inherently pretty complex – be it a modern tool such as a CT scanner, or a traditional device such as the stethoscope. Interpretation is tricky, and the background knowledge required can often be intimidating. While using the tongue and pulse to get a glimpse inside the human body is not an exception, one can nevertheless glean really useful, actionable information with even a basic understanding of the technique. This basic understanding can become richer and deeper with ongoing practice. The complexity evidenced in traditional texts on the subject should not be a reason to keep you from experimenting!

Basics: Excess / deficient. Hot / cold. Dry / moist. The polarities!
            Pick two people and look at their faces. Feel their skin. Who is more red? Whose skin more dry? Who speaks more loudly and often? Who is more reserved and shy? The answers to these questions are clinically relevant, and it is in these basic categories that we will try to fit our observations of pulse and tongue. They have been universally recognized in traditional healing systems, from Chinese yin/yang theory to the Western humors.

The Pulse: Neuromuscular tension and tone
            When feeling the pulse, set your fingers on the radial artery. It can be found on the palm side of the wrist, right where the hand (thumb side) ends. You can often find a pair of strong tendons here; feel for the pulse in the little “trench” just above these.
            What we can learn from pulses: relative state of anxiety, tension, stress. Underactivity in the heart, vessels, and spirit (or, conversely, overactivity). 
            Herbs we can use to rebalance pulse: aromatic plants, and sometimes rooty, nourishing adaptogens. Archetypal plant for the pulse: Holy Basil (Tulsi – ocimum sanctum).
            Polarities to observe:
-         The pulse has a depth. It is right on the surface, somewhere in the middle, or deep down. This is determined by the amount of pressure required to find it. Surface pulse with no depth indicates “paper fire” (quick burnout, moody and changeable, hyper then crashing. Consider lavender, linden). Deep pulse that’s hard to find can mean depletion (hard to get going, tends to depression, fatigued. Consider ashwagandha, ginger, cayenne, green tea).
-         The pulse has a width. Think of the artery as a river, ideally flowing through the middle channel of depth. If it’s full and noticeable at all depths, it might be called “flooding” (excess function, high blood pressure, over-intensity. Consider motherwort, rose). If it’s thin and feels like a string, it might be called “tight” (high tension, excess sympathetic discharge. Consider motherwort again, lemon balm, scullcap). If it’s just thin, it might be a sign of deficiency and we would turn to the nourishing herbs (ashwagandha, oat, licorice, American ginseng).
-         The pulse has a speed. This is a pretty classic assessment: greater physical activity usually raises the pulse rate. When sitting, speedy pulses usually indicate anxiety or poor physical conditioning. Aromatic plants and exercise are called for. In extreme situations (requiring hospitalization: shock, toxicity, severe dehydration) you can see rapid, thin pulses too – but hopefully you won’t ever run in to these as they are emergency situations.
-         The pulse should respond to breath. Feeling the pulse, have the person take a deep, full breath slowly. The pulse should quicken on inhale, and slow down noticeably on exhale. Failure to do so indicates poor heart rate variability: if the pulse has low depth, feels thin or absent, consider nourishing and building here (ashwagandha, oat, licorice, American ginseng). If the pulse is of surface depth, flooding, or tight consider aromatherapy, and any aromatic plants (chamomile, linden, lemon balm, scullcap, mint, rose, yarrow).
-         The pulse should come back well after being completely blocked. Occlude the artery by pressing hard, then feel for the return of blood. Slow return to the “normal” state (taking more than 1 second) may indicate blood stagnation (purple color, cold, areas of chronic pain. Consider yarrow, elderflower, Salvia milthiorrhiza)
Basically, aromatic nervines make great teas and are often just the ticket for an imbalance in the pulse. This is because the radial pulse reflects the degree of sympathetic, or fight-flight, tone really well, and these plants are supremely useful for those who have either excessive or deficient tension in their systems. They modulate how we respond to change in the world within and without – and if we’re not doing a great job of it, the pulse tells us. If the pulse truly seems weak, sunken, and/or thin, you might want to add nourishing adaptogens as well to provide a literal foundation for stress hormone production, not just a way to balance response.

The Tongue: state of the mucous membranes
            When looking at the tongue, ask the person to really open wide and stick their tongue out completely. Then, tell them to relax it (often the “sticking out” causes the tongue to get really tight and weirdly-shaped).
            What we can learn from the tongue: relative state of activity and moisture of the membranes that line the GI tract, but also the respiratory passages by reflex. Degree of inflammation. Degree of swelling / moisture.
            Herbs we can use to rebalance the tongue: bitter and astringent plants. Archetypal plant for the tongue: Agrimony (Agrimonia eupatoria).
            Polarities to observe:
-         The tongue has a body color. This is the general hue of the tongue itself, not its coating, and indicates the degree of blood flow and activity in the mucous membranes. Pale tongue can indicate anemia, poor nutrition (consider yellowdock, rehmannia, protein). Red tongue indicates inflammation and irritation (consider dandelion and also slippery elm or meadowsweet depending on dry vs moist below). Purple: blood stagnation (see above).
-         The tongue has a coat. It should be whitish/gray, and relatively thin. Absent coat calls for soothing, especially with a red body (consider slippery elm, licorice, flax seed meal). Thick coat calls for bitters, especially if the coat has any signs of yellow in it – though watch for coffee stains! (consider dandelion, yellowdock, burdock)
-         The tongue has a shape, largely determined by its moisture (though the coat can tell us about moisture, too). Wider, thicker, glistening tongues indicate a swollen, boggy gastric mucous membrane. Often there will even be the scallops of tooth marks on the side (consider specific bitters such as goldenseal or barberry, but also meadowsweet, cleavers). Thin, wrinkly tongues indicate an atrophied, dry gastric mucous membrane (consider dietary oils such as sesame, bitters, and potentially soothers such as slippery elm especially with redness).
Basically, bitters are often a great choice for any tongue signs, except maybe in cases where the tongue is really pale and wet and there are symptoms of looseness in the bowel. This is because bitter herbs stimulate and awaken digestive function, and tone the mucous membranes in the process. They help us deal well with what comes to us from the world outside (most often food) by making sure that the interface (the mucous membrane) is functioning well. The tongue is a convenient piece of mucous membrane we can always observe!

            None of the diagnostic signs are infallible, of course – and should always be read in the context of symptoms and case presentation. The assessment of pulse and tongue can precede the oral interview, and guide it: for instance, feeling a tight and rising pulse with poor response to breath, you might want to ask about tension, anxiety, and a difficult response to life’s changes and stresses. Or noticing a dry and red tongue, you might ask about heartburn and/or constipation. Conversely, the assessment can come at the end of the oral interview, and be used to corroborate information obtained through conversation. Finally, the maxim: treat the person, not the tongue (or pulse)!