Tongues, pulses, and points: TCVM diagnostics for the beginner

Traditional Chinese Veterinary Medicine, like Western medicine, is an extremely broad subject that can be studied for years. As with any medical system, a little knowledge helps you read the literature more critically and whets your appetite to learn more. This article gives you a start at understanding the TCVM diagnostic approach.

Comprehending the depth and breadth of Traditional Chinese Veterinary Medicine diagnoses requires specialized training. Understanding the origin of the five elements of Wood, Fire, Earth, Metal, and Water, and how each is associated with the organs, is essential. Also imperative is recognizing the tension between the two forces of Yin and Yang, and how it produces harmony, deficiency or excess. This is the basis of disease in Traditional Chinese Medicine/Traditional Chinese Veterinary Medicine. However, you can begin to understand articles written about TCVM by learning what some of the diagnostic information means. In particular, tongue and pulse information forms the backbone of physical diagnostics in TCVM.

TCVM takes a different approach than Western medicine

Traditional Chinese Veterinary Medicine looks at health from a different perspective than Western medicine does. In TCVM, health is regarded as the free flow of Qi and Blood without any blockages (Stagnation) along the channels of energy (meridians) in the body. Qi is the life force that animates a being. Without Qi, one is dead. With reduced, deficient, or stagnant Qi, the being (or part of the being) is weakened. Qi is carried in the Blood along meridians in the body, to animate the entire being. When Blood is Stagnant, pain occurs along with a lack of free-flowing Qi. The body needs the correct amount of both Blood and Qi, along with open channels, for optimal function and energy without pain.

Tongue diagnosis

In TCVM, the tongue is assessed for color, moisture, coating, and shape, and specific locations along the tongue are examined. Tongue color is easily changed by eating (think clover with horses) and forcing the mouth open, so it is best assessed by watching the animal carefully, or if necessary, peeking between the lips to see the tongue without the use of force.

Begin to look at tongue colors in different animals; notice the qualities of your patients’ tongues whenever they show you on their own during examinations, such as when they yawn or stick out their tongues.

Each animal species has a normal tongue color, and in dogs, this can vary by breed, such as the black tongue seen in the Chow Chow. The normal equine tongue color is pale pink, while carnivores have a darker pink color. Young and healthy animals can provide good examples of normal tongue colors. Just as in veterinary school, it is best to learn the normal first, so abnormal can be recognized. Abnormal tongue colors include paleness, red and deep red, shades of purple or lavender, yellow and black (when not physiologically normal).

  • Paleness can indicate a Qi or Blood Deficiency. A Qi-deficient tongue tends to be wet, often with teeth marks on the lateral edges due to swelling. Blood Deficiency is always associated with dryness and may or may not be associated with anemia. Often, a pale tongue associated with anemia is seen earlier than the condition is indicated by laboratory values. A Blood-deficient tongue tends to be dry as well as pale.
  • Red or deep red can indicate excess Heat in the body or Yin Deficiency (broken air conditioner of the body). Yin Deficiency is a lack of coolness and is frequently seen in older animals or those with chronic disease, but it can also be seen in some young animals. For example, patients with diabetes mellitus can have a red tongue without a coating due to a lack of coolness and moisture. On the other hand, a red or deep red tongue due to excess Heat will have a coating, as seen in animals with heat stroke.
  • Purple or lavender indicates Stagnation, which can be due to pain (Qi and or Blood Stagnation). It can also be due to Stagnation of Qi associated with an organ. An example is Liver Qi Stagnation, which can have varied causes, including the animal’s personality (decisive, assertive, competitive); external factors that affect the liver, such as medications or toxic substances; stressors in an animal with the aforementioned liver (Wood) personality; or liver/spleen disharmony, in which a gut issue affects the liver and/or gallbladder (e.g. triaditis in cats).
  • Yellow indicates Damp in the liver, or icterus.

Tongues can be dry or wet. A dry tongue will be seen in excess Heat conditions such as acute pneumonia or heat stroke, since the Heat is so extreme and/or quick that it dries up the Yin. Dryness will also be seen with a Deficiency of Yin, which is cool and wet; or Blood, which is warm and wet. A wet tongue occurs with Qi Deficiency, which is often seen in chronic disease or weakness of the whole body or organ system.

Tongues also have coatings. A normal tongue coating is thin and usually white, but can be other colors depending on the species and food in the mouth. A thin coating can be normal, whereas a thick coating tends to be seen with deeper or more chronic disease. Heat is indicated with a yellow coating, with deeper coloration indicating a more severe issue.

A swollen tongue, as mentioned earlier, can indicate Qi deficiency, but in some cases can also indicate a Heat pattern, so both color and coating must be considered. A thin tongue can indicate Blood or Qi deficiency.

The tongue also has a “map” of the organs, with the tip of the tongue indicating the Heart element. Just caudal to the Heart element is the Lung element. The lateral edges of the tongue caudal to the Lung element contain the Liver and Gallbladder, while the Kidney element is on the caudal aspect of the tongue. Depending on where a coating, shape change, or crack in the tongue is located, issues with the corresponding organ system can be identified. One example is a deep red color or cleft at the tongue tip, which can indicate diseases of the Heart element.

Pulse diagnosis

As with the tongue, the pulses are a window into imbalances in the body and are important for determining a TCVM Pattern diagnosis. The pulse is assessed in various locations, depending on species. Cats, dogs, goats, and sheep have their femoral pulses checked. Equine pulses are palpated using the common carotid at the base of the neck or external maxillary artery, while the ventral tail (median caudal artery) is assessed in the bovine. Pressing on the artery determines its strength/character on the surface (superficial), or with increased pressure, at a middle and deep location.

Pulses on the left side, when weak, indicate Blood or Yin Deficiency. Weakness in the right-sided pulses indicate Qi Deficiency. Left-sided locations include the Heart, Liver and Kidney Yin, while right-sided locations include the Lung, Spleen (gastrointestinal), and Kidney Yang (Qi plus Heat).

  • A strong and forceful pulse indicates an Excess pattern, while a weak pulse indicates Deficiency.
  • Slow pulse indicates Cold, while a fast pulse indicates Heat.
  • Slippery pulse is palpated in pregnant animals, and can indicate Excess Phlegm (something not normally in the body or mind of healthy animals, other than pregnant ones).
  • Wiry pulse feels like a tight violin string, and most frequently indicates Stagnation.

Pulse diagnosis is a great skill to develop, and whole book chapters are written on the variety of pulses and their association with different disease syndromes. When a clinician starts this process, however, it is important to remember the basics of determining pulse strength (strong or weak), the character of the pulse at organ spots and levels (superficial, middle, deep), and any unique quality it may possess (wiry).

Pulse and tongue diagnostics, combined with a medical history and the rest of the physical exam, form the basis of a TCVM Pattern diagnosis, which is then used to determine the best course of treatment, including acupuncture, Chinese herbal medicine, food therapy, and Tui-na (Chinese massage techniques) to help bring the body back into balance.

Traditional Chinese Veterinary Medicine (TCVM) is very different from Western veterinary medicine in diagnostics and treatment. Both systems, however, have the same goal – to achieve health for our animal patients. Knowing something about tongue and pulse diagnostics is a good first step toward understanding the TCVM approach.

This article has been peer reviewed.

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