Anda di halaman 1dari 60

ISBN 978-615-5169-35-9 Tongue, Face and Body Diagnosis

This book contains provocative material
not for children or the sexually immature

Disclaimer for Diagnosis So learn these simple techniques of diagnosis but don’t be too presumptive and don’t be too
assumptive and learn to take it easy.
As we study medicine we see we do not have to diagnosis or treat disease to treat or help people. If you are licensed to diagnose then you can use any tool or observation to make your diagnosis
Diagnosis is not an Exact Science and there are always Multiple Problems For Us to Consider. within your scope of practice. Please stay within your scope of practice. If you are a licensed
Correcting the health problems and stabilizing biology are more important than symptom biofeedback therapist then you can identify, detect, and recognize stress. You can help your
reduction. patient deal with stress. The tools in this book can help you see areas where stress has affected
your patient. So stick to your scope of practice and resist the urge to diagnose beyond it.
Diagnosis has been shown to be far less than accurate. There is always a fractal of causes of
disease involved with all patients. We do not need to diagnosis to treat or help people. We only
need to diagnose to get insurance payment. As that medicine has become a profit industry based
solely on the sale of SINthetic drugs. And to prescribe a drug Diagnosis is needed.
This book gives you many medical tips on diagnosis that are not essential for medicine but are
insightful in helping your patients. So please study them and realize that diagnosis is not essential
for treating and helping patients.

2 3
4 5
6 7
Diagnosis is always a guessing game. We want to • A branch of the San Jiao muscle channel
make our best guess. The average medical doctor links with the root of the tongue.
Table of Contents is less than 33% accurate in his diagnosis. Here
are some observational tips from Traditional and
Tongue areas as they correspond to 
internal organs in Chinese Medicine
Holistic Medicine, Acupuncture, Ayurveda, and
Disclaimer for Diagnosis 2 others. If you study these you can learn to become
Face Head Feet Body Diagnosis 39 a better doctor and look for sub-clinical trends
Face - Organ Map 39 before they are a crisis. Remember be careful
Phrenology43 and not too presumptive and also remember you
don’t have to diagnose to help
THE PULSE CLASSIC 62 connections in the body, both to the meridians
AIM AND METHOD OF PULSE DIAGNOSIS 63 and the internal organs. It is therefore very
PULSE CATEGORIES 64 useful and important during inspection for
TRADITIONAL PULSE TAKING METHODS 72 confirming diagnosis. It can present strong
FACTORS TO CONSIDER BEFORE AND DURING PULSE EXAMINATION 74 visual indicators of a person’s overall harmony
PULSE AS AN AID TO OTHER DIAGNOSTICS 76 or disharmony. The tongue has a special
THE POTENTIAL ROLE OF PULSE DIAGNOSIS IN MODERN PRACTICE OF TCM 78 relationship with the Heart, in that the Heart
ALTERED USE OF PULSE DIAGNOSIS 80 opens to the tongue. The tongue is said to be
ATTEMPTS TO MAKE PULSE DIAGNOSIS OBJECTIVE 82 an “offshoot” of the Heart, or “flowers” into
Tongue Diagnosis Method and
RECENT INVESTIGATIONS OF PULSE 82 the Heart. The normal tongue in Traditional
Chinese Medicine has a light red or pinkish Cautions
REFERENCES83 body with a thin white coating. Lighting
Nail Diagnosis 88 Connections Sunlight will give the most accurate color of
VINDICATE90 the tongue body and coat. If sunlight is not
Polyarteritis nodosa 94 Channels/Meridians Reaching the Tongue available, use a second light source such as a
Angiomas 94 small flashlight to compare the tongue color
Nail Diseases and Disorders  95 Heart Channel (Hand Shaoyin)
• The Luo connecting channel connects to to the original light source.
Nail clubbing 108 the root of the tongue. Position
HPOA110 Spleen Channel (Foot Taiyin)
• An internal branch of the primary channel The tongue should be extended in a relaxed
Expecting a Baby? Expect Some Changes In Your Hair, Skin, and Nails 110
spreads over the lover surface of the manner, and should not be held out for an
Ayurveda Diagnosis tips 112 tongue. extended duration.
Facial and Body Diagnosis in TCM Acupuncture Theory 117 • The tongue is penetrated by the Spleen
Food and Drink
Sounds (Listening) and Odors (Smelling) in TCM Acupuncture Theory 117 Divergent channel 
Kidney Channel (Foot Shaoyin) Food and drink, such as coffee, green tea,
The cost of this book is 32 Euro. The copyright is owned by QX Ltd., all rights reserved. • An internal branch of the primary channel and candy may alter the color of the tongue
terminates at the base of the tongue. coating.
Please pay to the pay pal under under donations. All of the books have low res for size and hi res
Bladder Channel (Foot Taiyang)
versions for clarity. Brushed Tongue
• A branch of the muscle/sinew channel
If you do not have the money pay what you can, and if you cannot pay anything please pay the cosmos back with binds to the root of the tongue. Some patients may brush their tongue to
good deeds to others. Pass on the good karma by being good to others and helping them the way I am helping you. San Jiao Channel (Hand Shaoyang)
Pass it on. help freshen their breath or as an Ayurvedic
8 9
10 11
practice. Ask the patient not to brush their Tongue Body Color
tongue, at least the day of their TCM tongue
diagnosis. Indicates the state of Blood, Yin organs, and
Ying (Nutritive) Qi.
Seasons of the Year 
Normal Tongue Body
In Summer, there may be more Dampness
present in the tongue coating, leaving • Pink or light red in color
it slightly thicker and light yellow. Bluish Purple or Reddish Purple Tongue Body
In Fall o r Autumn, the tongue may be
thinner with a coating that is more dry. • Purple can indicate both Heat and Cold
In Winter, there may also be more moist conditions.
or damp presenting in the tongue.
• A reddish purple tongue indicates Heat
In Spring, the tongue should be normal.
and Blood Stagnation.
Time of Day
• A dark reddish purple tongue that is dry
The coating of the tongue usually becomes usually indicates depleted fluids due to
thinner as the day progresses, while the color Excess Heat
of the tongue body becomes more red and
• A light purple, bluish purple, or greenish
purple tongue body color can indicate
Patient’s Age  Cold and Blood Stagnation.

In the elderly, Qi and Blood Deficiency Red Tongue Body

is more common, s o the tongue
• A red tongue body is darker than the
may present with dryness and cracks.
normal red, which is pinkish in color. It
Infants tend to have white thick
indicates either Deficient or Excess Heat.
coating that is easily removed,
peeled tongues are also common. • A red tongue body with a thick yellow
Overweight patients usually have more coat or swollen buds indicates Excess Heat
Damp and/or Phlegm and therefore their
tongues may be larger and lighter in color. • A red tongue body with a bright shiny
Thin patients tend towards redder tongues.  coat, little coat, or no coating indicates
Deficient Heat.
Tongue Feature Indications Red Tip
• Tongue Body Color • Heat in the Heart Zang
• Tongue Body Shape
• Tongue Body Features Scarlet Tongue Body
• Tongue Body Moisture
• A scarlet tongue that is also peeled or
• Tongue Coating
shiny indicates Yin Deficiency, usually of
• Tongue Coat Thickness
the Heart and/or Lung depending on the
• Tongue Body Cracks
area of swelling.
• Tongue Coat Root
Dark Red Tongue Body
• The red is darker and more crimson in color.

12 13
This tongue body can indicate internal is an indication of Excess, and often one of Big or Enlarged Tongue • This tongue is usually found in patients
injury such as trauma (De Da), invasion Internal Wind. with chronic Lung and Spleen Deficiency,
of external evil in the Ying (Nutritive) and • An enlarged tongue can indicate Phlegm, which tends toward Damp and Phlegm
Xue (blood) levels, or it can indicate Blood • If a stiff tongue is accompanied by a bluish Damp, or Water Stagnation. accumulation.
Stagnation. purple tongue body, this usually indicates
potential or impending Wind-Stroke. • An enlarged tongue with a pale body and Swollen Edges
• If there are red spots with a thin coat, this a moist coat may indicate Spleen and
usually indicates damage to the Ying or • If a stiff tongue is accompanied by a bright Kidney Yang Deficiency • This tongue may indicate Spleen Qi or
Xue level. red tongue body, this usually indicates yang Deficiency.
heat in the Heart and Pericardium • An enlarged tongue with a red body and
• If the tongue body also has cracks and disturbing the Shen (Spirit). a greasy yellow coat may indicate Spleen • If Spleen Yang is Deficient, the edges will
there is little or no tongue coat, this and Stomach Damp-Heat. also be wet.
usually indicates Deficient Heat due to • If a stiff tongue is accompanied by a
thick sticky tongue coating, this usually Half the Tongue Is Swollen Swollen Tip
internal injury.
indicates “Phlegm Misting the Heart”. • A half swollen tongue may indicate general • When the very tip of the tongue is swollen,
Pale Tongue Body weakness of the Channels. it usually indicates Heart problems.
• Indicates the quality of Blood, reflecting Hammer Shaped • If the tongue is also deep red, this may
Blood and/or Qi Deficiency or Cold. • The flaccid tongue is the opposite of the
stiff tongue. It is weak and lacks strength. indicate Heart Fire.
• This is where the front half or third of the
• If the tongue body is also moist, tender, It usually indicates Deficiency. When tongue is enlarged at the sides. • If the tongue is normal in color or pale,
and swollen, this can indicate Yang Cold. heat has consumed and damaged body this may indicate Heart Qi Deficiency.
fluids, they can not rise to nourish the • A hammer shaped tongue usually indicates
• A pale thin tongue body usually indicates tongue. This can indicate Yin Deficiency, Spleen, Stomach, and Kidney Deficiency Short and Contracted
Qi and Blood Deficiency. Qi Deficiency and/or Blood Deficiency. • This tongue is almost always indicative • When the patient can not show the entire
Green Tongue Body • A flaccid tongue that is also pale usually of a serious condition, and may indicate tongue, it usually indicates a more severe
• A green tongue body usually indicates indicates Qi and Blood Deficiency. mental illness. disease.
Excess Yin Cold or the presence of a strong • A flaccid tongue that is also dark red, dry, Local Swelling on One Side • If the tongue is also moist and pale, this
Excess evil with weak Zheng Qi. The Yang and has cracks usually indicates extreme indicates stagnation of Cold (bluish/
is not properly moving Blood and Fluids • Localized swelling of tongue with a normal purple) in the meridians or Spleen Yang
heat injuring fluids. tongue body color indicates Qi Deficiency
and there is Stagnation in the body. Deficiency.
• A flaccid tongue body with a scarlet • Localized swelling of tongue with a red
• Internal Wind may also present with a tongue body usually indicates Exhaustion • If a contracted tongue also has a sticky
green tongue body. tongue body color indicates Qi and/or tongue coating, this may indicate Turbid-
of Yin. Blood Stagnation Phlegm blocking the channels.
Tongue Body Shape Swollen Swollen Sides • If the tongue is also deep red and dry,
The body shape reflects the state of Blood • This is a very large tongue body and can • A tongue with swelling in Liver and excessive heat has consumed Body Fluids
and Ying (Nutritive) Qi, and indicates Excess indicate both Excess and Deficiency. Gallbladder area usually indicates Rising and stirred up internal Wind.
or Deficiency. Constitution can also affect the Liver Yang or Liver Fire.
shape of the tongue body. • A swollen tongue that is also pale can • A short, swollen, tender, and pale tongue
indicate Qi Deficiency Swollen Between the Tip and the Central usually indicates Qi and Blood Deficiency.
Stiff Surface
• A swollen tongue that is also bright red • A short or small frenum may be inherited
• A stiff or rigid tongue is difficult to move and painful can indicate Heart and Spleen • This area corresponds to the Lung area and is normal.
(protrude, retract, side to side). This Heat. This could also be due to excess and usually presents with a normal or
may cause speech abnormalities such as alcohol consumption. Long
pale tongue body.
slurring or mumbled speech. A stiff tongue • There is difficulty in retracting the tongue.
14 15
• This indicates interior Excess Heat, Heart (Liver/Gallbladder area) may also indicate Rolled Tongue Body Tongue Coating
Fire, or Phlegm-Fire Misting the Heart. a more severe illness.
• Reaction to insecticides. Indicates the state of the Yang organs,
• There may be numbness which is • Red spots on the back of the tongue especially the Stomach.
associated with (Kidney area) may indicate the advanced Teeth Marks on Tongue Body (Scalloped)
stage or chronic nature of an illness. White Tongue Coat
Front Swollen • If the tongue body has normal color, this
White Spots usually indicates Spleen Qi Deficiency. • A thin white tongue coating is normal.
• Swelling towards the front one-third of
the tongue may indicate Phlegm retention • White spots are usually due to Spleen • If there are teeth marks together with a • A thin white tongue coating can also
in the Lungs. and Stomach Qi Deficiency together with swollen tongue, this may indicate Spleen indicate external Cold patterns when
excess heat accumulating in the body. In Yang and/or Qi Deficiency. the appropriate clinical symptoms are
Thin this case, the tongue may also have sores present.
• If the tongue is also pale and moist, it is
• This can indicate that Qi and Blood are and pus. more likely Spleen Yang Deficiency or a • With a moist and pale tongue, a thicker
deficient and not able to properly nourish Black Spots Cold-Damp pattern. white coating can indicate Damp-Cold.
and moisturize the tongue. The tongue
body will also usually be pale in color with • Black spots usually indicate Qi and Blood Quivering or Trembling Tongue Body • A dry white coating can indicate Cold
Qi and Blood Deficiency. Stagnation or heat in the Blood. turning to Heat and starting to dry body
• Trembling of the tongue that can not be
• A thin tongue that is also dark red and dry Ulcerated Tongue Body controlled may be due to external febrile
may indicate Yin Deficient Fire. disease or excess heat consuming Yin. The White Like Powder Tongue Coat
• Suspect acid alkaline imbalance, vitamin K excess heat stirs up Internal Wind. The
deficiency, Iron excess, tongue body will be a deep red color and • A white and thick tongue coating like
Tongue Body Features powder indicates turbidity and external
the pulse will be rapid.
Rough or Tender Texture Numb Tongue Body pathogenic heat. This coating will usually
• If the tongue body is pale and trembling, change to yellow after a short time if the
• A tender tongue that appears smooth, • Manganese deficiency, Tardive Dyskinesia this usually indicates a chronic condition patient is not treated.
delicate, and is possibly swollen indicates Loose Tongue Body of Qi and Blood Deficiency, where the
deficiency. tongue is not being nourished. • If the tongue body is dark red, interior
• Manganese deficiency, Tardive Dyskinesia, toxins may be present.
• A rough tongue that appears wrinkled and loss of muscle tone, dystonia • Side effects of some western medications
rough indicates Excess. (pharmaceuticals) may cause trembling of White Like Snow Tongue Coat
Deviated Tongue Body the tongue.
Red Spots • This may indicate exhaustion of Spleen
• This is where the tongue tends toward Sore Covered Tongue Body yang with Damp-Cold in the Middle Jiao
• Red spots may indicate Heat Toxins in the one side of the mouth
Blood or Heat Toxins attacking the Heart. Side effects of some western medications Yellow Tongue Coat
• This is due to Wind, either from exterior
• Red spots can indicate the presence of • A slightly yellow coating indicates Wind-
Pathogenic Wind or internal Wind-Damp Tongue Body Moisture
Damp-Heat in the Xue Level, where the Heat or Wind-Cold turning to Wind-Heat
internal organs are accumulating toxins. Reveals the state of Yin and Fluids in the body. • A yellow tongue coat indicates an interior
Moving, Lolling, Wagging, Playful Tongue
• Red spots on the Tip (Lung/Heart area) is Dry Tongue Body heat pattern. The deeper the color of
usually not severe and may present in the yellow, the more severe heat. A burnt
beginning stages of illness. • This usually indicates heat in the Heart • Dehydration, lymphatic drainage disorder yellow indicates further accumulation of
and Spleen channels stirring up internal heat in the body.
• Red spots on the entire tongue may Slightly Dry Tongue Body
indicate a more severe illness. • If the coating is yellow and moist and
• Same progresive
• In children, this may indicate the tongue body is swollen and tender,
• Red spots on the sides of the tongue developmental problems. this indicates interior Damp-Heat or Yang

16 17
Deficiency. In the case of Yang Deficiency, • Both Gray and Black tongue coating can to thick, this indicates pathogens are • The normal tongue coating has Root,
the tongue is showing false heat signs, as indicate extreme Cold (wet tongue) or penetrating deeper into the interior of the which means that is “rooted” or attached
the Yin has forced the Yang to the surface extreme Heat (dry tongue). body. to the surface of the tongue body. It
of the body. cannot be easily scraped off or removed.
• Western drugs such as antibiotics can also Peeled, Mirrored, Shiny, No Coating
Dirty Yellow Tongue Coat cause a black tongue coating. Tongue Coat Has No Root
• With a mirrored tongue, there is no
• This tongue coating may indicate Stomach Half Yellow, Half White (Longitudinally) coating on the tongue. In less severe • A coating without root rests on the surface
and Intestinal Damp-Heat cases, there may be a partial coating on of the tongue, but can easily be removed
• This coating may indicate Heat in the Liver the tongue. or scraped off.
Simultaneous White and Yellow Tongue and Gallbladder
Coating • If the body of the tongue is also red, it • A coating without root usually indicates
Yellow Root With A White Tip usually indicates that Stomach Qi and Yin impairment of Spleen, Stomach, and
• Can indicate a Shaoyang pattern is severely damaged. Kidneys.
• This may indicate that exterior Pathogenic
• Can indicate a simultaneous Heat and Heat is penetrating more deeply into the • If the tongue body is also light in
Cold pattern, or a Cold pattern turning to interior of the body. color, this may indicate that Qi and
Heat Blood of the Spleen and Stomach is
Black in the Center, White and Slippery on
• Can indicate a simultaneous Interior and the Sides damaged and Deficient.
Exterior pattern • If the tongue body is also red or
• This may indicate Spleen Yang Deficiency
Gray Tongue Coat with interior Damp-Cold dark, Stomach and Kidney Yin is
damaged (body fluids dried up)
This tongue coating usually indicates an Tongue Coat Thickness due to heat.
internal pattern of either Heat or Damp-Cold.
Thin Coating Tongue Body Cracks
A dry gray coating can indicate internal Excess
Heat scorching Body Fluids or Yin Deficient • Normal Short Horizontal Cracks
• In disease, it indicates the disease is either • Vitamin B6 Deficiency
A wet or moist gray coating usually indicates external or an internal disease that is not
Cold-Damp Stagnation or Damp-Phlegm severe. Long Horizontal Cracks
retention. • Vitamin B6, B12, B2 Deficiency,
• If the tongue coating changes from thick
Black Tongue Coat to thin, this indicates pathogens are Transverse Cracks On the Sides of the
moving to the exterior of the body and Tongue
• Similar to the Gray coating above, but the disease is waning. Tongue Diagnosis
more severe. • Vitamin B6, B12, B3 Deficiency,
Thick Coating by Cathy Wong
• The black coating usually develops from Transverse Cracks Behind Tip
gray or a burnt yellow coating. • A thick coating usually indicates more of Chinese medicine practitioners believe the
an internal disease that is more severe. • Vitamin B6, B12, B2, B3 Deficiency, appearance of your tongue can reveal a lot
• A dry black coating (usually with cracks) about your health.
may indicate excessive Heat burning body • It may also indicate that exterior Very Deep Ventral Cracks With Other Smaller
fluids. pathogenic factors have penetrated more Cracks Tongue diagnosis is an important part of
deeply into the body. the Chinese medical assessment. During an
• A moist black coating and a pale tongue • Vitamin B6, B12, B2, B3, B5 Deficiency, examination, the practitioner usually looks at
body may indicate Yang Deficiency, • A thick tongue coating may also indicate the overall tongue coating, shape, and color.
Internal Excess Cold, with or without the retention of food. Tongue Coat Root Then he or she looks at specific areas on the
presence of Dampness. tongue.
• If the tongue coating changes from thin Tongue Coat Has Root
18 19
Different areas of the tongue are believed Tongue body color May be a sign of
to reflect the health of the different organ
Stagnant qi
systems. If there is an unusual color, coating,
and/or shape in a certain area, special Stagnant blood if
attention is paid to the corresponding organ Purple dark purple tongue
system. body and/or red
spots on the tongue
As with any assessment method, the doctor
doesn’t rely on tongue diagnosis alone, but What is the Tongue Shape?
uses it to provide a complete picture of a
person’s health. Normal tongue shape is not too thick or
thin, and the tongue body is smooth with no
Below are some of the guidelines Chinese cracks. Changes in the tongue shape usually
medical practitioners use to assess the tongue. reflect chronic illness involving blood, qi, or
This is only a selection of many different types body fluids.
of patterns.
Tongue shape May be a sign of
What is the Tongue Color? Spleen qi deficiency,
especially if teeth
Normal tongue color is light red, indicating that Swollen or puffy marks on the sides
a person’s vital energy (called qi) is strong. It
also reflects the health of the internal organs Damp heat
and blood circulation. Changes in the tongue Blood deficiency
color usually reflect chronic illness. Thin
Fluid deficiency
Tongue body color May be a sign of Trembling Spleen qi deficiency
Excess cold, Heart heat
especially if thick Elongated
white coating.
Liver qi stagnation
Spleen qi deficiency,
Pale especially if thin If the sides are
white coating. Sides curled up swollen and red, it
may indicate Liver
Blood deficiency,
especially if dull,
pale face and lips. Excess heat or yin
Excess heat,
especially if there Heart imbalance,
is a thick yellow especially if there
tongue coating. is a crack down the
Red middle of the tongue
Yin deficiency,
to the tip
especially if tongue
body is thin and
coating is thin,
absent or peeled. What does the Tongue Coating Look Like?

20 21
Normal tongue coating is thin and white. A vitamin C, and foods made with artificial food The following correspondences exist in this Width:
pale yellow and slightly thicker coating at the coloring. relationship:
back of the tongue may also be normal. The • a wide tongue reflects an overall balanced
tongue coating often indicates the health of Tongue self diagnosis  physical and psychological disposition.
the spleen and stomach. It also provides a • a narrow tongue reflects a lack of physical
Question:    Which aperture of the body adaptability with pronounced strengths
good indication of acute illness, such as colds
reflects the internal organs  related to  and weaknesses. Mentally, thinking may
and digestive problems.
excretion and assimilation? Anus, urinary be sharp but tend toward seeing a narrow
Tongue coating May be a sign of tract, ears, nose, or mouth? view.
Thick Excess • a very wide tongue reflects a generally
Answer: Mouth.
loose and expanded physical condition
Yellow, thick, glossy Damp Heat
and a tendency toward more psychological
Dry, yellow Excess heat concerns.
Deficient yin • A - the tip area reflects the rectum and the
descending colon. Tip:
Heart yin deficiency • B - the peripheral area reflects the large
if it's on the tip of the • a rounded tip reflects a flexible yet firm
intestine. physical and mental condition.
tongue • C - the middle region corresponds to the • a pointed tip reflects a tight, perhaps even
Peeled or absent Kidney yin deficiency small intestine. rigid physical condition and an aggressive
if it's all over the • D - the back edge region relates to the liver, or even offensive mentality.
tongue or at the gallbladder, duodenum, and pancreas. • a very wide tip reflects an overall weakness
back of the tongue Your tongue accurately reflects the state • E -the near back region corresponds to of the physical body and a flaccid or even
and the tongue body of your digestive system- from rectum to the stomach. “spaced out” mental condition.
is red. esophagus, including the stomach, small • F - the back region (‘the root of the • a divided tip reflects a tendency toward
intestines, colon (large intestine), pancreas, tongue’) reflects the esophagus. physical and mental imbalances with the
Are there any Specific Problem Areas? spleen, liver and gall bladder.  • G - the underside of the tongue reflects possibility of sharp fluctuations in thinking
the quality of blood and lymph circulation and mood.
Each area of the tongue is connected to Imagine, you don’t need a battery of tests to in each corresponding area.
specific internal organs. find out what part of your digestive tract is in Thickness:
• sides of the tongue - liver stress. You can diagnosis the whole GI tract Structural characteristics
and corresponding organ integrity all in one • a flat tongue reflects a balanced condition
• tip of the tongue - heart
easy view- just stick your tongue out and take Like each particular area of the body, the and the ability to flexibly adapt to
• center of the tongue - spleen
a good look at it. tongue can be used to evaluate one’s overall circumstances.
• back of the tongue - kidney
condition. • a thin tongue reflects a more mental
Other Tongue Tips As a whole the tongue reflects the condition orientation, with a tendency to be more
of the digestive system and the organs Zetsu Shin as it is called in Japanese, is one of gentle and easy going.
Some disorders don’t show up on the tongue. associated with blood, nutrient assimilation, the most important forms of diagnosis used • a thick tongue reflects a more physical
and excretion. You can also see how ‘hot’ or in Chinese medicine. Two main aspects are orientation, with the tendency to be
Tongue is usually examined for no longer considered in tongue diagnosis.
how ‘cold’ your internal organs are. Therefore assertive or even aggressive.
than 15 seconds at a time. If it’s extended
it has a high value as a diagnostic tool.   • In comparison to structure, the condition
for longer, the tension may alter the shape or First is the structure of the tongue. Is it wide
color. Specific sections of the tongue mirror the or narrow, thick or thin, pointed or rounded? of the tongue is influenced more by daily
condition of particular parts of the digestive Such qualities convey information concerning lifestyle and provides information about
The tongue should be examined under natural the individual’s basic constitution and overall an individual’s current state of health.
system and the digestion related internal
light. strengths and weaknesses of body and mind.
organs. Qualities to look for include:
Before examination, don’t eat foods that may
discolor the tongue, such as coffee, beets,
22 23
Color: tongue.
• a stiff, tense, or inflexible tongue.
• Dark red: indicates inflammation; • a loose or lolling tongue.
lesions or ulceration; and sometimes a • a tongue with a pronounced slant to the
degeneration of the related organ. left or right when it is extended.
• White: indicates stagnation of blood; fat
and mucus deposits; or a weakness in Pimples or projections of the tongue’s surface
the blood leading to such conditions as indicate the discharge of fat, protein, and
anemia. sugar. Where in the body this discharge is
• Yellow: indicates a disorder of the liver coming from can be determined by the specific
and gallbladder, resulting in an excess area of the tongue on which it appears. You
secretion of bile; deposits of animal fats, can find the correlation between the areas of
especially in the middle organs of the the tongue and the digestive tract.
body; and possible inflammation.
• Blue or Purple: indicates stagnation of The second major aspect considered in
blood circulation and a serious weakening tongue diagnosis is the coating, or moss, as it
of the part of the digestive system that is called in Chinese medicine, on the tongue’s
corresponds to the area of the tongue surface.
where the color appears. Qualities are again divided into antagonistic
The color on the underside of the tongue pairs, and include moist and dry, excessive
can also be used to determine the internal and deficient, thick or thin. The color of
condition. In general, the colors and their the coating reveals a precise information
indications listed above are the same, with concerning specific internal conditions.
the following exceptions: The guidelines explained above, particularly plan your treatment. Generally the tongue, is Common Tongue Geography and Meridian
• Blue or Green: In excess, either of these concerning the aspects of location and color, much easier to learn and less subjective than Correlations
color reflect disorders in the blood vessels can be used for a general understanding of pulse diagnosis. It is less meridian specific
the different qualities of coating found on the than the pulse, however, the tongue will show Lower Jiao
and in blood quality and circulation.
• Purple: In excess, this color reflects tongue. the depth and nature (hot, cold, etc.) of an The Base of the tongue corresponds to the
disorders of the lymphatic and circulatory They are especially extremely useful when imbalance and it is less effected by short-term Kidney, Urinary Bladder, Large Intestine and
system. It indicates a weakening of the fasting, cleansing or when one is ill. A precise influences such as nervousness. The tongue is Small Intestine Meridians.
immune ability and of the blood vessels. understanding of the nature of the problems also useful as a measurement tool to gauge
the progress of a disorder. Middle Jiao
Texture: can be achieved in seconds.
Below you will find detailed information about The sides of the tongue correspond to the Liver
• a swollen or enlarged tongue: indicates a Tongue Diagnosis in TCM Acupuncture
tongue diagnosis and the clinical significance and Gall Bladder meridians. Some theories
Jitsu, or full state. Theory
of the examination: place the Gall Bladder on the patients left
• a shriveled or withered-looking tongue: One of the most common questions that side and the Liver on the patients right side.
indicates a Kyo, or empty state. people ask about acupuncture is: • Common Tongue Geography and Meridian The Middle of the tongue corresponds to the
Correlations Stomach and Spleen Meridians.
Movement: “Why does my acupuncturi st look at my • Body Colors and Indications
tongue?” • Body Shape and Indications Upper Jiao
The flexibility of the tongue also reflects
the condition of the digestive system. • Tongue Coatings and Indications The Tip of the tongue corresponds to the Lung
Tongue and pulse diagnosis are two of the
Characteristics to look for include: • Sources and the Heart Meridians.
more important diagnostic tools in Chinese
• Acupuncture Theory Related Resources
• a flexible, supple, smoothly moving medicine. They are both used to derive a TCM
• Discuss Acupuncture Theory
diagnosis for your condition which is used to
24 25
Tongue Body Shapes and Clinical Indications
Body Shape Indications
if develops during illness indicates chronic
and severe, otherwise normal
location of cracks relates to organ pathology
+ red = empty heat consuming fluids
+ pale = blood & qi def
crack runs from center to the tip = ht disorder
or congenital ht problems
horizontal cracks = yin def
deviated (crooked) wind
deficiency heat
flaccid + pale = blood & qi def
+ dark red = yin collapse
long heat in the ht
rigid stroke or early signs of stroke
serious conditions
blood deficiency
ht deficiency
short (contracted)
+ pale or purple = cold or yang def
Tongue Body Colors and Clinical + swollen = damp or hlegm
Indications + red = heat consuming the fluids
heat in the ht
Body Color Indications
ht/sp heat
normal or mild disorder stiff
Pink phlegm obstructing the ht qi
yang, blood a/or qi def + normal & pale = wind, stroke
Deficiency Cold deficiency
+ thin & dry = blood def + pale & wet - yang def + teethmarks & pale =
Pale swollen
+ wet = qi def qi def or excess fluids + dark red = excess heat
+ swollen = qi def usually ht/sp
+ swollen & wet = yang def blood or fluid def
heat empty heat consuming fluids
+ no coating = yin def empty heat + pale = blood & qi def
Red + yellow coat = excess heat + red = yin def
+ wet = damp heat heat
+ dry = injured fluids congealed blood
extreme heat thorny (strawberry, granular) + on tip = ht fire
Dark Red (Scarlet, Cardinal) + on edges = lv/gb fire
more severe conditions than red
stagnation lv qi stagnation is likely + pale = + on center = st a/or intestines heat
Purple wind
Blue severe internal cold stagnant blood trembling (quivering) + pale = qi def
+ red = heat producing internal wind
26 27
Tongue Coatings and Clinical Indications

Tongue Coat Indications

thin normal
exterior condition, wind-cold
thick excess damp/phlegm
food stagnation
dry heat consuming yin
excess yang or fire
deficiency fluids
moist normal or mild imbalance
wet excess fluids from yang def
sticky (greasy, creamy) dampness or phlegm
retention of food
Coat Coloration Indications
white internal or external cold
if coat looks like cottage cheese = ST heat
+ thin coat & body aches = exterior wind-cold
+ thin coat & thorny = wind-heat
yellow internal or external heat
effected by coffee, tea a/or smoke intake
gray hot or cold internal condition
retention of phlegm heat
+ dry = heat consuming body fluids The tongue coat is a good indicator of the
+ moist = damp cold state of the Stomach and Spleen. It also
black severe condition involving hot or cold shows the strength, depth and temperature
+ pale = excessive cold from yang def of pathogenic factors.
+ dry & possible thorny = consumption of body A normal tongue coat is thinnest at the edges,
fluids thicker in the center and thickest at the root.
Coat Rooting Indications It is thin and white, slightly moist and has a
rooted strong st/sp qi root.
moss appears firmlz implanted
Learning Examples
rootles st/sp qi def
A Reddish-Purple tongue body colour
moss appears to float on the surface • Body colour: Reddish-Purple.
usually indicates Blood stasis deriving from
peeled sp qi def • Body shape: Swollen and cracked.
or associated with Heat (whereas a Bluish-
deficient yin or fluids • Coating: peeled.
Purple colour generally indicates Blood stasis
deriving from Cold). In this case, the tongue
colour is consistent over the whole tongue so
28 29
we cannot determine from the tongue alone • Body colour: Reddish-Purple, Bluish-
where the Blood stasis is located. The pulse Purple in the chest area on the right.
and the symptoms can tell us this. However, • Body shape: Stiff, slightly Swollen.
the most likely pattern is that of Liver-Blood • Coating: sticky coating without root.
stasis. The tongue body is also Swollen which
indicates the presence of Phlegm. The Lung The overall body colour of this tongue is Purple,
and Heart areas of the tongue are especially indicating Blood stasis. It is predominantly
swollen which points towards the fact that Reddish-Purple, which indicates Blood stasis
the Phlegm is predominantly in the Upper deriving from or associated with Heat but the
Burner. Phlegm and Blood stasis are often chest area on the right of the tongue is Bluish-
seen existing side by side, especially in older Purple which indicates that there is also some
patients, as they interact with and “promote” Cold which has lead to Blood stasis in the
each other. Blood stasis stops fluids from chest.
being transported around the body smoothly The tongue is also Stiff. A Stiff tongue indicates
therefore encouraging the production of either severe Blood stasis or internal Wind.
Phlegm, while Phlegm blocks the smooth flow As the tongue is also Purple, in this case it is
of Qi and Blood leading to stasis. most likely that it indicates Blood stasis.
The tongue is totally peeled (without coating) The sticky consistency of the coating simply
and with many cracks, both signs of chronic indicates that there is Dampness (or together
Yin deficiency. It is likely that the Yin deficiency with the Swollen tongue body Damp-Phlegm),
preceded the Blood stasis. Chronic Yin but the fact that it is rootless reflects a
deficiency leads to Empty-Heat and we know deficiency of Stomach-Yin. A rootless coating
in this case that the Blood stasis derives from reflects the beginning stages of Stomach-Yin
Heat as the tongue is a Reddish-Purple colour. deficiency.
Although we cannot tell conclusively from the
tongue only, the Yin deficiency is most likely Example 3 - NEW
of the Stomach and Kidneys
Therefore, in conclusion, we can say that this
many suffers from Yin deficiency with Empty-
Heat, Blood stasis and Phlegm in the Upper
Example 2 - NEW

• Body colour: Slightly Red but Pale on the

• Body shape: Swelling in the Spleen area
on the sides, Stomach cracks.
• Coating: Peeled.
This tongue shows clearly a relatively common
condition of Stomach-Yin deficiency (leading
30 31
to some Heat) and Spleen-Yang deficiency. • Body colour: slightly Red. Although the tongue points towards the Blood and to emotional problems: the deeper the
The cracks in the Stomach area indicate • Body shape: Swollen, especially in the stasis being especially in the Liver, treatment crack, the stronger this propensity. If, in the
Stomach-Yin deficiency and the overall colour chest area with a Heart crack. of this patient should focus equally on moving presence of a Heart crack, the tongue tip is
of the tongue is slightly Red showing that this • Coating: sticky coating. Blood in the Heart. The presence of a Heart red, it indicates that there already is a Heart
Yin deficiency has lead to some Heat, but the crack indicates a constitutional tendency to pattern usually from emotional problems.
sides of the tongue in the Spleen area are This tongue is slightly unusual in that it clearly Heart patterns. In other words, a change in colour of the
Swollen and Pale. This relects Spleen-Qi and shows us the exact location of a pathogenic tongue body indicates that that particular
Yang deficiency leading to Dampness. factor. The chest area is clearly more Swollen Example 6 constitutional tendency to Heart patterns
than the rest of the tongue indicating the has manifested itself and generated an actual
It is important to distinguish between the presence of Phlegm in the Upper Burner. Heart pattern. If we compare two people both
Liver and the Spleen areas on the sides of the with a red tip of the tongue, one with a Heart
tongue. The Liver area is a longer and thinner As a general rule, the tongue body shows
more the presence of Phlegm and the coating crack and the other without, the presence of
strip, covering nearly the whole side of the a Heart crack indicates that that person has
tongue, whereas the Spleen area is shorter reflects the presence of Dampness. When
the tongue body is Swollen and the coating is a constitutional tendency to Heart patterns
and fatter and in the middle of the side of the and that his or her condition is deeper and
tongue. sticky, as in this case, it normally indicates the
presence of Damp-Phlegm, in this case clearly more difficult to treat than that of the person
In the case of this patient, it would therefore in the Lungs. without a Heart crack.
be necessary to treat both Yin deficiency (of The small, transverse cracks on the sides
the Stomach) and Yang deficiency (of the Example 5 - NEW
• Body colour: pale. usually indicate severe, chronic Spleen
Spleen). Even though the Yin deficiency (and • Body shape: swollen, central Heart crack, deficiency. Thus, we can conclude that this
Empty-Heat) seem predominant because the transverse Spleen cracks on the sides. man suffers from a chronic Spleen-Yang
main area of the tongue body is Red and it is • Coating: thin-white (normal), slightly deficiency and Phlegm.
peeled, it is likely that the Spleen deficiency yellow in the centre.
came first. As the Spleen and Stomach are Example 7
so closely connected, a long-standing case of The pale tongue-bocolour indicates Yang
Spleen-Qi and/or Yang deficiency may lead deficiency (it may also indicate Blood
to a deficiency of the Stomach (which has a deficiency, but in a man, it is more likely to
tendency to become Yin deficient). be Yang deficiency). It is not possible from the
tongue only to establish which organ is mostly
A suitable remedy for this condition might be • Body colour: slightly Red. affected in this case by the Yang deficiency:
Shen Ling Bai Zhu San (Central Mansion in the • Body shape: Swollen, especially in the however, since the tongue body is also swody
Three Treasures remedies). chest area with a Heart crack. llen, which usually indicates Phlegm, it is
Example 4 - NEW • Coating: sticky coating. more likely to be Spleen-Yang deficiency. The
central crack in this case correlates with the
The Reddish-Purple coating is more distinct
on the sides in the Liver area which points • Body colour: dark red, redder on the
specifically towards Liver-Blood stasis. The A “Heart crack” is rather thin and long, sides.
Liver area on the sides is also Swollen which extending from near the root of the tongue to • Body shape: swollen on the sides,
usually indicates severe or chronic Liver-Heat. near the tip; a “Stomach crack” is rather wide Stomach crack.
The Liver area being Red and Swollen simply and is situated only in the middle section of • Coating: white, rootless.
indicates a more severe degree of Liver-Heat the tongue, in the Stomach area. What does
than if the Liver area is just Red. The strips of a a Heart crack indicate? It depends on its The dark red body colour clearly indicates
slightly thicker, white coating on either side of depth and on the colour of the tongue tip. intense Heat and the redder colour and
the tongue indicate a Gall-Bladder pathology, Generally speaking, a Heart crack indicates swelling on the sides shows that the Heat is in
most usually Dampness in the Gall-Bladder. a constitutional propensity to Heart patterns the Liver. Thus, this patient has suffered from

32 33
Liver-Fire for a long time (we can deduce it is Example 9 Example 10 Example 11
a long time from the dark-red colour) and the
intense Fire has begun to injure Yin.
We know this from the fact that the coating
is rootless:
• this indicates the beginning of Yin
deficiency and, since the tongue is dark-
red and there is a coating, we can deduce
that it is the Fire that is injuring Yin rather
than deficient Yin giving rise to Empty
• Body colour: red, tending to purple • Body colour: reddish-purple, red sides • Body colour: slightly pale, almost normal
Example 8 • Body shape: very swollen, Stomach crack. • Body shape: very swollen, swollen sides, • Body shape: very swollen, more so on the
• Coating: yellow, rootless, dry. Stomach crack (patient’s) left side
• Tongue coating: sticky-yellow, sticky-dry- • Tongue coating: thick-white-rootless
The red body colour indicates Heat while rough-yellow inside the Stomach crack. coating.
its slightly purple hue indicates that there
is some Blood stasis. The very swollen body The reddish-purple colour of the tongue The swelling of the tongue body indicates
shape indicates the presence of Phlegm. The body indicates Blood stasis deriving from Phlegm while the partial swelling on the
red colour, together with the Stomach crack or associated with Heat. The redness on left side often indicates a weakness of the
and the yellow coating, indicates that the the sides indicates Heat in the Spleen and/ channels on that side. Such weakness may
Heat is located in the Stomach. or Stomach; in this case, the redness on the derive either from a febrile disease with high
sides is not related to the Liver because it temperature or from an accident to that side
This is confirmed by the rootless coating occupies a wider area than the Liver are and of the body.
which indicates the beginning of Stomach-Yin also because it is associated with a Spleen-
• Body colour: red slightly tending to deficiency, presumably from the Heat injuring The rootless coating indicates Stomach-Qi
purple, redder tip. type of swelling on the sides.
Yin. The dryness of the coating confirms both or Stomach-Yin deficiency, but its thickness
• Body shape: swollen tip, tip curling up, the Heat and the Yin deficiency (it could be The general swelling of the tongue body indicates the presence of a pathogenic factor,
Heart crack. due to either). indicates the presence of Phlegm, while the probably Dampness. A thick-rootless coating
• Coating: normal but there is a slightly swelling on the sides is related to the Spleen is doubly bad because, on the one hand
peeled patch without coating on the left This tongue has a rootless but relatively and it indicates Dampness occurring against a Stomach-Yin is deficient, but, on the other,
side towards the root. thick coating: this is doubly bad. Why? The background of chronic Spleen deficiency. there is a pathogenic factor.
rootlessness of the coating indicates that
The red body colour indicates Heat and the there is the beginning of Yin deficiency but The sticky-yellow coating confirms the It is better for a rootless coating to be thin
slight purple colour indicates that there is the relative thickness of it indicates that there presence of Dampness while the Stomach (indicating Stomach-Qi deficiency but no
some Blood stasis. The red tip indicates Heart- is a pathogenic factor, in this case, Stomach- crack, together with the sticky-dry-rough- pathogenic factor) or for a thick coating to
Fire and the swelling of the tip and its curling Heat: thus, this patient suffers from a Full yellow coating insides it indicates Phlegm- have a root (indicating the presence of a
up confirm and reinforce this diagnosis. condition occurring against a background of Heat in the Stomach. pathogenic factor but also intact Stomach-Qi).
The presence of the Heart crack indicates that Stomach deficiency.
In conclusion, the main location of the
this patient had a constitutional tendency to In other words, it would have been better if disharmony in this case is in the Middle
Heart patterns and to emotional problems. the coating had been either rootless but thin Burner with Stomach and Spleen Heat, Damp-
The small patch without coating indicates the (indicating Yin deficiency but no pathogenic Heat and Phlegm-Heat in the Stomach. The
beginning of Stomach-Yin deficiency. factor) or thick with root (indicating the Blood stasis probably derives partly from the
presence of a pathogenic factor but also a Heat and partly from the chronic retention of
good state of the Stomach). Phlegm.
34 35
Example 12 indicate a chronic condition because this type
of swelling and the lack of coating develop
over a long period of time.
It is not possible to tell from the tongue only
which other organ (apart from the Stomach),
if any, is affected by the Blood stasis and the
Example 13

• Body colour: reddish-purple

• Body shape: swollen sides
• Tongue coating: thin-white-rootless
coating, peeled in patches.
The reddish-purple colour indicates Blood
stasis with Heat. The swelling on the sides
indicates chronic Spleen deficiency and the
rootless coating missing in patches indicates
Stomach-Yin deficiency. • Body colour: red, red tip
• Body shape: short.
This patient too suffers primarily from a • Tongue coating: thin-white.
disharmony in the Middle Burner with
chronic Spleen-Qi deficiency and Stomach- This slide is presented here mainly as an
Yin deficiency. Both the swelling on the sides example of a short tongue body. The patient
(related to the Spleen) and the rootless coating could not stick the tongue out more than that.
missing in patches (related to Stomach-Yin) The red tip indicates Heart Heat.

36 37
Face Head Feet Body issue. In particular TCM has a detailed map
of the face including lines, organ zones and
Diagnosis colour indications. Using TCM facial analysis
principles with relation to skin conditions, the
Do you ever wonder why no matter how much map and colours of the face can help indicate
sleep you get, the dark circles under your eyes the underlying causes and support the choice
never seem to get any better? Or why your of treatment.
cheeks are flushed even in winter? Or even Skin conditions that affect the face such as
why you seem to get blackheads on your nose eczema, psoriasis, rosacea and acne don’t
and can’t get rid of them no matter what usually affect the entire surface of the face.
topical creams you use? These issues are The affected areas are often confined to
actually signs that your body is giving you, and particular areas or zones so just by looking
using facial analysis, you can work out what at your face you can find out more about the
the root cause of your dark circles and flushed underlying cause of any skin condition. This
cheeks and finally do something about it. technique is not confined to skin conditions. It
From Greek medicine to Ayurveda and can also be used as a tool to assess wellbeing
Traditional Chinese Medicine (TCM), facial or to improve skin tone in general.
analysis has been used as an indication of
the health of the organs or to provide useful Face - Organ Map
clues as to the systems involved in any health

38 39
Facial Zone Organ or System Facial Zone Organ or System
Forehead In descending order down the forehead: Bladder, Large The Mouth Generally represents the digestive function. White or very
Intestine, Small Intestine. Usually lines across the pale lips may indicate low iron levels and poor circulation.
forehead reflect an imbalance. Congestion or acne in this Dry flaky skin or wrinkles can indicate dehydration.Cracks
area represents digestive congestion and possibly poor or sores in the corners of the mouth are signs of low B
detoxification. Red and dry or flaky skin is an indication vitamin or iron levels. Red, hot or bleeding gums are a
of lack of fluids in the digestive tract. sign of a hot or over-acidic stomach and so animal fats,
Between the Eyes This is the liver zone. A red patch between the eyes is a simple sugars and heating food & drink needs to be
possible indication of poor liver detoxification and even avoided.
heavy metal toxicity (particularly mercury). Vertical lines The Chin Corresponds to the kidneys and digestive system. Once
in this zone indicate Liver imbalance. again congestion in this area can be a sign of a diet high
Under the Eyes The top of the eye and directly below the eyes is the in processed foods, sugars and fats. It can also indicate
kidney zone. Puffiness and fluid retention in this area is unbalanced kidney function, which is usually the result
a sign the body is holding on to too much fluid (watery of pushing the body by working too hard, stress or going
and swollen with a blue tinge) or is mucus congested beyond normal physical endurance.
(fatty and swollen with a yellow tinge). Salt intake should The Jaw and under the jaw line Often a hormonal influence, particularly if worsens
be monitored, as should excessive sugary drinks such as in accordance with monthly cycles. Cysts rather than
fruit juice and soft drink. To reduce mucus congestion, pimples may indicate lymphatic toxicity, which may
reduce fat and dairy consumption.Blue circles or white result from medications, environmental toxins or a highly
under the eyes indicates tiredness or even exhaustion. A processed and sugar rich diet.
yellow tinge shows the liver and gallbladder are working
too hard. As a guide, go over each zone of the face and the face and their associated organs. Included
look for any changes in colour (from your are key indications about lines and colours
Dry, flaky or red skin in the creases above the eye shows normal skin tone), deep lines (that aren’t that provide additional information.
liver stress. part of the normal aging process), congestion
The Nose The nose tip corresponds to the lungs while the bridge (pimples, blackheads, milia, whiteheads) or Bumps on the top of the head can be related
reflects the health of the stomach. Congestion in the form puffiness. Below is a guide to the key areas of to diagnosis.
of blackheads usually represents poor stomach digestion
and possibly low hydrochloric acid levels.If the nose is red
or has broken capillaries, this usually indicates excessive
intake of heating liquids including alcohol, coffee and tea.
The Cheeks Represent the respiratory & circulatory systems. Pimples
or congestion in this area are often the result of a high
fat and mucus forming diet (simple sugar, dairy and
processed foods).Pale cheeks may be a sign of low
iron levels whereas overly flushed cheeks show poor
circulation and the consumption of too many hot foods
such as alcohol, coffee and spices and poor elimination.
A greenish tinge indicates liver congestion.

40 41
Phrenology fields such as anthropology/ethnology), and
are alleged to have sometimes comprised a
Phrenology (from Greek: φρήν, phrēn, sort of scientific racism.
“mind”; and λόγος, logos, “knowledge”) is a
hypothesis stating that the personality traits of History
a person can be derived from the shape of the A definition of phrenology with chart from
skull. It is now considered a pseudoscience. Webster’s Academic Dictionary, circa 1895.
Developed by German physician Franz The first attempts to measure skull shape
Joseph Gall in 1796, the discipline was very scientifically, and its alleged relation to
popular in the 19th century. The principal character, were performed by the German
British centre for phrenology was Edinburgh, physician Franz Joseph Gall (1758-1828), who
where the Edinburgh Phrenological Society is considered the initiator of phrenology. Gall
was established in 1820. In 1843, François was one of the first researchers to consider
Magendie referred to phrenology as “a pseudo- the brain to be the source of all mental activity.
science of the present day.” Phrenological
thinking was, however, influential in 19th-
century psychiatry and modern neuroscience
Phrenology is based on the concept that the
brain is the organ of the mind, and that certain
brain areas have localized, specific functions
or modules (see modularity of mind).
Phrenologists believed that the mind has a
set of different mental faculties, with each
particular faculty represented in a different
area of the brain. These areas were said to be
proportional to a person’s propensities, and
the importance of the given mental faculty. It
was believed that the cranial bone conformed
in order to accommodate the different sizes of
these particular areas of the brain in different
individuals, so that a person’s capacity for a
given personality trait could be determined
simply by measuring the area of the skull that
overlies the corresponding area of the brain.
As a type of theory of personality, phrenology
can be considered to be an advance over
the old medical theory of the four humours.
Phrenology, which focuses on personality
and character, should be distinguished from
craniometry, which is the study of skull size,
weight and shape, and physiognomy, the
study of facial features. However, researchers In 1809 Gall began writing his greatest
of these disciplines have claimed the ability work “The Anatomy and Physiology of the
to predict personality traits or intelligence (in Nervous System in General, and of the
42 43
Brain in Particular, with Observations upon publisher Robert Chambers, the astronomer 1848 edition of American Phrenological review article that initiated his realization
the possibility of ascertaining the several John Pringle Nichol, the evolutionary Journal published by Fowlers & Wells, New that phrenology could not be considered a
Intellectual and Moral Dispositions of Man environmentalist Hewett Cottrell Watson and York City. serious science, and his later books reflect his
and Animal, by the configuration of their asylum reformer William A.F. Browne. George acceptance of British psycho-physiology.
Heads. It was not published until 1819. In the Combe was the author of some of the most In the Victorian age, phrenology as a
introduction to this main work, Gall makes the popular works on phrenology and mental psychology was taken seriously and Phrenology was also very popular in the
following statement in regard to his doctrinal hygiene, e.g., The Constitution of Man (1828) permeated the literature and novels of the United States, where automatic devices for
principles, which comprise the intellectual and Elements of Phrenology. The American day. Many prominent public figures such as phrenological analysis were devised. One such
basis of phrenology: brothers Lorenzo Niles Fowler (1811-1896) the Reverend Henry Ward Beecher (a college Automatic Electric Phrenometer is displayed
and Orson Squire Fowler (1809-1887) were classmate and initial partner of Orson Fowler) in the in the Science Museum of Minnesota
• That moral and intellectual faculties are leading phrenologists of their time. Orson, promoted phrenology actively as a source in Saint Paul.
innate together with associates Samuel Wells and of psychological insight and self-knowledge.
British Prime Minister David Lloyd George was During the early 20th century, a revival
• That their exercise or manifestation Nelson Sizer, ran the phrenological business of interest in phrenology occurred on the
and publishing house Fowlers & Wells in New known to have a keen interest in the subject,
depends on organization once contriving a meeting with C.P. Snow after fringe, partly because of studies of evolution,
York City. Meanwhile, Lorenzo spent much criminology and anthropology (as pursued by
• That the brain is the organ of all the of his life in England where he initiated the noticing that the author had “an interestingly
shaped head.” Thousands of people consulted Cesare Lombroso). The most famous British
propensities, sentiments and faculties famous phrenological publishing house, L.N phrenologist of the 20th century was the
Fowler & Co., and gained considerable fame phrenologists for advice in various matters,
• That the brain is composed of as many such as hiring personnel or finding suitable London psychiatrist Bernard Hollander (1864-
particular organs as there are propensities, with his phrenology head (a china head 1934). His main works, The Mental Function
showing the phrenological faculties), which marriage partners. As such, phrenology as a
sentiments and faculties which differ brain science waned but developed into the of the Brain (1901) and Scientific Phrenology
essentially from each other. has become a symbol of the discipline. (1902) are an appraisal of Gall’s teachings.
popular psychology of the 19th century and
functioned in approximately the same way as Hollander introduced a quantitative approach
• That the form of the head or cranium to the phrenological diagnosis, defining
represents the form of the brain, and thus psychoanalysis permeated social thought and
relationships a century later. Beginning during a method for measuring the skull, and
reflects the relative development of the comparing the measurements with statistical
brain organs. the 1840s, phrenology in North America
became part of a counter-culture movement averages.
Through careful observation and extensive evident in the appearance of new dress In Belgium, Paul Bouts (1900-1999) began
experimentation, Gall believed he had styles, communes, mesmerism, and a revival studying phrenology from a pedagogical
established a relationship between aspects of of herbal remedies. Orson Fowler himself was background, using the phrenological analysis
character, called faculties, to precise organs in known for his octogonal house. to define an individual pedagogy. Combining
the brain. Gall’s most important collaborator phrenology with typology and graphology,
was Johann Spurzheim (1776-1832), who Throughout, however, phrenology was
rejected by mainstream academia, and he coined a global approach known as
disseminated phrenology successfully in the psychognomy.
United Kingdom and the United States. He was for instance excluded from the British
popularized the term phrenology (from the Association for the Advancement of Science. Bouts, a Roman Catholic priest, became the
Greek word “phrenos” meaning “brain”: The popularity of phrenology fluctuated main promoter of renewed 20th-century
compare with the word “schizophrenia”). during the 19th century, with some interest in phrenology and psychognomy
researchers comparing the field to astrology, in Belgium. He was also active in Brazil and
Other significant phrenologists included chiromancy, or merely a fairground attraction, Canada, where he founded institutes for
the Scottish brothers George Combe (1788- while others wrote serious scientific articles characterology. His works Psychognomie
1858) and Andrew Combe (1797-1847), on the subject. The last phrenology book in and Les Grandioses Destinées individuelle et
who initiated the Phrenological Society of English to receive serious consideration by humaine dans la lumière de la Caractérologie
Edinburgh. This Edinburgh group included mainstream science was The Brain and Its et de l’Evolution cérébro-cranienne are
a number of extremely influential social Physiology (1846) by Daniel Noble, but his considered standard works in the field. In
reformers and intellectuals, including the friend, William Carpenter, wrote a lengthy the latter work, which examines the subject
44 45
of paleoanthropology, Bouts developed his work has been continued by the Dutch
a teleological and orthogenetical view on foundation PPP (Per Pulchritudinem in
a perfecting evolution, from the paleo- Pulchritudine), operated by Anette Müller,
encephalical skull shapes of prehistoric one of Bouts’ students.
man, which he considered still prevalent in
criminals and savages, towards a higher form During the 1930s, Belgian colonial authorities
of mankind, thus perpetuating phrenology’s in Rwanda used phrenology to explain the so-
problematic racializing of the human frame. called superiority of Tutsis over Hutus.

Bouts died on March 7, 1999, after which Empirical refutation induced most scientists

46 47
to abandon phrenology as a science by the Method using a caliper. With this information, the • Vanity; ambition; love of glory (a quality
early 20th century. For example, various cases phrenologist would assess the character and “beneficent for the individual and for
were observed of clearly aggressive persons Phrenology was a complex process that temperament of the patient and address each society”).
displaying a well-developed “benevolent involved feeling the bumps in the skull to of the 27 “brain organs”. This type of analysis
organ”, findings that contradicted the logic of determine an individual’s psychological was used to predict the kinds of relationships • Circumspection; forethought.
the discipline. With advances in the studies attributes. Franz Joseph Gall first believed and behaviors to which the patient was • The memory of things; the memory of
of psychology and psychiatry, many scientists that the brain was made up of 27 individual prone. In its heyday during the 1820s-1840s, facts; educability; perfectibility.
became skeptical of the claim that human ‘organs’ that created one’s personality, with phrenology was often used to predict a child’s
character can be determined by simple, the first 19 of these ‘organs’ believed to exist future life, to assess prospective marriage • The sense of places; of space proportions,
external measures. in other animal species. Phrenologists would partners and to provide background checks of time.
run their fingertips and palms over the skulls for job applicants.
On Monday, October 1, 2007 the State of of their patients to feel for enlargements or • The memory of people; the sense of
Michigan began to impose a tax on phrenology indentations. The phrenologist would usually Gall’s list of the “brain organs” was lengthy people.
services. take measurements of the overall head size and specific, as he believed that each bump or • The memory of words.
indentation in a patient’s skull corresponded
to his “brain map”. An enlarged bump meant • The sense of language; of speech.
that the patient utilized that particular “organ”
• The sense of colours.
extensively. The 27+ areas were varied in
function, from sense of color, to the likelihood • The sense of sounds; the gift of music.
of religiosity, to the potential to commit
murder. Each of the 27+ “brain organs” was • The sense of connectedness between
located in a specific area of the skull. As a numbers.
phrenologist felt the skull, he could refer to • The sense of mechanics, of construction;
a numbered diagram showing where each the talent for architecture.
functional area was believed to be located.
• Comparative sagacity.
The 27 “brain organs” were:
• The sense of metaphysics.
• The instinct of reproduction (located in
the cerebellum). • The sense of satire; the sense of witticism.

• The love of one’s offspring. • The poetical talent.

• Affection and friendship. • Kindness; benevolence; gentleness;

compassion; sensitivity; moral sense.
• The instinct of self-defense and courage;
the tendency to get into fights. • The faculty to imitate; the mimic.

• The carnivorous instinct; the tendency to • The organ of religion.

• The firmness of purpose; constancy;
• Guile; acuteness; cleverness. perseverance; obstinacy.

• The feeling of property; the instinct

of stocking up on food (in animals);
covetousness; the tendency to steal.
• Pride; arrogance; haughtiness; love of
authority; loftiness.

48 49
50 51
effects of Foot Reflexology… the therapist’s
healing touch provides improvements in
structure (helping to streamline the body’s
lines), increases flexibility (producing
healthier feet), and lowers stress and relaxes
the body(which releases stored toxins and
restores the body’s chemical balance.
Depending on the nature of the issues being
addressed, the sensation will vary widely from
stretching to a nerve-like pinch to needle-like
sensations where it might feel like fingernails
are being stuck into your feet. These are
simply stress reactions of your body and will
change dramatically as your feet become
Many of my foot Reflexology clients start
by needing to address foot pain. Over time,
I’ve modified the approach for those clients
to incorporate some elements of Rolfing to
more effectively and more holistically correct
Many people believe that Reflexology dates
underlying issues.
back to ancient Egypt and China. There are
many references back to an old Egyptian Those Reflexology clients have almost always
hieroglyph depicting someone manipulating tended to migrate to regular Reflexology
another person’s foot. The hieroglyphics sessions even after the primary issues were
roughly translate to “Don’t hurt me” with a resolved because during the early therapy,
response of “I shall act so you praise me.” Reflexology clients generally also experience
However, there hasn’t been any direct the benefits of lower stress and higher levels
explanation of what was being done to the of relaxation throughout themselves.
Foot reflexology is an effective method of
Modern day Reflexology, as best we can trace addressing specific areas of aches and pains
it, appeared to have been formalized by a and is a wonderful way of relaxing. It will
Physiotherapist named Eunice Ingham who, keep your feet flexible and in great health,
through observation, created a mapping of minimizing the chances that the original
different areas of the feet to organs of the issues will recur and supporting a lower stress
body, proposing that underlying issues could level in your day to day living.
be helped by working the “reflected” organ
in the feet. Today, Reflexology is primarily Naples Rolfing — Certified Advanced Rolfing
performed on the feet and hands and involves and Nationally Licensed Deep Tissue Massage
the application of pressure to specific points. Therapy now in Madison Wisconsin.

There have not been many clinical studies

on Reflexology but people appear to
unequivocably benefit from some fundamental

52 53
54 55
Methods of Treatment pain in the ears, shoulders or back often Further effective areas for treatment are Important Areas to Treat
disappears within minutes. the tongue, the -inside wall of the mouth,
The easiest and most common form of especially the palate (top), under the tongue The foot and hand charts will give you a good
treatment is to apply pressure on sore points If there is a serious or acute problem, use and the back of the mouth (pharynx). You indication of where to find suitable points for
with the pad of a finger, the thumb, with reflexology several times a day. However, may press with the pad of a finger or thumb treating specific complaints. For best results
a knuckle or with a blunt instrument (for this treatment may stimulate a chronically or use a suitable instrument. work on all the major reflex areas: hands, feet,
example, the blunt end of a pencil or a pen). weak organ to increased activity and it may ears and mouth. Always treat in the same
become tender for a while together with its Pressure on the tongue may be applied by zone in which the problem arises. Your left
If it is quite sore, press straight down, with reflex areas. Generally, deep, strong and slow biting or pressing with the handle of a spoon. inner ear, for example is in zone 4. Therefore,
only light pressure at first. Gradually increase pressure is sedating and pain relieving, while This is effective for treating problems in other to treat it you will manipulate the left ring
the pressure as the pain lessens. Finally, when light, quick tapping or circling is stimulating. areas of the body belonging to the same zone. finger the third toe including its root on the
even strong pressure can be tolerated, you Select whichever is appropriate. For some left side, the ear points of the left ear and the
may apply the pressure in a slow circular points a so-called C-clamp is effective: press In addition, the tongue may be pulled out for
outer left side of the tongue and palate.
motion in order to relax the deeper muscles with the thumb from underneath the foot several minutes by grasping it with a cloth and
and ligaments. and with the index finger from the top. This moving it around. Alternatively, you may poke Work frequently around the joints of fingers
may be used for the liver, spleen and thymus. it out as far as possible and hold it in place and toes, especially digging underneath the
For self-treatment underneath the feet, it with your teeth. You may also work around lowest joints of the thumbs and big toes.
will usually be more convenient to press or Another method of applying pressure to the angles of the jaw and chin. Rubber bands or clothes pegs may be placed
roll the sore points on a golf ball, a stone or fingers and toes is to put tight rubber bands for five to 10 minutes on the tips of the digits,
another suitable object. To press reflex areas around them or to use clothes pegs to clamp Because of the sensitivity of the mouth,
or on or between the joints, depending
in the palms of the hands, it is usually more the digits. Rubber bands should never be left this treatment is often more effective than
on where there is more sensitivity. Lymph
convenient to use a knuckle or a suitable on for more than a few minutes at a time. In hand and foot reflexology, especially for all
drainage can be improved by press-massaging
blunt instrument than the pad of the thumb. addition, you may firmly grasp a metal comb, problems related to the head and throat.
the area of the upper chest on top of the feet
Usually, the pain begins to subside after a few pressing its teeth into the palm or the fingers. just below the toes.
minutes of pressing. If this happens, increase A metal comb or a brush may also be used to
sweep the backs of the hands and lower arms Generally, treat a sensitive area for five to 10
the pressure for a while, but if the pain instead
increases, stop the treatment. The effect on up to the elbows in quick upward strokes. Five
related body parts can be surprisingly quick: minutes of this will stimulate the circulation
and invigorate the body.

56 57
minutes at a time. For an acute problem, you by Dr John Whitman Ray it is recommended
may treat it several times daily, while chronic to work in a certain sequence for regenerating
problems may be treated once a day. For the body. Start with the so-called STO-point:
general health improvement you may select a press into the valley between the muscles
different area each day until you return to the from both sides of the spine and then up
same area after one or two weeks. This process under the skull (occiput). This is to improve
may continue for years, as formerly weak the nerve transmission to all parts of the body.
areas become activated and cause increased
sensitivity in their corresponding reflex areas. Then start working on points in the following
Walking barefoot on rough ground provides a order: pineal gland, hypothalamus, pituitary,
natural foot massage - make good use of it. medulla, thyroid, thymus, heart, solar plexus,
pancreas, adrenals, spleen, gonads (uterus,
The Brain ovaries, prostate, testicles), liver, kidneys,
gall bladder, bladder, small intestine, large
For general health improvement and intestine.
regeneration work frequently on the brain,
especially the pituitary gland, the pineal
gland, the hypothalamus and the medulla
The pituitary reflex often feels like a sharp
bone protrusion; press it in the direction of
the tip of the toe. The hypothalamus and
medulla are pressed from the insides of the
big toes. For general health improvement it is
best to start with activating these parts of the
brain and then continue with the other glands
and organs.
In the system of Body Electronics as developed

58 59
THE SIGNIFICANCE gone to endless seminars, but theory isn’t
doing it for me. All the theory is useless if
of its coating; and smelling (noting any
unusual smell of the body, mouth, or
A yin pulse that shows no stomach qi is called
the pulse of zhenzang [decaying pulse] and
OF TRADITIONAL you’re unsure of your diagnosis. What I need
is an experienced practitioner to work with
urine); the prognosis is usually death. Why? Because
a yin pulse reflects absence of yang and thus
• listening: to the quality of speech
PULSE DIAGNOSIS who can and will tell me if what I’m seeing on
the tongue and feeling in the pulse is correct. (including responsiveness to questions,
absence of life activity. If you can distinguish
the presence or absence of the stomach pulse,
rapidity of talking, volume of the voice);
IN THE MODERN Otherwise, I feel as if I’m fantasizing all the
time. Is that what Chinese medicine is all to the respiration; and to sounds of
you can know where the disease is located and
give the prognosis for life or death, and even
illness, such as coughing, gurgling from
the intestines; and
know when death might occur....When yang
pulses are absent in a patient, the yin or the
This practitioner has recognized something
MEDICINE that many others, who feel more confident • inquiring: obtaining information about
the patient’s medical history and their
decaying pulse of the liver is like a thin thread
on the verge of breaking, or like a tightly
despite limited training, may ignore: there wound wire about to snap. The patient will
Essay by Subhuti Dharmananda, Ph.D., is a great potential to simply “fantasize” symptoms and signs, such as chills/fever,
Director, Institute for Traditional Medicine, perspiration, appetite and dietary habits, die within eighteen days. If the decaying pulse
the diagnostic signs, that is, to read into it of the heart is like a thin fragile thread, the
Portland, Oregon something that is not really present. But, this elimination, sleep, and any pains; also,
for women inquiring about menstruation, patient will surely die within nine days. If this
is not what Chinese medicine is about; rather, pulse is found in the lung pulse, the patient
INTRODUCTION there is a clearly defined method of pulse pregnancy, leukorrhea and other gyno-
will not survive longer than twelve days. If it is
taking (and tongue examination, as well as obstetric concerns.
found in the kidney pulse, the patient will die
The changing setting in which Chinese other important diagnostic techniques) that All of these diagnostic methods yield in seven days. If it is found in the spleen pulse,
medicine is practiced in modern versus ancient can lead to reasonably well-defined syndrome information that helps to determine the the patient will die in four days.
times, especially with the advent of advanced determination. syndrome and constitution to be treated.
technological medical diagnostics, has raised While the Chinese pulse and tongue diagnosis A more complete prognosis involves coupling
questions as to the value of pulse diagnosis. The information presented below is aimed at the information about the pulse with the
examining the traditional and modern roles methods, because of their frequent mention
Should its use be limited to confirming a and somewhat unique quality among examination of the facial color and the “spirit”
diagnosis reached by other means? Or, does of pulse diagnosis, the techniques for taking expressed by the facial expressions (especially
the pulse, the interpretation of various pulse traditional medical systems, receive much
the pulse information add critical information attention, the other aspects of diagnosis the eyes). In the Neijing, it is said that: “In
that can greatly alter the treatment strategy? forms, and some of the controversies that diagnosis, observation of the spirit and facial
exist regarding the use of pulse diagnosis. cannot be ignored or downplayed.
Training in pulse diagnosis is often quite color, and palpation of the pulses, are the
limited; further, the requisites for carrying out The Chinese term indicating a blood vessel or a two methods that were emphasized by the
a traditional style diagnosis are sometimes THE ORIGINAL PLACE OF meridian (which are two interlinked concepts; ancient emperors and revered teachers....”
absent from the clinical setting, making the see Drawing a concept: jingluo) is mai, and
results of the pulse taking less certain. How
PULSE DIAGNOSIS IN THE the same term is used to describe the pulse.
As a text expounding on the virtues of the
ancient teachers, there were complaints
does one get the desired information under CHINESE TRADITION Pulse feeling is called qiemai, which is part of about failings of the modern practitioners in
such circumstances? the general diagnostic method of palpating or their diagnostic work, which echoes forward
Pulse diagnosis is one of the original set of four feeling the body: qiezhen [feeling method]. to the modern era. The practitioners of the
Several years ago, an acupuncturist in the U.S. diagnostic methods that are described as an
Pulse diagnosis is mentioned in ancient texts, time were encouraged not to forget the other
wrote to me saying: essential part of traditional Chinese medical
such as the Huangdi Neijing and the Huangdi necessary diagnostic methods, especially
I’ve been practicing for over five years now practice (1). The other three diagnostic inquiry:
Neijing of the Han Dynasty period, but with
and have a busy practice; but, I’m totally methods are:
only sporadic mention of various pulse forms Today, doctors deviate from [the treatment
disheartened about my abilities. The biggest • inspection: general observations of the and their meaning. In the Huangdi Neijing, methods of ancient times]. They cannot
difficulties are diagnostic. I graduated school patient, including facial expression; skin pulse is depicted primarily as a means even follow the changes in the four
as one of the best students in my class, yet color and texture; general appearance, of prognosis for impending death. As an seasons [that influence the pulse and other
neither I nor any of my classmates had any and the shape, color, and distinctive example, in the section of the book on yin and body conditions]. They do not know the
clear sense of tongue or pulse diagnosis. I’ve markings of the tongue and the nature yang it is said that (2): importance and principles of the complexion
60 61
and pulses....Doctors today should eliminate Physicians today do not thoroughly study the of the Huangdi Neijing); he may have fully After the production of the Mai Jing, many
their bad habits and ignorance, open their medical classics before they begin to practice, rewritten the first three critical chapters. different conceptions of pulse diagnosis
minds, and learn the essence of pulse and but merely follow their predecessors with His text on pulse diagnosis became known arose and led to a great deal of confusion
color diagnosis [i.e., analysis of facial colors]. no attempt to improve age-old forms....They as the Mai Jing (Pulse Classic). Although the about interpreting what was being felt by the
Only by doing so will they ever succeed in take the front pulse, but not the rear; check text had been regarded as quite difficult to physician. Xu Dachun (1693-1771) produced
reaching the level of the ancient sages.... the hands, but not the feet; and do not make understand, and was therefore often replaced a chapter on the Mai Jing in his book Yixue
There is one other important thing. That is a diagnosis of the complete upper, middle, by simpler, derivative tracts, it has, in modern Yuanliu Lun (12), commenting that:
the interrogation of the patient, the inquiry.... and lower parts of the body. How can a pulse times, been deemed a classic worthy of
Select a quiet environment; close all doors alone and careless observation tell about all preservation. A translation of the Mai Jing, Those experts who discussed the pulse
and windows; gain the trust of your patient the syndromes and diseases? based on a modern Chinese edited version, through the ages have all contradicted one
so that the patient can completely convey has been published by Blue Poppy Press (4). In another, and they all differed in what they
everything that is pertinent to the condition. The concern is about incomplete and careless the Mai Jing, a broad spectrum of applications considered right and wrong. They all cling to
Be thorough and differentiate the truth. diagnosis, particularly where the pulse is for pulse diagnosis is delineated, including their specific doctrine, and their advantages
the primary diagnostic method (omitting or etiology of disease, nature of the disease, and errors balance each other....Students
In the Huangdi Neijing (3), the pulse is minimizing the others), and failure to carry out and prognosis. As an example of etiology and reading the Mai Jing must consult the Nei
mentioned briefly and simply among a list of the full pulse taking (front and rear pulses). disease development, it is said that: “If the Jing, the Nan Jing, and the doctrines of Zhang
symptoms that would indicate a particular This is a theme that persists throughout pulse is bowstring, tight, choppy, slippery, Zhongjing [Huangdi Neijing, Jingui Yaolue].
disease stage or category; thus, for the Chinese medical history, and applies to floating, or deep, these six point to murderous
taiyang disease, the pulse is floating, for a modern medical diagnostics as well (where In other words, the classic texts of the
evils which are capable of causing disease in Han Dynasty have the basic doctrines of
yangming disease, the pulse is large, and medical doctors are chided for having missed various channels.” As an example of disease
for the jueyin disease, the pulse is feeble. In a diagnosis by not performing all necessary importance, and they must all be studied in
analysis, the following pulse characteristics order for the Mai Jing to be fully meaningful.
the companion volume Jingui Yaolue, there tests or by carelessly interpreting the test and implications are given:
is more description of the pulses and some results). The proclaimed failings in the Han The digressions in the theory and practice of
explanation of their meaning. For example, it Dynasty times, an era regarded by subsequent If its emerging and submerging are equal, pulse diagnosis that were made later should,
is said that: A pulse too strong or too weak authors as one of the high points of Chinese this is a normal state; if its submerging is according to Xu, be ignored, because they
denotes illness. A minute pulse on the cun site medicine, illustrate that the reverence for the twice as long as its emerging, this is shaoyin. introduce confusion rather than clarification.
and a chordal pulse on the chi site portends past is aimed at the wise instructions of the If its submerging is three time as long as its All the books mentioned by Xu in the above
thoracic debility and aching because it reflects small number of highly accomplished scholar emerging, this is taiyin. If its submerging quote are now available in English translation
an extremely weak condition of yang in the physicians (who left behind the classic texts), is four times as long as its emerging, this is (see: Some selected Chinese medical texts
upper warmer. Heart pain follows the thriving rather than the state of medical practice jueyin. If its emerging is twice as long as its in translation), reflecting the common view
yin evil as characterized by the deep chordal as a whole. The desire, which can only be submerging, this is shaoyang. If its emerging that they are essential to the study of Chinese
pulse. professed and never fully accomplished, is is three times as long as submerging, this is medical doctrines.
that all physicians should attain the highest yangming. If its emerging is four times as long
The presentation of diagnostic information possible standard and should master the as its submerging, this is taiyang. AIM AND METHOD OF PULSE
in these works of Zhang Zhongjing confirms
the importance of inquiry, since it is by this
diagnostic methods through diligent study of
the classics and continual attention to detail. As to prognosis, an example with great DIAGNOSIS
means that one learns the essential features specificity is: “If, on the seventh or eighth day,
described throughout most of the text, such a febrile disease exhibits a pulse which is not The aim of pulse diagnosis, like the other
as location of pain, duration of disease, and THE PULSE CLASSIC grasping-like but beating rapidly at a constant methods of diagnosis, has always been to
other factors that determine the selection of pace, there ought to arise a disease of loss obtain useful information about what goes on
herbs (thirst, mental conditions, urination, The subject of pulse diagnosis was first of voice. Perspiration is expected to come in inside the body, what has caused disease, what
etc.). In his preface to the Huangdi Neijing, tackled in an organized manner by Wang three days. If it fails to come then, death will might be done to rectify the problem, and
Zhang continues the complaint expressed in Shuhe, who lived during the 3rd century A.D. occur on the fourth day.” As before, the main what are the chances of success. According
the Neijing about practitioners in his time, (just after the fall of the Han Dynasty). Wang prognostic value of the pulse was in relation to to the Chinese understanding, the pulse can
a century or more after the Neijing was was responsible for recovering and organizing impending death (or, if the pulse is favorable, reveal whether a syndrome is of hot or cold
produced in the form we have currently: the Huangdi Neijing (see: A modern view recovery from the disease). nature, whether it is of excess or deficiency

62 63
type, which of the humors (qi, moisture, from 24-28 different pulse forms, depending that relate to the selection of traditional style hard pressure, usually seen in cases with
blood) are affected, and which organ systems on the recitation (sometimes a pulse therapeutics (i.e., acupuncture points and accumulation of cold pathogenic factors
suffer from dysfunction. In order to make type is subdivided into two; sometimes a individual herbs). Several of the pulses listed yielding formation of a firm mass; and damai
these determinations, the physician must complex pulse type is not included), though in the table represent pairs depicting yin/ (large pulse), is a high pulse wave that lifts the
feel the pulse under the proper conditions- simplified sets are often given in less formal yang opposites, such as: floating vs. sinking finger to a greater height then normal. Damai
following the established procedures-and presentations. Despite the numerous (surface/interior); slow vs. rapid (cold/hot); is either forceful (has a large mass behind it,
must then translate the unique pulse that descriptions of pulse forms in the lengthy Mai weak vs. replete (deficiency/excess); and indicating excess heat with damaged internal
is felt into one or more of the categories of Jing, the practitioner is really being asked to short vs. long (also indicating deficiency/ organ function) or weak (indicating little
pulse form. become familiar with this modest sized and excess). There are three additional pulse force, seen in cases of general debility, with
basic set of pulse categories, which were first types reported in the Dictionary (8): gemai “floating yang”). Many authors regard these
In his book reviewing pulse diagnosis (5), Bob outlined in the opening chapter of the Mai (hard and hollow pulse), is large and taut pulses as composites of two or more basic
Flaws emphasizes the importance of learning Jing. In the English language translation of the yet feels hollow like touching the surface of pulses rather than unique pulse types.
the basic pulse categories in order for pulse book, the description of these fundamental a drum, indicating loss of blood and essence;
diagnosis to be conducted effectively. He says: pulse categories take up just 3 pages out of it may also occur with hypertension; laomai Table 1: Pulse Categories in Translation.
In my experience, the secret of Chinese pulse 360. (a forceful and taut pulse) is felt only by
examination is exactly this: One cannot feel
a pulse image unless one can consciously PULSE CATEGORIES
and accurately state the standard, textbook
definition of that pulse image. Pulse Type Interpretation Comments
In a recent article describing the standard
pulse categories by terminology expert Scattered pulse An irregular pulse, hardly These are cases where the patient is
In support of this contention, he also quotes [sanmai] perceptible, occurring critically ill, perhaps near death; such
Xie Zhufan (7), 26 basic pulse types were
Manfred Porkert (6): in critical cases showing patients are normally hospitalized (or
outlined and given updated English
This, precisely, is the critical issue: there is no language interpretations (two of the types exhaustion of qi. sent home to die) and their diagnosis
point in attempting practical training in pulse have the same Chinese name but different is usually well-established. The pulse
diagnosis unless all pertinent theory and, descriptions). Table 1 presents these pulse only tells that the patient is severely
more important, the complete iconography categories. debilitated; it diffuses on light touch
[set of image categories] of the pulse has and is faint with heavy pressure.
In the table, the English translation term Intermittent pulse A slow pulse pausing at As with the scattered pulse, this pulse
previously been absorbed intellectually.
is given first; in a few cases, alternative [daimai] regular intervals, often type is usually only seen in cases
Chinese medical texts do not describe what English names are given for the same occurring in exhaustion of where the person is hospitalized or
the practitioner experience is (or should traditional category indicated by a single zangfu organs, severe trauma, otherwise in an advanced disease
be) during pulse diagnosis; this is left to be Chinese term (given in pinyin). The naming or being seized by terror. stage. It is expected to occur, for
passed on from accomplished practitioner to and interpretation of the pulse is taken example, with those having serious
student. In contrast, these Western scholars directly from the article Selected terms heart disease.
are trying to relate to their Western readers, in traditional Chinese medicine and their
Swift pulse [jimai] A pulse feeling hasty and This pulse is so rapid (twice the normal
in written form, the steps by which one can interpretations (7). The comments are added
swift, 120-140 beats per speed) that it is easily detected; the
master the diagnostic method. The basic here by the current author, with reference
minute, often occurring in acute febrile disease involves an easily
premise outlined by Flaws and Porkert-that also to information from the Dictionary of
severe acute febrile disease or measured high temperature and is
one must master the categories first-appears Traditional Chinese Medicine (8). The 7 pulses
consumptive conditions. usually subject of pathogen testing.
to be supported in the Chinese literature by presented first (scattered, intermittent, swift,
Consumptive conditions with such
the almost universal practice of introducing hollow, faint, surging, and hidden) are ones
high pulse rates are generally under
pulse diagnosis by listing and describing the that may have little relevance to practice of
emergency medical care.
basic set of pulse categories. traditional medicine in the modern setting.
The other 19 pulses appear more likely to
The most standard inconography involves help the practitioner determine imbalances

64 65
Pulse Type Interpretation Comments
Pulse Type Interpretation Comments Hurried pulse [cumai] A rapid pulse with irregular This is the excess version of the
Hollow pulse A pulse that feels floating, Massive blood loss can easily be intermittence, often due to knotted pulse. It is sometimes
[koumai] large, soft, and hollow, likereported. This pulse is felt lightly at excessive heat with stagnation called the "running" or "abrupt"
a scallion stalk, occurring in
the superficial level and lightly at of qi and blood, or retention pulse. The rapidity indicates heat
massive loss of blood. the deep level, but barely felt at the of phlegm or undigested food. and the irregularity indicates the
intermediate level. The light pulse is blockage caused by stagnation and/or
like the flexible scallion material, with accumulation.
a hollow center. It means that there Long pulse A pulse with lengthy extent Particularly in young people, the pulse
is still some flow of qi at the vessel [changmai] and prolonged stroke. A long is felt rather easily across all three
surface, but not much blood. pulse with moderate tension finger positions, as is characteristic of
Faint pulse [weimai] A pulse feeling thready and Extreme exhaustion is obvious to both may be found in normal the long pulse. The prolonged stroke
soft, scarcely perceptible, the patient and the practitioner. The persons, but a long and shows that the vessels are both strong
showing extreme exhaustion. pulse, lacking substance, volume, and stringy pulse indicates excess and flexible. A stringy quality indicates
strength, simply reveals the exhaustion of yang, especially liver yang. a certain level of tension, that
of the body essences. It is weaker than corresponds with a liver syndrome. In
the thready (faint) pulse. cases of acute disease, a long pulse
Surging pulse A pulse beating like dashing Excess heat syndromes are rarely will occur when there is a strong
[hongmai] waves with forceful rising and difficult to detect, so this pulse type confrontation between the body's
gradual decline, indicating adds little information. The force of resistance and the pathogenic factor.
excessive heat. the pulse indicates that the condition Short pulse A pulse with short extent. A The short pulse seems to deteriorate
is pathologically excessive, the gradual [duanmai] short and forceful pulse is from the central pulse position
decline shows that the syndrome often found in qi stagnation towards the two adjacent pulse
is primarily one of heat (qi excess) and a short and weak pulse positions. It strikes the middle finger
rather than fluid excess. The pulse is implies consumption of qi. sharply and leaves quickly. On the one
sometimes described as a "full pulse" hand, this can represent contraction
indicating the excess condition. of the qi, as in liver qi stagnation, or it
Hidden pulse [fumai] A pulse that can only be felt This pulse is quite extreme, in that one can represent deficiency of the qi.
by pressing to the bone, can barely detect it except by applying Fine pulse [ximai] or A pulse felt like a fine Although the deficiency can be easily
located even deeper than the deep pressure; it gives the sense that Thready pulse [ximai] thread, but always distinctly detected by other means, some
sinking pulse, often appearing the pulse is hidden in the muscles. If perceptible, indicating patients can show an artificially robust
in syncope or severe pain. there is little musculature, it is as if it deficiency of qi and blood or exterior appearance, while having
is resting on the surface of the bone. other deficiency states. notable deficiency. Essence deficiency,
The conditions for which it is typical, the result of chronic illness, can give
syncome (fainting) and severe pain, rise to this pulse type.
can easily be determined without Hesitant pulse A pulse coming and going This has a more irregular pattern
taking the pulse. [semai] or Uneven choppily with small, fine, than the knotted pulse that also
Knotted pulse A slow pulse pausing at Qi and blood stasis represents a pulse [semai] or slow, joggling tempo like shows stagnation of qi and blood.
[jiemai] irregular intervals, often traditional diagnostic category that Choppy pulse [semai] scraping bamboo with a knife, The severity of the blood disorder is
occurring in stagnation of qi does not have a direct correlation with indicating sluggish blood greater. As the knife scrapes across
and blood. modern diagnostics. In this pulse, the circulation due to deficiency the bamboo, it vibrates and irregularly
irregularity and slowness is due to of blood or stagnation of qi moves forward, yielding a choppy
obstruction. and blood. sensation with brief hesitations or
interruptions in movement.
66 67
Pulse Type Interpretation Comments
Replete pulse A pulse felt vigorously and This pulse gives relatively little
[shimai] or Forceful forcefully on both light and information other than that the
Pulse Type Interpretation Comments pulse [shimai] heavy pressure, implying condition is one of excess; one must
Slippery pulse A pulse like beads rolling on While use of the pulse to indicate excessiveness. further determine the nature of the
[huamai] a plate, found in patients pregnancy is no longer of value excess in order to select a therapeutic
with phlegm-damp or food (as more reliable tests are readily strategy. This pulse, however,
stagnation, and also in normal available), and while this pulse, generally rejects the use of tonification
persons. A slippery and rapid like the long pulse is often normal strategies, as it indicates that the body
pulse may indicate pregnancy. (occurring especially in persons who resistance is undamaged.
are somewhat heavy), it is a good Weak pulse [ruomai] A pulse feeling deep and soft, This pulse is similar to the fine pulse,
confirmation of a diagnosis of phlegm- usually due to deficiency of qi but has a softer quality. Usually, this
damp accumulation. It is sometimes and blood. indicates a weakness of the spleen qi,
referred to as a "smooth pulse." leading to deficiency of both qi and
Relaxed pulse A pulse with diminished The pulse has a softness or looseness blood. In the system of pulse taking, it
[huanmai] or Loose tension, occurring in that is due to the weakness of the serves as the opposite of the replete
pulse [huanmai] dampness or insufficiency of qi and the obstructing effect of pulse.
the spleen. dampness. The dampness differs from Soggy pulse [rumai] A superficial, thin, and soft This pulse is similar to the fine and
phlegm-damp in having no solidity. pulse which can be felt on weak pulses. The thready pulse
Moderate pulse A pulse with even rhythm and This is similar to the loose pulse, above light touch like a thread sensation felt on light touch gives the
[huanmai] moderate tension, indicating (and the Chinese name is the same), floating on water, but grows impression of being easily moved, as
a normal condition. except that it has a better tension, faint on hard pressuring, if floating on water; hence, it tends
showing that the qi is adequate. As indicating deficiency to indicate spleen-qi deficiency with
a normal pulse, it indicates that the conditions or damp retention. accumulation of dampness. It is
disease condition being treated is sometimes referred to as the "soft
localized and has not disturbed or pulse."
been caused by disturbance of the Feeble pulse [xumai] A pulse feeling feeble and This pulse is similar to the weak, fine,
viscera. void, indicating deficiency of and faint pulses. It occurs when the
Tense pulse [jinmai] A pulse felt like a tightly This is similar to the wiry pulse, qi and blood or impairment of deficiency of blood is more severe
or Tight pulse stretched cord, indicating cold but not as long. While pain can be body fluid. than in the case of weak and fine
[jinmai] or pain. easily reported, a cold syndrome is pulses, but not so deficient as with the
sometimes disguised by localized heat faint pulse.
symptoms; this pulse can indicate Rapid pulse A pulse with increased The rapid pulse is quite a bit more
either exterior or interior chill. [shoumai] frequency (more than 90 rapid than a normal pulse, and usually
Stringy pulse A pulse that feels straight and This is similar to the tense pulse, but beats per minute), usually occurs only when there is a serious
[xianmai] or Wiry long, like a musical instrument longer and more tremulous. While indicating the presence of illness and mainly when there is a
pulse [xianmai] string, usually occurring in severe pain can be easily reported, heat. fever. The pulse can become rapid
liver and gallbladder disorders the wiry pulse confirms the liver and/ from activity prior to pulse taking.
or severe pain. or gallbladder as the focal point of the Slow pulse [chimai] A pulse with reduced A slow pulse may also indicate a
internal disharmony. frequency (less than 60 beats person at rest who normally has a high
per minute), usually indicating level of physical activity, so must be
endogenous cold. interpreted in light of other diagnostic

68 69
Pulse Type Interpretation Comments
Sinking pulse A pulse that can only be felt The circulation of qi and blood from
[chenmai] by pressing hard, usually the internal viscera to the surface
indicating that the illness is is weak; it is usually confined to the
located deep in the interior of interior as part of the body's attempt
the body. to deal with a serious disorder
threatening the viscera. Sometimes
referred to as the deep pulse.
Floating pulse [fumai] A pulse that is palpable by The circulation of qi and blood is
light touch and grows faint focused in the body's surface to deal
on hard pressure, usually with an external pathogenic agent.
indicating that the illness is The internal circulation is temporarily
in the exterior portion of the sacrificed to assure that the pathogen
body. is eliminated before it can enter more
deeply and cause serious problems at
the visceral level. Debilitated patients
may show a floating pulse that is
feeble, indicating the inability to retain
the qi and yang in the interior due to
the deficiency of the vital organs.

Gao De, a diagnosis specialist at the Academy Single-feature pulse conditions are already
of Traditional Chinese Medicine, cautioned numerous enough and the additional
that pulse taking has become obscured by nomenclature adds even more names which
a multiplication of pulse categories (13). He have little clinical significance but add to
wrote: the difficulties for beginners. Therefore, it is
advisable to simplify the categories of pulse
The types of pulses that have been listed are conditions by omitting the names of those
too numerous and great disparity exists in confusing multi-feature pulse conditions. If
the ways in which they have been recorded. more than one feature has to be described,
Beginners often find them confusing. There the doctor can simply put those single
are two major reasons for such confusion: features together. With this in mind, I would
1. The difference between some categories recommend the following list of simplified
is not so sharp, such as that between pulse conditions:
overflowing and large, thready and small, • superficial vs. deep;
rapid and fast (hurried), and deep and
hidden. • slow vs. rapid;
2. Additional nomenclature is given to • empty vs. full;
the multi-feature pulse conditions.
For example, the leathery pulse is the • overflowing vs. thready; and
combination of hollow and wiry; weak- • minute, rolling, choppy, wiry, scattered,
superficial is another name for both weak hasty, knotted, and intermittent.
and superficial; firm (or hard) means the
combination of deep, full, wiry, and long; .
70 71
Mastery of these 16 basic single-feature types to be learned in detail, but that there to feel the bounding of the pulse up to the one can alternatively incorporate the
pulse conditions, together with their are only a few of them (sometimes grouping skin surface); intermediate palpation (light pericardium/triple burner system in place
possible combinations and their indications, similar pulses together) that are critical for pressure, to feel the basic pulse form); and of the kidney yang pulse.
is sufficient to meet the needs in clinical the everyday utilization of this diagnostic deep palpation (somewhat heavy pressure, to
differentiation of syndromes. technique used in combination with other feel how the pulse is able to emerge from the The interpretation of which pulse position
methods of diagnosis. Therefore, pulse physical constraint). In addition, the changes corresponds to which organ has changed
In the text Chinese Acupuncture and diagnosis should be within the grasp of all in pulse feeling as one moves from less to over time; the assignments commonly relied
Moxibustion (15), there is a listing of 17 pulses practitioners of traditional Chinese medicine. more pressure, and again from more to less upon today are attributed to Li Shizhen (1518-
to know, all of which are said to represent the Those who have limited training and abilities pressure, can also give some information 1593), who is most famous as the author of
abnormal conditions. The same paired pulses must learn about 8-17 fundamental pulse about the resilience of the pulse. In essence, the Bencao Gangmu. He wrote Binhu Maixue
as listed above by Gao De are included, but types; those who wish to make greater use there are nine pulse takings on each wrist: one (The Pulse Studies of Binhu), in which the
the list of additional pulses varies slightly. of this technique must be able to distinguish for each of the three pulse taking fingers at pulse taking method was elaborated, for
Compared to the list of 28 pulses in Table 1, the more subtle variations, but the number of each of the three levels of pressure. However, which 27 categories of pulse were listed.
categories that have been disregarded in order different pulses to learn is still limited. the system of pulse taking can be divided into
to yield the shorter list of abnormal pulses The various outcomes of the pulse diagnostics
two parts: are outlined succinctly and in table form in
include several of those that are indicating
severe deficiency diseases (scattered, hollow, TRADITIONAL PULSE TAKING • The general sensation of the pulse Ted Kaptchuk’s book The Web that Has No
Weaver (14). Here is an example for one pulse
faint) and those that indicate a relatively METHODS at the two wrists overall: instead of
type, the choppy pulse:
normal condition (long, relaxed, moderate). distinguishing each pulse position (cun,
In Essentials of Chinese Acupuncture (20), 12 A variety of sites for pulse taking have been guan, chi), the quality of the pulse is • Combination pulses: choppy and wiry
basic pulses are listed, with the same paired mentioned in the traditional literature. For categorized generally, as felt under the indicates constraining liver qi, congealed
pulses given above, plus the wiry pulse and example, in the Neijing Suwen, it is mentioned three fingers. In this case, there are just blood; choppy and frail indicates qi
three of the irregular pulses. that the yang pulses can be felt at the carotid three pulse readings at each wrist, with exhausted; choppy and minute indicates
artery (next to the Adam’s apple on the superficial, intermediate, and deep deficient blood and deficient yang; choppy
Similarly, in the book Chinese Herbal Science pressure. The results of this type of pulse
(17) by Hong-yen Hsu, the pulses of importance neck), while the yin pulses can be felt at the and thin indicates dried fluids.
radial artery (above the wrist). Under healthy reading are then categorized as in Table 1,
are limited in number. The author states: “In with combinations of two (or infrequently • Pulses by position: first position pulse
traditional Chinese pulse diagnosis, there are circumstances these pulses should be the
same, but they differ with disease. Feeling the more than two) pulse categories being being choppy indicates deficient heart qi
28 qualities, but they are grouping into eight possible. and chest pain; if only on the left side,
types according to the nature and associated pulse at more than one site is said to improve
the diagnosis. Other pulse taking methods heart pain and heart palpitations; if on
symptoms. The most important qualities for • Feeling the pulse at each of the individual the right side, deficient lung qi, cough
the physician to be able to differentiation include using the head and upper and lower positions on the wrists, to assess
limbs, and use of different pulse locations at with foamy sputum; second position
are floating, sinking, slow, and fast.” The the condition of each of the internal pulse being choppy indicates deficient
other four pulse qualities listed in this text arteries under certain acupuncture points organs. The association of individual
to assess individual organs (e.g, at taiyang, spleen qi and deficient stomach qi,
are: weak, solid, slippery, and full. The same pulse positions with internal organs has painful, distended flanks; if just the left
author gave a more detailed listing of pulses ermen, dicang, daying, shenmen, hegu, wuli, changed over time and varies from one
taichong, qimen, chongyang, and taixi). side, it means deficient liver blood; on
in a presentation on Chinese diagnostics (18), traditional system to another (illustrating the right side it means weak spleen and
with 7 types of floating pulses, 3 types of Despite the availability of more than one site a lack of consistency in interpretation). inability to eat; third position pulse being
sinking pulses, 5 types of late pulses, 5 types for pulse taking, standard Chinese medical The current understanding is that the left choppy indicates essence and blood are
of fast pulses, 6 types of weak pulses, 3 types diagnosis almost always is limited to the wrist wrist presents information for the heart, injured; constipation or dribbling urine,
of solid pulses, and 11 types of dying pulses. pulse. It is felt by placing three fingers at liver, and kidney yin, while the right wrist or bleeding from the anus; if just on the
Thus, 40 pulse types were depicted, but they the radial artery (see Figures 1 & 2), testing presents information for the lung, spleen, left side, it means lower back is weak and
fell into just a few basic categories. each arm one at a time. The classic Chinese and kidney yang. This classification is sore; if just on the right side, it means a
pattern of pulse taking is based on touching consistent with the five element system weak mingmen fire and/or essence injury.
The general implication of the literature on that depicts five basic viscera; the kidney
pulse is that there are about two dozen pulse the wrist with three levels of pressure:
superficial palpation (almost no pressure, is subdivided to make the sixth. However,
72 73
FACTORS TO CONSIDER of patient and practitioner often being full evaluation. Often, there is not enough • Gao De commented: A doctor must
less than ideal, thus distorting the pulse time available to perform a complete be aware of the fact that as numerous
BEFORE AND DURING PULSE reading. pulse diagnosis. As stated in Acupuncture: changes can take place within a man’s
EXAMINATION 3. The placement of the physician’s fingers
A Comprehensive Text: “The doctor body under natural physical condition, so
must refrain from quick pulse-taking in a can variations of normal pulse condition.
are at the cun (“inch”), guan (“bar”), hurried frame of mind. If this precaution is Such variations will be within certain
In the well-known study guide, Acupuncture: and chi (“cubit”) positions. The middle
A Comprehensive Text (15), it is said not observed, the resulting pulse readings limits and still bear the basic features of
finger is placed over the eminent head will be misleading.” the normal pulse condition. Theoretically
that: “Diagnosis by pulse is a subtle art of the radius and the other two fingers
and, even more than other diagnostic speaking, the demarcation line between
are placed adjacent to that one, but 6. One must take into account the season. variation of normal pulse condition and
procedures, requires a tremendous amount usually not touching one another or Although there is great detail in
of attentiveness and experience in order to diseased pulse condition is not clear cut....
just barely touching (the separation of describing seasonal influences on the Diseases pulse conditions: 1) are attended
acquire the sensitivity necessary to do it well.” fingers depends on the size of the patient, pulse in traditional texts, a most general
Proper pulse taking involves accounting for a with symptoms and signs corresponding
being greater in those who are tall and depiction is: the spring pulse is slightly to the pulse conditions; 2. cannot be
number of factors that can affect the ability have long arms, and less in patients who taut (bowstring); the summer pulse is
to feel the pulse and interpret it properly. explained by the external factors that
are relatively smaller), along the artery. slightly full and surging; the autumn may affect pulse condition [e.g., age, sex,
These factors include several that affect the The wide range of body types that are pulse somewhat floating and fine or
traditional practitioner in China, but some physical constitution, season, etc.]; and
encountered in the modern practice soft; and the winter pulse somewhat 3) remain abnormal after the external
that present new problems for the modern make it more difficult to place the fingers sinking and slippery or hard. If the pulse
practitioner: factors seemingly affecting the pulse are
properly to feel the pulse. type is consistent with the season, that removed unless effective treatment is
1. The patient must be relaxed and have indicates a normal condition, while if it applied.
4. The physician, through training and differs markedly, it suggests a pathological
not undertaken any vigorous activity for experience, applies the appropriate
some time prior to the pulse taking. It is condition. There is some question, • In addition to these factors based on
amount of pressure. Gao De, in his review however, as to how this seasonal influence traditional and natural considerations,
generally thought that the pulse should of pulse diagnosis, commented: “Doctors
be felt in the morning to get the best might be modified by modern living habits, one must take into account new factors
exerting different forces in pulse-taking including rising and going to bed out of that may influence the pulse, such as
reading. Unfortunately, most modern get different conclusions regarding both
patients rush through traffic to arrive at an synch with the sunrise and sunset, use of use of drugs, including nicotine products,
the depth at which the pulse beating is central heating and air conditioning, and pharmaceutical drugs, and illegal drugs.
appointment that takes place later in the felt and the strength of the pulse; hence,
day, after many activities have influenced eating foods out of season.
also different conclusions of the overall The numerous factors to be taken into
the quality of the pulse. pulse condition arise.” Having applied 7. One must take into account patient consideration and the associated difficulties
2. The patient’s arm, wrist, and hand must pressure properly, the doctor must be characteristics that influence the in interpretation mean that pulse taking in the
be relaxed, with the hand supported on a familiar with the different categories pulse. According to Acupuncture: A modern setting is rarely as informative as it is
small pillow or other object; the hand is of pulse conditions so as to be able to Comprehensive Text: depicted in the historical texts. Nonetheless,
below the heart, at about the location of classify that which is detected into the despite the problems that can arise, modern
category that most closely describes what • In a healthy person, the front position pulse taking can usually reveal most of the
the navel as the person sits. The physician tends to be floating, while the rear
is calm and able to concentrate; the is felt. As described above, this is the 24-28 basic categories. The pulse taking
essential feature of pulse taking, one that position is usually submerged....Athletes may not as easily reveal the more numerous
physician’s hand that is performing the often have a slow pulse, young children
diagnosis is also in a relaxed position. Western writers must emphasize because indications depicted in the Mai Jing or in
it is not necessarily taught that way in the have quick pulses. Fat people have deep some other texts. Of course, a practitioner
As described in Chinese Acupuncture pulses, while thin people have pulses with
and Moxibustion: “The three fingers are standard training programs. who specializes in pulse diagnosis and spends
a tendency to be bigger than normal. years studying the theory and categories and
slightly flexed, presenting the shape of an 5. Adequate duration of pulse diagnosis is Woman’s pulses are usually softer and
arch. The finger tips are kept on the same carefully takes the pulse of many hundreds of
allowed to assure that the pulse description slightly quicker than men’s. Also, women’s patients could still master the system, but the
horizontal level.” In many rushed modern holds true over many pulsations, and that right pulses are usually stronger than their
practices, the pulse is taken whenever impetus to do so seems muted: there are too
both arms are checked in order to give a left, while the opposite is true of men. many interferences of modern society that
it seems convenient, with the position
74 75
make the pulse less informative and there means, including modern medical testing, key criteria in examination: the floating, deep, According to Chinese Acupuncture and
is plenty of other diagnostic information or implying that something is missing from slow, and rapid. The floating and deep can Moxibustion: “As the process of disease is
available. Yet, those involved with modern the diagnosis when the pulse does not be discerned by light and heavy pressure of complex, the abnormal pulses do not often
Chinese medicine should not dismiss the agree, setting off a series of questions or the fingers. The slow and rapid may become appear in their pure form, the combination
pulse simply because a variety of factors investigations for additional information. This the moderate and the racing. This can be of two pulses or more is often present. The
need to be taken into account; it becomes application of pulse as confirmation is one identified by respirations [i.e., counting the condition of a number of pulses present at
necessary to become aware of these factors that Bob Flaws has argued against having number of pulses per respiration].” While the same time is called complicated pulse.
and give adequate time and attention so modern practitioners rely on, even though he Liu then goes on to give a somewhat more The indication of a complicated pulse is the
as to limit their potential for confusing the observed it as a common situation in China. complex system of diagnosis, with attention combination of indications of each single
interpretation. He wrote in the introduction to his book on focused on the three pulse positions of each pulse.” The complexity depicted in this
pulse: radial artery to discover ailments of the major textbook statement is applied to ordinary
PULSE AS AN AID TO OTHER This Western ambivalence toward and
internal organs, even that is greatly simplified cases that have occurred throughout medical
compared to what is found in the Mai Jing. history in China.
DIAGNOSTICS pervasive lack of mastery of the pulse Overall, Liu aims his comments on pulse at
examination is, I believe, exacerbated by a helping the practitioner to integrate pulse Today, the influence of surgery, powerful
During the development of Chinese medicine, somewhat similar attitude towards pulse information with other diagnostic methods, modern drugs that are taken chronically, and
there appears to have arisen, from time to examination current in the People’s Republic mainly rational inquiry. extreme variability in life style means that
time, an understanding that a well-trained of China at least in the 1980’s. When I the complexity can be even greater. Thus,
physician was able to make a diagnosis almost was a student in China during that time, In his book, Flaws goes on to argue that the the physician who wishes to rely on the pulse
entirely by pulse taking, while asking virtually the importance of pulse examination was importance of the pulse in modern practice under such circumstances must become
no questions of the patient. As a result, pulse deliberately played down by many of my lies with the complexity of chronic conditions familiar not only with several basic pulse
analysis sometimes took on a certain mystical teachers and clinical preceptors....I never suffered by many patients who turn to types, but must develop the ability to detect
aura and was a major focus of doctor-patient had a teacher tell me a pulse was anything acupuncture in the West. The idea is that and interpret very complex pulse forms,
interaction. Aside from the complaints about other than wiry, slippery, fast, slow, floating, these patients typically present a picture teasing out multiple pulse types within the
this in the historical literature as already deep, or seems that many modern that is difficult to sort out, and that the sensation under the fingers. Some physicians
cited, Gao De mentions it as a continuing Chinese TCM practitioners relegate pulse pulse can provide information that resolves have argued, instead, that the pulse diagnosis
problem in the practice of Chinese medicine examination to a minor, confirmatory role....I the dilemma. I would argue, contrarily, that should have a relatively limited role. Xu
up to the modern era: “Some even applied believe that mastery of pulse examination this complexity of the patients makes pulse Dachun commented: “In my own view, the
pulse diagnosis in clinical practice in a is vitally important to making a correct TCM diagnosis more difficult to rely on, rather than doctrine of the pulse only includes examining
completely isolated way, disregarding the pattern discrimination. And, I believe the more valuable. whether a patient’s qi and blood are present
other three, namely inspection, smelling, pulse examination is, perhaps, even more abundantly or insufficiently, and through
important to Western practitioners than for One can come to this view by reading the which meridian or through which organ cold,
and asking, thus having led the development indications of the pulses in the Mai Jing, in
of pulse diagnosis astray.” In Acupuncture: A our Chinese counterparts. heat, or other evil influences flow. This has to
which the interpretations are very succinct be compared to the patient’s symptoms....”
Comprehensive Text, the authors still allude Indeed, the set of pulses that Flaws mentioned and focused: this pulse is common in the
to the possibility of using the pulse as a sole hearing repeatedly in China is the most basic spring, this pulse means taiyin disease, this Clearly, the role of pulse within the full
method of diagnosis by saying: “While most set that must be learned and is similar to pulse means a fever, etc. By contrast, the framework of diagnosis will remain an
Chinese doctors would agree that the pulse what was described above by several authors complexity of modern patients, especially area of some contention. Advocates of
is best used in conjunction with the other as the key categories. He has relayed a group those who are older and suffer from numerous pulse diagnosis having a central role can
diagnostic methods, doctors well-skilled in of opposing pairs that help assure that the diseases, means that within one individual point to the large amount of information
pulse diagnosis can discover an enormous treatment is consistent with the underlying there is a complex of deficiencies and contained in the pulse that can lead one to
amount of information about their patients pattern and unlikely to cause adverse effects excesses, of internal and surface disorders, of an improved understanding of the disease
by this method alone.” by reinforcing an imbalance. In the opening stagnation and looseness, and influences of process affecting the patient; critics will
The utility of pulse diagnosis may be more chapter of The Heart Transmission of Medicine drugs, surgery, and daily habits that don’t fit point to the wide variation in results of pulse
properly viewed as belonging to the realm (9), by the famous 19th Century physician Liu any traditional pattern. The resulting pulse is taking, being dependent on so many factors,
of confirming a diagnosis attained by other Yiren, he states: “Four kinds of pulse are the more difficult to analyze and less informative. and will emphasize, instead, the essential
76 77
role of examining the medical history and tremendous amount of information about
current symptoms as revealed by inquiry. what goes on inside the body, so as to produce
However, few proponents of pulse diagnosis a diagnosis. Such tests reveal much about the
today would suggest downgrading the other functions of the internal organs; for example,
diagnostic techniques and few critics of pulse inflammation of the liver or malfunction
diagnosis propose eliminating it. So, a certain of the kidney filtration system is readily
level of consensus arises. detected with a simple blood test. Most of
these testing methods have been utilized only
THE POTENTIAL ROLE in recent decades and add a new dimension
to the practice of Chinese medicine.
While patients in China have come to rely
MODERN PRACTICE OF TCM on the traditional medical practitioners to
simply carry out their diagnosis in silence
In modern medicine, the traditional style of and prescribe a therapy to be taken without
pulse diagnosis, which was also practiced in question, modern patients in the West prefer
a slightly different form in Western medicine to talk about their diseases. They usually
until the 19th century, is replaced by a number demand to have explanations given for every
of other tests. Tests by stethoscope and blood step of diagnosis and for every factor that goes
pressure cuff are routinely performed as into a determination of a therapy. In fact, one
pulse diagnostic techniques. The stethoscope of the main complaints raised by Westerners
reveals pulse rate and, at a low level of who visit Chinese immigrant doctors is that
inference, irregularities in the structure there is no significant discussion of their
and function of the heart, which must be case, even when language is not a major
evaluated further. When deemed necessary, barrier. For the Western patient, the focus
additional testing is performed via various is shifted towards the concerns that can be
heart monitors, such as an electrocardiogram. verbally expressed and away from the more
The non-invasive sonograms as well as mysterious diagnosis attained by pulse taking.
the more invasive testing (e.g., insertion The complex condition of many modern
of monitors into the body) allow modern patients may require one to rely heavily on
physicians to examine the interior of the modern medical diagnostics as a primary
arteries and the heart. The information from resource, making it the essential fifth
these tests is generally understood to reflect diagnostic method for the practitioner of
only the conditions of the heart and major Chinese medicine. This is not a matter of
vessels (the cardiovascular system); it is not the traditional practitioner deciding that this
thought of as a means of examining other is the desired route, but a reflection of the
aspects of health. Unlike the traditional extent to which modern lifestyle and modern
concept, the pulse form or information medicine imposes itself on people who might
obtained by examining the vessels is not have an interest in a traditional and natural
thought to provide useful information about, approach.
for example, the liver, kidney, lung, or spleen
conditions. It is not uncommon for a patient to come to a
traditional practitioner with Western medical
Modern medicine has numerous other kinds test results and diagnosis and to want to
of tests, including blood tests, urine tests, and know what is going to be done specifically
a variety of scans and biopsies, that reveal a
78 79
about this situation as defined by those tests. ALTERED USE OF PULSE the pulse will change so that it is not as string- the softening and relaxing effect described
A response that the therapy will rectify qi like (or taut). He claimed that in those patients in this text applies to the immediate change
and blood and resolve the dysfunction of an DIAGNOSIS whose pulse changed (softened immediately, in the described pulse, as opposed to merely
organ system not mentioned in the modern as well as eventually, after several treatments) suggesting a change in the patient’s overall
test results may prove unsatisfying to the Many acupuncturists trained in the West with acupuncture, nearly all had their tense condition. It is difficult to know what
patient. Yet, it is precisely in this area-of have pursued a type of pulse diagnosis that symptoms relieved; of those whose pulse did was meant in the ancient text, but the lack of
measuring traditional-style indicators-that is not described in the traditional Chinese not change with acupuncture, or those that further reference to the spontaneous pulse
pulse diagnosis is employed in order to make literature. While the original Chinese showed immediate changes that promptly changes in the traditional Chinese medical
corrections. pulse taking is utilized to arrive at both a reverted after treatment, the symptoms were literature suggests that this was not a major
diagnosis and at prognosis, many Western usually not relieved (in 3 out of 4 cases). means of utilizing pulse evaluation.
The question arises: does the old system acupuncturists utilize a pulse analysis to
of pulse diagnosis still have a value to determine whether or not they have properly Dr. He indicated that, ideally, the pulse would It would not be surprising that acupuncture
practitioners of traditional medicine given the inserted the needles. This is done by feeling return to normal or markedly calm down after would alter the pulse sensation detected
wealth of information derived from modern the pulse after the needles have been the needle insertion and this improved pulse in some or even most individuals (see: An
tests? In particular, in Western countries inserted, either immediately or after they condition would continue until the needle was introduction to acupuncture and how it
where extensive testing is readily available, have been in place for several minutes. It is withdrawn; the pulse would stay calm at least works). More research would be needed to
can the traditional practitioner either ignore claimed that a properly conducted treatment for a time afterward. In some cases, the pulse determine how widespread this phenomena
the information from those tests in favor yields correction of the pulse to a normal, or returned to its former condition immediately is, since Dr. He described only one very broad
of traditional style diagnostic methods or more normal, condition which is detected at after needle removal; and in other cases, the type of pulse and did not indicate anything
even gain any additional information from the time of the treatment. Presumably, what pulse was not altered by acupuncture at all. In about the nature of the treatments given
traditional pulse diagnosis once the modern is being detected is the improvement in the rare cases, the pulse would actually become (for example, whether needles were inserted
tests have been conducted? This is answered flow of qi and blood under the influence of stronger, or more tense. He also noted that proximate to the artery on which the pulse
in favor of retaining pulse diagnosis because the acupuncture needles. over several treatments the majority of was measured). Such research might help to
of the nature of the therapeutics to be patients had their pulse gradually becoming confirm or deny whether such pulse changes
employed by the traditional practitioner. The source of this method and application more normal, while others took several were truly valuable indicators of the success
of pulse diagnosis remains unclear, but it treatments before this response developed of a long-term treatment. Certainly, this
For the most part, the indications and was described by He Honlao, a Chinese at all; some patients continually returned to method has a potential for good use in the
applications of acupuncture and herbal acupuncturist working in the U.S., in an article pretreatment pulse conditions after every modern setting where some people are asked
therapies are not described in terms that published in 1987 (10). He stated: “By clinical acupuncture session. to pursue acupuncture for many sessions over
correlate with the results of modern medical practice, I noticed the fact: There are changes several weeks in order to determine if it is
tests. They are described in terms of effects in the pulse condition after acupuncture.” In In the introduction to the article, Dr. He ultimately going to alleviate their condition.
on qi and blood, hot and cold, and the zangfu explaining the observation, he conjectured describes his observation as a “discovery,” The immediate pulse response or lack thereof,
organs. Even with the more limited use of that this use of the pulse analysis was a therefore not something belonging to the if truly informative as Dr. He suggests, might
pulse diagnosis that has been advocated means of detecting the “arrival of qi” with Chinese tradition and not something that he help the practitioner and patient determine
by many authorities-relying on only about acupuncture (see: Getting qi). From the was aware was being relied upon by other the likelihood of success after only a couple
half of the basic pulse categories to get the modern perspective, he referred to research acupuncturists at the time. In his discussion, of sessions. While this type of diagnosis
fundamental differentiation-the results of the carried out in China during the 1950’s that he cites one statement from the Jingui Yaolue may be valuable for its primary purpose as
pulse taking can be applied to determining the indicated a short term contraction followed that he believes supports his contention and a means of confirming the desired reaction
therapeutic strategy. Regardless of whether by a longer-term expansion (dilation) of the method. The quotation, taken here from a from acupuncture therapy, it is not the same
one considers pulse taking a central and key blood vessels as a response to acupuncture published translation (11), states: “If the pulse as the pulse taking method that is used for
part of a traditional style diagnosis or relegates therapy. In his article, he evaluated the pulse is minute and harsh on the cun site and thin basic diagnosis and should not be assumed to
it to a more minor confirmatory role, it still changes in 400 patients who had a string- and tense on the guan site, it is appropriate replace the traditional style and application of
belongs to the modern practice of traditional like pulse (in which he included wiry, tense, to activate yang qi by acupuncture in order pulse diagnosis. Rather, it can be regarded as
medicine and requires the practitioner to be solid, and firm pulse types), which indicated a to soften the harshness and to relax the an added technique which may be of value for
familiar with the major pulse categories. tension syndrome. Accordingly, if acupuncture tenseness, thus bringing about recovery.” the modern practitioner.
successfully dilates and relaxes the vessels, Dr. He has assumed, perhaps correctly, that
80 81
ATTEMPTS TO MAKE PULSE simulations are deemed a means of training with oral or facial neoplasms, physicians often so as to assure that the results of pulse taking
practitioners to perform the diagnosis, which resort to pulse-taking to follow-up the patient, are meaningful. Most authorities agree
DIAGNOSIS OBJECTIVE is to be mastered with actual pulse feeling and it is found that the chi pulse is weakened that in the modern era one must be able to
after learning the basics. Fei Zhaofu and in 50%, and absent in 25% of the patients, detect a relatively limited basic group of pulse
One of the serious objections to reliance his colleagues at the Shanghai College of which is statistically significant in comparison forms in order to utilize the information for
on pulse diagnosis is that the pulse form Traditional Chinese Medicine commented with the pulse of normal subjects. devising a therapy (i.e., acupuncture, herbs).
determined by a practitioner is very subjective. about the pulse-imitating devices used for These requisite forms determine whether
It relies on how the physician places fingers this purpose: In a study of advanced hepatitis patients with the focus of the pathological process is at
on the wrist, what pressure is applied, and cirrhosis or liver cancer carried out in Taiwan, the body’s surface or interior, is of a hot or
how the physician’s mind interprets the Imitating the pulse actually means that the it was reported that most of the patients had cold nature, or is of an excess or deficiency
sensations. Several physicians feeling the abstract descriptions and images [of the a weak pulse on the left wrist at the cun and type. The fundamental pulse categories that
pulse of the same patient consecutively may traditional system] are changed to specific chi positions, compared to normal subjects practitioners are to learn correlate directly
report differing pulses. In China, researchers figures signifying digital senses directly (22). with the well-known “eight methods of
hoped to illustrate the value of the wrist pulses felt and stored. During the process of therapy” (see: Enumerating the methods of
investigation, the device has been affirmed In a broad evaluation conducted in Hong
as a diagnostic method and also to aid in Kong, it was reported that specific pulse therapy). There have been recent attempts
standardizing their measurement by devising by many veteran practitioners of TCM, with to broaden the scope of pulse diagnosis;
repeated correction for improvement leading categories are more commonly found with the
modern devices for getting an objective pulse initial stage of illness, versus more developed for example, feeling the pulses immediately
form. The result of such a measurement, to its final approval by TCM circles. The device after insertion of acupuncture needles has
is therefore considered to have effectively and advanced stages of an illness (23). The
using devices to detect the pulse, is a printed common pulses were: been suggested recently as a means of
version, called a sphygmogram. inherited TCM sphygmology theory and determining whether the “qi has arrived” as
preserved the pulse feeling experience • Original pulses (initial stage of illness): a result of correct point selection and needle
In his article on pulse diagnosis, Gao De of TCM. Medical personnel may use it to floating, deep, slippery, uneven, long,
said that: “The most pressing need in our manipulation. There have also been attempts
gradually promote the standardization of short, taut, soft, large, small; to more clearly define the pulse forms; for
study on pulse taking diagnosis is to devise pulse diagnosis....
an instrument to assist doctors when they • Changing pulses (serious disease example, by developing medical equipment
take pulse with their fingers so as to get an develops): rapid, tense, slow, moderate, that can detect and record the pulse forms,
objective judgment of the patient’s pulse
RECENT INVESTIGATIONS OF full, hollow, indistinct, thready, firm, and to develop statistical analysis of pulse
condition.” Such instruments were soon PULSE weak; and types by disease. Pulse diagnosis remains an
important part of the practice of traditional
developed. At a 1987 traditional medicine
Chinese researchers have pursued the • Very abnormal pulses (critical illness): Chinese medicine that is still being explored
conference in Shanghai (19), several doctors
question of how often certain pulse types are tremulous, running, knotted, intermittent, and developed.
reported on methods of measuring the pulse
found, particularly with frequently occurring tympanic, scattered, deep-sited, replete,
by pulse detecting devices. They further
proposed that such measuring devices serious diseases, such as cancer and hepatitis. feeble, no pulse. REFERENCES
could assist students of Chinese medicine in For example, it was reported by researchers
learning pulse diagnosis, since the accuracy working at several institutions in mainland CONCLUSION 1. Academy of Traditional Chinese Medicine,
of the students’ pulse determinations could China that (21): Lectures on essentials of traditional
be verified by the sphygmogram. Indeed, Pulse diagnosis is one method of determining Chinese medicine VI: Methods of
Studies indicate that wiry, slippery, and rapid the internal conditions of patients with the diagnosis, Journal of Traditional Chinese
one author described the use of a device to
pulse, or simply wiry and rapid pulse, often aim of deciding upon a therapeutic regimen. Medicine 1982; 2(4) 321-328.
reproduce the measured pulse which could
denotes exacerbation of the illness [cancer]. In order to make use of this diagnostic, the
then transmit the pulse to the student. By this
When slippery and rapid pulse, wiry and rapid practitioner must learn the proper method 2. Maoshing Ni, The Yellow Emperor’s Classic
means, the different kinds of pulses, having
pulse, or weak and rapid pulse appears post- of taking the pulse, the factors that influence of Medicine: A New Translation of the
been prerecorded and stored in a computer,
operatively in patients with carcinoma, one the pulse, and the categories into which Neijing Suwen with Commentary, 1995
could be imitated for the student to experience
should seriously consider the possibility of each patient’s unique pulse form can be fit. Shambhala, Boston, MA.
so that each of the pulse categories could be
an incomplete operation. Owing to difficulty Practitioners must remain especially alert to
learned. Just as simulators are used today 3. Hong-Yen Hsu and Peacher WG (eds.),
in inspection of tongue features of patients new factors that influence the pulse readings
to train pilots learning to fly, these pulse Shang Han Lun: The Great Classic of
82 83
Chinese Medicine, 1981 Oriental Healing 15. O’Connor J and Bensky D (translators and Figure 1. Pulse positions on each wrist and
Arts Institute, Long Beach, CA. editors), Acupuncture: A Comprehensive their associated organs.
Text, 1981 Eastland Press, Seattle, WA.
4. Yang Shou-zhong, The Pulse Classic, 1997
Blue Poppy Press, Boulder, CO. 16. Cheng Xinnong, Chinese Acupuncture and
Moxibustion, 1993 Foreign Languages
5. Flaws B, The Secret of Chinese Pulse Press, Beijing.
Diagnosis, 1995 Blue Poppy Press, Boulder,
CO. 17. Hsu HY, Chinese Herbal Science, 1982
Oriental Healing Arts Institute, Long
6. Porkert, M, The Essentials of Chinese Beach, CA.
Diagnostics, 1983 Chinese Medicine
Publications, Zurich. 18. Hsu HY, A description of the four diagnoses
and the eight principles, Bulletin of the
7. Xie Zhufan, Selected terms in traditional Oriental Healing Arts Institute of U.S.A.,
Chinese medicine and their interpretations 1978;3 (2): 17-22.
(VIII), Chinese Journal of Integrated
Traditional and Western Medicine, 1999; 19. Editorial Committee, International
5(3): 227-229. Conference on Traditional Chinese
Medicine and Pharmacology Proceedings,
8. Xie Zhufan and Huang Xiaokai (editors), 1987 China Academic Publishers, Beijing;
Dictionary of Traditional Chinese 1087-1099.
Medicine, 1984 Commercial Press, Hong
Kong. 20. Anonymous, Essentials of Chinese
Acupuncture, 1980 Beijing Foreign
9. Yang Shouzhong, The Heart Transmission Languages Press, Beijing.
of Medicine, 1997 Blue Poppy Press,
Boulder, CO. 21. Yu Guiqing, et al., New progress in the four
diagnostic methods of cancer, Journal of
10. He Honlao, Exploration of the effect of Traditional Chinese Medicine 1990; 10(2):
acupuncture on string-like pulse, Journal 152-155.
of the American College of Traditional
Chinese Medicine 1987; (1): 51-55. 22. Chan Yensong, et al., The pulse
phenomenon of liver cirrhosis and
11. Hsu HY and Wang SY (translators), Chin hepatoma, Journal of Chinese Medicine
Kuei Yao Lueh, 1983 Oriental Healing Arts 1992; 3(2): 13-21.
Institute, Long Beach, CA.
23. Huang Huibo, New theory on pulse study,
12. Unschuld PU, Forgotten Traditions of in International Congress on Traditional
Ancient Chinese Medicine, 1990 Paradigm Medicine Abstracts, 2000 Academic
Publications, Brookline, MA. Bureau of the Congress, Beijing.
13. Gao De, A discussion on selected topics
relating to pulse-taking diagnostics,
Journal of the American College of
Traditional Chinese Medicine 1987; (1);
14. Kaptchuk T, The Web that Has No Weaver,
1983 Congdon and Weed, New York.
84 85
86 87
Nail Diagnosis rheumatoid arthritis. striations and discolouration. The nails
very slowly return to normality. This
• Nails that chip, peel, crack, or break easily condition is not seen in adults. This pic shows how many diseases are
Nail changes may signify a number of disorders show a general nutritional deficiency and reflected in the nails
elsewhere in the body. These changes insufficient hydrochloric acid and protein. • synonyms: Twenty-Nail-Dystrophy,
may indicate illness long before any other Minerals are also needed. Trachyonychia
symptoms appear.  Please do REMEMBER-
everything you see on the outside of your • Ridges can appear in the nails either
body, is a reflection of something going on vertically or horizontally. Vertical ridges
inside. Inside of it. Inside your body. indicate poor general health, poor nutrient
absorption, and/or iron deficiency; they
• Unusually wide, square nails can suggest a may also indicate a kidney disorder.
hormonal disorder. Horizontal ridges can occur as a result
• Brittle nails signify possible iron deficiency, of severe stress, either psychological or
thyroid problems, impaired kidney physical, such as from infection and/or
function, and circulation problems. disease.

• Brittle soft, shiny nails with a moon may • White lines across the nail may indicate a
indicate an overactive thyroid. liver disease.

• Dark nails and/or thin, flat, spoon-shaped • If the white moon area of the nail turns
nails are a sign of vitamin B12 deficiency red, it may indicate heart problems, if it
or anemia. Nails can also turn gray or dark turns slate blue, then it can indicate either
if the hands are placed in chemicals (most heavy metal poisoning (such as silver
often bleach) or a substance to which one poisoning) or lung trouble.
is allergic. • White nails indicate possible liver or
• Deep blue nail beds show a pulmonary kidney disorders or/and anemia.
obstructive disorder such as asthma or • White nails with pink near the tips are a
emphysema. sign of cirrhosis.
• Greenish nails, if not a result of a localized • Yellow nails or an elevation of the nail tips
fungal infection, may indicate an internal can indicate internal disorders long before
bacterial infection. other symptoms appear. Some of these
• Black, splinterlike bits under the nails are problems with the lymphatic system,
can be a sign of infectious endocarditits, respiratory disorders, diabetes, and liver
a serious heart infection; other heart disorders.
disease; or a bleeding disorder. • Downward-curved nail ends may denote
• A half-white nail with dark spots at the tip heart, liver or respiratory disease.
points to possible kidney disease. • Twenty-Nail-Dystrophy definition
• An isolated dark-blue bank in the nail bed, • Idiopathic nail dystrophy that appears in
especially in light-skinned people, can be early childhood. Despite the term, the
a sign of skin cancer. nail changes do not necessarily involve
• Nail beading (the development of bumps all 20 nails. The disorder is characterized
on the surface of the nail) is a sign of by excessive ridging, with longitudinal

88 89
VINDICATE erythema" doses of ionizing radiation over a in chemotherapy. (source eMedicine). disappear when trimmed. (wikipedea)
prolonged period, producing varying degrees They seem to be a simple interruption of
There are various types of nail changes, such of damage to the skin and its underlying pigmentation.
as thickening (onychogryposis), thinning, parts after a variable latent period of several
deformity, and separation from the nail bed months to several decades. Clinically,
(onycholysis). Whenever a peculiarity of the chronic radiodermatitis presents as atrophic
nail exists, the mnemonic VINDICATE will help indurated plaques, often whitish or yellowish,
recall all the causes. with telangiectasia, sometimes with
hyperkeratosis. t can be caused by Vitamin A
V—Vascular disease includes the anoxic deficiency.
(lack of Oxygen transfer) disorders that
cause clubbing, iron deficiency anemia that Hyperkeratosis: a thickening of the horny
causes spoon nails or koilonychia, Raynaud layer, usually accompanied by increase also in
disease, vasculitis (periarteritis nodosa), and the granular layer. As the horny layer normally
peripheral arteriosclerosis, which causes varies greatly in thickness in different sites,
dystrophy or onychogryposis of the nails. some experience is needed to assess minor
degrees of hyperkeratosis.
I—Inflammatory diseases that involve the Beau’s lines are horizontal lines of darkened
nail bring to mind fungus infections causing C—Congenital disorders include psoriasis, cells and linear depressions. They may be
onychia (nail bed inflammation), paronychia, congenital ectodermal defects, absence of associated with traumas, acute severe illness, Transverse Nail Ridges: Horizontal lines may
syphilis (which can cause almost any nail nails (onychia), micronychia, and macronychia. malnutrition, major metabolic condition, be a marker of a past episode of severe illness
change), SBE (sub acute bacteria in the heart A—Autoimmune disorders suggest chemotherapy or other damaging event, and (I wouldn’t swear to this - I think this may
or endocardium), and trichinosis, which scleroderma, periarteritis nodosa, eczema, is the result of any interruption in the protein happen after minor injury?)
causes splinter hemorrhages of the nail. and lupus. formation of the nail plate.

N—Neoplasms do not usually cause nail T—Trauma causes the familiar sublingual
changes, with the exception of clubbing and hematoma that causes the nail to turn dark
pallor from secondary anemia. Chondromas red or black.
(A chondroma is a benign cartilaginous tumor,
which is encapsulated with a lobular growing E—Endocrine disorders are probably some of
pattern.), melanomas, and angiomas are a the most important causes of nail changes.
few neoplasms that do. Intestinal polyposis Hypothyroidism produces nail dystrophy,
may cause nail atrophy. The N, however, brittleness, and onycholysis; similar
can be used to recall neurologic disorders changes, plus spooning of the nails, occur in
such as peripheral neuropathy (dystrophy or hyperthyroidism. In hypopituitarism, these
onychogryposis), syringomyelia, and multiple may be dystrophy, loss of the subcuticular
sclerosis. moons, and spooning. Thickening and
transverse grooving of the nails may be seen Mees’ lines or Aldrich-Mees’ lines are
D suggests deficiency disease such as in hypoparathyroidism. horizontal lines of discoloration which occur
avitaminosis (deficiency of B2 and D, but any
on the nails of the fingers and toes after an
B vitamin Zinc, iron or any mineral deficiency Some horizontal ridge phenomena episode of poisoning with arsenic or thallium
can affect the nails)). include or other heavy metals. They can also appear if Koilonychia (“spoon nails”) not exactly a
I—Intoxication includes arsenic (white lines the subject is suffering from renal failure. They horizontal ridge, this “depression”, but needs
Muehrcke lines are associated with albumin
and transverse ridges across the nails) and are typically white bands traversing the width to be distinguished.
deficiency (as is kidney disease, and liver
radiodermatitis. Chronic radiodermatitis of the nail. With growth of the nail, they are
and severe malnutrition), but also seen
occurs with chronic exposure to "sub- displaced upward on the nail and eventually
90 91
Nails may exhibit many different abnormalities. lance open infection in the skin to release it.
In the condition known as koilonychia (“spoon
nails”), the nails are flattened and have Acute paronychia is usually caused by
concavities. This condition may be associated bacteria. This is often treated with antibiotics,
with iron deficiency (but it can simply be a sometimes as a cream, other times orally.
normal variant).. Chronic paronychia is most often caused by
a yeast infection of the soft tissues around
the nail but can also be traced to a bacterial
infection. If the infection goes on and on then
a fungal infection is often the cause and this
needs anti-fungal cream or paint to treat it.
Whitlows are common, especially for people
Most source concur that the white stria who have to repeatedly wash their hands.
are caused by trauma to the nail matrix Excess water weakens the seal, while soaps
(the growth area or “moon”), for instance, and detergents remove the protective skin
wikipedia says, “ The most common cause oils leaving the skin dry and more liable to
is injury to the base of the nail (the matrix) split. Most often, trauma to the cuticle allows
where the nail is formed. A whitlow or felon is an infection of the tip of
infection in. Biting or picking at the cuticle,
the finger. A whitlow or felon is an infection of
damage through work and overenthusiastic
Leukonychia striata = white striations on the the tip of the finger.
manicuring are the usual culprits. If someone
nails. has a cold sore and puts their finger in their
mouth then a herpes infection whitlow may

A group of oncologists describe how a patient

on chemotherapy developed fingernail
anomalies."Two months into his second- The cuticle acts as a protective seal but if it
line chemotherapy, he developed multiple, is damaged in any way bacteria can enter
concomitant, transverse and longitudinal the skin and cause infection thus paronychia
black lines in all of his fingernails and toenails. as in the pic above. These infections can
After an interval of 3 months, he presented be extremely painful as the skin becomes
a complex pattern of nail hyperpigmentation, inflamed, hot, red and throbs continually.
from combined dense horizontal and
longitudinal streaks in some nails to diffuse Pus is usually present, along with gradual
(These are the sort of white marks people black discoloration in others (Figure).” The thickening and browning discoloration of the
associate with zinc deficiency) point here is that these doctors had no idea nail plate.
why these disfigurations were occurring.
If a large amount of pus has collected, then it
may be necessary to see your doctor who will
92 93
This is a picture of microscopic polyarteritis Symptoms not to diagnose or treat nail diseases and
on the shin. The term polyarteritis means disorders.  Please seek the advice of your
that many blood vessels are inflamed. These • Abdominal painAbdominal pain physician or dermatologist for a proper
nodules are located just below the skin's • Decreased appetiteDecreased appetite diagnosis and medical treatment.
surface (subcutaneous), are barely felt when
pressing on the skin (palpable), and are tender. • FatigueFatigue Paronychia infections of the nail fold can be
The skin is typically red (erythematous). caused by bacteria, fungi and some viruses.
• FeverFever The proximal and lateral nail folds act as a
barrier, or seal, between the nail plate and the
Polyarteritis nodosa • Joint achesJoint aches
surrounding tissue.  If a tear or a break occurs
• Muscle achesMuscle aches in this seal, the bacterium can easily enter. 
Polyarteritis nodosa is a serious blood vessel this type of infection is characterized by pain,
disease in which small and medium-sized • Unintentional weight lossUnintentional redness and swelling of the nail folds.  People
arteries become swollen and damaged. weight loss who have their hands in water for extended
Angiomas do not need to be treated unless
• WeaknessWeakness they bleed or are bothering one. They can periods may develop this condition,and it is
Causes highly contagious.
be treated with electrodesiccation, liquid
Polyarteritis nodosa is a disease of unknown Angiomas nitrogen or laser. All three types of treatment
cause that affects arteries, the blood vessels have similar amounts of discomfort and
that carry oxygenated blood to organs and There are many different types of angiomas. usually give a good cosmetic result. The
tissues. It occurs when certain immune cells An angioma is a benign growth that consists dermatologist will recommend the most
attack the affected arteries. of small blood vessels. These tumors can appropriate method if you desired treatment.
be located anywhere on the body. Some of Electrodesiccation consists of touching the
More adults than children get this disease. It skin with an electric needle and destroying
damages the tissues supplied by the affected the different types include spider angiomas,
cherry angiomas, and angiokeratomas. The the blood vessels, Liquid nitrogen is a cold gas
arteries because the tissues aren't receiving that is sprayed on the skin with a spray gun or
the oxygen and nourishment they need. cause of most types of angiomas is not known.
Cherry angiomas and are due to aging and applied with a cotton swab. Laser uses a beam
In this disease, symptoms result from damage do not have any known significance. Spider of concentrated light. Angiomas sometimes
to affected organs, often the skin, heart, angiomas are more common in childhood and recur after treatment.
kidneys, and nervous system. during pregnancy, and a few can appear on
Generalized symptoms include fever, fatigue,
anyone. When present in large numbers, the Nail Diseases and Disorders
may warn of liver damage. Angiokeratomas
weakness, loss of appetite, and weight loss.
are an overgrowth of blood vessels and skin Our bodies host a variety of microorganisms,
Muscle and joint aches are common. The skin
cells. They are not dangerous. some of which are beneficial to us.  These
may show rashes, swelling, ulcers, and lumps. Pseudomonas bacterial infection can occur
microorganisms also include bacteria and
Nerve involvement may cause sensory changes fungi.  Fungal infections are caused by between the natural nail plate and the nail
with numbness, pain, burning, and weakness. microscopic plants that live on our skin and bed, and/or between an artificial nail coating
Central nervous system involvement may on the dead tissue of our hair and nails.  The and the natural nail plate.  Many people have
cause strokes or seizures. Kidney involvement following list contains the more common nail been led to believe that the classic 'green'
can produce varying degrees of renal (kidney) irregularities, diseases and disorders.  For discoloration of this type of infection is some
failure. information on nail problems not listed here, type of mold.  In actuality, mold is not a
please refer to the links at the bottom of this human pathogen.  The discoloration is simply
When heart arteries are involved, heart page. a by-product of the infection and is caused
attack, heart failure, and inflammation of the primarily by iron compounds. Pseudomonas
sac around the heart (pericarditis) can occur. Please be aware that Nail Technicians are thrive in moist places; it feeds off the dead
only licensed to beautify the hands, and tissue and bacteria in the nail plate, while the

94 95
moisture levels allow it to grow.  The after Onychogryposis are claw-type nails that are Onychauxis is evidenced by over-thickening
effects of this infection will cause the nail plate characterized by a thickened nail plate and are of the nail plate and may be the result of
to darken and soften underneath an artificial often the result of trauma.  This type of nail internal disorders -- seek medical advice.
coating.  The darker the discoloration, the plate will curve inward, pinching the nail bed
deeper into the nail plate layers the bacteria and sometimes require surgical intervention
has traveled.  If the bacteria has entered to relieve the pain.
between the nail plate and the nail bed, it will
cause the same discolorations and may also
cause the nail plate to lift from the nail bed.

Tinea Unguis, or ringworm of the nails, is

characterized by nail thickening, deformity,
and eventually results in nail plate loss.

Leuconychia is evident as white lines or spots

in the nail plate and may be caused by tiny
bubbles of air that are trapped in the nail plate
layers due to trauma.  This condition may be
hereditary and no treatment is required as
Onychorrhexis are brittle nails which often the spots will grow out with the nail plate.
split vertically, peel and/or have vertical
ridges.  This irregularity can be the result of
heredity, the use of strong solvents in the
A fungal or yeast infection which results in workplace or the home, including household
Onychomycosis, can  invade through a tear cleaning solutions.  Although oil or paraffin
in the proximal and lateral nail folds as well treatments will re-hydrate the nail plate, one
as the eponychium.  This type of infection may wish to confer with a physician to rule
is characterized by onycholysis (nail plate out disease.
separation) with evident debris under the nail
plate.  It normally appears white or yellowish
Onychatrophia is an atrophy or wasting away
in color, and may also change the texture
of the nail plate which causes it to lose its
and shape of the nail.   The fungus digests
luster, become smaller and sometimes shed
the keratin protein of which the nail plate
entirely.  Injury or disease may account for
is comprised.  As the infection progresses,
this irregularity.
organic debris accumulates under the nail
plate often discoloring it.  Other infectious
organisms may be involved, and if left
untreated, the nail plate may separate from Beau's Lines are nails that are characterized
the nail bed and crumble off. by horizontal lines of darkened cells and
linear depressions.  This disorder may be
caused by trauma, illness, malnutrition or any
major metabolic condition, chemotherapy or
other damaging event, and is the result of any
96 97
interruption in the protein formation of the Pterygium Inversum Unguis is an acquired MMA Damaged Nails: D. Tuggle, owner of
nail plate. Seek a physicians diagnosis. condition characterized by a forward growth The Nail Academy, Jamaica, Queens, N.Y.,
of the hyponychium characterized by live submitted this picture of nails damaged
tissue firmly attached to the underside of by MMA to the BeautyTech Web Site and
the nail plate, which contains a blood supply allowed it to be added to this page.  MMA
and nerves.  Possible causes are systemic, (methyl methacrylate) is a liquid monomer
hereditary, or from an allergic reaction to used for acrylic nails by some unscrupulous
acrylics or solvents.  Never use force to 'push salons even though it is considered by and
back' the advancing hyponychium -- it is an prohibited by the FDA to be a poisonous and
extremely painful approach, and will result in deleterious substance.  According to Dianna
a blood flow.  Consult a physician for diagnosis Bonn of Indiana, as of May 1, 1999, 23 states
and treatment. have banned this chemical from being used
in nail salons.  MMA nails are very rigid and
do not bend or have the flexibility to break. 
When MMA does finally break, it will break
the natural nail with it, causing severe nail
Koilonychia is usually caused through iron
deficiency anemia.  these nails show raised
ridges and are thin and concave.  Seek a Pterygium is the inward advance of skin over
physicians advice and treatment. the nail plate, usually the result of trauma
to the matrix due to a surgical procedure or
by a deep cut to the nail plate.  Pterygium
results in the loss of the nail plate due to the
development of scar tissue.  Cortisone is used
to prevent the advancement of scar tissue.  Psoriasis of the nails is characterized by raw,
Never attempt to remove pterygium -instead, scaly skin and is sometimes confused with
consult a physician for advice and treatment. eczema.  When it attacks the nail plate, it will
leave it pitted, dry, and it will often crumble. 
The plate may separate from the nail bed and
may also appear red, orange or brown, with
red spots in the lunula.  Do not attempt salon
treatments on a client with Nail Psoriasis.
Consult with a dermatologist for diagnosis
and treatment. Brittle Nails are characterized by a vertical
splitting or separation of the nail plate layers
at the distal (free) edge of the nail plate. 
In most cases, nail splitting and vertical
Melanonychia are vertical pigmented bands, ridges are characteristic of the natural aging
often described as nail 'moles', which usually process.  This nail problem is also the result of
form in the nail matrix.  Seek a physicians care overexposure to water and chemical solvents
should you suddenly see this change in the nail such as household cleaning solutions.  As
plate.  It could signify a malignant melanoma we age, the nail bed's natural flow of oils
or lesion.  Dark streaks may be a normal and moisture is greatly reduced.  This oil
occurrence in dark-skinned individuals. and moisture is the cement that holds the
98 99
nail plate layers together and gives the plate Vertical Ridges are also characteristic of can attract fungi and bacteria.  If several days time or another). Once NPS is in a family,
its inherent flexibility.  At the first signs of aging, although are not limited to the aged have passed and the blood clot becomes the risk of transmitting the disorder from
splitting or peeling, re-hydrate the nail plate or elderly.  The nail plate grows forward on painful, the nail plate may require removal so parent to offspring is 50% for each pregnancy,
layers with a good quality cuticle and nail oil the nail bed in a 'rail and groove' effect, much the nail bed can be cleansed. regardless of the sex of the child, with females
that contains Jojoba and Vitamin E as two of like a train rides on its' tracks.  As we age, being affected approximately 10% more often. 
the botanical oils.  Jojoba oil has a very tiny the natural oil and moisture levels decline in
molecule which can penetrate the nail plate the nail plate, and this rail and groove effect
surface, open up the layers and draw the becomes apparent.  Ridged nails will improve
Vitamin E in after it. through re-hydration of the nail plate with
twice daily applications of a good quality nail
The molecular structure of Vitamin E is too and cuticle oil containing Jojoba and Vitamin
large to penetrate the nail plate layers or E.
the surface layer of the skin without the
benefits of Jojoba oil.  Oil the nail plate and
surrounding cuticle at least twice daily; more
if you have your hands in water a lot.  Wear
gloves whenever working with household
cleaning solutions, and remember:  water
is considered the 'universal solvent', and is
indeed a 'chemical'.

The severity of nail dysplasia is extremely

variable. Nails may be small and concave,
longitudinally grooved, abnormally split,
pitted, softened, discolored, or brittle. Toe nails
are usually less affected than finger nails. The
aforementioned nail irregularities are among
those experienced in the industry. There are
Nail Patella Syndrome is a rare genetic others that only a trained dermatologist will
A Hematoma is the result of trauma to the disorder involving nail and skeletal deformities be able to diagnose and treat.  Some are
nail plate.  It can happen from simply trapping (among a host of other related anomalies) contagious, and some are the result of injury
your finger or toe in the car door to friction that occurs in approximately 2.2 out of every or illness.  Physicians will sometimes examine
from  improperly fitting or 'too-tight' shoes, 100,000 people. It is transmitted as a simple your fingernails because many diseases will
to a sports related injury.  A hammer does autosomal dominant characteristic in the ABO appear as various changes in the nail plate. 
a pretty good job at causing a hematoma blood group (Autosomal dominant means Any change in the nail plate could be cause
as well!  The nail bed will bleed due to this that you only have to inherit one copy of the for concern, whether it is a simple splinter
trauma, and the blood is trapped between gene to get it). It also means that there is no hemorrhage that appears as a tiny black
the nail bed and the nail plate.  A hematoma such thing as an unaffected carrier, and NPS line in the nail plate, or a drastic change. 
may also indicate a fractured bone.  Many CAN NOT skip a generation. Nail technicians are trained to beautify the
people who participate in sports activities hands/feet and are not allowed to diagnose
experience hematoma because of the In cases where there seems to be no previous
nail diseases or to treat them in the salon. 
constant friction from the shoes against the family history of NPS, it is thought to be
For your nail health, seek the diagnosis and
toenails.  Hematoma may result in nail plate caused by a sporadic gene mutation (which is
recommendation of a dermatologist.
separation and infection because the blood probably how it began in all families at one
100 101
Yellow nail syndrome 3. Nail phalanges of ring- + middle finger
are spatulate in shape & always heavier
Yellow nail syndrome is characterized by yellow than the base phalanges – Yes, but Megan
nails that lack a cuticle, grow slowly, and are has only spatulate fingernails; but her
loose or detached (onycholysis). Yellow nail ‘famous’ thumb appears to be significant
syndrome is most commonly associated with here, for obviously the nail phalange of
lung disorders, and with lymphedema. her thumb is ‘heavy’ (it’s the condition
named: brachydactyly type d);
4. Pronounced muscular tonus, including a
sharp ‘thumb angle’ (see picture below) –
Yes, Megan has the typical thumb angle;
5. Back of the hands: coarse skin with a
masculine texture – No, obviously Megan
doesn’t have a masculine texture;
6. Ring finger is longer than index finger
– Yes, Megan’s ring finger is a bit longer
than her index finger (though her finger
length appears to be within the range of
‘normal’: see picture below);
7. Palm is square shaped, and never long
OCD & HANDS and narrow – Yes, Megan’s palm appears
to be a bit square shaped.
PDC analyst Arnold Holtzman has described
in his book about Psychodiagnostic Chirology
a list of 7 hand characteristics that appear
to be associated with Obsessive Compulsive
Disorder. Let’s see if Megan Fox’s hand meet
those characteristics:
NOTIFICATION: Holtzman described in this
book very explicitly: “Each of the (7) features
noted below must be in evidence for a
diagnosis of obsessive-compulsive personality
disorder to be valid.”

7 Hand characteristics of Obsessive

Compulsive Disorder:
1. Hard & inflexible hands and the palms are
never soft, nor dysplastic – No, Megan
appears to have flexible hands;
2. Pronounced knuckles – No, Megan has
smooth fingers;

102 103
19 images found for this diagnose

104 105
106 107
Clubbing phalanges (bones nearest the fingertips) • Suppurative lung disease: lung
of corresponding fingers of opposite hands abscess, empyema, bronchiectasis,
In medicine, nail clubbing (also known as are directly apposed (place fingernails of cystic fibrosis
"Drumstick fingers," "Hippocratic fingers," same finger on opposite hands against each
and "Watch-glass nails") is a deformity of the other, nail to nail), a small diamond-shaped • Mesothelioma
fingers and fingernails that is associated with "window" is normally apparent between the • A·V fistula
a number of diseases, mostly of the heart and nailbeds. If this window is obliterated, the
lungs Hippocrates was probably the first to test is positive and clubbing is present. • Heart disease:
document clubbing as a sign of disease, and
the phenomenon is therefore occasionally • Any disease featuring chronic hypoxia
called Hippocratic fingers. • Congenital cyanotic heart disease
When clubbing is encountered in patients, (most common cardiac cause)
Idiopathic clubbing can also occur and in 60% doctors will seek to identify its cause. They
of cases there is no associated underlying usually accomplish this by obtaining a medical • Subacute bacterial endocarditis
disease. history—particular attention is paid to lung,
heart, and gastrointestinal conditions—and • Atrial myxoma (benign tumor)
conducting a clinical examination, which • Gastrointestinal and hepatobiliary:
may disclose associated features relevant
to a diagnosis. Additional studies such as a • Malabsorption
chest X-ray and a chest CT-scan may also be • Crohn's disease and ulcerative colitis
• Cirrhosis, especially in primary biliary
Disease associations cirrhosis]
Although many diseases are associated with • Hepatopulmonary syndrome, a
clubbing (particularly lung diseases), the complication of cirrhosis
reports are fairly anecdotal. Prospective
studies of patients presenting with clubbing • Laxative abuse
have not yet been performed, and hence • Polyposis
Signs and symptoms there is no conclusive evidence of these
associations. • Esophageal CA
Clubbing develops in five steps:
• Others:
1. Fluctuation and softening of the nail bed Isolated clubbing
(increased ballotability) • Hyperthyroidism (thyroid acropachy)
Nail clubbing 2. Loss of the normal <165° angle (Lovibond Clubbing in the fingers of a 33-year old female
angle) between the nailbed and the fold with Eisenmenger syndrome. • Familial and racial clubbing and
Clubbing of the fingernail. The red line shows (cuticula) "pseudoclubbing" (people of African
Clubbing is associated with: descent often have what appears to be
the outline of a clubbed nail. 3. Increased convexity of the nail fold
4. Thickening of the whole distal (end part of • Lung disease: clubbing)
the) finger (resembling a drumstick) • Lung cancer, mainly large-cell (35% of • Vascular anomalies of the affected arm
5. Shiny aspect and striation of the nail and all cases), not seen frequently in small such as an axillary artery aneurysm (in
skin cell lung cancer] unilateral clubbing)
Schamroth's test or Schamroth's window test
(originally demonstrated by South African • Interstitial lung disease • Thymoma
cardiologist Dr Leo Schamroth on himself) is • Thalassemia
a popular test for clubbing. When the distal • Tuberculosis

108 109
HPOA for the enzyme 15-hydroxyprostaglandin Kroumpouzos, MD, PhD, co-author of Melasma or chloasma, known as the "mask
dehydrogenase (HPGD); this leads to "Dermatoses of Pregnancy" published in the of pregnancy," has been reported in up
Bone scan of a patient with HPOA decreased breakdown of prostaglandin E2 July 2001 issue of the Journal of the American to 70 percent of pregnant women. This
and elevated levels of this substance. Academy of Dermatology. "A careful history common condition causes an increase of
and thorough physical examination by a pigmentation that occurs almost exclusively
Pathophysiology dermatologist can relieve anxiety about in sun-exposed areas. "Melasma presents
the nature of these skin conditions and the in three facial patterns. The centro-facial
The exact cause for sporadic clubbing is
possible fetal or maternal risks associated pattern involves the cheeks, forehead, upper
unknown, and there are numerous theories
with them."  lip, nose, and chin," said Dr. Kroumpouzos,
as to its cause. Vasodilation (distended
Instructor, Department of Dermatology,
blood vessels), secretion of growth factors
Harvard University, Boston, Mass. "The malar
(such as platelet-derived growth factor and
pattern involves the cheeks and nose, and
hepatocyte growth factor) from the lungs, and
the mandibular pattern involves the side of
other mechanisms have been proposed. The
the cheeks and jawline." Melasma can also
discovery of disorders in the prostaglandin
develop on the forearms. Dermatologists
metabolism in primary osteo-arthropathy
encourage the use of proper sunscreen to
has led to suggestions that overproduction of
prevent this condition as well as treatment
PGE2 by other tissues may be the causative
with topical corticosteroids, bleaching agents,
factor for clubbing.
chemical peels or tretinoin. Most cases of
melasma resolve after pregnancy. 
The exact frequency of clubbing in the Hair and nail changes during
population is not known. A 2008 study found pregnancy 
clubbing in 1% of all patients admitted to a
department of internal medicine. Of these, "Pregnancy affects every area of the skin,
40% turned out to have significant underlying including hair and nails. Undesirable changes
disease of various causes, while 60% had no may occur that leave pregnant women feeling
A special form of clubbing is hypertrophic anxious," said Dr. Kroumpouzos. "A discussion
pulmonary osteo-arthropathy, known medical problems on further investigations
and remained well over the subsequent year. with a dermatologist can put a woman at ease
in continental Europe as Pierre Marie- regarding these changes." 
Bamberger syndrome. (In dogs the condition
is known as hypertrophic osteopathy.) This is Expecting a Baby? Expect Pigmentary changes during pregnancy  Hirsutism, a condition in which a woman
the combination of clubbing and thickening grows hair in areas where only a man would,
of periosteum (connective tissue lining of
Some Changes In Your Hair, Hyperpigmentation is common during such as the face or chest, can be triggered
pregnancy, affecting more than 90 percent
the bones) and synovium (lining of joints), Skin, and Nails of pregnant women. Hyperpigmentation is a
by the endocrine changes of pregnancy. This
and is often initially diagnosed as arthritis. condition usually regresses within six months
skin disorder in which dark spots appear on following birth. 
It is commonly associated with lung cancer. During pregnancy, changes in the skin, hair
the skin. This benign condition is attributed
Primary HOA. Primary hypertrophic osteo- and nails are common. The correct diagnosis
to an overproduction of melanin, a natural Telogen effluvium is the excess shedding of
arthropathy is HPOA without signs of and treatment of these conditions during
substance that gives color to the hair, skin, and hair that usually occurs one to five months
pulmonary disease. This form has a hereditary pregnancy are essential to ensure the health
iris. Normally hyperpigmented areas, such as following pregnancy. During pregnancy,
component, although subtle cardiac of both mother and baby.
the breasts and nipples, genital skin, and inner an increased percentage of scalp hairs go
abnormalities can occasionally be found.
"The body experiences profound adjustments thighs, may become darker in pregnancy. into the resting phase that is part of the
It is known eponymously as the Touraine-
during pregnancy, which make pregnant Freckles, nevi and scars may appear darker as normal growth-loss cycle of scalp hair. After
Solente-Golé syndrome. This condition has
women susceptible to changes of the skin, well. This condition disappears in the months pregnancy, these hairs begin to fall out and
been linked to mutations in the gene on
hair and nails," stated dermatologist George following pregnancy.  thin. However, this condition does not cause
the fourth chromosome (4q33-q34)coding
110 111
permanent hair loss or obvious bald patches. lips. A person with jaundice will have yellow impaired kidneys. A butterfly-like discoloration corresponding to the Pitta dosha. When the
Telogen effluvium resolves slowly beginning lips. Blue lips may signal heart problems. on the nose or on the cheeks may signal mal- person has a predominant pitta constitution,
six to 12 weeks postpartum. There is no absorption of iron or the folic acid and the the pulse under the middle finger will be
medical treatment available.  Eye Diagnosis sign of a low agni (fire).The nose can be used stronger. Ayurveda describes this pulse as
to determine the dosha of a person. Vata "active, excited, and move like jumping of a
Nails, like hair, can change noticeably during Vata eyes are characterized by small, nervous,
persons have crooked nose. Kapha persons frog."
pregnancy. Some women find that their nails with drooping eyelids and dry, scanty lashes.
have a blunt nose. On the other hand, a sharp
tend to split and break more easily during The white of the eye is muddy, while the iris This pulse is called frog pulse. When the
nose may denote a person with Pitta dosha.
pregnancy. Like the changes in hair, nail is dark, gray-brown or black. Pitta eyes are throbbing of the pulse under the ring finger
changes aren't permanent.  moderate in size. They are sharp, lustrous, Pulse Diagnosis is most noticeable, it is a sign of Kapha
and sensitive to light. The lashes are scanty constitution. The pulse feels strong and its
and oily. Pulse Diagnosis is a very important tool used
Ayurveda Diagnosis The iris is red or yellowish. Kapha eyes are
by all Oriental Medical Practitioners. It is a very
movement resembles the floating of a swan.
Hence, this pulse is called swan pulse.
important tool used by Chinese and Tibetan
tips large, beautiful and moist. They have long,
thick, oily lashes. The white of the eye is very
Health Practitioners as well as Conventional Sound and Odor self diagnosis
medical doctors. To a skilled practitioner,
Nail Diagnosis white. The iris is pale, blue or black. Excessive taking your pulse is more than counting the Question: Body odor with a sweet tinge to it? 
blinking is a sign of nervousness, anxiety or beats. Which internal organ does that indicate needs
Ayurveda considers nails as the waste fear. A drooping upper eyelid indicates a sense attention?
product of the bones. If the nails are dry, of insecurity, fear or lack of confidence. These The functioning and health of the entire Answer: Spleen/stomach
crooked, rough and break easily, it indicated are all signs of vata imbalance. mind body constitution can be determined
a predominance of the vata constitution. from the pulse, including the balance of the Diagnosis by Odor
Soft, pink, tender nails that are easily bent Prominent eyes indicate thyroid gland doshas, the health of the various organs,
dysfunction. An yellow conjunctiva may signal Within the category of listening diagnosis
are indication of a Pitta constitution. When advance warning signs of potential problems Oriental practitioners included the diagnostic
the nails are thick, strong, soft and very shiny, a weak liver. A small iris indicates weak joints. that may crop up later etc. By detecting early
A white ring around the iris may mean an technique that uses the sense of smell. A
then Kapha predominates. symptoms of imbalance and disease reaction disorder with either member of an organ
excessive intake of salt or sugar. If the white in the body, one can take preventive steps to
Longitudinal lines on the nails indicate mal- ring is very prominent and very white, it is an pair will often generate a particular telltale
absorption in the digestive system. Transverse correct the problem before it manifests into a odor. the solid, physically yang organs are
indication of joint degeneration with potential major one.
grooves on the nails may indicate the presence for arthritis and joint pain. considered to be the source of these specific
of long-standing illness or malnutrition. Radial pulse is felt with the first three fingers, smells.

Yellow nails indicate a delicate liver or

Facial Diagnosis the index, middle and ring fingers. Pulse from However, the hollow, structurally yin, partner
jaundice. Blue nails are manifestation of a both wrists is taken. To get an accurate pulse, organ will be affected whenever imbalances
Ayurveda teaches that face is the mirror of
weak heart. Undue redness shows an excess the patient should be as close to his norm as develop within its complementary partner.
the mind. Disorders and disease is manifested
of red blood cells. possible. Taking pulse after strong exertion, The correlation between the organs and their
on the face in the form of lines, wrinkles,
after exposure to a severe environment etc. related odors is listed in the following table:
etc. For example, horizontal wrinkling on the
Lip Diagnosis (OSTHA) will give wrong indications.
forehead indicates the presence of deep- "Odors" and the Five Transformations
If the lips are dry and rough, it may indicate seated worries and anxieties. The position of the index finger denotes
the Vata dosha. When vata is strong in the Using deodorant does one thing only- it
dehydration or vata imbalance. Pale lips A vertical line between the eyebrows on the
constitution, the index finger will feel the masks your health disorders and allows the
indicate anemia. Repeated attacks of right side indicates repressed emotions in the
pulse strongly. The pulse will be irregular deterioration in your health to continue.
inflammatory patches along the margins of liver. On the other hand, the presence of a
and thin moving in waves like the motion of Don't shoot the messenger.
the lips indicates the presence of herpes and vertical line between the eyebrows on the left
a chronic Pitta derangement. Poor digestion a serpent. This type of pulse is called a snake Those people who have good health and good
side will indicate that the spleen is holding in
of worms in the colon are indicated by the pulse. eliminations daily, don't have a problem with
presence of multiple pale brown spots on the The middle finger denotes the pulse body odor. 
A full and fluffy lower eyelids is an indication of
112 113
Odor Energy Organ Pair • Spleen/Pancreas: Troubles with these
organs produce a whining, complaining
Oily, Fatty Rising Liver/Gallbladder voice. It fluctuates between fast and slow,
high pitch and low pitch.
Burnt Active Heart/Small Intestine
• Liver/Gallbladder: Troubles with these
Fragrant, Sweet Downward Spleen/Stomach
organs produce an impatient, often blunt
Fishy Gathering Lung/Large Intestine speech pattern. the pitch is heavy, and the
pattern is short and often brusque.
Rotten, Putrefying Floating Kidney/Bladder
We can also list distinct "voices" each of
which relates to one of the five organ pairs.
I had to use deodorant for over 20 years. Since Listening diagnosis is based on the same If one of these voices is characteristic of
living on a cleansing-detox-rejuvenation-diet principles as visual diagnosis. The difference an individual's speech we can suspect an
it's over ten years that I have no need for it. being that listening deals with a different set imbalance in the energy of the related organ
of vibrations, or a different type of chee. Visual pair and meridians. By way of review these
Deodorant and all the other fragrant diagnosis uses light, while listening diagnosis
alternatives mask the bad body odor correlation's are as follows:
uses the vibration of sound.
problem,  thereby further complicating the
real present and future dangers! The application of this technique is based on "Voices" and the Five Transformations
the polar relationship between the paired
Bad body odor is a clear and immediate sign Voice Energy Organ Pair
complementary internal organs, which tells
that internally you need to get your health in us that if there is a problem with one organ in Shouting Rising Liver/Gallbladder
order. the pair, the other organ will also be affected:
Talking (excessive) Active Heart/Small Intestine
Diagnosis by Listening • Heart/Small Intestine: Problems with
either of these organs are reflected Singing Downward Spleen/Stomach
Diagnosing an individual through the sense of
in irregular speech patterns. Speech Crying Gathering Lung/Large Intestine
sound includes two complementary aspects.
does not flow smoothly, continuously,
The first more yang method is by direct or rhythmically. It is punctuated by Groaning Floating Kidney/Bladder
questioning to gain information about the inappropriate breaks. The individual may
symptoms and general condition. As the often make mistakes in wording as well. If
same time, one needs to pay attention to the the heart is expanded, a yin condition, the
patient's manner of speaking. Is the individual pitch will be high, and interrupted with
bright and cheerful, confident and optimistic, frequent pauses.
depressed, fearful, hesitant. These and
• Lungs/Large Intestine: If the energy of the
similar characteristics provides clues to the
lungs or large intestine is stagnated, the
individual's strengths and weaknesses, and
voice will be heavy and stuffy, especially
to the nature of the particular problem that
when mucus deposits exist in either
prompted him to seek help.
organ. In the case of a more yin condition,
The second, more yin method involves the voice will be thin or weak, as it is in
assessing the quality of the patient's voice. the case of tuberculosis.
From this alone, a skilled practitioner can
• Kidneys/Bladder: Problems in these
determine not only the cause of a problem
organs are generally caused by imbalances
but an individual's overall state of mental and
of liquid or salt. This produces a watery
physical health.
voice, and a low vibration.
114 115
Facial and Body Facial Colors Indications
excess damp or sp
Diagnosis in TCM yellow

Acupuncture Theory orange/yellow damp heat

The strength of Chinese medicine lies within + whole face =
its ability to look at a variety of signs and red excess
symptoms and come to a more precise + mallor flush = yin
diagnosis of underlying conditions. While the def
pulse and the tongue are the two principle lv qi a/or blood
diagnostic tools in Traditional Chinese blue/green (quin)
Medicine (TCM), looking at the colors and kd def or blood
qualities in a person’s body and face provides black/dark
valuable diagnostic information.
Skin Diagnosis - Qualities and
Body Diagnosis - Shape, Demeanor
and Indications
Skin Quality Indications
Body Shape/
Indications moist and clear better prognosis
muscular/strong tend towards excess dry and lifeless poorer prognosis
tend towards
overweight dampness - sp qi Eye Diagnosis - Qualities and
deficiency Indications
wind Eye Qualities Indications
tend towards yang dull expression shen disturbance
active movements
conditions unconscious
withdrawn/slow tend towards qi a/or movement
movements yang def lv qi stagnation a/or
red/congested color
hunched over upper jiao def wind-heat

Facial Diagnosis - Colors and Sounds (Listening) and

Indications Odors (Smelling) in TCM
Facial Colors Indications Acupuncture Theory
white cold or def
Listening to a person’s voice and noticing any
dull white blood def particular body odors that they may have
bright white qi or yang def are a basic part of the "Four Examinations"
in Chinese medicine. Along with the more
precise diagnostic tools such as pulse and

116 117
tongue diagnosis, listening and smelling Quality Indications
provide valuable input to form an appropriate
TCM diagnosis. singsong earth - sp
crying metal - lu
While used more as a casual observation
by most TCM practitioners, listening and groaning water - kd
smelling form an integral part of the Classical
Five Element color, sound, odor and emotion Smelling Diagnosis - Body Odors
(CSOE) method of diagnosis.
Quality Indications
Listening Diagnosis - Voice and Breath strong scent heat
st heat a/or food
Quality Indications bad breath
sudden loss of voice wind heat strong smelling
heat and dampness
gradual loss of voice lu qi or yin def stools
loud excess strong smelling urine heat and dampness
soft deficiency element - meridian
reluctance to speak cold or def rancid wood - lv
excessive speaking heat or excess burnt fire - ht
element - meridian sweet earth - sp
shouting wood - lv rank metal - lu
laughing fire - ht putrid water - kd

118 119