Saturday, January 21, 2012
How important are tongue and pulse diagnosis?
As I've mentioned in other posts, my treatment style (at least currently) emphasises palpation of the patients body for tight and tender areas, as I believe this often gives the most relevant clinical information. But the whole process of diagnosis and treatment is a balancing act, and because there is limited time, I try to concentrate on what I think will give me the most relevant information.
For example, if a young and apparently fit and healthy patient presents with an acute back pain, it is quite possible I won't take their pulse or look at their tongue, unless there is reason to believe there is an underlying organ imbalance contributing to the picture. I find TCM-style Zang Fu theory can easily confuse the picture in these cases - there is always an internal pattern of disharmony if you're determined to find one, but quite often what really needs to be examined and treated are the superficial sinew channels (i.e. tight and tender muscles).
If someone presents with gynaecological problems for example, the pulse and tongue will no doubt give vital clues. But even with what is seemingly a purely internal pattern, I think palpation of relevant channels is often just as important as tongue and pulse, if not more so. There are practitioners who will take the pulse very carefully, base their entire treatment on the information they glean, refer again to the pulse through the course of the treatment, and judge their success or failure on any perceived changes. This is fine if it leads to improvements in the patient's condition, but sometimes this priority seems to be lost - as long as the pulse is 'improving', the practitioner is happy. This seems odd to me - if the pulse changes radically for the better, but next week the patient comes back with the same back ache, has the patient really been served well?
Everyone develops their own style, and certainly I've come across a few experienced practitioners who can uncover remarkable information from the pulse, but I think this is rare. As a mere mortal, I generally use the pulse to get an 'overview' of the patient's internal condition, but only use this information as one piece of the puzzle. The tongue gives another, more objective level of information. Questioning fills in other gaps, and palpation often makes sense of the whole picture. Then, changes in the presenting condition over time let me know whether I'm on track or not.
Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.