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ABOUT CONSTITUTIONAL MEDICINE
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Underlying a person’s health and personality is their constitution, also described as their 'nature' or 'temperament' Much of modern Western herbal medicine has rather forgotten its roots in this matter, but a living, practical understanding of the constitution and the changing nature of the tongue and pulse have been central to all the old traditions of medicine, and very much continue to underpin Ayurvedic and Traditional Chinese Medicine Unearthing some of these old roots and finding great value in them, I have been sharing my understanding with colleagues and students for some time now. The basis of the following material is a paper presented at an international herbal medicine conference in Australia in 2011. It has been edited and re-presented here with fellow students of the old ways of healing in mind, along with anyone else who has a keen interest in this subject for their own reasons...
All things considered, Australian herbalists Dennis Stewart, Andrew Pengelly, Robyn Kirby & Raymond Khoury did a pretty good job at getting ‘water-wings’ on me in the 1980s but setting up a herbal medicine clinic in conservative Christchurch in 1989 was still rather like being thrown into the deep end of the Pacific Ocean with no land in sight! I had no savings or any other kind of support and It was soon clear that I either got good results with the few people who did start trickling in, nearly all of whom had rather difficult, chronic health problems that were not being helped by the fully tax-funded conventional system, or I would shortly need to find another way to make a living. It was sink or swim! Of course, the old ways of healing still worked, at least most of the time, and I'm still swimming, but the question 'what works?' still feels as vitally important as to get right as it ever did, and I continue to listen carefully to the answers, the results, that come back. The best, most reliable, of all answers have been that following the ancient ‘laws of healing', as listed above, can be entirely trusted to work. It really is Nature that does the healing, beyond any shadow of a doubt. Likewise, taking care to 'do no harm' whilst helping the patient remove the harm coming to them, i.e. 'treat the cause', changes things; people get better. Treating the cause means you have to get up close and look at it, which is tricky, not because causes are so very hard to see but because there can be so much to see. A person with a chronic problem rarely has just one origin to their troubles, and sometimes each layer you look at can have another one underneath! People are complex, so are their problems. You can throw all kinds of diagnostic darts at people and hit something important wherever it lands. Eventually it can all need a step back, a big breath, and some pause for thought. What exactly do we mean by this ‘treat the cause’ business? There are as many causes as there are problems. In chronic health problems, many of them are self-inflicted. People do all kinds of injuries to themselves with their diets, with bottling up stress, with resting and sleeping inadequately, with not moving their bodies or exercising their brains... It’s naïve to think we can remove every possible harm in our own lives, let alone another persons', but we still have a golden chance in a modern clinical setting to help people get into the nitty gritty of why they are suffering. This is a profoundly healing thing to do, it changes lives. Underlying a person’s experience of their life, including their strengths and weaknesses, is their constitution, also described as their nature. This underlying nature has a deep influence on their health, their personality and their experience of life. It contains their innate self-healing intelligence, their life-force, that same force of nature which is what heals them if they become sick. It also demonstrates visible cracks along similar lines when imbalances happen, as they inevitably do. The first concept to get a firm grasp on is that the ‘nature’, the constitution varies along several spectrums with many possible gradations. The first spectrum can be described as going from cooler to hotter. Some broad strokes to demonstrate what this means is that cooler constitutions tend to have somewhat slower metabolisms and tend to more chronic, rather than sudden and acute, responses to illness. They don't have inherently less energy, but it tends to be more inwardly directed. In contrast, hotter constitutions typically have faster metabolisms, they are likelier to get more acute or dramatic responses to illness and their energy tends to be more outwardly directed, i.e. they are usually somewhat more naturally extroverted. The second, equally important spectrum in the constitutional picture is described as going from dryer to damper. This overlaps the first spectrum, in other words people have a natural tendency to be cooler or hotter and, at the same time, they also have a tendency to be dryer or damper. Dryness and dampness are somewhat to do with just how much fluid (i.e. water and fats/oils) a person carries but it also relates to their personality and how they move, speak and live in the world. There are many permutations to how dryness or dampness can reflect in our health. For example, too much dryness can lead to general depletion and a need for nourishment, whilst too much dampness can lead to an excess of wastes and debris and a need for cleansing. Where the constitutional approach is incredibly useful to the practitioner is that it gives a window into understanding the most helpful things you can do to assist them with their imbalances. It can show you how to best support that natural, self-correcting ‘healing power of nature’. For more information on the different constitutions, including how to work out which one a person is, read the introduction to constitutional medicine here
In the discussion on tongue and pulse diagnosis that follows, you will see the occasional mention of signs that indicate a need, for example, for cleansing, nourishment, activation or relaxation. This is a subject which will reward further understanding when it is time to put any of this knowledge to practical use. It comes from a recognition that, in each of us, there is an innate cycle of healing that we go through innumerable times in the course of our lives. The four stages of the healing cycle are cleansing, activation, nourishment and relaxation and, in good health we go around, backwards and forwards, between these stages without any hindrance but, if any part becomes stuck or imbalanced, we inevitably become unwell. This subject is explored in more depth here
Before we talk about some of the valuable information you can get from looking at anyone's tongue, I want to remind you that each and every person alive, or who has ever lived, is unique. You know this, you've heard it before and it would be easy to gloss over this point, but that would be a mistake in learning this subject because a person's uniqueness is not just expressed in things like their personality, their voice, their face or their fingertips, it also shows through in their tongue and the many ways in which this remarkable tissue represents the complex organism behind it. This point needs a strong emphasis from the outset because, if you have already gone, or you later go further, into the subject of tongue diagnosis, you will find a plethora of online material, books, maps and charts that set out dozens of signposts that categorically say, 'this means that'. However, here's the thing, 'this means that' some of the time, but sometimes this means something else entirely. If a person attempts to rote-learn, through any system of classification, a number of different tongue signs and then tries to follow a 'this means that' formula, then they will likely miss more than they will catch. It is better to take impressions from the whole picture rather than latching on to one or two signs from the tongue and then try to bang what could well be a square peg into a round hole. It is more helpful to think of the tongue as showing the 'background terrain' of a person's health. It is not there to give you definitive black and white answers, it is there to help direct your attention towards what matters. Another key point in this regard is that the tongue changes, in fact it changes a lot, and unless you have been studying it and you already knew how it was before compared to now, you can also misinterpret which signs are showing something is out of balance and which signs are simply reflecting their constitutional nature to be hotter or cooler, dryer or damper etc. The more that any person who wants to learn tongue diagnosis keeps an open mind to receiving impressions rather than definitive answers from what they see, the better they will be guided towards what it can usefully tell. To any student of tongue diagnosis, I recommend to simply practice looking at the tongue openly and receptively but, rather than give feedback about what you see, keep taking in information from what their symptoms are saying, from their pulse, from any diagnostic tests that can be done, and from their history, including asking open questions to better understand how their biography may have become their biology. Staying receptive and keeping an open mind is the way to gain great insight into a person when we come into connection with them with the intention to be an 'agent for Nature' to help them get moving on their healing journey. Conversely, our ego, our need to be right, to have special knowledge, is the great enemy of the practitioner, it can badly get in the way of working out what is the best way to guide a person. In practice, when you study their tongue, the patient hardly ever needs you to talk about what you are seeing. In the rare instances when they do ask, it is easy to set their mind at ease with saying something non-scary and non-committal. It is better to set your intention to be an agent for Nature, for healing, and then look closely at the tongue and take in what it is telling you with a truly open mind. When you have taken in the many signs that are there to see and understand, including those from their tongue, and it comes time to make the recommendations for the right advice or the right medicine, those impressions will guide you well. In my own practice I always take a photo (more about that next) and then study it with the screen towards me as I feel their pulse at their wrist (something that also needs to be done in relative silence). This process can take a few moments, but the patient is always willing to sit quietly while you are absorbed in taking your impressions. Again, if I feel that they are too tense or apprehensive, I might say something non-scary or non-committal, or just make an 'mmm' sound, just to put them better at ease so that I can feel un-rushed as I go about my work. It is essential not to rush, to take as long as you need, and not to have any hesitation to come back to the tongue photo, or the pulse, any time you want to refocus your attention or absorb the impressions again, I cannot over-emphasise this point. You do not need to have mastered tongue or pulse diagnosis before you can use it. So long as you know when to hold you own tongue you will not do harm and you will get many insights that will guide you and help you in your work.
I highly recommend taking photographs of your patient's tongues for two reasons: Firstly, by using a smart phone and being able to look at the photo right away, you have the immediate ability to spend much longer looking at the tongue without needing them to keep it hanging out overlong! Putting your tongue right out in front of someone requires no small degree of trust, it is a very revealing thing to do and people instinctively know this. A photo lets you read the tongue with as much time as you need whereas, for most people, you would stop looking much sooner because you would sense their discomfort in having to keep holding it out. Secondly, it can be of great value and interest to be able to compare before and after pictures when you see that person again. Things will change, you will get new signals from the tongue as they go through any kind of treatment program. The remarkable ease with which we can take a tongue photograph in the modern world will rapidly increase your knowledge and understanding of this ancient art.
Remember, the first time you meet a patient is the first time you might see their tongue, you don't know what it normally looks like and, presumably, they will not be in good health right now, so it will have changed to reflect that... but changed from what? How did it look before? It's ok not to know, so long as you know this, then you can relax, you can keep an open mind, you can receive impressions. Allow yourself to simply take in the impressions that their tongue will be giving you. It's actually better if you don't think too much about what you are seeing. Just let yourself absorb it for as long as you need, which of course having a photo makes it much easier to do. Over time, with practice, these impressions will tell you more and more. What follows are some guidelines as to the kinds of things you are likely to see and, very generally, some of the things that you might construe from these impressions. Colour A reasonably consistent observation is that cooler people tend to have paler tongues overall and that hotter people get redder tongues overall but this, like everything, can change and be much affected by their current health. It is very helpful to see people of different ages in good health whereby you can get impressions of what a tongue 'should' look like. There is some variation between cooler to hotter constitutions, but it will be notable that, when a person is in good health, their tongue is a healthy and characteristic shade of 'pink'. As people go on a journey to recover their health, it is most gratifying to see 'before and after' photos of people moving from overly pale or red tongues towards this healthier colour and it reflects an old saying, when a person was thought to be in excellent health, that they were 'in the pink!' Coating In good health a person has a very light, fine coating on their tongue. If they have no coating at all then this may mean that their system is running too dry and so may have become too depleted or reactive. If they have a much thicker coating, then this tends to mean that they are running too damp and may have become too encumbered or congested. There are many levels to the appearance and thickness of a heavy coating and this can be a good indicator of how chronic or deep the excess dampness has become. A layer that is completely covering the tongue in a kind of solid 'film' is much more likely to have been there a long time whereas a coating that you can still see through is more likely to be coming and going. Hotter constitutions tend to more yellow coatings and cooler constitutions to more grey or white coatings, but this varies a lot according to when the liver (more yellow) or the kidneys (more white) are struggling under the load so note that the colour of the coating alone should never be taken as a definitive sign to determine the constitutional type. Similarly, plenty of dryer constitutions can and do get thick, heavy coatings on their tongues. Dryer constitutions can often struggle badly with symptoms of excess dampness, especially because their systems are not well equipped to deal with excess moisture or congestion by nature. A heavy coating is often an indicator that cleansing needs attention. When the coating is quite thick but only found in the back third of the tongue, close attention should be paid to the health of the kidneys starting with how well they are keeping hydrated. Making sure there is a good flow of water going in and a full release of urine going out at least once every two hours, and also perhaps using such herbs as Juniper, Cleavers or Golden Rod, can have a rapid and transformative effect on the tongue, and the health. When an excess, heavy or off-coloured coating covers the back but also comes forwards right into the middle, the body of the tongue, then it can mean that a deeper and longer process of cleansing that also includes the liver and the bowel is going to be required. In the many instances this occurs, then a clean diet should be followed for a while and there can be great help from such herbs as Celandine, Dandelion root, Burdock, Barberry, Cleavers & Red Clover. It is marvellous to see what a marked difference such treatments make in before and after photos and, of course, the patient feels much palpable benefit when this was what they needed. The important subject of cleansing is written up in more detail here
Along with the colour and coating, another immediate impression from the tongue is its texture, i.e. how smooth or rough it is, and whether there are any markings, grooves or fissures in the tongue body. In terms of how the tongue reflects the constitutional elements. Hotter signs on the tongue are typically shown by a rougher, more broken texture and cooler signs by a smoother, less textured appearance. In good health, in any constitution, the tongue will have an even, lightly dappled 'texture'. Cooler constitutions might have a naturally closer 'weave' to their tongues, but you can still see it if you look closely. Hotter constitutions might have a somewhat bumpier and more spread-out 'weave', but it should be reasonably even and symmetrical over the tongue body. When imbalance is occurring, in any constitution, the tongue can become irregular, asymmetrical, and either lose its texture and become completely smooth, showing things have become too cool, lacking vitality, or conversely become rough, bumpy and uneven, showing things have become too hot, and suffering from excess. Fissures, grooves, cracks and splits in the tongue can be striking signs but they can have diverse meanings and it is better to absorb their presence along with other impressions before making any assumptions because there may be a simple physical explanation for them. For example, some markings can simply come about from eating overly spiced or acidic foods in the last 24 hours. Likewise, a small percentage of people always have a highly fissured ‘geographic’ tongue as part of their genetic constitution and in such cases you will need to look at other signs in the tongue, aside from the many cracks all over the tongue body, to get useful information from it. If there is no obvious physical cause, a useful way to think of these somewhat dramatic signs is that they are showing an energetic imbalance, in other words that a person's life-force, their self-healing intelligence, that would normally flow around the body, is being blocked or misaligned in some way. If you see fissures or cracks in the front third of the tongue that are surrounded by pale, smooth, tissue, this can be a sign of deficiency and a need for nourishment in the healing cycle. This part of the tongue relates to the heart in oriental medicine; keep an open mind about whether this sign might be showing the need for physical nourishment or, equally, whether it's more of a soul-food that's needed. Fissures or cracks in the front third that are surrounded by bumpy corrugated tissue with an underlying redder than usual colour indicate excess heat and the further back that fissure goes the deeper you might take the imbalance to be. This kind of sign can be showing a need for a cooling treatment plan, one that may also include nourishment but also a need to focus on the 'cooling' that can come through relaxation. People who are prone to fissures in the middle part of their tongue often have an impaired gut lining showed by digestive disturbances and sensitivities to foods. There are many excellent herbs to help strengthen and heal the gut lining such as Calendula, Plantain, Yarrow, Slippery Elm and Chamomile. An example of a gut-healing tea is shown here Improvements in symptoms are usually accompanied by significant changes in the tongue. If there are no obvious gut problems, there may still be a deeper imbalance in the health picture, possibly reflected in a hormonal or other functional disturbance. Ask open questions and keep an open mind. Fissures and other such striking markings are very interesting to capture in a photograph and compare to in a later visit. If the person is getting much better, then the tongue will almost always clearly reflect this, However, we must be aware that, whilst such signs can be showing s a physical stress or imbalance that needs attention, it's just as possible that a mind-body difficulty is being reflected in broken tissues on the tongue. In that instance, some of the material in the chapter of emotional healing may be of help, introduced here
One further immediate impression that can be taken from the tongue is how dry vs. moist it is. A healthy level of moisture shows in a tongue that glistens without being notably 'wet' but a person or condition that has become excessively dry can reflect in a much dryer tongue with no 'glisten' whereas a person or condition that has become excessively damp can reflect in a much damper, wetter tongue. When a person or a condition becomes too dry or depleted, as well as the lack of any 'glisten' you might note that their tongue seems quite small or hard for them to extend. Attention put into the nourishment and/or perhaps the relaxation stages of the healing cycle can see a notable return to a fuller and moister tongue in before and after pictures. At the other end of the scale is when the tongue has become over-full. This can be shown by something called 'scalloping' along the sides of the tongue from where it has been indented by the teeth, and it can indicate excess dampness in the system. However, like all the tongue signs, you need to see this in the context of whatever else is going on in their health. For example, it might indicate some cleansing is needed if it shows in conjunction with the kinds of excess coatings we were discussing above whereas, by itself, 'scalloping' might simply mean that the person needs to get 'activated' to move their blood and get their circulation going.
If you have read the above notes and then go to work with a friend or patient, or yourself in the mirror, then you will likely take a good look at the next tongue you see and think... 'now what?' Looking at tongues is much more of an art than a science. Rather than trying to come up with a definitive 'answer' from what you are seeing. It is a thousand times better to take a general impression and to think of the tongue as showing you the general terrain of the internal body. Is the person obviously too dry or damp, too hot or cold, too congested or depleted? Do they first and foremostly need help with cleansing, or with activation, or with nourishment, or with relaxation? Don't worry if you don't have an immediate answer but by all means do ask the question! The insights gained from asking these questions and being open to the answers can be tremendously helpful to getting the right prescription or approach from the outset. The tongue can help you to guide a person well, especially if you are careful to double-check your impressions with other indicators, such as their pulse, their history and their symptoms. It is very okay to feel some uncertainty when you look at a tongue. Have you heard of something called 'confirmation bias?' It is where we form an opinion about something and then only take in further information that confirms that we were right whilst being able to completely ignore any evidence to the contrary that might suggest that we could be wrong! Confrimation bias exists in all areas where people gather special knowledge and, unfortunately, it is extremely common in health and medicine. I strongly encourage anyone who would work in holistic, or really any field of medicine, to recognise that part of themselves that wants the authority of certainty as a potential hindrance to their seeing what needs to be seen. Rather, to embrace uncertainty as a close and necessary companion when working with people and to learn how to become comfortable with having some doubts about things. This approach keeps us open, it ensures that we keep learning, and it makes it much less likely that we will lead others astray when a person is entrusting their precious health into our care.
The pulse is even more of a subjective 'art' than tongue diagnosis, but it can be extraordinarily useful in the way that it can put us directly in touch with the very heart of another person and let us feel their essential, self-healing, life-force. Life is movement; the cycle of healing, the innumerable activities within cells and organs, the breathing, blinking, talking, listening and 10 thousand other movements of everyday life. Underlying all of this is one vital movement that has been understood by all cultures to be the primary mover, the centre of the life-force; the beat of our hearts. The pulse, the most essential and original of all the signs of life, can be immediately felt and closely connected to by the simplest of actions, i.e. holding the hand of another and placing one's fingers to their wrist. All of the great traditions of medicine set huge store in the importance of the pulse. It literally demonstrates the 'vis medicatrix natura' the healing force of nature, that which makes us well when we become sick. So much more than the 'beats-per-minute rate' that modern medicine has reduced its practitioners to assessing, the pulse is of great help to anyone who wants to be able to feel if that healing force is weak or strong and, in time, if it is moving further into imbalance and sickness or moving towards balance and wellness. No special equipment or ability is needed to be able to feel and read the pulse. What is required is something that can't be taught but can certainly be practiced. It is to bring an 'empty mind and an open heart' to the process of feeling another living being's pulse. Just as was recommended with the tongue, it is generally best to avoid making any pronouncements on what you are thinking when you do this. You are not required to demonstrate your ability to read the pulse. It is a thousand times better to have the mindset that you are simply taking impressions and absorbing vital information so that, when the time comes for you to recommend the right support or to help a person understand what it is they need to know, you can be a good agent for Nature, to not do harm but rather guide them well. Learning to read the pulse is an art that, above all else, simply requires practice and the first and most important step in that practice is to get very familiar with the best technique to get as much of the 'body' of their pulse to your fingers as you can....
Feeling a pulse is like holding a shimmering fish as it swims underwater. If you touch it too lightly it will whisper through your fingers like smoke. Press too deep it will wriggle and writhe until you let it go, but if you wait with it patiently, it will give you its body and let you feel it swimming for as long as you need. To learn how to find and feel someone else's pulse you must first become adept at finding and feeling your own. See the picture just above to show the best hand position to feel your own pulse. Hold one hand and wrist in the palm of the other and wrap your fingers around your wrist so that your first, middle and ring fingers are all lined up in a row over the radial artery, just inside the bone, in line with the base of your thumb. This art of learning how to listen to the pulse is all about waiting, it is about allowing something to come to you, it is about being empty, open and receptive. Take your time, relax, move your fingers around while you are learning how to best find it, explore, go deeper, come back softer, try to get as much contact with the pulse as you can. Ideally, and with practice, you will be able to feel the pulse through all three fingers at the same time; nestle them in close together as if they were all wanting to get in there and have a feel! Don't use the very tips of your fingers, there are less nerve endings there than there are in the pads. The best part to use is the top half of where your 'finger-prints' are. Here is where some of the most sensitive tissues of your whole body are present. Those tissues, those nerves, are the ones you want feeling the movement, shape, and 'feel' of the pulse.
When you feel confident with finding and feeling your own pulse, you will be ready to practice with others. Note how, in the above picture, the middle finger is bent up more than the index and ring finger. It is very important to get all three finger-tips lined up together and to do this you will need to get used to bending, or shortening, your middle finger just a little. Like everything, this gets easy with practice. Just as described above, and this point cannot be over-emphasised. You are 'fishing' for the pulse. Don't expect to use the same pressure or even the exact same position to find and feel the 'most pulse' with each and every person. The best way to catch a person's pulse will vary a lot. Go deeper, then softer, move your fingers slightly up or down, back or forth. At some point, you will always be able to 'catch' the pulse. This is the place and the pressure where you can feel the pulse the most. In some people, especially from the cooler constitutions, it might slip out of your fingers again when you make the slightest movement, don't worry, it's always there, you'll catch it again. Once you have the pulse, just stay with it, 'hang-out' with it for a good few moments, don't rush, take as long as you need. Make sure your patient is not having to hold their arm up in any way that makes them tense up in any way. I often say something like 'just relax, this often takes me a few moments' just so that there is no sense of any time pressure. Sometimes it's good to make a 'mmm' sounds or to say something like 'ok' or 'good' so that they don't start tensing up in anticipation of what else you might say. Keeping your ego, your 'self' out of the way is the hardest part of this ancient art, but at the same time it's also completely effortless because there's nothing you have to actually do! Just listen to and feel their pulse as openly and receptively as you can. If you remove the need to make a diagnostic decision or some other kind of pronouncement. If you simply have the intention to receive an open impression of their life-force and whatever else their pulse might have to tell you, then you will be doing it right. I've tried to teach pulse-reading to quite a few health practitioners now, I wouldn't say it's an impossible task, but I will say that it's much harder to teach this method to a person who already has a mind full of knowledge and training than it is to a new student or even a complete lay-person! Whoever wishes to learn, at least we can make a good start with getting the technique right, as described above and please, if you have learned how to take a pulse before with two fingers, do be open to relearning this in a different way because it has often been seen how people who have previously learned how to feel the pulse usually have a method that only gives a rudimentary impression, enough to count the beats per minute, but nothing like the in-depth sensations that can be received by lining up all 3 fingers and 'fishing for the catch'. Once the fingers are in contact as best as they can be, the whole technique of pulse reading can be summed up in those four little words. 'empty mind - open heart'. That's it. You just listen, you empty your mind of the need to judge and keep your heart open to the fact that you are now directly in touch with the heart, the inner life-force of another human being. It probably isn't possible to teach another person how to have an empty mind and an open heart, but it is certain that if they really want it, that anyone can do it.
Even as you are beginning to catch the pulse, you will be forming numerous impressions. You can trust the evidence of your senses, especially from your sense of touch, let those impressions roll in. One of the most fascinating aspects of this ancient art is that, when you trust the process and let your mind be empty and your heart be open, that you will often get some remarkably helpful 'flashes' of insight. Feeling the pulse has the ability to connect us to our intuition just about more than anything, but not if you are trying to make that happen! True intuition embodies one of those rational-mind defying paradoxes where you just have to accept that 'you cannot go to it because 'it' must come to you'. Having said all the above, I also want to now share my own experiences of how certain impressions from the pulse reflect what the heart is saying it needs to get well, how it demonstrates imbalances and how it helps to show the constitutional tendencies to be cooler to hotter and dryer to damper...
There are many gradations between the markedly cooler to the markedly hotter pulse. In a clearly cooler person, or in a person whose current condition has gone to the cooler side of the spectrum, the pulse may take more than a few moments to find. You have to wait patiently and move your fingers ever so slightly one way or another, deeper or softer, in order to catch it. Even when you do have it, the markedly cooler pulse can be very slight, very subdued, and you must be well centered and quiet in yourself in order to be sensitive to what it has to tell you. By contrast, in a clearly hotter person, or in a person whose current condition has gone well over to the hotter side of the spectrum, the pulse tends to be quite full or even 'bounding'. This pulse is comparatively easy to 'catch' but it is just as vital to 'hang-out' with it for a little while, to let your fingers explore around it to see what else you can feel, not to only take the first impression but to let more information come in too, which it usually will if you wait for it. The pulse rate, the beats per minute, does give valuable information, even if it is a pity that it is the only thing most people think of taking note of. What can be seen is that, on average, cooler pulses tend to beat somewhat slower and hotter pulses tend to beat somewhat faster, but this is also so much affected by such things as a person's current level of stress as well as how fit they are, that it can't be taken as a reliable indicator of where they sit on the constitutional spectrum. In practice, where you have already taken some impressions about whether a person is a hotter or cooler constitution from things such as their complexion, their manner of speaking or moving, perhaps some questions about their temperature preferences, perhaps their tongue, the process of then carefully reading their pulse may confirm your sense of things but also, at least sometimes, it will make you question your earlier impressions and to feel unsure. If that happens to you, then great! People are complex, it's more than ok to have doubts, it's good, because it keeps you open, it keeps you listening and it keeps you absorbing impressions.
In a clearly dryer person, or in a person whose current condition has gone well over to the dryer side of the spectrum, the pulse tends to be much more clearly defined. This may come to the fingers in the sense of there being a little more room before and after each beat, it palpably has more 'air', It can feel like a beat against the dried skin of a drum. Not to do with the 'rate', i.e. with how slow or fast it is, the notably drier pulse can feel shorter, it runs under your fingers more quickly and there is more of a space between one beat and the next. In a clearly damper person, or in a person whose current condition has gone well over to the damper side of the spectrum, the pulse tends to be much less defined and much more 'slippery'. It can feel more like an underwater sensation, one beat running into the next rather than their being so much space between them. Once you 'catch' the drier pulse it tends to stay caught whereas damper pulses can sometimes somewhat wriggle away and need you to reset your fingers to keep feeling them at their fullest. Again, you may have already taken some impressions about where they sit on the dryer to damper spectrum from their skin or voice, or from certain questions you've asked, or maybe from the health problems they have presented with, and their pulse may then confirm and help fill in the picture further about how far they are on either side of this spectrum, or it may open up some doubt in which case stay with it and see what happens as you remain open to them and the complexity of their individual being. We are dividing things up in order to examine them but, in the actual practice of reading a pulse, you are feeling many things at once and the impressions will all collide together. As soon as you combine the hotter or the cooler with the dryer or the damper you will get distinctive differences in the way both spectrums feel. As you absorb these complex impressions, remember that this is an art that will take patience to learn but, like everything, the more you practice it, the better you will get.
Don't worry, it's actually not that hard. What you will experience is that a healthy pulse feels 'just right' for that person. It's nice to feel it, to listen to it. Their pulse will always have a characteristic shape and feel to it, according to how they are naturally cooler or hotter, dryer or damper, but whatever their constitution, when they are in good health their pulse feels good, it feels balanced, in harmony with life. A healthy pulse is not fixed in place either, it is a little changeable. For example, there should be a natural fluctuation in its speed whereby, at least a few times every minute it should rhythmically and gently speed up and slow down, not a great deal but certainly enough to notice when you are feeling it. This is called the heart rate variability (HRV) and its presence (or absence) has been found to be an extremely important indicator for good health and longevity. People who don't get HRV are out of balance, their system is in stress and it is not coping well with it. The healthy pulse has a feeling of buoyancy in it, a lightness, a flexibility. Getting in touch with the pulse is tuning into the essence of the life-force itself. Reading a healthy pulse is a feel-good experience, not something that can be easily quantified let alone explained, but it's undoubtedly there and you will feel it many times, both when you meet with a healthy person but also when you work with a person who has been ill but is now getting better. It is marvellous to feel how much of a difference there is in the pulse when a person is moving forwards on their healing journey, it's striking. Equally, it is a guarantee that, whenever a person is caught in imbalance or ill-health, that their pulse will reflect this in some way. Whilst very much wanting to encourage you to keep an empty mind and an open heart, I want to now share some of the impressions that I come across most often and how I usually interpret them.
Edgy pulses occur in many people. Once you have felt this a few times you will know exactly what I mean by this word 'edgy'. There is a kind of 'sharpness' in the pulse, an edge, something you can feel under your fingers that isn't there when things are in harmony. It usually simply means that there is just too much stress in the system. The relaxing 'down' phase of the healing cycle is not getting what it needs or too much time is going into the activation 'up' phase. Just as it can be hard to be around a person who is very tense, irritable and out of sorts, so it can be hard to 'hang-out' with the edgy pulse. Stay as long as you need to be sure, and then find a way to communicate with them about what it is you see they need to change to get well. If they do 'the work', you should be able to feel how much it has changed. As the coiled-up spring unwinds, the pulse softens and loses its hard, uncomfortable edge.
An 'uneven' pulse is not at all the same thing as the gentle cycle of the heart-rate variability as discussed above. An uneven pulse is where it is changing rapidly and giving conflicting or contrasting impressions. The uneven pulse can make you think you haven't got your position right but, with practice and when you know your fingers are in the right place, you will learn how it is usually reflecting an unquiet mind or a significantly imbalanced body, often both. The patient with an uneven pulse will often have disturbances in their sleep, their digestive systems, their hormones, or their moods. Our nervous and endocrine systems are what keep things in some kind of rhythm and harmony, and when they go out the repercussions are wide-spread and certainly include an unbalancing effect on the pulse. Establishing healthy routines and getting some kind of help from nervine or endocrine herbs can bring back a more balanced pulse and a return to health.
Some people's pulses are what could be called 'languid'. They are the opposite of edgy, if anything they are too soft, and you can feel how the slightest pressure would just cut them off. This pulse doesn't have enough 'oomph' or 'drive'. It is not to be confused with a cooler person's healthy but quieter pulse. A languid, weak, too-soft pulse is very common in people with advanced fatigue. Their resistance to stress is gone and they are often suffering from low spirits. Interestingly, in many cases the intervention that will help the most is one that sees them finding a way to become 'activated' through tonic herbs and some kind of mental or physical challenge. though it is highly common that some source of harm must be removed before they can 'rise up', so to speak. Remembering that the pulse is closely reflecting the life-force, the vitality, the difference in it when a person gets up and going again can be striking to say the least.
Another kind of pulse can be described as 'heavy' or congested'. This pulse will often be present alongside other signs on the tongue, such as thick or off-coloured coatings, and symptoms such as indigestion, bad skin, moodiness etc. that are showing a need to lighten the load with cleansing. The heavy pulse that feels 'too-full' is not the same as the pulse of a damper constitution in good health, in which case it will feel slippery but still quite light. When the blood, the body or the mind is burdened with excess wastes the heart has to carry this load too, the pulse feels weighed down and over-full. Then, it can be a lovely thing to compare how much more lightly the previously too-heavy pulse can skip along after a good cleanse has been carried out.
Lastly, difficult to describe, but an unmistakable pulse once you've felt it a few times, is what could be called a 'thin' pulse. Opposite to the over-full or heavy pulse described above, it feels pinched, reedy, tight. This is not the same as being too edgy or languid, there is a sense of depletion in this pulse. Imagine a river that has been reduced by drought. This thin pulse can be understood to show that 'nourishment' is sorely needed in the healing cycle. Perhaps the right nourishment will come from food, or herbs, or it may lie in some other part of life where the essential needs are not being met. So long as we recognise what's wrong we can usually do something about it. As the person's needs are met, their life-force lifts and the pulse reflects it like a river that has returned to flowing freely again.
The above impressions are just a few of the more common ones that stand out to be noticed. There are many more messages that can received by simply listening to the pulse with an empty mind and an open heart. Mostly I don't talk about these impressions or insights with my patient. If I do share anything from what I've picked up it is usually later, when it is time to reflect back my understanding of their 'story' i.e. how they have come to this point, where they are on their 'map' of their body, and what they might do to get where they need to go. I trust that it has been abundantly clear, throughout this article, that in talking about the tongue and pulse I am sharing an approach that is extremely subjective. This is art, not science, it is not reproducible over statistical samples with control groups and test groups. Every case you meet is an entire sample of one and, for the person who is stuck in sickness or suffering, all that matters about any of this is if it actually helps, i.e. if it works! Many experienced and successful practitioners, now and throughout history, have set great stock in the intuitive flash of ‘just knowing’ what is the right approach, or the right herb etc. and how when that happens wonderful things are usually seen to ensue in the healing journey. Perhaps we all have to find our own way of getting there but I believe it is no accident that the tongue and the pulse have been so integral to nearly every system of medicine; they seem to open our instincts into what is going on better than anything else. We are back to what it is that actually heals people. One of the greatest things that this process has done for me personally is that it has grown and continues to develop a sense of ‘that’ which actually heals, and that, my dear colleagues, is the best thing any of us have going for us, ever. Kia Kaha, be strong, and I wish you well with learning and practicing this great and wonderful art.
Please understand that I cannot personally advise you without seeing you in my clinic. |
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© 2011 R.J.Whelan Ltd