TCM Consultation: What to Expect, Tongue and Pulse Assessment and Treatment Plans

What this page covers

A traditional Chinese medicine (TCM) consultation is a visit in which a practitioner gathers information and describes it using TCM terms before suggesting treatment. This page explains the steps so a first visit is not a surprise. It also looks at what research says about how consistent the tongue and pulse parts are. It does not teach you to read your own tongue or pulse, because the research below shows that trained practitioners often disagree with each other.

What to expect

One overview of TCM describes four ways of gathering information: looking, listening, palpating (feeling) and questioning. [1]

• Looking at the brightness of the eyes, complexion, body structure and movement, skin, hair and tongue. [1]
• Listening to breathing, voice and speech. [1]
• Palpating the pulse at the wrist and pressing certain points on the body. [1]
• Questioning about causes, onset, duration, symptoms, earlier treatment, appetite, diet, energy, memory, mood, bowel and bladder habits and sleep. [1]

Bring a list of your medicines, supplements and diagnoses, plus any recent test results. A practitioner who does not ask about your medicines or medical history is a reason to be cautious. Tell them if you are pregnant, since many herbs and some treatments need extra care.

Traditional tongue assessment

In TCM, the tongue is looked at as one of the visible signs of the body's state. [1] Practitioners traditionally note the color of the tongue body and the coating on it. [2] In the TCM framework those features are read as clues to a pattern, which is a traditional category, not a diagnosis in the medical sense. See Traditional Pattern Differentiation in TCM.

What research found. A pilot study with 76 patients used a standardized camera setup so two observers could rate tongue color. Agreement on color between the same observer rating the real tongue and the photo ranged from kappa 0.34 to 0.59, and agreement between two observers was generally low. [2] A review of reliability research concluded that tongue diagnosis shows considerable variability. [3] Evidence label: insufficient evidence that tongue findings guide treatment reliably.

A tongue that looks different and does not settle, or a sore or patch that does not heal, is something to show a doctor or dentist rather than to interpret through TCM.

Traditional pulse assessment

The practitioner feels the pulse at the radial artery of each wrist, at three positions and two or three depths. [1] The overview lists dozens of traditional pulse qualities with names such as floating, sunken, slippery or tight, and notes that pulse diagnosis is complex, skill-dependent and based on TCM physiological concepts. [1] The same source says this creates a challenge for research, because science requires standardized, reproducible procedures. [1]

What research found. A review found studies of pulse diagnosis reached agreement ranging from low to very good, and studies of pattern diagnosis in general did not find a high level of reliability. [3] Evidence label: mixed to insufficient evidence. A practitioner's pulse reading is not a substitute for measuring heart rate and blood pressure or an electrocardiogram. A pulse that is very fast, very slow, irregular, or comes with chest pain, fainting or breathlessness needs urgent medical care.

How agreement among practitioners looks

In a trial where 38 acupuncturists rated the same ten patients from video, a photo of the tongue and a pulse description, overall agreement on diagnostic categories for painful periods was low (median kappa 0.26), whether or not a structured questionnaire or training was used. [4] In plain terms, two practitioners may reach different TCM diagnoses from the same information.

How treatment plans are described

A TCM plan usually names a pattern and then a set of treatments chosen to fit it. TCM practices include herbal medicine and dietetics, acupuncture and moxibustion, tui na bodywork, and qigong and tai chi exercise. [1] Ask the practitioner to explain, in plain language:

• what the plan is meant to achieve and how you will both know if it is working;
• how many visits are expected and what is the point at which you will review or stop;
• what each treatment involves, including herbs, their names and possible interactions;
• when you should return to your regular doctor.

Plans are described in TCM terms, so ask for the matching practical goal, for example "sleep better" or "less pain on walking". Compare it with research for that specific treatment on TCM Evidence by Use.

Safety and conventional care first

NCCIH advises that you discuss TCM with your health care providers and that TCM should not be used to replace or delay conventional care. [5] If you have new symptoms, chest pain, unexplained weight loss, bleeding, severe headache or a lump, see a doctor first. Training and licensing rules vary; see TCM Qualifications, Licensing and Medical Care.