Tibetan Diagnosis: Pulse, Urine and Questioning

What this page is

This page describes how Tibetan medicine (Sowa Rigpa) traditionally examines people. It is for understanding only. Pulse and urine reading take years of training, and there is no self-diagnosis guidance here. A traditional reading is not a medical test and cannot rule out serious illness.

Three ways of examining

A comparative review says Tibetan physicians diagnose through questioning, visual observation and palpation. [1] Questioning comes first and is used to work out which nyes-pa (see the three nyes-pa) is thought to be responsible for the disorder. [1] Visual observation includes the tongue, which is said to show which part of the body is affected, and the urine. [1] Diagnosis is described as mainly pulse and/or urine, sometimes with the tongue. [2]

Pulse

A Russian research team describes the method as feeling the pulse at six palpation points on the radial arteries of both wrists, from which an expert is said to evaluate organ and system function. [3] The same authors call pulse diagnosis "a subjective art of an experienced doctor." [3]

What research has tested. Those authors tried to "teach" a pulse device to pick out relevant pulse-wave features, exposing volunteers to stimuli with predictable effects on the body. They concluded that objectifying basic characteristics of Tibetan pulse diagnosis is possible, though in a limited scope. [3] That is a device-engineering exercise, not a test of whether practitioners agree with each other or whether pulse findings identify disease.

Urine

In a recent Bhutanese paper, pulse reading and urine analysis are called the primary diagnostic techniques of traditional medicine. [4] Urine is traditionally analyzed at three temperature stages (body temperature, lukewarm and cold), and the practice of heating urine for analysis is attributed to Sangye Gyatso. [4] One review adds that urine analysis is used to distinguish superficial from hidden diseases. [1]

What research has tested. At Bhutan's National Traditional Medicine Hospital and two other hospitals, researchers compared 91 specimens, from 35 men and 56 women, evaluated at body temperature and again after artificial heating. They found no significant differences in colour, odour, steam, bubbles, sediment or frothiness, apart from small colour differences in two categories. [4] This was a comparison of two ways of preparing a sample. It did not test whether urine findings are accurate for diagnosing disease.

Reliability and accuracy

Proper evidence not found. We searched PubMed for Tibetan medicine with pulse, urine and diagnosis, and searched the web for studies of agreement between practitioners or diagnostic accuracy. We found no study we could read that measured whether different Tibetan practitioners reach the same diagnosis from the same patient, or whether pulse or urine findings predict disease compared with standard tests. Until such studies exist, treat these methods as traditional practices whose accuracy is unknown.

Constitution questionnaires

A Tibetan medical college team in Qinghai tested a nyes-pa questionnaire, finding 80 to 93 percent agreement with experts' traditional assessments in a sample of 90. [5] That compares one traditional method with another. It is not evidence of diagnostic accuracy.

If you visit a practitioner

Expect questions about food, habits and symptoms, an examination of pulse, and sometimes urine or tongue. Say that you want to keep your regular care going. Tell the practitioner about every medicine and supplement you use, and tell your regular providers about the visit. [6] Do not skip a recommended test, scan or treatment because of a traditional reading. Practitioner standards vary by country; see how to check a traditional practitioner.

Related pages

Overview of Sowa Rigpa, history of Sowa Rigpa, and traditional pattern differentiation in TCM for a comparison with Chinese pulse and tongue diagnosis.