Chinese medicine diagnostics

From Return to Spring: Everything your acupuncturist is too busy to tell you!
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If you’re never been to an acupuncturist or doctor of traditional Chinese medicine before, you may be in for quite a shock when the doctor begins making his or her diagnosis. Don’t expect x-rays, stethoscopes, MRIs, and little rubber hammers banging you on the knees—Chinese medicine relies on an entirely different skill set which can seem pretty strange to those who don’t know what to expect. Don’t worry—this isn’t just some kooky performance being put on by your doc to make you think you’re getting your money’s worth. Rather, it is a regime of observational techniques that has been refined since the olden days when medical technology was very limited. The techniques might be old, but remember, the most advanced piece of technology on earth is still the human being.

TCM diagnosis is traditionally broken into four categories: looking, smelling and listening, inquiring, and touching. This happens to also be the traditional order in which they’re used, so we’ll start from the top.

Looking

It is the TCM doctor’s responsibility to begin diagnosis the moment the patient strolls into the clinic. Gait, posture, mannerisms, complexion, blemishes, wrinkles, hair health, hair style, clothing preferences, body type, body size, the “spirit” revealed by a person’s gaze, and much, much more all contribute to the physician’s goal of understanding the qi of a patient. In fact, to the trained eye, a huge amount of information is revealed the very moment a patient walks into the doctor’s office. (For this reason, it is helpful not to wear too much makeup when going in for a treatment—dress as you normally would, too)

“Looking” doesn’t stop there—before long you are probably going to be asked to poke your tongue out! The vast majority of TCM physicians rely on tongue diagnosis, which provides some of the most accurate diagnostic information as can be found on the body. Most of us don’t pay too much attention to what our tongues look like, but after one has seen thousands of them in the clinic, it becomes profoundly clear that not only do tongues vary from person to person, but that these differences have a lot to say about the states of our bodies. (To help your doctor, do not scrape your tongue before an appointment, and try not to eat or drink anything that will stain the surface of your tongue for a long period of time)

Visual diagnosis contains still more elements, some, none, or all of which a physician may choose to use. TCM has discovered that conditions in various parts of the body reflect in specific regions of the eyes, ears, and face as a whole. Though this is somewhat rare, some docs may even look at the back to gain information about other parts of the body. If you find your acupuncturist gazing deeply into your eyes, don’t worry (or get your hopes up!) that he or she is suddenly madly in love with you—chances are your practitioner is looking for clues about the health of your internal organs.

Visual diagnosis can also commonly involve analysis of the hands, as the states of your fingernails and even the wrinkles on your palm can contain diagnostic clues. TCM in general advises against painting the nails so that qi flow is not obstructed, and it is especially useful not to paint your nails before an appointment (especially if it’s your first visit and the doctor needs to make an all-around assessment of your condition), in case your practitioner utilizes this diagnostic method.

Smelling and Listening

Fortunately for doctor and patient alike, acupuncturists and Chinese_herbal_medicine_herbalists don’t give patients whole body once-overs with their noses, but smell is still a useful component of diagnosis. Don’t be embarrassed if a physician comments on your breath. If it is bad enough to be noticed, then it is definitely a sign of trouble as far as TCM is concerned, so don’t be afraid to bring up the question of halitosis with your practitioner. The good news is that TCM is very good at treating the sources of bad breath. The doctor may also ask you about the odor of your urine, feces, sweat, or vaginal discharge, in part because heat conditions often result in very stinky excrement. (Just as is the case with bad breath, TCM can also effectively treat the causes that lead to unusually strong odors coming from other parts of the body)

Whilst using their noses, TCM doctors also examine patients with their ears. It is typical to listen to the timbre, rhythm, pitch, speed, and volume of patients’ voices to determine their energy levels and psychological makeups. Different types of coughs, wheezes, and even sighs all provide useful diagnostic clues, as well.

Inquiring

Just as you would expect from a doctor or healer in almost any other tradition, traditional Chinese medicine doctors ask their patients detailed questions to get to the heart of any illness. But what’s unique to the way TCM asks questions?

First things first, your physician may ask questions that seem to have little or nothing to do with your condition. You may be very surprised if you go to an acupuncturist looking for help with your digestion and suddenly find him or her asking you detailed questions about your sleep habits or even your emotional life. This is not only normal but important—TCM views the body and mind as a whole, and understands that there is no condition that does not affect the whole of a person’s existence, even if only in subtle ways.

Secondly, your TCM doctor may sometimes ask questions that seem very personal, including about your emotions, your relationships with other people, major events in your past, your work and your pastimes, your trips to the bathroom, your dietary preferences, and even your sex life. Don't be shocked if you feel like you are being asked to describe every aspect of your existence. TCM is a holistic form of medicine; your physician will want to get to know the whole person (you, not just your illness!) who has come in for a consultation. A traditional Chinese medicine doctor conducts a thorough and detailed interview to understand the context of your life, not to be nosey. Furthermore, the same laws protecting privacy elsewhere in the medical field apply just as strongly to TCM.

Feeling with the hands

Touching, or to be more medical about it, palpation, is the final component of traditional Chinese medicine diagnosis, and no less important than those described above. In fact, some practitioners would argue that the information obtained by the fingertips is the most important of all.

Palpation is a normal part of a check-up in a modern hospital or doctor’s office, but TCM makes use of several common and important methods that are not a part of Western medicine.

Pulse diagnosis

The first method of touch diagnosis unique to TCM is a form of a taking the arterial pulse in order to gain information about the qi of the zang-fu organs and the meridians. Although the pulse can be taken all over the body, the most common place to look for it is at the wrist, so there is a very high chance that your doctor or acupuncturist will spend quite a bit of time quietly pressing three fingers into a specific part of both your left and right wrists. A small number of physicians may also palpate the pulse at the neck, on the ankles, and still elsewhere. This process can take three minutes or even longer, and your practitioner may prefer to keep his or her fingers on your wrists during the entire diagnostic interview.

Abdominal palpation

More common in traditional Japanese medicine (which evolved from Chinese medicine) than in TCM or other forms of Eastern medicine is palpation of the belly for diagnostic purposes. Physicians who use this method may ask you to lie face-up on a massage table so that they can press their fingertips into your abdomen, looking not only for sensitive or painful spots, but also areas that are unusually hard, asymmetrical, swollen, and so on. Some practitioners of TCM massage may incorporate diagnostic belly palpation alongside abdominal massage.

Osteopathic palpation

Certain TCM practitioners, especially those who utilize Chinese osteopathy, will also perform touch diagnosis of the tissues and bones of the spine and its surroundings, looking for asymmetry, dislocated vertebra, and slipped disks, and so forth. Manipulating and palpating bones, joints, and tissues elsewhere on the body—especially if you have a chronic condition—is also common.

Ah-shi points

Traditional Chinese medicine recognizes what are known as ah-shi acupoints. "Ah-shi" is a bit like Chinese for "Ow! That’s it!" Due to the way qi works in the body’s meridian system, all manner of imbalances and illnesses can create sore, tender, or painful spots near the surface of the body. Some of these “Ow!” points may lie directly on the meridians, while others may arise elsewhere. Palpating your body to find these painful points can provide important diagnostic information. Better yet, they can also be used for treatment; physicians can treat prick them with needles, massage them, burn moxa above them, or even project qi into them.

Knots, lumps, and cricks

As we age and accumulate injuries it's not uncommon for our bodies to develop hard, knotty areas, especially in the muscles of our necks and backs, but also elsewhere throughout the body. If you do develop any growths in your body, it is important to first consult with an MD to make sure they are not cancerous before you turn to traditional Chinese medicine. Where knots and lumps develop in our bodies sometimes relates to blockages in the flow of qi-blood traveling through our meridians and acupoints, and determining if this is the case can provide useful diagnostic information to TCM physicians. Furthermore, just as is the case with ah-shi points, they can be important starting points for treatments like acupuncture or moxibustion.