Observation, listening, asking and pulse feeling are the four basic methods in TCM diagnosis. They play an important role in the determination of disease and follow-up treatments. An experienced doctor shall fully understand the importance of these four methods by looking closely into every details of the symptoms, the patient’s physical conditions, and other clinical complications.
These four basic methods in diagnosis are not to be applied in fixed order but interchangeably according to factual conditions. Consideration shall be taken seriously when new symptoms are found or changes in the process have be noted. The exact cause or causes of the disease, its location, and reasons in pathology must be clearly analyzed and set in place before any formal treatment is carried out.
I am going to list only the main elements related to each of these four methods here.
Asking is a process when a doctor inquire about the health conditions of a patient with a specific purpose in mind.
In order to achieve this, a quiet and comfortable place is necessary so that the patient (and or someone who is accompanying him) can be at ease.
A doctor must show his care and kindness towards a patient, taking him as his own family member. A doctor must bear a positive attitude when he makes his inquiries. He should not show any pessimistic mood or gesture in front of a patient.
A doctor shall avoid using any technical terms that are difficult to understand. He is not encouraged to give hints to the patient for any information not related to this diagnosis. His questions shall focus on the main symptoms or causes of the possible disease.
General information to get from the patient might include the age, marriage status, kind of employment, family history of a certain disease, or specific aspects of his lifestyle. Questions related to these aspects are only for the purpose of understanding the real cause of the disease. Life habits like smoking or alcoholic play an important role in a patient’s health.
The main focus of asking shall be the most apparent symptoms: for instance, coughing with fever for 3 days, chest pain or heart discomfort. These inquiries help the doctor to understand the location, the seriousness and timing of the disease.
When asking about the present symptoms, a TCM doctor shall clarify whether they are of cold or heat nature, with or without sweats, the location of pain, whether the patient sleeps well or not, his appetite good or not, his stools normal or not, or menstrual discharge normal or not.
Observation is a process when a doctor looks carefully at the appearance of a patient with a view to understand his health conditions.
TCM holds that the human body is a miniature universe in itself, and a patient’s appearance, especially that of his face and tongue, reflects profound conditions of his inner health.
In order to achieve accuracy in observation, a TCM doctor must ensure his patient is exposed to enough natural brightness of sunshine or clinical light. His knowledge of physiology and anatomy helps his understanding of different parts of the body and their pathological conditions.
By an overall observation, a doctor looks at the spirit, color, form, and movements of the patient’s whole body. The spirit of the eyes, the color of the face, whether the patient has a thin/weak body or fat/strong body, whether his hands and feet can move freely, are all important signs to tell his general health conditions.
Partial observation of looking carefully into specific parts of the body gives the doctor a clearer picture of what the patient is suffering at most.
The size of the head, the condition of the hair, the movement of the mouth, the coating of the tongue, the rotten teeth, the color of the skin, the deformation of the limbs, all tell different stories of a patient’s health conditions.
Conditions of the tongue, wet or dry, white or red, smooth or rough, thin or thick coating, ect, give lots of information of a disease. TCM diagnosis pays special attention to the tongue conditions.
Another important factor to observe is the stool. Whether the patient goes to toilet normally, whether there is blood in stool, whether it is water-like or dark in color, they are all important signs of a possible disease.
Listening and Smelling
Listening and smelling is also very important in diagnosis. Through the voice of a patient, his breaths, speeches, coughs, heart beats, vomiting, burping, sighs, sneezing， abdomen sound, etc, or the smell from the patient’s body, discharged waste, a doctor can detect various complications of a patient.
The sound the patient makes is not only the result of movements of the mouth or nose, it is closely related to the functioning of the lungs, heart or kidney.
Under healthy conditions, the sound we make should be natural, clear, smooth, soft, and quick in responses. Young people and elderly make different sounds, people with different emotions of sadness or anger or happiness make different sounds. The voice of a patient, his snoring, sighs, cries of shock, weakness of breaths, is all different from what is natural. It is not difficult to tell the difference by a careful doctor.
A low and weak voice is generally related to a negative or cold nature symptom. A rough and sore voice often tells an excess of heat or humidity in the body that results in difficulty in breathing.
When a patient is in pain somewhere, like a stomachache or toothache, he makes painful voice or murmuring while toughing his belly or teeth.
When a patient is mentally ill, he speaks without reasoning, or lack of logic. Short of breaths can be a serious problem for the elderly.
Coughing can tell different stories with or without sound, with or without phlegm, dry or sticky phlegm.
Stronger heart beats may be the result of an excess of heat in the liver or high blood pressure; weaker beats my be the result of deficiency of the heart or lung functions.
Water sound in the belly may be the symptoms of cold nature deficiency of the stomach, spleen or intestines. Bowel gas may tell a different story of the same organs.
As to smells of the body, or part of the body, like bad smell of breaths, of sweats, of urine, of discharged waste, or the smell of vomiting, they are signs of different diseases in the liver, stomach, bowel or other digestive organs.
Pulse feeling has a long history in China. Ancient records over 3000 years in the Book of History show some cases of diagnosis by pulse feeling. One of the most famous physicians Li Shizhen recorded 27 kinds of pulses, each relates to different syndromes of patients.
Pulse feeling is based on a philosophy with detailed and careful techniques of diagnosis. The locations of pulse points and their relation to different energy channels reflect the fundamental theory of TCM.
Our heart beats is closely related to pulse movements. Our qi or energy flow and blood flow is moved about the body along with the pulse channels. When the pulses are strong, the qi and blood flow are pushed in a positive way; otherwise, weaker pulses relates to weaker movement of the energy or blood flow.
As our qi and blood flows all across the body, into and out of different organs, detecting the pulse movements is a way to understand the functioning of different organs.
In pulse feeling, the location (most commonly the wrist), timing(morning or afternoon), sex and ages, build of a patient, are all factors for consideration.
Pulse feeling requires an exercise, some time of professional training and experience to put the techniques to test. The study of basic TCM theories helps improve the practice and is necessary for all practitioners to become experts in the job.
Non TCM practitioners are encouraged to learn this technique as well, for the benefits of themselves and the patients.
Talk to you next time.