Diagnosis by Looking (Observation)

Observing and tuning in to a patient’s Shen (spirit) is particularly important to help determine the overal state and prognosis of an imbalance. The Shen gives vital imformation about vitality, and mental, emotional, and spiritual well being. The Shen shows in the eyes, complexion, and state of mind.

The Five Elements can be associated with body shapes and constitutions. Observing the appearance of a patient’s body parts tells a lot about a patient’s health. For example, the face color represents the strength of the Qi and Blood of the Zang Fu organs, and especially the Heart.

The eyes reflect the state of the Shen and Jing. It is said, “The Jing of the five Yin and six Yang organs ascends to the eyes.” We observe the “expression” of the eyes to see the spirit.

The Liver opens to the eyes (sense organ associated with Wood element). Eyesight changes tend to relate to the Liver.

Teeth are considered an extension of bone and are influenced by Kidneys. Gums are influenced by the Stomach.

Diagnosis by Listening (and Smelling)

A loud and course voice indicated an Excess pattern; A weak and low voice indicates a Deficient pattern. Shouting is a Liver imbalance; Constant Laughing is a Heart imbalance.

Coughing is usually related to Lung’s ability to properly disperse and descend Lung Qi, leading to rebellious Lung Qi. Shortness of breath, weak and/or difficult breathing may indicate the Kidney is too weak to grasp the Qi. This would include a Deficient type asthma.

In general, secretions and excretions related to Excess Heat type patterns have a foul odor. Less odorous secretions and excretions usually relate to Cold and Deficiency type patterns. Belching with a foul or sour odor indicates retention of food.

  • Rancid “goatish” odors are related to the Liver
  • Scorched or burned odors are related to the Heart
  • Fragrant, sweet, or cloying odors are related to the Spleen
  • Rank or Rotten odors are related to the Lung
  • Putrid odors are related to the Kidney

Diagnosis by Asking

Questioning or interviewing a patient during intake covers many topics, including:

  • Past medical history
  • Origin of the current problem
  • Living and environmental conditions
  • Current and past emotional issues, including family relationships, partner relationships, work issues etc.
  • Eating patterns and Diet
  • Specific questions relating to bodily systems

Identification of TCM patterns is done by using paradigms such as the 8 Principles (Ba Gong), Zang Fu organ diagnosis, Channel diagnosis, as well as other paradigms. Patterns can be identified generally as in the 8 Principles, or more specifically as in Zang Fu diagnosis.

Absence of a sign or symptom may, in some cases, be vital to a correct TCM diagnosis, and absence of symptoms are generally not reported by a patient. For example, absence of thirst may indicate a cold condition. Keep in mind that all relevant information is not usually provided by the patient.

Traditionally, there are ten areas of questioning

Common areas of Questioning today:

  • Chills and Fever
  • Sweating
  • Head and Body
  • Thorax and Abdomen
  • Food and Taste
  • Stools and Urine
  • Sleep
  • Ears and Eyes
  • Thirst and Drink
  • Pain
  • Gynecological Conditions
  • Pregnancy and Childbirth (where appropriate)

Questions should be relevant to the patients condition, as not all questions are useful in every situation. Additional questions should be asked based on information provided by the patient as well as what is observed by the practitioner.

Diagnosis by Palpation (Pulse Diagnosis)

In Western medicine, the pulse is only a minor diagnostic tool, it is, however, very important in TCM. Pulse diagnosis gives information on

  1. The state of balance of the body as a whole, i.e. the state of the Qi, Blood, Yin and Yang, and even the constitution.
  2. The state of individual Organs (esp. Yin Organs).

TCM practitioners feel the pulse and note the rate. They discern width or amplitude, length, how close it is to the surface, how deep and close to the bone, the strength, and other qualities.

Three positions at each wrist, along the radial artery. The pulses are palpated at three positions, superficial, middle and deep.

Each pulse position can reflect different phenomena in different situations. For example: The Lung pulse full can occur as a result of emotional problem (grief) affecting Lungs or from Phlegm in Lungs or from an Excess in Large Intestine channel, such as a tooth abscess.

Factors that Influence a Pulse Reading

  • The 4 Seasons: Pulse is deeper in Winter, more superficial in summer.
  • Gender: Men’s pulses are naturally a little stronger. In men, the LEFT pulse is slightly stronger and in women the RIGHT pulse is slightly stronger.
  • Occupation: those doing heavy physical work should have stronger pulse.
  • Patient should not have just eaten a large meal (1 hr. before OK). Otherwise, Stomach pulse will read very high and other Organ readings may be depleted.
  • Allow the patient to rest after arrival at office.
  • Allow 15 minutes after urination, defecation or ingestion of liquids.
  • Pulse diagnosis should take place in a calm, restful environment.
  • Silence should be maintained during procedure.
  • Western medications can interfere with reading, as can hypertension, and structural anomalies.

Edited from a description at Sacred Lotus



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