If you’ve been to a conventional medical provider, you’ve likely been part of that doctor’s diagnostic process.
Biomedicine tends to use blood tests, imaging (CT scan, MRI, X-ray) and a variety of other techniques in order to find the causative factor causing whatever symptoms you’re experiencing. Chinese medicine has different methods of diagnosis. As discussed on our page about Chinese medical science, there are some crossovers between conventional medicine and Chinese medicine. In fact, some people do incorporate conventional medical test results into their acupuncture practice, and there are a number of efforts to find connections between the two systems.
But, by and large, acupuncturists use classical Chinese medical methods of obtaining the information needed for diagnosis. Traditionally, the diagnostic process was broken down into four examination “pillars” which are:
- Looking
- Listening
- Asking
- Palpation / Touching
As the medicine has developed over the centuries, these four simple pillars have naturally been expanded and been subject to innovation resulting in the rich system of diagnosis that Chinese medicine providers use today.
It is important to understand that when a Chinese medicine practitioner “diagnoses” you, they are doing so in terms of Chinese medicine – NOT in terms of conventional biomedicine. We are not authorized in most US states to determine when a person has diabetes or cancer or any other well-known biomedical illness. The diagnostic terminology we use, and how it guides our treatment, is unique to our medicine.
Below, I’ll provide a brief description of the methods most Chinese medicine practitioners use to diagnose patients. Your practitioner may not use all of these methods, or they may use methods not discussed here.
Looking
Looking refers to all observational methods of diagnosis. All medical practitioners look at their patients to assess general demeanor, skin color / health and any observable pathologies such as rashes or lesions on the skin or changes in hair, eyes, body composition and a host of other factors. Chinese medicine practitioners utilize observation in similar ways, but also have specialized methods of “looking” that biomedical and other providers do not utilize.
Tongue diagnosis
One of the more well known and unusual methods of diagnosis in Chinese medicine involves looking at the tongue. Some of the things your practitioner may look at include: overall color & shape, qualities of movement & wetness, color and texture of the “fur” on the surface of the tongue, and the color and size of the veins underneath the tongue.
Each feature can tell your practitioner something about your body that may be helpful in guiding your treatment. Tongue diagnosis is particularly useful in diagnosing problems of the heart, lungs and digestive system.
Other observation based diagnostic methods
One of the things we learn in our 4+ year training programs in acupuncture and Chinese herbalism is how to be very astute observers of the everyday. We learn to pay attention with our eyes and our other senses. There are many systems of face reading and other observational techniques in certain lineages of Chinese medicine.
Listening / Asking
The part of the treatment that often takes the most time is the conversation we have before treatment. One of the things that people really enjoy about holistic medicine professionals is that they really seem to listen. This is true! We take a lot of time to listen to your concerns and ask you many questions in order to more fully understand the whole of your situation as a human being.
There are many reasons that holistic medical providers like acupuncturists spend so much time listening and asking. You could point to the differing business models and regulatory environments that acupuncturists and biomedical providers find themselves in. But, I think the most important reason is diagnostic.
For Chinese medicine practitioners, listening carefully to your story and asking many questions is a primary way we gather information to determine what treatment to give. At your first appointment, your practitioner will ask you about every system of your body, and will want to hear the story of what brought you to treatment. This information is combined with what you provide on the intake about your symptoms, family history, and supplements & pharmaceuticals.
All this information is so important! Even questions that seem totally unrelated to your primary condition could help me treat that primary condition more completely. So, don’t hold back! The more we know, the better.
Palpation / Touching
Pulse diagnosis
You have doubtless had your pulse taken by a biomedical provider at one time or another. Biomedical providers feel the pulse for less than a minute to determine the rate and rhythm of the heart. If they feel that your heart is too fast, too slow, or exhibiting an unusual rhythm they will follow up with other diagnostics to figure out what’s going on.
In classical Chinese pulse diagnosis, the pulse is taken on the radial (thumb) side of the wrist, just like in biomedicine. However, in Chinese pulse diagnosis, we are feeling at least 6 different positions and at least 3 different levels. And we are not feeling only for rate and rhythm but a diversity of other qualities all of which have their specific meaning in the diagnosis. Pulse diagnosis can be incredibly complex, and there are multiple lineage systems that teach providers how to use what they feel to come up with a diagnosis that leads to treatment.
There are diverse factors that can impact the pulse and make pulse diagnosis less reliable. This includes pharmaceuticals, cardiac devices such as pace makers, and more common influences like alcohol and caffeine. It’s best to take in no caffeine, alcohol, nicotine or pharmaceutical stimulants for at least four hours before treatment. If you do consume any of those items, inform your practitioner so they can factor it in when feeling your pulse.
Other palpation based diagnostic methods
Many Chinese medicine practitioners utilize abdominal palpation. Biomedical practitioners also sometimes will palpate the abdomen to look for swelling, pain and other signs of abnormality. Chinese medicine practitioners may look for similar things, but also feel along the acupuncture channels on the abdomen, feel for the distribution of fluids, feel for any adhesions (bound up tissue) on the surface of the abdomen, and even tap the abdomen to listen for splashing sounds or any empty tympanic sounds.
Chinese medicine practitioners sometimes also palpate other areas of the body – such as the back, limbs, or top of the head. In this case, we are generally checking the system of acupuncture channels for abnormalities that may help in our diagnosis. This may also include looking at structures of your body that feel pain in order to determine any swelling, the temperature and the quality of the skin. Palpation shouldn’t hurt and is always done within your level of comfort, so speak up if something is uncomfortable.