Diagnosis in Chinese Medicine
Imagine a new patient sitting in an acupuncturist’s waiting room. She suffers from headaches and has been given a conventional medical diagnosis of migraine, and is taking medication prescribed by her GP.
Going into the treatment room, the TCM practitioner asks her many questions.
Firstly about the nature of the headaches: how long have been occurring, when she gets them, where on the head get them, how do they feel. After this has occurred the practitioner then asks them a whole range of things about her day to day health, both physical and emotional.
He then asks her to poke out their tongue which he observes carefully. He then asks her present her wrists and he then spends a minute or two pressing the wrists on both sides.
What is going on here?
Well traditional Chinese medicine is truly holistic in nature. By this we mean that when a patient seeks acupuncture or herbal treatment the TCM practitioner will look at every aspect of the patients’ health and well being and not focus on symptoms alone. When we treat patients we are seeking to find a pattern of disharmony. A syndrome, in other words group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.
How TCM practitioners get to this point is called Bian Zheng Comprehensive diagnosis based on the analysis, identification, and differentiation of symptoms and signs according to the data collection from the four examination methods and basic Chinese medicine theories of viscera, meridian, and pathology.
The 4 elements Bian Zhen
- Listening and smelling
Diagnosis by Questioning
This is perhaps the most important of the four methods. Traditionally there were 10 questions asked about bodily function. These were:
- Bowel function
- Fertility and sexual function
Today many more questions are asked. The number of and diversity of questions asked is often quite surprising for the new patient.
Returning to the example of our lady with headaches, the TCM practitioner needs to know where the headache is on the head. What is the nature of the pain (distended, stabbing, dull, tight etc), when is it better and worse. Is it associated with other symptoms?
In this case she mentions that the pain is on the temple and is stabbing in nature. It can occur any time of the month but is worse before her period. Generally the patient says she is stressed and this makes her feel tired. Already the practitioner is leaning toward a diagnosis but needs more information to confirm this.
Previous medical and family history will also be taken into account
Diagnosis by Observation
Observation is both specific and general. General observation can be such things as the overall demeanor of the patient. Are they restless and fidgety? Do they seem subdued? What is the complexion like? Is it red, pale, waxen? Are there dark rings around the eyes? Etc.
There may be cause to look at specific things such as skin lesions, quality of the hair and nails etc.
One of the unique diagnostic methods in TCM is tongue diagnosis. We believe that the health of the body is reflected in the condition of the tongue. Firstly is the body of the tongue a healthy colour. Too pale may indicate deficiency, redness may be heat, and purple/darkness may be stagnation. Is the tongue an unusual shape thick or thin pointed?
The tongue coating may indicate pathogenic states. A thick yellow tongue coat may be a sign of heat for example. Certain areas of the tongue also relate to the organ systems so cracks, spots, or other signs in a specific area may be clinically significant.
Returning to our imaginary patient she has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.
Diagnosis by Palpation
Often the Chinese medicine practitioners will physically examine a patient. Does a pain get better for pressure or is it aggravated. This might tell us if the problem is one of excess or deficiency. For the acupuncture treatment of pain the practitioner will seek out ashi (painful) points. Literally trying to pin-point the pain.
Next comes the taking of the pulse. This is felt on both wrists at three positions at three depths. Traditionally the pulse was taken at various places about the body the throat or ankle for example. Today the pulse is only taken at the wrist. It is used to determine the current state of the organs and meridian function. Basically the practitioner will seek to measure the speed and depth of the pulse and the relative force at each position.
There are 28 ways the pulse reflects pathological changes in the body correlated with Chinese medical pattern discrimination. These 28 pulse images are taught, like so much of Chinese medicine, using a yin-yang dichotomy. Thus we have the floating and deep pulses, the large and small pulses, the fast and slow pulses, the slippery and choppy pulses, the short and long pulses, etc. According to Hua Tuo, a late Han dynasty expert in Chinese medical diagnosis, the majority of these 28 pulse images can be grouped under four headings. These four headings are: floating, deep, fast, and slow. For instance, there are seven floating or superficial pulses: floating, vacuous, drum-skin, spring onion-stalk, scattered, soggy, and surging. The descriptions of these pulses are quite beautiful at times. The slippery pulse is likened to pearls rolling on a plate. Our lady with the headaches has a choppy pulse one that feels like the back of a knife scraping along a piece of bamboo.
Diagnosis by Listening and Smelling
The TCM doctor might be interested in the Lung sounds, rattling of phlegm in the throat, the type of cough etc. There are more subtle things that may be heard. Each of the 5 organ systems has a particular voice associated with it. The Fire element voice is described as laughing the Water element as groaning. This may not be quite so obvious and may show a general tendency to an element type. Smelling might relate to an overall breath/body smell or the smell of a particular discharge. Our patients’ voice seems to have a clipped shouting quality.
Bringing it all Together
If we look at what information we have gathered about our patient.
- Migraine is on the temple and is stabbing in nature
- It is worse before her period
- She is stressed and this makes her feel tired
- She has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.
- Choppy pulse
- Clipped shouting quality to voice.
These signs and symptoms all point to the TCM diagnosis of blood stagnation. Points will be selected on the head because this is main area of complaint. In this case a point on the temple will be used. The main TCM organ/meridians involved are the Liver/Gallbladder/Triple heater and point from these channels are selected especially ones which move blood or Qi (chee) and or affect the head or temple. A herbal formula that moves blood and sedates the uprising Qi is used and this is given daily.
The success of the therapy depends on the ability of the practitioner to find the pattern of disharmony . In this sense TCM is truly holistic, patients are assessed and treated individually not handed a universal treatment based on one complaint alone.
If you would like to find out how TCM could help you please call me on 07724 899 833 or firstname.lastname@example.org
Dudley Kent MBAcC MRCHM MRSS
Acupuncture & Chinese herbs in central London & Salisbury