The 4 Methods of Diagnosis

The human body is an organic entity, so local pathological changes may affect the whole body. The pathological changes of the internal organs may reflect on the body surface. Diagnostic methods in traditional Chinese medicine include four basic methods which refer to diagnosis by observations, asking questions, hearing and smell, and taking the pulse. In clinical practice, the four methods are used in combination.

Detecting internal conditions through external manifestations is the key to diagnosis in Chinese medicine. This is based upon the theory that any internal conditions will be manifest externally.

Diagnosis by Observations

In making a diagnosis through observations, the physician uses the power of his or her eyes to evaluate the patient’s spirits, general physical condition (as manifest in muscles, bones and skin), coordination and vigor of movements, and keenness of response in order to judge the excess or deficiency of Yin, Yang, Energy, and Blood.

Observation of the Mind:This is to observe the patient’s spirit. Observations of the spirits are intended to determine whether the spirits are there, lost, or prolapsed. A person’s spirits are present, or a person is in good spirits, his or her eyes are active, speech is clear, complexion is moist and shiny and breath is in balance. When a person is in good spirits, a disease can be more easily treated with better results. A person’s spirits are lost when his or her eyes are passive, speech is incoherent, complexion is dull and dry and breath is in imbalance. When a person is lacking spirits, a disease may prove more difficult to treat. Prolapsed of the spirits refers to a deterioration of the loss of the spirits, which indicates a critical stage of a disease that should be treated as an emergency.

By observing physical conditions, such as of muscles, bones and skin, a physician is able to know about the conditions of a patient’s energy and blood. Observations of the spirits as expressed through the eyes can prove useful in understanding the conditions of energy and blood in the internal regions.

Observation of the Complexion:This includes evaluating whether the color is deep or superficial and dispersing or gathering and whether the skin is moist or dry. Generally, Brightness is seen as a superficial color that indicates a superficial disease or mild disease with a good prognosis. Darkness is viewed as a deep color that indicates a deep disease or serious disease condition with damage to the qi and essence, and a difficult treatment with poor prognosis. A light and falling color is one that is dispersing, which generally indicates a new disorder involving the superficial region; a deep and accumulating color is one that is gathering, which usually indicates a chronic and severe disease. A moist appearance of the skin indicates the presence of stomach energy; a withered appearance indicates the decline of stomach energy.

The complexion of a normal person should be shiny and moist, with a mixture of yellow and red. The complexion of a person can also be evaluated in terms of “good outlook” or “bad outlook”.

A moist and bright complexion indicates a good outlook, whereas a withering and dry complexion indicates a bad outlook.

Observation of the tongue,commonly called tongue diagnosis, is an important aspect of diagnosis by observations. It primarily focuses on the coating of the tongue and the quality of the tongue with reference to color, texture, shape, size and coating. A very red tongue indicates a fever or inflammation and is described in TCM as an excessive internal heat or dampness condition. A white tongue indicates some kind of deficiency of energy (qi), blood or moisture. In this system, each part of the tongue corresponds to the condition of an organ. The tip of the tongue, for example, represents the heart and lung organs. Observations of the tongue coating enable us to determine how deep the six external pathogenic energies have penetrated into the human body.

Diagnosis by questioning the patient (inquiring)

Obtaining information about the patient’s medical history and their symptoms and signs, such as chills/fever, perspiration, appetite and dietary habits, elimination, sleep, and any pains; also, for women inquiring about menstruation, pregnancy and so on.

Diagnosis by hearing and smell

Diagnosis by hearing and smell includes hearing the patient’s voice and the sounds of coughing, respiration and Smelling the patient’s mouth and body. Some diseases may give rise to offensive smells, such as ulcers, tumors, or carbuncles. In some acute contagious diseases or in failure of the liver and kidney functions, there may be special smells to be detected.

Pulse Diagnosis

Pulse diagnosis is one of the original set of four diagnostic methods that are described as an essential part of traditional Chinese medical practice. Pulses form a rich and detailed tableau of the patient’s condition and history and they are the only real-time system of diagnosis. In acupuncture, when you put a needle in, you can see the pulses change immediately, and you know what you’ve accomplished. One of the most important things that pulses can reveal is the development of a condition before there are any symptoms or other signs. For example, we can often see the development of breast or prostate cancer months before the first physical sign or an actual lump is found.

Pulse can tell us about the nature of the diseases. For instance, a superficial pulse is symptomatic of a superficial disease, a rapid pulse is symptomatic of a hot disease and a slippery or sliding pulse is symptomatic of a sputum disease, indigestion, excess-heat disease, or pregnancy. A normal pulse is also called a constant pulse, which is indicative of stomach energy and it appears harmonious, slow, but forceful, neither too fast nor too slow and at about four beats per act of respiration or 70 to 75 bets per minute. Children may display a faster pulse. Pulse rate may also be influenced by physical activities, climate and other environmental conditions. Abnormal pulse refers to any pulse other than a normal one. For example, a big pulse is an abnormal pulse, unless it is taken when a person is engaged in energetic activities.

All of these diagnostic methods include Inspection, Listening, Inquiring and Pulse diagnosis yield information that helps to determine the syndrome and constitution to be treated. While the Chinese pulse and tongue diagnosis methods, because of their frequent mention and somewhat unique quality among traditional medical systems, receive much attention, the other aspects of diagnosis cannot be ignored or downplayed.