Chinese Medical Diagnosis

The Chinese Medical Diagnosis is a two stage process, involving the examination of the patient and the identification of the pattern or patterns of the patient's disharmony. The first stage is examination, which is curried out using what in Chinese Medicine are called "the four diagnostic methods", or "the four examinations", i.e., observation, listening-smelling, interrogation, and palpation. The second stage is the interpretation of the information gathered by the four examinations: the analysis and synthesis of the signs and symptoms and the discrimination of the pattern or patterns of the patient's disharmony. A pattern of disharmony is a professionally grouping of signs and symptoms, which identifies the origin, location and nature of one's disease.

The Four Diagnostic Methods

Observation:

Observation is one of the most important aspects of Chinese medical diagnosis. In ancient times, it was considered the highest diagnostic art and the mark of a superior doctor who could diagnose simply by looking a patient without any need to ask questions or to palpate. Observation is also the first diagnostic technique used and begins the moment the patient appears before the practitioner. In observation, the practitioner observes the patient's general physical appearance, paying special attention to any part relevant to the presenting condition. Apart from observing the patient's spirit, overall appearance, and complexion, the practitioner also carefully examines the tongue, which can provide invaluable information about the patient's internal organs and their functioning.

Observation of the tongue is of vital importance in making diagnosis and gives clear information about an individual's underlying disharmony, even in the most complex cases. The tongue is observed for its color, shape, moisture, and coating. Different areas of the tongue also relate to different organs. Therefore, changes in color, shape, moisture, or coating in these areas is believed to reflect changes in these organs. In modern Chinese Medicine, tongue examination is extremely important, and practitioners typically spend some time checking and rechecking one's tongue.

Listening-smelling:

In ancient Chinese, there is a single verb which covers both listening and smelling. The 'listening' part of the listening-smelling examination involves listening to the sound of the patient's voice, breathing, couth (if present), and the sounds that express pain and discomfort. In terms of 'smelling', these days this is mostly covered under questioning, where the practitioner may ask the patient about bad breath, unusual body odor, or the smell of one's feces, urine, and/or vaginal discharges.

Interrogation:

Interrogation is based on asking and, in many ways, is the most important of the four examinations. It is important not only because the practitioner needs to elicit information from the patient but also because the way the patient talks during the interrogation is in itself a very important diagnostic sign reflecting the underlying physical, emotional and mental condition of the patient. Moreover, it is through the interrogation process that the practitioner interacts with the patient: therefore, the skill, tact and compassion with which the practitioner conducts the interrogation have a profound influence on the therapeutic results themselves. Thus, the process of "interrogation" of the patient is far more than a set of rules about which questions to ask and how to ask them: it is the heart of the therapeutic encounter between the practitioner and the patient: it is the crucible in which the healing takes place. If the patient is unconscious or is a baby or a small child, the questions are put to a close relative. Chinese medical practitioners ask many more questions than do Western MDs. They typically ask about the patient's appetite, diet, elimination, energy, sleep, mood, perspiration, sex drive, body temperature, menstrual cycle, reproductive history, and as many details as possible about his or her main complaints.

Palpation:

Palpation means feeling with one's hands. There are two divisions to palpation examination in Chinese Medicine. The first is general palpation of any areas of pain or discomfort. For instance, if one has sprained one's wrist, the practitioner will want to feel the wrist. Likewise, if one says he or she has abdominal pain, the practitioner will want to feel his or her abdomen. Some practitioners may palpate every patient's abdomen on a routine basis. There is a whole system of Chinese medical diagnosis based on abdominal palpation. However, not all modern day practitioners use this system.

The other main type of palpation in Chinese Medicine is palpation of the pulse. This primarily means feeling the radial arteries at the wrists of both hands. Chinese doctors have believed for at least 2,000 years that one can diagnose all the main viscera and bowels through palpation of these arteries. Although there are several different styles of pulse palpation currently in use, all are based on the division of this section of these arteries into three areas which correspond to three areas of the human body and their organs. By exerting different degrees of pressure at these three areas on the wrist, we believe one can detect pathological changes in all the main viscera and bowels of Chinese Medicine. In order to describe and record the feelings under their fingertips, Chinese doctors use 28 pulse images or feelings. One or more of these pulse images may combine together, thus forming a large number of possible variables. Pulse examination is the seemingly most arcane of the four Chinese medical examinations. However, it is based on definite standards and it has proven its worth in over 2,000 years of recorded clinical history. Some practitioners may also palpate other pulses on the body, such as at the top of the instep or on the front of the throat. This may be done routinely or in certain situations.

Identification of Patterns

Identification of patterns indicates the process of identifying the basic disharmony that underlies all clinical manifestations. This is the essence of Chinese medical diagnosis and pathology. Identifying a pattern involves discerning the underlying pattern of disharmony by considering the picture formed by all signs and symptoms.

Rather than analyzing signs and symptoms one by one in trying to find a cause for them as Western Medicine does, Chinese Medicine forms an overall picture taking all symptoms and signs into consideration to identify the underlying disharmony. In this respect, Chinese Medicine does not look for causes but patterns. Thus, when we say that a certain patient presents the pattern of Liver-Qi Stagnation, this is not the cause of the disease, but the disharmony underlying the disease or the way the condition presents itself. Of course, in other respects, after identifying the pattern, Chinese Medicine does go a step further in trying to identify the cause for the disharmony.

"Symptoms and signs" in Chinese Medicine have a rather different meaning than in Western Medicine . They are different from the relative narrow area explored by Western Medicine despite its battery of clinical tests. Instead, the doctor of Chinese Medicine widens his or her view to assess changes in a broad change of common bodily functions such as urination, defecation, sweating, thirst, and so on. Furthermore, the doctor of Chinese Medicine takes into account many clinical manifestations ranging from certain facial and bodily signs to psychological and emotional traits which are not really "symptoms" or "signs" as such, but rather expressions of a certain disharmony. Many of the clinical manufestations contributing to form a picture of an underlying disharmony would not be considered as "symptoms" or "signs"  in Western Medicine. Over many centuries of accumulated clinical experience by countless doctors, Chinese Medicine has developed a comprehensive and extremely effective diagnostic system and symptomatology to identify disease patterns and the underlying disharmonies.

Identifying the pattern of disharmony blends diagnosis, pathology and treatment principle all in one. It allows the practitioner to find the nature and character of the condition, the site of the disease, the treatment principle and the prognosis.

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