Diagnosis in Chinese medicine


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 I mentioned in the Chinese medical science portion of the site, 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 pillars,” which are : looking, listening, asking and palpation. As the medicine has developed, there have of course entered different ways of looking at the diagnostic process, and expansions of the original ideas.

Note well that when a Chinese medicine practitioner in the US gives you a diagnosis, they are doing so within the context of Chinese medicine – not biomedicine. I am not trained to determine when a person has diabetes or cancer or any other named biomedical illness. The terminology we use, and how it guides our treatment, is unique to our medicine. I am the most competent and safe practitioner I can be when I stay within this context – not pretending to have education I do not have.

Below, I'll provide a brief description of the methods I use to diagnose what ails you within the Chinese medicine framework. Soon, these simple and brief explanations will be replaced with links to several articles going into more depth about each topic.

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 natural 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 natural medicine 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, I will ask you about every system of your body, and will want to hear the story of what brought you to treatment. I'll of course want to hear about family health history, any medications, surgeries, or major life situations that may be impacting your health today.

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!

Pulse diagnosis

In classical Chinese pulse diagnosis, the pulse is taken on the radial (thumb) side of the wrist. The 2-3 inches of the wrist back from the wrist crease are used, as when most medical providers take the pulse. 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.

The best way to learn more about pulse diagnosis is to come in for an appointment and see for yourself!

Other palpation based diagnostic methods

Many Chinese medicine practitioners, myself included, utilize abdominal palpation. Biomedical practitioners also sometimes will palpate the abdomen to look for swelling, pain and other signs of abnormality. We do something similar, but have a different set of qualities we look for – and we add these to the pile of evidence we have amassed during the diagnostic process.

Similarly, I sometimes utilize palpation over other areas of the body – checking the area of the acupuncture channels for abnormalities that may clue me in to what's going on with the rest of your body. 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.

Tongue diagnosis

One of the more well known, and funny, methods of diagnosis in Chinese medicine utilizes the surfaces of the tongue. When I look at the tongue, I'm looking at the color, shape, quality, wetness, movement and the quality of the “tongue fur.” While tongue diagnosis is less a part of my particular training, it still informs my diagnosis, particularly in digestive and severe chronic diseases.

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.

For my part, I typically watch for abrupt changes in the face or the quality of the skin, changing colors underneath the skin surface, the quality and nature of visible veins and similar features. This is added to all the rest of the information I've gathered to help render an appropriate diagnosis.

Written by Watershed Team