TCM Diagnosis and Pulse Examination
Without the help of X-Rays, scanners, or surgery, Chinese doctors found other means of understanding what was happening to a person that was causing disease. They learned to diagnose using the Four Examinations.
The Four Examinations
1 - Looking (and Tongue) Diagnosis
The doctor observes the patient. Body tone, gait, skin, facial expression, emotional tone, and mannerisms are noted. The tongue is carefully observed.
The doctor looks carefully at the tongue. The heart revealed at the tip, the kidneys at the root. The color and appearance of the tongue and tongue coating show what may be hidden; revealing hot from cold, damp from dry; and true from false.
2 - Listening Diagnosis
The patient is encouraged to speak freely. Putting aside preconceptions as much as possible, the doctor listens with an open mind, attentive to the story and history,. The doctor also listens to the patient's voice, noting its volume and clarity, as well as the manner of speaking and use of language.
3 - Smelling and Tasting Diagnosis
The doctor may ask the about your tastes and body odors. Odors and tastes are clues. Strong tastes and odors or can be signs of heat, toxicity or digestive stagnation. Doctor may consider The Five Tastes.
(Correspondence of The Five Tastes: Bitter relates to the Heart, Sweet relates to the Spleen (digestion). Pungent (spicy) relates to the Lungs, Salty to the Kidney, and Sour to the Liver.)
4 - Touching (and Feeling the Pulse) Diagnosis
The doctor may also touch the body. Local sensitivity can reveal what needs attention. The doctor feels for tone, temperature, sensitivity, accumulations, or other signs of abnormality. She/he may feel the pulse to help sense inner disharmony.
Feeling the pulse is a skill perfected over a lifetime of practice. The doctor will feel the pulse on both wrists. Besides noting its rate, rhythm, and overall strength, she/he may note the type of pulse. Texts classify the pulse into at least twenty-eight types. Some of the common types are Wiry (feels tense, like a wire), Thready (feels thin, like a thread), Deep (strong pressure required to feel it), Short (slow and irregular), slippery (feels like a bubble moving), Choppy (uneven strength). By touching the patient in this manner, the doctor senses something of the internal condition of the patient.
How is the pulse felt?
Using three fingers, the doctor feels the pulse at three positions at each wrist along the radial artery: The front (at wrist crease) relates to the heart and lungs, the middle (just medial to radial styloid process) relates to the middle organs such as the liver and spleen, and just behind that is the proximal or rear position helping to diagnose the kidneys. By using finger pressure, the pulse is felt at three depths: superficial, middle and deep.The practitioner of Chinese medicine also notes the pulse rate. A normal pulse rate is 4-5 beats per breath. A slow pulse can lead to a diagnosis of internal cold or inactivity, though athletes can also present with a slow pulse. A rapid pulse indicates heat or hyperactivity in the body.
The patient may not tell the truth, but the pulse cannot lie.