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Diagnosis in traditional Chinese medicine is a careful art of gathering and interpreting information about the whole person. Rather than naming a single disease, the practitioner seeks to recognise the underlying pattern of disharmony – the particular imbalance of yin and yang, qi, blood, fluids and the organs that lies behind the symptoms. This is done through the time-honoured four examinations, and the findings are then organised through frameworks such as the eight principles.
1. Looking (inspection)
The practitioner observes the patient’s general vitality, complexion, posture and movement, and the lustre of the eyes (a reflection of the spirit). Central to inspection is tongue diagnosis: the tongue offers a remarkably clear, real-time picture of the interior. The body of the tongue (its colour, shape and moisture) reflects the state of the organs, the blood and the fluids – a pale tongue suggests deficiency or cold, a red tongue heat, a purple tongue stasis, a swollen scalloped tongue dampness. The coating reflects the state of the Stomach qi and the presence of pathogens – a thick coating indicates a strong pathogenic factor, a yellow coating heat, a greasy coating dampness or phlegm, and a peeled or absent coating injury to the fluids or yin. Different areas of the tongue correspond to different organs.
2. Hearing and smelling
The same Chinese term covers both listening and smelling. The practitioner notes the strength and tone of the voice, the quality of the breathing, and the sound of any cough – a loud, coarse voice and forceful breathing suggest an excess condition, while a weak, quiet voice and shallow breathing suggest deficiency. Significant odours may also provide diagnostic clues.
3. Asking
A thorough enquiry, traditionally summarised as the ‘ten questions’, builds a detailed picture of how the whole system is functioning. It covers sensations of cold and heat; sweating; the head and body (including pain – its location, nature and what relieves it); urine and stool; appetite, thirst and taste; the chest and abdomen; hearing; sleep; the emotions; and, for women, the menstrual cycle, discharge and obstetric history. The history of the present complaint and the patient’s general energy round out the picture.
4. Palpation
Palpation includes feeling the body and the channels for areas of temperature change, tension or tenderness, and feeling the abdomen. Above all it includes pulse diagnosis. By placing three fingers over the radial artery at the wrist, the practitioner reads three positions on each wrist (each relating to particular organs) at three depths (superficial, middle and deep). The classics describe some twenty-eight pulse qualities – among the most important are floating or deep (locating the problem at the exterior or interior), rapid or slow (heat or cold), full or thin/weak (excess or deficiency), wiry (Liver disharmony or pain), and slippery (dampness, phlegm, or pregnancy).
Forming a pattern diagnosis
The information from all four examinations is then synthesised. The first and broadest framework is the eight principles, which sort the picture along four polarities: interior/exterior (the location and depth of disease), cold/heat (its nature), deficiency/excess (the relative strength of the body and the pathogen), and yin/yang (the overarching summary). Further frameworks refine the diagnosis: zang-fu pattern identification (the most widely used, locating disharmony in specific organs), and, for febrile and epidemic diseases, the six stages, the four levels and the three burners.
Why pattern, not just disease
It is this individual pattern – unique to the person in front of the practitioner – that guides the choice of acupuncture points, the selection and combination of herbs, and advice on diet and lifestyle. It is also why two people with the same Western diagnosis may receive quite different Chinese medical treatment, and why one Chinese diagnosis may span several Western conditions. Careful pattern diagnosis is the foundation on which effective, individualised treatment is built.
This article is for general information and educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment.