Enjoy these articles outlining some of the diagnosis related processes many skilled acupuncturists use prior to starting treatment:
Acupuncture Diagnosis - Basics
The diagnostic process of Chinese medicine involves four areas, known as the Four Examinations. These are:
Observation of the patient's complexion, eyes, tongue, nails, gait (overall physical appearance), openness, and emotional demeanor.
Listening and Smelling, the focus being on the sound of the voice and breathing, as well as any odors associated with the body, or breath.
Questioning for information on present and past complaints including appetite, digestion, bowel movement, bladder, sweat, pain, patterns of sleep, family health history, work, living habits, physical environment, and emotional life.
Palpation, or touching the body to determine temperature, moisture, pain or sensitivity, and the taking of the pulse. The chinese method of pulse taking involves placing three fingers on each wrist to measure a total of 12 pulses, each associated with a corresponding meridian. Fourteen different pulse characteristics (slow, rapid, full, empty, etc.) are compared with each of the 12 pulses, and are used to determine which organ is not working properly.
Treatments aim to adjust and restore the Yin/Yang balance, and may incorporate one or more therapies, including:
- herbal remedies
Diagnosis - Observation
The observation portion of diagnosis begins the moment the patient appears before the practitioner. In this step, the practitioner is forming an initial impression of the patient, while assessing the seriousness of the condition based on four main considerations:
Vitality: the color, complexion and lustre of the skin, and the overall general impression of the patient are key points in observation. The appearance of the face is an excellent indicator of vitality as all the acupuncture meridians flow to the face, by their primary or secondary pathways, and the state of Blood and chi (qi) is very evident in this area.
As well, the color of the face may reveal problems in the functioning of the organs. For example, black circles under the eyes could indicate kidney weakness, whereas red coloring (which relates to heat/fire) is linked with the heart. Black or blue coloring is linked with the kidneys, blue-green may involve the liver, and white implies a lung problem.
Body Appearance: the appearance of the body can also provide the practitioner with good information as to where the problems lie. At this point the practitioner is mainly looking for the distribution of fat, type of build, appearance of body hair, etc.. For example, it is difficult for yang qi to be distributed in a body with excess fat, therefore an overweight person is more susceptible to cardiac arrest and stoke.
Facial Features: facial expressions tell the practitioner about the psychological status of the patient, whether it be sad, happy, anxious or overjoyed, and are a point of consideration prior to making a diagnosis. The features themselves, including the eyes, nose, mouth and lips, can also provide evidence of excess or deficient conditions causing imbalance in the body.
The Tongue and its Coating: the inspection of the tongue is a vital diagnostic procedure in the practice of Traditional Chinese Medicine. The color, coating, shape and texture of various parts of the tongue yield information about the state of the organs.
A normal tongue is moist and has an "appropriate" red color. A light red or pale tongue is a sign of deficiency in both qi and blood. A thick, purple colored tongue is often associated with alcoholism, while cracks in the tongue show dryness, heat, and deficient yin.
Prior to an examination, it is important not to eat or drink anything that will discolor the tongue and give a misleading impression to the practitioner.
Diagnosis - Questioning
During the first visit, a considerable amount of time is spent asking the patient for details about his or her general condition. These questions relate to all emotional, physical, and energy related signs and symptoms, and can help the acupuncturist form a more complete picture of the patient's condition.
A full medical history is usually taken, including details of past illness, operations, physical and mental traumas. While these issues may not seem pertinent to the patient at this juncture, they do provide important insights into the pattern of disharmony existing within the patient.
Other important questions which may be asked are:
- Preferences for heat or cold
- Frequency and consistency of urination and defecation
- Sleep patterns
- Diet and thirst
- Menstrual cycle (length, pain associated, heaviness of bleeding, etc.)
- Headaches (when they occur, where and under what circumstances)
- Perspiration (amount, time of day, circumstances)
In addition, the practioner may inquire regarding the nature of any pain or discomfort, as reactions to heat or cold may point to patterns of excess and deficiency, such as imbalances in Yin and Yang. For example, if pain is relieved by heat, a cold condition (Yin) is indicated. If the reverse is true, such as a discomforts alleviated by cold, a Yang condition could be present.
The site(s) of the pain are also noted as they may indicate a blockage or stagnation of qi within the meridians of the body.
Diagnosis - Listening and Smelling
A significant aspect of this part of diagnosis is the breathing of the patient and the sound of the voice.
A loud assertive voice suggests a yang pattern, while a weak or timid voice suggests the opposite, a yin pattern. Restless and heavy breathing occurs in an excess syndrome whereas shallow breathing is indicative of a deficient condition. Even the sound of a cough gives an indication of the level of phlegm in the lungs, and can be loud and sudden or weak and persistent.
The odor of the body and its excretions are also important aids in diagnosis, and require many years of experience to perfect. As such, this method is more widely practiced in traditional eastern diagnosis than it is in the western practices.
In general terms, there are two distinct smells which are considered to detect the presence of a hot, excess condition from a cold, deficient one. Yang (hot, excess) conditions are associated with a rancid or rotten smell and Yin (cold, deficient) conditions possess a strong, fishy aroma.
As a rule, any unusual or abnormal odors can indicate an illness, those listed above are merely a guideline.
Diagnosis - Pulse and Palpation
Palpation, or touching, is a form of diagnosis made by feeling and tapping local areas of the body to ascertain:
- Painful areas
- Temperature of the skin (heat, cold)
Pulse diagnosis, as it applies to Traditional Chinese Medicine, is the most important form of palpation, and is very different from that of Western physicians.
In performing pulse palpation, the practitioner places the index, middle, and ring fingers on the radial artery. Three degrees of pressure, the light touch, the medium touch, and the heavy touch are applied to the region and correspond to the upper, middle, and lower areas of the body.
In traditional terms, there are 28 pulse classifications, which describe the way the pulse feels to the fingertip. Some examples of these classifications are:
- Slippery - feels like a rolling pearl in a basin, very fluid and full
- Choppy - has no strength and is irregular
- Full - large and rounded, can be felt at all levels
- Empty - hard to detect or felt only slightly at the superficial level when pressure is applied
- Slow - slower than the normal rate of four to five beats per breath
- Rapid - six to seven beats per breath
- Superficial - easily felt on the skin surface
- Deep - only felt with a heavy touch
These, along with 20 other descriptions, must be taken into consideration during pulse diagnosis. This requires a tremendous amount of skill and practice, and when properly executed is one of the most important and accurate means of correctly diagnosing a patient. In fact, pulse and tongue diagnosis are considered to be the "two pillars" of the four examinations in traditional practice.