Everything that goes on within you
can be seen on the outside
The region of Lin Xian in central China is about forty miles across and in the 1960s boasted a population of seventy thousand. The region had garnered the attention of the Chinese government and the World Health Organization as having the highest rate of esophageal cancer in the world with a consistent 15 percent of the adult population dying of this cancer. In 1964 the Chinese government and the U.N. sent a team to study this problem. The team was made up of pathologists, surgical oncologists and gastrointestinal and infectious diseases experts. To be politically correct, they invited a few doctors of Chinese medicine to join their field research.
The team set out to examine and diagnose everyone in the county over the age of twenty-six, approximately 50,000 people. The time and cost were exorbitant. Among the diagnostic procedures was an endoscopy in which a balloon was inserted into the patient's stomach, inflated and then gently pulled out to collect cell samples from the esophagus. As patients arrived to be examined, one of the doctors of Chinese medicine often made remarks such as,“Oh, he's okay. Don't bother with him.” Or, “He really looks bad.” The doctor's assessment was almost always consistent with the balloon endoscopy, which baffled the Western doctors. When they questioned him, they learned that the doctor of Chinese medicine had based his opinion on examining the patients' tongues.
The field team, still skeptical, organized an independent comparative study, which concluded that the Chinese doctor's diagnosis was nearly as accurate as the balloon endoscopy. At the researcher's request, the doctor taught the entire team how to examine tongues, which sped up the diagnostic process tremendously.
The doctor of Chinese medicine understood what Chinese medicine has known for thousands of years: Everything that goes on within you can be seen on the outside. If you truly understand the significance of the concept of wholeness, then it logically follows that every aspect of your mind, body and spirit will affect and be reflected in every other part of your mind, body and spirit. From asking questions and observing, the doctor can organize all of the information into a meaningful pattern of harmony or disharmony to arrive at a diagnosis and treatment plan.
The objective of diagnosis in Chinese medicine is different from the objective or goal of diagnosis in Western medicine, which focuses primarily on gathering information in order to arrive at a specific diagnosis so that treatment can be determined. In Chinese medicine, the outcome of collecting, analyzing and integrating data from history gathering and examination of the patient is aimed at determining the Zheng. Zheng is a comprehensive assessment of the nature of the patient's condition that weaves together all the relevant information about the condition into a meaningful pattern, including (1) the Causes (explained below), (2) the patient's state of Qi—strong or weak, or one of the many states in between, (3) the circumstances such as location and season, (4) personal data such as constitution and temperament and (5) lifestyle factors.
In Chinese medicine as in Western medicine, physicians are taught to follow the Law of Parsimony. When there is more than one complaint or symptom your doctor tries to find the most simple, singular answer that accounts for all, or the majority, of the signs and symptoms. For example, if you have a headache, sore throat and runny nose, chances are that you do not have a brain tumor, throat cancer and allergies, but rather have the flu.
The causes of disease from a Chinese medicine perspective are organized into the following major categories: External Causes, Internal Causes, Non-Internal Causes, Non-External Causes. (These terms are capitalized throughout to define them as Chinese medical terms.)
When identifying the causes of illnesses, Chinese medicine refers to External Causes: Wind, Cold, Summer Heat, Dampness, Dryness and Fire. External Causes do not refer to the actual physical entities of wind, cold, heat, dampness, dryness or fire but rather imply that a given Cause shares the properties of these phenomena. In other words, Wind does not mean that your body is invaded by a gust of wind. Rather, the Cause shows some similar properties of those of wind, such as being transient and changeable, appearing and disappearing quickly. Wind, Cold, Summer Heat, Dampness, Dryness and Fire are symbolic. A disease is typically caused by a combination of several Causes.
Wind: In nature, wind is swift, mobile, changeable and strikes suddenly. Consider the flu, which is often caused by the External Cause Wind. It invades your system with sudden onset of illness, and the symptoms can also change rapidly. The condition can begin with a sore throat. By the time you receive medication for your sore throat the symptoms may have moved into your chest.
Cold: Associated with degeneration and a decrease in metabolism. In nature cold is contracting, congealing, stiffening and tightening. A patient suffering from flu can also suffer from chills, tight muscles and stiff joints.
Summer Heat: Characterized by a pronounced inflammation, accelerated metabolism and hyperactivity. For instance, a patient with acute pneumonia with high fever, profuse sweating, thirst, dehydration and agitation and even delirium would be said to be suffering from the External Cause Heat.
Dampness: Connected with properties such as abnormal accumulation of fluid or moisture, swelling, heaviness, sluggishness and a stubborn and protracted course of illness. Dampness can be seen in the case of fungal or candida infection, or certain dermatological conditions that are characterized by pronounced swelling and oozing caused by an infectious agent as well as watery diarrhea, edema (water retention) and phlegm accumulation in the lungs or nose.
Dryness: Dryness mainly damages your body's Fluid—such as symptoms that can be seen in certain types of bronchitis where the patient has dry cough, accompanied by pronounced dry mouth, throat, lips and nostrils.
Fire: Fire has a property similar to Summer Heat, except that it is much more extreme. Many infections are considered to present an element of Fire. Fire is present when there is localized swelling, redness and the area is hot to the touch, such as with mumps, and the bodily discharge can become discolored or pustulant.
Li Qi: Any External Cause may also be considered Li Qi, if aside from exhibiting typical properties of other External Causes, it is highly contagious, evolves rapidly and causes the same or a very similar pattern of severe symptoms among different patients. Smallpox, typhus, tuberculosis and HIV would all be considered to be Li Qi. External Causes that have the condition Li Qi are usually also characterized by Heat or Fire.
External Toxins: External Toxins are chemical and biological toxins such as environmental pollutants, viruses and bacteria. Water polluted with human waste would be considered an External Toxin. External Toxins can appear in any season, although they tend to appear more with the warm weather.
Relative Proportions: It is important to determine the relative proportions of the various causatory factors involved before designing a treatment program. Successful treatment requires precise recognition of various proportions, combinations and interactions of External Causes and/or Toxins. The herbalist must refine his or her senses to recognize the interactions among different Causes, as well as among the interactions between the Causes and the patient's Qi. Herbal formulas are tailored exactly to the diagnosis of relative proportions to ensure maximum results and minimum side effects.
In Chinese medicine, for example, when diagnosing and treating arthritis, the various Causes involved, the relative proportions of the Causes and the state of Qi are determined.
Different symptoms of arthritis are caused by various External Causes.
External Wind: Arthritic symptoms that are somewhat fleeting and changeable in nature. The pain moves from joint to joint.
External Cold: Significant pain that remains localized in a particular joint(s); the pain is clearly aggravated by cold environment and/or weather.
External Dampness: The patient suffers joint swelling and edema.
External Heat: The patient's arthritis causes notable redness and inflammation.
A patient with symptoms of 60 percent Wind, 20 percent Cold, and 20 percent Dampness will be treated with a different approach than an arthritis patient with 60 percent Cold, 30 percent Dampness, and 10 percent Wind. In chronic arthritis the state of the patient's Qi would invariably be weakened or damaged, which needs to be considered when planning treatment strategies.
This is a simplified explanation of diagnosis using relative proportions. Regardless of the illness, an experienced and talented Chinese doctor uncovers a complicated web of interactions involving many factors, which may be immediately evident or extremely subtle.
The Association Between External Causes and the Seasons: External Causes are often associated with the seasons. When the Energy of the season becomes abnormal or excessive, it can lead to imbalances. For example, Wind is predominantly seen in the spring, Cold in winter, Summer Heat and Fire in summer, Dampness in the late summer and early fall (called Long Summer in Chinese medicine) and Dryness in fall.
When weather becomes erratic, such as when the temperature becomes unseasonably warm in winter or cold in summer, people's bodies can be thrown out of balance. This abnormal change can create an incubator effect, providing the invading External Cause a highly favorable environment in which to flourish. It is often the case that when there's a sudden cold spell during the summer, there is an outbreak of infectious disease. This is known in Chinese medicine as “untimely Energy.” For example, when a flu hit hard in late summer and early fall in Beijing in the 1960s, many industries had to close down because two-thirds of their employees were sick. The government intervened and established many temporary sidewalk stands to make enormous amounts of herbal formulas to pass out to people on the street. The teas, called decoctions, were made from a classic formula designed to treat the flu. But the formula did not work very well and people continued coming down with the flu.
The government consulted a well-respected herbalist, Dr. Pu Fuzhou. Dr. Pu understood that the original classic formula, created about 1,800 years ago, was proven effective and often used to treat upper respiratory infection with a high fever. But the particular virus that was going around China at the time had a strong element of Dampness because of the time of the year in which it occurred. Dampness in nature is heavy, stubborn and clinging. It tends to attach to or become entangled with other Causes and make them difficult to clear. Dampness was not considered in the design of the original formula. Dr. Pu added just one herb—Cang Zhu (Red Atractylodes), which is traditionally used to resolve Dampness—to the original classic formula, which dramatically improved the efficacy of the formula. This story demonstrates how a Cause that is associated with a certain season can interact with the human body, thereby altering the disease pattern.
Internal Causes
In addition to External Causes, there are also Internal Causes. These are psychological in nature. The Internal Causes were described by the Chinese medical classics as the Seven Emotions: Anger, Joy, Sadness, Grief, Pensiveness, Fear and Fright. These emotions represent a wide range of inner states. They are, by themselves, neither good nor bad. But when excessive or out of control, they can lead to imbalances and illness.
Non-Internal, Non-External Causes
Between Internal Causes and External Causes is the third category, called Non-Internal, Non-External Causes. This category includes Constitutional Factors, Lifestyle Factors, Intermediate Causes and Unforeseen Events.
Constitutional Factors: Each individual has a unique configuration of Yin and Yang balance, with a slight tilt one way or the other. This defines your Energetic individuality. A minor imbalance does not necessarily mean illness. In fact, it is very rare to see a person with a picture-perfect balance. However, a constitutional tendency toward imbalance can interact with an illness, influencing how it manifests and even determining the direction the illness will evolve. For example, when someone with a Warm constitution is invaded by a Cold Cause, although initially he or she will experience symptoms reflecting the nature of the Cold Cause, after a short time his or her Warm constitution will interact with the nature of the Cause, and the person will show signs and symptoms of Heat. This is known as the theory of “conformity and transformation,” which stipulates how disease and different constitutional types interact.
Your unique constitution impacts the way you get sick. Everyone has his or her unique constitution. Some of us run Hot, others Cold. Some are robust and others are delicate. Your constitution will affect the way your illnesses develop, progress and resolve. Let's say that you have a constitutional imbalance and do not have enough cooling Energy to balance the warming Energy. This is the most commonly seen constitutional type in the West. When you come down with a flu caused by the External Causes Wind and Cold, after a day or two your constitution (Yin deficiency) and the natural Causes characteristic of influenza (Wind and Cold) will interact and change the entire picture of your illness. Your Yin deficiency (warm body temperature) will begin to turn the characteristic Wind and Cold disharmony into a Wind and Heat disharmony.
In this case, the initial Wind and Cold symptoms, such as congestion with clear nasal discharge, pronounced chills and body ache, would disappear quickly, and the person would soon develop Heat symptoms, such as sore throat, more pronounced fever, and yellow or discolored nasal discharge and Phlegm.
Conversely, if a person with a Cold constitution is invaded by a Wind and Heat Cause, the symptoms that are characteristic of Heat, such as sore throat, discolored discharge and more pronounced fever, would soon conform to the patient's basic constitution. The sore throat would disappear within a day or two, the discharges would turn white and thin and the degree of fever might lessen, replaced by pronounced sensitivity to cold or draft, possibly with achiness all over or a stiff neck or tightness in shoulders and upper back.
If the External Cause and your basic constitution are opposite, the External Cause can be altered by your constitution. That is why we all may feel lousy when we have the flu, but we feel lousy in different ways.
Some people have a significant constitutional weakness in a certain area that makes them vulnerable to specific illnesses. A person's constitution is also important in health maintenance and disease prevention. If your lifestyle agrees with your system by helping to correct your original imbalance rather than aggravating it, you will then have a relatively healthy life. But if your lifestyle goes against your constitution, it will eventually lead to illness. A Chinese doctor can predict which direction your health is heading in the future based on your constitutional tendency, and can take steps to prevent illness from occurring.
External Causes and Internal Causes interact with your unique body constitution. In addition, Chinese medicine recognizes that the evolution of illness depends on the relative strength of the External Cause and its ability to cause illness and the power of your immune system to heal your body. Everyone is different—a fact that is extremely important in Chinese medicine.
From a Western medical point of view, many conditions are single diseases that are caused by a definitive cause, for example, the flu virus. In other words, everyone receives the same diagnosis and everyone is treated similarly. But in Chinese medicine the flu can be classified in several categories and herbal formulas are widely varied.
Historically, Chinese medicine recognized that the flu is caused by an External Cause that it is contagious and evolves rapidly. Wind is often a major factor in flu, because the nature of flu is to strike suddenly and to change rapidly. From the Chinese medical point of view, there are many different types of flu. Symptoms common to all types of flu are fatigue, congestion, runny nose, fever and chills. But there are many types or variables. Each type depends on the nature of the External Causes and the interactions of your unique composition.
Lifestyle Factors: This includes dietary patterns, stress levels and stress management and excess or indulgence due to lack of moderation and discipline. For example, eating sweets and oily foods tends to generate Damp stagnation. Eating overly hot and spicy foods can increase internal Heat. Overeating Cooling or cold foods will slow down your Energy movement.
Intermediate Causes: At various stages, some diseases can create or generate disease-causing substances—such as stagnation of Blood and Phlegm— that cause other illnesses. Others are Internal Toxins, which are mostly due to abnormally accumulated metabolic waste. Much metabolic waste is toxic to the human body and needs to be regularly eliminated from the body. For example, according to Western medicine, urea is an end product of protein metabolism, and highly toxic to the body. It is eliminated through urination. If for any reason it becomes abnormally accumulated in the body, it will cause serious problems. Similarly, a patient with severe constipation can have headaches and mood fluctuations due to the reabsorption of toxins simply because the fecal matter stayed inside the body for too long.
Unforeseen Events: Illnesses caused by unforeseen events such as accidents and injuries are different from illnesses caused by External or Internal Causes for obvious reasons, but they can nonetheless cause severe damage to the structure and Energy of a healthy person. Therefore they are considered one of the causes of illnesses and can be treated based on exactly what is damaged.
Diagnosis in Chinese medicine includes an assessment of the Vital Substances that make up the human body: Yin, Yang, Qi, Jing (Essence), Blood, Fluid and Shen. Recognizing and identifying the patterns of imbalance or R disharmony is referred to as Bian Zheng, or Differentiation of Patterns of Disharmony. Bian Zheng is the most important process and method of diagnosis in Chinese medicine, during which doctors collect information and weave it into a meaningful pattern, and upon which the treatment is targeted. The Eight Principles of Differentiations are:
Yin, Interior, Cold, Deficiency
Yang, Exterior, Heat, Excess
The Cold and Heat here refer to Energetic temperature. They are the result of imbalances between Yin and Yang and are different from physical temperature.
The theories of Chinese medical diagnosis and treatments are founded on thousands of years of knowledge and experience. The Chinese method of diagnosis relies heavily on the senses, which is what makes the practice of Chinese medicine such an art. The more experience a doctor of Chinese medicine has, the more refined his or her senses become. The traditional Chinese medical diagnostic procedure follows what is called the Four Examinations: Inquiring, Looking, Listening/Smelling and Touching. The Four Examinations determine the pattern of harmony and disharmony. An examination will take between thirty minutes and one hour.
The Four Examinations
Inquiring: When you see a doctor of Chinese medicine, your evaluation will begin with in-depth questions about yourself, not just your current complaints or symptoms. The doctor will listen to you—which for many is perhaps one of the most appealing aspects of Chinese medicine. Chinese medicine believes that you are the best judge of how you feel, and values your symptoms as much as the physical signs.
The doctor of Chinese medicine will question you thoroughly about your main complaint.
How did your problem start? Is your problem consistent or intermittent? Has it been getting worse over time? Does it have a pattern? What makes your problem worse or better? Has your initial problem led to other symptoms or problems? How are you handling the problem emotionally?
How is your family's health? How is your parents' health? How is your grandparents' health? Are you aware of any family history of disease? These questions help to evaluate your constitutional strength or imbalance and dictate prognosis to some degree.
Do you have any children? This question can evaluate Jing (Essence) in certain situations, such as when an individual is having infertility problems.
How is your energy/vitality? This is to evaluate if your Qi is sufficient or deficient. People's Energy has differing patterns. Some people's Energy is better in the morning and goes down as the day progresses. Others have a hard time getting up in the morning, but their Energy picks up later in the day. These different patterns have significance in Chinese medicine. There are physical and psychological Energies. Even though they often go hand in hand, they can become independent of each other.
Does your body generally run on the Cold or Warm side? This question is directed at evaluating your Yin and Yang balance or imbalance. So that this question is not mistaken to mean fever or chills, your Chinese doctor will also ask: How many covers do you use at night? Do you dress warmly or coolly? Do you prefer warm weather or cool weather? Do you prefer warm drinks to cool drinks?
Do you feel thirsty or have a dry mouth? This question evaluates the level of Fluid. You can be thirsty and have a dry mouth, thirsty and not have a dry mouth or have a dry mouth and not be thirsty. Everyone is different, and these variables in dry mouth and thirst provide information about your particular Imbalance. Thirst and dry mouth are two different symptoms even though they often appear together. Different combinations of their presence can have different clinical meanings. For example, in certain types of Yin deficiency the patient can have dry mouth but does not want to drink.
Do you sweat easily? Do you have spontaneous sweating or night sweats? Do you hardly sweat at all? This question also evaluates the level of Fluid and balance between Yin and Yang, assesses the state of Wei Qi and can indicate imbalances with Energetic systems.
How is your breathing? Do you have any shortness of breath? Any cough? Any bronchial irritation? Any feeling of phlegm in your throat? Do you have to clear your throat? Do you have any wheezing? This question evaluates Lung Energy.
How is your appetite? Does food appeal to you? Do you have any cravings? Do you have any nausea, stomachache, heartburn? If you have stomach pain, does your pain have any pattern? Does food make it better or worse? Does physical pressure, such as massage, make it better or worse? Does applying heat help or make it worse? This question evaluates Spleen and R Stomach (digestive) Energy.
How is your digestion? Do you have any indigestion, gas and bloating, burping, abdominal cramping or distension? This question evaluates Spleen (digestive) Energy.
How is your diet? What do you typically eat? These questions evaluate your Energetic pattern of your food in relation to your constitution or your imbalances.
Are your bowel movements regular? Any diarrhea or constipation? Is your elimination complete? This question evaluates Stomach, Spleen and Intestine Energies.
Is your urination frequent? Do you have any irritation or pain? What is the color of your urine? This question evaluates the function of Bladder and Kidney Energies.
How is your sleep? Do you have any difficulty falling asleep or staying asleep? Is your sleep restful? Do you have nightmares? This question evaluates your Heart, Liver and Kidney Energies and your Shen.
How are your emotions and moods? How is your stress level? Do you experience any mood fluctuations? Do your mood fluctuations have any patterns? Do you feel irritable, anxious or depressed? This question evaluates your Heart, Liver and Kidney Energies and your Shen.
How is your sex drive? Has there been any change? Does sexual intercourse affect your energy level? Are you sexually active, and how often do you have sex? This question evaluates your Jing (Essence) and the level of your Kidney Energy.
How is your cognitive functioning? How is your mental clarity, concentration and memory? How is the speed of your information processing? How is your sense of centeredness? This question evaluates your Jing (Essence) and your Shen.
Do you exercise? What kind of exercise do you do? How much and how often? This question evaluates Qi, Blood, Kidney and Liver Energies and your Shen.
(If you are female) Are your menstrual cycles regular? How many days is your cycle? How long does your period last? How is the flow—light, moderate or heavy? Any clotting? Any abdominal cramping? Any PMS? This question evaluates Liver, Kidney, Blood Energies and your Shen.
Looking: The Chinese doctor also learns about you by observing your body build and body language, movement, appearance and complexion, behavior, tongue, eyes, ears, palms, hair, fingernails, tears, sweat, phlegm, nasal discharge, vaginal discharge, vomit, urine and feces. Traditionally, because Chinese homes did not have bathrooms with sinks and running water next to the bedrooms, people used chamber pots. In old times, doctors came to patients' homes, and it was natural for the doctor to examine the contents of the chamber pot. Today, when necessary, a Chinese doctor can ask a patient to collect a specimen. The doctor is also able to observe certain body fluids such as perspiration while examining a patient. In addition, your doctor will look at your Shen.
Since it is beyond the scope of this book to cover all of these areas, we will focus on observing the tongue, which is central to Chinese diagnosis.
Observing the tongue
Observing the tongue is one of the most important diagnostic methods of Chinese medicine. The doctor looks at the form, including the size and shape, color, texture, movement, coating and moisture. Tongue diagnosis takes a lot of experience and a trained eye. A healthy tongue is pink, neither too red nor too pale. It is not puffy or too thin. It looks flexible yet firm, straight and steady. It has a uniform, transparent thin white coating. It is moist but neither too wet nor too dry. It fits comfortably and moves freely within the mouth.
Some tongues are relaxed or steady and some tongues are edgy or quivery. Some tongues look fresh and pinkish, and some tongues look “old” or purple. There are, obviously, a lot of variables. Some abnormalities do not necessarily mean that there is a problem. Some imbalances are constitutional and define your unique constitution.
The first part (tip) of your tongue reflects the balance and imbalances of your Heart and Lung Energy. The middle part of your tongue reflects your Spleen and Stomach Energy. The back part of your tongue reflects your Kidney and Urinary Bladder Energies. Both sides of the middle section reflect the Liver and Gall Bladder Energy.
You may wish to learn the basics of tongue examination to observe on your own or to better understand what your Chinese doctor sees on your tongue. Begin by looking at your tongue in natural light. Keep your tongue relaxed.
Size and shape
Swollen, enlarged, puffy: Indicates Qi deficiency. Sometimes the tongue will be so swollen that it will have teeth marks or indentations along the edges. When Qi is deficient, Fluids accumulate abnormally, and the tongue is one of the first places where this abnormal accumulation of Fluids (Dampness) can be seen.
Flabby: Indicates Qi deficiency. Your tongue has a group of muscles that maintain a proper posture. When there is an underlying Qi deficiency these muscles lose their ability to maintain the muscle tone and your tongue becomes flabby, lies against your lower palate and becomes imprinted with teeth marks.
Hard or ridged: This is a sign of extreme Heat or Cold in an illness that is caused by an External Cause.
Small, thin: If your tongue is small, thin and pale then you are severely Blood and Qi deficient. If your tongue is small and thin but scarlet and dry then you are either severely Yin deficient or extremely Fluid deficient (dehydrated).
Small or shriveled: This is a sign of Yin deficiency.
Figure 6
Color
Red: Indicates Heat.
Pale: Indicates Cold or Blood deficiency. R 1L
Purple or dark: Indicates stagnation or excess Cold.
Texture
Old or aged: Indicates Heat or stagnation.
Tender or frail: Indicates Qi and Blood deficiencies.
Cracks or fissures: Indicates Yin deficiency.
Strawberry-like appearance: Indicates Heart or Stomach Heat.
Movement
Trembling: If your tongue is trembling and pale, you have Heart and Spleen Energy deficiency or Qi and Blood deficiency. If your tongue is scarlet and trembling, you have Heat that resulted in Internal Wind.
Off center to one side: Indicates Liver imbalance and/or Blood deficiency or both, which can lead to Internal Wind and stroke.
Darting: Can indicate either impending stroke or children who are cognitively underdeveloped (Jing and Shen deficiency).
Lolling: Indicates Qi exhaustion.
Coating
White coat: Indicates Cold or superficial illness.
Yellow coat: Indicates Heat or internal illness.
Gray coat: Gray and moist indicates Cold and Damp. Gray and dry indicates that Heat has damaged Fluids.
Black coat: Indicates extreme Heat or extreme Cold or extreme stagnation.
Thick coat: Indicates that the External Cause is more pronounced or the illness is more severe. When the coating changes from thick to thin, it means that the illness is resolving.
Thin coat: Indicates that the External Cause is less pronounced and the illness is mild. When coating changes from thin to thick, it means that the illness is progressing and becoming more severe.
Density: The degree of stickiness or denseness indicates the amount of internally accumulated Dampness. Peeled coat: Indicates Yin deficiency. A peeled coat is the area of the surface of the tongue that has a geographic look and where the texture of tongue underneath looks raw and without any coating.
Partially peeled coat: Indicates Qi and Yin deficiencies.
Wet coat: Indicates abnormal Fluid accumulation.
Dry coat: Damaged Fluid or Yin deficiency or excess Heat.
Evaluation of body language, posture and self-presentation
A person's body language reflects what is going on internally. Your Chinese doctor (like your Western doctor) will get a general impression of you by how you present yourself. Whether you are thin or heavy, slouched over or erect, pointed in your speech or mumbling, strong or weak, physically fit or out of shape, hyper or sedate are all factors that will give your Chinese doctor an impression of you as a whole.
Listening: Like your Western doctor, your Chinese doctor listens to the quality of your voice. Some people have big voices, some quiet, some clear, some hoarse. Some people articulate and are precise, others are scattered and fumble for words. The strength of your breathing, rhythm and rate are all important. Listening also includes the sounds of your digestive tract, heartbeat, coughing, wheezing, hiccups, burping, sniffling and sneezing.
Smelling: Smelling includes the detection of unusual odor not only from bodily discharge but also from the patient's breath and overall body scent.
Touching/Palpating: Touching as a means of diagnosing involves two methods. One method is to palpate the body. Certain information about the nature of the imbalance can be acquired through feeling the patient's temperature (hot or cold), muscle tone (hard or flaccid), moisture (clammy or dry), tenderness (whether physical pressure helps or aggravates pain or discomfort),any abnormal masses and around certain acupuncture points or along the fourteen Meridians.
Pulse
Another important method of diagnosis is taking the pulse. Traditionally in China, pulse taking is such a prominent diagnostic method that seeing a doctor is often referred to as “having my pulse taken.”
In Western medicine, the main purpose of pulse taking is to find out the pa-tient's pulse rate. In Chinese medicine, doctors look for much more than that. Pulse taking requires a great deal of training, experience and sensitivity.
The pulse is taken on both wrists, as each side reflects different aspects of the body. The pulse is taken at three different positions on each side along the radial artery near the wrist about one and a half to two inches apart—the width of the middle three fingers held snugly together. At each position, three different depths of pressure are exerted. This results in a total of eighteen pulses taken.
Aside from the pulse rate, the Chinese doctor also feels for the depth, strength, width, shape, rhythm and length of the pulse. Classically, there are twenty-eight pulse “characters.” Pulse character is the distinctive feel discernible by a trained practitioner, and gives a particular diagnostic significance, such as a strong or weak pulse.
The sixteen most common pulse characteristics are:
Floating or superficial pulse. Distinct or apparent at the surface, less so with moderate or deep pressure. Indicates early stage of invasion by External Causes.
Deep or sinking pulse. Only palpable at a deep level. Indicates the imbalance or disharmony is internal.
Slow pulse. Slower than normal rate. Indicates internal Cold.
Rapid pulse. Faster than normal rate. Indicates internal Heat or certain weaknesses.
Thin or thready pulse. Small in width yet distinct. This can also be described as narrow in width. Indicates Blood deficiency. Can also indicate Yin deficiency.
Large or big pulse. Broad in width yet distinct. This can also be described as wide in width. Indicates excess of any condition such as Heat, Cold, Qi or Blood or Phlegm stagnation, to name a few.
Empty pulse. Large but lacking strength. Indicates Qi and Blood deficiency.
Full pulse. Large yet forceful. Large refers to the width of the pulse. Forceful means the property opposite of weakness. So the full pulse is the combination of these two characters. Indicates pronounced excess of any condition, such as Heat, Cold, Qi or Blood or Phlegm stagnation, to name a few.
Wiry pulse. Feels taut and distinct. Indicates Liver Energy imbalance or pain or stagnation.
Slippery pulse. Feels slithery and fluid. Indicates excess of Dampness or Phlegm and Dampness.
Choppy pulse. Opposite of a slippery pulse. It feels catchy, scraping, rough and uneven. Indicates Blood stagnation or deficiency.
Tight pulse. Taut and full like a stretched rope. Indicates excess Cold, stagnation.
Soggy pulse. Soft and nebulous, lack of distinction. Indicates Qi and Blood deficiency/Damp accumulation.
Irregular/knotted pulse. Slow and skips beats irregularly. Indicates Heart Yang deficiency/Cold excess; Heart Qi and Blood stagnation.
Intermittent pulse. Skips beats at a regular interval. Indicates serious Heart disharmony. Depleted condition of all the Energetic systems.
Hurried pulse. Racing, skips beats irregularly. Indicates excess imbalance disrupting Heart, Qi and Blood.
Western medicine tends to value science above symptoms. Because Western medicine is a more crisis-oriented medicine, most diagnostic tests are designed to pick up the signs of acute illness. In diagnosing chronic illness, Chinese medicine has the advantage because it recognizes signs before an illness becomes a crisis and can therefore take steps to prevent that crisis.
When an illness occurs, even though it may appear that it affects a certain part or aspect of your body, it is really affecting you as a whole, and your body and mind react as a whole. Western medicine tends to focus on and identify the part of the body that is most affected. Yet the information your whole body gives out in reaction to an illness is different from the information extracted from a singular area. This information inevitably involves the combined reactions of all the parts that are affected, such as your organs, immune system, nerves, endocrine system and circulatory system, as well as your emotional and psychological reactions. This combined information contains the essence of your body's imbalance and is the basic content of the Zheng—the objective of Chinese medical diagnosis. While this information is valuable, so is the information garnered by Western medical technologies. By using both Western and Chinese diagnostic methods to gather different types of information, diagnosis and treatment would clearly be more effective and comprehensive. We can have a medical system that has the analytical power of modern technology combined with heightened sensitivity for human beings with all their complexities and subtleties.