Diagnosis

The hallmark of professional Traditional Chinese Medicine is that treatment is based on “pattern discrimination” rather than disease diagnosis.  In Chinese there is a saying: “One disease, different treatments.  Different diseases, same treatment.”

During the initial consultation, the Chinese medicine practitioner gathers a great deal of information about all physical signs and symptoms, even those that don’t seem to be related to the chief complaint.  For example, a woman goes to a Chinese medicine practitioner seeking treatment for her migraine headaches.  The practitioner spends about 45 minutes asking her questions about all aspects of her health, including her digestion, her sleep, her energy, her menstrual cycles, her emotions, and many other things.  The practitioner also examines her tongue, takes her pulse, and observes her manner and appearance, such as her tone of voice, her body language, the color of her skin, and her body type.

This examination would probably reveal a number of signs that are very important to making a Chinese medical diagnosis, but that a conventional health care provider would probably consider “irrelevant”.  For example, in addition to migraine headaches, this patient might experience:

  • Irritability
  • Bloating after eating
  • Persistent fatigue
  • Seasonal allergies
  • Trouble falling asleep at night
  • Red eyes, itchy eyes
  • Dry mouth and throat
  • PMS, including tender breasts before menstruation
  • Painful periods
  • Vertical ridges on her fingernails
  • A bitter taste in her mouth in the morning

This information would lead the practitioner to diagnose the patient with Liver Qi stagnation, depressive heat in the Liver, and Spleen Qi deficiency (caused by wood overacting on earth).  Rather than treating migraine headaches, per se, the practitioner would proceed to administer acupuncture and herbs intended to resolve Liver Qi stagnation, clear depressive heat, and tonify the Spleen.  This may seem like a small distinction, but it is key.  By treating the pattern rather than treating the disease, the patient would be likely to experience resolution of all the “irrelevant” signs and symptoms listed above, while at the same time experiencing relief from the migraine headaches.

The interesting thing about this system of diagnosis is that a given pattern of disharmony does not result in the same disease diagnosis for all patients.  For instance, another patient diagnosed with the same pattern of disharmony (Liver Qi stagnation, depressive heat, and Spleen Qi deficiency) might come to the clinic complaining of irritable bowel syndrome, having never experienced a migraine headache in her life.  This patient would be treated in a way that is very similar to the treatment administered to the first migraine patient.  On the other hand, a third patient might come seeking treatment for migraines, but present with a set of signs and symptoms that leads to the diagnosis of another pattern of disharmony (and therefore a completely different treatment).  This is why the ancient texts said, “One disease, different treatments.  Different diseases, same treatment”.

I often have people call me or e-mail me to ask “Do you carry an herb that treats depression?” or “Which point do I press to get rid of a headache?” without realizing that they are asking a complicated questions.  In Chinese medicine, there are many herbs that treat disharmonies which can cause depression and many points that treat disharmonies that cause headaches, but there is no such thing as a “depression herb” or “headache point” that will be universally effective.  This is why it is important to seek consultation with a trained Chinese medicine professional before taking Chinese herbal medicine – only a practitioner can accurately pinpoint your diagnosis and prescribe herbs that will be appropriate for your particular case.

Tongue

According to Chinese medicine, examination of the tongue reveals information about the function of the internal organs.  The practitioner examines the tongue at each appointment to diagnose the pattern of disharmony and assess the progress of the treatment.  Specific things that the practitioner pays attention to include:

  • Tongue shape and size – Is it fat or thin, small or large?  Are there teethmarks on the edges (which suggest swelling)?
  • Tongue body color – Is it pale, red, orange, or bluish?  Is it especially red on the tip, or pale on the sides?
  • Tongue coat color and thickness – Is the tongue coat white or yellow?  Is the coat distributed evenly, or is it thicker on some areas and absent in others?  Is the tongue coat especially thick or thin?
  • Cracks – Are there any cracks on the tongue?  Where are they located?  Are they deep or narrow?
  • Does the tongue tremble?  Is it pulled to one side?
  • Are the veins underneath the tongue swollen or discolored?

Pulse

The pulse is also assessed at each appointment to make the initial diagnosis and gauge treatment progress.  According to Chinese medicine, there are 12 pulse positions and 28 pulse qualities.  Typically, the practitioner will feel the 12 pulse positions with the index, middle, and ring fingers simultaneously pressed on the wrist.  Each pulse position is associated with the function of a particular organ.

Pulse diagnosis is an art that takes many years to master.  Practitioners who are very adept at this practice often ask very few questions of their patients – they are able to pinpoint the problem using the pulse only.  One of my teachers in school was so adept at the pulse that he was able to accurately identify when stressful events had taken place in the life of a patient, or what the patient had eaten for dinner the night before, all on the basis of the pulse only.  Most American practitioners use the pulse as only one piece of information as they make a diagnosis or assess the status of treatment.

In addition to revealing information about the health of the internal organs, the pulse can be used by a skillful practitioner to diagnose pregnancy, determine the sex of a baby before it is born, or identify areas of pain.

Asking

As already mentioned, the practitioner must ask many detailed questions in order to arrive at an accurate diagnosis.  Many of these questions may seem irrelevant or very personal to a patient who is new to Chinese medicine.  For example, when treating a women’s health concern, the practitioner will usually ask many questions about the menstrual cycle, including:

  • If there pain with the period, and if so, where is the pain (abdomen, back, external genital area, etc.)?
  • How many days of bleeding are there?
  • How much bleeding is there?  How often do pads or tampons need to be changed?
  • What color is the blood (bright red, pink, brown, black)?
  • Are there clots in the flow?  If so, what size (pea, grape, golf ball, tennis ball)?
  • Is there a vaginal discharge at other times of the month?  If so, what color is it, what consistency, what does it smell like?

Also, the practitioner may ask detailed questions about digestion, sexual habits, and emotional life that may seem intrusive.  It is important to remember that the practitioner has “heard it all before”, that all the information will be kept confidential, and that the tiniest details may end up making an important difference in treatment.

Ear examination

Another diagnostic technique that some practitioners use is examination of the auricle (external ear).  In Chinese medicine, there are hundreds of acupuncture points on the ear, and stimulation of these points can be very effective for the relief of pain and other symptoms.  In addition, visible or electrical changes to the ear become apparent in many conditions.  For instance, areas of swelling, discoloration, flaking skin, or creases are representative of conditions in other areas of the body.  A crease on the ear lobe that starts at the base of the tragus and runs to the middle of the bottom of the ear lobe has been shown to be a better predictor of cardiovascular disease than many other tests, including blood cholesterol.  Examination of the auricle with a device that measures the electroconductivity of the skin surface can be used to pinpoint areas of current or past injury or disease.  Researchers have found auricular examination to be useful in the diagnosis of malignant tumors, tuberculosis, hepatitis, gall bladder disease, and gastritis.