DIAGNOSIS IN TCM
A completely different system of medicine
For a TCM trained practitioner, the aim of the case history taking and clinical examination is the same as that of his Western counterpart: to arrive at a diagnosis, which then leads to various treatment options. However, there are significant differences between the two approaches. The TCM doctor sees the patient as a whole - the whole body, the mental and emotional state, the work and home environments, and lifestyle factors such as diet, exercise and recreation. In addition, the basic paradigm of TCM is considerably different to that of Western biomedicine: the anatomy, physiology and cosmology diverge so far, that it is sometimes difficult to reconcile the two approaches.
However, we must always remember that our particular world view and our understanding of the human body are based on various theories that have changed considerably over time. If you compare the type of medicine that was practiced in the 17th century, there is very little resemblance to modern day medical science. However, TCM has had consistent theoretical and practical foundations for the past 2,000 years or more, and good clinical results have been, and are still being achieved by this type of medicine.
Diagnostic methods of TCM
The traditional diagnostic methods of TCM are fourfold: Inspection; Inquiry; Auscultation and Olfaction; Palpation. Inspection or visual examination consists of observing the patient’s vitality and overall appearance, complexion, physical condition, behavior, tongue, bodily secretions and excretions. Inquiry, or interrogation, involves asking the patient (or companion) about the history of the disease, the history of the patient’s life and family, his own subjective sensations and emotions. Auscultation involves listening to the voice, speech, respiration, cough and respiratory sounds, abdominal sounds and other abnormal sounds such as hiccoughs, belching, sighing and sneezing. Olfaction involves the assessment of the patient’s bodily odor, and the odor of the bodily secretions and excretions, or the patient’s reported observations of the same. Palpation consists of the examination of the pulse as well as points or areas on the abdomen and the back.
Importance of the Tongue and the Pulse
TCM practitioners pay particular attention to examination of the tongue and the pulse. The inspection of the tongue provides much clinical significant information, such as the state of the Qi (normal or deficient), state of the Blood (normal, deficient or stagnant), disease location, and nature of the pathogenic factors (e.g. Hot, Cold, Damp, etc.). However, the information gained from observing the tongue is very rarely used in isolation; it is generally considered together with the presenting signs and symptoms, the pulse and the patient’s history.
Bilateral examination of the radial artery at the wrist is the other unique component in the art of diagnosis in TCM. This is a diagnostic method whereby meaningful clinical data can be gained from a careful and systematic palpation of the radial artery, which is supported by over twenty centuries of traditional practice. Pulse taking may reveal such information as location of the disease, state of the Qi (normal, deficient or stagnant), state of the Blood (normal, deficient or stagnant), nature of the pathogenic factors (e.g. Hot, Cold, Damp, etc.), and internal organ systems affected.
Unique nature of TCM Diagnosis
Once sufficient information has been gathered, the TCM doctor puts it all together to diagnose the location and nature of the disorder together with the underlying dynamic causes. This is generally described in terms of a syndrome or pattern of imbalance, e.g. in a patient complaining of a cough the diagnosis might be ‘cough due to Lung Yin deficiency’ or ‘cough due to Phlegm and Heat congestion of the Lung’. Following on from this particular example, the treatment protocol with Chinese herbs would include the selection of specific herbs that alleviate coughing (being careful to select ones that do not have a warming action, in these two cases) together with herbs that balance and assist healing of the Lung. In addition, various dietary and lifestyle recommendations will be given to promote and assist the healing process.