Traditional Chinese Medicine Diagnosis

Use of Touch in Traditional Chinese Medicine Diagnosis

Whether your pulse races or slugs along, a practitioner can determine your health.
Whether your pulse races or slugs along, a practitioner can determine your health.

The use of touch in making a diagnosis in Chinese medicine is integral. The art of touch in traditional Chinese medicine is highly sophisticated and includes the palpation of areas of pain and diagnostic points and the reading of the patient's pulse.

For example, an area of the body that feels hot to the touch is experiencing a heat condition, while a place that is cold to the touch is under the influence of cold or dampness. Tumors or swellings that are hard with a well-defined border are due to blood stagnation, while soft nodules with an indistinct border are a result of qi or phlegm stagnation.

Diagnostic points on each acupuncture meridian can be palpated to assess the condition of an internal organ. When there is an imbalance in the organ, the point is painful or has a flaccid feeling. For example, there are points on the back known as transporting points, each one corresponding to an internal organ. If an imbalance occurs in one of these organs, the transporting point for that organ might be tender or sore.

The treatment would include needling that point in order to heal the organ that is associated with it. The Japanese have also developed a highly sophisticated system of abdominal palpation; entire books have been written on the subject.

By far, the most important form of palpation in Chinese medicine is the art of pulse diagnosis. This highly sophisticated system provides abundant information about the entire body, and it can easily take an entire lifetime to become truly proficient in this ancient diagnostic method.

In an ideal situation, the pulse is taken in the morning while the person is still calm and rested. In actuality, however, the procedure usually takes place in the clinic during the initial interview. It is important to let patients who have just arrived rest for a while to allow the pulses to settle down. Otherwise, it would be easy to mistake a rapid pulse for a heat condition when it is actually due to the person's hurrying to make the appointment. This is one situation when sitting in the waiting room is to the patient's advantage!

Although the pulse can be felt in a number of locations, the primary location is at the radial artery in the wrist. Each wrist has three positions that correspond to different organs. The left wrist corresponds to the heart, liver, and kidney yin. The right wrist gives information about the lungs, spleen, and kidney yang.

These six positions are also felt at three different depths: deep, middle, and superficial. In addition to the information that can be gleaned from these 18 locations, the experienced practitioner can identify 28 different types of pulses. It's not hard to understand why it takes a lifetime of practice to become truly proficient at pulse-taking.

A normal pulse is strongest at the middle depth. In patterns of deficiency, the pulse is only palpable at the deepest levels. A person fighting off a cold will have a strong pulse at the superficial level due to the defensive qi rushing to the surface of the body. This "floating" pulse is fairly easy for a beginner to identify, and it can be very useful clinically.

Many times, this pulse appears a couple of days before a person experiences any cold symptoms, making it possible to practice early intervention. Since a rapid pulse is a sign of heat and a slow pulse is a sign of cold, a floating, rapid pulse occurs if the condition is a case of wind heat. In this case, the pulse is also strong, since wind heat is an excess condition. A weak pulse, on the other hand, indicates a deficient condition. For example, a person with kidney yang deficiency has a deep, weak pulse, especially in the area on the right wrist that corresponds to kidney yang.

Since learning the pulses requires hands-on experience, a detailed description is beyond the scope of this book. In a clinical setting, however, students are trained to discern the following types of pulses: floating, sinking, slow, fast, empty, full, wiry, slippery, flooding, hollow, leather, soggy, hidden, confined, moderate, choppy, knotted, intermittent, hurried, spinning bean, tight, sick, scattered, small, minute, short, long, and frail.

Each one of these pulses is associated with a variety of imbalances, and an experienced practitioner can learn an enormous amount of information from the pulse alone. In clinical practice, however, the physician always combines the pulse information with the whole picture derived from looking, listening, smelling, and asking. Through this process, traditional Chinese practitioners are able to accurately diagnose the patterns of imbalance in their patients without the help of laboratory tests or expensive diagnostic equipment.

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Bill Schoenbart has been practicing traditional Chinese medicine (TCM) since 1991, when he earned a Masters degree in TCM. He teaches TCM medical theory and herbalism at an acupuncture school in California, and also maintains a clinical practice.

Ellen Shefi is a licensed massage technician, licensed acupuncturist, and registered dietician. She is a member of the American Association of Acupuncture and Oriental Medicine, the American Herb Association, and the Oregon Acupuncture Association.