CHINESE MEDICINE DIAGNOSIS
WHAT TO EXPECT ON YOUR FIRST VISIT
We hope you find this section informative. It was put together to educate our patients on how an acupuncturist will properly diagnose and treat disease. It is a great idea to review this information prior to your first treatment to get an idea of what to expect.
Practitioners of Chinese medicine use an entirely different model than western doctors to diagnose and treat various diseases. This holistic model is based on thousands of years of observation and experience, handed down through generations by some of the most brilliant minds in Chinese medicine.
Using tongue and pulse diagnosis, 8 Principle diagnosis (based on the theory of Yin and Yang) and the 10 Questions at the bottom of this page, a skilled acupuncturist can put together what we call in Chinese medicine, a pattern differentiation.
TRADITIONAL CHINESE MEDICINE
“A PART REFLECTS THE WHOLE”
Based on the strength of centuries of accumulated information and clinical experience, a acupuncturist can derive detailed information about the state of a whole organism, i.e. the human body, from examination of a small part of it. Pulse Diagnosis and Tongue Diagnosis and Auricular (Ear) diagnosis are perfect examples.
In a way discussing the clinical significance of an isolated symptom, such as back pain or insomnia, for example, contradicts the whole spirit of Chinese Medicine. That’s why we put all the signs and symptoms that we see before us during your initial visit and place them into a meaningful pattern of disharmony. No signs or symptoms can be considered in isolation. The essence of the process of diagnosing in this way and identifying the pattern of disharmony is that all symptoms and signs must be considered in relation to others.
So not only are we going to inquire about your back pain or your insomnia or whatever other symptom you are reporting, we are going to perform a comprehensive intake using The Four Pillars of Chinese Medicine Diagnosis to examine your body as a whole system. The Four Pillars are:
- Inspection (Tongue Diagnosis)
- Inquiry (10 Questions)
- Listening / Smelling (Observation of patient’s voice, scent and other perceivable and oftentimes subtle signs)
- Palpation (Pulse Diagnosis)
That is how we find the root cause of your problem. Finding the root cause and treating the root cause…that is how we truly heal!
According to the basic ideas underlying Chinese Medicine Diagnosis, practically everything regarding signs and symptoms, such as emotions, skin, complexion, bones, preferences, tongue, pulse, demeanor, smells, sounds, mental state, and body build reflects the condition of the internal organs and can be used in diagnosis. So in a sense we, as practitioners of Chinese Medicine, inspect the exterior to examine the interior of a human organism.
When you come for your initial visit, your acupuncturist most likely will look at your tongue, feel your pulse at various positions on the wrist and ask you 10 questions (see below) regarding your health.
TRADITIONAL CHINESE MEDICINE and TONGUE DIAGNOSIS
Chinese medicine practitioners believe the tongue is a veritable map of the entire organ and meridian system and can reveal a lot about your health. Chinese Medicine Tongue Diagnosis is an important part of the Chinese medical assessment. During your initial examination, and usually before each subsequent treatment, your acupuncturist will look at the overall tongue coating, shape, and color, and also look at specific areas on the tongue.
In Traditional Chinese Medicine, different areas of the tongue are believed to reflect the condition and overall health of the organ systems. If there is an unusual color, coating, and/or shape in a certain area of the tongue, a good practitioner will look to the corresponding organ system. Chinese Medicine Tongue Diagnosis can also be used to confirm a diagnosis and help provide a complete health assessment.
So take a look in the mirror at your tongue. What do you see? A normal tongue is pink (not red or pale), has a thin white coating (not a thick white or yellow coat, nor a completely peeled coat) and your tongue should not have any swelling on the sides or on the tongue body as a whole. There’s a lot more to it but that’s a start. When you come in for your first treatment we will explain tongue diagnosis in further detail.
TRADITIONAL CHINESE MEDICINE and PULSE DIAGNOSIS
Chinese Pulse Diagnosis is a powerful method of gathering information about the patient. The radial arterial pulse at the juncture of the wrist and forearm is typically used to make diagnostic assessments. Chinese Medicine Practitioners typically place three fingers on the radial artery just proximal to the hands. The fingers are used to palpate each location.
Each location is considered to represent a different organ and meridian system such as Lung, Kidney, Spleen/Stomach, Liver, and Heart. Distinctions are made such as rapid or slow, forceful or weak, deep or superficial, and hard to yielding. These distinctions represent the current state of the organ and meridian system being evalauted. An overall rapid pulse may indicate too much heat or an excess in the body, while a slow pulse may indicate a cold or deficient pattern. A deep and weak pulse in the Spleen/Stomach area may indicate Spleen Qi Deficiency.
As part of The Four Pillars of Chinese Medicine Diagnosis, Pulse diagnosis is combined with Tongue Diagnosis and the 10 Questions to put together a clear picture of the health of the patient.
THE 10 QUESTIONS RELATING TO CHINESE MEDICINE DIAGNOSIS
The following 10 questions are a primary focus in doing a good thorough intake. It is important to report any of these issues at your initial intake and if they happen in between visits. This information is organized to create a complete, accurate and comprehensive Chinese Medicine Diagnosis. Keep in mind, the success of your treatment depends upon accurate information regarding the subjects outlined below. Before your first treatment it is a good idea just to read through this section below and if anything stands out it should be reported to your acupuncture physician at the time of the initial exam. We realize that it is a lot of questions, but on the other hand, an accurate diagnosis equates to a quicker healing time. So reading through this section will definitely be of benefit.
1. YOUR CURRENT EMOTIONAL STATE
When a particular emotion is in excess, suppressed or unexpressed it can create imbalances. These imbalances bring about disharmony in the body that can lead to potential illness or disease. It is important to report if you have you been experiencing any of the following: frustration, resentment, rage, anger, outbursts of anger, impatience, depression, moodiness, grief, sadness, worry, unhappiness, irritability, feeling wound up, fidgetiness, uneasiness, despair, pensiveness, mental confusion, anxiety or mental restlessness, palpitations, heart racing, fear, shock or fright, obsessive thoughts or compulsions, over-excitement, fluctuation of mental state, uncontrolled laughter or crying.
2. WHAT IS YOUR CURRENT ENERGY LEVEL?
Do you feel sluggishness, lassitude, lethargy, fatigue, or mania throughout the day? What is your typical level of energy on a normal day? Are you currently living at a satisfying level of physical energy? Has your chief complaint, or secondary complaints, affected your normal level of daily activity? Does your energy level dip after eating a meal? At what time of day or night is your energy level highest? Lowest? Is there dizziness or heaviness (of the limbs or head) associated with the low energy level you are experiencing?
3. ARE YOU EXPERIENCING ANY TYPE OF PHYSICAL PAIN?
Your acupuncturist is looking for the location, onset, duration and nature of your pain. Where is the pain located? Is it in a fixed location? Is it in different areas on different days? Is it in the joints or the muscles? What brought on the pain (was it gradual or sudden)? When did it start and for how long have you been experiencing this pain (duration)? And what is the nature of the pain you are experiencing? Is the nature of the pain dull, sharp, cramping, numbing or burning? Does pressure or massage make it feel better or worse? Are you experiencing any numbness or dizziness associated with the pain? Is there swelling or inflammation or a feeling of heaviness associated with the pain? What makes it better or worse? Is it better or worse with rest or movement? Is it better or worse with warmth or cold applications?
4. QUALITY AND QUANTITY OF SLEEP
Your acupuncturist will want to know if insomnia is an issue (falling asleep and staying asleep)? Is the quality of your sleep satisfactory? Do you wake up refreshed or tired? What is the quantity (hours) of sleep you get and is it sufficient? Are you able to fall asleep, stay asleep and sleep well once asleep? Or do you wake often during night? Do you experience dream-disturbed sleep? If so, do you remember the content of your dreams? Do you wake early, unable to fall asleep again? Do you suffer from somnolence (excessive sleeping)?
5. CURRENT STATE OF APPETITE AND DIGESTION
An acupuncturist will ask important questions regarding your appetite or lack thereof, as well as questions regarding digestion, bloating, gas, food retention, taste, nausea and vomit. Is your condition relieved or aggravated by eating? Are you always hungry? Is there a feeling of fullness and distension after eating? Do you experience bloating, gas, or food retention? Is there a preference for hot food or cold food? What taste do you have in your mouth usually (sweet, sour, bitter, or salty)? Or do you have a lack of taste? What taste do you prefer? Do you wake up in the middle of the night to eat? Do you experience any of the following in excess: belching, hiccups, sighing, vomiting, acid regurgitation?
6. URINE AND STOOL
Information regarding urine and stool are very important in making an accurate TCM diagnosis. Anything significant should be reported to your acupuncturist. The following questions are usually reviewed during your intake.
Are you experiencing difficulty urinating or inability to urinate (retention of urine), burning sensation when urinating, inability to complete urination, dribbling, lack of force in urination, or enuresis/incontinence? Is urination frequent & copious (especially at night)? Or is it frequent & small in quantity? Is your urine very dark or very pale like water? Is there any pain before, during, or after urination? Is the color of your urine turbid/cloudy? Is the amount of urine large/profuse or scanty?
How often do you have a bowel movement and what is the color of the stool (dark brown, black, green, yellow, etc)? Are you experiencing any bouts with diarrhea and constipation? Is it an acute or chronic condition? Are you experiencing borborygymus (gurgling in the abdomen), or flatulence? Is your condition alleviated or worsened after bowel movement? If you are constipated, are the stools small and bitty? Are you experiencing infrequent dry stools with a sense of thirst? Are your bowel movements difficult but the stools are not dry? Is their abdominal pain associated with your bowel movements? Is their alternating Constipation and Diarrhea? If there is diarrhea is it with pain? Is it with foul odor or absence of odor? Is it urgent with a burning sensation in the anus? Is it daily in the AM? Is it with mucous, blood, or with undigested food? Is it black or very dark?
Your acupuncturist will ask questions regarding thirst to determine whether your disharmony is related to a Heat or a Cold pattern. The following questions are important: What is your level of thirst (absence of thirst to extreme thirst) and the amounts of liquids taken in daily? Do you desire hot or cold, or room temperature liquids? Do you have a thirst with no desire to drink? Or if there is a desire to drink but to do so by sipping liquids, especially warm liquids, rather slowly? Do you experience dry mouth or throat? What do you drink? Water? Tea? Soda?
8. CHILLS & FEVER
Chills and/or Fever can be related to interior or exterior patterns of disharmony in the body. Your acupuncturist will most likely ask you the following questions: Are you currently experiencing chills or fever? Chills as in feeling cold and having an aversion to cold. Covering up with blankets does not alleviate the problem. Fever as in a subjective sensation of heat rather than actual temperature. Are the chills and fever alternating, as in having chills for a period of time followed by fever for a period of time? Time of day or night is also important – do you have an afternoon fever or night fevers? Do you have a feeling of heat or cold in the 5 Palms (chest and soles and palms)? Do you have a feeling of heat or cold throughout the whole body? Accompanying perspiration with chills and/or fever is also significant. Are you perspiring with your chills and/or fever? Do you have cold limbs? Cold hands or feet? Do you have a feeling of heat or malar flush in the afternoon or evenings?
Sweating at inappropriate times may indicate disharmonies within the body. It is important to report to your acupuncturist if you experience Spontaneous Sweating, Night Sweating or Sleep Sweating, Profuse/Excessive Sweating? The existence of any type of sweating, the time (night sweats or daytime), the amount (profuse or absence of sweat), the location (area of body) and any accompanying symptoms are important to tell your acupuncturist.
A woman’s menses gives an acupuncturist a clear idea of the condition of her Qi & Blood. What is your cycle length? Do your periods come early, late, or are they irregular? Also take note of the following and report anything significant to your acupuncturist:
- amount of bleeding (Heavy loss, absence of blood, scanty periods, or abnormal uterine bleeding)
- color of blood (dull red (normal), very dark or bright red, pale blood, or purplish/black)
- quality of flow (congealed blood, watery blood, or turbid blood)
- pain (before, during, or after period) or other symptoms
- pre menstrual tension/irritability?
- vaginal discharge- take note of the color, consistency (watery or thick), and odor of your discharge
- pregnancy (fertility issues, miscarriages)
- childbirth (nausea and heavy bleeding, sweating and fever, postnatal depression after delivery)