There are many TCM diagnostic techniques to draw from when you are diagnosing a patient’s problem. We rely on several and combine them to get a cross reference and a fuller picture of what is happening for our patients.
Begin your study with the basics – observation, listening, smelling, asking questions, and palpation (which includes pulse taking as well as palpating the channels and the body).
All of these tools can be used to arrive at a diagnosis and differentiation. Diagnosis refers to the name of the problem or the patient’s chief complaint such as “headache” or “nausea.” Differentiation is the underlying reason that the chief complaint exists in the first place – what caused the chief complaint. There may be a number of differentiations for a diagnosis. A headache, for instance, could be caused by dampness or by Liver Yang rising, or by blood stagnation. TCM diagnostic techniques help you define the reason for the problem and create a working plan of treatment.
Basic TCM diagnostic techniques covers the Four Diagnostic Skills….which encompass a whole lot of other skills under this umbrella. Here’s a basic overview of what you can expect.
Using your own sense organs to gather data about a patient. This includes looking at their demeanor, watching how they walk, looking at complexion and body type, observing the eyes, and more.
Interview skills you need to get the information to help you make a good diagnosis. Why don’t we just rely on the interview? Because patients are always accurate or forthcoming about the information we need. That’s why we combine this with other less subjective methods for gathering data.
Palpation comes in many forms. The most prevalent one you will study at first is pulse taking. For some people, this comes fairly easy. For the rest of us, it takes a lot of practice and a lot of time feeling pulses before it starts to come together. Honestly? It’s a life-long skill. If you have difficulty with it at first, you are definitely not alone!
But palpation of the pulses isn’t the only thing we do. Palpation of the body and the channels can give you worlds of information about what is happening beyond the skin.
Listening and Smelling
Fun fact: Did you know that Western docs also used these skills until the advent of medical technology? True story. My mom once worked for an eye/ear/nose/throat specialist who graduated from med school in 1910. He relied heavily on listening to how a patient spoke and coughed, what their phlegm smelled like, and more. Good skills to have.
There are several diagnostic models presented in the material linked above. None of them is the “right one.” You chose one or more of them depending on the situation you are facing.
The Eight Principles
Awesome when you’re stumped. Helps you understand whether the disease is hot or cold, yin or yang based, deficiency or excess, interior or exterior. I defaulted to this when presented with a WTH?! case in clinic. Helps you hone in on which direction to go. The Eight Principles are outlined in the following notes: Part I (starts on page 2 of the class notes), Part II.
Eight Principles Quick Reference Chart
This is the TCM go-to for most schools. Once I got into my own clinic I found that Zangfu is excellent for herbal diagnosis and treatment, but not always the best for determining acupuncture treatment. You’re heavily tested on it though…you need to know it and have it down cold.
The Six Stages or Six Channel Theory
Crafted by the fabulous Zhang Zhong-jing in the Shang Han Lun, the Six Stages define the progression of a disease through the body and refers to “cold diseases,” diseases that are characterized more by cold than hot. Many of the elegantly simple formulas Zhang Zhong-jing outlines are still in use today.
The Four Levels
The Four Levels describe the progression of a “warm disease,” a disease characterized by more warm/hot than cold. These often start with symptoms of a wind-heat invasion. Like the Six Stages, it’s an excellent model for epidemic disease.
The San Jiao Model
San Jiao refers to the three divisions of the body – the Upper Jiao, Middle Jiao, and Lower Jiao. This model describes the progression of a disease from the Upper to the Lower.
What is not covered in these classes are meridian and channel theories which help a great deal with musculoskeletal pain and other issues. Master Tung and balance method theories rely more heavily on meridian and channel theories as well.