Basic TCM Diagnosis consists of what is referred to as the Four Diagnostic Skills. These are observation, asking questions, palpation, and listening and smelling. Overview discussions and links to class notes are included below.
A person’s Shen or spirit has a lot to do with their health. A patient who has given up has a poor physical or disease prognosis. See pages 2 and 3 for what to look for in a person’s Shen.
How to classify and diagnose the body based on Yin and Yang characteristics, Five Element types, prenatal and postnatal influences, body build, and pain and drug tolerance. The discussion starts on page 3.
Reading the complexion can tell you a lot about a person’s diagnosis and differentiation. Physiological complexions have a dominant or native coloration and a guest coloring (which are influences from the environment). When a pathological condition is present, the face takes on coloring that help you define what is happening inside the body.
Wind can strongly affect the body and is associated with Liver, the element of wood. Wind in the TCM model can cause tremors of the head and limbs, neck rigidity. Wind pathologies can cause facial paralysis, twitching, and deviation of the mouth and eyes.
Notes on pages 1-3.
You can get a lot of information by looking at the condition of the skin on the face and head and by looking at the hair. Dandruff, hair loss, alopecia, even dry/brittle, and Professor Snape-like greasy hair can help you diagnose.
Notes on pages 3-4
Eye Observations or Five Wheel Diagnosis
Are you getting the idea that the whole body is talking to you at all times? That’s because it is.
Page 6 for more on that.
Did you know receding gums can indicate Kidney essence and qi deficiency? True story. Read on for more.
Notes on pages 6-7.
Notes on pages 7-8
Notes on page 8
Notes on page 9
The visible blood vessel on a child’s index finger can give you a lot of information for children 3 years old or less. You will need to know the specifics of the index finger diagnosis and what the colors mean. The colors you find here are different than the five element chart and different from adult diagnosis. Memorize this. You’ll often get a couple of questions about it on your tests and boards. See the end of page 9 and the top of page 10 in the above-linked document.
Tongue Observation and Diagnosis
Pay close attention to this one. The tongue body, tongue coating, and sublingual vessels can give you a wealth of information you need for diagnosis. Pulse and tongue are two of the primary methods we use for diagnosis. With practice, you can often look at the tongue, take the pulse, and ask people questions based on what you observed about things they didn’t think to tell you. That surprised look on their faces when they think you’re some kind of ninja is just awesome.
Notes for diagnosing using tongue observation are found in Class 4 and Class 5.
Also known as interviewing, asking questions help you get information from your patient about what they would like help with. Interviewing is more than a collection of questions. It’s an art form. Read the material provided about interviewing your patients and practice on everyone who will let you!
Class 6 & Class 7 are the class notes about interviewing skills.
While pulse diagnosis is the most common form of palpation you will find in most TCM schools, it is by no means the only form of palpation. Palpation of skin and muscle, hands, feet, chest, and abdomen are all part of TCM also. Though it isn’t covered in the notes, I routinely palpate the channels to find lumps, bumps, depressions, and temperature changes, all of which tell me a lot about how Qi is flowing in the channels.
If you feel like you can’t feel much when you take pulses, don’t feel alone! You have to feel a LOT of pulses for this to start making sense. Once I was out of school, I stopped using traditional wording to describe the pulses in my charts and realized I was actually understanding a lot more about pulses as I kept feeling and making detailed descriptions. Keep trying, keep feeling pulses, and know this can take a lifetime to master!
My final gift to you on pulses:
Notes from Class Pulse Seminar with Dr. Will Morris
This is truly excellent material. Don’t skip it. It could make a lot more of this clear for you.
Palpation of skin, muscle, hands, feet, chest, and abdomen.
Notes start on page 3.
Listen for the sound of the breath, wheezing, coughing, the timbre and pitch of the voice, and more. Smell your patient’s breath (there are ways to do this in a non-creepy manner!). Listen for speech that doesn’t make sense, for mumbling, and for dissonant answers. If something smells or sounds jarring, pay attention and explore further.