Traditional versus modern Acupuncture

6. DIAGNOSIS IN TCM

TCM Diagnosis was based on four principles: looking, listening, feeling and smelling, i.e. on input signals from 4 of the 5 senses (sight, hearing, touch and smell).

LOOKING: The patient is inspected carefully for any abnormalities of gait, posture, swellings (oedema, inflammation etc), atrophy, muscle spasm, paralysis etc. Great attention is paid to the skin and face (colour, texture, sweat), ears (abnormal blotches, scales, flakes, papules), tongue (colour, saliva, coating) and iris. Colour and consistency of stools, urine and other secretions/excretions are noted.

LISTENING: The case history is taken. The emotions, symptoms and sounds (strength of voice, respiration, abnormal gut and joint sounds etc) are noted.

FEELING: The patient is palpated carefully to check skin temperature (hot or cold); variation in skin temperature, for instance one limb colder than the other; location of abnormal swellings, muscle tension, flaccidity; location of Ahshi (tender) points. Great attention is paid to palpation of the Mu and Shu points, the Xi, Yuan and Luo points. Tenderness at these points can indicate the COS involved.

Channel diagnosis by point sensitivity: In severe disorders of a Channel, many points along the Channel may show abnormal tenderness to pressure palpation, electric current or heat. This is especially true for the Ting (most distal) points at the nail of a toe or finger). Ting (Well, near the nail) point sensitivity is the basis of the diagnostic methods of Akabane (Japanese diagnosis by measuring heat sensitivity) and Voll (German electrodiagnosis). The Shu and Mu points may also be tender. Other important points (which may be tender in Channel disorders) lie below the knee or elbow: the Five Phase Points, the Luo, Yuan and Xi points.

Pulse Diagnosis is the ultimate in TCM diagnostic palpation. According to TCM, the pulse in the distal, middle and proximal positions on the left radial artery reflects the energy status of the SI, GB and BL Channels on superficial palpation and the HT, LV, KI Channels on deep palpation respectively. The pulse in the distal, middle and proximal positions on the right radial artery reflects the energy status of the LI, ST, TH Channels on superficial palpation and the LU, SP, PC Channels on deep palpation respectively. Porkert (1983) describes 31 different pulse types.

Some TCM practitioners claim to be able to make an accurate energetic diagnosis in human patients (which Channels are involved and whether they are hyper- or hypo-active) on the basis of Pulse Diagnosis alone ! However, many translations of Chinese medical AP texts ignore or pay little attention to the classical pulse types.

Classical Pulse Diagnosis is a controversial issue, even in China and Japan. Recent studies (doppler ultrasonography or use of pressure transducers to measure pulse characteristics) cast great doubt on the objective validity of Classical Pulse Diagnosis. Most veterinary AP texts ignore it. In my opinion, pulse diagnosis is not objective but some people can make accurate diagnosis by the Pulses by subjective (psychic, extra-sensory perceptive) means, as in medical radiaesthesia/medical divination and Extra-Somato Projection.

SMELLING: In TCM, the practitioner smells the breath, the skin and excreta of the patient. TCM attributes typical smells to various disorders. For instance, in Earth disorders (SP, ST, diabetes), there may be a sweet (ketone) smell; in Water disorders (KI, BL), there may be a putrid smell (uraemia, ammonia) etc.

The aim of TCM/TAP diagnosis is to establish (a) the nature of the disease in terms of the Eight Principles and the Six Evils and (b) the COSs involved.

Having assessed the patient by the four principles (looking, listening, feeling and smelling), the nature and location of the disorder is defined in traditional terms. Steps are then taken to remove or alleviate the cause, or to enhance the body's Wei (Defensive) Qi, or to re-balance any energetic imbalances which have been diagnosed.

TCM diagnosis was developed at a time when knowledge of internal anatomy and physiopathology were primitive. Millennia had to pass before the development of current western concepts of biochemistry, microscopy, immunology, bacteriology, genetics, Selye's concepts of the Stress Reaction, concepts of nutrition (mineral, vitamin and essential amino-acid imbalances etc) and biotechnology.

In spite of ignorance of modern medicine, the ancient Chinese had one very important concept: They knew that vital energy (Qi, Vix Naturae) was the key to health and recovery from disease; they taught that the body healed itself by its own natural defense systems; the aim in healing is to stimulate and enhance those mechanisms, thereby attaining balance (homeostasis).