The Four Ways Chinese Medicine Detects and Diagnoses Your Qi Needs

Chinese medicine relies on four specific forms of intake to determine diagnosis: looking, listening, asking and feeling the pulse.

From there, we properly select the right combination of acupuncture points, specific to each individual’s needs. Each treatment is totally individualized and constitution-based, and considers what the patient’s Qi properties are on the very day they come in, at the very moment of treatment. 

What does “constitution” mean in TCM?

Constitution-based treatment is a form of personalized medicine related to the concepts of TCM. Your constitution is your whole body’s own unique print, like a fingerprint. No two people have the exact same one.  

A person’s constitution is affected by acquired factors such as diet, environment, emotions and lifestyle, as well as genetic factors, meaning inherited traits. A TCM practitioner will use a patient’s constitution as a way to understand their individual body condition, which changes over time. It helps us better understand why they are more prone to certain diseases but not others, and the factors associated with the exact timing of an acquired ailment. 

There are a total of nine major classifications for types of constitution: neutral, Qi deficient, yang deficient, yin deficient, phlegm and dampness, damp heat, blood stasis, Qi stagnation and special constitution. I’ll write about these more in a future post! For now, what’s important to know is that this fundamental concept lays the foundation for a TCM practitioner to offer precise diagnosis, treatment and disease prevention advice.

Qi is always in a state of flux, so having the proper tools for diagnosis is very important in making sure we offer you the appropriate treatment for your body’s needs in that moment. Your needs will vary depending on what you have been experiencing in terms of stress, changes in your immediate environment, how you slept the night before, what you ate for breakfast or the night before... basically, anything that creates a shift in your routine and surroundings. All of these things need to be taken into consideration. 

Chinese medicine diagnostics is structured to get a full picture of your health—physically, emotionally, mentally and spiritually. Your quality of life is of paramount importance. 

Let’s talk about those four diagnostic tools!

First, the TCM practitioner looks at and inspects the patient.

TCM practice uses observation of the patient's appearance to determine the patterns and development of illness. We pay attention to the patient’s walking gait—is there a limp or reduced balance? We look for things such as: Do they have a glowing complexion, bright eyes and healthy skin? Or do they have damaged skin and dull eyes? What about the quality of their hair and nails? We assess a lot with observations even before our interaction has started, and before we even ask the first question. 

In TCM, we understand the five sense organs of the face as a reflection of the five major inner organs. The eyes relate to the liver, the ears associate with the kidneys, the tongue represents the heart, the nose is the lungs, and the lips correspond to the spleen. Just by looking at the face, we can identify any health problems that are internal. Don’t wear makeup when you see your practitioner! 

A bit later in the appointment, we also look at the tongue. The tongue is a vital area for diagnosis; it’s an aid that gives us information similar to what you might get through a gastroscope in Western medicine. Each part of the tongue relates to different internal organs, while changes to the colour and coating of the tongue help us to understand how well the digestive system is working.

Second, the TCM practitioner listens and smells.

We call these approaches auscultation and olfaction. 

Auscultation means listening to the patient’s voice for signs that indicate Qi strength or weakness. A patient’s voice can change according to their immune system and may sound hoarse from phlegm, or have a form of loss from too much talking. Auscultation also helps to better identify areas from their daily routine: for instance, does the patient spend most of the day projecting their voice over a phone or in a classroom? 

With olfaction, we smell. If a patient has poor digestion or has been mentally taxed, that can lead to bad breath, which is a manifestation of imbalance. Also, certain body odours can determine if a patient has a issue with perspiration or hot flashes. Some odours can be detected coming from your pores if you have been eating way too much garlic or going through a detox. Smell says it all! If you were smoking, I can smell it a mile away! 

The smell factor may seem a bit gross if you’re used to a more distant clinical approach, but in TCM we understand the importance of paying attention to everything the body is saying, not just the signals we can detect from five feet away. 

Third, we ask the patient questions.

Asking questions shows the practitioner’s human concern, their empathy and interest. It helps the patient to relax so they don’t feel they are at a scary doctor’s visit. Questions are part of the detective work the practitioner does to align your concerns and the information you provide with the physical signs we’re observing. This process is very important in helping us draw on a larger picture while using the other areas of diagnosis to confirm what the treatment will be. 

We’ll always ask about your daily routines, such as sleep, diet and work schedule. Other examples of questions would include: 

·      What time do you go to bed and wake up? 

·      Are you aware of how your body is responding to stress?

·      How’s your energy level after 2:00 p.m.? 

·      When was your last menstrual cycle? 

·      Have you done any recent traveling or have you moved recently? 

·      What have you had to eat in the last three days?

·      If you are experiencing pain, can you describe the location and the factors that help or make it worse? 

Each question guides the direction of treatment. And most importantly, verbal communication helps us show compassion to our patients. Sometimes, when we start talking together, that in itself creates an ease and a comfortable, safe place for healing. These types of information in combination help us understand where imbalance is rooted.

Lastly, we take your pulse. 

Pulse is the essence of TCM as well as a distinguishing feature for diagnosis. We don’t use it to determine your heart rate, blood pressure or beats per minute the way you might be used to at your family doctor’s office. Instead, we assess the shape, contour and fluidity of the pulse. We analyze the pulse on three levels: superficial (Qi), middle (blood) and deep (root yin). 

Beyond that, the pulse on each side of the body also represents the energy of three different organs. The left side represents the heart (the distal position), liver (middle position) and kidney yin (proximal position). The right side represents the lung, spleen and kidney yang. 

All together, these combined factors give us 28 different types of pulse to choose from, and each one of them means something different about your state of health. I’ll write more about pulse another day—there’s lots to say and it’s fascinating stuff!
These four methods add up to precise TCM diagnosis.

Every detail of your daily life will contribute to your state of health, and the signals that your everyday experiences leave behind help us diagnose disease. The magic of TCM is that it captures the tiny changes in people. It’s a direct, fast, convenient approach for understanding a person’s individual situation, even before the symptoms present themselves, and it gives us the chance to bring the body back into good health before you have to fight serious illness. These precise diagnostic tools make it all about your Qi, not anyone else’s!


The Qi FactorJulie Amarkey