Diagnosis in Chinese Medicine

Imagine a new patient sitting in an acupuncturist’s waiting room. She suffers from headaches and has been given a conventional medical diagnosis of migraine, and is taking medication prescribed by her GP.

Going into the treatment room, the TCM practitioner asks her many questions.

Firstly about the nature of the headaches: how long have been occurring, when she gets them, where on the head get them, how do they feel. After this has occurred the practitioner then asks them a whole range of things about her day to day health, both physical and emotional.

He then asks her to poke out their tongue which he observes carefully. He then asks her present her wrists and he then spends a minute or two pressing the wrists on both sides.

What is going on here?

Well traditional Chinese medicine is truly holistic in nature. By this we mean that when a patient seeks acupuncture or herbal treatment the TCM practitioner will look at every aspect of the patients’ health and well being and not focus on symptoms alone.  When we treat patients we are seeking to find a pattern of disharmony. A syndrome, in other words group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.

How TCM practitioners get to this point is called Bian Zheng Comprehensive diagnosis based on the analysis, identification, and differentiation of symptoms and signs according to the data collection from the four examination methods and basic Chinese medicine theories of viscera, meridian, and pathology.

The 4 elements Bian Zhen

• Questioning
• Observation
• Palpation
• Listening and smelling

Diagnosis by Questioning

This is perhaps the most important of the four methods. Traditionally there were 10 questions asked about bodily function. These were:

     i.        Temperature

    ii.        Perspiration

   iii.        Digestion

  iv.        Sleep/energy

    v.        Exercise

  vi.        Urination

 vii.        Thirst

viii.        Appetite

  ix.        Bowel function

    x.        Fertility and sexual function

Today many more questions are asked. The number of and diversity of questions asked is often quite surprising for the new patient.

Returning to the example of our lady with headaches, the TCM practitioner needs to know where the headache is on the head. What is the nature of the pain (distended, stabbing, dull, tight etc), when is it better and worse. Is it associated with other symptoms?

In this case she mentions that the pain is on the temple and is stabbing in nature. It can occur any time of the month but is worse before her period. Generally the patient says she is stressed and this makes her feel tired. Already the practitioner is leaning toward a diagnosis but needs more information to confirm this.

Previous medical and family history will also be taken into account

Diagnosis by Observation

Observation is both specific and general. General observation can be such things as the overall demeanor of the patient. Are they restless and fidgety?  Do they seem subdued? What is the complexion like? Is it red, pale, waxen?  Are there dark rings around the eyes? Etc.

There may be cause to look at specific things such as skin lesions, quality of the hair and nails etc.

One of the unique diagnostic methods in TCM is tongue diagnosis. We believe that the health of the body is reflected in the condition of the tongue.  Firstly is the body of the tongue a healthy colour. Too pale may indicate deficiency, redness may be heat, and purple/darkness may be stagnation. Is the tongue an unusual shape thick or thin pointed?

The tongue coating may indicate pathogenic states. A thick yellow tongue coat may be a sign of heat for example. Certain areas of the tongue also relate to the organ systems so cracks, spots, or other signs in a specific area may be clinically significant.

Returning to our imaginary patient she has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.

Diagnosis by Palpation

Often the Chinese medicine practitioners will physically examine a patient. Does a pain get better for pressure or is it aggravated. This might tell us if the problem is one of excess or deficiency. For the acupuncture treatment of pain the practitioner will seek out ashi (painful) points. Literally trying to pin-point the pain.

Next comes the taking of the pulse. This is felt on both wrists at three positions at three depths.  Traditionally the pulse was taken at various places about the body the throat or ankle for example. Today the pulse is only taken at the wrist. It is used to determine the current state of the organs and meridian function.  Basically the practitioner will seek to measure the speed and depth of the pulse and the relative force at each position.

There are 28 ways the pulse reflects pathological changes in the body correlated with Chinese medical pattern discrimination. These 28 pulse images are taught, like so much of Chinese medicine, using a yin-yang dichotomy. Thus we have the floating and deep pulses, the large and small pulses, the fast and slow pulses, the slippery and choppy pulses, the short and long pulses, etc. According to Hua Tuo, a late Han dynasty expert in Chinese medical diagnosis, the majority of these 28 pulse images can be grouped under four headings. These four headings are: floating, deep, fast, and slow. For instance, there are seven floating or superficial pulses: floating, vacuous, drum-skin, spring onion-stalk, scattered, soggy, and surging. The descriptions of these pulses are quite beautiful at times. The slippery pulse is likened to pearls rolling on a plate.  Our lady with the headaches has a choppy pulse one that feels like the back of a knife scraping along a piece of bamboo.

Diagnosis by Listening and Smelling

The TCM doctor might be interested in the Lung sounds, rattling of phlegm in the throat, the type of cough etc. There are more subtle things that may be heard. Each of the 5 organ systems has a particular voice associated with it. The Fire element voice is described as laughing the Water element as groaning.  This may not be quite so obvious and may show a general tendency to an element type. Smelling might relate to an overall breath/body smell or the smell of a particular discharge. Our patients’ voice seems to have a clipped shouting quality.

Bringing it all Together

If we look at what information we have gathered about our patient.

·        Migraine is on the temple and is stabbing in nature

·        It is worse before her period

·        She is stressed and this makes her feel tired

·        She has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.

·        Choppy pulse

·        Clipped shouting quality to voice.

These signs and symptoms all point to the TCM diagnosis of blood stagnation.  Points will be selected on the head because this is main area of complaint. In this case a point on the temple will be used. The main TCM organ/meridians involved are the Liver/Gallbladder/Triple heater and point from these channels are selected especially ones which move blood or Qi (chee) and or affect the head or temple.  A herbal formula that moves blood and sedates the uprising Qi is used and this is given daily.

The success of the therapy depends on the ability of the practitioner to find the pattern of disharmony . In this sense TCM is truly holistic, patients are assessed and treated individually not handed a universal treatment based on one complaint alone.

If you would like to find out how TCM could help you please call me on 07724 899 833 or email dudleykent@aol.com

Dudley Kent MBAcC MRCHM MRSS

Acupuncture & Chinese herbs in central London & Salisbury

www.city-acupuncture.com

Autumn Survival Guide: Protect your metal

At this time of year I often see many patients coming to the clinic with colds and coughs. In traditional Chinese medicine (TCM) the Lungs govern something called the Wei Qi. This is the TCM equivalent of our immune system. What you may not know that is that the Chinese have long said the autumn has a special affinity with your Lung meridian. In this guide to I would like to introduce that link and show you some tips to:

“Protect Your Metal”

In the Chinese tradition, the autumn is allied with the colour white, the sound of crying, the emotions of both bravery and grief, the lung organ, the metal element, and a white tiger. Autumn is also coupled in Chinese thinking with the direction west, considered to be the direction of dreams and visions.

The Autumn & The Metal Element from Sept 21 to the winter solstice of December 21

In all seasons change occurs. In the metal phase (autumn) a downward the amount of daylight lessens, days grow shorter, and energy descends back into the earth for the dormant cycle. Leaves fall from the trees, the last fruits ripen, and Qi energy contracts.

Preserving our Metal

In the season of autumn, the Metal element is at its pinnacle and particularly open to change. Luckily using Chinese medicine, we can revive and rebuild our metal element - in a physical and on an emotional level.

Acupuncturists often use points located on the Lung and Colon meridians (energy pathways) when treating the energy of the Metal element. Each of these points has a spirit and purpose, as do all of the acupuncture points on the body. When used at the right time, a point's effect is profound.

As well as using herbs and acupuncture to protect or Lungs understanding of the metal element means we can help ourselves.

The energy of this phase, more than any other, supports our letting go of waste. The organs of metal the Lungs and the Colon both are organs of elimination. It governs the removal of carbon dioxide from the blood, and waste from the colon.

Some form of gentle exercise that is focused on the breathing is excellent at this time of year to strengthen the Metal.

Tai Qi, Qi Gong, meditation and yoga can be excellent for this. Particularly when done early in the morning (between 3am-7am), as this is the time when the Lung & Large intestines are most active.

On an emotional level now this is a good time to be riding ourselves of the old and stale in our lives, leaving us open to the pure and new, giving us an idea of who we are in our essence. Autumn returns us to our core, moves us to eliminate what we no longer need, revealing what is most valuable in our lives.

Because white is the colour of autumn in the Chinese belief, light white candles against the rising darkness of the season, or put white flowers on your table.

Foods That Benefit the Metal Element

Grain: White, brown, and sweet rice

Vegetables: cauliflower, cabbage, Chinese cabbage, celery, daikon radish, onions, watercress, mustard and turnip greens, turnips, garlic, cucumber, leeks

Beans and Pulses: white beans

Fruits: Banana, pear, apples

Fish: Bass, snapper, cod, haddock, herring, flounder, sole, halibut

Herbs and Seasonings: dill, fennel, thyme, ginger root, horseradish, cinnamon, cayenne, basil, and rosemary

Introduction to the 5 Phases/Elements

The ancient Chinese understood the universe was in a constant state of change. They saw that things germinate and begin to expand (spring).  Grow and develop (summer) and they mature and ripen (late summer). They then begin to dry and wilt (autumn). They store and conserve (winter). For the ancient Chinese these five seasons (now called the five elements or five phases) were a constant sequence that continued endlessly. Each period of rest at winter was followed by one of new growth in spring. The 5 element/phases system is a traditional Chinese way of explaining the relationships and interactions between all natural phenomena. It is not just particular to Traditional Chinese medicine it is used to understand many different aspects of ancient Chinese thought and society, areas such as politics, astrology, martial arts, and music.

Each one of the phases has its own correspondences, these may be directions, sounds, colours, and importantly for medicine emotions, organs, body parts and tendencies to states of health and illness

	FIRE	EARTH	METAL	WATER	WOOD
Yin Organs	Heart	Spleen	Lung	Kidney	Liver
Yang Organs	Small Intestine	Stomach	Colon	Bladder	Gall Badder
Sense Organs	Tongue	Mouth	Nose	Ears	Eyes
Colors	red	yellow	white	blue/black	green
Sounds	Laughing	Singing	Crying	Groaning	Shouting
Emotions	Joy	Worry or Pensiveness	Grief or Sadness	Fear	Anger
Seasons	Summer	Late Summer	Autumn	Winter	Spring
Environment	Heat	Dampness	Dryness	Cold	Wind
Tastes	Bitter	Sweet	Pungent	Salty	Sour

To understand how the elements relate to each other we use two models. The generating cycle and the control cycle, which can be used to understand and treat element imbalances.

The Generating Cycle

The strength of an element is dependent of the strength of the previous phase. This is called the mother and child relationship. In TCM if an element is weak we often treat the weakened element and its mother element for added benefit.

As TCM (traditional Chinese medicine) practitioners we remember the generating cycle this way:

§  Wood feeds Fire;

§  Fire creates Earth (ash);

§  Earth bears Metal;

§  Metal carries Water (as in a bucket or tap, or water condenses on metal);

§  Water nourishes Wood.

The Control Cycle

This cycle is preventing one of the elements from becoming too dominant.

In the clinic we might see a patient with an excess of fire. The main fire organ is the heart which dominates the spirit. This might be seen in problems such as anxiety insomnia etc. To help this we might use points and herbs that benefit the Kidneys (the water organ) to balance out the excess fire.  Similarly an element can overact on another such as when wood over acts on earth, this is one of the most common 5 element diagnoses of IBS.

§  Wood Holds  Earth (such as roots; or, Trees can prevent soil erosion);

§  Earth channels Water (or an Earth dam can control water);

§  Water quenches Fire;

§  Fire melts Metal;

§  Metal chops Wood.