Click the above “Public Account” to subscribe!
In TCM clinics, it is common to see a scene where a patient, after sitting down, immediately extends their arm and says, “Doctor, please check my pulse to see what illness I have.”
Is TCM diagnosis solely reliant on pulse taking? Not at all. TCM emphasizes the concept of “Four Diagnostic Methods,” of which pulse diagnosis is just one. Relying solely on pulse taking during clinical diagnosis is far from sufficient. Below, we will detail the four diagnostic methods of TCM.
The so-called four diagnostic methods of TCM refer to Wang (Observation), Wen (Listening), Wen (Inquiry), and Qie (Palpation). These methods were proposed by the ancient Chinese physician Bian Que based on the experiences of his predecessors. At that time, Bian Que referred to them as “observing color, listening to sounds, writing images, and feeling pulses.” The earliest existing theoretical work of TCM, the Huangdi Neijing (Yellow Emperor’s Inner Canon), states: “What is the diagnostic method… by feeling the pulse’s movement and stillness, observing the five colors, and examining the excesses and deficiencies of the five organs, the strengths and weaknesses of the six fu organs, and the state of the body, one can determine life and death.” This shows that diagnostic methods are a comprehensive approach to examining the human body to assess health and disease status. The four diagnostic methods of TCM have been used to this day and are an important basis for diagnosing diseases and formulating treatment plans.
Wang (Observation)
Wang refers to using the eyes to observe, including examining the body shape, mental state, complexion, tongue, and excretions, to understand the patient’s condition. Long-term practice in TCM has proven that there is a close relationship between the external body and the internal organs, especially the face and tongue. Therefore, through external observation, one can understand the overall pathological changes, as stated in the Huangdi Neijing: “By observing the external, one can know the internal, thus understanding the disease.” Observing the overall condition includes four aspects: observing spirit, color, shape, and state. Observing local conditions includes examining the head and face, five senses, neck, body, limbs, and skin. Observing the tongue includes examining the tongue body and coating, while observing excretions includes examining secretions, vomit, and excretions. Additionally, pediatrics has a specialized diagnostic method, which is to observe the child’s index finger pulse.
For example, in observing color, if a patient walks into the clinic and the TCM doctor sees their complexion is yellow and dull, it indicates that the patient may have spleen deficiency and insufficient qi and blood. Similarly, in observing the tongue, different individuals have different tongues; if the tongue coating is thick and yellow with peeling, it is evident that the patient has an excess of damp-heat and insufficient stomach yin.
Wen (Listening)
Wen includes listening to sounds and smelling odors to understand health status and diagnose diseases. Listening to sounds refers to examining the patient’s breathing, coughing, vomiting, sneezing, bowel sounds, and other noises. Smelling odors refers to detecting various smells emitted from the patient’s body, secretions, and excretions. The various sounds and smells of the body are produced during the physiological activities and pathological changes of the internal organs, reflecting their physiological and pathological changes. For instance, if a patient has a heavy, muffled cough, it often indicates a condition of phlegm-damp obstructing the lungs due to cold. Additionally, if one enters a sickroom and smells a rotten apple-like odor, it is often seen in severe cases of diabetes.
Wen (Inquiry)
Wen is a clinical information collection method involving direct verbal communication between the doctor and the patient, playing a crucial role in the diagnostic process. Many aspects of the disease, such as medical history and family history, can only be obtained through inquiry. Understanding these situations provides reliable evidence for the doctor to analyze the condition, determine the location of the disease, and grasp its nature, thus facilitating accurate diagnosis and treatment. Especially when the patient has not yet shown objective signs and only has subjective symptoms, it is only through inquiry that the doctor can grasp the clues of the disease and make a diagnosis. The TCM “Ten Inquiry Song” summarizes the content that needs to be inquired about in great detail, and it is one of the essential songs that every TCM practitioner must know.
Qie (Palpation)
Qie means to touch, approach, and press. Qie refers to the method where the doctor uses their fingers or palms to touch, feel, and press certain parts of the patient to understand their condition and diagnose diseases. As one of the four diagnostic methods of TCM, palpation plays a very important role in obtaining health and disease information and acquiring important diagnostic data. Palpation includes pressing and pulse diagnosis.
Pressing refers to the doctor examining the patient with their hands to determine whether the body parts are cold or hot, moist or dry, soft or hard, and whether there is tenderness, swelling, or other abnormal changes, thus inferring the location, nature, and severity of the disease.
Pulse diagnosis, commonly referred to as feeling the pulse, involves the doctor using their fingers to press on the superficial arteries at specific locations on the patient to perceive the pulse’s characteristics and understand the body’s condition. TCM believes that the blood vessels connect the entire body, linking the internal organs and the exterior. The heart governs the blood vessels, and the heart’s yang energy can promote the movement of qi and blood within the vessels. Therefore, the pulse can reflect comprehensive information about the functions of the internal organs, qi and blood, and yin and yang. Historically, there have been many methods for pulse diagnosis, with the three most widely used being the three positions and nine pulses method, the three positions method, and the cun-kou method. Currently, the most commonly used in clinical practice is the third method. Pulse diagnosis has been emphasized by TCM practitioners throughout history, and its theory and application have continuously developed and improved, forming one of the most distinctive diagnostic methods in TCM.
Wang, Wen, Wen, and Qie are the four methods of TCM for investigating and understanding diseases, each with its unique role and cannot replace one another. Diseases are complex processes, and their clinical manifestations can vary in many aspects. If only a single diagnostic method is used, it may lead to incomplete diagnostic information, which in turn affects treatment decisions. Moreover, the four diagnostic methods of TCM have a complementary and corroborative role. To fully understand the condition and ensure the accuracy and comprehensiveness of clinical data, all diagnostic methods must be organically combined; observation should include listening, listening should include inquiry, and inquiry should include palpation. It is not sufficient to rely solely on one diagnostic method to determine the disease. If a doctor is particularly fond of a single diagnostic method such as palpation or observation, or has research or expertise in it, it is certainly commendable. However, to adopt one method while neglecting the other three, or to replace the four methods with one, is not acceptable. Only by achieving “Four Diagnostic Methods in Harmony” and comprehensively examining the patient’s condition can a correct diagnosis be made.
Written by｜Li Guangyu, Beijing Hospital of Traditional Chinese Medicine, Chinese Academy of Traditional Chinese Medicine
Edited by｜Xu Jing
Reviewed by｜Ma Jun, Bai Xiaoyun
