In Traditional Chinese Medicine (TCM) clinics, it is common to see the following scenario: as soon as a patient enters and sits down, the doctor will ask you to extend your arm and then begin to take your pulse.
Many people may wonder, is pulse diagnosis the only method for diagnosing in TCM? The answer is no. TCM emphasizes the “Four Diagnostic Methods,” of which pulse diagnosis is just one. Relying solely on pulse diagnosis is far from sufficient in TCM clinical practice.
Below, we will provide a detailed introduction to the four diagnostic methods in TCM.
What are the Four Diagnostic Methods in TCM?
The Four Diagnostic Methods in TCM refer to observation (望, wàng), listening (闻, wén), inquiry (问, wèn), and palpation (切, qiè). 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 taking pulse.”
The earliest existing theoretical work in TCM, the “Huangdi Neijing” (黄帝内经), states: “What are the diagnostic methods… observe the pulse’s movement and stillness, examine the essence and brightness, assess the five colors, observe the excess and deficiency of the five organs, the strength and weakness of the six fu organs, and the state of the body to determine life and death.”
It is evident that these diagnostic methods provide a comprehensive examination of the human body to assess health and disease states. The Four Diagnostic Methods in TCM have been used to this day and are an important basis for diagnosing diseases and formulating treatment plans.
01 Observation (望诊, wàng zhěn)
Observation, as the name suggests, involves using the eyes to look, including observing 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 appearance of the body and the internal organs, especially the face and tongue. Therefore, by observing the external features, one can understand the overall pathological changes, as stated in the “Huangdi Neijing”: “Observe the external manifestations to know the internal organs, thus understanding the disease.”
Observation of the whole body includes four aspects: observing spirit (望神, wàng shén), color (望色, wàng sè), shape (望形, wàng xíng), and state (望态, wàng tài).
Observation of local conditions includes observing the head and face, five senses, neck, body, limbs, and skin.
Observation of the tongue includes examining the tongue body (望舌质, wàng shé zhì) and tongue coating (望舌苔, wàng shé tái).
Observation of excretions includes examining secretions, vomit, and excrement.
Additionally, in pediatrics, there is a specialized diagnostic method, which is to observe the child’s index finger pulse (望小儿食指络脉, wàng xiǎo ér shí zhǐ luò mài).
For example, in observing color, if a patient enters the clinic and the TCM doctor sees a yellowish, dry, and dull complexion, it indicates that the patient may have spleen deficiency and insufficient qi and blood.
Similarly, in tongue observation, different individuals have different tongues. If the tongue coating is thick and yellow with peeling, it is evident that the patient has internal damp-heat and also a deficiency of stomach yin.
02 Listening (闻诊, wén zhěn)
Listening involves hearing sounds and smelling odors to understand health status and diagnose diseases.
Hearing 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 odors of the human body are produced during the physiological activities and pathological changes of the internal organs, reflecting their physiological and pathological states.
For example, if a patient has a heavy, turbid, and muffled cough, it often indicates a pattern of excess due to cold phlegm and dampness accumulating in the lungs, leading to the lung’s failure to disperse and descend. Another example is the odor in the sickroom; if one enters the ward and smells a rotten apple-like odor, it is often seen in severe diabetes.
03 Inquiry (问诊, wèn zhěn)
Inquiry is a clinical information collection method involving direct verbal communication between the doctor and the patient, playing a very important 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, grasp the nature of the disease, and subsequently provide a differential 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 Questions 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.
04 Palpation (切诊, qiè zhěn)
Palpation means to touch, approach, and press. Palpation is a method where the doctor uses fingers or palms to touch, feel, press, and apply pressure to certain areas of the patient to understand the condition and diagnose diseases.
As one of the Four Diagnostic Methods in TCM, palpation plays a very important role in obtaining health and disease information from the patient and acquiring important differential diagnostic data.
Palpation includes pressing (按诊, àn zhěn) and pulse diagnosis (切脉, qiè mài).
Pressing refers to the doctor examining the patient with their hands to understand 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 taking the pulse, involves the doctor using fingers to press on certain superficial arteries of the patient to feel the pulse’s characteristics and understand the body’s condition.
TCM believes that the blood vessels connect throughout the body, linking the internal organs and the exterior. The heart governs the blood vessels, and the yang energy of the heart can promote the movement of qi and blood in the vessels. Therefore, the pulse reflects 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 (寸口诊法, cùn kǒu zhěn fǎ). Currently, the most commonly used in clinical practice is the third method.
Pulse diagnosis has been emphasized by many TCM masters throughout history, and its theory and application have continuously developed and improved, forming one of the most distinctive diagnostic methods in TCM.
Conclusion
Observation, listening, inquiry, and palpation are the four methods used in TCM to investigate and understand diseases, each with its unique role and cannot replace one another.
Disease is a complex process, and its clinical manifestations can vary in many aspects. If only a single diagnostic method is used, it may lead to incomplete differential information, which in turn affects treatment decisions.
Moreover, the Four Diagnostic Methods in TCM have a complementary and corroborative role. To fully understand the condition, ensure the accuracy and comprehensiveness of clinical data, all diagnostic methods must be organically combined: observation should include listening, listening should include inquiry, inquiry should include palpation, and one cannot rely solely on one method to diagnose a 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 rely on one method while neglecting the other three is not acceptable.
Only by achieving “Four Diagnostic Methods in Combination” and comprehensively examining the patient’s condition can a correct diagnosis be made.■
Source: Official account of China Traditional Chinese Medicine News, Guangdong Traditional Chinese MedicineEditor: Xu ZhenrongProofreader: Wu HanchunReviewer: Lu Yuxiang
