In ancient dramas,
whenever there is a scene of seeing a doctor,
the first thing the doctor does upon entering is almost always
↓ ↓ ↓
That’s right, it’s taking the pulse!
Infected with wind-cold? First, take the pulse.
Poisoned? First, take the pulse.
Wondering if there is joy? First, take the pulse.
Dizzy and lightheaded? First, take the pulse.
……
△ Scene of Xu Xian diagnosing pulse in the TV series “The Legend of the White Snake”
Is it true that TCM diagnosis relies solely on pulse-taking?
Actually, it is not.
Traditional Chinese Medicine emphasizes the “Four Diagnostic Methods,” of which pulse diagnosis is just one. Relying solely on pulse-taking is far from sufficient in TCM clinical diagnosis and treatment.
So the question arises:
What are the Four Diagnostic Methods in TCM?
Let’s get to know them: Observation, Listening, Inquiry, Palpation
The so-called 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 sound, 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, observe the five colors, and assess the excess and deficiency of the five organs, the strength and weakness of the six fu organs, and the prosperity and decline of the body, to 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 differentiating syndromes.
Observation (望诊, wàng zhěn)
Observing facial color and tongue coating
Observation, as the name suggests, involves using the eyes to see, including observing the patient’s physique, mental state, complexion, tongue, and excretions, to understand the condition of the disease.
Long-term practice in TCM has proven that there is a close relationship between the external body and the five internal organs, especially the face and tongue. Therefore, through external observation, one can understand the overall pathological changes, just as the “Huangdi Neijing” states: “By observing the external, one can know the internal organs, thus understanding the disease.”
For example, according to the principle of the “Five Colors Diagnosis” in TCM, green indicates liver disease, red indicates heart disease, yellow indicates spleen disease, white indicates lung disease, and black indicates kidney disease. If a patient’s complexion shows any of these five colors, it may indicate an issue with the corresponding organ. When a patient enters the consultation room, if the TCM doctor sees a yellow, dull complexion, they may suspect that the patient has spleen deficiency and insufficient qi and blood.
Similarly, regarding tongue observation, under normal conditions, the tongue should be light red. If the tongue coating is yellow and thick, with peeling, it indicates that the patient has excess damp-heat and insufficient stomach yin.
Listening (闻诊, wén zhěn)Listening to sounds and smelling odors
Listening involves both hearing sounds and smelling odors to understand health status and diagnose diseases. Various sounds and odors from the human body are produced during the physiological activities and pathological changes of the internal organs, reflecting their physiological and pathological changes.
Hearing sounds refers to examining the patient’s voice, speech, breathing, coughing, vomiting, sneezing, bowel sounds, and other noises, mainly distinguishing between cold, heat, deficiency, and excess based on the volume, pitch, and clarity of the sounds. For example, a loud voice indicates that the righteous qi is not deficient, belonging to an excess or heat condition; a heavy and muffled voice indicates an external invasion of wind-cold and unexpressed lung qi; a low and short voice with little energy indicates deficiency of the middle qi.
Smelling odors refers to detecting various odors emitted from the patient’s body, as well as odors from secretions, excretions, and the environment. The odors of the diseased body are mainly due to pathogenic toxins affecting the internal organs, qi, blood, and body fluids, producing foul qi. Therefore, different odors can help distinguish the cold, heat, deficiency, and excess of the internal organs. For instance, if one enters a sickroom and smells an odor similar to rotten apples, it is often seen in severe diabetes.
Thus, various sounds and odors from the human body reflect the physiological and pathological changes of the internal organs.
Inquiry (问诊, wèn zhěn)Asking about lifestyle and symptoms
Regarding inquiry, there are many relevant records in the “Huangdi Neijing,” such as: “Whenever one wants to diagnose a disease, they must ask about diet and living conditions.” “One must carefully inquire about the onset of the disease and the current symptoms, and then take the pulse accordingly.” This lays the foundation for inquiry in TCM.
Because TCM emphasizes syndrome differentiation and treatment, even for the same disease, different treatment methods may be required for individuals with different constitutions. Especially for many aspects of the disease, such as medical history and family history, only through inquiry can this information be obtained. 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 differentiate syndromes and treat accordingly. Thus, inquiry holds a very important position in the process of disease diagnosis.
In the Ming Dynasty, Zhang Jingyue summarized the main content of inquiry into “Ten Questions” and composed a song for it: “First ask about cold and heat, second ask about sweating, third ask about head and body, fourth ask about bowel movements, fifth ask about diet, sixth ask about chest and abdomen, seventh ask about deafness, eighth ask about thirst, and so on. The ninth question is about old diseases, and the tenth question is about causes, also considering medication changes.” This is one of the essential songs every TCM practitioner must know.
Palpation (切诊, qiè zhěn)Diagnosing pulse and pressing the chest and abdomen
Palpation refers to contact diagnosis. Palpation includes the well-known pulse diagnosis, which is the “taking pulse” mentioned at the beginning, as well as pressing on the affected areas for diagnosis.
Palpation involves the doctor using their fingers or palms to touch, feel, press, and apply pressure to certain areas of the patient to understand the condition and diagnose the disease. 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 gathering important syndrome differentiation data. Palpation includes pressing diagnosis and pulse diagnosis.
TCM believes that the pulse is the vessel of blood, and the qi and blood of the five internal organs circulate through the blood vessels. When the body is stimulated by internal and external factors, it inevitably affects the circulation of qi and blood, leading to changes in the pulse. Based on this, the doctor uses their fingers to palpate certain superficial arteries of the patient to feel the pulse’s characteristics, thus understanding the body’s condition.
Historically, there have been many pulse diagnosis locations, with the three most widely used methods 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 many generations of TCM practitioners in long-term medical practice, and its theory and application have continuously developed and improved, forming one of the most distinctive diagnostic methods in TCM.
Pressing diagnosis refers to the doctor examining the patient by touch to determine whether the affected area is 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.
Observation, listening, inquiry, and palpation encapsulate the essence of thousands of years of Chinese medicine. They are the four methods 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. Relying solely on one diagnostic method can lead to incomplete syndrome differentiation information, which in turn affects treatment decisions.
Moreover, the Four Diagnostic Methods in TCM have a mutual reference, supplementation, and verification effect. To fully understand the condition and ensure the accuracy and comprehensiveness of clinical data, all diagnostic methods must be organically combined. When observing, there should be listening; when listening, there should be inquiry; when inquiring, there should be palpation. One cannot rely solely on one diagnostic method to determine the disease. Only by achieving “Four Diagnostic Methods Combined” can one comprehensively assess the patient’s condition and make an accurate diagnosis.
ENDProfessional Review | Chen Fuqing, Associate Chief TCM PhysicianIllustration | Li LijingEditor | Li LijingProofreader | Shen XiaoxianPublished by | Chen Yaoshan
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Renai, Hezhi, Jingqin, Chengjin