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THE OUTSIDE IS THE INSIDE:
Diagnosing in Traditional Chinese Medicine
By: MaryEllen Velahos
Many sources date the practice of acupuncture at around 5,000
years old. While it is a very effective modality it is surprisingly low-tech in
its techniques. Needles have evolved from the stone chards of antiquity
to the sterile single use stainless steel filaments that we use today but by
and large we are using the same techniques of diagnosis and treatment as
described in the Nan Jing text of 2,500 years ago. As a practitioner of
Traditional Chinese Medicine (TCM), I find the most challenging aspect of this
profession to be in diagnosing the nature of a patient’s disorder. This
challenge is what makes practicing Chinese medicine so exciting. While the
nuances of diagnosis can take a lifetime to perfect, there is a simple
principle that can say it all – the outside is the inside. In
other words, what we see and feel on the outside of the body is a reflection of
the condition and functioning of the internal organs.
We have several basic techniques to assess a patient and
your acupuncturist has probably briefed you on these techniques. We
examine the tongue, take pulses and ask questions based on what we see.
By examining the tongue we can see the condition of all the internal organs.
Before the advent of MRIs, blood testing and EKGs, Chinese physicians were
looking at the color, shape and coating on the tongue and gaining knowledge
about the health of any particular person that could rival some of the most advanced
diagnostic tools of the 21st century. The tongue of a healthy
toddler has the ideal qualities (color, shape, texture) of a healthy tongue and
healthy internal organs. The conditions that vary from that ideal would
be clues to the health or disease of any patient. Is the coating on the
tongue too thick? Perhaps the patient suffers from a digestive
imbalance. Is the tongue swollen with teeth marks or scallops around the
edges? The spleen energy system could be in a weakened state. Is
the color of the tongue scarlet red, pale and whitish or more purple
tinged? All of this is information for the TCM practitioner to use in
order to assess the overall condition of the patient.
Along with assessing the tongue we also take pulses at each
wrist. Like allopathic physicians, we check the rate of the pulse, but
that is just one aspect of our assessment. We feel to see if it is too hard or
too soft. Does the quality of the pulse change with light pressure or
disappear when pressed? Is the pulse felt deep within the wrist or more
active at the top layer of the skin? Chinese pulse taking involves
feeling the quality of the pulse at twelve different areas of the wrist – six
on each side. Each pulse point that we “listen to” represents one of the twelve
interdependent energy systems that flow through the body and keep it in working
condition. When the energy systems are flowing freely and completely, we
have health. When there is a deficiency or excess or blockage in one
energy system, it can affect all of the systems. It is the job of the TCM
practitioner to figure out where the imbalance lies. We then correct it
by inserting tiny acupuncture needles at the appropriate areas and restoring
healthy function of the energy system. Once the energy meridian is
corrected, the body is in condition to restore itself back to proper operation.
In addition to pulse taking and tongue diagnosis, we also ask
questions about all of the bodily functions even when they don’t seem related
to the reason for the visit to the acupuncturist. We are interested in
all of the products and by-products of the human body – what color is the
urine, what is the quality of the bowel movements – are they too hard,
too soft, not complete enough? What is the quality of sleep? Excessive
and vivid dreaming can indicate problems with the digestive process.
Difficulty in falling asleep indicates a different type of disorder than
difficulty in staying asleep.
Once we have all the information from our diagnostic exam we
can formulate our diagnosis. Diagnosing a patient according to principles
of Chinese medicine can identify disorders - called patterns, with names
such as Liver Qi (pronounced chee – this is the energy that flows
through the meridians that run up and down on the whole body like electrical
cords that contain an energy stream) Stagnation or Kidney Yang
Deficiency. This does not necessarily mean that the liver or kidneys have
a disease. The name of the pattern identifies that the energy system that
is imbalanced. It has the name of Kidney energy system or Liver energy
system because it passes through or energizes the kidney or the liver.
For example, someone who comes to the clinic for chronic headaches may find
that their TCM diagnosis is Liver Qi Stagnation. Obviously, a headache
does not happen in the liver but the meridian of energy that passes through the
actual liver of the body does also run through areas of the head and when it is
imbalanced a headache can result as the symptom. Once we use needles to
correct the function of the Liver Meridian – often placed in the foot and leg –
we can cause the energy to move in the correct way so as to relieve the pain in
the head. Many patients are surprised to find that while they come to the
acupuncture clinic for a problem that exists in their abdomen or head we may
actually insert needles in the ankles or foot or knees to heal them.
What I have presented here is a very simplified version of what we
do as TCM practitioners. It should serve to explain why Traditional Chinese
Medicine is a holistic system that can heal the whole body, mind and spirit and
bring about true holistic health.