Many new patients often ask what we are looking for when we take pulse and tongue and how we select our acupuncture points for each treatment. This post is intended to answer these questions and more as we walk through the general process of diagnosis and acupuncture point selection.
The Chinese medicine diagnosis process is broken down into what are collectively called the “four pillars” of diagnosis. These four are looking, listening, question asking and palpation (touch). Each practitioner and style of acupuncture might have some variations about how they go about incorporating these “four pillars” in the clinic, and some might put more emphasis on one pillar over another, but ALL acupuncturists should be using a combination of these methods in practice regardless of style and training. This is a methodology that is so crucial to the medicine that it is considered one of the defining foundations of acupuncture practice. It is important to distinguish Chinese medicine diagnosis from Western medicine diagnosis. Legally, an acupuncturist is unable to diagnose a according to Western medicine unless one is licensed as an MD, so it is important for all acupuncturists to be well versed in the four pillars even if the patient comes in having already been given a diagnosis from a conventional medicine practitioner. The terminology we use, and how it guides our treatment, is unique to our medicine. For example, when your acupuncturist says “Liver,” they may or may not be referring to your physical liver. In Chinese medicine the “Liver” means three things- 1) the physiological functions associated with the Liver according to Chinese medicine theory. 2) The acupuncture channel/meridian called the Liver. 3) The actual organ. Thus, when referring to the Liver of Chinese medicine we often use a capital L to distinguish it from the liver of biomedicine so as to prevent confusion when writing about the two.
The first of the four pillars is looking, or observing the patient. This happens the minute the patient comes into the clinic as we first observe the gait and then the eyes as the come closer as we greet them. The classics our medicine state that the shen (spirit) is best observed in the eyes. In fact, the medical classics also go so far as to say the eyes can give us an indication as to the prognosis of the patient as well. If the quality of the shen is very weak, the prognosis is poor for the patient being able to heal quickly or fully recover, where as prognosis for quick recovery or full healing is greatly increased if they person has good shen in their eyes. Other things we observe are the skin color and tone, the nails, the lips and the tongue. Since many people ask what we are looking for in the tongue, I will tell you that we look at the color, coat, shape and for other abnormalities like cracks, bumps, and deviation of the tongue.
Listening/ Question Asking
The part of the initial treatment that often takes the most time is the conversation we have before the actual treatment. For Chinese medicine practitioners, listening carefully to your story and asking many questions is a primary way we gather information to determine our Chinese medicine diagnosis and the point selection for treatment. We do a detailed initial intake asking many questions about the chief complaint as well as gathering information about different bodily systems to try and obtain the whole picture. The intake form for new patients also includes gathering information such as family health history, any medications, surgeries, or other things that may be impacting your current situation.
All this information is very important, so don’t forget to mention something even if it seems trivial or unrelated to your primary reason for coming! The more information the better, as it gives us more to work with for the purpose of diagnosis and treatment. Information is to INFORM us of what is going on inside your body. Question asking is a real skill, and the best doctors know how to ask the right questions to obtain pertinent information for the case.
In classical Chinese pulse diagnosis we look for much more than in Western pulse taking. Yes, we do observe the speed and if it is regular or irregular like Western doctors do, but we also look for quite a bit more. This is why we feel the pulse on both wrists, not just one. We are feeling 6 different positions and at 3 depth levels. And we are not feeling only for rate and rhythm but particular qualities all of which have their specific meaning in the diagnosis. Chinese medicine has over 25 different pulse qualities!
Many Acupuncture practitioners utilize abdominal palpation. This is especially popular in Japanese styles, as originally only blind people were allowed to practice acupuncture in Japan, thus extra emphasis was placed on palpation of the body since the blind are unable to use the observation of the patient to obtain information. When palpating the body, we look for masses, tender spots, temperature changes and other factors that help diagnosis excesses and deficiencies of the channels, organs and other layers of the body.
So, now you hopefully have better insight into what it is we are doing when we assess you before we stick you with the needles. Hopefully, this information is helpful and answers some of the burning questions you have about the whole acupuncture process. Also, don’t forget to tell us if you ate or drank anything that might affect your pulse or tongue, such as coffee, candy, curry, etc. Changes in medications are also important to mention not just for contraindications of herbs, but also because it can affect the pulse and tongue.