Monday, November 23, 2009


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.

Mary Ellen Velahos L.Ac., Dipl. Ac.
The Center For Acupuncture and Traditional Medicine
8 Cynwyd Road, Suite 102
Bala Cynwyd, PA 19004
United States
610-668-1338 - phone