As my education progresses, Oriental medicine continues to reveal to me more and more methods and perspectives of extraordinary perception into a person’s being. I’ve been learning a detailed system of pulse diagnosis and asking diagnosis in school; I just came back from an extracurricular training in Japanese meridian therapy that involves significantly more emphasis on sensation of qi (or ki, as it’s called in Japanese), and various other methods of diagnosis. The totality of it is staggering to me.

So, to help organize it in my own mind, I’ve decided to present a brief little introduction to Oriental diagnostic methods, so far as I’ve experienced them in my brief sojourn into the medicine.

Oriental medicine rests on what is called the Four Examinations, or the Four Pillars of Diagnosis. They are:

1. Looking
2. Listening/Smelling
3. Palpation
4. Asking

However, it gets much more in depth than this! There are many, many systems and microsystems that can be examined and plundered for information, and all of them rest on the assumption that the microcosm reflects the macrocosm. That is, that a small area, like the ear or the pulse, is a holographic representation of the larger whole of the human body. This means that nearly any part of the body can be an image of the entire body. The methods that I list here are only a few of the major ones.

(Click on the images to enlarge.)

1. Looking

One thing that almost everyone has at least amateur training in is diagnosis of the face.

The simplest way I’ve learned to diagnose from the face is simply to notice the color on a face. However, even this simplicity is deceptive, because colors usually do not stand out in stark contrast. There are many subtle shades that layer themselves simultaneously in a face. This means that it requires a lot of visual sensitivity to see that color!

Often, the system I just learned teaches to look at color between the eyebrows and around the mouth, primarily.

Each color is associated with one of the Five Phases (Wood, Fire, Earth, Metal, and Water), and thereby indicates a disharmony in an organ system.

Along with color, the luster of the skin is also noted.

Things can get much more complicated, though, because every individual feature of the face indicates something about the health of the body. Large ears, for instance, indicate robust Kidney qi, and since the Kidneys in Oriental medicine are the root of one’s constitutional energy, that means that you were born with a lot of energy to spend, so to speak. Every feature correlates with something. The eyebrow area represents the Liver/Gall Bladder, the nose represents the Lungs, etc.

But one of the confusing things about Oriental medicine is that the same face can provide different information, depending on the map you’re using. For example, in addition to representing the Lungs, the nose can also represent the whole spine, and bumps along the nose can indicate where the spine is out of whack.

Additionally, there are whole systems of interpreting character from the face. For instance, a cleft in the chin is associated with a strong desire to be noticed. I see this a lot on Hollywood actors and actresses.

Face reading can reach even to the eerie realms of fortunetelling. Dr. Shen, whom I mentioned recently, was a master at this, and combined with the pulse, could sometimes tell someone within minutes of meeting them that they had had a traumatic experience at a certain age.

Dr. Shen is the only one from whom I have heard of examining the sclera, looking at the veins under the eyes, which can tell you what side of the body has had trauma, whether there is toxicity present, etc.

Of course there is iridology, which I haven’t learned but certainly seems to fit in this category.

Another microsystem is the ear. One of my instructors at school has made the ear his specialty, and can tell instantly by looking at the ear where someone has pain, where a woman is in her menstrual cycle, etc. The whole body is often treated through the ear, using needles or seeds.

As you can see from the image, in this case the whole body is represented according to the image of an upside-down fetus mapped onto the ear, with the navel right in the center.

But to make things more complicated, there is yet another system of looking at the ear that looks at the outer edge of the ear as representing events that happened in childhood. So if you have any notches at the edges of your ear, those represent traumatic events at particular ages in your life.

One of the most important methods of looking diagnosis in mainland Chinese medicine is the tongue. Many, many details of the tongue are examined, including qualities such as:

• Color
• Size
• Shape
• Depressions, swollen areas
• Enlarged papillae
• Moisture
• Thickness and color of coating
• Movement

I’m not entirely sure why the tongue became so crucial to the mainland method, yet is virtually unexamined by other styles (such as Worsley Five Element Acupuncture); possibly because it more directly represents the energy of the digestive system, which is more relevant to the mainland Chinese emphasis on herbal medicine.

2. Listening/Smelling

The voice is classified into roughly five types — shout, laugh, sing, weep, groan — according to the Five Phases. Clearly this type of diagnosis can be rather vague and general unless something is more pronounced; but then again, the more pronounced it is, the more the associated organ system is considered to be out of balance.

Actually, even with a little bit of practice it becomes not only easier but common sense to know that when someone has kind of a wheeze or a weep in their voice, their Lungs (Metal phase) are weak and they may be holding onto some grief; and when there’s a forceful shout in their voice, their Liver, associated with the Wood phase and with the emotions of anger and frustration, is out of balance.

Smelling is classified with Listening as one of the “Four Pillars,” probably because most people don’t or can’t specialize in this. You can’t exactly sniff your patients very closely. It just provides another piece of the puzzle.

Interestingly, though, I know of at least one practitioner out in California who has trained dogs to detect the odor of people who have cancer, and has had very accurate results.

I’m sure tasting has had a history of diagnosis — the ancient Greeks noticed that the urine of diabetics tasted sweet, and I’ve read that Tibetan physicians taste urine as part of diagnosis. But I think I won’t be going that far!

3. Palpation

The pulse has been the single most emphasized diagnostic method at the school I attend, which is interesting considering that I’ve met other acupuncturists who claim that the pulse is not very valid or that they literally spend five seconds on the pulse. I have a hard time gathering enough information in ten minutes! But I guess that just indicates that I’ve learned a very different style of pulse.

Actually, there have historically been many different kinds of pulse diagnosis. The most widely practiced pulse system and the pulse system I’m learning are only two. But all of them run, once again, on the principle that the microcosm reflects the macrocosm, and that a window into organ functioning.

The picture on the left depicts six positions (three on each side) and two different depths or pressures at which you access the pulse, the superficial and the deep. This is the standard for many pulse diagnostic systems. Classically there are 28 different qualities that can be found on the pulse.

This is mostly consistent with the simple system I just learned that accompanies Japanese meridian therapy.

The other system that I’ve been learning, however, incorporates those six pulse positions plus something like seventeen other positions. There are not three but eight depths, and not 28 but maybe over a hundred qualities.

These systems all yield different information, and I’m learning to appreciate them. The latter allows piercing insight into the whole organism, from physiological to psychological. The former gives a broad view of the character of the organism at its root. I think they are best understood in the context of their diagnostic paradigms, which is too much to get into here. Just know that many different methods exist, and they work if you apply them correctly.

To make things more complicated, there are pulses to be found at many other sites throughout the body, such as on the foot and the head. These are rarely used today by the Chinese, but I just spent a weekend using them with the Japanese meridian therapists.

Another form of diagnosis is the palpation of the abdomen. Once again, there are many maps of the torso, and also many ways to palpate. I went to a doctor from China once who palpated the abdomen with rather strong, firm pressure. This is in distinct contrast to the Japanese style I just learned (the image is from that style), which emphasized feather-light touch with only occasional pressure, and sensitivity to very slight changes in texture, temperature, and firmness of the skin.

Palpation of the acupuncture meridians is yet another method of diagnosis. This involves knowing all twelve of the main meridians (also called channels) and where they travel, and feeling the skin to sense, once again, changes in tone, texture, and temperature.

4. Asking Diagnosis

Traditional diagnosis centers around the “Ten Questions.” I actually don’t have any idea exactly what are the ten questions because there are so many little areas that we ask about; and admittedly, part of the reason I chose this college was that from my observation their asking diagnosis went much more in depth than other schools.

Oriental medical practitioners ask people about a broad variety of things, beginning with the main complaint, but branching out and including tension/pain, energy, sleep, digestion, thirst, menstruation, urine, bowel movements, sweating, mental functioning, emotional functioning, relationships, and even the birth history sometimes.

And every little area has other, related questions involved. Headache is a good example: We ask about the location of the headache on the head, the quality of the pain (sharp, dull, throbbing, etc.), how often it comes on, what time of day, if it’s associated with stress or food, and what makes it better or worse.

Putting It All Together

Despite the seeming complexity of all of these systems, the real work is in integrating all of this information. Because in real world situations, much of the information will not match! And this is why diagnosis is an art form: We are like Sherlock Holmes, gathering as many clues as we can, trying to notice the small details that everyone else misses, sifting through the information to determine what’s relevant and what’s not. We journey through the microcosms of the body, peer through the many different lenses, trying like hell to penetrate the veil of a person’s being.

Eventually, if we become masters like Dr. Shen, we will see to the root of a problem and be able to pinpoint exactly where and how to treat a person, whether it is through an acupuncture point, an herbal formula, or a simple conversation.

That’s how we facilitate healing.