When You Visit a Chinese Medicine Practitioner from The Chinese
Way to Healing:
Many Paths to Wholeness
By Misha Ruth Cohen
When you go to a Chinese medicine practitioner, whether for
treatment of an illness, acute pain, or to begin a program of preventive care,
the doctor will follow a system of evaluation and diagnosis that depends on observation
and questioning. In accordance with the philosophy of the Tao, diagnosis is a
process of perceiving signs and symptoms and relating them to one another to reveal
how they form patterns of harmony or disharmony. Each symptom or sign has meaning
only in relationship to other signs and symptoms and to the whole of your mind/body/
The Four Examinations
In order to begin to develop an accurate
picture of your whole being, the Chinese medicine practitioner examines you, using
the traditional Chinese method, called the Four Examinations: inquiring, looking,
listening/smelling (these two seemingly different acts are grouped together--in
Chinese they are the same word) and touching. This process of examination reveals
which of the Eight Fundamental Patterns of disharmony are at work and what type
of disharmony of the Essential Substances, Organ Systems and channels you may
The Four Examinations are sometimes done formally, but often the practitioner
uses intuition and casual observation to create a vivid profile of a patient.
Every gesture, word and attribute provides clues to a person's health and well-being.
Let's look at each step in the diagnostic process in more detail, breaking
down the Four Examinations into their components, so you'll know what to expect.
Step One: Asking Questions
The Chinese medicine doctor takes
a great deal of time to ask you about yourself. Your answers allow the practitioner
to benefit from the knowledge that you have, for no one can know your body as
well as you do. Questioning allows the practitioner to observe your emotions,
voice and self-presentation. Basic questions focus on:
· Your reaction
to heat and cold
· Your patterns of perspiration
· If and
when you experience headaches or dizziness
· What type of pain, if
any, you may have
· Your bowel and bladder function
thirst, appetite, and tastes
· Sleep patterns
· Your sexual
functioning, sexual activity, and reproductive history
· General medical
· General physical activity
Two: Evaluation of the Tongue
The tongue is the mirror of the body. Harmony
and disharmony are reflected in the tongue's color, moisture, size, coating and
the location of abnormalities.
Healthy Organ Systems and a lack of External
Pernicious Influences produce a healthy tongue, which is pinkish red, neither
dry nor too wet, fits perfectly within the mouth, moves freely and has a thin
Imbalances in the Organ Systems and/or invasion by Pernicious
Influences produce an unhealthy tongue. External Pernicious Influences produce
changes in the tongue coating. Interior problems, such as Organ System or Essential
Substance disharmonies, produce changes in the tongue body.
the tongue, the Chinese medicine doctor looks at the color of the tongue body,
its size and shape, the color and thickness of its coating or fur, locations of
abnormalities, and moistness or dryness of the tongue body and fur. These signs
reveal not only overall states of health but correlate to specific organ functions
and disharmonies, especially in the digestive system. To evaluate the tongue accurately,
always do the examination in natural light.
The tongue body
is a fleshy mass and has color, texture, and shape independent from the apparent
qualities of the tongue coating. A pale tongue body indicates deficient Xue, Qi,
or Yang or Excess Cold. An overly red tongue body indicates Excess Heat. A purple
tongue indicates that Qi and/or Xue are not moving harmoniously and are stagnant.
Pale purple means the Stagnation is related to Cold. Reddish purple is related
to Stagnation of Heat. When the tongue is black or gray, it indicates extreme
Stagnation; if black and dry, that indicates extreme Heat Stagnation; if black
and wet, that indicates extreme Cold Stagnation. Bright red indicates Deficient
Yin or Excess Heat. Dark red indicates Excess Heat. Cracks in a red tongue indicate
Deficient Yin or Heat Injuring the Fluids. If the tongue is pale and cracked,
there is Deficient Qi or Xue. Thorny eruptions of the buds on the tongue alert
the doctor to Heat or Stagnant Xue.
The tongue's coating is
best described as moss or fur. It arises when the Spleen causes tiny amounts of
impure substances to drift upward to the tongue. When the Spleen and stomach are
in balance, there is a uniform density of fur, with a slightly thicker area in
the center of the tongue. Thick fur indicates excess. Thin fur is related to deficiency
during illness, but is normal if you are well. Fur that is wet indicates Excess
Jin-Ye (fluids) and/or a Deficient Yang. Dry fur is a sign of Excess Yang or Deficient
Jin-Ye. A greasy fur is a sign of mucus or dampness in the body. If the fur looks
peeled off or missing, it reveals Deficient Spleen or Yin or fluids. White, moist
fur indicates Cold. Yellow fur means Heat. However, white fur, resembling cottage
cheese, points to heat in the Stomach. Gray/black fur with a red body is associated
with extreme Heat; gray/black fur with a pale body is a sign of extreme Cold.
Size and Shape
The healthy tongue rests comfortably in the mouth. It is
neither too small nor too large. If a tongue is enlarged and flabby, it indicates
Deficient Qi. If, in addition to being enlarged and flabby, the tongue has scalloped
(or tooth marked) edges, then it indicates dampness due to Deficient Qi or stagnation
of fluids. If the tongue is enlarged and hard, it is a sign of Excess. If it swells
so that it fills the mouth and is deep red, that means Excess Heat in Heart and
Spleen are a problem. A small, thin tongue can indicate Deficient Yin or Xue.
A trembling, pale tongue indicates Deficient Qi. A flaccid tongue
that is pale often reveals extreme Qi or Xue Deficiency. A flaccid tongue that
is deep red reveals severe Yin Deficiency. A trembling, red tongue indicates interior
Wind. If the tongue sits off-center in the mouth, early or full-blown Wind stroke
may be present. A rigid tongue accompanies an Exterior Pernicious Influence and
fever. This may indicate the invasion of the Pericardium by Heat and Mucus Obstructing
the Heart Qi.
Location of Abnormalities
The location of disturbances on
the tongue are vivid indications of where disharmonies in the mind/body/spirit
are located. Certain organs are associated with the Upper, Middle and Lower Triple
Burner, which are in turn associated with the front, middle and back sections
of the tongue. For example, if there are red spots on the front third of the tongue,
which is associated with the Upper Burner, this indicates that there is Heat in
the Lungs. If the tip of the tongue is red, that indicates Heat in the Heart.
Menstrual cramps, when associated with Stagnant Xue, are often accompanied by
purple spots on the edges of the tongue in the Liver/Gallbladder area.
Role of Tongue Diagnosis
Not all tongue irregularities are indications of
disharmony, however. Food and drugs may change the coating or color of the body
of the tongue. For example, coffee yellows the coating and Pepto-Bismol turns
the tongue black.
Furthermore, some people have minor, unchanging cracks on
their tongue, which are considered normal. Others are born with what is called
a geographic tongue, which is covered with severe cracks and covered with hills
and valleys. This is considered normal by some practitioners, but a sign of congenital
disharmony by others.
The way a tongue appears is not an absolute indicator
of the location of the disharmony, but when taken as part of an overall pattern
that includes a complete evaluation, it offers strong clues to the location of
Step Three: Evaluation of Body Language--Styles of Movement, Posture
Seeking clues to possible Pernicious Influences, the
practitioner looks for signs of heat or Cold influences, Excess or Deficiency,
Yin or Yang disharmonies. If a person has a heavy-footed walk, loud voice and
sits in a sloppy, spread-out posture, this may indicate Excess. If a person acts
frail and weak, sits with shoulders slumped and is shy and receding, that may
indicate a Deficiency. On the other hand, fast, jerky, impulsive movement and
an outgoing personality indicate Heat. If combined with a full, red face, high
energy and a loud voice, then both Heat and Excess may be at work. Cold, as you
might suspect, is associated with slow but not sloppy movements and a pale face.
When coupled with a low voice, shortness of breath, or passivity, Cold and Deficiency
may be at work.
Step Four: Evaluation of Facial Color
When you are feeling
off-balance or have a specific disharmony, facial colors offer clues to the nature
and the severity of the imbalance.
There are several different methods of
facial diagnosis: Korean, Japanese, Worsley School, even macrobiotic. The following
evaluation of facial colors is derived from a combination of Traditional Chinese
Medicine and Five Phases principles. I have found this system provides accurate
TIP In order to obtain a clear idea of what the various facial colors
look like, always use natural light when examining your face in a mirror.
Significance of Facial Colors
· If facial color is bright and fresh,
then the disease is called floating and is on a superficial level.
If the color is moist, neither wet nor dry, the disease is not severe and will
be easy to treat.
· If the color is shallow and scattered over a large
area, the number of days of the disease will be short.
· If the color
is dark and cloudy, then the disease is sinking into the inner organs.
If the color is dark, cloudy and dry, the disease is severe and will be difficult
· If the color is deep and accumulated in one spot, the disease
is a long-term one.
Reading Between the Lines
Five colors appear on the
face: red, green, yellow, white and black. Depending on a person's constitution,
a healthy face may have one color that is more predominant than others, but several
may be visible. To determine what colors are present in your face, always examine
it in natural light. Look for the overall color tone; study the skin to see what
tones appear from under the surface; look at any visible veins. For contrast,
hold your hand up alongside your face.
Red is the color associated with the
Heart Organ System and Xue. If the face is a fresh red, the Xue is Hot. If the
face is dark red, the Xue is Stagnant. If it is light red, the Xue is Deficient.
Green is the color associated with the Liver System and circulation of the
Xue. If veins on the face appear greenish purple, the Xue is Hot. If the veins
appear greenish black, the Xue is Stagnant. If the condition is severe, the veins
on the face appear black.
Yellow is the color associated with the Spleen System.
If the face appears light yellow, then the Spleen system is Damp and Hot. If the
face appears deep yellow, Heat has accumulated. If it is dark yellow, Heat is
the result of Xue Stagnation. Withered yellow indicates a Heat Deficiency.
is the color associated with the Lung System, which regulates Qi, the breathing
in of oxygen, and the exhalation of carbon dioxide. If a person is not able to
exhale completely-as in emphysema-his or her face will take on a grayish white
color. If the person inhales inadequately, then the face will appear pale and
Black is the color associated with the Kidney System. If the face
is cold and black, the Kidney System is not filtering Xue properly. If the face
color is black but bright and moist, the condition can be treated. If the face
is not shining, the condition is not good. If the face is withered, the Kidney
System Yin is dry. If the face is cloudy and dark, the Kidney System Yang is dying.
Occasionally, there are combinations of colors. This further refines the evalua
tion. For example, if the color is red and white, both the Heart and Lung channels
LISTENING AND SMELLING
Step Five: Evaluation of Voice
to the sound of a person's speech, breathing and cough can help identify a disharmony
that results from one or more pernicious influence and pattern of disharmony.
For example, if the voice is too loud and strident, that indicates Excess, as
does the sudden onset of a violent cough. A weak, low voice that doesn't project
and a weak cough indicate Deficiency. Losing your voice or hoarseness can indicate
either Deficiency or Excess. Wheezing arises from Dampness.
Step Six: Evaluation
According to TCM theory, there are two main odors that clue a doctor
to the origin of disharmony. A strong stench from secretions or excretions indicates
Excess and Heat. A weaker odor indicates Deficiency and Cold.
practitioners generally rely on smell more than TCM practitioners do. Each smell
is associated with a phase and can indicate disharmony with the associated organ
or among organs that are related through the Five Phases cycle. The smells used
in Five Phases diagnosis are: goatish, associated with wood; burning, associated
with fire; fragrant, associated with earth; rank, associated with metal; and rotten,
associated with water.
Step Seven: Evaluation of Pulses
are twenty-eight pulse qualities that are essential to Traditional Chinese Medicine's
process of evaluation and diagnosis. Learning to read pulses requires years of
study and practice and is not something that can be done at home on yourself.
However, your Chinese medicine practitioner will talk to you about your pulse
diagnosis, and you will want to have a passing familiarity with the terminology
that's used. The most common descriptions are: floating, slippery, choppy, wiry,
tight, slow, rapid, thin, big, empty and full. (For a more detailed explanation
of pulse diagnosis, see The Web That Has No Weaver,by Ted Kaptchuk.)
are evaluated on a superficial, middle and deep level. The normal pulse resides
at the middle level and is usually about four or five beats for each complete
inhalation and exhalation of breath.
Disharmonies of the pulses indicate:
the condition of Qi, Xue and Fluids; Organ System imbalance(s); the location of
the imbalance(s); and the nature (Heat or Cold) of the disease, along with many
For example, a wiry pulse may indicate that the Liver System
has Stagnant Qi. However, there are no absolute meanings to pulses. They contribute
to a diagnosis only when viewed in context with other diagnostic techniques.
Eight: Evaluation of Sensitivity to Touch
Palpation of acupuncture points
and channels can trigger, increase, or reduce pain and indicate disharmony in
the associated channels and Organ Systems.
· If you have a pain you
can't pinpoint, that indicates Stagnant Qi. Stagnant Qi is also indicated by a
pain that moves around.
· If the pain is fixed, it may indicate Stagnant
· Pain that feels better with pressure is due to Deficiency.
Pain that feels worse with pressure is due to Excess.
· Pain that feels
better with warmth is associated with Cold.
Palpation of the body does not
have to be confined to the twelve channels', fifteen collaterals' or eight extraordinary
channels' acupuncture points. Ear acupuncture points are also powerful tools for
diagnosis and provide refined clues to the sources of disharmony. They are also
useful for self-massage. Reflexology, while not a traditional Chinese method of
diagnosis and treatment, is another useful tool at this stage of diagnosis.
Now that you have an understanding of the basics of Chinese medicine
and what to expect if you go for acupuncture or herbal therapy, you may be ready
to make an appointment to see a Chinese medicine practitioner. The following guidelines
may help you find a qualified practitioner.
SELECTING A PRACTITIONER
you are selecting an acupuncturist, herbalist, or a Chinese medicine doctor, the
two most important factors to consider are the doctor's training and your goals.
In order to gain the full benefit of Chinese medicine therapy,
the practitioner who administers the treatment(s) should have reputable training
and a keen sense of the philosophical underpinning of Chinese medicine.
best way to determine if a practitioner meets those standards is to ask a lot
of questions about his or her training, length of practice, scope of practice,
specializations, attitudes about wellness and disharmony and understanding of
Chinese medicine philosophy.
Meeting Basic Standards
The Taoist system
of belief is not some fancy window dressing that can be cast aside. It is part
and parcel of Chinese medicine treatments. No particular Chinese medicine therapy,
such as acupuncture or herbal remedies, can deliver its full healing potential
if it is separated from the philosophical context of the Tao.
you want to find a practitioner who is schooled in the Chinese medicine therapies
that you want to use. There are practitioners who are licensed acupuncturists
(L.Ac.) but who do not offer herbal therapy; there are others who are herbalists
but provide no acupuncture; there are licensed acupuncturists who also have training
as herbalists; and there are doctors of Oriental medicine who provide acupuncture
and herbal therapy.
Every acupuncturist should be licensed (in states with
licensing requirements) or certified. In more than half the states there are state
licensing boards and nationally there is the National Commission for the Certification
of Acupuncturists (NCCA). You may call the commission for a listing of certified
acupuncturists in your area.
If you live in a state without a state licensing
board, it is particularly important that your acupuncturists have a certificate
from the NCCA. Acupuncture degrees in this country come from accredited schools
of acupuncture and Traditional Chinese Medicine schools and colleges.
herbalist (who may also be your acupuncturist) should have either a certificate
of training or a long-standing reputation and years of experience. Many schools
train people in herbal medicine, but there is no independent licensing for Chinese
herbalists. Since 1982, California is the only state that requires practitioners
to take an exam in both acupuncture and herbal therapy to be licensed to practice
acupuncture. The NCCA does offer an herbal certification, but it doesn't lead
You also want to decide if you are looking for
a primary care physician, someone to work with your primary care doctor, or simply
someone who can provide shortterm treatment for a specific complaint.
are looking for a primary care physician, I recommend someone who is knowledgeable
about all aspects of Chinese medicine and Western medical procedures; someone
who will know when to refer you for Western evaluations and testing, and someone
who is willing to work with a Western doctor, if doing so provides you with the
To sum up what to look for in a primary care Chinese medicine
Someone who does not make promises to cure disorders and diseases
for which there is no cure (applies to all practitioners, no matter what you use
Someone who understands that there may be many different modalities
that work for an individual and does not insist that his or her way is the only
right or good way to go
Someone who has a bedside manner that pleases you
(What pleases some people most is ability, and they don't care about personality
at all. That's fine. For others, a more personal relationship is important. You
should make that individual decision.)
Someone who is able to explain what
she or he is doing from both a Chinese and a Western viewpoint-or is at least
willing to find out about the alter native perspective when necessary
who is not unconditionally opposed to any drug therapy in conjunction with acupuncture
or herbal treatment, and who understands the interactions of drugs and herbs
who will work with medical doctors and other practitioners
In cases of serious
illnesses, you want to select a practitioner who understands Western medical terminology
and concepts of the immune system, viruses and cancer, as well as Chinese concepts,
if you are going for treatment of these problems.
If you have HIV, chronic
hepatitis, or CFIDS (chronic fatigue immune defi ciency syndrome), be sure that
the practitioner's attitude is that you can live with this chronic, manageable
viral infection and that acupuncture and herbs may help you be more successful
in that process.
When you select a practitioner and
go for treatment, you don't surrender control of your health. Chinese medicine
recognizes that we each possess the tools we need to preserve or reclaim good
health. The good (or excellent) practitioner simply acts as the guide, helping
to coax the body's own defenses to prevent or mend disharmony.
There are four
basic healing techniques that the practitioner may suggest as treatments: acupuncture
and moxibustion, herbal therapy, dietary therapy,and Qi Gong exercise/meditation.A
brief description follows here, and each therapy is discussed in detail in the
Chinese dietary therapy uses foods
to strengthen digestion, increase energy and balance the body's energy. Dietary
therapy is often used prior to or in conjunction with other therapies to increase
the effectiveness of these treatments.
Acupuncture and Moxibustion
acupuncture is the art of inserting fine, sterile, metal filiform needles into
certain points along the channels and collaterals (tributaries of the channels)
in order to control the flow of the Qi. These days, practitioners also use electro-stimulation
of the needles, lasers and even ultrasound to stimulate the points.
is well-known for its effectiveness as a painkiller. Even more powerful is its
ability to alter the flow of the Qi so that the body can heal itself when attacked
by pathogens that trigger disharmony. Acupressure and massage are subsets of acupuncture.
Moxibustion, the burning of the herb moxa (Chinese mugwort) over channel points
and certain areas of the body, is used to warm, tonify and stimulate. It also
induces the smooth flow of the Essential Substances, prevents diseases and preserves
health. Doing moxa regularly on specific acupuncture points is said to promote
strength and longevity. In fact, an old Chinese saying is, "Never take a
long journey with a person who does not have a Moxa scar on (the acupuncture point
called) Stomach 36."
Chinese Herbal Medicine
Herbal medicine is actually
a misnomer. Although the overwhelming majority of medicinal substances come from
plants, some are derived from minerals and animals. Whatever their origin, they
are used to balance the mind/body/spirit as well as to reverse disease processes.
Most Chinese herbs should only be taken under the supervision of a trained herbalist.
Qi Gong Exercise/Meditation
Qi Gong, the Chinese art of exercise/meditation,
uses dynamic movements and still postures in combination with mental and spiritual
concentration to influence the flow of Qi. It is a powerful preventive therapy
and can help remedy disharmony in the Organ Systems and the channels.