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Diagnosis in TCM

Diagnosis in TCM

by | 2121,Mar, 2025 | Traditional chinese medicine

An ancient and subtle art

In a small consultation room bathed in subdued light, Maître Liang, an elderly practitioner of traditional Chinese medicine (TCM), is carefully observing his patient. Not a word has yet been exchanged, but already many clues are revealing themselves before his trained eyes. Because in TCM, diagnosis is an art as subtle as it is profound, going far beyond the apparent symptoms.

A legacy of Chinese wisdom

Traditional Chinese medicine does not simply identify an illness; it seeks to understand the individual as a whole. Every pain, every sensation, every bodily change is perceived as a message from the body, revealing a deeper imbalance.

Qi, the vital energy that circulates through the meridians, blood and body fluids, must flow harmoniously.

When an imbalance arises, the body speaks… You just have to know how to listen

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Observation (望诊, Wàng zhěn)

First of all, without saying a word, Maître Liang observes every detail:

  • The complexion and colour of his patient’s face, which mirrors his internal state.
  • The tongue, a veritable map of the organs, whose colour, shape and coating reveal any imbalances.
  • The eyes, skin and nails, which provide information about vitality and the state of the Blood.

    Auscultation (闻诊, Wén zhěn)

    Experience has also taught him to listen and feel. For example, the voice will be weak when there is a deficiency of Qi. It will be hoarse or loud if there is too much fluid.

    He observes whether breathing is fluid or, on the contrary, jerky or wheezy.

    Similarly, strong body odour is a sign of excessive heat or digestive problems.

    Palpation (切诊, Qiè zhěn)

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    Next comes palpation. This includes :

    • Taking the pulse (脉诊, Mài zhěn), which reveals the state of the organs by assessing the depth, rhythm and strength of the beats.
    • Palpation of acupuncture points, whose sensitivity reflects energy blockages.
    • Palpation of the body. The temperature and texture of the skin reveal the state of Yin and Yang.

    Palpation (切诊, Qiè zhěn)

    Next comes palpation. This includes :

    • Taking the pulse (脉诊, Mài zhěn), which reveals the state of the organs by assessing the depth, rhythm and strength of the beats.
    • Palpation of acupuncture points, whose sensitivity reflects energy blockages.
    • Palpation of the body. The temperature and texture of the skin reveal the state of Yin and Yang.
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      Interview (问诊, Wèn zhěn)

      Now that he has a general idea of the situation, Master Liang asks his patient a few questions about :

       

      • His medical and emotional history.
      • Lifestyle: diet, sleep, sources of stress, etc.
      • Body sensations: pain, shivering, digestion, elimination.

      A personalised diagnosis

      Finally, Master Liang closes his eyes for a moment and thinks… he analyses:

      • The general nature of the imbalance: Yin or Yang.
      • The extent of the imbalance: Superficial or Profound.
      • The presence of excess heat or cold. It may be the opposite, in fact; we speak of lack, emptiness or insufficiency. The same applies to energy.

      Each diagnosis is unique. The same symptom can have several origins, and only a careful look can identify the root cause.

      Tailor-made treatment

      By cross-referencing the information gathered through these different stages, Maître Liang makes his diagnosis and puts in place a treatment strategy to restore harmony:

      • Acupuncture will unblock the meridians and restore the circulation of Qi.
      • Chinese pharmacopoeia will prescribe plants and minerals to restore balance.
      • Therapeutic nutrition will adjust the diet to strengthen deficient organs.
      • Qi Gong and Tai Chi will help to get the energy flowing.

        The Pulse Melody

        Among all these methods, pulse-taking (see box) takes pride of place. Three positions and two levels (superficial and deep) are analysed on each wrist, providing invaluable information about the organs and meridians.

        Like a musician tuning his instrument, he listens to the melody of the beats, looking for the discordant note.

        As you will have gathered, for Maître Liang, diagnosis is much more than a simple clinical examination; it’s an in-depth reading of the body, an interpretation of the signs that the body is constantly sending out. Every patient is an enigma, every consultation a journey through the body’s energy flows.

        By understanding these subtleties, we realise that Chinese medicine is an art, an art of listening, observing and seeking harmony in all its complexity.

        Pulse diagnosis

         

        Hipocrate

        Chinese pulse diagnosis, or mai zhen (脈診), is a fundamental diagnostic method in traditional Chinese medicine (TCM). Its origins date back thousands of years, with ancient texts such as the Huangdi Neijing (黃帝內經) describing its principles.

        This technique developed during the Han Dynasty (206 BC–23 AD) at a time when respect and modesty required doctors to have minimal physical contact (especially with the Empress!).

        Using six pairs of points spread over three areas of each wrist and on two levels (superficial and deep), the practitioner listens to the harmony and quality of the pulse, much like a musician checks that an instrument is in tune.

        The practitioner feels the radial artery at the wrist in three positions (cun, guan, chi) corresponding to different organs. They assess the depth, rhythm, strength, shape, and other characteristics of the pulse, which provide information about energy imbalances and the possible presence of pathogenic factors.

        There are 28 pulse shapes (slippery, rough, tense, etc.) classified into four categories: deep or superficial; fast or slow; long or short; thin or wide.

        Pulse diagnosis is used in conjunction with other diagnostic methods (observation, questioning, palpation) to establish a complete energy assessment.

        It is particularly useful for evaluating the functions of internal organs and the state of Qi, blood, and body fluids.

        Taking the pulse is a complex skill, a subtle art that requires a lot of practice and keen listening.

        Tongue examination

        Tongue examination

        by | 2323,Nov, 2024 | Traditional chinese medicine

        An essential TCM diagnostic tool

        Chinese physicians make extensive use of tongue examination. It forms an integral part of his diagnostic tools, along with observation, questioning, palpation and pulse taking. This tongue examination is based on a holistic vision of the human body as unified and harmonious, with each organ and function interdependent. In this context, the tongue is seen as a microcosm of the body.

        The ancient Chinese observed that by examining the tongue, one could gain insight into the state of the internal organs and meridians. Classical texts of Traditional Chinese Medicine (TCM), such as the Huangdi Neijing – The Yellow Emperor’s Internal Classic – explain that the tongue reflects the individual’s Qi (vital energy) and Blood. The shape, color and texture of the tongue reveal information about the health of internal organs such as the heart, spleen, liver, lungs and kidneys.

        This diagnosis, which dates back thousands of years, helps to understand energy imbalances in the body. This approach makes the tongue examination a fundamental pillar in Traditional Chinese Medicine (TCM) for assessing a person’s overall health.

        What can we see on the tongue?

        By observing the tongue, we can assess the deep roots of the body and mind at the origin of energetic imbalances detrimental to health.

        The tongue of a healthy, “normal” individual is bright. It is light red in color and supple. It is neither swollen nor too thin, has no cracks, and should not tremble when pulled. The coating is thin and slightly white, a little thicker behind the tongue. The tongue is slightly moist, but not overly so; no traces of liquid should be visible. The sublingual veins (under the tongue) should not be swollen or too purplish.

        In this way, the Chinese doctor diagnoses the state of the organs according to the color of the tongue, its shape, the state of the body fluids, as well as thermal syndromes.

        A map of internal organs

        • Location of internal organs: The tongue is divided into zones corresponding to the various internal organs. For example, the tip of the tongue is associated with the heart, while the center represents the spleen and stomach.
        • Color: The color of the tongue reflects the state of Qi and Blood in the body. A pale tongue may indicate a deficiency of Qi or Blood, while a bright red tongue could suggest excess heat in the body.
        • State of body fluids: The appearance of the lingual coating (the layer on the surface of the tongue) reveals the state of fluids in the body. A thick or absent coating may indicate fluid stagnation or dryness.
        • Thermal syndromes: the color, texture and structure of the tongue help determine whether the disease is caused by excess heat or cold in the body.
        cartographie de la langue

        Benefits of the tongue examination

        Tongue examination offers several advantages for TCM diagnosis:

        • It is non-invasive. The examination allows practitioners to gather information about internal health without the need for intrusive tests.
        • The assessment is holistic. In effect, the state of the whole body through a single organ is examined. The language reflects the health of the various systems, enabling a global assessment.
        • It gives precisions to the energetic diagnosis. The different aspects of the tongue enable us to diagnose specific imbalances, such as excess heat or cold, Qi stagnation and blood deficiencies.
        • A powerful aid to follow-up. Observing the tongue enables us to monitor the consultant’s progress. It enables us to see the progress of a treatment and to adjust care according to visible changes.

          It’s fair to say, then, that the examination of the tongue in TCM is an art. This refinement in the art of healing provides access to a subtle understanding of internal imbalances. Mastery of this art is a powerful tool for interpreting the body’s signs. Complementing the other axes of diagnosis, it reinforces the link between external signs and energetic health.

          Key observation points

          During the examination, several aspects of the language are analyzed, each revealing valuable information about the individual’s internal state.

          • Colour
            Bright red: excess heat or inflammation in the body.
            Pale: deficiency of Qi or Blood, often associated with fatigue or weakness.
            Purple or bluish: blood stagnation, which may be linked to chronic pain or poor circulation.
            Yellow: excess heat, often related to the stomach or liver.
          • Coating
            Thick: often indicates stagnation, fluids or an imbalance in digestion.
            Thin: suggests good digestion and fluid balance.
            White: sign of cold in the body.
            Yellow: indicates excess heat.
          • Shape
            Swollen: spleen deficiency or accumulation of fluids in the body.
            Thin: deficiency of blood or body fluids.
            With teeth marks: spleen Qi deficiency (see photo below).
          • Moisture
            Dry: sign of heat or deficiency of body fluids.
            Wet: reflects a good balance of body fluids.
            Viscous or with stringy saliva: may indicate stagnation of body fluids.

          Clinical case

          A consultant’s tongue is slightly bluish, with a thick, moist yellow coating. There is also a crack in the center of the tongue. The pulse resembles a kind of elusive wave to the touch, and is said to be slippery. (A slippery pulse is fluid, like water flowing under the fingers. It often has a livelier cadence that reinforces the impression of continuous movement).

          What is this person suffering from, and how can it be treated?

          In Chinese medicine, a slippery pulse (滑脉, huá mài) associated with a thick, moist, yellow lingual coating often indicates an accumulation of moisture and heat, especially in the spleen and stomach.

          A bluish tinge to the tongue, on the other hand, may indicate blood or qi stagnation, often linked to cold or disrupted qi circulation. The central fissure is generally linked to weakened spleen and stomach energy, which may be exacerbated by humidity and heat blocking their function.

          Based on these signs, it seems likely that the person is suffering from what is known as a “humidity-heat syndrome” with a deficiency of the spleen and stagnation of qi or blood.

          Principles of treatment

          Treatment would aim to:

          1. Eliminate humidity and heat from the body.
          2. Strengthen the spleen to restore its capacity for transformation and transport.
          3. Circulate qi to relieve stagnation.

          Spleen and hypertension

          Spleen and hypertension

          by | 2424,Jul, 2024 | Traditional chinese medicine

          The role of the spleen in hypertension

          Arterial hypertension (AH) corresponds to an abnormal increase in blood pressure on the artery walls. It is also defined by figures measured by a blood pressure meter: from…

          In Traditional Chinese Medicine (TCM), hypertension is not considered a pathology, but a syndrome that alerts us to a dysfunction of certain internal organs. TCM diagnosis identifies the energy imbalances underlying these dysfunctions. These vary naturally from one individual to another.

          Hypertension according to TCM

          Chinese medicine is always interested in the causes of so-called diseases, and never stops at the symptoms alone. The factors that can lead to hypertension are extremely varied. It is generally accepted that they are closely linked to a healthy lifestyle. Among these, the psycho-emotional aspect plays a vital and recognized role in hypertension.

          Excessive anxiety related to the difficulties of daily life, constant stress, and underlying depression can lead to high blood pressure.

          While each organ can play a role in the development of hypertension, particularly the liver and kidneys, we have chosen to focus here on the role of the spleen in high blood pressure through the production of Tán.

          Spleen functions

          The Spleen is a very important organ in TCM. It belongs to the Earth in the Five Elements theory, and is linked to the emotion of anxiety. It is at the center of the body and has the property of “bringing up” and “bringing down” the essences it extracts from food.

          The Spleen transforms food and drink into blood and qi. It also plays a role in sorting and eliminating waste through stool, urine and perspiration.

          A high-quality diet is therefore essential for the proper energy balance of the spleen. However, our diet is often too rich, and we eat too much.

          What’s more, we consume foods that provide a lot of moisture (sugars, fats), or foods that are too raw or too cold. In both cases, we damage the spleen.

          If the spleen is weak, its transformation and elimination properties will be disrupted. The spleen will not be able to eliminate all the waste from the digestive tract, which will then turn into Tán, or phlegm. The Tán formed can be either cold or hot in nature, depending on the individual.

          This Tán will settle in the most vulnerable areas of the body, particularly on the walls of the blood vessels, thus hindering the free circulation of blood.

          It is through Tán that the spleen is linked to blood pressure. Tán obstructs the blood vessels, making them harder and less elastic. This particularly affects the heart.

          L'angélique chinoise, trésor de la mtc

          Tán and digestion

          This explains the importance of a properly functioning spleen. It plays a decisive role in the quality of digestion. Thus, the same meal eaten by several people will not be digested in the same way by each person, depending on the state of their spleen and, more generally, their yin/yang balance. If the spleen is functioning properly, it can assist in the elimination of excess food.

          As the role of the spleen is to transform nutrients into Qi and Blood, it is important that food is easy to digest. This limits the risk of stagnation of poorly digested food, which can generate Tán.

          Finally, if the spleen is functioning properly, Tán, even if it is produced, can be easily eliminated and will not be deposited in the blood. Thus, Tán is always related to poor digestion or overeating.

          Preventing the formation of Tán

          Tán is not only one of the causes of high blood pressure, but it can also lodge in other parts of the body, particularly the lungs. This can lead to coughing, bronchitis, or asthma. Tán can also block the flow of qi, causing stagnation, poor blood circulation, and pain. Finally, Tán can also disturb the mind and cause mental confusion, anxiety, and depression.

          As we have seen here, it is essential to maintain the spleen, and all of the organs in general, in a good state of energetic balance. Chinese medicine can restore the necessary balance through acupuncture or herbal prescriptions. However, patients must also take action to rebalance their lifestyle, particularly their diet (see below). They must also take care to manage their emotions better.

          Diet and Tán production

          Taking care of your diet is the best way to avoid Tán production. Here are the main foods to avoid:

          1. fried foods (French fries, doughnuts and breaded foods) oily and fatty foods, which are difficult to digest;
          2. Sugar and sweet foods, including sugary drinks (sodas, sweetened fruit juices, energy drinks, etc.) and alcohol;
          3. Dairy products (especially full-fat cheeses, whole milk, cream and yoghurts). These are humidifying and can therefore encourage the production of mucus;
          4. Cold foods and drinks. Cold or iced drinks, or food taken out of the fridge too cold, weaken the spleen. The same is true of too much raw food;
          5. Refined and processed foods from the food industry.

          Care should also be taken with the cooking method. Some cooking methods are conducive to the production of mucus or Tán, such as :

          1. Frying, which increases the fat content of food;
          2. Grilling and roasting at very high temperatures;
          3. Cooking with a lot of oil.

          On the contrary, we recommend :

          • Light cooking, such as steaming, which preserves the nutritional value of food while facilitating digestion;
          • Boiled or braised foods;
          • Hot, cooked foods such as soups and broths, which support spleen function;
          • Steamed, lightly sautéed or boiled vegetables;
          • Whole grains (brown rice, quinoa, oats, etc.);
          • Lean proteins (fish, chicken, legumes)