My experience of diagnostic methods

This post related to question in Forum of Course B “Anybody has good experience in tongue diagnosis? or other diagnostic methods?”, but I can’t to send post to this Forum, so I’m sending it to Acupuncture Forum.

I’m not sure that my experience is good enough, however during many years I started each treatment from diagnostic. Unfortunately I didn’t study diagnostic methods in China, so undoubtedly I did a lot of mistakes and therefore opinion of specialists in TCM is valuable to me.
For each patient I’m using folder with standard set of papers which I prepared: a questioning (for inquiring), pictures of face, tongue, eyes, ears, foots (to mark and to make a notes), pages for each treatment (to make notes about some new diagnostic findings, about the patient condition before and after treatment and about used acupoints and auxiliary methods). So after years I have a reference source for my work.
First of all with each patient I’m going according to the next plan of diagnostic:
A. Inquiring
B. Inspection:
1. Observation of the face
2. Observation of the tongue
3. Observation of the eyes, including iridodiagnostics
4. Observation of the ears
5. Observation of the foot
C. Palpation
D. Auscultation and olfaction

Only when all this diagnostic methods shown commensurable results, I’m started to think about concluding diagnosis.
Two methods: observation of the face and auscultation and olfaction I’m carrying out at the time of inquiring.
1. I don’t think that I can add something new to face observation, but the next signs in my practice were sure for superfluity:
redness of chin - Kidney
red spots (or dilated vessels) on the left cheek - Liver
red spots on the right cheek- Lung
red spot (or eruption) on forehead (mainly between eyebrows) - Heart
red and swollen lips – Spleen
red nose – Stomach
Signs of deficiency were less noticeable:
small or flabby chin – Kidney
brown spots on the left cheek (and other places) – Liver
dry lips – Spleen
wrinkles on forehead (mainly between eyebrows) – Heart
protrusion of the head – deficiency of Qi (sign of the vitality?).
For Lung most likely sign was common dryness and flabbiness of the skin.
The Bladder problems were visible as swollen places (red or flabby) in zygomatic region. I observed them frequently for patients suffering from chronic prostatitis.
There were other diagnostic signs too (such as different wrinkles), but signs described above were the most prevalent.
2. In tongue diagnosis in addition to observation of the color and form of the tongue proper and quality and color of the tongue coating for me was helpful to pay attention to features of tongue protrusion. Labored protrusion (deficiency, cold of the Heart), quaking tongue (deficiency of Yang), deviation to the right (exertion in the Lung) or to the left (exertion in the Liver) were very helpful signs. Red tip of the tongue was typical for Heart-heat (and mental pressure), while red lateral parts of the tongue were typical for Liver-heat (and shortness of temper). I have also observations of small signs on different parts on the tongue such as white packed areas (in cases of some tumors) or hemangiomas on lateral parts of the tongue (in cases hemangiomas in the liver).
3. In the part of observation of the eyes the next signs were most frequent.
For superfluity:
straw-colored sclera or/and surface irregularities of the sclera – Lung-heat
red conjunctiva – Liver-heat
yellow sclera – Gallbladder-heat
red medial and lateral corners of the eye – Heart-heat
Signs of deficiency:
pale medial and lateral corners of the eye – Heart
dimness of pupil - Kidney
sunken eyes - deficiency of Qi (sign of the vitality?).
Interesting that most of patients with straw-colored sclera or/and surface irregularities of the sclera appealed to oculist for medical aid, but they were considered by oculist as healthy persons.
Sometimes small various signs (for example, red or brown spots) were observed on some parts on the eye or eyelids in cases of different diseases (such as red spot on lower eyelid in case of peptic ulcer of stomach).
Among signs of the iris, sign in area of thyroid gland was very helpful. Nearly in each case of detection of lacuna in this area following blood test shown pathology of thyroid gland or inherited susceptibility.
4. Observation of the ears I did according to various signs on areas and acupuncture points of
the ear.
Red areas of course were connected with superfluity (area of the liver and gallbladder, area of the heart). Red ear lobule was typical for blood stagnation in the head.
Furrow on the ear lobule was indicative of heart problems or/and diabetes.
Appearance of wrinkles anterior to the ear was typical for sexual activity deterioration and for diminution of vitality.
5. Observation of the foot in my opinion is of greatest utility.
During this diagnostic it was possible to determine physical and mental state of patient.
For example, the common signs were:
dry foot – diabetes, inactivity
red foot – hypertonia, shortness of temper
cold humid foot – deep emotion
emptiness of the foot – tendency to cancer, diminution of vitality.
For my opinion observation of the foot is the most significant for evaluation of the vitality. In many cases I observed strong foot constitution for old patients with excellent health. On the contrary emptiness of the foot for yang (good looking!) patients was bad prognostic sign.
Division of the foot to 4 areas (from the heel to the toes) – earth, water, fire and air – and observation of this elements on their own place and in areas of other elements give a lot of addition information.
I’m sorry, I can discuss this method too much time… If it is interesting to somebody I’ll give more detailed information.
C. Palpation.
1. In this part I used only stomach palpation to make a comparison of upper and lower abdomen (temperature, flabbiness or tension) for evaluation of Kidney, Spleen (Bladdar, Stomach) state. I did not use this method for each patient because of touching to stomach is unpleasant for many of them.
2. I did not use feeling the pulse on account of difficulties in studying the pulse diagnosis without a good teacher. Instead of this I used Ryodoraku measurement, and it is very interesting for me to know opinion of specialists in TCM on this method. This method is based on checking of electro-conductivity of acupuncture points (Ryo – good, do – electro-conductive, raku - lineage system) and was described firstly by Nakatany (Nakatany, Y. A Guide for Application of Riodoraku Autonomous Nerve Regulatory Therapy. Tokio: Japanese Society of Ryodoraku Autonomic Nervous System,1972) and later by Koji Okazaki and others in Recent Advances in Acupunctere Research (Ed. F.F.Kao, J.J. Kao), 1979.
According to the last publication I used for checking of electro-conductivity the next points:
for the hand Meridians – Taiyuan LU9, Daling PC7, Shenmen HT7, Yangxi LI5, Yangchi SJ4, Yanggu SI5;
for the foot Meridians – Taichong LR3, Taibai SP3, Taixi KI3, Qiuxu GB40, Chongyang ST42, Shugu BL65.
As you can see most of them are Yuan-Primary Points.
I’m only changed Shuiquan KI5 suggested in the article to Taixi KI3 because of some reasons: Shuiquan KI5 is Xi-Cleft Point and it is often painful, in cases of swollen instep it is easier to find Taixi KI3 precisely, and Taixi KI3 is a Yuan-Primary Point.
My husband (he is a painter and designer) constructed for me very handy device, enabling quantitatively measure value of electro-conductivity (in microampere) of acupuncture points, rate and direction of changes of this value.
After using this device during years I have statistics of comparison between this method, other diagnostic methods and state of patient. In each case of excess syndromes I observed high electro-conductivity in the point of corresponding meridian. A low values were typical for deficiency syndromes. When during measurement a value changes drastically, it was possible to draw a conclusion, that energy in certain meridian changes now (increases or decreases correspondingly).
Of course pulse diagnosis gives more parameters for state characteristic of a meridian, but Ryodoraku measurement allows watching the patient state and describing it quantitatively. This measurement was useful to control process of treatment and to add some acupuncture points if value still too high or to lower. After successful course of treatments followed equilibrium condition characterized by nearly the same values of electro-conductivity for control points of each meridian.
Sometimes at first treatment of old patients with chronic disease may be observed false equilibrium probably because of low resistibility (low vitality?). In this case was helpful first of all treat acupoints with common action, such as Hegu LI4, Neiguan PC6, Sanyinjiao SP6, Zusanli ST36 and others. That results in changing of false stability and showing up plausible reason of disease.

I've been interested in pulse diagosis since I first heard of it. But I have heard, and now know from experience, that it takes a loooong time before one develops the required sensitivity to use it successfully. I understand what Sophia is talking about!

I suppose the best way of learning how to do pulse diagosis is just trying it, even if you're not sure what you're feeling. And if one is in a clinical environment, exposed to many different illnesses, and therefore exposed to many different pulses, one can eventually learn how to tell one from another.

But I just had an idea. What if a device were made that can mimic the different types of pulses. Basically building an artificial wrist with flexible fluid-filled tubing inside, a pump, and a controlling device or software that controlls how much fluid goes where, how strong, and in what frequency.

Take this device to someone versed in pulse diagnosis and calibrate it. That way one could select what type of pulse he/she wants to memorize, and feel it right away.

Instead of saying [i:80b282f03a]"I wish I had a patient with Liver Qi stagnation so I could experience a deep, tense pulse"[/i:80b282f03a], one could simply say [i:80b282f03a]"hey, I want to memorize a deep, tense pulse, right now"[/i:80b282f03a].

Maybe there is such a thing already. If not, it looks like your husband has some work to do, Sophia

I just remembered, there is a doctor that I know who bought a device (not sure if in China or in Japan) that apparently takes a person's pulse and prints it out on paper. So you have a graphical representation of a person's pulse and health, without having to take the pulse yourself.

But now that I read Sophia's post, I wonder if it is Ryodoraku machine that this doctor has. In which case, it's not the pulse that it takes of course, but the electroconductivity of yuan points, as Sophia stated.

In any case, I'll be in China soon, and was wondering if ryodoraku machines or pulse diagnosis machines (if they exist) can be easily aquired there? (Easier than aquiring them in Mexico, I'm sure)

There's another type of inspection which I honestly haven't had the chance to work with very much, but which is supposedly meant to be used instead of pulse diagosis in children under 3 years old. I wonder if it can (or why it can't) be used with adults?

I know it as [i:80b282f03a]vascular observation[/i:80b282f03a], and it is done by examining the child's index finger's vascular network.

I'll briefly describe it for those who may not be familiar with it.

It is considered that a branch of the Lung channel, on which the radial pulse is also found, passes through the palmar face of the index finger.
So one is to squeeze the finger from base to tip, and do the diagnosis based on the depth and coloration of the vascularity in each of the three sections of the finger.

I'm sure this method can be used at least in some adults, if they have thin enough skin, can't it?

[quote:80b282f03a="David King"]So if you say you are around the smart people Serpent, maybe you are the smartest, right? [/quote:80b282f03a]

That's right, I'm the smartest of all!
No, seriously speaking, it's really great to be around people who are willing to share their knowledge with us less knowledgeable folk.

Dear Serpent,
Before I started to work with Riodoraku method, I’m also interested in pulse diagnosis device. I found some articles in which such attempts were made. But difficulties were not in technique of pulse registration, but in results deciphering. It was a reason, why in Japan started look for other ways for Meridians state registration.

Dear Sophia,

Dear Sophia,
Sorry it’s a bit too late to paste my opinions about your precious diagnostic experience herein.
However, I post it to the Forum of course B on the name of Lady Sophia.
Indeed you have done a great job in your practice of traditional Chinese medicine, and your experience of diagnosing diseases is of great value as I used to tell Serpent.
In fact, even in China, some TCM physicians would rely on the modern diagnostic techniques too much and don’t pay enough attention of the traditional ways and measurers, that’s BAD!!!
For sure as the time goes on, there have been a lot of changes in the TCM diagnostics, e.g. the simplification of the pulse taking. It is well known that in ancient time, (Han Dynasty, around 200 BC to 1800 AD), the pulse was taken in three regions of the body, not only that of the wrist. It was required to take the pulse for much long time for each patient in ancient time but nowadays it’s only a matter of couple of minutes. That’s because in clinic physicians have to work very hard to fulfill the demands of patients for there are too many patients here in the hospitals in China. So if you come one day here, you will know how many patients each doctor would have.
To observe a patient, at the moment, I (and majority of the TCM physicians, I think) would observe mainly their complexion and vitality on their face, so I can judge the deficiency or excess, and the vital conditions. To see the vitality, for sure the eyes are also important, which could also disclose the kidney condition apart from the complexion.
The complexion and the lips would help judge the function of the heart, I think the text has enough descriptions on this point.
Personally I did pay a great attention on the tongue, for sure to see both the body and coating.
...to be continued

Dear Sophia,

Dear Sophia,
Sorry it’s a bit too late to paste my opinions about your precious diagnostic experience herein.
However, I post it to the Forum of course B on the name of Lady Sophia.
Indeed you have done a great job in your practice of traditional Chinese medicine, and your experience of diagnosing diseases is of great value as I used to tell Serpent.
In fact, even in China, some TCM physicians would rely on the modern diagnostic techniques too much and don’t pay enough attention of the traditional ways and measurers, that’s BAD!!!
For sure as the time goes on, there have been a lot of changes in the TCM diagnostics, e.g. the simplification of the pulse taking. It is well known that in ancient time, (Han Dynasty, around 200 BC to 1800 AD), the pulse was taken in three regions of the body, not only that of the wrist. It was required to take the pulse for much long time for each patient in ancient time but nowadays it’s only a matter of couple of minutes. That’s because in clinic physicians have to work very hard to fulfill the demands of patients for there are too many patients here in the hospitals in China. So if you come one day here, you will know how many patients each doctor would have.
To observe a patient, at the moment, I (and majority of the TCM physicians, I think) would observe mainly their complexion and vitality on their face, so I can judge the deficiency or excess, and the vital conditions. To see the vitality, for sure the eyes are also important, which could also disclose the kidney condition apart from the complexion.
The complexion and the lips would help judge the function of the heart, I think the text has enough descriptions on this point.
Personally I did pay a great attention on the tongue, for sure to see both the body and coating.
...to be continued

(...continuing)
Besides I would also watch the ears a bit when I have a chance, but I would do it according to my own experience, not really the ear acupuncture theory.
Certainly the body is very helpful, so by the first impression you may have something basic.
What I’m going to stress is the pulse diagnosis! Many people of TCM would complain that it’s TOO DIFFICULT to learn the pulse diagnosis!!! It is true the pulse diagnosis is of great difficulty, but not really as hard as they would think so!!!
Personally I do think it needs some talent but the right method is also helpful.
First of all, you’d better have a good reading about the descriptions on how various types of the pulses should feel like. For sure if you can read in Chinese, it would be much more helpful.
Secondly, you have to understand these descriptions! For instance, when it is said the string-taut pulse is straight and long, and feels like the string of a musical instrument like violin, you have to feel the pulse is not change along the course of the artery, and it is really straight all along the course. And the surging pulse is compared to a tide, with a strong and powerful rising but a slow and subsiding retreating, so you should have the feeling of the up and down.
...to be continued

(... continuing)
The third is you should have someone (for sure a good teacher) who can tell you or even show what the types of the pulses are feel like.
The fourth and, I think, the most important is the talent and the practice. Only with good talent, you can have a right feeling and know how to distinguish the difference of the pulses; and with the practice, you may have the real feeling, so you can prove what you learned from the book or the teaching.
The fifth is when you take the pulse, you should also pay a lot of attention on the other diagnostic methods which are a bit easier to be understood, so you can check and prove your feeling of your pulse. For instance, you feel the pulse is thready, deep, and weak, and you find that the person’s tongue is pale and smaller, without much coating, the complexion is also a bit pale, the voice is a bit low, and the person looks weaker, so it’s sure you have a right feeling of the pulse.

...to be continued

[quote:5aac044dee="Sophia"]Dear Serpent,
Before I started to work with Riodoraku method, I’m also interested in pulse diagnosis device. I found some articles in which such attempts were made. But difficulties were not in technique of pulse registration, but in results deciphering. It was a reason, why in Japan started look for other ways for Meridians state registration.[/quote:5aac044dee]

Actually, there are several models of pulse diagnostic devices (non, to my best knowledge, has been evaluated by the FDA or Health Canada).

An example of such a device is a Russian device (accupuncture has been recognised by the official medicine in Russia since 1959) called Pulse Analysis System (PAS), a computer-based system which is capable, according to the manufacturer's statement, of:
- diagnostics of person's health in terms of acupoints / meridians,
- planning the acupuncturist's approach,
- monitoring meridians through computer-based pulse diagnostics.
The PAS requires a computer with at least Pentium II CPU, 64 Mb RAM and serial COM or USB port. Windows 98/ME, 2000, XP.

Analysis tools rovided by PAS include the "Health matrix", the complex estimation of patient health, including a conditions of separate channels and it interaction. (The Health matrix displays the deviations of Qi energies from the "harmony" order in the meridians).

The software used in PAS is free to download, but one would need the Pulse wave sensor, a small device with the cost of 580 Euro (license for 500 pulse registrations, not including shipment). A license for unlimited number of registration has an additional price.

More information in English (including a list of their reperesentatives worldwide) is awailable at http://pulse-academy.com/index.html.

IT WOULD BE INTERESTING TO KNOW WHAT THE CHINESE TCM PRACTITIONERS THINK ABOUT THIS KIND OF DIAGNOSTIC DEVICES.

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