My experience of diagnostic methods

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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.