DIAGNOSTIC METHODS

Four Diagnostic Methods

Visual examination
Auscultation and olfaction
examination
Inquiry
Pulse taking and palpation
When a disease occurs, there must
be its abnormal outward
manifestations, from which the
pathological changes may be
inferred.
The four diagnostic methods
examine and learn about the
pathological conditions from
different angle and aspect and find
out the etiology and pathogenesis,
thereby providing the basis for
The four methods are related
to and supplement one
another.
They cannot be separated from
one another, each having its
specific function that cannot be
substituted for the others.
In clinical practice, only when
the four techniques are
organically combined, can a
disease be understood
thorough.
Thus, a correct diagnosis can
be made.
Visual examination
is the first diagnostic procedure by
which the physician may observe the
patient's vitality, complexion, physical
build, head, neck, five sense organs,
skin, tongue, external genitalia and
anus on purpose so as to understand
the condition of a disease.
TCM holds that the human body is an
organic whole.
The exterior of the body is closely
related to the internal organs.
Auscultation and Olfaction
examination
Auscultation means listening to the
patient's voice, speaking, respiration,
coughing and moaning.
While olfaction means smelling the
patient's odor of the secretion and
excretion.
Both of them, the physician can learn
lots of information about the
pathological changes of the internal
organs.
Take voice and breath for
example

Loud, sonorous turbid voice

indicates excess syndrome
Low, faint voice indicates
deficiency syndrome
Rough and asthmatic breath
indicates excess syndrome
Weak and short breath indicates
deficiency syndrome
Take smell for example
Sour and foul smell in the mouth
indicates retention of food in the
stomach
Putrid and foul smell in the mouth
indicates internal ulcer
Inquiry
is a diagnostic method in which the
patient or his companions are inquired to
collect the information concerning a
disease.
The content of inquiry includes the chief
complaints, present case history, past
history, life history, family history, as well
as age, sex, native place, occupation,
address and so forth.
Inquiry, though covering a wide range of
topics, should be conducted step by step
in a planned way, with questions focused
Therefore, when asking a patient.
The physician should focus his attention
on the chief complaint to understand
both the main reasons for the disease
and clearest, the most suffered
symptoms of the patient.
Besides, the physician should
understand the occurrence, progress,
diagnosis and treatment of a disease
through asking.
Cold and heat
1.Fever and aversion to cold——
patient feel cold with high body
temperature.
Invasion of the exterior body by
exogenous pathogens.
2.Cold without fever
Interior-deficiency-cold syndrome.
3.Fever without aversion to cold
Exterior excess heat syndrome.
4.Tidal fever: fever arises or peaks
at a definite time, usually in the
afternoon
Yangming tidal fever: from 3 to 5
P.M.
Accumulation of pathogenic heat
in Yangming Fu organs (stomach
and intestines), presenting excess
heat syndrome.
Damp-warm tidal fever: recessive
fever peaks at late afternoon
Due to damp-heat restriction in the
interior preventing the heat to
reach at and disperse from the
exterior, unabated by sweating.
Yin deficiency tidal fever: a lower fever
occurs in the afternoon or evening,
accomplished by night sweating,
feverish sensation in palms, soles and
chest, flushed cheeks, dryness in the
mouth and throat.
Due to deficiency of Yin leading to
internal heat, also known as steaming
bone tidal fever.
5.Alternation of fever and chills
Malaria or some other disease in
which pathogenic heat is in
between exterior and interior.
Perspiration
Spontaneous sweat: Qi(Yang)
deficiency
Night sweat: Yin deficiency

Because of the deficiency of Qi,

the function of controlling the
open-close of the pores is out of
order, and sweat happen.
Pain
Distention pain
Due to Qi retardation
Heavy pain
Damp factor
Because damp is heavy, turbid and
sticky, when obstructing the
channel and impeding the Yang Qi,
it will cause pain and heavy
sensation.
Prickling pain
Blood stasis
Burning pain
Due to pathogenic fire burning the
collateral veins, or deficiency of Yin
giving rise to Yang heat.
Cold pain
Due to obstruction of collateral by
pathogenic cold, or Yang Qi
insufficiency, Zang-Fu organs and
channels lacking in warmth.
Dull pain
Due to Yin cold accumulation and
Qi-blood circulation obstruction as
a result of Qi-blood insufficiency.
Location
Chest pain——lung
Hypochondriac pain——liver
Epigastric pain——stomach
Abdominal pain——spleen and
stomach
Lumbago pain——kidney
Diet (food, drink, taste)
Poor appetite due to weakness and
deficiency of the spleen and stomach
indicates deficiency syndrome.
Poor appetite due to damp factor
disturbing the spleen Qi indicates
excess syndrome.
Anorexia (disgust at the sight or thought
of food) is due to injury caused by
improper diet, or damp-heat
accumulated in the liver and
gallbladder.
Thirst with preference for cold fluid
is due to interior heat syndromes
Absence of thirst, or thirst with
preference for only small amount
of warm fluids, indicates cold-
damp syndromes.
Defecation and urination
Constipation
+dryness stools, thirst, dry tongue
with yellow coat——excess heat
syndrome.
+fatigue, weak pulse——deficiency
of Qi
Diarrhea
+foul mucoid stools——dampness-
heat in the intestines
+watery stools, limbs cold, white
coat——interior cold syndrome
Urination
Polyuria: deficiency-cold syndrome
Oliguria: excess-heat syndrome
Hearing and vision
Ears are the portals of the kidney,
Tinnitus and hearing problems are
mostly associated with deficiency
of kidney essence.
Eyes are the portals of the liver,
Eyes troubles are attributable
chiefly to the liver condition.
Palpation
is the fourth diagnostic method, including
pulse taking and other palpation of different
parts of the body.
The former is a diagnostic procedure by
which the physician may feel the patient's
radial arteries with the fingertips to judge
pulse condition, thus learning and inferring
the condition of illness.
The latter is also a procedure by which the
physician may touch, feel, push and press
certain parts of the body to detect local
abnormal changes, thereby determining the
Pulse examination
It is the diagnostic methods
performed by pressing the radial
artery posterior to wrist to
examine the conditions of the
pulse.
It is the most frequently used
method in TCM to diagnose
diseases.
Why Pulse examination can
diagnosis the diseases
 Heart govern the blood vessels, and
receive blood from the vein and pump it
through the artery by alternate dilation
and contraction, then pulse is formed.
 Spleen control the blood
 Liver store the blood
 Qi is the commander of blood
So by palpation the blood vessels in
specific parts of body, it is possible to
detect the state of Qi-blood and Zang-Fu
organs.
What Pulse examination can
do?

 Detect the state of Qi-blood and

Zang-Fu organs.
 Ascertain the location and nature
of the disease
 Assess whether the condition is
improving or deteriorating
 Forecast the chances of recovery
Pulse-taking in general
Position: Cun-kou
pulse (radial styloid
pulse) is common
used.
2. Guan: is located on
the anterior face of
the radial styloid
process.
3. Cun: is on its distal
side.
4. Chi: is on its
proximal side.
Time for pulse-taking
Pulse should be taken in a quiet,
relaxed, and friendly atmosphere,
let the patient feel at ease,
so that disturbances from both
external and internal factors can
be reduced to be minimum.
In the early morning
Posture
The patient should
seat upright or lie
down,
and stretch out his
forearm in a
horizontal position
level with the heart,
the palm facing
upward,
the wrist resting on a
soft pad.
Method for taking the
pulse
 The middle finger on
the Guan part
 The index finger on
the Cun part
 The ring finger on
the Chi part
The three fingers Chi Guan
should be in bow- Cun
shaped with their
tips in the same
line.
 The spacing of the three fingers
depend on the height of the individual
2. for a tall patient, the fingers should be
spaced apart
3. For a short patient, the fingers should
be keep comparatively close to
together
4. The pulse of infant, is more shorter, so
feeling the pulse with one finger is
suggested.
Three-steps palpation
1. First apply finger force but lightly——
on skin, examining Yang, the Fu
organs, and also the heart and lung
2. Then apply finger force moderately
(neither too forceful nor too light)——in
muscle and blood, examining the
harmonious between Yin and Yang,
also the state of the spleen and
stomach
3. Finally press down firmly——between
sinew and bone, examining Yin, the
Zang organs, especially the liver and
 Heart Lung
Liver Spleen
Kidney Kidney

Left hand Right hand

General pulse taken
Feel the pulse simultaneous with
the index, middle and ring fingers
respectively on Cun, Guan and Chi.
Individual pulse taken
Apple the fingers individually to
the three parts.
For example, apple only the middle
finger on the Guan part of the left
pulse to get further information
about the liver condition.
In clinical practice, general pulse
taken and individual pulse taken
are often used in cooperation.
Palpation may provide data of the
depth, rate, rhythm, strength,
smoothness, and form of the pulse
which are valuable for determining
the location and nature of disease.
The pulse should generally be felt
attentively for at least two to three
minutes.
Normal pulse
Smooth and forceful with regular
rhythm and approximately four
beats per respiration, i.e. 60-80
T/M.
Neither too deep nor too
superficial.
1.Rate-
a. Slow pulse
Slow pulse: less than 60 T/M.
Indicates: Cold syndrome.
The coagulation of cold lead to the
retarding of the blood circulation.
It just like the water
The more cold
The more slow
1.Rate-
b. Rapid pulse
Rapid pulse: more than 90 T/M.
Indicates: Heat syndrome.
The pathogenic heat accelerates
the blood circulation.
It just like the water
The more heat
The more fast
Heat and cold syndrome
are two principles used to differentiate
the nature of diseases.
Heat and cold syndrome reflect the
states of Yin and Yang in the body.
Cold syndrome is attributable to the
invasion of pathogenic cold factor, or to
depletion of Yang, excess of Yin.
Heat syndrome denotes to symptom
complex that is attributed to invasion of
pathogenic heat, or excess of Yang,
depletion of Yin, hyperactivity of the
organism.
2.Depth –
a. Superficial pulse
Superficial pulse: it can be easily
felt by slight touch on the skin, but
becomes less perceptible when
further pressure is applied.
Indicates: exterior syndrome
Exterior syndrome
indicates the exterior parts of body
is affected by exogenous
pathogenic factors and the disease
is in its primary stage and
relatively mild.
When the exogenous pathogenic
factors attacks the muscles, the
defensive Qi resists, and meridian
Qi goes outside, hence the
superficial pulse.
if the enemy invades our border, our
army will go out for fight, and then the
border will become the battlefield at
this moment.
And the Superficial pulse reflects the
place which is battlefield, if you feel the
Superficial pulse, it show you the state
of struggle between healthy Qi and
pathogenic factors is in the exterior
place.
So it indicate the exterior syndrome.
2.Depth –
b. Deep pulse
Deep pulse: it can be felt only with
heavy pressure.
Indicates: Interior syndrome
Interior syndrome
indicates the disease is in the interior
parts of the body.
if our army are unable to resist the
enemy's invasion, then the enemy will
invade into our city, even the capital-
beijing, the condition is more serious at
this time.
So the Deep pulse shows us the state of
struggle between healthy Qi and
pathogenic factors is in the interior
place.
2.Depth –
c. Hidden pulse
Hidden pulse: deeper than the
deep pulse, it can be detected only
by pressing forcefully through the
sinew right to the bone.
Indicates: in cases with syncope,
severe pain, invasion of the
interior body by pathogen which
impedes the flow of Qi and blood.
3.Strength –
a. Vacuity pulse
Vacuity pulse: weak and vacuous
upon three-steps pulse-taking.
Indicates: deficiency syndrome.
The weakness of pulse beating is
due to the deficiency of Qi “too
weak to move the blood”, and as
the blood is also vacuous, the
vessels become less flourish.
Deficiency syndrome
chiefly denotes to insufficiency of
health Qi.
Deficiency of the essence in the
body, so pulse taking will be weak.
3.Strength –
b. Repletion pulse
Repletion pulse: forceful in response to
each of the three-steps pulse-taking.
Indicates: excess syndrome.
Though the pathogenic factors are
exuberant, the body resistance is not
deficient, and the struggle between
them makes the Qi and blood excessive
and the vessels and and full, so the
pulse is forceful and responds to the
fingers.
Excess syndrome
denotes to excess of pathogenic
factors.
Because of excess of pathogenic
factors, so too much evil Qi is in
the body make the vessels
Repletion.
3.Strength –
c. Weak pulse
Weak pulse: an extremely soft,
deep and thready pulse can be felt
only by heavy pressure.
Indicates: depletion of Qi and
blood.
Because of the insufficient blood is
unable to fill the vessels and the
weakness of Yang Qi fails to
promote the blood circulation, the
pulse is deep, thready, and soft.
4.Rhythm——heart illness
Intermittent pulse
Abrupt pulse arrhythmia
Knotted pulse

Indicates: heart illness

4.Rhythm——
a. Intermittent pulse
Intermittent pulse: a slow and
weak pulse that makes a fairly
long pause at regular intervals
before it starts to beat again.
Indicates: debilitation of Zang Qi,
and heart disease.
4.Rhythm——
b. Abrupt pulse
Abrupt pulse: the beating of the
pulse is sudden and hasty with
irregular intermittence.
Indicates: excess heat syndrome,
attributable to Yang heat
exuberance, Qi-blood stasis,
phlegm and food retention, or
swollen pulse.
4.Rhythm——
c. Knotted pulse
Knotted pulse: the pulse is slow
with pause at irregular intervals.
Indicates: Yin exuberance, Yang
disharmony, Qi stagnation, cold
phlegm, blood stasis, channel Qi
retardation.
5.Smoothness-
a. Rolling pulse
Rolling pulse: a pulse coming and going
smoothly, feeling slick to the fingers like
pearls rolling in a dish.
Indication: excess heat syndrome,
phlegm retention, food stagnation.
Health people, pregnant women which
implies an abundance of Qi and blood,
and should not be mistaken as a morbid
pulse.
This pulse often appears when
pathogenic factors of the excess type
due to phlegm humor and retention of
food are stagnated inside the body and
the body resistance is still very strong,
causing excess of Qi and surging of
blood.
If the pulse is rolling and harmonious, it
is a normal pulse condition, showing
that Health people.
A smooth and rapid pulse in pregnant
women is a vigorous and harmonious
phenomenon of Qi and blood.
5.Smoothness-
b. Rough pulse
Rough pulse: the pulse is coming and
going un-smoothly and in choppy a way
like a knife scrapping the bamboo.
Indication: depletion of essence, blood,
and fluid; Qi and blood stasis.
 The deficiency of essence and blood is
unable to nourish the meridians and
vessels, causing retardation of blood
circulation and uneven flow of the
meridian Qi, hence the unsmooth and
weak pulse.
 The stagnation of Qi and blood stasis
and the retained phlegm and food can
cause obstruction of Qi and blood
circulation, therefore, the pulse is
unsmooth and forceful.
Rolling pulse and Rough
pulse
The circulation of Qi and blood in
the body are like the flow of the
river,
Qi and blood circulate smooth in
the body, it will be Rolling pulse,
while the circulation of Qi and
blood are unsmooth when they are
blocked, and you fell Rough pulse.
6.Form-
a. Full pulse
Full pulse: a pulse that is felt like waves
surging, full, large, and forceful.
However, forceful in rising but feeble in
falling.
Indication: exuberance of pathogenic
heat.
Abundant internal heat causes the
blood vessels to expand and accelerate
Qi and blood circulation, thus leading to
a bounding pulse.
6.Form-
b. thready pulse
Thready pulse: a pulse feel like a well-
defined thread under the fingers and is
feeble yet easily perceptible.
Indication: exhaustion of Qi and blood,
various deficiency syndromes.
Because the insufficiency of nutrient
and blood fails to fill the blood vessels
and deficiency of Qi is unable to propel
the blood circulation, this pulse is very
fine and weak.
6.Form-
c. Wiry pulse
Wiry pulse: is straight and long,
and felt like the string of musical
instrument to the touch.
Indication: pain syndrome, liver
and gallbladder diseases, retention
of phlegm and fluid.
Wiry pulse is the manifestation of the
retention of meridian Qi
The liver dominates the free flow of Qi
and blood and regulates the flow of Qi.
Usually, the meridian Qi is soft.
When pathogenic factors are stagnated
in the liver, the free flow of Qi and blood
and the Qi activity dysfunction, or the
meridian Qi is obstructed by pain
syndrome or phlegm retention, the wiry
pulse will appear due to the tension of
the meridian Qi.
6.Form-
d. tense pulse
Tense pulse: felt tense and
forceful, like a stretched twisted
cord.
Indication: the presence of cold
and pain, or retention of
undigested food.
When pathogenic cold invades the
human body, the Yang Qi is disturbed.
The struggle between the cold and the
body resistance makes the vessels tight
and contracted, hence the tense pulse
appears.
The tense pulse found in severe pain
and retention of food also results from
the struggle between the cold and the
body resistance.
6.Form-
e. hollow pulse
Hollow pulse: is floating, large, soft
and hollow, classically described as
“a scallion stalk pulse”.
Indication: a sign of heavy blood
loss, Yin impairment, as can
usually be observed in cases of
major hemorrhage.
The appearance of the hollow pulse is
always related to the loss of blood,
which is unable to fill the vessels.
This pulse results from a sudden
decrease of blood or from the deficiency
of body fluids because insufficient blood
cannot fill the vessels.
The Yang Qi has nowhere to adhere to
and scatters outwardly, then the hollow
pulse results.
6.Form-
f. soft pulse
Soft pulse: is floating, thready and
soft by gentle touch, but becomes
indistinct on heavy press.
Indication: deficiency syndrome,
damp syndrome.
In case of deficiency of Qi and
weakness of Yang, the deficiency
Yang results in a superficial, soft,
and thready pulse.
If dampness restricts the blood
vessels, the soft pulse may appear.
Question
slow and deep pulse appear at the
same time
What is syndrome?
slow pulse indicates cold syndrome
deep pulse indicates interior
syndrome
judged synthetically, the meaning
of this pulse station is cold and
interior syndrome.
we just talk basic knowledge about
pulse examination,
in the clinical practice there are
lots of pulse,
so it need everybody to
understand and master further by
practice in the future.
Classification of pulses
Name of Pulse condition Indication
pulse
Superficial To be felt only by light Exterior
touch, but grows faint on syndrome
heavy pressure
Deep Hardly felt by light touch, interior
but distinct under heavy syndrome
pressure
Hidden To be felt only by deep Stagnation of
pressure to the level of the pathogenic
bone, and even then the factors in the
beats seem to come from a interior,
deeply located place syncope, severe
Slow Only three beats per pain
cold syndrome
Rapid respiration
More than five beats per heat syndrome
respiration
Vacuity Forceless and Deficiency
empty in the syndrome
three regions
Repletion Vigorous and Excess
forceful in the syndrome
three regions
Weak Extremely soft, Deficiency of Qi
deep, and and blood
thready
Intermittent Irregular heart Heart illness
Abrupt beat
Knotted
Full Surging like roaring waves Preponderance of
which come vigorously and pathogenic heat
Thread fade away
Thready like a fine thread, Exhaustion of Qi and
y but very distinct and clear blood deficiency and
dampness syndromes
Wiry Taunt and long, like the Diseases of the liver
string of a musical and gallbladder, all
instrument kinds of pain, phlegm
Tense Tight and forceful, like a retention
Cold, pain, retention of
tightly stretched and twisted food
Hollow rope
Superficial, large, and hollow Loss of blood, injury of
like pressing the tubal leaf Yin
of spring onion
Soft Superficial, thready, and soft Deficiency, dampness
General palpation
Skin
Four limbs
Abdomen
Acupoints
Cold——Yang deficiency or Yin
excess
Heat——Yin deficiency or Yang
excess
Abdomen
Pain alleviated by Pain aggravated
pressure by pressure
deficiency excess syndrome
syndrome
Review
Visual examination
Auscultation and olfaction
examination
Inquiry
Pulse taking and palpation
Conclusion----eight
principles
Slow pulse Indicates Cold syndrome.
Rapid pulse Indicates Heat syndrome.
Superficial pulse Indicates exterior
syndrome.
Deep pulse Indicates Interior syndrome.
Vacuity pulse Indicates deficiency
syndrome.
Repletion pulse Indicates excess
syndrome.