To establish the energy balance of a patient, the practitioner of Traditional Chinese Medicine (TCM) proceeds in two stages:
- it gathers information through the four stages of the examination: observe, auscultate, palpate and question (each is presented in more detail at the next level);
- he organizes this information into one or more coherent syndromes, thanks to very precise analysis grids.
It is through a set of concrete signs – clinically observable using the five senses – that the practitioner recognizes the pathological state or the proper functioning of the Organs and their spheres of influence (see Organic Spheres), as well as the balance between what TCM calls the Correct energies and the Perverse energies.
The data collected through examinations are mainly used to treat imbalances whose manifestations are already apparent (illness, pain, insomnia, malaise, etc.), but they often make it possible to prevent the appearance of illnesses or latent imbalances.
The four stages of the examination: question – auscultate – feel – observe
Here is a brief description of the four parts of the exam. For more details, click on the titles of each of them.
The interrogation makes it possible to go beyond the immediate condition of the patient, to know his habits of life and his personal history, while offering him the possibility of expressing himself. To be profitable, it must be both thorough and concise. First of all, the practitioner deepens the patient’s reason for consultation using the analysis grid (see below) that he deems most appropriate. Then, he proceeds to an investigation of the “field” of the patient, that is to say the present state of his body, his Organs, his physiological systems, the care he brings to them and his characteristics. hereditary. Finally, modern diagnostic tools (from blood tests to magnetic resonance) are highly appreciated today by practitioners who thus benefit from even more reliable analyses.
Auscultation involves the senses of hearing and smell. It is mainly used in case of respiratory disorders where the evaluation of the type of cough and lung capacity are essential. It can also be useful for evaluating Qi, the state of which is revealed by the strength of the voice. The odors released by the body and its substrates – which are often very characteristic – are used much less today.
The first element of palpation is taking the Chinese pulse. It is practiced by placing three fingers on each wrist and requires a lot of dexterity. This has always been, along with the examination of the tongue, one of the tools most valued by the great masters of Chinese medicine to draw up their energy balance. The taking of the six pulses is done methodically by applying variable pressures in order to feel the different characteristics. Not only is the rhythm of the pulses assessed, but also their regularity, strength, depth and quality; this makes it possible to obtain precise and very diversified information.
Palpation is also practiced on certain parts of the body and on very specific acupuncture points. It is essential in the evaluation of cases of pain and allows, by a reflex effect, to check the state of the various organs and internal systems of the body.
Analysis grids to establish the energy balance
To complete the examination of his patient and succeed in establishing the precious energy balance, on which the treatment plan will depend, the practitioner uses what TCM calls an analysis grid. This grid will direct his investigation, like a funnel, by gradually specifying the characteristics of the condition, which will lead to its origins and allow the assessment to be produced.
Among the many TCM analysis grids, the three most frequently used are those of the “Eight Rules” (BaGang), the “Viscera” (ZangFu) and the “Meridians” (JingLuo). These grids make it possible to approach the same condition from different perspectives, each being more relevant for analyzing this or that type of problem. For example, the Meridians grid is the most used in cases of musculoskeletal pain (see Tendinitis), while the Viscera grid will be more convenient for internal medicine conditions. However, each practitioner may have their preferences, regardless of the type of problem treated.
The symptoms of the common cold, for example, will be classified differently according to their manifestations. Factors such as the color of the secretions, the presence or absence of perspiration, the type of sensations in the throat will determine whether we are in the presence of Cold or Heat. Thus, yellow secrets, sweating and a sore throat will be associated with Heat, while white secrets, without sweating, with a throat that only slightly itches will be signs of Cold. The cold is considered as an Excess which reaches the External: the body aches signal that the circulation at the Surface of the body (skin and muscles) is disturbed. This Excess can progress towards the Interior to invade the Lung, resulting in symptoms of coughing, chronic sputum and shortness of breath.
From this binary method of classification derives the two other grids, that of the Viscera, applying above all to internal disorders, and that of the Meridians, to external disorders.
The story of Ms. Loiselle’s tendinitis is a good illustration of the application of the Meridian grid in the case of persistent pain. Essentially, the acupuncturist attempts to identify which Meridian is involved, through questions regarding the pain pathway.
Multiple diagnoses and treatments
All practitioners do not proceed in the same way and do not systematically use all the diagnostic tools of TCM. Many rely on pulse and tongue to guide their protocol, some favor palpation – as in the case of Japanese approaches – while others adopt a method closer to what we know in Western medicine, relying more on lab results to guide their diagnosis.
It is therefore considered that there are multiple ways of making diagnoses, and also of treating conditions. This conception is quite far from what Western medicine advocates where, despite the evolution of treatments, the basic protocols usually remain the same for a given pathology. For example, a patient with the signs and symptoms of sinusitis will undergo X-ray examinations; if the Review results confirm thickening of the mucous membranes, antibiotics will be prescribed. In the presence of this same patient, a Chinese doctor will rather choose among many treatment strategies depending on what the examination will have revealed to him: the acute or chronic nature of the sinusitis, the signs and symptoms associated with it (phlegm, cough, headache, etc.), the stress that the patient will have been confronted with beforehand, the energy balance of his digestive sphere, etc.