Written by Jeonghwa Lee, Choonjae Lee, Published by Korea Institute of Oriental Medicine
The medical examination of TKM is broadly divided into examination and diagnosis. Examination is the process of gathering individual symptoms that a patient shows. Meanwhile, diagnosis is to generalize and analyze relative information and conclude the general disease. Then the cause and course of the disease are followed in order to decide treatment courses. Appropriate drugs, acupuncture, moxa cautery, and physical therapy are then prescribed for treatment. Among the main examination methods of oriental medicine are inspection, listening and smelling examination, inquiry and palpation.
1. Inspection
As one of the four diagnostic examinations, inspection refers to how to observe a patient’s facial expression, complexion, mental state, physical condition, etc.
Observation of facial colors indicates the nature of the disease and conditions of the five viscera and six bowels. Also, the degree of skin luster represents conditions of the visceral functions and is important in determining convalescence as well as the seriousness of disease. One of the most important in inspections is a tongue diagnosis.
1) Tongue Diagnosis
This is to examine the disease by observing the tongue. A TKM doctor examines a patient’s entire tongue and the change of its coating, which white, gray, or yellowish brown. Since the tongue represents conditions of visceral functions and qi and blood, it is very important in determining the seriousness and convalescence of disease.
The coating of the tongue – a thin layer of moss-like material – represents overall conditions of the stomach. On its observation, a doctor can examine the function of the stomach and bowels and the cause, nature, and location of the disease, as well as judge the convalescence of disease. The condition of the tongue tells the function of the heart and spleen. A taste function can be competently performed if heart qi is in harmony because the qi flows into the tongue. Taste functions go on smoothly, if spleen qi is in harmony because it runs through the cavity. Therefore, it can be assumed that something is wrong with the heart and spleen, if the tongue is rough, taste organs are atrophied, and taste functions are reduced. The color of the tongue coating is white in a slight or mild disease. According to the symptom, it represents deficiency pattern caused by deficiency of the healthy qi, cold pattern caused either by insufficient yang qi or by an acceleration of yin qi, and dampness pattern resulting from dampness in the stomach and bowels.
If the color of the tongue coating is yellow, it indicates retention of heat in the interior, febrile disease, and ulcer in the stomach, bowels, and duodenum. If the color of the tongue coating is light black, it indicates the lack of fluid and humor due to extreme retention of heat. The color of the tongue coating is thick black, when a chronic or critical febrile disease is present.
TKM does not regard the tongue as an organ that functions just in talking and eating. Examination through the tongue tells the seriousness, progress and decline of the diseases, and the required convalescence. It also helps understand the strength and weakness of body’s resistance, and the location, cause and symptoms of the disease.
2) Tiger’s Mouth Diagnosis
In TKM, pulse diagnosis, done by checking the condition of the pulse on the wrist, is commonly used for adults. However, Tiger’s Mouth diagnosis, which is named after the hand shape resembling a tiger’s mouth with the thumb and index finger joined together during examination, is used for children under 3 years of age instead, as a way of examining Tiger’s Mouth in order to make diagnosis.
Tiger’s Mouth diagnosis is done by taking the tip of the child’s index finger and rubbing it from the palm to the hand tips several times. As a result, blood vessels appear. Diagnosis is made through an observation of the length, color, and shape of the blood vessels. There are three bars for the three segments of the index finger – wind bar for the proximal segment of the index finger, qi bar for the middle segment of the index finger and life bar for the distal segment of the index finger.
The reasons for observing in such a way are as follows:
First is to make the examination of the child more convenient. It is not easy to use various kinds of examination methods accurately since children are scared easily, cry, and make a fuss by moving around. Second, it is not easy to have children examined at the wrist as adults are. Third, the fingerprint that appears here can replace an examination of the pulse because it represents the side branch of the pulse that can be felt at the wrist.
As a result of the examination, the disease is mild if the blood vessel is found at the wind bar, and severe if it is found at the qi bar. Also, the disease is dangerous and hard to cure if the vessel is seen at the life bar. It is especially critical if the vessel appears as far as the fingernail.
2. Listening and Smelling Examination
The listening and smelling examination is a diagnostic method through various kinds of strange changes in sounds and smells. That is, listening is a diagnostic method in which a doctor listens to a patient’s speech, respiration, cough, etc. Smelling is a method to make a diagnosis of the excretions, secretions and abnormal odors emitted from a patient’s body.
3. Inquiry (Questioning)
As one of the four diagnostic examinations, inquiry, or questioning, is a way of examining diseases by asking a patient or his or her guardian about the onset and duration of the disease, its medical history, its present symptoms, and other relevant complaints. A patient himself knows best about his and his family’s medical history, the symptoms he feels, and his health condition at ordinary times. Therefore, it is very important to ask a patient or his / her guardian directly about how he feels.
Inquiry is required when a patient feels symptoms and physical symptoms are barely noticeable, or when the disease is caused by an emotional factor. A doctor can discover an aspect of a disease that must be examined by focusing on a patient’s symptoms and complaints. In inquiry, visible symptoms are the most important because they are significant clinical clues to discerning what the problem is.
With inquiry, a practitioner asks a patient not only about the location, nature, seriousness, cause and duration of the disease and its incidental symptoms but also about food, sleep, urine and stools. Then he makes a diagnosis.
4. Palpation
After several thousands of years of research and investigation, and the healing of perhaps millions of patients, the theory and practice of Palpation has accumulated abundant proof. It is divided into pulse diagnosis, which is made the pulse and body palpation which. As one of the four diagnostic examinations, it is a way in which a doctor checks for pathological changes by touching the body surface with his / her hands or fingers. The pulse is then taken by pressing the skin, hands, feet, chest, abdomen and other areas of the body.
Pulse Diagnosis
Pulse diagnosis is one of methods of observing the nature and condition of the pulse. The doctor presses the tips of his index, middle, and ring fingers on the wrist where the radial artery throbs. There are three sections over the radial artery for feeling the pulse – the bar (gwan) which is just central to the radial styloid at the wrist, where the tip of the physician’s middle finger is placed, the chon (inch) which is next to it on the distal side where the tip of the physician’s index finger rests, and the cheok (cubit) which on the proximal side where the tip of the physician’s ring finger is placed. At each of the
three sections, the nature and condition of the pulse are examined carefully by gradually the strength in the fingers.
The pulse can be divided into tens of types in terms of its frequency, shape, strength, and others but usually into eight types of main pulses – floating, sunken, slow, rapid, slippery, rough, string-like, and tight.
A doctor diagnoses a patient’s condition and the disease depending on pulse diagnosis, and determines how to cure. He judges whether his treatment was appropriate when he compares the pulses before and after the treatment.
Pulse diagnosis plays a very important role in the examination of patients in TKM. However, there are some patients who tend to estimate the doctor’s ability only by pulse diagnosis, neglecting many other methods. They need to get rid of this wrongful attitude to prevent mistaken diagnoses and to cure their own disease.
By analyzing the patient’s symptoms through the above-mentioned diagnostic examinations, a doctor accurately understands the patient’s conditions and then decides appropriate treatment methods. This method of analyzing data and categorizing it into basic types is referred to as pattern identification or syndrome differentiation. The fundamental and guiding principles, including yin and yang, exterior and interior, cold and heat, and deficiency and excess, are referred to as the eight principles.
5. Instruments for Diagnosis and Treatment in TKM
In TKM, a doctor examines a patient with inspection, listening and smelling, inquiry and palpation. When these types of diagnosis are not available for complete examination, however, other methods are used. As modern medical science uses the X-ray, MRI, CT, ultrasonography, EKG, blood tests, and urine analysis, so TKM doctors use high-tech equipments such as neuro-meter / skin resistance monitor, meridian pathway diagnosing device, undulate examination device, acupuncture point detector, and obesity measuring instrument. The neuro-meter is used to measure the strength of very small electrical impulses that flow through the 12 meridian pathways of the human body.
Its purpose is to control the deficiency and excess of the five viscera and six bowels through drugs, acupuncture, or electro-stimulation, depending on the results.
The meridian pathway diagnosing device is a more advanced machine than the neuro-meter. Minute electrical impulses that flow through the human body, especially in the 12 meridian pathways, are measured. This aids in the diagnosis of the cause and phenomenon that have occurred in the body, which have caused the disease. This is a device that distinguishes the difference between minute electrical impulses and resistance found on the skin, and also systematically studies changes in the meridian pathways and acupuncture points. In addition, it is an important measuring device that confirms the academic values and meaning of acupuncture and detects the deficiency and excess of the five viscera and six bowels.
This device is very effective in curing the five viscera and six bowels by controlling their deficiency and excess when acupuncture is applied or drugs are administered. The undulate examination device is used in wave examination. Wave examination is one of the newer diagnosis methods of TKM. People, healthy or weak, all have their own unique waves. The undulate examination device uses this basic principle to induce waves by drugs and creates waves of a healthy person.
It is the high-tech diagnosis method that helps recover from disease and maintain health. The obesity measuring instrument is a device that measures not only the amount of fat in the skin, muscles, and abdominal cavity but also the concentration
of protein and water content by sending a certain type of electric current to both hands and feet. Examination and treatment will be studied and developed with the use of these instruments in the future, leading to the further development of TKM.
