Diagnosis in Traditional Chinese Medicine
The Four Diagnostic Methods are:
Observation (望诊 – Wàng Zhěn)
Observation is a diagnostic method that involves examining external signs of the body for abnormalities or changes. This includes observing Shen (神) – the spirit or vitality seen through the facial expression, emotional display, complexion, posture, tongue appearance, and bodily secretions. The goal of this diagnostic method is to assess the pathological condition of internal organs as reflected through external physical changes. This helps the practitioner gain insight into the nature and severity of the illness. In particular, the face and the tongue are considered by Traditional Chinese Medicine to be closely connected to the internal organs, making them especially important areas for visual diagnosis.
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Listening (听诊 – Tīng Zhěn)
This involves analyzing various sounds made by the patient, such as:
Smelling (闻诊 – Wén Zhěn)
This involves detecting abnormal body odors that can reflect internal health conditions:
Note: Observation and inquiry should be used together with smelling. For example, if there is a rotten smell in the patient's room without visible wounds, it may indicate severe internal disease.
Pulse Diagnosis (脉诊 – Mài Zhěn)
Pulse diagnosis has a long history spanning thousands of years in the People’s Republic of China. Traditional Chinese medicine practitioners use pulse-taking as a key method for diagnosing illness and determining treatment approaches, based on the principles of natural science and empirical observation on human beings. Around 2,500 years ago, a renowned Chinese physician named Bian Que (扁鹊) was known for his expertise in diagnosing diseases through pulse examination.
During the era of Emperor Huangdi (黄帝)
Emperor Huangdi composed the classic medical text Huangdi Neijing (黄帝内经 / 内经).
The Huangdi Neijing (Inner Canon of the Yellow Emperor) describes the concept of "San Bu Jiu Hou" (三部九候).
San Bu (三部) refers to the positions for pulse diagnosis on both wrists. Each wrist has three positions: Cun (寸) – closest to the wrist crease Guan (关) – in the middle Chi (尺) – furthest from the wrist crease
At each of these three positions, the pulse is felt with three levels of pressure: Fu (浮) – superficial or light pressure Zhong (中) – medium or moderate pressure Chen (沉) – deep or heavy pressure
These 3 positions combined with 3 levels of pressure make up 9 types of pulse observation, known as "San Bu Jiu Hou" (三部九候) Literal translation: Three sections and nine indicators
During the Han Dynasty – Zhang Zhongjing (张仲景)
During the Han Dynasty, Zhang Zhongjing authored important medical texts on disease diagnosis.
He concluded that accurate and complete diagnosis must be based on four diagnostic methods, which are: Observation (望 – Wàng) Inquiry (问 – Wèn) Listening and Smelling (闻 – Wén) Palpation (切诊 – Qiè zhěn)
Later, during the Western Jin Dynasty – Wang Shuhe (王叔和) During the Western Jin Dynasty, Wang Shuhe compiled the "Mai Jing" (脉经 – Pulse Classic).
This classic synthesized earlier works from before the Han Dynasty, including Huangdi Neijing (内经) Nanjing (难经) Medical texts by Zhang Zhongjing and Hua Tuo (华佗)
In the Mai Jing, Wang Shuhe classified 24 types of pulse. This became one of the most comprehensive and influential works on pulse diagnosis, and it was widely studied both in China and internationally.
During the Ming Dynasty
Li Shizhen (李时珍) authored the Pinghu Maixue (频湖脉学), a treatise that compiled the distinctive features of Maixue (脉学) — the study of the pulse — from before the Ming Dynasty. This work was based on the foundational text Maijing, which identified 24 types of pulse. Li Shizhen added 3 more types, bringing the total to 27. He composed this information in verse to make it easier to memorize.
Later, the Chinese physician Li Shicai (李士材) wrote the Zhenjia Zhengyan (诊家正眼), adding one more pulse type known as Jimai (疾脉), increasing the total to 28 pulse types — a classification still in use today.
In addition, there was the Maijue Huibian (脉诀汇), written by Li Yangang (李延罡). Afterwards, many other Chinese physicians became interested in pulse diagnosis as a method for identifying various diseases. Learning to diagnose through pulse examination requires fundamental study and understanding of different methods. It also demands heightened tactile sensitivity in the fingers, practical experience under expert guidance, careful consideration, and consistent practice in order to achieve accurate diagnoses.
Natural Changes in the Pulse Related to the Body and Environment. The human pulse naturally changes in response to internal bodily conditions and external environmental factors. These variations are influenced by physical condition, surroundings, age, gender, body type (fat or thin), lifestyle, and emotional state — all of which cause the pulse to vary in different ways.
For example:
In children, the pulse may beat up to 7 times per breath cycle.
In healthy young adults, the pulse tends to be smooth and unobstructed.
In the elderly, the pulse may feel tight and firm.
In women, compared to men, the pulse is generally softer, thinner, and slightly faster.
During pregnancy, the pulse becomes slippery and rapid.
In overweight individuals, the pulse tends to be slightly sunken.
In thin individuals, the pulse may feel floating and broad.
In tall people, the pulse feels longer; in shorter individuals, it feels shorter.
After exercising, eating, or consuming alcohol, the pulse tends to become slippery, rapid, and forceful.
Hunger weakens the pulse, making it feel soft and lacking in strength.
Those who meditate or practice spiritual cultivation often have a soft and gentle pulse.
Changes in mood and emotion can also affect the pulse. For example:
Anger impacts the liver, causing the pulse to feel tight and thin.
Fear or shock may cause the pulse to become irregular or disordered.
Therefore, people experiencing intense emotions such as fear, surprise, joy, grief, excitement, stress, or anxiety will have pulse changes that correspond to those emotional states. Once the emotional state returns to normal, the pulse typically also returns to its normal rhythm.
The Influence of the Four Seasons on Pulse Changes
The four seasons also affect pulse patterns:
In spring, the pulse tends to feel tight.
In summer, the pulse becomes large and forceful.
In autumn, the pulse tends to be light and thin.
In winter, the pulse becomes deep and tight
There are also changes between day and night:
During the day, the pulse is more floating and forceful.
At night, the pulse becomes slightly sunken and slower.
People living in cold climates often prefer grilled or roasted foods, which can cause the pulse to become deep and strong.
In contrast, those living in hot climates are exposed to heat and humidity, which causes the pores to open and the muscles to relax both internally and externally. As a result, the pulse becomes slightly faster and softer.
