Pulse taking is a vital part of the traditional Chinese medicine diagnosis

Chinese Medicine Diagnosis

Chinese medicine diagnosis is based on a diagnostic system traditionally known as the Four Examinations or Four Pillars. These are Looking, Listening/Smelling, Palpation and Asking. An acupuncturist seeks to understand your state of health by using this diagnostic model at every treatment.


Looking relates to the observation of the tongue, the face as well as any problematic area. The tongue reflects gradual changes (unless there is an acute infection for example) and your practitioner will look at many aspects of the tongue such as colour, texture, moisture, coating, shape, movement, cracks and other markings, deviation, veins under the tongue and so on.

Looking at the face is useful as it provides additional diagnostic information as it can reflect how a person may have had various trauma or stresses during their life, as well as it being representative of expressive tendencies that are based on a person’s unique emotional ‘constitution’. It also contains many microsystems or maps of the body that help to understand problematic areas.

Looking at problematic areas of the body enables your practitioner to understand the balance of Yin (cold, contracting, downward/inward-moving) and Yang (hot, expansive, upward/outward-moving) qualities. For example, if a skin condition is more red, itchy and affecting the upper-body, it shows an excess of Yang energy (or Yang Qi) and this needs a different treatment from a condition that is more pale, damp and affecting the lower body (more of a Yin condition).


Practitioners will listen to the sound of the voice to determine which one of the five types of voice is most dominant. These relate to the Five Element system of Chinese medicine, where each of the five types of sound relate to a specific meridian system and organ.

The sound of the voice also tells us about certain types of disease progression, particularly of the lungs. This is common during certain seasons and some people complain of losing their voice or becoming more hoarse in Autumn for example.

Smelling is classified with Listening as one of the Four Pillars of Chinese medicine diagnosis, based on a similar rationale. Practically speaking, we do not sniff our patients directly! This skill is much more difficult to use than the more objective observations that can be made. However, there may be occasions when a patient is left to rest in the treatment room and the practitioner will re-enter the room and observe specific diagnostic odours that are present, as subtle emanations from the body during times of stress. This is why, it is preferable to avoid wearing perfume or scented body sprays or deodorants at your first session.

It is interesting to note, that in more recent times, dogs have been trained to detect the odor of people who have cancerous changes in their body. A trial in 2015 was approved by the NHS and showed highly accurate results.


Traditional Chinese medicine diagnosis also includes palpation. The primary location of palpation is at the two wrists in order to feel the pulse at the radial artery. Feeling the pulse enables the acupuncturist to gather information about a person’s state of health in a lot of detail.

There are three main positions that are felt, two or three depths (depending upon the pulse system used) and classically, 28 different pulse qualities that are looked for at each position. Each wrist and position relates to different organ systems, so as you can see, there is a huge amount of information that can be accessed.

As well as the traditional method of pulse diagnosis, Lee also uses the Shen-Hammer, Contemporary Chinese Pulse Diagnostic system which utilises many more pulse positions and three, rather than two depths for each position to gain more insight into a person’s functioning.

One of the reasons that the first visit is so long, is that a great deal of time is spent feeling the pulses to gather a baseline of information, which is added to at each visit to build a more accurate understanding of a person’s health.

The pulses at the head and ankle may also be felt and this is a classical way to further understand the flow of energy through the body.

Palpation of the abdomen is also very useful to gather further diagnostic information, identifying tender areas or areas with a different temperature, sensitivity, tone or texture to highlight particular meridians and organ systems with imbalance.

Palpating the 14 main meridians (again, for temperature, sensitivity, tone and texture) can be important to identify energetic blockages along these pathways. It may not be possible to palpate all of the meridians in the first session, so your practitioner may choose to work with the meridians that traverse any problematic areas first.

It is important to note, that all of the diagnostic methods are used within the boundaries of a patient’s comfort levels and performed respectfully. If you have any concerns or questions about this process please ask.


This is the diagnostic process that people are most familiar with in the West! It involves asking
about many areas including the main complaint in great detail. For example, with headaches you might be asked where in the head is the pain felt, what is the quality of the pain (eg: sharp, dull, throbbing, stabbing, contracting, expanding, hot, cold, moves around etc), what time of day does it appear, what effect does certain foods and drinks have on it, what makes it better or worse and so on.

You will be asked about any medication, supplements, diet, lifestyle, sleep, the body-systems such as bowels and urination, mental functioning, mood and emotional issues, relationships, birth and childhood history as well as stressful periods and other aspects of life that may be relevant. All of the information you share with your practitioner is kept in the strictest confidence.

Integrating all of the information from all of these methods is where the traditional Chinese medicine diagnosis comes to fruition. Once this has happened, a treatment strategy can be formulated to provide a very specific treatment plan for the individual. This can be modified at every treatment based on observations of any changes identified using the above system of diagnosis.