The Four Exams of Oriental Medicine
Ideally the true practitioner leads an exemplary life, does no harm, ignores the wealth of the patient, has compassion for life, and looks upon the sufferer as if he himself had been stricken. A good practitioner of Oriental Medicine is curious about the patient, and will want to know details about his/her way of life. Disease is rooted in the life of the patient, so the practitioner must be a detective, sifting clues in order to solve the mystery. The practitioner may administer herbs or acupuncture, and the practitioner may practice philosophy, offering insight to reveal the cause and permit the cure. The practitioner diagnoses according to the Four Examinations or the Four Concepts of Exam
1. Looking - The practitioner observes the patient. Body tone, gait, skin, facial expression, emotional tone, and mannerisms are noted. The practitioner looks carefully at the tongue. The heart revealed at the tip, the kidneys at the root. The color and appearance of the tongue and tongue coating show what may be hidden; revealing hot from cold, damp from dry; and true from false.
2. Listening -The practitioner must be attentive to the patient's story and history, putting aside preconceptions. The practitioner listens to the patient's voice, noting its volume and clarity, as well as manner of speaking and use of language.
3. Smelling and tasting -The practitioner may ask the about the patient’s body odors and tastes. Odors and tastes are clues. Strong tastes and odors or can be signs of heat, toxicity or digestive stagnation.
4. Touching - The practitioner will feel the pulse on both wrists. Besides noting its rate, rhythm, and overall strength, practitioner may note the type of pulse. Texts classify the pulse into at least twenty-eight types. Some of the common types are wiry (feels tense, like a wire), thready (feels thin, like a thread), deep (strong pressure required to feel it), short (slow and irregular), slippery (feels like a bubble moving). By touching the patient in this way, the practitioner senses something of the internal condition of the patient. The patient may not tell the whole truth, but the pulse never lies.[1]
The taste concept (which would actually be a fifth) is also no longer used by the practitioner personally, but in ancient times Asian practitioners tasted the urine. These concepts are used to get the macrocosm of the patient, where as, western medicine uses the microcosm to view the patient. These four concepts of exam are used in conjunction with the eight principles to diagnose and treat the patient. A patient, who is agitated, sweaty, and nervous, looking in many directions, is observed by looking at the patient. The patient is asked questions and doesn’t answer appropriately in a hoarse deep voice, is observed by listening to the patient. A rapid, inconsistent, and strong, pulse, and skin which is hot and damp, are all felt by touching the patient. The patient whom has a putrid burnt smell would be observed by smelling the patient. All these observations assist in the whole picture of the patient. What is going on in the patient’s life? How s/he is feeling and how are their thought processes and moods? Are they able to focus? Are they happy, Nervous, Fearful? All this information gives the practitioner a clue into how to help the patient to achieve balance and what treatment would work best. A patient with heat and phlegm symptoms brought on by stress and would be treated for heat and phlegm but also for stress. Along with a suggestion of life-style change may be in order or a modification in life-style like mediation, a vacation or a decrease in working hours. A patient with heat symptoms would not be treated with moxa because it would further aggravate the problem.
[1] http://www.drshen.com/traditionalchinesemedicine.html#whattoexpect
1. Looking - The practitioner observes the patient. Body tone, gait, skin, facial expression, emotional tone, and mannerisms are noted. The practitioner looks carefully at the tongue. The heart revealed at the tip, the kidneys at the root. The color and appearance of the tongue and tongue coating show what may be hidden; revealing hot from cold, damp from dry; and true from false.
2. Listening -The practitioner must be attentive to the patient's story and history, putting aside preconceptions. The practitioner listens to the patient's voice, noting its volume and clarity, as well as manner of speaking and use of language.
3. Smelling and tasting -The practitioner may ask the about the patient’s body odors and tastes. Odors and tastes are clues. Strong tastes and odors or can be signs of heat, toxicity or digestive stagnation.
4. Touching - The practitioner will feel the pulse on both wrists. Besides noting its rate, rhythm, and overall strength, practitioner may note the type of pulse. Texts classify the pulse into at least twenty-eight types. Some of the common types are wiry (feels tense, like a wire), thready (feels thin, like a thread), deep (strong pressure required to feel it), short (slow and irregular), slippery (feels like a bubble moving). By touching the patient in this way, the practitioner senses something of the internal condition of the patient. The patient may not tell the whole truth, but the pulse never lies.[1]
The taste concept (which would actually be a fifth) is also no longer used by the practitioner personally, but in ancient times Asian practitioners tasted the urine. These concepts are used to get the macrocosm of the patient, where as, western medicine uses the microcosm to view the patient. These four concepts of exam are used in conjunction with the eight principles to diagnose and treat the patient. A patient, who is agitated, sweaty, and nervous, looking in many directions, is observed by looking at the patient. The patient is asked questions and doesn’t answer appropriately in a hoarse deep voice, is observed by listening to the patient. A rapid, inconsistent, and strong, pulse, and skin which is hot and damp, are all felt by touching the patient. The patient whom has a putrid burnt smell would be observed by smelling the patient. All these observations assist in the whole picture of the patient. What is going on in the patient’s life? How s/he is feeling and how are their thought processes and moods? Are they able to focus? Are they happy, Nervous, Fearful? All this information gives the practitioner a clue into how to help the patient to achieve balance and what treatment would work best. A patient with heat and phlegm symptoms brought on by stress and would be treated for heat and phlegm but also for stress. Along with a suggestion of life-style change may be in order or a modification in life-style like mediation, a vacation or a decrease in working hours. A patient with heat symptoms would not be treated with moxa because it would further aggravate the problem.
[1] http://www.drshen.com/traditionalchinesemedicine.html#whattoexpect
posted by Jame'e at 12:47 PM
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