To establish the energy balance of a patient, the practitioner of Traditional Chinese Medicine (TCM) proceeds in two steps:

• he collects information through the four stages of the examination: observe, auscultate, palpate and question (each is presented in more detail at the next level);
• it 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 correct Energies and perverse Energies.

The data collected through examinations are mainly used to treat imbalances whose manifestations are already apparent (diseases, pain, insomnia, discomfort, etc.), but they often help prevent the onset of diseases or latent imbalances.

Here is a brief description of the four stages of the exam. For more details, click on the titles of each one.

1- Question

The questioning makes it possible to go beyond the immediate condition of the patient, to know his lifestyle 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 goes into more detail about the reason for consulting the patient using the analysis grid (see below) that he deems most appropriate. Then, he proceeds to an investigation of the “ground” of the patient, that is to say of the present state of his body, his Organs, his physiological systems, the care he brings them and his characteristics. hereditary. Finally, modern diagnostic tools (magnetic resonance blood tests) are now highly appreciated by practitioners who thus benefit from even more reliable analyzes.

2- Auscultate

Auscultation appeals to the senses of hearing and smell. It is mainly used in cases of respiratory disorders where the assessment 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 given off by the body and its substrates – which are often very characteristic – are used much less today.

3- Palpate

The first element of palpation is the Chinese pulse. It is practiced by placing three fingers on each wrist and requires a lot of dexterity. It has always been, along with the language examination, one of the most popular tools for the great masters of Chinese medicine to draw up their energy balance. The six pulses are taken methodically by applying varying pressures in order to feel their different characteristics. Not only the rhythm of the pulses is 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.

4- Observer

For a seasoned practitioner, observation begins as soon as the patient enters their practice. Already, gait, posture, movements and gaze are all non-verbal elements that can be revealing. The physical examination itself will focus on the sensory openings which are parts of the anatomy each having a privileged link with one of the Organs, and which can inform us about their state. The mere observation of the tongue (one of the Sensory Openings) by an acupuncturist can provide surprisingly rich information.

Skin tone is another important part of the observation, as it informs not only about the mind and emotional state of the patient, but also about his Qi and Blood. Madame Dubois, who illustrates the case of depression for example, has a complexion that denotes both a deficiency of the Qi of the Spleen / Pancreas because it is yellowish and a disturbance of the Spirit because it is dull.

To complete the examination of his patient and to establish the precious energy balance, on which the treatment plan will depend, the practitioner uses what TCM calls an analysis grid. This grid will direct its investigation, like a funnel, by progressively specifying the characteristics of the affection, which will lead to its origins and will make it possible to produce the assessment.

Among the many TCM analysis grids, the three most frequently used are those of “Eight Rules” (BaGang), “Viscera” (ZangFu) and “Meridian” (JingLuo). These grids make it possible to approach the same condition from different perspectives, each one being more relevant for analyzing a particular type of problem. For example, the Meridian grid is the most used in cases of musculoskeletal pain (see Tendinitis), while that of the Viscera will be more convenient in relation to ailments relating to internal medicine. However, each practitioner can have their preferences, regardless of the type of problem being treated.

The Eight Rules grid

The Eight Rules grid is the oldest analysis grid; it works in the binary mode by classifying – by associations – all the symptoms according to their belonging to Yin or Yang, Cold or Heat, Void or Excess, Inside or Outside, from so as to establish an overall energy balance.

Cold symptoms, for example, will be classified differently depending on their manifestations. Factors such as the color of the secretions, the presence or not of perspiration, the type of sensations in the throat will determine whether we are in the presence of a Cold or a Heat. Thus, we will associate yellow secretions, sweating and a painful throat with Heat, while white secretions, without perspiration, with the throat that itches only slightly will be signs of Cold. The common cold is considered to be an Excess which reaches the External: muscle aches indicate that the circulation to the surface of the body (skin and muscles) is disturbed. This excess can progress inwards to invade the lungs, resulting in symptoms of cough, chronic sputum and shortness of breath.

From this binary method of classification derive the other two grids, that of the Viscera, which applies especially to internal disturbances, and that of the Meridians, to external disturbances.

The viscera grid

This grid is the most complex, and requires a thorough knowledge of the organic spheres, Organs, Entrails and their multiple interdependencies according to the Theory of the five Elements. To arrive at an energy balance, the practitioner questions the patient on a set of signs and symptoms relating to the same viscera and assesses the possibilities of links with other Organs and Bowels.

Madame Dubois’ depressive state is a good illustration of the result of two concomitant syndromes: the Spleen / Pancreas is deficient in terms of Qi production, and the Heart is also deficient in blood production.

The Meridian grid

According to the Meridian Theory, each structure of the body is irrigated by a specific Meridian. This grid is mainly used in cases of musculoskeletal disorders, which TCM often describes as external. On the other hand, when the disorders are internal, it is preferable to use the Viscera grid, which is more complete in the diagnosis and in the treatment strategy.

Ms. Loiselle’s story of tendonitis is a good illustration of the application of the Meridian grid in the case of persistent pain. Essentially, the acupuncturist tries to identify which Meridian is involved, through questions regarding the pain path.

Not all practitioners work in the same way and do not consistently use all TCM diagnostic tools. Many rely on the pulse and the 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, by basing more on laboratory 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 signs and symptoms of sinusitis will undergo x-ray examinations; If the test results confirm thickening of the mucous membranes, antibiotics will be prescribed. In the presence of this same patient, a Chinese doctor will rather choose from among many treatment strategies depending on what the examination will reveal to him: the acute or chronic nature of the sinusitis, the signs and symptoms associated with it (phlegm, cough, headache …), the stress that the patient will have been confronted with beforehand, the energy balance of his digestive sphere, etc.