How does an acupuncturist diagnose?

The answer to this question is easy: with every one of their senses! Unlike your GP who may remain glued to a computer screen throughout the whole of a consultation and hardly even look atyou, your acupuncturist will be looking, listening, touching, even smelling you!

Acupuncturists pick up diagnostic information with all of their senses. So as you are telling them what is wrong with you they are not only listening to the facts you are telling them but they are alsolistening to how you are saying them. Loud or soft? What kind of voice? Shouting, groaning, singing, crying, laughing? In a smooth flow or with lots of stops and starts? And what does your breathing sound like?

They will also be looking at you. Making eye contact, yes, but also looking at your body shape, your posture, your movements, your skin tone, any unusual colours such a hints of blue, red orgreen that may be on your face or on your body. They will also want to look at your tongue – the only inside part of the body we can see. The tongue can reveal lots of information about heat or cold trapped in the body, the quality of the fluid metabolism, the strength of the blood, or the workings of the digestive system.

Taking the pulse comes under the sense of touch. Acupuncturists take the pulse in a much more complex way than a Western medical practitioner – they are still taking the rate of the heartbeat, but they are also pressing and releasing the pulse to pick up various qualities that reflect what is happening in different parts of the body. Abdominal palpation can be used to reveal if there is any discomfort related to the internal organs. Palpating the muscles can reveal information about musculoskeletal imbalances, evaluating skin tone can inform us about nutrition and the fluid metabolism, pressing the acupuncture channels can give clues to blockages in the flow of Qi in the body.

Smell is much less commonly used diagnostically nowadays as (thankfully!) most people bath and shower regularly or wear perfumes or colognes. One acupuncturist I know waits until her clients are laying face down on the treatment couch with needles in their backs and then quietly sniffs between their shoulder blades (where few people can reach when washing) to see if she can pick up a residual smell. Pooh!

Stories are told of wise old Chinese doctors who would sit at the end of a long corridor. Patients would walk the length of the corridor, and by the time they got to the doctor the diagnosis was already made! How could this be? From a distance the doctor would be able to see the shape and body type of the person. How they walked and held themselves would give hints and clues about musculoskeletal conditions. As the patient came closer the doctor could start to see skin colour and tone, and as they got even closer the strength of the person’s Shen or spirit could be assessed
in their eyes. And if they were unfortunate enough, they could also get a sense of how their patient smelt! So although the patient may not have even said what was wrong with them, the practitioner would already have a good sense of where their underlying imbalances might be.

So next time you go for treatment, look at your practitioner – closely – and you might see just how closely they are looking back!!

Paul Johnson, Senior Lecturer, The City College of Acupuncture