The Diagnostic Process

The practice of medicine predates the invention of modern diagnostic techniques by thousands of years. Long before laboratory blood analysis and imaging equipment like x-rays and ultrasound, however, people were successfully diagnosing and treating each other's conditions. As it turns out, there is quite a lot of useful information that can be gathered in other ways. Take observation, for example, which is based on the principle that our outward appearance reflects the health of our internal organs and systems. This is one of the most important aspects of diagnosis in alternative medicine and, in ancient times, was considered to be the highest art and the mark of a superior practitioner who could diagnose simply by looking at a patient. Observation is also the first diagnostic technique that we use when we meet a new patient and it can reveal many things about you, from structural issues to your general energy level and sate of mind. Observing how you walk, for example, can show us if your posture is off or if there are certain areas that are contracted by pain. If you move slowly and and your posture is hunched, it can indicate to us that you may have low energy or that you are emotionally depressed. The health of your skin, hair, and nails, the color and condition of your complexion, the appearance of your sensory organs, and so many other things can all give us important clues about your overall health.

 

Another way to make a diagnosis is through palpation, or touch. If you come in complaining of pain and the tissue in that area is warm or hot to the touch, then there is probably some inflammation. If the tissue feels cold, there may be a lack of nourishment or circulation. Not only that, but a pain that is better with pressure will require a very different approach than a pain that is worse with pressure, and will require the treatment to be customized in a different way. Palpation can also let us know if the tissues is tight and contracted, loose and lacking tone, or dense and knotty, all clues that indicate different types of pathological processes. For those of us who are familiar with anatomy, the location of knots can indicate which muscles or connective tissues are involved as well. Furthermore, healthy tissue, which is supple, will feel noticeably different from unhealthy tissue, which may be ropey or thick. Another very important part of palpation is in the reading of the pulse which, especially in Chinese medicine, is evaluated not just for its speed and regularity but even for qualities like force and depth.

 

Listening is a third method of diagnosis and includes not just listening to what you say when we interview you but also listening for things like the character of your voice (soft or strong?), the type of cough that you have (wet or dry?), or for emotional indicators like the timber of your voice or frequent sighing. The number one thing we learn from listening, however, is what your chief complaint is and how long you have had it. Knowing how long you have had a condition is an invaluable piece of information and will influence the type of treatment that we give you. Lower back pain that has only been around for a few days is probably due to strain or sprain, for example, while lower back pain that has persisted for years may point to an issue with your internal organs, possibly your kidneys. Another example is a cough that has been around for a few days, which would most likely be due to an infectious organism, versus a cough that has been around for months that may be due to dryness or weakness of the lungs. The nature of your pain can also help us make a diagnosis, and we will treat it differently depending on whether your describe it as tingly, hot, cold, dull, achy, bursting, twisting, or sharp. For those of you who come to us with chronic conditions of the internal organs, general questions about all of your body's systems and functions are invaluable in helping us put your symptoms into the bigger context of your overall health, identifying what the underlying mechanisms or root issues may be. So, as you can see, there are many ways to make a diagnosis.