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Home > Education > Diagnosis > Listening

The Things People Say - TCM Diagnosis and the Listening Examination

By Victoria Dragon

In TCM it is vitally importantly that one listens to what the client has to say. This is vitally important in all systems of healing, but TCM recognizes how critical it is. The weakest link in any healing system is always analysis/ diagnosis. Proper treatment depends on the proper analysis of the underlying root.

TCM healers not only listen to what clients say, they listen and observe the way clients say thing. For example, if speech is rapid, this suggests a problem with Heat. Heat speeds things up (the speech, the pulse, the body movements). If the speech is slow, this suggests a problem with Cold because Cold slows things down (the speech, the pulse, the movements).

There will be variations based on other factors. For example, in the U.S., people raised in the North, in particular in New York City will tend to speak a lot more rapidly than people raised in the South. These are regional differences that need to be taken into account. But in general, when things are speeded up (speech, pulse, movements) suspect and rule in or rule out a Heat problem. When things are slowed, suspect and rule in or rule out a Cold problem. (One important exception to Cold slowing things down is that well-conditioned athletes will have slower than normal pulses.)

The loudness and the force of the voice tends to be important clues too though not as exact as the fast-slow thing indicating possible Heat-Cold problems. In general, loud voices and a forceful manner of speaking will point to Excess conditions (problems caused by there being too much of something). In general, a low, quiet voice and a lack of forcefulness in speaking (or moving) will point to Deficiency conditions (problems caused by there not being enough of something). I say "in general" because there are a lot of exceptions to this one. For example, a person with severe Excess Cold problems probably won't be very loud or very forceful.

One area of Western medicine that is all but neglected is that people with a given medical condition will tend to say certain things which are typical of that condition. For example, some of the typical comments made by a person with CFIDS are "exercise makes me sicker, alcohal makes me feel worse, I have to rest up for special activities and then rest up afterwards to recover, I never know how I'm going to feel from day to day or hour to hour or even minute to minute," etc. Diabetics may talk about "nervous energy", and may make comments like "I feel like I have to keep busy and do something, but I'm too tired to be keeping busy." (BTW, this is a comment that also is typical of Yin Deficiency. Yin Deficiency frequently is a factor in diabetes, BUT Yin Deficiency doesn't always manifest as diabetes. Yin Deficiency may be marked by both agitation and fatigue. As far as I know it's the only TCM syndrome which is marked by both fatigue and agitation. There are a lot of TCM syndromes that can manifest as fatigue, and there are several which can manifest as agitation, but Yin Deficiency is the one which can manifest as both agitation and fatigue. So when you hear someone talk about having "nervous energy" even though they're tired, automatically consider the possibility of Yin Deficiency and rule in or rule out. You'll need to rule in/ rule out because it also is possible that a person may be suffering from more than one TCM syndrome - one that accounts for fatigue and another that manifests as agitation.)

What I'm talking about here goes beyond the usual noting of symptom profiles in Western medicine (i.e., fatigue, thrist, increased urination, etc). It involves learning to watch out for specific comments (as well as manner of saying things things) that people with a specific problem typically will say.

Western doctors used to pay a lot more attention to learning typical comments than they do today. This practice has all but died out in Western medicine. However, it never died out in TCM and has remained a mainstay of analysis in TCM. In TCM, typical comments frequently are listed in the profiles for TCM syndromes.

One of the most well-known of the typical comments in TCM is "plum pit in the throat." People in cultures beside China may talk about a feeling of a "stone in the throat". People in the U.S. may talk about "having a lump in the throat". The central idea in these descriptions is the feeling of an obstruction in the throat. This points very, very strongly to Liver Qi Stagnation. So when you hear someone talk about a plum pit, a stone, a lump, or some other obstruction in the throat (when there is no actual obstruction like a tumor in the throat), automatically think about the possibility of Liver Qi Stagnation and rule in or rule out.)

The feeling of an obstruction in the throat (when there's not an actual physical obstruction) is very, very suggestive of Liver Qi Stagnation in particular. However, there are other comments that can suggest Qi Stagnation in general. For example, if a person comes in and complains of feeling "tight" or "things needing to loosen up" or "things not moving very smoothly", suspect Qi Stagnation problems. Note: Some people with Qi Stagnation problems will actually report after taking herbs to move Qi or after acupuncture or after starting Qi Gong exercises that "it feels like things are loosening up on the inside". They may also talk about feeling more relaxed.

If someone talks about hating winter, automatically consider the possibility of Cold problems. It may be an abnormal sensitivity to Exterior Cold invading to the Interior or Deficiency Cold (Yang Deficiency - not enough Yang energy in the body to warm the body properly). If someone talks about hating the summer and having more problems in the summer than at other times of the year, automatically consider Heat problems.

Victoria Dragon


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