What Is Acupuncture? (6)

How does acupuncturists/TCM practitioners make diagnoses?

Have you ever wondered how acupuncturists choose points to needle? Is it just random selection or is there some methods behind it?

Every treatment starts with a diagnosis. Unlike modern medicine, aka western medicine that uses diagnostic imagining, such as X-ray, and lab tests to make diagnoses, TCM has its own diagnostic procedures.

TCM’s diagnoses consist 4 approaches: 望-observing, 闻-listening/smelling, 问-inquiring, 切-palpating

  • 望-observing: What is observed is a patient’s overall appearance, such as complexion, gait, body type, and the tongue. Complexion can tell a person’s current bodily condition. For example, pale complexion indicates the patient is lack of Qi, or energy, which can be seen on patients with anemia.

Observation of the tongue is an important part of TCM diagnosis. What are observed are the colors, shapes, coating and size of the tongue.

The center of the tongue corresponds to the stomach and the spleen(pancreas). People with chronic digestive
The colors and shapes indicate different TCM conditions
A red tongue indicates Heat condition, which is often seen in women who are going through menopause, hot flushes, agitation, etc
  • 闻-listening/smelling: What a practitioner listens and smells is a patient’s voice, breathing pattern and breath. A weak voice or shallow breathing indicates a deficiency pattern, which is often seen in heart and lung diseases. A bad breath without dental issue indicates a digestive condition.
  • 问-inquiring: There are 10 categories of questions asked.
  1. Natural body temperature: A warm body temperature indicates a heat/excess pattern, often seen in menopause, a cold body temperature indicates a cold/deficiency pattern, such as eating disorders.
  2. Sweating: Sweating on light exertion indicates a deficiency pattern, often Qi deficiency, such as in heart and lung diseases, or chronic fatigue syndrome. Running a fever without sweating indicates the condition is at its peak, which is often seen in fever caused by a cold.
  3. Head and overall body: Questions including headaches (type, location, manifestation) and musculoskeletal aches/pain.
  4. Bowel movements and urination: Times of bowel movements within a day, constipation (dry stool or feeling lack of movement)/diarrhea. Is there pain/urgency with urination, incontinence while laughing, coughing or sneezing,etc.
  5. Digestion: How is the appetite, the pattern of hunger (barely hungry-stomach cold or always hungry-stomach heat). Bloating, belching, acid reflex, etc.
  6. Chest: Is there heart palpitation, chest oppression/pain, shortness of breath, etc.
  7. Vision and hearing: Are there floaters in vision?(a liver pattern), is there ringing in the ear or diminished hearing/sudden deafness?(a kidney or kidney/liver dual pattern)
  8. Thirst: Are the mouth and throat often get dry even with adequate water intake? (a dry condition, often the lung, which is seen in smokers, also could be other heat patterns)
  9. Past medical history
  10. Overall life: This includes life style, changes (sudden or gradual) in one’s life
  • 切-palpating : What is palpated is the pulse on the radial side of the wrists. There 3 positions on each wrist to asses, each position represents 2 organs on a upper and deep levels. There are 28 types of pulsations, and they are categorized by speed, forcefulness, pulsating patterns and depth.


There are 3 positions for pulse palpation
Heart is a the upper level on the left wrist, and small intestine is on the lower level at the same spot. TCM/acupuncture diagnoses are all made by the 4 methods combined. But this is only the initiation, the next step is to narrow down the specific cause of illnesses, which includes the concept of TCM/acupuncture’s view on organs and bodily substances. I will explain in next blog.
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