The Bare Hands Doctor - Master Tim Wong

When the Yin and Yang of a body fail to balance, or a disorder occurs in an organ, there are often signs on the surface of the body; this is called internal pathological change and external manifestations. This reaction is partly conducted by the connection of the Meridian channels and points (also called reaction points) and partly by the connection of the interior and exterior relationships of the body. The basic Chinese organic examination methods comprise four ways and eight principles. These ways and principles are employed by acupuncturists and herbal medicine doctors, however, Tui-Na doctors employ additional techniques in order to examine external symptoms, understand internal dynamics, and arrive at a diagnosis and treatment methodology.

The Four Ways

(1) Inspection: Observe appearance, movement, unusual color on the face and on the body. Inspection also includes the color of sputum from a cough, discharge of fluid and blood, urine and stools. For observation of Tui-Na, the first thing to observe is the way the client walks. Does the client walk straight? Head up? Back straight? Are steps even? Any limping? Observe sitting behavior - is it straight? Observe hand movements - is the client grabbing at his or her neck or squeezing their shoulders? These are signs of neck and shoulder problems. If the client keeps re-adjusting their sitting position or trying to straighten up, this could suggest they have some lower back problems. These are important common methods of inspection for Tui-Na.

(2) Hearing and Smell: Listen to the voice, respiration and the cough. Smell the breath.

(3) Question: The patient's feelings, age, occupation, marriage, drinking and smoking habits, diet and sleep, menstruation and discharge, history of the illness, how, where and when. There are many questions that should be asked related to the symptoms.

(4) Touch: Apply touching and pressure to certain areas of the body to detect anything unusual of the body, such as pulse, temperature, tenderness and stiffness of the muscles and joints.

The Eight Principles

The Eight Principles are used to analyse the characteristics of a syndrome, for example exterior and interior, cold and heat, deficiency and excess, and Yin and Yang.

Principles 1 & 2: Interior and Exterior

Interior and Exterior generalize the direction of the development of a disease. The skin, hair, muscles and the superficial portion of meridians and collaterals of the human body belong to the exterior, while the five Zang and six Fu organs pertain to the interior. Exterior syndromes refer to the invasion of the superficial portion of the body marked by a virus or bacteria, such as the common cold or flu. Such syndromes are marked by sudden onset of symptoms with short duration. Interior syndromes are the result of the pathological development of the exterior syndromes. There are three pathological conditions which can attack Zang-Fu organs directly: drastic emotional changes, improper diet, and  stress and strain. These affect Zang-Fu organs directly and lead to functional disturbances. For example, emotional changes can give rise to stomach or gastric problems, while stress and strain can cause liver problems.

Principles 3 & 4: Cold and Heat

Cold and Heat refer to distinguishing the nature and conditions of a disease. Some syndromes manifest as heat, like inflammation, fever, sweating in winter, constipation, deep-yellow urine, red tongue with yellow and dry coating, or  rapid pulse. These are the signs of heat syndrome. Aversion to cold, tastelessness in the mouth, absence of thirst, cold limbs, loose stools, large amounts of clear urine, pale tongue with a white, moist coating, and a slow or tense pulse are signs of cold syndrome. While cold and heat represent the different natures of a particular syndrome, they maintain a very close relationship. They can exist simultaneously: cold in the morning and hot in the evening, or heat in the upper half of the body with cold in the lower half  (this is known as "heat above with cold below"). Sometimes they can transform into each other. In general, the mutual transformation of cold and heat syndromes takes place in certain conditions. Cold changing into heat may indicate that health has been restored, while heat changing into cold may indicate the failure of treatment or the collapse of anti-pathogenic Chi.

Principles 5 & 6: Deficiency and Excess

Deficiency and Excess are two principles which  distinguish the relative strength of pathogenic factors and anti-pathogenic Chi. One of the basic practices of Chinese Medicine is to determine the treatment protocol (promotion or elimination) of Deficiency and Excess Syndromes. Common Deficiency and Excess Syndromes effect Yin and Yang as well as Chi and blood. Certain Deficiency Syndromes include blood and Chi, hormones, and chemical or protein deficiencies. For example, iron deficiency results in anemia, whereas Excess Syndromes may result in conditions such as diabetes where there is an excess of sugar in the urine or in blood.

Principles 7 & 8: Yin and Yang

Yin and Yang refer to the two opposites of energy or Chi - Yin Chi (negative) and Yang Chi (positive) . Collapse of Yin Chi can be seen in women as  heavy menstruation, distension and tenderness of breasts and ribs, lower abdominal pain and dry stools; this may last more than four days. Patients of this type also can be seen to consume massive amounts of water. On the other hand, patients that suffer impotency, prolapsed uterus or urinary incontinence are the result of the collapse of Yang Chi. Yin and Yang are also used to describe the other six principles: interior (Yin) and exterior (Yang), cold (Yin) and heat (Yang), and deficiency (Yin) and Excess (Yang). To be in a healthy state, these two energies must always be in balance. Naturally, the deficiency of Yin will lead to an excess of Yang; this indicates the presence of  a Heat Syndrome. An excess of Yin will result in a deficiency of Yang, indicating that a Cold Syndrome is present.

TCM Diagnostic Methods