• Inspection– This is an exhaustive visual investigation of a client. The investigator notes both the general appearance–’thin face, rather pale, walks slowly’–and the pertinent specifics–’tongue body pale and swollen with tooth impressions’. The latter observation of the tongue image is especially important to the acupuncturist. The investigation of numerous qualities of the tongue, including form, bearing, color, and fur, provides essential information.

• Listening and smelling–Chinese diagnosis is holistic and exhaustive. While rather less emphasized in modern practice in China, judging the strength of the voice or being aware of odors associated with particular disorders are examples of listening and smelling examination techniques.

• Inquiry–Inquiry is a systematic question and answer process. This is customarily performed using a guideline of ten steps. These may include inquiry into: cold and heat, sweating head and body, stool and urine, diet and taste in the mouth, chest and abdomen, hearing and vision, sleep, old illnesses, emotions, lifestyles, and working environment, along with female issues or pediatrics.

• Palpation–Although palpation may insinuate the general palpation of key anatomical regions, the Chinese traditional and modern practitioner stresses the pulse examination portion of palpation. This is an extremely refined art which recognizes 28 or 29 basic pulse qualities and incorporates six specific pulse positions and three different depths. In some practices, the pulse examination alone determines the entire treatment plan. This approach unfortunately disregards the the classical injunction to ‘correlate all four examinations’ (si zhen he can).

The four examinations yield a generous collection of data. Viewed analytically these bits of information begin yield a comprehensive clinical picture.

The Chinese disease diagnosis is a matter of rudimentary classification. Chinese disease categories are not the same as biomedical diseases: Chinese diseases are descriptions of pathology unique to Chinese medical theory. In our hypothetical case, the condition does not warrant a formal, classical disease diagnosis. Instead, the key symptom, cough, is isolated a a disease category. Within any textbook of Chinese medicine, cough will appear as a general classification. This serves as our Chinese disease diagnosis.

Of more importance to the Chinese practitioner is the identification of patterns of disharmony. In many ways, identifying a pattern or patterns is the lynchpin of any successful treatment. There are a number of systems used to describe patterns, including:

• six-channel pattern identification
• eight principle pattern identification
• disease cause pattern identification
• qi, blood, and body fluid pattern identification
• twelve channels and networks pattern identification
• defense qi, construction, and blood pattern identification
• triple burner pattern identification
• vicera and bowel pattern identification

Here we will restrict our discussion to viscera and bowel pattern identification, a key system in modern Chinese practice.

In conjunction with all of the information assembled on the hypothetical client–which may include a history of previous illness, a family history, and a personal history–we have an exhaustive clinical picture. It is noted that the client suffered from two serious case of pneumonia in his late teens. Pneumonia might be basically classified in Chinese medicine as a wind-heat invasion. This appears in the diagnostic procedure at the bingyin or Chinese disease cause. In the case of client XX, the historical disorder was treated with antibiotics and, from a biomedical point of view, he recovered. From the standpoint of Chinese medicine (where long-term, chronic disorders are stressed) the client was left with a serious deficit of Lung qi (vital force) which was aggravated by extenuating circumstances. His vacuous Lung qi resulted in an impairment of the Lung’s functions of diffusing and downbearing manifested as the counterflow qi disharmony of his cough. Adding insult to injury, our client indulged in smoking for eight and a half years. He also chooses not to exercise or implement good dietary habits. The years of intemperant living have taken their toll, leaving XX with barely enough Lung qi to speak at times, particularly during coughing spells.

The treatment principles are treating the root and the tip and simultaneous supplementation and attack. In this case, the root is the vacuity of Lung qi and the tip is the chief complaint, an unproductive cough for twenty years. Having experienced severe symptoms for several months, the client desires relief from the constant hacking cough. Nonetheless, an approach with naively tries to suppress the symptoms neatly misses the overriding problem of fundamental Lung qi vacuity. As soothing and welcome as the temporary relief of a Chinese syrup, as an example, might be, it will do little to address the underlying concerns. It is therefore decided to both treat the root and the tip through simultaneous supplementation (nourishing and boosting) of XX’s Lung qi and attack of the problematic symptom of cough.

The treatment method for simple Lung qi vacuity pattern (actually relatively rare as a singular presentation) is to supplement and boost the lung qi. The appropriate formula is subsequently selected.