Every Chinese treatment begins with the four examinations. These are four classical roads of investigation into the nature of disharmony. These approaches are each distinct, but the significance of the results of each examination is relative to the other three.

• 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.