Oriental medical practitioners evaluate by asking, looking, listening and even smelling the patient. The signs and symptoms derived from these methods are indicators of disharmonies of the patient's qi dynamic.
When considering that signs and symptoms provide an indirect understanding of the patient's qi dynamic, the question arises if we, as practitioners, can gain a more direct understanding of the patient's qi. The answer is yes.
One simple method is to develop our "qi awareness" and use a technique called "scanning." When scanning, the hand is held at various positions relative to the patient's body in order to feel the patient's qi dynamic and/or "energetic" structures. Those imbalances are correlated to traditional Oriental medical terms and confirmed by asking, listening, etc.
To become qi aware, begin by sensitizing your hands. Hold your hands apart in front of your body while you are relaxed. Hold them at about 6 to 8 inches apart, with palms facing each other. Move your hands toward and away from each other at minute distances until you feel something. At first, the sensation is barely perceptible. Pay attention, and the sensation will increase in intensity. Relaxation is vital to this process.
To scan, hold the palm of your hand about 3 to 6 inches away from the patient. Then move your hand slowly about the patient; at about the speed of stroking a cat. The direction is not particularly important, but the general tendency is along the midline from head to toe or along the meridian.
As you move your hand over the patient, you will notice that your hand is "pulled" at some areas of the patient's body, "pushed" at others, and you will feel boundaries at still others. These sensations are indicative of the energetic structures and the qi dynamic of the patient. You will notice different sensations at different distances from the surface of the body.
The area an inch or two from the body is called the inner aura (subtle energetic field surrounding the body) or "etheric body" and is where acupuncture structures are readily felt. (Although not directly connected to TCM, it's good to know it exists because you will eventually find it anyway.) When the hand is held with the palm facing the patient about a few inches away, a definite boundary parallel to the body is detected; this is the boundary of the aura. When the fingertip is moved over an acupuncture point, a definite boundary is felt that is about a half inch to 1 inch in diameter. The finger feels as though it was being pulled in the direction of the flow when held pointed toward the meridian.
Once the normal is known, then the abnormal becomes more apparent. Those areas where the hand is pulled toward the body are associated with deficiency. Those areas where the hand is pushed away are associated with excess. Those areas of clear boundaries are associated with stagnation - typically pain. A stagnation that is clearly defined is associated with a sharp, stabbing pain. Diffused stagnation is associated with a dull, achy pain. The more pronounced the stagnation, the more severe the pain. Where the fingers are drawn against the flow, the meridian is counter-flow.
Specific disharmonies with symptoms are readily confirmed by asking the patient. I like to ask about imbalances in the following order: region, organ, emotion and time. For example, if my hand is pulled toward the body at the low back; I would consider the region deficient and ask if they have low back pain, then, if there is localized or general weakness, or urinary difficulties; and finally, issues of fear. If the patient says no, then I ask if any of these have been recent problems. The reason is that symptoms are often not completely resolved, but just diminished to a level where it is no longer noticed. In other instances, it is indicative of an impending symptom. If doubt remains, then the typical findings take priority.
These disharmonies may even occur in a "layered" fashion. For example, a patient may have low back pain along the muscles, yielding a finding of an area of stagnation, but the overall region is deficient. In this case, the patient may have qi stagnation with an underlying qi (kidney) deficiency.
If you find unusual sensations, then investigate with an open mind. I once had a patient whose face had a very well-defined, thin area of stagnation; it seemed to have "felt" like a wire. She had trigeminal neuralgia. This technique is easy to integrate into the treatment. You can perform the regular intake, then scan to confirm or explore. You can also perform the intake and scan at the same time.
Words of caution: Do not let your hand linger at any one region for more than a few seconds. This is to avoid inadvertent "energetic interaction." This is where the patient's qi dynamic interacts with yours. When using this technique, remember to wash your hands with running water to wash away any qi that may have accumulated on your hands. If you notice that your hands/fingers feel heavy, "shake it off." This is due to the patient's qi/energy accumulating on your hands. This interferes with your perception and potentially may allow qi to gather - stagnate in the joints - eventually causing joint pain.
Diagnosing by touching the qi isn't just a diagnostic method; it's a learning process. It allows us to think in the same terms the ancient practitioners might have thought. An area where the patient's qi is not moving and is defined by a boundary is where it is stagnated. It just makes sense.