Something More Important Than the Tongue and Pulse
By Kenton Sefcik, RAc, DiplAc, DiplTCM
When I was in school, we all heard the legends of amazing Chinese medicine practitioners who could tell their patients all sorts of interesting things if all they could check was their pulse. Things like when a patient's last meal was – and the consistency of the food, the last time the patient had intercourse and whether or not they had an internal organ problem.
One of the greatest mysteries was all about the pulse and its ability to convey 28 images; each image having diagnostic value. Bob Flaws was the one to demystify the art a little bit by informing us that we could learn to read all of the possible pulses if we just memorized their qualities. Call me blasphemous, but I don't believe pulse diagnosis is as important as it's made out to be. Instead, it's just another piece of the puzzle, along with tongue diagnosis. In fact, I believe there's something more important than tongue and pulse combined: what my patient says and how they say it.
Malcolm Gladwell, in his book Blink: The Power of Thinking Without Thinking, describes something that happens after many years in any given field: a person starts to gather information at tremendous speed, basing it all off their previous experiences. For example, he writes how veteran firefighters often get a "sixth-sense" about when to leave a building. The same can happen in our field of Chinese medicine.
Lonny Jarrett was the first person I read about being able to do this. He wrote how, many times, he had a patient partially diagnosed from just a voicemail message. While I never thought this level of diagnostic was achievable, I now believe it is – it just takes time.
Stereotypes: say what you want about them, but people generally live up to them. We often dress the same, talk the same and move the same way as others in a certain "group." Observing how a patient walks into the waiting room is critical. Already, we have the ability to "thin-slice" them based on their choice in clothes, hair-style, tattoos, piercings, and movement revealing pain immediately – and we can bounce all this information off things such as the neighborhood we work in, the weather, and their age and sex.
Simply put, go ahead and look for patterns, just like you would for Kidney Qi Deficiency. Instead of just relying on our basic patterns of signs and symptoms, start to put together your own. This can even be done while walking down the street or in the grocery store. Start applying your deep Chinese-medicine-influenced knowledge on everyone – patient or not.
I'm really big on language. How many times have we heard in our industry about the "other" medical counterpart's bad bedside manner? Even so, I've seen plenty of patients who've had poor experiences with acupuncturists ... and many times they tell me it comes down to what's coming out of the practitioner's mouth.
This is a large reason why I don't get into talking about my patient's qi or Liver or whatnot in front of them. If it took some of my colleagues years to realize that a Heart is not a heart, per se, I can imagine how I would confuse my patient. If they ask what's going on, I usually try to tell them in "real language" – not in Chinese medicine speak that will only mix them up. I also use very positive language throughout my treatment.
If language is important – so much so that an acupuncture treatment hinges on what the practitioner has said – it should be just as important when observing what comes out of a patient's mouth. How they talk about themselves and the world around them gives a good clue as to what they feel in their core. Tone should also be observed; it's not always what is said, but how it's said.
Looking for similar words used to describe different situations can be helpful. Finding out if the patient plays a victor or victim role in their life can be used to help build an acupuncture or herbal treatment.
Body language is more than just how a patient communicates; there are many things to watch for. Going back to when the patient just enters the waiting room, this is a good time to start sizing them up. Many patients will show their pain by holding a sore body part or walking a certain way. They also non-verbally describe how they are feeling – for example, slumped shoulders show signs of sadness (and therefore Lung Qi Deficiency).
From the waiting room to the intake questions, it's important to watch for any changes in body language. The ability to give eye contact can change, along with shifting or restless movements in a chair. Again, I watch for changes in tone of voice and types of words used when a patient is speaking about specific health topics.
For example, I see how comfortable a patient is talking about their bowels, menstruation or previous birth stories. Sometimes a patient is almost too comfortable sharing all that's going on with them – or perhaps they ramble on about how everything with their body (and subsequently their life) is bad.
I'm a very visual person; therefore, I use my patient's own innate ability to show me where their pain is. I ask them to try to put a finger on where the discomfort is coming from – or the area where the condition is manifesting. If they can't put a finger on it, I ask for a hand – all the while tracking acupuncture channels and points in my mind. What they tell me is of high importance. It's their body. It's their pain.
I then put myself in their shoes and, having received lots of acupuncture by others and self-treatment, along with massage, chiropractic and osteopathy, I imagine what I would like to have done to remedy the problem if the roles were reversed.
Finally, if the patient is of sound mind, what they tell me about their chief complaint is the most important of all. What's the good of detecting a minor Lung Qi problem on the pulse when they want their lower back pain fixed? If there are a plethora of Spleen Qi Deficiency symptoms, but the tongue shows Heart-Fire, what is the use?
I'm not saying we should throw out all the diagnostic value of tongue and pulse, but instead use our intuition and experience to rate their importance when diagnosing each and every health concern our patient presents with.
Most of the time our patients come in with a chief complaint and if that chief complaint isn't dealt with immediately (results seen at least within the first three treatments), we'll lose their trust in us and our healing modality. If we are not careful to choose acupuncture and herbs to remedy where they show us to have concern, we'll never be able to treat the underlying/root conditions.
Honesty and communication play a big part in this. Telling our patients what we feel will heal up first and then hierarchically to last is important. This will enable our patients to have realistic expectations. Also, if things seem to be taking longer than normal, we must be able to tell them so and ask (yes, ask) them to stick around for a few more weeks.
Too Good To Be True
If a story sounds too good to be true, it probably is. As a martial artist for more than 20 years now, I've seen it all – from boards not breaking because the grain was held wrong, to (supposed) qi projection. Legends and metaphors are important in Chinese medicine because they help mold our diagnostics. However, while keeping our head in the clouds, our feet should remain on the ground. Bottom line: what my patient tells me about their chief complaint is more important than any other diagnostic available.
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