Four Examinations Diagnostic Method (四诊)

Overview

The fundamental diagnostic framework in Traditional Chinese Medicine, referenced in Bian Que's practice. Physician assesses patient through four distinct methods.

The Four Examinations

1. 望诊

Procedure:

1. Observe patient's general appearance and demeanor
2. Examine facial color and complexion
3. Observe tongue (color, coating, shape)
4. Note body posture and movement
5. Assess spirit/vitality (神)

Key Indicators:

• Color changes indicate organ pathology
• Dull eyes suggest declining spirit
• Abnormal movements reveal internal conditions

2. 闻诊

Procedure:

1. Listen to patient's voice quality
2. Note breathing patterns and sounds
3. Detect any abnormal body sounds
4. Smell breath and body odors

Key Indicators:

• Weak voice = qi deficiency
• Harsh voice = excess condition
• Foul breath = heat or stagnation

3. 问诊

Procedure:

1. Ask about chief complaint
2. Inquire about onset and progression
3. Question about appetite, sleep, elimination
4. Ask about pain location and quality
5. Investigate emotional state
6. Review medical history

Key Questions:

• Cold or heat preference?
• Thirst and drinking habits?
• Urination and defecation patterns?
• Sleep quality?

4. 切诊

Procedure:

1. Position patient comfortably
2. Locate pulse points (typically radial artery at wrist)
3. Apply three levels of pressure (superficial, middle, deep)
4. Assess pulse at three positions on each wrist
5. Note pulse qualities: rate, strength, depth, width

Pulse Categories:

• Floating (浮) = external condition
• Deep (沉) = internal condition
• Rapid (数) = heat
• Slow (迟) = cold

Integration Process

1. Gather information from all four examinations
2. Identify patterns across examinations
3. Correlate findings with organ systems
4. Formulate diagnosis
5. Determine treatment principle

Expected Outcome

• Comprehensive understanding of patient's condition
• Pattern differentiation (辨证)
• Foundation for treatment planning

Verification

1. Confirm that all four examinations (望, 闻, 问, 切) have been completed before formulating a diagnosis.
2. Validate that findings across multiple examinations are correlated and consistent with the identified organ systems.
3. Ensure the final diagnosis includes both the pattern differentiation (辨证) and a clear treatment principle derived from integrated findings.