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Health Check-Up

A Traditional Chinese health check-up involves the reading of basic physical signs of health and illness such as facial appearance, eyes, color and the shape of tongue and tongue fur. The patient's habits and pulse are very important information too.

Through long time development, Chinese herbalists have a certain medical theories and treatments. Nevertheless the relationship between the herbalist and patient keep in touch throughout the course of treatment and constantly review the change of symptom is very essential. Herbal prescriptions are thus regularly revised according to the requirements indicated by the latest developments and symptoms.

	In general there are four basic methods for health check-up: interviewing, observing, listening and pulse-touching. Interviews take the form of comprehensive, and detailed dialogue between the herbalist and patient. The interview is well-organised and systematic, focusing on the major symtoms of the illness and background reasons which causes the problem.

This is followed by and explanation of how, when, and where he first felt ill. Folowed by a description of the history of the illness from its first day to the day he visits the herbalist. The herbalist note especially symptomatic changes, specific pains, and other manifestations unique to the ailment. Usually there are six main points must be focused during the part of interview:

Chills and Fever: The body's fever and chills usually indicate a change which affects both the internal and expernal organs, or is moving from one organ to another organ. Fever and thirst with no chills indicates an internal ailment. Chills without fever reflects yang-deficiency, and fever without chills indicates an over-abundance of yang-energy.

Perspiration; The amount and viscosity of sweat, when it occurs and on what area of the body it appears, are important signs of the body's changing.

Stool and Urine: Constipation accompanied by hard stools is a sign of "heat" and "full" sickness. Loose stools containing partially digested food indicates a "cold" and 'empty" sickness. The presence of blood or mucus in the stool must also be researched. Scanty, dark urine reflects "heat-excess", while profuse, clear urine is a sign of "cold" and 'empty" sickensss. Cloudy urine indicates "moist-heat excess."

Food, Drink and Taste; Patients like to have hot drinks reflect a "cold" tendency, while a preference for cold drinks and food have tendency a "hot type" problem. A revulsion towards drinking water is a sign of "moist" problem. The presence of a flat, bitter, sweet, or other dominant taste in mouth should be noticed. Patients have strong desire for spicy, deep-fried foods or strange materials (such as dirt, candle-wax, coffee-grounds etc.) usually indicates the possiblity of having parasites in bodies.

Sleep: Excessive sleep indicates yang-deficiency, while insomnia is a sign of poor circulation, excessive worry, or spleen-deficiency. Fitful sleep indicates emotional disturbance or over-indulgence in food and drink. usually early rising often indicates an over-active heart.

Sex, Menstruation, and Pregnancy: For men, the serious questions here involves sexual vitality, impotence, incontinence, nocturnal emissions and spermatorrhoea, and frquency of coitus. For women, frequency of menstruation, its color and texture, other vaginal discharges such as leukorrhoea, past pregnancies, abortions, childbirths, frequency of coition are vital indicators of the change in body.

In addition to the history of the specific problem based on the above indicators, a comprehensive past history of the patient himself is also considered.

Besides stressing past illness, living habits, enviromental surrounding, allergies, and so forth, the general health history of the patient's family is also covered. In cases involving infants, the deaf and dumb, and others who are unable to conduct the interview for themselves, the relevant information is provided by the patient's spouse, parent, close family member, or friend.

Methodical visual observation of the patient is the supplemently technique used by traditional Chinese Herbalists. Changes in the body's skin cloring and form, tongue color and tongue fur, eyes, secretions and excretions, all reflect the state of illness.

First the herbalist notes the patient's mood and movements. If he is spirited and alert, with regular breathing and normal coloring, the illness is not yet serious and can be easily treated. If he is depressed and moody, with irregular breathing, wan complexion, and listless eyes, the illness has reached a serious stage and treatment will be more complicated.

The color and flesh-tone of a patient's facial complexion are direct indicators of pathological changes in the vital organs. The herbalist observes the patient's general physical condition by noting the demenor he walks, talks, sits down, lies, breathes, and moves his limbs.

One of the most important methods of health check-up is visual examination of the tongue. Such factors as muscular form and color of the tongue and the color and texture of the tongue fur reveal the empty-full nature of illness well as its severity. Normal tongues and soft and moist, light-pink in color and neither thick nor thin.

If the tongue appears tight and shrivelled, the disease is of the 'full' type; if it appears thick, porous, and tender, the ailment is of the 'empty' type. A fat and swollen tongue indicates 'moist-heat' excess inside the body. A light, pallid color instead of the normal soft-pink indicates 'blood-empty' and qi-empty' problem, while a bright-red color reflects 'hot' and 'full' problem.

Normal tongues have a thin, white, clear fur coating that is neither too moist nor too dry. Disease in the body usually thickens this fur coating. A raw, white fur results from 'cold' and 'moist' disease, while a yellow fur indicates 'hot' and 'full' disease. In observing tongue-fur, care must be taken not to confuse symptomatic color changes with residual coloring from food and drink.

Here is a chart gives a detailed account of health check-up indications of tongue structre, color, and fur.

The listening technique includes examination by ear and stethoscope as well as by smell(one Chinese character for 'hear' also means 'smell'). The herbalist listens to the patient's speech, brething, coughing, and to the sounds emanating from the visceral organs. He uses his nose to check the smell of the patient's body excretions, which helps to determine the nature and location of disease. 'Empty' ailments are indicated by low, weak speech, shallow, weak-sounding respiration, and a weak, low-pitched cough. 'Full' ailments are reflected in restless, confused speech, rapid and noisy breathing, and a heavy, loud cough. Examination of the internal organs by stethoscope is performed over the heart, lungs, and abdomen. The various sounds or murmurs made by the heart during various stages of heart beat, and the sounds produced by the lungs during inhalation and exhalation are all important diagnostic indicators of energy imbalance and dysfunction in those organs.

Tactile examination includes traditional Chinese pulse diagnosis and other manual methods such as massage and acupressure. In pulse diagnosis, the physician places his first three fingers along the radial artery of the patient's wrist, feeling for three special points. Light pressure on these points reveals three separate pulses, while heavy pressure reveals yet three different ones, a total of six pulses on each wrist. Each of the twelves pulses reflects the condition of one of the twelve vital organs. With skilled, sensitive fingers, the Chinese herbalists can detect over thirty different pulse qualities on each of the twelve pulses.

The pulse qualities about 'floating', and 'sunken,' 'weak,' 'bounding,'- indicate the condition of the related organ. Past, as well as current disease sustained by the organ are revealed by this method. It may also indicate inherent weakness which may lead to disease in the future. Chinese pulse diagnosis is a delicate art, difficult to master and requiring many years of practice. Its proven ability to trace the sources and courses of disease in the vital organs- past, present and future- seems almost miraculous to those unfamiliar with the technique.

Other tactile techniques include light massage examination and palpitation of the internal organs. Massage reveal the temperature of the skin, flesh, and extremities, 'full' and 'hot' or 'empty' and 'cold' disease. Massaging the spinal column often indicates where a disease is located because the spinal nerves associated with the diseased organ will be knotted and tight to the touch.

Certain vital points along the meridians, called 'alarm points.' will be tender and painful under acupressure when the related organ is diseased or weak. Palpitation involves applying finger and palm pressure to the body's surface directly over vital organs to check their consistency and tone. Similar to this method is percussion: The herbalist uses the middle finger of one hand to hit the mid-joint of the middle finger of the other hand, which is placed palm down over the organ. The resonance of this percussion indicates the condition of the organ below.

Determining the nature and location of disease is only the beginning of Chinese health check-up. To treat patients effectively with herbal medicines, the herbalist must next make a 'differential diagnosis' based on symptomology.

Differential diagnosis determines in which direction the disease is moving and the nature of its symptoms. Symptoms sometimes seem to disappear during treatment. In actual fact, they have usually transformed and moved elsewhere, following, for better or worse, the course of disease. Halting treatment at this juncture, when the disease is still inside, may permit the disease to recur at some time in the future. Continuing the same herbal treatment, when the symptoms and disease have already changed form, is not effective in the long run.

Herbal prescriptions must be regulary adjusted to the everchanging symptomatic situation. Since no two patients are exactly alike in their reactions to disease to medications, differential diagnosis is vital to the successful application of Chinese herbal medicine in individual patients.

There are eight principles for health check-up comparison (ba gang): yin/yang, internal/external, cold/hot, and empty/full. These principles ultimately overlap, and all disease falls into one of the two great priciples of yin and yang, according to the clinical manifestations of all the eight indicators.

The principles of differential diagnosis are indispensable guides for prescribing herbal treatments which match the requirements of the disease and its symptoms.

Yin-yang desinates whether the disease is primarily injuring the patient's yin energy or yang energy and whether to teat with yin or yang herbs. Based on the four diagnositic techniques, the general symptoms indicate yin or yang disease, as outlined below:

Internal-external indicators differentiate the site, extent, and seriousness of the disease, revealing in which dicrection it is moving. As diseases get worse, they tend to move inward toward the bones and vital organs. Movement towards the exterior usually indicates that the cure is working. Cold-hot manifestations are used to differentiate the nature of the disease itself, while empty-solid indicators reflect the nature and extent of the illness, as well as the body's resistence to the specific disease. The following chart lists the broad indications drawn from the eight principles of differential diagnosis.

There are, of course, many different combinations of the above factors, and their manifestations are different for every patient and disease. The important point is to match the medications directly to the actual symptoms at hand, regardless of the original diagnosis. Some of the more common combinations of the eight principles are charted below.

Chinese Health check-up involves a three-step process: The four diagnostic techniques, (si zhen), are first employed to determine the general type, location, and cause of the disease. Next, differential diagnosis based on the eight principles (ba gang), is applied to reveal to what extent the disease has developed; in which direction it is moving and exactly how the symptoms are affecting the individual patient. Finally based on the latest differential diagnosis, an herbal prescription is prepared which takes the body in the opposite symptomatic direction of the disease and redresses the energy imbalances caused by it.

Regulary reevalutation of the data and diagnosis, followed by re-adjustment of the herbal formulas prescribed, continues until a complete cure is effected. Having breifly covered the essential principles upon which traditional Chinese medicine is founded. We now see the treatment be used by applying the eight principles.

Abridged from The book of Chinese Herbal Medicine by Daniel P. Reid.

Shifu Hwang accepts health check-up appointments by phone call or e-mail.

Time: Monday to Saturday 10:00a.m.-12:00a.m.

The health check-up fee is $35.

If you would like to learn more about medical cases, you may view the General Health Forum on the Tai Chi People discussion board.