Kampo Examinations

Traditional Kampo and Chinese Medicine Diagnostic Methods

Tim H. Tanaka, Ph.D.

 

Just as with Traditional Chinese Medicine (TCM), there are four types of Kampo examinations: Inspection, Audio-olfactory assessment, Inquiry and Palpation.

Tongue and pulse diagnoses form the core component of TCM assessment. These are also utilized by many Kampo practitioners. Abdominal diagnosis, though, is used only in Kampo medicine. Abdominal diagnosis is not commonly included in the TCM diagnosis procedures.

It is important to note that, typically, no single assessment is sufficient to deliver a proper diagnosis. Experienced Kampo practitioners will gather all available information (using both Eastern and Western systems of evaluation) to best determine the nature of their patients’ illness, as well as when developing an effective strategy for Kampo treatment.

Below is a brief introduction of the examination methods used in Kampo medicine. Click the links below for information about each method of diagnosing illness.

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Inspection:

facial-diagnosis

A doctor’s observations of both the general and specific appearance of a patient can provide vital information toward revealing the patient’s specific sho. Thorough observation, the Kampo practitioner may be able to determine specific sho of the patient, such as whether or not the patient is exhibiting yin or yang sho, or having an indication of Kekkyo-sho (blood deficiency), or Oketsu-sho (blood stasis). The specific characteristics of each sho often manifest in their body shape, posture, and skin complexion.

Tongue Diagnosis:

tongue-appearance

In both Kampo and TCM, a close observation of the tongue is an important part of evaluating the health of the patient. The tongue often presents strong visual indicators of a person’s overall harmony or disharmony. To perform a tongue diagnosis, the practitioner typically asks the patient to stick out their tongue for observation. The practitioner will then evaluate the size, shape, color, and coating of the tongue. To perform an accurate assessment, it is important for the patient to avoid any activities that may infuluence the apperrence of their tounge prior to the examination, such as consumption of certain artificially-colored foods drinks, or candy. Patients who will be having their tongues inspected are also warned against brushing the surface of their tongue.

While tongue color and coating provide important information, such as signs of blood or qi vacuity, heat, or blood stasis, these observations can be hugely influenced by the lighting in the examination room. Another important part of the tongue evaluation is the observation of sublingual veins, found on the bottom side of the tongue. Patients whose tongues exhibit inadequate shape, length, and/or thickness may be indicating signs of blood stasis. Unfortunately, it is often difficult to accurately observe the bottom side,due to poor lighting conditions..

To solve the problem of the often-obscured underside of the tongue, and to provide the necessary tools for a more accurate and repeatable tongue evaluation, a high resolution camera with a special twin macro flash system has been utilized at The Pacific Wellness Institute in Toronto. By capturing an image of each patient’s tongue in a standardized setting (same lighting, aperture, exposure, color balance etc.), these results are far more reliable and highly useful in progress evaluations.

Related Article: Tongue diagnosis: relationship between sublingual tongue morphology in three tongue protrusion angles and menstrual clinical symptoms. Journal of Integrative Medicine. 13(4):248-56, 2015 [Medline]

Inquiry:

The inquiry stage involves asking the patient about his or her medical history, as well as asking if the patient has any current medical complaints or active symptoms.

Modern Kampo practitioners are required to understand and be able to explain the pathophysiology of different diseases in both Western and Eastern terms. Kampo practitioners inquire about patient’s illnesses by asking similar questions that Western doctors would ask, including ones regarding previous medical treatments and examinations such as blood tests or X rays that patients may have had in the past.

In addition to using Western methodology, Kampo practitioners will cover a broad range of other questions, such as asking patients if they have any feelings of warmness or coldness, changes in their appetite or sleep cycles, or difficulty with elimination. In addition, the Kampo practitioner will inquire into the patient’s emotional status, their perspiration, their menstruation (if female), all to gain further insight into the patient’s health. All of those questions have a specific Eastern diagnostic meanings, and are thus very important.

Audio-Olfactory Assessment:

At this stage of analysis, practitioners will evaluate the tone of voice and the sound the patient makes when they breathe. For example, should the patient have a loud talking voice, that could suggest Jitsu-sho (replete pattern) while patients with soft and quiet voices often indicate the Kikyo-sho (diagnosis of qi vacuity pattern). In some cases, the patient’s various odors provide additional clues to help determine diagnosis. A strong odor, for instance, may indicate a heat/excess condition, while a patient with only slight or no odor may indicate a cold/deficiency condition.

Palpation:

Palpation refers to the practitioner using their hands to make a physical assessment of patient’s body surface. In Kampo, pulse and abdominal diagnoses constitute the main part of the palpation examination.

Pulse Diagnosis:

pulse-types

six-position-pulse

With regard to pulse diagnosis, Western doctors are known to conduct this procedure, but only in a limited fashion. They usually only evaluate the rate of a patient’s pulse, using the procedure to count beats per minute, for instance. In contrast, Oriental medicine practitioners evaluate patient’s pulse in far more detail, focusing on the pulse quality and if it exhibits different characteristics:

Pulse characteristics may indicate conditions related to heat or cold, acute or chronic states, vacuity or repletion states, and other constitutional patterns and difficulties. A method of pulse diagnosis in six positions may also be used to determine a potential organ or meridian imbalance.  However, Oriental pulse diagnosis has been criticized as highly subjective means of examination. It is considered an art more than it is a science. In order to obtain more accurate and reliable pulse information from patients, practitioners need to be fully aware of the fact that cardiovascular functions are instantly and profoundly affected by various environmental factors and common activities such as posture, respiration, and mental alertness etc. Accordingly, those factors and activities can influence almost all basic categories of classical pulse including Speed, Strength, Size, Tension, and Flow. It is very important to carefully consider and control various influential factors while assessing the patient. Only then, the pulse diagnosis, when conducted skillfully, can provide useful and vital information about patient’s illness or constitution.

influence-activity

A study using autonomic blocking agents indicated that increase of heart rate,

upon standing and during mental arithmetic, is caused by excitation of sympathetic nerve

β receptor. Larger fluctuations of HR during deep breathing are mainly influenced by cardiac

vagal activity.

heart-rhythm-changes

bloodpressure

Note:

At The Pacific Wellness Institute in Toronto, I have been using heart rate variability (HRV) and blood volume pulse (photo plethysmograph-PPG) analysis for over a decade. I have found that through combining the subjective measure of Eastern pulse analysis with the more and objective, repeatable cardiovascular tests,  can be useful in clinical practice.

Observing heart rate variability is not same as measuring a patient’s heart rate. It is a far more complex analysis of heartbeat patterns. HRV is a well-recognized non-invasive evaluation of cardiac sympathetic (considered yang in nature) and parasympathetic (considered yin in nature) activities. Analysis of finger PPG waves correspond with blood volume. This practice has been utilized in Western medical fields for the evaluation of arterial sclerosis. The amplitude and shape of a recorded PPG wave likely corresponds with the classical Chinese pulse definitions of thickness and tension.

Results derived from other modern medical devices and evaluation methods such as Doppler ultrasound, pulse transit time, and Beat to Beat Blood Pressure monitoring may have some correlation with other parameters used classically to analyze pulse. From this perspective, it can be argued that Western medicine is only now discovering the importance of various pulse and circulatory qualities, information that Eastern physicians have been attempting to obtain with their fingers for thousands of years.

Abdominal Diagnosis:

An abdominal diagnosis, a practice known as Fukushin is unique to the Kampo School. This practice is not included in modern iterations of TCM. Fukushin is considered one of the most vital parts of the Kampo diagnosis procedure. It has been found to have a relatively higher intra- and inter-examiner correlation than what was found through studies of pulse analysis.

Fukushin is different compared to other abdominal palpation commonly performed by Western physicians, at least in terms of its intent and procedure. In Western medicine, the main purpose of palpation is to attempt to feel a patient’s organs through their body surface. In this scenario, a patient’s knee is bended to minimize the interference of their abdominal muscles.

In Kampo, abdominal diagnosis is usually conducted while patient’s leg is fully extended, being that its primary purpose is to evaluate the responses reflected by the surface of the patient’s body.

Common Abdominal Diagnostic Patterns (Fuku-sho):

  1. Stuffiness and rigidity below the heart A feeling of stuffiness associated with local rigidity in the epigastric region.
  1. Fullness in the chest and hypochondriumA bloated feeling in the chest and hypochondriac region.
  1. Stomach splashing sound When the practitioner elicits a splashing sound when they lightly tap the patient’s upper abdominal wall.
  1. Palpitations above/besides/below the umbilicusRapid pulsations felt in the umbilicus region
  1. Rectus tension Hyper tonicity along the rectus muscles
  1. Blood Stasis signs When a patient complains of resistance and tenderness in the lower abdomen, including along the inguinal ligaments, the superior margin of the pubis, and beneath the umbilicus.
  1. Lower abdominal numbnessLoss of sensation in the lower abdominal region
  1. Lower abdominal contracture Cramping sensation of the lower abdomen

abdominal-diagnosis

There are different Kampo herbal formulas that are typically prescribed to match each pattern of abdominal diagnosis. Examples of these common formulas are explored later in this paper.

Terminologies and definitions used in this section are adopted from the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region and Kampo Treatment for Climacteric Disorders where applicable. [1, 2]

[1]        Choi SH, Chang IM. A Milestone in Codifying the Wisdom of Traditional Oriental Medicine: TCM, Kampo, TKM, TVM–WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. Evid Based Complement Alternat Med. 2009 Jan 6.

[2]        Shibata Y, Wu J. Kampo Treatment for Climacteric Disorders. Brookline, Massachusetts: Paradigm Publications 1997.