The Chinese Four Pillars of Diagnosis Used in Acupuncture

chinese-four-pillarsChinese medicine has a different approach to diagnosing patients than you will typically find in a Western medical health care setting. Looking, listening, touching, asking — these important components make up the Chinese four pillars of diagnosis used in acupuncture. The four pillars are also referred to as the four examinations. Each pillar provides information that adds up to a holistic view of the patient and any health issues that can be alleviated through acupuncture and traditional Chinese medicine. Read on to learn more about the each pillar.


A lot can be gleaned from a patient during an examination through observation. As part of a diagnosis, the practitioner will likely note the color and luster of the face and skin throughout the body. Different features of the body, including the eyes and ears, also convey information about underlying imbalances. The acupuncturist will also likely examine the tongue, which may indicate the state of a patient's health by characteristics like its shape, texture and coating or moisture level. Other aspects of a patient that might be observed include their movements and their mannerisms.


The sound of someone's voice provides a window into their health. Practitioners generally classify the voice into these five types:

  • Shout
  • Laugh
  • Sing
  • Weep
  • Groan

Each type connects to different organs and provides information about which systems of the body may have ailments.


This pillar is commonly called palpation. During this part of the examination, the practitioner feels various pulse points, including along the radial artery, to ascertain the state of the pulse — be it choppy, rapid, strong or possessing any number of other characteristics. These classifications offer deep insight into both the physical and mental state of the patient. The practitioner may also palpate the abdomen or specific acupuncture points to glean additional diagnostic information.

During the touching or palpation portion of the exam, the acupuncturist is looking for areas that are:

  • Tender or painful
  • Hot or cold
  • Swollen
  • Sweaty
  • Discolored


The final pillar involves a process of inquiries starting with the specific or main complaint, if any, and then branching out from there. A traditional Chinese medical diagnosis may involve ten questions, which range in subject from the patient's sleeping habits to their appetite to the characteristics of the pain they have. Additional related questions may follow these main areas of inquiry.

A practitioner may also include smelling and tasting as part of the diagnostic process by inquiring about any body odors or tastes experienced by the patient. Smelling and tasting are less used by practitioners today than they were in the past.

All of the external symptoms communicate the condition of a patient's interior organs and systems. The information gathered during an exam using the four pillars of diagnosis allows the practitioner to understand the patient as an individual and come up with a treatment plan that addresses and imbalances they have with their qi — or life force energy.

To learn more about pursuing a degree in acupuncture and Oriental medicine or massage therapy, download our free guide that breaks down how to change careers into four easy steps.

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