The Four Examinations: Looking, Listening and Smelling, Asking, Touching
The four traditional examinations in Chinese medicine (looking, listening and smelling, asking, touching), how a visit is structured, and how reliable the findings have been in studies.
Content last updated . This page has not been medically reviewed.
What the four examinations are
Traditional Chinese medicine (TCM) practitioners gather information in four ways, often called the four examinations or four diagnostic methods: looking, listening (and smelling), asking and touching. One overview of TCM describes them as looking, listening, palpating (feeling) and questioning, and explains that the practitioner combines them to build a picture of the person. [1] This page describes the method in general terms. It is not a self-check, because there is no reliable way to apply it to yourself.Looking
The practitioner observes the brightness of the eyes, the facial complexion, the body structure and movement, the skin, the hair and the tongue. [1] The tongue has its own page: Tongue Diagnosis in Chinese Medicine.Listening and smelling
Listening involves attending to the person's breathing, the characteristics of the voice and the coherence of speech. [1] The overview we read does not describe the smelling part in detail, so we do not describe it here. Ask a practitioner what they note and why.Asking
Questioning covers causes, onset, duration and symptoms, results of previous treatment, appetite and diet, energy, memory, mood, bowel and bladder habits and sleep. [1] Good practitioners also ask about your medicines, medical history and pregnancy. Questions you may meet are explained in Questions TCM Practitioners Ask and Why.Touching
Palpation means feeling the pulse at the radial artery of each wrist and pressing certain points on the body. [1] See Pulse Diagnosis in Chinese Medicine.Putting it together
The findings are combined and described as a traditional pattern, which then guides the treatment plan. [1] The pattern is a framework term, not a medical diagnosis; see Traditional Pattern Differentiation in TCM. A typical first visit is walked through in Your First TCM Visit.What research shows about reliability
Reliability means whether two practitioners, or the same one on two days, reach the same finding.| Part of the visit | What studies found | Evidence label |
|---|---|---|
| Pattern diagnosis overall | Studies of reliability of pattern diagnosis in a range of disorders had not generally found a high level of reliability [2] | Mixed to limited |
| Pulse | Reliability studies reached agreement from low to very good [2] | Mixed |
| Tongue | Considerable variability across studies [2] | Mixed |
| Combined findings for painful periods | 38 acupuncturists rating video, tongue photo and pulse description: median kappa 0.26 (low) [3] | Limited |
These findings concern agreement, not whether the method leads to better outcomes. We did not find a source comparing outcomes of treatment guided by the four examinations with treatment guided another way, so for that question the answer is proper evidence not found.
Frequently asked questions
What are the four examinations in TCM?
Looking, listening (and smelling), asking, and touching (palpation). [1]
Do I have to be touched or have my pulse taken?
The overview describes pulse and point palpation as part of the standard approach. [1] You can ask what will happen before the visit and decline anything you are uncomfortable with.
Are the four examinations accurate?
Agreement between practitioners has been mixed to low in the studies we read. [2][3]
Can I do the four examinations on myself?
No. We do not provide self-diagnosis tools, and studies show trained practitioners often disagree. [3]
Is the result a medical diagnosis?
No. It is a traditional pattern. Ask for the medical diagnosis too, and keep your doctor informed. [4]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety and when to see a doctor first
References
- Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications. Healthcare (Basel). 2021;9(3):257. Full text on PubMed Central. Read 2026-10-22.
- O'Brien KA, Birch S. A review of the reliability of traditional East Asian medicine diagnoses. J Altern Complement Med. 2009;15(4):353-66. Read 2026-10-22.
- Schnyer RN, McKnight P, Conboy LA, et al. Can reliability of the Chinese medicine diagnostic process be improved? A prospective randomized controlled trial. J Altern Complement Med. 2019;25(11):1103-1108. Read 2026-10-22.
- Traditional Chinese Medicine: What You Need To Know (NCCIH). Read 2026-10-22.