Your First TCM Visit: What Happens Step by Step

Before you go

A first visit to a traditional Chinese medicine (TCM) practitioner is mostly a conversation and a hands-on examination. Nothing here is a self-treatment guide. If your symptoms are new, severe or getting worse, see a doctor first. TCM should not be used to replace or delay conventional care, and you should tell all your health care providers about the approaches you use. [1]

Useful things to bring or be ready to say: your medicines and supplements (including any herbs), your diagnoses, recent test results, and what you hope to get from the visit.

Step by step

The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (Canada) describes a typical visit this way. Other places and practitioners vary. [2]

1. Consent. The practitioner explains the proposed treatment and asks for your informed consent before anything starts. In Ontario, practitioners are required by law to do this, and the College recommends a signed form. [2]
2. Health history. The practitioner asks about your medical and family history, medicines, and current symptoms, including energy, sleep, appetite, thirst, sweating, chills or fever, pain, bowel habits, urine and menstruation. [2] See Questions TCM Practitioners Ask and Why.
3. Looking. They observe your face, eyes and tongue (color, coating and shape). [2]
4. Listening and smelling. They notice your breathing, voice and cough, and any breath odor. [2]
5. Touching. They may feel the body for temperature, moisture and pain, and press on points used in acupuncture. [2]
6. Pulse. The practitioner feels the pulse at the radial artery on each wrist, at three positions and two or three depths. [3]
7. Explanation and plan. The practitioner gives a TCM diagnosis, explains it, and proposes a plan that may combine herbal medicine with acupuncture, moxibustion, cupping, gua sha or tui na. [2]

These steps are the traditional "four examinations": looking, listening/smelling, asking and touching. [3] For more detail see The Four Examinations and TCM Consultation: Tongue and Pulse Assessment.

How much to trust the tongue and pulse findings

Tongue and pulse are skilled judgments, not lab tests. A review of reliability research found that pulse agreement between practitioners ranged from low to very good, tongue findings varied considerably, and pattern diagnoses were not found to be highly reliable. [4] So it is reasonable to ask the practitioner to explain what they found in everyday words, and to expect that another practitioner might word it differently.

If needles, herbs or other treatments are suggested

• Acupuncture. In the US, the FDA regulates acupuncture needles as medical devices and requires them to be sterile and labeled for single use. Complications have resulted from nonsterile needles and improper delivery. [5] Details: Acupuncture Session: First Appointment.
• Herbs. The NHS (UK) says not to take herbal medicines if you are pregnant or breastfeeding, have kidney or liver problems, or take certain medicines, and to check with a pharmacist first if you take other medicines. It also says herbal medicines are not recommended for children. [6] Some Chinese herbal products have been found contaminated with heavy metals or undeclared drugs. [1]
• You can say "let me think about it" to any suggestion, including herbs, and ask for the plan in writing.

Checking who you are seeing

Qualifications differ by place. In Ontario, only registered members of the College may use the titles "Traditional Chinese Medicine Practitioner" or "Acupuncturist." [2] In the US, most states license acupuncturists, but requirements vary. [5] In the UK, the NHS notes that many herbal medicine practitioners do not need to be registered by law and suggests choosing one registered with a professional organization accredited by the Professional Standards Authority. [6] We do not list or recommend practitioners. See How to Choose a TCM Practitioner and Questions to Ask Your TCM Practitioner.

Stop signs

Tell the practitioner and a doctor if you feel unwell, faint, or develop a rash, burning, swelling, or any new symptom after a treatment or herb. For an emergency in the US, call 911.