Chapter One: Introduction1. Basic Principles★★
Understanding the external to infer the internal; recognizing the subtle to understand the significant; using the common to measure the changes.
2. Basic PrinciplesHolistic examination; integration of the four diagnostic methods; correlation of symptoms and signs.
Chapter Two: Observation Diagnosis
1: Observation of Spirit
1. Obtaining Spirit, Losing Spirit, Weak Spirit, False Spirit
Obtaining Spirit
Clear consciousness, agile movements – healthy;Weak Spirit
Fatigue, sluggish movements – deficiency of righteous qi, slight damage to essence;
Losing Spirit
Confused consciousness, sluggish response – deficiency of essence and spirit – mental fatigue, extreme deficiency of organ essence, severe damage to righteous qi, Excessive evil causing confusion – groping for clothes and bed, Excessive evil qi, heat damaging the spirit or liver wind with phlegm, Obscuring the clear orifices;False Spirit
Sudden “improvement” – critical condition, prolonged severe illness, extreme exhaustion of essence and qi, extreme deficiency of organ essence.
2. Spirit Disturbance
Anxiety and Fear – constant fear, anxiety, palpitations, shortness of breath, inability to be alone – deficiency of heart and gallbladder qi, heart not nourished (organ agitation)Restlessness – irrational behavior, restlessness, incoherent speech, violence – phlegm-fire disturbing the spirit (mania)Apathy and Dementia – expressionless, confused consciousness, muttering to oneself, unpredictable laughter and crying – phlegm obscuring the heart spirit or congenital insufficiency (mania, dementia)Sudden Fainting – sudden fainting, loss of consciousness, foaming at the mouth, eyes rolling back, limbs convulsing, awakening after a while, returning to normal – liver wind with phlegm rising, obscuring the clear orifices (epilepsy)
2: Observation of Facial Color
Five Colors
White – deficiency syndrome (blood, qi, yang), cold syndrome, blood loss syndrome – pale and dull complexion, pale tongue and lips – blood deficiency syndrome, blood loss syndrome – yang deficiency syndrome – pale and floating; yang deficiency with water retention – pale (white with a hint of blue) – sudden loss of yang (yang collapse), internal excess of yin-cold, significant blood loss.
Red
– heat syndrome, yang excess syndrome
– flushed face – external heat invasion, internal organ fire blazing (excess heat) – red cheeks – yin deficiency with yang excess (deficiency heat) – pale complexion with red cheeks like makeup – deficiency yang rising (yang excess).
Yellow
– spleen deficiency, damp syndrome
– sallow complexion – spleen deficiency leading to insufficient transformation – sallow and floating – spleen deficiency with dampness – yellow and swollen – jaundice.
– Yin yellow – cold damp obstruction – yang yellow – damp heat steaming.
Green
– cold syndrome, qi stagnation, blood stasis, pain, convulsions
– bluish-black or pale green complexion – severe cold, intense pain.
– bluish-gray complexion, cyanotic lips – heart yang collapse, blood vessel obstruction.
– chronic illness with bluish complexion and lips – heart qi, heart yang deficiency or lung qi obstruction.
– greenish-yellow complexion – liver-spleen disharmony; liver-spleen disharmony: stool – loose or constipated; complexion – greenish-yellow or sallow.
– children with blue color between eyebrows, nose, and around lips – convulsions or signs of convulsions.
Black
– kidney deficiency, cold syndrome, water retention, blood stasis, severe pain
– black and dull – kidney yang deficiency
– black and dry – kidney yin deficiency.
– dark circles around the eyes – kidney deficiency with water retention, cold damp discharge.
– dark and rough skin – blood stasis.
3: Observation of Body Shape
Abnormal Posture
Sitting
– can only sit, cannot lie down, lying down causes qi to rebel.
– cough and shortness of breath due to lung distension.
– water retention in the chest and abdomen – can only lie down, sitting causes fatigue or dizziness.
– deficiency of qi and blood.
– loss of qi and blood.
– liver yang transforming into wind.
Sitting with hands holding head, unable to raise head – mental decline.
Lying
– lying outward, prefers movement, can turn by oneself – yang syndrome, heat syndrome, excess syndrome.
– lying inward, prefers stillness, cannot turn by oneself – yin syndrome, deficiency syndrome, cold syndrome.
– curled up, feet drawn in, adding clothes and blankets – deficiency cold syndrome.
– lying on back, feet extended, removing clothes and blankets – excess heat syndrome; cough and reverse breathing, cannot lie down, lying down causes qi to rebel.
– lung qi stagnation.
– heart yang deficiency, water retention obstructing the heart.
Standing
– both hands protecting the abdomen, leaning forward – abdominal pain.
– unsteady standing + dizziness – liver wind moving internally, brain pathology.
– cannot stand for long, needs to lean on something for support – qi deficiency, blood decline.
– walking with unsteady body shaking – liver wind moving internally.
Abnormal Movements
– eyelids, face, lips, fingers (toes) trembling from time to time – external invasion – signs of moving wind.
– internal injury – qi and blood deficiency, internal wind moving.
– limbs convulsing, arching back, neck and back stiffening
– strychnine poisoning, childhood convulsions, epilepsy, tetanus, eclampsia.
– sudden fainting, loss of consciousness
– crooked mouth and eyes, hemiplegia – stroke.
– foaming at the mouth, returning to normal after waking – epilepsy.
– chills and shivering – malaria, typhoid fever, warm disease.
– limbs moving ineffectively – weakness without pain – atrophy syndrome.
– joint stiffness, difficulty in flexion and extension – bi syndrome.
– children’s hands and feet twisting, frowning, sticking out tongue
– qi and blood deficiency, internal invasion of wind-damp.
4: Observation of Head and Face
1. Observation of Hair
Yellow Hair – children with sparse yellow soft hair, slow growth – congenital insufficiency, kidney essence deficiency; children with hair like tassels – malnutrition★★.
White Hair – adolescents + insomnia and forgetfulness – overthinking damaging blood.
– adolescents with white hair + tinnitus and lower back pain – kidney deficiency★★. Hair Loss – young adults with thinning hair, easy to fall out + dizziness, forgetfulness, lower back and knee soreness – kidney deficiency; Sudden large patches of hair loss, with bald spots – alopecia areata, blood deficiency with wind; Hair loss + itchy scalp, dandruff – blood heat causing dryness.
2. Observation of Face
Facial Swelling – yang edema – rapid onset, eyelids swollen (external invasion of wind evil, lung failing to descend); yin edema – slow onset, severe swelling below the waist (kidney yang deficiency, water dampness flooding); heart and kidney yin deficiency, water retention obstructing the heart – facial swelling + palpitations and shortness of breath, unable to lie flat.
Parotid Swelling – mumps – swelling on one or both sides centered around the earlobe – external invasion of warm toxin; swelling under the jaw – redness and swelling under the cheekbone and above the ear – yangming heat toxin attacking upwards.
Facial Asymmetry – stroke – crooked mouth and eyes + hemiplegia;
– inability to close the mouth on the affected side, inability to close the eyes – wind evil invading the collaterals.
3. Observation of Eyes
Organ Correspondence – blood vessels of the eyes – blood wheel – heart.
– white of the eyes – qi wheel – lung; black of the eyes – wind wheel – liver; pupil – water wheel – kidney.
– eye flesh – meat wheel – spleen.
Observation of Eye State – constricted pupils – poisoning from Chuan Wu (Aconitum), Cao Wu (Aconitum), toxic mushrooms, organophosphates, morphine, chlorpromazine; – dilated pupils – cranial injury, cerebral hemorrhage – both sides dilated + loss of light reflex – death; – internal wind or belladonna poisoning.
– fixed gaze – staring straight ahead, fixed upward gaze – reversed eye reflex, fixed sideways gaze – squinting are all signs of internal wind moving. – eyes open during sleep – spleen qi deficiency, seen in vomiting and diarrhea damaging fluids, chronic spleen wind.
– eyelid drooping – bilateral drooping – congenital insufficiency, deficiency of spleen and kidney; unilateral drooping – trauma.
4. Observation of LipsShape and Color of the Mouth – drooling at the corners of the mouth – spleen deficiency with dampness; – mouth ulcers – internal damp heat; – canker sores – heat in the heart and spleen channels (gray-white small ulcers); – thrush – heat accumulation in the heart and spleen, rising to the mouth and tongue (white patches).
Dynamic of the Mouth – mouth open – deficiency syndrome, lung qi about to collapse; – mouth closed – excess syndrome, stroke, epilepsy, convulsions, tetanus; – mouth pursed – childhood umbilical wind; – mouth movements – internal channel observation.
Observation of LipsColor of the Lips – pale white – blood deficiency, blood loss; – deep red – excessive heat; – bright red – severe heat; – cherry red – carbon monoxide poisoning; – cyanotic – blood stasis; – bluish-black – severe cold, extreme pain.
Shape of the Lips – dry and cracked lips – dryness and heat damaging fluids, yin deficiency and fluid depletion; – eroded lips – heat accumulation in the spleen and stomach; – eroded inner lips, pale red – deficiency fire rising; – sores on the lips, red and swollen – heat accumulation in the heart and spleen; – sores at the corners of the mouth – angular cheilitis; – sores in the philtrum – philtrum sores.
Fullness of the Philtrum – lips turning inward – impending collapse of spleen qi, critical condition.
Observation of Teeth and Gums
Observation of TeethColor of the Teeth
Yellow and falling teeth – prolonged illness, bone depletion; – dry teeth – stomach yin has been damaged; – dry and rough like stone – excessive heat in the yangming channel, severe damage to fluids; – dry like withered bones – kidney yin depletion.
Dynamic of the TeethTeeth tightly closed – phlegm obstructing the collaterals, extreme heat generating wind; – grinding teeth – excessive heat generating wind; – grinding teeth during sleep – stomach heat, parasitic accumulation, normal people.
Color of the Gums
Pale white – blood deficiency or blood loss; – red, swollen, and painful – excessive stomach fire.
Shape of the Gums
Bleeding gums
Red, swollen, and painful – stomach heat damaging the collaterals; – not red, not painful, slightly swollen – qi deficiency or kidney fire damaging the collaterals.
Gum recession: gum tissue atrophied, tooth roots exposed, teeth loose, kidney deficiency or stomach yin deficiency.
Dental ulcers: ulceration of the gums, flowing foul-smelling blood and water, external invasion of epidemic evil, accumulation of toxins rising.
6. Observation of Throat
Color of the Throat
Throat deep red, significant swelling and pain – lung and stomach heat toxin obstructing; throat tender red, mild swelling and pain – yin deficiency with excessive fire; throat pale red and swollen – phlegm damp accumulation.
Throat Shape
Milk throat – lung and stomach heat accumulation or deficiency fire rising; white throat (pseudomembrane) – lung and stomach heat toxin damaging yin, severe infectious disease.
Throat abscess – heat toxin lodged in the throat.
Throat ulceration – ulceration forming patches or depressions – lung and stomach heat toxin obstructing; ulceration dispersing superficially – light lung and stomach heat; ulceration lasting long, surrounding area pale red or sallow – deficiency syndrome.
Five Observations of the Body and Limbs1. Observation of Neck
Goiter – lump in the throat, moving up and down with swallowing – liver qi stagnation or phlegm qi obstruction; scrofula – lumps on the side of the neck or under the jaw, clustered like beads, lung and kidney yin deficiency, phlegm fluid disease, or external invasion of wind-heat toxin.
Neck atrophy – neck swelling, scrofula ulceration not healing for a long time, phlegm fire long-term accumulation, qi and blood stagnation, ulcer not healing.
Neck abscess, neck swelling – swelling and redness on both sides of the neck, painful and burning, wind-heat evil toxin steaming, qi and blood stagnation, phlegm toxin mutually obstructing. Neck veins bulging – neck veins visibly swollen, worse when lying flat, heart blood stasis, lung qi stagnation, heart and kidney yang deficiency, water retention obstructing the heart.
Trachea deviation – trachea deviating to one side – unilateral goiter, mass pulling or pressing, water or gas in the chest cavity, seen in suspended fluid, pneumothorax, stone goiter, flesh goiter, lung tumors.
Stiff neck – neck stiffness with chills and fever – wind-cold invading the taiyang channel causing neck stiffness, unable to bend forward; – strong fever, mental confusion, convulsions – warm disease fire evil attacking, or brain marrow disease; – neck stiffness and discomfort + dizziness – yin deficiency with yang excess, or qi stagnation; – neck stiffness after sleeping – improper sleeping position (wry neck).
Soft neck – children with soft neck – congenital insufficiency, kidney essence deficiency, postnatal malnutrition, developmental disorders (rickets).
Long-term illness, severe illness soft neck – organ qi and blood exhaustion.
Vein Pulsation
Quiet + pulse at the renying point – liver yang rising, severe blood deficiency.
2. Observation of Limbs
External Shape – atrophied limbs – qi and blood deficiency, meridians obstructed, limbs lacking nourishment.
Swollen limbs – red, swollen, and painful – heat obstructing blood stasis; – lower limb swelling – water retention; – lower limb swelling + skin thick like elephant skin – filariasis; – blue veins on the calves – internal invasion of cold damp, blood stasis in the meridians; – lower limb deformities (knee varus, knee valgus, foot inversion, foot eversion) – congenital insufficiency, kidney qi not sufficient; postnatal malnutrition.
– “crane knee wind” – prolonged cold damp retention, qi and blood deficiency.
Dynamic
Limbs weak and inactive – essence and fluids deficiency, damp heat soaking, tendons and meridians lacking nourishment; limbs convulsing – liver wind moving internally, tendons and meridians stiffening; hands and feet stiffening – cold evil stagnating, or qi and blood deficiency, tendons and meridians lacking nourishment.
Hands and feet trembling – blood deficiency, tendons and meridians lacking nourishment, excessive drinking; hands and feet writhing – yin deficiency causing wind; groping for clothes and bed, groping for empty lines – severe illness, loss of spirit; raising hands and pacing – heat disturbing the spirit.
6. Observation of Skin
Observation of Skin Color
Skin red (color like painted red) – erysipelas.
– occurring on the head and face – head fire erysipelas.
– occurring on the lower leg and foot – flowing fire; – occurring all over the body, wandering and unpredictable – red wandering erysipelas.
Skin yellow (face, skin, nails) – jaundice.
– bright like orange peel – yang jaundice (damp heat steaming).
– dark like smoke – yin jaundice (cold damp obstructing).
Skin white spots – appearing on the face and limbs – vitiligo (wind-damp invasion, qi and blood disharmony).
Observation of Rashes
Rash – flat on the skin, does not hurt when touched, does not fade when pressed; eruption – raised above the skin, hurts when touched, fades when pressed.
7. Observation of Excretions
Observation of Phlegm
Yellow, thick, and clumpy phlegm – heat phlegm; white, clear, and thin phlegm, or with gray-black spots – cold phlegm; white, slippery, and abundant phlegm – damp phlegm; little, sticky phlegm, difficult to cough up – dry phlegm; phlegm with blood – heat injuring lung collaterals (lung yin deficiency or liver fire invading lung or phlegm heat obstructing lung).
Coughing up purulent, bloody, foul-smelling phlegm – lung abscess.
Observation of Nasal Discharge – clear nasal discharge – external invasion of wind-cold; – turbid nasal discharge – external invasion of wind-heat; – paroxysmal clear discharge, abundant like a stream – allergic rhinitis; – prolonged turbid discharge, abundant, thick, with a foul smell – chronic sinusitis.
Observation of Vomit – clear, thin, and odorless – stomach yang deficiency or cold evil invading the stomach; – foul-smelling, sour, and stinky – heat evil invading the stomach; – clear water phlegm + rumbling sound in the stomach – fluid retention in the stomach.
– vomit with sour, undigested food – food injury; – vomit with yellow-green bitter water – liver-gallbladder damp heat or stagnant heat; – vomit with dark red or purple blood clots – stomach with accumulated heat or liver fire invading the stomach or stomach with blood stasis.
8. Observation of Children’s Index Finger Collaterals
Floating and Sinking Distinction – floating and prominent – external invasion; – sinking and hidden – internal injury; – thin and weak – deficiency syndrome.
Thick and coarse – excess syndrome.
Red and Purple Distinction of Cold and Heat★★★
Bright red – exterior syndrome; Purple red – interior heat syndrome; Blue – pain, convulsions; Pale white – spleen deficiency, malnutrition.
Purple-black – blood vessel obstruction.
Three Positions to Measure Severity
First segment of the index finger – wind position (evil qi entering the collaterals, mild illness);
Second segment of the index finger – qi position (evil qi entering the meridians, severe illness);
Third segment of the index finger – life position (evil entering the organs, critical illness);
Fingerprint reaching the fingertip – penetrating position (dangerous condition, poor prognosis).