Fundamental Knowledge of TCM Observation Diagnosis

Observation of the Face Overall Abnormalities

1. Facial Swelling: Commonly seen in edema, which can be classified into (yang shui) and (yin shui). Additionally, if accompanied by cyanosis of the lips, palpitations, shortness of breath, and inability to lie flat, it often indicates heart and kidney yang deficiency, blood stasis, and water qi obstructing the heart.

2. Parotid Swelling: Unilateral or bilateral swelling centered around the earlobe, with unclear edges, and tenderness upon palpation, is often due to “mumps,” typically caused by external wind-heat pathogens; redness and swelling in the zygomatic and submandibular areas, accompanied by chills and fever, belong to “fa yi,” often due to yangming heat toxin attacking upward.

3. Sunken Cheeks and Prominent Zygomas: Also known as facial atrophy, characterized by muscle wasting in the face, prominent cheekbones, and sunken eye sockets and cheeks, often indicates deficiency of qi and blood, exhaustion of organ essence, commonly seen in critical stages of chronic diseases.

4. Asymmetrical Mouth and Eyes: Also known as mouth-eye deviation, characterized by the mouth and eyes being skewed to one side, with a shallow nasolabial fold. If there is no hemiplegia, it indicates wind pathogen obstructing the channels; if accompanied by hemiplegia, it indicates stroke, caused by hyperactivity of liver yang and obstruction of channels by wind-phlegm.

5. Special Facial Appearances: Common examples include “fearful expression,” “bitter smile,” and “lion face.”

Observation of the Eyes

The eyes are the orifice of the liver and the messenger of the heart spirit, with the essence of the five organs and six bowels converging in the eyes, particularly closely related to the heart, liver, and kidneys, reflecting the state of organ essence.

1. Abnormal Color

① Red and swollen eyes — indicative of excess heat syndrome.

Red sclera — indicates lung fire.

Red pain in both inner canthi — indicates heart fire.

Red and ulcerated eyelid margins — indicates damp-heat in the spleen channel.

Entire eye red and swollen — indicates wind-heat in the liver channel.

② Yellow sclera — a primary sign of jaundice, often caused by damp-heat or cold-damp accumulation, leading to bile overflow.

If a slightly raised light yellow plaque appears on the sclera of middle-aged and elderly individuals, it is called lipid deposition, which should be distinguished from jaundice.

If a gray-white cloudy ring appears at the edge of the cornea, it is called a senile ring, commonly seen in the elderly, generally asymptomatic, and does not affect vision, resulting from deficiency of liver and kidney.

③ Pale inner canthi — often indicates blood deficiency or blood loss, resulting from insufficient blood nourishing the eyes.

④ Dark and dull eye sclera — often indicates kidney deficiency, a sign of kidney essence and qi depletion.

2. Abnormal Shape

(1) Eyelid edema: a common manifestation of edema. Since the eyelids belong to the spleen, which dislikes dampness, and the tissue in this area is loose, edema can first appear in the eyelids. Observing slight swelling here can help detect edema early. However, transient eyelid swelling after sleeping with a low pillow in healthy individuals is not pathological.

(2) Sunken eye sockets: often due to fluid depletion or insufficient qi and blood. Can be seen in patients with vomiting and diarrhea or qi and blood deficiency. If the eye sockets are deeply sunken in chronic severe illness, to the point of not being able to see the person, and the true pulse is absent, it indicates a critical condition of yin and yang exhaustion.

(3) Protruding eyeballs: if accompanied by shortness of breath and difficulty breathing, it indicates lung distension. If phlegm obstructs the lungs, leading to unexpressed lung qi and difficulty in breathing. If protruding eyeballs are accompanied by slight swelling in the neck and irritability, it indicates goiter, caused by liver stagnation transforming into fire and phlegm qi obstructing.

(4) Styes and chalazia: both caused by wind-heat pathogens or heat accumulation in the spleen and stomach attacking the eyes.

3. Abnormal Dynamics

(1) Constricted pupils: often indicates excessive liver and gallbladder fire or poisoning.

(2) Dilated pupils: often indicates critical conditions of kidney essence depletion. If both pupils are fully dilated, it is one of the clinical signs of death. If one pupil gradually dilates, it can be seen in stroke or cranial trauma patients, also indicating a critical condition. Additionally, it can be seen in patients with internal wind disorders (glaucoma).

(3) Fixed gaze: the patient’s eyes are fixed forward, and consciousness is unclear, indicating impending exhaustion of organ essence, a critical condition.

(4) Ocular retroflexion: the patient’s eyes are upward, unable to move, with neck stiffness and convulsions, indicating exhaustion of the taiyang channel, also a critical condition.

(5) Crossed eyes: often indicates internal movement of liver wind.

(6) Eyes open during sleep: often indicates spleen and stomach deficiency. Can be seen in children with vomiting and diarrhea or chronic spleen wind.

(7) Eyelid droop: eyelids sagging, indicating spleen and kidney deficiency.

(8) Difficulty closing eyes: bilateral difficulty in closing eyes often indicates goiter; unilateral difficulty often indicates wind obstructing the channels; if a child sleeps with eyes open, it often indicates spleen qi deficiency, insufficient qi and blood, and lack of nourishment to the eyelids. Commonly seen in children with vomiting and diarrhea or chronic spleen wind.

Observation of the Ears

The kidneys open to the ears, and the hand and foot shaoyang channels are distributed in the ears, with reflex points for all body organs and limbs on the auricle, particularly closely related to the kidneys and gallbladder, thus observing the ears can diagnose kidney, gallbladder, and systemic diseases.

Abnormal Color of the Ears	Ear rim pale — often indicates qi and blood deficiency. Ear rim red and swollen — often indicates liver and gallbladder damp-heat or heat toxin attacking upward. Ear rim bluish-black — often seen in patients with internal cold or severe pain. Ear rim dry and blackened — often indicates kidney essence depletion. Children with red veins on the ear back and cool ear roots — often a precursor to measles.
Abnormal Shape of the Ears	Small and thin auricles — often indicates congenital deficiency and insufficient kidney qi. Dry and atrophied auricles — often indicates critical conditions of kidney essence depletion. Skin lesions on the auricle — can be seen in patients with long-standing blood stasis.
Internal Ear Pathologies	Pus and fluid discharge from the ear, known as “pus ear,” indicates liver and gallbladder damp-heat. Localized swelling and pain in the ear, accompanied by pulling pain in the auricle — indicates ear canal abscess; later stages may turn to deficiency — often indicates kidney yin deficiency and virtual fire rising. If blood and fluid discharge from the ear after trauma, consider skull base fracture, indicating a critical condition.

Observation of the Nose

The nose is centrally located on the face, serving as the orifice of the lungs, with corresponding areas of various organs surrounding it. The bridge of the nose corresponds to the liver, the tip corresponds to the spleen, and the nostrils correspond to the stomach, with the foot yangming stomach channel distributed beside the nose. Therefore, observing the nose can diagnose not only lung and spleen-stomach diseases but also assess the deficiency and excess of organs, the severity of the condition, and prognosis.

Abnormal Color	White tip of the nose — often indicates qi and blood deficiency. Red tip of the nose — often indicates lung and spleen heat accumulation. Blue tip of the nose — often indicates cold abdominal pain [severe condition]. Black tip of the nose — often indicates kidney deficiency with cold water retention. Dull and dry tip of the nose — often indicates depleted stomach qi, indicating a severe condition.
Abnormal Shape	Red and swollen nose with sores — often indicates stomach heat or blood heat. Red papules on the tip of the nose — known as “alcoholic nose” — often caused by lung heat accumulation. Collapsed nasal columella — often seen in syphilis patients. Collapsed nasal columella and eyebrow loss — often indicates severe leprosy. Nostrils flaring — often seen in patients with lung heat obstruction or asthma, indicating a severe condition.
Internal Nasal Pathologies	Clear nasal discharge — indicates wind-cold exterior syndrome. Nasal congestion with discharge — indicates exterior syndrome due to external pathogens. Thick purulent nasal discharge with foul odor — indicates nasal phlegm — often due to external wind-heat or heat accumulation in the gallbladder attacking upward. Nasal bleeding — known as “epistaxis” — often due to lung and stomach heat injuring the nasal vessels.

Observation of the Lips

The mouth is the passage for food and drink, the orifice of the organs, and the spleen opens to the mouth, with its beauty reflected in the lips. The hand and foot yangming channels encircle the mouth and lips, thus observing the abnormalities of the mouth and lips primarily allows for the diagnosis of spleen and stomach diseases.

Abnormal Color

Pale lips — often indicates blood deficiency or blood loss. Deep red lips — often indicates excessive heat evil. Cyanotic lips — often indicates blood stasis syndrome. Black lips — often indicates extreme cold or severe pain conditions. Cherry-red lips — often seen in carbon monoxide poisoning.

Abnormal Shape

Cracked lips — often indicates dryness and heat injuring fluids or yin deficiency. Ulcerated lips — often indicates heat accumulation in the spleen and stomach attacking upward. — Children often indicate spleen deficiency with excessive dampness. Drooling at the corners of the mouth — — Adults often indicate stroke with mouth deviation. Oral ulcers — ulcers in the oral cavity. Extensive oral ulceration — known as “oral erosion,” often indicates heat accumulation in the heart and spleen attacking upward. Children with white patches like snowflakes on the oral cavity and tongue are known as “oral thrush,” often indicates warm-heat and turbid evil attacking upward. If small gray-white spots appear on the buccal mucosa (at the second molar area), surrounded by a red halo, it is known as Koplik spots, indicating the impending onset of measles.

Observation of the Teeth and Gums

Teeth are the remnants of bones, which are governed by the kidneys, and gums are where the hand and foot yangming channels are distributed. Therefore, observing the teeth and gums primarily allows for the diagnosis of kidney and stomach diseases, as well as the balance of body fluids.

1. Observation of the Teeth

Abnormal Tooth Manifestations	Main Diseases and Symptoms
Grinding teeth during sleep	Stomach heat, parasitic accumulation
Dry teeth	Often indicates stomach yin injury
Teeth dry as if they are withered bones	Often indicates kidney yin depletion
Loose and sparse teeth	Often indicates kidney deficiency or virtual fire rising
Teeth with tartar	Indicates excess heat in the stomach and kidneys, but qi and fluids are not exhausted
Teeth without tartar	Indicates severe heat in the stomach and kidneys, with qi and fluids exhausted

2. Observation of the Gums

Abnormal Gum Manifestations	Main Diseases and Symptoms
Pale gums Red and swollen gums Gum bleeding known as “gingival hemorrhage” Accompanied by red and swollen painful gums Accompanied by pale, non-swollen, slightly painful gums Gums pale, with atrophy Ulcerated gums, with foul-smelling blood discharge known as “dental gangrene”	Often indicates blood deficiency or blood loss Often indicates excessive stomach fire, rising along the channels Indicates stomach fire rising, injuring the gum vessels Indicates spleen not governing blood, or kidney deficiency with virtual fire rising Often indicates kidney deficiency or insufficient stomach yin Often due to external pathogens or residual toxins attacking upward

Observation of the Throat

The throat is the gateway to the lungs and stomach, serving as the passage for breathing and eating. The foot shaoyin kidney channel runs through the throat and under the tongue, thus observing the throat primarily allows for the diagnosis of lung, stomach, and kidney diseases.

Abnormal Throat Manifestations	Main Diseases, Symptoms, and Severity
Red and swollen	Deep red throat, significant swelling and pain Throat red and tender, significant swelling and pain	Often indicates lung and stomach heat toxin, obstructing upward Often indicates kidney yin deficiency, with virtual fire rising
Pus formation	Throat swelling high and protruding, deep red color, surrounded by tight red halo, persistent fever Throat pale, swelling diffuse, no clear boundaries, mild pain	Indicates pus has formed Indicates pus has not formed
Ulceration	Throat ulceration superficial and scattered Throat ulceration in patches or depressions	Indicates mild lung and stomach heat or virtual fire rising Indicates severe lung and stomach heat toxin obstructing upward
Pseudomembrane	Pseudomembrane loose and thick, easily wiped away Pseudomembrane tough, not easily wiped away, heavy peeling with bleeding, quickly regenerating	Indicates milder condition Indicates more severe condition
Location and Shape	Throat not swollen on both sides, with red and swollen tonsils accompanied by yellow-white pus points, often indicates excessive lung and stomach heat, with fire toxin steaming.
Diphtheria	Severe infectious disease in children caused by external pathogens.
Throat abscess	Often caused by wind-heat phlegm-fire obstruction.

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