Comprehensive Guide to Observation Diagnosis in TCM
1. Observation of Spirit
The severity of the condition is assessed by observing the spirit. Calmness indicates a yin condition, while agitation suggests a yang condition. Blood deficiency and fluid loss often lead to confusion, dullness, and depression caused by emotional distress. Restlessness and anxiety indicate depletion of the spirit, while a hot person with a clear mind suggests a yang condition. Fatigue is seen after prolonged illness, and clarity in the chest does not require alarm.
2. Observation of Color
The state of qi and blood is assessed by color. Yellow indicates dampness, while red indicates heat. A blue color is associated with wind and the liver, while black is often seen in kidney conditions due to overwork. White indicates cold pathogens affecting the lungs. Bright colors and dark colors should be differentiated; the latter indicates internal issues, while the former indicates external ones. Chronic and acute conditions must be recognized.
3. Observation of Body Shape
Observing body shape is also important. Distinguishing between obesity and emaciation is crucial. Those who are overweight tend to have excess dampness and are prone to phlegm, while those who are thin often have insufficient fluids and blood, leading to excessive heat and cough. Nails, muscles, skin, and tendons are important for clinical differentiation and understanding.
4. Other Physical Forms
A bent posture indicates convulsions, while facial asymmetry suggests stroke. Dull hair and pale complexion indicate lung deficiency, while skin and nail abnormalities suggest blood deficiency. Stiff neck indicates wind-cold, while spasms in hands and feet suggest acute conditions. Weakness in the lower limbs indicates atrophy, while tremors and paralysis vary in presentation.
5. Observation of Head and Face
Swelling of the head and face indicates severe conditions, while kidney inflammation leads to swelling and sores. A bulging fontanelle indicates excessive heat affecting the brain, while a closed fontanelle suggests kidney deficiency. Shaking the head helps differentiate between chronic and acute conditions. Chronic illness leads to weakness, indicating deficiency, while sudden onset suggests a strong constitution.
6. Observation of Hair
Normal black hair indicates health, while white hair suggests blood deficiency. Yellow hair indicates heat from qi and blood. Hair loss indicates deficiency of essence and dryness of blood, while brittle hair suggests severe deficiency. Sparse hair in children indicates malnutrition. Healthy hair reflects good blood and qi, while sweating and wheezing indicate severe lung issues.
7. Observation of Eyes
Bright eyes indicate vitality, while dull eyes suggest deficiency. Yellow sclera indicates jaundice, while red, swollen eyes suggest liver heat. Eyes that remain open during sleep indicate spleen deficiency, while dilated pupils indicate a critical condition.
8. Observation of Nasal Color
A dark nose indicates deep heat toxicity, while red indicates wind-heat affecting the spleen and lungs. White indicates qi deficiency or blood loss, while black suggests fluid retention. Flared nostrils indicate lung heat, while nasal bleeding often results from heat damaging yin. Clear nasal discharge indicates wind-cold, while turbid discharge indicates wind-heat.
9. Observation of Mouth and Lips
A locked jaw indicates convulsions or stroke, while an open mouth suggests different conditions. Mouth sores indicate heat in the heart, while canker sores suggest heat attacking the heart and spleen. A crooked mouth indicates a stroke, while a full mouth indicates oral thrush. Dry lips suggest spleen deficiency, while cracked lips often indicate dryness.
10. Observation of Tongue Shape
A tongue with prickles indicates deep heat accumulation, while swelling often suggests fluid retention. A heavy tongue indicates heat accumulation in the heart and spleen, while a thin tongue suggests deficiency. A long tongue indicates qi deficiency, while a curled tongue suggests a yin condition. A stiff tongue indicates wind, while a slippery tongue suggests dampness and dryness.
11. Observation of Tongue Coating
A thick coating indicates phlegm-dampness, while a thin coating suggests exterior pathogens. A greasy coating indicates external disturbances, while a slippery coating indicates normal cold dampness. A dry tongue indicates yin deficiency, while a white coating indicates lung abscesses. A cracked tongue indicates yin deficiency, while a mottled tongue suggests serious conditions.
12. Observation of Red Tongue
A bright red tongue indicates heat conditions, while a red tongue with a yellow coating suggests yin deficiency. A red tongue with red edges indicates liver heat, while a red tip indicates heart fire. A mirror-like tongue indicates internal fluid depletion, while a dry red tongue suggests stomach heat.
13. Observation of Crimson Tongue
A crimson tongue indicates heat affecting the nutrient level, while both qi and blood are consumed. A crimson tongue with a moist coating indicates heart fire, while a dry crimson tongue suggests stomach heat. A crimson tongue with a coating indicates damp-heat.
14. Observation of Purple Tongue
A purple tongue indicates blood stasis, while a dark purple tongue suggests severe conditions. A blue-purple tongue indicates yin deficiency, while a purple tongue with a white coating suggests internal heat. A purple tongue with a dry coating indicates severe conditions.
15. Observation of White Coating
A white coating indicates external pathogens, while a thick white coating suggests phlegm-dampness. A white coating with red edges indicates wind-heat, while a thick white coating indicates internal heat. A white coating with a dry tongue indicates severe conditions.
16. Observation of Yellow Coating
A yellow coating often follows a white coating, indicating internal heat. A yellow coating suggests damp-heat, while a thick yellow coating indicates excess heat. A dry yellow coating indicates internal heat.
17. Observation of Gray Coating
A gray coating indicates internal heat, while a dry gray coating suggests severe conditions. A gray coating with dark spots indicates internal heat.
18. Observation of Black Coating
A black coating indicates severe conditions, while a dry black coating suggests internal heat. A black coating with a red tongue indicates severe conditions.
19. Observation of Phlegm
Thick phlegm indicates heat, while thin phlegm indicates cold. Phlegm with blood indicates lung injury, while chronic conditions indicate internal heat.
20. Observation of Blood
Red blood indicates excess heat, while pale blood indicates deficiency. Dark blood indicates stasis, while purple blood indicates excess qi.
21. Observation of Stool
Loose stools indicate cold in the intestines, while dry stools indicate heat. Blood in stools suggests spleen deficiency or hemorrhoids, while black stools indicate bleeding.
22. Observation of Urine
Cloudy urine indicates damp-heat, while clear urine indicates deficiency. Dark yellow urine indicates heat, while frequent urination indicates damp-heat.
23. Observation of Hands and Feet
Spasms in hands and feet indicate convulsions, while pain in limbs indicates blockage. Hemiplegia often results from stroke, while tremors indicate qi and blood deficiency.
24. Observation of Skin
Nail abnormalities indicate lung deficiency, while dry skin indicates blood deficiency. Yellow skin indicates damp-heat, while black skin indicates cold retention.
25. Observation of Chest and Abdomen
A soft abdomen indicates chicken breast deformity, while a barrel-shaped chest indicates emphysema. Abdominal swelling indicates excess heat, while a sunken abdomen indicates chronic illness.
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