Liver:The liver opens to the eyes; individuals with poor liver and gallbladder health often experience dry, gritty, and dull eyes, with many even “rapidly blinking”. Its manifestation is seen in the nails; when the liver and gallbladder are healthy, the immune system is strong, and the nails tend to be smooth, shiny, and strong. Otherwise, they may be brittle, prone to breakage, or show signs of fungal infection. The liver governs the tendons (muscles and ligaments), and visible veins on the back of the hands indicate poor liver and gallbladder health. Emotionally, individuals may be prone to anger. Some people can become irritable quickly, slamming tables and glaring after just a few words, usually due to excessive liver fire. Those with liver issues often prefer sour foods and may have a pale, dull complexion.Heart (Small Intestine):The tongue is the manifestation of the heart. How can we assess heart health through the tongue? If the tongue is pale and white, it indicates insufficient heart blood and poor circulation. If there is blood stasis, the tongue appears dark purple. Tongue ulcers may indicate excessive heart fire. Its manifestation is seen in the face; a healthy heart typically results in a complexion that is rosy and vibrant. A pale, dull face indicates insufficient blood supply to the heart. A dark purple face suggests excessive heart fire and areas of stasis. Emotionally, a healthy heart is associated with joy and frequent smiling, even when alone, while a poor heart may lead to a preference for bitter foods, such as bitter melon, almonds, and grapefruit juice. A flushed (purple-red) face, especially in overweight individuals, often indicates cardiovascular issues.Spleen (Stomach):It opens to the mouth and lips, and its manifestation is seen in the muscles. Individuals with good spleen and stomach health have lips that are light red and glossy; poor health is indicated by pale, white, or sallow lips. Those with stomach issues often experience bad breath, especially in cases of gastritis or ulcers. The spleen is responsible for the limbs; when the spleen and stomach are healthy, the muscles are strong and toned. Otherwise, they may be flabby and weak. Emotionally, individuals may be prone to worry, often frowning as if overly burdened by trivial matters, which is a sign of poor spleen and stomach health. Additionally, they may have a sweet tooth (preferring sweeter foods than average) and a yellowish complexion, which can appear waxy, dull, and lacking transparency.Lungs:The lungs open to the nose. The nose is used for breathing, inhaling fresh air and expelling waste gases. Poor nasal health can affect normal circulation within the body, leading to lung diseases and respiratory issues, which may also trigger nasal inflammation. Its manifestation is seen in the skin; the lungs nourish the skin, and poor lung health results in dry, rough skin, with disordered hair growth and enlarged pores. Emotionally, individuals may experience sadness and worry, often crying without reason. Lin Daiyu from “Dream of the Red Chamber” is a classic example; she suffered from severe tuberculosis, and her tears flowed from spring to autumn and then to winter. Those with lung issues may prefer spicy foods, and their complexion may appear pale, lacking blood color, resembling a white sheet.Kidneys:According to TCM, the kidneys govern the bones and open to the ears, with their manifestation seen in the hair. Individuals with poor kidney health may experience tinnitus and gradual hearing loss. Elderly individuals often show symptoms of deafness, reflecting kidney deficiency and decline; the kidneys nourish the bones, and some people may feel unwell without any detectable issues at the hospital, which can be attributed to kidney deficiency causing overall weakness and soreness. Those with poor kidney health often prefer salty foods, have a strong taste preference, and may be prone to fear and anxiety, indicating poor psychological resilience. A dark complexion (iron-black) is common among patients in kidney dialysis centers. A yellowish face indicates weak spleen and stomach function; a pale face indicates weak lung function; a flushed face indicates weak cardiovascular function; a bluish face indicates weak liver and gallbladder function; a dark face indicates weak kidney and bladder function. Observing the kidney area is crucial, as the kidneys are the foundation of life. The area from the cheekbones to the ears and down to the jaw is the kidney zone, which is the largest area. “National Kidney Supplementation” has become an issue that cannot be ignored due to environmental pollution, which places a heavy burden on the kidneys. If there are moles or spots in this area, it indicates congenital kidney deficiency, which can lead to soreness in the lower back, legs, and waist.This area may have deep and large spots, which could indicate kidney stones. A dark kidney area, or the presence of red blood vessels, acne, or deep crow’s feet, indicates kidney deficiency. If there are moles or spots in the kidney area and deep vertical lines on the forehead, along with a strong taste for salty foods, it suggests a predisposition to hypertension or future cardiovascular diseases. The kidneys govern the bones, so when observing the kidneys, focus on the areas of soreness; the corners of the mouth represent the shoulders and elbows, while the downward direction represents the upper and lower limbs. The chin area represents the cervical, thoracic, lumbar, and sacral vertebrae. If the chin shows a small dent or “bumps” when the mouth is closed with slight force, ask if they often experience lower back pain; the answer will likely be affirmative. Especially for women, they may experience soreness and fatigue before and after their menstrual period.Next, let’s look at the male and female reproductive systems, which are reflected in the philtrum and around the lips. If a man over 40 has a thick upper lip or acne on the upper lip that recurs, and a particularly round and protruding chin, it indicates a predisposition to prostate enlargement or hypertrophy. If a woman has recurrent ulcers at the corners of her mouth, it may indicate ovarian inflammation or adnexitis. Pale lips in women often indicate anemia or insufficient menstrual flow. If a woman has vertical lines on the outer part of her upper lip, it may indicate early menopause and uterine atrophy. If moles or spots are found on a woman’s lips, or if the lip line is unclear, it is advisable to undergo a gynecological examination.The bladder’s reflex area is located on both sides of the philtrum, near the nasal roots. If this area is red, with red blood vessels, acne, or sores, it indicates cystitis, which may lead to symptoms such as dark yellow, frequent, or urgent urination. Cystitis can also cause lower back pain. In women, cystitis may sometimes be due to gynecological issues. If the nasal root is red but there is no frequent or urgent urination, and the entire nasal bridge is red, it may indicate rhinitis.The kidneys open to the ears; if there are deep vertical lines around the ears, it indicates hearing loss. If there are moles, it suggests a tendency for ear itching, tinnitus, or ear problems, and it is advisable to take “Gu Yuan” (Kidney Tonic). If the earlobes are particularly rosy and transparent, the tip of the nose is uneven, and the kidney area has red blood vessels with a red nose wing, along with puffy eyelids and cracked lips, it may indicate diabetes or a family history of diabetes. After examining the kidney area, look at the spleen and stomach area, as the stomach is the mother of postnatal health.The tip of the nose represents the spleen, while the nose wings represent the stomach. A red nose tip (rosacea) indicates poor spleen and stomach health. If the spleen is unhealthy, the stomach will certainly be affected; “nine out of ten have stomach issues”. If the nose tip is red or swollen, it may indicate spleen heat or spleen enlargement, often accompanied by a heavy head, cheek pain, and irritability. If the nose tip is yellow or white, it indicates spleen deficiency, which may lead to excessive sweating, aversion to wind, lethargy, and lack of appetite. You may notice that many people have rough, dark skin on both sides of the nose, indicating poor stomach care, especially during youth. If the nose wings are red, it indicates stomach fire, leading to hunger and bad breath. If the nose wings are grayish-blue, it indicates stomach cold; when shaking hands, you can feel the person’s fingertips are cold, indicating they may have abdominal pain and diarrhea due to wind-cold. If the nose wings are sunken, it often indicates a history of stomach pain, which may lead to atrophic gastritis, increasing the risk of stomach cancer. Poor stomach health can also reflect in lower back pain, lethargy, and lack of energy. If one parent has stomach issues, children under ten are likely to be hyperactive, have difficulty concentrating in school, and prefer sweet foods. If you now notice a yellow complexion, pale lips, dryness, and peeling, along with red nose wings.Next, observe the liver and gallbladder area, which is represented by the triangular area at the back of the eyebrows (temples) and the middle of the nose. (You may observe many elderly individuals with liver function decline or disease; age spots often appear in this area). The sides of the nose represent the gallbladder; the liver and gallbladder are interconnected; if the liver is unhealthy, the gallbladder will also be affected. Individuals with gallbladder issues often have spots or growths on both sides of the nose, indicating liver and gallbladder problems. If this area has red blood vessels, acne, or if they wake up with a bitter taste in their mouth, it indicates mild inflammation of the gallbladder; if there are spots, it may indicate cholecystitis. If this area has vertical lines or wrinkles when smiling, it indicates gallbladder issues. If there are moles or spots in this area, it indicates congenital gallbladder deficiency. Dark circles under the eyes also indicate poor gallbladder health. If both the liver and gallbladder areas are dark or have spots, or are uneven, it may indicate fatty liver. If either of these areas has acne (bumps), it indicates excessive liver fire, emotional instability, or menopause. If both areas have noticeable spots and the complexion is dull and unattractive, indicating a thin appearance, it suggests liver disease (hepatitis or cirrhosis).The outer corners of the eyes extending down to the nostrils represent the large intestine system. Why do women develop melasma? One reason is hormonal imbalance, and another is that during pregnancy, the large intestine may be compressed, leading to constipation, resulting in toxins being reabsorbed into the body. If this area has red blood vessels, acne, spots, or moles, it indicates poor large intestine elimination function, often leading to dry stools, constipation, or diarrhea. If this area has crescent-shaped spots, it indicates constipation or hemorrhoids.The intersection of the lower line of the nasal root and the outer corner of the eyes is the reflex area for the rectum; if there are spots here, it indicates hemorrhoids. If this area is red or has white spots, there may be a possibility of rectal cancer. The inner side of the large intestine represents the small intestine, which is primarily responsible for absorption. If the spleen and stomach are unhealthy, the small intestine will naturally be affected. If this area has acne, spots, or moles, it indicates poor absorption function of the small intestine, often leading to weakness. The small intestine area may have prominent red blood vessels, which may be caused by low blood pressure or a family history of abnormal blood pressure. Moving up, the eyebrows are divided into two sections; the middle section represents the respiratory system (lungs). If this area has enlarged pores or is red, it indicates respiratory issues. Long-term smokers may develop spots or pigmentation.If the middle of the forehead is particularly sunken, dark, or has spots, it indicates lung disease and difficulty breathing; if there are pimples, it indicates recent colds or sore throats. If there are moles, spots, or white or prominent lines between the eyebrows, it indicates a tendency for pharyngitis, tonsillitis, or chest tightness, and may also be hereditary. Individuals with poor lung function often have poor large intestine elimination function. The upper third of the forehead (hairline) represents the heart system; if this area has acne (bumps) or differs in color from the rest of the face, it indicates significant psychological stress. If there are spots, it indicates heart disease (e.g., heart failure); if there are moles or spots, it indicates congenital heart function deficiency.The reflex area for the heart is located between the corners of the eyes on the bridge of the nose. If there are horizontal lines or prominent horizontal lines here, it may indicate arrhythmia or poor heart condition; if the horizontal lines are deep and there are deep vertical lines on the tongue, it may indicate severe heart disease. Individuals with heart disease often have poor small intestine function, which can also lead to diseases of the blood vessels, brain, thyroid, and parathyroid. Wrinkles on the lower lip indicate coronary heart disease, while purple lips indicate heart disease. The brain’s reflex area is located between the eyebrows; if there are vertical lines, deep vertical lines, and redness in this area, it indicates insufficient blood supply to the heart and brain, headaches, nervous exhaustion, frequent dreams, poor sleep, palpitations, and irritability. Dark circles around the eyes indicate insufficient blood supply to the brain or poor sleep and rest.The chest (breast) reflex area is located between the corners of the eyes and the bridge of the nose. If this area is dark or blue in men, it indicates chest tightness. If this area is dark or blue in women, it indicates breast tenderness during menstruation. If there are moles or bumps on the inner side of the upper eyelid, or if there are pimple-like protrusions when the eyes are closed, it indicates lobular hyperplasia in women or pleurisy in men. If there are small lumps at the corners of the eyes in women, it indicates breast hyperplasia or breast tumors.TCM uses visual observation to purposefully examine the spirit, color, shape, and state of the patient’s body and local areas to diagnose diseases. This is one of the four diagnostic methods. In clinical practice, observation diagnosis is combined with listening, questioning, and pulse diagnosis to comprehensively and systematically understand the condition and make accurate judgments about diseases.1. Theoretical Basis Observation diagnosis is a method of examining diseases based on the theories of the organs and meridians. The external aspects of the human body are closely related to the functions of the internal organs. If there are changes in the functions of the organs, they will inevitably be reflected in the external aspects of the body, such as spirit, color, shape, and state. The five organs and six bowels are interconnected with the body surface through the twelve meridians, and they correspond to the body’s muscles, bones, skin, flesh, and pulse (the five bodies): the lungs govern the skin, the liver governs the tendons, the spleen governs the muscles, the heart governs the blood vessels, and the kidneys govern the bones. The five senses are also related to the five organs: the nose corresponds to the lungs, the eyes to the liver, the mouth to the spleen, the tongue to the heart, and the ears to the kidneys. Therefore, observing changes in the body surface and the morphology and function of the five senses can infer changes in the internal organs. It can also reflect the overall balance of vital energy in the body. Changes in essence, qi, and spirit are primarily manifested in the head and eyes, and they also reflect the overall shape, language, breath, facial color, and even pulse and tongue appearance. Sufficient essence, qi, and spirit are signs of health; deficiency in these aspects indicates disease and its causes. Therefore, observation diagnosis can not only detect internal organ changes but also understand the dynamic changes in the body’s essence, qi, and spirit. 2. ContentIt is divided into overall observation and partial observation. Overall observation focuses on the spirit, color, shape, and state of the entire body, while partial observation examines local changes to understand related pathological changes. In clinical practice, there is no strict distinction between overall and partial observation. In specific steps, overall observation can be conducted first, followed by orderly partial observation.1. Observing SpiritFocuses on the eyes, facial expressions, and mental activity, which are important for assessing clinical prognosis and life activities. (See observing spirit) 2. Observing Facial ColorFocuses on changes in facial color and luster, including the five colors of blue, red, yellow, white, and black, which can reflect the changes in the qi and blood of the organs and the location of pathogenic factors. (See observing facial color) 3. Observing ShapeInvolves diagnosing by observing the patient’s body shape and posture.① Observing Body ShapeFocuses on observing the strength, fatness, and thinness of the body and the shape of the trunk and limbs. Body shape characteristics generally reflect the yin-yang and qi-blood constitution of the body. For example, slender individuals often have yin deficiency and yang excess, while short and stout individuals often have yang deficiency and yin excess. Those with balanced body shapes are generally in a state of yin-yang balance. Additionally, body shape can reflect the nature of diseases; for instance, overweight individuals often have phlegm, while thin individuals may have excessive heat.The shape of the trunk and limbs also has diagnostic significance; for example, a chicken breast or hunchback often indicates congenital insufficiency or poor nourishment due to kidney essence deficiency or spleen and stomach weakness. A barrel-shaped chest often indicates phlegm accumulation leading to cough and asthma; a distended abdomen with thin limbs indicates abdominal distension.② Observing PostureInvolves observing the patient’s movements, stillness, posture, and actions. For example, trembling of the lips or fingers may indicate heat disease or internal injury; limb spasms, neck stiffness, and arching of the back may indicate convulsions, often seen in liver wind or heat. Abnormal motor function of the hands and feet and various pain symptoms can also be inferred from observing posture. For instance, weakness and lack of movement in the hands and feet without pain indicate atrophy; swollen and painful joints in the hands and feet indicate bi syndrome; inability to move the hands and feet, numbness, or stiffness indicate paralysis; holding the abdomen while leaning forward often indicates abdominal pain; holding the waist while bending over indicates back pain, etc. Additionally, observing posture can also provide insights into related diseases based on behavioral intentions. For example, if a patient is reluctant to undress, it may indicate aversion to cold, suggesting exterior cold or interior cold syndrome; if they want to uncover themselves, it may indicate aversion to heat, suggesting exterior heat or interior heat syndrome; wanting to see people and preferring coolness often indicates yang syndrome; fearing to see people and preferring warmth often indicates yin syndrome. The sitting or lying posture can also indicate the changes in yin and yang and the balance of the right and evil qi. For example, curling up while lying down and preferring to be inward often indicates yang deficiency and cold syndrome; lying down exposed and preferring to be outward often indicates yang excess and heat syndrome; preferring to lean forward while sitting often indicates lung deficiency and shortness of breath; preferring to lean back while sitting often indicates lung excess and qi counterflow.4. Observing the Head, Face, Neck, and Nape The head, face, neck, and nape are where the governing and conception vessels and the three yang meridians of the hands and feet intersect, and the foot jueyin liver meridian also ascends to the head. The brain is the center of mental activity. The brain is the sea of marrow, governed by the kidneys. The heart governs blood vessels, and blood vessels nourish the face, so the heart’s manifestation is seen in the face. Therefore, observing the head, face, neck, and nape can provide insights into the qi and blood of the organs. In fact, observing spirit and color primarily focuses on the head and face.① Observing the HeadHead shape that is too large or too small is often due to congenital developmental issues or insufficient kidney essence. A child’s sunken fontanelle is called a sunken fontanelle, while a delayed closure of the fontanelle is called a cranial defect, indicating congenital insufficiency or empty brain marrow. A child’s fontanelle that is high and bulging is called a bulging fontanelle, often caused by the invasion of warm disease fire, indicating a solid condition. Involuntary head shaking often indicates wind disease or insufficient qi and blood. Sparse and dry hair indicates insufficient essence and blood; premature graying in youth indicates kidney deficiency and blood deficiency; a child’s hair that is tufted indicates malnutrition.② Observing the FaceFocuses on the expression and color of the face. Other signs, such as facial swelling, indicate edema occurring in the eyelids and face; red, swollen, hot, and painful facial skin often indicates wind-heat or fire toxin invasion; facial muscle paralysis may cause crooked mouth and eyes, indicating wind evil invasion or empty collaterals, often seen in yangming meridian diseases.③ Observing the Neck and NapeStiffness in the head and neck can be a symptom of convulsions, often caused by warm disease heat or internal wind. Weakness in the head and neck falls under the category of the five soft conditions in children (soft head, soft neck, soft hands, soft feet, and soft muscles), indicating congenital insufficiency and kidney essence deficiency. If there are lumps in the front of the neck or under the jaw, which may move with swallowing, it indicates goiter, often caused by liver qi stagnation and phlegm accumulation, or related to local environmental factors. 5. Observing the Five SensesThe five senses (eyes, ears, nose, mouth, tongue) are related to the qi and blood of the five organs. Observing changes in the spirit, color, and shape of the five senses can directly diagnose organ diseases.① Observing the EyesThe eyes are the orifice of the liver, and the essence and qi of the five organs and six bowels all converge in the eyes. The five organ-related areas of the eyes are called the five wheels (see the five wheels and eight areas), so observing the eyes can not only assess spirit but also diagnose five organ diseases. Bright and clear eyes with a lively spirit indicate good health and are easier to treat; if the whites of the eyes are cloudy, the pupils are discolored, and the spirit is lost, it indicates a more difficult condition. Redness in the corners of the eyes indicates heart fire; pale white indicates blood deficiency; red in the whites indicates lung heat; yellow indicates internal damp-heat; swelling indicates liver fire; red and swollen eyes indicate wind-heat; dark eyes indicate kidney deficiency. Swelling around the eyes is an early sign of edema, while sunken eyes indicate exhaustion of the internal organs’ essence and qi; protruding eyeballs often indicate goiter. If the pupils change color or if there are membranes forming in the eyes, it indicates cataracts or other eye diseases. If the pupils dilate, it indicates exhaustion of kidney essence, often seen in critical conditions, or internal wind and certain types of poisoning; if the pupils constrict, it often indicates excessive liver and gallbladder fire, qi disturbance, or poisoning. Drooping eyelids indicate congenital insufficiency or deficiency of the spleen and kidneys, and may also be caused by trauma. If the eyes roll upward or stare straight ahead, it indicates a more serious condition; if the eyes remain open during sleep, it is often seen in children with spleen deficiency or chronic wind.② Observing the EarsThe ears are the orifice of the kidneys and are also the area where the three yang meridians of the hands and feet converge. Observing the ears primarily involves examining the color, shape, and secretion of the ear lobes.③ Observing the NoseThe nose is the orifice of the lungs and belongs to the spleen meridian, which is connected to the stomach meridian. A blue nose tip indicates abdominal pain, yellow indicates damp-heat, white indicates blood loss, red indicates heat in the lungs and spleen, and slightly black indicates water retention. Dry nostrils often indicate yangming heat syndrome. If the nostrils flare, it initially indicates wind-heat obstructing the lungs, but if prolonged, it indicates insufficient lung qi. Additionally, observing the nose can provide diagnostic significance for nasal polyps, alcoholic nose, leprosy, syphilis, and other diseases.④ Observing the Mouth and LipsThe spleen opens to the mouth, and its manifestation is seen in the lips. If the lips are rosy, it indicates harmonious qi and blood and abundant stomach qi. Pale lips indicate blood deficiency, light red indicates cold deficiency, deep red indicates excess heat, and bluish-black indicates qi stagnation and blood stasis. Cracked lips indicate insufficient fluids, while drooling at the corners of the mouth indicates spleen deficiency or stomach heat. Additionally, observing the mouth and lips can provide direct clinical significance for conditions such as stomatitis, oral ulcers, angular cheilitis, and chapped lips.⑤ Observing the TongueThe tongue is the orifice of the heart, and through the meridians, it is directly or indirectly connected to the five organs and six bowels. Observing the tongue primarily involves examining the tongue body and tongue coating. (See tongue diagnosis)⑥ Observing the GumsThe kidneys govern the bones, and the teeth are the remnants of the bones. The hand and foot yangming meridians connect to the gums. Therefore, observing the teeth and gums can provide insights into kidney and gastrointestinal diseases. This is particularly significant in diagnosing warm diseases. In healthy individuals, the teeth are white and moist, and the roots are firm, indicating abundant kidney qi and fluids. If the teeth are dry, it indicates excessive heat damaging fluids; if they are dry and hard like stone, it indicates excessive yangming heat; if they are dry and brittle like withered bones, it indicates depletion of kidney yin. Loose and sparse teeth, with exposed gums, often indicate kidney deficiency. Pale gums indicate blood deficiency, while receding gums indicate insufficient stomach yin or kidney deficiency; swollen gums indicate stomach fire. Bleeding gums that are painful and red indicate heat in the stomach; if they are not painful or red but slightly swollen, it often indicates kidney deficiency or qi deficiency.⑦ Observing the ThroatThe throat is the passage for breathing and eating, related to the lungs and stomach. In healthy individuals, the throat is light red and smooth, allowing for unobstructed passage. If the throat is ulcerated and red and swollen, it often indicates excess heat; if the tonsils are ulcerated and suppurating, it indicates lung and stomach heat. If the throat is ulcerated and covered with a white membrane, resembling a white film, it is called a pseudo-membrane. If the pseudo-membrane is tough and difficult to peel off, it often indicates diphtheria.6. Observing the SkinThe skin is the body’s exterior, where defensive qi circulates, and it is internally connected to the lungs. It plays a role in sweating, regulating body temperature, and resisting external pathogens. The essence and qi of the five organs and six bowels circulate through the meridians to nourish the skin, maintaining its warmth, luster, and normal function. Therefore, observing the color and shape of the skin can provide insights into the nature of diseases and the qi and blood status of the organs.① Observing Skin ColorIts principles and methods are similar to observing facial color. Generally, if the skin color is moist and vibrant, it indicates that the essence and qi of the organs are still strong, and even if there is illness, it is easier to treat; if the skin color is dry, dull, and lacks luster, it indicates that the essence and qi of the organs are deficient, and the condition is more severe. Diseases that can be effectively diagnosed through skin color include erysipelas and jaundice. If the skin is red like it has been dyed, it indicates erysipelas. If the entire skin is cloud-like red, wandering and variable, or swollen and painful, it is called red wandering erysipelas, caused by external wind-heat, excessive heart fire, or infantile toxic heat. If it occurs locally, it is called flowing fire; if the lower limbs are red and swollen, it indicates damp-heat and fire toxin descending; if the skin on the head and face is red, swollen, and painful, it indicates wind-heat toxin invasion. If the skin, face, eyes, and nails are abnormally yellow, it indicates jaundice. Among them, bright yellow like orange indicates yang jaundice, caused by internal damp-heat; dark yellow like smoke indicates yin jaundice, caused by cold dampness obstructing the spleen; if the skin is yellow with a blackish hue, it is called black jaundice, caused by blood stasis or kidney deficiency.② Observing Skin ShapeAbnormal skin shapes include swelling, rashes, white spots, and blisters. Swelling in the head, face, abdomen, waist, and limbs, with tight skin that sinks when pressed and does not rise when the hand is lifted, indicates edema, caused by internal water retention or external skin overflow; if the skin is floating and sinks when pressed, it indicates qi stagnation. Rashes are patches that appear on the skin’s surface, which are not palpable, divided into yang rashes and yin rashes. Yang rashes, also known as eruptive rashes, are large patches that are red or purple, sometimes even purple-black, often accompanied by fever, irritability, delirium, thirst, red tongue, and rapid pulse, seen in external warm diseases or heat entering the blood. Yin rashes vary in size, are light red or dark purple, hidden and not prominent, appearing and disappearing unpredictably, with a clear mind, cold limbs, diarrhea, pale tongue, and thin pulse, often caused by internal injury and qi and blood deficiency. The rash emerges from the skin’s blood vessels, resembling millet grains, red and raised, seen in diseases like measles and rubella, characterized by small papules. Generally, the color and distribution of rashes are evenly spread and sparse, with a rosy hue indicating a favorable condition; if the spots are dense or tightly bound at the roots, with a deep color, it indicates a reverse condition and a severe illness. White spots are small papules that rise above the skin, containing fluid, often seen in summer heat and dampness, indicating internal dampness and sweat not being expelled. Blisters are raised above the skin, varying in size, containing fluid, seen in chickenpox, herpes, eczema, etc. Additionally, there are also changes in skin morphology and color, such as carbuncles, abscesses, boils, and furuncles.7. Observing the Pulse Vessels Involves diagnosing diseases by observing the changes in the color and shape of the pulse vessels in the hands, fingers, and nails.① Observing the Index Finger Pulse VesselsAlso known as observing the child’s fingerprints, primarily used for children under three years old, focusing on the shape, color, thickness, and length of the pulse vessels. The visible and distributed pulse vessels on the palmar side of the child’s index finger can be divided into three sections: wind section, qi section, and life section (see diagram). During diagnosis, the doctor uses the right thumb to apply moderate pressure from the life section to the qi section and wind section repeatedly, gradually revealing the pulse vessels for observation. In healthy individuals, the pulse vessels are bright red, with a mix of red and yellow, usually appearing slanted and single, with moderate thickness. Dark color indicates severe illness, light color indicates mild illness; pale color often indicates deficiency, while stagnant color (difficult to push and slow to return) indicates excess; light red often indicates cold, while dark red indicates heat; purple-black indicates blood stasis, while blue indicates wind or pain. If the pulse vessels are floating and shallow, it indicates an exterior condition; if they are deep and hidden, it indicates an interior condition. Thickening indicates a solid condition or heat condition, while thinning indicates a deficiency condition or cold condition. Gradual growth indicates worsening of the condition, while shortening indicates improvement. The index finger pulse vessels are seen in the wind section, indicating a light exterior condition; if they extend to the qi section, it indicates the condition has progressed from exterior to interior; if they reach the life section, it indicates the condition has penetrated into the organs, and if they reach the fingertips, it indicates a critical condition.② Observing the NailsThe nails are remnants of the tendons and are external indicators of the liver and gallbladder. The liver stores blood and governs the smooth flow of qi, so observing the nails can provide insights into the state of qi and blood and their circulation. Healthy nails are rosy, glossy, strong, and curved, indicating abundant qi and blood and smooth circulation. If the nails are deep red, it indicates heat in the qi level; yellow indicates jaundice, often accompanied by yellowing of the face and skin; pale white indicates blood deficiency or deficiency of both qi and blood; pale indicates cold deficiency; purple-black indicates blood stasis; and blue indicates cold conditions. If pressing the nails turns white and the color returns slowly, it indicates qi stagnation and blood stasis; if it does not return to red, it often indicates blood deficiency. Flat and concave nails are called spoon nails, often due to liver blood deficiency; dry and brittle nails are often due to liver heat or deficiency of liver blood and heart yin. Thin and brittle nails are often due to qi and blood deficiency, and may also be seen in wind diseases, nail fungus, or chronic atrophy.③ Observing the Thenar Pulse VesselsThe thenar area is the fleshy part at the base of the thumb, where the hand taiyin lung meridian circulates, and it is also related to the qi and blood of the stomach. Observing the thenar pulse vessels primarily involves observing color; for example, blue indicates cold, while red indicates heat. This method is currently used less frequently. 8. Observing Excretions Includes observing vomit, phlegm, saliva, nasal discharge, sputum, urine, menstrual discharge, pus, and other forms, colors, qualities, and quantities.① VomitClear and thin vomit without odor primarily indicates cold conditions; foul and turbid vomit indicates heat conditions; if undigested food is mixed in with a sour odor, it often indicates food stagnation; if there is clear phlegm, accompanied by dry mouth and reluctance to drink, with a greasy tongue coating, it often indicates phlegm-damp. Vomiting yellow-green bitter water indicates liver and gallbladder damp-heat; if vomiting fresh blood or dark purple clots mixed with food residue, it indicates stomach heat or liver fire, or the presence of blood stasis.② PhlegmYellow, thick, and clotted phlegm indicates heat phlegm; white, clear, and thin phlegm with many bubbles indicates wind phlegm; white, clear, and thin phlegm with gray-black spots indicates cold phlegm; white, slippery phlegm that is abundant and easy to expel indicates damp phlegm; scanty and sticky phlegm that is difficult to expel indicates dry phlegm. Phlegm with blood that is bright red often indicates yin deficiency with excessive fire or heat damaging the lung collaterals.③ Nasal Discharge Thick nasal discharge indicates external wind-heat, while clear nasal discharge indicates external wind-cold; persistent thick nasal discharge indicates nasal congestion.④ SalivaExcessive drooling from the corners of the mouth, unable to control, with clear and abundant quality, indicates spleen deficiency; if the saliva is thick and turbid, it indicates spleen and stomach damp-heat; excessive drooling in children may be due to parasitic accumulation or stomach heat. Excessive salivation may also be due to cold in the stomach, food stagnation, or kidney deficiency.⑤ Urine and StoolStool resembling sauce indicates large intestine heat accumulation; resembling duck droppings and being loose indicates deficiency-cold; sticky indicates excessive heat damaging fluids; dry and hard indicates fluid deficiency, with red and white pus indicating dysentery, and undigested food indicating food stagnation or spleen deficiency. Dark yellow and turbid urine, or white like rice wash water, indicates damp-heat descending; clear and long white indicates kidney yang deficiency; red and turbid indicates blood in the urine.⑥ MenstruationHeavy menstrual flow, thick quality, or mixed with blood clots, dark red color, often indicates blood heat; if the flow is heavy, thin, and light red, it often indicates qi deficiency; dark menstrual blood with clots often indicates blood stasis; irregular menstrual flow, whether heavy or light, indicates liver qi stagnation.⑦ Vaginal DischargeWomen may have a small amount of white vaginal discharge. If the discharge is excessive or continuous, it indicates a discharge disorder. If the discharge is white, it indicates cold-dampness; if yellow, it indicates damp-heat; if red and white mixed, it indicates liver damp-heat; various colors mixed indicate five-color discharge, indicating severe gynecological conditions. If the discharge is clear and thin, it indicates deficiency-cold; if thick and sticky, it indicates excess-heat; if resembling saliva, it indicates spleen deficiency with dampness; if resembling pus, it indicates internal abscesses.⑧ PusPus is the liquid decay product of skin and flesh, often seen in surgical abscesses. If the pus is yellow-white and thick, with bright color, it indicates abundant qi and blood expelling pathogens; if the pus is yellow-white and thin, with clear color, it indicates a favorable condition, showing that the righteous qi is overcoming the evil; if the pus is yellow and turbid, it indicates excessive internal heat; if the pus is green-black and thin, it indicates deep-seated toxic evil.(1) Diagnosing Tongue Locations1. Diagnosing Tongue Locations Based on Organs The heart and lungs are located at the top, so the tongue tip corresponds to the heart and lungs; the spleen and stomach are in the middle, so the middle part of the tongue corresponds to the spleen and stomach; the kidneys are at the bottom, so the root of the tongue corresponds to the kidneys; the liver and gallbladder are located on the sides of the body, so the sides of the tongue correspond to the liver and gallbladder, with the left side corresponding to the liver and the right side corresponding to the gallbladder. This method is generally used for internal injuries and miscellaneous diseases.2. Diagnosing Tongue Locations Based on the Three Jiao The tongue tip corresponds to the upper jiao, the middle part corresponds to the middle jiao, and the root corresponds to the lower jiao. This method is often used for external pathogenic changes.3. Diagnosing Tongue Locations Based on the Stomach The tip of the tongue corresponds to the upper stomach, the middle part corresponds to the middle stomach, and the root corresponds to the lower stomach. This method is commonly used for gastrointestinal diseases. The various parts of the tongue correspond to the organs, which is one of the current research topics in biological holography. Although there are different interpretations, they all have reference value. In clinical diagnosis, tongue quality and coating examination should be combined for verification, but all four diagnostic methods should be integrated for comprehensive judgment, without being overly mechanical.Observing the tongue can be divided into observing tongue quality and tongue coating. The tongue quality, also known as the tongue body, includes the muscle and vascular tissues of the tongue. Observing tongue quality can be divided into observing spirit, color, shape, and state. Tongue coating is a layer of coating attached to the tongue body, and observing tongue coating can be divided into observing coating color and coating quality. The normal tongue appearance is referred to as “light red tongue with thin white coating”. Specifically, the tongue body is soft, moves flexibly, has a light red color that is bright and vivid; its size is moderate, without abnormal shapes; the tongue coating is thin, white, and moist, with uniform granules, lightly covering the tongue surface, and it cannot be wiped away, with the root and tongue body being one entity, with moderate dryness and wetness, not sticky or greasy. In summary, the normal appearance of the tongue is a combination of the normal manifestations of the basic factors of tongue quality and coating. 1. Observing Tongue Quality (1) Tongue SpiritThe tongue spirit is primarily reflected in the luster and liveliness of the tongue quality. The key to assessing tongue spirit is to distinguish between luster and dullness. Luster indicates a moist and vibrant appearance, characterized by flexible movement, a rosy color, bright luster, and vitality, indicating a good prognosis, even in illness. Dullness indicates a dry and lifeless appearance, characterized by inflexible movement, a dry and dark tongue body, indicating a poor prognosis. Thus, the presence or absence of tongue spirit reflects the status of the organs, qi, blood, and fluids, which is related to the prognosis of diseases. (2) Tongue ColorColor refers to the color of the tongue body.Generally, it can be divided into light white, light red, red, dark red, purple, and blue. Except for light red, which is the normal tongue color, the others indicate pathological conditions.① Light Red Tongue:The tongue color is light red, neither too deep nor too shallow, indicating a good state of qi and blood, suggesting sufficient heart qi and yang qi distribution, thus being the normal tongue color. ② Light White Tongue:The tongue color is lighter than light red, even lacking blood color, referred to as light white tongue. This is due to the deficiency of yang, leading to a reduction in the function of generating yin blood, and the ability to promote blood circulation is weakened, resulting in a pale and white tongue. Therefore, this tongue indicates deficiency-cold or dual deficiency of qi and blood. ③ Red Tongue:The tongue color is bright red, deeper than light red, referred to as red tongue. This is due to excessive heat causing qi and blood to surge, resulting in a bright red tongue, indicating heat syndrome. It can be seen in solid conditions or deficiency-heat conditions. ④ Dark Red Tongue:Dark red indicates a deeper color than red tongue. This is referred to as dark red tongue. The diseases can be divided into external and internal injuries. In external diseases, it indicates heat entering the blood; in internal injuries, it indicates yin deficiency with excessive fire. ⑤ Purple Tongue:Purple tongue is generally caused by poor blood circulation and stasis. Therefore, purple tongue indicates disease, distinguishing between cold and heat. Excessive heat damages fluids, leading to a dry and purple tongue; cold coagulates blood stasis or yang deficiency leads to a pale purple or blue tongue that is moist. ⑥ Blue Tongue:The tongue color resembles exposed “blue veins”, lacking any red color, referred to as blue tongue, described in ancient texts as resembling a water buffalo’s tongue. This is due to excessive yin-cold, leading to stagnation of yang qi, causing blood to coagulate and stagnate, thus the tongue appears blue. It indicates cold coagulation and yang stagnation, or yang deficiency and cold coagulation, or internal blood stasis. (3) Tongue ShapeRefers to the shape of the tongue body, including age, fatness, thinness, swelling, cracks, prickles, and teeth marks. ① Old Tongue:The tongue quality is rough, and the shape and color are firm, referred to as old tongue. Regardless of the tongue color or coating, a rough tongue quality indicates a solid condition. ② Tender Tongue:The tongue quality is delicate, with a tender color and often appears swollen, referred to as tender tongue, indicating a deficiency condition. ③ Swollen Tongue:Divided into fat and swollen. A tongue that is larger than normal, even extending to fill the mouth, or has teeth marks, is called a fat tongue. A tongue that is swollen and fills the mouth, unable to retract, is called a swollen tongue, often due to phlegm and dampness obstruction. Swollen tongues are often caused by heat toxins or alcohol toxins causing qi and blood to stagnate, indicating heat syndrome or toxic conditions. ④ Thin Tongue:A thin, small, and dry tongue is referred to as a thin tongue. This is often due to insufficient qi, blood, and fluids, leading to an inability to fill the tongue body. It indicates dual deficiency of qi and blood or excessive yin deficiency with fire. ⑤ Prickly Tongue:If the soft papillae on the tongue surface are enlarged and raised, causing a prickly sensation, it is called prickly tongue. This is often due to excessive heat. The more prickles, the more severe the heat. Depending on the location of the prickles, it can indicate heat in the internal organs; for example, prickles on the tongue tip often indicate excessive heart fire; prickles on the sides of the tongue often indicate excessive liver and gallbladder fire; prickles in the middle of the tongue indicate excessive heat in the stomach and intestines. ⑥ Cracked Tongue:If there are cracks on the tongue surface without coating, it is called cracked tongue. This is often due to deficiency of essence and blood, leading to damage to fluids and lack of nourishment to the tongue body. Therefore, it often indicates deficiency of essence and blood. Additionally, about 0.5% of healthy individuals have deep longitudinal cracks on the tongue surface, referred to as congenital tongue cracks, which are often covered with tongue coating, and do not indicate any other discomfort, differing from cracked tongue. ① Teeth Marks: If there are impressions of teeth on the edges of the tongue, it is called teeth-marked tongue. This is often due to spleen deficiency, leading to an inability to transform water and dampness, causing stagnation in the tongue and resulting in teeth marks. Therefore, teeth marks are often seen with a fat and tender tongue, indicating spleen deficiency or excessive dampness. (4) Tongue StateRefers to the state of the tongue during movement. The normal tongue state is that the tongue moves flexibly and freely, while pathological tongue states may include rigidity, weakness, elongation, shortening, numbness, trembling, tilting, or protruding. ① Rigidity:The tongue is stiff and rigid, making movement difficult, leading to unclear speech, referred to as rigid tongue. This is often due to heat disturbing the heart spirit, causing the tongue to lose its function, or high fever damaging yin, leading to loss of nourishment to the muscles, or phlegm obstructing the tongue collaterals. This is often seen in heat entering the pericardium, high fever damaging fluids, phlegm obstructing, or as a precursor to stroke. ② Weakness:The tongue is weak and lacks strength, unable to flex and extend, referred to as weak tongue. This is often due to extreme deficiency of qi and blood, leading to loss of nourishment to the muscles. This can be seen in conditions of qi and blood deficiency, excessive heat damaging fluids, or extreme yin deficiency. ③ Elongation:The tongue extends outside the mouth and is difficult to retract, referred to as elongated tongue. This is often due to relaxation of the tongue muscles. This can be seen in excessive internal heat, phlegm-fire disturbing the heart, or qi deficiency. ④ Shortening:The tongue is tight and cannot extend, referred to as shortened tongue. This can be due to cold coagulating the muscles, leading to retraction; internal obstruction of phlegm and dampness causing liver wind; or excessive heat damaging fluids, leading to muscle contraction; or deficiency of qi and blood, causing the tongue to lack nourishment and warmth. Regardless of whether it is due to deficiency or excess, it indicates a critical condition.⑤ Numbness:The tongue feels numb and cannot move, referred to as numb tongue. This is often due to the inability of the blood to nourish the tongue. If the numbness occurs without reason and comes and goes, it indicates heart blood deficiency; if the numbness is accompanied by trembling or stroke symptoms, it indicates internal wind. ⑥ Trembling:The tongue trembles and shakes involuntarily, referred to as trembling tongue. This is often due to deficiency of qi and blood, leading to loss of nourishment to the muscles, or excessive heat damaging fluids, leading to wind. This can be seen in blood deficiency leading to wind and excessive heat leading to wind. ⑦ Tilting:If the tongue extends to one side, it is called tilting tongue. This is often due to wind evil invading the collaterals or wind phlegm obstructing the collaterals, but it can also indicate wind affecting the internal organs, leading to one side of the meridians and muscles being obstructed, causing the tongue muscles on the affected side to relax, thus tilting towards the healthy side. This is often seen in stroke or as a precursor to stroke. ⑧ Protruding:If the tongue frequently extends outside the mouth, it is called “protruding tongue”; if the tongue licks the lips up and down or side to side, or if the tongue slightly extends outside the mouth and retracts immediately, it is called “playing tongue”. Both are referred to as protruding tongue, often due to heat in the heart and spleen damaging fluids, leading to contraction and frequent movement. Playing tongue is often seen in children with developmental delays.2. Observing Tongue Coating Normal tongue coating is produced by the upward steaming of stomach qi, thus the abundance or deficiency of stomach qi can be reflected in the changes of the tongue coating. The formation of pathological tongue coating is due to the upward rise of turbid qi from food stagnation or the rise of pathogenic qi. Observing tongue coating should focus on both the quality and color of the coating.(1) Coating QualityCoating quality refers to the thickness, moisture, roughness, stickiness, decay, shedding, and whether it has roots or not. ① Thickness:Thickness is assessed based on whether the tongue body is visible through the coating. If the tongue body is faintly visible through the coating, it is called thin coating. This is produced by stomach qi and is considered normal; if seen in illness, it often indicates the early stage of disease or a light exterior condition. If the tongue body cannot be seen through the coating, it is called thick coating. This often indicates that the pathogenic factor has penetrated internally or that there is food stagnation, indicating a more severe condition. If the coating changes from thin to thick, it indicates that the righteous qi is unable to overcome the evil, and the condition is worsening; if the coating changes from thick to thin, it indicates that the righteous qi is recovering, and the internal evil is dissipating, indicating improvement in the condition.② Moisture:If the tongue surface is moist, with moderate dryness and wetness, it is called moist coating, indicating that fluids are not damaged; if there is excessive moisture, it feels slippery and may even drip when the tongue is extended, indicating slippery coating. This reflects the presence of dampness and cold, often seen in yang deficiency with phlegm and water retention. If the coating appears dry and rough, it is called dry coating, often due to heat damaging fluids or insufficient yin, leading to dryness. If the coating changes from moist to dry, it indicates that the drying evil is damaging fluids, or that heat is severe, indicating worsening of the condition; if the coating changes from dry to moist, it indicates that the drying heat is receding, and fluids are gradually recovering, indicating improvement in the condition.③ Decay:If the patient’s tongue has coating that suddenly sheds completely or partially, revealing the tongue body, it is called shedding coating. If the entire coating sheds without new coating forming, leaving a smooth surface like a mirror, it is called mirror tongue or smooth tongue. This is due to exhaustion of stomach yin and severe damage to stomach qi, indicating a critical condition. If the coating sheds incompletely, leaving some patches of coating, it is called mottled coating, indicating damage to both stomach qi and yin. The change from having coating to none indicates insufficient stomach qi and yin, and declining righteous qi; however, if the coating regrows to a thin white coating after shedding, it indicates that the evil has been expelled and the righteous qi is recovering, which is a good sign. It is important to note that whether the coating increases or decreases, it should gradually change; if the coating changes suddenly, it often indicates a rapid change in the condition.④ Coating with Roots and Without Roots:Regardless of the thickness of the coating, if it adheres tightly to the tongue surface, appearing as if it grows from the tongue, it is called coating with roots, also known as true coating; if the coating is not firmly attached and appears to float on the tongue, easily scraped off, it is called coating without roots, also known as false coating. Coating with roots indicates that the pathogenic factor is strong, but the stomach qi is not yet exhausted; coating without roots indicates that the stomach qi has declined. In summary, observing the thickness of the coating can indicate the depth of the disease; observing the moisture of the coating can indicate the status of fluids; observing the decay of the coating and whether it has roots can indicate the changes in qi and yin and the trend of the disease.(2) Coating ColorCoating color refers to the color of the tongue coating. Generally, it can be divided into white, yellow, gray, and black, along with mixed colors, as the coating color is related to the nature of the pathogenic factors. Therefore, observing the coating color can provide insights into the nature of the disease. ① White Coating:Commonly seen in exterior conditions and cold conditions. If the external pathogenic factors have not yet penetrated internally, the tongue coating often shows no significant changes, remaining as normal thin white coating. If the tongue is pale with white and moist coating, it often indicates internal cold or cold-damp conditions. However, in special cases, white coating can also indicate heat conditions. For example, if the tongue is covered with thick white coating, resembling a pile of white powder, and feels moist, it indicates the presence of external turbid and improper qi, or excessive internal heat. This is often seen in warm diseases or internal abscesses. If the coating is white, dry, and cracked like sand, it indicates that the damp condition has rapidly transformed into heat, leading to internal heat rising quickly, often seen in warm diseases or improper use of warming tonics.② Yellow Coating:Generally indicates internal conditions and heat conditions. Due to heat evil scorching, the coating appears yellow. Light yellow indicates mild heat, while deep yellow indicates severe heat, and scorched yellow indicates heat accumulation. In external diseases, if the coating changes from white to yellow, it indicates that the exterior evil has penetrated internally and transformed into heat. If the coating is thin and light yellow, it indicates exterior wind-heat or wind-cold transforming into heat. If the tongue is pale and plump with yellow and slippery coating, it often indicates yang deficiency with water-dampness not transforming.③ Gray Coating:Gray coating is a light black color. It often develops from dark white coating and can also be seen alongside yellow coating. It indicates internal conditions, often seen in internal heat conditions, and can also be seen in cold-warm conditions. If the gray coating is dry, it often indicates excessive heat damaging fluids, which can be seen in external heat diseases or internal injury diseases. If the gray coating is moist, it indicates phlegm-dampness retention or internal cold-dampness obstruction.④ Black Coating:Black coating often develops from scorched yellow or gray coating. Generally speaking, regardless of whether it is cold or heat, it often indicates a critical condition. The darker the coating, the more severe the condition. If the coating is black and dry, it may indicate severe heat damaging fluids; if it is black and dry, it may indicate intestinal dryness and constipation, or impending stomach failure; if it is seen at the root of the tongue, it indicates severe heat in the lower jiao; if it is seen at the tip of the tongue, it indicates heart fire; if it is black and slippery, with a pale tongue, it indicates excessive internal cold and water-dampness not transforming; if it is black and sticky, it indicates phlegm-dampness obstruction.3. Comprehensive Diagnosis of Tongue Quality and CoatingThe development of diseases is a complex and holistic process, so while understanding the basic changes in tongue quality and coating and their associated diseases, it is also necessary to analyze the relationship between tongue quality and coating. Generally, it is believed that observing tongue quality focuses on distinguishing the deficiency and excess of righteous qi, which also includes the nature of the evil qi; observing tongue coating focuses on distinguishing the depth and nature of the evil qi, which also includes the survival of stomach qi. In terms of their relationship, both must be integrated for a comprehensive understanding; whether the changes occur separately or simultaneously, they should be comprehensively observed. In general, the changes in tongue quality and coating are consistent, and their associated diseases often reflect a combination of their respective diseases. For example, in internal heat syndrome, the tongue is often red with yellow coating and dry; in internal deficiency-cold syndrome, the tongue is often pale with white coating and moist. This is the key to learning tongue diagnosis, but there are also times when their changes are inconsistent, so it is necessary to integrate all four diagnostic methods for comprehensive evaluation. For example, although white coating often indicates cold or dampness, if the tongue is red and has dry white coating, it indicates dryness-heat damaging fluids, as the drying qi transforms into fire rapidly, and the coating has not yet turned yellow, indicating that it has already entered the blood; similarly, thick white coating may indicate excessive heat, and gray-black coating can indicate heat or cold, requiring a combination of tongue quality and moisture to differentiate. Sometimes the diseases indicated by the two may contradict each other, but they still need to be observed together. For example, a red tongue with white slippery coating may indicate heat in the blood and dampness in the qi; in internal injuries, it may indicate excessive yin deficiency with fire, along with phlegm and food stagnation. This shows that while learning, one can grasp the distinctions, but in practice, one must conduct comprehensive observations.(3) Methods and Precautions for Observing the TongueTo obtain accurate results in tongue observation, it is essential to pay attention to methods and be aware of certain issues, which are described as follows:1. Tongue Extension Posture:When observing the tongue, the patient should extend the tongue outside the mouth, fully exposing the tongue body. The mouth should be opened as much as possible, and the tongue should be relaxed without force, with the tongue surface flat and the tip naturally hanging towards the lower lip. 2. Sequence:Observing the tongue should follow a certain sequence, generally starting with the tongue coating, then the tongue quality, in the order of tongue tip, tongue sides, tongue middle, and tongue root. 3. Lighting:Observing the tongue should be done in sufficient and soft natural light, facing the light source, allowing the light to shine directly into the mouth, avoiding colored doors and windows and strong reflective colored objects nearby, to prevent false impressions of the tongue coating color. 4. Diet:Diet has a significant impact on tongue appearance, often causing changes in the shape and color of the tongue coating. Chewing food repeatedly can make thick coating thinner; drinking water can moisten the tongue surface; excessively cold, hot, or spicy foods can often change the tongue color. Additionally, certain foods or medications can stain the tongue coating, creating false impressions, referred to as “stained coating”. These are temporary false tongue qualities or coatings caused by external interference and do not directly reflect the essence of the patient’s condition. Therefore, in clinical practice, when the tongue quality does not match the condition or when the tongue coating suddenly changes, it is essential to inquire about the patient’s recent diet and medication, especially in the period leading up to the consultation.I believe that observation diagnosis is about observing rather than simply looking. It requires not only observation but also insight. Since I began studying TCM, I have been particularly fond of Zhang Zhongjing’s preface. My interest in observation diagnosis also began with this. Even someone as skilled as Zhang Zhongjing admired Bian Que’s observation diagnosis, and later he had many miraculous stories about observation diagnosis. I have been influenced by this since childhood, and I wonder when I will also be able to “see the person from a distance”.In my nearly thirty years of practice, I have come to realize that as long as one masters the methods, it is not difficult. The difficulty lies in not holding the mindset that “I am best at observing the nose, I am best at observing the eyes…”. Dr. Zhu has a saying: no matter how accurate observation diagnosis is, it only has a 70% accuracy rate. If I have three methods to diagnose a stomach disease, and I observe three areas, does that not increase the accuracy to 80%? If I have five methods, does that not increase it to 90%? In clinical practice, I not only observe multiple areas but also integrate observation, listening, questioning, and pulse diagnosis, which significantly increases the accuracy.One theory of multi-information in observation diagnosis: observation diagnosis must obtain information from multiple aspects to be accurate. The first point I summarize in two sentences: “Focus on the intentional aspects, discover the unintentional aspects.” What do I mean by intentional? When someone comes to you for treatment, can you still be indifferent? I say “intentional” means that when a patient comes, I must focus on them, I must concentrate, but I should not stare at them rigidly. There was a situation where a patient came in, and a student next to me was staring at them, making even a male patient blush. This would cover up certain aspects, making it difficult for us to observe. Therefore, I find that peripheral vision is very useful; I am good at stealing glances! This stealing glance must be skillful; it should not make others feel that you are sneaky, but rather that you are friendly and caring. Patients have a virtue; you should point it out immediately, and the atmosphere will ease significantly. When I examine a patient, if I notice a mole on their eye, I might say, “You have beautiful eyes.” The patient will smile, and their facial expression will relax. When I observe a patient, I often look at their tongue multiple times; in fact, when I observe the tongue, I also steal a glance at their face, which is very important, as they are less guarded when showing their tongue. Later, I found that after observing the tongue three times, the results differ. I pay great attention to fluids. When a person first enters, even before speaking, if they extend their tongue and it is very moist, it indicates a good condition. If after talking for a while, the tongue remains moist, it indicates that their condition is easier to treat; if after ten minutes of conversation, the tongue appearance changes, I need to consider fluid issues, as the fluids may not be sufficient, which could lead to irritability and anger. In treatment, I would need to increase some qi and yin nourishing herbs or add some uplifting herbs.“Attention” also has another meaning, which is to keep observing and incorporate observation into verbal communication, allowing the patient to relax and cooperate with you as soon as possible. For example, when I stand here to lecture, I feel a bit nervous, and my expression becomes unnatural. If I am not casual, you will not see the real me. The same goes for seeing patients; many patients sweat from their palms as soon as they sit down, but their palms are not genuinely sweaty; after sitting for ten minutes, if you touch their hands, it will be different. At this point, you can have a general understanding of their diagnosis. The so-called “discovering in the unintentional” means discovering in a natural manner. I have a belief: I hope to break the barrier with the patient within two minutes and enter a stage of tacit understanding. This is very important. The so-called tacit understanding is not about the patient understanding you, but rather you understanding the patient. When the patient first comes in, you intentionally observe them, and they are unaware, still talking non-stop.The second stage is entering the diagnostic state; patients have different mindsets, and their level of cooperation varies. At this point, I need to adopt some methods. I believe that the patient knows their disease best, not the doctor. You need to first understand what the patient is seeking when they come for treatment. As a doctor, the patient wants to solve their problems, not what you think they should treat.The third stage is the stage of divine transformation. The “divine” refers to the patient coming out, and “transformation” refers to the doctor entering. You need to quickly transform the patient’s manifestations into the information you have mastered, and then receive feedback from them. If a patient says they have back pain, you should say, “Okay, I will treat your back pain.” The patient will definitely refuse; they want you to explain why their back hurts. If you have not thought about it, that would be troublesome. If a patient comes in with back pain, I might first observe the kidney area—this area is located at the two temples (in front of the ears). If there are no issues, I will look at another area—the outer corners of the eyes, which also correspond to the kidneys. How I come to this conclusion will be explained later. Therefore, I need the patient to cooperate, and unknowingly, they enter the circle set by the doctor. This circle is not meant to harm the patient but to allow the patient to incorporate their discomfort into your vision and treatment.For example, if a patient has deep-set eyes, I generally believe that deep-set eyes indicate stomach qi deficiency. At this point, I quickly look at the color changes in the nose wings, as both areas reflect stomach qi. I also check if the tongue has stomach qi. If the patient only has deep-set eyes and no supporting evidence in other areas, I will carefully feel their pulse and find that their pulse is particularly strong. I will ask, “Do you have high blood pressure?” They will say yes. I will say, “Your high blood pressure is kidney-related.” They will say that the hospital also said the same. I find that this area is related to the kidneys, and the same situation presents differently in different individuals. Therefore, do not rigidly interpret the same thing.Once, I was discussing hand diagnosis with students, and someone skilled in hand diagnosis told a patient that their stomach was not good, and they had to specify whether it was a stomach ulcer or gallbladder inflammation, etc., and be precise. I said that is not TCM. We must avoid this rigid approach to observation diagnosis. Later, I found that people who frequently blink—what do you think the eyes are related to? Students: The liver. Is it only related to the liver? “The essence of the five organs and six bowels all converge in the eyes!” Some believe that blinking is solely related to the liver, but that patient was actually related to the kidneys.
