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Diseases vary widely, and their clinical manifestations are diverse. However, any condition can be categorized using the principles of yin and yang, and the nature can be explained using cold, heat, phlegm, and stasis. The deficiency and excess can indicate the strength and weakness of the pathogenic and righteous qi. Therefore, understanding the comprehensive manifestations of yin, yang, cold, heat, deficiency, excess, phlegm, and stasis in terms of complexion and form is one of the essential aspects of observation diagnosis in Traditional Chinese Medicine (TCM).
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Observation of Body Constitution
1. Yang Excess Constitution Observation: The typical characteristics of individuals with a Yang Excess constitution are: robust physique, often with a red complexion, prefers coolness and fears heat, tends to wear less clothing, has a lively personality, is active and talkative, speaks clearly and fluently, is strong-willed, and tends to be decisive. When standing or walking, they often puff out their chest and protrude their abdomen, with exaggerated gestures. Clinical Significance: The presence of the above physical and behavioral characteristics suggests that the patient has a Yang Excess constitution. The pathological feature is that Yang qi is relatively excessive while Yin qi is relatively deficient, making it easy for pathogenic factors to transform into heat. Such patients often exhibit heat-related symptoms, and treatment should focus on suppressing Yang and supporting Yin.
2. Yin Excess Constitution Observation: The typical characteristics of individuals with a Yin Excess constitution are: a plump physique, dark complexion, thick skin, and a tendency to be secretive, speak little, and have an introverted personality. Clinical Significance: The presence of the above physical and behavioral characteristics suggests that the patient has a Yin Excess constitution. The pathological feature is that Yin qi is relatively excessive while Yang qi is relatively deficient, making it susceptible to cold and damp pathogenic factors. Such patients often exhibit cold, damp, phlegm, qi stagnation, and blood stasis symptoms, and treatment should focus on supporting Yang and suppressing Yin, promoting qi and invigorating blood.
3. Yang Deficiency Constitution Observation: The typical characteristics of individuals with a Yang Deficiency constitution are: a weak or plump physique, pale complexion, fatigue, lack of energy, slow movements, relaxed and weak muscles, prefers warmth and fears cold, often wears more clothing. According to TCM diagnostic studies, individuals with Yin organ deficiency often exhibit Yang deficiency and Yin excess, with a physique that tends to be short and stout, round head, short and thick neck, broad shoulders, and a wide, short, round chest, often leaning backward. Clinical Significance: The presence of the above physical and behavioral characteristics suggests that the patient has a Yang Deficiency constitution. The pathological feature is insufficient Yang qi, leading to the easy generation of cold and dampness, making them susceptible to cold and damp pathogenic factors. The symptoms often manifest as internal cold, damp obstruction, and stagnation of water and phlegm, indicating organ dysfunction and phlegm accumulation.
4. Yin Deficiency Constitution Observation: The typical characteristics of individuals with a Yin Deficiency constitution are: a thin and emaciated physique, red cheeks and lips, excited demeanor, bright eyes, easily agitated, quick movements, and an impatient personality. TCM diagnostic studies suggest that individuals with Yang organ deficiency often exhibit Yin deficiency and Yang excess, with a physique that tends to be long and thin, long head, slender neck, narrow chest, and often leaning forward. Clinical Significance: The presence of the above physical and behavioral characteristics suggests that the patient has a Yin Deficiency constitution. The pathological feature is insufficient Yin essence, with excessive Yang qi, making them susceptible to heat and dryness pathogenic factors. The symptoms often manifest as Yin deficiency, essence deficiency, and internal dryness, with Yang excess.
5. Balanced Yin and Yang Constitution Observation: Individuals with a balanced Yin and Yang constitution have a physique that is moderate in height and weight, with graceful and composed behavior, a calm and gentle personality, and good adaptability to their natural and social environment. Clinical Significance: The presence of the above physical, behavioral, and personality characteristics suggests that the individual has a balanced Yin and Yang constitution. Such individuals are less susceptible to various pathogenic factors and have a strong adaptability to their environment. Their diseases often manifest as mild and moderate, and treatment can be managed according to conventional principles.
Five Elements Classification of Constitution
1. Wood Type Observation: The physical characteristics of individuals with a Wood type constitution are: pale greenish skin, small head, long face, broad shoulders, straight back, small stature, and agile limbs. Their personality and behavior traits include high intelligence, poor physical strength, and a tendency to worry. Clinical Significance: Wood type individuals are prone to pathogenic factors in autumn and winter, making them susceptible to illness. They tend to be in better health during spring and summer.
2. Fire Type Observation: The physical characteristics of individuals with a Fire type constitution are: red skin, good complexion, wide dental roots, sharp and thin face, small head, well-developed muscles in the shoulders, back, hips, and brain, and relatively small hands and feet. Their personality and behavior traits include steady walking, sharp thinking, impatience, and a tendency to be financially careless and untrustworthy. Clinical Significance: Fire type individuals are prone to premature death, with good health in spring and summer, but susceptible to pathogenic factors in autumn and winter.
3. Earth Type Observation: The physical characteristics of individuals with an Earth type constitution are: yellow skin, round shape, large head, well-developed shoulders and back, large abdomen, strong thigh and calf muscles, and relatively small hands and feet. Their personality and behavior traits include steady walking, calm demeanor, helpfulness, and good interpersonal relationships. Clinical Significance: Earth type individuals tend to be in better health during autumn and winter, but are prone to illness in spring and summer.
4. Metal Type Observation: The physical characteristics of individuals with a Metal type constitution are: white skin, square face, small head, small shoulder and back structure, small abdominal fat, and small hands and feet. Their personality and behavior traits include quick and agile movements, integrity, sharp thinking, calm demeanor when still, and strong leadership and management abilities. Clinical Significance: Metal type individuals tend to be in good health during autumn and winter, but are prone to illness in spring and summer.
5. Water Type Observation: The physical characteristics of individuals with a Water type constitution are: dark black skin, many wrinkles, large head, wide jaw, narrow shoulders, large abdomen, agile limbs, and swaying body when walking. Their personality and behavior traits include lack of sincerity in social interactions and a tendency to be deceitful. Clinical Significance: Water type individuals tend to be in better health during autumn and winter, but are prone to illness in spring and summer.
Classification of Constitution Based on Innate and Acquired Factors
1. Abundant Innate Endowment Observation: Individuals with abundant innate endowment have the following physical characteristics: broad and full forehead, large nose, wide cheeks, full muscles, high and thick jawbone, large and square ears, long earlobes, well-proportioned facial features, normal complexion, even breathing, firm muscles, and dense skin. Clinical Significance: The presence of the above physical characteristics suggests that the individual has abundant innate endowment, making them easier to treat after illness.
2. Insufficient Innate Endowment Observation: Individuals with insufficient innate endowment have the following physical characteristics: crowded facial features, narrow forehead, small nose, short philtrum, narrow cheeks, thin ears, and a short jawbone, with a narrow face and shallow breathing. Clinical Significance: The presence of the above physical characteristics suggests that the individual has insufficient innate endowment, with deficiency in qi, blood, yin, and yang, making them susceptible to pathogenic factors, and treatment is relatively difficult.
3. Good Acquired Nourishment Observation: Individuals with good acquired nourishment have the following physical characteristics: rosy complexion, robust physique, firm muscles, dense skin, abundant energy, and shiny hair. Clinical Significance: The presence of the above physical characteristics suggests that the individual has good acquired nourishment, with strong spleen and kidney functions, abundant qi, blood, yin, and yang, making them less susceptible to pathogenic factors, and easier to treat when ill.
4. Poor Acquired Nourishment Observation: Individuals with poor acquired nourishment have the following physical characteristics: lethargy, pale complexion, dry hair, yellowish skin, thin physique, and loose muscles. Clinical Significance: The presence of the above physical characteristics suggests that the individual has poor acquired nourishment, with weak spleen and stomach functions, deficiency in qi, blood, yin, and yang, making them susceptible to external pathogenic factors, and often presenting with deficiency symptoms.
5. Qi Deficiency with Phlegm and Dampness Constitution Observation: Individuals with a Qi deficiency with phlegm and dampness constitution have the following physical characteristics: plump appearance, pale complexion, large abdomen, slow movements, lazy temperament, and lack of activity. Clinical Significance: The presence of the above physical characteristics suggests that the individual has a Qi deficiency with phlegm and dampness constitution, often presenting with symptoms such as dizziness, obesity, and stroke.
Drug and Pain Tolerance
1. Strong Drug and Pain Tolerance Observation: Individuals with strong drug and pain tolerance have the following physical characteristics: dark skin, robust physique, strong bones, weak tendons, and relaxed muscles. Clinical Significance: The presence of the above physical characteristics suggests that the individual has a strong tolerance for drugs and pain. When diagnosing and analyzing the condition of such patients, it is essential to consider their pain tolerance, and treatment dosages can be heavier.
2. Weak Drug and Pain Tolerance Observation: Individuals with weak drug and pain tolerance have the following physical characteristics: thin physique, firm muscles, and thin, delicate skin. Clinical Significance: The presence of the above physical characteristics suggests that the individual has a weak tolerance for drugs and pain. Such patients often moan and call out when in pain, and it is crucial to consider their weak pain tolerance when diagnosing and analyzing their condition, avoiding being misled by false appearances. Treatment should use lighter dosages; otherwise, side effects may occur.
Bravery and Cowardice in Individuals
1. Brave Individuals Observation: The typical characteristics of brave individuals are: deep, wide, and upward-turned eyes, abundant lung qi, full spirit, strong voice when angry, expanded chest, wide-open eyes, bristling hair, and a pale complexion.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has a strong character, great courage, and abundant qi and blood.
2. Cowardly Individuals Observation: The typical characteristics of cowardly individuals are: large but shallow eyes, short and small sternum, weak internal organs, lethargy, and inability to exert authority when angry.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has a cowardly personality, with qi and blood easily disturbed, and the internal organs’ qi is often deficient.
3. Fat Individuals
Observation: The typical characteristics of fat individuals are: relaxed muscles, moist skin, large abdomen, and a preference for warmth and fear of cold.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has excessive Yang qi, with strong resistance to cold pathogenic factors, and their diseases often manifest as heat symptoms.
4. Flesh Type Individuals
Observation: The typical characteristics of flesh type individuals are: large frame, plump physique, and tightly connected flesh.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has abundant blood and a peaceful temperament, making them less susceptible to pathogenic factors.
5. Thin Individuals
Observation: The typical characteristics of thin individuals are: emaciated physique, pale complexion, weak muscles, thin lips, and often speak quickly or softly.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has smooth circulation of qi and blood. Thin individuals with pale skin are prone to qi and blood deficiency diseases, and treatment should avoid excessive harm to qi and blood. Thin individuals with dark skin are prone to heat and Yin deficiency diseases, and warming and drying herbs should not be used indiscriminately.
Observation of Elderly and Young Individuals
1. Normal Elderly Individuals
Observation: The typical characteristics of normal elderly individuals are: moderate physique, wrinkled face, but still in good spirits, gray hair but still alert, slow but steady movements.
Clinical Significance: The presence of the above physical characteristics suggests that the internal organs’ yin, yang, qi, and blood are declining but still within the normal range.
2. Strong Elderly Individuals
Observation: The typical characteristics of strong elderly individuals are: despite their age, their hair remains black and lustrous, their face is bright and shiny, with few wrinkles, abundant energy, clear hearing and vision, quick reactions, and agile movements, with a physique that is moderate in size.
Clinical Significance: The presence of the above physical characteristics suggests that the internal organs’ functions are normal, with sufficient yin, yang, qi, and blood, making them less susceptible to pathogenic factors.
3. Weak Elderly Individuals
Observation: The typical characteristics of weak elderly individuals are: emaciated physique, loose skin with many wrinkles, often with brown age spots, dry and withered hair, haggard appearance, lethargy, dull eyes, hearing loss, tooth loss, stooped posture, slow movements, unsteady limbs, dull reactions, and repetitive speech.
Clinical Significance: The presence of the above physical characteristics suggests that the internal organs’ functions are declining, with deficiency in yin, yang, qi, and blood, often presenting with deficiency symptoms.
4. Premature Aging
Observation: The typical characteristics of individuals showing premature aging are: gray and withered hair, increased wrinkles, brown age spots on the face, lethargy, dull eyes, loose teeth, hearing loss, lack of energy, slow movements, dull reactions, repetitive speech, and stubborn personality, despite being in their prime.
Clinical Significance: The presence of the above physical characteristics suggests that the individual is experiencing premature aging, often related to insufficient innate endowment, poor acquired nourishment, and disease consumption.
5. Normal Young Individuals
Observation: The typical characteristics of normal young individuals are: closure of the fontanelle and appropriate intellectual development for their age, agile movements, quick reactions, and a healthy complexion.
Clinical Significance: The presence of the above physical characteristics suggests that the internal organs’ development is normal; in pathological cases, it indicates that such children have a short illness duration and mild condition, with no significant deficiency in righteous qi, making treatment relatively easy.
6. Strong Young Individuals
Observation: The typical characteristics of strong young individuals are: robust physique, abundant energy, strong bones, lively and alert, with thick and shiny hair, agile movements, quick reactions, taller stature, and more teeth than peers.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has abundant innate endowment and proper acquired nourishment, with strong internal organ functions, abundant qi, blood, yin, and yang, making them less susceptible to external pathogenic factors and having strong adaptability to their environment.
7. Weak Young Individuals
Observation: The typical characteristics of weak young individuals are: lack of energy, pale complexion, thin or plump physique, pale lips, sparse and dry hair, slow movements, lack of lively demeanor, and delayed development in height, intelligence, and speech compared to peers.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has insufficient innate endowment, poor acquired nourishment, and weak internal organ functions, with deficiency in qi, blood, yin, and yang, making them susceptible to external pathogenic factors, often presenting with deficiency symptoms and mixed symptoms of deficiency and excess, requiring careful treatment and longer recovery time.
Observation of Strong and Weak Individuals
1. Strong Individuals
Observation: The typical characteristics of strong individuals are: young and robust, strong bones, thick joints, well-developed muscles, thick lips, thick skin, dark complexion, abundant energy, and full spirit.
Clinical Significance: The presence of the above physical characteristics suggests that the individual is strong and less susceptible to pathogenic factors, often presenting with symptoms of qi stagnation and blood stasis.
2. Weak Individuals
Observation: The typical characteristics of weak individuals are: although they are in their youth, they are thin, or plump and bloated, with pale complexion, lethargy, thin skin, and thin lips, and are unable to endure fatigue.
Clinical Significance: The presence of the above physical characteristics suggests that the individual is weak and susceptible to pathogenic factors, often presenting with symptoms of deficiency in qi, blood, yin, and yang.
Observation of Spirit and Mind
Spirit has two meanings: one refers to the entire life activity of the human body, also known as the spirit mechanism; the other refers to human cognitive activities, also known as spirit, mind, and brilliance.
Spirit originates from the innate essence but relies on the continuous nourishment of the acquired essence from food and water. Essence, qi, and blood are the material basis of spirit, and spirit is their external manifestation. The TCM Dictionary summarizes it as: human life originates from essence, is maintained by qi and blood, and is expressed through spirit.
Spirit and form are closely related; they cannot be separated. Therefore, combining the observation of form to assess the rise and fall of spirit is the basic principle of observing spirit.
Mind refers to emotions, which are the psychological, emotional, and cognitive responses of individuals to external stimuli. The basic content and forms include: joy, anger, melancholy, worry, sadness, fear, panic, anxiety, etc. The activities of emotions are closely related to the functions of the internal organs and the state of qi and blood.
Observing spirit can help understand the strength of internal organ functions and the rise and fall of essence, qi, and blood. The specific content of observing spirit mainly includes the vitality of life functions, the presence of spirit in the face, hair, and eyes.
Spirit and Form
1. Both Spirit and Form Present
Observation: Individuals with both spirit and form present have the following physical characteristics: robust appearance, firm muscles, well-proportioned body, rosy complexion, bright and spirited eyes, abundant energy, shiny hair, agile movements, and quick reactions.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has strong internal organ functions, abundant qi and blood, and is less susceptible to pathogenic factors, making treatment easier even when ill.
2. Form Abundant but Spirit Weak
Observation: Individuals with abundant form but weak spirit have the following physical characteristics: robust physique, strong bones, but weak spirit, dull eyes, haggard appearance, indifferent expression, slow movements, dull reactions, and shortness of breath upon exertion.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has weakened righteous qi, with excessive pathogenic factors, making treatment difficult and prognosis poor.
3. Weak Form but Strong Spirit
Observation: Individuals with weak form but strong spirit have the following physical characteristics: long-term illness, weak physique, thin muscles, but clear and strong speech, coarse breathing, and bright eyes.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has deficiency in yin and blood, with excessive pathogenic factors, making treatment difficult and prognosis sometimes poor.
4. Both Form and Spirit Weak
Observation: Individuals with both form and spirit weak have the following physical characteristics: emaciated physique, lethargy, haggard appearance, indifferent expression, dry hair, dull eyes, low speech, and lack of movement.
Clinical Significance: The presence of the above physical characteristics suggests that the individual has deficiency in both yin and yang, with a long illness duration, making prognosis poor.
Key Points in Observing Spirit
1. Spirit Mechanism
Observation: The spirit mechanism refers to the external manifestation of life activities. Observing the spirit mechanism is crucial. A vigorous spirit mechanism indicates abundant energy, robust physique, bright eyes, rich expressions, agile movements, and quick reactions. A weak spirit mechanism indicates emaciation, lethargy, dull eyes, and slow movements.
Clinical Significance: The spirit mechanism can indicate the strength of righteous qi and the changes in pathogenic factors. A vigorous spirit mechanism suggests that the individual has sufficient yin, yang, qi, and blood, with no significant damage to internal organ functions; a weak spirit mechanism indicates that the individual has excessive pathogenic factors, with significant damage to righteous qi and internal organ functions.
2. Spirit Light
Observation: Spirit light refers to the mental state and is an important aspect of observing spirit. Sufficient spirit light indicates a clear mind, abundant energy, strong voice, even breathing, clear thoughts, and quick reactions. Insufficient spirit light indicates lethargy, low voice, indifferent expression, and a tendency to sleep excessively.
Clinical Significance: Spirit light can reflect the strength of internal organ functions and the state of qi and blood. Individuals with sufficient spirit light indicate that their qi and blood are not deficient, with strong internal organ functions and mild illness; those with insufficient spirit light indicate that their qi and blood are depleted, with weakened internal organ functions and severe illness.
3. Spirit Color
Observation: Spirit color mainly refers to the presence of luster in the face, skin, hair, and eyes. Observing spirit color is also a key point in assessing spirit. Individuals with vibrant spirit color have a rosy complexion, bright eyes, shiny hair, rich expressions, and a joyful demeanor. Individuals with dull spirit color have a haggard appearance, dry hair, lack of luster, dull eyes, and a lack of expression.
Clinical Significance: Spirit color reflects the functions of internal organs and the state of qi and blood. Individuals with vibrant spirit color indicate strong internal organ functions and abundant qi and blood, even when ill; those with dull spirit color indicate deficiency in qi and blood, weakened internal organ functions, and severe illness.
Key Points in Observing Color
1. Good and Bad Color
Observation: The good and bad color manifests in two ways. First, when the skin color shows pathological changes, bright and moist is good, while dark and exposed is bad. Second, seasonal skin color changes, with seasonal vitality being good and personal vitality being bad. Observing the good and bad color helps determine the prognosis of the disease, mainly based on the first situation.
Clinical Significance: Individuals with moist and concealed skin color indicate that although they are ill, their internal organs’ essence and qi have not significantly declined, with mild pathogenic factors, suggesting a good prognosis; those with dark and exposed skin color indicate that their internal organs’ essence and qi are depleted, with severe pathogenic factors, suggesting a poor prognosis.
2. Floating and Sinking Color
Observation: Floating and sinking color mainly refers to the superficiality and depth of the disease color. Superficial disease color, floating on the skin, is called floating color; deep disease color, hidden within the skin, is called sinking color.
Clinical Significance: Superficial disease color indicates that the disease is located superficially, with a lighter condition and easier treatment, suggesting a good prognosis; deep disease color indicates that the disease is located internally, with a more severe condition and greater difficulty in treatment, suggesting a poor prognosis.
3. Clear and Turbid Color
Observation: Clear and turbid color refers to the clarity and brightness of the disease color. Bright and clear disease color indicates a yang condition, while dark and turbid disease color indicates a yin condition.
Clinical Significance: Clear and bright disease color suggests a yang condition, with the disease located relatively superficially and the righteous qi not yet depleted; dark and turbid disease color indicates a yin condition, with the disease located internally and the righteous qi depleted, suggesting a more severe condition.
4. Scattered and Gathered Color
Observation: Scattered and gathered color refers to the dispersion and aggregation of disease color. Scattered disease color indicates a short disease duration and easier treatment, suggesting a good prognosis; gathered disease color indicates a long disease duration, severe condition, and aggregation of pathogenic factors, suggesting greater difficulty in treatment and a longer duration.
Clinical Significance: Scattered disease color suggests a short disease duration and easier treatment, while gathered disease color indicates a long disease duration and severe condition, suggesting greater difficulty in treatment.
5. Subtle and Intense Color
Observation: Subtle and intense color refers to the lightness and darkness of the disease color. Light disease color indicates a subtle condition, while dark disease color indicates an intense condition.
Clinical Significance: Light disease color suggests deficiency in righteous qi and insufficient qi and blood, while dark disease color indicates a more severe pathogenic condition.
6. Luster and Dullness of Color
Observation: Luster and dullness of color refer to the brightness of the disease color. Bright and moist skin color indicates vitality, while dull and dry skin color indicates a lack of vitality.
Clinical Significance: Bright and moist skin color suggests that the individual has not been significantly affected by pathogenic factors, while dull and dry skin color indicates a more severe condition.
7. Reverse and Normal Color
Observation: Reverse and normal color refers to two different situations when the disease and color do not correspond. When the disease and color are in a generative state, such as liver disease showing black or red, spleen disease showing red or white, heart disease showing green or yellow, kidney disease showing white or green, and lung disease showing yellow or black, it is called normal color. In contrast, when the disease and color are in a restraining state, such as liver disease showing yellow or white, heart disease showing white or black, spleen disease showing black or green, lung disease showing green or red, and kidney disease showing red or yellow, it is called reverse color.
Clinical Significance: Reverse color indicates a more severe condition, with stronger pathogenic factors and weaker righteous qi, making treatment difficult and suggesting a poor prognosis.
8. Dynamic Changes in Color
Observation: When observing color, it is essential to examine the good and bad color, floating and sinking color, subtle and intense color, clear and turbid color, scattered and gathered color, and the dynamic changes in disease color. Especially in chronic diseases, the dynamic changes in skin color often have significant clinical diagnostic value. As the disease progresses, the skin color also changes accordingly.
Clinical Significance: Observing the dynamic changes in disease color can help understand the severity of the disease, the depth of the disease location, and the changes in the strength of pathogenic and righteous qi. Changes from scattered to gathered, from dull to bright, indicate a worsening condition, while changes from bad to good, from reverse to normal, indicate improvement.
Normal Skin Color
Observation: The normal skin color of Chinese individuals should be a subtle yellow, bright and moist. Due to innate endowment, constitution, and various factors such as occupation, environment, and lifestyle, there can be significant individual differences, which should not be considered pathological.
Clinical Significance: The normal skin color of yellow-skinned individuals indicates strong stomach qi, healthy internal organs, smooth blood circulation, and abundant energy, suggesting a good prognosis.
Yellow as a Primary Disease Color
1. Jaundice
Observation: Patients with jaundice exhibit yellowing of the skin and eyes, which may be bright like orange or dark like smoke, with yellow urine, greasy tongue coating, and fatigue.
Clinical Significance: Jaundice is often caused by dietary irregularities, damp-heat, or toxic pathogenic factors, primarily affecting the liver, gallbladder, spleen, and stomach, with symptoms indicating damp-heat, cold-damp, or blood deficiency.
2. Yellow and Edematous
Observation: Patients with yellow and edematous conditions exhibit pale yellow skin, swollen face and limbs, with no yellowing of the eyes, pale conjunctiva, pale lips, tongue, and nails, and fatigue.
Clinical Significance: Yellow and edematous conditions are often seen in hookworm disease, related to labor in contaminated environments, leading to blood loss and qi deficiency.
3. Withered Yellow
Observation: Patients with withered yellow conditions exhibit pale yellow skin, lack of luster, fatigue, and sparse hair.
4. Pale Yellow
Observation: Patients with pale yellow conditions exhibit yellowish skin, abdominal distension, and visible veins on the abdomen, with a thin physique.
Clinical Significance: Pale yellow skin is often seen in patients with ascites, indicating a more severe condition.
5. Dry Yellow
Observation: Patients with dry yellow conditions exhibit yellow, dry skin, lacking elasticity, with thin muscles and a red tongue.
Clinical Significance: Dry yellow skin suggests issues with the spleen and stomach, with symptoms indicating heat or deficiency.
6. Damp Disease
Observation: Patients with damp disease exhibit yellow, dull skin, often accompanied by fatigue, abdominal fullness, and greasy tongue coating.
Clinical Significance: The presence of these characteristics indicates damp disease, often due to damp pathogenic factors affecting the spleen and lungs.
7. Accumulation in Children
Observation: Children with accumulation exhibit pale yellow skin, haggard appearance, and abdominal distension with visible veins.
Clinical Significance: The presence of these characteristics suggests issues with the spleen and stomach, often related to dietary irregularities.
8. Fetal Jaundice
Observation: Fetal jaundice primarily manifests as yellowing of the skin and eyes in newborns, which may vary in intensity and duration.
Clinical Significance: Fetal jaundice occurring within the first few days after birth is generally a normal physiological phenomenon.
Red as a Primary Disease Color
1. Heat Syndrome
Observation: Patients with heat syndrome exhibit red skin and face, often accompanied by fever, thirst, and red tongue with yellow coating.
Clinical Significance: The presence of these characteristics suggests a heat syndrome.
2. Yang Qi Stagnation
Observation: Patients with yang qi stagnation exhibit red skin, restlessness, and fever without sweating.
Clinical Significance: The presence of these characteristics suggests stagnation of external pathogenic factors.
3. Yin Deficiency
Observation: Patients with yin deficiency exhibit red cheeks, dry mouth, and red tongue.
Clinical Significance: The presence of these characteristics suggests a yin deficiency.
4. Yang Collapse
Observation: Patients with yang collapse exhibit pale complexion, cold sweat, and weak pulse.
Clinical Significance: The presence of these characteristics suggests a critical condition.
5. Carbon Monoxide Poisoning
Observation: Patients with carbon monoxide poisoning exhibit drowsiness or coma, red or cherry-red skin, rapid breathing, and agitation.
Clinical Significance: The presence of these characteristics suggests carbon monoxide poisoning.
White as a Primary Disease Color
1. Yang Deficiency
Observation: Patients with yang deficiency exhibit pale complexion, cold skin, and a preference for warmth.
Clinical Significance: The presence of these characteristics suggests a deficiency in yang qi.
2. Yang Collapse
Observation: Patients with yang collapse exhibit pale complexion, cold sweat, and weak pulse.
Clinical Significance: The presence of these characteristics suggests a critical condition.
3. Qi Deficiency
Observation: Patients with qi deficiency exhibit pale complexion, lethargy, and weak pulse.
Clinical Significance: The presence of these characteristics suggests a deficiency in qi.
4. Blood Deficiency
Observation: Patients with blood deficiency exhibit pale complexion and dry skin.
Clinical Significance: The presence of these characteristics suggests a need for blood tonics.
5. Cold Syndrome
Observation: Patients with cold syndrome exhibit pale complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a cold pathogenic factor.
Green as a Primary Disease Color
1. Cold Syndrome
Observation: Patients with cold syndrome exhibit pale complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a cold pathogenic factor.
2. Yang Deficiency with Blood Stasis
Observation: Patients with yang deficiency and blood stasis exhibit pale complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in yang qi.
3. Wind Stroke
Observation: Patients with wind stroke exhibit pale complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a wind stroke.
Black as a Primary Disease Color
1. Kidney Yin Deficiency
Observation: Patients with kidney yin deficiency exhibit dark complexion and dry skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in kidney yin.
2. Yang Deficiency with Internal Cold
Observation: Patients with yang deficiency and internal cold exhibit dark complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in yang qi.
3. Cold Dampness and Water Retention
Observation: Patients with cold dampness and water retention exhibit dark complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in kidney function.
4. Blood Stasis
Observation: Patients with blood stasis exhibit dark complexion and cold skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in blood circulation.
Purple Cyanosis as a Primary Disease Color
1. Blood Stasis
Observation: Patients with blood stasis exhibit purple lips and cyanosis.
Clinical Significance: The presence of these characteristics suggests a deficiency in blood circulation.
2. Cold Congealing Blood Vessels
Observation: Patients with cold congealing blood vessels exhibit cyanosis and cold skin.
Clinical Significance: The presence of these characteristics suggests a deficiency in blood circulation.
3. Poisoning
Observation: Patients with poisoning exhibit cyanosis and cold skin.
Clinical Significance: The presence of these characteristics suggests a need for immediate medical attention.
Observation of Body Shape
Individuals vary in height and weight, and the strength and flexibility of the body are closely related to the internal organs’ health. Therefore, observing the external characteristics of patients can provide insights into the state of their internal organs.
1. Tall Individuals
Observation: Patients with gigantism exhibit proportional growth, with an exceptionally tall and robust physique, often exceeding the height and weight of peers.
Clinical Significance: The presence of these characteristics suggests that the individual has gigantism, often related to pituitary tumors.
2. Tall Individuals with Proportional Growth
Observation: Patients with proportional growth exhibit a tall stature but with disproportionate limb length.
Clinical Significance: The presence of these characteristics suggests that the individual has a condition affecting growth.
3. Abdominal Prolapse
Observation: Patients with abdominal prolapse exhibit a long and thin physique, with weak muscles, often seen in women.
Clinical Significance: The presence of these characteristics suggests that the individual has a condition affecting the internal organs.
4. Tuberculosis
Observation: Patients with tuberculosis exhibit a thin physique, often with red lips and cheeks, coughing, and hemoptysis.
Clinical Significance: The presence of these characteristics suggests that the individual is susceptible to pulmonary tuberculosis.
Short Individuals
1. Dwarfism
Observation: Patients with dwarfism exhibit a short stature, with a height significantly below that of peers, often retaining a childlike appearance.
Clinical Significance: The presence of these characteristics suggests that the individual has dwarfism, often related to genetic factors.
2. Innate Insufficiency
Observation: Children with innate insufficiency exhibit short stature and delayed development.
Clinical Significance: The presence of these characteristics suggests that the individual has insufficient innate endowment.
3. Malnutrition
Observation: Children with malnutrition exhibit thin or short stature, pale complexion, and dry skin.
Clinical Significance: The presence of these characteristics suggests that the individual has malnutrition, affecting growth and development.
Observation of Fat and Thin Individuals
1. Fat Individuals
Observation: Fat individuals exhibit a robust physique, with slow and clumsy movements, often preferring to sleep and snore loudly.
Clinical Significance: The presence of these characteristics suggests that the individual is prone to phlegm-dampness and qi deficiency, making them susceptible to diseases.
2. Thin Individuals
Observation: Thin individuals exhibit a slender physique, with dry skin and visible bones.
Clinical Significance: The presence of these characteristics suggests that the individual is prone to qi and blood deficiency.
Observation of Other Characteristics
1. Observation of Muscles
Observation: Individuals with well-developed muscles exhibit prominent muscles and agile movements, while those with weak muscles exhibit thin and weak muscles.
Clinical Significance: The strength of muscles reflects the health of the spleen and stomach, with strong muscles indicating good health and weak muscles indicating susceptibility to pathogenic factors.
2. Observation of Skin Texture
Observation: Skin texture varies due to physiological and pathological factors, reflecting the state of internal organs.
Clinical Significance: Skin texture is related to the size of internal organs and reflects the state of the three burners and bladder.
3. Abdominal Distension
Observation: Abdominal distension is characterized by a protruding abdomen and thick skin, often seen in middle-aged individuals.
Clinical Significance: The presence of these characteristics suggests that the individual is prone to diseases such as chest tightness and stroke.
4. Elbow Deformities
Observation: Elbow deformities are characterized by an inward or outward angle of the elbow joint.
Clinical Significance: The presence of these characteristics suggests that the individual may have rickets or severe injury.
5. Knee Deformities
Observation: Knee deformities are characterized by an inward or outward bowing of the legs.
Clinical Significance: The presence of these characteristics suggests that the individual may have rickets or nutritional deficiencies.
6. Bowed Legs
Observation: Bowed legs are characterized by a bowing of the legs, often seen in children.
Clinical Significance: The presence of these characteristics suggests that the individual may have rickets.
7. Foot Deformities
Observation: Foot deformities are characterized by inward or outward turning of the feet.
Clinical Significance: The presence of these characteristics suggests that the individual may have spinal cord injury or genetic factors.
8. Chicken Breast
Observation: Chicken breast is characterized by a protruding sternum and retracted ribs.
Clinical Significance: The presence of these characteristics suggests that the individual may have rickets or chronic cough.
9. Turtle Back
Observation: Turtle back is characterized by a curved spine.
Clinical Significance: The presence of these characteristics suggests that the individual may have rickets or spinal deformities.
Observation of Dynamics
Observing the patient’s movements, posture, and behavior can reflect their mental state, the health of their internal organs, and the balance of yin, yang, qi, and blood. Careful observation of the patient’s dynamics is an essential part of TCM observation diagnosis.