Traditional Chinese Medicine (TCM) observation diagnosis is one of the four diagnostic methods in TCM (observation, listening, inquiry, and palpation). It is an important component of TCM diagnostics, which involves observing the patient’s overall appearance, complexion, tongue presentation, as well as changes in the skin and facial features to understand the nature, severity, and prognosis of diseases.
1
Observations of the Eyes in Disease Diagnosis
The essence of the five organs and six bowels is reflected in the eyes. If the spleen qi is deficient, yang declines, failing to contain yin, leading to the scattering of spirit light outward, resulting in a wide appearance of the eyes. The nourishment is in the liver, the master is in the kidney, and the harmony is in the spleen, which can combine the yin of the kidney and spleen, allowing the liver to reach it, thus returning essence to both eyes.
Clear eyes indicate cold;
Dark and turbid eyes indicate heat;
Cloudy eyes indicate dampness;
Dry eyes indicate dryness;
Dry and rough eyes indicate insufficient liver yin;
Red and swollen eyes indicate wind-heat in the liver channel;
Swollen eyeballs indicate liver fire and external wind-heat;
Constricted pupils often indicate blazing liver and gallbladder fire;
Dark and swollen eyelids indicate kidney qi deficiency;
Dark eyelids often indicate kidney deficiency;
Red and moist eyelid margins indicate spleen damp-heat;
Eyes open during sleep indicate spleen qi and blood deficiency;
Eyes that cannot close during sleep indicate weak spleen qi;
Eyes that cannot close when awake indicate kidney deficiency;
Distinct eyelids indicate phlegm-damp disease;
Weak eyelid opening indicates deficiency of original qi;
Sunken eyelids with crying but no tears indicate severe injury to yin fluids;
Swollen eyelids resembling sleeping worms with yellow urine indicate jaundice;
Swollen eyelids often indicate signs of edema;
Eye corners with opacity indicate liver fire rising;
Red and painful eye corners indicate heart fire;
Pale white eye corners indicate blood deficiency;
Red sclera indicates lung fire;
Red sclera indicates external wind-heat;
Red sclera with many signs indicates excessive yin deficiency fire;
Eyes that are slightly fixed indicate internal phlegm-heat obstruction;
Eyes that are cross-eyed indicate internal liver wind;
Eyes that stare without life indicate internal liver wind;
Eyes that are dull and slow to move indicate kidney essence deficiency;
Dull and slow-moving eyes indicate a precursor to wind stroke.
Eyes without brilliance and unresponsive indicate deficiency of organ essence.
Children sleeping with open eyes often indicate spleen qi and blood deficiency.
2
Observations of the Throat and Teeth in Disease Diagnosis
Deep red and swollen throat with obvious pain indicates excess heat syndrome;
Soft red throat with mild swelling and pain indicates yin deficiency with excess heat;
Soft red throat with mild swelling and pain indicates heat evil phlegm obstructing the lungs;
Red and swollen throat indicates excess heat and toxins in the lungs and stomach;
Purulent and ulcerated throat with yellow-white necrotic spots indicates severe heat toxin in the lungs and stomach;
Gray-white necrotic spots in the throat indicate diphtheria, with heat injuring the lungs and kidneys.
Dry teeth indicate injury to yin fluids;
Teeth that are dry and smooth like stone indicate extreme stomach heat;
Teeth that are the color of dry bones indicate impending kidney yin depletion;
Teeth tightly closed or with sounds between teeth indicate phlegm obstructing the channels;
Teeth tightly closed or with sounds between teeth indicate extreme heat causing spasms.
3
Observations of the Face in Disease Diagnosis
White complexion indicates cold syndrome, often due to yang deficiency or initial external invasion;
White complexion indicates yang deficiency, qi deficiency, and blood deficiency;
White complexion with cold and blood stasis indicates constricted meridians;
Pale complexion often indicates lung disease;
White and swollen complexion indicates qi deficiency;
White and emaciated complexion indicates blood depletion;
White complexion like dry bones indicates severe lung disease;
White complexion with emaciation, red cheeks, and red lips indicates excess heat due to yin deficiency;
White complexion with slight redness and luster indicates sufficient qi and blood.
Yellow and red complexion indicates heat;
Yellow complexion indicates dampness;
Pale yellow complexion indicates cold dampness;
Yellow complexion with a floating sheen indicates wind-damp;
Yellow and red complexion indicates wind-related conditions;
Pale yellow complexion without luster indicates spleen deficiency;
Yellow complexion like orange indicates damp-heat;
Yellow complexion like bitter orange indicates extreme spleen qi deficiency;
Yellow complexion with dark blue indicates blood stasis with damp-heat;
Yellow complexion with a reddish hue indicates wind, indicating wind-heat disease;
Yellow complexion with luster indicates recovery from illness;
Yellow complexion with a greasy sheen indicates swelling and pus conditions;
Yellow complexion with a slight yellow hue indicates presence of stomach qi;
Red complexion with fever and delirium indicates internal heat;
Bright red complexion indicates severe blood conditions, indicating blood loss or local congestion;
Bright red complexion indicates yang qi stagnation on the surface, with sweating not fully resolved.
Blue complexion indicates cold stagnation, qi stagnation, and blood stasis;
Blue complexion indicates qi and blood stagnation, often indicating cold and pain;
Blue complexion like grass indicates severe lung disease;
Black complexion indicates pain-related diseases;
Black complexion indicates severe cold pain;
Black complexion indicates kidney yang deficiency, with internal cold and qi and blood stagnation;
Black complexion indicates unprocessed water retention, with blood losing warmth and meridians constricted;
Black and dry complexion often indicates kidney yin deficiency;
Black complexion like stove soot indicates extreme kidney qi deficiency;
Withered and dull complexion indicates chronic illness and deficiency conditions;
Bright and clear complexion indicates superficial illness;
Dull and murky complexion indicates deep-seated illness;
Red cheeks on both sides often indicate internal heat due to yin cold;
Bright red cheeks in the afternoon indicate water depletion and fire excess, indicating fire-type lung metal.
4
Observations of the Nails in Disease Diagnosis
White nails indicate deficiency of both qi and blood;
Pale white nails indicate blood deficiency;
Pale nails indicate lung and stomach cold;
Pale nails indicate yang deficiency with cold, and deficiency of both qi and blood;
Yellow nails often indicate jaundice;
Bright red nails with emaciation indicate excess heat due to yin deficiency;
Deep red nails often indicate internal heat;
Blue-purple nails often indicate blood stasis;
Black nails often indicate death conditions;
Pressing nails turns them white, returning to red indicates a treatable condition; if they remain white, the condition is difficult to treat.
5
Observations of the Voice in Disease Diagnosis
Low voice often indicates internal injury and deficiency;
Loud voice often indicates external invasion and excess;
Raving and delirium often indicate heat conditions;
Low voice with few words often indicates deficiency and cold conditions;
Sudden hoarseness often indicates wind-phlegm obstructing fire;
Rough and uneven voice often indicates external heat excess, often affecting the lungs and stomach;
Weak and shallow voice often indicates internal injury and chronic illness;
Excessive coughing with rough voice often indicates lung and stomach excess heat;
Weak voice with short breaths often indicates kidney deficiency;
Coughing without phlegm, with cough being the main symptom, indicates treatment focused on the lungs;
Coughing due to phlegm, with phlegm being the main symptom, indicates treatment focused on the spleen;
Sudden cough with hoarseness often indicates excess heat;
Chronic cough with hoarseness often indicates deficiency and injury;
Coughing with much phlegm and nasal congestion often indicates a cold, which is easily treated;
Sudden and continuous coughing often indicates a more difficult condition.
6
Observations of the Mouth in Disease Diagnosis
Facial asymmetry indicates wind-phlegm obstructing the head and face channels, with yangming storing phlegm and taiyang being externally affected by wind. Wind-phlegm obstructing the head and face channels leads to channel obstruction and muscle malnourishment, hence the asymmetry. If there is no external evil, qi and blood can still circulate, and the relative urgency indicates the urgency of the condition. Therefore, facial asymmetry is treated by expelling wind-phlegm, unblocking the channels, and stopping spasms, allowing the wind to dissipate and phlegm to clear, thus enabling recovery.
Sweet and greasy taste in the mouth indicates spleen damp-heat;
Salty taste in the mouth indicates kidney deficiency;
Bland taste in the mouth indicates stomach dampness, often due to spleen and stomach deficiency;
Sour taste in the mouth indicates poor digestion and gastrointestinal stagnation;
Bitter taste in the mouth indicates liver and gallbladder fire, with gallbladder fire rising;
Smelly taste in the mouth indicates heat in the stomach and poor digestion;
Ulcerated mouth indicates heart and spleen heat accumulation, severe cases leading to mouth sores;
Dry mouth and throat indicate yin deficiency with excess heat, with true yin being depleted;
White patches in the mouth indicate oral thrush;
Chapped lips often indicate food accumulation;
Dry and chapped lips indicate food accumulation with spleen heat;
Red and swollen lips indicate severe heat;
Bright red lips indicate excess heat due to yin deficiency;
Pale and swollen lips indicate qi and blood deficiency;
White and swollen lips indicate wind conditions;
Pale blue lips indicate wind-cold binding the exterior;
Red and swollen lips indicate severe heat;
Purple-red lips indicate blood stasis;
Bright red lips indicate excessive diarrhea damaging yin;
Asymmetrical lips indicate stroke;
Closed mouth with inability to speak indicates spasm conditions;
Closed mouth with difficulty opening indicates excess conditions;
Pale skin around the mouth with flushed cheeks indicates severe heat.
7
Observations of the Tongue in Disease Diagnosis
1) A thin and small tongue indicates deficiency conditions;
2) A red tongue with a white, slippery coating indicates heat in the nutrient level;
3) A pale and tender tongue with a white, moist coating indicates deficiency-cold conditions;
4) A pale, plump tongue with a yellow, slippery coating often indicates yang deficiency with water retention;
5) A tongue that is overly pale or white indicates anemia and water retention, often indicating deficiency-cold conditions;
6) A red and swollen tongue often indicates excess heat in the heart and spleen;
7) A crimson tongue indicates severe heat, while a purple tongue indicates blood stasis;
8) A red tongue with dryness and little or no coating indicates severe heat injuring fluids;
9) A red tongue with a white, slippery coating indicates dampness in the qi level, with yin deficiency and excess heat with phlegm and food accumulation;
10) A red tongue is often seen in excess heat conditions and yin deficiency;
11) A crimson tongue is often seen in the extreme phase of externally contracted heat diseases and excess heat due to yin deficiency;
12) A crimson tongue often indicates externally contracted diseases with heat entering the nutrient and blood levels;
13) A crimson tongue with little coating and moistness often indicates blood stasis;
14) A pale red tongue with thick yellow coating is often seen in externally contracted wind-cold transforming into heat, or externally contracted damp-heat evil;
15) A red tongue with a yellow, greasy coating indicates liver and gallbladder damp-heat, often accompanied by rib and abdominal distension and pain;
16) A plump tongue often indicates water retention or dampness, possibly indicating hypothyroidism;
17) A quivering tongue is a precursor to stroke. Tongue diagnosis is best performed in the morning after waking, before brushing, for the most accurate observation;
18) A tongue without coating, like a peeled kidney bean, indicates loss of fluids, which is untreatable.
Thorny protrusions on the tongue, resembling thorns, are sharp red or yellow-black granules, referred to as thorny protrusions. The presence of thorny protrusions on the tongue indicates excessive heat in the qi level, with excessive yang heat in the organs; it indicates excessive yang heat in the organs or extreme heat in the blood.
“Observations of the Tongue” states: “The presence of thorny protrusions on the tongue indicates excessive heat accumulation.”
“TCM Tongue Diagnosis” states: “Evil heat entering the nutrient level can occur in the middle or lower jiao, leading to thorny protrusions.”
Key Points for Diagnosis of Thorny Protrusions on the Tongue:
1) Thorny protrusions on the tongue tip often indicate excessive heart fire;
2) Thorny protrusions on the tongue edges often indicate excessive liver and gallbladder heat;
3) Thorny protrusions on the tongue body often indicate extreme stomach and intestinal heat;
4) A red tongue with thorny protrusions indicates heat in the yangming qi level;
5) A crimson tongue with thorny protrusions indicates heat has penetrated deeply into the nutrient and blood levels;
6) A tongue with many thorny protrusions indicates increasingly severe evil heat, with excessive heat in the qi level and organs;
Key Points for Diagnosis of Severe Conditions via Tongue Observation:
1) A tongue resembling a mirror surface indicates a critical condition;
2) A tongue resembling a fire-dried color indicates a critical condition;
3) A tongue resembling a peeled kidney bean indicates a critical condition;
4) A tongue with no coating indicates that stomach qi has been exhausted, which is untreatable;
5) A tongue that is rough and prickly, dry and cracked, indicates a critical condition;
6) A tongue that is tightly bound, unable to move, with slurred speech indicates a critical condition;
7) A tongue that is stiff and unable to move, with difficulty in speech, indicates a critical condition.
8
Observations of the Tongue Coating in Disease Diagnosis
1) A thin coating indicates a mild illness, with the evil being relatively superficial, often indicating an external invasion;
2) A thick coating indicates a severe illness, with the evil penetrating deeply. A thick coating may indicate poor appetite, food accumulation, or phlegm-dampness. A yellow coating indicates damp-heat;
3) A tongue with no coating (also known as peeled tongue resembling flower petals) generally indicates severe injury to both stomach qi and yin, with depletion of both qi and blood; a tongue without coating, like a peeled kidney bean, indicates loss of fluids, which is untreatable. A tongue with little or no coating indicates yin deficiency, with a smooth tongue surface resembling a mirror, known as chicken heart tongue, indicating severe yin injury;
4) A white coating indicates exterior cold syndrome; if damp-heat is present, the coating may be white; a white coating indicates exterior cold syndrome. If there is a white coating, it may indicate a half-exterior, half-interior condition. A moist coating indicates cold, while a dry coating indicates heat;
5) A yellow coating indicates interior heat syndrome. If damp-heat is present, the coating may be yellow; a yellow coating indicates interior heat syndrome. A yellow coating indicates that the evil is in the interior, while a black coating indicates that the disease has penetrated into the shaoyin, often indicating a critical condition;
6) A moist coating indicates exterior cold syndrome, early dampness, or blood stasis; a moist coating indicates cold, while a dry coating indicates heat;
7) A dry coating indicates high fever, excessive sweating, vomiting, diarrhea, or damp obstruction, or excessive use of warming and drying herbs;
8) A moist coating with a white, tight pulse indicates cold stagnation in the liver channel, often accompanied by lower abdominal pulling pain radiating to the testicles;
9) A greasy coating: the coating is fine and dense, merging into sheets that are difficult to scrape off, indicating dampness, phlegm, or food accumulation; a greasy coating with thick structure indicates excessive dampness;
10) A rotten coating: the coating is coarse and loose, resembling tofu dregs, covering the tongue surface, easily scraped off, indicating excessive heat and dampness in the stomach;
11) A black coating that is dry indicates excessive heat, while a black coating that is moist indicates excessive cold. A black coating indicates that the disease has penetrated into the shaoyin, often indicating a critical condition.
9
Observations of Headaches in Disease Diagnosis
Why observe the head and face? The head is the meeting point of all yang, with the governor vessel and the three yang channels of the hands and feet all converging in the head. The yin channels include the ren vessel and the foot jueyin liver channel, which also converge in the head. The head is the residence of the spirit, housing the brain marrow, which is the palace of the original spirit. The brain is the sea of marrow, governed by the kidneys, with the essence of the kidneys manifesting in the hair, which is the surplus of blood, nourishing the head and face. Therefore, observing the head and face, neck, and hair is primarily to understand the heart, kidneys, and the fluctuations of qi and blood.
All six channels can have headaches:
Headache in the back of the head belongs to the taiyang channel (foot taiyang bladder channel, hand taiyang small intestine channel);
Headache on both sides belongs to the shaoyang channel (foot shaoyang gallbladder channel, hand shaoyang sanjiao channel);
Frontal headache belongs to the yangming channel (foot yangming stomach channel, hand yangming large intestine channel);
Vertex headache belongs to the jueyin channel (foot jueyin liver channel, hand jueyin pericardium channel);
Head and body pain indicates exterior evil;
Head heaviness often indicates damp-heat;
Head heaviness often indicates brain deficiency and heavy dampness;
Constant head shaking indicates internal liver wind;
Constant head shaking indicates qi and blood deficiency, leading to brain nourishment loss;
Continuous headache with alternating cold and heat indicates external invasion;
Headache with dizziness and intermittent pain indicates internal injury;
Dizziness with cold often indicates phlegm-damp obstruction, preventing clear yang from rising;
Dizziness with deficiency often indicates kidney deficiency and excessive liver yang;
Wind-phlegm headache indicates liver and spleen involvement.
10
Observations of the Hands and Feet in Disease Diagnosis
Numbness in the hands and feet, or numbness in one part of the body, often indicates qi deficiency;
Numbness in the hands and feet extending to the elbows and arms often indicates a precursor to stroke;
Involuntary movements of the hands and feet often indicate spleen and stomach qi deficiency, leading to loss of nourishment to the tendons;
Trembling hands and feet often indicate blood deficiency, leading to loss of nourishment to the tendons;
Trembling hands and feet after excessive drinking often indicate a precursor to stroke;
Inability to walk, weakness without pain indicates atrophy syndrome;
Pain in the feet while walking often indicates spleen deficiency;
Weakness and fatigue in the limbs indicates inability of the spleen essence to distribute nourishment;
Cold limbs with fatigue and weakness indicate spleen yang deficiency.
Heart disease often presents with pain in both arms; spleen disease often presents with pain in the feet; lung disease often presents with pain in the shoulders and back; kidney disease often presents with pain in the lower abdomen; liver disease often presents with pain in the sides, radiating to the lower abdomen.
11
Observations of Diet in Disease Diagnosis
Abdominal distension and pain after eating indicate excess;
Relief of pain after eating indicates deficiency;
Preference for cold food often indicates heat conditions;
Preference for hot food often indicates cold conditions;
Generally, if eating worsens the condition, it often indicates excess;
Generally, if eating provides slight relief, it often indicates deficiency;
Abdominal distension and discomfort after eating indicate qi stagnation and food obstruction;
Good appetite with distension indicates a strong stomach and weak spleen;
Inability to eat due to stomach discomfort indicates phlegm-fire obstruction;
Excessive eating with weight loss indicates internal stomach fire, leading to consumption.
12
Observations of Urination in Disease Diagnosis
Clear and pale urine indicates cold;
Yellow and red urine indicates heat;
Deep yellow urine indicates internal damp-heat;
Bright red urine indicates blood-heat;
Short and yellow urine indicates excess conditions;
Yellow-brown urine resembling pus indicates damp-heat jaundice;
Yellow-red and turbid urine with painful urination indicates damp-heat;
Foul-smelling and turbid urine indicates damp-heat affecting the bladder;
Foul-smelling and turbid urine indicates bladder damp-heat;
Frequent urination with clear urine indicates deficiency-cold;
Frequent urination with clear urine indicates qi deficiency;
Dribbling urine with abdominal pain and fever indicates excess heat;
Reduced urination or inability to urinate with cold in the lower back indicates deficiency conditions;
Dribbling urine with pain in the urethra often indicates a sexually transmitted disease;
Frequent urination indicates kidney deficiency;
Painful urination with blood indicates blood-heat;
Frequent and painful urination with red urine often indicates bladder damp-heat and kidney deficiency.
Frequent urination with thirst and weight loss often indicates diabetes.
Frequent urination with involuntary urination indicates kidney qi instability. In children, bedwetting often indicates developmental immaturity;
In boys, a scrotum that is neither tight nor loose indicates strong kidney qi; a loose scrotum often indicates deficiency or fever.
13
Observations of Bowel Movements in Disease Diagnosis
Loose, thin, and watery stools indicate spleen yang deficiency;
Weak and loose stools indicate spleen qi deficiency;
Thick, sticky, and foul-smelling stools indicate heat;
Black, tarry stools indicate blood stasis;
Purple stools indicate damp-heat;
Foul-smelling and rotten stools often indicate internal heat accumulation;
Stools with pus and blood indicate dysentery, often due to large intestine damp-heat;
Foul-smelling stools indicate internal heat accumulation and poor digestion;
Loose stools with little odor indicate spleen and stomach deficiency;
Stools that are hard and dry, with blood deficiency pulse, indicate blood depletion and dry intestines;
Constipation with abdominal fullness and pain indicates excess conditions;
Constipation with blood deficiency pulse indicates blood depletion and dry intestines;
Constipation with hard stools followed by loose stools often indicates spleen and stomach deficiency;
Natural diarrhea without abdominal pain indicates deficiency conditions;
Diarrhea occurring at dawn (“five morning diarrhea”) often indicates spleen and kidney yang deficiency;
Diarrhea with undigested food indicates cold diarrhea;
Diarrhea with urgency and burning pain indicates heat diarrhea;
Constipation with blood deficiency pulse indicates blood depletion and dry intestines;
Constipation in the elderly, chronic illness, or pregnancy often indicates fluid depletion and blood deficiency, leading to both qi and blood deficiency.
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