Introduction: “To know by observation is called spirit (shen),” how can we improve the accuracy of observation diagnosis? Today, let us learn from Mr. Wei Changchun’s insights on observation diagnosis!
In Traditional Chinese Medicine (TCM) diagnosis, the four examinations and eight principles are fundamental, with observation being the most important. A detailed observation can provide a preliminary understanding of the severity and prognosis of the condition, which is of practical value.
1. Observation of the Face
In observation diagnosis, the face is of primary importance.
A pale or bluish face indicates pain; generally, a bluish complexion, a slow pulse, a pale red or pale white tongue, and a thin white or slippery white coating without fever suggests stagnation of qi, spleen dysfunction, poor qi flow, and fullness or pain in the chest and abdomen, indicating the need to move the qi in the chest.
If the complexion is bluish and dark, with a large pulse, shortness of breath, spontaneous sweating, and loose stools without fever, it often indicates a long-term deficiency of the spleen and kidneys, with dysfunction of ascending and descending, requiring urgent intake of qi and consolidation of the condition.
If a woman has a pale blue complexion and sunken eye sockets, it indicates cold stagnation and blood stasis.
If a child has a pale blue complexion, delayed speech and movement, and although plump, lacks color in the face, and is prone to diarrhea and colds, it indicates congenital deficiency of yang qi, requiring warming of the three burners and tonifying the spleen and kidneys.
Individuals who have been vegetarian for years may show malnutrition, with a complexion that is pale with a bluish tint, and may have edema and shortness of breath, indicating qi deficiency and damp stagnation.
If there is an external pathogen, the face may appear red and tender with a white tint, resembling a slight intoxication; the pulse is large and rapid, while the deep pulse is weak and slow, with a bright red tongue and moist surface without coating, indicating a deficiency of the lower source, floating yang rising, and a false appearance of deficiency, which should not be mistaken for excess heat.
If the face is completely red, with a rapid pulse, a deep red tongue, thick yellow coating, thirst, and constipation, it indicates excessive dryness and heat in the stomach and intestines. It is advisable to clear and resolve hidden heat and urgently nourish yin.
In both cases, the complexion appears red, but the patterns of deficiency and excess are vastly different; careful consideration and discernment are necessary during diagnosis to avoid mistakes.
If a long-term illness leads to a rosy complexion with bright red cheeks and a rapid, slippery pulse, it indicates true yin exhaustion and rising fire, historically referred to as “peach blossom disease,” which is a sign of tuberculosis.
Individuals who are thin with prominent cheekbones and have a history of lung obstruction or hemoptysis, upon exposure to external pathogens, should be treated with a comprehensive approach, addressing both the symptoms and the root cause, ensuring that exterior treatments do not hinder the underlying deficiency, and preserving the source without allowing external pathogens to invade. This is why ancient practitioners included tonifying herbs in exterior-releasing formulas and added exterior-releasing herbs in tonifying formulas.
Internal injuries often present with a sallow, lifeless complexion, lacking vitality, or a yellow, thin, pale appearance, or a bluish, dull, and dry complexion; while external pathogens often present with a red or yellow complexion, or an oily sheen, indicating a more robust spirit.
Dark circles around the eyes are often caused by anger. Symptoms include fullness in the chest and abdomen, dizziness, irritability, and insomnia; treatment should focus on relieving stagnation, regulating qi, and soothing the liver and stomach.
Sunken eye sockets with a yellow, thin, lifeless complexion often indicate deficiency of central qi, or prolonged illness with diarrhea, indicating deficiency of both spleen and kidneys.
A pale complexion with a bluish nose often indicates abdominal pain or diarrhea, suggesting a deficiency-cold condition, and treatment should focus on warming and tonifying the yang of the spleen and kidneys.
If a child has a bluish nose and frequently experiences diarrhea and crying, it indicates spleen deficiency, and treatment should focus on strengthening the spleen and resolving accumulation.
2. Observation of the Lips
The lips are associated with the spleen and are the foundation of muscle. Observing the color of the lips can reveal spleen diseases.
Dry and chapped lips often indicate food accumulation.
Purple or dark lips, along with a peculiar temperament and irritability, indicate spleen qi disharmony and poor qi flow; treatment should focus on regulating qi and blood, and harmonizing the liver and spleen.
Pale lips with a yellow face, vomiting saliva, and reduced appetite indicate weakness of the stomach and inability to transform; treatment should focus on warming the middle and stopping vomiting.
Lips that are pale yellow with abdominal fullness indicate internal damp-heat and inability to transform.
Red or purple lips indicate blood stasis with heat; if there is pain from parasitic accumulation, cooling blood, detoxifying, and expelling parasites should be used.
Ulcerated lips with vomiting, headache, and abdominal pain indicate parasitic accumulation.
Bright red lips with symptoms of hemoptysis, irritability, and constipation indicate stomach heat; treatment should focus on clearing heat, harmonizing the stomach, and dispelling stasis.
3. Observation of the Nose
Dry nostrils indicate heat in the yangming channel, which may lead to nosebleeds over time.
Dry nostrils that are black like coal, with symptoms of confusion or high fever, indicate deep yang toxin heat; treatment should focus on cooling blood and detoxifying.
Flared nostrils in children indicate that the evil heat cannot reach the lungs, indicating severe pneumonia; in adults, it often indicates phlegm-heat obstructing the lungs. Treatment should focus on clearing heat, transforming phlegm, and opening the lungs. In cases of prolonged illness with a pale complexion, sweating, and cold limbs, flared nostrils indicate a deficiency condition of lung qi.
In postpartum women, black nostrils often indicate a dangerous condition of lochia rising; immediate support for the original spirit and expulsion of blood stasis is necessary.
A black and cold nose bridge indicates deficiency-cold; a bluish color indicates kidney deficiency, often accompanied by low back pain and nocturnal emissions in men, and leukorrhea and uterine cold in women; treatment should focus on warming kidney qi.
4. Observation of the Teeth
The teeth are a residue of the kidneys, and the gums are the collateral of the stomach.Heat pathogens can dry up stomach fluids and deplete kidney essence; if the disease deeply affects the blood, it can lead to swelling in the gums. Yang blood appears purple like dry lacquer, while yin blood appears yellow like sauce. Treatment for yang blood focuses on clearing the stomach; treatment for yin blood focuses on rescuing the kidneys.
Teeth that are dry and shiny like beans indicate severe stomach heat; treatment should focus on clearing and draining.
If the teeth appear like dry bones, it indicates depletion of kidney and stomach fluids; if the upper half is still moist, it indicates that water is not ascending and fire is rising. Urgent treatment should focus on clearing fire and rescuing water until the dry areas become moist and stable.
Grinding teeth indicates a spasm due to heat pathogens transforming into wind. If grinding is unilateral, it indicates aggressive stomach heat; if grinding is bilateral with a tight jaw and weak pulse, it indicates either a decline in stomach qi or internal wind invading the collaterals, or a deficiency of water and excess of wood, indicating a sign of extreme deficiency presenting as excess.
If the teeth are covered in a grayish paste, it indicates that the stomach lacks qi; this condition is often serious.
Initial symptoms of teeth bleeding with pain indicate dental inflammation, which is due to stomach fire; if there is no pain, it indicates internal liver fire.
Teeth that are dry and without residue indicate danger; if dry but with residue, it indicates kidney heat and stomach turbidity, which can be treated with slight purging or by clearing the stomach and nourishing the kidneys.
5. Observation of the Hands
Clubbed fingers indicate pulmonary tuberculosis.
Fingernails with ridges often indicate liver disease.
Dark or bluish nails often indicate anemia, and may also belong to a deficiency-cold condition. Purple nails indicate blood stasis. The color of the nails indicates blood coagulation.
In individuals with chronic illness, although they may be emaciated, if the fleshy part of the palm (thenar) is prominent, the condition may be treatable; if other areas have sufficient muscle but the area behind the thumb is flat and sunken, the condition is critical and difficult to treat.
6. Observation of the Tongue
In general, a normal tongue should be rosy and moist.
A pale red tongue often indicates deficiency; a pale white tongue indicates deficiency of original yang; a deep red tongue indicates heat; a bright red tongue indicates heat entering the nutritive and blood levels in external conditions, while in internal injuries, it indicates damage to the five organs and depletion of yin fluids.
A tongue that is smooth and devoid of coating indicates insufficient liver and kidney yin. If it suddenly shows a floating white coating upon exposure to external pathogens, avoid using pungent and drying exterior-releasing herbs; instead, provide mild flavors to clear and diffuse lung qi. Once the qi is unblocked, the external pathogen will resolve, and the white coating will recede, after which nourishing and supportive agents can be administered.
A pale tongue with a white coating often indicates deficiency-cold, but there may also be cases of phlegm-heat obstructing, presenting with chest tightness and irritability, requiring the use of slightly bitter and mildly cold agents to resolve.Once the hidden pathogen is expelled, the tongue may turn red, and the coating may turn yellow or completely disappear, at which point chest tightness will ease and irritability will settle. If the diagnosis is unclear and warming agents are mistakenly used for deficiency-cold, it may lead to a sudden change in symptoms.
A tongue with a smooth surface and a thin coating on the edges indicates injury to the stomach yin and insufficient fluids; avoid using pungent and drying agents, and ensure that stomach fluids are adequately supported.
A tongue with a pale red coating and cracks indicates damage to both qi and yin of the spleen and stomach. If there is an external pathogen, it is necessary to supplement with nourishing agents to prevent exacerbation of both internal and external conditions.
If the tongue is dry with prickles and has horizontal lines, it indicates transformation of food into fire.
A tongue with a thick yellow coating generally indicates a heat condition.If symptoms include fullness in the chest, qi counterflow, abdominal distension after eating, clear and prolonged urination, and thin stools, it indicates middle deficiency and qi stagnation.
A tongue with a thick yellow and greasy coating, plump but not dry, indicates failure of clear qi to rise and turbid qi to descend. Avoid using bitter and cold purging methods; instead, use light methods to resolve excess, aromatic herbs to awaken the spleen and stomach, and once the coating gradually transforms, then proceed with sweet and warm tonics for the spleen and stomach.
A bright red tongue often indicates internal heat.
A red tip indicates heart fire; red on both sides indicates hidden heat; if the upper half has a white coating and the lower half is pure red, it indicates a raging heart fire, requiring urgent administration of large doses to clear the heat from the nutritive level, without concern for the white greasy coating.
Small red spots on the tongue often indicate internal frustration due to unhappiness; the more spots, the more severe the frustration.
A pale red tongue with small red spots indicates weakness of the spleen and stomach, along with liver and gallbladder qi stagnation; a deep red tongue with small red spots indicates yin deficiency and blood heat, along with frustration and discomfort.
Blue-purple edges on the tongue often indicate old injuries or blood stasis; if there is a new illness, attention should be paid to treating the old stasis.
A bright red tongue without moisture, although often associated with yin deficiency and blood heat, may also be due to phlegm obstructing the qi mechanism, preventing fluids from ascending. At this time, it is essential to inquire whether the chest is comfortable or distended, whether the head is clear or dizzy, and whether the bowels are functioning normally or constipated to confirm the diagnosis.
A bright red tongue with a shiny surface, resembling a mirror, is known as a “mirror tongue,” often indicating a critical condition. In cases of external pathogens, it suggests a pre-existing yin deficiency and blood heat, with new heat entering the blood level. Immediate administration of large doses of cooling blood-clearing agents is necessary for urgent treatment. If it is due to internal obstruction, such as esophageal obstruction or liver cirrhosis with ascites, it indicates exposure of true qi and depletion of yin fluids, which is a critical sign.
A bright red tongue with a white greasy coating (commonly known as “rice flower coating”) indicates damage to both qi and fluids, and internal failure; if there is prolonged diarrhea with refusal to eat and symptoms of hiccups, it indicates counterflow of qi and inability to retain.
A pale red, plump tongue with a white slippery coating often indicates qi deficiency and insufficient original yang, but may also belong to phlegm-damp conditions.
A tender red tongue with teeth marks on the edges indicates weakness of the spleen and blood deficiency, often accompanied by indigestion, stomach pain, and tidal fever.
A dark-colored tongue often indicates blood stasis. A bluish-dark tongue indicates cold stasis in the liver; a purple-dark tongue indicates heat stasis; a bluish-dark tongue at the root indicates stasis in the lower jiao, often associated with conditions like hernias.
A pale white, dry tongue with cracks in the elderly, along with shortness of breath and no heat, indicates a weak condition of both qi and fluids, requiring urgent use of warming and nourishing agents.
Black coating indicates a distinction between cold and heat.
A gray-black coating with a pale red, moist tongue that is not purple or red indicates a sign of deficiency-cold; a plump tongue indicates spleen cold, while a short and round tongue indicates kidney cold;
If a tongue has a dry, black coating with a deep red, dry, and lack of moisture, it indicates a heat condition: if symptoms include thirst and heat, it indicates yangming dryness heat; if thirst leads to cold, with heart pain, it indicates a jueyin condition. Additionally, there are cases of spleen yang deficiency with dampness, which may also present with black coating, but the tongue is pale and not dry.
Individuals with spleen and stomach qi dysfunction often present with discolored coatings.For example, after eating olives, the coating may turn black; after eating loquats, it may turn yellow; after consuming vinegar, it may turn gray, and various coatings may appear after taking medications. It is essential to inquire about what was consumed to determine the cause and avoid misdiagnosis.
In cases of infectious diseases, appropriate medication will lead to the tongue coating changing from white to yellow, from yellow to retreating, and then returning to a new thin white coating, which is a favorable sign; if the medication is inappropriate, the coating may change from yellow to white, from white to black, which is an unfavorable sign. Sudden changes that are not gradual indicate a critical condition.
Generally, individuals with strong stomach qi have a soft tongue, and their conditions are easier to treat; if stomach qi is absent, the tongue becomes hard, making treatment difficult. For example, in cases of stroke affecting the organs, the tongue may be difficult to articulate; in cases of typhoid fever, the tongue may be short, indicating a critical condition. If external pathogens cause damp-heat or summer heat, and the tongue is hard and unable to speak, it often indicates a condition of excess heat in the stomach and intestines.
Note:Specific treatments and medications should follow medical advice!This article is excerpted from “Selected Clinical Experiences of Wei Changchun,” compiled and edited by Zhejiang Chinese Medicine Hospital, published by Zhejiang Science and Technology Press, October 1984. This public account is used for academic exchange; if there is any infringement, please contact us for deletion, and please indicate the source when reprinting.
The cover image is sourced from Shetu Network.
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