Gan (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; a healthy liver and gallbladder usually result in smooth, shiny, and strong nails. Otherwise, nails may become brittle, prone to breakage, or infected with fungi. 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, with some easily losing their temper over minor issues, often due to excessive liver fire. Those with liver issues tend to prefer sour foods, and their complexion may appear pale and dull. Xin (Heart): 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 blood supply. If there is blood stasis, the tongue may appear dark purple. Ulcerated tongues can indicate excessive heart fire. The face of a person with a healthy heart is rosy and vibrant. A pale, dull complexion may indicate insufficient blood supply to the heart. A dark purple face suggests excessive heart fire and blood stasis. Emotionally, a person may be overly cheerful, often smiling even when alone, which can indicate poor heart health. They may have a preference for bitter foods, such as bitter melon, almonds, and grapefruit juice. A flushed (purple-red) complexion, especially in overweight individuals, often indicates cardiovascular issues. Pi (Spleen): The spleen 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 may experience bad breath, especially in cases of gastritis or ulcers. The spleen is responsible for the limbs; a healthy spleen and stomach result in strong, toned muscles. Otherwise, muscles may become weak and flabby. Emotionally, individuals may be overly pensive, often frowning as if burdened by worries. They may have a sweet tooth (preferring sweeter foods than average) and a yellowish complexion, which can appear waxy and dull. Fei (Lung): The lungs open to the nose, which is used for breathing, inhaling fresh air, and expelling waste gases. Poor nasal health can affect normal circulation and lead to lung diseases, which may also trigger nasal inflammation. Its manifestation is seen in the skin; poor lung health results in dry, rough skin, with disordered hair growth and enlarged pores. Emotionally, individuals may be prone to sadness and worry, often crying without reason. Lin Daiyu from “Dream of the Red Chamber” is a classic example, known for her severe tuberculosis, with tears flowing from spring to autumn and then to winter. They may prefer spicy foods and have a pale complexion, lacking blood color, resembling a white sheet. Shen (Kidney): 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, indicating kidney deficiency. The kidneys nourish the bones; some may feel unwell without any detectable issues at the hospital, which can be attributed to kidney deficiency causing overall weakness. Those with kidney issues tend to prefer salty foods, may be prone to fear, and have a low tolerance for stress. A dark complexion (iron black) is common among patients in kidney dialysis centers. Kidney Area: The kidney area, considered the foundation of life, extends from the cheekbones to the ears and down to the jaw. This 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 pain in the lower back, legs, and waist. Deep and large spots in this area may 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 preference for salty foods, it suggests a higher risk of hypertension or future cardiovascular diseases. The kidneys govern the bones, and pain in the kidney area can be observed in the mouth corners, representing the shoulders and elbows, while pain radiating downwards represents the upper and lower limbs. The chin area represents pain in the cervical, thoracic, lumbar, and sacral vertebrae. If pressing the mouth together causes small pits or “bumps” on the chin, you can ask if they often experience lower back pain; the answer will likely be yes. Especially for women, they may experience pain and fatigue before and after their menstrual period. 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 susceptibility to ear itching, tinnitus, or ear problems. It is recommended to take “Gu Yuan” (Kidney Tonic) if there are issues. If the earlobes are particularly rosy and transparent, and the tip of the nose is uneven, along with signs in the kidney area, we can further examine 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 recurrent acne on the upper lip, along with a particularly round and protruding chin, it indicates a family history of prostate enlargement or hypertrophy. If a woman has recurrent sores at the corners of her mouth, it may indicate ovarian inflammation or appendicitis. Pale lips often indicate anemia or insufficient menstrual flow. If a woman has vertical lines on her upper lip, it may indicate early menopause and uterine atrophy. If moles or spots are found on the lips, or if the lip line is unclear, it is advisable to undergo a gynecological examination. Bladder Reflex Area: Located at the sides of the nose below the philtrum. If this area is red, with red blood vessels, acne, or sores, it indicates cystitis, which may cause symptoms like dark yellow, frequent, or urgent urination. Cystitis can also be related to gynecological issues. If the bridge of the nose is red but there are no frequent or urgent urination symptoms, it may indicate rhinitis. Spleen and Stomach Area: The stomach is the mother of postnatal life. The tip of the nose represents the spleen, while the wings of the nose represent the stomach. A red tip of the nose (rosacea) indicates poor spleen and stomach health. If the spleen is unhealthy, the stomach will certainly be affected; “nine out of ten people have stomach issues”. If the tip of the nose is red or swollen, or if the pores are enlarged, it may indicate spleen heat or spleen enlargement, often accompanied by symptoms like heaviness in the head, facial pain, and irritability. If the tip of the nose is yellow or white, it indicates spleen deficiency, which may lead to excessive sweating, aversion to wind, lethargy, and lack of appetite. You can observe that many people have rough, dark skin on both sides of the nose, indicating poor stomach care, especially during youth. If the wings of the nose are red, it indicates stomach fire, leading to hunger and bad breath. If there are severe red blood vessels, it is often gastritis. If the wings of the nose are grayish-blue, it indicates stomach cold, and you can feel the person’s fingertips are cold when shaking hands. This person may experience abdominal pain and diarrhea due to wind-cold. If the wings of the nose 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 more 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 skin, the liver and gallbladder area is represented by the triangular area at the temples and the bridge of the nose. (You can observe that many elderly individuals develop age spots in this area due to liver function decline or disease). The sides of the bridge of the nose represent the gallbladder; the liver and gallbladder are interconnected. Individuals with gallbladder issues often have spots or growths on the sides of the bridge 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 there are 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 appear dark or have spots, or if they are uneven, it may indicate fatty liver. If these two areas or one of them has acne (bumps), it indicates excessive liver fire, emotional instability, or menopause. If both areas have noticeable spots and the complexion appears dull and unattractive, indicating a thin physique, it suggests liver disease (hepatitis or cirrhosis). Large Intestine System: The area from the outer corner of the eyes down to the nostrils. Why do women develop melasma? One reason is hormonal imbalance, and another is that during pregnancy, the uterus may press on the large intestine, causing constipation, leading to toxins being reabsorbed into the body. TCM believes that to maintain beauty, one must first detoxify. “Shun Yi Hang” can help expel a large amount of toxins from the body, allowing many women to regain their beautiful appearance. If this area has red blood vessels, acne, spots, or moles, it indicates poor large intestine excretion, often leading to dry stools, constipation, or diarrhea. If this area has a crescent-shaped spot, it indicates constipation or hemorrhoids. The intersection of the lower part of the nose and the outer corner of the eyes is the rectal reflex area; 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. Small Intestine: The inner side of the large intestine is 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 thinness. The small intestine area may have noticeable red blood vessels, which may be caused by low blood pressure or a family history of abnormal blood pressure. Respiratory System (Lungs): Looking further up, the area between the eyebrows is representative. 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 sunken and dark, or if there are 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 areas between the eyebrows, it indicates susceptibility to pharyngitis, tonsillitis, or shortness of breath, and lung disease may also be hereditary. Individuals with poor lung function often have poor large intestine excretion. Cardiac System: The upper third of the forehead (hairline) represents the cardiac system. If there are pimples (bumps) or discoloration in this area, it indicates significant psychological stress. If there are spots, it indicates heart disease (such as cardiomyopathy); if there are moles, it indicates congenital heart function deficiency. The reflex area for the heart is located between the inner corners of the eyes on the bridge of the nose; if there are horizontal lines or prominent lines, it may indicate arrhythmia or poor heart condition. If the horizontal lines are deep and there are also 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 glands. Wrinkles on the lower lip indicate coronary heart disease, while purple lips indicate heart disease. Brain Reflex Area: The brain reflex area is located between the inner corners of the eyebrows. If there are deep vertical lines and redness in this area, it indicates insufficient blood supply to the heart and brain, headaches, neurasthenia, vivid dreams, poor sleep, palpitations, and irritability. Dark circles around the eyes indicate insufficient blood supply to the brain or poor sleep. Chest and Breast Reflex Area: This area is located between the outer corners of the eyes and the bridge of the nose. If a man has a dark or blueish hue in this area, it indicates chest tightness and shortness of breath. If a woman has a dark or blueish hue in this area, it indicates breast tenderness during menstruation. If there are moles or bumps on the inner side of the upper eyelids, 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, it indicates breast hyperplasia or breast tumors in women. TCM uses visual observation to purposefully observe the spirit, color, shape, and state of the patient 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. Theoretical Basis: Observation diagnosis is a method of diagnosing diseases based on the theories of the organs and meridians. The external body and the five internal organs are closely related; if the functions of the organs change, it will inevitably reflect in various aspects of the external body. The five internal organs and the body surface are interconnected through the twelve meridians, and they correspond to the body’s muscles, bones, skin, and flesh. 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 internal 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 external body and the five senses can infer changes in the internal organs. It can also reflect the overall vitality of the body. Changes in essence, qi, and spirit are mainly reflected in the head and eyes, and also manifest in the overall body shape, speech, breath, facial color, and even pulse and tongue appearance. Sufficient essence, qi, and spirit are signs of health; deficiency in essence, qi, and spirit indicates disease. Therefore, observation diagnosis can not only detect internal organ changes but also understand the dynamic changes in the body’s essence, qi, and spirit. Content: Observation diagnosis can be divided into overall observation and partial observation. Overall observation involves observing the spirit, color, shape, and state of the entire body, while partial observation involves understanding related lesions through changes in specific areas. 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. Observing Spirit: Focuses on the gaze, facial expressions, and mental activity, which are important for assessing clinical prognosis and life activities. (See Observing Spirit) Observing Facial Color: Focuses 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 vitality of the internal organs and the location of pathogenic factors. (See Observing Facial Color) Observing Shape: Involves diagnosing by observing the patient’s body shape and posture. 1. Observing Body Shape: Primarily involves observing the strength, fatness, and thinness of the body and the shape of the trunk and limbs. Body shape characteristics can 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 example, overweight individuals often have phlegm, while thin individuals often have heat. The shape of the trunk and limbs also has diagnostic significance; for example, a pigeon chest 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 ascites. 2. Observing Posture: Involves observing the patient’s movements, posture, and behavior. For example, trembling of the face, lips, fingers, and toes may indicate heat disease or internal injury; limb spasms, neck stiffness, and arching of the back may indicate convulsive diseases, often seen in liver wind or heat. Abnormal motor function of the limbs and various pain symptoms can also be inferred through posture. For example, weakness and lack of strength in the limbs without pain indicate atrophy; swollen and painful joints with difficulty moving indicate bi syndrome; inability to move the limbs, numbness, or stiffness indicate paralysis; holding the abdomen with a forward-leaning posture often indicates abdominal pain; holding the waist with a bent back and difficulty turning indicates back pain. Additionally, posture can also reflect behavioral intentions related to diseases. For example, shrinking away from clothing indicates aversion to cold, which may indicate exterior cold or interior cold; wanting to uncover clothing indicates aversion to heat, which may indicate exterior heat or interior heat; wanting to see people and preferring coolness often indicates yang syndrome; fearing to see people and preferring warmth often indicates yin syndrome. From sitting and lying postures, one can also infer the changes in yin and yang and the balance of righteousness and evil. 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. Observing the Head, Face, Neck, and Nape: The head, face, neck, and nape are where the governing and conception vessels intersect with the three yang meridians of the hands and feet, and the liver meridian also ascends to the head. The brain is the center of mental activity, and the brain is governed by the kidneys. The heart governs blood vessels, and blood vessels nourish the face, so the heart’s vitality is reflected in the face. Therefore, observing the head, face, neck, and nape can provide insights into the vitality of the internal organs. In fact, observing spirit and color primarily focuses on the head and face. 1. Observing the Head: An overly large or small head may result from congenital developmental issues or insufficient kidney essence. A sunken fontanelle in children 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 protruding fontanelle in children is called a filled fontanelle, often due to the invasion of warm disease fire, indicating a solid condition. Involuntary head shaking may indicate 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; tufted hair in children indicates malnutrition. 2. Observing the Face: Focuses on facial expressions and color. Other signs, such as facial swelling, indicate edema occurring in the eyelids and face; red, swollen, and painful facial skin often indicates wind-heat or fire toxin invasion; facial muscle paralysis may cause facial asymmetry, indicating wind invasion or empty collaterals, often occurring in the yangming meridian. 3. Observing the Neck and Nape: Stiffness in the head and neck may be a symptom of convulsive diseases, often caused by excessive heat or internal wind. Weakness in the head and neck may indicate one of the five soft conditions in children (soft head, soft neck, soft hands, soft feet, soft muscles), resulting from congenital insufficiency or kidney essence deficiency. If there are lumps in the throat area, such as goiter, which may move with swallowing, it indicates goiter, often caused by liver qi stagnation and phlegm accumulation, or related to local environmental factors. Observing the Five Senses: The five senses (eyes, ears, nose, mouth, tongue) are related to the vitality of the five internal organs. Observing changes in the spirit, color, and shape of the five senses can directly diagnose internal organ diseases. 1. Observing the Eyes: The eyes are the orifice of the liver, and the essence and qi of the five internal organs all converge in the eyes. The five organ-related areas of the eyes are called the five wheels (see Five Wheels and Eight Borders), so observing the eyes can not only assess the spirit but also diagnose internal organ diseases. Clear and bright 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, while pale white indicates blood deficiency; red whites indicate lung heat, while yellow indicates excess damp-heat; swelling of the eyelids indicates liver fire; redness and ulceration of the eyelids indicate spleen fire; overall redness and swelling of the eyes indicate wind-heat; swelling of the eyelids indicates phlegm-dampness, while dark eyelids indicate kidney deficiency. Swelling of the eye sockets indicates the initial signs of edema, while sunken eye sockets 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 over the eyes, it may indicate cataracts or other eye diseases. If the pupils dilate, it indicates exhaustion of kidney essence, often seen in critical conditions, or may indicate certain types of poisoning; if the pupils constrict, it often indicates excessive liver and gallbladder fire, qi deficiency, or poisoning. Drooping eyelids indicate congenital insufficiency or deficiency of the spleen and kidneys, and may also result from trauma. If the eyes roll upward or stare straight ahead, it indicates a more serious condition, often seen in children with spleen deficiency or chronic wind. 2. Observing the Ears: The ears are the orifice of the kidneys and are also where the three yang meridians of the hands and feet converge. Observing the ears primarily involves examining the color, shape, and secretion of the auricle. (See Auricle Observation) 3. Observing the Nose: The 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 lung and spleen heat, and dark indicates water retention. Dry nostrils often indicate yangming heat syndrome. If the wings of the nose are flaring, it initially indicates wind-heat obstructing the lungs, but if prolonged, it indicates lung qi deficiency. Additionally, observing the nose can also provide diagnostic significance for nasal polyps, rosacea, leprosy, syphilis, and other diseases. 4. Observing the Mouth and Lips: The 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 deficiency-cold, 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 like stomatitis, oral ulcers, angular cheilitis, and chapped lips. 5. Observing the Tongue: The tongue is the orifice of the heart and is directly or indirectly connected to the five internal organs through meridians and tendons. Observing the tongue primarily involves examining the tongue body and tongue coating. (See Tongue Diagnosis) 6. Observing the Gums: The kidneys govern the bones, and the teeth are a residue of the bones. The three yang meridians of the hands and feet are connected to the gums. Therefore, observing the teeth and gums can provide insights into kidney and gastrointestinal diseases, especially in the context of warm disease differentiation. Normal teeth are white and moist, with firm roots, indicating abundant kidney qi and fluid. Dry teeth indicate excessive heat damaging fluids, while hard and dry teeth indicate excessive yangming heat. 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, and swollen gums indicate stomach fire. Bleeding gums that are painful and red indicate stomach heat, while painless and slightly swollen gums often indicate kidney deficiency or qi deficiency. 7. Observing the Throat: The throat is a vital passage for breathing and eating, related to the lungs and stomach. In healthy individuals, the throat appears light red and smooth, with no obstructions. If the throat is ulcerated and swollen, it often indicates excess heat; if the tonsils are ulcerated and suppurating, it indicates a condition called “lactation moth”, caused by excessive heat in the lungs and stomach. If the throat is ulcerated and covered with a white membrane, resembling a white film, it is called a false membrane. A tough and difficult-to-remove false membrane often indicates diphtheria. Observing the Skin: The skin is the body’s surface, where defensive qi circulates, connecting to the lungs, and plays a role in sweating, temperature regulation, and resisting external pathogens. The essence and qi of the five internal organs circulate through the meridians, supplying qi, blood, and fluids to the skin to maintain its warmth, nourishment, and normal function. Therefore, observing the color and shape of the skin can provide insights into the nature of pathogenic factors and the vitality of the internal organs. 1. Observing Skin Color: The principles and methods are similar to observing facial color. Generally, a healthy skin color indicates that the internal organs’ essence and qi are still strong, making it easier to treat diseases; if the skin color is dry, dull, and lacks luster, it indicates weakness of the internal organs’ essence and qi, suggesting a more severe condition. Diseases that can be effectively diagnosed through skin color include erysipelas and jaundice. If the skin appears red as if dyed, it indicates erysipelas. If the entire skin is cloud-like red, with variable swelling and pain, it is called red erysipelas, caused by external wind-heat, excessive heart fire, or fetal toxins in children. If it occurs locally, it is called flowing fire; swelling and redness in the lower limbs indicate damp-heat and fire toxins descending; redness and swelling of the facial skin indicate wind-heat toxin invasion. If the skin, face, eyes, and nails appear 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 appears yellow with a blackish hue, it is called black jaundice, caused by blood stasis or kidney deficiency. 2. Observing Skin Shape: Abnormal skin shapes include swelling, spots, white patches, and blisters. Swelling in the head, face, chest, abdomen, waist, and limbs, with tight skin that leaves indentations when pressed, indicates water retention; if the skin is soft and sinks when pressed, it indicates qi stagnation. Spots are flat patches on the skin that do not feel solid, divided into yang spots and yin spots. Yang spots, also known as rash spots, are large, red or purple, and may be accompanied by fever, irritability, delirium, thirst, red tongue, and rapid pulse, often seen in external warm diseases or heat entering the blood. Yin spots vary in size, are light red or dark purple, and appear intermittently, often indicating internal injury due to insufficient qi and blood. Rashes emerge from the skin’s blood vessels, appearing as small red bumps, often seen in measles or rubella, characterized by small, raised red spots. Generally, the color and distribution of spots indicate the severity of the disease; evenly distributed and sparse red spots indicate a mild condition, while dense spots or tightly clustered spots indicate a severe condition. White spots are small, raised bumps containing fluid, often seen in patients with summer heat or dampness, indicating internal dampness and insufficient sweating. Blisters are raised areas of varying sizes containing fluid, seen in conditions like chickenpox, herpes, and eczema. Additionally, there are other skin manifestations such as boils, ulcers, and carbuncles. Observing Vessels: This involves examining the changes in the color and shape of the vessels in the hands and fingers. 1. Observing the Finger Vessels: Also known as observing children’s fingerprints, this is primarily used for children under three years old, focusing on the shape, color, thickness, and length of the vessels. The visible and distributed vessels on the palmar side of the child’s index finger can be divided into three sections: wind, qi, and life (see diagram). During examination, the doctor uses the right thumb to apply moderate pressure from the life section towards the qi and wind sections, repeatedly, until the vessels become visible for observation. Normal finger vessels are bright red, with a mix of red and yellow, often appearing slanted and single, with moderate thickness. Dark color indicates severe illness, while light color indicates mild illness; pale color often indicates deficiency, while stagnant color (difficult to push and slow to return) indicates excess; light red indicates cold, while dark red indicates heat; dark purple indicates blood stasis, indicating a critical condition; blue indicates wind or pain. If the vessels are shallow and visible, it indicates an exterior condition; if they are deep and hidden, it indicates an interior condition. Thick vessels indicate solid or heat conditions, while thin vessels indicate deficiency or cold conditions. Gradually increasing thickness indicates worsening conditions, while decreasing thickness indicates improvement. Finger vessels seen in the wind section indicate a mild condition; if they extend from the wind section to the qi section, it indicates a worsening condition; if they reach the life section, it indicates deep penetration into the internal organs, with direct extension to the fingertips indicating a critical condition. 2. Observing the Nails: Nails are the residue of the tendons and reflect the health 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 vitality of qi and blood and their circulation. Healthy nails are rosy, glossy, strong, and curved, indicating abundant qi and blood and smooth circulation. Deep red nails indicate heat in the qi level; yellow nails indicate jaundice, often accompanied by yellow skin; pale nails indicate blood deficiency or deficiency of both qi and blood; white nails indicate deficiency-cold; dark purple nails indicate blood stasis; blue nails often indicate cold conditions. If pressing the nails turns them white, and the color takes time to return, it indicates qi stagnation and blood stasis; if the color does not return, it often indicates blood deficiency. Flat and concave nails are called spoon nails, often indicating liver blood deficiency; dry and brittle nails indicate liver heat or liver blood deficiency or heart yin deficiency. Thin and brittle nails often indicate deficiency of qi and blood, and may also be seen in conditions like wind-heat, nail fungus, or chronic atrophy. 3. Observing the Thenar Vessels: The thenar area is the fleshy part at the base of the thumb, where the hand taiyin lung meridian runs, and is related to the vitality of the stomach. Observing the thenar vessels primarily involves observing color, with blue indicating cold and red indicating heat. This method is currently used less frequently. Observing Excretions: This includes observing vomit, phlegm, saliva, nasal discharge, sputum, urine, menstrual discharge, pus, and other excretions for their shape, color, quality, and quantity. 1. Vomit: Clear and watery vomit indicates cold conditions; foul-smelling and sour vomit indicates heat conditions; vomit containing undigested food and sour smell often indicates food stagnation; clear watery phlegm with dry mouth and lack of thirst indicates phlegm-dampness. Vomiting yellow-green bitter water indicates liver and gallbladder damp-heat; if vomiting fresh blood or dark clots mixed with food remnants, it indicates stomach heat or liver fire, or blood stasis. 2. Phlegm: Yellow, thick, and clotted phlegm indicates heat phlegm; white, clear, and thin phlegm indicates wind phlegm; grayish-black phlegm indicates cold phlegm; white, slippery, and abundant phlegm 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 wind-heat, while clear nasal discharge indicates wind-cold; persistent thick nasal discharge indicates nasal congestion. 4. Saliva: Involuntary drooling indicates spleen deficiency; if the saliva is thick and turbid, it indicates spleen and stomach damp-heat; children may drool due to parasitic infections or stomach heat. Excessive salivation may indicate stomach cold, food stagnation, or kidney deficiency. 5. Urine: Dark yellow and turbid urine, or white urine resembling rice water, indicates damp-heat; clear and long white urine indicates kidney yang deficiency; red and turbid urine indicates blood in the urine. 6. Menstruation: Heavy menstrual flow with thick quality or clots indicates blood heat; if the flow is heavy, thin, and light red, it indicates qi deficiency; dark menstrual blood with clots indicates blood stasis; irregular menstrual flow indicates liver qi stagnation. 7. Vaginal Discharge: Women may have a small amount of white 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 mixed red and white, it indicates liver damp-heat; if mixed colors, it indicates severe gynecological conditions. If the discharge is clear and thin, it indicates deficiency-cold; if thick and sticky, it indicates excess heat; if it resembles saliva, it indicates spleen deficiency with dampness; if it resembles pus, it indicates internal abscesses. 8. Pus: This is the liquid waste from skin and flesh, often seen in surgical ulcers. If the pus is yellow-white and thick, it indicates sufficient qi and blood expelling pathogens; if the pus is yellow-white and thin, it indicates a favorable condition; if the pus is yellow and turbid, it indicates internal heat; if the pus is green-black and thin, it indicates deep-seated toxins. Diagnosis Based on Tongue Observation: The tongue is divided into three parts for diagnosis: the tip represents the upper jiao, the middle represents the middle jiao, and the root represents the lower jiao. This method is often used for external diseases. 2. Diagnosis Based on Stomach Regions: The tip of the tongue represents the upper stomach, the middle represents the middle stomach, and the root represents the lower stomach. This method is often used for gastrointestinal diseases. The various parts of the tongue correspond to the internal organs, which is one of the current research topics in biological holography. Although there are different theories, they all have reference value. In clinical diagnosis, tongue body and coating observations should be combined for verification, but all four diagnostic methods should be considered together for comprehensive judgment, avoiding overly mechanical adherence. Observing the Tongue Body: The tongue body, also known as the tongue’s muscle and vascular tissue, can be observed in terms of spirit, color, shape, and state. The tongue coating is a layer of coating on the tongue body, which can be observed in terms of coating color and coating quality. A normal tongue appearance is referred to as “light red tongue with thin white coating”. Specifically, the tongue body is soft, flexible, and the color is light red and vibrant; its size is moderate, without abnormal shapes; the coating is thin, white, and moist, evenly distributed, and cannot be wiped off, with a root that is integrated with the tongue body, and the moisture is moderate, neither sticky nor greasy. In summary, the combined normal manifestations of the tongue body and coating represent a normal tongue appearance. 1. Observing the Tongue Body: (1) Tongue Spirit: The tongue spirit is primarily reflected in the luster and mobility of the tongue body. The key to assessing tongue spirit lies in distinguishing between vitality and dullness. Vital tongues are moist and vibrant, showing flexibility and a bright red color, indicating abundant qi and blood, and are easier to treat even in illness. Dull tongues are dry and lack luster, showing inflexibility and a dark color, indicating a poor prognosis. The presence or absence of tongue spirit reflects the vitality of the internal organs, qi, blood, and fluids, which is related to the prognosis of diseases. (2) Tongue Color: The color of the tongue body can generally be classified into light white, light red, red, crimson, purple, and blue. Except for light red, which is the normal tongue color, the others indicate disease. ① Light Red Tongue: The tongue color is light red, neither too deep nor too shallow, indicating a healthy state of qi and blood, suggesting sufficient heart qi and yang qi. ② Light White Tongue: The tongue color is lighter than light red, even lacking blood color, indicating a light white tongue. This indicates a deficiency in yang and a weakened ability to generate blood, leading to insufficient blood circulation in the tongue. ③ Red Tongue: The tongue color is bright red, deeper than light red, indicating heat conditions. This can be seen in solid or deficient heat conditions. ④ Crimson Tongue: A deep red tongue, darker than a red tongue, indicates a distinction between external and internal diseases. In external diseases, it indicates heat entering the blood; in internal diseases, it indicates excessive fire due to yin deficiency. ⑤ Purple Tongue: A purple tongue indicates blood circulation issues, often due to cold or heat. Heat can cause dryness and stagnation, while cold can lead to dampness and stagnation. ⑥ Blue Tongue: A blue tongue indicates cold conditions, often due to excessive cold or blood stasis. (3) Tongue Shape: Refers to the shape of the tongue body, including age, thickness, swelling, cracks, prickles, and teeth marks. ① Old Tongue: A rough tongue body with a hard texture indicates an old tongue, regardless of color or coating. ② Tender Tongue: A delicate tongue body with a tender color and often swollen indicates a tender tongue, often indicating deficiency. ③ Swollen Tongue: A tongue that is larger than normal, even filling the mouth, or has teeth marks, is called a swollen tongue. This often results from phlegm or dampness obstructing the tongue. ④ Thin Tongue: A thin and small tongue indicates deficiency of qi and blood. ⑤ Prickly Tongue: A tongue with enlarged soft papillae is normal, but if they become enlarged and sharp, it indicates excessive heat. The more prickles, the more severe the heat. The location of prickles can help determine the affected organ. ⑥ Cracked Tongue: A tongue with cracks that are not covered by coating indicates a cracked tongue, often due to deficiency of essence and blood. ⑦ Teeth Marks: A tongue with indentations from teeth is called a teeth-marked tongue, often due to spleen deficiency. 4) Tongue State: Refers to the state of the tongue during movement. A normal tongue state is flexible and responsive, while pathological states may include rigidity, weakness, curling, shortening, numbness, trembling, tilting, or protruding. ① Rigidity: A rigid tongue that is stiff and unresponsive indicates a rigid tongue, often due to heat disturbing the heart or damage to the yin. ② Weakness: A weak tongue that cannot move freely indicates a weak tongue, often due to extreme deficiency of qi and blood. ③ Curling: A tongue that extends outside the mouth and cannot retract is called a curling tongue, often due to excessive heat or phlegm. ④ Shortening: A tongue that is unable to extend is called a shortening tongue, often due to cold or phlegm obstruction. ⑤ Numbness: A tongue that feels numb and cannot move is called a numb tongue, often due to insufficient blood supply. ⑥ Trembling: A tongue that trembles uncontrollably is called a trembling tongue, often due to deficiency of qi and blood. ⑦ Tilting: A tongue that tilts to one side is called a tilting tongue, often due to wind invasion or phlegm obstruction. 5) Protruding: A tongue that frequently extends outside the mouth is called a protruding tongue; if the tongue licks the lips or moves around, it is called a moving tongue. Both are often due to heat in the heart and spleen. Observing Tongue Coating: The normal tongue coating is produced by the stomach qi, so the vitality of the stomach can be reflected in the changes of the tongue coating. Pathological tongue coating forms due to the 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 Quality: Refers to the thickness, moisture, roughness, stickiness, peeling, and whether it has roots. ① Thickness: The standard for thickness is whether the tongue body can be seen through the coating. If the tongue body is slightly visible, it is called thin coating, indicating normal stomach qi. If the tongue body cannot be seen, it is called thick coating, indicating deeper illness. ② Moisture: A moist tongue indicates sufficient fluids, while a dry tongue indicates insufficient fluids. ③ Roughness: A rough tongue indicates excessive heat or dampness. ④ Peeling: If the coating suddenly peels off, it indicates a severe condition. ⑤ Rooted vs. Non-rooted: Rooted coating indicates strong pathogenic factors, while non-rooted coating indicates weakened stomach qi. In summary, observing the thickness of the coating can indicate the depth of the disease; observing moisture can indicate fluid balance; observing roughness can indicate dampness; observing peeling can indicate qi and yin balance. (2) Coating Color: Refers to the color of the tongue coating, generally classified into white, yellow, gray, and black, along with mixed colors, indicating the nature of the pathogenic factors. (1) White Coating: Commonly seen in exterior or cold conditions. If the coating is thick and dry, it indicates rapid internal heat. (2) Yellow Coating: Indicates internal heat conditions. (3) Gray Coating: Indicates internal heat or cold conditions. (4) Black Coating: Indicates severe conditions, often associated with critical illness. · End ·Warm Reminder:This platform shares health-related graphic information for reference and learning purposes only and is not a substitute for medical diagnosis. Please consult a physician for guidance.⊙ Copyright Notice: The article is sourced from the internet; please contact us for removal if there are any infringements.
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