1
There is a saying in the Nanjing: “To know by observation is called spirit.” What does this “spirit” mean?
In fact, “spirit” refers to a highly sensitive perception. It does not mean that the doctor is extraordinary, like a deity, but rather that the doctor must possess a heightened sensitivity. In Zhuangzi: The Master of Nourishing Life, it mentions the butcher Ding carving an ox, stating, “Not by sight but by spirit encounter,” where “spirit” also refers to perception. Thus, the observation diagnosis in TCM primarily involves perceiving the overall impression of a person.
The character for “望” (wàng) resembles an eye above and a person standing on a slope below, gazing around.
In Chongqing, there is a saying called “打望” (dǎ wàng), which describes people enjoying the sight of handsome men and beautiful women.The characteristic of “打望” is to maintain a certain distance, observing with curiosity, focusing and scanning to appreciate the other person.
Similarly, the “望” (wàng) in observation diagnosis has a similar essence to “打望”. Although observation diagnosis carries a sense of scrutiny, the process is filled with love and care from the physician, who observes the patient comprehensively and delicately, appreciating the patient’s current state of righteous qi while also exploring the subtle traces of pathogenic factors causing symptoms, enabling the physician to grasp the overall situation and make correct judgments and decisions.
Our process of integrating the four examinations is also like this: collecting all information, reasoning and judging through the brain to reach a conclusion, and then using this conclusion as the basis for our next actions.
For example, when the human resources department recruits a new employee, upon seeing the person, one can often gauge their educational background, personality, and life experiences, as if everything is written on their face. Observation diagnosis is a similar process; it is about how we use our perception to judge what state the person is in and whether they are suitable for the current job.
When making friends, do we not also use an inner intuition to judge whether a person is worth befriending?
Therefore, for a physician, at the moment of seeing a person, everything about them is written on their face, and all diseases are reflected in their actions and words.Upon seeing this person, an impression is already formed.
The Suwen states: “The Classic of Changes says: The Dao knows the celestial phenomena above, the geographical features below, and the human affairs in between, which can lead to longevity.” If we have rich life experiences, upon seeing any person, we will see a background that matches them.
2
So, what exactly does observation diagnosis observe?
TCM has a characteristic called “司外揣内” (sī wài chuāi nèi), meaning to interpret the external phenomena to understand the internal state. The “external” refers to external manifestations, while the “internal” refers to the state of qi and blood circulation. We often say, “Only qi and blood can fill the body.” Therefore, the content of diagnosis is essentially the internal state of qi and blood circulation. The purpose of diagnosis is not merely to identify what disease the person has, but to conclude the state of qi and blood circulation within the body through the integration of the four examinations.
For qi and blood, their pathway is called meridians (jingluo), their residence is called organs (zangfu), and the supporting structures are our limbs and bones. Qi and blood nourish the organs and limbs through the meridians and organs, producing a series of spiritual and functional movements.
Thus, our research ultimately revolves around qi and blood. Where is the qi and blood located, how much is there, what is the speed of circulation, and in what direction? This includes storage volume, circulation volume, and direction. From here, we can discern deficiency and excess, cold and heat, and the overall framework. This serves as the basis for all subsequent diagnosis and treatment.
3
What specific aspects does observation diagnosis focus on? For instance, when a person stands here, what can everyone see?
When a person stands here, what can everyone observe? It can be roughly divided into two parts: spirit and form.
The “spirit” part includes: demeanor, aura, expression, and tension.
The “form” part includes: clothing, body shape, skin, hair, eyes, eyebrows, and movements.
By listing these two parts, we know what we should observe.
Although we see many people every day, we may never focus all our attention on one person. When we look at a person, focusing all our attention on them allows us to quietly observe them. “望” (wàng) is essentially about quietly observing them.
When a person comes to see you, their demeanor is very important. If they sit in front of you with a majestic aura, you will know that their usual life is at a high position. When you adjust them, their qi may easily float up. If you step on them, it will come down. Some people have an air of arrogance, making them seem invincible; such people’s qi also tends to rise.If you see someone who is very frightened, they may have a deficiency of heart and gallbladder qi; if someone appears weak and droops their head, they may not have slept well last night or may be suffering from long-term malnutrition.Demeanor, aura, and expression all reflect a person’s state. When a person arrives, you will have a sense of their position and mindset in viewing the world.There are two supports here: one is the support of the body’s qi and blood, and the other is the support of their identity and status. By understanding their qi and blood, and then their identity and status, you will know what can be done within the body and what can be done outside of it.Many people become ill because of their identity and status. For example, a famous actor who is used to being worshipped by others may feel frustrated due to some reason and unable to land roles; when they come to see you, their aura will have changed. If they come to see you when they are flourishing and their career is thriving, it will be a different state. Different states require different treatments.Within identity and status, there is also their daily routine. When they work and when they rest is also very important. For instance, a writer may dine, drink, and chat with others during the day, but at night they need to write; an artist may have various social engagements during the day but work all night. A person’s daily routine directly affects their qi and blood state.Knowing these factors is essential; otherwise, one cannot make correct judgments and may often misunderstand the other party.
4
Tension and relaxation have similarities with the previously mentioned aura. When a person sits in front of you, whether they are tense or relaxed is related to the amount of qi and blood within them. If the amount of qi and blood is sufficient, the person is relaxed; if the amount is insufficient or they are cold, they will be more tense.On the other hand, a person’s tension and relaxation are also related to their emotions.When observing any person, we must consider the emotional aspect.Emotions have a significant impact on the body. No matter how healthy a person is, if they suffer an emotional blow, it can cause great damage. There is a saying: “A man does not easily shed tears, but only because he has not reached the point of heartbreak.”
Emotions are not independent of the body. Every emotion has its physiological basis, which is where its qi mechanism lies.“Anger causes qi to rise, joy causes qi to relax, sadness causes qi to dissipate, fear causes qi to descend, cold causes qi to contract, heat causes qi to leak, shock causes qi to become chaotic, labor causes qi to deplete, and thinking causes qi to stagnate.”If these key points are understood, it becomes easier to find solutions, and the physician will know how to guide the patient’s qi and blood in the right direction. We can use the principles of the five elements to design methods for emotional regulation. On one hand, we create favorable conditions for emotions externally, and on the other hand, we adjust the flow and speed of qi and blood internally. Both work together to regulate the qi mechanism, ultimately changing the emotions.All diseases can be summarized in four characters: “qi and blood disorder.” Whenever a sick person comes to us, we need to understand whether their qi and blood are stagnating in a certain area or if they are moving in the wrong direction. Our treatment is essentially about finding ways to allocate their qi and blood as needed. The circulation of qi and blood can be summarized in four actions: ascending, descending, exiting, and entering. If we can smooth out the flow of qi and blood, we have succeeded.● Treating illness is a momentary inspiration.● Summary of Dr. Lin Jie’s TCM course information.● Recommended method suitable for meditation and daily health maintenance, which can help replenish original qi.(This article is compiled from the transcripts of Dr. Lin Jie’s TCM course.)