Observation of local conditions, also known as sectional observation, is based on overall observation and focuses on specific areas of the patient’s body according to the condition or diagnostic needs. Since overall pathological changes can reflect in local areas, observing local conditions helps to understand the overall pathological situation.
（一）Observation of the Head and Face
1. Observation of the Head：The observation of the head mainly involves examining the shape, dynamics, and changes in hair color and loss. This helps to understand the conditions of the brain and kidneys, as well as the state of Qi and blood.
（1）Observation of Head Shape：If a child’s head is too large or too small, accompanied by intellectual disability, it is often due to congenital insufficiency and kidney essence deficiency. An enlarged head may be caused by hydrocephalus. When observing a child’s head, it is essential to examine the fontanelle. If the fontanelle is sunken, it is termed “sunken fontanelle,” indicating fluid damage and insufficient brain marrow; if the fontanelle is bulging, it is termed “self-filling,” often due to excessive heat evil, indicating a disease of the brain marrow; if the fontanelle fails to close in a timely manner, it is termed “open fontanelle,” indicating insufficient kidney Qi and developmental issues. Whether in adults or children, an inability to control head shaking is a sign of internal liver wind movement.
（2）Observation of Hair：In normal individuals, hair is thick, black, and lustrous, indicating abundant kidney Qi. Sparse or slow-growing hair indicates kidney Qi deficiency.
Yellow, dry hair with prolonged hair loss often indicates insufficient essence and blood. Sudden patchy hair loss is caused by blood deficiency and wind. Hair loss in adolescents is often due to kidney deficiency or blood heat. Premature graying in youth, accompanied by forgetfulness and weakness in the lower back and knees, indicates kidney deficiency; if there are no other symptoms, it is not pathological.
Children with hair knots resembling tassels are often seen in malnutrition diseases.
2. Observation of the Face：The observation of facial complexion has been discussed previously. Here, we focus on changes in facial shape. Facial swelling is often seen in edema.
Swelling of the parotid gland, either unilaterally or bilaterally, that suddenly enlarges and is painful to touch, often accompanied by sore throat or hearing loss, is often due to warm toxins, seen in mumps. Facial asymmetry, with the mouth and eyes skewed, often indicates a stroke. A frightened expression is often seen in children with convulsions or rabies, while a grimacing expression is seen in tetanus patients.
（二）Observation of the Five Organs
Observation of the five organs involves examining the eyes, nose, ears, lips, mouth, gums, and throat. Observing abnormal changes in these organs can provide insights into visceral diseases.
1. Observation of the Eyes：The observation of the eyes mainly focuses on their spirit, color, shape, and state.
（1）Eye Spirit：The presence or absence of spirit in the eyes is a key focus. Clear vision, vibrant inner essence, and abundant spirit light indicate the eyes have spirit; if the sclera is cloudy, the pupil is dull, lacking brilliance, and the light is superficial, the eyes lack spirit.
（2）Eye Color：If the eyes are red, it indicates heart fire; if the sclera is red, it indicates lung fire; if the sclera shows red vessels, it indicates yin deficiency and excess fire; if the eyelids are red, swollen, and ulcerated, it indicates phlegm fire; if the entire eye is red and swollen with tears in the wind, it indicates liver channel wind heat. If the eye discharge is pale white, it indicates blood deficiency. Yellowing of the sclera indicates jaundice. Black discoloration around the eyes indicates kidney deficiency and water retention, or cold dampness affecting the lower body.
（3）Eye Shape：Slight swelling of the eyes, resembling a sleeping silkworm, indicates early-stage edema; elderly individuals with facial swelling often have kidney Qi deficiency. Sunken eye sockets indicate depletion of yin fluids or exhaustion of essence. Bulging eyes with shortness of breath indicate lung distension; protruding eyes with swelling indicate goiter.
（4）Eye State：If the eyes are fixed and cannot move, it is termed “eye retraction,” often seen in convulsions, seizures, or severe cases of spirit exhaustion. Crossed eyes indicate internal liver wind movement. Drooping eyelids, termed “eyelid failure,” may be congenital or acquired due to spleen Qi deficiency or post-traumatic blood and Qi disharmony. Dilated pupils often indicate exhaustion of kidney essence, a sign of impending death.
2. Observation of the Nose：The observation of the nose mainly examines its color, shape, and secretions.
（1）Nasal Color：A bright and moist nose indicates that the stomach Qi is intact or has recovered after illness. A red nose tip indicates lung heat; a white nose indicates Qi deficiency and blood loss; a yellow nose indicates internal damp heat; a blue nose often indicates abdominal pain; a slightly black nose indicates internal water retention.
A dry and cracked nose tip indicates spleen and stomach deficiency, where the stomach Qi cannot nourish the nose. A dry nasal cavity indicates yin deficiency and internal heat, or dryness invading the lungs; if the nose is dry and bleeds, it is often due to excessive yang in the upper body.
（2）Nasal Shape：A red nose tip or nose with papules is often seen in rosacea, caused by stomach fire affecting the lungs and blood stasis in the lung vessels. Nasal polyps that obstruct the nasal passages, making breathing difficult, are termed “nasal hemorrhoids,” often caused by wind heat stagnating in the lung channel. Frequent flaring of the nostrils during breathing indicates “nasal flaring.” If this occurs in chronic illness, it indicates lung and kidney Qi deficiency; if it occurs in acute illness, it often indicates lung heat.
（3）Nasal Secretions：Clear nasal discharge indicates external wind-cold; turbid nasal discharge indicates external wind-heat; foul-smelling turbid discharge indicates nasal phlegm, often due to external wind-heat or heat accumulation in the gallbladder channel.
3. Observation of the Ears：The observation of the ears should focus on their color, shape, and internal conditions.
（1）Ear Color：Normal ear color is slightly yellow and rosy. A predominantly white ear color often indicates a cold condition; a blue-black ear color often indicates pain; a dry, blackened ear rim indicates extreme kidney essence deficiency, where essence fails to nourish; a red vein on the ear and a cool ear base often indicate a precursor to numbness. Ear color should ideally be rosy; yellow, white, blue, or black colors indicate pathological conditions.
（2）Ear Shape：Normal ears are thick and moist, indicating sufficient congenital kidney Qi. If the ear is thick and large, it indicates excess; if the ear is thin and small, it indicates deficiency. Enlarged ears indicate excess evil; thin ears indicate deficiency of righteous Qi. Thin and red or black ears indicate kidney essence deficiency. A dry ear rim is often seen in lower body deficiency. A deformed ear rim is often seen in chronic blood stasis. Atrophy of the ear rim indicates extreme exhaustion of kidney Qi.
（3）Internal Ear Changes：Pus in the ear indicates ear pus, caused by damp heat in the liver and gallbladder, accumulating over time. If small growths appear in the ear resembling a goat’s nipple, they are termed “ear hemorrhoids”; if they protrude outside the ear and are painful to touch, they are termed “ear protrusions,” both caused by liver channel fire or kidney channel fire, or stomach fire accumulation.
4. Observation of the Mouth and Lips：Observation of the lips requires attention to their color and dynamic changes.
（1）Observation of the Lips：The clinical significance of lip color diagnosis is similar to that of facial color, but due to the thin and transparent mucosa of the lips, their color is more pronounced than that of the face. Normal lips are red and moist. Deep red lips indicate excess or heat; pale red lips often indicate deficiency or cold; deep red and dry lips indicate extreme heat damaging fluids; tender red lips indicate yin deficiency and excess fire; pale white lips often indicate deficiency of both Qi and blood; blue-purple lips often indicate deficiency of yang Qi and stagnation of blood flow. Dry, cracked lips indicate fluid damage, leading to loss of moisture. Ulcerated lips often result from heat accumulation in the spleen and stomach, causing heat evil to burn. Ulceration inside the lips, with pale red color, indicates upward fire; sores at the corners of the lips, red and swollen, indicate heat accumulation in the heart and spleen.
（2）Observation of the Mouth：Observation of the mouth should focus on its shape: a closed mouth that is difficult to open indicates a spasm; if the mouth is closed and speech is difficult, accompanied by limb convulsions, it often indicates a spasm or convulsion; if accompanied by hemiplegia, it indicates a severe case of stroke. A tightly closed mouth indicates a common symptom in children with umbilical wind or adults with tetanus. A skewed mouth, either left or right, indicates a stroke. An open mouth that cannot close indicates impending lung Qi exhaustion.
5. Observation of the Teeth and Gums：Observation of the teeth and gums should focus on their color, shape, and moisture changes.
（1）Observation of the Teeth：Teeth that lack luster indicate fluid damage. Dry teeth indicate stomach fluid damage; teeth that are dry as stone indicate extreme heat in the stomach and intestines, leading to severe fluid damage; dry teeth resembling withered bones indicate exhaustion of kidney essence, failing to nourish the teeth; loose and sparse teeth with exposed roots often indicate kidney deficiency or upward fire. Grinding teeth during sleep often indicates internal liver wind movement. Grinding teeth during wakefulness often indicates stomach heat or accumulation of parasites. Teeth with cavities and foul odor often indicate dental caries, commonly referred to as “cavity teeth.”
（2）Observation of the Gums：Red and moist gums are normal. Pale white gums indicate blood deficiency; swollen or bleeding gums often indicate stomach fire. Slightly red and swollen gums that are not painful, or bleeding between the teeth, often indicate kidney yin deficiency and upward fire; pale white gums that are not swollen or painful, with bleeding between the teeth, indicate spleen deficiency unable to hold blood. Ulcerated gums with foul-smelling blood indicate dental disease.
6. Observation of the Throat：Symptoms of throat diseases are numerous; here we only introduce general observable content. If the throat is red and swollen and painful, it often indicates accumulation of heat in the lungs and stomach; if red and swollen with yellow-white necrotic spots, it indicates deep heat toxin; if it is bright red and tender with mild swelling, it indicates excess fire due to yin deficiency.
If both sides of the throat are red and swollen, protruding like papillae, it is termed “papillary throat,” indicating excessive lung and stomach heat, with external wind evil accumulating. If a gray-white membrane appears in the throat that cannot be wiped away, and wiping causes bleeding, it indicates diphtheria, which is infectious and is also known as “epidemic throat.”
（三）Observation of the Body
The observation of the body includes the neck, chest, abdomen, waist, back, and the front and back of the lower body.
1. Observation of the Neck：The neck connects the head and trunk; the front is called the neck, and the back is called the nape. The observation of the neck should focus on shape and dynamic changes.
（1）Shape Changes：If there are lumps or tumors in the area under the jaw that move with swallowing, with unchanged skin color and no pain, and are persistent and non-ulcerated, it is termed “goiter,” commonly known as “big neck.” If there are lumps on the side of the neck resembling beads, with unchanged skin color and initial pain, it is termed “lymphadenitis.”
（2）Dynamic Changes：If the neck is weak and lacks strength, it is termed “weak neck.” If the neck is stiff, with difficulty bending forward and turning sideways, it is termed “stiff neck.” If stiffness occurs after waking, it is termed “wry neck.” Stiffness of the neck with a bowing posture is often due to internal liver wind movement.
2. Observation of the Chest：The area above the diaphragm and below the collarbone is termed the chest. Observation of the chest should focus on shape changes.
In normal individuals, the chest is symmetrical and moves freely during breathing. If a child’s chest protrudes forward and outward, becoming deformed, it is termed “chicken breast,” often due to congenital insufficiency and postnatal imbalance, leading to inadequate nourishment of the bones. If the chest appears barrel-shaped, with cough, wheezing, and emaciation, it indicates phlegm heat obstructing lung Qi. If the patient experiences fullness between the ribs, with pain upon coughing, it is often due to fluid retention in the chest. If there are hard lumps in the ribs resembling beads, it indicates rickets, often due to kidney essence deficiency, leading to soft and deformed bones. Localized redness and swelling of the breasts, even ulceration and pus, indicate breast abscess, often due to liver dysfunction, leading to obstruction of milk flow.
3. Observation of the Abdomen：The area below the diaphragm and above the pelvis is termed the abdomen. Abdominal observation mainly examines changes in abdominal shape.
If the abdominal skin is taut and distended like a drum, it is termed “distension.” If the abdomen is high when standing and flat when lying down, it indicates “water distension.” If the abdomen is sunken like a boat, it is termed “abdominal depression,” often seen in chronic illness with severe deficiency of spleen and stomach Qi, or in new illnesses with depletion of yin fluids. If an infant has a protruding mass in the umbilical area with shiny skin, it is termed “umbilical protrusion,” also known as umbilical hernia.
4. Observation of the Back：The area from the nape to the waist is termed the back. Observation of the back mainly focuses on shape changes.
If the spine protrudes backward, it is termed “humpback,” often due to insufficient nourishment during childhood, leading to spinal deformity. If the patient has a stiff neck and bends forward, forming a bow shape, it is termed “bowing posture,” often seen in tetanus or convulsions. Boils, sores, and abscesses occurring on the back are collectively termed “back sores,” often due to fire toxins stagnating in the muscles.
5. Observation of the Waist：The area below the ribs and above the iliac crest is termed the waist. Observation of the waist mainly focuses on shape changes.
If there is pain in the waist with difficulty turning, it is termed “waist stiffness,” often due to external cold and dampness, leading to obstruction of Qi, or due to external injury causing blood stasis. If there are water blisters on the skin of the waist, clustered like beads, it is termed “waist fire dan.”
6. Observation of the Front Genitals：The front genitals, also known as the “lower yin,” refer to the external reproductive organs and urethra in both males and females. The front genitals have reproductive and urination functions.
（1）Scrotum：If the scrotum is enlarged, non-itchy, and transparent, it indicates “water hernia.” If the scrotum is enlarged, painful, and not hard, it indicates “inguinal hernia.” If there is a mass in the scrotum that retracts when lying down and descends when standing, it is termed “fox hernia.”
（2）Penis：If the penis is soft and retracts into the abdomen, it indicates “penile retraction,” often due to deficiency of yang Qi or external cold condensing the meridians. If the penis has hard lumps that ulcerate and discharge pus, it is often seen in syphilis.
（3）Female Genitals：If there is a protrusion in the female genitals resembling a pear, it is termed “prolapsed uterus,” often due to insufficient middle Qi, postpartum fatigue, or weakness in lifting, causing the uterus to descend outside the vaginal opening.
7. Observation of the Back Genitals：The back genitals refer to the anus, also known as the “po gate,” which has the function of defecation. Observation of the back genitals should focus on prolapse, hemorrhoids, and anal fissures.
Prolapse of the rectum outside the anus is termed “rectal prolapse.” If there are protrusions around the anus, with pain and even bleeding during defecation, it indicates “hemorrhoids,” with external hemorrhoids occurring outside the anus and internal hemorrhoids occurring inside; if both are present, it is termed “mixed hemorrhoids.” If hemorrhoids ulcerate and do not heal over time, leading to the formation of a fistula around the anus, it is termed “anal fistula.” If there is a fissure in the anus, causing pain and bleeding during defecation, it is termed “anal fissure.”
（四）Observation of the Limbs
The limbs refer to the two lower limbs and two upper limbs. Observation of the limbs mainly examines the shape and color changes of the hands, feet, palms, wrists, fingers, and toes.
1. Observation of the Hands and Feet：If the hands and feet are stiff and difficult to flex or extend, it is often due to cold condensing the meridians. If they are flexed but cannot be extended, it indicates muscle spasms; if they are extended but cannot be flexed, it indicates joint stiffness. Hand and foot convulsions are often seen in cases of excessive heat or internal liver wind movement; if the hands and feet tremble uncontrollably, it indicates deficiency of both Qi and blood, leading to internal wind movement. Muscle atrophy in the limbs is often due to spleen Qi deficiency and insufficient nourishment of the blood. Hemiplegia indicates paralysis. If the feet are weak and unable to walk, it is termed “lower weakness.” Swelling in the shins or ankles that leaves a mark when pressed indicates edema. If the feet and knees are swollen while the thighs and shins are thin, it indicates “gouty arthritis.”
2. Observation of the Palms and Wrists：If the skin on the palms is dry and cracked, with pain and peeling, it is termed “goose palm wind.”
3. Observation of the Fingers and Toes：If the fingers are spasmodic and cannot be straightened, it is termed “chicken claw wind.” If the joints of the fingers and toes are swollen and deformed, with difficulty flexing and extending, it is often due to long-term rheumatism or deficiency of liver and kidney. If the skin on the toes is purple-black, with ulceration and foul discharge, it indicates “gangrene.”
（五）Observation of the Skin
Observation of the skin should focus on changes in color and shape.
1. Color
Skin color can also exhibit the five colors, and the five-color diagnosis applies to skin observation. Common clinical observations with special significance include redness and yellowness.
（1）Red Skin：If the skin suddenly turns red, resembling being dyed, it is termed “erysipelas.” It can occur on any part of the body, initially appearing bright red and often moving unpredictably, and in severe cases, it can spread throughout the body. If it occurs on the head and face, it is termed “head fire erysipelas”; if on the trunk, it is termed “erysipelas”; if on the ankles, it is termed “flowing fire.” Due to different locations, colors, and causes, there are various names, but all erysipelas is due to excessive heart fire, often combined with wind-heat evil.
（2）Yellow Skin：If the skin, face, and nails are all yellow, it indicates jaundice. There are two main categories: yang jaundice and yin jaundice. Yang jaundice is bright yellow, resembling orange, often due to damp heat in the spleen and stomach; yin jaundice is dark yellow, resembling smoke, often due to cold dampness obstructing the spleen and stomach.
2. Shape
（1）If the skin is swollen and puffy, leaving indentations when pressed, it often indicates excessive water retention. If the skin is dry and shriveled, it often indicates fluid damage or deficiency of essence and blood; if the skin is dry and rough, resembling scales, it is termed “scaly skin,” often due to blood stasis obstructing nourishment.
（2）Pustules: If the skin develops vesicles resembling beans, it is termed “pustules.” It is often accompanied by external symptoms, including diseases like smallpox and chickenpox.
（3）Rashes: Rashes are skin lesions that occur during the disease process. Rashes are red, large, and flat under the skin, not palpable. Due to different pathogenesis, there are distinctions between yang rashes and yin rashes. If the rash resembles a chestnut, is red and raised, and is palpable, it is due to different causes and can be classified as measles, rubella, hidden rashes, etc.
（4）Blisters and Vesicles: Both blisters and vesicles are elevated skin lesions; vesicles contain fluid, while blisters refer to a broader category of lesions of varying sizes.
（5）Boils, Abscesses, Carbuncles, and Furuncles: All refer to visible surgical lesions on the skin. The distinctions are as follows: if the affected area is large, red, swollen, hot, and painful, it is termed a boil. If it is diffusely swollen without a head, with a flat base and unchanged skin color, and is not hot or painful, it is termed an abscess. If it is small, initially resembling a grain, with a hard base, numbness or itching, and later turns white and painful, it is termed a carbuncle. If it occurs superficially, is small and round, with mild redness, swelling, and pain, and easily forms pus, it is termed a furuncle.
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