1. Liver (Gallbladder):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”. The health of the liver and gallbladder is reflected in the nails; when the liver and gallbladder are healthy, the immune system is strong, and the nails are usually smooth, shiny, and strong. Otherwise, they may be brittle, prone to breakage, or show signs of fungal infection.
Additionally, the liver governs the tendons (muscles and ligaments). Prominent veins on the back of the hands indicate poor liver and gallbladder health, and emotionally, this can manifest as irritability. Some individuals may become angry quickly, slamming tables and glaring, often due to excessive liver heat. Those with liver issues tend to prefer sour foods, and their complexion may appear greenish and dull.
2. Heart (Small Intestine):The tongue is the manifestation of the heart. How can we assess heart health through the tongue? A pale, white tongue indicates insufficient heart blood and poor blood supply. If there is blood stasis, the tongue may appear dark purple. Tongue ulcers can indicate excessive heart heat.
The face reflects the heart; a healthy heart typically results in a complexion that is rosy and vibrant. A pale, dull face indicates insufficient blood supply to the heart. A dark purple face suggests excessive heart heat and areas of blood stasis.
Emotionally, a healthy heart is associated with joy and frequent smiling, even when alone. A preference for bitter foods, such as bitter melon, almonds, and grapefruit juice, is common. A red (purple-red) complexion, especially in overweight individuals, often indicates cardiovascular issues.
3. Spleen (Stomach):The spleen opens to the mouth and lips, and its health is reflected 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 often experience bad breath, especially in cases of gastritis or ulcers. The spleen is responsible for the limbs; when the spleen and stomach are healthy, the muscles are strong and toned. Otherwise, the muscles may be weak and flabby.
Emotionally, individuals with spleen and stomach issues may be overly pensive, often frowning and worrying excessively over trivial matters. Additionally, they tend to have a sweet tooth (preferring sweeter foods than average) and may have a yellowish complexion, which can appear waxy and dull.
4. Lungs:The lungs open to the nose. The nose is used for breathing, inhaling fresh air and expelling waste. Poor nasal health can affect normal circulation within the body and lead to lung diseases, as well as respiratory issues that may trigger nasal inflammation. The health of the lungs nourishes the skin and hair; when lung health is compromised, the skin and hair become dry, rough, and coarse, with enlarged pores on the face.
Emotionally, individuals with lung issues may experience sadness and worry without cause, often crying. An example is Lin Daiyu from “Dream of the Red Chamber”, who suffered from severe tuberculosis, with her tears flowing from spring to autumn and then to winter. A preference for spicy foods and a pale complexion, lacking blood color, is also common.
5. Kidneys:According to TCM, the kidneys govern the bones and open to the ears, with their health reflected 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 or decline; the kidneys nourish the bones, and some individuals may feel unwell without any detectable issues at the hospital, which can be attributed to kidney deficiency causing overall weakness and fatigue.
Those with kidney issues tend to prefer salty foods, may experience fear easily, and have a low tolerance for stress. A dark complexion (blackish) is common; patients in kidney dialysis centers often exhibit this complexion. A yellowish face indicates weak spleen and stomach function; a pale face indicates weak lung function; a red face indicates weak cardiovascular function; a greenish face indicates weak liver and gallbladder function; and a black face indicates weak kidney and bladder function. The kidney area, from the cheekbones to the ears and down to the jaw, is the largest area to observe.
“National Kidney Health” has become an issue that cannot be ignored; due to environmental pollution, the burden on the kidneys is indeed heavy. 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 darkened 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, a preference for salty foods indicates a higher risk of hypertension or potential cardiovascular diseases in the future.
The kidneys govern the bones; focus on areas of pain. The corners of the mouth represent the shoulders and elbows, while the chin represents pain in the neck, thoracic, lumbar, and sacral regions. If pressing the mouth together causes small pits or “bumps” on the chin, ask if they often experience lower back pain; the answer will likely be yes. Especially women may experience pain and fatigue before and after their menstrual periods.
6. Observing the male and female reproductive systems, the reflex areas are located around the philtrum and lips.
If a man over 40 has a thick upper lip or acne on the upper lip that recurs, and a particularly round and protruding chin, it indicates a predisposition to benign prostatic hyperplasia or hypertrophy. If a woman has recurrent ulcers at the corners of her mouth, it may indicate ovarian inflammation or adnexitis.
Pale lips often indicate anemia or insufficient menstrual flow. If a woman has vertical lines on the 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, a gynecological examination is recommended.
7. The reflex area for the bladder is 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 such as dark yellow, frequent, or urgent urination. Cystitis can also lead to lower back pain. In women, cystitis may sometimes be due to gynecological issues. If the bridge of the nose is red but there is no frequent or urgent urination, and the entire bridge of the nose is red, it may indicate rhinitis.
The kidneys open to the ears; if there are deep vertical folds around the ears, it indicates hearing loss. If there are moles, it suggests a tendency for ear itching, tinnitus, or ear problems, and it is recommended to take “Gu Yuan” (Kidney Tonic). If the earlobes are particularly red and translucent, and the tip of the nose is uneven with red blood vessels and the wings of the nose are red, along with swollen eyelids, dry lips, and a red line in the middle of the tongue, it may indicate diabetes or a family history of diabetes. After examining the kidney area, check the spleen and stomach area, as the stomach is the mother of postnatal health.
8. 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 have stomach issues”. If the tip of the nose is red or swollen, or the pores are enlarged, it may indicate spleen heat or spleen enlargement, often accompanied by a heavy 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.
Many people have rough, darkened 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 heat, leading to hunger and bad breath. If there are red blood vessels and it is severe, it is often gastritis. If the wings of the nose are grayish-blue, it indicates stomach cold, and one can feel the person’s fingertips are cold when shaking hands, indicating they may suffer from 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 fatigue. If one parent has stomach issues, children under ten are often hyperactive, have difficulty concentrating in school, and prefer sweet foods.
If one notices a yellow complexion, pale lips, dry skin, and red wings of the nose, then examine the liver and gallbladder area, which is represented by the triangular area behind the eyebrows (temples) and the middle of the nose.
9. The areas on both sides of the nose bridge represent the gallbladder; the liver and gallbladder are interconnected. If the gallbladder is unhealthy, the liver will also be affected.
Individuals with gallbladder issues may have spots or growths on both sides of the nose bridge, indicating liver and gallbladder problems. If this area has red blood vessels, acne, or if one wakes up with a bitter taste in the mouth, it indicates mild inflammation of the gallbladder; if there are spots, it may indicate cholecystitis. If there are vertical folds in this area, or if one smiles and vertical folds appear, 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 liver and gallbladder areas appear dark or have spots, or are uneven, it may indicate fatty liver. If these two areas or one of them has acne (bumps), it indicates excessive liver heat, emotional instability, or menopause. If both areas have noticeable spots and the complexion appears dull and unattractive, indicating the person is thin, it suggests liver disease (hepatitis or cirrhosis).
10. The outer corners of the eyes extending down to the nostrils represent the large intestine system.
Why do women develop melasma? One reason is hormonal imbalance, and another is that during pregnancy, the large intestine may be compressed, leading to constipation, resulting in 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 there are crescent-shaped spots in this area, 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 may indicate hemorrhoids. If this area is red or has white spots, there may be a risk of rectal cancer. The inner side of the large intestine represents 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 weakness. If there are noticeable red blood vessels in the small intestine area, it may be caused by low blood pressure or a family history of abnormal blood pressure.
11. Moving up, the area between the eyebrows is representative of the respiratory system (lungs).
If this area has enlarged pores or is red, it indicates respiratory issues. Long-term smokers may develop spots and pigmentation. If the middle of the forehead is sunken and dark, or has spots, it indicates lung disease and difficulty breathing; if there are acne spots, it indicates recent colds or sore throats.
If there are moles, spots, or white areas on the eyebrows, it indicates a tendency for pharyngitis, laryngitis, or tonsillitis, or chest tightness and shortness of breath, and may also be hereditary.Individuals with poor lung function often have poor large intestine excretion.
12. The upper third of the forehead (hairline) represents the heart system.
If there are acne spots (bumps) or if the color of this area differs from the rest of the face, it indicates significant psychological stress. If there are spots, it indicates heart disease (e.g., heart failure); if there are moles or spots, it indicates congenital heart function deficiency. The heart reflex area is located between the corners of the eyes on the bridge of the nose; if there are horizontal lines or if the lines are prominent, 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 and may also develop diseases of the blood vessels, brain, thyroid, and parathyroid.
Wrinkles on the lower lip indicate coronary heart disease, while purple lips indicate heart disease. The brain reflex area is located between the eyebrows; if there are vertical lines, and this area is red, it indicates insufficient blood supply to the heart and brain, leading to headaches, neurasthenia, vivid dreams, poor sleep, palpitations, and irritability. Dark circles around the eyes indicate insufficient blood supply to the brain or poor sleep.
13. The chest (breast) reflex area is located between the corners of the eyes and the bridge of the nose.
If this area appears dark or blue in men, it indicates chest tightness and shortness of breath. If this area appears dark or blue in women, it indicates breast tenderness during menstruation. If there are moles or bumps on the inner side of the upper eyelid, it may indicate lobular hyperplasia in women, or pleurisy in men. If there are small lumps at the corners of the eyes, it may indicate breast hyperplasia or breast tumors in women.
TCM utilizes visual observation to purposefully examine the spirit, color, shape, and state of the patient’s body and local areas to diagnose diseases. This is one of the four diagnostic methods.In clinical practice, observation is combined with auscultation, inquiry, and palpation to comprehensively and systematically understand the condition and make accurate judgments about diseases.
Theoretical basis: Observation is a method of diagnosing diseases based on the theories of the organs and meridians. The external aspects of the human body are closely related to the internal organs. If there are changes in the functional activities of the organs, it will inevitably reflect in the external aspects of the body, such as spirit, color, shape, and state. The organs and the body surface are interconnected through the twelve meridians, and they correspond to the body’s muscles, bones, skin, flesh, and pulse (the five bodies): the lungs govern the skin and hair, 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 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 morphology and function of the five senses can infer changes in the internal organs. It can also reflect the overall balance of vital energy.
Changes in essence, qi, and spiritare primarily reflected in the head and eyes, and also manifest in the overall body shape, speech, complexion, pulse, and tongue appearance. Sufficient essence, qi, and spirit indicate health; deficiency in essence, qi, and spirit indicates disease and its causes. Therefore, observation can not only diagnose internal organ changes but also understand the dynamic changes in the body’s essence, qi, and spirit.
Observation and sectional observation. Overall observation focuses on the spirit, color, shape, and state of the entire body, while sectional observation uses local changes to understand related lesions. In clinical practice, there is no strict distinction between overall and sectional observation. In specific steps, one can first conduct overall observation, followed by orderly sectional observation.
1. Observing the spirit—focusing on the gaze, facial expressions, and mental activity is an important aspect of assessing clinical prognosis and life activities.
2. Observing the complexion—focusing on changes in facial color and luster, including the five colors of blue, red, yellow, white, and black, can reflect changes in the qi and blood of the organs and the location of pathogenic factors.
3. Observing the morphology—is a method of diagnosing by observing the patient’s body shape and posture:
① Observing the body shape.Primarily observing the strength, weight, and shape of the body 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 harmony. Additionally, body shape can reflect the nature of diseases; for instance, overweight individuals often have phlegm, while thin individuals may have excessive heat. The shape of the trunk and limbs also has diagnostic significance; for example, a pigeon chest or hunchback often indicates congenital insufficiency or postnatal malnutrition 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.This involves observing the patient’s movements and stillness, as well as their behavioral actions. For example, trembling of the lips or fingers may indicate heat disease or internal injury; limb spasms and stiffness of the neck and back may indicate convulsions, often seen in liver wind or heat. Abnormal motor function of the hands and feet and various pain symptoms can also be inferred from posture.
If the hands and feet are weak and powerless, and movement is difficult without pain, it indicates atrophy; if the joints are swollen and painful, making movement difficult, it indicates obstruction; if the hands and feet cannot move, are numb, or are stiff, it indicates paralysis; if the hands are placed on the abdomen and the body leans forward, it often indicates abdominal pain; if the hands are placed on the lower back, bending forward is difficult, it often indicates lower back pain.
Additionally, posture can also reflect behavioral intentions related to disease. For example, if a person shrinks away and does not want to remove their clothing, it indicates aversion to cold, which may be a sign of exterior cold or interior cold; if they want to uncover themselves, it indicates aversion to heat, which may be a sign of exterior heat or interior heat; if they want to see people and prefer coolness, it often indicates a yang condition; if they fear seeing people and prefer warmth, it often indicates a yin condition.
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 indicates a yang deficiency and cold condition; lying down exposed and preferring to be outward indicates a yang excess and heat condition; sitting and preferring to lean forward often indicates lung deficiency and shortness of breath; sitting and preferring to lean back often indicates lung excess and qi counterflow.
4. Observing the head, face, neck, and shoulders—The head, face, neck, and shoulders are where the governing and conception vessels and the three yang meridians of the hands and feet intersect, and the foot jueyin liver meridian also ascends to the head. The brain is the center of mental activity and is governed by the kidneys. The heart governs blood vessels, and the blood vessels nourish the face, so observing the head, face, neck, and shoulders can provide insights into the qi and blood of the organs.
① Observing the head.An overly large or small head may be due to congenital developmental issues or insufficient kidney essence. A sunken fontanelle in children is called a sunken fontanelle, while a delayed closure is called a cranial defect, indicating congenital insufficiency or brain marrow deficiency. A high protruding fontanelle in children is called a filled fontanelle, often due to the invasion of warm disease heat, indicating a solid condition. If the head shakes uncontrollably, it 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 or blood deficiency; and a tufted appearance in children’s hair indicates malnutrition.
② Observing the face.Focusing on facial expressions and color. Other signs, such as facial swelling, indicate edema occurring in the eyelids and face; redness, swelling, and pain in the facial skin often indicate wind-heat or fire toxin attacking; facial muscle paralysis may cause drooping of the mouth and eyes, indicating wind evil invading the collaterals or deficiency of the collaterals, often seen in yangming meridian diseases.
③ Observing the neck and shoulders.Stiffness in the neck may be a symptom of convulsions, often due to heat disease or internal wind; weakness in the neck may fall under the category of the five soft conditions in children (soft head, soft neck, soft hands, soft feet, and soft muscles), indicating congenital insufficiency or kidney essence deficiency. If there are lumps in the neck or under the jaw, they may be goiters, often caused by liver qi stagnation and phlegm accumulation, or related to local environmental factors.
5. The five senses (eyes, ears, nose, mouth, tongue) are related to the qi and blood of the five organs—Observing changes in the spirit, color, and shape of the five senses can directly diagnose organ diseases.
① Observing the eyes.The eyes are the orifice of the liver, and the essence and qi of the five organs all converge in the eyes. The five organ-related areas of the eyes are called the five wheels (see the five wheels and eight corridors), so observing the eyes can not only assess the spirit but also diagnose five organ diseases. Clear and bright eyes with a lively spirit indicate good health; if the whites of the eyes are cloudy, the pupils are discolored, and the spirit is lacking, it indicates a more difficult condition.
Redness in the corners of the eyes indicates heart heat; pale white indicates blood deficiency; redness in the whites indicates lung heat; yellow indicates internal damp-heat; swelling indicates liver heat; and overall redness indicates wind-heat. Swelling in 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 in the eyes, leading to unclear vision, it may indicate internal or external 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 or gallbladder heat or poisoning. Drooping eyelids indicate congenital insufficiency or deficiency of the spleen and kidneys, and may also be caused by 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 conditions.
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 ear lobes.
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 tip of the nose indicates abdominal pain; yellow indicates damp-heat; white indicates blood loss; red indicates heat in the lungs and spleen; and slightly black indicates water retention. Dry nostrils often indicate yangming heat conditions. If the nostrils flare, it may indicate wind-heat obstructing the lungs; if prolonged, it may indicate insufficient lung qi. Additionally, observing the nose can also provide diagnostic significance for nasal polyps, rosacea, leprosy, syphilis, and other diseases.
④ Observing the lips and mouth.The spleen opens to the mouth, and its health is reflected in the lips. If the lips are red and moist, it indicates harmonious qi and blood, and abundant stomach qi. Pale white 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 lips can also provide direct clinical significance for conditions such as 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 organs through the meridians and tendons. Observing the tongue primarily involves examining the tongue body and coating.
⑥ Observing the gums and teeth.The kidneys govern the bones, and the teeth are the remnants of the bones. The hand and foot yangming meridians connect to the gums. Therefore, observing the teeth and gums can provide insights into kidney and gastrointestinal diseases, especially in the diagnosis of warm diseases. Healthy teeth are white and moist, with firm roots, indicating abundant kidney qi and fluids.
If the teeth are dry, it indicates excessive heat damaging fluids; if they are dry and hard, it indicates excessive yangming heat; if they are dry and brittle, it indicates kidney yin deficiency. Loose or sparse teeth, with exposed gums, often indicate kidney deficiency. Pale gums indicate blood deficiency, while receding gums indicate insufficient stomach yin or kidney deficiency; 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 the passage for breathing and eating, related to the lungs and stomach. In healthy individuals, the throat appears pale red and smooth, with no obstructions. If the throat is ulcerated and surrounded by redness and swelling, it often indicates a heat condition; if the tonsils are ulcerated and pus-filled, it indicates lung and stomach heat. If the throat has ulcerations covered with a white membrane, it is called a pseudo-membrane. If the pseudo-membrane is tough and difficult to remove, it often indicates diphtheria.
6. The skin—is the body’s exterior, where defensive qi circulates, and it is internally connected to the lungs. It plays a role in excreting sweat, regulating body temperature, and resisting external pathogens. The essence and qi of the five 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 qi and blood status of the organs.
① Observing the skin color.The principles and methods are similar to observing the complexion. Generally, a moist skin color indicates that the essence and qi of the organs are still strong, and even if there is illness, it is easier to treat; if the skin color is dry, dull, and lacks luster, it indicates that the essence and qi of the organs are deficient, and the condition is more severe. Diseases that can be effectively diagnosed through skin color include erysipelas and jaundice. If the skin appears red as if dyed with pigment, it indicates erysipelas. If the entire skin is cloud-like red, wandering and variable, or swollen and painful, it is called red wandering erysipelas, often caused by wind-heat invasion, excessive heart fire, or fetal toxins in children.
If it occurs locally, it is called flowing fire; if the lower limbs are red and swollen, it indicates damp-heat and fire toxins descending; if the skin on the face and head is red, swollen, and painful, it indicates 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 indicates black jaundice, caused by blood stasis or kidney deficiency.
② Observing the skin morphology.Abnormal skin morphology includes swelling, spots, white patches, and blisters. Swelling in the head, face, chest, abdomen, back, and limbs, with tight skin that sinks when pressed and does not rise when the hand is lifted, indicates edema, caused by internal water retention or external skin overflow; if the skin is floating and sinks when pressed, it indicates qi stagnation.
Spots—are flat patches on the skin that do not feel raised, divided into yang spots and yin spots. Yang spots, also known as red spots, are large and red or purple, even dark purple, often accompanied by fever, irritability, delirium, thirst, red tongue, and rapid pulse, indicating external warm disease or heat entering the blood; yin spots vary in size, are light red or dark purple, hidden and not prominent, appearing and disappearing unpredictably, with clear spirit, cold limbs, diarrhea, pale tongue, and thin pulse, often caused by internal injury and qi-blood deficiency.
Rashes—arise from the skin’s blood vessels, appearing as small red bumps, often seen in measles or rubella, characterized by point-like papules. Generally, the color and distribution of spots and rashes are even and sparse, with a red and moist appearance indicating a favorable condition; if the spots are dense or tightly clustered, with a deep color, it indicates a more severe condition. White spots are small blisters that contain fluid, often seen in summer heat or damp patients, indicating internal dampness and insufficient sweating.
Blisters—are raised areas on the skin of varying sizes that contain fluid, seen in conditions like chickenpox, shingles, and eczema. Additionally, there are other skin morphology changes such as abscesses, ulcers, and carbuncles.
7. Observing the pulse—is a method of diagnosing diseases by examining the changes in the color and shape of the pulse at the fish belly, index finger, and fingernails:
① Observing the index finger pulse.Also known as observing the child’s fingerprints, it is mainly used for children under three years old, focusing on the shape, color, thickness, and length of the pulse. The appearance and distribution of the index finger pulse on the palm side can be divided into wind, qi, and life pulses. During diagnosis, the doctor uses the right thumb to apply moderate pressure from the life pulse towards the qi and wind pulses, repeatedly, until the pulse becomes visible for observation.
Normal fingerprints are bright red, with a mix of red and yellow, usually hidden within the wind pulse, often appearing slanted and single. A deep color indicates a severe condition, while a light color indicates a mild condition; pale colors often indicate deficiency, while stagnant colors (difficult to push and slow to return) often indicate excess; light red indicates cold, while dark red indicates heat; dark purple indicates blood stasis, and blue indicates wind or pain.
If the pulse is floating and shallow, the disease is superficial; if it is deep and stagnant, the disease is internal. An increase in thickness indicates an excess condition or heat condition, while a decrease indicates a deficiency condition or cold condition. A gradual increase indicates a worsening condition, while a decrease indicates an improvement. The index finger pulse seen in the wind pulse indicates a mild condition; if it penetrates from the wind pulse to the qi pulse, it indicates a worsening condition; if it reaches the life pulse, it indicates a deep-seated condition, often referred to as penetrating the pulse.
② Observing the fingernails.The nails are the remnants of the tendons and are the external signs 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 state of qi and blood.
If the nails are red and glossy, it indicates abundant qi and blood and smooth circulation. If the nails are deep red, it indicates heat in the qi; yellow indicates jaundice, often accompanied by yellow skin; pale white indicates blood deficiency or deficiency in both qi and blood; pale indicates deficiency-cold; dark purple indicates blood stasis; and blue indicates cold conditions. If pressing the nails turns them white, and the color takes time to return, it indicates qi stagnation and blood stasis; if they do not return to red, it often indicates blood deficiency.
Flat and concave nails are called spoon nails, often due to liver blood deficiency; dry nails are often due to liver heat or liver blood deficiency or heart yin deficiency. Thin and brittle nails indicate qi and blood deficiency, and may also be seen in conditions like wind-heat, nail fungus, or chronic pain.
③ Observing the fish belly pulse.The fish belly is the fleshy area at the base of the thumb, where the hand taiyin lung meridian circulates, and is related to the qi and blood of the stomach. Observing the fish belly pulse primarily involves observing color, such as blue indicating cold and red indicating heat.
8. Observing excretions—includes examining vomit, phlegm, saliva, nasal discharge, sputum, urine, menstrual discharge, and pus for their shape, color, quality, and quantity.
① Vomit.Clear and thin vomit indicates a cold condition; foul and sour-smelling vomit indicates a heat condition; if there is undigested food mixed in, with a sour smell, it often indicates food accumulation; if there is clear watery phlegm, accompanied by dry mouth and reluctance to drink, with a greasy tongue coating, it often indicates phlegm-damp. 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 may indicate blood stasis.
② Phlegm.Yellow, thick, and clotted phlegm indicates heat phlegm; white, clear, and thin phlegm with many bubbles indicates wind phlegm; white, clear, and thin phlegm with gray-black spots indicates cold phlegm; white, slippery phlegm that is abundant and easy to expel indicates damp phlegm; and scanty, sticky phlegm that is difficult to expel indicates dry phlegm. Phlegm with blood that is bright red often indicates yin deficiency with excessive heat or heat damaging the lung collaterals.
③ Nasal discharge.Thick nasal discharge indicates wind-heat invasion, while clear nasal discharge indicates wind-cold invasion; persistent thick nasal discharge indicates nasal congestion.
④ Saliva.Excessive drooling at the corners of the mouth indicates spleen deficiency; if the saliva is thick and sticky, it indicates spleen and stomach damp-heat; in children, drooling may be due to worm accumulation or stomach heat. Excessive salivation may indicate stomach cold, food accumulation, or kidney deficiency.
⑤ Urine and stool.Stool resembling paste indicates large intestine heat accumulation; loose and watery stool indicates deficiency-cold; thick and sticky stool indicates excessive heat damaging fluids; dry and hard stool indicates fluid deficiency, often accompanied by red and white pus indicating dysentery, or undigested food indicating food accumulation or spleen deficiency. Dark yellow and turbid urine, or white urine resembling rice wash, indicates damp-heat descending; pale and clear urine indicates kidney yang deficiency; and red and turbid urine indicates blood in the urine.
⑥ Menstruation.Heavy menstrual flow, thick quality, or clots indicate blood heat; if the flow is heavy, thin, and light red, it indicates qi deficiency; dark menstrual blood with clots indicates blood stasis; and varying amounts of menstrual flow, whether heavy or light, indicate 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-damp; if yellow, it indicates damp-heat; if mixed red and white, it indicates liver damp-heat; if various colors are present, it indicates a serious gynecological condition. If the discharge is clear and thin, it indicates deficiency-cold; if thick and sticky, it indicates excess heat; if resembling saliva, it indicates spleen deficiency with dampness; if resembling pus, it indicates internal abscesses.
⑧ Pus.Pus is a liquid decay product from skin and flesh, often seen in surgical ulcers. If the pus is yellow-white and thick, with bright color, it indicates sufficient qi and blood expelling pathogens; if the pus is yellow-white and thin, with clear color, it indicates a favorable condition, showing that the righteous qi is overcoming the evil; if the pus is yellow and turbid, it indicates excessive internal heat; if the pus is green-black and thin, it indicates deep-seated toxic evil.
1. The tongue is divided into areas corresponding to the organs: the heart and lungs are at the top, represented by the tongue tip; the spleen and stomach are in the middle, represented by the tongue body; the kidneys are at the bottom, represented by the tongue root; the liver and gallbladder are on the sides of the body, represented by the tongue edges, with the left side corresponding to the liver and the right side to the gallbladder. This method is generally used for internal injuries and miscellaneous diseases.
2. The tongue is also divided according to the three burners: the tongue tip represents the upper burner, the middle part represents the middle burner, and the tongue root represents the lower burner. This method is often used for external pathogenic changes.
3. The tongue can also be divided according to the stomach area: the tongue tip represents the upper stomach, the middle part represents the middle stomach, and the tongue root represents the lower stomach. This method is commonly used for gastrointestinal diseases. The various parts of the tongue correspond to the organs, which is one of the current research topics in biological holography. Although the methods vary, they all have reference value. In clinical diagnosis, the examination of tongue quality and coating should be combined, but all four diagnostic methods should be used together for comprehensive judgment, without being overly mechanical.
Observing the tongue—The content can be divided into observing the tongue body and the tongue coating. The tongue body, also known as the tongue quality, includes the muscle and vascular tissues. Observing the tongue body can be divided into observing the spirit, color, shape, and state. The tongue coating is a layer of coating on the tongue body, and observing the tongue coating can be divided into observing the coating color and coating quality.
Specifically, the tongue body should be soft, flexible, and of a pale red color; it should be of moderate size, without abnormal shapes; the tongue coating should be thin, white, and moist, with evenly distributed granules, lightly covering the tongue surface, and should not be easily wiped off, with the root and tongue body appearing as one entity, with moderate dryness and moisture, and not sticky or greasy. In summary, the normal tongue appearance is a combination of the basic factors of the tongue body and coating.
1. Observing the tongue body:
(1) Tongue spirit—The tongue spirit is primarily reflected in the luster and liveliness of the tongue body. The key to assessing the tongue spirit is to distinguish between luster and dullness. A lusterful tongue is moist and vibrant, indicating lively movement, a red and bright color, and vitality, which is a good sign, even in illness. A dull tongue is dry and lacks luster, indicating poor movement, a dry and dark tongue, which is a bad sign, indicating danger. Thus, the presence or absence of tongue spirit reflects the status of the organs, qi, blood, and fluids, and relates to the prognosis of the disease.
(2) Tongue color—The color of the tongue can generally be divided into pale white, pale red, red, crimson, purple, and blue. Except for pale red, which is the normal tongue color, the others indicate disease.
① Pale red tongue:The tongue color is pale red, neither too deep nor too shallow, indicating a good flow of qi and blood, suggesting sufficient heart qi and yang qi, thus representing a normal tongue color.
② Pale white tongue:The tongue color is lighter than pale red, even lacking blood color, referred to as pale white tongue. This indicates a deficiency in yang, leading to a reduced ability to generate blood, resulting in a pale tongue. Thus, this tongue indicates deficiency-cold or dual deficiency of qi and blood.
③ Red tongue:The tongue color is bright red, deeper than pale red, referred to as red tongue. This indicates excessive heat, leading to a surging of qi and blood, resulting in a bright red tongue, thus indicating a heat condition. This can be seen in solid conditions or deficiency-heat conditions.
④ Crimson tongue:Crimson refers to a deep red tongue, deeper than a red tongue. This indicates a distinction between external and internal diseases. In external diseases, it indicates heat entering the blood; in internal diseases, it indicates excessive internal heat.
⑤ Purple tongue:A purple tongue is generally caused by poor blood circulation and stasis. Thus, a purple tongue indicates disease, distinguishing between cold and heat. Excessive heat damages fluids, leading to a dry and purple tongue; cold coagulates blood stasis, resulting in a pale purple or blue tongue.
⑥ Blue tongue:The tongue color resembles exposed “blue veins”, lacking any red color, referred to as blue tongue, described in ancient texts as resembling a water buffalo’s tongue. This indicates excessive cold and dampness, leading to stagnation of yang qi, resulting in a blue tongue. This indicates cold stagnation and yang stagnation, or internal blood stasis.
(3) Tongue shape—This refers to the shape of the tongue body, including age, thickness, swelling, thinning, cracks, prickles, and teeth marks.
① Old tongue:The tongue body appears rough, with a hard texture, referred to as old tongue. Regardless of tongue color or coating, an old tongue indicates a solid condition.
② Tender tongue:The tongue body appears delicate, with a tender color, often swollen, referred to as tender tongue, indicating a deficiency condition.
③ Swollen tongue:This can be divided into swollen and enlarged. A swollen tongue is larger than a normal tongue, even filling the mouth, or has teeth marks, referred to as a swollen tongue. A tongue that is swollen and cannot retract is referred to as a swollen tongue, often due to phlegm and dampness obstructing the tongue. A swollen tongue is often due to heat toxins or alcohol toxins causing qi and blood stagnation, indicating a heat condition or toxic disease.
④ Thin tongue:A thin and small tongue is referred to as a thin tongue. This is often due to insufficient qi, blood, and fluids, leading to an undernourished tongue. This indicates dual deficiency of qi and blood or excessive heat due to yin deficiency.
⑤ Prickly tongue:The tongue surface has soft prickles (i.e., tongue papillae), which is normal; if the prickles on the tongue surface enlarge and rise, feeling sharp to the touch, it is referred to as prickly tongue. This is often due to excessive heat. The more prickles, the more severe the heat. Depending on the location of the prickles, one can distinguish heat in the internal organs; for example, prickles on the tongue tip often indicate excessive heart fire; prickles on the tongue edges often indicate excessive liver and gallbladder fire; prickles in the middle of the tongue indicate excessive stomach and intestinal heat.
⑥ Cracked tongue:If there are cracks on the tongue surface without coating, it is referred to as a cracked tongue. This is often due to deficiency of essence and blood, leading to damage to fluids and lack of nourishment to the tongue. Thus, it often indicates deficiency of essence and blood. Additionally, about 0.5% of healthy individuals may have deep grooves on the tongue surface, referred to as congenital tongue fissures, which are covered with tongue coating, and do not indicate any other discomfort, differing from cracked tongues.
① Teeth marks:Teeth marks on the edges of the tongue are referred to as teeth-marked tongue. This is often due to spleen deficiency, which cannot transform water and dampness, leading to stagnation on the tongue, causing the tongue to swell and be pressed by the teeth. Thus, teeth marks are often seen with a swollen tongue, indicating spleen deficiency or excessive dampness.
(4) Tongue state—This refers to the state of the tongue during movement. A normal tongue state is one where the tongue moves flexibly; pathological tongue states may include rigidity, weakness, elongation, shortening, numbness, trembling, tilting, or protruding.
① Rigid tongue:A rigid tongue is stiff and straight, making speech unclear, referred to as a rigid tongue. This is often due to heat disturbing the heart spirit, leading to the tongue being unable to move, or high fever damaging yin, or phlegm obstructing the tongue collaterals. This is often seen in heat entering the pericardium, high fever damaging fluids, phlegm obstructing, or as a precursor to stroke.
② Weak tongue:A weak tongue is soft and lacks strength, unable to extend or retract, referred to as a weak tongue. This is often due to extreme deficiency of qi and blood, leading to the muscles and tendons being unable to nourish the tongue. This is often seen in conditions of qi and blood deficiency, excessive heat damaging fluids, or extreme yin deficiency.
③ Elongated tongue:An elongated tongue protrudes from the mouth and is difficult to retract, referred to as an elongated tongue. This is often due to relaxation of the tongue muscles. This is often seen in excessive internal heat, phlegm disturbing the heart, or qi deficiency.
④ Shortened tongue:A shortened tongue is tight and cannot extend, referred to as a shortened tongue. This may be due to cold coagulating the muscles, leading to retraction; internal phlegm and dampness causing liver wind; or excessive heat damaging fluids, leading to muscle contraction; or qi and blood deficiency, leading to insufficient nourishment and warmth of the tongue. Regardless of whether it is due to deficiency or excess, it indicates a critical condition.
⑤ Numb tongue:A numb tongue is one that feels numb and lacks movement, referred to as a numb tongue. This is often due to the inability of the blood to nourish the tongue. If the tongue is numb without reason, occurring intermittently, it indicates heart blood deficiency; if the tongue is numb and trembles, or shows symptoms of stroke, it indicates internal wind.
⑥ Trembling tongue:A trembling tongue shakes and quivers involuntarily, referred to as a trembling tongue. This is often due to deficiency of qi and blood, leading to the muscles and tendons being unable to nourish the tongue, or excessive heat damaging fluids, leading to wind. This is often seen in blood deficiency leading to wind or excessive heat leading to wind.
⑦ Tilted tongue:A tilted tongue protrudes to one side, indicating an abnormal position, referred to as a tilted tongue. This is often due to wind evil invading the collaterals or phlegm obstructing the collaterals, but it can also indicate internal wind affecting the organs. This is often seen in stroke or as a precursor to stroke.
⑧ Protruding tongue:A tongue that frequently protrudes from the mouth is referred to as a protruding tongue; if the tongue licks the lips or moves up and down, or if the tongue slightly protrudes and immediately retracts, it is referred to as a moving tongue. Both are referred to as protruding and moving tongues, often due to heat in the heart and spleen damaging fluids, leading to muscle contraction and frequent movement. Moving tongues are often seen in children with developmental delays.
2. Observing the tongue coatingThe normal tongue coating is produced by the stomach qi, thus the rise and fall of stomach qi can be reflected in the changes of the tongue coating. The formation of pathological tongue coating is due to the rise of turbid qi from food stagnation or the rise of pathogenic qi. Observing the tongue coating should focus on both the quality and color of the coating.
（1）Coating quality—The coating quality refers to the thickness, moisture, roughness, stickiness, decay, peeling, and whether it has roots or not.
① Thickness:Thickness is determined by whether the tongue body is visible or not. If the tongue body is faintly visible through the coating, it is referred to as thin coating. This is produced by stomach qi and is considered normal; if seen in illness, it often indicates the early stage of disease or superficial pathogenic factors, indicating a milder condition.
If the tongue body is not visible through the coating, it is referred to as thick coating. This often indicates deep-seated pathogenic factors or gastrointestinal stagnation, indicating a more severe condition. If the coating changes from thin to thick, it indicates that the righteous qi is unable to overcome the evil, and the condition is worsening; if the coating changes from thick to thin, it indicates that the righteous qi is recovering, and the internal evil is dissipating, indicating improvement.
② Moisture and dryness:If the tongue surface is moist and moderately dry, it indicates moist coating, suggesting that the fluids are intact; if there is excessive moisture, it feels slippery and may even lead to drooling, indicating slippery coating, reflecting dampness and cold, often seen in yang deficiency with phlegm and water retention.
If the coating appears dry and lacks moisture, it indicates dry coating, often due to excessive heat damaging fluids or insufficient yin fluids, leading to dryness. This is often seen in conditions of excessive heat damaging fluids, or lung dryness. If the coating changes from moist to dry, it indicates that the dry evil is damaging fluids, or that excessive heat is harming fluids, indicating a worsening condition; if the coating changes from dry to moist, it indicates that the dry heat is receding, and the fluids are recovering, indicating improvement.
③ Decay and stickiness:If the coating is thick and has large, loose granules resembling tofu dregs on the tongue surface, which can be wiped off, it is referred to as decayed coating. This is due to excess internal heat, leading to the rise of turbid qi from the stomach. This is often seen in phlegm and food accumulation, and may indicate gastrointestinal heat. If the coating is fine and dense, and cannot be wiped off, it is referred to as sticky coating, indicating that the spleen is unable to function properly, leading to internal dampness and stagnation, often seen in phlegm and internal dampness.
④ Peeling:If the patient has coating on the tongue base that suddenly peels off entirely or partially, revealing the tongue body, it is referred to as peeling coating. If the entire coating peels off without regrowth, leaving a smooth tongue, it is referred to as mirror tongue or smooth tongue. This is due to exhaustion of stomach yin or severe damage to stomach qi, indicating a critical condition. If the coating peels off partially, leaving some remnants, it is referred to as mottled peeling coating, indicating damage to both stomach qi and yin.
The change from having coating to none indicates insufficient stomach qi and yin, and a gradual decline in righteous qi; however, if the coating regrows to a thin white coating after peeling, it indicates that the evil has been expelled and the righteous qi is recovering, which is a good sign. It is important to note that whether the coating increases or decreases, it should gradually change; if the coating suddenly increases or decreases, it often indicates a sudden change in the condition.
⑤ Rooted and unrooted coating:Regardless of the thickness of the coating, if it is tightly attached to the tongue surface, appearing to grow from the tongue, it is referred to as rooted coating, also known as true coating; if the coating is not firmly attached and appears to float on the tongue, easily wiped off, it is referred to as unrooted coating, also known as false coating. Rooted coating indicates that the pathogenic factors are strong, but the stomach qi is still intact; unrooted coating indicates that the stomach qi has declined.
In summary, observing the thickness of the tongue coating can indicate the depth of the disease; observing the moisture and dryness can indicate the balance of fluids; observing decay and stickiness can indicate dampness; and observing peeling and rooted/unrooted can indicate the changes in qi and yin and the trend of the disease.
（2）Coating color—The coating color refers to the color of the tongue coating. Generally, it can be divided into white, yellow, gray, and black, along with variations. Since the coating color is related to the nature of the pathogenic factors, observing the coating color can provide insights into the nature of the disease.
1. White coating:Commonly seen in exterior conditions and cold conditions. If the external pathogenic factors have not yet penetrated internally, the tongue coating often remains as normal thin white coating. If the tongue is pale with a moist white coating, it often indicates internal cold or damp-cold conditions. However, in special cases, white coating can also indicate heat conditions. For example, if the tongue is covered with thick white coating resembling powder, it indicates the presence of external pathogenic factors, often seen in warm diseases or internal abscesses. Additionally, if the coating is white and dry, resembling sand, it indicates rapid transformation of dampness into heat, often seen in warm diseases or due to improper use of warming herbs.
2. Yellow coating:Generally indicates internal conditions and heat conditions. Due to the burning of heat pathogens, the coating appears yellow. Light yellow indicates mild heat, while deep yellow indicates severe heat, and scorched yellow indicates heat accumulation. In external diseases, if the coating changes from white to yellow, it indicates that the exterior evil has penetrated and transformed into heat. If the coating is thin and light yellow, it indicates exterior wind-heat or wind-cold transforming into heat. If the tongue is pale and plump with a yellow slippery coating, it often indicates yang deficiency with dampness.
3. Gray coating:Gray coating is a light black color. It often develops from white coating and may also appear alongside yellow coating. It indicates internal conditions, often seen in internal heat conditions, but can also be seen in cold-warm conditions. If the coating is gray and dry, it indicates excessive heat damaging fluids, often seen in external heat diseases or internal injuries. If the coating is gray and moist, it indicates phlegm and dampness retention or internal obstruction.
4. Black coating:Black coating often develops from scorched yellow or gray coating. Generally, regardless of whether it is cold or heat, it indicates a critical condition. The darker the coating, the more severe the condition. If the coating is black and dry, it may indicate extreme heat and fluid depletion; if it is black and dry, it may indicate intestinal dryness and constipation, or impending gastric failure; if it is seen at the root of the tongue, it indicates severe heat in the lower burner; if it is seen at the tip of the tongue, it indicates self-burning heart fire; if it is black and slippery, with a pale tongue, it indicates excessive internal cold and dampness; if it is black and sticky, it indicates phlegm and dampness retention.
（3）Comprehensive examination of tongue quality and coating—The development of diseases is a complex and holistic process, so while understanding the basic changes in tongue quality and coating and their associated diseases, one should also analyze the relationship between tongue quality and coating.
Generally, observing the tongue quality focuses on distinguishing the deficiency and excess of the righteous qi, which also includes the nature of the evil qi; observing the tongue coating focuses on distinguishing the depth and nature of the evil qi, which also includes the survival of the stomach qi. In terms of their relationship, both must be considered together for a comprehensive understanding; whether the changes occur separately or simultaneously, they should be examined together.
In general, the changes in tongue quality and coating are consistent, and their associated diseases often reflect a comprehensive understanding of each other. For example, in internal heat conditions, the tongue often appears red with a yellow and dry coating; in internal cold conditions, the tongue often appears pale with a white and moist coating. This is the key to learning tongue diagnosis, but there are also times when the two changes are inconsistent, so it is necessary to use all four diagnostic methods together for comprehensive evaluation.
For example, a white coating may indicate cold or dampness, but if there is a red tongue with a dry white coating, it indicates dryness and heat damaging fluids, as the dry qi transforms into heat rapidly, leading to the tongue coating not yet turning yellow, indicating that it has already entered the blood; similarly, a thick white coating may indicate excessive heat, not necessarily cold; gray-black coating can indicate heat or cold, and must be combined with the moisture and dryness of the tongue to differentiate.
Sometimes the two may indicate contradictory diseases, but they must still be viewed together. For example, a red tongue with a white slippery coating may indicate heat in the blood and dampness in the qi; in internal injuries, it may indicate excessive yin deficiency with fire, along with phlegm and food accumulation. Thus, while learning, one can grasp the distinctions, but in practice, one must conduct a comprehensive examination.
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