TCM Diagnosis by Looking (Observation) - One of the 4 Pillars
What is observed by the Practioner.
Shen (Spirit)
Observing and tuning in to a patient's Shen (spirit) is particularly important to help determine the overal state and prognosis of an imbalance. The Shen gives vital imformation about vitality, and mental, emotional, and spiritual well being. The Shen shows in the eyes, complexion, and state of mind.
Body (appearance)
The Five Elements can be associated with body shapes and constitutions
- Wood Type
Slender and tall body shape
- Fire Type
Pointed head and chin, small hands, with curly or a small amount of hair - Metal Type
Square and broad shoulders, strong body type, and a triangle shaped face - Earth Type
Large head, larger body and belly, strong legs, and a wide jaw - Water Type
Round face and body with a longer than normal torso
Long Term Body Changes
- Emaciated, body, esp. with dry skin
Deficient Blood or Yin - Very large thighs
Spleen Deficiency - Great weight loss over course of long illness
Essential Qi exhausted - Overweight
Deficient Spleen Qi with tendency to Dampness or Phlegm (often with Stagnation of Qi) - Hair loss
Kidney Jing Deficiency or Blood Deficiency - Musculoskeletal pain, soreness, numbness or heaviness with swelling and restricted movement
Bi Syndrome (Painful Obstruction syndrome) - Gradual onset of weakness, motor impairment, and muscular atrophy of the limbs:
Wei Syndromes (flaccidity syndrome)
Short term bodily changes
- Change in Muscles (e.g. flaccid, wasting)
Spleen disharmony - Change in Tendons (e.g. stiffness, weakness)
Liver disharmony - Change in Blood Vessels (hardening, producing hard pulse)
Heart disharmony - Change in skin (e.g. tone, dryness
Lung disharmony - Change in bones (e.g. brittle)
Kidney disharmony
Appearance and Demeanor
Includes posture and movement of body as a whole and of individual parts, e.g. eyes, face, mouth, limbs, fingers.
| Symptom(s) | Cause or Pattern |
| Overweight with Mental Depression | Qi Xu and Excess Damp Phlegm |
| Loss of Weight in Long Term Illness | Exhaustion of Essential Qi |
| Thin with Dry Skin | Blood Xu |
| Extended Neck | Excess Lung Syndrome with Excess Phlegm |
| Facing Downward | Qi Xu with Shortness of Breath, Dislike of Speaking |
| Violent Movement of Limbs | Wind Diseases, Infantile Convulsions |
| Weakness, Motor Impairment, and Muscular Atrophy of Limbs | Wei Syndromes |
| Pain, Soreness, Heaviness and Numbness in Tendons, Bones and Muscles, with Swelling and Restricted Movement of Joints | Bi Syndromes |
| Numbness or Impaired Movement of Limbs on One Side of the Body | Hemiplegia or Wind Stroke |
| Active patient with excessive/jerky movement: | Yang, Excess or Heat patterns |
| Passive manner or lack of movement/slow movement: | Yin, deficient, Cold |
| Continuous fidgeting, especially of legs: | Deficient Kidney Yin |
| Tremors, convulsions (of whole body or localized): | Interior Liver Wind |
Head and Face
Hair
- Hair relates to Blood or Kidney Jing.
- Hair loss and premature graying of the hair may be due to Blood Deficiency or Kidney Jing Deficiency.
- Dandruff usually relates to Liver Blood or Yin Deficiency
Face
- Two light and shallow lines between the eyebrows indicates a healthy Liver.
- Two deep lines or three line between the eyebrows can indicate a Liver problem, such as frequent anger
- A single line can indicate a more serious Liver problem. This can occur after considerable hardship.
Face Color
- Represents the strength of the Qi and Blood of the Zang Fu organs, and especially the Heart.
- The complexion should be moist and lustrous.
| Red (Excess or Xu Heat) | |
| Whole Face | Heat from External Evil or Hyperactivity of Zang Fu (Excess) |
| Cheeks, Tidal Fever, Night Sweats | Internal Heat (Xu) |
| Pale (Cold or Loss of Blood) | |
| Pale White | Yin Excess or Yang Xu |
| Bright White with Puffy and Bloated Appearance | Yang Qi Xu |
| Withered White | Blood Xu |
| Yellow (Damp or Xu) | |
| Body, Face, Eyes, and Skin | Jaundice |
| Bright Orange | Yang Jaundice (Damp Heat) |
| Smoky Dark | Yin Jaundice (Cold Damp or Long Term Stagnation) |
| Pale Yellow (Not Bright) | Blood and Qi Xu |
| Blue (Cold, Pain, Blood Stagnation, Convulsions) | |
| Pale with Blue Tinge and Severe Pain in the Epigastrium and Abdomen | Excess Yin and Cold |
| Bluish Purple Face and Lips with Intermittent Pain Behind the Sternum or Precordial Region | Stagnation of Heart Blood |
| Bluish Purple Face and Lips with High Fever and Violent Movement of Limbs in Children | Infantile Convulsion |
| Dark Gray (Blood Stagnation and Kidney Xu) | |
| Pale and Dark with Lumbar Soreness and Cold Feet | Kidney Yang Xu |
| Dark without Brightness with Scaly Skin | Prolonged Blood Stagnation |
Observation of Sense Organs
Eyes
The eyes reflect the state of the Shen and Jing. It is said, "The Jing of the five Yin and six Yang organs ascends to the eyes." We observe the "expression" of the eyes to see the spirit.
The Liver opens to the eyes (sense organ associated with Wood element)
Eyesight changes tend to relate to the Liver
| Symptom(s) | Cause or Pattern |
| Shining and are Clear | Good vitality of Shen & Jing |
| Redness and Swelling | Wind Heat or Liver Fire |
| Yellow Sclera | Jaundice |
| Ulceration or Canthus | Damp Heat |
| Upward, Straight Forward, or Sideways Staring | Liver Wind |
| Dull or Clouded eyes | Disturbed Shen, weakened Jing. Commonly seen in drug users and long term emotional problems |
| Nystagmus | Disturbance of Liver Wind |
| Spots in visual field: | Deficiency of Liver Blood or Kidney Yin or Jing |
| Swelling or dark rings under eyes: | Deficiency of Kidney |
Nose
| Symptom(s) | Cause or Pattern |
| Tip of the Nose | Relates to Spleen and Stomach |
| Flapping of Ala Nasi | Heat in the Lungs or Qi Xu of both Lung and Kidney |
| Clear Discharge | Wind Cold |
| Turbid Discharge | Wind Heat |
| Prolonged Turbid Discharge, with Stinking Discharge | Rhinitis or Chronic Sinusitis |
Mouth and Lips
Color, moisture and appearance. Normal color is pale red, moist and shiny
| Symptom(s) | Cause or Pattern |
| Pale Lips | Blood Xu |
| Bluish Purple Lips | Retention of Cold or Blood Stagnation |
| Red and Dry Lips | Excess Heat |
| Breathing through mouth | Lung Qi Deficiency |
| Mouth always slightly open | Deficiency |
| Sudden Collapse with Open Mouth | Xu |
| Sudden Collapse with Lockjaw | Excess |
| Greenish around mouth | Liver Blood Stasis or Liver invading Spleen |
Teeth and Gums
Teeth are considered an extension of bone and are influenced by Kidneys. Gums are influenced by the Stomach.
| Symptom(s) | Cause or Pattern |
| Moist teeth | Good Fluids, and healthy Kidneys |
| Pale Gums | Blood Xu |
| Redness and Swelling of Gums | Stomach Fire |
| Redness and Swelling of gums with Bleeding | Injury of Vessels by Stomach Fire |
Throat
| Symptom(s) | Cause or Pattern |
| Redness, Swelling, and Soreness | Lung and Stomach Heat |
| Redness and Swelling with Yellow or White Ulcer Spots | Toxic Heat in Lung and Stomach |
| Slightly sore, dry, red, not swollen, chronic condition | Deficient Kidney Yin |
| Bright Red with Mild Soreness | Yin Xu with Hyperactive Fire |
| False Gray and White Membrane over Throat that is Hard to Remove, and Bleeds Following Removal | Diphtheria from Heat in the Lung Consuming Yin. |
Ears
Observe color, discharge, skin tone, any spots or discoloration.
| Symptom(s) | Cause or Pattern |
| Burnt Black and Dry and Withered Auricles in Severe Illness | Consumption of Kidney essence |
| Purulent Discharge | Damp Heat of Liver and Gall Bladder |
Limbs
Flesh around wrists and ankles should be a good color and firm: indicates a good condition of the fluids.
| Symptom(s) | Cause or Pattern |
| Dry, dull skin on wrists/ankles with withered flesh | Exhausted Fluids |
| Thenar eminence | State of Stomach |
| Bluish color of venules on thenar eminence | Cold in Stomach |
| Red venules | Heat in Stomach |
Nails
| Symptom(s) | Cause or Pattern |
| Pale | Blood Deficiency |
| Bluish | Liver or Heart Blood Stasis |
| Split | Liver Blood Deficiency |
Digital Venule Examination in Children
Examine the venules on the index finger in children under 2.
Use left index finger in boys and right in girls.
Creases in joints of index fingers are called "gates".
- Wind Gate
First, crease at mcp articulation - Qi Gate
Second (1st interphalangeal) - Life Gate
Third (distal interphalangeal)
Method: rub finger towards body. Venules may appear.
If venules are only present beyond the Gate of Wind, this indicates mild disease (invasion by exterior pathogen). If venules extend beyond Gate of Qi: interior, more severe condition. If venules extend beyond Gate of Life: serious, life-threatening condition. Bluish venules indicate a Cold pattern whereas red venules indicate aHeat pattern
Skin
- Skin relates to the Lungs in Five Element Theory.
- Skin also indicates the condition of the Blood (and therefore the Liver, which stores Blood).
- Many skin conditions relate to Heat in the Blood or stasis of Blood and may relate to Liver.
- Skin disease can also relate to Heat in the Stomach which can cause Blood Heat.
Indications
- Dry skin
Often indicates Deficient Blood - Itchy skin
Wind - Pitting edema
Kidney Yang Deficiency
Venules (spider veins) on the skin are exterior manifestation of the superficial channels. They are often seen behind the knees or around ankles in older people.
| Venule Color | Cause or Pattern |
| Red | Heat |
| Bluish | Cold |
| Greenish | Pain |
| Purple | Blood Stasis |
