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Observation of Tongue (舌)

One of the most important diagnostic tools in TCM, the tongue reflects the state of the Zang-Fu, Qi-Blood, and pathogenic factors.

Body Colour

Heat (red), Cold (pale), Blood stasis (purple)

Body Shape

Swollen (Damp), Thin (deficiency), Cracked (Yin Deficiency)

Coating

Reflects Stomach and Damp/Phlegm

  • White = Cold

  • Yellow = Heat

  • Thick = Excess

  • Thin = Deficiency

 

Moisture

Yin deficiency or Heat; Wet = Damp or Cold

Different regions of the tongue correspond to different Zang-Fu organs

  • Tip = Heart/Lung

  • Centre = Spleen/Stomach

  • Sides = Liver/Gallbladder

  • Root = Kidney

 

Thin body

Yin or Blood deficiency

Obese body

Dampness, Phlegm, Spleen Qi deficiency

 

Upright posture

strong Zheng Qi

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Observation of Body Shape and Posture

Thin body

Yin or Blood deficiency

Obese body

Dampness, Phlegm, Spleen Qi deficiency

Upright posture

strong Zheng Qi

Slouched or stiff posture

Qi/Blood stagnation, Wind, Pain

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Observation

The process of "Looking" (望诊 wàng zhěn) is one of the Four Diagnostic Methods (四诊 sì zhěn), and it plays a critical role in gathering visual diagnostic information. The practitioner uses observation to assess the patient's Qi, Blood, fluids, organ function, and pathogenic influences by examining various external signs that reflect internal states. This process involves detailed inspection of the patient's complexion, demeanour, body shape, posture, tongue, secretions, and specific parts of the body. It is a non-invasive but highly informative method to identify both the nature and depth of disease.

Goals of Looking in TCM Diagnosis

  • Assess the vitality and balance of Yin-Yang

  • Detect signs of Heat, Cold, Excess, Deficiency

  • Identify organ dysfunction and meridian imbalances

  • Observe manifestations of emotions and pathogenic factors

Looking is a diagnostic art that reveals the state of Zang-Fu organs, vital substances, and pathogenic influences through visual signs on the body. By observing the Shen, complexion, tongue, posture, skin, eyes, secretions, and other visual cues, practitioners gather essential information about the internal condition of the patient without invasive testing. It is used in combination with listening/smelling, asking, and palpation to achieve an accurate pattern differentiation (辨证).

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Looking

Observation of Shen (Spirit/Vitality 神)

Shen refers to the overall expression of life: clarity of the eyes, facial expression, movement, speech, and responsiveness.

Shen reflects the Heart, Kidneys, and overall vitality (Zheng Qi).

Healthy Shen

Bright eyes, clear mind, responsive, good posture

Disturbed Shen

Dull eyes, confusion, restlessness, depression

Shen Collapse

Delirium, coma, inability to focus, very weak pulse

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Observation of Complexion (面色)

The face reflects organ health, Blood flow, and Qi status.

Pale

Metal (LU), Earth (SP)

Blood or Qi deficiency, Cold

Red

Fire (HT)

Heat (Excess or Deficiency Heat)

Yellow

Earth (SP)

Dampness (dull yellow), SP Deficiency (pale)

Blue green

Wood (LR)

Pain, Cold, Wind, Liver imbalance

Dark grey/Black

Water (KI)

Cold, Kidney Xu, Blood stasis

Observation of Eyes (目)

Eyes reflect the state of the Shen and Liver.

Bright, clear eyes

Good Shen and Liver Blood

Dull, lifeless eyes

Shen disturbance, Blood or Yin deficiency

Red, swollen eyes

Liver Fire, Wind-Heat

Dry eyes

Liver Yin Deficiency

Jaundice in sclera

Damp-Heat or Damp-Cold in the Liver/GB

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Observation of Skin and Limbs

Dry skin

Blood or Yin deficiency, Dryness pathogen

Edema

Fluid retention (Yang Xu or Dampness)

Tremors

Internal Wind, Liver Wind, Qi/Blood/Yin Deficiency

Numbness

Blood deficiency, Wind or Damp blocking channels

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Observation of Secretions and Discharges

Sputum

Colour and thickness indicate Cold, Heat, Damp, or Phlegm

Sweat

Spontaneous (Qi deficiency), Night sweats (Yin deficiency)

Urine

Colour, frequency (e.g., dark = Heat; clear = Cold)

Stools

Consistency, colour, presence of mucus or blood

Observation of Children (Paediatric Diagnosis)

Special attention to:

  • Facial vein (index finger venule): superficial vein visibility relates to Wind, Cold, Heat

  • Crying: tone, timing may indicate hunger, pain, or fear

  • Fontanelle: sunken (deficiency), bulging (excess)

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