The human body is an organic entity, so local pathological changes may affect
the whole body. Moreover, the pathological changes of the internal organs may
reflect on the body surface.
Diagnostic methods in traditional Chinese medicine include four basic methods:
inspection, auscultation and olfaction, inquiry and palpation. The case history,
symptoms, and signs gained through those four diagnostic methods are analyzed
and generalized to find the causes, nature, and interrelations of the disease,
and to provide evidence for the further differentiation of syndromes. The four
diagnostic methods are therefore indispensable and important steps in the
differentiation and treatment of syndromes.
Inspection is a method to examine the patient by observation of the expression,
appearance, color, and abnormal changes of secretion and excretion, etc.
1. Observation of the Mind
This is to observe the patient's spirit, clearness of consciousness,
coordination and vigour of movements, and keenness of response in order to judge
the excess or deficiency of yin, yang, qi, and blood in the zang-fu organs and
make a prognosis of the disease condition.
Strength of Spirit: The patient is in good spirits, the body resistance and
functions of the zang-fu organs are normal, therefore the patient has a good
prognosis. Generally speaking, the patient is in good spirits, behaves normally
with a sparkle in the eye, and has a keen response.
Loss of Spirit: The patient is spiritless, indifferent in expression, has dull
eyes and a sluggish response, or may even be unconscious or have a mental
disturbance. This shows damage to the body resistance, a severe disease
condition, and a poor prognosis.
2. Observation of the Complexion
Observe the color and luster of the facial region. Generally, a lustrous
complexion with normal color indicates ample qi and blood, and a mild disease
with a good prognosis. If the complexion is deep in color and withered, this
indicates a serious disease condition with damage to the qi and essence, and a
difficult treatment with poor prognosis.
White Color: A white color is the sign of a qi and blood deficiency. A pale
complexion indicates a yin excess with yang deficiency. A qi deficiency
manifests a lusterless and pale complexion and is accompanied by swelling. A
pale emaciated face indicates a blood deficiency. A sudden pale complexion with
cold sweat is the sign of sudden prostration of yang qi due to febrile diseases
caused by exogenous pathogenic wind-cold.
Yellowish Color: a yellowish color is the sign of spleen deficiency and damp
accumulation. A complexion that is yellowish, withered and lusterless indicates
a qi deficiency of the spleen and stomach. A yellowish, flabby complexion is the
sign of damp accumulation due to spleen dysfunction of transportation and
transformation. The yellow color of the face, eyes, and skin indicates jaundice.
In traditional Chinese medicine a bright orange yellow is diagnosed as yang
jaundice caused by pathogenic damp-heat; dark yellow in yin jaundice due to
Red Color: Redness indicates excessively full blood vessels due to excessive
heat. A red complexion is mostly due to the fever of a common cold, or may be a
heat syndrome due to excessive yang in the zang-fu organs. Malar flush with
bright red color indicates xu heat syndromes due to yin deficiency and yang
Bluish Color: Bluish color indicates syndromes of cold, pain, and blood stasis
or convulsion, and is the manifestation of qi and blood obstruction in the
channels. Pathogenic cold causes stagnation of qi and blood leading to pain.
Children's high fever also shows a bluish complexion, the symptoms of acute
Black Color: Black color indicates kidney deficiency, humor accumulation, and
blood stasis. This is the manifestation of excessive cold and water, or
stagnation of qi and blood. If the complexion is as black as bronze, it is
mostly due to an extreme weakness of kidney yang and cold accumulation
manifesting as xu-cold syndromes. A dark dray color around the eyes denotes
phlegm-humor syndrome due to kidney deficiency. This leads to a dysfunction of
the water metabolism or leukorrhea, due to the downward flowing of kidney
essence. A dark gray malar can be seen in patients with frequent urination due
to kidney deficiency. A dark gray complexion indicates prolonged stagnation of
blood such as a consumptive disease with blood deficiency accompanied by
menoplania or amenia.
3. Observation of the Tongue
Indicates xu and cold syndromes or symptoms due to yang qi
deficiency and insufficiency of qi and blood.
Red Tongue: Indicates heat syndromes, mostly shi types of disease caused by
interior heat, or symptoms of fire preponderance due to yin deficiency.
Deep Red Tongue: Denotes the excessive heat seen in febrile disease due to
invasion of exogenous pathogenic heat which as been transmitted from the
exterior to the interior of the body. It also can be seen in miscellaneous
diseases due to a preponderance of fire caused by yin deficiency, or seen in
diseases of accumulated fire in the liver channel.
Purplish Tongue: Shows the syndrome of blood stagnation. A tongue with purplish
spots or petechiae also indicates blood stagnation.
Flabby Tongue: A flabby tongue body with teeth marks on the margin and pale in
color indicates a yang deficiency of the spleen and kidney leading to
accumulation and obstruction of phlegm-dampness.
A flabby tongue with a deep red
color indicates excessive pathogenic heat attacking the heart and spleen.
Thin and Small Tongue: This indicates consumption and deficiency of blood and
yin. A thin and small tongue with a pale color denotes deficiency of both qi and
blood. A thin dry tongue with a deep red color is mainly due to a preponderance
of fire and great exhaustion of body fluids.
Rigid Tongue: Seen in febrile diseases due to the invasion of exogenous
pathogenic heat transmitted into the pericardium or due to an obstruction of
pathogenic phlegm. It may also be seen in high fever leading to consumption of
body fluids and preponderance of pathogenic heat. It is a prodrome of
wind-stroke (cerebral stroke).
Deviated Tongue: This is a prodrome of wind-stroke.
Cracked Tongue: Cracks on the tongue with deep red color indicate excessive
heat. A cracked pale tongue indicates insufficiency of yin and blood. However, a
cracked tongueof long term duration without any other symptoms can be considered
In the first place, the properties of tongue coating should be examined.
Thinness and Thickness: Generally, if substantial pathogenic factors such as
damp, phlegm or food accumulation occur and cause obstruction, they further
affect the spleen and stomach leading to the ascent of turbid qi and forming of
a thick tongue coating. A white thin tongue coating is formed if nonsubstantial
pathogenic factors such as wind, heat, dryness, or cold attack the body; or if
the pathogenic factors stay on the body surface; or if body resistance is weak
during the disease development.
Moistness and Dryness: The normal tongue coating is moist, which indicates that
plenty of body fluid is flowing upward. If the tongue coating is dry, it is due
to body fluids failing to moisten the tongue. A dry tongue coating may also be
present in some febrile diseases where pathogenic heat consumes the body fluid.
A slippery tongue coating may be due to pathogenic damp-humor floating over the
Sticky and Curdled Tongue Coating: A sticky coating is due to hyperactivity of
endogenous pathogenic phlegm and damp rising tot he tongue, and is mostly seen
in diseases caused by pathogenic damp-heat or phlegm-humor. A curdled tongue
coating is the outcome of food accumulation in the stomach leading to the ascent
of turbid qi to the tongue surface. It is also seen in disease caused by
Peeled Tongue Coating: Mostly due to deficiency of qi and yin. If peeled tongue
is accompanied by a sticky coating, it indicates a complicated disease condition
to which the body resistance is weakened.
No Tongue Coating: Changes in the tongue coating indicate fluctuation in the
disease condition. For example, if a qi deficiency of the stomach is manifested
by no tongue coating at an early stage, the tongue coating will reappear after
the stomach qi is recovered. If a disease has no tongue coating, then suddenly
appears, this indicates a perversive flow of stomach qi, or excessive pathogenic
heat. If a disease has a tongue coating at the beginning which disappears
abruptly, this indicates stomach yin fluid has decreased. If a thick coating
gradually turns into a thin white coating, this indicates that pathogenic qi is
being gradually weakened, and the disease condition is becoming milder.
Generally, an observation of the thinness and thickness of the tongue coating
will indicate the depth of pathogenic qi. The tongue's moistness or dryness
shows the body fluid condition. The degree of curdling and stickiness of the
tongue coating indicates the dampness of the stomach and spleen. The appearance
or disappearance of tongue coating signified the cure or worsening of the
Color of Tongue Coating
White Coating: Indicates exterior-cold syndromes. A white and thin coating is
seen mostly in exterior syndromes, while a white and thick coating appears in
interior-cold syndromes. If there is a powder-like whitish coating covering the
tongue surface, it is caused by the internal accumulation of summer-humid heat
and is usually seen at the onset of pestilential diseases.
Yellow Coating: Indicates interior and heat syndromes. A light yellow tongue
coating is seen in cases of slight fever. A deep yellow color indicates high
Brownish tongue coatings represent an accumulation of pathogenic heat.
Grayish Coating: Denotes interior-heat syndrome or interior-cold syndrome.
grayish black and slippery coating on the tongue usually indicates
symptom-complex due to cold-damp in the interior. A grayish, yellow, and sticky
tongue coating usually indicates the accumulation of damp-heat. Grayish and dry
tongue coatings are usually due to the consumption of body fluid by excessive
Black Coating: This is often seen at the serious and dangerous stage of disease,
and indicates extreme heat or cold. A black, yellow, and dry coating with thorns
on the tongue surface usually denotes consumption of body fluid by extreme heat.
A black and slippery tongue coating shows excessive cold due to yang deficiency.
Copyright 1995 Hopkins Technology