Chinese Medicine Diagnosis (Part I): Observation

Chinese Medicine Diagnosis (Part I): Observation

Observational diagnosis is one of the four diagnosis methods used in Chinese medicine. Observational diagnosis consists of: observing the spirit, colour, body form; observing the tongue, face, five senses and skin; observing what is eliminated or secreted from the body. Some of these are not directly observed in the clinic but information about urine, stools and secretions can be obtained by questioning the patient.

1. What is Observation?

This method is where the practitioner uses their observation skills to get information from your body. This includes:

a) Spirit and vitality
We can see the overall vitality of your body through your eyes, voice, emotions and movements.

b) Body shape and skin
We can get information about the health of your internal organs through the shape of your body, tightness or looseness of your muscles and the dryness or moistness of your skin.

c) Tongue diagnosis
This is a treasured part of traditional Chinese medicine diagnosis. We see the tongue as a mirror of the body’s internal health, and it reflects pathological changes in the internal organs of the body. We look at the colour of the tongue, the shape and the coating (colour and thickness). I will give you more detailed information on tongue diagnosis in a separate article.

d) The five senses
Chinese medicine considers the five senses to be strongly associated with the health and function of the internal organs. The five senses are:

  • Sight (Eyes are associated with the Liver)
  • Touch (Mouth is associated with the Spleen)
  • Smell (Nose is associated with the Lung)
  • Hearing (Ears are associated with the Kidney)
  • Taste (Tongue is associated with Heart)

Sometimes when there is a problem with an internal organ the first sign of this can actually show in one of the senses.

e) Secretions
This includes sweat, nasal mucous or discharge, saliva, tears, urination, bowel movements, menstrual flow and semen. We can tell the characteristics of disease, such as excess or deficiency from looking at details of the secretion, such as colour, amount, smell, contents etc. With most secretions we need help from our clients to take notice and tell us the details of their secretions.

Most details of secretions are covered in separate articles on our website if you are interested in finding out more.

An experienced Chinese medicine practitioner will observe and pay attention to all of these factors that we have mentioned above from the time they meet the patient and throughout the entire consultation.

2. Observation for Children

Observation is even more important for diagnosis in children, especially children under three years of age, as they cannot tell us clearly themselves how they are feeling.

Even the parents have difficulty knowing exactly how their child is feeling while they are sick. Traditional Chinese medicine has its own special methods for observation in children. For example, observation of the shape of the head, the skin between the eyebrows, the index finger and development and shape of the body. Details of these factors can give us clues about internal organ disorders.

3. Examples of Observation in the Clinic

The following examples are about the relationship of our observation and your internal organs.

i) Nails
White spots, depressions or ridges, thin and easily broken and nail-biting usually indicates a Liver Qi and Blood disorder. These people may also experience the following symptoms: depression, stress, stiffness and pain in the neck and shoulders, insomnia or bloating.

ii) Mouth and Tongue
Purple colour on the tongue and around the mouth usually indicates a lack of circulation around your Heart and chest. These people may also experience the following symptoms: tightness in the chest, shortness of breath or chronic lung or heart disorders.

iii) Tongue
Thick coating on the tongue, especially in the middle usually indicates old food stagnation in your digestive system. These people may also experience the following symptoms: bloating in the abdominal area, constipation or sluggish bowel movements, flatulence and bad breath.

iv) Eyes
Puffiness or black around the eyelids usually indicates a Kidney or Spleen disorder. These people may also experience the following symptoms: lower back pain, puffiness and heaviness in the arms and legs, lack of energy, and decreased libido.

v) Urination
Yellow coloured urination usually indicates that the body contains a lot of heat or is dehydrated. These people may also experience the following symptoms: thirst, constipation, a red face, the body feels hot, perspires easily and is easily irritated or anxious.

vi) Menstruation
Large blood clots and dark coloured blood during menstruation usually indicates blood stagnation in the abdomen, lower back area or the Liver and Gall Bladder channel. These people may also experience the following symptoms: period pain, headache, breast fullness, insomnia, and severe PMS symptoms. In the clinic, a lot of cases we have seen with these symptoms are associated with the following diseases: endometriosis, polycystic ovarian syndrome and infertility.

vii) Semen
Clear and thin semen usually occurs in male infertility issues, and indicates a Kidney Jing and Yang deficiency. These people may also experience the following symptoms: lack of energy, lower back pain and decreased libido.

viii) Bowel Movements
Loose frequent stools with a pale yellow colour usually indicates a weak Spleen. These people may also experience the following symptoms: lack of energy, bloating in the abdominal area, overweight, and heaviness and puffiness in the arms and legs.

 4. How to cooperate with your Chinese Medicine Practitioner with Observation

i) Avoid strenuous exercise thirty minutes before your consultation. This may change the condition of your skin, such as colour, moisture and temperature.

ii) Avoid excessively drinking hot water, coffee, tea or alcohol thirty minutes before before your consultation. In the case where you have eaten certain foods which may change the colour of your tongue or stools (eg. beetroot, lollies, certain medications) please mention this to your practitioner.

iii) Avoid emotional things happening to you an hour before your consultation as they may change your spirit (eg. anger due to running late, car accident). If the situation is unavoidable, please mention to the practitioner that something has happened, and they can account for this in their diagnosis. This is important to avoid the practitioner observing the wrong information leading to an inaccurate diagnosis.

As you can see, many details are involved in a Chinese medicine consultation. I hope that your consultation will be an enjoyable experience.

Next, learn about Listening and Smelling in Chinese medicine diagnosis.

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Dr Ping Wang is the clinic founder and senior practitioner of Ping Ming Health. She has over 30 years of experience in traditional Chinese medicine teaching and practice. Dr Ping especially enjoys sharing her knowledge of Chinese medicine through our popular clinic articles, seminars and clinical training of students and practitioners.