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Diagnosis by Observation

A working observation checklist for "Diagnosis by Observation". Tick signs as you observe them in the patient; each item shows its usual diagnostic significance. Your ticks are saved in this browser only (nothing is sent anywhere) so you can safely close and reopen this page mid-consultation.

Pattern Summary

Shows patterns backed by 2 or more ticked signs — updates live as you tick, and prints with the form. A single matching sign is treated as noise and left off; a higher count means more of the ticked signs agree on that pattern. Not a diagnosis by itself.

No pattern yet backed by 2 or more ticked signs.

Patient Details 🌟 1. Spirit (Shen) 🧍 2. Constitutional Body Types 🏃 3. Demeanour & Body Movements 💇 4. Hair 🎨 5. Face Colour 👁️ 6. Eyes 👃 7. Nose 👂 8. Ears 👄 9. Mouth & Lips 🦷 10. Teeth & Gums 🗣️ 11. Throat (Pharynx & Tonsils) 🦵 12. Limbs 🧴 13. Skin 👅 14. Tongue 🌊 15. Channels

Patient Intake

Saved in this browser only, same as the rest of the form.

Personal Details

Medical History

Blood Pressure
Diabetic
Thyroid
On individual parts and the whole: a central principle of diagnosis by observation is that a single, small part of the body (the face, the tongue, the ear, even the second metacarpal bone) can reflect the whole. Alongside actual disharmony signs, always weigh a patient's constitutional Five-Element body type — a trait that is simply constitutional (not a current disharmony) becomes significant mainly when the patient deviates from their own type.
🌟 Spirit (Shen)

Whether a patient 'has spirit' or not — assessed via the complexion, eyes, state of mind and breathing.

Presence of Spirit

Complexion healthy, with lustre; face colour clear
Good state of Spirit — even a pathological colour may still carry Spirit and Stomach-Qi, a positive prognostic sign.
Eyes have lustre, reveal inner vitality
Good state of Spirit.
Mind clear, breathing even
Good state of Spirit.
Clear voice projecting outwards; lively expression; erect posture; naturally optimistic, alert mind
Strong Spirit (mental-emotional-spiritual sense) — a good sign even if the person has suffered emotional problems in the past.

Absence of Spirit

Complexion dull, lacking lustre
Lack of Spirit — poor prognosis.
Eyes lack lustre, show no inner vitality, not clear
Lack of Spirit — poor prognosis.
Mind unclear; breathing laboured or shallow
Lack of Spirit — poor prognosis.

Notes

🧍 Constitutional Body Types

The Five-Element constitutional body shape someone is born with — a tendency, not itself a disharmony. Deviation from a person's own type is more diagnostically significant than the type itself.

Five-Element Types

Wood type: small head, long face, broad shoulders, tall sinewy body, elegant hands/feet; hard worker, tends to worry
Constitutional tendency toward Liver/Gall-Bladder patterns; losing hair may indicate Fire burning within Wood.
Fire type: red florid complexion, wide teeth, small pointed head/chin, well-developed shoulder/back/hip muscles; quick, energetic, short-tempered
Constitutional tendency toward Heart/Blood-vessel patterns (hypertension, heart disease) if not living up to type — e.g. walking slowly.
Earth type: yellowish complexion, round face, big head, wide jaws, large abdomen, strong thigh/calf muscles; calm, generous, steady
Constitutional tendency toward Spleen/Stomach patterns; weak muscles suggest problems.
Metal type: pale complexion, square face, small head/shoulders, flat abdomen; strong voice, swift mover, honest, decisive
Constitutional tendency toward Lung patterns; a weak voice or fast walking indicates a problem.
Water type: dark complexion, wrinkles, big head, round face/body, broad cheeks, narrow shoulders, large abdomen, long spine; sympathetic, laid-back, good negotiator
Constitutional tendency toward Kidney patterns; overindulgence in sexual activity may cause Kidney-Essence deficiency, reflected in dull eyes.

Body Tissue Signs

Weakness or stiffness of the sinews
Liver disharmony.
Hardening of blood vessels (hard, Wiry pulse)
Heart disharmony.
Weak, flaccid muscles
Spleen deficiency.
Flaccid skin
Deficiency of Lung-Qi.
Brittle bones
Kidney deficiency.

General Body Shape

Large, barrel-like chest and epigastrium
Full condition of Lungs and/or Stomach.
Large, overweight thighs
Spleen deficiency.
Thin body
Yin deficiency.
Overweight body
Yang deficiency (and Phlegm).

Notes

🏃 Demeanour & Body Movements

The way a person moves, and movement (or lack of it) in individual parts of the body: eyes, face, mouth, limbs, fingers.

Movement Patterns

Excess or rapid, jerky movement
Yang, Full or Hot pattern.
Lack of movement, slow movements
Yin, Empty or Cold pattern.
Moves quickly, throws off bedclothes in bed
Excess pattern of Heat, often of the Liver or Heart.
Moves very slowly, likes to lie down, feels generally cold
Deficient pattern of Cold (Yang deficiency), usually of the Spleen and/or Kidneys.
Small movements, continuous fidgeting, especially of the legs
Empty-Heat pattern of the Kidneys.
Tremors, convulsions (pronounced)
Liver-Wind, Full type (often derives from Heat).
Fine tremors, tics (of an eyelid or cheek)
Liver-Wind, Empty type (usually arises from Blood and/or Yin deficiency).
Paralysis of a limb
Internal Wind, always related to the Liver.
Stiffness and rigidity
Full pattern — Qi stagnation, Blood stasis, or (acute) external Wind.

Notes

💇 Hair

Reflects the condition of Blood, Kidney-Essence and the Liver.

Hair Signs

Falling hair
Blood deficiency.
Prematurely greying hair
Decline of Kidney-Essence.
Dull and brittle hair
Deficiency of Liver-Blood.

Notes

🎨 Face Colour

The face colour reflects the state of Qi and Blood and is closely tied to the condition of the Mind — an extremely important part of visual diagnosis.

White

Dull, pale-white complexion
Blood deficiency.
Bright-white complexion
Yang deficiency.
Bluish-white complexion
Yang deficiency with pronounced Cold.

Yellow

Sallow yellow
Stomach and Spleen deficiency, or Blood deficiency.
Bright orange-yellow
Damp-Heat, prevalence of Heat.
Hazy, smoky yellow
Damp-Heat, prevalence of Dampness.
Withered, dried-up yellow
Heat in Stomach and Spleen.
Dull-pale yellow
Cold-Damp in Stomach and Spleen.
Ash-like yellow
Long-standing Dampness.
Pale yellow surrounded by red spots
Spleen deficiency and stasis of Liver-Blood.
Clear, moist yellow between the eyebrows
Stomach-Qi recovering after illness — good prognostic sign.
Dried-up, withered yellow between the eyebrows
Poor prognostic sign.

Red

Whole face red
Full-Heat.
Only cheekbones red
Empty-Heat.

Green

Pale-greenish colour under the eyes
Liver-Qi stagnation.
Greenish complexion on the cheeks
Liver-Qi stagnation, Liver-Blood stasis, Cold in the Liver channel, or Liver-Wind.
Green complexion with a red tinge
Lesser-Yang pattern.
Green complexion with red eyes
Liver-Fire.
Yellowish-green cheeks
Phlegm with Liver-Yang rising.
Green colour on the nose
Qi stagnation with abdominal pain.
Dark-reddish green complexion
Stagnant Liver-Qi turning into Heat.
Pale-green colour under the eyes
Liver-Blood deficiency.
Grass-like green complexion
Collapse of Liver-Qi.

Blue

Dark-bluish colour under the eyes
Cold in the Liver channel.
White-bluish complexion
Cold or chronic pain.
Dull-bluish complexion
Severe Heart-Yang deficiency with Blood stasis, or chronic pain.
Bluish complexion in children
Liver-Wind.

Black

Black and moist-looking colour
Cold, or Kidney disease (Kidney-Yin deficiency).
Black, dried-up, burned-looking colour
Empty-Heat from Kidney-Yin deficiency.

Overall Colour Quality

Floating colour
Exterior, mild, Yang condition.
Deep colour
Interior, severe, Yin condition.
Distinct colour
Yang condition, Upright Qi still intact.
Obscure colour
Yin condition, Upright Qi exhausted.
Thin colour
Deficiency.
Thick colour
Fullness.
Scattered colour
New disease.
Concentrated colour
Old disease.
Moist colour
Good prognosis.
Dry colour
Poor prognosis.

Notes

👁️ Eyes

Eye Signs

Red corner of the eye
Heart-Fire.
Dull-white corners
Heat.
Pale-white corners
Blood deficiency.
Red sclera
Lung-Heat.
Yellow sclera
Damp-Heat.
Whole eye red, painful, swollen
Invasion of Wind-Heat or Liver-Fire.
Swelling under the eyes
Kidney deficiency.

Notes

👃 Nose

Nose Signs

Green or blue tip of the nose
Abdominal pain from Cold in the Spleen.
Yellow tip
Damp-Heat in the Spleen.
White tip
Blood deficiency.
Red tip
Heat in Lungs and Spleen.
Grey tip
Impairment of Water movement.
Greenish bridge of the nose
Liver-Qi stagnation.
Greyish or dark bridge
Liver-Blood stasis.
Red bridge
Liver-Fire.
Nose slightly moist and shiny
Good prognosis.
Dry nose
Heat in the Stomach or Large Intestine.
Dry and black nose
Toxic Heat.
Clear watery discharge
Cold pattern.
Thick yellow discharge
Heat pattern.
Flaring of the nostrils with high fever
Extreme Heat in the Lungs.

Notes

👂 Ears

Ear Signs

White ears
Cold pattern.
Bluish or dark ears
Pain.
Dry, withered, dark ear lobes
Exhaustion of Kidney-Qi.
Shiny and moist ear lobes
Good prognosis.
Dry and withered ear lobes
Poor prognosis.
Swelling and pain of middle ear
Heat in the Lesser Yang channels.
Swollen ear
Presence of a pathogenic factor (Full pattern).
Thin ear
Deficiency of Qi or Blood.
Long and full ear lobe
Strong constitution, good Kidneys.
Small, thin ear lobe
Rather poor constitution.

Notes

👄 Mouth & Lips

The lips reflect the state of the Spleen; the mouth, the Spleen and Stomach.

Mouth & Lip Signs

Pale-red, moist and shiny lips
Normal — good state of Spleen.
Pale lips
Yang or Blood deficiency.
Red and dry lips
Heat in Stomach and Spleen.
Purple or bluish lips
Blood stasis.
Mouth slightly open
Empty pattern.
Breathing through the mouth
Lung-Qi deficiency (unless due to a blocked nose).
Greenish colour around the mouth
Liver-Qi stagnation or Liver-Blood stasis.

Notes

🦷 Teeth & Gums

Teeth are an 'extension of the bones', under the influence of the Kidneys; gums are under the influence of the Stomach.

Teeth & Gum Signs

Swollen and painful gums, perhaps bleeding
Heat in the Stomach.
Swollen but not painful gums
Empty-Heat.
Very pale gums
Deficiency of Blood.
Moist teeth
Good state of Body Fluids and Kidneys (Kidney-Yin).
Dry teeth
Exhaustion of fluids and deficiency of Kidney-Yin.
Bright and dry teeth, like a stone
Heat in the Bright Yang (exterior/febrile diseases).
Dry and greyish teeth, like bones
Empty-Heat from Kidney-Yin deficiency.
Bleeding teeth
Extreme Heat in the Stomach.

Notes

🗣️ Throat (Pharynx & Tonsils)

Pharynx Signs

Deep red pharynx
Heat (interior or exterior).
Pale red pharynx
Empty-Heat.
Acute pain, redness and swelling of throat
Invasion of Wind-Heat.
Chronic pain, redness and swelling of throat
Stomach-Heat.
Chronically sore and dry throat, not swollen/red
Lung- and/or Kidney-Yin deficiency with Empty-Heat.
Pale-red throat
Empty-Heat affecting the Lung and/or Kidney channels.
Erosion, redness and swelling
Toxic Heat.
Erosion, swelling, yellowish-red
Heat in Stomach and Intestines.
Chronic erosion that comes and goes
Empty-Heat.
Chronic dryness and erosion with greyish ulcers
Severe Yin deficiency.
Chronic erosion with ulcers, raised hard edges
Blood stasis with Phlegm-Heat.

Tonsil Signs

Swollen tonsils of normal colour
Retention of Dampness or Phlegm against a background of Qi deficiency.
Chronically red and swollen tonsils
Heat or Toxic Heat, often in the Stomach and/or Large Intestine channel.
Acutely red and swollen tonsils
Invasion of Wind-Heat with accompanying Toxic Heat.
Chronic redness/swelling that comes and goes
Chronic Heat in Stomach/Large Intestine channel, or Empty-Heat in the Lung channel.
Acutely red and swollen tonsils with exudate
Invasion of Wind-Heat complicated by Toxic Heat in Stomach and/or Large Intestine channel.
Greyish tonsils
Acute stage of glandular fever (mononucleosis).

Notes

🦵 Limbs

The limbs indicate the state of the Spleen (which influences muscles) and Stomach (which transports Food Essences to the limbs).

Swelling of the Joints

Swelling of joints of the four limbs
Painful Obstruction (Bi) Syndrome, especially from Dampness.
Joints swollen, red and hot to the touch
Retention of Damp-Heat.
Swollen joints against a background of Blood deficiency
Painful Obstruction Syndrome with Liver-Blood deficiency — common in adult women.

Oedema of the Four Limbs

Oedema of the hands
Lung-Yang deficiency.
Oedema of the feet
Kidney-Yang deficiency.
Oedema of all four limbs
Spleen-Yang deficiency.
Non-pitting oedema of the limbs
Dampness in the muscles, or Qi stagnation.
Acute oedema of the hands and face only
Invasion of the Lungs by Wind-Water (a type of Wind-Cold).

Flaccidity, Rigidity, Paralysis, Contraction

Flaccidity, acute, following Wind-Heat invasion
Lung-Heat injuring Body Fluids.
Flaccidity, chronic, Full type
Damp-Heat in the Stomach and Spleen.
Flaccidity, chronic, Empty type
Stomach and Spleen deficiency; in severe cases, Kidney-Yin deficiency.
Rigidity, acute, sudden onset
Invasion of external Wind.
Rigidity, interior, in the elderly
Liver-Yang rising or Liver-Wind.
Rigidity with swelling and joint pain
Painful Obstruction (Bi) Syndrome with Dampness and Phlegm.
Rigidity with pain worsening at night
Blood stasis.
Rigidity, Empty type, in the elderly
Deficiency of Liver- and Kidney-Yin, or Spleen- and Kidney-Yang.
Paralysis, ranging from slight to complete (hemiplegia)
Stomach and Spleen deficiency; general Qi and Blood deficiency; Liver- and Kidney-Yin deficiency; or Full causes: retention of Dampness, Blood stasis.
Hemiplegia after a stroke
Retention of Wind and Phlegm in the channels, against a background of Qi/Blood or Yin deficiency.
Contraction, acute, sudden onset
Invasion of Wind (short duration, self-resolving).
Contraction, Full type
Dampness obstructing the muscles, or Heat injuring Body Fluids.
Contraction, Empty type (e.g. Dupuytren contracture in the elderly)
Liver-Blood or Liver-Yin deficiency.

Tremor & Spasticity

Tremor of the hands
Liver-Wind.
Tremor of the four limbs in the elderly
Liver-Wind and Phlegm affecting the channels and sinews.
Fine tremor in women
Liver-Wind deriving from Liver-Blood deficiency.
Mild, fine tremor of the limbs
General deficiency of Qi and Blood.
Spasticity and tremor in febrile disease
Liver-Wind, or Empty-Wind from Yin deficiency.

Nails, Thenar Eminence & Index Finger (Babies)

Pale nails
Deficiency of Blood.
Bluish nails
Stasis of Blood (of the Liver).
Ridged nails
Deficiency of Liver-Blood.
Bluish venules on the thenar eminence
Cold in the Stomach.
Bluish and short venules on the thenar eminence
Empty pattern.
Red venules on the thenar eminence
Heat in the Stomach.
Purple venules on the thenar eminence
Blood stasis in the Stomach.
Infant index-finger venules beyond the 'Gate of Wind' only
Invasion by an exterior pathogenic factor — mild disease.
Infant index-finger venules beyond the 'Gate of Qi'
Interior, more severe disease.
Infant index-finger venules beyond the 'Gate of Life'
Serious, life-threatening disease.
Infant index-finger venules bluish
Cold pattern.
Infant index-finger venules red
Heat pattern.

Notes

🧴 Skin

The skin relates to the Lungs, but also to Blood and, through it, the Liver; some skin disease also relates to Stomach-Heat.

Skin Signs

Dry skin
Liver-Blood deficiency.
Itchy skin
Wind, often deriving from Liver-Blood deficiency.
Pitting oedema (skin pits and changes colour on pressure)
Kidney-Yang deficiency (true 'Water oedema').
Non-pitting oedema
Qi stagnation ('Qi oedema').
Bright-yellow skin
Yang jaundice, from Damp-Heat.
Dull-yellow skin
Yin jaundice, from Damp-Cold.
Red venules
Heat in the Blood.
Purple venules
Blood stasis.
Green venules
Pain.
Blue venules
Cold in the Blood.
Papules
Heat in Lungs and/or Stomach.
Vesicles
Dampness.
Macules, red
Blood-level disharmony — Blood-Heat.
Macules, purple
Blood stasis.
Macules, bluish
Cold in Blood.

Notes

👅 Tongue

A pillar of diagnosis — remarkably reliable, and it usually reflects the basic, underlying pattern even when other manifestations conflict. Based on four items: body colour, body shape, coating, and moisture.

Body Colour — Pale

Pale, slightly wet tongue
Yang deficiency.
Pale, slightly dry tongue
Blood deficiency.
Pale sides
Liver-Blood deficiency.
Orangey sides (severe)
Severe Liver-Blood deficiency.

Body Colour — Red / Deep-Red

Red tongue with coating
Full-Heat.
Red tongue without coating
Empty-Heat.
Red tip
Heart-Fire or Heart Empty-Heat (with/without coating).
Red sides with coating
Liver-Fire or Gall-Bladder Heat.
Red sides without coating
Liver-Yin deficiency with Empty-Heat.
Red centre
Heat or Empty-Heat of the Stomach.
Red points on the tip
Heart-Fire.
Red points on the sides
Liver-Fire.
Red spots on the root
Heat in the Lower Burner.
Red points in or around the centre
Stomach-Heat.
Deep-Red tongue (a shade darker than Red)
Same significance as Red, but more severe.

Body Colour — Purple / Blue

Reddish-Purple tongue
Blood stasis from Heat (develops from a Red tongue).
Bluish-Purple tongue
Blood stasis from Cold (develops from a Pale tongue).
Purple on the sides
Liver-Blood stasis.
Bluish-Purple sides in a woman
Blood stasis in the Uterus.
Purple in the centre
Blood stasis in the Stomach.
Blue tongue
Interior Cold giving rise to stasis of Blood (same significance as Bluish-Purple).

Body Shape

Thin body, Pale
Blood deficiency (chronic).
Thin body, Red without coating
Yin deficiency (chronic).
Swollen tongue
Retention of Dampness or Phlegm.
Swollen and red tip
Severe Heart-Fire.
Swollen and red sides
Liver-Fire.
Swollen, wider sides, usually Pale
Spleen deficiency.
Swelling in the front third
Phlegm in the Lungs.
Stiff tongue
Interior Wind or Blood stasis.
Flaccid tongue
Deficiency of Body Fluids.
Long tongue
Tendency to Heat, particularly Heart-Heat.
Short tongue, Pale and wet
Interior Cold.
Short tongue, Red and Peeled
Extreme deficiency of Yin.
Short horizontal/vertical cracks ('Stomach crack')
Stomach-Yin deficiency.
Long, deep midline crack reaching the tip ('Heart crack')
Tendency to a Heart pattern.
Short transverse cracks on the sides, middle section
Chronic Spleen-Qi or Spleen-Yin deficiency.
Quivering tongue
Spleen-Qi deficiency.
Deviated tongue
Interior Wind.
Tooth-marked tongue
Spleen-Qi deficiency.

Coating

Thin white coating
Normal — Stomach digesting food properly.
Thick coating
Presence of a pathogenic factor (the thicker, the stronger).
Coating 'without root' (looks added on, not grown out)
Deficiency of Stomach-Qi.
Partial absence of coating
Deficiency of Stomach-Yin.
Total absence of coating
Deficiency of Stomach- and Kidney-Yin.
Total absence of coating with Red tongue body
Deficient Kidney-Yin with Empty-Heat.
White coating (thick)
Cold pattern.
Yellow coating
Full-Heat pattern.
Grey or black coating, tongue wet
Extreme Cold.
Grey or black coating, tongue dry
Extreme Heat.

Moisture

Normal tongue, slightly moist
Body Fluids intact and being properly transformed/transported.
Tongue too wet
Yang deficiency — Yang Qi not transforming/transporting fluids, forming Dampness.
Tongue too dry, with coating
Full-Heat.
Tongue too dry, without coating
Empty-Heat / Yin deficiency.
Sticky or slippery coating
Retention of Dampness or Phlegm.

Notes

🌊 Channels

Manifestations appearing along a channel are an important aid to diagnosis, but should always be integrated with all other findings, not used alone to decide treatment.

Connecting-Channel Manifestations

Greenish colour along a channel
Qi stagnation in the channel, or severe pain.
Reddish colour along a channel
Heat in the channel.
Bluish colour along a channel
Cold in the channel.
Objective feeling of heat along a channel
Retention of Heat.
Objective feeling of cold along a channel
Retention of Cold.
Flaccidity of the muscle along a channel
Deficient condition — channel starved of Qi and Blood (often seen in Atrophy Syndrome).
Rigidity or hardness of a muscle along a channel
Excess condition — retention of Cold in the channel, or stagnation of Liver-Qi.

Notes