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