Traditional Chinese Medicine Diagnosis

Diagnosis by observation

Spirit - observed through the eyes, complexion, breathing, vitality, & aura – describe, either strong or weak

Body constitution

wood – tall & slender

 fire – small pointed head and small hands

metal – broad square shoulders, strongly built and a triangular face

earth – slightly fat, large head belly and thighs, wide jaws

water – round face and body, and a long spine

Demeanour – how the person moves should correspond with their constitution

- rapid jerky movements (Yang excess, or Heat)

- slow or lack of movement (Yin deficiency, or Cold)

Hair

- falling hair (Blood deficiency)

- premature graying (Kidney Essence deficiency)

- dull splitting (Lung deficiency)

Face

- clear and moist (Stomach Qi healthy)

- dry and lusterless (Stomach Qi deficiency)

- green (Liver, interior Cold, pain, internal Wind)

- red (whole face – excess Heat, malar – deficiency Heat)

- yellow (Spleen deficiency, Damp)

- bright orange-yellow (Damp/Heat)

- dry yellow (Spleen or Stomach Heat)

- dull pale yellow (Spleen Stomach Damp/Cold)

- white dull (Blood deficiency)

- white bright (Yang deficiency)

- black moist (Cold)

- black dry (Kidney - black moist (Cold)

- black dry (Kidney Yin deficiency)

***Important to use corresponding facial areas to aid in diagnosis.

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Eyes (there are differing theories, only one will be discussed)

- red inner corners (Heart Fire)

- red sclera (Lung Heat)

- yellow sclera (Damp/Heat)

- whole eye red painful swollen (Wind/Heat, or Liver Fire)

- pale white corners & lids (Blood deficiency)

- dark or swelling under the eye ‘bags’ (Kidney deficiency)

Nose

- green-blue (abdominal pain)

- yellow (Damp/Heat)

- white (Blood deficiency)

- red (Lung Spleen Heat)

- grey (impairment of water movement)

- dry tip (Stomach or Large Intestine Heat)

- dry black (Toxic Fire)

- clear discharge (Cold)

- yellow discharge (Heat)

Ears

- blue-black (pain)

- white (Cold)

- lobes dry withered black (Kidney deficiency – prognosis bad)

- lobes shiny and moist (prognosis good)

- lobes long and full (strong Kidneys)

- lobes thin and small (weak Kidneys)

- infection with pain (Fire in Shaoyang meridians)

Mouth & lips

- pale lips (Blood or Yang deficiency)

- red dry lips (Spleen Stomach Heat)

- purple-bluish lips (Blood Stasis)

- mouth always slightly open (deficiency)

- breathe though mouth (Lung Qi deficiency)

- green around mouth (Liver Blood Stasis, and Wood overact on Earth)

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Teeth and gums

- dry teeth (Kidney Yin deficiency, or Yangming Heat)

- poor tooth development (Kidney deficiency)

- swollen painful gums with possible bleeding (Stomach Heat, if no pain deficiency Heat)

- pale gums (Blood deficiency)

Throat

- pain, redness, swelling (Wind/Heat, or Stomach Fire)

- sore and dry, not red and swollen (Kidney Yin deficiency Heat)

Nails and limbs

- pale nails (Blood deficiency)

- purple-blue (Liver Blood Stasis)

- dry lifeless skin around the wrists and ankles (body fluid deficiency)

- in children, the first joint on the index finger is the ‘gate of wind’, the second is the ‘gate of Qi’, and the third is the ‘gate of life’.

                - after rubbing the finger towards the body…

                - veins appear only beyond the ‘gate of wind’ (mild, exterior invasion)

                - veins appear beyond the ‘gate of Qi’ (internal, more serious)

                - veins appear beyond the ‘gate of life’ (serious life threatening disease)

                - blue veins (Cold)

                - red veins (Heat)

Skin

- dry (Blood deficiency)

- itchiness (Wind)

- pitting edema (Kidney Yang deficiency)

- non-pitting edema (Qi stagnation)

- bright clear yellow Yang jaundice (Damp/Heat)

- dull yellow Yin jaundice (Damp/Cold)

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Tongue

- root (Kidney)

- middle (Spleen Stomach)

- sides (Liver Gallbladder)

- tip (Heart)

- behind tip (Lungs)

body colour indicates condition of blood, Ying Qi, and Zang organs

- pale red (normal)

- pale (Blood or Yang deficiency)

- red (excess or deficient heat)

- red spots/papillae (Heat or Blood Stasis)

- deep red (more severe Heat)

- purple (Blood Stasis)

- blue (Cold causing Blood Stasis)

body shape shows blood and Ying Qi

- thin (blood or Yin deficiency)

- swollen (Yang deficiency causing Damp or Damp/Heat)

- stiff (internal Wind)

- flaccid (body fluid deficiency)

- long (Heart Heat)

- short (interior Cold or severe Yin deficiency)

- cracked (horizontal = Stomach Yin deficiency, midline to tip = Heart, midline shallow wide = Stomach Yin deficiency)

- quivering (Spleen Qi deficiency)

- tooth-marked (Spleen Qi deficiency)

coat shows the Fu organs (in particular the Stomach, the coat is the left over from the digestion)

- thin white (Stomach is digesting normally)

- thick (Wind, Cold, Damp, retention of food, Phlegm, Heat, Fire, the thicker the more severe)

- no coat (Stomach or Kidney Yin deficiency)

- white (Cold)

- yellow (excess Heat)

- grey or black (severe Cold or Heat depending on the moisture)

moisture shows body fluids

- dry (Heat has injured the body fluids)

- slightly moist (normal)

- too wet (Yang Qi deficiency Damp)

- sticky or slippery (Damp or Phlegm)

Meridian diagnosis

The following symptoms are signs which apply only to the specific meridian, organ symptoms have been left out.  In addition to the following clinical manifestations, any pain, heat or coldness, numbness, stiffness, knots, tingling, aches, redness, or any other sign along the course of a meridian is also an obvious meridian symptom.

Diagnosis by hearing & smelling

Sounds

Voice

- sudden loss (Wind/Heat)

- gradual loss (Lung Qi or Yin deficiency)

- loud coarse (excess)

- weak (deficiency)

- talk too much (Heat), quiet/reserved (Cold)

- shouting (Liver)

- laughing (Heart)

- singing (Spleen)

- whimpering (Lung)

- groaning (Kidney)

Cough

- loud (excess)

- weak (deficiency)

- dry (Lung Yin deficiency)

Breathing

- loud coarse (excess)

- weak (deficiency)

Vomiting (same as breathing)

Hiccup (same as breathing)

Borborygmi (same as breathing)

Smell

- strong foul (Heat)

- no smell (Cold)

- bad breath (Stomach Heat)

- smelly urine (Damp)

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Diagnosis by inquiry 

(pattern identification through 8 principles, Zang Fu, pathogenic factors, & meridians)

Chills and fever (feeling of heat)

- aversion to cold (Wind/Cold or Wind/Heat)

- fever and chills (Wind/Cold, Taiyang stage), more fever than chills (Wind/Heat, Wei Qi level)

- fever without aversion to cold (internal Heat, Yangming stage)

- alternating chills and fever (exterior invasion of Wind/Cold or Wind/Heat at Shaoyang stage)

- relief of coldness (clothing/covering relieves – internal yang deficient cold, no relief – Wind/Cold)

- low grade fever worse in afternoon or at night with sweats (Yin deficiency)

- constant low grade fever (Damp/Heat)

Sweating

- sweat with exterior symptoms (Wind/Heat, or Wind/Cold with deficiency)

region

- only on head (Stomach Heat, or Damp/Heat)

- on forehead, oily (Yang collapse)

- only on arms and legs (Spleen Stomach deficiency)

- only on hands (Lung deficiency, or nerves)

- whole body (Lung deficiency)

- 5 centers (Yin deficiency)

time

- daytime (Yang deficiency)

- night (Yin deficiency)

condition

- profuse cold sweats (Yang collapse)

- oily sweat on forehead like pearls not following Yang collapse (danger of imminent death)

Quality

- oily (severe Yang deficiency)

- yellow (Damp/Heat)

Pain

excess

obstruction of Qi flow in the meridians, more severe, constant

- exterior pathogenic invasions

- internal Cold or Heat

- Qi stagnation (distension/throbbing more than pain, no fixed location)

- Blood stagnation

- Phlegm stagnation

- food retention

- Blood Stasis (stabbing, fixed location)

deficiency

dull intermittent

- Qi and/or Blood deficiency

- Yin deficiency consuming body fluids

Head and body

headache

onset

- recent, short duration (Wind/Cold)

- gradual onset, come in attacks (interior)

time of day

- day time (Qi or Yang deficiency)

- evening (Blood or Yin deficiency)

location

- nape of neck: taiyang (Wind/Cold, or Kidney deficiency)

- forehead: yangming (Stomach Heat, or Blood deficiency)

- temples/temporal region: Shaoyang (Liver Gallbladder Fire)

- vertex: jueyin (Liver blood deficiency)

- whole head (Wind/Cold)

pain characteristics

- heavy (Damp or Phlegm)

- inside the head/brain (Kidney deficiency)

- pounding, distending, throbbing (Liver Yang rising)

- boring, like a small nail point (Blood Stasis)

condition

- with exterior symptoms (Wind/Cold, or Wind/Heat)

- aggravated by cold (Cold)

- aggravated by heat (Heat)

- aggravated by fatigue, better with rest (Qi deficiency)

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pain in whole body

- sudden onset with chills and fever (Wind/Cold)

- pain everywhere with tiredness (Qi blood deficiency)

- after childbirth

                dull pain (Blood deficiency)

                severe (Blood Stasis)

                pain in arms only when walking (Liver Qi stagnation)

- pain in all muscles & hot sensation of the flesh (Stomach heat)

- pain with heavy feelings (Damp obstructing muscles)

pain in joints

- wondering from joint to joint (Wind)

- severe fixed (Cold)

- fixed with swelling & numbness (Damp)

backache

- continuous dull (Kidney deficiency)

- acute severe with stiffness (Blood Stasis)

- severe, aggravated by cold and damp weather (Cold/Damp invasion of the meridians)

- boring pain, tough to turn waist (Blood Stasis)

- extending up to the shoulders (exterior attack)

numbness

- arms and legs only, or hands and feet only (Blood deficiency)

- fingers, elbow and arm on one side only, especially the first three fingers (Wind and Phlegm, possible Wind stroke)

dizziness

Mostly diagnosed through identification of other symptoms

- usually root cause is Blood deficiency

- giddiness when everything seems to sway, lose balance (internal Wind)

- mild, with heaviness and cloudiness in head (Phlegm)

- aggravated when fatigued (Qi deficiency)

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Thorax and abdomen

- chest pain (Heart Blood Stasis due to Yang deficiency)

- chest pain with cough and copious yellow sputum (Lung Heat)

- hypochondriac distension (Liver Qi stagnation, if severe – Liver Blood Stasis)

- epigastric pain (food retention, Stomach Heat)

- dull epigastric pain (deficient Cold of Stomach)

- epigastric fullness (Spleen deficiency or Damp)

- low abdominal pain (internal Cold, Liver Qi stagnation, Liver Blood stagnation, Damp/Heat, intestinal or uterine Blood Stasis)

- hypogastric pain (Damp/Heat in Bladder, or Liver Fire moving down to the Bladder)

Diet & appetite, & taste

- discomfort relieved by eating (deficiency), aggravated by eating (excess)

- no appetite (Spleen deficiency)

- always hungry (Stomach Heat)

- fullness and bloating after meals (food retention)

- prefer hot temperature foods (Cold)

- prefer cold temperature foods (Heat)

taste

- bitter taste (Liver or Heart Heat)

- sweet taste (Spleen deficiency, or Damp/Heat)

- sour taste (food retention, or Liver Stomach disharmony)

- salty taste (Kidney Yin deficiency)

- lack of taste (Spleen deficiency)

- pungent taste (Lung Heat)

vomit

- sour vomit (Stomach insult Liver)

- bitter vomit (Liver Gallbladder Heat)

- clear watery (Stomach Cold with fluid retention)

- soon after eating (Heat)

Stool

constipation

- pain after movement (deficiency)

- pain relieved after movement (excess)

- acute with thirst, dry yellow tongue coat (Stomach and intestine Heat)

- old people or after childbirth (Blood deficiency)

- small bitty rabbit stools (Blood deficiency, Liver Qi stagnation, or Heat)

- difficult to move but not dry (Liver Qi stagnation)

- with abdominal pain (deficient Yang Cold)

- dry stools without thirst (Kidney and/or Stomach Yin deficiency)

- alternating constipation and diarrhea (Wood overact on Earth)

diarrhea

- painful (Liver, or Heat)

- foul smell (Heat), no smell (Cold)

- chronic (Spleen and/or Kidney Yang deficiency)

- 5am (Kidney Yang deficiency)

- abdominal pain (Cold in intestines)

- with mucous (Damp), mucous and blood (Damp/Heat)

- undigested food (Spleen deficiency)

- burning sensation (Heat)

- bowel incontinence (Spleen Qi sinking)

- black tarry stools (blood stasis), if blood comes first (Damp/Heat in intestines)

- if blood comes first, is dirty, and anus feels heavy and painful (Heat in Blood)

- if stool comes first then blood that is thin and watery (Spleen can’t keep blood in vessels)

- borborygmi