VISUAL DIAGNOSIS IN CHINESE

MEDICINE
Nathaniel Whitmore, Herbalist

The Four Pillars of Diagnosis in Traditional Chinese

Medicine
Inquiry Information is gained though questions regarding symptoms, health
history, etc.
Palpation Touch is used to understand pain, the abdomen, the pulse,
acupoints, etc.
Listening and Smelling These more-or-less subtle indications are included
here together.
Visual Looking is focused on body type, face, hands, skin, and tongue.
Visual assessment has many distinctions among these four pillars. First, it
begins immediately as soon as a doctor sees a patient, visual assessment begins.
Apparently, in days of old visual methods were especially used when male doctors
saw women patients, who they were not permitted to touch for pulse assessment (a
primary diagnostic method in TCM). A picture is worth 1,000 words. In many
cases, simply observing something visually is easier than describing the condition.

Facial Diagnosis
Each of the Five Organs of Chinese medicine are reflected in the face:
The heart manifests in the nose: redness shows heat, purple shows
stagnation.
The spleen manifests in the shape of the face, at the bridge of the nose, and
eyelids.
(stomach heat manifests as red checks)
The lungs manifest on the cheeks and in the complexion: gray smokers
complexion
(large intestines manifest below the eyes and on forehead)
The kidneys manifest in the area below the eyes: puffiness and purple show
stagnation.
The liver manifests between the eyes: the liver line
(gall bladder manifests at the temples)
* (Solid/hollow organ pairs: heart & small intestine, spleen & stomach, lungs & large intestine, kidneys & bladder,
liver & gall bladder)

Several bi-lateral meridians (energy channels) and important acu-points are on the
face:

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stomach meridian runs down the cheek, including jaw and hairline.
large intestine meridian ends at the nosrils (a lung diagnostic area).
bladder meridian runs over the head from the inside corner of the eyes.
gall bladder meridian runs through the temple and zig-zags to hairline.
triple heater meridian ends at the eyebrow.
small intestine meridian is at the side of the cheek.
conception vessel runs up the center of the chin.
governing vessel runs down the center of the face to the mouth.

Tongue Diagnosis
Tongue diagnosis is a particularly interesting aspect of visual assessment in that it
comes close to looking inside the body. The tongue is most directly connected to
the digestive system and in this way primarily reflects the spleen, though much of
the assessment is based on a map of the organs that is projected onto the
tongue.
A healthy tongue is pink, indicating a healthy condition of the blood and flesh, and
has a coating, called the moss, that indicates the condition of fluids. Tongue
diagnosis is largely based on the observation of the body of the tongue and of the
moss.
The body of the tongue is observed in terms of shape, color, etc.
A swollen tongue is enlarged to the point that it pushed on the teeth,
indicating dampness.
A shrunken tongue indicates yin deficiency, the lack of fluids.
Cracks in the tongue indicate yin and chi deficiency.
Dips in the tongue indicate chi deficiency.
A red tongue indicates heat and inflammation.
A purple tongue indicates blood stagnation.
The tongue moss is observed primarily in terms of thickness and color.
Lack of moss indicated yin deficiency (dryness).
Thick moss indicates dampness, the accumulation of fluids creating mucus,
etc.
Thick yellow moss indicates damp-heat.
The various organs of TCM are reflected in different places on the tongue.
The tip of the tongue reflects the heart.
Just behind the tip is the lung area.
The sides of the tongue reflect the liver.
The middle of the tongue (as well as the body of the tongue) reflects the
spleen.
The back of the tongue (the root) reflects the kidneys.

Body Type
Body type is often the first visual feature observed and some rather basic things can
easily be understood. However, observation of body type in Chinese medicine is
often based on an understanding of the Five Element theory and is not so easily
presented to beginners. While the organ associations referenced above are also
related to the Five Elements, this handout is not geared towards these more
advanced theories. Again, some basics can be easily observed:
A heavy, or big-boned, type indicates a tendency towards dampness and
other stagnation.
A thin body indicates yin deficiency, a tendency towards dryness.
Poor posture indicates chi deficiency.