Observations, Shen, Face and Tongue

Here are some of the things that are important to getting down to a root cause.

First thing is to "look the spirit over".  This is a combination of facial expression, muscle tone, posture, mode of speech and general appearance.  If the condition is not serious, he will be spirited, good complexion, clear eyes and speech, normal posture, quick to replying to questions.

If the disease is serious, the patient's face will be dark, shows little interest in what is going on, doesn't hold normal posture, frequently pauses in talking and will be dispirited.

When one fact like speech or posture suddenly seems to change for the better, without and corresponding improvement in the other features, it is a sign the disease has entered a critical phase, because it represents a major imbalance in the body.  It is particularly grave if a seriously ill patient becomes euphoric.

Certain types of people are prone to certain disorders.  Obese people tend to suffer from diseases like Phlegm and Dampness, while thin people tend to be yin deficient.

Changes in skin color are important, as they indicate a difficulty with a particular organ.

Pale complexion reflects a deficient or cold condition
Dusky and swollen indicates deficient Qi.
Pale and lusterless indicates insufficent blood.
Red indicates heart.  Pale red in the cheeks in the afternoon is deficient heart
Flushed face and red eyes indicates excessive heat.
Yellow color is from dampness and deficiency
Bright yellow-orange is Yang Jaundice from damp heat
Yellow-black especially under the eyes is Yin jaundice from deficient kidneys and congealed blood.

Tongue diagnosis involves looking at the shape, coating and body of the tongue.  While tongue diagnosis is a little more difficult these days with good dental hygiene, you can still glean much information from the tongue.  When you see a strange color, make sure you eliminate what the patient has recently eaten or drank, such as coffee, beets, tea, chocolate.

A healthy tongue is pinkish red, neither obese or too thin or pointed, slightly moist with no fur or a thin white coating and usually without crevices.  If a person has a tongue like this, their disease is likely to be mild.

Obese tongue with teeth indentations on the side indicates deficient qi or excess dampness.
White moist coating reflects deficient qi, while a greasy coating indicates dampness.
Thin and narrow tongue indicates either insufficient yin fluids or deficient qi and yin.
Red body of tongue, disorder is deficient yin alone.
Pale body of tongue, disorder is both qi and yin are weak.

Red eruptions on the tip or edges of the tongue indicate excess heat.
Red or purplish eruptions on the sides in the liver area indicated congealed blood, pain or liver not spreading qi properly.  This is often observed in women with menstrual disorders.

Cleavage in the tongue, either superficial or deep indicate the presence of heat and/or dryness.  In a very minority of cases, it is congenital and therefore, not significant.

The color of the tongue indicates the degree of heat in the body, and indicates the condition of the Qi and blood in the body.  A normal tongue is lighter.  If darker it is called red, if still darker is called deep red.  Sometimes the tongue has areas that are dark-blue or purple.

Pale tongue signifies deficient blood and qi.
Very pale, it may be a symptom of interior cold.
A red tongue indicates the presence of interior, deficient heat.
With excessive heat, the entire tongue is red.
With deficient heat, only the tip is colored.
Dark red, heat is deep in the body.
Deep red tongue with ulcers says Fire in the Heart
Purple or dark blue patches, blockage in the flow of qi or blood.
If the patches are localized, then the disorder is limited to that organ that the position on the tongue indicates.

A healthy tongue has a thin coating on it.
Too much moisture to cause a semi-transparent layer is a wet coating, dampness is present
Excessive dryness of the coating indicates insufficient fluids (one of the very first symptoms of it)
If you can see the tongue through the coating, it is a thin coating, indicates the excess is mild (usually damp, heat or cold)
If you cannot see the tongue through the coating it is a thick or greasy coating, and indicates the excess is severe dampness or indigestion.
If there is no coating at all on the tongue, it is considered bare or peeled, indicates the yin fluids are seriously depleted or the stomach Qi is very weak.

The color of the coating determines the nature of the disease.  It is normally thin and white.  If the tongue looks like this, the disease is not serious, or is still at the Exterior stage.
White, wet indicates cold.
White, dry indicates the cold excess is transforming into heat.
Thick, greasy white coating indicates phlegm or dampness.
Yellow coating indicates Heat.

Other observations:

If the head hair is dry and thinning, indicates deficient kidney qi or weak blood.
The colors and moisture of the lips are similar to the body of the tongue.
If the corners of the lips do not close firmly, and the philtrum is shrunken, the Qi is close to exhaustion and the disease is probably terminal.
Drooling saliva is due to either Deficient spleen or Heat in the stomach.
Red swollen or bleeding gums are caused by stomach fire.
Pale swollen gums and loose teeth indicate deficient kidneys.

Breathing
In deficient diseases, the breathing is shallow and soft, and difficulty inhaling.
In excess diseases, the breathing is rough and heavy, with forceful exhale.
A cough that produces gurgling sounds in the throat is due to damp or phlegm
A dry hacking cough is dry heat in the lungs.