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Inspection is a method to examine the patient by observation of the expression, appearance, color, and abnormal changes of secretion and excretion, etc.

1. Observation of the Mind

This is to observe the patient's spirit, clearness of consciousness, coordination and vigour of movements, and keenness of response in order to judge the excess or deficiency of yin, yang, qi, and blood in the zang-fu organs and make a prognosis of the disease condition.

Strength of Spirit: The patient is in good spirits, the body resistance and functions of the zang-fu organs are normal, therefore the patient has a good prognosis. Generally speaking, the patient is in good spirits, behaves normally with a sparkle in the eye, and has a keen response.

Loss of Spirit: The patient is spiritless, indifferent in expression, has dull eyes and a sluggish response, or may even be unconscious or have a mental disturbance. This shows damage to the body resistance, a severe disease condition, and a poor prognosis.

2. Observation of the Complexion

Observe the color and luster of the facial region. Generally, a lustrous complexion with normal color indicates ample qi and blood, and a mild disease with a good prognosis. If the complexion is deep in color and withered, this indicates a serious disease condition with damage to the qi and essence, and a difficult treatment with poor prognosis.

White Color: A white color is the sign of a qi and blood deficiency. A pale complexion indicates a yin excess with yang deficiency. A qi deficiency manifests a lusterless and pale complexion and is accompanied by swelling. A pale emaciated face indicates a blood deficiency. A sudden pale complexion with cold sweat is the sign of sudden prostration of yang qi due to febrile diseases caused by exogenous pathogenic wind-cold.

Yellowish Color: a yellowish color is the sign of spleen deficiency and damp accumulation. A complexion that is yellowish, withered and lusterless indicates a qi deficiency of the spleen and stomach. A yellowish, flabby complexion is the sign of damp accumulation due to spleen dysfunction of transportation and transformation. The yellow color of the face, eyes, and skin indicates jaundice. In traditional Chinese medicine a bright orange yellow is diagnosed as yang jaundice caused by pathogenic damp-heat; dark yellow in yin jaundice due to pathogenic cold-damp.

Red Color: Redness indicates excessively full blood vessels due to excessive heat. A red complexion is mostly due to the fever of a common cold, or may be a heat syndrome due to excessive yang in the zang-fu organs. Malar flush with bright red color indicates xu heat syndromes due to yin deficiency and yang preponderance.

Bluish Color: Bluish color indicates syndromes of cold, pain, and blood stasis or convulsion, and is the manifestation of qi and blood obstruction in the channels. Pathogenic cold causes stagnation of qi and blood leading to pain. Children's high fever also shows a bluish complexion, the symptoms of acute convulsion.

Black Color: Black color indicates kidney deficiency, humor accumulation, and blood stasis. This is the manifestation of excessive cold and water, or stagnation of qi and blood. If the complexion is as black as bronze, it is mostly due to an extreme weakness of kidney yang and cold accumulation manifesting as xu-cold syndromes. A dark dray color around the eyes denotes phlegm-humor syndrome due to kidney deficiency. This leads to a dysfunction of the water metabolism or leukorrhea, due to the downward flowing of kidney essence. A dark gray malar can be seen in patients with frequent urination due to kidney deficiency. A dark gray complexion indicates prolonged stagnation of blood such as a consumptive disease with blood deficiency accompanied by menoplania or amenia.

3. Observation of the Tongue

Tongue Proper

Pale Tongue: Indicates xu and cold syndromes or symptoms due to yang qi deficiency and insufficiency of qi and blood.

Red Tongue: Indicates heat syndromes, mostly shi types of disease caused by interior heat, or symptoms of fire preponderance due to yin deficiency.

Deep Red Tongue: Denotes the excessive heat seen in febrile disease due to invasion of exogenous pathogenic heat which as been transmitted from the exterior to the interior of the body. It also can be seen in miscellaneous diseases due to a preponderance of fire caused by yin deficiency, or seen in diseases of accumulated fire in the liver channel.

Purplish Tongue: Shows the syndrome of blood stagnation. A tongue with purplish spots or petechiae also indicates blood stagnation.

Tongue Appearance

Flabby Tongue: A flabby tongue body with teeth marks on the margin and pale in color indicates a yang deficiency of the spleen and kidney leading to accumulation and obstruction of phlegm-dampness. A flabby tongue with a deep red color indicates excessive pathogenic heat attacking the heart and spleen.

Thin and Small Tongue: This indicates consumption and deficiency of blood and yin. A thin and small tongue with a pale color denotes deficiency of both qi and blood. A thin dry tongue with a deep red color is mainly due to a preponderance of fire and great exhaustion of body fluids.

Rigid Tongue: Seen in febrile diseases due to the invasion of exogenous pathogenic heat transmitted into the pericardium or due to an obstruction of pathogenic phlegm. It may also be seen in high fever leading to consumption of body fluids and preponderance of pathogenic heat. It is a prodrome of wind-stroke (cerebral stroke).

Deviated Tongue: This is a prodrome of wind-stroke.

Cracked Tongue: Cracks on the tongue with deep red color indicate excessive heat. A cracked pale tongue indicates insufficiency of yin and blood. However, a cracked tongueof long term duration without any other symptoms can be considered normal.

Tongue Coating

In the first place, the properties of tongue coating should be examined.

Thinness and Thickness: Generally, if substantial pathogenic factors such as damp, phlegm or food accumulation occur and cause obstruction, they further affect the spleen and stomach leading to the ascent of turbid qi and forming of a thick tongue coating. A white thin tongue coating is formed if nonsubstantial pathogenic factors such as wind, heat, dryness, or cold attack the body; or if the pathogenic factors stay on the body surface; or if body resistance is weak during the disease development.

Moistness and Dryness: The normal tongue coating is moist, which indicates that plenty of body fluid is flowing upward. If the tongue coating is dry, it is due to body fluids failing to moisten the tongue. A dry tongue coating may also be present in some febrile diseases where pathogenic heat consumes the body fluid. A slippery tongue coating may be due to pathogenic damp-humor floating over the tongue surface.

Sticky and Curdled Tongue Coating: A sticky coating is due to hyperactivity of endogenous pathogenic phlegm and damp rising to the tongue, and is mostly seen in diseases caused by pathogenic damp-heat or phlegm-humor. A curdled tongue coating is the outcome of food accumulation in the stomach leading to the ascent of turbid qi to the tongue surface. It is also seen in disease caused by phlegm-damp.

Peeled Tongue Coating: Mostly due to deficiency of qi and yin. If peeled tongue is accompanied by a sticky coating, it indicates a complicated disease condition to which the body resistance is weakened.

No Tongue Coating: Changes in the tongue coating indicate fluctuation in the disease condition. For example, if a qi deficiency of the stomach is manifested by no tongue coating at an early stage, the tongue coating will reappear after the stomach qi is recovered. If a disease has no tongue coating, then suddenly appears, this indicates a perversive flow of stomach qi, or excessive pathogenic heat. If a disease has a tongue coating at the beginning which disappears abruptly, this indicates stomach yin fluid has decreased. If a thick coating gradually turns into a thin white coating, this indicates that pathogenic qi is being gradually weakened, and the disease condition is becoming milder.

Generally, an observation of the thinness and thickness of the tongue coating will indicate the depth of pathogenic qi. The tongue's moistness or dryness shows the body fluid condition. The degree of curdling and stickiness of the tongue coating indicates the dampness of the stomach and spleen. The appearance or disappearance of tongue coating signified the cure or worsening of the disease condition.

Color of Tongue Coating

White Coating: Indicates exterior-cold syndromes. A white and thin coating is seen mostly in exterior syndromes, while a white and thick coating appears in interior-cold syndromes. If there is a powder-like whitish coating covering the tongue surface, it is caused by the internal accumulation of summer-humid heat and is usually seen at the onset of pestilential diseases.

Yellow Coating: Indicates interior and heat syndromes. A light yellow tongue coating is seen in cases of slight fever. A deep yellow color indicates high fever. Brownish tongue coatings represent an accumulation of pathogenic heat.

Grayish Coating: Denotes interior-heat syndrome or interior-cold syndrome. A grayish black and slippery coating on the tongue usually indicates symptom-complex due to cold-damp in the interior. A grayish, yellow, and sticky tongue coating usually indicates the accumulation of damp-heat. Grayish and dry tongue coatings are usually due to the consumption of body fluid by excessive heat.

Black Coating: This is often seen at the serious and dangerous stage of disease, and indicates extreme heat or cold. A black, yellow, and dry coating with thorns on the tongue surface usually denotes consumption of body fluid by extreme heat. A black and slippery tongue coating shows excessive cold due to yang deficiency.

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