Looking Diagnosis in TCM

There is a lost art (and I use the term ‘art’ deliberately) in examining a patient or even ourselves. Simply by looking at ourselves and consciously seeking a diagnosis in TCM can reveal where we need to concentrate in our lives even when we don’t feel sick. The problem with disease is that very often, it gives minor warning symptoms before it gets serious but we tend to ignore them because we have lost the understanding of listening to our bodies. Instead, modern society is so busy and rushed that we tend to leave things go until we become seriously ill and then we are reliant on someone else to diagnose us and treat the symptoms that are causing us pain. A looking diagnosis in TCM is where we consciously take note of all the tiny things we usually don’t even see and use them to build an understanding of our health.

This is not to say that we should ignore doctors or medical advice. Rather, it is saying that we need to start paying attention to our own bodies which are constantly feeding information back and forth to the brain – only we are consciously missing the signals.

There is a growing awareness of the issues surrounding depression, anxiety and stress and how they interact with physical illness or our sense of wellness. We can take all these forms of wellness – our body, mind and spirit and call it our holistic wellness or our holistic health. Ancient disciplines like Traditional Chinese Medicine or Japanese Shiatsu intuitively took these into account in their diagnosis of a patient. They have their own stock of tools for diagnosing symptoms of dis-ease and look to rebalance the body – mind – soul connections.

Even today, we often hear people describe others as ‘under a cloud’, ‘green with envy’, ‘red faced’, ‘hyperactive’ or more extreme descriptions like ‘the face of death’, ‘walking dead’ or ‘drowning in sorrow’. These are all ways of describing the outward appearance of somebody – ancient medicines called this assessment the ‘Looking Diagnosis’ and it was where an assessment was made as to the constitution of somebody and what part of the body might be out of balance.

We do this diagnosis in TCM by examining the body from a macro level right down to the micro level. So we start with an overall impression of the person – what type they are, whether they are naturally excess or deficient or neither (Read on to learn about all this!) and then begin breaking it down to examine signs that may suggest where we need to pay attention such as our kidneys, lungs, spirit or souls.

Our Overall Body Type

The Five Elements can be applied to our body types to give a general indication of our constitution. In reality, most people are a fluid mix of these;

  • Fire – Wide forehead and high cheekbones. Finely pointed features. Red complexion, adventurous possibly of a nervous disposition. Small hands.
  • Earth – Natural tendency towards overweight. Strong legs and belly. Sallow or yellow complexion. Slow moving. Calm and practical.
  • Metal – Broad shoulders, strong body type but lean. White pale tone. Enjoys stillness. Rational but prone to bouts of melancholy.
  • Water – Soft. Adaptable to circumstances but can be slow and lazy. dark or bluish tone.
  • Wood – Organised but tense and rigid movement. Tight muscles and green or purplish skin tone. Often tall and slender.

When we have an idea of our base constitution, we can use the 5 element theory to assess what imbalances we may be susceptible to.

Excess or Deficient

Moving from our body type we can examine whether the person is in an excess or deficient condition. This incorporates not only their physical appearance but also their demeanor and spirit. For example, fidgeting hands and still legs could be one sign of excess in the upper body. Bouncing the leg but having still hands could suggest excess in the lower body.

A trained eye can distinguish a body that is in excess or deficient (Jitsu or Kyo in Shiatsu). We could be predominatly excess in the upper half of the body compared to our lower half. You could also be more excess in the anterior (front) of the body compared to the posterior (back) – for example, someone who wanted to appear very strong to everybody might have an excess front but weak back.
When examining the back, excess areas tend to ‘stand out’ and deficient areas are depressed. This can sometimes be seen but more often felt by discerning between areas on the back that feel full of vitality or lacking thereof.

Left or right excesses or deficiencies are easier to spot as there is a symmetrical body to view. These conditions are more coommon in people who have a prior injury, skeletal discrepancy or a diseased organ.


As we delve deeper into the looking diagnosis, we need to begin to recognise areas of the face or body that may be showing a colour. These are subtle but present all over and the more we practise looking at people for these, the easier they are to spot. As well as an overall colour to the skin, tongue and face, certain areas or the body will be shaded different if there is an imbalance in the associated organ.

In general, the colours and their symptoms are;

RedHeat in body
YellowAssociated with dampness and/or spleen deficiency
GreenInternal cold/pain and possibly Liver disharmony
Black/Dark BlueCold/pain and possibly Kidney issues
WhiteCold and general deficiency

Diagnostic Areas in TCM

Bearing in mind the colours and their imbalances they suggest, we can now begin to get more specific at what the dis-ease in our body may be. Certain areas of the body have been associated with our organs an/or spirit. These areas have been refined over thousands of years as our understanding of meridians and relationships between areas grew. Common ones are outlined below but always bear in mind in diagnosis in TCM, these are set against the background of the persons constitution and are therefore fluid in nature and require careful analysis. Use the other diagnostic modalities (touch, listening and questioning) to further refine an analysis.

Pulse taking - diagnosis in TCM
Pulse taking – diagnosis in TCM


Red Ears – Kidney heat


Red nose tip – Weak Heart
Red but swollen nose tip – Heat in Heart
Yellow on bridge of nose and possibly temples – Weak Spleen transformation
Vertical line on upper bridge of nose – Spleen disharmony.
Red nostrils – Heat in Lungs
Clear discharge – Wind Cold
Turbid discharge – Wind Heat


Yellow between bridge of nose and lip – Weak Stomach digestion
Upper Lip swelling – Stomach disharmony
Upper Lip cracking/dryness – Stomach yin deficiency
Red lower lip/jaw – Damp heat in Large Intestine
Lower lip swelling – Weak Large Intestine elimination function
Lower lip dryness – Intestines short of fluids
Mouth area purple – Qi stagnation in Lower Warmer (especially for Women)
Mouth area red – Damp Heat in reproductive organs
Pale Lips – Deficient Blood
Red Lips – Excess Heat
Bluish/Purple Lips – Blood stagnation or retention of Cold.
Pale gums – Deficient Blood


Dark rings under the eyes – Kidney weakness.
Puffy Eyes – Kidney yang deficiency
Sunken red hollows – Kidney yin deficiency
Red eyelids – Heat in Gallbladder
Furrows between eyebrows – Liver Qi stagnation
Vertical lines between eyebrows – Anger of excess Liver Qi
Red patch between eyebrows – Liver Heat/Liver Fire
Darkness of inside corner of eyesocket – Spleen weakness
Eyes lack luster and cloudy – Shen (Spirit) and Jing (essence) need attention
Staring upwards, sideways or straight – Liver Wind



The tongue is a diagnostic book in itself and is widely used in Asian traditional medicines for observation and diagnosis. Tongue diagnosis in TCM utilises the area of the tongue, color and tongue covering. A normal healthy tongue is red with a thin white coat, the tongue is moist and unblemished.

Tip of Tongue – Heart
Upper Tongue (distal to tip of tongue) – Lung
Sides of Tongue – Gallbladder, Liver (side of tongue also related to the ‘sides’ of our body)
Middle of Tongue – Our digestive organs e.g Stomach and Spleen
Back of Tongue – Urinary Bladder
Underside of Tongue – Kidneys

The coating on our tongue is related to our health. Applying our knowledge of the coating, area of the tongue and our broad color associations can give a clearer picture of the diagnosis;

Thin white coating, teeth marks, pale tongue – Qi Deficiency
Thin yellow coating, red tongue – Heat
Greasy white coating and swollen tongue – Dampness
Greasy yellow coating, red tongue – Damp Heat
Thick white coating, pale swollen tongue – Yang deficiency
Little to no coating, pale tongue – Blood deficiency
Little to no coating, red tongue and cracks – Yin deficiency
Quivering or trembling tongue – chronic illness, fatigue


White discoloration – Lung Qi or Lung Yang deficiency
Red discoloration – Lung Yin deficiency or Lung Heat


Dry/cracked/dark – Deficient Liver Blood
‘Step’ down in nails – Deficient Liver Blood
Split Nails – Liver blood deficiency

Hands / Feet

Meridians start or finish in the toes or fingers and imbalances in the meridians or organs often produce deviations at those points, especially in the toes which do not get as much exercise and the hands. They are useful then in diagnosis in TCM as an easy part to observe. Shoes can prevent distortion from becoming apparent – for example, the fifth toe will rarely suffer lateral deviation because of shoe pressure.

Medial deviation – Deficiency
Lateral deviation – Excess condition
Dry skin around ankles/wrists – Lacking fluids


Loss of Hair – Blood or Kidney Jing deficiency.
Premature Greying of Hair – Blood or Kidney Jing deficiency

Leave a Reply

Your email address will not be published. Required fields are marked *