Section 1　Inspection of the Circumstances of the Entire Body

Inspection of the circumstances of the entire body is a primary diagnostic method. When the practitioner examines a patient, inspection of the spirit (vitality/shen), colour, body shape and posture is the first important procedure in the general understanding of any disease. These factors are the outward manifestation of the vital activities of the body, and can allow the practitioner to obtain not only a whole overall impression of the state and characteristics of the illness, but also a deep basic knowledge of the disease.

Inspection of theShen (Spirit)

Concept:

Theshen is a generic name for the human body's vital movement and it is the summation of all the human body's vital phenomena. Theshen can be divided into a generalised spirit and the specific sense of spirit (Fig. 2-1). Inspection of theshen refers to diagnosis of disease by observing the manifestations of life activities.

Principle:

The material base ofshen is the prenatal essence, postnatal essence, qi, blood and body fluids, which transform into each other (Fig. 2-2).

The relationship between theshen and essence-qi: If the essence-qi is adequate then the body is healthy, theshen is prosperous and the ability to resist disease is strong. If the essence-qi is frail then the body is feeble, theshen is debilitated and therefore the ability to resist disease is weak.

Clinical significance:

By inspecting theshen, one may realize if the essence-qi of thezang-fu organs is exuberant or deficient. Such an inspection is important for analysing the disease, whether it is mild or severe, benign or malignant and the prognosis is good or poor.

Points of note:

During inspection of theshen, the expression of the eyes, facial expression, facial complexion, mental status and movement of the body should all be inspected, but the most important of these is the expression of the eyes.

Judgments can be made on theshen, and the manifestations of the spirit include: being spirited (having presence of spirit), lack of spirit, being spiritless (loss of spirit) and false spirit (Table 2-1).

Spirited: means havingshen, or good spirit; indicating sufficientzheng (healthy)qi, normal functioning of the organs and indicates a favourable prognosis.

Lack of spirit: this is commonly seen in a deficiency pattern; particularly deficiency of qi and blood.

Spiritless (loss of spirit): this means poor spirit and damage of essence, which is due to insufficientzheng qi, deficiency of essence-qi, and indicates serious disease and unfavourable prognosis. It also includes exuberance of pathogens with mental disorders which is due to heat disturbing the mental activity, or inward invasion of the pericardium by a pathogen, or liver wind with phlegm confusing the seven orifices, all of the above indicate serious disease.

False spirit: indicates exhaustion of essence-qi, separation of yin from yang, escape ofzheng qi, floating of yang due to exhaustion of yin unable to control yang. At this moment, the patient is on the verge of death, in a critical state.

Mental disorders: includes, irritability, coma, delirium, mania, depression, epilepsy, hysteria, etc.

Panic andhysteria often appear as anxiety and fear, which mostly belong to deficiency patterns.

Manic disease andexternal heat diseasepresent as madness, irritability and restlessness, and belong to yang patterns (kuáng狂).

Mania anddementiapresent as apathy, vacancy and feeble mindedness, and belong to yin patterns (diān癫).

Epilepsy appears as sudden coma, convulsion of the limbs, drooling and unconsciousness, after which the person returns to normal (xián痫).

Inspection of Colour

The inspection of colour mainly includes observation of changes in the colour and lustre of the facial complexion and body skin.

1. Concept, Principle and Significance

Inspection of colour involves both the colour and lustre.

Colour refers to changes of the skin colour; it is the external manifestation of blood colour and skin colour together. Skin colour reflects the blood and yin; it reveals the different natures of diseases and patterns of differentzang-fu.

Lustre refers to the sheen of the skin and relates to changes of brightness or radiance. Lustre reflects the quality of the qi and yang; it reveals the exuberance and debilitation of thezang-fu's essential qi, and allows for a judgment of the severity and prognosis of a condition.

The relationship between colour and lustre is that colour (especially on the face) may be varied so, whatever the colour, the lustre of the skin is always a better reflection of the body's condition. If the complexion is moist and lustrous, it indicates that thezang-fu organs are normal, and thezheng qi is adequate and prognosis is favourable. If the complexion is dry and dull, it indicates insufficiency ofzang-fu essence and implies serious illness.

2. Facial Areas and Their Relationship to theZang-fu Organs

A. The method to divide the face according to thezang-fu organs given in theBasic Questions - Needling the Febrile Disease (Sù Wèn - Cì Rè,素问·刺热).

B. Dividing method of theThe Spiritual Pivot-Five Colours (Líng Shū-Wŭ Sè,灵枢·五色).

The Spiritual Pivot - Five Colours divides the areas of the face into five parts as below (Fig. 2-3).

See Fig. 2-4, for the dividing method of thezang-fu organs byThe Spiritual Pivot-Five Colours.

3. Ten Methods for Observing Colour

The Classic to Obey for Inspection Diagnosis (Wàng Zhĕn Zūn Jīng,望诊遵经) points out ten methods of viewing colour, which was written by Wang Hong (王宏, 1875) in theQing Dynasty. They include: superficial and deep (浮沉); clear and turbid (清浊); faint and extreme (微甚); scattered and conglomerate (散抟); sheen and perishing (泽夭)(Table 2-2).

Briefly, the 'Ten-methods' can distinguish exterior or interior, yin or yang, deficiency or excess, acute or chronic, favourable or unfavourable.

4. Normal Colour and Morbid Colour

Normal colour is divided into the governing colour and the guest colour. Morbid colour is divided into the benign colour and malignant colour.

(1) Normal colour

The normal colour should be the natural colour of the person's race/ethnicity and should be moist and with a bright sheen (pinkish-white for white people, and brownblack for black people, slightly yellow-red for Chinese, etc.). However, the characteristics related to being moist with a bright sheen more significantly implies a healthy disposition than the actual colour and this healthy complexion is often described as a blooming or glowing complexion. Thus firstly, the complexion being moist with a bright sheen is a manifestation of engorged essence. Secondly, the complexion colour implied in the skin and not the natural pigmentation of the skin, is the manifestation of essence unable to discharge outward. It is described as the lustrous and moist facial colour with hidden redness (redness should always be seen in combination with whatever the innate colour of the patient is).

The governing colour is the colour, which basically does not change from the time of birth. The guest colouris the normal changes of complexion due to the different seasons and climates.

(2) Morbid colour

Morbid colour is the change in complexion due to disease; its characteristics are dark and it appears as if exposed on the surface. Firstly, dull and dry, complexion reflects a decline of essence. Secondly, the complexion, which is obviously abnormal, is a manifestation of critical diseases.

Benign colour is the complexion with moist and bright sheen, which indicates normal condition of the essence and stomach qi, new-onset, mild disease or a yang pattern.

Malignant colour is the dull and dry complexion, which indicates insufficient essence and stomach qi, prolonged or serious disease or a yin pattern.

5. Major Manifestations and Significances of the Five Colours (Table 2-4)

A. White:

White may indicate deficiency; cold; desertion of blood or sudden collapse of yang qi.

a. Complexion is pale without lustre—— Blood deficiency pattern; pattern of blood loss.

b. White dull complexion with facial edema—— Pattern of yang deficiency and water floating edema.

c. Complexion is pale—— Sudden loss of yang qi and exuberant internal yincold.

B. Yellow:

Yellow may indicate deficiency of the spleen and dampness pattern.

a. Withered yellow complexion—— Qi deficiency of the spleen and stomach.

b. Yellowish complexion with facial edema—— Deficiency of the spleen and accumulation of dampness.

c. Face, eyes and body skin all yellow—— Jaundice.

C. Red:

Red may indicate heat pattern and floating yang pattern.

a. Redness of the whole face—— Excess-heat pattern.

b. Malar flush - tidal redness only in the cheeks—— Yin deficiency.

c. Pale face with occasional migratory bright-red, like the patient is wearing makeup—— Floating yang pattern.

D. Blue-green:

Blue-green may indicate cold; pain; qi stagnation; blood stasis and convulsions in children.

a. Complexion is light or dark blue-green—— Excessive cold, intense pain.

b. Complexion and lips are blue-green and purple—— Debilitation of heart qi and heart yang with blood stasis.

c. Complexion is blue-green and yellow—— Liver stagnation and deficiency of the spleen.

d. In children, the area between the eyebrows, nose bridge and around the lips becomes blue-green—— usually associated with convulsions.

E. Black:

Black may indicate kidney deficiency; cold; water-rheum and blood stasis.

a. Dark black without lustre —— Kidney yang deficiency.

b. Dry and black complexion —— Kidney yin deficiency.

c. Black rim around the eyes —— Retention of fluid due to kidney deficiency or leucorrhea due to cold-dampness.

d. Blackish complexion with scaly skin —— Prolonged blood stasis.

Inspection of the Form of the Body

Inspection of the form of the body primarily means to observe whether the patient is strong or weak, fat or thin. Inspection of the form of the body considers aspects of the constitution, shape and bearing and whether there is any physical abnormality.

Principle

① Form of the body has a close correlation with thezang-fu organs. Body constitution is associated with thezang-fu organs, whilst the function and condition of thezang-fu organs may be reflected by the body.

② Different forms of the body reflect different conditions of relative exuberance or debilitation of the yin and yang, and this reflects the likelihood of affliction by disease and the expected prognosis of a disease.

Significance

Inspection of the form of the body may help practitioners to examine the deficiency or excess of thezang-fu organs, exuberance or decline of the qi and blood, strength or weakness of the disease resistance and prognosis of some diseases.

Content

(1) Inspection of the form of the body

The content of the inspection of the form of the body includes: strong, weak, fat and thin.

Body Mass Index (BMI) is the index which is commonly used for determining fatness or thinness of the body mass:

Character and significance of the form of the body:

A. Strong:

Character: big and strong bones, broad and thick chest, well-developed muscles, moist and lustrous skin.

Clinical significance: powerful function of thezang-fu; exuberance of qi and blood; strong resistance against pathogenic invasion.

B. Weak:

Character: weak and small bones, narrow chest, thin muscles, withered skin.

Clinical significance: weak function of thezang-fu; shortage of the qi and blood; weak resistance against pathogenic invasion.

C. Fatness:

Character: fat and overeating; solid muscles, prosperous and powerful.

Clinical significance: surplus of qi; sufficient essence; healthy body.

Character: fat but eats only small amounts; flabby muscles and skin, mental fatigue.

Clinical significance: obese build and deficient qi; shortage of yang qi; excessive phlegm and dampness.

D. Thinness:

Character: thin body and red cheeks, scorched and dry skin.

Clinical significance: yin deficiency; shortage of yin-blood; internal deficient fire.

Character: chronic disease and lying in bed, thin as a rake.

Clinical significance: insufficiency ofzang-fu essence; excessive shortage of qi and fluid; often being critically ill.

(2) Character and significance of the form of the constitution

The recognition of the constitution of the human body can be traced back to theYellow Emperor's Inner Classic. Initially there were the five human forms (The Spiritual Pivot-Yin and Yang Twenty-Five People Types,灵枢·阴阳二十五人) and "strong constitution" (The Spiritual Pivot-Treatise on Reversal,灵枢·厥论). Important Formulas Worth a Thousand Gold Pieces for Emergency (Bèi Jí Qiān Jīn Yào Fāng,备急千金要方)andComprehensive Treatise on Protecting Children's Lives (Xiăo Ér Wèi Shēng Zŏng Wēi Fāng Lùn,小儿卫生总微方论) called it "constitution" in theTang Dynasty. Zhang Jie-bin also called it "constitution" in theMing Dynasty. People accepted and recognised it as such gradually in the late-Ming Dynasty and the beginning of theQing Dynasty.

The constitution reflects the relative exuberance or debilitation of the yin, yang, qi, blood, etc. of the different physical features. Thus, inspecting the type of constitution helps the practitioner to understand the exuberance or debilitation of the yin, yang, qi, blood, and the prognosis of the disease.

Characteristic and significance of the form of the constitution:

A. A yinzang person:

Character: short and fat body type; round head and thick neck; broad shoulder and thick chest. The pose of the body is usually still.

Clinical significance: yang deficiency and yin excess; cold forming with yin.

B. A yangzang person:

Character: thin and tall body type; long head and thin neck; narrow shoulders and flat chest; bowed posture.

Clinical significance: yin deficiency and yang excess; heat forming with yang.

C. A yin and yang harmonised person:

Character: type of the body somewhere between the yin and yangzang person discussed above.

Clinical significance: harmony of yin and yang, sufficient qi and blood.

Inspection of Posture and Movement

Inspection of posture and movement means to examine the patient's posture in passive and active states as well as look for any abnormal movements.

Principle

① The posture of the patient is closely related to the conditions of yin and yang of the body, as well as the nature of the illness, like being cold or hot or suffering from deficiency or excess.

② Patterns of yang, heat and excess mostly appear as restlessness; patterns of yin, cold and deficiency mostly appear as a liking for quietness and dislike of movement.

The abnormal movements of the limbs have a definite relationship with disease.

Significance

Inspection of posture is helpful for deciding the nature of yin, yang, cold, heat, deficiency and excess in pathological conditions as well as the degree of pathological changes in thezang-fu organs. Movement, strength, lifting the head and stretching the body are ascribed to yang, heat and excess patterns; on the contrary, tranquillity or quietness, weakness, bending the head forward and curving the body are ascribed to yin, cold and deficiency patterns.

Contents

Inspection of posture includes examining for abnormal posture, abnormal movements, deficient and exhausted postures (Table 2-5).