We acupuncturists are a voyeuristic group. We’re watching our patients pretty much all of the time, and for a good reason. The diagnostic process in Chinese medicine can be long and detailed, and one of the cornerstones of diagnosis is observation. You see, things like the way you move, the color of your complexion, the light in your eyes, and the texture of your skin all offer clues to the underlying state of your health.
I have found that one of the best times to observe my patients is the moment they walk in the door. They’re walking in fresh, and my first impression is usually pretty accurate. I can tell if a patient isn’t sleeping, is upset, or feeling pretty good, just from that first glance. That’s not to say I can diagnose a patient the moment they walk in, but it does mean that those visible clues are things that I’ll ask about before I form a diagnosis and begin my acupuncture treatment.
So what do I see? Here are a few visible clues and what they may mean in the process of making a complete diagnosis:
Body type. While there are lots of different body types, a couple really stand out for me. People who are large and overweight have a tendency to be damp.** Excess weight is damp tissue, which means it’s wet and heavy. When dampness sits around for awhile, it can congeal and turn to phlegm, so I’ll be sure to ask about sinus issues, lung conditions, and coughs. In addition, dampness often comes from poor digestion and poor food choices, so diet, sugar cravings, and digestion are at the top of my ask list, too.
Patients who are thin, and seem tightly wound are often deficient in Yin, the body’s nourishing coolant. People with this kind of body type sometimes run hot, so I need to ask about things like night sweats, restless sleep, and irritability. Women with this kind of body type frequently shortchange themselves nutritionally in an attempt to stay thin, so I ask whether or not they’re getting enough nourishing foods, including nuts and seeds, oils, eggs, and colorful fruits and vegetables.
I see a lot of patients who have thin arms and legs, but have gained a bunch of weight around their middle. To me, this is a sign that they’re under a lot of stress, which is messing up their metabolism and leads me to ask about stress, depression, food cravings, and diet.
It’s in your face. Patients with a red face obviously have some kind of heat. It’s up to me to determine what kind of heat and where it’s coming from. Is it heat that rises up to the face when they’re upset? Is their face red all the time? Is this a hot flash? There are a number of reasons heat can manifest in the face, and most can easily be treated.
Patients who appear pale generally have some kind of depletion. It is their overall Qi? Are they Blood deficient? Both? I want to know if they’re cold all the time—it may be their internal fire—Yang—that’s depleted. Something as simple as a pale complexion can set off a whole spate of questions.
Your eyes. It has been said that your eyes are the mirror to your soul. When it comes to the inner self, your eyes tell me a lot. Fatigue, sickness, lack of sleep, and pain will show up in your eyes as a kind of dullness. People with red eyes always send me looking for Liver issues—Liver Yang rising upward, constrained Liver heat, or possible allergies.
Lots of women become frustrated with bags or dark circles under their eyes. Generally bags under your eyes have something to do with dampness—it’s just pooling in a weird place. Dark circles can be related to the health of your Kidneys or possibly Blood stagnation, in which your blood is sluggish and sitting under your eyes. Dark circles may also be a sign that you’re not getting enough sleep.
Your skin. When I suspect someone has a Blood depletion, I will always check out their skin. Is it dry? Do they have dandruff or dry scalp? Do their nails break easily? A lack of nourishment associated with Blood depletion often shows up right on the surface—your skin.
Easy bruising can be a problem for patients who have a Qi depletion. One of the jobs of your body’s Qi is to hold stuff—to hold still and hold things in. Easy bruising is one sign that the holding function of your Qi is not up to par, so we’ll need to talk about food choices, digestion, stress, and how hard you’re working.
In addition to easy bruising, lots of varicose veins and small spider veins tell me that Blood stagnation may be a problem. Blood stagnation means that your blood is a little sluggish and tends to pool. Interestingly, patients who have a tendency towards Blood stagnation will also have lots of little veins near the surface of their ears.
How you move. Finally, how a patient is moving will tell me if they’re in pain, tired, or raring to go. Their movements also tell me about the severity of their pain. The ones who are in a world of hurt will hesitate to sit, and when they do, they move very slowly. They may sit on the edge of their chair, and brace themselves to get up.
Patients who can’t seem to sit still; those that are tapping their feet or fidgety might be doing so because of a heat condition. In contrast, people who have tremors or twitches most likely have internal wind causing their movement.
While I do a complete health history with each patient, some of the signs that I observe send me in one direction or another. By simply by sitting back and watching, most patients will give several visible clues to the state of their health.
**For more information and explanations of the terms used, check out my book, Simple Steps: The Chinese Way to Better Health.
