Spirit refers to the general manifestations of life activities, including mental states and mental activities. The material base of spirit is essence. The congenital essence depends on the cereal nutrients to nourish and promote as well as the normal visceral functions to protect. That is why the spirit is said to be the external manifestations of the conditions of visceral essence. Inspection of spirit can enable one to understand whether the essence is exuberant or deficient and whether the visceral functions are strong or weak. Such an understanding is important to the analysis as whether the pathological conditions are light or serious and whether the prognosis is benign or malignant.

Inspection of spirit mainly focuses on the examination of the mental states and emotional conditions, including facial expressions, complexion, eye expressions, speech, breath, physical conditions and response to the external stimulation, etc. Since the visceral essence infuses upward into the eyes and the ocular system is connected with the brain, and also because the eye is the orifice related to the liver, governed by the heart and housing the spirit the inspection of eye expressions is very important. Inspection of spirit means, by examining of the aspects mentioned above, to differentiate whether the spirit is in existence, deficient, lost, false or in disorder for the purpose of deciding whether the healthy qi is abundant or deficient, the visceral functions are strong or weak, the pathological conditions are light or serious and the prognosis is benign or malignant.

Existence of spirit:
The manifestations are mental consciousness, normal vitality, natural facial expressions, ruddy complexion, flexible eyes with brightness and vitality, accurate verbal expression and reply, normal voice and breath, normal and natural movement of the limbs. These manifestations suggest non-impairment of healthy qi, normal visceral functions, mild pathological conditions, or favorable prognosis even for serious diseases.

Lack of spirit, also known as insufficiency of spirit:
The manifestations are mental consciousness, dispiritedness, pale complexion, dull expressions of eyes, short of breath, no desire to speak and low voice. These manifestations suggest mild consumption of healthy qi, weak visceral functions, more serious disease and better prognosis. These manifestations are usually seen in patients at the rehabilitating stage or with weak constitution.

Loss of spirit, also known as depletion of spirit:
The manifestations are dispiritedness, pale complexion, dull eye expressions, weak breath or dyspnea, emaciation, difficulty in movement, retard response or even unconsciousness; or coma with delirium and floccitation. The former suggests great impairment of the primordial qi and decline of the visceral functions, usually seen in chronic disease and serious disease with unfavorable prognosis. The latter suggests exuberance of pathogenic factors and serious disturbance of the viscera, often seen in critical pathological conditions with unfavorable prognosis.

False spirit:
False spirit is usually seen in prolonged disease, serious disease and extreme exhaustion of essence with the false manifestations in disagreement with the nature of the disease. For example, dull or pale complexion suddenly changes into reddish cheeks; or extreme dispiritedness, mental derangement and retard response suddenly change into excitation but with restlessness; or no desire to speak, low and weak voice and incoherent speech suddenly change into incessant, but simply repeated talking. These phenomena indicate declination of essence and floating of yang due to failure of yin to control yang. This condition is clinically known as "the last radiance of the setting sun" and "sudden spurt of vitality before death", the premonitory signs of death.

Clinically cautions must be taken to differentiate false spirit and improvement of pathological conditions. The manifestation of false spirit is sudden "improvement" in certain aspect which is not in agreement with the whole pathological conditions and immediately turns worse. The improvement of spirit depletion takes place in the course of the improvement of the whole pathological conditions.

Mental derangement:
This condition is usually seen in the case of mania. The usual manifestations are indifferent expression, taciturn and depression, followed by being in a trance, now laughing and then crying due to stagnation of phlegm which confuses the mind; the manifestations like dysphonic, running wildly, shouting, fighting against people or even family members are usually due to disturbance of the heart by phlegmatic fire the manifestations like sudden coma, drooling, staring upwards, convulsion of limbs and groaning like pig and goat usually indicate epilepsy due to endogenous liver wind and phlegm confusing the mind which can heal automatically.

It should be pointed out that the symptoms of mania and mental derangement correspond to the cause and occurrence of these diseases. The clinical syndrome differentiation of these manifestations is different from serious dysfunction of viscera at the advanced stage of serious disease and spirit depletion due to exhaustion of essence.