The Body Speaks to Us Before Illness

Farzollah Gholizadeh and Fariba Bayrami

What is clinical assessment, and how can outward signs lead us to the body’s inner state?

Sometimes the body starts sending signals long before illness shows itself through severe pain, weakness or an abnormal test result.

The colour of the face changes.
The tongue becomes coated.
The skin dries out or becomes too oily.
The eyes lose their usual clarity.
The nails become brittle or change colour.
The hair changes.
The lips take on a different colour.
The breath smells different.
Sleep, appetite, thirst, sweating or bowel and bladder habits change.

Most of us notice these changes but move on without stopping to think.

We buy a cream for dry skin, use mouthwash for bad breath, paint over a discoloured nail, drink coffee for tiredness — but we don’t ask ourselves:

Why did this change happen?

That question is where clinical assessment begins.

What does clinical assessment mean?

Clinical assessment means getting to know a person’s condition by observing, asking questions, touching, listening and putting the signs together .

Before laboratories, ultrasound, CT scans and today’s advanced devices existed, a physician got most of their information from the patient themselves.

They looked.
They listened.
They asked questions.
They felt the pulse.
They examined the skin.
They looked at the tongue and the eyes.
They paid attention to breathing.
They examined urine, stool and other secretions.
And then they brought all this information together.

This is exactly what history-taking and physical examination are — and much of medicine still rests on them today.

The difference is that today a physician can complete and confirm clinical findings with tests and more precise diagnostic tools.

So clinical assessment is not the opposite of testing.

Clinical assessment tells us where to look more closely; tests can measure or confirm some of what we find.

Why should internal organs affect how we look?

At first this may seem strange.

The liver is inside the abdomen — what does it have to do with the skin?
How can the stomach affect the tongue or the breath?
Why should the state of the blood show in the lips, the skin or the nails?

The answer lies in a simple principle:

The body is not a collection of separate parts; it is an interconnected system.

Skin, hair, nails, tongue and eyes depend on blood, oxygen, water, nutrients, hormones and the normal working of the internal organs in order to live.

If one of these factors changes for a while, traces of it sometimes appear in the body’s visible tissues too.

That is why a doctor assessing an internal illness may also look at the patient’s eyes, skin, mouth, nails or feet .

The face is more than our features

The face is one of the first places where changes in the body can be seen.

Pallor, yellowing, unusual redness, puffiness, dryness, skin changes or a loss of vitality can each tell us something.

But the key point in reading signs is this:

Compare a person’s current appearance with their own normal, not with other people.

Naturally dark skin is not an illness.
Naturally fair skin is not an illness either.

What matters more is change.

If someone who has always had rosy cheeks is gradually turning pale, that change is worth looking into.

Eyes are not only for seeing; they can be seen

Sometimes the eye itself offers a clue.

A physician may look at the white of the eye, the inner lining of the eyelid (the mucosa), the pupil, the area around the eye and even eye movements.

Yellowing of the whites of the eyes can point us towards checking bilirubin, the liver and the bile ducts.

Paleness of certain mucous membranes, together with other signs, can draw attention to the state of the blood.

Puffiness around the eyes can have various causes too.

But again the same principle applies:

A sign is a clue, not a definite diagnosis.

The tongue: one of the body’s most accessible mirrors

We only need to open our mouths to see one of the most easily observed organs in the body.

The colour of the tongue, its coating, moisture or dryness, cracks, swelling, tooth marks, spots, sores and the quality of the saliva can all be observed.

In Avicennian–Greek medicine, the tongue and mouth were considered together with the quality of digestion, the humours and other signs.

Today we also know that some oral diseases, nutritional deficiencies and general illnesses can show signs on the tongue and in the lining of the mouth.

But the real skill is not saying:

“A white tongue means such-and-such disease.”

The real skill is being able to ask:

Is the whiteness in the tongue itself, or in the coating on top of it?
Is the coating thick or thin?
Is the tongue dry or moist?
How long has this been going on?
And what other signs come with it?

That is clinical thinking.

The skin: the body’s largest visible page

The skin covers almost the whole body and so offers the observer a great deal of information.

Things to notice include:

Colour, warmth, moisture, dryness, thickness, elasticity, sweating, itching, spots, pimples, swelling and surface blood vessels.

For example, pallor can in some cases draw our attention to the state of the blood.

Marked yellowing of the skin and eyes can indicate that the liver and bile ducts need to be examined.

Thick, velvety darkening in certain skin folds can occur together with insulin resistance.

A bluish tinge to the lips or skin can draw attention to oxygenation.

That is why observing the skin remains an important part of examination in modern medicine too.

The nail: where the body’s past sometimes leaves a mark

Nails grow slowly.

This means that some past disturbances can stay visible on the nail for a while.

Colour, shape, thickness, brittleness, lines, small pits, growth rate and how well the nail attaches to its bed can all offer clues.

Sometimes a change in a nail is simply the result of a knock, detergent or a local infection.

But sometimes several nails change at once, and then the body’s general condition also needs to be considered.

Even in modern medical examination, the nails and mucous membranes can be part of the search for clues to a general illness.

Hair is part of the story too

Hair is not independent of the body’s general state either.

A sudden change in hair loss, dryness, brittleness, thickness or growth pattern can be influenced by different factors, such as nutrition, hormones, the thyroid, stress, illness, medication and genetics.

But, as with nails, no illness can be diagnosed from a single strand of hair.

What matters is the pattern.

The lips and mouth have messages too

Lip colour, dryness, cracks, sores, swelling, the condition of the gums, breath odour, taste in the mouth and the amount of saliva are also part of the examination.

Modern medicine also regards examining the mouth as part of a general examination; some oral findings can be the first sign of a general illness.

So the mouth is not just where the teeth are.

Sometimes what happens in the mouth leads us to ask questions about another part of the body.

Urine and stool: the body’s reports on itself

Today most people flush the toilet straight away.

Yet physicians of the past gave great importance to urine and stool.

Colour, amount, frequency, smell, consistency and changes in these give information about the body’s fluid balance, the digestive system, the kidneys, the urinary tract and the general condition.

In the classical sources of Avicennian–Greek medicine, examining urine was an important part of reading signs; historical studies show that physicians such as Rhazes, Avicenna and Jurjani paid attention to the colour, consistency, amount, frequency, smell and sediment of urine.

It is true that laboratories now offer far more detailed analysis. But devices alone cannot catch some important clues; here the eye and clinical judgement of an experienced, skilled physician make the difference.

The pulse: a sound heard with the fingers

The pulse is one of the oldest clinical assessment tools in the history of medicine.

Avicenna gave the pulse special importance, examining features such as its rate, strength, size, regularity and quality in different conditions. Historical sources show that the Canon devotes a long section to the pulse and its use in examination.

The pulse is still part of clinical examination today, even though new devices can measure heartbeat and rhythm precisely.

Sometimes a device shows a number; but the skilled hand of the practitioner notices in which person, and under what conditions, that number arose .

Voice, movement and even the way we walk can tell us something

Clinical assessment is not only about looking at the skin and tongue.

Sometimes even the way a person walks into the room is informative.

Do they walk with energy, or with effort?
How is their breathing?
Is their voice strong or weak?
Do their hands tremble?
Are their movements fast or slow?
Is their face symmetrical?
How are their alertness and attention?

In modern clinical examination too, general appearance, breathing, skin and mucosal colour, swelling in the limbs and many other observable signs are part of assessing the patient.

How does Avicennian–Greek medicine view this?

One of the important features of Avicennian–Greek medicine is that it looks at the person as a whole.

From this perspective the only question is not:

“Which organ is ill?”

The question is broader:

“How has this person’s overall condition changed?”

What is the temperament like?
What about heat and moisture?
How is digestion?
How is sleep?
How are appetite and thirst?
How is elimination?
What does the pulse say?
How have the complexion, skin, tongue and eyes changed?

This is why an alamet (sign) gains meaning together with a delil (indication).

Avicenna also stressed in his medical works the importance of gathering all the signs together and using clinical observation; historical research shows that the study of signs and differential diagnosis form an important part of his medical writings.

Don’t jump from a single sign to a single disease

This may be the most important principle in this article.

A white tongue does not always mean a particular disease.
Brittle nails do not always mean a particular deficiency.
Puffiness under the eyes does not always mean kidney disease.
A bitter taste in the mouth does not mean liver disease.
Dry skin does not necessarily mean a melancholic temperament.
A pimple on the face does not necessarily mean a problem with a particular internal organ.

Why?

Because one symptom can have dozens of causes.

And conversely, one illness can cause dozens of symptoms.

Clinical assessment means finding the pattern .

What does “pattern” mean?

Suppose a person only has dry skin.

We still have very little information.

But now imagine the same person:

has dry skin,
feels cold all the time,
has dry hair too,
has less energy,
is constipated
and has seen their weight change compared with before.

Now we are no longer facing “a single symptom”.

A pattern is taking shape.

Or think of someone else whose:

tongue has changed,
who has grown pale,
tires quickly,
gets short of breath climbing stairs
and whose nails have also changed.

Again, the signs taken together are worth far more than any single symptom.

This is what we can call reading the body .

Where does temperament fit into this story?

In Avicennian–Greek medicine, temperament is like the background on which the signs appear.

Two people can eat the same meal and not react the same way.

Two people can live in the same climate, yet one constantly feels hot and the other constantly cold.

One person’s skin is naturally drier, another’s moister.

So to understand a change, we first need to know what that person’s normal state is .

Temperament helps us know exactly this personal baseline.

But temperament, too, is not determined from a single sign.

Skin colour, how the body feels to the touch, build, sleep, activity, response to heat and cold, the quality of elimination and many other features are assessed together.

Can every disease be diagnosed just by looking?

No.

And knowing this limit is also part of the skill of assessment.

Some diseases may show no clear outward sign for a long time.

High blood pressure, abnormal blood lipids, early stages of some cancers and many other diseases may not be detectable just by looking at a person’s appearance.

On the other hand, a single outward sign can have several different causes.

So a definite diagnosis may require blood tests, imaging, a biopsy or other investigations in addition to observation and examination.

Even in dermatology, where observation is extremely important, diagnosing some lesions requires a biopsy or additional tests.

Good observation does not replace science; good observation is where science begins.

Read the body like a book, not like a single word

If you open a book and read only one word on a page, you cannot understand the story.

The body is the same.

The skin is one page.
The tongue is another.
The nails, hair, eyes and lips are other pages.
Pulse, sleep, appetite, thirst, urine, stool, sweating and mood are further chapters of the same book.

The mistake happens when we tear out a single page and think we have understood the whole story.

Clinical assessment is reading the different pages and finding the connections between them.

Everyone should know their body’s language to some extent

The aim of learning to read signs is not for everyone to become their own doctor, or to worry about illness at every small change.

The aim is much simpler and much more valuable:

To know our own normal body.

To know what our skin is usually like.
To know what our tongue looks like.
To know how our nails grow.
To know what our normal sleep and appetite are.
To know what has changed compared with the past.

When we know our body’s normal state, we notice meaningful changes earlier.

Five golden questions for reading any sign of the body

When you notice a change, ask five questions before drawing any conclusion:

• Has this always been there, or is it new?
• Is it local, or does it appear in several parts of the body?
• What other signs appeared at the same time?
• What makes it better, and what makes it worse?
• Do all these changes together form a particular pattern?

These five simple questions make a big difference between seeing and clinical observation .

From “seeing” to “understanding”

We all have eyes and we all see the body.

But clinical observation is a skill that can be learned.

Two people can look at the same tongue; one just says “white”, while the other notices:

what colour the body of the tongue is,
what colour the coating is,
how thick it is,
whether the tongue is dry or moist,
whether it is swollen or normal,
and how these findings relate to digestion and other signs.

Two people can see the same nail; one sees only a spot, while the other asks:

Where did this spot start?
Has it moved as the nail has grown?
Is one nail affected, or all of them?
Has the colour of the nail bed changed too?
And have the person’s skin, hair or general condition changed as well?

This distance between seeing and understanding is an important part of the science of signs.

Before the body shouts, it sometimes whispers

Everyone understands severe pain.
Everyone notices a high fever.
Everyone sees bleeding.

But the art of observation begins where the body has not yet started to shout.

A small change in colour,
a change in the tongue,
a line on a nail,
unusual dryness of the skin,
a change in sleep,
a change in appetite,
a change in elimination,
or several small signs coming together.

None of these necessarily means illness.

But sometimes it is exactly in these ways that the body tells us:

“Something has changed compared with before — pay closer attention.”

Conclusion: the art of reading the body’s signs

Clinical assessment is turning scattered observations into a meaningful picture.

In other words, it is knowing:

what to look for,
where to look,
how to look,
what question to ask,
and above all, how to put several signs side by side.

Avicennian–Greek medicine has a rich heritage of observation, the pulse, and the signs and indications of disease. Avicenna also stressed the importance of using all the senses to recognise illness, and of examining the patient and the body’s secretions.

Diagnostic tools today are far more advanced, but one principle still holds:

Illness does not happen only in the laboratory; it happens in a person.

And that person needs to be seen, listened to, touched, asked questions and known in their changes.

Skin, tongue, eyes, lips, hair and nails are each a piece of the puzzle.
Pulse, sleep, appetite, digestion, elimination, thirst, sweating and general condition are the other pieces.

No single piece shows the picture on its own.

But when the pieces fall into place, their meaning becomes clear.

Before the body cries out through illness, it sometimes speaks through signs.
The art of clinical assessment is learning the language of those signs.

For those who want to learn this language in more depth

What you have read in this article is only an introduction to the wide world of “Elaim & Delail”.

How to examine the skin, hair, nails, lips, tongue, mouth, eyes, nose, secretions, pulse and other signs; how to tell a person’s basic temperament apart from changes caused by illness; and above all, how to bring several signs together to build a meaningful clinical pattern — all of this takes step-by-step training.

Dr Kalan’s book and course set “Elaim & Delail” (in Turkish) cover this sign language of the body in an organised, practical way.

The aim is not to memorise a list of “symptom = disease”.

The aim is to learn:

to see the body,
to recognise the signs,
to find the connections,
and to open a window from the outside in, to know the inside better.

References

• Avicenna (Ibn Sina). Al-Qanun fi al-Tibb (The Canon of Medicine); sections on signs, indications, temperament, pulse, urine and diagnosis.
• Rhazes (al-Razi), Muhammad ibn Zakariya. Al-Hawi fi al-Tibb; sections on clinical observation and differential diagnosis.
• Jurjani, Sayyid Ismail. Zakhira-i Khwarazmshahi.
• Aghili Khorasani, Mohammad Hosein. Kholasat al-Hikmah.
• Nayernouri T. Avicenna and clinical experiences in Canon of Medicine.
• Shoja MM, Tubbs RS. The history of anatomy in Persia. Journal of Anatomy. 2007.
• Historical studies on the place of the pulse, urine, signs and clinical observation in the works of Avicenna, Rhazes and Jurjani.
• Clinical medical sources on physical examination and the skin, oral and nail signs of systemic disease.
• Dr Kalan scientific and educational resources.

Related articles

• Signs of Anaemia on the Tongue, Nails and Skin
• 5 Golden Questions for Reading the Body