Diagnostics cont. - 2/16

Question 1

Inspection of the Face

Yang Type Edema

Yin Type Edema

Answer 1

YANG-type:

• excess pattern
• abrupt onset
• wind, cold, damp attack Lung, Spleen
  
  • Lung dec/diff impaired, body fluids accumulate

YIN-type:

• deficiency pattern
• slow onset
• Spleen and Kidney Qi or yang deficiency

Question 2

Inspection of the hair can tell us about:

What doesn normal look like?

What does abnormal look like?

Answer 2

• condition of qi, blood, kidney

Normal: thick luxuriant, evenly distributed, moist, with sheen – (normal exbuerance of essence and blood)

Abnormal:

1. Dry, withered, thin, hair loss
   - Xu of blood, essence, Kidney; blood heat; after severe illness, extreme taxation-fatigue, post-partum
2. Sudden hair loss
   - xu blood with internal wind
3. Graying
   - can be normal; kidney xu (poor memory, sore, weak knees)

Question 3

Ling Shu: “The essence-qi of the five viscera and six bowels ascends to _____”

“_____ opens to the eyes”

What can inspection (of the eyes) tell us about?

Answer 3

• eyes
• eyes
• inspection can tell us the condition of the Mind (shen), organs, and essence

Question 4

Spirited Eyes vs. Spiritless Eyes

What do they look like?

What do they indicate?

Answer 4

Spirited

• bright, shiny; clear and correct vision; flexible and lively movement
• indicates: absence of disease; mild disease that is relatively easy to treat

Spiritless

• dull and/or turbid sclera; lack of brightness; blurred vision; inflexible movement, staring forward or upwards
• indicates: presence of disease; disease is relatively severe and more difficult treat

Question 5

Inspection of the Eyes: Congruencies

**Need to Memorize

Pupil

Iris

Sclera

Corners

Eyelids

Congruency + Color =

Answer 5

Pupil: Kidney

Iris: Liver

Sclera: Lung

Corners: Heart

Eyelids: Spleen

(upper: Spleen, lower: Stomach)
- Congruency + color helps determine location and nature of illness (e.g. red sclera = lung heat)

Question 6

RED eyes

Governs

Red Canthus

Red Sclera

Entire Red Eye

Red, Swollen Eyelids

Answer 6

Governs - Heat/Fire

Red Canthus - Heart Fire

Red Sclera - Lung Fire

Entire Red Eye - Liver Fire, Liver channel wind-heat

Red, Swollen Eyelids - damp-heat Sp/St, damp-heat in Liver/GB

Question 7

Yellow Eyes

Green-Blue Eyes

White Eyes

Black Eyes

Answer 7

Yellow - (dampness) damp heat; damp cold

Green-Blue - (wind) Liver wind

White - (deficiency) - pale white blood vessels in canthus or interior aspect of lower eyelids – blood xu, qi and blood deficiency

Black - (water) Spleen and Kidney xu; Water-dampness

Question 8

Form and Bearing of Eyelids

Drooping Eyelids

Incomplete Closure of the Eyes

Strabismus (eyes not properly aligned)

Styes

Answer 8

Drooping - Spleen qi xu

Incomplete closure - Spleen xu, qi and blood xu

Strabismus - Liver wind

Styes - wind heat; Sp and St heat

Question 9

Inspection of the NOSE

1. Clear, watery white nasal discharge
2. Thick-yellow or turbid nasal discharge
3. Nosebleed

Answer 9

1. Invasion of Lung by wind-cold (nasal congestion with frequent sneezing)
2. Invasion of the Lung by wind-heat
   - Phlegm heat
3. Invasion of the lung by wind-heat
   - Lung heat, stomach fire, liver fire, traumatic injury

Question 10

Inspection of the THROAT

1. Red, swollen, painful throat
2. Dry, red, painful
3. Tender-red, mild pain

Answer 10

“Open passage to Lung and Stomach”

• Kidney channel connects to the throat
  1. excess heat
  2. heat damaging Lung fluids
  3. Kidney yin xu with deficient heat flaring up

Question 11

Inspection of the LIPS

1. Red-purple
2. Red and dry
3. Fresh-red
4. Pale
5. Blue-green

Answer 11

“Luster of the Spleen” - normal: bright, red, moist

1. heat
2. heat damaging fluids
3. yin deficiency heat
4. blood deficiency
5. pain

Question 12

TONGUE CORRESPONDENCES

**need to memorize

tip

center

root

margins/sides

Answer 12

Tip: Heart and Lung

Center: Sp and St

Root: Kidney

Margins/sides: Liver (right), GB (left)

Question 13

NORMAL TONGUE

Answer 13

• pale red, thin white coat,

Question 14

Pale or White Tongue

Image

Significance

Answer 14

• lighter in color than a normal pale-red/pink tongue; may not even have any red coloration at all

SIGNIFICANCE:

• Deficiency Cold pattern (Yang xu)
• Excess Cold pattern
• Deficiency or exhaustion of qi and blood (Qi xu)

Question 15

Red Tongue

Image

Significance

Answer 15

• more red than a normal tongue, or with bright red color

SIGNIFICANCE:

• heat pattern
• deficiency heat pattern (yin xu) - (bright red, THIN or fissured, little to no coating) tongue body small
• excess heat pattern (bright red, rough or even prickled tongue, a thick yellow gray or black dry tongue coating

Question 16

Crimson/Scarlet Red Tongue

Image

Significance

Answer 16

• deep red color, deeper than the red tongue

SIGNIFICANCE:

• heat pattern
  
  • excess heat - crimson tongue with possible prickles or red spots, a yellow and dry coating
  • deficiency heat - crimson tongue with little coating or without coating, possible fissures
• blood stasis with heat - crimson tongue with purple dots

Question 17

Blue-Green-Purple Tongue

Image

Significance

Answer 17

• ranges from blue-green to purple to purple-red in color

SIGNIFICANCE:

• blood stasis - due to a variety of causes
• qi stagnation (added in class) bc it causes blood stagnation

Question 18

TONGUE

1. Crimson-purple, dry, possibly with cracks =
2. Pale-purple, slippery, wet =
3. Blue-green-purple, dim, stasis molecules =

Answer 18

1. interior heat excess (heat leads to abundance of blood in vessels, with blood stasis and damage to body fluids)
2. interior cold excess (cold leads to stasis of blood)
3. blood stagnation

**Yin deficiency doesn’t make the blood stagnate

Question 19

PUFFY tongue

Image

Significance

PALE, PUFFY, WET =

PALE, PUFFY, TOOTHMARKS =

Answer 19

• bigger than normal, or even filling the entire mouth, usually with tooth-marks

SIG: retention of dampness, phlegm, phlegm fluid

PALE PUFFY WET = Yang xu

PALE PUFFY TOOTHMARKS = Spleen Qi xu

Question 20

Small Tongue

Image

Significance

RED, THIN BODY, DRY =

Answer 20

• thin, small and withered tongue (length, width, depth/thickness)

SIGNIFICANCE:

• deficiency of both qi and blood (small, pale-red tongue)
• yin deficiency with empty fire (emaciated, dry, crimson tongue, and little or no coating)

RED THIN DRY = yin xu

Question 21

Prickled Tongue

Image

Significance

Answer 21

• tongue with prominent spots (red, purple, black) commonly seen on the tongue tip and sides

SIGNIFICANCE:

• toxic-heat entering the blood level (the larger and greater the quantity of prickles, the stronger the heat)
• heat (added in class)
• blood stasis (added in class)

Question 22

Tongue with patches/spots (“stasis macules”)

Image

Significance

Answer 22

• bluish-purple or purplish black patches

SIGNIFICANCE:

• blood stasis

Question 23

Cracked/Fissured tongue

Image

Significance

1. Dry, crimson, scant coat, cracks
2. Red, scant coat, cracks
3. Pale-red, smooth, cracks
4. Pale-white, cracks

Answer 23

• tongue with cracks/fissures of varying shapes and depths on the surface

SIGNIFICANCE

1. heat damaging yin fluids (yin: blood, body fluids)
2. yin deficiency
3. blood, deficiency (usually in elderly)
4. dryness due to blood deficiency

Question 24

Tooth-marked Tongue

1. Pale white, slippery white coat, tooth-marks =
2. Pale-red, smooth, toothmarks =

Answer 24

• top and sides of the tongue body have clear impressions made by the teeth (usually seen together with a puffy tongue)
  1. retention of dampness
  2. Spleen Qi xu

Question 25

STIFF tongue Image Significance

Answer 25

- loss of flexibility, difficulty in stretching or retracting, or even rigidity with the inability to move, slurred speech SIGNIFICANCE * **invasion of the pericardium by exuberant pathogenic heat** (dark-red or crimson, stiff and dry tongue) * **wind-phlegm obstructing collaterals in the tongue** (pale-red or green-blue, puffy and stiff tongue with thick, greasy coating, unconsciousness, deviated mouth and eye, hemiphlegia)

Question 26

FLACCID tongue Image Significance

Answer 26

- soft without strength, and inability to move easily SIGNIFICANCE: * deficiency patterns (yin, qi and blood, body fluids) * channel obstruction (added in class)

Question 27

TREMBLING tongue Image Significance

Answer 27

- involuntary trembling, rapid movement when extended SIGNIFICANCE * **Liver-wind** * **Exuberant heat** (crimson, purple and quivering tongue) * **Qi and blood xu** (pale or white, slightly trembling tongue) * **Yin xu** (red, quivering tongue with little or no coat)

Question 28

DEVIATED tongue Image Significance

Answer 28

- tongue deviating to one side when extended SIGNIFICANCE * **wind patterns** * deviated (pale-red tongue), facial paralysis, inability to raise the eyebrows * **external wind obstructing collaterals** * purplish-red and deviated tongue, dizziness, numbness, spasms * **internal wind**

Question 29

What is tongue coat/fur generated by? What does normal look like?

Answer 29

- Stomach qi - thin, white, moist

Question 30

WHITE coating represents what 2 kinds of patterns?

Answer 30

- Exterior patterns - Cold patterns

Question 31

YELLOW coating represents what 2 kinds of patterns?

Answer 31

- Heat patterns - Interior patterns

Question 32

GRAY coat represents what 3 kinds of patterns?

Answer 32

- Interior patterns - Heat - Cold

Question 33

BLACK coating represents what 3 kinds of patterns?

Answer 33

- Interior patterns - Extreme heat - Extreme cold

Question 34

THICKNESS of the tongue coating differences between Thin and Thick

Answer 34

- depth and severity of diseases THIN - normal, disease in EXTERIOR, mild disease, Evil qi on surface THICK - disease in INTERIOR, more severe disease, Evil qi deeper in body

Question 35

MOISTURE of the tongue coating Moist vs Slippery vs Dry

Answer 35

- existence or collapse of body fluids _Moist_ - normal _Slippery_ * excessive fluids on tongue, tendency to flow downward when the tongue is protruded * yang xu with retention of phlegm-fluid and water damp _Dry_ * body fluids damaged by heat * yin xu * yang qi xu failing to steam fluids upward * pathogenic dryness attacking the lung

Question 36

GREASY tongue coating Exuberance of what?

Answer 36

- relatively small and fine particles, sticking together making a shiny surface, can not be scraped away easily EXUBERANCE OF PHLEGM-DAMP which inhibits yang-qi * turbid dampness * phlegm-fluids * food retention * damp-heat

Question 37

CURD-LIKE tongue coating

Answer 37

- relatively rough, large, granular, loose, and thick, as if bean curd is piled on the surface of the tongue, can easily be scraped away PHLEGM DAMPNESS without weak yang-qi and/or heat * food retention causing damp heat * phlegm dampness with heat

Question 38

SUBLINGUAL VEINS 1. Purple, black, distended 2. Dark purple and thin 3. Very pale or not visible 4. Filmy, creamy

Answer 38

1. blood stasis 2. yin xu 3. qi and blood xu 4. dampness