Inspecition,the highest level of diagnosis in Chinese medicine, inspect and know is called God!

by with No Comment TCM Diagnosis

Inspection Diagnosis

 

The inspection diagnosis includes the complexion and morphology, but the focus is on the diagnosis of complexion and tongue. At the beginning of clinical practice, I often think that inquiring is the first of the four diagnoses, not able to understand the essence of diagnosis by inspection, but after a long period of practice, I can gradually understand the true meaning of “inspect and know is called God”, and the revelation of  “five complexions  diagnosis of ” is better than the appearance, the shape, and the motion.

 

1. Complexions diagnosis

Complexions Diagnostic is also called “five-complexion diagnosis”. The main focus is to observe the complexion of the face, and other parts of the body can also be analogous. Observation of facial complexion can measure the vitality of the viscera and blood, because the 12 meridians and blood are injected into the face, and there are corresponding changes under the disease.

 

Regardless of the five complexions, the common basic feature to distinguish the positive from the negative is that the positive is bright and terma, while the negative is obscure and exposed. At the same time, it also further relates to the eight levels of diagnosis to grasp the different nature of the lesions. For example, if the face is red, the redness on eyes and face indicates excesssive, and the redness on cheeks indicates deficiency; if the face is greenish, the pale face indicates cold, and the redness on face indicates heat. The Su Wen – Five Organs Generation Chapter determines the good and bad fortune of the patient according to the complexion of the face, pointing out that “those who are as green as the emerald feather can be saved, those who are as red as the crown of a chicken can be saved, those who are as yellow as the belly of a crab can be saved, those who are as white as the paste of a wild boar can be saved, and those who are as black as the feathers of a bird can be saved”; “those who are as green as the straw can not be saved, those who are as yellow as the hedgehog can not be saved, those who are as black as the coal can not be saved, those who are as red as the blood of a squid can not be saved, and those who are as white as the dry bones can not be saved.

 

The specific methods of the five organs in the corresponding parts in the face from the Nei Jing can be found in Su Wen – Theory of Stabbing Heat, which uses the forehead for the heart, the nose for the spleen, the left cheek for the liver, the right cheek for the lung, and the chin for the kidney. It is simpler than the “Ling Shu – Five Complexions” method.

 

Inspection of the eyes is an important aspect when inspecting the face. It is important to see whether the eyes are bright or dark, and to pay attention to their pathological characteristics. The floating eye cell is caused by wind or spleen deficiency and dampness, the swollen eye is caused by liver fire and phlegm stasis, the oblique view is caused by wind and fire, the straight view and upward view is caused by phlegm and stasis clouding the mind, the unequal pupil size on both sides is caused by water stasis in the skull and brain, the greenish eye and flexible vision is caused by liver exuberance, the red blood filled eye is caused by fire in the heart and liver, the deep yellow eye is caused by damp and heat in the liver and gallbladder, the pale white eye and face is caused by blood deficiency, the dark eye orbit is caused by phlegm stasis and kidney deficiency. If there are yellow spots in the eyes, it is due to phlegm and stagnation.

 

2. Tongue Diagnosis

Tongue diagnosis is mainly to observe the texture, coating, shape and dryness of the tongue.

 

As the veins of the five organs are all connected to the tongue, depending on the transmission of Qi, blood and fluids, so through tongue diagnosis we can observe the deficiency and excess of the internal organs to which the lesion belongs, the surplus and deficit of Qi and blood, the nature and depth of the disease.

 

We should pay attention to the color of the coating and the changes in the texture of the tongue. A light red tongue is normal; a light white tongue indicates deficiency of qi and blood; a red-red tongue indicates heat and yin; a blue-violet tongue indicates blood stasis.

 

Color of coating of tongue can be white, yellow or grayish black. White coating of tongue is mainly for exterior and cold, thin white and moist for normal people, thin white and dry for fluid deficiency exterior, thin white and slippery for cold and damp, thick white for dampness, phlegm and food accumulation. and rotten coating of tongue for dampness and heat and filthy turbidity up steaming.

 

Yellow coating is mainly for interior and heat, thin yellow for the evil heat is not yet strong, starting to spread into the interior; yellow greasy for damp heat or food accumulation of heat; yellow and sticky for dampness, phlegm and heat gum; yellow and dry, even burnt yellow for dry heat damage to fluids; light yellow and lubricant, mostly for dampness and phlegm aggregation.

 

If the coating is gray and black, a dry coating is mainly heat and a moist coating is mainly cold; a white, greasy, gray and black coating with a moist tongue is Yang deficiency and cold dampness and phlegm; a yellow, greasy, gray and black coating is dampness and heat for a long time,while a burnt, black and dry coating is heat and drained fluid.

 

At the same time, the dryness and moistness of the coating should be observed in order to know the excess and deficit of fluid in the body and its distribution.

 

① According to the external influenza and internal injuries, respectively, grasp the focus.
External acute fever: emphasis on the observation of the coating of the tongue, in order to understand the nature of the disease, hot and cold, and the progress and decline of the evil.
Internal injury chronic miscellaneous diseases: emphasis on the observation of tongue texture, in order to understand the deficiency or excess of qi and blood in the internal organs, the characteristics of the symptoms and the attributes of the disease mechanism

 

②The same coating of the tongue, in terms of the deficiency and excess, heat and cold, there is a difference between the lightness and the depth, for example: white greasy tongue is cold and damp, but the degree of white greasy varies greatly, we must judge the lightness of the dampness; the same yellow greasy tongue, the disease is damp-heat, but deep yellow thick greasy for deep damp-heat interior, the central accumulation of rotting is damp-heat and stagnant, if dry and less fluid, there is an opportunity to hurt Yin.

 

③ distinguish the true and false attributes of the disease mechanism: the same black coating, if black and lubricating, is the strong Yin cold interior, with the trend of exceeding water transforming to fire; if black and dry and cracked with thorns, it is the evidence of extreme heat.

 

④ Pay attention to the mixed pathogenesis: If the tongue is yellow and white, it is mostly mixed with cold and heat, or the warm evil is transmitted from the exterior to the interior. If the texture of the tongue is light and less fluid, it is mostly a sign of deficiency of Qi and Yin.

 

⑤ identification of the correspondence of five organs in the tongue: “Bi Hua Yi Jing” said that “the tip of the tongue is for heart, the middle of the tongue is for spleen and stomach, the edge of the tongue is for liver and gallbladder, and the root of the tongue is for kidney”. This can be for your reference in diagnosis.

 

The tongue is closely related to the heart and stomach pathology, because the tongue is the seedling of the heart, the color and texture of the tip of the tongue can mostly show the pathology of the heart meridian; the tongue is the gastroscope, the tongue coating is produced by the steam of the spleen and stomach, the color and texture of the coating can mostly show the pathology of the spleen and stomach.

 

Observation of tongue shape is also an important part. The old and young are observed to identify evil or deficiency; the fat and thin are seen to identify yang deficiency, dampness or deficiency of yin and blood; the tongue with cracks is for the loss of essence and blood and yin and fluid; the “Strawberry like” tongue is for the heat of the internal organs, and the tooth marks on the tongue are for the deficiency of yang and dampness interior. Atrophy of the tongue is extreme heat and yin damaged, and prolonged atrophy is deficiency of qi and blood; Stiff tongue is heat and yin damage, or wind and phlegm blocking the veins; Crooked tongue is internal wind and phlegm, and stasis blocking the veins; Curled tongue is cold and dense, or phlegm blocking the root of the tongue, or heat damages fluids; Coarse swelling and bruising of the veins under the tongue is blood stasis.

 

The diagnosis of listening and smelling, how to diagnose the condition by sound and smell?

by with No Comment TCM Diagnosis

Diagnosis by smell&sound

Listening & Smelling diagnosis is a diagnosis method to understand the condition and provide a basis for diagnosis by the sound and smell. Further, listening to the patient’s complaints and understanding his or her suffering is also closely related to the diagnosis of Listening & Smelling.

 

Listening to the voice: If the patient’s voice is hoarse, or he even loses his voice, the sudden onset of violent illness is more likely to be excess syndrome, while the accumulation of long-standing illness is more likely to be deficient, or health qi is deficient while pathogenic qi is excessive . Delirium and wild speech are excessive, and are mostly caused by phlegm and fire-heat stasis; Zheng sound and solitary speech are mostly caused by great injury to heart qi, or qi depression and phlegm obstruction; strong tongue is mostly caused by wind and phlegm obstruction.

 

Hearing breathing: in patients with wheezing and roaring, wheezing is mainly characterized by polypnea, roaring is mainly characterized by phlegm sound in the throat, and roaring must be accompanied by wheezing, while wheezing may not be accompanied by roaring; wheezing and phlegm surge with loud sound and heavy breathing is excessive, wheezing and phlegm sound like snoring, weak breathing, intensified while moving is deficient; short breathing or hard to breathe, low sound hardly to hear, is deficient, different from rapid shortness of breath, the number of breath is not continuous, and the symptoms have the difference of deficiency and excess.

 

Listen to the cough: frequent, violent, paroxysmal, lound sound and shortness of breath, mostly attributed to the excess symdrome of external sensation; the slight intermittent cough, low sound and shortness of breath, mostly attributed to the deficiency symptom of internal injury; in the case of asthma caused by prolonged coughing, then the nighttime coughing continues unabated, while breathing is short, even eructation, belching, sighing, sneezing, intestinal tinnitus

 

Listen to the vomiting: should be distinguished from vomiting when eating, vomiting at night while eating in the morning, vomiting slowly or acutely so as to distinguish the deficiency and excess; Hiccup loudly and frequently is excessive, lowly,weakly and intermittently deficient.

 

Smell the odor: breath comes with sour and rotten odor means gastrointestinal stagnation; putrid smell in the mouth, gum erosion means ulcerative gingivitis; coughing and vomiting fishy pus, blood and phlegm means pulmonary carbuncle; warm-heat disease has bad breath or sweat odor for epidemic poisoning; the body has corpse odor means the danger of organism failure, etc. In combination with the identification of disease, we need to pay attention to urine odor in the mouth of uremia, liver coma liver odor, diabetic ketosis rotten apple smell, coughing and vomiting blood patients with the smell of blood.