Course: Diagnostics I Date: July 31, 2007 Class #: 3

Course: Diagnostics I Date: July 31, 2007 Class #: 3 Focus for today: Observation of the eyes See the mental condition thru the eye. Today talk about the specifics Complete theory of eye observations. KNOW this for all DX tests! Observation of the philtrum What kind of info? What organs? Observation of the mouth Observation of the teeth and gums Know teeth, gums, which organ related to which area. Mouth, teeth, gums, philtrum. Observation of the index fingers Young kids cannot give you information verbally. Also cannot feel pulse use index finger observation. Facial observations Facial paralysis. Must be able to know the type of paralysis very important. The type may be life threatening or may be chronic. Need to know which side is healthy, which is the problem side. Observation of Body Movements Wind KNOW: Zhu feng diao xuan jie shu yu gan. Translates: Different wind (zhu feng) uncontrollable (diao) circling/vertigo/dizziness (xuan) are all related to Liver. No matter what age, these signs = Liver. Liver per the Five Element Theory is related to wind. Tremors are caused by wind, regardless of whether it is interior or exterior wind. Inner wind is not caused by external forces. Inner wind includes epilepsy and Parkinson s Disease. Hypertension can cause inner wind. You can see Liver Wind in red face, anger. Dizziness can be inner wind too. External wind is caused by external conditions. An example would be Bell s Palsy. There are 2 reasons wind affects the body: Extreme heat which generates wind. Anger is one kind of extreme heat. Chronic depression long term also changes to fire as can Liver Qi Stagnation. Look for a red face, dizziness, vertigo. Blood deficiency. Malnutrition, chronic. Wind on the skin itchy, comes and goes quickly. 1. Tremor of head. This is the most important sign of wind in the body. a. Shaking of the head, head usually moving back and forth is the most common and visible sign. b. Tremor ranges from very light w/ small amplitude to pronounced with large amplitude Mild tremors = deficiency (generally lasts longer more chronic) More severe tremors = excess (usually short period of time, is more acute) Page 1 of 10

c. Two types: i. Full type (excess): LV fire or LV yang rising. Too much heat. ii. Empty type (deficiency): LV and K yin deficiency (most common causes) or LV blood deficiency. Hypertension tied to empty type. In a few cases, the empty type may indicate Heart yin exhaustion. Explanation: When yin is deficient, yang is much stronger, unchecked. Too much yang = too much heat = production of wind just like in the environment. Yang qi is very light, will go upwards. Like an internal tornado. Treatment: tonify. 2. Rigidity of the Neck Go to sleep, wake with stiff neck. Exposure to wind causing a stiff neck. This does not apply to neck stiffness from trauma related problems which would indicate a local qi and blood stagnation, but wind exposure and resulting pain/stiffness. General questions to ask: Location of the pain and stiffness? How long has this lasted? Chronic=long lasting, short=acute. Ask what makes it better, what makes it worse? Is pain fixed? Probably stasis. Does it move? Wind related. Nature of pain? Strong, mild, fixed, moving. a. Rigidity with aversion to wind and a floating pulse = external wind invasion. b. Rigidity and pain = cold-dampness invasion c. Slight rigidity and dizziness = BL and K deficiency. 3. Deviation of the eye(s) and mouth Sign of facial paralysis of various kinds. a. Deviation of eyes and mouth i. How to determine which is the healthy side Mouth is pulled toward the healthy side (because muscle still works) Healthy side will have a deep naso-labial groove (because muscle still works) Forehead will wrinkle (because has muscle control) ii. How to determine which is the affected side Inability to close or open the eye completely in the affected side. Difficult to grimace, to bulge cheeks in affected side. No nasolabial groove, no forehead wrinkle. Eye leaks this side, can t get food out of this side of mouth, but can chew. Eye cannot totally close. Eye turns upwards. b. Facial paralysis i. Peripheral facial paralysis (Bell s Palsy) better prognosis. Bell s manifests as flat forehead one side, can t totally close eye and can t move muscles on one side. Page 2 of 10

ii. Central facial paralysis forehead wrinkles all across, eyes ok, mouth deviates. Prognosis is bad. Comes from CNS. c. Facial tic Twitching of parts of face. Definitely wind symptom. 4. Limbs and Body Same thing tremors are still wind related. If cannot control limb (like move leg from hip rather than with the leg muscles), still wind. Spine curving backwards yang side is too strong and convulses still = wind! a. Paralysis b. Tremor or spasticity of limbs c. Twitching of muscles d. Opisthotonos e. Contraction of limbs f. Hemiplegia g. Tremor of hands h. Tremor or feet i. Contraction of fingers Observation of Head, Face and Hair 1. Head signs a. Dry scalp: LV and/or K yin deficiency b. Red and painful scalp: W/H or LV fire c. Tremor of head: LV wind d. Swelling of head and face: W/H e. Boils and ulcers: full heat or toxic heat f. Head leaning to one side: Spleen or marrow xu g. Head tilted with eyes rolled up: Liver wind h. Late closure of fontanelles Kids: fontanella on top should be closed at 18 months. Posterior fontanella should be closed by 4 months. Which organ? Kidney essence deficiency is a likely candidate. 2. Facial signs a. Acute edema: Sudden onset = wind/water in lungs. Sudden=wind. b. Chronic edema Lung and/or Spleen Yang Xu. Pale in color. c. Acute swelling and reness: wind/toxic heat d. Ulcers under zygomatic arch toxic heat in stomach. e. Papules on face/nose Lung heat at qi level. f. Macules on face/nose: blood heat g. Lined face with uneven skin surface: blood def of heat and dryness. h. Deviation of eye and mouth: wind syndrome. See previous section. Page 3 of 10

3. Hair falling out Cause is blood disorder! Usually blood deficiency, but not always Hair is an excess of blood. Other causes: a. Liver blood/kidney essence deficiency b. Blood heat from Liver fire. c. Serious, acute disease d. Chronic, protracted disease e. Chemotherapy or radiation 4. Alopecia (hair suddenly falls out in clumps) Related to wind, to blood deficiency. Any internal wind or blood heat will cause this. a. Blood heat: falling out in clumps b. Internal wind: giddiness with wiry pulse c. Blood stasis: dark complexion with purple tongue. 5. Dry brittle hair Caused by blood or Yin Xu (deficiency). Causes: a. Liver blood or kidney essence def b. General Qi and blood def c. Stomach/spleen defic d. Chronic loss of blood 6. Greasy hair a. Dampness or phlegm 7. Premature graying of hair a. Liver Blood and/or Kidney Essence deficiency b. General Qi and Blood deficiency c. Liver and Heart fire d. Hereditary disorder 8. Dandruff: wind, xu, or excess a. Liver Dlood deficiency b. Liver Wind c. Liver Fire d. Damp-heat in Liver e. Toxic heat Page 4 of 10

Observation of the eyes Very important. Mental conditions can be known through observation of the eyes. They are, afterall, the windows to the soul. Five wheel theory Each component of the eye can reflect the health or imbalance of the body. I have given you mnemonic clues below, all related to the Five Element Chart (which you had to memorize in Foundations) to help you remember the associations. Dr. Luo does put this theory into almost every test you will take in both Diagnostics I and II. Memorize this! Wind and Liver Reflected through the iris of the eye. I think of a green eye, even though this one is blue sorry about that. Green in the 5 Element chart from your Foundations class is associated with Liver and Liver is associated with Wind. Water and Kidney Reflected through the pupil of the eye. The pupils are black. Black is the color associated with Kidney and Kidney is associated with water. Qi and Lung The condition of the patient s Qi and the Lung are reflected in the sclera. The sclera should be white in a healthy patient. White is the color associated with metal and the Lung. Blood and the Heart The condition of the patient s Blood and their Heart system is reflected in the inner and outer canthus of the eyes. These small parts of the eye are generally red or pink. Red is the color associated with the Heart in your 5 Element charts. Red is also the color of blood. Muscles and Spleen Reflected through the eyelids. I don t have a great association for this for you, but if you memorize the other associations, then this is the only one left standing! Remember that the Spleen and the muscles are linked in the Five Element chart. The 8 Ramparts are this theory, but include more detail. Example using Five Wheel Theory: A patient who is worried and anxious will eventually have Heart fire, their eyes will become red at the corners (inner and outer canthus). Someone whose eyelids are swollen may well have a spleen problem. Other aspects of eye observation: luster control of eyes color of eyes pathological signs Page 5 of 10

Observation of the Nose Related to the stomach, urinary bladder, du channel. Both the main and muscle channels of the LI flow to the bottom of the nose. Stomach channel connects with nose Bladder muscle channel reaches bridge Governing vessel flows downwards thru nose. Relationship between nose and internal organs Area between eyebrows: LU Area between the inner canthus (root of nose): Heart Nose bridge: Liver Sides of bridge: gallbladder Tip: spleen Sides of nose: stomach. Red nose, red bridge: alcohol causes damp/heat in spleen, stomach, liver. Nose to top lip = UB/BL, urinary tract, urogenital area. Greasy nose with secretion? Nose will be oily. Aspects of nose observation Abnormal colors o Red = heat Swollen nose - dampness o Red or pale? Flapping alae nase (wings of the nose or the exterior nostrils) Asthma will cause nostrils to flare for example Nose bleeds Ask how long it s been going on? Acute or chronic? Color of blood? (bright red = excess, dark/pale = deficient) Polyps Ulcers on nose Papules on nose Observation of Lips, Mouth, Palate, Teeth, Gums, Philtrum Philtrum Urine bladder upper philtrum Uterus lower philtrum Burning pain in urine? Look at this area color and quality will tell you about what is causing it. Red = heat for example Page 6 of 10

Lip and Mouth Observe color and quality. Drooping lips spleen qi defic Teeth and Gums Teeth are a surplus of bone, therefore related to Kidney. Thus Kid def manifest with teeth problems. Channel influencing the teeth and gums. Stomach = upper gums Stomach higher than LI (Red upper gums for instance indicates stomach heat.) Large Intestine = lower gums LI lower than stomach. (red lower gums could be heat in LI, maybe with constipation) Kidney = teeth and gums shrunken gums for instance, leaving teeth too exposed. Governing vessel = teeth and gums Aspects of observation Tooth cavities Loose teeth Plaque Teeth color Gum problems Inflamed: heat or empty heat in St, LI. Or Yin xu. Bleeding: weak Sp qi not holding blood or empty heat in St, Kidney, deficient fire. Bleeding, red and swollen: stomach fire Receding gums: qi and blood def, stomach fire, kidney yin def with empty heat. Gums oozing pus: stomach fire Gums chronically oozing pus: severe xu of Qi and blood Abnormal colors pale defic or cold red heat, either excess or deficient heat. purple stasis Observation of the Ears Channels influencing ears: GB main channel SJ main SI main Page 7 of 10

Bl main ST main LV connecting/collateral Aspects of ear observation Size most important in clinic. o Larger equals good luck, good health. Congenital goodness. Kidney essence good. o Small ears not so good. Essence deficiency Swollen can be dampness Contracted ears Dry and contracted helix Sores on ears Warts on ears Abnormal color Distended blood vessels on ear Excessive wax prod Discharge from ears. Observation of nails Nail surface abnormalities related to Liver, blood, deficiency. Nail will change with deficiencies. Ridges: liver blood or liver yin xu Indented Abnormal nail coloring White spots: qi def Pale white: blood xu of liver and sp Dull white: spleen and kidney yang xu Red: heat, generally full Yellow: damp heat of st, sp, lv, gb Bluish: blood xu w/internal cold Greenish: severe sp qi xu w/wind Blue/green: blood stasis Dark: kidney yin or yang xu, blood stasis Purple: liver blood stasis Red-purple: liver blood stasis Red purple in febrile disease: heat in blood Lunulae and significance Nail bed reflects state of yang qi while lunulae reflects state of yin and essence. Correspondence of lunulae to organs Thumb: lung Index finger: heart Middle finger: spleen Ring finger: liver Page 8 of 10

Little finger: kidney Observation of chest and ab Protruding chest o chronic retention of phlegm, liver qi stag Sunken chest o Lung qi o Yin xu o Kidney xu Observation of 4 Limbs/legs Spleen relates to 4 limbs. If Sp is weak, same in limbs. Edema of 4 limbs. Pitting edema. Press in front of tibia, impression stays long time. Spleen, kidney yang qi def with dampness. More deficiency related. Edema without the pitting is qi problem, usually qi stagnation. More excess related. (see notes) Observation of secretions. Key points: Check amount, color, property, smell. Examples: Sputum. Large amount, white, loose, no smell. That would be damp phlegm. Urine. Deep color with strong smell and scanty = heat. Menstrual blood. Large amount, pale color, low smell is a deficiency, probably qi. If has damp heat, less of it, deep color, strong smell. Same with vaginal discharge. Observation of Skin Red = heat. Bright is full, pale red is empty. Carbuncle = due to heat. Swollen, red, large, painful. Yang excess usually. Gangrene = yin at this point. Color is dark. Diabetes can cause this. No nutrition, no blood. Nail-like boil = like millet grain in the center at first. Slowly will change: root is tight with white on top (pus). Due to toxic fire. Furuncle: shallow, superficial, small and round. Usually not so red/swollen/hot. Sometimes transformed into pus. Due to damp/heat. Know the differenc between them. Observation of Children Index finger when child is less than 3 years old. Pulse and interrogation won t work. Observe vein and crease on finger. 3 parts know normal/abnormal indicators. Proximal segment: Wind gate Page 9 of 10

Less severe. Normal: Should be slightly red, perhaps a little bit yellowish. Abnormal: Purple and red: interior heat. Different from adult! Purple and dark/black: collateral is blocked. Blood stasis. *Bright red vein: indicates exterior problem. Different from adults. Mid segment: qi gate More severe Distal segment: life gate Life threatening Observation of Abdomen Distension of epigastrium and lower ab: liver qi stagnation Distention with bowel disorder: qi stag in intestines Slight chronic distension: spleen def Severe distention; damp-phlegm Page 10 of 10