4/17/2018 Inspection and tongue study methods in TCM

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> What to Expect from a TCM Doctors' Examination?
> Inspection

Diagnostic methods: I.Questioning | II. Inspection | III Listening&Smelling | IV.

Palpation

II. Inspection
Examination through inspection entails the physician using visual senses to
investigate a patient's condition. This includes observation of the entire body (spirit,
color, form, bearing), as well as content derived from areas of the body, the tongue
etc. This is a method for TCM physicians to understand and predict the pathological
changes of internal organs through observing abnormal changes in the patient's
vitality, appearance, secretions and excretions. The Chinese physicians realized the
close relationship between the external part of the body, especially the face and
tongue, and the organs. Any slight changes that appear reveal the pathological
conditions of various parts of the body. Chinese medicine usually focuses on the
following:

Spirit
Spirit is the outward manifestation of vital activities. By inspecting it, one gains insight
into the development of the disease, and can measure the strength or weakness of
the disease, and judge the prognosis. If the person behaves normally, is alert and co-
operative, the disease is usually mild. But if responses are sluggish or confused, the
disease could be serious.

Colour
Skin colour varies according to your race. The lustre (or moisture) of the skin reflects
the prosperity or decline of the qi (vital energy) and essence. In TCM, skin colours
are divided into five colours corresponding to the organs - blue is for the liver, red for
the heart, yellow for the spleen, white for the lungs, and black for the kidneys.
Changes in skin colour reflect the nature of a disease and various syndromes of
different organs. Discolorations are usually seen: purple or green-blue, yellow, red,
pale and dark gray.

Common discolorations in TCM examination

Discoloration Associated syndrome(s)
Purple, Cold syndrome, painful syndrome, blood stasis
Green-blue or liver disease
Red Heat syndrome
Dampness syndrome, syndromes of deficiency
Yellow
(xu) type
Cold syndrome of deficiceny (xu) type, blood
Pale
loss
Kidney deficiency, cold syndrome, painful
Dark gray syndrome, blood stasis or static fluid
syndromes.

Form
The body shape can be described as strong, weak, heavy or skinny. TCM believes
overweight people tend to be excessive in phlegm and dampness. A thin person
with dry skin indicates insufficiency of blood. Great loss of weight in the course of a
long illness indicates exhaustion of essence.

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4/17/2018 Inspection and tongue study methods in TCM

Bearing
The patient's movement and posture are outward manifestations of pathological
changes. There is a variation of movement and posture in different diseases. For
example, the appearance of numbness and impaired movement of the limbs on one
side of the body indicates stroke, pain and soreness. Heaviness and numbness in the
tendons, bones and muscles accompanied by swelling and restricted movement at
the joints appear in rheumatism.

TCM Tongue examination

Observation of the tongue, also known as tongue
diagnosis, is an important procedure in TCM
examination. It includes observing the tongue and
any coating it may have. The tongue body refers to
the muscular tissue of the tongue. The tongue
coating (fur) refers to a layer of "moss" over the
tongue surface, which is produced by the stomach
qi. In ancient times, it was established that different
parts of the tongue correspond to different internal
organs. The tip of the tongue reflects the heart and
lungs; the middle part, the spleen and stomach; its
root, the kidneys; and both sides of the tongue, liver Division of tongue surface
and gall-bladder.

The tongue body and fur together create the tongue sign. Tongue signs are an
important factor in diagnosis, as changes in the signs, reflect changes in the condition
of the disease. A normal tongue sign is proper size, soft in quality, free in motion, pale
red in color and with a thin layer of white coating which is neither dry nor overly moist.

Different diseased tongue signs:

Pale tongue with white Pale red tongue with Red tongue with fissures; and the
and thin coating white glossy coating coating is white, thin and a little
rough.

Red tongue with yellow, Deep red tongue Purple tongue with white, thin and
thick and greasy coating. without any coating. slimy coating.

Commonly seen tongue signs

Tongue body Tongue coating Problem Indicated
Pale, tender, slightly larger Thin, white Qi deficiency
than normal
Pale, normal in size or Slightly dry, thin, white Blood deficiency
slightly shrunken
Pale, enlarged and tender, Damp and moist with much Yang depletion causing internal
teeth impression on the fluid, white and thick collection of cold-dampness
sides
Pale Thin, white, peeled center Insufficient stomach yin
Pale Yellow, slimy Weakness of spleen and stomach
Pale red Thin, white, moist Normal or invasion by wind-cold

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4/17/2018 Inspection and tongue study methods in TCM
evils.
Pale red Red tip with white fur Flaming up of heart fire
Red, rough Yellow Retention of heat
Red, prickles Thick, yellow, dry Extreme heat in the interior
Red Dry in center of the tongue Heat scorching the stomach fluids
Red Yellow and slimy Dampness and heat in the qi (vital
energy) aspect
Red Thick, yellow and glossy Dampness and heat distending and
stagnating in the spleen and
stomach
Red Little or no fur Yin deficiency causing virtual fire,
deficiency in qi (vital energy) and yin
Deep red (crimson), Thick, yellow Heat evil entering the blood
prickles
Deep red Dry with cracked fur Heat evil burning yin
Deep red Black fur Extreme retention of heat
Deep red, shrunken Dry, little or no fur Long term yin deficiency
Deep red Yellow and slimy Internal heat acompanied with
phlegm and dampness
accumulation
Dark red Bruised spots or patches Blood stasis with heat
Pale purple, tender, Glossy damp, moist Internal cold flourishing
Purple, with bruised spots white Internal accumulation of blood
or patches stasis
Blue-green and purple Yellow and dry Extreme exhaustion of yin and
blood, internal exuberance of virtual
fire
Green-blue White and glossy Serious cold syndrome
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