Key Point One Observing Skin Color and Its Clinical Significance(1) Red SkinSudden bright red patches on the skin, with a color resembling vermilion, clear edges, and a burning sensation with swelling, indicate erysipelas.1. If it occurs on the head and face, it is called Bao Tou Huo Dan (Head Fire Erysipelas).2. If it occurs on the lower leg and foot, it is called Liú Huǒ (Flowing Fire).3. If it occurs all over the body and is migratory, it is called Chì Yóu Dān (Red Migratory Erysipelas).4. If it occurs in the upper body, it is often due to wind-heat transforming into fire; if in the lower body, it is often due to damp-heat transforming into fire, and it can also be caused by external injury leading to infection.(2) Yellow SkinWhen the face, skin, and nails are all yellow, it indicates jaundice, often caused by external damp-heat, epidemic toxins, internal injury from food and drink, or spleen deficiency with damp accumulation, blood stasis, and qi stagnation.1. Bright yellow like orange peel indicates Yang Huang (Yang Jaundice), caused by damp-heat accumulation leading to bile overflow onto the skin.2. Dull yellow like smoke indicates Yin Huang (Yin Jaundice), caused by cold-damp obstruction leading to bile overflow onto the skin.(3) Purple-Black SkinDiffuse brown-black changes on the face, hands, areola, armpits, external genitalia, and oral mucosa are often due to black jaundice, caused by kidney damage from overexertion; generalized skin darkening can also be seen in patients with kidney yang deficiency.(4) White Patches on SkinWhite patches of varying sizes with clear boundaries on the limbs and face, with a slow progression, indicate Bai Bo Feng (Vitiligo). This is often due to invasion of wind-damp, disharmony of qi and blood, and blood not nourishing the skin.Key Point Two Observing Rashes and Their Clinical Significance 2012Spots and rashes are symptoms of systemic diseases manifesting on the skin.(1) SpotsRefers to deep red or purplish patches appearing on the skin and mucous membranes,flat on the skin, not raised when touched, and do not fade when pressed. These can be caused byexternal invasion of warm-heat pathogens, heat toxins affecting the blood, internal pressure on the blood and qi,or spleen deficiency leading to blood not being contained, or yang deficiency causing cold stagnation and blood stasis, or external injury causing blood to seep into the skin.(2) RashesRefers to the appearance of red or purplish,granule-like rash points, raised above the skin, painful to touch, and fade when pressed. Commonly seen inmeasles, rubella, and hidden rashes and can also be seen in warm-heat diseases. Often caused by external invasion of wind-heat pathogens, or allergies, or heat entering the blood.1. Measles rash is peach-red, resembling millet, first appearing at the hairline behind the ears, gradually spreading to the face, trunk, and limbs, and fading in the order of appearance. Caused by external invasion of pathogens, it is a common infectious disease in pediatrics.2. Rubella rash is light red, small and sparse, with persistent itching, appearing and disappearing intermittently. Caused by external invasion of wind-heat pathogens.3. Urticaria presents as light red or pale wheals of varying sizes and shapes, itchy, merging into patches, raised above the skin, appearing and disappearing rapidly. Caused by external wind or allergies.Key Point Three Observing Blisters and Their Clinical Significance(1) White MitesAlso known as white rashes. Refers to small white vesicles appearing on the skin. Characterized by being crystal clear like millet, raised above the skin, bursting and oozing fluid, commonly found on the neck and chest, occasionally on the limbs, but not on the face. The appearance of white mites is often due to external invasion of damp-heat, stagnating on the skin surface, with insufficient sweating, seen in damp-warm diseases.White mites can be classified into Jing Mite (Crystal Mite) and Ku Mite (Dry Mite). The color is white, small and fine, bright and moist like crystal, called Jing Mite, indicating a smooth condition; if the mite is dry, it is called Ku Mite, indicating fluid depletion, representing a reverse condition.(2) ChickenpoxRefers to the appearance of pink papules on the skin of children, quickly transforming into oval-shaped small blisters, crystal clear and bright, with thin fluid, easily broken, appearing in batches, of varying sizes, accompanied by mild chills and fever, known as chickenpox. Caused by external invasion of pathogens and internal damp-heat accumulation, it is a common infectious disease in pediatrics.(3) EczemaRefers to the appearance of red patches on the skin, quickly forming papules and blisters, oozing fluid after bursting, leading to red, moist, ulcerated areas. Often due to damp-heat accumulation, further affected by wind pathogens, stagnating on the skin.(4) Heat SoresClusters of small blisters appear around the mouth, lips, and nose, with burning, itching pain.Often caused by external invasion of wind-heat or heat from the lung and stomach.(5) Waist Fire ErysipelasRedness of the skin on the waist, with clusters of vesicular rashes, grouped together, distributed in a band around the waist. Often caused by external invasion of fire toxins, or damp-heat in the liver channel affecting the skin..Key Point Four Observing Ulcers and Their Clinical Significance(1) CarbuncleRefers to a red, swollen, raised area at the affected site, accompanied by burning pain, and can form pus-filled ulcers. Characterized by easy resolution before pus forms, easy rupture once pus forms, and easy closure of the ulcer, belonging to a yang condition. Often caused by internal damp-heat fire toxins, with qi and blood stagnation.(2) AbscessRefers to a swollen area without a head, with unchanged skin color, and persistent pain. Characterized by difficulty in resolution, difficulty in rupture, and difficulty in closure, with potential damage to muscles and bones after rupture, belonging to a yin condition. Often caused by qi and blood deficiency, with cold stagnation.(3) BoilRefers to an initial appearance like millet or rice, with a hard root, numbness or itching, and a white painful tip. Commonly occurs on the face and hands and feet. Caused by bamboo or wood injuries, or invasion of epidemic toxins, fire toxins, etc.(4) FuruncleRefers to a small, round area that is red, swollen, and mildly painful, with a shallow root, and healing occurs once pus is discharged. Caused by external invasion of fire-heat toxins or damp-heat accumulation.
TCM Diagnostic Studies
TCM Diagnostic Studies
Observational Diagnosis: Observing Spirit
Observational Diagnosis: Observing Complexion
Observational Diagnosis: Observing Morphology
Observational Diagnosis: Observing Facial Features
Observational Diagnosis: Observing Body and Limbs
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