Ten Types of Observation Diagnosis for Women’s Health
Guiding Expert: Associate Professor Pang Zhenmiao, Department of Gynecology, First Affiliated Hospital of Guangzhou University of Chinese Medicine
Reporter: Lin Henghua, Correspondent: Zhang Qiuxia
2016-5-10New Express B01 Edition
“Observation, Listening, Inquiry, and Pulse Taking” are the four major diagnostic methods in Traditional Chinese Medicine (TCM). Ancient medical texts suggest that a divine doctor can diagnose a condition at a glance, a sage doctor can discern it from the patient’s voice, a skilled doctor can determine it after listening to the patient’s account, and a clever doctor can ascertain it after pulse taking. This indicates that observation diagnosis holds a crucial position in TCM diagnostics. In modern TCM outpatient clinics, observation diagnosis remains an important method for disease assessment. Particularly in gynecology, through ten types of observation diagnosis, one can “read” the health signals emitted by women’s bodies.Observation of Complexion: Abnormal Complexion Relates to Organ HealthAssociate Professor Pang Zhenmiao from the First Affiliated Hospital of Guangzhou University of Chinese Medicine points out that a pale complexion suggests lung issues, often indicating qi deficiency, blood loss, or chronic blood loss in women, such as in cases of metrorrhagia or excessive menstruation. A pale complexion with a bluish tint indicates both qi and blood deficiency along with liver wind. A sallow complexion, which is pale yellow and lacks luster, suggests spleen deficiency and blood deficiency. A red complexion indicates excess heat, which can be seen in cases of early menstruation, excessive menstruation, metrorrhagia, postpartum fever, or acute pelvic inflammatory disease. A flushed complexion suggests yin deficiency with excess fire. If accompanied by paroxysmal heat and sweating, it reflects a disorder of kidney yin and yang during menopause. A dark or mottled complexion suggests both spleen and kidney deficiency, particularly kidney deficiency. If the eye sockets are dark, with both upper and lower eyelids dark, it indicates kidney deficiency; if only the lower eyelids are dark, it indicates spleen deficiency. Dark cheeks with spots belong to spleen and kidney deficiency. A deepening and expanding dark color indicates worsening health; a lightening of the dark color and fading spots indicates improvement or recovery.Observation of Eyes: Related to Kidney, Liver, and Lung HealthFrom a TCM perspective, the pupil represents the kidney, the outer black part of the eye represents the liver, the white part represents the lung, the inner and outer canthi represent the heart, and the eyelids represent the spleen. If there is congenital kidney qi deficiency, poor spleen and stomach function, and frequent late nights, the eyes will appear lifeless; regular exercise, good blood circulation, adequate nutrition, and sufficient sleep will make the eyes lively. If kidney and liver functions are good, the black part of the eye will be very dark; if one goes to bed early, rises early, avoids late nights, exercises in fresh air, and eats a balanced diet, the whites of the eyes will be clear and free of bloodshot. Many older individuals have bags under their eyes. Both upper and lower eyelids are governed by the spleen, which controls muscles; if the spleen is deficient and its function is poor, the muscles lack elasticity, leading to sagging eyelids.Observation of the Tongue: Tongue Quality, Thickness, and Coating Reflect HealthTongue diagnosis is very important in gynecology, especially the quality of the tongue has significant diagnostic value. A pale tongue indicates qi and blood deficiency or internal cold, commonly seen in cases of excessive menstruation, insufficient menstruation, metrorrhagia, amenorrhea, postpartum blood collapse, or cold womb infertility. A dark red tongue indicates qi and blood stagnation, often seen in irregular menstruation, painful menstruation due to blood stasis, or pelvic inflammatory disease. A red tongue indicates blood heat. A red tip of the tongue suggests heart fire or concurrent lung heat and blood heat, commonly seen with heavy menstrual flow. A red edge of the tongue indicates liver and gallbladder fire, often seen in early menstruation, excessive menstruation, fetal leakage, postpartum fever, or yin sores. Stasis spots on the tongue indicate blood stasis within the body, commonly seen in painful menstruation, amenorrhea, masses, infertility, postpartum abdominal pain, or prolonged lochia. A pale and dark tongue indicates spleen and kidney deficiency, especially common in patients with habitual miscarriage. A dark and stagnant tongue primarily indicates kidney deficiency. A completely dark tongue differs from a tongue with red edges and stasis spots; the former indicates kidney deficiency, while the latter indicates blood stasis, both of which are common tongue presentations in gynecology. In gynecological conditions, a thick tongue is more common than a thin tongue. A thick tongue often indicates qi deficiency, spleen and kidney yang deficiency, seen in metrorrhagia, excessive menstruation, menstrual edema, leukorrhea, uterine swelling, and uterine prolapse. A thin tongue often reflects chronic blood deficiency, yin deficiency, or insufficient body fluids. A thin, pale tongue indicates both qi and blood deficiency; a thin, red, and dry tongue indicates yin deficiency with internal heat. A moist and thick tongue coating indicates internal cold and dampness, such as cold-induced painful menstruation, deficiency-type leukorrhea, or uterine swelling. A yellow coating indicates heat. A thin, slightly yellow coating suggests mild heat; a thick, deep yellow coating indicates severe internal heat; a thick, yellow, and greasy coating indicates damp-heat accumulation; a thick and dry coating indicates heat damaging body fluids. Tongue presentations indicating heat damage can be seen in cases of excessive menstruation, intermenstrual bleeding, damp-heat leukorrhea, pelvic inflammatory disease, or postpartum fever. A red tongue with little or no coating indicates yin deficiency with internal heat. In summary, a thick and greasy coating often indicates the presence of dampness and other pathogenic factors.Observation of Lip Color: Related to Gynecological Diseases and Reproductive IssuesIn TCM, the spleen opens to the mouth, and its manifestation is in the lips. A dark upper lip color suggests menstrual disorders, infertility, or a tendency to miscarriage; a dark ring around the lips often indicates menstrual disorders or difficulty in conception; pale, red, purple, or cracked lips suggest deficiency, heat, stasis, or excess yin deficiency fire; additionally, excessive hair growth around the lips often indicates kidney deficiency and phlegm-dampness, which can be seen in polycystic ovary syndrome, infertility, amenorrhea, or metrorrhagia.Observation of Teeth: Reflecting Qi and Blood HealthIn TCM, the kidney governs the bones, and teeth are the extremities of the bones. The whiteness and alignment of the teeth indicate the strength of kidney qi. Additionally, healthy gums should be pink; deep red gums indicate poor qi and blood levels.Observation of Hair: Reflecting Kidney Qi SufficiencyIn TCM, “hair is the surplus of blood,” and hair is also referred to as the “flower of the kidney.” Observing whether the hair is thick and black helps assess whether kidney qi is sufficient and whether qi and blood are abundant.Observation of Hands: Strongly Related to Qi and BloodIf the palm muscles are plump and elastic, and quickly return to shape after pressing the thenar eminence, it indicates sufficient qi and blood; if the hands are very hard and difficult to press down, it suggests excessive qi and sticky blood, which may indicate cardiovascular issues; if the hands are too soft and the fingertips are limp, it indicates insufficient qi and blood. The normal color of a person’s palm is pink. If the palm color is too dark red, it indicates overly sticky blood; if the color is pale, it indicates insufficient blood, malnutrition, or even anemia, commonly seen with delayed menstruation. The half-moon marks on the fingers are also related to health. A healthy person should have 6-8 half-moon marks on both hands, and the normal half-moon mark should occupy 1/3 to 1/5 of the nail area. The little finger represents the kidney, which generally does not show half-moon marks. If the half-moon marks are too large, it suggests excessive consumption of true qi; if they are too small, it indicates insufficient true qi. The normal color of half-moon marks should be milky white with clear boundaries.Observation of Body Shape: Both Overweight and Underweight are Concerning Both obesity and emaciation are problematic. Overweight individuals often experience delayed menstruation, often with qi deficiency, phlegm-dampness, and yang deficiency with excess yin, commonly accompanied by symptoms of fatigue and excessive sweating, which may benefit from warming tonics; emaciated individuals often indicate liver stagnation, excess fire, yin deficiency, emotional instability, and excessive sensitivity, which do not benefit from warming tonics but require nourishing kidney yin, replenishing essence, and soothing the liver.Observation of Menstruation: Related to Qi and Blood, Liver and SpleenMenstruation that is early, heavy, dark red, thick, or contains small clots suggests blood heat; menstruation that is early, heavy, but light in color and thin suggests qi deficiency due to spleen yang not being able to hold. Late menstruation with light flow, dark color, or clots, accompanied by cold pain in the lower abdomen, suggests blood cold; late menstruation with light flow and thin color suggests blood deficiency. Dark red menstruation with heavy flow or prolonged bleeding, with clots, and pain that reduces after clots are expelled, suggests blood stasis. Irregular menstruation with varying flow, intermittent, or dark purple with small clots, accompanied by fullness and discomfort in the chest and abdomen, suggests liver stagnation and blood stasis, with qi and blood circulation being obstructed and regulation being lost.Observation of Leukorrhea: Related to Spleen, Kidney, and Liver OrgansLeukorrhea that is abundant, white, or yellowish like mucus or saliva suggests spleen deficiency with excessive dampness; abundant, clear, and watery leukorrhea suggests kidney yang deficiency and inability to contain. Yellow or red leukorrhea, continuous dripping, and external itching often belong to damp-heat descending from the liver; leukorrhea that is purulent or bloody often indicates heat toxin or damp toxin. If there is a foul odor, it may suggest a malignant tumor, requiring further examination.
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