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Local observation is a diagnostic method based on the overall observation, focusing on certain local areas of the patient according to the condition and diagnostic needs, to assess the disease. Traditional Chinese Medicine (TCM) believes that the human body is an organic whole, with various organs and tissues coordinating functionally and influencing each other pathologically. Systemic changes can reflect in corresponding local areas, and local changes can also affect the whole body. Therefore, observing local abnormal changes can help diagnose specific local diseases and understand overall pathological changes.
The content of local observation includes observing the head and face, five senses, neck, body, limbs, and skin.
1. Observation of the Head and Face
The head is the residence of the essence and spirit, housing the brain marrow, which is transformed from kidney essence; the head is where all Yang channels converge, with the three Yang channels of the hands and feet and the Governor Vessel ascending to the head, while the Foot Jueyin Liver Channel and Ren Vessel also reach the head. Therefore, the essence and Qi of the organs all nourish the head; the face is the manifestation of the heart, with the essence and Qi of the organs nourishing the face; the kidney’s manifestation is in the hair, which is the surplus of blood. The observation of the head and face mainly focuses on the shape of the head, fontanelle, hair, and the condition of the face.
(1) Observation of the Head
1.Head Shape: The size, shape, and dynamics of the head are primarily observed. The size of the head can be measured by the head circumference, using a measuring tape from above the eyebrows, around the head at the occipital protuberance. Generally, the head circumference of newborns is about 34 cm, about 42 cm at 6 months, about 45 cm at 1 year, about 47 cm at 2 years, about 48 cm at 3 years, and close to adult size after 5 years. If the head circumference of a newborn is less than 32 cm, or remains less than 45 cm after 3 years, it is considered too small; if the head circumference is greater than 37 cm, it is considered too large. Head circumference is an important indicator for measuring the brain and skull, and can also be used to assess certain brain diseases in infants. Abnormal head shapes include excessively large, small, or square heads.
(1)Large Head: An enlarged skull with open sutures, a smaller face, and intellectual disability is often due to congenital insufficiency, kidney essence deficiency, and fluid accumulation in the brain.
(2)Small Head: A narrow skull with a pointed top, early closure of sutures, and intellectual disability is often due to kidney essence deficiency and poor skull development.
(3)Square Head: A protruding forehead with a flat top, resulting in a square-shaped skull, is often due to kidney essence deficiency or spleen and stomach weakness, leading to poor skull development, commonly seen in rickets or congenital syphilis.
2. Dynamics: Involuntary shaking of the head, known as head shaking or “shaking head wind,” is often a sign of internal wind from the liver, seen in both adults and children. The “Medical Guidelines” states: “Head shaking belongs to wind and fire; in the elderly or after illness, it often indicates deficiency.”
3.Fontanelle: The fontanelle is the gap between the skull bones in infants that has not yet fully closed, with anterior and posterior fontanelles. The posterior fontanelle is triangular and closes within 2-4 months after birth; the anterior fontanelle, located between the parietal and frontal bones, is diamond-shaped and closes between 12-18 months after birth, and is a key area for clinical observation.
(1)Bulging Fontanelle: This indicates a protruding fontanelle, often associated with excess conditions. It may be due to excessive heat, fire toxins attacking upward; or fluid accumulation in the brain; or diseases of the brain marrow. The fontanelle may temporarily bulge slightly when the infant cries but returns to normal when calm.
(2)Sunken Fontanelle: This indicates a sunken fontanelle, often associated with deficiency conditions. It may be due to vomiting and diarrhea damaging fluids, insufficient Qi and blood, and congenital kidney essence deficiency, leading to insufficient brain marrow. However, a slight sunken fontanelle in infants under 6 months is normal.
(3)Delayed Closure of Fontanelle: This refers to a fontanelle that closes late, with unclosed sutures, also known as “fontanelle separation” or “unclosed fontanelle.” This is a manifestation of congenital kidney essence deficiency or acquired spleen and stomach weakness, leading to poor development, commonly seen in rickets, often accompanied by the “five delays” (delayed standing, walking, speaking, teething, and growth) and the “five softs” (soft head and neck, soft mouth, soft hands, soft feet, and soft muscles). The “Pediatric Compendium” states: “Delayed closure of the fontanelle is due to insufficient innate Qi and severe kidney deficiency, as the kidney governs the brain marrow; if the kidney is deficient, the brain marrow is insufficient, leading to fontanelle separation.” The “General Principles of Pediatric Hygiene” states: “The fontanelle is related to the spleen and stomach.”
(2) Observation of Hair
The growth of hair is closely related to the strength of kidney Qi and the abundance of essence and blood, so observing hair can assess the strength of kidney Qi and the abundance of essence and blood. In normal individuals, hair is black, thick, and lustrous, indicating abundant kidney Qi and sufficient essence and blood.
1.Color: Yellow, dry, sparse hair that falls out easily often indicates insufficient essence and blood, seen in patients after severe illness or chronic deficiency; sparse, yellow, soft hair in children with delayed growth is often due to congenital insufficiency and kidney essence deficiency; premature graying in young adults, often accompanied by symptoms like tinnitus and lower back pain, indicates kidney deficiency; if accompanied by insomnia and forgetfulness, it is due to overthinking and blood injury; sudden extensive graying of hair, accompanied by emotional depression, indicates liver Qi stagnation; in children, hair that is dry and yellow, with a pale face and thin body, often indicates malnutrition.
2.Hair Loss: Sudden patchy hair loss, revealing round or oval shiny scalp, is called alopecia areata, commonly known as “ghost shaving head,” often due to blood deficiency and wind. Sparse and brittle hair that falls out easily is often due to kidney deficiency and insufficient essence and blood. In young adults, if hair is sparse and falls out easily, accompanied by dizziness, forgetfulness, and weakness in the lower back and knees, it indicates kidney deficiency; if accompanied by itchy scalp, dandruff, and oiliness, it indicates blood heat causing wind, leading to partial or complete hair loss. If hair does not grow back over time, accompanied by headaches, dark complexion, dark tongue, or purple spots, and thin, rough pulse, it indicates blood stasis.
(3) Observation of the Face
The face refers to the facial area, including the forehead. Observation of the face should focus on color, shape, and abnormalities. Since the color of the face has been discussed in the color observation section, this section focuses on abnormal facial shapes.
1. Abnormal Facial Shape
(1)Facial Swelling: Facial edema with unchanged skin color is often seen in edema diseases; facial redness and swelling, with a color like red dye, accompanied by heat and pain, is known as “head fire toxin,” often caused by wind-heat and fire toxins attacking upward; if the head is swollen like a bowl, with severe facial swelling, inability to open the eyes, accompanied by high fever, thirst, and yellow tongue coating, it is known as “big head plague,” caused by seasonal epidemics and toxic fire attacking upward.
(2)Parotid Swelling: Swelling of one or both sides of the parotid area centered around the earlobe, with unclear edges, yielding a soft feel and tenderness, is known as mumps, caused by external temperature toxins; often seen in children. If the jaw and chin area is swollen and painful, with limited mouth opening and accompanied by chills and fever, it is known as “jaw swelling,” often due to Yangming heat toxins attacking upward.
(3)Facial Emaciation: Also known as facial atrophy, characterized by emaciated facial muscles, prominent cheekbones, and sunken eyes and cheeks. This is often due to Qi and blood deficiency, with exhaustion of the essence and Qi of the organs, indicating a loss of spirit.
(4)Facial Asymmetry: The mouth and eyes are crooked and cannot close, also known as “facial paralysis” or “mouth deviation.” If only the mouth and eyes are asymmetrical, with relaxed facial muscles on the affected side, numbness of the skin, disappearance of forehead wrinkles, shallow nasolabial folds, inability to close the eyes, inability to frown or puff cheeks, and drooping of the mouth corner towards the healthy side, it is known as “mouth deviation,” caused by wind invading the meridians; if facial asymmetry is accompanied by hemiplegia, it is often due to liver Yang transforming into wind, with phlegm obstructing the meridians.
2. Special Facial Expressions
(1)Fearful Expression: The face shows signs of shock and fear, often triggered by loud noises or seeing water, commonly seen in rabies.
(2)Wry Smile: The face shows a helpless, bitter smile. This is often due to muscle spasms in the face, a special sign of tetanus.
2. Observation of the Five Senses
The eyes, ears, mouth, nose, and tongue are each associated with the five organs. The “Lingshu” states: “The nose is the organ of the lungs, the eyes are the organ of the liver, the mouth and lips are the organs of the spleen, the tongue is the organ of the heart, and the ears are the organs of the kidneys.” Therefore, observing the spirit, color, shape, and state changes of the five senses can provide insights into the normal and abnormal conditions of the related organs. The observation of the tongue will be discussed in a separate section, so this section mainly introduces the observation of the eyes, ears, nose, mouth, lips, gums, and throat.
(1) Observation of the Eyes
The eyes are the orifice of the liver and the messenger of the heart, with the essence and Qi of the five organs and six viscera all converging in the eyes, thus the eyes are closely related to the five organs and six viscera. Ancient texts divided the different parts of the eyes according to the five organs, stating: “The essence of the eye is the pupil, the essence of the bone is the iris, the essence of the tendons is the sclera (the white part of the eye), the essence of the blood is the blood vessels, and the essence of the muscles is the eyelids.” Later physicians summarized this into the “Five Wheel Theory,” which states that the pupil belongs to the kidney, called the water wheel; the iris belongs to the liver, called the wind wheel; the blood vessels at the corners belong to the heart, called the blood wheel; the sclera belongs to the lungs, called the Qi wheel; and the eyelids belong to the spleen, called the flesh wheel. It is believed that observing the changes in the five wheels can diagnose corresponding organ diseases. Therefore, observing the eyes is not only significant in assessing the spirit but also in understanding the diseases of the five organs, and can even play a role in diagnosing certain diseases, as stated in the “Revised Common Cold Treatise”: “In critical illness, one must observe the eyes, looking at their color to know the life or death of the disease; thus, observing the eyes is the primary diagnostic method.”
Observation of the eyes can be approached from the aspects of spirit, color, shape, and state. Since the spirit of the eyes has been introduced in the spirit observation section, this section focuses on the color, shape, and state abnormalities of the eyes.
1.Eye Color: In normal individuals, the inner eyelids and corners are rosy, the sclera is white, the iris is brown or hazel, and the cornea is colorless and transparent. Abnormal changes include:
(1)Red Eyes: Redness in one or both eyes, commonly known as “red eyes” or “fire eyes.” If redness is accompanied by swelling and pain, it often indicates a condition of excess heat. If the entire eye is red and swollen, it is often due to wind-heat attacking the liver; if the corners are red and painful, it is often due to heart fire; if the sclera is red, it is often due to lung fire; if the eyelid edges are red and ulcerated, it is often due to spleen damp-heat. If the sclera is red and burning, with sticky discharge and sensitivity to light, and is infectious, it is often due to seasonal heat toxins, also known as “seasonal red eyes.”
(2)Yellow Sclera: This is a primary sign of jaundice. The “Source of Various Diseases” states: “The text states that yellow eyes indicate jaundice, as the eyes are the gathering place of the meridians, and the heat of the meridians rises to the eyes, thus yellowing the eyes, which can be recognized as jaundice.” Accompanied by yellowing of the body and face, yellow urine, etc., it is often due to internal damp-heat or cold dampness obstructing the liver and gallbladder, leading to abnormal bile flow, with distinctions between Yang jaundice and Yin jaundice.
(3)Pale Eyelids: This indicates blood deficiency or blood loss, as insufficient blood cannot nourish the eyes.
(4)Dark Circles: Often indicate kidney deficiency; dark circles around the eyes may be due to kidney deficiency causing water retention, or cold dampness descending; dark circles around the eyes, accompanied by skin issues, may indicate blood stasis; poor sleep can also lead to dark circles.
(5)Cloudy Iris: This indicates cataracts, which are external eye diseases. If the iris has a deep circular opacity that obstructs vision, it is known as “cloudy iris,” often due to invasion of toxins, or liver and gallbladder fire attacking upward, or damp-heat steaming, or Yin deficiency with excess fire, commonly seen in eye injuries and certain systemic diseases; if a child has long-standing malnutrition, it may also lead to cloudiness in the eyes, presenting as dry eyes, night blindness, and severe cases may lead to ulceration and perforation.
2. Eye Shape
(1)Swollen Eyelids: This refers to swelling and discomfort of the upper and lower eyelids. If the eyelids are swollen, with unchanged skin color or a shiny appearance, it is an early sign of edema; if the eyelids are red and swollen, with small lumps resembling grains, it is known as a stye; if the entire eyelid is swollen, red like dye, and may become purulent, it is known as “eye sore.” The latter two are caused by wind-heat toxins invading the eyelids, or heat toxins accumulating in the spleen and stomach, leading to local Qi and blood stagnation.
(2)Sunken Eyes: If seen after vomiting or diarrhea, it is often due to fluid damage; if seen in chronic or severe illness, it indicates exhaustion of the essence and Qi of the organs, indicating a difficult condition.
(3)Protruding Eyes: Protruding eyes with shortness of breath indicate lung distension, often due to phlegm obstructing the lungs, leading to difficulty in breathing; protruding eyes with neck swelling indicate goiter, often due to liver Qi stagnation transforming into fire, with phlegm and Qi obstructing.
3.Eye State: In normal individuals, the pupils are round, equal in size, with a diameter of 3-4 mm, responsive to light, and the eyeballs move freely. Abnormal changes mainly include:
(1)Pupil Constriction: Often due to excessive liver and gallbladder fire, or overexertion of the liver and kidney, leading to internal heat disturbance. It can also be seen in poisoning (morphine, Aconitum, poisonous mushrooms, organophosphate pesticide poisoning).
(2)Pupil Dilation: Often indicates kidney essence depletion, seen in critical patients, and is one of the signs of impending death. It can also be seen in liver and gallbladder wind-fire disturbances, poisoning (such as from almonds, ephedra, and belladonna), and certain Western medications (such as atropine) causing drug-induced pupil dilation.
(3)Fixed Gaze: The patient’s eyes are fixed and cannot move, with fixed forward gaze known as “staring”; fixed upward gaze known as “upward gaze”; fixed sideways gaze known as “side gaze.” This often indicates internal wind disturbance from the liver, often accompanied by confusion and convulsions, indicating a severe condition; it can also be seen in exhaustion of the essence and Qi of the organs, or phlegm-heat obstructing. Staring can also be seen in goiter.
(4)Exposed Eyes During Sleep: This refers to the eyes being exposed when the eyelids do not close during sleep. This is often due to spleen deficiency failing to raise the clear Yang, or severe fluid damage, leading to eyelid malnourishment and abnormal closure, often seen in children with spleen and stomach deficiency or fluid damage from vomiting and diarrhea. Additionally, exposed eyes during sleep can also be seen in normal individuals, commonly known as “sheep eyes.”
(5)Drooping Eyelids: Also known as eyelid ptosis, refers to the upper eyelid drooping and being difficult to lift, with mild cases partially covering the pupil and severe cases completely obscuring the pupil, making it difficult to open. Eyelid drooping can be congenital or acquired. In cases of bilateral eyelid drooping, it is often due to congenital insufficiency, spleen and kidney deficiency, leading to muscle malnourishment; in cases of unilateral eyelid drooping, it is often due to spleen Qi deficiency, leading to malnourishment of the vessels and muscle relaxation, and can also be seen in trauma.
(2) Observation of the Ears
The ears are the orifice of the kidneys, with the hand and foot Shaoyang meridians distributed in the ears, and the hand and foot Taiyang and foot Yangming meridians also distributed in the ears or around the ears. The “Lingshu” states: “The twelve meridians, three hundred sixty-five collaterals… their separate Qi flows to the ears and serves as hearing.” Thus, the ears are the gathering place of the “meridians.” Additionally, there are reflex points for all body organs and limbs on the auricle. Therefore, the ears are connected to the whole body, especially closely related to the kidneys and gallbladder, and observing the ears can reveal changes in the kidneys, gallbladder, and even the whole body. The observation of the ears mainly focuses on the color, shape, and internal changes of the ears.
1.Ear Color
(1)Moisture and Dryness: In normal individuals, the auricles are red and moist, indicating sufficient Qi and blood; if the auricles are black and dry, it often indicates kidney essence deficiency.
(2)Color: Pale auricles often indicate Qi and blood deficiency; red and swollen auricles often indicate liver and gallbladder damp-heat or heat toxins attacking upward; bluish-black auricles are often seen in patients with internal cold or severe pain; in children, if the back of the ear has red veins and the ear root is cool, it often indicates a precursor to measles.
2. Ear Shape
(1)Large Auricles: Thick and large auricles indicate abundant kidney Qi; if the auricles are swollen and red, it indicates excess pathogenic Qi, often due to Shaoyang fire attacking upward.
(2)Small Auricles: Thin and small auricles indicate congenital deficiency and insufficient kidney Qi; if the auricles are thin and dry, it indicates deficiency of Zheng Qi, often due to kidney essence depletion or kidney Yin deficiency; if the auricles are atrophied, it indicates exhaustion of kidney Qi.
(3)Skin Changes on the Auricle: This indicates skin changes on the auricle, often due to long-term blood stasis.
3.Internal Ear Changes
(1)Pus in the Ear: Pus flowing from the ear canal, which may be yellow or green, thick or thin, is known as “pus ear.” The presence of pus can indicate excess or deficiency conditions, involving the liver, gallbladder, and kidney meridians. If the pus is yellow and thick, with severe ear pain, it indicates an excess condition, often due to wind-heat disturbance or liver and gallbladder damp-heat; if the pus is thin and clear, with milder ear pain, it indicates a deficiency condition, often due to kidney Yin deficiency and internal heat.
(2)Red and Swollen Ear Canal: Localized redness and swelling in the ear canal, with pain, resembling pepper spots, is known as an ear boil, often due to heat invading the ear or external heat obstructing the ear orifices.
（3）Observation of the Nose
The nose is located centrally on the face, is the orifice of the lungs, and is associated with the spleen, also connected to the foot Yangming stomach meridian. Observing the nose can diagnose diseases of the lungs, spleen, and stomach. The observation of the nose should focus on color, shape, and internal changes.
1. Nose Color
(1)Moisture and Dryness: A slightly yellow and moist nose tip indicates a new illness, with the stomach Qi not yet damaged, indicating a milder condition; if seen in a long-term illness, it indicates recovery of stomach Qi, indicating improvement. A dark and dry nose tip indicates weakened stomach Qi, indicating a severe condition.
(2)Color: A white nose tip often indicates Qi and blood deficiency; a red nose tip indicates lung and spleen heat; a yellow nose tip indicates damp-heat; a blue nose tip indicates cold abdominal pain; in children, if the bridge of the nose has blue veins, it often indicates liver Qi stagnation, cold accumulation, or disharmony between liver and spleen, or food stagnation.
2. Nose Shape
(1)Swollen Nose Tip: If red and swollen or ulcerated, with pain, it indicates excessive heat, often seen in stomach heat or blood heat. If the nose and surrounding skin are dark red or blood vessels are dilated, accompanied by papules, pustules, or nasal polyps, it is known as “alcoholic nose,” often due to lung and stomach heat, with blood stasis causing the nose to become swollen.
(2)Collapsed Nose: Often seen in syphilis patients; if the nose collapses and the eyebrows fall out, it indicates leprosy.
(3)Nostrils Flaring: The nostrils flare due to rapid breathing, also known as “nose flaring.” This often indicates lung heat or can be seen in asthma, indicating lung Qi obstruction and difficulty in breathing; if nostrils flare during severe illness, with sweating on the forehead, it indicates impending lung Qi failure.
3. Internal Nose Changes
(1)Clear Nasal Discharge: If accompanied by chills, fever, and nasal congestion, it often indicates wind-cold exterior syndrome; if clear nasal discharge is persistent and profuse, it often indicates allergic rhinitis, often due to weak Yang Qi.
(2)Thick Nasal Discharge: If accompanied by chills, fever, and sore throat, it often indicates wind-heat exterior syndrome; if thick nasal discharge is persistent and foul-smelling, often accompanied by headaches, nasal congestion, and reduced sense of smell, it is known as “nasal phlegm,” often due to wind-heat invasion or heat in the gallbladder attacking the nose.
(3) Nosebleeds: Nosebleeds are known as “epistaxis.” If caused by external factors, it often indicates wind-heat invading the lungs or dryness injuring the lungs; if the bleeding is profuse, dark red, and thick, it often indicates liver fire invading the lungs, or excessive stomach fire, leading to heat injuring the Yang vessels, causing blood to overflow; if the blood is light red and thin, it often indicates spleen Qi deficiency, leading to blood not circulating properly. Some women may experience nosebleeds during their menstrual cycle, known as “reverse menstruation,” often due to liver Qi stagnation transforming into fire invading the lungs, or Yin deficiency with lung heat.
(4)Nasal Polyps: These are fleshy growths in the nasal cavity resembling grapes or pomegranates, smooth and soft, with a stalk that can move, and are painless, known as nasal polyps. If they obstruct the nostrils, they can cause difficulty in breathing. They are often due to damp-heat toxins obstructing the nasal orifices.
(4) Observation of the Mouth and Lips
The mouth is the passage for food and drink, the orifice of the organs, with the spleen opening at the mouth, and its essence manifested in the lips. The hand and foot Yangming meridians surround the mouth and lips, so observing the mouth and lips can diagnose diseases of the spleen and stomach. Observation of the mouth and lips should focus on changes in shape, color, moisture, and dynamics.
1. Observation of the Mouth
(1)Salivation at the Corners of the Mouth: Salivation in children is known as “stagnant jaw,” often due to spleen deficiency and excess dampness. The “Source of Various Diseases” states: “Stagnant jaw disease is when children salivate excessively, soaking the jaw, due to cold liquid from the spleen.” In adults, it often indicates a stroke causing the mouth to droop.
(2)Oral Ulcers: Small, superficial ulcers appear on the oral mucosa, yellow-white in color, with red halos and local burning pain, known as oral ulcers, also referred to as “oral sores” or “mouth ulcers” in the “Huangdi Neijing.” These are often due to heat accumulation in the heart and spleen, or due to Yin deficiency and excess fire. If oral ulcers recur, with varying severity, pale ulcer surfaces, mild pain, accompanied by fatigue, loose stools, pale tongue, and weak pulse, it often indicates deficiency of the middle Qi.
(3)Thrush: If a child has white patches covering the oral cavity and tongue, resembling a goose’s mouth, it is known as thrush, also called “snow mouth.” This is often due to invasion of pathogenic toxins, heat accumulation in the heart and spleen, or due to kidney Yin deficiency leading to excess fire.
(4)Mouth Dynamics: Normal individuals can open and close their lips freely, with coordinated movements. The “Observation Guidelines” categorize abnormal mouth dynamics into “six mouth shapes.”
Mouth Open: The mouth is open and cannot close, indicating deficiency; if it resembles a fish mouth, with air escaping but not entering, it indicates impending lung Qi failure.
Mouth Locked: The mouth is difficult to open, with tightly clenched teeth, indicating excess conditions. If the mouth is locked and the limbs convulse, it often indicates spasms or seizures; if accompanied by hemiplegia, it indicates a severe stroke.
Mouth Pursed: The upper and lower lips are tightly pressed together, indicating a struggle between excess and deficiency. If accompanied by arching of the back, it often indicates tetanus; if a newborn cannot suckle due to pursed lips, it often indicates umbilical wind.
Mouth Deviation: The corners of the mouth are tilted to one side, seen in patients with wind invading the meridians or wind affecting the organs.
Mouth Trembling: Trembling of the lips, often seen in the early stages of malaria.
Mouth Movement: Frequent opening and closing of the mouth, unable to control, indicates weak stomach Qi; if the corners of the mouth twitch continuously, it indicates wind movement.
2.Observation of the Lips: The color diagnosis of the lips is similar to that of the face, but due to the thin and transparent mucosa of the lips, color changes are more pronounced and easier to observe. In normal individuals, the lips are rosy, indicating sufficient stomach Qi and balanced Qi and blood.
(1)Pale Lips: Often indicates blood deficiency or blood loss.
(2)Deep Red Lips: Often indicates excessive heat; deep red and dry lips indicate excessive heat injuring fluids.
(3)Blue-Purple Lips: Often indicates deficiency of Yang Qi and blood stasis.
(4)Black Lips: Caused by cold coagulating blood stasis, or extreme pain causing blood stasis.
(5)Cracked Lips: Indicates fluid damage, often due to dryness and heat injuring fluids or Yin deficiency leading to fluid depletion.
(6)Ulcerated Lips: Often due to heat accumulation in the spleen and stomach attacking upward, burning the lips; if the inner lips are ulcerated and pale red, it indicates excess fire attacking upward.
(7) Ulcers at the lip edges, with redness and pain, indicate heat accumulation in the heart and spleen.
(5) Observation of the Teeth and Gums
The teeth are the remnants of bones, which are governed by the kidneys; the gums protect the teeth and are where the hand and foot Yangming meridians are distributed. Therefore, observing the teeth and gums can diagnose diseases of the kidneys and gastrointestinal tract, as well as the balance of fluids. The warm disease school places great importance on examining the teeth; in cases of Yangming heat and heat injuring kidney Yin, observing the moisture and dryness of the teeth and gums can provide insights into the status of stomach fluids and kidney fluids.
1.Observation of the Teeth
(1)Teeth Color and Shape: In normal individuals, the teeth are white, moist, and strong, indicating sufficient kidney Qi and undamaged fluids. If the teeth are dry, it indicates damage to stomach Yin; if the teeth are dry and hard like stone, it indicates severe Yangming heat and significant fluid damage; if the teeth are dry like withered bones, it often indicates kidney Yin depletion, with insufficient essence nourishing the teeth, often seen in the late stages of warm diseases, indicating a severe condition; if the teeth are yellow and fall out over time, it indicates bone depletion, indicating a severe condition.
(2)Teeth Dynamics: If the teeth are tightly clenched, it often indicates phlegm obstructing the meridians or extreme heat causing wind; if the teeth grind against each other, producing a grinding sound, it often indicates excessive heat causing wind, or can be seen in spasms; if grinding teeth during sleep, it often indicates stomach heat, food stagnation, or accumulation of parasites, but can also be seen in normal individuals.
2. Observation of the Gums
(1)Gum Color: In normal individuals, the gums are light red and moist, indicating sufficient stomach Qi and balanced Qi and blood. Pale gums often indicate blood deficiency or blood loss, leading to malnourishment of the gums; red, swollen, and painful gums often indicate excessive stomach fire, with heat rising to the gums.
(2)Gum Shape: If the gum tissue is atrophied, exposing the tooth roots, with loose teeth, often accompanied by bleeding and pus, it is known as “gum disease,” often due to kidney deficiency or insufficient stomach Yin, leading to excessive fire burning the gums, and can also be seen in cases of Qi and blood deficiency; if the gums are ulcerated, with foul-smelling blood, leading to tooth loss, it is known as “gum gangrene,” often due to heat accumulation in the stomach, combined with invasion of wind-heat or epidemic toxins attacking the gums.
(3)Gum Bleeding: Bleeding between the teeth is known as “gum bleeding.” This often indicates excessive heat in the gastrointestinal tract, or can be due to kidney and stomach Yin deficiency, leading to excessive fire rising, damaging the vessels, or spleen Qi deficiency leading to blood not circulating properly.
(6) Observation of the Throat
The throat is the passage between the mouth, nose, and lungs, serving as the gateway for breathing and eating, and is also a junction for the meridians, closely related to the five organs and six viscera. Therefore, diseases of the five organs and six viscera can reflect in the throat, with lung, stomach, and kidney diseases being more prominent and diagnostically significant. Observation of the throat mainly focuses on redness, swelling, pain, ulceration, and the presence of false membranes.
In healthy individuals, the throat is light red and moist, without pain or swelling, with unobstructed breathing and normal voice, and food can be swallowed smoothly.
1. Redness and Swelling
(1) In new illnesses, the throat appears deep red and swollen, often indicating an excess heat condition, due to wind-heat toxins or lung and stomach heat toxins accumulating.
(2) In chronic illnesses, the throat appears light red and mildly swollen, often indicating a Yin deficiency condition, due to kidney Yin deficiency leading to internal heat.
(3) If the throat is light red and mildly swollen, with slight pain, it often indicates phlegm-damp accumulation.
(4) If one or both sides of the throat are red and swollen, resembling a nipple, or like a silkworm, with yellow or white purulent secretions, and throat discomfort, it is known as “throat moth” (Figure 1-4), also known as “throat moth.” This is due to external wind-heat invading, or lung and stomach heat accumulating. If the throat is swollen, with mild pain, and does not resolve over time, often recurring, it may indicate lung and kidney Yin deficiency, leading to internal heat.
(5) If the throat is red and swollen, with severe pain, difficulty swallowing and speaking, and accompanied by chills and fever, it is known as “throat abscess,” often due to organ heat accumulation, combined with external pathogens, leading to heat toxins invading the throat.
2.Ulceration: In new illnesses, if the throat is ulcerated, with superficial, scattered lesions and surrounding redness, it indicates light heat in the lung and stomach; if the ulceration is extensive or deep, with surrounding redness, it indicates severe lung and stomach fire toxins accumulating, burning the mucous membranes; if the throat ulceration is superficial and recurrent, with surrounding light redness, it often indicates internal heat rising; if the ulceration is extensive and deep, with surrounding pale or ashen color, and does not heal for a long time, it often indicates Qi and blood deficiency, kidney Yang deficiency, and internal toxins.
3.False Membrane: If the throat is ulcerated, with a layer of yellow-white or gray-white necrotic membrane covering the surface, it is known as a false membrane. If the false membrane is loose and easily wiped away, it indicates a mild condition, often due to lung and stomach heat toxins accumulating in the throat; if the false membrane is firm and difficult to remove, causing bleeding when forcibly removed, or if it regenerates after removal, accompanied by barking cough and wheezing, it indicates a severe condition, known as “diphtheria,” often due to external epidemic toxins invading, with internal heat toxins accumulating, or heat toxins injuring Yin.
3. Observation of the Neck
The neck connects the head and trunk, with the front part being the neck and the back part being the nape, collectively known as the neck. The neck contains the respiratory tract and digestive pathway, and is also a passage for the meridians leading to the head and face. Obstruction of the neck meridians can lead to systemic changes; conversely, imbalances in the Qi and blood of the organs can also reflect in the neck.
In normal individuals, the neck is upright and symmetrical, with the trachea in the center; short and stout individuals have slightly thicker necks, while tall and thin individuals have slightly thinner necks; men have prominent Adam’s apples, while women do not; the carotid pulse is not easily seen when at rest. The neck can flex and rotate freely, with a range of motion of 30 degrees to the left and right, 30 degrees backward, 30 degrees forward, and 45 degrees to each side. Observation of the neck mainly focuses on changes in shape and dynamics.
1. Shape Changes
(1)Goiter: A lump protruding from the front of the neck, either unilaterally or bilaterally, which can move up and down with swallowing, is known as a goiter. This is often due to liver Qi stagnation, phlegm accumulation, or due to environmental factors causing phlegm and Qi stagnation.
(2)Lymphadenopathy: Lumps under the skin on the sides of the neck, below the jaw, or behind the ears, resembling beans, are known as lymphadenopathy. Larger lumps are known as lymph nodes, while smaller ones are known as nodules. This is often due to kidney and lung Yin deficiency, leading to internal heat damaging fluids, forming phlegm nodules; or due to external wind-heat or toxins causing Qi and blood stagnation in the neck.
2. Dynamic Changes
(1)Stiff Neck: This refers to tightness or rigidity of the neck muscles, with limited movement, often accompanied by headache and chills, indicating invasion of wind-cold into the Taiyang meridian, leading to Qi stagnation; if accompanied by high fever and confusion, it may indicate extreme heat causing wind; if stiffness occurs suddenly after waking, it is known as “wry neck,” often due to improper sleeping posture or wind-cold invading the meridians, or due to muscle strain in the neck.
(2)Soft Neck: This refers to weakness in the neck, with difficulty lifting the head. In children, soft neck often indicates congenital insufficiency, kidney essence deficiency, or poor nourishment leading to developmental issues, commonly seen in rickets; in chronic or severe illness, weakness in the neck, with the head drooping and deep-set eyes, often indicates exhaustion of the essence and Qi of the organs, indicating a critical condition.
(3)Prominent Neck Veins: This refers to visible swelling of the neck veins, which is more pronounced when lying down. This is often seen in patients with heart blood stasis, lung Qi obstruction, or heart and kidney Yang deficiency, with water retention affecting the heart.
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