Traditional Chinese medicine inspection mainly includes two aspects: hope and shape.
First, look.
Hope refers to the patient's spirit and color. Looking at the face includes the overall observation of the patient's mental state, facial color, body movements and posture.
(1) Look to God
In traditional Chinese medicine, the concept of "God" is relatively broad. Broadly speaking, it refers to the vitality of the human body, so it is very important to look up to God.
Looking at God as a whole requires careful observation from the patient's manners, movements, language, expressions and eyes.
1. Look at the eyes, the eyes are the windows to the soul. "On the Daze of Soul Pivot" said: "The essence of the five internal organs is more important than the eyes, and it is better than the eyes." It is also said that "the eyes take the heart as the spirit", so the functional state of the eyes can reflect the rise and fall of the essence of human organs, and also reflect the overall state of human life phenomena to some extent. The eyes are black and white, shiny, elastic, and chiseled like a god, which is the expression of sufficient essence of viscera; Dull eyes, dull eyes, unclear vision, inflexible movements, or floating light are all manifestations of deficiency of vital energy of viscera.
Staring intently, known as "wearing eyes", is mostly due to the failure of vital qi, and the essence can not be arrogant, which is a manifestation of critical illness.
2. Look at the expression The so-called expression refers to people's facial expressions, which are the external manifestations of the mind and one of the external manifestations of people's spiritual consciousness and thinking activities. It looks comfortable, relaxed and happy, which is the performance of righteousness; Dull expression, slow response and dull expression are manifestations of mental damage. In short, people's clear-headed, orderly thinking, normal emotions and decent behavior are the normal manifestations of God's functional state; When the mind is disturbed or lacks nutrition, people may feel confused, confused, emotionally extreme or behave strangely.
3. Getting God and Absence
(1) deity: also known as "God". The clinical manifestations are conscious, flexible eyes, bright eyes, steady breathing, clear language, rosy complexion, free movement and quick response. It shows that the human body is full of vital qi, full of essential qi and normal and healthy body function. If it is sick, it is also a light syndrome that vital qi is not injured and essence is not decayed.
(2) Mental deficiency: The clinical manifestations are listlessness, listlessness, pallor, muscle relaxation, fatigue, shortness of breath, laziness in speaking and slow action. Explain that vital qi is insufficient, essence is damaged, and physical function is weak. It can be seen in the recovery period of mild illness or disease or weak constitution.
(3) Absence: also known as "the absence of God". The clinical manifestations are listlessness, dull complexion, dull eyes, slight or rapid breathing, language disorder, emaciation, difficulty in movement, unresponsiveness and even confusion. It shows that the vital qi is seriously damaged, the essence is insufficient, and the physical function is seriously declining. More common in patients with long illness and serious illness.
False god: refers to all kinds of false clinical manifestations of temporary mental "improvement" of critically ill patients. Clinically, people who have been ill for a long time or are seriously ill have been absent, but suddenly they wake up, their spirits improve, they talk more, their appetite increases, they want to see their relatives, their faces are dull, and their cheeks are as red as makeup. The overall situation of his body is not consistent with his sudden changes, indicating that the patient's viscera and vital qi are extremely exhausted, vital qi will be removed, yin will not converge yang, yang will be insufficient, and yin and yang will be separated soon. Clinically, it is more common in critically ill patients, which is often the performance of patients on their deathbed.
Mental disorders: The clinical manifestations of mental disorders are anxiety and fear, or mania, or apathy and dementia, sudden fainting, etc. Most of them are recurrent attacks, and mental disorders are not obvious in remission.
(2) Look at the color
Seeing color is to observe the color of the patient's skin surface, and clinically it is mainly to observe the color of the face. This diagnostic method is also called "five-color diagnosis". Traditional Chinese medicine believes that the five internal organs are the main colors, green controls the liver, red controls the heart, yellow controls the spleen, white controls the lung and black controls the kidney; The five internal organs dominate the peak season of a year, such as the liver governing spring, the heart governing summer, the spleen governing long summer, the lung governing autumn and the kidney governing winter. In the four seasons of the year, the five colors of the five internal organs are presented according to their prosperous times, not as sick colors.
1. The normal color of the human body should be subtle and shiny and cannot be completely exposed. Huangdi Neijing said: "Red desire is like white wrapped in Zhu ... white desire is like goose feather ... green desire is like pale jade ... yellow desire is like Luo wrapped in realgar ... black desire is like heavy paint color", which means five colors should be implied, such as red should be white and red, and yellow should be white and yellow. Due to the differences in skin color and individual characteristics, such as slightly white or slightly black, it also belongs to the normal range. As "The Golden Mirror of Medical Zong" said: "The color of the five internal organs, as seen by people of the five elements, remains unchanged for a hundred years, so it is the main color." Because man and nature are a whole, people's skin color will change slightly with the change of natural season and temperature, for example, skin color will become slightly green in spring, slightly red in summer, slightly white in autumn, slightly black in winter and so on. But this is not obvious and needs careful observation to identify it.
2. Sick colors Because of illness, people often change their colors. Generally speaking, cyan is the main pain, white is the main cold, and yellow and red are the main heat. If the color is completely exposed, it is a manifestation of a long illness.
White: deficiency syndrome, cold syndrome, blood loss and qi deficiency. The patient's pale face is due to qi deficiency and lack of blood or yang failure and cold excess, so that qi and blood can not be proud of the face. Pale face and pale lips are mostly blood deficiency syndrome or blood loss syndrome; Those with white complexion are mostly yang deficiency, while those with excess and excess are mostly yang deficiency and water excess; Pale face, mostly due to sudden loss of yang or yin cold.
Yellow: spleen deficiency syndrome and dampness syndrome. The patient's complexion is yellow, which is caused by spleen deficiency and malnutrition, or the accumulation of damp evil and the loss of spleen health.
Those with sallow complexion mostly belong to spleen and stomach qi deficiency syndrome; Those with yellow face and floating deficiency mostly belong to spleen deficiency and dampness accumulation syndrome; Those appearances are yellow, bright yellow belongs to jaundice, and dark yellow belongs to jaundice.
Color red: the main heat syndrome can also be regarded as Dai Yang syndrome. The patient's face is red, which is caused by the expansion of facial pulse caused by yang heat, qi and blood filling or deficiency yang fluttering. Those with flush face mostly belong to excess heat syndrome with excessive pathogenic heat; Flushing on cheeks in the afternoon is mostly due to yin deficiency and hyperactivity of yang, and deficiency of fire is the syndrome of inflammation. People who are pale after a long illness and serious illness, but sometimes their faces are as red as makeup, belong to Dai Yang's syndrome of yin failing to converge yang and deficiency of yang floating.
Cyan: Treating cold syndrome, pain, qi stagnation, blood stasis and convulsion. The patient's complexion is blue, which is caused by cold coagulation and blood stasis, or blood stasis, or facial pulse stasis caused by tendon spasm. Pale or black, mostly cold pain drama; Those with blue complexion and blue lips are mostly syndromes of deficiency of heart qi and heart yang; Pale face, blue lips and weak limbs are mostly true heartache syndrome of sudden loss of heart yang; Yellow complexion can be seen in liver depression and spleen deficiency syndrome; Children with blue eyebrows, nose posts and lips are mostly caused by pathogenic heat.
Black refers to kidney deficiency, cold syndrome, drinking water syndrome and blood stasis syndrome. Deficiency of kidney yang, excess of Shui Han, loss of warm blood and poor blood circulation.
Those with dull complexion mostly belong to kidney-yang deficiency syndrome caused by yang deficiency and fire failure, Shui Han failure and warmth; Those with dull and dry complexion mostly belong to kidney-yin deficiency syndrome with yin deficiency and excessive fire and malnutrition; People with dark circles around the orbit mostly belong to kidney deficiency and drinking water syndrome or cold-damp leukorrhagia syndrome; Those with dark complexion and wrong nails are mostly blood stasis syndrome with a long course of disease.
(3) Look at the luster
Skin color and lustrous complexion are the manifestations of viscera essence; Pale complexion and dull skin indicate that human viscera and qi are deficient and stomach qi is not glorious. Generally speaking, new symptoms, mild symptoms and yang are bright and moist, which is "lewd"; Chronic illness, serious illness and gloomy syndrome are "evil colors" As "Su Wen's pulse should be subtle" said: "My husband is smart and full of gas. He wants to be as white as Zhu, but he doesn't want to be like chains; White desires are like goose feathers, but not like salt; Green desire is like the color of pale jade, but not like blue; Yellow wants to wrap realgar, unlike loess; Black desire is like heavy paint, and I don't want to be like the ground. "
Second, the form of hope.
Visit fortune-teller mainly includes two aspects: visit fortune-teller and visit fortune-teller
(1) Telescopes
1. Pentathymia refers to tendons, veins, meat, skin and bones. Traditional Chinese medicine believes that these are the exposed parts of the five internal organs, and the rise and fall of qi and blood of the viscera can be judged through the changes of these parts.
Fat and thin: a normal body should be moderately fat and thin, well-proportioned, too fat or too thin is a disease state. Obesity, gloomy complexion and mental depression belong to "qi deficiency with excess", mostly yang deficiency; Thin body, sallow complexion, narrow chest and dry skin are more common in yin-blood deficiency; Big meat is gone, weak and timid, more common in essence.
Fascia: strong tendons, fatigue resistance, flexible joint movement, reflecting liver blood filling; On the other hand, muscle weakness, fatigue, and unfavorable joint flexion and extension are the manifestations of liver-blood deficiency.
Fur: the fur is moist and shiny, and the muscle carbuncle is close to the lung qi; Thin fur and flabby muscles are manifestations of lung qi deficiency.
Bone hair: the bones are strong and strong, and the figure is tall and straight, reflecting that the kidney essence is sufficient, the essence can fill the marrow, and the marrow can nourish the bone; For example, fragile bones, or weak bones, or physical deformities are all manifestations of insufficient kidney essence and loss of bone support. Traditional Chinese medicine believes that the kidney is "abundant", and the rise and fall of kidney qi can be reflected from the rise and fall of hair. Dry hair and easy folding are kidney essence loss; Hair is sparse, easy to fall off, or dry, mostly caused by insufficient blood; Sudden flaky alopecia, mostly due to blood deficiency wind; Young people's hair is sparse and easy to fall off, and dizziness, forgetfulness and soreness of the waist and knees are mostly kidney deficiency; Scalp itching and dandruff are mostly caused by blood heat and dryness; Children's hair is sparse, yellow and soft, growing slowly, or even not developing for a long time, mostly due to congenital deficiency and kidney essence loss; Children's hair is like a sharp thorn, yellow and dull, which is more common in malnutrition syndrome. "Teeth are outside the bone", and the dryness and loss of teeth are also manifestations of kidney qi deficiency and kidney essence dystrophy.
2. Hope constitution is the individual quality of body structure and function formed in the process of human growth and development, which can reflect the difference of yin and yang, the rise and fall of qi and blood and the difference of endowment to a certain extent, and is helpful for the diagnosis of diseases.
The body tends to be short and fat, with wide shoulders and thick chest, round head and thick neck, like heat and hate cold, and have a lot of stools. It is characterized by weak yang and strong yin, and it is easy to turn from yin to cold after illness.
The figure tends to be slender, the shoulders are narrow and the chest is flat, the head is long and the neck is thin, I like cold and hate heat, and my stool is dry. It is characterized by yin deficiency and hyperactivity of yang, and it is easy to turn from yang to heat after illness.
Body shape is between the above two, characterized by yin-yang balance and qi-blood balance, and it is the physical type of most people.
(2) Look at the posture
Looking posture is to observe the patient's behavioral characteristics, such as sitting posture, lying posture, likes and dislikes, etc. The patient's dynamic and static state is closely related to the rise and fall of yin and yang of the body.
In the sick state, if the patient lies flat, his body is light, he can rotate freely, and his face is often outward, his symptoms are mostly yang, heat and excess; The patient's weight is difficult to turn sideways, his face is often inward, and his spirit is sluggish. Most of his symptoms are yin, cold and deficiency. When the patient lies on his back, he stretches his feet on his back and often takes off his clothes and quilt, which is mostly heat syndrome; Patients curl up into a ball when lying down, and like to add clothes and quilts, mostly due to cold syndrome; Patients are not allowed to lie down while sitting, and there are gasps when lying down, which are mostly caused by water vapor; Patients sit with their heads up and their lungs are mostly filled with phlegm and saliva; Patients who sit in the bow are short of breath and lazy to talk, mostly because of lung deficiency or renal failure; Patients are not allowed to lie flat when sitting, and there is wheezing when lying flat, which is mostly caused by water vapor.
When a disease occurs, patients often have some abnormal behaviors. The patient's lips, eyelids, fingers and toes vibrate, which is more common in the early stage of exogenous fever or internal injury, such as qi and blood deficiency and tendon dystrophy; Stiff neck, eyes looking up, limbs twitching, angular arch extending backward, which is more common in liver wind moving, caused by extreme heat; Sudden fall, unconsciousness, mouth askew and hemiplegia are stroke syndrome; The pawn fell unconscious, foaming at the mouth, twitching limbs, and woke up as usual, which was epilepsy; Limbs weakness, ineffective movements, mostly flaccidity syndrome; Touching the bed after clothes, empty-handed, mostly critical syndrome.
Third, look at the head and face.
(1) head
The head is the wisdom house, the brain marrow is hidden in the middle, the brain is the marrow sea, the marrow is refined, and the kidney is the essence. Therefore, the change of head type can reflect the situation of storing sperm in five internal organs, especially in kidney. Abnormal head shape, or abnormal head shape, is more common in infants during development. There are two fontanels on children's heads. The front fontanel is rhombic and closes at about 12 ~ 18 months after birth, while the rear fontanel is triangular and closes at 2 ~ 4 months after birth.
Children's heads are evenly enlarged, cranial sutures are cracked, their faces are small, and their intelligence is low. Most of them belong to congenital deficiency and kidney essence deficiency. Children's narrow head, round head, early closure of cranial suture and mental retardation are mostly caused by insufficient kidney essence and skull dysplasia; Children's foreheads protrude left and right, and their heads are flat, showing a square skull shape, which is mostly caused by deficiency of kidney essence or weakness of spleen and stomach; The fontanelle process is mostly empirical, either due to the outbreak of febrile disease and fire poison, or due to the stagnation of intracranial fluid; The fontanel depression is mostly a reflection of pathological changes of deficiency syndrome, such as vomiting and diarrhea, deficiency of qi and blood, or brain marrow deficiency caused by congenital deficiency of essence and qi. In the later period, the closure of fontanel is mostly rickets caused by deficiency of kidney-qi and dysplasia.
(2) Face
One or both cheeks are swollen with the earlobe as the center, with unclear edges, elasticity or tenderness, often parotitis; The mouth and eyes are skewed without hemiplegia, the muscles on the affected side are relaxed, the forehead lines disappear, the eyes cannot be closed, and the nasolabial groove becomes shallow, mostly due to wind evil in the collaterals; If the mouth and eyes are skewed and accompanied by hemiplegia, it belongs to the stroke syndrome of hyperactivity of liver yang and obstruction of collaterals by wind and phlegm; Patients' facial expressions are frightened, which is more common in children with convulsion and tetanus. The expression of patients is distorted, which is more common in neonatal umbilical wind and tetanus hemifacial spasm.
(3) Five senses
1. Eye
(1) eye shape
① Eye cell edema: Eye cells are like lying silkworms, which is a manifestation of Feng Shui syndrome and is caused by excessive moisture.
② sunken eye socket: it is more common in patients with fluid injury or deficiency of qi and blood, such as severe vomiting and diarrhea, chronic illness or severe deficiency of qi and blood.
(3) Exophthalmos: Exophthalmos combined with dyspnea due to upper qi belongs to pulmonary distension; Exophthalmos with slight swelling in front of the neck, impatience and irritability, is a disease.
④ Eye cells are red and swollen: most of them are caused by wind-heat of liver meridian, and red and rotten eyes are caused by damp-heat of liver and spleen.
(2) wink ① red eyes: white eyes are red due to lung fire or exogenous wind heat, two corners of eyes are red due to heart fire pain, and the whole eyes are red due to liver meridian swelling.
② Yellow eye white: Yellow eye white is mostly jaundice, which is caused by damp-heat or cold-dampness, abnormal hepatobiliary excretion and bile overflow.
3 pale eyes: this is mostly because of insufficient blood and blood, which is not superior to the purpose.
④ Dark color of eye cells: mostly caused by insufficient kidney essence or excessive Shui Han.
(3) Oculodynamics ① binocular direct vision: The patient's eyes are staring at the front, and his mind is not clear, which is mostly a dangerous syndrome in which the viscera and qi are running out.
② Eye-wearing reflex: The patient's eyes can't turn when looking up, and there is a strong twitch and upturned corner arch, which is a unique syndrome of the Sun Meridian.
③ Sleeping with eyes exposed: it is more common in children with spleen deficiency, vomiting and diarrhea or slow spleen wind.
4 ptosis: most of the patients with double ptosis are congenital deficiency, spleen and kidney deficiency; Single eyelid drooping is mostly caused by weak temper or trauma.
2. Ear discoloration (1) ① The helix is pale and white, which is mostly caused by deficiency of qi and blood.
② The helix is red and swollen, which is mostly caused by damp-heat in the liver and gallbladder or invasion of heat toxin.
③ The helix is bluish black, which can be seen in patients with yin cold or severe pain.
④ The helix is dry and black, which mostly belongs to severe kidney essence deficiency.
⑤ Redness behind the ears and chills at the roots of the ears are mostly signs of measles.
(2) Changes in the ear: The purulent water in the ear is purulent ear, mostly caused by damp-heat in the liver and gallbladder.
3. The nose (1) is congested at or around the nose, with red papules and rosacea, mostly due to lung and stomach heat.
(2) The nose column is ulcerated and collapsed, which is common in leprosy or syphilis.
(3) Alar agitation, more common in lung heat wheezing.
(4) The nose is red, swollen and painful, mostly caused by stomach heat or blood heat.
4. If the lip color is pale white, it means that the patient's blood deficiency or blood loss is caused by insufficient qi and blood. If the lip color is deep red, it means that heat is more than blood; If the lip color is blue, it means there is blood stasis or cold coagulation and blood stasis; If the lips are red, swollen and dry, it means that the body is full of heat; The chapped lips and wrinkles are caused by body fluid injury, which is more common in body fluid injury caused by exogenous dryness or heat. Salivation is more common in children with spleen deficiency and dampness or stomach heat, or adults with skewed air outlet; Oral and lip erosion is mostly caused by accumulated heat in the spleen and stomach.
If you don't keep your mouth shut, it's mostly a deficiency syndrome; If you open your mouth and keep your breath straight, you will only be unable to get in, which is mostly a critical manifestation of lung qi dying; It is difficult to open your mouth. Dental emergency is difficult to open your mouth, which is mostly empirical and more common in spasms, convulsions and tetanus. The upper and lower lips are tightly gathered into a pinch, which is more common in tetanus (neonatal umbilical wind); The corners of the mouth are tilted to one side, which is more common in stroke patients; Jaw trembling, bulging, mouth vibration is mouth vibration, which is more common in sweating or malaria attacks caused by the dispute between good and evil; The convulsion of quarrel is not only the convulsion of quarrel, but also a sign of heat or spleen deficiency.
5. Those with pale gums are mostly blood deficiency; The gums are red and swollen, mostly due to stomach fire inflammation; The bleeding and redness of gums are mostly caused by stomach fire; Patients with bleeding gums and slight swelling are either qi deficiency or fire deficiency, resulting in collateral damage.
Dry teeth, mostly stomach heat and body fluid injury; Dry teeth, such as dry bones, are mostly caused by dry kidney essence and unbearable kidney water; Loose and sparse teeth, exposed roots, mostly caused by kidney deficiency or deficiency of fire; Biting teeth or rodents during sleep is common in the stomach with fever or insects.
6. The swelling and pain in the throat are mostly caused by the accumulation of heat in the lung and stomach; Red, swollen and festering, with yellow and white rot spots, full of lung and stomach heat toxin; The color is bright red and delicate, and the pain is not very good, mostly due to yin deficiency and fire; There is a gray-white false membrane, which can't be wiped off. After repeated rubbing, it bleeds, which is diphtheria caused by lung heat and yin injury.
Fourth, look at excrement.
(1) Phlegm
Mainly from the thickness and color of sputum, whether it is refreshing after coughing, and so on.
1. White and thin phlegm is mostly cold phlegm.
2. Those with yellow and thick phlegm or white and thick phlegm are mostly hot phlegm.
3. Phlegm is less sticky, and it is not easy to be discharged, mostly dry phlegm.
4. White sputum is easy to cough up, mostly wet sputum.
5. People who cough and vomit pus and blood like rice porridge are mostly lung abscess syndrome with heat toxin accumulating in the lung.
6. There is blood in phlegm, mostly due to heat injury to lung collaterals.
(2) Saliva
Saliva is spleen fluid, and the amount of salivation in the mouth is large, mostly due to spleen and stomach deficiency and cold; People who spit sticky saliva in their mouths are mostly damp-heat in the spleen and stomach; Children's salivation and saliva stains are called "loss of appetite", which are mostly caused by spleen deficiency and inability to absorb body fluids.
(3) vomiting
The vomit is thin and mixed with food, without sour taste, which is mostly caused by insufficient stomach gas and cold; Vomiting is yellow and bitter, mostly due to fever in the liver and gallbladder and loss of health in the stomach; Vomiting is smelly and sour, mostly caused by stomach heat or food accumulation; Vomiting is phlegm and saliva, mostly stomach cold; Hematemesis is red or dark red with food in it, which is mostly caused by liver fire or blood stasis.
(4) defecation
Mainly observe whether the stool is shaped, the smell and color of the stool and other inclusions.
The stool is as thin as water, mostly cold and damp diarrhea; The stool is yellow, thin, erosive and sticky, mostly because there is damp heat in the intestine; If the stool freezes into purulent blood, it is dysentery; The stool is blood first, then feces, close to blood; The stool is feces first, then dark brown blood, which belongs to distant blood.
(5) The urine volume is mostly deficiency-cold syndrome; Urine Huang Chi, less urine, mostly heat syndrome; Turbid urine, or wet turbidity, or spleen and kidney qi deficiency; Blood in urine's patients are mostly heat-induced blood collateral damage; Urine such as ointment is ointment; A person with sand and gravel in his urine is a stone shower.
Five, look at the tongue
Looking at the tongue is an important diagnostic method in traditional Chinese medicine, also known as "tongue diagnosis", which belongs to the characteristic diagnostic method of traditional Chinese medicine like pulse diagnosis. Tongue diagnosis mainly includes two aspects: tongue diagnosis body and tongue coating. Tongue body refers to the tongue body, and tongue coating is a layer of attachment on the tongue body. When the diagnosis is made, the patient is required to spit out his tongue as much as possible for observation. When looking at the tongue, doctors should pay attention to whether the light is sufficient, whether the patient has just eaten colored food or even dyed his tongue, and whether the posture of sticking out his tongue is correct to ensure the correctness of judging the tongue picture.
According to the meridian theory and the principles of "top to top" and "bottom to bottom", Chinese medicine divides the tongue surface into the tip of the tongue, the edge of the tongue, the middle of the tongue and the root of the tongue, observing the pathological changes of the five internal organs with the tip of the tongue waiting for the heart and lungs, the edge of the tongue waiting for the liver and gallbladder, the heart of the tongue waiting for the spleen and stomach, and the root of the tongue waiting for the kidney.
(A) the quality of looking at the tongue
Looking at the tongue is mainly to observe the color and shape of the tongue body.
1. Normal tongue color should be reddish, moist and fresh.
Pale white tongue: the color of tongue is lighter than normal red, which is a syndrome of deficiency cold and deficiency of qi and blood.
Red tongue: the color of the tongue is darker than normal, with the syndrome of excessive heat in the main body and internal heat due to yin deficiency.
Crimson tongue: the color of the tongue is deep red, and the heat enters the blood camp, and the chronic illness is yin deficiency and fire is flourishing.
Purple tongue: the tongue is purple and dry, with insufficient body fluid, mostly due to excessive pathogenic heat, and vaginal fluid has been injured; The tongue is pale purple or purple slippery, which is mostly caused by yin cold and blood stasis. There are purple spots on the tongue, mostly caused by blood stasis.
2. The normal tongue shape should be neither fat nor thin, with moderate shape and flexible rotation.
Fat tongue: fatter than normal tongue. Tongue body is fat and tender, and its color is pale, which mostly belongs to the syndrome of yang deficiency of spleen and kidney, stagnation of body fluid and phlegm-dampness blocking water; The tongue is swollen and red, which is mostly caused by excess heat of heart and spleen.
Light and thin tongue: light and thin tongue, mostly caused by yin deficiency and blood deficiency; Thin and pale, mostly due to deficiency of both qi and blood; The color is thin and crimson, which is mostly caused by yin deficiency and excessive fire, body fluid consumption and injury.
Cracked tongue: there are obvious cracks on the tongue surface, mostly due to yin fluid loss; The tongue is chapped and crimson, which is mostly caused by heat and body fluid injury; The tongue is dry and pale, mostly caused by blood deficiency.
Tooth marks: there are traces of teeth on the edge of the tongue, which are mostly caused by the hypertrophy of the tongue and the oppression of the tooth edge. Fat tongue with teeth marks, mostly spleen deficiency syndrome; The tongue is pale, white, moist and has teeth marks, which are mostly caused by spleen deficiency, cold and dampness.
Thorn on the tongue: the nipple of the tongue is enlarged and bulged like a thorn, which is difficult to reach. The tongue is dry and itchy, mostly caused by excessive heat. There are thorns on the tip of the tongue, mostly caused by excessive heart fire; There are thorns on the tongue side, mostly liver and gallbladder fire; The tongue has an itchy feeling, mostly caused by gastrointestinal heat.
3. When the tongue is in a normal state, the tongue should rotate flexibly.
Toughness: the tongue is tough, inflexible, inconvenient for flexion and extension, or unable to rotate. This tongue image is seen in exogenous diseases, mostly due to heat entering the pericardium or excessive pathogenic heat; Seen in miscellaneous diseases, most of them are precursors of stroke.
Weak flaccidity: the tongue is flaccid and soft, unable to stretch and roll, and inconvenient to rotate. Long-term illness, soft tongue, is both qi and blood deficiency; The tongue is crimson and soft, which is a yin injury caused by heat burning.
Trembling: the tongue is unstable and unable to decide. Tongue war after a long illness belongs to deficiency of both qi and blood or yang deficiency; Tongue tremors caused by exogenous diseases are mostly signs of extreme heat or wind moving in deficiency and wind generating.
Skew: The tongue body leans to one side, which is mostly a stroke or a stroke precursor.
Shortening: the tongue is tight and unable to stretch, which is mostly critical syndrome.
(2) Wang Tongwei Tongwei is a layer of attachment on the tongue, which Chinese medicine believes is steamed by stomach qi. Under normal circumstances, there is a thin layer of white fur on the tongue body, which is moderately dry and wet, not slippery or impetuous, which is the expression of stomach qi. Clinically, the disease is mainly judged by the thickness, color and dryness of the tongue coating.
1. moss
(1) White fur: White fur can be seen in both exterior syndrome and interior syndrome. The exterior syndrome of exogenous diseases shows thin white fur, at this time, the evil has not spread inward; Pale tongue with white fur is common in internal cold syndrome; The tongue coating is as white as white powder on the tongue surface, and it is not dry. It is a accumulation of powder coating, and most of them are infected with foul and turbid gas.
(2) Yellow fur: main heat syndrome and interior syndrome. Yellow fur is caused by heat pathogen, so heat syndrome is the main reason. Generally, the yellower the coat color, the heavier the heat pathogen, the lighter the yellow coating, the heavier the dark yellow coating and the heavier the scorched coating. Yellow fur often appears side by side with crimson tongue, indicating that heat syndrome is included.
(3) Gray moss: the main internal syndrome. Both internal heat syndrome and cold-dampness syndrome can be seen. Gray fur can be transformed from white fur, and yellow fur can also be seen. Gray moss usually develops into black moss. The fur is gray and moist, mostly due to cold and dampness, or phlegm drinking; Dry gray hair is mostly caused by heat injury to body fluid or yin fire.
(4) Black moss: the main internal syndrome, the main heat pole, the main cold. Black moss often develops from gray moss or brown moss, which is common in the severe stage of illness. The fur is black, chapped and prickly, mostly caused by heatstroke; The coating is black and slippery, mostly due to yang deficiency and cold excess.
2. The thickness of the tongue coating Through the tongue coating, you can vaguely see the thin coating of the tongue body, but the thick coating cannot be seen. The thickness of tongue coating can reflect the severity of pathogenic factors and the advance and retreat of diseases to a certain extent. If the condition is mild, the tongue coating is thin; When the pathogenic factors spread, the condition changes from mild to severe, or there is phlegm in the diet, how thick the tongue coating is. The thickness of tongue coating changes from thin to thick, indicating that the condition changes from light to heavy, which means the condition progresses; The tongue coating turns from thick to thin, indicating that pathogenic factors spread from inside to outside, and the illness turns from heavy to light, which is a disease retreat.
3. The tongue coating is wet. Normal tongue coating is moist, not wet or dry. Dry fur, dry eyes, and no body fluid in the mouth are more common in the symptoms of excessive heat hurting body fluid or yin losing body fluid, and can also be seen in the dry syndrome of qi deficiency failing to produce fluid and glory. There is too much moisture on the surface of moss, which is slippery and wet. Tongue coating changes from dryness to moistening, which is a sign of improvement after illness. If it turns from wet to dry, it is a sign that the body fluid is injured and the heat potential is aggravated.
4. The tongue coating is greasy. The surface of the tongue is covered with a layer of turbid and greasy moss. The particles are fine and dense and difficult to scrape. It is more common in diseases such as dampness, phlegm, food stagnation and so on. Rot moss is a kind of accumulated phlegm, covered by the tongue, large and soft, shaped like bean dregs, easy to scrape off, more common in excessive yang heat, rot turbidity rises in transpiration stomach.
5. The peeling off of the tongue coating, the presence or absence of the tongue coating and the changes of its growth and decline are all manifestations of the struggle between good and evil. The tongue coating suddenly turns pale, and the tongue surface is smooth as a mirror, which is called "mirror tongue", which is the performance of stomach yin failure and stomach qi injury; If the tongue coating is not completely peeled off, it is called "flower peeling", which also belongs to the injury of stomach qi and yin.
6. The tongue coating has roots and no roots. Tongue coating is close to the surface of the tongue, which is solid and difficult to scrape, and is a root tongue coating; On the contrary, if the tongue coating is false, if it floats on the tongue surface and is scraped off, it is rootless tongue coating. Tongue coating has roots, mostly due to excess heat syndrome, indicating stomach qi; Tongue coating is rootless, mostly due to deficiency syndrome and cold syndrome, indicating stomach qi failure.
Comprehensive observation of tongue diagnosis: clinical observation of tongue should be combined with the comprehensive situation of tongue quality and tongue coating. Generally speaking, the inspection of tongue picture quality should focus on distinguishing the deficiency and excess of viscera; The examination of tongue coating should focus on distinguishing the depth of pathogenic factors and the presence or absence of stomach qi.
For example, the tongue coating is thin and white, and the tongue is red or the tip of the tongue is red, which is mostly exogenous syndrome; White and fat tongue coating is mostly deficiency-cold syndrome.
If the tongue is light and moist, it is mostly a syndrome of yang deficiency and cold excess; The tongue is old and dry, mostly caused by extreme heat and exhaustion of body fluids. In practical application, comprehensive observation is needed, and we can't neglect it.
Sixth, look at the child's fingerprints
The fingerprint mentioned here refers to the collaterals that the child floats on the front edge of the index finger palm. During the examination, the doctor holds the end of the child's index finger with his left thumb and index finger, and pushes it several times from the finger end to the root with his right thumb, with moderate strength, which can make the fingerprint more obvious. Clinically, it is mainly used for the diagnosis of children under 3 years old.
(A) three levels of setting weights
The appearance and distribution of index finger fingerprints can be divided into three stages: wind, qi and life. The first stage from fingertip to fingertip is wind, the second stage is qi, and the third stage is life. The handprint of Fengguan is light and pathogenic, and the handprint of Ventilation Guan is deep, and it is terminally ill when it comes to life Guan. Those who reach the end of the nail are called "nail piercing", and the condition is particularly serious.
(2) The ups and downs are divided into two parts.
Judging from the ups and downs of fingerprints, the most obvious disease is exterior disease, and the most hidden disease is interior disease.
(3) Red and purple distinguish cold and heat.
Normal fingerprints, pale red in color, bright red if looming in Fengguan, mostly belong to exogenous wind-cold exterior syndrome; People with purple color are mostly heat syndrome; Purple and black people are mostly blood collaterals and blood stasis, and their condition is critical; Those with light purple color are mostly deficiency syndrome; Those with dim colors are mostly empirical; Those blue ones are more common in convulsions or various pain syndromes.