Inspection and tongue study methods in TCM


II. Inspection

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

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

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

Common discolorations in TCM examination Discoloration Associated syndrome(s) Purple, Green-blue Cold syndrome, painful syndrome, blood stasis or liver disease Red Heat syndrome Yellow Dampness syndrome, syndromes of deficiency (xu) type Pale Cold syndrome of deficiceny (xu) type, blood loss Dark gray Kidney deficiency, cold syndrome, painful syndrome, blood stasis or static fluid syndromes.
Form
The body shape can be described as strong, weak, heavy or skinny. TCM believes overweight people tend to be excessive in phlegm and dampness. A thin person with dry skin indicates insufficiency of blood. Great loss of weight in the course of a long illness indicates exhaustion of essence.

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

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

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

Different diseased tongue signs: Pale tongue with white and thin coating Pale red tongue with white glossy coating Red tongue with fissures; and the coating is white, thin and a little rough. Red tongue with yellow, thick and greasy coating. Deep red tongue without any coating. Purple tongue with white, thin and slimy coating.


Commonly seen tongue signs

Tongue body Tongue coating Problem Indicated Pale, tender, slightly larger than normal Thin, white Qi deficiency Pale, normal in size or slightly shrunken Slightly dry, thin, white Blood deficiency Pale, enlarged and tender, teeth impression on the sides Damp and moist with much fluid, white and thick Yang depletion causing internal collection of cold-dampness Pale Thin, white, peeled center Insufficient stomach yin Pale Yellow, slimy Weakness of spleen and stomach Pale red Thin, white, moist Normal or invasion by wind-cold evils. Pale red Red tip with white fur Flaming up of heart fire Red, rough Yellow Retention of heat Red, prickles Thick, yellow, dry Extreme heat in the interior Red Dry in center of the tongue Heat scorching the stomach fluids Red Yellow and slimy Dampness and heat in the qi (vital energy) aspect Red Thick, yellow and glossy Dampness and heat distending and stagnating in the spleen and stomach Red Little or no fur Yin deficiency causing virtual fire, deficiency in qi (vital energy) and yin Deep red (crimson), prickles Thick, yellow Heat evil entering the blood Deep red Dry with cracked fur Heat evil burning yin Deep red Black fur Extreme retention of heat Deep red, shrunken Dry, little or no fur Long term yin deficiency Deep red Yellow and slimy Internal heat acompanied with phlegm and dampness accumulation Dark red Bruised spots or patches Blood stasis with heat Pale purple, tender, Glossy damp, moist Internal cold flourishing Purple, with bruised spots or patches white Internal accumulation of blood stasis Blue-green and purple Yellow and dry Extreme exhaustion of yin and blood, internal exuberance of virtual fire Green-blue White and glossy Serious cold syndrome