Inspection of the Skin

Exposed bluish sinews

Wrinkled skin, lacking elasticity

Purple stasis spots on the right arm

Primary disease diagnosis

Exhaustion of the essential qi of the viscera with disharmony of qi and blood

189 Liver palm

		Presentation
Case example	Exhaustion of the essential qi of the viscera with disharmony of qi and blood
	Late stage liver cancer with severe malnutrition Atrophy of the thenar and hypothenar muscles Contracture and shrinkage of the sinews and vessels of the fingers Hypertenacity of the muscles	Primary disease diagnosis
		Case example

190 Yang jaundice-A

Heart and spleen depletion with extreme deficiency of qi and blood

Wind-phlegm obstructing the collaterals

Damage and depletion of yin fluids

Wind-phlegm obstructing the collaterals

Amyotrophic lateral sclerosis (same as case 095)

Presentation

Bilateral fusiform deformation, swelling and distention of the metacarpal joints of the first digit

Disorder is characterized by morning stiffness, bilateral symmetry and tendency to affect the small joints

Primary disease diagnosis

Wind, cold, damp and/or heat bi syndrome with stagnation in the sinews and joints

191 Yang-jaundice-B

		Presentation
Case example	Bone bi, similar to rheumatic arthritis Enlargement of the distal interphalangeal joints-also called drumstick fingers
Spleen deficiency generating phlegm to the degree in which there is phlegm-rheum congestion of the lungs, as well as heart blood stasis and obstruction (often seen in bronchiectasis, bronchial asthma, emphysema, pulmonary heart disease, lung cancer, secondary acute endocarditis, and/or cyanotic congenital heart disease).		Primary disease diagnosis
		Case example

192 Yin jaundice-A

Phlegm-rheum congestion of the lung

Bronchial asthma, emphysema and pulmonary heart disease

Presentation

Reddish purple swelling and distention of the right leg

Blackened, necrosis of the toes

Primary disease diagnosis

Cold-dampness pouring downward, with long term constraint transforming into heat and toxins, and damp-heat in the collaterals (seen in thromboangiitis obliterans and in disease conditions of the leg due to diabetes).

193 Yin jaundice-B

Case example	Damp-heat obstructing the collaterals Disease conditions of the leg due to diabetes Dusky redness, swelling and distention of both legs Blackened, necrosis of the large toe	Presentation
Cold-dampness pouring downward with long term constraint transforming into heat and toxins, and damp-heat in the collaterals (seen in thromboangiitis obliterans, thromboangiitis obliterans, and disease conditions of the leg due to diabetes).		Primary disease diagnosis
	Damp-heat obstructing the collaterals
	Arteriosclerosis (Autoamputation of the right toe 7-8 years prior)	Case example

194 Red papulae

Inspection of the skin involves examining its color, luster and texture. These characteristics allow the practitioner to understand the state of the lung organ, the strength of qi and blood, as well as determine the nature and level of disease pathogens. Healthy, normal skin should be soft and tenacious, shiny and lustrous.

Although inspection of changes in color, luster and texture of the skin are considered within the scope of external medicine, dermatological diseases and the internal organs are very closely related.

Redness of the muscle belly of the thenar and hypothenar

Liver and gallbladder damp-heat, with qi stagnation and blood stasis

195 Measles affecting the abdomen

		Presentation
Liver and gallbladder damp-heat, with qi stagnation and blood stasis Chronic hepatitis, early stage liver cirrhosis		Primary disease diagnosis
Presentation	Pale yellow, bright and supple facial complexion Indistinct red spots and lines Yellow jaundice of both eyes
		Case example

196 Measles affecting the low back

Spirit lacks vigor, vitality

Pale yellow tongue with white coat, peeled in the center

Primary disease diagnosis

Spleen deficiency and exuberant damp, more heat less damp

Spleen deficiency with liver constraint and qi stagnation

Injury to stomach yin by damp-heat

Case example

Yang jaundice with spleen deficiency, liver constraint and liver and gallbladder damp-heat

Acute infectious hepatitis with jaundice

Black host complexion

197 Yang maculae

Yellow disease complexion

Yellow jaundiced eyes

Emaciation of the face

Presentation

Damp-heat accumulation with more heat, less damp

Liver and gall-bladder damp-heat

Spleen and stomach damp-heat

Primary disease diagnosis

Epigastric pain

Damp-heat accumulation with qi stagnation and blood stasis

Cancer of the biliary duct and pancreas

Case example

198 Polymorphic red maculae (erythema)

Presentation

Soot-like, tarnished, dim and pale yellow facial complexion

Pale, tender tongue with sticky, grayish black coat

Primary disease diagnosis

Yang deficiency of the kidney and the spleen

Cold dampness in the spleen and the stomach

Insufficiency of both qi and blood; with more dampness and less heat

Case example

Yin jaundice

Spleen deficiency and blood depletion; Cold-dampness constraint and accumulation

Acute infectious hepatitis with jaundice

Soot-like, tarnished, dim and yellow facial complexion

Dark blackness at the mid-forehead

Blackness around the mouth

199 Nodule-like red maculae (erythema nodosum)

	Emaciation of the face Eyes are closed and patient does not speak	Presentation
	Spleen deficiency with exuberant damp, more damp less heat Cold-damp injuring the spleen Kidney water subjugating the heart
	Yin jaundice	Primary disease diagnosis
	Constrained damp transforming into heat, with injury to yin and yang Cholangiole hepatitis
Presentation	Yellow host complexion, neither lifeless nor turbid Concealed red papulae
		Case example