2 Inspection of the five sense organs
The five sense organs refer to the eyes , ears , nose , mouth and tongue which are closely related to the viscera ,.Each organ itself is directly or indirectly related to several viscera and its functions are also associated with the heart spirit .Therefore , the inspection of the five sensory organs is not only helpful for the selection of treatment of the sensory organs themselves based on syndrome differentiation , but also helpful for understanding the pathological changes of the viscera . The inspection of tongue is discussed in another section . The following is the discussion of the inspection of the eyes , ears , nose , mouth , lips , gums and throat .
1.1.2.2.1 Inspection of the eyes
The eyes are the orifices related to the liver .However , all the visceral essence flows upward into the eyes .In the ancient time , people divided the eye into five parts in the ¡°theory of five wheels ¡±, corresponding to the five zang organs ,i .e . the eyelids pertaining to the spleen known as blood wheel , the white part pertaining to the lung known as qi wheel , the black part pertaining to the liver known as wind wheel and the pupil pertaining to the kidney known as water wheel . According to the theory of five wheels , inspection of the abnormal changed of different parts of the eyes can reveal the disorders of the related viscera .
Colour of the eyes : Redness of the eyes indicates heat .To be specific , red canthus indicates heart fire ,redness of the white part indicates pulmonary fire , redness of the white part with reddish veins signfies exuberant fire due to yin asthenia , redness of the whole eyes shows wind heat in the liver meridian , and red , swelling and ulcerated eyelids indicates splenic fire or damp heat .For example , yellowish change of the white part is a sign of jaundice and pale canthus and eyelids shows insufficiency of blood .
Shape of the eyes : Sunken orbit is often due to loss of body fluid resulting from excessive vomiting and diarrhea , or due to decline of visceral essence resulting from chronic disease .Dropsy of the eyelids and cheeks usually indicates edema ; prolapse of the lower eyelid in the middle-aged is not morbid .Exophthalmus accompanied by swelling neck is goiter .
Movements of the eyes : Staring straight upward and obliquely during the course of a disease mostly indicates internal disturbance of liver wind .Immobile straight staring is a severe condition of the declination of visceral essence .Slight fixation of the vision is usually due to internal retention of phlegmatic heat .Open eyes during sleep is often caused by weak functions of the spleen and stomach .Platycoria and no reaction to light are critical signs of kidney essence exhaustion , also seen in poisoning .Miosis results from exuberant fire in the liver and gallbladder or asthenic impairment of the liver and kidney and up-flaming of asthenic fire , or poisoning .Anisocoria suggests blood stasis or phlegm and fluid retention in the brain .
1.1.2.2.2 Inspection of the ears
The ears are the orifices related to the ears and the places where all meridians converge .Besides , the shaoyang meridians of both the hand and the foot flows anterior to the ears and the taiyang and yangming meridians distribute over the ears .So the ears closely connected with the whole body through meridians and collaterals .Therefore , many visceral disorders can be reflected over the ears .Generally speaking , inspection of the ears is chiefly helpful for understanding the conditions of the kidney essence and the pathological changes of the gallbladder .
Inspection of the ears should concentrate on the colour , shape and inner part of the ears .
Colour and shape of the ears : Ears of healthy people are characterized by rich flesh , slight yellow , reddish and moist luster , which are the signs of sufficiency of kidney essence .Whitish colour of the whole ears indicate cold syndrome ;bluish and blackish colour of the ears are a sign of insufficiency of kidney essence ;scorching dry and black colour of the ears signifies extreme loss of kidney essence .
Pathological changes inside the ears : Pathological changes in the ears are mainly otorrhea of pus .Otorrhea of yellowish pus and white pus is all due to prolonged stagnation of damp heat in the liver and gallbladder .
1.1.2.2.3 Inspection of the nose
The nose is the orifice related to the lung , corresponding to the spleen meridian and connecting with the stomach meridian .So inspection of the changes of the nose is helpful for understanding changes of the lung , spleen and stomach .
Inspection of the nose mainly concentrates on examining the excreta as well as the colour and shape of the nose .
Colour and shape of the nose : Reddish swelling with sore of the nose is usually caused by exuberant heat in the stomach or blood heat .Enlargement of the nose tip with thickened skin , bulging surface like acne or wart is called rosacea caused mostly by accumulation of heat in the lung and stomach ,Ulceration and sinking of the nose bridge is usually seen in syphilis ;sinking of nose bridge with the loss of brows is usually a critical condition in leprosy .
Asthma with flapping nose wings is usually caused by retention of pathogenic heat or phlegm in the lung in new disease and is a critical condition of the exhaustion of pulmonary and renal essence in chronic disease .
Nasal excreta : See the section of inspecting excreta .
1.1.2.2.4 Inspection of mouth and lips
The spleen opens to the mouth , flourishes on the lips and is internally and externally related with the stomach .The spleen and the stomach are the production source of qi and blood .So , inspection of mouth and lips is helpful for understanding the functions of the spleen and stomach as well as the pathological changes of qi and blood in the whole body .
Inspection of mouth and lips mainly focuses on inspecting the luster , clour , dryness , moisture and shape .
Colour , luster , dryness and moisture : The normal colour of lips is reddish , fresh and moist .Deep red heat ;purplish and brownish dry lips indicates extreme exuberance of stagnant heat ; bright red lips indicates yin asthenia and exuberant fire : lips as red as cherry usually indicates poisoning by coal gas ; pale lips is caused by asthenia of both qi and blood ; purplish lips indicates qi stagnation and blood stasis ; blackish colour around the mouth indicates kidney qi on verge to exhaust ; dry and fissured lips indicate impairment of fluid ; swelling and painful lips or lips with ulceration and sores are often caused by fumigation of heat accumulating in the spleen pad stomach .
Shape : During the course of a disease , constant opening of mouth indicates that pulmonary and splenic qi is on verge to exhaust and that the syndrome is asthenic ;difficulty in opening mouth is lockjaw seen in convulsion in sthenia syndrome .
1.1.2.2.5 Inspection of gums
Gums are connected with the collaterals of yangming meridian .So inspection of gums is helpful for understanding the pathological changes of the stomach , Inspection of gums mainly concentrates on examining the colour of gums .Nomrally , gums are light red and moist , Pale gums indicates blood asthenia ; reddish swelling and painful gums without pain indicate up-flaming of asthenic fire;bleeding and reddish swelling gums indicate impairment of the collaterals by gastric fire ;bleeding gums without reddish swelling suggest impairment of the collaterals by asthenic fire .
1.1.2.2.6 Inspection of throat
The throat is the door to the lung and stomach , the pathway for breathing and eating and the region over which the kidney meridian circulates .So inspection of throat is helpful for examining the pathological changes of the lung , the stomach and the kidney .
Inspection of throat mainly concentrates on the colour and shape of the throat .Reddish swwlling and pain of throat is due to virulent wind heat attacking the upper or due to stagnant heat in the lung and stomach to fumigate the upper ; reddish swelling and ulceration of the throat indicates extreme exuberance of heat virulence ;bright red and tender throat with slight swelling and pain is due to up-flaming of asthenic fire resulting from deficiency of kidney yin; unilateral or bilateral reddish and painful lumps like mastoid process is due to accumulation of heat in the lung and stomach or due to wind heat attacking the upper ; reddish swelling and ulceration with erasable yellowish white pus-like substance or suppurative points is called tonsillitis due to exuberant virulent heat as well as heat fumigation and muscle decaying ; false whitish membrane on the throat that is not erasable , bleeding when rubbed heavily and reappearing is diphtheria due to accumulation of pestilent factors in the lung and stomach that fumigates the throat and must be treated in isolation .
