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Diagnosis in TCM External Medicine

Although external diseases can easily be diagnosed by visual inspection, TCM usually employs all four examination techniques to ascertain the overall health condition of a patient. Subsequently, physicians can link up local pathologies with affected organs or meridians, identify the diseased stage and formulate an appropriate therapeutic strategy. Below are important diagnostic criteria.

1. Affected regions and their corresponding meridians
Affected Regions Corresponding meridians
Head crown Middle Governor Vessel Meridian
Lateral sides Bladder Meridian
Face Stomach Meridian
Breasts Stomach Meridian
    Tail part Gall Bladder Meridian
    Nipples Liver Meridian
Eyes Liver Meridian
Ears Auricular Gall Bladder and Triple Burner Meridians
Inner ear Kidney Meridian
Tongue Heart Meridian
Nose (inner part) Lung Meridian
Lips Spleen Meridian
Neck and sides of ribs Liver and Gall Bladder Meridians
Palms Pericardium Meridian
Soles Kidney Meridian
Back Middle Governor Vessel Meridian
Lateral sides Bladder Meridian
Arms Lateral side The three Yang Meridians of the arms
Medial side The three Yin Meridians of the arms
Legs Lateral side The three Yang Meridians of the legs
Medial side The three Yin Meridians of the legs
Abdomen     The three Yin Meridians of the legs, Conception Vessel Meridian

2. Summary of yin and yang syndromes
Differentiation of yin and yang is the main guiding principle for diagnosing external diseases, particularly wound infections. They help to decide the therapeutic methods to be used, to predict disease development as well as the prognosis of the condition. Generally, yang syndromes have more favorable outcomes.

     Yang syndromes Yin syndromes
Acute Chronic
Located superficially on the skin and in the muscles Located deeply in the bones and tendons
Localized conditions Skin turns red Normal or dark-purple skin color
Scorching heat Only mild heat
Protruding swelling Flat or collapsed swelling
Confined area Diffuse and extensive
When newly formed, the area is firm but gradually turns soft after ulceration. When pressed, the area feels either solid or soft. 
Very painful Dull pain, soreness or no pain at all
Thick, sticky pus Thin, watery pus
New tissue is red and tender. New tissue is darkish and purple in color
Systemic conditions There are chills and fevers, thirst, constipation and yellowish urine in the initial stage. No obvious symptoms in the initial stage, but after the site becomes ulcerated, there may be virtual fire signs or signs that suggest that blood and qi are insufficient.  
Tongue and pulse observation The tongue is red and covered by yellow coating; the pulse is strong. The tongue is pale and covered by white coating; the pulse is weak.
Duration Short Long

Different kinds of sores
3. Specific details on swelling, pain, itching and pus formation
In Western medicine, the microscopic investigation of septic infections and skin ulcers needs to be carried and before appropriate treatment can commence. However, TCM physicians usually focus on external body signs like swelling, pain, itching, and pus formation rather than what kind of microbial contamination is involved. TCM holds that the presence of certain symptoms indicates internal disharmony, such as meridian obstruction or stagnated flow of the blood and qi (vital energy). These pathological signs mean that the body has created a favorable condition for disease development; if the body can restore to normal heath state, then it will be strong enough to fight against the pathogens. Therefore, the ultimate goal of treatment is to resume the internal harmony of the body, so that pathogens can no longer to do harm. During diagnosis, TCM strongly emphasizes specific details of the condition, as they help determine the appropriate technique and choice of drugs.

Types of swelling

Swelling indicates blockage in the meridians or stagnated blood or qi flows; however, some influential factors lead to other kinds of manifestations.   

Influential factors Manifestations
Fire The swelling has burning pain and its surface appears shiny and bright red.
Coldness The swelling is firm and is usually associated with dull pain or a cool feeling; its surface is pale and purple in color and is matte in appearance.  
Wind The swelling is diffuse and extensive or shifts constantly. There is mild pain, no redness and the area is slightly hot.
Dampness There can be extensive swelling with pitting or blisters.  
Phlegm The swelling is either solid or very soft; it is neither painful nor hot.
Blood stasis There is acute blue-purplish swelling such as that occurs with trauma.  

Types of pain

In external medicine, impaired blood and qi circulation usually cause pain; however, various factors and the regions involved all determine the nature of the pain. For example:    

Influential factors Manifestations
Heat Burning pain that can be relieved by cooling; the surface area is bright red.
Cold Dull pain that can be relieved by warming; there is no redness or heat.
Wind The pain tends to be always moving and changing.
Blood stasis Distending or stabbing pain with bruising. 

Types of itching

In TCM, itching usually arises from a disturbance in pathogens accumulated in the superficial muscles or on the skin. There can be a single or multiple pathogens, exogenous or endogenous.

Influential factors Manifestations
Wind dominating The itching constantly moves around the body; dry marks appear on the skin. 
Dampness dominating Itchiness with a secretion; the more eroded the area, the more severe the itch. 
Heat dominating Skin rash associated with itchiness and a hot sensation; in severe cases, there may be scabs and a secretion.
Blood deficiency Itchiness associated with dryness, thickness and peeling.

Type of pus formation

TCM believes that pus is the end product of excessive heat accumulation and tissue decay, and that blood and qi stagnation facilitate its formation. Thus, the nature of pus provides crucial information about the progress of a condition.

Texture Thick and sticky pus indicates primordial energy is in abundance, while thin and watery pus indicates insufficiency. If yellow pus changes gradually from turbid to clear with a thick discharge, then it is a favorable sign. If thick and sticky pus turns thin and watery, it is a sign of bodily deterioration, which does not favor wound healing.  If pus is thin, turbid and milky or contains decayed tissue and is foul smelling, then it is a poor sign.
Color Bright, white-yellow thick pus indicates that blood and qi are abundant; dirty yellow thick pus means there is still resistance; thin and clear yellow pus means resistance is very weak. If the pus is darkish-green, thin and watery, that means it is a chronic wound and there may be bone and tendon damage. 
Odor Thick pus with a mild fishy smell indicates favorable progress, while foul and watery pus indicates unfavorable progress.