In part I of this discussion, we went over the diagnostic applications of blood pressure and heart rate. In the second part, we will discuss applications of regional body temperature, color, and texture, and how they can lead the practitioner to form a better, more accurate clinical diagnosis.
Body temperature is one of the vital signs that the practitioner should check in each patient. There are four different areas of the body where body temperature should be checked: the dorsal aspect of the arm directly above the elbow, the LI 10 area, the palmar aspect of the hand, and the dorsal aspect of the hand. When I say check the temperatures here, it can be done with either a digital laser thermometer, or it can be done more subjectively by touch. In a healthy individual, the temperatures at these four different areas should be around the same. If one particular area varies too much in temperature from the rest, then there is sickness in the part of the body the area represents.
The palmar aspect of the hand represents the ventral aspect of the body, the abdominal and pelvic cavities. The dorsal aspect of the hand represents the dorsal aspect of the body, especially the back.
The LI 10 area of the arm represents the stomach. If this area feels hot, it is an indication of stomach fire. If LI 10 is hot but the palmar aspect of the hand is cold, then there is the possibility of a parasite in the patient’s system. The patient will present with digestive issue and sleeping problems. If the LI 10 area and the palmar aspect of the hand are both hot, then it is an indication that the immune system is out of balance, and may also indicate that there are allergies. In this case Xiao Chai Hu Tang (Minor Bupleurum Decoction) is a great formula to use. It works on both the hold and cold aspects of the body to harmonize it.
If the LI 10 area and palmar aspect of the hand are both very hot, it indicates stomach fire. The palm can also represent the lower jiao or pelvic region, which indicates that the hormones are out of balance, and the patient may experience hot flashes, especially in the evening. Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) and Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) should be used in combination.
If both the LI 10 area and palmar aspect of the hand are cold, it represents a hormone deficiency, or kidney yang deficiency. In cases like this, it is important to evaluate the blood pressure and heart rate as well to confirm true deficiency. If it happens that blood pressure and heart rate indicate excess heat, it means the patient’s constitution is cold, but they are being affected by a hot exogenous pathogenic factor that is in excess.
If the blood pressure and heart rate are both low, but LI 10 area is hot, 20% of Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) should be added to the treatment formula to clear the underlying heat. If the blood pressure and heart rate are both low but the palmar aspect of the hand is hot, 20% of Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) should be added to counteract the underlying yin deficiency.
The color of the skin and blood vessels, as well as the texture of the skin and muscles are also useful diagnostic tools. The color of the forearm, the color of the veins around the Neiguan (PC 6) area, and the texture of skin and muscles should always be checked.
In general, a red color indicates heat and inflammation, and a blue color is indicative of blood stagnation. On the dorsal aspect of the arm, the area around the elbows represents the neck and shoulders. the PC 6 area of the arm should be checked for color of skin as well as color of the blood vessels underneath.
For women, if the skin there is dark, and the veins beneath are blue and green, it represents stagnation of menstrual blood. If the skin and veins are pale, it represents blood deficiency.
When examining the skin, dryness indicates a blood or yin deficiency, and a sand-like texture is indicative of water retention. Another way to find water retention is by trying to make a depression in the skin along the tibial surface. If the depression does not rebound right away, or remains visible for any amount of time, it is indicative of water retention.
About the Author
Master Jimmy Wei-Yen Chang has over 25 years of concentrated clinical experience applying his expertise in differential diagnosis and herbal prescription. The author of a pulse diagnosis manual, Pulsynergy, Master Chang currently pursues his specialties in private practice in Hacienda Heights, California, and is widely recognized for his skills in correlating expert pulse taking and herbal prescription.
To learn more about pulse diagnosis and herbs, click here [2] to view a complete list of courses by Jimmy Chang.