Inspection of Limbs and Diagnosis of Diseases
Inspection of Limbs and Diagnosis of Diseases
Inspection of limbs and diagnosis of diseases:
In normal subjects, there is an aversion angle of 5-15 degrees between the extending line of the upper arm and forearm when the elbow joint is extended. If the angle is bigger than the normal range, it is called cubitus valgus; if the angle is smaller than the normal range it is known as cubitus varus.
A flat palm without an apparent depression and with the extended thumb on a same plane as the palm indicates the paralysis of the median nerve. Difficulty putting fingers side by side indicates injury to the ulner nerve.
Continuous twitching of some muscles of the upper limb without any apparent movement of the arm may appear in patients of uremia or multiple neuritis. Tremors of the fingers may appear in patients with hyperthyroidism or neurasthenia.
Subconscious movement of the hands to seemingly grasp at something in vain or continuously rub a fixed object in chronic patients lying in bed for a long time is a critical sign of delirium caused by high fever, hepatic coma or alcoholism.
Bowleg and knock-knee may appear in rickets patients. Swollen legs with rough and thickened skin and swollen lymph nodes may appear in patients with filariasis. Enlarged knee like the knee of a crane may appear in patients of rheumatism, rheumatoid arthritis, Kaschin-Beck disease, inflammatory diseases, tumor, external trauma or tuberculosis of the knee joint.
Dizziness, blurred vision, palpitations of the heart and shortness of breath in patients with lean limbs is caused by deficiency of qi and blood. In weak people or chronic patients, weakness, leanness and tremor of the limbs, soreness and weakness of the waist and knee, and hotness in the heart, palms and soles are caused by deficiency of liver and kidney Yin; and cold body and limbs, impotence and emission of semen is due to deficiency of spleen and kidney Yang. A similar syndrome in children may be caused by deficiency of congenital and acquired kidney essence and poor nutrition of tendons, bones and muscles, and the children may also suffer from five types of retardation (of standing, walking, speaking and growing of teeth and hair) and five types of weakness (of the head, mouth, hands, feet and muscles).
Weak and flaccid limbs, lean and atrophic muscles and mental tiredness are due to deficiency and weakness of the spleen and stomach; weakness, numbness and tremor in the limbs with soreness and weakness of the waist and back, dizziness and tinnitus are due to deficiency of liver and kidney Yin.
Heaviness, weakness and numbness in the lower limbs with difficulty walking are due to paraplegia or stroke if the upper limbs are normal. Stiff limbs with difficulty flexing may appear in weak and obese people; and the stiff limbs may also be caused by deficiency of the liver and kidneys, deficiency of Yang qi or stagnation of qi and blood.
Symmetrical edema of the limbs is a local manifestation of general edema of the body. Edema of one limb may be caused by blockage of local veins or lymph vessels. Blockage of veins is caused by thrombosis of veins, paralysis of limbs or malnutrition of nerves; and blockage of lymph vessels may appear in patients of filariasis, which may cause rupture of lymph vessels, Overflow of lymph, marked hyperplasia of connective tissue and thickening of skin to form elephantiasis with local non-pitting edema.
The enlarged and expanded terminals of limbs with hyperplasia of local soft tissues, bones and ligaments may appear in patients of acromegaly and giantism caused by over-secretion of growth hormone from a hyperplastic pituitary gland or acidophilic adenoma in the pituitary gland.
Muscular atrophy of the limbs may be caused by myositis, injury of peripheral nerve or disuse of muscles for a long time. Muscular spasms are due to deficiency of qi and blood and attack of wind-cold or cold dampness pathogens; and spasms of limbs with fever, chills and stiffness of the neck and back are due to blockage of meridians by wind pathogens and disturbance of circulation of qi and blood, or caused by invasion of toxic wind pathogens after trauma and disturbance of distribution of Ying (nutrient) and Wei (defensive energy).
Varicosis of the lower limbs with local redness, swelling, hotness, soreness and pain is caused by accumulation of damp-heat pathogens; varicosis of the lower limbs with swelling, heaviness, numbness, coldness and pain, exacerbated in cold cloudy weather is caused by accumulation of cold dampness pathogens; and varicosis of the lower limbs with heaviness and distension, exacerbated after tiredness, is due to deficiency of qi and stasis of blood. Weak, drooped shoulders are due to deficiency of lung qi.
Inspection of the soles of the feet and diagnosis of diseases:
In traditional Chinese medicine, inspection of the soles of the feet for diagnosis of diseases is an important part of traditional diagnostics. Diseases of the internal organs can be diagnosed by observing abnormal changes in the projecting areas of those organs on the soles of the feet (Figs. 5-2 and 5-3).
When an organ in the body is diseased, some abnormal changes in color and shape may appear on the projecting area of that organ on the soles of the feet.
How can the diagnosis of diseases of the internal organs be made by observation of the abnormal changes of color and shape on the soles of the feet? According to the theory of traditional Chinese medicine, the meridians have their fixed origin, end points and pathways to connect different organs and structures in the body. Therefore, the pathological changes of a diseased organ can be reflectively shown on the pathway of its meridian for diagnosis of disease in the corresponding organ. According to the theory of foot reflex in Western medicine, abnormal changes on different areas of the foot can indicate diseases in different organs of the body .
Fig. A and Fig. B show the relation b etween various areas on the soles of the feet and their corresponding organs. The tenderness produced by pressing the projecting area indicates the disease in the corresponding organ.
Fig. C shows the toe nail in normal subjects. The pink crescent zone occupies 1/5 of the length of the whole nail, and the vertical streaks indicate extreme tiredness and hypofunction of the body.
Fig. D shows a dorsally curved nail, indicating myopia, pseudomyopia, astigmia or tiredness of the eyes. If all the toe nails are dorsally curved, it indicates mental stress.
Fig. E shows the network of coarse striae and pinpoint pits on the big toe, indicating dysfunction of the sex glands in women with irregular menstruation and reduction of sexual desire.
Fig. F shows the unevenness of the big toe, indicating drug overdose.
Fig. G shows a lateral view of the dorsally tilted 2nd and 3rd toes, indicating diseases of the stomach and intestines.
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