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, colour, dryness, moisture and shape.
Colour, luster, dryness and moisture： The normal colour of lips is reddish, fresh and moist. Deep red and dry lips indicates consumption of fluid by exuberant 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 and 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 sydnrome.
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 indicate exuberance of gastric fire; slight swelling 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.
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 swelling and pain of throat is due to virulent wind heat attacking the upper or clue 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.
Inspection of neck
Neck is the part connecting the head with the trunk of the body; the anterior part is called neck and the posterior part is called nape. Normal neck should be erect and symn；trical with the trachea located on the middle. Laryngeal protuberance is prominent in the male and invisible in the female. The neck can be rotated, bent and raised freely in standing and sitting position. So inspection of neck concentrates on the shape and movement of the neck.
Changes of the shape
The commonly seen changes are：
Goiter: Goiter refers to unilateral or bilateral lumps like tumor below the laryngeal protuberance which is either small or large and movable with swallowing, usually caused by stagnation of liver qi and retention of phlegm, sometimes due to local climate and environment.
Scrofula: Scrofula refers to cervical clustered nodules, usually caused by asthenic fire scorching phlegm into nodules due to asthenia of lung and kidney yin, or by accumulation of qi and blood in the neck due to attack by wind fire and seasonal pestilence.
Changes of movement
Abnormal changes of the movement of the neck include the following aspects.
Flaccidity of the neck： Weakness of the neck unable to support the head is called flaccidity of the neck.Flaccidity of the neck in the babies over 4 months old is due to congenital deficiency, insufficiency of essence and marrow, or due to postnatal improper feeding which leads to asthenia of qi and blood and malnutrition of the skeleton. Flaccidity of the neck with dispiritedness in chronic and severe diseases is due to exhaustion of essence.
Stiff neck: Stiff neck refers to spasm of the muscles and sinews over the neck, making it difficult for the neck to bend, raise and rotate. Stiffness of the neck after sleep is due to improper posture in sleep or due to wind cold attacking the neck. Stiffness of neck with high fever, headache and vomiting is usually due to heat virulence in febrile disease attacking the upper; stiffness of neck and back with posterior bending of the head, stretching of the trunk, bending of the spine and spasm of the limbs is called opisthotonus, usually seen in tetanus and exogenous febrile disease with wind generated by extreme heat.
Inspection of mouth and lips