OBSERVATION OF THE LEGS

Chapter 19


imageOBSERVATION OF THE LEGS



Observation of legs includes both observation of the legs themselves and also of the gait.


The symptoms and signs related to the legs are in Chapter 66 of Part 5.



LEG SIGNS



Oedema


Observation, Chapter 18; Interrogation, Chapter 39; Symptoms and Signs, Chapters 64, 66, 68


Oedema is generally caused by Yang deficiency of the Lung, Spleen or Kidneys or by retention of Dampness. When oedema affects the legs, it is due either to a Spleen-Yang deficiency, a Kidney-Yang deficiency or a combination of the two. In some cases, oedema may also be due to an accumulation of Dampness in the legs, which prevents the proper transformation of fluids; in this case, besides showing oedema, the legs will look generally puffy. Oedema caused by deficiency of Yang or Dampness shows pitting, that is, the skin pits on pressure. In a few cases, oedema may be due to stagnation of Qi and Blood in the legs, in which case it is non-pitting (Fig. 19.1).



Case history 19.1 illustrates a pattern of Spleen- and Kidney-Yang deficiency underlying leg oedema.



Case history 19.1


A 51-year-old man had been suffering from oedema of the legs and abdomen, breathlessness, night sweating and inability to lie down for 8 months. A Western diagnosis revealed that he suffered from congestive cardiac failure. He also experienced a feeling of heat in the head and a feeling of throbbing of the head; from a Western diagnostic point of view this was due to hypertension. On interrogation, it transpired that he also experienced a feeling of pressure in the right eye in the morning, tinnitus, thirst and a tendency to diarrhoea.


He was slightly overweight and his body shape was of the Fire type, having a relatively round body shape, round head and small hands and feet. However, the Fire type should walk briskly and talk fast, whereas this patient walked and talked rather slowly. His complexion was dull pale.


His tongue was very slightly Pale, very slightly Red on the sides with a deep Heart crack and a sticky-white tongue coating. His pulse was Weak on both Rear positions, but especially on the right, Weak on the right Front position and Slippery on the left Front position.


Diagnosis: First of all, the contradiction between the Fire body shape and his slow walk and talk indicates straight away a potential problem in the Fire Element and the Heart. This is confirmed by the presence of the deep Heart crack on the tongue, which usually indicates either severe emotional problems (which was not the case in this patient) or a heart problem. The heart problem is also confirmed by the Slippery quality on the Heart position, which is all the more striking considering the Weak quality of most of the other pulses. When only the Heart pulse is Slippery, especially in its lateral or medial aspects, this often indicates the possibility of heart disease in a Western sense. Thus, in this patient, the contradiction between the body type and his walking and talking, the pulse and the tongue all clearly indicate the possibility of an actual heart disease, which was of course confirmed by the Western diagnosis.


In terms of patterns, there is a deficiency of Spleen- and Kidney-Yang manifested by the tinnitus, tendency to diarrhoea and Weak pulse on both Rear positions, with Water overflowing to the Heart, which is manifested by the oedema, breathlessness and inability to lie down. In addition to these two patterns there is also Liver-Yang rising (stemming from the Kidney deficiency) manifesting with a feeling of heat and throbbing of the head, thirst, pressure in the eye and Red sides of the tongue.

Related posts:

  1. SEXUAL SYMPTOMS
  2. PROBLEMS AT PERIOD TIME
  3. DIGESTIVE SYSTEM AND TASTE
  4. MENTAL AND EMOTIONAL SYMPTOMS

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Apr 15, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on OBSERVATION OF THE LEGS

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