OBSERVATION OF HEAD, FACE AND HAIR

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OBSERVATION OF HEAD, FACE AND HAIR

Chapter contents

HEAD

In observation of the head, one should first of all make a general assessment of the patient’s constitution based on the facial features. A person with a good constitution will generally have a head with smooth features, a broad forehead and long ears with thick ear-lobes. A person with a poor constitution will have a head that is too small or with uneven features and small ears with small ear-lobes.

The features discussed are as follows:

Dry scalp

Symptoms and Signs, Chapter 55

A dry scalp indicates Liver- or Kidney-Yin deficiency, or both.

Redness and pain of the scalp

Redness and pain of the scalp indicate either an acute invasion of Wind-Heat or the flaring up of Liver-Fire.

Tremor of the head

Observation, Chapter 4; Symptoms and Signs, Chapter 55

Tremor of the head indicates internal Liver-Wind and is seen in Parkinson’s disease in the elderly.

Swelling of the whole head

Symptoms and Signs, Chapter 55

A swelling of the face and the whole head with redness of the eyes is called ‘Big Head Warm Disease’, which is due to Wind-Heat with Toxic Heat invading the Upper Burner. It is often seen in parotitis.

Boils on the scalp

Symptoms and Signs, Chapter 55

Boils on the scalp are due to Liver-Fire, Damp-Heat in the Liver channel, or Toxic Heat.

Ulcers on the scalp

Symptoms and Signs, Chapter 55

Ulcers on the scalp are due to Liver-Fire, Damp-Heat in the Liver channel, or, if they are in the region of Du-20 Baihui, Heat in the Governing Vessel.

Ulcers in the mastoid region

Symptoms and Signs, Chapter 55

Ulcers in the mastoid region are due to Damp-Heat in the Gall-Bladder channel or to Liver-Fire.

Erosion of the scalp

Symptoms and Signs, Chapter 55

Erosion of the scalp (when the skin is broken) with itching and oozing of a fluid is due to Damp-Heat in the Liver channel.

Head leaning to one side

Symptoms and Signs, Chapter 55

If the head leans to one side and the patient is unable to keep it straight, this is due to either a deficiency and sinking of Spleen-Qi or a deficiency of the Sea of Marrow.

Head tilted backwards

Symptoms and Signs, Chapter 55

If the head is tilted backwards with eyes rolled up, this indicates internal Liver-Wind, which is frequently seen in acute febrile diseases in children.

Late closure of the fontanelles

Symptoms and Signs, Chapter 90

In babies, one should observe the fontanelles: late closure of the fontanelles indicates poor hereditary Kidney constitution. The posterior fontanelle usually closes about 2 months after birth, the sphenoid fontanelle closes at about 3 months, the mastoid fontanelle closes near the end of the first year, and the anterior fontanelle may not close completely until the middle or end of the second year.

Box 5.1 summarizes the head signs.

BOX 5.1 HEAD SIGNS

• Dry scalp: Liver-/Kidney-Yin deficiency

• Red and painful scalp: Wind-Heat or Liver-Fire

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