Symptoms 5, head and neck

Below is a brief description of the major head and neck symptoms, with links to entries that provide more detail.

Hair

Hair loss (发脱 fǎ tuō): Occurs in insufficiency of kidney essence and in liver yīn vacuity.

Premature graying of the hair (头发早白 tóu fǎ zǎo bái): Attributed to insufficiency of kidney essence.

Head

Headache (头痛 tóu tòng): Also referred to as regular headache (正 头痛 zhèng tóu tòng) in contrast to hemilateral headache (偏 头痛 piān tóu tòng). Any pain in the head. Headache has more causes than any other symptom. It can arise when qì and blood are obstructed or when they are insufficient and fail to nourish the head.

• Externally contracted wind-cold: Headache sometimes reaching into the nape and back, with tight feeling, exacerbated by wind and cold.
• Externally contracted wind-heat: Headache with a feeling of distension and exacerbated by exposure to heat.
• Externally contracted wind-damp: Head heavy as if swathed, with cloudy feeling and headache that is exacerbated by yīn-type rainy weather.
• Cold congealing in the liver channel: Headache often taking the form of vertex headache.
• Blood stasis: Splitting headache with a possible history of trauma.
• Phlegm turbidity: Headache with clouded head and dizziness.
• Ascendant hyperactivity of liver yáng: Headache on both sides or at the vertex with dizziness.
• Blood vacuity and yīn depletion: Dull headache with dizziness.
• Center qì vacuity: Headache with an empty feeling in the brain.

In traditional literature, persistent remittent, usually intense headache attributed to wind-cold or wind-heat invasions and obstruction of the channels by phlegm and static blood is called head wind (头风 tóu fēng).

Distending pain in the head and eyes (头目胀痛 tóu mù zhàng tòng): A painful sensation of pressure in the head and eyeballs. It occurs in ascendant hyperactivity of liver yáng.

Dizziness (头晕目眩 tóu yūn mù xuàn, 眩晕xuàn yūn): A subjective feeling of fogginess, often called clouded head (头昏 tóu hūn) or, in more severe cases, of turning within the head and visual disturbances. A distinction is made between dizzy head (头晕 tóu yūn) and dizzy vision (目眩 mù xuàn), although the two are not always clearly distinguishable. Dizziness is attributed to insufficiency of qì and blood depriving the head and eyes of nourishment or to evils (fire, wind, phlegm-rheum, static blood) disturbing the normal movement of qì and blood. Dizziness that threatens collapse (眩晕欲仆 xuàn yūn yù pū) is severe dizziness causing a loss of balance; it indicates liver wind stirring internally. Because of its wide range of causes, dizziness appears in many disease patterns:

• Qì and/or blood vacuity: Dizziness with white facial complexion, lassitude of spirit and physical fatigue, pale tongue, and a fine pulse. Where qì vacuity is prominent, dizziness is often exacerbated by fatigue. Dizziness appears notably in heart blood vacuity, spleen vacuity qì fall, liver blood vacuity.
• Liver and/or kidney yīn vacuity: In liver yīn vacuity, dizzy head manifests in dizziness with dry eyes, dull rib-side pain, and vacuity heat signs. In kidney yīn vacuity, it manifests with signs such as aching lumbus; tinnitus; and seminal emission.
• Ascendant hyperactivity of liver yáng: Dizziness with a pronounced feeling of imbalance (such as felt on a boat) and accompanied by distension in the head, tinnitus, limp aching lumbus and knees, red face, bitter taste in the mouth, dry throat, red tongue with scant fur, and a pulse that is stringlike and fine. This type of dizziness is often exacerbated by anger.
• Liver fire flaming upward: Dizziness with distension in the head, vexation and agitation, irascibility, a red tongue, and a pulse that is stringlike and rapid.
• Wind-phlegm: Visual whirling suggests wind-phlegm harassing the upper body. In severe cases of liver wind stirring internally, patients may feel as if they are losing their balance, which is described as dizziness that threatens collapse (眩晕欲仆 xuàn yūn yù pū).
• Phlegm-damp or phlegm-rheum: Dizziness with heavy-headedness (often described as head heavy as if swathed), oppression in the chest, retching and nausea, and a slimy white tongue fur, as in cold rheum collecting in the stomach or in rheum collecting in the chest and rib-side.
• Blood stasis obstructing the network vessels: Dizziness with stabbing pain.

Dizzy vision (目眩 mù xuàn): Also called flowery vision (目花 mù huā). A condition (poorly or if at all distinguishable from dizzy head) in which the visual field appears to turn or move, as if one were on a moving boat or vehicle, or when flies appear to cross the eyes (mouches volantes). Vacuity patterns include from liver-kidney yīn vacuity, where depletion of essence and blood deprives the eyes of nourishment, and spleen vacuity qì fall with clear yáng failing to ascend. Repletion patterns include wind-fire harassing the clear orifices and phlegm-damp clouding the clear orifices.

Heavy-headedness (头重 tóu zhòng): A subjective sensation of heaviness and clouding of the head. Like heavy cumbersome limbs, it is a sign of dampness.

Head heavy as if swathed (头重如裹 tóu zhòng rú guǒ) is heavy-headedness often accompanied by headache and arises when externally contracted dampness evil or phlegm-damp of internal origin cloud the upper body.

Heavy head and light feet (头重脚轻 tóu zhòng jiǎo qīng): A feeling of top-heaviness. It occurs in ascendant hyperactivity of liver yáng.

Eyes

Dry eyes (目干涩 mù gān sè): Lack of fluid to ensure the smooth movement of the eyelids. It is mostly attributed to liver yīn vacuity.

Red eyes (目赤 mù chì): A condition in which the eyes appear red, colloquially described in as blood-shot eyes (as from conjunctival hyperemia). Red eyes are usually attributable to externally contracted wind-heat (wind-fire eye) or epidemic toxin (heaven-current red eye) and sometimes referred to as fire eye. These forms are equivalent to acute conjunctivitis in biomedicine. Other causes include liver fire flaming upward, ascendant hyperactivity of liver yáng, liver-kidney yīn vacuity, or intense heart fire. In some cases, red eyes are associated with copious eye discharge.

Blurred vision (视物模湖 shì wù mó hú): Also called clouded vision (目昏 mù hūn). Poor visual acuity. It is a sign of liver blood vacuity.

Flowery vision (目花 mù huā): See dizzy vision above.

Ears

The kidney opens at the ears. It governs the bones and engenders marrow. The brain is the sea of marrow. For these reasons, depletion of kidney yīn and kidney essence causes hearing problems. The gallbladder channel passes through the region of the ears and directs liver-gallbladder repletion evils to the area to cause hearing disturbances.

Tinnitus (耳鸣 ěr míng): Ringing or other sounds subjectively felt in the ear. A distinction is made between vacuity and repletion.

• Vacuity: Tinnitus that develops gradually, is faint like the sound of cicadas or mosquitoes and is relieved by pressure is ascribed to vacuity. It is usually attributable to liver-kidney yīn vacuity, ascendant hyperactivity of liver yáng, or insufficiency of kidney essence. It can also occur in spleen vacuity qì fall.
• Repletion: Tinnitus of sudden onset that is like the sound of frogs or the rushing sound of the sea on the shore and that continues when the ears are pressed is ascribed to repletion and is mostly associated with exuberant liver-gallbladder fire or phlegm-fire.

Deafness (耳聋 ěr lóng): Partial or complete hearing loss. Mild cases are known as hardness of hearing (重听 zhòng tīng). A distinction is made between fulminant deafness and gradual deafness.

• Fulminant deafness (暴聋 bào lóng) is sudden and severe deafness as if the ears were plugged. It is associated with a bitter taste in the mouth, headache, and nasal congestion. It is attributable to liver-gallbladder fire rising to the head through the channel or to external evils affecting the lesser yáng (shào yáng) (shào yáng) channel, which passes through the ears.
• Gradual deafness (渐聋 jiàn lóng) is of slow onset, usually in advancing years, and can affect one or both ears. It is caused by insufficiency of kidney essence or insecurity of kidney qì.
• Deafness can also be caused by streptomycin, especially in children.

Nose, Mouth, and Throat

The lung opens at the nose. Nose and throat signs are the result of non-diffusion of lung qì. Most frequently, they are the result of externally contracted evils.

Nasal congestion (鼻塞 bí sè): Copious nasal discharge from the nose that obstructs the airways. It is caused by wind-heat or wind-cold. In general, wind-cold causes thin runny discharge (all disease with watery humors that are clear, pure, and cold is ascribed to cold), while wind-heat, by concentrating fluids, tends to produce a thicker turbid yellow discharge.

Runny nose with clear snivel (流清涕 liú qīng tì): Thin discharge from the nose, usually attributable to wind-cold fettering the lung. See nasal congestion above.

Runny nose with turbid yellow snivel (流黄浊涕 liú huáng zhuó tì): Discharge from the nose that is yellow and turbid. See nasal congestion above.

Sneezing (喷嚏 pēn tì): It is caused by wind-cold and other evils affecting diffusion of lung qì. It occurs in wind-cold fettering the lung, measles, and smallpox.

Flaring nostrils (鼻翼煽动 bí yì shān dòng): Dilation of the alae nasi on inhalation. It is common in panting.

Mouth and tongue sores (口舌生疮 kǒu shé shēng chuāng): Ulcerations of the tongue or other parts of the oral cavity. These are associated with hyperactive heart fire.

Clenched jaw (牙关紧闭 yá guān jǐn bì): A tightly closed jaw, called trismus in biomedicine. It occurs most commonly in fright wind caused by extreme heat engendering wind, in lockjaw caused by external wind toxin damage, and in other tetanic disease patterns.

Deviated eyes and mouth (口眼喎斜 kǒu yǎn wāi xié): Tension in the sinews on one side of the face and relaxation in those of the other side, manifesting in skewing of the mouth to one side and sometimes inability to close the eyes. It can occur in wind stroke with hemiplegia (mostly attributed to wind-phlegm) but may occur on its own (in which case it corresponds to facial paralysis, or Bell’s palsy, and is usually attributed to external wind).

Dry throat and mouth (咽干口燥 yān gān kǒu zào): Dryness of the throat and mouth often accompanies thirst and results from the damaging effect of heat or dryness on the fluids. When mild and chronic, it is a sign of vacuity heat.

Bleeding gums (牙龈出血 yá yín chū xuè): Bleeding from inside the juncture of the gums with the teeth. It is most commonly attributable to stomach heat, spleen failing to control the blood, or kidney yīn vacuity.

Painful swollen ulcerating gums (牙龈肿痛溃烂 yá yín zhǒng tòng kuì làn): Mainly caused by intense stomach heat.

Toothache (牙齿痛 yá chǐ tòng, 牙痛 yá tòng): Pain felt in the teeth. Toothache is most commonly caused by tooth decay, a rotting away of the teeth, that the ancient Chinese ascribed to the work of worms. Where decay is absent, Chinese medicine attributes toothache to wind-fire, wind-cold, stomach heat, kidney vacuity, or qì vacuity.

Loosening of the teeth (齿松 chǐ sōng, 牙齿松动 yá chǐ sōng dòng): Occurs in insufficiency of kidney essence and in kidney yīn vacuity.

Thirst (口渴 kǒu kě): Desire to drink fluids. Thirst is most commonly attributed to heat. When heat is pronounced, the patient may want cold fluids. Thirst without desire to drink much is a sign of blood stasis, phlegm-rheum, or dampness.

Absence of thirst (口不渴 kǒu bù kě): Absence of normal desire for fluids. Absence of thirst or intake of warm fluids in small amounts indicates a cold pattern. In cold patterns, normal sweating is reduced, and diminished fluid loss can be compensated with lesser amounts of fluid.

Hoarse voice (声音嘶哑 shēng yīn sī yǎ); loss of voice (失音 shī yīn): Partial or complete loss of the ability to produce sounds from the larynx can occur in vacuity and repletion.

• Repletion: Hoarse voice or loss of voice is most commonly caused by external evils invading the lung, impairing diffusion of lung qì, and causing replete metal failing to sound (金实不鸣 jīn shí bù míng).
• Vacuity: Hoarse voice or loss of voice may also be caused by insufficiency of yīn-liquid of the lung depriving the voice of moisture, which is called broken metal failing to sound (金破不鸣 jīn pò bù míng).

Heavy turbid voice (声音重浊 shēng yīn zhòng zhuó): A deep, muffled voice, mostly occurring in external contraction of wind-cold or in phlegm-damp obstruction that causes non-diffusion of lung qì and blockage of the nose.

Faint low voice (语生低微 yǔ shēng dī wēi): A voice that speaks in a low volume. It is a sign of qì vacuity. A faint low voice is usually accompanied by laziness to speak (懒言 lǎn yán), a lack of energy or inclination to talk.

Painful red swollen throat (咽喉红肿痛 yān hóu hóng zhǒng tòng): This is mostly attributable to wind-heat invading the lung, but mild forms may also occur in wind-cold or in lung yīn vacuity. Severe painful swollen throat is sometimes referred to as throat impediment.

Itchy throat (喉痒 hóu yǎng): This is usually attributable to wind-cold impairing diffusion of lung qì. Less commonly, it is attributed to wind-heat invading the lung, dryness evil invading the lung, or lung yīn vacuity.

Plum-pit qì (梅核气 méi hé qì): The sensation of a lump in the throat that can neither be swallowed nor spat out. It reflects depressed liver qì, often with phlegm. It is called globus hystericus or globus pharyngeus in biomedicine.

Nape and Neck

Stiff nape (项强 xiàng jiàng): Stiffness and discomfort in the back of the neck. In liver disease, it is a sign of liver yáng transforming into wind. A stiff nape may also be caused by externally contracted wind-cold or wind-damp, by damage to liquid by evil heat, or by wind toxin entering wounds (lockjaw). When severe, it is often referred to as rigidity of the nape and neck (颈项强直 jǐng xiàng jiàng zhí), which is associated with extreme heat engendering wind or with lockjaw, which is caused by external wind toxin damage.

Lump at the front of the neck (颈前有肿块 jǐng qián yǒu zhǒng kuài): A diffuse swelling on one or both sides of the anterior aspect of the neck that moves up and down as the patient swallows. It indicates goiter (瘿病 yǐng bìng, 瘿瘤 yǐng liú), colloquially known as fat neck or big neck (颈粗 jǐng cū, 大脖子 dà bó zi) in Chinese. Goiter is attributed to various factors including depressed liver qì, phlegm, blood stasis, and/or heat. See goiter.

Bean-like lumps at the side of the neck (颈侧有肿块如豆 jǐng qián yǒu zhǒng kuài): Small lumps on the sides of the neck. They are observed in scrofula, which is mostly attributed either to lung-kidney yīn vacuity with vacuity fire scorching the fluids and condensing them into phlegm, which binds at the neck, or to wind externally contracted wind-fire seasonal toxin binding at the neck.