For convenient learning, the nail and palm diagnosis techniques with the most specific diagnostic value are discussed in the following:

1. Nail diagnosis

Information about the health of the body can be obtained by observing, touching, pressing, and moving the nail, subungual tissue (nail matrix) and the conjunction of nail and skin. The value of nail diagnosis is briefly discussed as follows:

1) Normal nail:

Shape: The normal nail is an elliptic, ball-shaped plate with a small vertical and horizontal curvature. It has the proper thickness, an elastic hardness, a concealed pink color and a smooth, shiny, and semi-transparent appearance. The lunar zone is normal. The nail fold at the junction of the nail root and skin is red, smooth, soft and regular. There are no ridges or fissures on the surface of the nail plate and no stripes or petechiae on the subungual tissue. The soft red color may be quickly restored after pressure is applied and then released from the nail plate (Fig. 4-5).

Indication: These indicate that both qi and blood are sufficient, meridians are clear, the function of the organs is normal, the body is healthy, and vital energy is plentiful.

Fig. 4-5 Normal, long, and short nails

2) Long nail :

Shape: The nail plate is bright and clean, but longer than normal and scattered with fine vertical grooves. The subungual tissue is bright, but slightly pale, and the lunar zone is normal. Sometimes, a small hangnail may appear in the nail groove (Fig. 4-5).

Indication: This indicates the impairment of respiratory function, dysfunction of stomach and intestine, and an unsteady emotional condition.

3) Short nail:

Shape: The nail plate is shorter than normal and occupies only one-third of the distal phalanx of finger. The color of the nail plate and subungual tissue is normal and the lunar zone is very small or hiddened underneath the nail fold (Fig. 4-5).

Indication: People with short nails are healthy and robust with a good bursting strength (strength instantly released). Their emotional condition is unstable. People with short nails are easily annoyed, quick to anger, and susceptible to hyperten-

sion and liver disease.

Fig. 4-6 Round, oval and narrow nails

4) Round nail:

Shane: This is a semicircular nail with its peripheral borders coincident with the edge of the distal phalanx, except the proximal border. The nail fold is irregular, but the color of the nail plate and subungual tissue is normal (Fig. 4-6).

Indication: People with round nails have a strong physique, good bursting strength, and an unstable emotional condition, and are susceptible to vertigo, migraine, and metabolic diseases.

5) Oval nail:

Shape: This nail is a small oval plate with normal color and some fine vertical lines visible against the light. The color of subungual tissue is normal and the lunar zone is also normal (Fig. 4-6).

Indication: People with oval nails are healthy, but their emotional makeup is unstable with strong unsatisfied desires. They are susceptible to stomach diseases, headache, and insomnia.

6) Narrow nail:

Shape: The nail plate is narrow and occupys only one-third the width of the distal phalanx of finger. The skin fold beside the nail is almost as wide as the nail plate. The nail color is uneven and with careful observation some fine horizontal lines are visible on the nail plate. (Fig. 4-6).

Indication: People with narrow nails are susceptible to cervical and lumbar spinal column diseases, hyperosteogeny, and heart disease.

7) Broad nail:

Shape: This nail plate is broad with a much wider free margin. The nail root is depressed and the lunar zone is a narrow stripe. Some vertical and horizontal lines are visible against light. The nail color and subungual tissue are normal (Fig. 4-7).

Indication: People with broad nails are susceptible to thyroid gland dysfunction and sterility.

Fig. 4-7 Broad, square, and ladder-shaped nails

8) Square nail:

Shape: The nail plate is square with a transverse diameter narrower than that of the broad nail, and its vertical length is less than one-half of the distal phalanx of finger. The nail plate color, subungual tissue, and lunar zone are all normal. Some-times red spots may be found on the surface of the nail plate with red and purple colors mutually intermingled in the subungual tissue (Fig. 4-7).

Indication: People with square nails are susceptible to cardiovascular diseases, especially heart diseases.

9) Ladder-shaped nail:

Shape: The free margin of nail plate is narrower than that of the nail root, but the nail's vertical length is normal. There-fore, the nail assumes a ladder shape. The nail plate color, subungual tissue, and lunar zone are all normal. Sometimes the lunar zone also may be in a ladder or triangular shape (Fig. 4-7).

Indication: People with ladder-shaped nails are susceptible to respiratory diseases such as pneumonia and bronchitis.

10) Triangular nail:

Shape: The nail plate is triangular with a wider free margin and a narrower nail root. The nail plate color and subungual tissue are normal. Sometimes the subungual tissue is a white and purple color. The recovery of original color in the subungual tissue is slow after pressure applied to the nail plate is released (Fig. 4-8).

Indication: People with triangular nails are susceptible to cerebral hemorrhage and thrombosis.

Fig. 4-8 Triangular nail, ingrown nail, and nail with vertical grooves

11) Ingrown nail:

Shape: The bilateral borders of the nail plate, sometimes with a small hangnail, may grow into the nearby soft tissue. The nail is less transparent and the lunar zone is irregular (Fig. 4-8).

Indication: People with ingrown nails are susceptible to dysfunction of the nervous and circulatory systems such as neurasthenia, dysfunction of vegetative nervous system, and con-genital heart disease.

12) Nail with vertical grooves:

Shape: The nail plate is uneven and notched with several vertical grooves (Fig. 4-8).

Indication: This indicates deficiency of qi and blood, deficiency of liver and kidney, and an upward attack of liver Yang. These people are susceptible to malnutrition, allergies, and metabolic and respiratory diseases.

13) Convex nail:

Shape : The central part of the nail plate is convex over the peripheral section and the free margin of the nail is curved to the palmar side like a clam or reversed spoon. Some pits on the nail plate are visible against the light. The color of nail plate and subungual tissue is pale, and the lunar zone color is more pink (Fig. 4-9)

Indication: People with convex nails are susceptible to tuberculosis, especially those with a purple nail root.

Fig 4-9 Convex nail, concave nail, and nail with horizontal grooves

14) Concave nail :

Shape : The central part of the nail plate is depressed below the peripheral section and some pits and vertical lines on the nail plate can be observed. The color of the subungual tissue is uneven (Fig. 4-9).

Indication: This indicates liver and kidney dysfunction and susceptibility to infertility with fatigue and low vitality.

15) Nail with horizontal grooves:

Shape: Several horizontal grooves can be seen on the nail plate, so that it is uneven and its transparence is reduced (Fig. 4-9).

Indication: This indicates liver dysfunction, stagnation of liver qi, susceptibility to hair loss, depression, and dysfunction of the endocrinal system. Petechiae on the subungual tissue are usually caused by trauma.

16) Spoon nail :

Shape: The free margin of the nail is curved to the dorsal side, assuming a spoon shape, and the lateral border of the nail plate splits easily. The color of the subungual tissue is pale, the nail fold is irregular, and some white spots may appear on the nail plate (Fig. 4-10).

Fig. 4-10 Spoon nail, soft and thin nail, and stripped nail

Indication: This is a manifestation of anemia and malnutrition.

17) Soft and thin nail:

Shape: The nail plate is thin and soft and its resistance and protective function reduced. The color of the subungual tissue is pale and the lunar zone and nail fold are irregular (Fig. 4-10).

Indication: People with soft and thin nails are susceptible to hemorrhagic diseases and calcium deficiency. It is also a manifestation of chronic diseases.

18) Stripped nail:

Shape: The nail plate is stripped from the free margin to the proximal section of the nail bed, like the stripped bark of a bamboo shoot. The nail plate is soft, thin, lusterless and greyish white (Fig. 4-10).

Indication: This indicates susceptibility to hemorrhagic diseases such as digestive tract hemorrhage and anemia due to malnutrition.

19) Nail with black lines:

Shape: One or several vertical black lines appear on the nail plate. The color of the subungual tissue is uneven, the nail fold is irregular, and the lunar zone is dark red and shifted to one side (Fin. 4-11).

Fig. 4-11 Nails with black lines, and white or red spots

Indication: This indicates dysfunction of the endocrinal system, irregular menstruation, and dysmenorrhea or exhaustion of mental or physical energy.

20) Nail with white spots:

Shape: The small white opaque spots usually appear on all the nails of the hands. On the hands of children they are cloudy white spots (Fig. 4-11 ).

Indication: This indicates the presence of digestive diseases, and dysfunction of the endocrinal or digestive system. It may appear in children with intestinal parasites. The white pin-point spots or mixed white and red spots in the central part of the nail indicate ascaris infection.

21) Nail with red spots:

Shape: The red spots appear on the nail plate. A dark purple or whitish red color appears in the subungual tissue. The lunar zone and nail fold are both irregular (Fig. 4-11).

Indication: People with red spots on the nails are susceptible to diseases of the circulatory system such as endocarditis, hemorrhagic diseases, and thrombocytopenia.

22) Spotted nail:

Shape: The nail plate is not smooth and shiny and is scattered with dull yellow spots and unclear vertical lines (Fig. 4-12).

Indication: This indicates the presence of digestive diseases, intestinal parasites, and chronic neurasthenia. People with this condition are easily fatigued.

Fig. 4-12 Spotted nail, nail with strings of beads, and nail with laterally shifted lunar zone

23) Nail with strings of beads:

Shape : The nail plate is covered with strings of protruding beads or scattered with strings of spots in the nail matrix (Fig. 4-12).

Indication: This indicates the presence of malnutrition, impairment of intestinal absorption, deficiency of minute elements, and localized lesions in the digestive tract.

24) Nail with laterally shifted lunar zone:

Shape: The lunar zone is shifted to one side and does not have the shape of a crescent moon. The subungual tissue is an intermingled with dark and pale pink (Fig. 4-12).

Indication: This indicates the exhaustion of physical strength, poor absorption of nutrients, and impairment of body resistance due to exaggerated catabolism.

25) Nail without lunar zone:

Shape: There is no lunar zone on the nail root (Fig. 4-13).

Indication: If the lunar zone is present only on the nail root of thumb and the subungual tissue is pale and dull pink, this indicates that daily life has been disturbed with nervousness, fatique, and impairment of body resistance; and if the lunar zone is absent in all the nails, this indicates susceptibility to circulatory and blood diseases.

Fig. 4-13 Nail without lunar zone, cylindrical nail ,and nail with vertical fissure

26) Cylindrical nail :

Shape: The lateral borders of the nail plate are ingrown forming a cylinder. This is also called tubular nail, like the tubular leaf of a green onion. The pale color of the subungual tissue appearing after pressure is applied to the nail plate may remain for a long time (Fig. 4-13).

Indication: This indicates deficiency of qi and blood and the impairment of body resistance in chronic patients or sedentary people, making them susceptible to serious diseases.

27) Nail with vertical fissure:

Shape: The nail plate is fragile and divided from midline into two parts (Fig. 4-13).

Indication: This indicates susceptibility to circulatory diseases and dementia. It can also be found in those with trauma, tinea manuum, and chronic diseases.

28) Detached nail:

Shape: The nail plate is detached from the nail bed (Fig. 4-14).

Fig. 4-14 Detached nail, nail with echymosis, and tinea unguium nail

Indication: This is usually caused by pyogenic infection of the fingers. This is also a manifestation of a critical disease called "Jinjue" (destruction of tendons) in traditional Chinese medicine. If the nail does not regenerate, this indicates the patient's extreme weakness caused by the exhaustion of fire in Mingmen.

29) Tinea unguium nail:

Shape: The nail surface is dull, lusterless and rough, and the nail plate is dry, fragile, and yellowish in color like a piece of rotten wood. The nail is thickened on the bilateral borders from the distal end with erosion and defects (Fig. 4-14).

Indication: This condition is caused by impairment of blood circulation, poor nutrition, and an attack of wind and damp pathogens. Those afflicted are susceptible to angitis and muscular atrophy.

30) Nail with echymosis:

Shape: The echymoses in the subungual tissue does not fade away under pressure applied to the nail plate (Fig. 4-14).

Indication: The dark red echymoses indicate a mild injury in the past 3-5 months with a good prognosis; the bluish purple echymoses indicate a recent severe injury or one in the past 1-2 years with a good prognosis; the black echymoses indicate a severe injury in the past 2-5 years with a poor prognosis; and the yellow echymoses indicate an injury over 5 years ago, or a severe injury within a shorter period with a poor prognosis. The spotted echymoses indicate a blunt injury; the striped echymoses indicate a laceration; and the patched echymoses indicate a crushing injury. The nail can be divided into left, right, distal, proximal and central parts to define the location of injury in the correspondent region of the body. The thumbnail represents the head; the index finger nail represents the upper body above the diaphragm; the middle finger nail represents the upper abdomen above the umbilicus; the ring finger nail represents the lower abdomen above the pubic area; and the little finger nail represents the lower body below the pubic area.

The 30 types of nails mentioned above may be used as a reference, but this method does not produce a conclusive clinical diagnosis. In most patients, several types of nails may be present at the same time. Therefore, a diagnosis can be made only after a comprehensive analysis of the information obtained from nail diagnosis.

2. Palm diagnosis:

Fig. 4-15a Diagram of palm diagnosis

1-stomach meridian (radial side) 2-spleen meridian (ulnar side) 3-gallbladder meridian (radial side) 4-liver meridian (ulnar side) 5-small intestine meridian (radial side) 6-heart meridian ( ulnar side ) 7-large intestine meridian ( radial side) 8-lung meridian (ulnar side) 9-urinary bladder meridian (radial side) 10- kidney meridian (ulnar side)

This is a method of diagnosis by inspecting, touching, moving, and pressing the comparatively stable diagnostic areas of the palm.

The diagnostic areas on the palm (Fig. 4-15a and 4-15b) have been determined by repeated clinical practice. Most of them are the holographic reflecting areas for treatment, while some others are specific reflecting areas. Four diagnostic techniques are used in combination and the areas with positive responses and the correspondent areas of the diseased internal organs should be carefully examined.

Fig. 4-15b Diagram of palm diagnosis

1-deficiency of qi 2-rectum 3-anus 4-1eft shoulder 5-dreaminess and fatigue 6-in-somnia and fatigue 7-hypertension 8-hypotension 9-constipation 10-cough and asthma ll-reproduction 12-mouth and nose 13-right shoulder 14-right lung 15-1eft lung 16-esophagus 17-right waist 18-1eft waist 19-spleen 20-gallbladder 21-abdomen 22-pelvic cavity 23-stomach 24-kidney 25-hemorrhoid 26-rheumatism with edema 27-urinary bladder 28-right heart 29-1eft heart 30-liver

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