Primary Skin lesions

Question 0

Diagnosis- White macule

Answer 0

• Qi Stagnation or

- Qi & Blood not harmonised

Question 1

Definition of a macule (incl. patch)

Answer 1

• A flat lesion that cannot be palpated
• It is not elevated or depressed
• Usually smooth, although a fine scale can sometimes be discerned
• If larger than 10mm its called a patch

Question 2

Diagnosis: Brown Macule

Answer 2

• Qi Stagnation or
• Qi & Blood not harmonised or
• Kidney Xu

Question 3

Diagnosis: Red Macule (pale or pinkish), small area, no or slow spreading

Answer 3

Heat

Question 4

Red Macule:
Redness
- pronounced
- widespread
- actively spreading

Answer 4

Fire

Question 5

Red macule:

Redness which disappears on pressure

Answer 5

Heat in the Qi or Blood level

Question 6

Red macule:

Redness which does not disappears on pressure

Answer 6

Extreme Heat or Blood stasis

Question 7

Purple macule

Answer 7

• Stagnant Heat in the Blood or

- Blood Stasis

Question 8

Definition of a Papule

Answer 8

• a raised lesion less than 10mm in diameter
• if slightly raised, flat topped and >10mm called a plaque
• a papule may remain a papule or develop into a vesicle, a pustule, lichenify or scale
• the surface may be smooth, rough, shinny, rounded, flat topped, or umbilicated
• they may be discreet, grouped or form into annular rings

Question 9

Definition of a nodule

Answer 9

A raised lesion >10mm in diameter

Question 10

Red papule

Answer 10

Wind-Heat or

Blood-Heat

Question 11

Red papule accompanied by exudate

Answer 11

Damp-Heat

Question 12

Flesh coloured papule

Answer 12

Stagnant Toxic-Heat

Question 13

Purple papule

Answer 13

Stagnant Heat in Blood or

Blood Stasis

Question 14

Nodule: starts red, turning dull purple

Answer 14

Stagnant Qi with Blood Stasis

Question 15

Flesh coloured Nodule, moveable, not painful

Answer 15

Stagnant Qi & Phlegm

Question 16

Definition of Vesicle

Answer 16

• A raised lesion, containing clear fluid (less than 5mm)

- Fluid turns murky over time

Question 17

Vesicle with red border

Answer 17

Toxic-Heat

Question 18

Vesicle with no red border

Answer 18

Damp or

Damp-Heat

Question 19

Blood filled Vesicle

Answer 19

Heat in the Blood

Question 20

Definition of a Bulla

Answer 20

A vesicle >5mm (i.e. a blister)

Question 21

Bulla with red border

Answer 21

More heat & toxin present

Question 22

Bulla without red border

Answer 22

More Damp is present

Question 23

Definition of a Pustule

Answer 23

• raised lesion containing yellow pus (that may be sterile or infected)
• generally thin walled pustules that break easily with a red border imply an attack by exterior toxin
• thicker walled pustules are usually internally generated toxins from heat toxin putrefying flesh

Question 24

TCM significance of a pustule

Answer 24

Fire-Toxin

“When heat enters the blood there is putrifaction, where there is putrifaction there is pus”.

Question 25

Definition of a wheal

Answer 25

• Transient, elevated lesion, often with central pallor
• Its is oedematous (made up of non-localised interstitial fluid)
• It does not leave any mark after resolution
• Although transient they tend to be highly pruritic
• Size can range in diameter from a few millimeters to many centimeters
• Typically only rubbed by patients, not scratched or picked

Question 26

White Wheal

Answer 26

• Wind
• Wind-Cold or
• Yang Xu

Question 27

Red Wheal

Answer 27

• Wind-Heat or

- Yin Xu

Question 28

Small Wheals induced by emotional upset or heat (Cholinergic urticaria)

Answer 28

Heat in the Blood

Question 29

Red linear Wheals produced by scratching

Answer 29

Blood-Heat with Wind

Question 30

Wheal caused by pressure

Answer 30

Blood Stasis