Guest guest Posted March 31, 2007 Report Share Posted March 31, 2007 I have a question for folks here about a particular patient's tongue. I have a link to the picture here <I%20have%20a%20question%20for%20folks%20here%20about%20a%20particular%2\ 0patient%27s%20tongue.%20%20I%20have%20a%20link%20to%20the%20picture%20a\ t%20http://www.acupunctureandherbs.com/images/tp.jpg> I don't know if it will show up well for you or not, but the middle-sides off of the center (and between the edge) is very swollen, which you can just see in the shadow from the mouth. This leads out to a wide tongue body with thin sides, which you can see at the junction of the tongue body and lips. The tongue color has varied between red-purple and red. Care to offer any impressions of the tongue picture? Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2007 Report Share Posted March 31, 2007 Oops - look like that rich-text editor is really a beta version, just like it says! Here's the link: http://www.acupunctureandherbs.com/images/tp.jpg Geoff , " G Hudson " <crudo20 wrote: > > I have a question for folks here about a particular patient's tongue. I > have a link to the picture here > http://www.acupunctureandherbs.com/images/tp.jpg> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2007 Report Share Posted April 1, 2007 Hi, Geoff, I checked a relatively obscure Chinese text on tongues (shiyong zhongyi shezhen ISBN7-5337-1093-2/R.231) and found a close but not exact match (most of the illustrations are " worst case senarios). The closest match indicates 1. exogenous superficial syndrome of wind heat 2. exogenous wind cold tending to transmit interiorly and transform into heat I would add my own observation that there is some qi xu (thin sides) with some excess damp or phlegm retention (thick middle sides). other S & S?? chief complaint?? pulse?? veins underneath?? Of course lighting is everything here... natural light might show a more exact color of the coating. white v/s yellow. definitely heat prickles w.w.w. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2007 Report Share Posted April 1, 2007 Geoff, From what I can see of the tongue is this: - the tongue body itself is more pale pink than red, which is even more evident in contrast to the red prickles of the front - the tounge is enlarged but the sides look thin. The slight swelling between the middle edge and the midline is characterisitic of a liver depression, Qi stagnation becoming chronic. - the horeshoe shape of the tongue tip is characterisitc of a heart blood vacuity. Based on what I can see, I would think that there is some type of mental/ emotional problem that is stemming from a liver depression qi stagnation, heart xu, and some depressive heat. Just my thoughts, Trevor , " G Hudson " <crudo20 wrote: > > I have a question for folks here about a particular patient's tongue. I > have a link to the picture here > <I%20have%20a%20question%20for%20folks%20here%20about%20a%20particular%2\ > 0patient%27s%20tongue.%20%20I%20have%20a%20link%20to%20the%20picture%20a\ > t%20http://www.acupunctureandherbs.com/images/tp.jpg> > > I don't know if it will show up well for you or not, but the > middle-sides off of the center (and between the edge) is very swollen, > which you can just see in the shadow from the mouth. This leads out to > a wide tongue body with thin sides, which you can see at the junction of > the tongue body and lips. The tongue color has varied between > red-purple and red. Care to offer any impressions of the tongue > picture? > > Geoff > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2007 Report Share Posted April 1, 2007 I'm a student, so I'm hardly qualified to comment on the tongue diagnosis, but I came from the imaging field to chinese medicine, so I thought I'd comment on the comment by Dr. Waldrope about the color of the photo. Geoff did a good job capturing a pretty accurate depiction of the tongue. The gray card held by the patient captures the light from the camera strobe, and the camera adjusts the capture time during exposure to obtain an optimum exposure. The yellow color in the background is the overhead light in the room mixing with the light from the strobe; therefore, it looks yellow. When you open the picture in an image editing program like photoshop, you can place the cursor on the gray card and measure the light reflecting from the card. I did this, and the card is remarkably neutral, meaning the photo is a good representation of " natural " light in the area where the color needs to be accurate. Actually, taking the picture outside under most conditions would get an inaccurate result, as the color temperature of outdoor light can have great variance from one minute to the next. Electronic camera flashes were a great invention for accuracy of color reproduction. Steve E. Dr. W. W. Waldrope DOM AP wrote: > Hi, > > Geoff, I checked a relatively obscure Chinese text on tongues > (shiyong zhongyi shezhen > ISBN7-5337-1093-2/R.231) > and found a close but not exact match (most of the illustrations are > " worst case senarios). > The closest match indicates > > 1. exogenous superficial syndrome of wind heat > 2. exogenous wind cold tending to transmit interiorly and transform > into heat > > I would add my own observation that there is some qi xu (thin sides) > with some excess damp or phlegm retention (thick middle sides). > > other S & S?? > chief complaint?? > pulse?? > veins underneath?? > > Of course lighting is everything here... natural light might show a > more exact color of the coating. white v/s yellow. > > definitely heat prickles > > w.w.w. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2007 Report Share Posted April 2, 2007 Thanks all for the comments. Trevor - I've been treating along the same lines, nice analysis of the tongue. Steve - thanks for the comments, yes, that is a 18% gray card for color correctness and I corrected before posting the photo. I am not happy with my gray card since it has light and dark patches when lit by flash (maybe d/t a bumpy surface). I use a lumiquest bounce for light control / lighting. I think the flash helps to provide a constant temperature light source and obliterates color casts of other sources. The walls are green in the room, so that's the normal color. I still don't think the tongue showed up as red as it normally does, but it's interesting to watch the change of the color through the menstrual cycle. Thanks for the reminder of Qi Xu causing thin sides. It's not really common to find these sharply thin sides in my experience. Dr.WWW - +2 distended sublingual veins. MC: dysmenorrhea, Wx Dx endometriosis. My Dx is that she has Liv Qi Zhi c underlying BL Xu - PMS Sx of various sorts, with Full Cold & Blood Yu in the uterus (painful menses d1 & d2 c dk. clots, and Hx of swimming in cold local rivers when camping during her menses). Right before her menses, the tongue really turns red-purple. I have to see if I can time a shot better. Geoff , " Trevor Erikson " <trevor_erikson wrote: > > Geoff, > From what I can see of the tongue is this: > - the tongue body itself is more pale pink than red, which is even more evident in contrast > to the red prickles of the front > - the tounge is enlarged but the sides look thin. The slight swelling between the middle > edge and the midline is characterisitic of a liver depression, Qi stagnation becoming > chronic. > - the horeshoe shape of the tongue tip is characterisitc of a heart blood vacuity. > Based on what I can see, I would think that there is some type of mental/ emotional > problem that is stemming from a liver depression qi stagnation, heart xu, and some > depressive heat. > > Just my thoughts, > Trevor > , " G Hudson " <crudo20@> wrote: > > > > I have a question for folks here about a particular patient's tongue. I > > have a link to the picture here > > <I%20have%20a%20question%20for%20folks%20here%20about%20a%20particular%2\ > > 0patient%27s%20tongue.%20%20I%20have%20a%20link%20to%20the%20picture%20a\ > > t%20http://www.acupunctureandherbs.com/images/tp.jpg> > > > > I don't know if it will show up well for you or not, but the > > middle-sides off of the center (and between the edge) is very swollen, > > which you can just see in the shadow from the mouth. This leads out to > > a wide tongue body with thin sides, which you can see at the junction of > > the tongue body and lips. The tongue color has varied between > > red-purple and red. Care to offer any impressions of the tongue > > picture? > > > > Geoff > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2007 Report Share Posted April 2, 2007 Steve E. Good point about the lighting... Geoff, sounds like your right on the money with dx. Tell her to watch that swimming!! good luck www Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2007 Report Share Posted April 2, 2007 Geoff, The Kodak gray cards tend to appear a little uneven; I would suggest you get a Gretag Macbeth Mini-Color Checker. It's a bit expensive ($65), but it is small (2.5 " x3.5 " ) and easily placed in the photo. It has a six-patch gray scale; just place the gray scale side of the card away from the face. The Macbeth cards patches usually appear more even in a photo. If the tongue doesn't appear as red as it usually does to your perception, that could be the image processing in the camera, or possibly the color temperature of the flash. Another thing is that if you look at the tongues in the green-painted room under room light (which might be incandescent or fluorescent light), your perception of the color may be influenced by the room light. There are some nice small daylight fluorescent lamps being made now that should be an excellent choice for viewing tongues. You can also place daylight fluorescents in the ceiling, but room color will affect perception. I could ramble on for a while, but you get the idea... good job on the photography! Steve G Hudson wrote: > Thanks all for the comments. > > Trevor - I've been treating along the same lines, nice analysis of the > tongue. > > Steve - thanks for the comments, yes, that is a 18% gray card for > color correctness and I corrected before posting the photo. I am not > happy with my gray card since it has light and dark patches when lit > by flash (maybe d/t a bumpy surface). I use a lumiquest bounce for > light control / lighting. I think the flash helps to provide a > constant temperature light source and obliterates color casts of other > sources. The walls are green in the room, so that's the normal color. > I still don't think the tongue showed up as red as it normally does, > but it's interesting to watch the change of the color through the > menstrual cycle. Thanks for the reminder of Qi Xu causing thin sides. > It's not really common to find these sharply thin sides in my > experience. > > Dr.WWW - +2 distended sublingual veins. MC: dysmenorrhea, Wx Dx > endometriosis. My Dx is that she has Liv Qi Zhi c underlying BL Xu - > PMS Sx of various sorts, with Full Cold & Blood Yu in the uterus > (painful menses d1 & d2 c dk. clots, and Hx of swimming in cold local > rivers when camping during her menses). Right before her menses, the > tongue really turns red-purple. I have to see if I can time a shot > better. > > Geoff > > > <%40>, " Trevor Erikson " > <trevor_erikson wrote: > > > > Geoff, > > From what I can see of the tongue is this: > > - the tongue body itself is more pale pink than red, which is even > more evident in contrast > > to the red prickles of the front > > - the tounge is enlarged but the sides look thin. The slight > swelling between the middle > > edge and the midline is characterisitic of a liver depression, Qi > stagnation becoming > > chronic. > > - the horeshoe shape of the tongue tip is characterisitc of a heart > blood vacuity. > > Based on what I can see, I would think that there is some type of > mental/ emotional > > problem that is stemming from a liver depression qi stagnation, > heart xu, and some > > depressive heat. > > > > Just my thoughts, > > Trevor > > > <%40>, " G Hudson " <crudo20@> > wrote: > > > > > > I have a question for folks here about a particular patient's > tongue. I > > > have a link to the picture here > > > > <I%20have%20a%20question%20for%20folks%20here%20about%20a%20particular%2\ > > > > 0patient%27s%20tongue.%20%20I%20have%20a%20link%20to%20the%20picture%20a\ > > > t%20http://www.acupunctureandherbs.com/images/tp.jpg > <http://www.acupunctureandherbs.com/images/tp.jpg>> > > > > > > I don't know if it will show up well for you or not, but the > > > middle-sides off of the center (and between the edge) is very swollen, > > > which you can just see in the shadow from the mouth. This leads > out to > > > a wide tongue body with thin sides, which you can see at the > junction of > > > the tongue body and lips. The tongue color has varied between > > > red-purple and red. Care to offer any impressions of the tongue > > > picture? > > > > > > Geoff > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 On 4/1/07, Steve Edwards <sedwards16 wrote: > > The gray card held by the patient captures the light from the > camera strobe, and the camera adjusts the capture time during exposure > to obtain an optimum exposure. The yellow color in the background is the > overhead light in the room mixing with the light from the strobe; > therefore, it looks yellow. When you open the picture in an image > editing program like photoshop, you can place the cursor on the gray > card and measure the light reflecting from the card. I did this, and the > card is remarkably neutral, meaning the photo is a good representation > of " natural " light in the area where the color needs to be accurate. > I've been playing around with gray cards lately too. A couple of questions: 1) Most cameras have a setting whereby you locate the brightest white in the room, and expose everything else for that tone. I can't quite remember what that's called right now, but I've been using that with so-so results. 2) When importing into Photoshop, I would think that the benefit of the gray card in the image would be to have photoshop alter the RGB to make the gray an 18% in this case. So, if Photoshop measures the gray at 25%, it would globally alter the entire image to make the gray 18% and this would allow for a better representation of the true colors of the tongue as they're actually presenting. I presume that this is what you're suggesting. My question is, how do you do that? I'm looking at the " info " window which measures the RGB, and CMYK values, or I can eyedrop the color and look at it in other formats such as hex and HSB and LAB, but I don't see a specific percentage reading for gray anywhere. Would it be the K in CMYK? -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 Al, Good questions. Here's my answers: <1) Most cameras have a setting whereby you locate the brightest white in the room, and expose everything else for that tone. I can't quite remember what that's called right now, but I've been using that with so-so results.> That's called the white balance. That feature is designed to figure out what is white in a scene. If you take the picture in a room with fluorescent light without changing the white balance (assuming you are not using a flash), any white area in the scene will reflect the color of the fluorescent light, which may be a green color, depending on the type of bulb used. White balance is handy to use in any situation: outdoor light is constantly changing color temperature over a wide range of color. We think of " daylight " in photography as being a color temperature of about 5000° to about 6500° kelvin. Incandescent lights are at about 2800° to 3400° K. Fluorescent bulbs vary widely, and outdoor light can vary over the entire range up to around 19,000° K (VERY blue). So, any time you use the white balance feature, you are adjusting for the particular scene (if you are not using flash). <2) When importing into Photoshop, I would think that the benefit of the gray card in the image would be to have photoshop alter the RGB to make the gray an 18% in this case. So, if Photoshop measures the gray at 25%, it would globally alter the entire image to make the gray 18% and this would allow for a better representation of the true colors of the tongue as they're actually presenting. I presume that this is what you're suggesting. My question is, how do you do that? I'm looking at the " info " window which measures the RGB, and CMYK values, or I can eyedrop the color and look at it in other formats such as hex and HSB and LAB, but I don't see a specific percentage reading for gray anywhere. Would it be the K in CMYK?> If you take Geoff's picture into photoshop and look at the RGB and CMYK values in the Info panel, you will see that the RGB values range about 4 units apart. The CMYK values are in percentages of each color, cyan, magenta or yellow at the location of the picture. If you look at the values for black (K) over the area of the gray card, they should range from about 21 - 25%. Now, cameras expose for 18% gray, meaning that if you take an 18% gray card exposure reading under the conditions of lighting used in a photograph, then use that reading to take the photograph, you will obtain a good exposure (this is a lie when concerning subjects such as snow, which requires about 2-3 stops more exposure to render detail). I took Geoff's photograph and placed the cursor in the middle of the gray card, then read a value of 23% in the K reading. Then I went to the menu bar and selected Image >Adjust >Brightness/Contrast. Then I entered a value of +10 in the Brightness area of the dialog box and clicked " OK " . The info bar K value then read 18%. So, at this point the gray card is a pretty good representation of the original gray card, thus the photograph is a pretty good representation of the original scene. This stuff can get pretty involved, but I'm interested in improving the quality of tongue photographs available to practitioners. The books offered on the subject appear to suffer mostly from bad printing quality (it would cost a fortune to print a real quality tongue atlas). I hope this helps you out. Let me know of any more questions you have. Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 On 4/3/07, Steve Edwards <sedwards16 wrote: > > The info bar K value then read > 18%. So, at this point the gray card is a pretty good representation of > the original gray card, thus the photograph is a pretty good > representation of the original scene. > Gotcha, so use the " K " value (which is for " blacK " ink) as your gray scale. > This stuff can get pretty involved, but I'm interested in improving the > quality of tongue photographs available to practitioners. The books > offered on the subject appear to suffer mostly from bad printing quality > (it would cost a fortune to print a real quality tongue atlas). > Barbara Kirschenbaum has been on this list in the past, not sure if she's reading it now, but her books really provide some excellent images when it comes to the tongues. I do however agree that there is a significant lack of well-reproduced tongue images out there. On the practical portion of my state board exam in California, we were given an image of a face and their tongue. These were reproduced by a color laser printer. I didn't see any color scale and so I didn't assume to know for sure if the tongue was pink or red or whatever. Knowing this, or at least knowing that I didn't know, I focused instead on the thickness of the coating and the shape of the tongue. This allowed me to make some crucial decisions which differentiated the syndromes correctly and answered all the following questions consistent with that one choice not to take the color seriously. I ended up passing the test well ahead of those who made assumptions regarding the color. Just a word to the wise for those taking OM licensing exams in which tongue images are used. If nothing else, the tongue image should include a legend to its side that shows with the same paper and ink, what pale, pink, red, etc. look like on that sheet. Only then would it be possible for someone to make statements regarding its colors. If you don't have that, you may not really know what color the camera saw. -al. -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 Yeah. Use the K value for gray scale adjustment, but I would suggest leaving your file in RGB color space. If you want to work in other color spaces, I would suggest getting a good Photoshop book. Dan Margulies has written several. A practitioner in Ohio who attended my school mentioned that Barbara Kirschenbaum used a good quality setup for her books. I haven't really looked at her books (must do that...), but I have seen some bad representations of tongues. For what it's worth, I think that a DVD database of tongues would be an excellent teaching and reference source. If you have standardized, neutral tongue photos on disk, I think most people would pay the $300-$400 to get a decent flat screen monitor and the freely available images used to set contrast and brightness on monitors. Here's a good site for setting up your monitor - http://www.normankoren.com/makingfineprints1A.html Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 Steve, Great info - thanks for your input. I think it would be a great idea to buy the macbeth color checker for us lay people. I'm a bit geeky, but get lost quickly when people start talking about using color spaces, spider monitor calibrators, printer profiles etc etc. If we can use a standard color reference, then it's easy enough to just make changes as we need for our equipment / possible professional printing or publishing at a later time. > (it would cost a fortune to print a real quality tongue atlas). But - it's amazing what kind of prints they can do out of China these days for so little money. Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 Geoff, The color checker comes in two sizes; 8.5 " x 11 " and the 2.5 " x 3.5 " versions. Just make sure to differentiate when searching for one. Also, the small version has very small patches - both cards have 24 patches, 6 gray scale and 18 color patches. The color information comes with the cards. Also, if you're using a digital SLR with the flash that attaches to the hot shoe, I'd offer the suggestion that you purchase a remote cord for the flash, then hold the flash in your left hand to the left side of the camera - you can capture the lower jiao coating with the flash nearer the lens. Good luck with your tongue photography! Steve G Hudson wrote: > Steve, > Great info - thanks for your input. I think it would be a great idea > to buy the macbeth color checker for us lay people. I'm a bit geeky, > but get lost quickly when people start talking about using color > spaces, spider monitor calibrators, printer profiles etc etc. If we > can use a standard color reference, then it's easy enough to just make > changes as we need for our equipment / possible professional printing > or publishing at a later time. > > > (it would cost a fortune to print a real quality tongue atlas). > > But - it's amazing what kind of prints they can do out of China these > days for so little money. > > Geoff > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 Steve, Al, et al: Sometime in the past we covered photographing tongues. Tom Verhaeghe posted this great list of tips and tricks for better photos. I thought I would bump it along for your enjoyment. Geoff , " Tom Verhaeghe " <verhaeghe_tom wrote: > > > Geoff et al, > > here's the reply I got from my friend (my translation): > > - she likes your pics and sees you also took some with lateral ambient > light. She does not recommend direct sunlight= too harsh. If you use > sunlight, filter it through chalk paper or a very thin curtain > - she noticed some pictures are out of focus. She thinks the main > reason is because people moved, but there are also instances where > other parts of the face are really sharp. Probably because you lost > sharpness using a bigger aperture. > She recommends shooting in aperture priority mode, if possible. Use a > smaller diaphragm, e.g. use 2.8 instead of 8 or 11. This way your > depth of field will increase, making the whole tongue sharp, instead > of only part of it, or only the face. > - if you have flash synchronisation at faster shutter speeds, make use > of it. Try 1/125 and always make sure you have enough depth of field= > small diaphragm > - standardization: she noticed you used a grey card. That's great, but > you let your clients hold them, so you lose any standardization you > might get. Always use a grey card from the same distance and from the > same angle. > She further recommends to have the clients seated against a wall or > head support, so that they won't move. Use a tripod. To make maximum > use of available light, you may use a piece of white cardboard in > which you make a hole so that your camera's lens can peep through it. > The panel will reflect light and brighten shadows. BUT this can also > increase glare on the wet spots on tongue surfaces. Explore. She > thinks the glare you got on your pics is really not too bad. She > reckons it could function as a control for wetness of the tongue. > Always ask people to close their eyes, especially children, when you > flash from such a short distance. Children better cover their eyes, as > this can be dangerous. > She noticed that the colour of the garments clients wear also > influences colour balance to some degree. If you really want to > niggle, you can let the clients wear a light grey scarf, so everyone > will get the same reflex. Even the photographer's clother can > influence the picture... > - you can soften your flash by using chalk paper or professional half > tough spun or full tough spun from LEE filters, or ROSCO (sorry don't > know what these are). Chalk paper may be the easiest, but you will > need stronger light. > - as long as you use a flash, you will get some glare. But, she thinks > it is not too bad... > > Thanks to Kari Decock, the photograper/ acupuncturist for her tips! > She also sends her regards to Geoff... > > Tom. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2007 Report Share Posted April 3, 2007 All, I saw one probable misinterpretation in the post you forwarded: > She recommends shooting in aperture priority mode, if possible. Use a > smaller diaphragm, e.g. use 2.8 instead of 8 or 11. This way your > depth of field will increase, making the whole tongue sharp, instead > of only part of it, or only the face. It's actually the reverse: use aperture priority mode, but use a larger number for the aperture setting. The larger the number, the greater the depth of field in the photograph. This is easily verified experientially. I'm using f/16; the flash just boosts the power to compensate for the smaller aperture. The smaller the aperture number, the larger the aperture. You are getting the softer light by using the lumiquest attachment - many photographers use homemade attachments, but I never understood that; if you've got $3000 worth of camera, lens and flash unit in your hand, why not spend the $25 for the lumiquest? :-) Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2007 Report Share Posted April 4, 2007 Hi Steve, yes, that was my translation mistake while writing- I remember Roger Wicke had also spotted that one at the time. Thanks for the tips, Tom. , Steve Edwards <sedwards16 wrote: > > All, > > I saw one probable misinterpretation in the post you forwarded: > > > She recommends shooting in aperture priority mode, if possible. Use a > > smaller diaphragm, e.g. use 2.8 instead of 8 or 11. This way your > > depth of field will increase, making the whole tongue sharp, instead > > of only part of it, or only the face. > > It's actually the reverse: use aperture priority mode, but use a larger > number for the aperture setting. The larger the number, the greater the > depth of field in the photograph. This is easily verified > experientially. I'm using f/16; the flash just boosts the power to > compensate for the smaller aperture. The smaller the aperture number, > the larger the aperture. > Quote Link to comment Share on other sites More sharing options...
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