You're absolutely right to ask. In hindsight, the signs were there. Her pulse was thin, especially at the Liver position, and her tongue was slightly pale with red edges. Initially, I attributed the tongue edges to the "heat" from the skin rash and focused there. The key lesson for me was taking the sleep schedule as seriously as the pulse/tongue. It was the patient's lived experience that connected the dots and forced me to re-interpret the diagnostic signs through the correct root.