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How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics. (part 4)

 

Hey, I'm back to start on one new special technique only used by TCM practitioner. This is the little vein-like fingerprint show up only upon rubbing over the infant's index finger.  This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 4)


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How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics (part three)

Hey, I'm back to continue on the subject of How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 3)

There are so much to elaborate in the tongue observation and I'll discuss these again in my later blogs as and when necessary.
So without delay, I'll move on to the other orifices such as the eye and the rest.

The Eye Observation


The first and foremost observation of the eyes is the changes in the 'shen' of the eye.
The healthy child should have dark, round and large iris and pupil as one. Both eyes must be equal or similar in observation. The iris is the muscles that control the dilation and constriction of the pupil's size in different light conditions. The look of the eye of the healthy child must be vigorous.*
This vigorous look is the reflection of abundance in Qi and Blood from the Liver and Kidneys in the TCM perspective.
On the contrary,  the observed look can be dull with:
  •  even close the eye to avoid seeing the thing around
  •  anisocoria(having one dilated pupil and other constricted) will break into:
  1. physiological--differences between pupils are usually less than 1mm, so no harm and no medical attention is needed
  2. mechanical-- usually due to injuries and need medical attention
  3. Pathological -- need medical attention
Since the Essence and Qi from the 5 Yin organs are all reflected in the eye, so the observation will include checking on the:
  • The sclera which is the white portion of the eyeball
  • Inner and outer canthi which are the corner of the eye where the upper and lower eyelids meet.
  • Changes in pupil size.
  • The upper and lower eyelids

Anterior Eye Anatomy


The Mouth Observation

This observation includes the following 3 main points:
  • 1) changes in the colour of the lips and gums too
  • 2) changes in the lubrication of mouthparts
  • 3) changes in the external appearance of the mouthparts
I had discussed many points in my previous blogs on the mouthparts and so I'll just add the new relevant points such as:
Cherry red lips indicate acute diarrhoea and inevitably deplete the Yin in the TCM perspective.
The gum is also part and parcel of the stomach grouping and so the inflammation swelling is due to the accumulated fire rises to the gum from the stomach.
The late eruption of the infant's teeth indicates a deficiency in the Kidney's Qi.

The Nose Observation

This should be easy as the classification is pegged at what is the colour of the nasal mucus that was excreted:
  • Light and transparent mucus indicates flu due to cold and wind
  • Thick and yellowish mucus indicates flu due to heat and wind.

The Ear Observation

The observation of the ear appearance would determine the weakness or strength in the child physiological development.
The premature baby usually has the ear closely stick to the side of the skull.  Depending on the number of days prematurely born, the outer appearance of the ear is incomplete and inconspicuous.
The appearance of a greenish-purple vein behind the ear and a cool feeling at the top edge of the ear with a tearful eye indicate the onset of measles.
If there is upward swollen from the earlobe indicates the onset of cheek slap or mumps.

Boy's reproductive organ

Observe the child's scrotum appearance, should not look tighten or loosen, depicts abundance in Kidney's Qi.
On the contrary, if it appears to loosen, indicates heat is intensified within or generalised as an overall deficiency.
If the scrotum swells and subsides with intensified swelling during crying is a sign of a hernia.
If both the scrotum and penis also swells at the same time, indicates mild oedema due to inflammation of the Kidneys in the TCM perspectives.

Girl's urinary organs

If the observation of the external vaginal area is slightly red and wet, indicates wetness with heat intensified at (Xia jiao) the lower abdomepn.
If the observation is inconsistent wetness and itchy, check for pinworm infections.
Check for bloodstain in the daily stool, if yes, indicates possible Anal Fissure.
A very rare case of rectal prolapse is a clear case of deficiency in Zhong Qi.

Urine and Defecation Observation

The infant should have soft and paste stool up to one year old depending on how early the infant can consume semi-solid food.
So the child should have a mixture of nice-looking yellowish solid stool.
If the stool:
  • is hardened then indicates interior heat intensified with Yin deficiency.
  • has some white patches indicates dairy indigestion.
  • is thin, yellowish and smelly indicates wetness stagnated with heat.
  • has a trace of indigested food indicates a deficiency in Spleen and Kidney in the TCM perspective and should go along with usual diarrhoea.
  • has a trace of blood and mucus that looks like a currant jelly with occasional irritated crying indicates a possible Intussusception
The colour:
  1. of the Meconium which is the greenish tar-substance or sometimes turned into reddish-brown treated as the infant's first few bowel movements, released after birth or in the amniotic fluid.  It is sticky and no smell.
  2. of the stool after breastfeeding is golden with a sour smell
  3. of the stool after cow milk feeding is yellowish-white and form a more solid-state
The normal colour of the child's urine is light yellowish.
It turns yellowish due to perspiration in the summer is normal.

Pathological colours are:
  • Reddish-yellow or even slightly milky with less quantity and little painful indicates wetness with heat intensified in the lower abdomen.
  • Reddish-brown is called gross Hematuria, only Hematuria means the blood in the urine can be seen under a microscope.
  • Either case has to be check by a doctor to find out the causes.
  • Yellow and yellow stain can not be removed easily indicates jaundice.

A glossary
A glossary






Best of all, 







Xiong



 





















 ***Reference:

Emperor's Interior Sutra is available on sales better known as the esoteric scripture of the yellow emperor in Amazon, it's just a different way of naming the book cover)
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How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics (part two)

  

Hey, I'm back to continue on the subject of How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics.(part 2)

3 main types of Observations

So without delay, there are 3 main types of Observations besides all those discussed in part one:

  • 1) observe the physical body and integumentary system
  • 2) observe the bodily movement 
  • 3) examine the various Orifices that I've discussed so far. (all are implanted in the TCM Fundamentals)
Observe the Physical Body and Integumentary System

Areas that are needed to observe by sequence:

  • 1) The main Fontanelles especially the Anterior Fontanelle
  • 2) The Head and Body
  • 3) The Limbs
  • 4) The Integumentary System

A healthy baby classification in TCM perspective:
  • For the baby, the 'Shen' must be lively and vivacious.
  • A smooth and firm complexion 
  • Hair dark and shiny
  • Follow the normal development milestone as discussed earlier
Although I did mention that all babies will catch up sooner or later but that makes the world go round isn't it?
Not all babies are the same and proving the earth is round.

On the contrary, if these negative observations are seen:
  • 'Shen' is sluggish
  • Loose and puffy or dry complexion
  • Late closure of the Fontanelle
  • Big skull but tapered chin, eyeball sagging
Need medical attention.

Common observations are:
  • Sunken anterior Fontanelle indicates dehydration
  • Loose and dark yellowish complexion indicates stagnated indigestion
  • Lost of hair indicates a deficiency in Qi and blood
  • Slight corrugated or purple colour nail indicates heart Yang deficiency causing Qi and Blood stagnation
Observe the Bodily Movement

The child sleeping behaviour and pattern depict the following: 

Sign of acute heat
  • Can turn side to side on the child's free will
  • More usual than not, face the sunny bright side 
Sign of cold and overall deficiency especially in Yang
  • Lazy to turn to the side
  • More usual than not, face the darker side 
  • 'Shen' appears to be a sluggish 
Sign of dryness and heat
  • More usual than not sleep on back lying position and stretchy
  • Remove clothing and blankets during the sleep
Sign of pneumoniatic cough
  • Nasal flaring during the cough with the depressed chest( can see the rib cage)

Nasal Flaring

Examine the various Orifices

  • 1) The Tongue foretells everything about the heart
  • 2) The Eyes indicates the condition of the liver
  • 3) The Nose foretells about the condition of the lung
  • 4) The Mouth foretells the condition of the spleen
  • 5) The Ears, urinary organ and anus foretell the Kidney's condition

A clear explanation about the various orifices on the above aforesaid paragraphs are found in the reference***:  Emperor's Interior Sutra.

The Tongue
The normal condition of the tongue is moist, light red with flexible movement, indicating the physiological function of the heart is normal.  Therefore:
  • When heat from the heart so to speak in the TCM perspective affecting the lung's Yin rise along the meridian path would cause a sore throat, lips ulcer and Red tongue.
  • When there is a diagnosed blood stagnation, the obvious colour of the tongue would be purple and black spots found on the tongue.
  • When the heart's Yang is deficient, the tongue would appear fat and pale.
  • When the heart's Yin is deficient, the tongue would appear skinny and depicts a very obvious dull red colour.
So in the TCM clinical observation, there are 3 usual classifications of the tongue:
  • 1) the tongue appearance 
  • 2) the colour
  • 3) the tongue coating
Tongue Appearance(in the TCM perspective)
  • 1) Teeth imprint on the side of the fat tongue indicate Spleen-kidneys Yang deficiency or wetness with phlegm and water retention
  • 2) Swollen and greenish-purple indicate Qi and blood stagnation
  • 3) Fat and bloated with a cracked coating imprint indicates Qi and Blood deficiency
  • 4) Stiffened tongue indicate intensified heat causing dehydration, would aggravate further when its length shortening, coupled with Dry and dull red indicates acute heat further intensified 
  • 5) 'Wooden tongue' indicates swollen tongue to the extent blocking the entrant of the mouth and turning of the tongue is almost impossible due to the intense heat from the spleen and heart rise along the meridian path to the tongue.
  • 6) Swollen tongue to the extent of tiny protruded tissue called a double tongue indicates fire intensified from the spleen and heart risen to cause it.
  • 7) Tongue unable to tuck out through the mouth, unable to turn or twist tongue and articulation is not clear indicates tongue frenulum too short, in other words, tongue tie.
  • 8) On the contrary, the tongue sticking out of the mouth and unable to retract, usually occurs to people recovering from a major illness or is a sign of the down syndrome
  • 9) Involuntary sticking out of the tongue and retract slowly, indicates the heat begin to intensify in the heart meridian 

The Colour (in the TCM perspective)
  • The normal colour of the tongue: lightly red
  • Turn to lightly pale indicates deficiency in Qi and Blood
  • Turn to dull red with red 'thorn' indicate a virus infection has invaded into the 3rd and 4th level which is the yin and blood level out of (1st level= wei,2nd level=Qi, 3rd level=yin, 4th level=blood) in the TCM perspective
  • Red tongue with a thin coating or no coating indicates yin deficient with fire intensified.  ( see diagram on these 4 levels)
  • Turn to dark Purple indicates Qi and Blood stagnation
  • Turn dark red with large red 'thorns' indicate the infection of German measles and related infections.

4 levels of wei qi ying xue virus infections
4 level of TCM virus infections

 The Tongue Coating
White indicates cold:
  •  ----coupled with greasy dull or shine indicates:
  • a) wetness grasp and stagnate with this 'cold' infection
  • b) phlegm grasp and stagnate with this 'cold' infection
  • c) indigestion 
  • -----coupled with an appearance like peeling moss indicates yin has dehydration 
  • -----peeling moss looks like a world map indicates stomach Qi yin deficiency
  • -----coupled with thick greasy coating indicates constipation or stagnant indigestion

Yellow indicates heat 
Coupled with any of them:
  • 1) greasy dull or shiny
  • 2) wetness
  • 3) phlegm
  • 4) peeling moss look
  • 5) thick greasy coating
Indicate the next level of virus infection, more severe and intensified in the TCM perspective.









Best of all, 









Xiong




















 

























 ***Reference:

Emperor's Interior Sutra is available on sales better known as the esoteric scripture of the yellow emperor in Amazon, it's just a different way of naming the book cover)

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