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


Hey, I'm so excited to return to continue on the Bone Proportion Measurement because you are here to learn it and surely would like to ask for it.  So anyway, I'll prepare the whole meal for easy digestion.

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 7)

 The Chest

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So far, I've discussed the required measurement of the head and forearm which is important for the location of the 3 Yang and 3 Yin meridian paths that spread along there.  
Next, I'll move on to the chest, abdomen and lateral lumbar for this blog.

The first thing is to identify one anatomical point called the Suprasternal Fossa of the human body.  So it is located at the top of the breast bone better known as the chest sword bone,  where it's the exact depression formed between the 2 clavicles.  Everyone should have this anatomical point as it is easy to locate as you slide your finger along the collar bone or the clavicle to the vertical mid-central dividing line of the chest.  However,  it is more practical to use official medical terms;  so the breast bone is called the Sternum.  And it is divided into 3 portions called:

  • The Manubrium (M)
  • The Gladiolus (G)
  • The Xiphoid Process (X)

To make it easier, the manubrium is like the handle of the sword 
The gladiolus is the body of the sword
The xiphoid process is the tip sharp edge of the sword.

And that's all about it.

The ribcage just joins the sternum anteriorly with 12 vertebrae posteriorly and it serves to protect the delicate organs like the lung and heart.  This is also called the thoracic cage.


Measurement between Tian Tu to bifurcation QiGu


So over here, I'm using the acupuncture point as the reference point called Tian Tu**  of the Ren Meridian Channel which connect up all the 6 Yin meridian channels altogether.  It is located just at the edge of the Suprasternal Fossa as illustrated in the picture above.

The next reference point to locate for the measurement is at the tip of the chest sword bone where the Xiphoid Process is attached to the Gladiolus( see diagram).  The word Qi Gu means bifurcation where the soft cartilage of the 7 to 9 rib bones are attached to the sternum at this point.
So the measurement to be taken from this bifurcation midpoint to the acupuncture point called Tian Tu at the edge of the handle of the breast bone is a standard 9 inches across.

As you can see from the diagram above, the next important reading to be taken is the distance between the 2 Nipples horizontally and should be a standard 8 inches across for all sizes. 


The left and right lumbar region for TCM bpm


So far so good,  I have not confused you, haven't you?  I'll touch on the left and right lateral lumbar region for one measurement.
We will find another new reference point called the Apex of the armpit.  And of course, we need a diagram to show where is the Apex of the armpit on the human body.
And so the location is at the small gap or interval between the superior border of the scapula(shoulder blade), the posterior border of the clavicle(collar bone) and the external border of the first rib.


Apex of the armpit



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The Lumbar 

So, I'm going to shift the body laterally to show you where about is the Free end of the floating eleventh rib.  And once again, there must have some diagrams to illustrate the exact position of the acupuncture point, Zhang Men.  This is very clear here and the exact position of the Zhang Men is situated at the slight depression below the tip of the floating rib as shown. 
Next, the required bpm is the distance between the Apex of the Armpit to the acupuncture point, (Zhang Men) which is a standard 12 inches across regardless of size.

There is still further explanation to be carried out and it needs some time for you to digest all the above.
 











 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 six)

Hey, I'm so excited to return to continue on the Bone Proportion Measurement with more individual detail diagrams as you wouldn't be able to memorise every part so easily.  

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 6)

The Upper Arm

The length of the upper arm(BPM) in the TCM perspective is taken from the anterior axillary line to the elbow line in a supinated position and is a standard 9 inches throughout.

So it is still read as a standard 9 inches even if measurement is taken from the posterior position but is taken from the posterior axillary line to the tip of the elbow or better known as Olecranon.  (See diagram)




Let's go a little slow in this approach as l have to refer you to my previous blogs on fontanelle and forehead.  The first measurement is:

The Head and Face

  1.  to identify the forehead (front) hairline
  2.  where the position is 3 inches upward from the midpoint between 2 eye brown.
This is standard reading for all whether it is for male or female.  The reason being there are cases of males with receding front hairline at about 30 years old and females having "widows peak" as early as in their late twenties.  So therefore there must have some reference points and it is so, otherwise, all head acupuncture points would become very messy.
Next, the front hairline runs horizontally until it bends at 2 'corners' on both sides of the face downwards to form the sideburn just in front of the ear.  These 2 first corners are the next reference to be measured.
  • The distance measured across the 2 front hairline corners point is standard 9 inches for all (Please see diagram)
  • There are other acupuncture points to be drawn from these 9 inches intervals and would discuss them as and when necessary.
Systematically, it runs in a straight line curve around the skull from the midpoint of the front forehead hairline to the midpoint of the posterior hairline measured to be a standard 12 inches for all.
 
The next acupuncture reference point is: 
  • Da Zhui 
  • Which is 3 inches downwards from the midpoint of the posterior hairline.
A diagram to illustrate location of Da Zhui

Next, I'm going to highlight the Mastoid Fontanelle which forms a very important landmark as well as one acupuncture point after closing.  This is a bony prominence located just inferior to the ear canal at the mastoid area of the temporal bone, called the Mastoid Process.
This is the next required measurement to be taken on the head as it is a standard 9 inches measured across along the posterior hairline.
It can be easily felt when you slide your finger just behind your ear and at the same time just slightly inferior to this conical bone is the sunken hollow which is an acupuncture point that l want you to identify called Wan Gu. 

A diagram to show the position of the Mastiod Process


Glossary


GLOSSARY


I'll continue on the next blog for the rest of the measurement leaving you time to digest this blog material.

















 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 five)

Hey, I'm so excited to return to present you with the Bone Proportion Measurement with many diagrams as you wouldn't be able to memorise every part so easily.  

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 5)




So in locating the anatomical landmarks on the human body surface, BPM forms a very important subject because this is where the identification of all the previous and newly updated acupuncture points are found and possibly better known as the natural anatomical landmarks. These are then classified into 2 types:  
  • Fixed and Movable landmarks.
Fixed landmarks:

It comprises sunken hollow and protrusion formed from the result of the moving muscles layer joining the bone structure.
The rest of the fixed landmarks are position along with the facial organs,  hairline (see diagrams), canthus, tummy button and so on.
Let's have some fun now, please search on your body for these few common acupuncture points: 
  • Yang Ling Quan is located at the lower end of the fibular head anteriorly just as you slide your finger down the fibular head and reach the first sunken hollow which is approximately one-inch point from the tip of the fibular head.
  • The inch measurement will be explained in the next paragraph.
  • San Yin Jiao is located at 3 inches point above the tip of the medial malleolus, just slightly behind the inner rim of the tibia posteriorly, again as you slide across the tibia bone you can find the sunken hollow at the 3 inches point.
  • Zan Zhu is located at sunken hollow found on the medial side of the eye brown.
  • Tian Shu is located horizontally 2 inches on both sides of the tummy button. (see diagram horizontally)
Movable landmarks:

It comprises all sunken hollows, gaps, wrinkles and tips caused as a result of the movement of the body from every joint, muscle, tendon and skin.  There is some necessary corresponding active posture to be taken up to reveal the required landmarks for acupuncture treatment.
Okay, let's have fun again, you need to look into the mirror to search for these acupuncture points:
  • Ting Gong is located at the sunken hollow revealed between the Tragus and the Mandibular joint when the mouth is slightly open up.
  • Jia Che is located at the anterior upper mandibular angle and is the protruding point of the masseter muscle during chewing.  Pay particular attention to this acupuncture point because the correct method to reach for the Jia Che is to press into the bulged up muscle to feel for the sunken hollow.
  • I just hope that you did not get confused.
The Inch Measurement
This method is the one-inch distance position measurement to be taken according to the size of the patient index and the third finger as shown in the diagram below.  I will limit this reading to 3 inches to be precise in locating the acupuncture point on the human body, that is to take a 3 inches measurement with the distance of 4 fingers lying together(index, middle ,ring and small fingers).




Next, I'll move on to the various part of the human body to dictate the proportional distance which would be more precise in practice.

The Lower Arm

The distance from Chi Ze (elbow line)to Tai Yuan(wrist line) is a standard 12 inches formed by the wrinkle on each end.
So the location of the midpoint is proportioned and so on.
And now it's fun to locate for yourself the acupuncture point called Kon Zui before referring to my diagram below.


Distance between the elbow lone to the wrist line is 12 inches


I'll continue on the same subject in my next blog as it is academic and need some time to digest.


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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