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


Hey,  I'm back to continue onto the explanation of the limb bone construction and location for the following:

  • The Greater Trochanter
  • The Upper Margin of the Medial Epicondyle of Femur
  • The Line Below the Medial Tibia Condyle
  • Tip of Medial Malleolus
  • Tip of Lateral Malleolus
These 5 locations would suffice to complete the 4 required measurements in the limb's BPM in this blog. 





The Greater Trochanter

So my next reference point to take would be the upper edge of the Greater Trochanter. The most effective way to search for the Greater Trochanter is to flex the leg to see the Greater Trochanter protrudes to the highest point laterally. Once this point is located, there is one popular acupuncture point situated within one and half-inch diameter from this point called Huan Tiao**, which belongs to the Gall Bladder meridian channel commonly used by TCM practitioner to be listed in this blog.  It is a definite good reference point used to locate Huan Tiao Xue.  The remaining 5 locations are related to this and therefore the explanations of the femur and tibia bone are necessary.




Popliteal Line

The next reference point to take note of is the popliteal line or stripe found behind the knee cap posteriorly.  This line is formed as a result of flexing of the femur and tibia bone.   Please see the diagram.  It measures a standard 19 inches from the upper edge or margin of the Greater Trochanter to this popliteal line regardless of size. 

The Tip of Medial Malleolus 

So, what is Malleolus?  It is a bony projection similar to a hammerhead, located on either side of the ankle.  Therefore, the identification of these 2 points is very clear now, the tip of the Medial Malleolus is the lower end protruding edge of the tibia bone which is slightly higher than the tip of the Lateral Malleolus. 

The Tip of Lateral Malleolus

This tip is the distal end of the fibular bone fused with a fibular notch of the tibia bone to form the lateral ankle bone.  
The 2nd required measurement is from the popliteal line to the Tip of the Lateral Malleolus which is standard 16 inches across regardless of size. Please see the diagram.

The Femur

So it is more appropriate to start with the femur bone and its position to identify the position of the Greater Trochanter on the body surface.  This is one small part of the Femur bone forming the lateral side of the upper extremity. 
In other words, the femur bone has 2 extremities, namely:
  1. The Upper Extremity
  2. The Lower Extremity

The Upper Extremity

It contains the femoral head, femur neck and the great trochanter forming the superior epiphysis or the enlarged end part of the shaft. (like plateau)
The femur bone is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia or (shinbone) and patella (kneecap), forming the knee joint

The Lower Extremity

The lower extremity of the femur or distal extremity is the lower end of the fumer bone in human and other animals, closer to the knee. It is larger than the upper extremity of the femur. It is somewhat cuboid in form but its transverse diameter is greater than its anteroposterior.  (Looks like a plateau)

It consists of 2 oblong eminences better known as:

  1. Lateral epicondyle 
  2. Medial epicondyle

Upper Margin of the Medial Epicondyle
 
The main function of the Medial Epicondyle is merely for attachment of the ligament to its rough surface.  However, our interest here is in TCM perspective is to find the reference point below this epicondyle rough surface when you slide your finger over the skin surface to the point just as the bone taper in to form the angle with a straight femur bone shaft.  This is the reference point called the Upper Margin of the Medial Epicondyle of Femur.
The 3rd required measurement is taken from the Upper Edge of the Symphysis Pubis to the Upper Margin of the 
Medial Epicondyle is a standard 18 inches across regardless of size.

The Line below the Medial Tibia Condyle

The Tibia bone together with the Fibular bone form the lower limb.
It also has 2 extremities and provides 2 wide platforms or plateau to facilitate weight-bearing force from the body.
At the upper extremity, as the plateau taper at the angle to join the shaft of the Tibia bone, this angle is marked at the Line below the Medial Tibia Condyle.
The 4th required measurement is taken from this reference point to the Tip of the Medial Malleolus which is a standard 13 inches across regardless of size.  Please refer to the diagram.

That's it and it wraps up all Bone Proportion Measurement required for the human body, right from the head to the ankle bone.  Pat yourself for you had learnt so much now and digested of course.

















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 nine)

 

Hey,  I'm back to continue on the remaining bone proportion measurement for the posterior shoulder blade and the limb.  My discussion in this blog includes the study of the Acromion's position and its surrounding acupuncture points and would be very interesting when you discover them because it is always there unexpectedly missed by most people.

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 9)



Posterior Scapula


So, there are many new acupuncture points to include in this blog for you to slide your finger across, namely
  • Jian Yu 
  • Jian Liao 
just for the time being.    These 2 acupuncture points are easily found and how to locate them will be discussed later with diagrams.  By and large, they are both depressed hollows that would show up automatically when the arms are lifted 90° from the vertical position.  (They will be listed in the glossary in the last paragraph).


Acromion


Acromion


The first landmark to establish is the Acromion which is the high projecting point of the scapula or the shoulder blade.  It is located along the lateral side of the clavicle in which it joins the Acromion to form the Acromioclavicular joint Then the required measurement to be taken is the point at the most lateral highest point slightly away from the Acromion's peak to the posterior midline.  It is a standard 8 inches across for all sizes.  Please see the diagram.


The inner edge of the Scapula


The next required measurement is the distance between the inner edge of the scapula to the posterior midline which is a standard 3 inches across for all sizes.  This reference point is important because there are also many acupuncture points around the region especially in the posterior portion of the heart where patients had complained of long term painful spots.
Let's have some practice here, l will draw an imaginary line down from the 3 inches point to the waist in parallel with the posterior midline.



Gao Huang



Gao Huang


So, we are searching for the acupuncture point called Gao Huang which is located on the imaginary line 3 inches away from the posterior midline in adjacent to the depressed hollow below the 4th thoracic vertebra spinous process.
We have reached the search climate as why is this particular acupuncture point called Gao Huang and not any other name. 
This is the reason.
In ancient times,  Gao was referred to as Ointment paste and the Huang was referred to as the area between the heart and the diaphragm, and the ointment paste was applied to this place where it was not effective.
Next, there is another appropriate Chinese proverb that links with this Gao Huang which is:
Bing Ru Gao Huang. ( explained in the glossary)
It means that the disease has escalated to such critical condition that it has became incurable.  It also means that things have reached the point of irreversibility.
All terminally sick is classified in the same description as above.


Spinous process


Over here, l need to introduce one new part called the Spinous process.
The spinous process is a bony projection off the posterior (back) of each vertebra. And as you slide your finger over the vertebrae, you should be able to feel the difference in the spacing as each vertebra are not equal in size.  I'll provide the diagram to illustrate the size of the vertebrae(33 of them). 
This is the feel of the bony protrusion when you slide your finger along the backbone and the depressed hollow is just below each protrusion.


Spinous process


The Limb


The Limb comprises a vast understanding of the limb bone construction and location for the following:
 
  1. The upper margin of the Epicondyle of Femur
  2. The Line Below the Medial Tibia Condyle
  3. The Greater Trochanter
I'll discuss these in the next blog and giving you more time to digest the above.


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 eight)

Hey,  how can l leave my blog without telling what is the meaning of those phrases and medical terms that l mentioned previously?    So without delay now, I'll put up the glossary and is very excited to continue with part 8 of the same topic on BPM.

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Pajolpation in Paediatrics. (part 8)



The  Abdomen

In the previous blog, I've discussed the bifurcation midpoint and now it is time to take the next measurement which is the distance from this midpoint to the tummy button.  It is a standard 8 inches across for all size which is the border of the diaphragm to the tummy button(transverse colon and small intestine posteriorly) in the TCM perspective.  Please see the diagram.  It's a little different from the (XU)which is the Xiphoid centre of umbilicus distance in western medical terminology.


Xiphoid centre of umbilicus distance


There is also one other acupuncture point already discussed previously called the Zhang Men found at depression below the tip of the 11th floating rib.  So Zhang Men is the 'mu' acupuncture point of the spleen meridian channel.  Indeed, there are lots of explanation to be done in regards to (MU) acupuncture point and will be discussed as and when necessary.  It's imperative and interesting now to indicate the areas of explanation to take note of.  Therefore the (Mu xue) acupuncture point evolved from a group of classification as follow:

  1. Yuan xue
  2. Luo xue
  3. Qie xue
  4. Mu xue
  5. Yu xue
  6. 8  Meridian Channels Intersection xue

So, the emphasis here is to show how effective the (Mu xue) point established in the whole spleen meridian channel functioning as the solicitation and collection centre for all Zhang Fu Qi coming from the 12 YinYang organs to intersect with each other.  This is important because it's here that TCM practitioner can fully display the role performance by boosting the deficiency or vice versa.( To apply the appropriate Acupuncture, of course)  I'll list the terminology in the glossary at the end of this blog so that preliminary understanding can be digested by you.

So far so good and should be easy to digest this round.

The next measurement to be taken is the distance between the Tummy Button to the Upper Edge of the Symphysis Pubis.  Does it sound familiar to you?

You can refer to my older blogs in the previous months and it should be a good revision so that all the TCM fundamentals will pop up in front of you.

Therefore the distance between these 2 points is a standard 5 inches across regardless of all size. (See diagram)

And that warps all the required measurement necessary for bpm in the abdomen.

The Glossary


Glossary 2























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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