Hey, so today, I'm starting on palpation with all the important points. This is How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics(part 13).
Palpation
Child palpation is much simpler than an adult. This is because of the relationship to the simplicity of the child virus infection due to the lack of 7 emotions that would aggregate the infection in different stages and levels. So it is easier to treat a child infection in comparison to the adult and hence very often our decoction dosage guidance is pegged at smaller quantities to that of the adult dosage. Nevertheless, what are the 7 emotions that would affect the various stages of virus infections in the TCM perspective and they are as follows:
- Happiness
- Anger
- Grief
- Ponder
- Sadness
- Freight
- Fear
All these 7 emotions will be discussed as and when necessary in later blogs. Please refer to the mandarin translation in the glossary below. Specifically, the difference between freight and fear is:
- the former has feelings of shock and surprise,
- the latter comprises feelings of suspicion and apprehension.
Treatment of these 2 emotions is different from the TCM perspective.
Palpating the Pulse rate
Under the normal condition, the rhythm of a healthy child's pulse is very even, softer but faster than the adult with gradual slow down as the age phase in progressively.
Over here, I'm revealing the secret of how the TCM practitioner read the pulse rate during palpation.
The secret is based on the number of counts taken between one normal breathing in and out of the TCM practitioner.
- Neonate to 1 year= 7 to 8 counts or (120 to 140 counts / minute)
- 1 to 3 years old=6 to 7counts or (110 to120 counts/ minute)
- 4 to 7 years old= 6 counts or (110 counts/minute)
- 8 to 13 years old= 5 counts or (90 counts/minute)
- 14 years old= adult's reading (76 to 80counts/minute)
Please flip to my earlier blog on how to palpate the infant to 3 years old and browse through quickly.
So, the technique is about how much pressure is applied on the finger contact area to palpate the pulse rate. By and large, it is divided into 3 levels namely;
- Light
- Moderate
- Heavy(slightly more than moderate)
Practice will make the palpation perfect as you try out with your children and friends. Palpation is not only about the applied pressure, it also includes the consideration of amplitude, length and timing as well. Typically, there are a total of 28 types of pulse rhythmic conditions and constantly updated with discoveries but I'll be discussing only 6 types for children pulse palpation.
These 6 pathological types are:
- Float
- Sunk
- Late
- Fast
- Strong
- Weak
From infant to 13 years old
- Light=exterior or superficial=Float
- Float+strong=superficially extensive, consider as mild yet caused by extensive heat
- Float+weak=superficially deficient, consider as mild due to overall deficiency
- Heavy=interior or deep=Sunk
- Sunk+strong=interiorly extensive, consider as acute caused by extensive heat
- Sunk+weak=interiorly deficient, consider as acute due to an overall deficiency
- 5 counts or less=Late=Cold
- Late+strong=cold caused by extensive stagnation
- Late+weak=cold due to overall deficiency
- 7 counts or more=Fast=Heat
- Fast+strong=extensive Heat
- Fast+weak=Heat due to overall deficiency
There are rare cases of irregular and tight string-like feeling pulse which is outside of our scope today. I'll discuss them as and when necessary.
Palpation of the Head
Under this section, you can only inspect and there is no necessity to feel because we're just inspecting the largest fontanelle which is the anterior fontanelle. There are only 2 possibilities:
- sunken
- slightly protruding
The former indicates dehydration and the latter is found to have vomiting and fever, which indicates possible mild seizure due to Yang wind combined with accommodated heat and fire.
This condition has another TCM terminology called (Gan Feng Nei Dong) and it will appear in many clinical explanations as well as classical books.
Please see the direct translation in the glossary below.
So, once you see the same terminology in any passage, just do the reverse engineering and you would know what is the next step and how to handle it.
Palpation of the Neck and Armpit
Under normal conditions, there are some small soft superficial lymph nodes beside the neck and armpit. The lymph node may get bigger with fever and gets painful if pressed in, the result looks like a skin carbuncle.
If the condition worsens, when the size of the lymph node gets uneven with texture gets harden, forming a pearl-like necklace, is a Scrofula.
Palpation of the Limbs
Under normal conditions, the limbs of the child should be warm.
- So, when the limbs are cold indicate Yang is deficient and if the limbs are jerky, indicate signs of shock.
- Either left or right or both limbs are weak and smaller, with no movement indicates signs of polio.
- On recovery from febrile illness, the limbs tend to be jerky with the stiffen straight body, which is a condition of (Xu Feng Nei Dong) in the TCM perspective. This is the result of depletion of the kidney essence and liver blood, this deficiency has caused the liver to malfunction giving this kind of jerky limbs.
Palpation of the skin and body
Palpating the skin and body is to find out about cold, heat and sweat regulating purposes for the body. Therefore:
- When the body is cold and sweaty=Yang deficiency
- When the body is hot and has no perspiration=sweltering heat
- Palm and sole is hot=Yin deficient and heat accumulated
- The body appears puffy and swollen, depress the puffiness and the depression caused cannot recover after a long time=water retention
- Skin appears to be dry and loose, the usual causes are: Dehydration due to vomiting and diarrhoea.
Palpation of the chest and abdomen
Over here, palpation and observation consecutively to note that the breastbone was deformed to be pushed outward instead of being flush against the chest which is called Pectus Carinatum.
When palpating and press in the deformed backbone that shape like a hunchback which is painless.
This condition is called kyphosis.
All these are due to the deficiency in the Kidney's Qi in supporting the Du meridian channel causing further deficiency in the formation of the early childhood's backbone development in the TCM perspective.
Another important point to palpate is the apex beat or the apical impulse.
Please refer to my earlier blog on apical impulse and browse through quickly.
It is not a good sign if the apical pulse is :
Palpation of the left lumbar region if found to be swollen =spleen enlargement
Palpation of the right lumbar region if found to be swollen= liver enlargement
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)