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:
- physiological--differences between pupils are usually less than 1mm, so no harm and no medical attention is needed
- mechanical-- usually due to injuries and need medical attention
- 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:
- 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.
- of the stool after breastfeeding is golden with a sour smell
- 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.
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)