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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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