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How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics. (part 4)

 

Hey, I'm back to start on one new special technique only used by TCM practitioner. This is the little vein-like fingerprint show up only upon rubbing over the infant's index finger.  This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 4)


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

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:
  1. physiological--differences between pupils are usually less than 1mm, so no harm and no medical attention is needed
  2. mechanical-- usually due to injuries and need medical attention
  3. 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:
  1. 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.
  2. of the stool after breastfeeding is golden with a sour smell
  3. 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.

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


Hey, I'm back to write on a new topic in Pediatric, ie the 4 basic methods of TCM diagnosis:

which is slightly different from the way in treating an adult.
This would be interesting and should break the monotony of the hardcore TCM fundamentals implantation.


5 Facial Portions presenting 5 Organs



First and foremost, we need to divide the face of the child into 5 portions, namely: 
5 portions representing 5 organs

OBSERVATION


In short, the Observations include:

 
So if the Shen is favourable, even though the baby is sick, the recovery is good and easy. On the contrary, it means seriousness in the illness.  So it's very important.


Next, the Observation  would be enhanced by the 5 colours discrimination as shown here:

White or Pale

If the face show white colour or pale would have the following indications:

Next, if the face showed pale and puffy indicate Yang Deficient and water retention.  This is water from Yin in the TCM perspective.
If the face show pale with cold limbs indicate Yang Qi is leaving the body and need immediate attention.

A pale face coupled with pale lips would indicate blood deficient as seen in  Anaemia.


If the face show red colour would have the following indications:

1) Heat

So if the face shows a red colour:
- Coupled with red ears, sore throat indicates heaty wind flu.
- Especially so in the afternoon with red lips indicates Yin Deficient with trap heat causing your sore throat.
- Turn pale with cold limbs and cold sweat indicate Yang Deficiency with Yang coming to an end, omens life-ending.
- Turn pale and with glossy surface indicates having vomit and diarrhoea


The 4 TCM diagnostic methods

Yellow


If the face show yellow colour would have the following indications:
The usual pathological state is:

-Dull yellow colour coupled with the skinny physique indicates weak TCM spleen-stomach physiological function usually seen in case of malnutrition.
-Face and eye showing bright yellow indicates internal accumulation of heat and wetness better known as Yang yellow.

-Face and eye showing very dull yellow colour indicate stagnation of cold and wetness better known as Yin Yellow.

Yang Yellow and Yin Yellow are 2 terms commonly used in Pediatric TCM treatment as I'll discuss more in the later blogs.

Green

 
If the face show green colour would have the following indications:
-Face showing greenish-white and frowning usually indicates abdominal pain with cold.
-The face would show a dull green colour, the child becomes unconscious or with seizures usually happen just before shock and epilepsy.
-Face show green with purple lips coupled with shortness of breath indicates a blockage in the Lung because of Qi and blood stagnation.

Black


If the face show black colour would have the following indications: 
3 variations:

-When the face shows a greenish-black colour with cold limbs indicates Cold intensify in the Yin.
-When the face shows a dull black colour with abdominal pain and vomiting indicates possible food poisoning or wrong drug administration.
-When the face shows a dull greenish-black colour indicates the failure of Kidney Qi meaning it needs immediate medical attention in the TCM perspective.


So after discriminating the 5 colours differentiation above, I'll go onto the facial divided portions to narrow down to the correct diagnosis and off course the treatment later on.
So without delay, the first portion is:

The left cheek represents the Liver,
  • Sit on the East and depicting slightly greenish in the Springtime.
  • If turn into dark green indicates illness.
  • On the contrary, slightly whitish is fine.

The right Cheek represent the Lung,
  • Sit on the West and depicting slightly whitish in the Autumntime.
  • If turn into pure white indicate illness. 
  • On the contrary, slightly red is fine

The forehead represents the Heart,
  • Sit on the South and depicting slightly red in the summertime.
  • If turn into pure red indicate illness.
  • On the contrary, slightly black is fine.

The nose represents the Spleen,
  • Sit on the Central and depicting slightly yellowish as regular
  • If turn into dark yellow indicate illness
  • On the contrary, slightly greenish is fine

The Chin represents the TCM kidneys
  • Sit on the North and depicting slightly black as regular
  • If turn into dark black indicate illness
  • On the contrary, slightly yellowish is fine.









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 link the TCM Fundamentals of the 6th Yin Organ - The Pericardium with the Integumentary System as well as the San Jiao(triple burner)


    Hey, I've come to the closing of the TCM fundamentals with you just for one last organ:

    3 layers of the Pericardium


    It's this Pericardium which links up with the San Jiao both in term of the inter-organ backup exterior-interiorly and also by way of Meridian path links up between the 2 organs.  The former is real and positioned close to the Heart and the latter is imaginary largest Yang organ making use of the 11 Yin Yang organs to complete the physiological functions from the facial organs to the abdominal orifices at the Urethra end and the Anus. 

    The only shortcoming of the 2 organs is:

    • their respective Meridian Paths and 
    • Points are found along the arm and head.  

    However, the 12 meridians paths link up with each other throughout the human body.  There are many reviews on the San Jiao but real philosophy is the innate Qi that passes through the organs very much like link-up of all the paths together which is so in reality.  The stress is the application of the San Jiao or the triple burner is realised when the appropriate understanding of the fundamentals blends in with the related Meridian knowledge to save the sick which is the basic instinct of every medical physician.  So if acupuncture application using the correct meridian path can do something on the terminal sickness, why are there still hesitation or forbidden to use it especially in the hospital.

    I have seen patients claiming that their cancerous growth cannot be treated any longer using western drugs.  So after 6 months of my applied treatment, I had reduced and shrank the lump to reasonable small in size that doctor would say no medicine is needed as the growth is under control.

    So the application of TCM with the correct Fundamentals is very important and I should divert back to our topic to feed you with more foundation today.

    I will discuss more on treatment as and when we move in the various pathological studies.

    I'm going to show you How to link the TCM Fundamentals of the 6th Yin Organ - The Pericardium with the Integumentary System as well as the San Jiao(triple burner)

    TCM FUNDAMENTALS

    The pericardium is the membranous capsule that covers and protect the heart. It's the 6th Yin Organ which also would comply with the Yin Organs fundamental as:

    • Store without leakage or spillover(Storage)**
    • Filled and never congested**
    There are 2 layers of pericardium, namely the
    The fibrous layer is a very tough layer of fibrous tissue that sticks together with serous layer creating the limited scalability within the heart. The serous layer is then further divided into 2 layers called the
    So together they anchor the heart into position.

    There is one important gap or cavity that lies between the parietal and epicardium which is filled with a specific quantity of fluid called the pericardial fluid.**  It is this fluid within the sealed cavity which will lubricate the movement, reducing friction on the heart surface as well as the prevention of over-distension of the heart.
    In this way, it would maintain the quantity of blood contained at a specific constant under normal condition.

    The problem associated with pericardium is always link with the heart and treatment is related to fortifying the heart Yin and Yang:*

    Due to the scalability of the fibrous layer is very small,
    so when the pericardial fluid is abnormally increased, it is not possible for the heart to expand exterior and as a result, 
    This would lead to symptoms like:
    The necessary medical procedure must be taken to reduce the pericardial fluid.

    *Reference to my blog on the heart











     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 link the 6th Yang Organ-The San Jiao to the Yin Organs

     

    Hey, I am back to the pageant of How to link the 6th Yang Organ-The San Jiao to the Yin Organs.  As I mentioned in the previous blogs, the best correlated Yin organ match for the imaginary organ, San Jiao, is the Pericardium  However, 

    • what is San Jiao means and very importantly 
    • how does San Jiao come into being
    • where and
    • when

    does the San Jiao commence or be generated?  These answers would provide you with a better understanding of what is San Jiao all about.



    A picture to show the acupuncture point of the San Jiao

    TCM FUNDAMENTALS

    1) Clear Passage for Smooth Sailing of the Yang Qi

    The San Jiao is the ambassador of the Yuan or Yang Qi which is the clear energy as a result of digestion from Yang Ming and Tai Yin. This Yuan Qi will have to pass through the 6 Yin organs and the 5 Yang Organs to complete the physiological function in these organs in its voyage. 
    Due to this long voyage, this Yuan Qi is renamed as:
    • Zong Qi, in the upper voyage 
    • Zhong Qi, in the mid-voyage
    • Yuan Qi, in the lower voyage
    So it means this ambassador, the San Jiao, enable the free flow of this innate Yuan Qi in the 11 Yin Yang Organs including the chest and abdominal cavities resembling the tubular characteristics.  Finally, it forms the 6th Yang organ which is the largest among the rest.

    2) Dredge and Unblock the Water Path

    I quote from the  Emperor's Interior Sutra:

    The San Jiao is {the officer in charge of opening the water dam to irrigate the water path and ensure the smooth passage of the water flow}  Unquote.

    The San Jiao regulates the in vivo water metabolism from the upper stream to the gasification from the mid and lower stream.  It makes use of all functions of the related organs to ensure no excessive water absorption or abnormal water retention in the tissueIt doesn't store and passes on the function to the next organ.

    The San Jiao, the largest Yang organ is divided into 3 portions, namely: 

    Upper portion comprising Yin and Yang organs from the diaphragm upwards to the facial organs: 

    • Heart  
    • Lung

    Mid portion starts from the diaphragm to the tummy button comprising of:

    • Spleen
    • Stomach and 
    • Gall Bladder

    Lower portion starts from the tummy button to the 2 lower orifices; the Urethra end and Anus, comprising Yin Yang organs such as:

    • Liver  (categorised here because of a closed relationship with the kidneys in the TCM perspective)
    • Kidneys 
    • Small intestine 
    • Large Intestine
    • Bladder 
    • Reproductive organs

    3) Transportation of Nutrients

    The San Jiao transports the clear nutrients from 
    • the upper portion to assist in the nourishment of the various vital functions of the human body such as the integumentary system
    • Aids in administrating the digestion process and excretion of the turbidity in the mid and lower portion.


    The San Jiao complies strictly to the:

    • tubular configuration and 
    • TCM Fundamentals
    Therefore the San Jiao is the 6th largest Yang Organ and back up the Pericardium exterior-interiorly.








    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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