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)

How Ying Wei Zhang Fu and Jing Luo 4 Qi blend into the seasonal infections in Pediatric part three

Hey, I'm so excited to come back to continue on part 3 of the previous subject.

So without delay, I'll write up the formula that I promised you for unblocking the Liver Qi stagnation.  

A decoction to relieve Liver Qi stagnation

So whether to use formula (a) or (b) depends on the clinical observation that you had gathered and know why, when and how to use the correct formula effectively.

I'll discuss these 2 formulas later so that you then would realise why is it so important to know the TCM fundamentals.

 Now it's time to show How Ying, Wei, Zhang Fu and Jing Luo 4 Qi blend into the seasonal infections in Pediatric part three step by step.

TCM FUNDAMENTALS

Wind

Has the characteristics of which are: 

• Yang's property. ( propelling and warm turn into heat in nature)
• Moving on swiftly
• Transfers from one to another rapidly
• Changes from heat to fire rapidly (Qi transportation theory)
• Effortlessly inducing liver wind in the TCM perspective

Normally, it would link up to a minimum of 3 types of seasonal virus-like cold with wind and wetness causing Arthralgia in children. The seasonal virus also commonly seen to affect, with the intake of dairy product, the body causing stomach flu ( cough, running nose, vomiting, bloated and diarrhoea.)

This would be the typical first TCM syndrome called:

• (1) Heat wind invades Lung {see attached diagram below}

In the perspective.

Cold 

Has the characteristics of which are:

• Yin's property (cooling down and contract to cause atrophy)
• Easily dominated over Yang Qi, and 
• Consumption of cold food causing further cooling to affect the Lung Qi 
• Result: wheezing sound in the lung leading to cold asthma. (feeling cold, cough, running nose, phlegm light, foamy, tongue coating white)

Cold affecting Spleen Yang directly result in :

• Cold loose stool, colour-- light, smelly, 
• Abdominal pain, 
• (Shen) looks indifferent,
• Urine light and plentiful, not dehydrated, 
• Tongue light colour,
• (rare case= Neonatal scleredema.)

Delay treatment or recovery can lead to speedy transfer to kidneys causing (Shen) becoming indifferent, appearing pale and cold limb.

A cold usually lead to atrophy:

• followed by Blood Stagnation eg premature neonate with Yang Qi deficient, 
• causing Yang Qi unable to warm the dermis layer to the surface
• further lower body temperature 
• weak crying of the baby and hardening of the skin.

This would be the typical second TCM syndrome called:

• (2)Cold wind traps stagnation {see attached diagram}

in the perspective.

Dryness

Has the characteristics of which are:

• Yang's property
• Easily transfer from heat to fire,
• Leads to high fever, coma and convulsion

Means heat turn into fire produce wind = intense wind =move phlegm=intense phlegm =seisure

This would be the typical third TCM syndrome called:

• (3) Lung Dryness and Injured Yin

in the perspective.

Wetness 

Has the characteristics of which are:

• Yin's property (cold and sticky)
• Stagnation usually cause the Spleen to become like-immobilised causing Spleen's Yang to be sluggish and 
• So much so that when wetness is abundant then diarrhoea could be the resultant phenomena.
• When wetness combines with heat and affects the respective meridian, i.e. the usual spleen and stomach, the resultant phenomena =Atrophy.

This would be the typical fourth TCM syndrome called:

• (4) Wetness adds heat grip phlegm

in the perspective.

Heat

Has the characteristics of which are:

Obvious Yang's property

Easily dominate over fluid naturally; heat virus invaded the lung and stomach would cause inflammation along the meridian path and stagnate at the throat causing symptom of early sore throat.

The heat virus usually will penetrate through the mouth to reach the lung would dominate and dry up the fluid and causing preliminary pulmonary failure.  The usual sign would be:

• Dry cough, 
• Little phlegm,
• Sore throat, 
• Tongue red, 
• Tongue coating yellow. 

This would be the typical fifth TCM syndrome called:

• (5) Prolong trap heat causes fire

in the perspective.

Fire

Has the characteristics of which are:

Obvious Yang's property

Finally, all the 6 seasonal viruses would affect the children in such a way that could easily cause in vivo haemorrhage or coma eventually.

Genetic Transfer

So besides the seasonal viruses, genetic illnesses like epilepsies and asthma would affect the growth of the child after birth.  I'll discuss the short labour time of premature baby and the related problems like:

• hyperactive
• 5 lates
• 5 softs,
• dementia,
• stay small syndrome
• congenial foolishness 

in the later blogs as and when necessary in paediatrics.

This would be the typical sixth TCM syndrome called:

• (6) Fire with heat cause inflammation

in the perspective.

I would like to include some glossaries for easy understanding of the terms that I used in the blogs.

A typical chart for the 6 seasonal viruses in the TCM perspective 

Very often, it is from these special classifications that the preliminary diagnosis and treatment are formulated.

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)

How Ying Wei Zhang Fu and Jing Luo 4 Qi blend into the seasonal infections in Pediatric part one

Hey, I'm back to continue on the subject related to Pediatric.  There are a lot more which I'm going to write before link up the 6 kinds of seasonal infections like wind, cold and so on with the child development.  You would be able to digest them bit by bit just like the stages of baby growth discussed in the previous blogs.  

TCM FUNDAMENTALS

.

This is how Ying Wei Zhang Fu and Jing Luo 4 Qi blend into the seasonal infections part one.

So you had learned about Zong Qi, Zhong Qi and Yuan Qi, I would introduce:

• Ying Qi

• Wei Qi

• Zhang Fu Qi

• Jing Luo Qi

in a relationship with Qi deficiency and Stagnation.  I'm going to discuss How Ying, Wei, Zhang Fu and Jing Luo 4 Qi blend into the seasonal infections in Pediatric part one.

4 essential substances are forming the basic material requirement of the human body, namely:

• Essence
• Blood 
• Qi
• Fluid

is also the foundation for all organs and meridians to complete their respective physiological function.  They are the sustainable life-giving materials without which the human body is dead.

Yang's property

Qi is the ever-moving clear nutrient energy in charge of:

• Propelling
• Warming 
• Defending
• Capturing and yet not over spilling

Yin's property

Blood is divided into fluid and plasma cell; both are in liquid form.

So Fluid is termed as the common name for watery substances in the human body.

Both fluid and blood would function to lubricate and nourish the body with clear nutrients.

Therefore 

1. The Growth
2. Development 
3. Mature and Age
4. Sickness and Death 

of the human body are the results of changes in the movement of:

• Qi
• Blood 
• Fluid

in the life cycle.

Last and not least, the Essence is the innate important basic material requirement which has 2 meanings.  In the narrow sense, Essence refers to as the reproductive Essence.

Essence in the broader sense refers to every clear nutrient in the human body and called the Essence Qi.

So far okay for you and am I going too fast?

Qi is the very dynamic energy comprising of vital clear nutrients circulating the human body.  You can imagine Qi is reaching from near to every far end and classified as a momentum of air.  This momentum is vividly displayed as:

• Raise or ascend 
• Lower or descend
• Exit or move out
• Entrance or move in

I quote from the Emperor's Interior Sutra:

{The four phenomena; raise, descend, exit and move in, is found in every organ.}Unquote

The human lively hood in the fundamentals is found on this 4 phenomenon.

Therefore in another word, life will come to an end when this 4 phenomenon stops its function.

So I'll revise with you on Yuan and Zong Qi and blend in the Ying Wei Zhang Fu and Jing Luo 4 Qi to our subject on Paediatrics.

Yuan Qi

is the innate Qi derived from parents and store in the sealed Kidneys.  Primarily, Yuan Qi is in charge of driving the Growth, Development, Warmth and Stimulation of all vital bodily organs and the related physiological function.

So Yuan Qi becomes the driving energy of human life activities.  Therefore:

1. Yuan Qi = abundant = robust body = less prone to sickness
2. Yuan Qi = deficient = weak body = more prone to sickness

Ying Qi

is the nutrient-rich Qi that flows within the pulse together with the blood.  It is formed as a result of digested clear nutrient from the stomach and spleen.  So the primary function of the Ying Qi is continuously producing blood to carry nutrient-rich energy to all parts of the body.  So Qi and blood is one indispensable pair as one body in the TCM perspective.

Wei Qi

is the Qi that flows just exterior or outside of the pulse to defence the body against exterior seasonal infections.

It doesn't conform to the restriction by the pulse tubular structure.  Its primary physiological function is to disperse within the chest abdominal region to warm the organs in the aforesaid region.  The Wei Qi also travel outward to reach the integumental system to regulate moist and lubrication for the skin and hair.

Zong Qi

is derived from Yuan Qi after fresh air being inhaled by the Lung combined with the raised clear nutrients from the digestive effect of the Stomach and Spleen.  So Zong Qi localised in the chest region called Tan Zhong.  I will discuss more on this acupuncture point in later blogs as and when necessary.

So the primary physiological functions of the Zong Qi are:

1) regulate the breathing mechanism

2) energise and regulate the heartbeat.

3) regulate the bodily movement and temperature in the TCM perspective.

The apex of the heart (as the heart lies in situ) is located on the midclavicular line, in the 5th intercostal space (As shown in the picture above) where it serves as a medical indicator for cardiac apex beat.   Abnormal reading will foretell the underlining cardiac disease in the person about the Pericardium.

The Apex is the same point called Xu Li in the TCM perspective where the palpitation of the Xu Li is correlated to the pulse to prognosticate the abundance or total deficit of the Zong Qi.

Zhang Fu Qi

is derived from Yuan Qi to spread out to individual organ (or called Zhang Fu), as a result, we have Spleen Qi, Stomach Qi and so on.

Therefore these organ Qi is depicted as the basic material required to complete the self physiological function of the organ.

Jing Luo (Meridian)Qi

is again derived from Yuan Qi which passes through the meridian path and termed as Jing Qi.  So during acupuncture treatment, the usual observed reaction is the electrifying or heavy effect felt by the patient is referred to as "obtaining the Qi".  This means Qi is activated to reach treatment optimisation.

Am I going too fast and it is the end of part one in this blog?

I will be back soon to continue on the same topic part two.

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)

Physiological Characteristics development of the child in the context of TCM fundamentals

Hey, have I given you enough time to digest and 'absorb' the Yin Yang fundamentals?  These fundamentals are very, very important throughout the Traditional Chinese Medicine applications. The Fundamentals RULE throughout TCM practice worldwide. It's just like any fundamentals lay in any structure, without which, the structure will collapse in no time. There are a lot more which I'm going to write about in TCM theory and you would be able to digest them bit by bit just like the stages of baby growth discussed in the previous blogs.

Physiological Characteristics 

Today, I'm going to continue where I have left out on the Physiological Characteristic development of the child in the context of the TCM fundamentals. There are many ancient classical medical schools of thought advocating this topic in their specific fields.  However, only the most appropriate aces are then picked and categorised into these 2 main groups:

1. The Vibrant and Rapid Development
2. Delicate Organs in the Unfilled Shape

Based on these 2 benchmarks, another 2 relevant theories are formed, namely:

• Pure Yang Theory
• Juvenile Yin and Juvenile Yang Theory

The Real Inner Layer of the Pericardium

The Vibrant and Rapid Development

The choice of these 2 words was enough to make them a metaphor to the rapid growth and development of childhood. We will look at it from the bodily growth perspective point of view:

From 0 to 3 years old

• Weight
• Increase by 3 times
• 
  
• Height
• Increase by 1.5 times
• 
  
• Head Circumference
• Increase by 50% 

These ancient physicians have observed this dynamic changes of every child possessing this vibrant and rapid development characteristic.  So much so they had established the Pure Yang Theory to umbrella this special phenomenon.

A diagram showing the Lung and the Air Sacs

However, by looking into the terminology of Yin Yang fundamentals alone, it doesn't mean that the child possesses only Yang energy with no Yin at all.  (I have to grab you out of this spin to rest and digest).  So the Pure Yang Theory only stipulate this vibrant and rapid development as the fundamentals. That's it.

Delicate Organs in Unfilled Shape

Take a break and pat yourself for well done.  In TCM fundamentals, when we refer to Delicate Organs, there are only 5 Yang organs and 6 Yin organs.  That's it.  The Pericardium is taken out but I would write on how The Pericardium correlates with the Triple Burner in acupuncture treatment in my blogs later.  

It would take at least one to two blogs to complete the explanations on these 2 organs, mainly the Pericardium and the Triple Burner.

Anatomy of the Spleen

Ok, I'm going back to our topic again.  The  'Shape' consists of Body Structure, Fluid and 'Gasification' function(much like industry gasification). And 'Unfilled' refers to the physiological function that needed to be fortified. The observation was done on the child's Unfilled Shape by the ancient physician which formed the fundamentals of Juvenile Yin and Juvenile Yang theory.

The Observation 

From the Neonate to Childhood stage

• The upper body is longer than the lower 
• Generally, Anterior Fontanelle will be closed by 18 months
• Hair thin and yellowish
• Perspire easily during sleep(pores not closed because the overall physiological process is not fortified as yet)
• 
  

A diagram showing the Heart

I hope you can 'absorb' some ideas on the above discussion.  The classification and terminology of both theories are straight forward and super, super easy. 

***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)

Best of all, 

Xiong

The Philosophy of Yin Yang and 5 Elements Theory

Hey everybody, before I can write on the topic of a physiological characteristic of the child, I have to break here to introduce The Philosophy of Yin Yang and 5 Elements Theory to make clear the terminology and classification used through my blogs later on.  So what is the Philosophy of Yin Yang and 5 Elements Theory?   By and large, it is an ancient philosophy of dialectical materialism.  To make it simple, just break up the 3 words; philosophy, dialectical and materialism to each own definition. 

• Philosophy, in short, is the study of science
• Dialectical is the discussion in general 
• Materialism is all the surrounding material

Yin and Yang

The ancient physician used this philosophy to accumulate clinical experiences and formed the fundamentals of the present-day Traditional Chinese Medicine System.

The fundamentals of Yin Yang and 5 Elements are:

• Inter transformation
• Interdependence
• Mutual consumption(mutual roots)

When there is a Yin, there must be a Yang.  So Yin and Yang contains each other; one compliment and supplement each other.

There comes a time when one element has a deficiency or in abundance; each will either supplement or consume the other element, causing pathological conditions.

Yin and Yang Phenomena

The list of Yin and Yang phenomena is extensive, nevertheless, here are the few examples:

Yin 

• Chronic
• Body
• Introvert
• Anatomy
• Medial
• Deficiency

Yang

• Acute
• Head
• Extrovert
• Physiology
• Lateral
• Excess

Yin Organs:

• Lung
• Heart
• Liver
• Spleen
• Kidney
• Pericardium

Yang Organs:

• Large intestine
• Small intestine
• Gallbladder
• Stomach
• Bladder
• Triple burner(san jiao)

Yin and Yang in Balanced Equilibrium 

Yin and Yang Pathology 

When Yang is excessive, it causes heat syndrome and vice verses the reverse takes place.

The same applies to the Yin force.  So the fundamentals of Yin and Yang rule everywhere.

Before I go on to my next blog to write on the child physiological characteristic, I like to quote you some very famous Yin and Yang phenomena that apply to everyone in daily routine.

1. Being and non-being produce each other
2. Difficult and easy complement each other
3. Long and short define each other
4. High and low oppose each other
5. Fore and aft follow each other

***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)

Best of all, 

Xiong

Sensory Motor and Speech Development is directly correlated to the muscle growth and central nervous system

Hey, I'm very sure that this will be the most interesting blog you would like to check against and see the daily change in your baby.  Some parents even think of getting to reach home soonest to enjoy this ever-changing characteristic of the baby.  All these are taking place because the baby is ready to undergo the physiological changes in Sensory-Motor and Speech evolution. Primarily, the Sensory-Motor and Speech development is directly correlated to the muscle growth and central nervous system.

Sensory-Motor Development 

The neonate has 2 kinds of activities:

1. Reflective ( sucking and sipping)
2. Involuntary

We shall see all activities taking place in the order of:

1. From the top(upper) to the bottom(lower)
2. Inconsistency to coordination 
3. Coarse to fine

• 1 month old
• Neonate always stretch the body after each sleep 
• 
  
• 2 month old
• Infant can raise the head on prone position
• 
  
• 3 to 4 month old
• The infant will be able to lift the upper body
• 
  
• 6 month old
• Able to rollover
• 
  
• 7 month old
• The infant can sit upright
• 
  
• 9 month old
• Able to crawl, some even able to hold on to the railing to stand up
• 
  
• 1 year old
• Able to stand upright, can do cruising
• 
  
• 1 1\2 year old
• Able to walk

After this, as the infant progress into the next stage and so on, a movement like climbing the stairs and jumping over will be more powerful, precise and accurate.

Accuracy and Precision

The stages of precisive movement development are reflected in how the child grips an object, like:

• 5 month old
• When the movement of the eye and hand are incoordination, the infant can grasp the object placed in front with one grasp depicting the awareness to grip it
• 
  
• 9 to 10 months old
• Able to use thumb and index finger to take a small object and move it back and forth
• 
  
• 15 months old
• Movement is getting more dexterous and accurate, able to stack blocks
• 
  
• 18 months old
• Can stack 5 to 6 blocks
• 
  
• 2 years old
• Able to stack 6 to 10 blocks
• 
  
• 3 years old
• Able to stack 12 blocks
• 
  

A 5 months old infant raising the upper body trying to grasp object placed in front

Speech Development

The development of speech capability is often a reflection on the level of development of the central nervous system.  Generally, it has to be categorised into 4 stages:

1. Sound Articulation Stage
2. Babbling Stage
3. Monolingual Sentence Stage
4. Idiom Stage 

• Sound Articulation Stage

• The neonate can produce the crying sound only
• 2 months old, can articulate cooing and harmonious vocal sound
• 3 months old can articulate mumbling sound.
• 
  

• Babbling Stage

• 5 to 6 months old can articulate a monotonous syllable
• 7 to 8 months old can articulate repeated polyphony sound like "mama", simultaneously can repeat after adult on single-syllable sound.

• 
  

• Monolingual Sentence Stage

• After 1 year old, a toddler can articulate a daily living single word such as sleep, eat, and go, etc.
• 15 months old, a toddler can read out ownself name.
• 18 months old, a toddler can articulate a single and simple sentence to express oneself feeling.
• 
  

• Idiom Stage

• After 2 years old, a toddler can do simple communication
• 4 to 5 years old, can use complete wordings to express oneself request
• After 7 years old, can be better off in controlling the language and words learnt.

Best of all, 

Xiong

 .

Limelight to the Fontanelles and the Deciduous Teeth because they form the ending transition of the develpoment portion

Hey, I'm back to write on the development transition of the child, I would like to add some Limelight to the Fontanelles and the Deciduous Teeth because they form the ending transition of the development portion.  So there are altogether 6 fontanelles, the 'soft spot' so to speak, noticeable right on top of the baby's head.  And they are positioned as follows:

FONTANELLE 

• Anterior Fontanelle
• The 'soft spot' noticed on the top of the head, diameter about 2.1 cm.
• 
  
• Posterior Fontanelle
• Triangular in shape located at the back of the skull, diameter less than 1cm.
• 
  
• Sphenoid Fontanelle
• One on each side of the skull, position nearest to the temples.
• 
  
• Mastoid Fontanelle
• One on each side of the skull, positioned lower to back of the ear.

Each of these fontanelles has a  very important profile related to 4 acupuncture points located just on top of this closure. (Anterior DU22 and 23; Posterior DU18 and 19) Off course, I will be illustrating how to use it effectively to treat migraine, prolapse, just to name a few in my later blogs. I have paste 4 diagrams below, each showing the position of the individual fontanelle on the skull.

Why are these fontanelles so important?  

Birth

It has to make provision for these bones of the skull to overlap each other so that the baby head can move through the birth canal.

Growth

The fontanelle provides space for brain development during the first two years of baby's life.  Please go to my previous blogs to read more.  

Time taken for closure of these fontanelles are as follows:

• Anterior
• Starts to close from the 6 months up to 2 years old
• 
  
• Posterior
• Part of fontanelle close from  2 to 4 months, (some already closes on birth)
• 
  
• Sphenoid
• By the 6 months 
• 
  
• Mastoid
• By 6 months, complete by 12 to 18 months 
• 
  

Indications or Clues

Normal

Slightly curved inwards

Obvious Sunken

Dehydration due to improper bottled feed, vomiting, diarrhoea or overheated.

Bulging

If slightly raised during crying and goes off when the baby stops crying, it is normal and nothing is wrong.

On the other hand, if the bulging did not subside after the baby stops crying and feeling a little hard, then it could be a sign of health problem.

So all these closure timings are indicators for normal condition.  Anything outside of these timing is indicators for medical conditions.  Your baby needs to see a doctor immediately.  I will write on intracranial pressure, stay small syndrome and congenital foolishness on related topics later on.

 DECIDUOUS AND  PERMANENT TEETH

A child has 2 sets of teeth:

1. Deciduous
2. Permanent

• From 5 to 10 months          
• 4 deciduous teeth
• 
  
• 1 year old
• 8 deciduous teeth
• 
  
• After 1 year old
• 
  
  2 upper and 2 lower molar
• 
  
• 1 1/2 years old 
• Canine erupted
• 
  
• 2 years old
• 2nd molar erupted
• 
  
• 20 to 30 months old
• Completed 20 deciduous teeth
• 
  
• After 6 years old
• Deciduous start to loose and permanent replaced
• 1st permanent molar erupted
• 
  
• After 12 years old 
• 2nd molar erupted
•  
• 12 to 15 years old
• Completed with 28 permanent teeth
• 
  
• 17 to 30 years old(adolescence to adult) 
• 3rd molar may or may not erupt(wisdom tooth)

 Best of all,

Xiong