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

Hey, I'm so excited to return to continue on the Bone Proportion Measurement with more individual detail diagrams as you wouldn't be able to memorise every part so easily.  

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 6)

The Upper Arm

The length of the upper arm(BPM) in the TCM perspective is taken from the anterior axillary line to the elbow line in a supinated position and is a standard 9 inches throughout.

So it is still read as a standard 9 inches even if measurement is taken from the posterior position but is taken from the posterior axillary line to the tip of the elbow or better known as Olecranon.  (See diagram)

Let's go a little slow in this approach as l have to refer you to my previous blogs on fontanelle and forehead.  The first measurement is:

The Head and Face

1.  to identify the forehead (front) hairline
2.  where the position is 3 inches upward from the midpoint between 2 eye brown.

This is standard reading for all whether it is for male or female.  The reason being there are cases of males with receding front hairline at about 30 years old and females having "widows peak" as early as in their late twenties.  So therefore there must have some reference points and it is so, otherwise, all head acupuncture points would become very messy.

Next, the front hairline runs horizontally until it bends at 2 'corners' on both sides of the face downwards to form the sideburn just in front of the ear.  These 2 first corners are the next reference to be measured.

• The distance measured across the 2 front hairline corners point is standard 9 inches for all (Please see diagram)
• There are other acupuncture points to be drawn from these 9 inches intervals and would discuss them as and when necessary.

Systematically, it runs in a straight line curve around the skull from the midpoint of the front forehead hairline to the midpoint of the posterior hairline measured to be a standard 12 inches for all.

 

The next acupuncture reference point is: 

• Da Zhui 
• Which is 3 inches downwards from the midpoint of the posterior hairline.

Next, I'm going to highlight the Mastoid Fontanelle which forms a very important landmark as well as one acupuncture point after closing.  This is a bony prominence located just inferior to the ear canal at the mastoid area of the temporal bone, called the Mastoid Process.

This is the next required measurement to be taken on the head as it is a standard 9 inches measured across along the posterior hairline.

It can be easily felt when you slide your finger just behind your ear and at the same time just slightly inferior to this conical bone is the sunken hollow which is an acupuncture point that l want you to identify called Wan Gu. 

Glossary

I'll continue on the next blog for the rest of the measurement leaving you time to digest this blog material.

If you are reading my blog for the first time, please remember to subscribe by email address correctly and click 'submit' below so that you wouldn't miss anything I teach here.

There are so many other blogs out there but none teach you why, when and where to use the relevant herbs, only I give the reasons for 3 W; why, when and where.

 Best of all

Xiong Sian 

 ***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 to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics (part five)

Hey, I'm so excited to return to present you with the Bone Proportion Measurement with many diagrams as you wouldn't be able to memorise every part so easily.  

This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics. (part 5)

So in locating the anatomical landmarks on the human body surface, BPM forms a very important subject because this is where the identification of all the previous and newly updated acupuncture points are found and possibly better known as the natural anatomical landmarks. These are then classified into 2 types:  

• Fixed and Movable landmarks.

Fixed landmarks:

It comprises sunken hollow and protrusion formed from the result of the moving muscles layer joining the bone structure.

The rest of the fixed landmarks are position along with the facial organs,  hairline (see diagrams), canthus, tummy button and so on.

Let's have some fun now, please search on your body for these few common acupuncture points: 

• Yang Ling Quan is located at the lower end of the fibular head anteriorly just as you slide your finger down the fibular head and reach the first sunken hollow which is approximately one-inch point from the tip of the fibular head.
• The inch measurement will be explained in the next paragraph.
• San Yin Jiao is located at 3 inches point above the tip of the medial malleolus, just slightly behind the inner rim of the tibia posteriorly, again as you slide across the tibia bone you can find the sunken hollow at the 3 inches point.
• Zan Zhu is located at sunken hollow found on the medial side of the eye brown.
• Tian Shu is located horizontally 2 inches on both sides of the tummy button. (see diagram horizontally)

Movable landmarks:

It comprises all sunken hollows, gaps, wrinkles and tips caused as a result of the movement of the body from every joint, muscle, tendon and skin.  There is some necessary corresponding active posture to be taken up to reveal the required landmarks for acupuncture treatment.

Okay, let's have fun again, you need to look into the mirror to search for these acupuncture points:

• Ting Gong is located at the sunken hollow revealed between the Tragus and the Mandibular joint when the mouth is slightly open up.
• Jia Che is located at the anterior upper mandibular angle and is the protruding point of the masseter muscle during chewing.  Pay particular attention to this acupuncture point because the correct method to reach for the Jia Che is to press into the bulged up muscle to feel for the sunken hollow.
• I just hope that you did not get confused.

The Inch Measurement

This method is the one-inch distance position measurement to be taken according to the size of the patient index and the third finger as shown in the diagram below.  I will limit this reading to 3 inches to be precise in locating the acupuncture point on the human body, that is to take a 3 inches measurement with the distance of 4 fingers lying together(index, middle ,ring and small fingers).

Next, I'll move on to the various part of the human body to dictate the proportional distance which would be more precise in practice.

The Lower Arm

The distance from Chi Ze (elbow line)to Tai Yuan(wrist line) is a standard 12 inches formed by the wrinkle on each end.

So the location of the midpoint is proportioned and so on.

And now it's fun to locate for yourself the acupuncture point called Kon Zui before referring to my diagram below.

I'll continue on the same subject in my next blog as it is academic and need some time to digest.

If you are reading my blog for the first time, please remember to subscribe by email address correctly and click 'submit' below so that you wouldn't miss anything I teach here.

There are so many other blogs out there but none teach you why, when and where to use the relevant herbs, only I give the reasons for 3 W; why, when and where.

I would like to leave you now so that you can have more time to digest this blog.

Best of all

Sian 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 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 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

If you are reading my blog for the first time, please remember to subscribe by email address correctly and click 'submit' below so that you wouldn't miss anything I teach here.

There are so many other blogs out there but none teach you why, when and where to use the relevant herbs, only I give the reasons for 3 W; why, when and where.

Best of all, 

Sian 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 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 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.

If you are reading my blog for the first time, please remember to subscribe by email address correctly and click 'submit' below so that you wouldn't miss anything I teach here.

There are so many other blogs out there but none teach you why, when and where to use the relevant herbs, only I give the reasons for 3 W; why, when and where.

Best of all, 

Sian (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)