Diagnosis is a way to differentiate syndromes and diseases through the information collected from various means of diagnosis. Since the infants are unable to express themselves, physiologically and pathologically different from adults and often crying during the diagnosis,the pulse conditions will certainly be affected, making it difficult to diagnose. Thus the doctors of all dynasties emphasized much the inspection in the four diagnostic methods, i. e. inspection, olfaction and auscultation, inquiry, pulse taking and palpation. The inspection is usually done in combination with the other three. The pediatricians should master the use of these four diagnostic methods in pediatrics well, including diagnostic methods and the pathological significance of the unusual syndromes.
Observation of vitality
Vitality is a general term for life activities. In the infants, abundance of the spirit, vigorous vitality, vivacious expressions, ruddy complexion, bright eyes, even respiration and quick movements, usually indicate sufficiency of visceral qi, harmony between qi and blood and good health. With such manifestations of the spirit, even if there is a disease, the disease is usually superficial and easier to cure with favorable prognosis. The manifestations of dispiritedness, dull expression, silence, somnolence or dysphoria, dull eyes, uneven respiration and inflexible movement of the limbs are all indicating seriousness of the pathological conditions or unfavorable prognosis.
Observation of the complexion
Normal complexion of the infants, regardless of the colour of the skin, is ruddy and lustrous, indicates harmony between qi and blood and health. The normal complexion of the neonatal babies is usually tender and ruddy. Under morbid conditions, the complexion of the infants also changes along with the nature of the disease.
Inspection in pediatrics includes observation of vitality, facial expression, physical build, orifices, macular eruption, urination, defecation and superficial venule of the index finger.
Whitish complexion mostly indicates cold and asthenic syndromes due to stagnation of cold in the vessels, inactivation of qi and blood as well as asthenia of the vessels and meridians. At the early stage of exogenous diseases, the manifestations of pale complexion, cold limbs, anhidrosis and floating-tense pulse indicate the superficial cold syndrome due to the attack by exogenous cold. Sudden pale complexion accompanied by cold limbs, profuse sweating and indistinct pulse indicate the critical condition of sudden loss of yang-qi. Pale complexion, lips and nails usually indicate blood asthenia, and pale complexion often signifies the overflow of water due to asthenia of yang.
Yellowish complexion indicates asthenia and dampness syndromes due to failure of the asthenic spleen to transform dampness and fluid or damp heat steaming the liver and gallbladder. The sallow complexion accompanied by emaciation, poor appetite and abdominal distension of ten signifies asthenia of the spleen and stomach qi: bright yellowish complexion and eyes often indicates yang jaundice due to the steaming of damp heat: yellowish and dull complexion usually indicates yin jaundice due to the stagnation of cold damp.
Reeddish complexion mostly indicates heat syndromes. With the promotion of heat, more blood flows to the face.That is why the complexion is reddish. Reddish complexion and red eyes, tumescent throat and floating-rapid pulse usually signify exogenous wind-heat syndrome. While reddish complexion accompanied by high fever, thirst and brownish urine often indicates excessive internal heat. Reddish cheeks in the afternoon accompanied by tidal fever and night sweating are the signs of internal heat due to yin asthenia, while bright reddish cheeks of the infants with serious disease accompanied by pale complexion, cold limbs and profuse cold sweating indicate the critical condition of deficient yang floating upwards.
Bluish complexion indicates cold, algesia, convulsion and blood stasis syndromes due to stagnation of the vessels and meridians resulting in the unsmooth circulation of qi and blood. Alternate pale and bluish complexion and worried look usually indicate interior cold and abdominal pain: cyanosed lips and complexion accompanied by dyspnea of ten signifies stagnation of the lung qi and blood stasis due to qi stagnation. Bluish and dull complexion, especially the region around the nose and the lips, often indicates premonitory convulsion or seizure of epilepsy.
Observation of physical build
Observation of physical build includes the configuration and constitution and movement of the infants. The physical characteristics, active and static postures and special position of" the body all can be used as the basis for diagnosis and differentiation of syndrome. For example, squared-shaped head with scanty hair, metopism, deformity of the thorax, clustered ribs and twisted lower limbs are usually the signs of rickets; scanty hair, thin neck, bulging abdomen and emaciation usually indicate infantile malnutrition. Preference to sleep is often due to internal damage with improper diet; preference to sleep with curled body is often due to internal cold or abdominal pain; quiet supination with dull eyes signifies serious disease, prolonged illness or extreme weak constitution; sitring up ereetly with wheezing due to sputum indicates asthma; stiff neck, spasm of the limbs and opisthotonos show infantile convulsion; writhing due to restlessness and crying with hands holding the abdomen indicates abdominal pain.