Observation of the baby's fingerprints
Observation of fingerprint means to inspect the changes of the radial superficial veins over the index finger of the infants under three years of age, a supplementary diagnostic method used to replace the pulse taking. The fingerprint refers to the radial superficial vein from Hukou, the region between the thumb and index finger, to the tip of the index finger. This vein can be divided into three sections, i. e. wind, qi and life. The first section of the finger is called wind pass, the second section qi pass and the third section life pass. Clinically the doctor uses his or her thumb to push the index finger of the infants from the life pass to the wind pass to make the vein visible. Usually the normal condition of the infantile fingerprint is slightly purplish and faintly visible below the wind pass. However many factors may affect fingerprint, such as age, subcutaneous fat, physical shape, colour of the skin, individual difference in vessels, blood circulation, oxygen in the blood temperature. Therefore, the observation of fingerprint should be done according to the normal condition of the agnosis. 2,1.6.1 Differentiation of exterior and interior syndromes according to the superficial and deep fingerprint
Superficial fingerprint indicates the early stage of exogenous diseases and the location of which is superficial, while the deep fingerprint usually indicates interior syndroroms.
Differentiation of heat and cold according to the reddish and purplish fingerprint
Reddish fingerprint indicates cold while purplish fingerprint signifies heat; bluish fingerprint means fright while blackish fingerprint indicates stagnation. For example, brightly reddish and superficial fingerprint indicates exogenous wind and cold; brownish and purplish fingerprint indicates stagnation of pathogenic heat; purplish and blackish fingerprint indicates aggravation of pathogenic heat or qi stagnation and blood stasis; bluish fingerprint indicates convulsion or pain.
Differentiation of asthenia and sthenia according to the pale and dark fingerprint
Pale fingerprint, no matter what colour it is and whether it is a new disease or prolonged disease, is all the manifestation of asthenic syndrome, usually seen in the infants with weak constitution, consumption of qi and blood as well as malnutrition. Dark fingerprint with slow rebounding after being pushed indicates sthenic syndrome, usually seen in the infants with phlegmatic dampness, heat virulence, qi stagnation and blood stasis.
Determining the conditions of the disease according to the three passes
Appearance of fingerprint on the wind pass indicates mild pathological conditions; appearance of fingerprint on the qi pass indicates serious pathological condition; appearance of fingerprint on the life pass indicates very serious condition; appearance of the superficial veins extending through the three passes towards the finger nail indicates critical pathological condition.
Olfaction and auscultation
Olfaction and auscultation refer to smelling the patient's odour and listening to the patient's voice. Listening to the voice includes infantile cry, cough, breath and speech. Smelling the odour includes the odour from the mouth, vomitus, urine and stool. Listening to cough is important in differentiating syndromes of the respiratory system. Smooth cough and expectoration indicate mild syndrome; cough with light voice and thin nasal discharge indicates the attack by exogenous wind cold; heavy cough with thick or yellowish sputum indicates the attack by exogenous wind heat; hoarse cough with yellowish and thick sputum indicates retention of phlegm and heat in the lung; dry cough with sonorous sound indicates the attack on the lung by dryness; repeated cough with echo is called proxysmal cough; hoarse cough like the bark of a dog indicates laryngitis or diphtheria.
Inquiry in pediatrics includes not only direct inquiry of the elder infants but also inquiry of their family members and the workers from nursery about state of onset. Inquiry should cover such aspects as sex, age, state of ill- ness and date of onset of the illness, treatment (including the use of drugs), personal history, vaccination and family hereditary histories.
Inquiry of pathological conditions
Inquiry of cold and fever
Fever can be tested by thermometer or by feeling, such as feverish palms and soles, feverish forehead and feverish sensation when the infants sucking the breast.
Aversion to cold can be known from the changes of the postures, such as snuggling up to the mother and curling themselves up when sleeping. Elder infants can be inquired directly. Fever in the infants is usually low in the morning and high in the evening. So time should be taken into account during inquiry of fever.
Inquiry of sweat
The skin and muscles of the infants are thin and tender, making it liable to sweating. But it is not pathological. If there is profuse sweating in the daytime or sweating right after movement, it is called spontaneous sweating due to weakness of Wei-qi defensive qi, resulting from asthenia of qi.
Sweating during sleep at night is called night sweat due to asthenia of yin or asthenia of both qi and yin. Lingering of fever after sweating indicates transmission of pathogenic factors from the superficies to the interior in febrile diseases.
Inquiry of head and body
Elder infants can tell the doctor whether or not they suffer from headache and dizziness which are usually caused by high fever and anemia. Fever with pain of the limbs is often due to attack by pathogenic wind, cold, dampness and heat. In some eruptive diseases and urticaria cutaneous pruritus often appears.
Inquiry of diet
Inquiry of diet includes the intake of food and water. Normal conditions of food intake are regular taking of food, normal appetite and no vomiting. Anorexia and poor appetite indicate weakness of the spleen and the stomach. Preference to cold water indicates heat syndrome; preference to hot water or no thirst indicates cold syndrome; frequent drinking of water with dry mouth and lips indicates insufficiency of stomach yin and consumption of body fluid; thirst without desire to drink water indicates dampness in the middle energizer.
Inquiry of chest and abdomen
Stuffiness and distress of the chest and wheezing with sputum indicate stagnation of the lung collaterals by phlegm as in asthma; chest pain with fever and cough with dyspnea indicate cough due to pneumonia; epigastric and abdominal distension is often caused by retention of indigested food; abdominal dull pain around the navel is often seen in ascariasis. Besides, acute and severe abdominal pain in the infants may be caused by some surgical problems.
Inquiry of urination and defecation
Inquiry of urination and defecation includes the frequency, nature and colour of urine and stool. Frequent,loose or sticky stool is a morbid manifestation. Clear profuse urine and night urination indicate asthenia of kidney yang. Frequent urination with occasional pain indicates downward migration of damp heat, such as heat stranguria. Dripping urination with stabbing pain or sandy stones is called stony stranguria.
Inquiry of sleep
Normally the infants are quiet in sleep. And the younger the infants are, the longer the sleeping time is.Lethargic sleep and somnolence are usually caused by invasion of pathogenic factors into the pericardium or phlegm clouding the upper orifices in febrile diseases. Restless sleep in rickets and oxyuriasis are accompanied by restlessness and night sweat in the former and anal pruritus in the latter.
Inquiry of age
A number of infantile diseases are related to age, such as tetanus neonatorium, neonatal jaundice, bleeding of the umbilicus and umbilical sore often seen among the neonatal within one week after birth; thrush, umbilical hernia and night crying usually seen among the nursing infants; enuresis frequently seen among the infants under the age of five.
Inquiry of personal history
Inquiry of personal history includes birth history, feeding history, growth and physical development history. Birth history includes times of pregnancy and delivery,whether the delivery is full term, eutocia or dystocia, whether there is the experience of abortion, the style, place and condition of delivery as well as the nutrition and health of the mother during pregnancy. Feeding history includes feeding method, supplementary food, weaning and conditions after weaning. For the elder infants, the inquiry should include habit of taking food and appetite.
Developmenal history includes physical development and mental development, such as the time of being able to sit, stand, speak and walk as well as tooth eruption and closure of fontanel. As to the children of school age, the inquiry extends to cover the progress of study and inference of the development of intelligence.
Inquiry of vaccination history
Inquiry of vaccination history means to ask the parents whether they have applied for vaccination card from the local medical unit after the birth of their infants. Preventive vaccination includes BCG vaccine and live attenuated measles virus vaccine as well as whooping cough, diphtheria, tetanus, encephalitis B, epidemic cerebrospinal meningitis, typhoid fever and paratyphoid, etc.. The vaccination age and reactions should be well recorded.
History of family hereditary diseases
The occurrence of many diseases is related to hereditary factors. So the health of the family members and directly-related members should be inquired to see if there is family hereditary diseases such as bronchial asthma, haemophilia and hypophrenia as well as consanguine ous marriage.
Feeling Pulse and palpation
Feeling pulse in diagnosis of the infants is known as one finger touching the three portions of the pulse. That is to say, the doctor uses his or her thumb or index finger to press the three portions of Cun, Guan and Chi to distinguish the variations of pulse under light, moderate and heavy pressure of the finger. The basic pulse conditions of the infants are floating, sinking, slow, rapid, forceful and forceless ones which can be used to differentiate the exterior, interior, cold, heat, sthenia and asthenia of diseases.
Palpation includes the pressure and palpation of the fontanel, neck, armpit, limbs, skin, chest and abdomen, especially the fontanel and abdomen.
Examination of the fontanel should focus on the closure time, size, depression and bulge of the fontanel.Premature closure of the anterior fontanel and small head usually indicate microcephaly; retarded closure of the fontanel with wide fissure is called metopism; depression of the fontanel is often caused by collapse of the gastrosplenic qi or dehydration due to over purgation; bulge of the fontanel accompanied by high fever, vomiting and stiff neck is usually due to accumulation of pathogenic heat and endogenous liver wind. In examining the abdomen of the in-fants, the temperature of the doctor's hand should be similar to that of the infantile skin. In the examination, the doctor should pay attention to the facial expressions of the infants. Usually palpation of the abdomen should start from the lower side of the abdomen on the left side. If there is abdominal pain, palpation should start from the region without pain to avoid tension of the muscles. Normally the skin of the infantile abdomen is soft, warm and painless under pressure. Abdominal pain with preference to pressure and alleviation under pressure is usually of asthenic cold syndrome; unpalpable abdominal pain or abdominal pain aggravated under pressure is often due to internal stagnation of sthenic pathogenic factors, or ascariasis, or dyspepsia, or retention of dryness in the intestine. Flatulence of the abdomen like tympanites is usually due to stagnation of qi; migratory dull sound under percussion often indicates ascites.