Main contents and clinical significance of pediatric examination
The tour includes two parts: the whole tour and the local tour.
1. The overall investigation includes four parts: spirit, color, shape and state.
(1) Seeing God: God is the external expression of viscera function, qi, blood and body fluid, and also refers to consciousness, mental state and thinking activities. God is reflected in eyes, face, expression, consciousness and posture, so we should observe it carefully from the part to the whole. The eyes are the guide of the heart, the orifices of the liver communicate with the brain, and the essence of the five internal organs is concentrated in the eyes, so observing the eyes is the focus of seeing God.
God: big black eyes, bright eyes, flexible rotation, full of vitality, lively expression, often amused. His complexion is ruddy, his breathing is even, and his limbs move autonomously, indicating that dirty qi is clear and qi and blood are harmonious. God is a sign of health, even if you are sick, it is easy to treat.
Absence: dull eyes, listlessness, dull complexion, fatigue and lethargy, uneven breathing, muscle relaxation, illness or serious illness.
(2) Look at the color: children's facial skin is thin and tender, so the profit and loss of qi and blood and the change of color are easy to show. Color is color, and skin color can be divided into five types: blue, white, yellow, red and black, which are called five colors for short. Red face and excessive heat syndrome; White face, cold syndrome is mostly deficiency cold; Yellow face, mostly weak and wet; Blue face, main cold, main pain, main shock, main blood stasis; Black face, treating cold syndrome, kidney deficiency, pain syndrome, blood stasis syndrome and water retention.
(3) Vision: Observe the head, trunk, limbs, hair, nails and other parts in turn. Anyone with moist hair, flexible skin, full muscles, strong bones and muscles and flexible demeanor is a sign of good health. People with sallow hair, dry orange skin, weak bones and muscles, emaciated and barren muscles and dull expression are mostly congenital endowment deficiency or acquired malnutrition.
Patients with rickets have less head hair and the fontanel closes later.
Craniotomy showed large neck contraction, wide anterior fontanel, split head seam and drooping eyes.
Dry skin, lack of elasticity and sunken eyes are signs of dehydration.
(4) Look at people's posture:? Yang takes the initiative, while Yin is quiet? .
Most people who like to lie down are breast-feeding due to internal injuries;
People who like to lie down are mostly cold or abdominal pain;
Fidgeting, crying loudly, clutching his stomach with both hands, mostly abdominal pain;
Asthma is mostly caused by sitting up and shortness of breath, excessive phlegm and wheezing;
Shortness of breath, nasal confusion, chest rib depression, frequent pneumonia, cough.
2. Local examination includes head and face, seedling orifices, fingerprints, stool spots, rashes, rashes and acne.
(1) Tongue diagram: Children's tongue is soft, free to move and reddish in color. Inspection includes looking at the tongue and coating the tongue.
Tongue: Normal tongue is reddish, neither fat nor thin, moist and soft, and moves freely. Pale and white tongue is deficiency of qi and blood.
Tongue coating: at the beginning of exogenous disease, the disease is on the exterior, and the tongue coating is thin and white; Thin white and dry, or light yellow, for exogenous wind and heat; Thin, white and wet people are exogenous cold.
(2) eye observation: first observe the eyes. If black eyes are round, bright and flexible, they are full of qi and blood for liver and kidney; Eyes without luster, eyes without god, are pathological; Eyes staring, straight or oblique, mostly due to liver wind moving; The pupil is dilated, the light reflex is slow, and the condition is critical; Pupil contraction, mainly due to heat toxicity, is seen in poisoning (organophosphorus, toadstool or some drugs). Pay attention to whether the eye socket is sunken, whether the eyelids are swollen and drooping, whether the conjunctiva is congested, and whether the sclera is yellow.
(3) Look at the nose: stuffy nose, runny nose, accompanied by sneezing, is a cold; Those with yellow and turbid nose are mostly wind-heat invading the lungs; Turbid nose, unpleasant smell, repeated difficult to heal, mostly caused by heat depression in lung meridian, common in sinusitis; Epistaxis is fever of lung meridian and rash caused by blood heat; Dry nostrils are caused by lung heat injuring body fluids or dryness invading the lungs; Nasal alar tremor, accompanied by high fever, is mostly caused by pathogenic heat and lung resistance.
(4) Look at the mouth: observe the lips, oral mucosa, gums and throat in turn.
Dry lips, cherry red, mostly caused by diarrhea and yin injury;
The upper and lower lips are tightly closed, which is mostly caused by wind evil entering the collaterals or liver wind moving internally.
The oral cavity and tongue mucosa are ulcerated and eroded, and the mouth is full of white debris, like snowflakes, which is stagnation of spleen channels, more common in thrush;
There are needle-tip-sized' white spots' on the mucosa of both cheeks, and the surrounding areas are red, which are measles mucosal spots.
Red and swollen gums are mostly caused by stomach fire; The swelling of moths is caused by exogenous wind-heat or stomach-heat;
There is a gray-white false membrane in the pharynx, which can't be lightly wiped, but it bleeds after heavy wiping, and the white membrane resurfaces, often diphtheria.
(5) Otological examination: purulent secretion in the ear, and earache is caused by excessive fire in the liver and gallbladder, which is seen in suppurative otitis media.
If the earlobe is the center of diffuse swelling and pain, it is mumps.
(6) Look at the second yin: the girl's front yin is red and wet, and most of them are hot and humid bets. Those who itch should pay attention to the presence of trichomonas. The anus damp has a rash, mostly diaper dermatitis, and anal pruritus, especially at night, is mostly infested by pinworms; Rectal prolapse after defecation is mostly caused by insufficient middle qi, which is seen in proctoptosis.
(7) Identification of macula: Attention should be paid to the identification of macula's shape, eruption location, time, sequence, regression, complications, the relationship between fever and eruption, and the performance in recovery period.
(8) Check the second stool: the stool of infants is jam-colored, accompanied by crying, which is often caused by intussusception; Biliary atresia can be seen with gray stool.
Methods of fingerprint diagnosis and its clinical significance
1. Methods The superficial vein in front of the radial index finger in children under 3 years old was observed. Fingerprints are divided into three levels: wind, qi and life. During the examination, gently push the finger from the life gate of the child's index finger to the windward, and observe it under natural light. Normal fingerprints are lavender, but not obvious above Guan Feng.
2. Significance
(1) Location: If the fingerprint is at Fengguan, the pathogenic factors are new, the pathogenic factors are shallow and the illness is mild; Those who have reached the gas barrier are deeply evil and seriously ill; People who cross life are dying; It is dangerous to shoot armor through customs.
(2) ups and downs: floating in the main table and sinking in the main. At the beginning of exogenous diseases, veins appear; The pathogen is in the room, which is heavy but not obvious.
(3) Color: the grain color is bright red, which is exogenous wind and cold; Deep purple is pathogenic heat stagnation; Purple-black refers to heat evil or qi stagnation and blood stasis; Most people with blue and black color are blood collaterals and blood stasis; Those with fine and slippery fingerprints are mostly due to lack of healthy qi.
Ups and downs are divided into exterior and interior, red and purple are divided into cold and heat, light and depressed are divided into excess and deficiency, and three levels are divided into severity.
Diagnostic significance of children crying
Crying with tears, crying loudly, is normal. Babies may cry because of hunger, thirst, acupuncture, insect bites, drowsiness or discomfort caused by wet diapers. Crying for a long time, sucking milk in your mouth, mostly hungry; Suddenly crying, loud and urgent, sometimes screaming, sometimes stopping, mostly abdominal pain; Crying hoarse, accompanied by dyspnea, mostly throat edema; Crying and refusing to eat, accompanied by salivation and irritability, mostly aphtha.
Pediatrics asked about personal medical history and vaccination history.
1. Ask about personal history
(1) Birth history: including parity, parity, full-term or not, mother's health during pregnancy, delivery or dystocia, delivery technique, asphyxia, bleeding, infection, birth weight and postpartum score, etc.
(2) Feeding history: including feeding methods, types of milk substitutes, weight gain, addition of complementary foods, etc.
(3) Growth and development history: the growth of body length and weight with age, sports development, language development and social adaptability.
2. Ask about vaccination history, understand the implementation of planned immunization and immune response.
Basic pulse condition of children
There are six pulse conditions in children: floating, heavy, late, fast, strong and weak. Ups and downs are divided into exterior and interior, cold and heat are divided, and strength cannot determine the actual situation. Soft pressure energy is shallow pulse, which is more common in exterior syndrome. Strong floating is a superficial reality, while weak floating is a superficial deficiency. Heavy pressing can only touch the deep pulse, which is more common in the internal syndrome, which is heavy and powerful inside, and weak inside; Pulse frequency, pulse condition with a breath count of more than six or seven times, is more common in heat syndrome, with strong number being excess heat and weak number being deficiency heat. Liver disease and convulsion can be seen as string pulse; Too much phlegm or saliva, often slippery pulse.
According to the diagnosis of children (skin, head, chest and abdomen, limbs)
1. From the point of view of skin swelling, most of them are spleen and kidney yang deficiency; According to depression, most of them fight with each other; Skin elasticity is poor, mostly because of liquid damage and dehydration. People with cold and sweaty skin are mostly yang deficiency; Those with hot hands and feet are mostly internal injuries due to yin deficiency or food stagnation.
2. According to the anterior fontanel of skull, most of them are microcephaly; Overdue closure, mostly rickets; Most patients with fontanel depression are vaginal effusion; Most patients with fontanel protrusion are excessive heat toxicity or increased intracranial pressure. Nodules on both sides of the neck of children are swollen, mostly due to accumulation of phlegm and toxin, accompanied by fever, sore throat and hepatosplenomegaly, which is seen in infectious mononucleosis; If the beads are in a string, the texture is hard and accompanied by night sweats, tuberculosis should be suspected.
3. According to the chest, the sternum protrudes and the front and rear diameter increases, which is called chicken breast; The depression of sternum is funnel-shaped, which is called funnel chest; Rib softening is pulled by diaphragm and invaginated into groove, which is called Hausdorff; Chest ribs touching beads and rib edges everting are all manifestations of rickets. The lower limit of normal liver is below the costal margin of the right clavicle midline, and the baby is less than 2cm. General school-age children should not touch the liver under the costal margin. The spleen of a normal newborn can be palpated at 1 ~ 2 cm below the left costal margin, but it should not be palpated after 1 year. Normal liver and spleen are soft without tenderness.
According to the normal abdomen, the child's abdomen is soft, gentle, not bloated or painful. Abdominal pain is relieved if it is pressed, which is mostly caused by deficiency and cold; Those who refuse to press or press abdominal pain are mostly due to internal resistance of evil or accumulation of food by insects; Abdominal distension and drumming are mostly due to qi stagnation; Patients with voiced percussion and a sense of fluctuation are mostly ascites.
5. According to the limbs, the limbs are cold, mostly yang deficiency; Sudden convulsion of limbs is a sign of spasm; One or both limbs are emaciated and their activities are limited, which can be seen in the sequelae of polio.