Pediatric examination can be divided into general examination and sub-examination General inspection includes appearance and shape, while sub-inspection includes inspection of seedlings, identification of spots, inspection of feces and reading of fingerprints.
Matters needing attention in outpatient service
1. access should be done in order, first the whole access, and then the branch access. Some visits will cause discomfort and resistance of children, such as oral examination and tongue examination, which should be carried out after the completion of other items in the four consultations.
2. The visit must be carried out in natural light, so as not to affect the visit effect.
3. Fingerprint is an auxiliary diagnostic method, which is suitable for children under 3 years old. When the fingerprint observation results are inconsistent with symptoms and tongue images, symptoms can be "excluded".
Look at God.
Facial examination is an important part of children's appearance. The commonly used face-to-face diagnosis methods are five colors governing diseases and five internal organs. Clinically, children's diseases are mainly judged according to the five-color main diseases.
1. Five-color main diseases: The so-called five colors refer to red, blue, yellow, white and black, also known as five-color diagnosis.
Pale complexion, mostly cold syndrome, deficiency syndrome and vomiting and diarrhea.
Red face, mostly heat syndrome.
Yellow complexion, mostly deficiency syndrome or dampness syndrome, can be seen in malnutrition, stagnation and insect syndrome.
Blue complexion, mostly cold syndrome, pain, blood stasis syndrome and epilepsy.
Black face, mostly due to cold syndrome, pain, epilepsy, or water in it to stop drinking.
The five internal organs refer to the left cheek, right cheek, forehead, nose and chin. The relationship between five internal organs and five internal organs.
Appearance state
Seeing the shape includes observing the dynamic changes of the body and posture of the sick child to infer the nature of the disease.
1. Visible bodies mainly include head, body, limbs, skin, hair, nails, etc. , inspection should be observed in sequence. Those with lively expression, plump muscles, dark skin, strong bones and muscles and normal development are the manifestations of adequate fetus, good nutrition and good health.
2. Look at the dynamics, including the dynamic and static posture changes of all parts of the body. Normal children have normal development in all parts of their bodies and can move freely without pain or discomfort. Different diseases often have different postures.
Wangmiao bridge
1. Clinical observation of tongue, mainly observing the changes of tongue body, tongue quality and tongue coating.
The tongue is fat and tender, with obvious tooth marks on the edge of the tongue, mostly due to yang deficiency of spleen and kidney, or retention of phlegm and dampness in drinking water; The tongue is swollen and blue, which can be seen in qi and blood stasis; Fat and cracked tongue, mostly due to deficiency of both qi and blood; The tongue is tough, mostly due to heat and body fluid injury; When acute fever occurs, the tongue body is shortened and the tongue is dry and crimson, which is caused by heat injury to body fluid and dystrophy contracture of meridians. (There are also wooden tongues, heavy tongues, connecting tongues, making tongues and spitting tongues. )
2. First of all, you should observe the changes of your eyes. Healthy children's black eyes are round and full of energy, which is a manifestation of sufficient blood in liver and kidney. When observing the eyes, we should also observe the changes of eyelids, inner and outer canthus, white eyes and pupils.
3. When observing the oral cavity, carefully observe the color, moistening and appearance changes of lips.
4. Nasal diagnosis mainly observes the changes of nasal secretions and nasal shape.
The shape of the ear is a sign to judge the physical strength of the child. A child's ear shell is rich and ruddy, which is a sign of congenital kidney qi and health.
6. The tightness of the scrotum of a boy with two yin is a sign of abundant kidney-qi.
According to the shape of macula, macula has different names, such as rash, herpes, macula, wheal and leukoplakia.
The rash is as small as hemp.
Herpes vary in shape and size, higher than the skin surface and containing liquid. White as crystal is chicken pox; If herpes has pus, it is mostly pustulosis.
The macula is red and bright, which does not interfere with touch and does not fade when pressed. Most of them are heat toxin, and the disease is in the blood; If the macula does not come out, it is dim and inconspicuous, or the macula is purple and dark, pale, cold limbs, thin pulse, and blood overflows the pulse because of the lack of qi and blood.
There is localized edema on the skin of wheal, such as cloud fog, with obvious scratches, one after another, which occurs repeatedly, and is seen in urticaria, which is caused by wind evil invading muscles and blood heat.
White is also called "white prickly heat" and "sweat rash". It is a small white herpes with serosity, raised surface and bright color. White is bright and full; Dry white without liquid is the opposite, also known as "dryness", which belongs to the syndrome of gas-liquid consumption and injury. White is more common after long-term fever and sweating caused by damp-heat syndrome or other fever.
Chaerbian
Except for newborns and younger babies, the stool can be mushy, 1 about three times a day, and the stool of normal children should be yellow with moderate humidity. Normal children's urine is light yellow.
Look at the fingerprints
Fingerprint refers to the superficial radial vein from the tiger's mouth to the inside of index finger, which is divided into three stages: wind, qi and life. The first stage is wind, the second stage is qi, and the third stage is life. For children under 3 years old, fingerprint reading is an auxiliary diagnostic method instead of pulse diagnosis.
Most normal children's fingerprints should be lavender and faint, but they are not above the wind. If diseases occur, the fluctuation, color and position of fingerprints will change accordingly. The changes of children's fingerprints after illness are summarized as follows: ups and downs are divided into exterior and interior, red and purple are divided into cold and heat, light depression determines excess and deficiency, and three levels measure severity.