Red

Children are prone to Heat conditions and a red complexion is fairly common. It always indicates Heat and may pertain to the Lungs, Stomach, Heart or Liver. In Lung-Heat the cheeks, in particular the right cheek, are red. Stomach-Heat is common in children and this may cause a redness on both cheeks, especially in the lower part.

Yellow

A yellow complexion always indicates a Stomach and Spleen disharmony, which may be a Stomach- and Spleen-Qi deficiency (in which case the complexion would be pale yellow) or Dampness in the Stomach and Spleen (in which case the complexion would be bright yellow). A yellowish complexion in children may also indicate retention of food.

Pale

A pale complexion in children generally indicates Qi or Yang deficiency and usually of the Spleen or Lungs, or both.

Bluish-greenish

A bluish complexion indicates Cold or shock, while a greenish complexion indicates Wind or Pain. A greenish colour around the mouth usually indicates Liver-Wind (in children normally after a febrile disease), abdominal pain from Cold or Liver-Qi invading the Spleen. A bluish colour on the forehead pertains to the Heart and it indicates shock, while a bluish colour on both the forehead and chin in a baby may indicate prenatal shock.

Box 22.1 summarizes the complexion colours.

Eyes

A redness of the sclera indicates either external Wind-Heat or internal Heat. A yellowish colour of the sclera indicates Dampness, while a bluish-greenish colour of the sclera indicates Liver-Wind.

Streaming red eyes may indicate measles. Red and cracked corners of the eyes indicate Damp-Heat in the Intestines and retention of food.

“White membrane on the pupil in children” is called Gan Yi in Chinese, which means Childhood Nutritional Impairment Nebula; it consists of a white membrane covering the pupil, often starting with the symptom of decreased vision at night. As its name implies, it occurs in children suffering from nutritional impairment. A nebula is a translucent, greyish corneal haze, scarring or opacity. For a more detailed discussion of this sign, see Part 5, Chapter 61.

Box 22.2 summarizes the patterns underlying eye signs.

Ears

Small and contracted ears indicate poor hereditary Kidney constitution. Redness at the back of the ears indicates Wind-Heat; if the body is also hot and the face red, it may indicate chickenpox. If the helix of the ear is bluish-greenish, it indicates either abdominal pain from Cold or Liver-Wind after a febrile disease.

Box 22.3 summarizes the patterns underlying ear signs.

Nose

A runny nose with white-watery discharge in acute cases indicates an invasion of Wind-Cold. If the discharge is yellowish, this indicates Wind-Heat. A white, watery nasal discharge in a chronic condition indicates allergic rhinitis and it is due to Lung-Qi deficiency.

A blocked nose with difficulty in breathing generally indicates Dampness or Damp-Heat in the nose; this is very common in children and it is usually a residual pathogenic factor after repeated external invasions (especially when treated with antibiotics). A flapping of the nostrils in a child with fever indicates Phlegm-Heat in the Lungs and it is a relatively serious sign. Sweating on the nose in chronic conditions indicates Lung-Qi deficiency.

Box 22.4 summarizes the patterns underlying nose signs.

Mouth

Observation of the mouth includes observation of the lips, gums and throat.

The lips pertain to the Spleen and pale lips indicate Spleen-Qi deficiency whereas red lips indicate Heat in the Spleen and Heart. If the lips are dark and dry, this indicates a severe injury of Yin after a febrile disease.

Swollen and red gums indicate Stomach-Heat, retention of food or worms.

The throat should always be observed in children. In acute cases, a redness of the throat indicates Wind-Heat; in chronic cases, a redness of the throat is often due to Heat in the Stomach and Intestines.

Erosion, redness and swelling of the pharynx indicate Toxic Heat. This is seen more frequently in children suffering from acute upper respiratory infections.

Swollen tonsils of a normal colour indicate retention of Dampness or Phlegm occurring against a background of Qi deficiency. This is seen frequently in children with retention of a residual pathogenic factor (e.g. Dampness or Phlegm) after repeated acute upper respiratory infections.

A chronic swelling of the tonsils in children is often accompanied by a chronic swelling of the adenoids, itself also a sign of retention of residual Dampness or Phlegm.

Red and swollen tonsils indicate Heat or Toxic Heat often in the Stomach or Large Intestine channel, or both. The tonsils should always be inspected in acute invasions of Wind-Heat, particularly in children. Red and swollen tonsils are frequently seen in children during acute upper respiratory infections. During acute invasions of Wind-Heat, a swelling and redness of the tonsils indicates a more severe degree of Wind-Heat and often the presence of Toxic Heat; it also points to an involvement of the Stomach or Large Intestine channel, or both. It also tells us that the child probably has a pre-existing condition of Heat, often Stomach-Heat.

A chronic redness and swelling of the tonsils that comes and goes indicates either chronic Heat in the Stomach or Large Intestine channel, or both (more common in children and often due to a residual pathogenic factor), or Empty-Heat in the Lung channel. In Chinese medicine, a chronic redness and swelling of the tonsils was called “milky moth” (ru ): the tonsils look like a moth’s wings and have a milky fluid on them.

Red and swollen tonsils with exudate indicate Toxic Heat in the Stomach or Large Intestine channel, or both; they are usually seen during acute upper respiratory infections and are more common in children. Their presence definitely indicates an invasion of Wind-Heat (as opposed to Wind-Cold) and it indicates that it is complicated by Toxic Heat.

A swelling of the tonsils from Toxic Heat was called “stone moth” (shi e): the two tonsils look like a moth’s wings and have a stony hardness.

In any of the above pathologies of the tonsils, if both tonsils are affected, it generally indicates a greater severity than if only one is affected.

Box 22.5 summarizes patterns underlying signs in the mouth, lips, gums, throat and tonsils.

BOX 22.5   MOUTH, LIPS, GUMS, THROAT AND TONSILS

• Pale lips: Spleen-Qi deficiency

• Red lips: Spleen- and Heart-Heat

• Dark and dry lips: severe injury of Yin

• Swollen red gums: Stomach-Heat, Retention of food or worms

• Red throat: Wind-Heat or Heat in Stomach and Intestines

• Erosion, redness and swelling of the pharynx: Toxic Heat

• Swollen tonsils: Dampness or Phlegm (background of Qi deficiency)

• Red and swollen tonsils: Heat or Toxic Heat in the Stomach/Large Intestine

• Red, swollen and purulent tonsils: Toxic Heat

• On-off chronic redness and swelling of the tonsils: Heat in the Stomach/Large Intestine, Empty-Heat in the Lungs

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Related posts:

1. OBSERVATION OF THE GENITALIA
2. MENSTRUAL SYMPTOMS
3. DIAGNOSIS BY HEARING
4. OBSERVATION OF THE COMPLEXION COLOUR

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