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All lessons   Module 5: Going deeper   Lesson 3

Module 5   Lesson 3   Xiao Er, Lao Ren

Children and older people

How do you read tongue and pulse in a child and in an older person, and what is normal there that would stand out in an adult?

After this lesson you can read the finger vein in a child under three (place, colour, depth and length through the three gates), feel the pulse of an older child with one finger and set the rate beside the age, you know a child's tongue and the milk that is not a coating, you know what vessels, age, medication and dentures change in the tongue and pulse of an older person, and you recognise the red flags in a child with fever and an older person in decline.

The index finger, thumb side, in a child under three palm 风关 气关 命关 Wind Gate Qi Gate Life Gate up to the nail: critical push gently a few times from the tip to the palm mild, exterior deeper, more severe severe Four rules superficial: exterior hidden: interior red or purple: Cold or Heat pale or stagnant: empty or full the gates: how severe Colour, Chinese textbooks bright red: Wind-Cold purple-red: Heat blue: Wind, fright, pain purple-black: stasis, severe pale: Deficiency Child and older person from age 3: one finger child: faster is normal child's tongue: tender, loose older: harder and weaker older: tongue often dry
Schematic, our own drawing (the drawing program of this course does not draw fingers). The gates are the three segments from the palm, as in the Chinese textbooks; some English-language sources count from the joint creases. The vein runs on the thumb side, at the edge of the palm side. Colours according to the Chinese textbooks; English-language sources read them differently (step 3).

Know by heart

  • The finger vein, under three. Thumb side of the index finger, in good light; push gently a few times from the tip to the palm. Three gates from the palm: Wind (first segment), Qi (second), Life (third); mnemonic: the further towards the tip, the more severe.
  • Reading the finger vein. Visible superficially: exterior; hidden: interior. Bright red: external Wind-Cold; purple-red: Heat; blue: Wind, fright or pain; purple-black: stasis, severe; pale: Deficiency. Pale and thin is empty, dark, thick and stagnant is full; mnemonic: where, which colour, how full, how far.
  • The normal finger vein. Pale red with a little yellow or purple through it, barely visible, not beyond the Wind Gate.
  • The child's pulse. From age three with one finger, usually the thumb, across the three positions; read mainly superficial or deep, rapid or slow, with or without strength. Faster is normal: an infant seven to eight beats per breath of the practitioner, a young child around six; crying and moving speed it up.
  • A child's tongue. Pale-Red, tender, moist, thin coating that comes off easily; peeled patches are more common. White that wipes away is milk; white that stays, with red underneath, is thrush. A thick sticky coating with a bloated abdomen: food retention.
  • Older people. The pulse is more often somewhat harder and tenser, and weaker; the tongue more often dry and cracked. Weigh it against age and medication. An irregular pulse: ECG. A dry tongue does not prove dehydration.
  • Red flags. Child: under three months with fever, drowsy or not rousable, spots that do not fade on pressure, grunting or fast and laboured breathing, dehydration, fever for five days or more with red eyes and lips. Older person: suddenly confused, cold and drowsy, a fall, an irregular pulse with symptoms.

The rest of this lesson is reference.

Three practice questions from this lesson

Case. A baby of ten weeks, 38.4 °C since this afternoon; she is drinking a little less than usual.
  1. Call a doctor straight away
  2. Read the finger vein first, then decide
  3. A GP tomorrow if it persists

Answer: Call a doctor straight away. In a baby under three months, 38 °C or more is always a reason to call a doctor straight away. A young baby shows few signs of a serious infection.

Case. A girl of eighteen months with 39 °C, sleepy and hard to wake. On her legs there are a few purple spots that do not fade under a glass.
  1. Call emergency services (112) at once
  2. Read the finger vein first, then call a GP
  3. Heat at the Nutritive-Qi level: treat at home

Answer: Call emergency services (112) at once. Drowsiness and spots that do not fade, with fever, are meningococcal sepsis until proven otherwise. That means emergency services (112); you do not read the finger vein here.

Case. A boy of two, 38.8 °C for a day and a half, clear runny nose, sneezing, not sweating. He drinks, passes urine and plays in between. The finger vein is bright red, clearly visible, and runs only in the Wind Gate.
  1. Exterior, Wind-Cold, still mild
  2. Interior, Heat, already deeper
  3. Spleen deficiency, for weeks already

Answer: Exterior, Wind-Cold, still mild. Superficial is exterior, bright red is Wind-Cold in the Chinese textbooks, and only in the Wind Gate is mild. The symptoms fit. Interior Heat gives a purple-red, deeper vein; Deficiency a pale, thin one.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 18 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 5: Going deeper.

Try two lessons freeSee Tongue and Pulse