TCM Pediatrics Pediatrics was first started in China approximately 2000 years ago (100 BC) and has gradually progressed since this time.

Transcription

1 TCM Pediatrics Pediatrics was first started in China approximately 2000 years ago (100 BC) and has gradually progressed since this time. New Borns: Will weigh 3 kg at birth, loose weight at first before gaining weight and tripling their weight by the end of their first year. They will begin growing their teeth around the age of 10 months and grow their adult teeth at the age of 6. An infant s respiration will be faster than that of an adult (40 per min) as well as an infants pulse rate (160 beats per min) although they will have a lower blood pressure. General Development: 2 months: head movement 4 months: arm movement 6 months: roll over 7 months: sit up 8 months: crawling 9 months: holding and standing months: walking Pediatrics in TCM: In traditional texts, children are considered deficient in: - Spleen Qi susceptible to GI illness and nutritional problems; - Lung Qi susceptible to exterior insult (cold, dampness, etc) and frequent lung problems Children are considered Yin deficient (therefore, they develop fever easily); and Yang excessive (therefore, they can be hyperactive, crying and constantly moving). Children s Qi (vital energy) develops as they grow. Meridians are not well organized and are superficial. As a result, children get sick more easily and progress more quickly and severely then adults. However, they get better faster since they have clearer Zangfu (TCM concept) and better Qi flow. Pediatric Acupuncture: In general, acupuncture is of limited use in children due to needle phobia and pain. Interestingly, a recent study showed that after first session most children (ages 6-18 yrs) described their acupuncture experience as weird but not uncomfortable. When compared to acupuncture in adults, pediatric practitioners use small, solid needles (36-40 Gauge), fewer needles per session, an in-and-out technique (vs. keeping needles in place). Non-invasive stimulation techniques such as acupressure, massage and various blunt instruments (brushes, scrapers) may be used as alternatives to needles on the same points. Many techniques can be taught to parents for home use. Emphasis is also placed on diet and herbal therapies. In the following syllabus you may find that the treatment sessions are kept blank for your group discussion in the classroom. What you need to bear in your mind is that children do not like many needles at all. 1

2 1. Common Cold - Gan Mao Cold, which is generally called attack of pathogenic wind, refers to diseases due to exogenous pathogenic factors, manifested as fever, chillness, stuffy nose, nasal discharge, cough, headache and general aching. It can occur in any season of the year. The incidence is highest in winter and spring. Its cause is affection of wind-cold or wind-heat pathogen. Complications may occur along with the disease such as sputum, stagnated food in the stomach and convulsion, because infants have delicate lung, deficiency of the spleen-qi and aplasia of nervous system. Main Symptoms 1. Common Cold of Wind-cold Type Severe chillness, slight fever, anhidrosis, stuffy nose with watery discharge, sneezing, cough with watery sputum, headache, itching of the throat, thin and whitish fur on the tongue, floating and tense pulse, and floating red coloured superficial venule of the index finger. 2. Common Cold of Wind-heat Type High fever, slight chillness, perspiration, stuffy nose with turbid discharge, sneezing, cough with yellowish and thick sputum, headache, swelling and sore throat, dry mouth and thirst, red tongue with thin and yellowish fur, floating and rapid pulse, and floating red coloured superficial venule of the index finger. 3. Complications Cough with Sputum: Severe cough with dull voice, rale, greasy and thick fur on the tongue, floating smooth and rapid pulse, purple and stagnated superficial venule of the index finger. Common Cold with Stagnated Food: abdominal distention and fullness, loss of appetite, vomiting with fetid odour, eructation with fetid odour, sour and odour stools, abdominal pain with diarrhea or constipation, scanty dark urine, greasy and thick fur on the tongue, full and smooth pulse, and purple and stagnated superficial venule of the index finger. Common Cold with Fear: Night cry due to fright, restlessness in sleep, reddish tip of the tongue, wiry and rapid pulse, and black-purple superficial venule of the index finger. Treatment (group discussion) 2. Modification of Prescription according to Syndromes Common Cold of Wind-cold Type: Common Cold of Wind-heat Type: 2

3 Common Cold with Sputum: Common Cold with Stagnated Food: Common Cold with Fear: Common Cold with Cough: 3

4 2. Infantile Diarrhea Xiao Er Fu Xie Infantile diarrhea refers to increased frequency of defecation with thin or even watery stool. Though it can occur in four seasons, it occurs more often in summer and autumn. Children under 2 years are most frequently affected. Traditional Chinese medicine holds that the main causes of the disease are exogenous pathogenic factors (including pathogenic cold, dampness, summer-heat and heat), improper diet or deficiency of the spleen and stomach. Now a days the causes of the disease are considered to be associated with infection by pathogenic colibacillus, viruses, mycetes and other infections apart from the factors of diet and climate. Main symptoms 1. Diarrhea due to Cold-dampness The main symptoms are thin stool with foam or watery stool light in colour with no stink, borborygmus with stomachache, pale face, no thirst, cold extremities, prolonged urine, smooth and white fur on the tongue, slow pulse and reddish superficial venule of the index finger. 2. Diarrhea due to Dampness-heat The child passes loose stool the moment he feels abdominal pain. The onset is abrupt with yellowish-brown and stinking stool. The child has a slight fever, feels thirsty with less yellow-coloured urine, red anus with burning sensation, red tongue, yellowish and greasy fur, smooth pulse and purple superficial venule of the index finger. 3. Diarrhea due to Indigestion The child cries before passing stool and feels abdominal distention and pain, which may be allayed after defecation. The child patient passes more sour and stinking stool, green in colour with lumps of milk, accompanied with eructation with fetid odour, nausea, vomiting, thick fur, smooth pulse and purple superficial venule of the index finger. 4. Diarrhea due to Hypofunction of the Spleen The symptoms and signs are repeated attacks of diarrhea with long duration, abdominal frequent passage of loose stools with light white colour lumps of milk and residue of food. It occurs more often after meals. The patient has emaciation with sallow complexion, anorexia, pale tongue with thin fur, floating pulse and reddish superficial venule of the index finger. If the diarrhea lasts long, it can damage the kidney-yang, manifested as pale complexion, watery stools with more frequency, cold limbs, pale tongue with white fur, feeble pulse, or even persistent diarrhea with undigested food in the stool, cold extremities, faint pulse and mental confusion due to the exhaustion of the body fluid and yang. Treatment (Group discussion) 2. Modification of Prescription according to Different Syndromes 4

5 Diarrhea due to Cold-dampness: Diarrhea due to Dampness-heat: Diarrhea due to Indigestion: Diarrhea due to Hypofunction of the Spleen: 5

6 3. Vomiting Ou Tu Vomiting is a symptom, manifested as the adverse rising of food from the stomach by the mouth and nose. In the ancient literature of TCM, it is divided into three types, namely ou (vomiting with food and sound), tu (vomiting with food but without sound), ganou (vomiting with sound but without food). Vomiting is a common symptom in clinical pediatrics. It may occur as a single disorder or as a symptom of many other diseases. Children at any age can be affected. It occurs mostly in children under the age of 1 year. TCM holds that vomiting is often caused by exogenous pathogenic factors (such as pathogenic cold, dampness, summer-heat and heat) and improper diet or dirty food. Modern medicine believes that it is due to adverse peristalsis of the esophagus, the stomach or the intestinal tract accompanied by spasmodic contraction of abdominal muscles, which forces food and other contents to cast up from the stomach by way of the esophagus, mouth and nose. Additionally, because of the delicate stomach, relaxation of cardia, if the infant is fed improperly, intakes extra air or overfed, the milk can adversely flow to the mouth, then overflow from the mouth. This, in TCM, is called milk eructation which should not be considered as a disease. Main symptoms 1. Vomiting due to Pathogenic Cold It often occurs at a certain time after meals. The food vomited is not sour and odorous. The symptoms and signs may include pale complexion, fatigue, cold extremities, abdominal pain that may be relieved by warmth, loose stools, pale tongue with thin and white fur, sunken and slow pulse, and reddish superficial venule of the index finger. 2. Milk Vomiting It is manifested as frequent vomiting with sour and offensive milky fragments and indigestive food, halitosis, slight fever or no fever, stuffiness in the chest and anorexia, abdominal pain and distention, constipation or sour and stinking stools, white and greasy tongue fur, smooth and full pulse, dark and superficial venule of the index finger. Treatment (Group discussion) 2. Modification of Prescription according to Syndromes Cold type vomiting: 6

7 Heat type vomiting: Vomiting due to improper diet: 7

8 4. Abdominal Pain Fu Tong Abdominal pain which can occur in many diseases is one of common clinical symptoms in pediatrics. TCM believes that many factors can lead to abdominal pain. It is mainly caused by retention of pathogenic cold-heat in the intestine, stagnation of milk and food, parasitic infestation, and hypo-function of the spleen and stomach. Abdominal pain caused by organic pathologic changes must be diagnosed and treated early in order to avoid deterioration of the disease. Main symptoms 1. Abdominal Pain due to Pathogenic Cold The disease is manifested as abrupt abdominal pain with dysphoric crying. It occurs mostly after catching cold or eating raw and cold food. It may be aggravated by cold and relieved by warmth. The other symptoms are black and pale complexion, desire for heat and aversion to cold, watery stool, light-coloured urine, pale tongue with moist and white fur, and reddish superficial venule of the index finger. 2. Abdominal Pain due to Pathogenic Heat The disease is manifested as paroxysmal abdominal pain and tenderness, burning abdominal wall, flushed cheeks, warm breath, red lips, extreme thirst, constipation, dark urine, red tongue with yellowish and greasy fur, and purplish superficial venule of the index finger. 3. Abdominal Pain due to Improper Diet The disease is manifested as abdominal distention and pain, tenderness, anorexia, acid regurgitation and eructation with fetid odour, nausea, vomiting, frequent farting, diarrhea or constipation, less pain after fecal discharge, thin and greasy fur on the tongue, smooth pulse and purple superficial venule of the index finger. 4. Abdominal Pain due to Helminths The disease is manifested as abrupt abdominal pain which is more severe around the umbilicus, peristaltic mass in the abdomen which is palpable now and then, the history of fecal discharge with worms in most cases, emaciation, anorexia or paroxia. If the ascaris enter the biliary tract, paroxysmal colicky pain can occur in the right upper abdomen which may be accompanied with vomiting, thick fur on the tongue and wiry pulse. 5. Abdominal Pain due to Asthenia-cold The disease is manifested as dull abdominal pain, inclination for local pressure and warmth, sallow complexion, emaciation, anorexia, diarrhea, pale tongue with thin and whitish fur, reddish superficial venule of the index finger. Treatment 2. Modification of Prescription according to Different Syndromes 8

9 Abdominal Pain due to Pathogenic Cold: Abdominal Pain due to Pathogenic Heat: Abdominal Pain due to Improper Diet: Abdominal Pain due to Ascariasis: Abdominal Pain due to Astehnia-cold: 9

10 5. Malnutrition and Anorexia Gan Ji and Yan Shi This disease includes malnutrition of children and stagnation of food in the stomach. Stagnation of food in the stomach is a syndrome of chronic digestive disorder due to retention of milk and food in the stomach, manifested as anorexia, indigestion, emaciation and irregular bowel movement. Malnutrition of children refers to deficiency of body fluid and qi, manifested as emaciation, dry skin, brittle hairs, listlessness, and abdominal distention with visible superficial veins. The two syndromes are usually differentiated from each other according to their severity. The symptom of stagnated food in the stomach can develop malnutrition as it was said in ancient time that most cases with malnutrition result from stagnated food in the stomach. Parasitic infection can also develop malnutrition. The disease occurs more often in infants under the age of 3. TCM holds that stagnation of food is due to improper feeding to the infant, which damages the spleen and stomach resulting in disorder of transportation of the spleen and stomach; malnutrition of children is due to stagnated food in the stomach or other factors, resulting in weakness of the spleen and stomach leading to nutritional disorder, and deficiency of qi and blood. The disease is almost the same as infantile malnutrition: in Western medicine. Complications such as hypochromemia and, vitamin (A, B, C, D) deficiency may occur in severe patients due to low resistance against diseases, which may affect the infant s normal growth. Main symptoms 1. Damage of the Spleen due to Stagnation of Food. Manifested as emaciation, fullness of the abdomen, loss of appetite, indigestion, irregular bowel movement with fetid odour or slight fever, listlessness, restlessness in sleep, thick and greasy fur on the tongue and purple and stagnated superficial venule of the index finger. 2. Deficiency of both Qi and Blood Manifested as sallow or pale complexion, brittle hair with heptrichosis, emaciation, big head with thin neck, big and rigid abdomen, visible superficial veins, loss of appetite, diarrhea with loose stools, cloudy urine, listlessness or irritability, restlessness in sleep, weak cry, cold extremities, maldevelopment, pale tongue with white and thin fur, and light-coloured superficial venule of the index finger Treatment (Group discussion) 2. Modification of Prescription according to Syndromes Damage of the Spleen due to Stagnation of Food: Deficiency of both Qi and Blood: 10

11 6. Constipation Bian Mi It refers to a condition of difficulty in defecation, including disposia or with desire to defecate, long intervals as well as reduced amount of feces. TCM holds that constipation results mainly from retention of sthenia heat in the stomach and the intestines, and the deficiency of qi and blood. Main symptoms 1. Sthenia-type Constipation The condition is manifested as disposia, long intervals, flushed face, fever, saburra, red lips, excessive thirst, desire for cold drink, scanty dark urine, feeling of fullness and stuffiness in the chest and hypochondrium, poor appetite, abdominal distention and pain, dry, rough and yellowish fur and purple superficial venule of the index finger. 2. Asthenia-type Constipation Defecation is difficult although stools are not hard. The patient has pale face, light coloured fingernails, emaciation, lassitude, pale tongue with thin whitish fur and light coloured superficial venule of the index finger. Treatment (Group discussion) 2. Modification of Prescription according to Syndromes Sthenia-type constipation: Asthenia-type constipation: 11

12 7. Fever Fa Re It is a common symptom with the body temperature above the normal standard, which is commonly seen in pediatric department. Fever is usually caused by exogenous pathogenic factors, stagnated heat in the lung and stomach, and deficiency of yin-liquid. Main Symptoms 1. Fever due to Exogenous Pathogenic Factors Wind-cold Type: Manifested as slight fever, severe chillness, anhidrosis, headache, stuffy nose with watery discharge, thin and whitish fur on the tongue, floating pulse and floating red superficial venule of the index finger. Wind-heat Type: Manifested as higher fever, slight chillness, headache, slight perspiration, stuffy nose with yellowish discharge, sore throat, dry mouth and thirst, reddish tongue with thin and yellowish fur, floating and rapid pulse, and red-purple superficial venule of the index finger. 2. Heat of the Lung and Stomach: Manifested as high fever, flushed cheeks with red lip, thirst with a desire for drink, feeling dry in the mouth and nose, shortness of breath, loss of appetite, fidgets, constipation, yellowish urine, red tongue with dry, rough and yellowish fur, fullness and rapid pulse, and dark-purple superficial venule of the index finger. 3. Fever due to Yin-deficiency: Manifested as fever in the afternoon, feverish sensation in the chest, palms and soles, spontaneous perspiration or night sweat, emaciation, poor appetite, reddish tongue with a little fur or exfoliated fur, thready and rapid pulse, and light purple superficial venule of the index finger. Treatment (Group Discussion) 1. Fever due to Exogenous Pathogenic Factors Essential Prescription: Modification of Prescription According to Different Syndromes Wind-cold Type: Wind-heat Type: 2. Heat f Lung and Stomach Essential Prescription 3. Fever due to yin-deficiency Essential Prescription 12

13 8. Cough Ke Sou Cough is the most common symptom among the diseases of the respiratory system. It can be caused by many diseases such as common cold, asthma, pneumonia, etc. The cough mentioned here is caused by acute and chronic bronchitis. TCM considers that the main cause of the disease is catching exogenous pathogenic factors (Such as wind-cold, wind-heat and dryness) and internal damage of Zang-organs and Fuorgans. Main Symptoms 1. Cough due to Exogenous Pathogenic Factors: Manifested as cough with sputum, stuffy nose, nasal discharge, chillness, fever, headache, thin fur of the tongue and floating pulse. If the disease is caused by wind-cold, the patient may have cough with sputum and watery nasal discharge with white colour, severe chillness, slight fever, anhidrosis, and thin and whitish tongue fur. If it is due to wind-heat, the patient may have cough with sputum and thick yellowish nasal discharge, slight chillness, high fever, slight perspiration, thirst, sore throat, thin and yellowish fur and floating and rapid pulse. 2. Cough due to Internal Injury: Manifested as protracted cough, slight fever, unproductive cough with little sputum or productive cough with much sputum, pale face, spontaneous perspiration or night sweat, poor appetite, lassitude, emaciation, pale tongue with whitish fur or reddish tongue with little fur, and thready and rapid pulse. Treatment (Group discussion) Modification of Prescription According to Different Syndromes Cough due to Exogenous Pathogenic Factors Wind-cold Type: Wind-heat type: 2. Cough Caused by Internal Injury: 13

14 9. Asthma Xiao Chuan Asthma is one of the allergic diseases manifested by shortness of breath and audible wheezing which may be so severe as to cause the patient to open his mouth and raise his shoulders to gasp for breath, with difficulty in failing asleep. Asthma hereof may mean bronchial asthma and asthmatic bronchitis named in Western medicine. TCM considers that the cause of the disease is due to weakness, stagnation of phlegm-dampness resulting from exogenous pathogenic factors (including windcold, wind-heat or contact with allergens or eating allergenic food by mistake) or excitement. Main symptoms Before the onset, some of the patients may have prodromata of sneezing and discomfort. It can also occur suddenly. The major symptoms of the disease are stuffiness in the chest and rapid respiration with bronchial wheezing. The infant suffering from the disease has to sit up. Generally, the onset may last from several minutes to several hours, even several days for severe patients, accompanied by cyanosis, sweating, regular varicosity named continuous state of asthma. When the attack is relieved, the patient will cough up some frothy mucous sputum first. The disease can occur repeatedly with the complications of pulmonary emphysema, pulmonary heart disease etc. 1. Heat-type Asthma It occurs with thick and yellowish sputum, restlessness, thirst and desire to drink, reddish tongue with thin yellowish fur and purple superficial venule of the index finger. It occurs mostly during hot seasons. 2. Cold-type Asthma It occurs with watery sputum which is white and frothy, pale tongue with whitish thin fur, and reddish superficial venule of the index finger. It occurs mostly during cold seasons. Treatment. (Group discussion) 2. Modification of Prescription According to Syndromes Heat-type: Cold-type: 14

15 10. Enuresis Yi Niao It refers to involuntary passage of urine in children over 3, occurring especially during sleeping at night. So it is also called bed-wetting. It may occur in children under 3, resulting from insufficiency of the cerebrospinal cord and unforming of regular passage of urine. This is not considered as illness. TCM holds that the major causes of the disease are deficiency of kidney-qi, insufficiency of both the spleen and lung after illness, and loss of retaining power due to deficiency of qi. Main symptoms The child passes urine involuntarily during sleeping. It occurs more often during day time when the patient feels tired or in cloudy and raining days, once every several nights but once or twice or more every night for severe patients. If the disease lasts longer the patient may have sallow complexion, listlessness, lassitude, dizziness, soreness of loins, spontaneous perspiration, night sweat, cold extremities, pale tongue with thin and whitish fur and deep and thready pulse. Treatment (Group discussion) 2. Modification of Prescription according to Syndromes Diarrhea: Anorexia and abdominal distention: Spontaneous perspiration and night sweat: 15

16 Daily Child Massage for Health Care Child massage for health care refers to using certain manipulations to operate on some points to improve children s health. It can invigorate the spleen, regulate the stomach-qi, promote appetite, build up the constitution, prevent diseases and promote growth. The manipulations can be done anytime and are convenient and painless, so they are easy to be accepted by children. 1. Manipulation Reinforcing Pijing times, rubbing the abdomen 2-5 minutes, pressingkneading Zusanli (St 36) times and pinching the spine 3-5 times. 2. Point for Attention 1. Generally it is suitable to be done in the morning or before meal, once a day. One course of treatment includes 7 days. Another course can be done 1 day later. The child will recover from his illness 3-4 courses later. The children s height and weight will increase after 3-6 months of treatment. 2. Massage must be suspended when the child has acute infectious disease and can be resumed after the child recovers from his illness. 16