The publishers do not advocate nor endorse self-medication by laypersons. Chinese medicine is a professional medicine. Laypersons interested in availing themselves of the treatments described in this book should seek out a qualified professional practitioner of Chinese medicine. It was based on my research of the English language literature available at that time and my study of and clinical experience in pediatric tui na in China.
That book sold well and undoubtedly helped many practitioners and patients alike. Blue Poppy Press still gets orders for that book even though it has been out of print for some years. However, although Turtle Tail filled a need in its time, after several years it became apparent to me that, as a clinical manual of TCM pediatrics, it was seriously flawed.
As publisher of Blue Poppy Press, I have tried several times to commission a really good TCM pediatric text to meet the needs of Western practitioners and their patients. Unfortunately, no one has submitted a completed manuscript though more than one Chinese practitioner has promised. In the intervening years, I have taught myself to read medical Chinese.
Thus I have taken it upon myself to create a new English language clinical manual on the TCM treatment of pediatric diseases. As my practice has developed over the years, I have more and more concentrated on the prescription of internally administered Chinese herbal medicines. Turtle Tail gave herbal, acupuncture, and tui na treatments for most of the diseases it covered. In this book and consistent with the majority of Chinese TCM pediatric books, except for a short chapter on pediatric acupuncture in general and a short section on acupuncture under most of the diseases discussed, I have primarily focused on the herbal treatment of pediatric diseases.
Acupuncture can be an effective modality for the treatment of certain pediatric diseases. However, I find the prescription of Chinese herbal medicines mostly sufficient, quite convenient to administer, and I prefer, if possible, not to make my little friends cry. As for pediatric tui na, Blue Poppy Press has published a treatment manual on pediatric tui na written by Dr.
Fan Ya-li formerly of the Shandong. College of TCM. Therefore, I have left it to that book to discuss that treatment modality. In reviewing the Chinese literature on pediatrics, it is clear that most Chinese pediatric manuals discuss a number of diseases that Western children do not commonly suffer from, such as malnutrition, epidemic dysentery, and epidemic encephalitis B. Other conditions discussed in Chinese manuals, such as polio, tetanus, and leukemia, are better and more appropriately treated by modern Western medicine.
Therefore, I have kept the topics discussed in this book solely to the diseases and conditions which typically present in a TCM outpatient clinic in the West. These diseases, other than seasonal epidemics such as measles and mumps, have been presented in a roughly longitudinal manner, meaning that they have been introduced more or less chronologically in terms of their likelihood of appearance.
The material in this book is taken from a number of Chinese sources. These are listed in the bibliography. Medicinals are identified in Pinyin followed by Latin pharmacological nomenclature in parentheses. These identifications are primarily based on Bensky et al. Chinese Herbal Medicine: Materia Medica. This book is meant for students and professional practitioners of Traditional Chinese Medicine.
That book is meant as a companion volume to this one, explaining traditional Chinese theories on diet and child care. Although that book does give a number of simple home remedies for common pediatric complaints, parents of children who are ill are advised to seek out professional TCM care for their charges. The full benefit of TCM pediatrics is only made manifest when treatment is based on a professional pattern discrimination which is beyond the means of most Western parents.
Many readers know that my first specialty is TCM gynecology. I treat so many women, when they see how much good Chinese medicine has done for them, they frequently ask me to also treat their children. Therefore, it is not uncommon for me to see in my clinic as many or even more infants and toddlers in a day than adult women. However, it is my experience that Chinese medicine offers quick and effective treatment for the majority of common childhood complaints.
Once one knows the key essentials of TCM pediatric diagnosis and treatment, TCM pediatrics is a relatively simple specialty and one which deserves much more attention in the Western world.
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Hopefully this book will help to show how easy it is to diagnosis and treat our little friends with Chinese medicine. Qian Yi, also known as Qian Zhong-yang, was one of the earliest and most famous Chinese pediatric specialists. He was also the first Chinese pediatrician to detail the different patterns in measles, scarlet fever, chicken pox, and smallpox. Qian pointed out the unique characteristics of infants and young children and he introduced new methods of diagnosis and treatment based on those unique characteristics. In the Ming dynasty CE , a number of influential pediatricians summarized their experiences and theories in various books on TCM pediatrics.
This is a comprehensive text which lists the pulse, treatment principles, acupuncture protocols, and herbal formulas under each pediatric disease. Wan Quan, also know as Wan Mi-zhai, was one of the most famous Ming dynasty pediatricians. He was the third generation in his family to practice medicine and he, therefore, 3.
Wan Quan advocated that children should be frequently exposed to sunlight and fresh air, trained to resist cold, protected from being frightened, and should not be overfed or given too much medicine. In addition to chapters on materia medica, pulse examination, febrile and miscellaneous diseases, and gynecology, Shen included a section on pediatrics. This book, because of its rich content, is still a popular book in TCM circles in China. Today, every TCM college in China teaches undergraduate and postgraduate courses in pediatrics, and every TCM hospital has a pediatric department.
In addition, hundreds of books on TCM pediatrics have been published in China in this century. When one visits such a department in a Chinese TCM hospital or if one looks at a modern Chinese TCM pediatric textbook, one will see that the primary modality employed is the prescription of Chinese herbal medicine. This is because, traditionally, pediatrics er ke was seen as a subdivision along with gynecology [fu ke] or was at least connected with internal medicine nei ke , and nei ke in China means the administration of internal herbal medicine.
This means that, although many Chinese acupuncture books contain sections on pediatric diseases and although one can see some children receiving treatment in Chinese acupuncture clinics, the specialty of pediatrics in TCM implies, at least to the Chinese, the use of Chinese herbal medicine. However, there is one other place where pediatrics is also practiced and written about as a specialty within Chinese medicine, and that is in tui na. Tui na is Chinese medical massage, and within tui na there is the very healthy and robust specialty of xiao er tui na or pediatric massage.
However, its real blossoming occurred in the Ming dynasty. During the Ming and Qing dynasties, numerous books were published on pediatric massage and now every Chinese TCM college and hospital have their pediatric massage departments. Readers interested in Chinese pediatric massage should see the bibliography at the back of this book for English language titles and videotapes. As mentioned above, in Chinese medicine, infants and young children are not just miniature adults. This means that, in TCM pediatrics, young children are prone to certain disease causes and disease mechanisms, certain methods are used specifically for diagnosing young children, and that children even have their own treatment principles and treatment modalities.
Therefore, in TCM, pediatrics is really very much a specialty. The good news is that, if one keeps these basic differences in mind and understands their implications, then the rest of TCM pediatrics is relatively easy to understand and practice. The viscera and bowels are tender and delicate and the form qi is not full. Children have a pure yang constitution. Because yin is not capable of checking and controlling yang, yang easily becomes hyperactive. When yang becomes hyperactive, it may easily manifest as evil heat.
Children are easily susceptible to disease which then transmits and changes rapidly. This means that children are prone to getting sick more easily than adults. Every parent and pediatrician is well aware of this fact. However, when children do get ill, their diseases progress more rapidly through the various divisions or stages described by Chinese medical theory than in adults. According to TCM theory, there are three main viscera responsible for the majority of pediatric diseases. These are the lungs, spleen, and liver. Therefore, external evils easily enter the exterior and assail the lungs.
The exterior defensive refers to the exterior of the body guarded and controlled by the defensive qi. The defensive qi is, in turn, controlled by the lungs. If evils enter the exterior of the body, they hinder and obstruct the free flow of the defensive qi which then accumulates in the exterior producing symptoms of muscular aches and pains as well as fever.
Thus the lung qi counterflows upward, resulting in sneezing and coughing. In addition, because fluids are not sent down to the bladder, fluids may accumulate in the lungs, transforming or congealing into phlegm. Therefore, they are easily damaged by food. In addition, the word fortify also technically implies the spleen in Chinese medicine. When one specifically wants to supplement the spleen, we say that the spleen should be fortified. This means that spleen function vis a vis digestion is weak and immature in children.
When this happens, it may result in several possible diseases or disease mechanisms. Secondly, it may give rise to symptoms of evil heat. This is because food depression is a yin evil which obstructs the flow of yang qi. When yang qi is not allowed to flow freely, it becomes stagnant or depressed and accumulates. Because it is yang, when it accumulates, it may manifest as heat, since warmth is one of the inherent characteristics of yang qi. Third, food stagnation implies that the clear and the turbid are not separated as they should be. The clear is not upborne and the turbid is not downborne.
Thus turbid fluids accumulate and these may transform and congeal into phlegm. And fourth, because stagnant food hinders and obstructs the upbearing of the clear qi, the spleen is not fortified by this qi. This then becomes a vicious circle about which we will have plenty more to say. This is due to several reasons. It is the liver which stores the blood and the sinews are controlled by the liver.
If the sinews do not receive adequate nourishment and moistening from the blood, then they contract, causing spasms. Stagnant qi results in the liver losing its control over coursing and discharge. Thus the liver becomes replete at least in terms of qi. Since the liver is the wind wood viscus, internal stirring of wind is typically associated at least in some way with the liver in TCM, if not causally, at least in terms of treatment. Because children are young and new, their viscera and bowels have not yet accumulated a lifetime of evil qi.
The types of evil qi we accumulate with age are dampness and turbidity, stagnant qi and static blood, and deep-lying or hidden evils. Secondarily then, the viscera and bowels do not engender and transform the same amounts of qi and blood. Consequently, the body does not receive adequate nourishment and prenatal or former heaven essence is used up. In children, this has not yet happened to any appreciable degree. Therefore, when they do get ill, they tend to recuperate very rapidly. This also means that they tend to respond to light treatment and small doses.
Other key statements of fact about the unique pathophysiological characteristics of children In addition, there are a number of other traditional sayings about the unique pathophysiological characteristics of children. Division here refers to the six divisions of the Shang Han Lun Treatise on Damage [Due to] Cold and the four divisions of wen bing xue or warm disease theory. This means that external evils may easily and relatively quickly go from the tai yang to the shao yang or from the wei to the ying or xue fen.
The spleen is the root of latter heaven essence manufactured from the excess of qi and blood engendered and transformed by the spleen from food and liquids. When one goes to sleep, this excess or superabundant qi and blood are transformed into acquired or postnatal essence. Therefore, they do not store as much acquired essence as a more mature person does.get link
TCM for Pediatrics (English)
Consequently, because they do not have this backup reserve of acquired essence which can be turned back into qi and blood, they easily lose weight if anything damages their spleen function. Qi is the forefather of spirit and essence is the child of qi. Thus qi is the root of essence and spirit. Great is qi!
When qi accumulates, it produces essence. When essence accumulates, it renders essence wholesome. This means that spirit is nothing other than an accumulation of qi and essence in the heart. However, since essence is nothing other than an accumulation of qi, spirit is really nothing other than an accumulation of qi. As we have already seen, the spleen is the postnatal root of engenderment and transformation of qi and, in young children, the spleen is inherently vacuous and weak.
Thus it is easy to see why the spirit would be so restless and easily upset in infants and young children. The spirit is quiet or calm only if it is nourished by sufficient qi and blood. Since these tend to be scanty and weak, the spirit likewise is easily upset. Such congenital toxins are called fetal toxins in TCM, and they are a species of deep-lying or hidden warm evils. Deep-lying or hidden evils are evils which remain latent in the body until some later circumstance allows them to become active.
If children have inherited or developed fetal toxins in utero, certain types of invading seasonal or pestilential qi can combine with these fetal toxins and result in rather virulent epidemic pox diseases. These include rubella, rubeola, and chicken pox as specifically pediatric pox diseases. It is qi which keeps the body warm. Therefore, if qi becomes weak, there is cold. If qi becomes inhibited and depressed, then there is depressive or transformative heat.
In the latter case, the spleen is not strong enough to transport and transform a lot of food at one time. Thus infants and young children have to eat many small meals throughout the day. External causes refers to the six environmental excesses and pestilential qi. Internal causes refers to damage by the seven affects or emotions. And neither external nor internal causes refers to a miscellaneous collection of disease causes, such as diet, lifestyle, sex, trauma, poisoning, drowning, etc.
Although pediatric diseases may be due to any of these three groups of disease causes, in children under six years of age, diet is, by far in my experience, the leading cause of the commonly encountered pediatric complaints with external and internal causes aggravating the ill effects of a faulty diet. The stomach is likened to a fermentation vat.
However, this pot of the stomach sits on a stove. That stove is the spleen which provides the heat which drives off the essence of the food and drink the same way that fire under a still drives off the alcohol from the mash. This means that it is the warmth of the spleen which provides the force for the transformation of food and liquids.
This warmth of the spleen is called the spleen yang when describing its warming function, while it is referred to as spleen qi when describing its transforming and transporting function. Thus the spleen yang qi transforms the finest essence of food and liquids and sends this upward to the heart and lungs. This finest essence of food and liquids becomes qi in the lungs, while it becomes blood in the heart. The lungs then send the qi out to the rest of the body just as the heart sends the blood out to the rest of the body.
The qi provides the motivating force for all other transformations and transportations in the body, while the blood provides the moistening and nourishment for all the tissues of the body. If the qi and blood are sufficient and flow freely and without impediment to the entire body, then there is power to function and nourishment to build and repair the body and also to fuel that function. If, however, there is insufficient qi and blood, then function and nourishment are weak and deficient and there is the possibility of disease. The finest essence which becomes the qi and blood is like the essence of alcohol that is driven off to collect in the cooling coils of a still.
In Chinese medicine, this finest essence is often simply referred to as the clear. In contradistinction, the dregs or what is left behind are called the turbid. Hence the creation of qi and blood out of the finest essence of food and drink is also described as the separation of clear and turbid. The clear is sent upward to become the qi and blood, while the turbid is sent downward to be excreted as waste from the body through urination and defecation.
On the one hand, this means that, although the baby eats and drinks, they do not make the same amount of qi and blood an adult would. Thus the baby spends much more time sleeping than the adult. On the other hand, this means that turbid qi is not always excreted as efficiently as possible. This turbid material may also overflow from the middle burner or middle section of the body, the home of the spleen and stomach. Typically, this turbid residue is seen as damp in nature. Thus this turbid dampness may cause all sorts of symptoms associated with excess dampness, such as diarrhea and vomiting as well as damp skin lesions.
If this dampness congeals, it may form phlegm. According to Chinese medicine, phlegm is nothing other than congealed dampness resulting from incompletely digested food and drink. Because it is the spleen which is the motivating force for the separation of clear and turbid, i. The most commonly encountered pediatric diseases are either upper respiratory tract complaints, such as cough, cold, asthma, and allergies, or are digestive tract complaints, such as colic, diarrhea, stomachache, and vomiting. The first group of diseases all have to do with phlegm accumulating in the lungs, while the second group have to do with poor digestion.
However, since according to the Chinese medical theory, phlegm is a by-product of poor digestion, one can say that all these complaints are, in children, at root all due to their immature and, therefore, faulty digestion. This is why my first teacher of Chinese medicine, Dr.
Eric Tao Xi-yu of Denver, was fond of saying that all pediatric diseases are due to indigestion. Qi is also what transports and transforms food and liquids. If qi fails to transport and transform these foods and liquids and a turbid residue gathers and accumulates, this may obstruct the free and normal flow of the qi. The qi builds or backs up. Since it is inherently warm, if the qi backs up abnormally, there will be an abnormal accumulation of heat in that part of the body and this pathological accumulation may manifest as inflammation.
Thus dampness may become damp heat, stagnant food may become stagnant food and stomach heat, and phlegm may become phlegm heat. If this qi builds up to a certain point, eventually it must go somewhere. If turbid dampness, food, and phlegm keep the qi from flowing normally and it builds up like gas in a balloon, eventually it must find some avenue of escape. Because qi is yang, it also has an inherent tendency to move upward. That means that if it builds up past a certain point, qi will tend to counterflow abnormally upwards.
Therefore, one can see that the poor digestion associated with young infants and children under the age of five or six canot only produce excessive dampness and phlegm inside the body but can also indirectly be associated with counterflowing qi and inflammatory heat. When one adds these two disease mechanisms to the list, one can see that weak digestion may play a part in even more of the diseases and symptoms associated with infants and children.
And further, it is the qi which protects the body from invasion by various pathogens in the external environment. In Chinese medicine, various pathological bacteria, viruses, and fungi existing outside the body are called external evils. If the spleen and stomach promote good, efficient digestion, sufficient qi and blood are manufactured and this sufficient qi defends the exterior of the body by these external evils or pathogens. If this qi is not manufactured in sufficient quantities, then the exterior of the body may be abnormally susceptible to invasion.
Thus because babies have weak stomachs and spleens, they are also more easily invaded by external pathogens than adults. The implications of the above theory The fact that weak or immature digestion is the root of most common pediatric diseases has three main implications. First and very obviously, if digestion plays such a pivotal role in the health and well-being of infants and young children, then diet is extremely important both in terms of preventing disease as well as treating it.
And third, because the spleen and stomach automatically mature around the age of six or so, most common pediatric diseases are self-limiting. This means that children automatically tend to outgrow them. This is an important point which laboring parents should keep in mind when they have lost sleep for the third night in a row due to a coughing son or a feverish, crying daughter with an earache.
Therefore, Sun felt it was harder to diagnose and treat women than men. Further, babies cannot talk. Therefore they cannot explain what they are feeling. Because of this, pediatrics has sometimes been jokingly referred to in Chinese medicine as specialization in mutes. Because he could not question his young patients the way he would adults, Sun felt that they were even more difficult to diagnose than women.
If one understands the pivotal role of diet and indigestion in pediatrics, babies are actually much easier to diagnose and, therefore, treat than women. Therefore, I love to treat babies and do not find them all that difficult to diagnose. Essentially, what the Chinese doctor is trying to determine in most pediatric illnesses is whether the baby is abnormally hot or cold, whether their righteous qi is sufficient or insufficient, and whether there is some evil or unhealthy qi or substance which needs to be eliminated from the body. In order to make those determinations, the TCM practitioner uses four basic methods called the four examinations.
Looking In , Zhou You-fan compiled a list of 15 steps in a pediatric diagnosis. Eleven out of those 15 steps all have to do with looking or inspection. Inspecting the spirit Looking at the eyes tells the practitioner how serious the disease is. If the eyes are clear and shining and the baby is aware and intelligent, then the disease is not all that serious and should respond to treatment without too much worry. A red facial complexion A healthy child should have a pink facial complexion which is lustrous or shiny. The deeper or darker the shade of red, the more intense the heat. If there are habitually redder than normal cheeks, this typically suggests food accumulation or stagnation with transformation of heat.
If the cheeks are only redder than normal in the afternoon, this suggests either damp heat or vacuity heat. If both cheeks are bright red while the rest of the face is a bright white, and if there is accompanying cold limbs and a chilly sweat, this indicates that vacuous yang has lost its root and is counterflowing upward. If the facial complexion is red with a white forehead, this suggests internal heat combined with lung vacuity.
Traditionally, the right cheek was indicative of the lungs and the left cheek was indicative of the liver. However, in modern TCM, if only one cheek is redder than normal, local inflammation due to teething should be suspected. A pale facial complexion A paler than normal face usually indicates qi or yang vacuity.
If the face is a somber white, this suggests qi vacuity, while if it is a bright white, this indicates a yang vacuity. If the facial complexion is bright white with chilled limbs, this may indicate yang desertion, while a white, edematous face suggests qi or yang vacuity with dampness. If there is a bright yellow facial complexion, then dampness is mixed with heat. If this yellow color is dull, then dampness is associated with spleen qi vacuity.
If there is a dull yellow facial complexion with white, powdery patches on the cheeks lateral to the corners of the mouth, then intestinal parasites should be suspected. A green-blue facial complexion A green-blue facial complexion indicates either cold or considerable pain.
If there is a green-blue complexion with purplish, i. In particular, the practitioner should look at the vein at the root of the bridge of the nose between the two eyes. This area is called shan gen in Chinese. This translates as the root of the mountain, the nose being the mountain of the face. This is a very reliable diagnostic sign and one which is easy to determine. Are there any bald spots on the head? Withered, dry, brittle hair suggests extreme qi and blood vacuity for some reason, while underdeveloped muscles and bones also suggests visceral weakness and insufficiency.
Further, if the belly is distended with prominent blue veins, this may suggest chronic indigestion and, therefore, malnutrition associated with parasites. In addition, the practitioner should look to see whether the child moves about normally, if they are limping, guarding, or protecting some body part, or if they are holding some body part as if in pain.
If the child is asleep or unconscious when the practitioner inspects them, sleeping on the abdomen may be a sign of food stagnation or intestinal parasites, while sleeping on the back suggests a prolonged or serious disease. Sleeping with many covers and the body curled up in a ball suggests cold, while sleeping with the arms and legs thrown outward and the covers and bedclothes thrown off suggests heat.
Arched back rigidity of the neck and spasms and contracture of the four limbs suggest infantile convulsions as do frequent, occasional startled reactions. Inspecting the tongue It is usually impossible to inspect the tongue of a very young child. Basically, tongue signs in children mean the same things they do in adults. For instance, a paler than normal tongue means qi and blood vacuity. A red tongue indicates heat. A deep red tongue in the case of a warm disease suggests that heat has entered the constructive and blood divisions.
And a thorny red tongue like a red bayberry indicates toxic heat in the blood division with consumption and exhaustion of yin fluids. A purplish tongue indicates stasis and stagnation. As for the fur or coating, a white, slimy coating indicates dampness and phlegm internally. If the coating is yellow and slimy, then there is damp heat or turbid dampness in the middle burner. If the tongue coating is yellow, slimy, and dirty looking, there is food stagnation with depression transforming heat.
A dry, scanty, or peeled tongue coating suggests yin fluid vacuity and consumption, while a geographic or patchy tongue coating which comes and goes from time to time indicates spleen and stomach vacuity weakness. However, when it comes to a tongue coating in very young children and infants, any tongue coating which is thicker than normal usually indicates food stagnation and the presence of internal heat due to depression. Inspecting the eyes We have already discussed inspecting the eyes for the presence of spirit.
Here we are looking more closely for particular pathological signs in the eyes. If the sclera are red, this often suggests wind heat. Watering eyes are an early sign of measles or a severe common cold. A yellow sclera indicates the presence of damp heat internally, while black or dark bluish spots in the sclera point to the presence of intestinal parasites. Abnormally dilated or contracted pupils suggest kidney qi exhaustion and vacuity.
Slight corneal opacity in infants and young children may be a sign of malnutrition. And staring straight ahead with fixed eyes and a dull expression indicates infantile convulsions. Inspecting the nose A stuffy nose or runny nose with a clear, watery discharge indicates either a common cold, respiratory allergies, or chronic spleen vacuity with dampness.
A thicker nasal discharge indicates the presence of some heat. The thicker this discharge becomes and if it turns from white to yellow to green, this indicates more severe heat affecting the lungs. However, the practitioner should be careful at this point. If the wings of the nose tremble or move with breathing, this is characteristic of pneumonia.
Dry, yellow nasal mucus or crusting around the nose of dry mucus suggests dryness and heat. Inspecting the mouth Red, swollen gums with erosion indicate upward counterflow of stomach fire, while canker sores typically indicate spleen damp heat. Sores on the tongue are mostly due to heat in the heart and spleen, while a patchy white covering on the tongue indicates thrush and is usually associated with damp heat.
However, this damp heat may typically be associated with concomitant spleen vacuity. If the tonsils are swollen and inflamed and are covered with a white or yellowish white membrane which can be wiped away, then there are definitely heat toxins causing tonsillitis. If there is a greyish white membrane covering the back wall of the throat which cannot be wiped away, this suggests diphtheria. Inspecting the ears Swelling and pain of the auditory duct of the ear with a greenish yellow, purulent discharge from the ear canal indicates heat counterflowing and upwardly harassing.
Most often, this heat is due to food stagnation transforming into depressive heat. Locally, this heat is in the gallbladder and triple burner channels, but the site of its engenderment is in the stomach and intestines. If there is a watery, slightly turbid, whitish discharge from the ear, this is due to enduring spleen qi vacuity not containing fluids.
It is seen in cases where the eardrum has ruptured and then fails to heal. If there is marked swelling and pain in the glands under the ears, this suggests epidemic parotitis or mumps due to wind heat toxins invading the foot shao yang. Inspecting the two yin In Chinese medicine, the two yin refer to the anus and urethra in males and to the anus and vaginal meatus including the urethra in females. The urethra and vaginal meatus are the front or anterior yin, while the anus is the rear, back, or posterior yin.
If the external genitalia are red and moist in little girls, this indicates the presence of damp heat in the lower burner. Itching of the anterior yin indicates pinworms or trichomoniasis of the vagina. If the scrotum is unusually flaccid in little boys, this suggests kidney qi vacuity, while one-sided enlargement and downward drooping of the scrotum indicates hernia due to spleen qi vacuity. Dampness and itching of the anus with white, thread-like worms crawling out from inside the anus at night indicates a pinworm infestation, while redness, inflammation, chapping and cracking of the skin, and possible oozing of turbid fluids suggests diaper rash due to damp heat.
Small, papular eruptions Small, fine papular eruptions or rashes are characteristic of measles, rubella, and scarlet fever. Vesicular eruptions Raised vesicles which are red colored at their base and which may occur on the head, face, and four limbs are characteristic of chicken pox and impetigo. Chicken pox begins as fine, raised papules which then become water blisters the size of soybeans. After the eruptions break, they dry up, crust, and scab. Impetigo, on the other hand, is characterized by turbid, pus-filled lesions with red bases or roots which typically affect only a localized area.
These lesions may then spread if the pus filling the lesions touches the surrounding skin. Macular eruptions Bright red macular eruptions which are not noticeably raised, thorny, or papular on palpation and which do not lose their color when pressed are characteristic of heat toxins having entered the constructive and blood divisions.
If macular eruptions are indistinct or dark purplish in color accompanied by a pale complexion, cold limbs, and a fine pulse, then qi is too vacuous to contain and restrain the blood within its vessels. These are called yin eruptions as compared to the yang eruptions above and indicate a serious pathological condition. The stools Newborns and nursing infants usually have soft stools frequently throughout the day. These are yellow in color and neither too dry nor too wet. This is normal. If the stools of a newborn or infant change from this norm in any way, this is a very important indicator of the presence of disease.
Small, hard, round, dry stools with several days between movements indicate replete heat in the yang ming or consumption of yin fluids due to warm disease. Loose stools containing white milk curds or brightish yellow in color and smelling like rotten eggs indicate food stagnation due to unregulated feeding. Blood and pus or mucus in the stools suggest the presence of damp heat in the intestines.
If there is more blood, there is more heat. If there is more pus or mucus, there is more dampness. If the stools are bloody like the color of soy sauce in a nursing infant accompanied by crying from time to time, this indicates intestinal obstruction and intussusception. The urine Normal urine is clear and light yellow in color. If the urine becomes scanty and dark yellow during very hot weather and profuse perspiration, this is also normal. If the urine is dark yellow, frequent, and painful or burning, this suggests the presence of damp heat percolating downward. Turbid urine like rice washing water is due to turbid dampness in turn due to unregulated feeding.
Deep brown or reddish urine suggests hematuria. In order to determine the cause of this hematuria, one must check other signs and symptoms. This is a special diagnostic method developed in the Tang dynasty specially for children under years of age. The three bars are the three joints of the index finger. The metacarpal-phalangeal joint is called the wind bar. And the second or distal most interphalangeal joint is called the life bar. Why this can be called a pediatric method of pulse examination is that the word in Chinese for pulse, mai, also means vessel and any visible vein is a type of vessel in Chinese medicine.
This type of pulse examination was developed to take the place of palpation of the pulse in infants which is much harder to do accurately and efficiently than in adults. Traditionally, it was the left index finger which was inspected in little boys and the right index finger in little girls. Nowadays in China, the right index finger is examined in both boys and girls. Depending upon the size, color, prominence, location, and shape of the vein on the palmar surface of the index finger, the practitioner can tell whether the disease is hot or cold, vacuous or replete, how far it has progressed, and how dangerous the condition is.
One begins by moistening the palmar surface of the index finger in order to see this vein more clearly. This is the same as moistening a piece of wood or a stone in order to reveal the grain more clearly. Next, one gently stretches the index finger backwards in order to also make the vein more visible. In general, observation of this vessel is divided into four basic criteria: 1 the depth of the vessel, 2 its color, 3 its size, and 4 its location in terms of the three joints of the index finger.
Depth In a normally healthy child, this vein should only be dimly visible. If the vein is easily seen and looks close to the surface of the skin, this indicates an exterior pattern. If the vein looks indistinct and deeper under the skin, this indicates an interior pattern. Color In a healthy child, the vein is a pale purple color or reddish brown in color. If the color changes from this norm, then this suggests pathology. A light red vein suggests vacuity cold or qi and blood dual vacuity, while a red vein indicates replete heat. Whereas, a bluish purple vein indicates spasms and tremors, painful conditions, and blood stasis.
Size A thicker than normal vein indicates repletion, while a thinner than normal vein indicates vacuity. Location In a healthy child, this vein should only be seen at the wind bar. If there is an easily seen vein at the metacarpal-phalangeal joint but no easily seen vein at the other two more distal joints of the index finger, this traditionally shows that any externally invading evil qi is in the exterior.
This is why this is called the wind gate. In my experience, an engorged, slightly purplish or red purplish vein at the wind bar indicates food stagnation with depressive heat due to unregulated feeding. Typically, the symptoms which go along with a visible vein at the wind bar are headache, bodily heaviness, loss of appetite, and a slight fever. If the vein is visible and unusually prominent at the wind bar and the first or proximal interphalangeal joint, then disease has either entered the channels or is more serious.
Therefore, this section is called the qi bar. The symptoms which commonly go along with this sign are high fever, no appetite, fatigue and somnolence, and diarrhea. The child should be treated professionally, but the disease should respond to treatment without difficulty. If the vein is visible at all three joints or bars or is prominently visible at the third or life bar, then the disease has entered the viscera.
In this case, the symptoms are more severe and include possible vomiting, continued or even higher fever, nightmares, delirium, and convulsions. This disease most definitely requires speedy professional treatment and, if left untreated, the consequences may be permanent or life-threatening. This is why the third joint is called the life bar. In addition, the TCM practitioner will also want to look at any place the child or the parent says they hurt or any location which is diseased.
For instance, if there is a diaper rash, the practitioner will want to see that rash to determine what color red it is, how extensive it is, whether it is wet or dry, and whether the skin is broken or intact. Likewise, any other skin rash would be inspected in the same way. If a rash was very red, then this suggests pathological heat. If the rash is wet and weeping, this suggests pathologic dampness, while if there is pus production, this also suggests toxins. What the Chinese medical practitioner is listening for is the sound of any cough.
Is it strong or weak? A strong cough typically goes along with a replete pattern, while a weak cough goes along with a vacuity pattern. Is it wet or dry? A wet cough indicates profuse phlegm, while a dry cough indicates insufficient lung fluids. Is the cough spasmodic? In modern TCM, this question helps determine not so much the pattern of the cough but the necessity of using certain wind medicinals which have a pronounced antispasmodic ability.
The practitioner listens to the sound of breathing. Is it asthmatic and wheezing? Does it sound phlegmy and obstructed? If there is either the sound of phlegm obstructing the nose or phlegm in the throat, then the practitioner knows there is the presence of phlegm. Further, the practitioner listens to the sound of the voice and the speech.
Is the voice hoarse or raspy? A hoarse or raspy voice indicates either a wind heat invasion or yin vacuity. Is the voice a normal loudness or very faint and weak? Can the child speak normally for their age? This tells us about their development which in turn tells us about their spleen and kidneys. Are they delirious? Delirium in a warm disease suggests that heat has affected the pericardium and thus given rise to disquietude and, therefore, chaos and confusion of the heart spirit. As for smelling, the practitioner smells the breath. This is very important for finding out if there is stagnant food in the stomach.
If there is, the breath will tend to be sour and bad-smelling. If the breath is fresh and clean, then food stagnation is probably not the issue. Further, the practitioner will want to at least know from the parents how the stools smell. If they are very foul-smelling, then there is probably heat and possibly food stagnation. If they are odorless, this suggests that the spleen is weak. Is the urine strong smelling?
If it is, this again suggests heat. In actual practice, it is mostly the parents doing the smelling of the urine and stools and the practitioner questions the parents about this. The parent may not know this, but the practitioner has already begun their diagnosis. At some point in the examination, the practitioner will probably lie the child on their back and feel their abdomen. Is it too hot or cold? Is it too firm and distended or too slack and infirm? Even still, their fingers may not be able to distinguish adequately these three positions. In that case, one can feel the entire pulse with only one or two fingers, attempting to get an overall impression of whether the pulse is floating or deep, fast or slow, weak or forceful, large or fine, slippery or wiry.
Li Shi-zhen says that when feeling the pulse on infants, one need only use a single finger to check all three positions and it is enough to check for strong or weak, slow or rapid pulses. According to Li Shi-zhen, the normal pulse rate for children between the ages of years old is seven beats per respiration. Eight or nine beats per respiration cycle indicates heat, while four or five beats per respiration cycle indicates cold. A more modern interpretation is that: beats per minute is a normal pulse rate in newborns beats per minute is normal in a one-year-old beats per minute is normal in a four-year-old 90 beats per minute is normal in an eight-year-old beats per minute is normal in a year-old.
Questioning Although questioning the child itself is often not possible due to youngness of age, the practitioner will question the parent. They will want to know how the disease began, how long it has been going on, what are the symptoms, how is the appetite, the stools, urination, energy, mood, and sleep. What color is any phlegm? What treatments have already been tried and with what result?
What does the child eat? What were they eating when they got ill? What else was happening when they got ill? Has the child had any fever? Do they seem to be running hot or cold, etc. The exact questions which the practitioner will ask very much depend on the major complaint.
For instance, if the major complaint is vomiting of milk in a child which is still breast-feeding, then some of the questions will include: How long ago did the vomiting start? When does the child vomit — directly after meals, at other times of the day? What does the vomitus look like? What does the vomitus smell like? When the child vomits, does it come out with force or does it just dribble out?
Are they restless and agitated or sleepy and somnolent? Do they tend to feel hot or cold? Is their face typically red or pale? What are their bowel movements like? All these questions are meant to determine vacuity from repletion and heat from cold. Establishing a TCM pattern In TCM as a specific style of Chinese medicine, the hallmark of our methodology is treating on the basis of a pattern discrimination and not just on a disease diagnosis alone.
There are ten different methods of pattern discrimination used in TCM: 1.
Calaméo - TCM for Pediatrics (English)
Eight principle pattern discrimination 6. Five phase pattern discrimination 7. Disease caused pattern discrimination 3. Six division pattern discrimination 4. Four division pattern discrimination 5. Frequently more than one of these pattern discrimination methods will be used to describe the total pattern in a given patient. For instance, if we say that our young patient exhibits a spleen qi vacuity, we are using a combination of three different TCM methods of pattern discrimination.
Because we have said that the pattern involves the spleen and not any other of the viscera and bowels, we have used viscera and bowel discrimination. Because we have said that the pattern involves the qi and not the blood, we have used qi and blood pattern discrimination. And because we have said that the pattern is one of vacuity and not repletion, we have used eight principle pattern discrimination, vacuity and repletion being one pair of these eight principles.
In TCM as a system, we do not give treatment on the basis of a disease or a main symptom alone. That is what makes TCM the safe, holistic, and effective medicine it is. The final TCM pattern discrimination or diagnosis will depend on the synthesis of information gathered by these four examinations. The TCM practitioner may or may not be interested in laboratory tests and cultures. But even if such tests have been done, the TCM pattern discrimination is not made on their basis. As TCM practitioners, we may choose to take the fact that a baby has tested positive for Streptococcus or has red eardrums into account, but we do not prescribe treatment based solely on such Western medical criteria.
This book describes the main, professionally recognized TCM patterns under each of the diseases discussed and gives representative guiding formulas for the treatment of each of these patterns. However, the practitioner will often need to modify these patterns in order to exactly describe their individual patient. This means that the pattern must be modified to fit the patient and not the patient made to fit a particular textbook pattern.
If we modify a pattern, this then means that the formula must be modified as well. These can be summarized in four key statements. It is essential to treat in time while the righteous is still firm and being cautious. This means that treatment should be begun at the first sign of disease. This is based on the assumption that it is better and easier to prevent a disease which has yet to manifest than to treat a disease after its symptoms have already appeared. In actual clinical practice, preventive treatment is often easier to talk about than to do.
However, when it comes to children, it is actually possible to provide preventive treatment in a realistic manner. This means insuring that the child sticks to a clear, bland diet of cooked, easily digested foods designed to fortify the spleen. If parents are able to correct the diet and remedy the very simple or minor symptoms above, then it is less likely spleen dampness will congeal into phlegm and cause inflammation, thus giving rise to earaches, bronchitis, asthma, or tonsillitis. Practitioners may also teach parents how to do some simple Chinese pediatric massage in order to drain the stomach and fortify the spleen or they may choose to give parents some Bao He Wan Protect Harmony Pills or Bao Ying Wan Protect Babies Pills which treat food stagnation and the accumulation of phlegm.
Armed with knowledge of the signs and symptoms of incipient pediatric disease, knowledge about the role of diet in pediatric disease, and some pediatric massage maneuvers or ready-made formulas for food stagnation, parents can do wonders in preventing the occurrence of disease in their young charges. It is essential to stop treatment in the middle of disease. It is, therefore, one of the unique features of TCM pediatrics that internal medical treatment should be suspended in many cases before a complete cure has been effected.
Once the symptoms are clearly moving in the proper direction, treatment should be suspended and the practitioner should rely on the parents instituting a proper diet and lifestyle. If the disease does not continue to abate or reverses itself and gets worse, the practitioner can then always resume administration of internal medicine. It is my own personal clinical experience in treating babies and toddlers that treatment may improve one symptom and cause some other symptom to crop up.
In that case, if one suspends all treatment other than proper diet and lifestyle, commonly all the symptoms then disappear. If one does not suspend all treatment, one may go around and round in a circle. One treats for the original complaint and that complaint goes away but another appears. Then one switches to treat that other complaint and the original complaint comes back. In that case, stop all treatment and see what happens. In my experience, often both complaints go away entirely.
One should use suitable methods of administration and even new forms of Chinese medicinals in pediatrics. One should know well the methods of administering Chinese medicine in decoction to children. However, this is really not so. Yes, if one tries to give a baby or young child a decoction in a teacup and ask them or even try to force them to drink it, they typically will not. First of all, children do not need and, in fact, should not be given the same doses as adults.
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It is my experience that babies and young children can get very good results with a very small dose of Chinese medicinals in decoction. About this product. Stock photo. New other : lowest price The lowest-priced item in unused and unworn condition with absolutely no signs of wear. Will include dust jacket if it originally came with one. Text will be unmarked and pages crisp. Satisfaction is guaranteed with every order. See details. Buy It Now. Add to cart. Be the first to write a review About this product. New other : lowest price. About this product Product Identifiers Publisher.
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