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TCM Pediatrics General Introduction. Violet Song. Introduction. Bian Que (4 century BC.) The first TCM Pediatrician in history. Sui Dynasty Cao Yuanfang(6-7 century A.D) Zhu Bing Yuan Hou Lun (Treatise on the Origins & Symptoms of Various Diseases). North Song Dynasty
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TCM Pediatrics General Introduction Violet Song
Introduction Bian Que (4 century BC.) The first TCM Pediatrician in history
Sui Dynasty • Cao Yuanfang(6-7 century A.D) Zhu Bing Yuan Hou Lun (Treatise on the Origins & Symptoms of Various Diseases)
North Song Dynasty • Qian Yi (1032-1113 A.D) Xiao Er Yao Zheng Zhi Jue (A Collection of Essential Pediatric Patterns &Treatments) Pediatric Sage
Physiology • The internal organs are tender and fragile and the Qi is not full • Children have a pure yang constitution
Etiology • Congenital factor • External factor • Diet • Emotional factor • Injury • Medical factor
Pathology • Children are easily susceptible to disease which then transmits and changes rapidly • Children’s internal organ Qi is clear and effective; therefore, they easily and quickly return to health
Insufficient Lungs Spleen Kidneys yin Excessive Liver Heart yang
Pediatric Diagnosis • Observation • Listening and smelling • Inquiring • Palpation
Observation • Observe Shen and color • Observe body form • Observe sprouts and orifices • Skin eruption • Urine & stools • Index finger vessel
Yellow, relates to SP, indicates : • Weak constitution • Improper diet • Dampness
Green, relates to Liver, indicates: • Wind • Pain • Blood stasis • Convulsion
Red, relates to H, indicates: • Heat • Convulsion
White, relates to LU, indicates: • Deficiency • Cold
Black, relates to K, indicates • Cold • Pain • Water retention • Malignant situation
Observe body form • head, neck, fontanel • trunk • limbs • skin • hair • nails
Observe Sprouts &Orifices • Eyes • Nose • Teeth • Throat • Cheeks • Tongue • Ears • Two lower orifices Babies have white coat syndrome! Babies afraid of you? Take off your coat.
Observe stools • Observe urine
Check the location of veins in the index finger • Veins in Wind Bar (the area between the metacarpal phalangeal joint and the proximal inter-phalangeal joint): indicates acute stage, superficial and beginning of a disease and therefore it has a better prognosis • Veins in Qi Bar (between the proximal and distal inter-phalangeal joints): indicates the middle stage of a disease and the prognosis is not as good; • Veins in Life Bar (from the distal inter-phalangeal joint to the tip of the index finger): indicates the severe stage of a disease and the prognosis is worse.
Superficial-Exterior • Deep- Interior • Red-Cold • Purplish- Heat • Fluency-Deficiency • Sluggish-Excessive
Check the color of the veins • Fresh red: external excessive cold • Purple red: external or internal excessive heat syndrome • Green color: pain and panic or fear • Dark purple or black purple: food stagnation, particularly for blood stagnation • Light or pale red: deficient cold • Light or pale yellow: Inner wind due to spleen deficiency • Light or pale purple: deficient heat
Listening & smelling • Crying • Breathing • Coughing • Language • Smelling
Palpation • Fontanel • Skin • Chest • Abdomen
Superficial Slow With strength Deep Rapid Without strength Pulse Age >3 y Take 3 guans with one finger
Age Breathe(/min) Pulse(/min) B:P • New born 40~45 120~140 1:3 • <ly 30~40 110~120 1:3~4 • 2~3y 25~30 100~120 1:3~4 • 4~7y 20~25 80~100 1:4 • 9~l4y 18~20 70~90 1:4
Treatment • Treatment principles • Treatment methods • Dosage
Be careful with extremely bitter, cold, acrid, heat herbs, toxic herbs, harsh herbs • Once the treatment works , do not continue. • Choose the mild herbs from the same category • The prescription must be convenient for taking • Do not prescribe herbs without symptoms
Internal treatment - herbal • External treatment • Tuina and acupuncture
Other Methods • Inhalation therapy • Drops • Herb bags • Bathing • Warm ironing
Dosage • New born baby 1/6 of adult dose • < 1 year old, 1/3 of adult dose • 1-6 years old, 1/2 of adult dose • 7-12 years old, 2/3 of adult dose • Over 12 years old, same dose as adult
Administration • <1y 100ml • 1~3y 100~250ml • >3y 250~500ml
TCM Pediatrics Cough
Introduction • 1.Concept • 2. Onset • Season • Age: <3 years • Characteristics • Prognosis
The Etiology and Pathogenesis • Due to invasion of external pathogens • Due to irregular diet • Spleen and lung Qi deficiency due to poor body constitution
Dysfunction of dispersing and descending; Obstruction of qi tract Wind Cold External Attack Skin/Mouth/Nose LU Wind Heat Ph-H Adversely upward qi due to qi obstruction Cough Source of phlegm Phlegm Dysfunction of SP Ph-Damp Internal Invasion Weak Constitution Susceptible to ex- pathogenic factors Injury of LU & SP Dysfunction of descending
The key points for diagnosis • The sound of cough • The amount of phlegm • The color of phlegm
Commonly used herbs for cough • Herbs to remove external pathogens • Ma Huang, Zi Su Ye, Jing Jie, Fang Feng, Qiang Huo, Sheng Jiang; Bo He, Sang Ye, Chai Hu • Herbs to descend lung Qi • Chen Pi, Zhi Ke, Lai Fu Zi, Hou Po • Herbs to remove phlegm • Qian Hu, Bei Mu, Gua Lou, Dan Nan Xing (heat-phlegm); • Ban Xia, Zhi Tian Nan Xing, Xuan Fu Hua, Jie Geng (cold-phlegm); • Xing Ren, Zi Wan, Kuan Dong Hua, Su Zi, Pi Pa Ye, Sang Bai Pi (relieve coughing and wheezing); • Fu Ling, Du Huo (dampness)
Herbs to remove heat • Zhi Zi, Shi Gao, Lu Gen, Huang Qin, Lian Qiao, Yu Xing Cao • Herbs to moisten lungs • Sha Shen, Mai Men Dong, Yu Zhu • Herbs to tonify lungs • Huang Qi, Ren Shen, Dang Shen, Gan Cao, Bai Zhu
Differential Diagnosis and Treatment • 1.External cough • 2.Internal cough
1-1 Wind-Cold Cough • Symptoms- Frequent cough with heavy sound, itchy throat, thin white phlegm, stuffy nose and runny nose, aversion to cold and without perspiration, or fever with body pain • T-light red tongue body with thin white coating • P-floating tight pulse; floating red finger vessel • Therapy-Expel wind – cold, disperse lungs to stop cough.
Formula: Jīng Fáng Bài Dú Sǎn • Jīng Jiè • Fáng Fēng • Qiāng Huó • Dú Huó • Chuān Xiōng • Chái Hú • Qián Hú • Jié Gěng • Zhǐ Ké • Fú Líng • Gān Cǎo • Shēng Jiāng Jīng Fáng Èr Huó Èr Hú Xiōng Zhǐ Ké Fú Líng Jié Gān Yōng
Modification: • Cough with large amount of phlegm, greasy coating : Hòu Po, Cāng Zhú • Severe cold: Má Huáng
1-2. Wind-Heat Cough • Symptoms- cough with sticky yellow phlegm or with difficulty to cough phlegm out. Thirst and sore throat, turbid snot, or accompany with fever and headache, aversion to wind, sweating • T- red tongue body with thin yellow coating • P-floating rapid pulse; floating purple finger vessel. • Therapy-Expel wind and clear heat, disperse lung and resolve phlegm.
Formula-Sāng Jú Yǐn • Sāng Yè • Jú Huā • Xìng Rén • Lián Qiào • Bó He • Jié Gěng • Gān Cǎo • Lú Gēn SāngJúYǐnYòngJiéXìngQiào LúGēnGānCǎoBóHèRáo
Modifications • Severe LU heat with yellow sticky phlegm, yellow coating: HuángQín, ZhīMǔ, YúXīngCǎo • Severe ST heat with heavy breathe, severe thirst: ShíGāo, TiānHuāFěn • Red and swollen tonsil: NiúBàngZǐ, ShèGān, XuánShen, BǎnLánGēn • Sever cough & a lot of phlegm: ZhèBèiMǔ, TíngLìZǐ
2-1. Damp-Heat Cough • Symptoms-Cough with large amount of phlegm, or cough with retching. Epigastria distension and poor appetite; turbid thick snot; afternoon fever, the disease is lingering. • T-red tongue body with thick greasy or greasy yellow coating • P-slippery & rapid; purplish sluggish finger vessel • Therapy-clear and disperse lung, resolve phlegm and eliminate dampness
Formula –Shàng Jiāo Xuān Bì Tāng • Pí Pā Yè • Shè Gān • Dàn Dòu Chǐ • Yù Jīn • Tōng Cǎo