TCM Pediatrics General Introduction

1. TCM Pediatrics General Introduction Violet Song

2. Introduction Bian Que (4 century BC.) The first TCM Pediatrician in history

3. Sui Dynasty • Cao Yuanfang(6-7 century A.D) Zhu Bing Yuan Hou Lun (Treatise on the Origins & Symptoms of Various Diseases)

4. North Song Dynasty • Qian Yi (1032-1113 A.D) Xiao Er Yao Zheng Zhi Jue (A Collection of Essential Pediatric Patterns &Treatments) Pediatric Sage

5. Physiology • The internal organs are tender and fragile and the Qi is not full • Children have a pure yang constitution

6. Etiology • Congenital factor • External factor • Diet • Emotional factor • Injury • Medical factor

7. 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

8. Insufficient Lungs Spleen Kidneys yin Excessive Liver Heart yang

9. Pediatric Diagnosis • Observation • Listening and smelling • Inquiring • Palpation

10. Observation • Observe Shen and color • Observe body form • Observe sprouts and orifices • Skin eruption • Urine & stools • Index finger vessel

11. Observe Shen and color

12. Yellow, relates to SP, indicates : • Weak constitution • Improper diet • Dampness

13. Green, relates to Liver, indicates: • Wind • Pain • Blood stasis • Convulsion

14. Red, relates to H, indicates: • Heat • Convulsion

15. White, relates to LU, indicates: • Deficiency • Cold

16. Black, relates to K, indicates • Cold • Pain • Water retention • Malignant situation

17. Observe body form • head, neck, fontanel • trunk • limbs • skin • hair • nails

18. 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.

19. Observe stools • Observe urine

20. Veins in the Index Finger

21. 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.

22. Superficial-Exterior • Deep- Interior • Red-Cold • Purplish- Heat • Fluency-Deficiency • Sluggish-Excessive

23. 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

24. Listening & smelling • Crying • Breathing • Coughing • Language • Smelling

25. Inquiring

26. Palpation • Fontanel • Skin • Chest • Abdomen

27. Superficial Slow With strength Deep Rapid Without strength Pulse Age >3 y Take 3 guans with one finger

28. 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

29. Treatment • Treatment principles • Treatment methods • Dosage

30. 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

31. Internal treatment - herbal • External treatment • Tuina and acupuncture

32. Other Methods • Inhalation therapy • Drops • Herb bags • Bathing • Warm ironing

33. 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

34. Administration • <1y 100ml • 1~3y 100~250ml • >3y 250~500ml

35. TCM Pediatrics Cough

36. Introduction • 1.Concept • 2. Onset • Season • Age: <3 years • Characteristics • Prognosis

37. The Etiology and Pathogenesis • Due to invasion of external pathogens • Due to irregular diet • Spleen and lung Qi deficiency due to poor body constitution

38. 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

39. The key points for diagnosis • The sound of cough • The amount of phlegm • The color of phlegm

40. 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)

41. 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

42. Differential Diagnosis and Treatment • 1.External cough • 2.Internal cough

43. 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.

44. 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

45. Modification: • Cough with large amount of phlegm, greasy coating : Hòu Po, Cāng Zhú • Severe cold: Má Huáng

46. 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.

47. Formula-Sāng Jú Yǐn • Sāng Yè • Jú Huā • Xìng Rén • Lián Qiào • Bó He • Jié Gěng • Gān Cǎo • Lú Gēn SāngJúYǐnYòngJiéXìngQiào LúGēnGānCǎoBóHèRáo

48. 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

49. 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

50. Formula –Shàng Jiāo Xuān Bì Tāng • Pí Pā Yè • Shè Gān • Dàn Dòu Chǐ • Yù Jīn • Tōng Cǎo