Class 10: Pediatric Diseases: Infantile convulsion, infantile diarrhea, infantile malnutrition, infantile paralysis, and mumps Xianhui Li

Introduction Disease of Children have the similar characteristics of wind. –change and transform quickly. –convulsions. Easy to have food stagnation

Key points in diagnosing children Inspecting the vessel of the bars at the tiger’s mouth –Observe the vein at the base of the palmar side of the index finger. Specially children under 2-3 years of age. The three gates are the three joints of the index finger. The metacarpal-phalangeal joint is called the wind gate. The first interphalangeal joint is called the qi bar. The distal interphalageal joint is called the life bar.

Key points in diagnosing children Pulse examination – beats per minute in newborns – beats per minute in a one year old –110 beats per minute in a four year old –90 beats per minute in a eight year old.

Infantile convulsion Infantile convulsion is commonly seen in pediatrics, manifested by series of muscle contractions accompanied by impairment of consciousness.

Etiology and Pathogenesis Acute infantile convulsion –External pathogenic factors or internal phlegm fire generates wind invading pericardium and liver. Or sudden fright harms the mind. Chronic infantile convulsion –Congenital deficiency, insufficient nutrition, persistent dysentery, severe vomiting and diarrhea, or chronic illness damages liver yin and blood, giving rise to wind

Acute infantile convulsion Manifestations –Unconsciousness, upward gazing, lockjaw, neck rigidity, opisthotonos, contracture of limbs, rapid and wiry pulse Treatment Principle –Restore consciousness, eliminate heat and suppress wind Acupuncture Treatment: Yintang, DU26, LR3 –Yintang has a sedative action –DU26 can regulate the Governor vessel and promote resuscitation –LV3 subdue liver wind –Invasion of pathogenic heat: DU14, LI11, Jing-well points, –Convulsion due to phlegm heat: SJ18 (qi mai) clear heat from TB to relieve convulsion, Ren12, ST40, LI4 –Convulsion due to fright: Sishencong has the action of tranquilization for those suffering from fright, KI1, PC7, PC8 Herbal treatment: qing wen bai du yin or bao he wan or hu po bao long wan

Chronic infantile convulsion Manifestations –Emaciation, pale complexion, lassitude, intermittent convulsion, cold limbs, poor appetite, loose stool, clear and profuse urination, enuresis, deep and week pulse. Treatment Principle –Tonify spleen and kidney and relieve convulsion Acupuncture Treatment: DU20, DU24 shenting, Ren4, SP6, ST36, BL20, BL23, Ren12, LV3, KID2 –Ren4, Ren12, SP6 and ST36 tonify spleen and stomach –BL23 and KI2 tonify kidney –BL20 tonify spleen and resolve dampness –LV3 soothe the liver –DU24 extinguishes interior wind and calms spirit –DU20 raise yang Herbal treatment: huan gan li pi tang or da ding feng zhu

Infantile diarrhea Infantile diarrhea is characterized by disharmony of the spleen and stomach with frequent bowl movements, and loose or watery feces.

Etiology and Pathogenesis Irregular diet, contaminated food, fright, or invasion of external pathogenic factors

Manifestations and treatment Manifestations –Abdominal distension and pain, borborygmus, several times of defecation per day, loose stool with undigested food. Treatment Principle –Harmonize spleen and stomach, stop diarrhea Acupuncture Treatment: ST25, ST37, Sifeng (Extra point) –The He-sea points are applied for the diseases of the fu organs. ST25 and ST37, the front mu point and He-sea point of the large intestine are selected to the principal points to remove stagnation of qi in the large intestine. Dampness will be resolved in case qi is regulated –Sifeng can promote digestion to remove the stagnation, and strengthen transportation to stop diarrhea –Diarrhea due to over feeding: Ren11, Ren12, Ren6 –Diarrhea due to damp heat: LI11, LI4, SP9 Herbal treatment: bao he wan or ge gen huang qin huang lian tang

Infantile malnutrition Infantile malnutrition is characterized by emaciation, sparse hair, distended belly, loss of appetite and listlessness.

Etiology and Pathogenesis Irregular intake of food, improper nursing, parasitosis, or chronic illness injures the spleen and stomach

Manifestations and treatment Manifestations –Gradual onset with slight fever or tidal fever in the afternoon, dry mouth, abdominal distension, diarrhea, anorexia, irritability, sallow complexion, emaciation, scaly and dry skin, protruding umbilicus, sparse hair, dirty and sticky coating of the tongue, or complete loss of coating, weak pulse. Treatment Principle –Harmonize spleen and stomach, stop diarrhea Acupuncture Treatment: ST25, Sifeng (Extra point), Ren12, Ren10, SP3, BL21, BL20, ST36, Baichongwo –ST25, regulates the stomach and large intestine, remove the heat and dampness –Ren12 ST36, BL21 and BL20 tonify spleen and stomach –Ren10 harmonizes stomach and eliminate heat –SP3 shu point of the spleen, reinforce the spleen and remove food stagnation –Sifeng, a specific point beneficial for treating infantile malnutrition –Baichongwo (1cun above SP10), a specific point to treat parasitosis Herbal treatment: zi sheng jian pi wan or fei er wan

Infantile paralysis Xiao er ma bi Contagious disease caused by toxic, seasonal and epidemic evils. Affects children under five years old, especially those between six months and two years old. –Initial stages: fever, coughing, inflamed throat, general aches and pains and sometimes vomiting and diarrhea. –Paralysis stage: paralysis of limbs, muscular atrophy and deformity of the joints. Includes: polio or poliomyelitis

Etiology and pathogenesis Toxic wind, heat and dampness invade the lung and stomach and cause symptoms similar to those of the common cold, epidemic toxins spread internal along the channels and connections, which obstruct qi and blood and thereby denying nutrients to the sinews and cause flaccid paralysis of limbs. Further lacking treatment, qi becomes depleted and blood stagnates, liver and kidney are affected

Manifestations and treatment Manifestations –Weakness and paralysis of the muscles and cold skin. Deformity of the bone. Treatment Principle –Tonify Qi and blood and nourish tendon and muscles Acupuncture Treatment –For upper limbs: LI15, LI11, LI4, TE5, DU14, BL10 tianzhu, –For lower limbs: ST36, ST41, GB30 huan tiao, GB34, GB39, BL60, Huatuojiaji –For the abdominal muscles: ST25, ST21, GB26, Ren4 –Contracted knee: ST33 –Reverse flexion of knee: BL36, BL40, BL57 –Inversion of foot: GB41, BL62, GB40 –Eversion of foot: KI6, KI3 –Difficult intorsion and extorsion of hand: SJ4. LI5, SI3, SJ9, HT3 –Drop of wrist: SJ9, SJ5 Herbal treatment: qiang huo sheng shi tang or bu yang huan wu tang

Mumps (Epidemic parotitis) Mumps is an acute infectious disease characterized by painful swelling in the parotid region.

Etiology and Pathogenesis Invasion of epidemic pathogen which enters the body via the mouth and nose, together with phlegm fire obstructing the Shaoyang meridian.

Manifestations and treatment Manifestations –Sudden onset with chills and fever, redness, pain and swelling in unilateral or bilateral parotid regions and dysmasesia. Pain and swelling of the testis, high fever, dry mouth, constipation, dark urine, yellow tongue coating, superficial and rapid pulse. Treatment Principle –Expel wind and heat and remove the agglomeration Acupuncture Treatment: ST6, TE17 yi feng, TE5, LI11, LI4 –TE17, the meeting point of hand and foot shaoyang meridians, is used to resolve the local stagnation of qi and blood –Since hang yangming meridian travels up to the face, ST6, LI11, LI4 are applied to eliminate the pathogenic heat –TE5, the meeting point of hand shaoyang meridian and yang wei meridian, is employed in combination with the points from yang ming meridian, to expel the wind, dissipate the agglomeration, and clear away the pathogenic heat –Chills and fever: LU7 disperses wind and alleviate the exterior symptoms –High fever: DU14, twelve jing well points –Swelling and pain of testis: LR3, LR8 regain the normal circulation of qi in foot jue yin meridian Herbal treatment: yin qiao san or pu ji xiao du yin