TCM Pediatrics General Introduction

TCM Pediatrics General Introduction
Violet Song

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

(Treatise on the Origins & Symptoms of Various Diseases)
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 Inventor of Liu Wei Di Huang Wan. Hurray for this dude! Also, five zang in ped’s, kids diagnostic methods, and the idea that kids’ yin and yang are immature and easily turn into heat and cold. Focused on regulating kids’ MJ. Did not just decoction, but pills, powder, and other forms making it easier for kids to take. Qian Yi also gave us methods for kids’ pulses.

Physiology The internal organs are tender and fragile and the Qi is not full Children have a pure yang constitution Have to know the features and characteristics of kids. Above are 2 principles. Zang fu not well developed in kids – easily damaged and hurt by external pathogens/other pathogenic factors. Clarification: kids have both yin and yang, but yang phase shows obviously. This is because they are developing rapidly. The up side is the recovery is very quick – shows that yang phase is active also. During disease however heat is easily trx’d and will show more heat more quickly. You usually divide the stages like so: Fetus – from conception to 40th week during preggers. Newborn – from 0-28 days old. Should be very careful because children are so weak and fragile as compared to other stages. Have to keep them warm because cannot yet self-regulate. Toddler – 1 month to 1 year old. Very fast development! Body weight will triple during this time, and height will increase 1.5 times. Daycare stage – 1 to 3 years old. Are starting to eat like adults at this time. This is why you must be very careful with the MJ. Milk teeth are coming out. Preschool – 3 to 7 years old. Onset of disease is much lower than earlier but easily get respiratory problems as they encounter more and more of the world. Elementary School – 7 years to 11 for girls, but 7 to 13 for boys. Teeth will change from milk teeth to adult teeth. Early kidney disease, asthma will show here more. Teenager – girls 11 to 17, boys 13 to 20. Kidney essence will be most abundant now. Any person under 18 can see a pediatrician.

Etiology Congenital factor External factor Diet Emotional factor
Injury Medical factor Congenital factor: from family 1.3% kids are born with congenital deficiencies, especially if mother is over 35 years old. Can also be influenced by the environment and pollution. How the mother did or did not take care of herself. Can be drug related (think thalidamide and alcohol). Alcohol can cause low fetal body weight. External factors: seasonal factors Though all seasonal factors can influence kids, because they are so yang-y, the most common related problem is heat and fire: the warm diseases. Plague, epidemic, flu’s and such will easily attack kids. Diet: Kids don’t have an accurate sense of full, so they will keep eating even when their stomachs are full. This imbalances the MJ and causes fun problems. (Thrush = damp heat in TCM. In biomed it’s a fungal infection… etiology can be eating too much = food stagnation = too much heat.) Small amounts and frequent feedings are best for kids. Kids like something and they keep eating it like mad. Emotional factor: Yes, kids are affected by the emotions of those around them. Divorce is really hard on them too – this is a threat to the root chakra and survival and kids are totally dependent on those parents for survival. Night time bed wetting and night terrors can be tied to this. Injury: Don’t have life experience and don’t know what is dangerous and what is safe. Natural curiosity compounds this. Medical factors: Hospitals and doctor’s offices? Freakin’ dangerous! Keep them out of contagious zones as much as possible – this includes visits to relatives who are sick, people that are getting radioactive therapy as kids are *very* susceptible to this.

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 When kids get diseases the changes will be very very rapid. Can go from mild fever to convulsions within a short period of time for instance. Recovery is fast however – can get over a cold in a day. They respond to therapy very quickly too. Symptoms will show very clearly also when compared to adults with the same disease/pattern. That said, giving herbs to kids is not for the weak! Easier if they have no idea what sweet is, which is why it’s easier to treat babies. With older kids you generally have to negotiate.

Insufficient Lungs Spleen Kidneys yin Excessive Liver Heart yang
Know these for the test. Deficiencies Lung – tied to immune system. Kids’ immune systems aren’t as strong as in adults. The lung is the last system to develop in the fetal stage. Thus the wei qi is not fully developed when they are born and are children. Wei qi maintains health but also body temperature. Cough and asthma are common in kids for this reason. Ped’s often treats about 50% cough – the most common thing to treat. Spleen – develop quickly so need more nutrients and yet Spleen is so young it can’t handle a lot of input. Stagnation is common for this reason. Probably the 2nd most common reason you’ll see kids in clinic. Kidneys – contains the original yin and yang. At this time these resources are very immature. Still need nutrients so that these can grow. This the 3rd most common problem. Wen giving the meds/drugs to kids have to be very careful that you don’t damage the Kidney. Strep is very dangerous in kids since it spreads faster than in adults and can target the Kidney causing nephropathy and other kidney illnesses. Western medical treatment for nephropathy is steroids which can cause Cushing’s Disease/Syndrome. You don’t use acupuncture on young kids unless they can sit still – you can give herbs more easily. Can reduce dosages to ½ then ¼ and can regulate the nephropathy, even reverse it when you use Chinese herbs and eliminate the need for steroids. We rock at this one. Excess Liver – growth of a tree is at the top. Liver goes to the top of the body/tree. This channel is related to fast development. Wind is the excess pattern you will see here. Convulsions in kids and such. Heart – relates to heat/fire. Can see a lot of that in kids. Dao chi san was invented for heart fire transformed to urine – have the mom observe the urine of the baby which is harder with diapers. The kids that are potty trained to a potty chair will be easier to dx here.

Pediatric Diagnosis Observation Listening and smelling Inquiring
Palpation The most important and useful is observation for Pediatrics. And as for inquiring? Forget it. For many kids you aren’t getting squat out of ‘em, even if care givers can answer.

Observation Observe Shen and color Observe body form
Observe sprouts and orifices Skin eruption Urine & stools Index finger vessel Observe Shen and color – energetic or not? Happy and playful or lethargic/fearful? Shows their vitality. As for color

Observe Shen and color 3rd eye area and mid forehead above this is yin and fire. Put your hand here to see if they are feverish. Cheek apples is the Lung on right, Liver on left. Will often have redness on both. Chin – kidney area. Nose/mouth – spleen Root of the nose to the tip of the nose is the most important area on kids as far as color. Related to whether pt is having convulsions or malnutrition. The skin is very shallow here so changes of color in blood vessels will show easily. Green: malnutrition Greenish white: convulsions Greenish on the bridge of the nose is also malnutrition

Yellow, relates to SP, indicates :
Weak constitution Improper diet Dampness Pale or dusky yellow. Depends on the skin color natively.

Green, relates to Liver, indicates:
Wind Pain Blood stasis Convulsion Blood vessels will squeeze showing the green.

Red, relates to H, indicates:
Heat Convulsion High fever and heat can show red in the face.

White, relates to LU, indicates:
Deficiency Cold Again, depends on native skin color. Face may look pale white.

Black, relates to K, indicates
Cold Pain Water retention Malignant situation Kind of a cement color. Panda eyes indicate Kidneys. Also, don’t sleep well, stay up late, etc. will also show this. Good sleep is the best herbal medicine!

Observe body form head, neck, fontanel trunk limbs skin hair nails
Fontanels – there are two to be aware of: front and occipital. 25% of babies are born with occiput closed, should be closed in 3 months max. This is a hollow area on the back of the head. The frontal may take a while to close – usually within 18 months tops. Can see the bounce of the blood vessels here when they don’t have much hair. If the fontanelle doesn’t close, it’s often related to Kidney xu – That’s why the dude came up with Liu Wei Di Huang Wan. Helps that bone close. Closing too early is bad too – need that room for the brain to expand during those first 18 months. Trunk – can see vitamin D xu, see if spine is well developed, abdominal distention (which they can’t tell you but you can see – you can see the LI area pretty easily), Limbs – see if they have bruises, pain, development, breaks, etc. Skin – urticaria, eczema, fungal infections, baby acne. Hair – brittle, breakage. Bear in mind that the quality of hair can depend on race. African american kids will have higher density of hair. Asian babies have a ton of hear for the most part. Caucasians tend to have less hair density, less hair as children. Look for thickness and texture – if dry and rough this indicates unhealth. Nails – white spots are related to Zinc deficiency. Half moons - the more you have the better your constitution.

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. Eyes are the spiritual window of the Shen. Kids’ eyes are usually clear and move easily. Newborns can’t see you even up close – that’s why their eyes are less mobile when they are first born. If you’re smiling at your new born, she’s not smiling back! She can’t freakin’ see you. Look for discharge from the eyes – solid discharge for instance is related to heart heat espeically. Nose – look for congestion, runny nose. Teeth – another clue to Kidney essence development. Usually come out around 8 months and will come from bottom. Then the upper two front teeth, then the ones beside. Usually during 1st year will have 8 teeth and can bite. Delayed growing of teeth, give ‘em Liu Wei Di Huang Wan because this indicates insufficient Kidney essence, ability of Liver to promote growth. Throat – when kids are young you can’t ask about the throat. You just have to look – but to do that you either have to make them laugh or make them cry. Look for red tonsills or red throat. Also, babies have white coat syndrome Tongue – similar to what we already know. Milk drinkers will show as a white thickness in the center – this is normal for them. Look for red tongue tip and edges as well as other things. Tongue is more important than pulse in Ped’s. Ears – discharge, blockage, etc. Two lower orificies – having redness due to diaper rash? That can really piss ‘em off and make ‘em cry. Baby girls when born can have some vaginal spotting – not uncommon. Baby boy may have a little bit of boobs – that’s fine too.

Observe stools Observe urine
Stools will tell you if digestion is good or not. Look at color, texture, frequency (constipation, too frequent). May poop 7x day like each time they eat – that’s normal too. Small white mucus like texture ok too – that’s milk. Breast milk feeders will have looser stools than those on powders or formulas – powders/formulas will make constipation worse. Mother’s milk is better. Goat is the best sub if you can’t produce enough breast milk. Some babies are allergic to cow’s milk. For those that don’t produce enough you can also use milk banks (in China there are people who will feed the baby – they are called Milk Mothers!) – that’s fine and works even better than goat milk. Mother’s milk will last longer than other subs also and will build the immunity better. Chinese say 10 months is the maximum to feed – switch them to other foods then as breast milk is not as good then – they say this is a pacifier after the age of 10 months. Stools may be yellowish green with mother’s milk. Yellow if they get cow’s milk. When they morph to adults will have similar bm’s to adults – 1 to 2 times. Urine – is the color really yellow or not? If very yellow = heat. Easier to discern when they start on the potty chair. Recommend light colored potty chairs so you can see the color.

Veins in the Index Finger
Covered in board exam! Under 3 years old you can’t get an accurate pulse reading. Over 3 years old the skin is too thick and you can’t see it well any longer. Look at both index fingers- left hand is better. Hold the wrist with one hand between your middle and ring finger. Hold the fingers – use the radial side of your other thumb to scrub from the tip of the finger downward on the index finger on theirradial side. Look for color, look for fill rate. See a couple of slides down. . Feng Guan Blood vessel response here = superficial Qi Guan More severe. Ming Guan When blood vessel shows all 3 guan this is dire.

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 It’s hard to tell superficial from deep. KNOW the colors. That’s different from adults. Fluency and Sluggish is hard to see too, refers to fill rate. Clinically, tongue will be better than the vessel method.

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 KNOW this! Color changes due to blood circulation changes which morphs rapidly. A very light red is normal, but that is kind of hard to see.

Listening & smelling Crying Breathing Coughing Language Smelling
Quality of crying – will change depending on what’s wrong. When baby cries loudly at newborn stage that is good – good Lung qi. If baby can’t cry at birth, means they can’t take that outside air in. That’s bad. If a baby cries loudly can be excess, if softly can be deficiency. Breathing – listen for wheezing, lung Qi obstruction. Listen for phlegm too. Young babies don’t know how to cough out phlegm. When sleeping will hear a rattling sound of phlegm in throat. Coughing. Kind of a duh. Language – development, speaking can relate to Autism. Bear in mind that some Asian kids and other multi-lingual kids will have delayed speech because they don’t know which one to use to respond. Also, ADD and Turret’s kids will have unusual vocalizations and inappropriate speech. Screaming is part of language too. Smell – usually babies smell good, but you are smelling for sour poop, smell of various discharges – can be related to heat/damp heat.

Inquiring Nada. Kids mostly can’t tell you stuff. It’s kinda like being a vet.

Palpation Fontanel Skin Chest Abdomen
Palpate fontanel gently – brain development. Skin – smooth or rough, papules, sores. Chest and Abdomen – look for hardness, solidity, pain areas.

Take 3 guans with one finger
Pulse Age >3 y Take 3 guans with one finger Superficial Slow With strength Deep Rapid Without strength Between 3 and 8 years old. Use your thumb on the radial side where you’d normally take a pulse on an adult. All you have to ID are the 3 things above. Their pulses are so short you can’t hope to feel all 3. Even if you’re Wang Freakin’ Shuhe.

Age Breathe(/min) Pulse(/min) B：P
New born 40~ ~ ：3 <ly ～ ~ ：3~4 2～3y ～ ~ ：3~4 4～7y ～ ~ ：4 9～l4y ～ ~ ：4

Treatment Treatment principles Treatment methods Dosage

Once the treatment works , do not continue.
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 Prefer mild herbs for kids – that pure yang will help them heal/cure fast. Their bodies can get fast recovery, so don’t use harsh herbs. They easily imbalance the other direction. Decoctions from raw is a pain in the butt. Parents aren’t going to comply and even if they do the kid isn’t going to take it without a little child abuse. You can hide herbs in foods and that’s fine. If you give them liquids, put it on the side, not in the center of the tongue. Some parents want to get herbs without symptoms – they will read about renshen, dang shen, and goji berries. You don’t want to do this – if no disease, no herbs! To regulate appetite – choose food category herbs.

Internal treatment - herbal External treatment Tuina and acupuncture
Don’t give kids acupuncture unless they can be still. Tuina is more commonly used than acupuncture for this reason.

Other Methods Inhalation therapy Drops Herb bags Bathing Warm ironing
Herb bags – aromatic herbs you put on the body usually for dampness. Warm ironing is a warm herb bag rubbed on the belly to promote digestion, treat cold types diarrhea.

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 IMPORTANT

Administration <1y 100ml 1~3y 100~250ml >3y 250~500ml
This is per day. 100ml is 3 oz or so. Divide dose into more than 5 parts. Too much liquid at a time will influence diet – they have tiny stomachs. You can start herbal treatment and ped tuina very very early – newborn and up. Spine pinching and manip on belly will help digestion. Diagnosis: finger most important under age of 3. 3 – 12 use thumb to feel pulse. Older than that do like adult.

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 Irregular diet: Phlegm generated from Spleen. Lung is just the container which holds the phlegm. Phlegm irritates and causes cough. This is an internally generated cough – in these kids, no signs of common cold. This is a diet issue.

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 Skin/mouth/nose is a gate to the Lung. This is an external pathogenic factor. Lung qi goes 4 directions – up, down, descending, dispersing. When a pathogen blocks the outside layer, dispersing becomes dysfunctional, so can’t descend quickly, so will flow upward and cause cough. Internal reasons: Spleen dysfunction generating phlegm which can trx to phlegm heat after long time or can stay as phlegm damp. Blocks qi which then flows up. Weak body constitution can leave you open to externals causing injury to Lung and Spleen. This is a dynamic process – internal can generate conditions leaving you open to external. External can damage a strong internal and damage Lu/Sp. 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 Single sound, continuous sound, vomiting nausea sound, barking sound. All can tell you about the Lung Qi and how strong the pathogen is, which then drives whether you use strong herbs or milder herbs. One sound like clearing throat is mild Qi impairment. Many repeat coughs is more damage. Cough so much you gag means Lung Qi is dragging Stomach Qi upward also – Lung channel starts from the MJ, so when really affected will involve ST qi also. Easy to ask adults this stuff, not kids though. Kids don’t know how to cough the phlegm out or blow their noses. To identify if they have phlegm you have to listen to breathing, coughing. Listen when they are sleeping if possible – you can hear rattles clearly. High and low pitches to cough may have to do with the upper versus lower locations. Color – you just have to see it. Hard to identify the color of the phlegm even in adults. In China you take a piece of white paper and have them cough it out so you can see the color. Most of us are not trained to know what our phlegm really looks like and many people can’t describe it right.

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) External pathogen removal should initially be somewhat mild. Ma huang often used in ped’s for wheezing/coughing. Pay attention to dosage/processing in peds. Never use sheng ma huang, but ma huang rong. Ma huang rong is ground and it breaks the joints and helps reduces the content of the epi. You can also fry it with honey to make it milder. Usually don’t use more than 3g of ma huang in peds. Now can only get the powder form in the US – no raw forms. Powder form is sheng, but not honey fried. Boo. Pathogenic Cold Zi su ye, jing jie, fang feng is always the first choice for pathogenic cold. Can also use these in heat type invasions by combining since their warmth is very mild. Can add sheng jiang and decoction of cong bai with these 3 herbs and will usually kick out the problem in a day. 2nd day can do it again anyhow to seal the deal. When you see runny nose, treat it seriously even if you assume they have allergies. Think about why they have allergies – external pathogen! Qiang Huo is stronger than the 3 herbs above for W/C. Shivering, feels like cold in the body, sx of common cold, use Qiang Huo. Strongest of the list above so far. Sheng Jiang is a great kitchen herb – dispersing the pathogenic WC, good to harmonize the Stomch and Lung to resolve external. Can also protect stomach. Pathogenic wind heat Bo He/Sang Ye for heat attack – mild usage. Chai Hu very commonly used for fevers – also releases exterior w/h (large dosage – 20g raw for adult), soothes liver qi (9-12g), and lifts yang qi (3-6g). The dose for kids is dependent on age and weight. So for fevers and wind/heat you base it on the 20g adult dosage. Chai hu has been developed into an injectable form in China for childhood fevers with good effect. Fever options are chai hu (mildest), qing hao (medium), shi gao (strongest). Chai hu is the mildest. Descend Qi Chen pi is a great idea for kids – easy to find at home too – because it descends both LU and ST qi. You can wash the tangerine, peel, cool/dry it and store it. Clears the smell in the fridge, can cook with it as a spice. There’s also a way to cure it into a snack by mixing sugar and salt. Lai fu zi (chao) which is fried is better – the non-fried is too strong. Hou po is aromatic, direction is downward. Be aware of the direction of the herbs – board exams will ask about this for less common herbs! Qian hu will stop cough, clear phlegm heat. Bai qian is warmer, not as good at resolving. Zhi Bei Mu is good – won’t need chuan bei mu because that’s more for deficient cough. Gua Lou commonly used herb for phlegm in kids. 3 Types of Gua Lou: Gua lou pi (opens chest, moves qi), Gua lou ren (moistens intestine – may have cough + constipation so use this), Gua lou shi (the whole thing). Dan Nan Xing – cow bile processed tian nan xing – used for severe degree of hot phlegm that can’t be coughed out easily and also for epilepsy. Dan nan xing is a very cold herb. It’s a little strong for regular old wind/heat. Use it when the phlegm and heat are going deeper. Descend Qi. Ban Xia often used – we have 2 forms here. Fa Ban Xia – commonly used for phlegm. Jiang Ban Xia – stops vomiting – ginger processed. Jing Ban Xia in China = makes it very mild, used a lot in pediatrics. Remember that no processing forms are 100% guaranteed for any herb – even fu zi. Xuan Fu Hua eliminates phlegm and descends Lu/St qi. Jie Geng common to resolve phlegm. Cough/Wheeze Xing Ren relieves cough/wheeze – often used because it is neutral and can be used for all kinds. Zi Wan and Kuan Dong Hua – these are couplet herbs and are perfect in combination. Learn how to add paired or couplet herbs – these are known to enhance each other’s effect, work better together than apart. Use for severe cough/continuous cough and use it instead of Ma Huang when you can’t get Ma Huang. Su zi is for wheezy coughing – very warm herb – if patient has red tongue/thirsty/other warm signs, don’t give this! Pi Pa Ye also for heat phlegm with cough. Sang Bai Pi peel of mulberry tree root – good to descend Lu qi, clear Lu heat. Pi pa ye, sang bai pi for cold. Others for heat. Dampness related: Fu ling – commonly used. Decoction for children very troublesome when using fu loing – grind the raw into powder. Hard for water to penetrate. Du huo is stronger for eliminating dampness than fu ling and rarely used. Fu ling usually does the trick. Du huo is too strong for peds really.

Herbs to remove heat Herbs to moisten lungs Herbs to tonify lungs
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 Remove Heat Kids diseases easily trx into heat. Carefully clear heat – their yang is pure and fragile and yang can be easily damaged. Zhi zi is milder. Shi gao is more severe – high fevers wheezing. Lu gen can be found in the neighborhood – root of the reed. Lu gen promotes body fluids, urination. Huang qin commonly used to clear heat in kids. Don’t use huang lian! Try to avoid b/c is so bitter they won’t take it. Lian qiao is commonly used, not harsh. Yu xing cao is common for heat – use for pneumonia especially and infx of respiratory system. Developed into IV in China – competes with penicillin for effectiveness. Also made into eye drops for conjunctivitis with good effect. Yu xing cao and lian qiao don’t taste so bad. Lu gen doesn’t have much taste. Shi gao has no flavor either. Only huang qin is the nasty in this grouping. Moisten the Lungs Sha shen commonly used. Wei rui also Tonify Lungs Weak body constitution – often get cough, common cold. Premies are most susceptible – lungs mature last so may not be fully developed. Dang shen better than ren shen. Ren shen only used for very very weak constitution. Gan cao not all that often used – making kids formulas, you never use over 8 herbs, 12 in very weird conditions. Gan cao not much effect, don’t really need to harmonize that much. Bai zhu (chao) to tonify

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.

Jīng Fáng Èr Huó Èr Hú Xiōng Zhǐ Ké Fú Líng Jié Gān Yōng
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 Wind Cold Cough. Good strength for kids – other stuff you use for adults (ma huang tang) too strong. (Use that bit on the bottom to rap it into a song.) This is for wind cold with dampness. This is the classic formula – you can modify it to suit the kid. You can leave out herbs if you’re customizing, or you can use the pre-fab powder. If you’ll take more than ½ the herbs out, make a singles combination – if you’re going to take just a couple herbs out, just get the pre-fab. The pre-fabs are sometimes better because they have been decocted together then powdered! Sometimes raw works better than powder because it’s the decotion interaction that is the magic – so combining single powders isn’t as good sometimes as either raw or pre-fab powder. KNOW: ingredients of this formula! She will ask us what formula contains xxx herbs.

Modification: Cough with large amount of phlegm, greasy coating : Hòu Po, Cāng Zhú Severe cold: Má Huáng When using cang zhu – use the fried kind – fried with wheat bran to extract the juices better. But watch out for celiac disease since it’s processed with wheat bran.

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. Children’s nasal discharge easy to see since they have no idea how to blow their noses! But they can’t tell you when they have a headache.

Sāng Jú Yǐn Yòng Jié Xìng Qiào
Formula-Sāng Jú Yǐn Sāng Yè Jú Huā Xìng Rén Lián Qiào Bó He Jié Gěng Gān Cǎo Lú Gēn Sāng Jú Yǐn Yòng Jié Xìng Qiào Lú Gēn Gān Cǎo Bó Hè Ráo Many times kids are past the sang ju yin stage – jump to yin qiao san.

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 Many times kids are past the sang ju yin stage – jump to yin qiao san. Yu xing cao: can drink it in a tea. When fresh has a strong stinky fish smell, but not the processed. Shi gai will help settle stomach heat and control heavy breathing. Tian hua fen clears heat, +body fluids. Tian hua fen is gua lou gen actually, so good for phlegm, but not as strong. Niu bang zi, she gan, xuan shen+ ban lan gen decocted tastes ok. Shan dou gen too cold for kids. Ting li zi good for lots of phlegm and severe wheezing. Purges the lung – more than descend, flushes the lung.

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 Lingering is due to damp.

Formula –Shàng Jiāo Xuān Bì Tāng
Pí Pā Yè Shè Gān Dàn Dòu Chǐ Yù Jīn Tōng Cǎo Shang Jiao = upper jiao. Damp heat obstruction in UJ. Pi pa ye clr heat/-ph. Dan dou ch opens UJ. Yu jin is aro, opens orifices, resolves phlegm, esp heat. Yu jin is from the ginger family. Jiang huang is related but is warm – also a ginger. Yu jin is the cool one. Tong cao drains damp thru urination. Remember in warm disease to drain damp you promote urination as the treatment.

Modifications: Severe dampness: Bàn Xià Severe heat: Huáng Qín
Ban xia strengthens drying function.

2-2 Phlegm-Heat Cough Symptoms-cough with thick sticky yellow phlegm and with difficulty to cough the phlegm out. Red face and lips, bitter taste in mouth and thirst; fever, dry stools, concentrated urine T-red tongue body with greasy yellow coating P-slippery & rapid; purple finger vessel， Therapy-clear heat from lungs and resolve phlegm How is this different from damp? Phlegm heat is stickier/small amt/hard to cough out, dampness is more amt/easier to cough out/not so sticky. Phlegm pt’s will have more concentrated everything – hence the dry stools.

Formula-Qīng Qì Huà Tán Wán
Guā Lóu Rén Dǎn Nán Xīng Huáng Qín Bàn Xià Chén Pí Zhǐ Shí Xìng Rén Fú Líng Jiāng Zhī Commonly used rx.

Modification: A lot of phlegm and fast breathing: Yú Xīng Cǎo, Sāng Bái Pí Sticky plegm which is difficult being coughed out : reduce Bàn Xià, add Qīng Dài, Hǎi Gé Fěn, Shā Shēn Also use yu xing cao and sang bai pi in adults. Reduce ban xia for sticky/can’t cough out because is too drying – need to moisturize the lung to loosen the phlegm and cough out. Qing dai is extract from da qing ye – clears heat. Hai ge fen is also hai ge ke. Dai ge san is a combination of qing dai and hai ge ke – softens and loosens the phlegm. Sha shen nourishes yin, + body fluids. This is about the only time you nourish yin in the presence of phlegm. Here you need to float the boat to float out the phlegm. That said, this will increase the amount of phlegm, but will come out more easily.

2-3 Phlegm Dampness Cough
Symptom-cough with large amount of white watery phlegm. Chest oppressed and poor appetite, fatigue and lassitude T-light red tongue body with white greasy coating P-slippery Therapy-dry dampness and resolve phlegm Can be a mix of phlegm and damp, no heat.

Formula 1- Liù Ān Jiān Bàn Xià Chén Pí Fú Líng Gān Cǎo Xìng Rén
Bái Jiè Zǐ Shēng Jiāng Very important in Ped’s. Liu = 6, an = calm, jian = decoction. One mod is to use ting li zi instead of bai jie zi because bai jie zi could easily cause sticky phlemg since it’s so hot. Another mod is to change ban xia to jing ban xia and chen pi to ju hong. Ju hong is grapefruit peel, stronger to resolve phlegm. If you do this, the whole formula is focused on eliminating phlegm. Yin qiao san – wind heat Sang er zi san – phlegm or not Zhi sou san - cough or not, no phlegm related Shang Jiao Xuan Bi - dampness heat Xin Zhi Liu An Jian - Large amt phlegm (this is the mod of the above formula as discussed in that first paragraph. Can use liu an jian or xin zhi liu an jian for adult COPD patients also. Keep bai jie zi if lots of phlegm.

Formula 2 –Èr Chén Tāng Bàn Xià Chén Pí Fú Líng Zhì Gān Cǎo

Modification With oppressed chest : Sū Gěng、Zhǐ Ké
With food stagnation: Shén Qǚ, Mài Yá, Shān Zhā, Lái Fú Zǐ Su geng is zi su ye stem. Food stag causes phlegm to get worse – and having phlegm can cause food stagnation. Better to fry all of these into a deep brown (jiao method) to reduce harshness.

2-4 Dry Cough due Yin-Deficiency
Symptoms-non-productive cough, or with little sticky phlegm and with difficulty to cough it out. Thirst and dry throat, hoarse voice, feverish palms, or phlegm with blood, afternoon fever, night sweating T-red tongue body lack of coating P-thin rapid。 Therapy-moisten lung yin Lung yin xu

Formula- Shā Shēn Mài Dōng Tāng
Yù Zhú Mài Dōng Tiān Huā Fěn Biǎn Dòu Shēng Gān Cǎo Sāng Yè Commonly used for lung yin xu. First group in blue nourishes body fluids.

Modification Yin deficiency: Xuán Shēn, Shēng Dì Huáng
Severe cough: Chuān Bèi Mǔ, Zhì Pí Pá Yè, Zhì Bǎi Bù Blood in phlegm: Bái Máo Gēn, Ǒu Jiē, Cè Bǎi Yè, Ē Jiāo Tidal fever and nigh sweating: Yín Chái Hú, Biē Jiǎ, Qīng Hāo, Dì Gǔ Pí Zhi pi pa ye – honey roasted. Zhi bai bu also. Honey good to add to process for coughing. You can mix a bit of honey into decoction to improve taste. Dosage form is important – many kids cough meds in China is syrup to make it taste good, more likely to take.

2-5 Chronic Cough due to Lung qi deficiency
Symptoms-repetitive cough, cough without strength, watery white phlegm, pale white face, short of breath with disinclination to talk. Low & weak voice, prefer warmth but aversion to cold. Spontaneous sweating and aversion to wind T-pale tongue body with teeth marks on edge P-thin & lack of strength Therapy-invigorate spleen to tonify qi and to stop cough.

Formula-Liù Jūn Zǐ Tāng
Rén Shēn Bái Zhù Fú Líng Zhì Gān Cǎo Chén Pí Bàn Xià Cough with weak body constitution. Tonify earth to generating metal.

Modification Qi and yin deficiency: Shēng Mài Sǎn
Long duration of cough: Wū Méi、Hē Zǐ、Wǔ Wèi Zǐ Sour astringent will astringe. Wu wei zi – outgoing of qi and chronic cough. Never use at onset or will keep pathogen inside. Case: male 5 yo. Cough for 3 days, worse for 1 day, intermittent cough. Not easily cough out phelgm. Runny nose with turbid nasal discharge, red tonsils. Red t body with thin yellow coat, floating rapid pulse. Disease: cough Diff: wind heat with phelgm obstructing Rep Rx: Sang ju yin. Better to treat cough than yin qiao san. Qing qi hua tan wan. Sang ye 10g, ju hua 10g, jie geng 5g, xing ren 10g, bo he 10g, lian qiao 10g, qian hu 10g, gua ke 10g, pi pa ye 12g, gan cao 3g. 1 bag for 2 days for kids, even in China. You use basically this mix for wind heat cough with very little variation. Case: male 3yo. Cough 5 d, worse for 2d. Heavy turbid cof , red complx, red lips, dry stool, yellow scanty. Red tongue thin y coat, purple finger vein to qi bar. Disease: cough, dx ph ht obstruct lung. Xing ren 8, gua lou ren 10, huang qin 10, pi pa ye 12, sang bai pi 10, dan nan xing 8, di gu pi 10, bai bu 6.

Pediatric Asthma

Introduction 1.Concept 2. Onset Season Body constitution Stimulators
Body const includes genetic predisposition. Stimulators = allergens/irritants/even cold air. Eczema and asthma closely related, tied together.

Etiology Internal factors External factors
poor body constitution with lung, spleen and kidney Qi deficiency, as well as retention of phlegm and dampness External factors Invasion of external pathogens, such as wind, cold, dampness and dryness, etc, attacking the lungs Cold food or spicy food;

Pathogenesis Rebelling lung Qi with retention of phlegm
Wheezing is called Xiào while dyspnea is called Chuǎn. Dyspnea may be seen in other diseases but the wheezing must have dyspnea.

Phlegm & water retention Ex-cold & In-heat LU lost descending Acute
Cold-ph block Lu/Sp/K deficiency Ph-heat bind Endogenous Phlegm & water retention Ex-cold & In-heat LU lost descending Acute Weak constitution with lingering pathogen Asthma Phlegm obstruct in air tract Temperature change Exogenous Deficient ex Pathogenesis and mechanism Lu/Sp/Ki xu and/or ph/water ret. Remember that asthma requires acute treatment and also chronic treatment. Damage can be irreversible – can cause more and more frequent asthma. Tonify the chronic problem to prevent more freq onsets. If can’t reverse a kid’s problem could be environmental and only moving to a new environment without the stimulant can help. Acute onset stage: ph cold/ph heat, external cold/interior heat (ice wrapping fire), weak constitution. Acute onset is a very small part – bigger part of this is the remission/chronic stage. Acupuncture + herbs can prolong repeat onset. Educate your patients – don’t come when you feel sick, but before you get sick. Attach to stimulators Remission Deficient mid-qi Deficient Original qi

Diagnosis Main symptoms Repetitive onset Disease history
Compare with pneumonia Main sx: Wheezing, plus shoulders moving upward, the hollows at ST 12, flared nostrils. Disease hx: Allergies, allergic to what. May have to do a lot of testing, watching, etc. Comparison to pneumonia: Increase in WBC, fevers during disease, wheezing. Asthma won’t have these for the most part.

Treatment strategies In acute stage, one should treat the excess in the lungs while in the remission stage, one should tonify lung, spleen and kidneys. It’s therefore called treat the upper in acute stage and treat the lower in chronic stage. Prevent the dampness and phlegm is another important issue. Take no cold food or heavy greasy products. Prognosis is not as good for asthma as for cough, but earlier treatment = better prognosis. Best tx age is preschool from 5-7 years. If too young, not enough vital qi to fight.

During acute attack 1. Hot asthma
Symptoms-Cough, panting, and wheezing, thick, yellow-colored phlegm, fever, a red face, a stuffy, oppressed feeling in the chest, thirst with a desire to drink, reddish yellow urine, dry stools or constipation, T-red tongue body with yellow coating P-slippery rapid pulse Therapy-Clear the lungs, transform phlegm, and stabilize the asthma

1. Hot asthma Formula1- Dìng Chuǎn Tāng Má Huáng Bái Guǒ Huáng Qín
Sāng Bǎi Pí Bàn Xià Kuǎn Dōng Huā Xìng Rén Sū Zǐ Gān Cǎo Ma huang is best for asthma whether adult or kid. Form of ma huang as previously discussed is important. Stuff in Blue is clear heat herb.

1. Hot asthma Formula 2-Má Xìng Shí Gān Tāng Má Huáng Shí Gāo Xìng Rén
Gān Cǎo Stronger on clearing heat than Ding Chuan Tang. Severe heat signs.

Modifications Severe heat: Yú Xīng Cǎo； A lot of phlegm: Zhú Lì
Constipation: Quán Guā Lóu, Dà Huáng If no zhu li, use ginger juice or pear juice. Or eat pear. Da huang for lung qi disturbed, can’t descend. Will get constipated w/o da huang.

During acute attack 2. Cold asthma
Symptoms-Cough with rapid breathing, the sound of phlegm rattling in the throat, cough with clear, watery, white-colored phlegm, a cold body and no perspiration, a dull, lusterless, stagnant facial complexion which may even be a bit bluish green, lack of warmth in the four limbs, no thirst or thirst with a desire for hot drinks only, T-white greasy coating P-floating slippery pulse Therapy- Warm the lungs, transform phlegm, and stabilize asthma

2. Cold asthma Formula 1- Xiǎo Qīng Lóng Tāng Má Huáng Guì Zhī
Sháo Yào Gān Jiāng Bàn Xià Xì Xīn Wǔ Wèi Zǐ Gān Cǎo Xiǎo Qīng Lóng Yòng Guì Zhī Tāng Má Xì Bàn Xià Wǔ Wèi Cháng Acute onset W/C attack with interior bod fluid retention. Lg amt clr profuse phlegm.

Formula 2- Shè Gān Má Huáng Tāng
Xì Xīn (remove for kids) Zǐ Wǎn Kuǎn Dōng Huā Bàn Xià Shēng Jiāng Wǔ Wèi Zǐ Dà Zǎo Another choice. Both have xi xin – this is original to the formula, but you take it out!

During acute attack 1-3 Exterior Cold & Interior heat
Symptoms-fast wheezing, cough with phlegm sound in throat, stuffy nose and sneezing, runny nose with watery snot. Or aversion to cold, hot sensation, yellow sticky phlegm, thirst, dry stools, yellow urine T-red tongue body with white coating P-slippery rapid pulse, or with floating tight pulse. Therapy-relive exterior and clearing interior to arrest asthma Mixture of cold and heat sx. Relieve the esxterior, clear interior. Cold closes the pores, interior heat can’t get out. Think about mountaineers digging snow caves or eskimos building ice houses. Keeps the heat inside and insulates.

Formula-Dà Qīng Lóng Tāng
Má Huáng Guì Zhī Xìng Rén Zhì Gān Cǎo Shēng Shí Gāo Shēng Jiāng Dà Zǎo Major Dragon Decoction. Adds sheng shi gao.

Modifications Severe heat:HuángQín
A lot of phlegm :Bàn Xià、Chén Pí、Sū Zǐ，or Bái Jiè Zǐ、Tíng Lì Zǐ； Severe dyspnea: Dì Lóng； Heat phlegm: Dài Gé Sǎn, Zhú Lì Di long warms, opens the channels, stops wheezing. Ge jie will also stop wheezing for chronic asthma. Dai ge san is qing dai + hai ge ke.

During acute attack 1-4 LU Excess & K Deficiency
Symptoms-long duration of asthma, wheezing with fullness in chest, getting worse after activities. Lusterless complexion, aversion to cold and cold limbs, fatigue, poor appetite, watery urine with large amount. Often accompany with cough and phlegm in throat T-pale tongue body with thin white coating; P-thin weak pulse Therapy- purge lung and tonify kidneys, consider both Biao & Ben. Harder to inhale, easier to exhale. Root and branch combination.

Formula 1- Sū Zǐ Jiàng Qì Tāng
Zǐ Sū Zǐ Bàn Xià Qián Hú Hòu Po Chén Pí Dāng Guī Ròu Guì Gān Cǎo Shēng Jiāng Dà Zǎo Esp Ki xu with Lu excess.

Formula 2- Shè Gān Má Huáng Tāng
Shēng Jiāng Xì Xīn Bàn Xià Zǐ Wǎn Kuǎn Dōng Huā Wǔ Wèi Zǐ Dà Zǎo

Formula 3- Dū Qì Wán Shú Dì Shān Yào Shān Yú Ròu Dān Pí Zé Xiè Fú Líng
Wǔ Wèi Zǐ Based on LWDHW

Modifications: Dyspnea with heavy sweating: Wǔ Wèi Zǐ， Huáng Qí， Fú Xiǎo Mài； Skin is related to Lung. Patients with asthma can have spon sweating, sweat a lot. Can make the external invasion worse esp with sweating on back. Don’t change the clothes if the kid is sweaty – use a fresh towel on the back, change it out under the shirt as needed.

During the remission stage
2-1. Lung Qi deficiency Symptoms- A dull white or somber white facial complexion, shortness of breath and disinclination to speak, a soft, low voice, fatigue, lack of strength, spontaneous perspiration or sweating on slight movement, fear of chill, lack of warmth in the four limbs, T- a pale tongue with thin white coating P-thin lack of strength pulse Therapy- Tonify lungs and secure the defensive Asthmatics may have purplish lips due to cyanosis.

2-1. Lung Qi deficiency Formula-Yù Píng Fēng Sǎn Huáng Qí Fáng Fēng
Bái Zhú Shen Ling Bai Du San is actually used more often clinically. But Know Yu Ping Feng San for the test and boards.

Modifications Heavy sweating: (duan) Lóng Gǔ、Mǔ Lì、Fú Xiǎo Mài；
thirst, fever in palms and feet, red tongue body with peeling coating: Shā Shēn、Mài Dōng、Wǔ Wèi Zǐ

2-2. Spleen Qi deficiency Symptoms-Cough with profuse phlegm, diminished appetite, a full feeling in the upper abdomen, a yellow, lusterless facial complexion, loose stools, emaciation, fatigue, lack of strength, T-a pale tongue with scanty fur, P-a slow forceless pulse. Therapy-Tonify spleen Qi and transform phlegm

2-2. Spleen Qi deficiency Formula-Liù Jūn Zǐ Tāng Rén Shen Bái Zhù
Fú Líng Gān Cǎo Chén Pí Bàn Xià Or shen ling bai du san.

Modifications Loose stools: Mù Xiāng、Shā Rén；
Poor appetite: Jiāo Shān Zhā、Shén Qū、Chǎo Gǔ Yá、Chǎo Mài Yá Jiao san xian = 3 charred faeries. Treat children’s digestion. Only takes a day or 2 to recover the appetite.

2-3 Kidney Qi deficiency Symptoms-A somber or dull white facial complexion, a cold body and fear of chill, lack of warmth particularly in the feet and lower legs, lack of strength in the lower legs, exertion causing heart palpitations and rapid breathing, watery, loose stools, possible bed-wetting at night, T- a pale tongue with white coating, P- deep, forceless pulse. Therapy-Tonify kidneys and secure the root Long hx of asthma.

2-3 Kidney Qi deficiency Formula- Jīn Guì Shèn Qì Wán Dì Huáng
Shān Yú Ròu Shān Yào Fú Líng Zé Xiè Dān Pí Guì Zhī This builds Ki qi. Use the 2nd heaven to enhance 1st heaven. Mod:

Modifications Yin & yang deficiency :Rén Shēn、Gé Jiè、Xiān Líng Pí、Wǔ Wèi Zǐ； Red tongue body with peeling coating: take out Fù Zǐ、Ròu Guì，add Wǔ Wèi Zǐ； Night urine: Yì Zhì Rén、Tù Sī Zǐ

Other treatments Empirical Recipes External treatment
Acupuncture and moxibustion

Dry Dì Lóng powder in capsules 3g × 2 per day for heat type.
Má Huáng、Wǔ Wèi Zǐ、Gān Cǎo ea. 30g Grind into powder and divide into 15 bags 1 bag × 2 per day for cold type. Shēng Shài Shēn 60g（DǎngShēn120g），Gé Jiè 2 Pc，Má Huáng30g，Xìng Rén100g，Zhì Gān Cǎo50g，Shēng Jiāng60g，Hóng Zǎo120g，Bái Guǒ100g Decoct 3 times and concentrate the decoction with rock candy 500g. 2 Scoops per day for remission stage with short of breath problem. Dōng Chóng Xià Cǎo 10g，stew pork 150g，LU & K deficiency type。 Can make to foods to eat or capsules for wheezing. Stew with pork.

Ginger juice mix the powder as large as 5 cents coin.
Bái Jiè Zǐ、Yán Hú Suǒ ea 21g，GānSuì、Xì Xīn 12g，powder，divide into 3 bags, every 10 days per bag. Ginger juice mix the powder as large as 5 cents coin. paste on BL13, BL15, BL17, REN17 for 2～4h the three ten-day periods of the hot season San Fu Jiu Tie = herbal moxa you don’t have to light. You treat in the summer to prevent winter attack – treat on the hottest days of the year. Do this 3 years and be diligent and you will see a huge reduction. Bai jie zi has an oil in it. When comes out is very strong. Will irritate skin slightly but that is the point! For adults too. The herbal moxa patches have herbs mixed in with the liquid moxa for different purposes in White Crane. Patches for spondylopathy, some for menstrual disorders.

Lack of Appetite Sidebar note: herbal moxa rocks. You can get it in patches. Great for ped’s asthma Middle Jiao issues MJ is like a restaurant for the body. Stomach is the waiter and host, welcoming the guests (food) and serving the food. Spleen is the chef, manipulating the food and making sure everyone is fed. Lack of appetite is a function of the Spleen (can’t cook, so guests not coming) and a lack of Stomach qi (not recruiting guests). Lack of appetite sometimes mistranslated to “anorexia” when translating from Chinese to English.

Introduction 1.Concept 2. Onset Season Age: 1~6 years Prognosis
This chapter is about lack of appetite not related to other diseases. And prognosis is pretty good if this is the case. Summer is often a time when lack of appetite is worse – heat and damp can affect it. Age 1-6 is time for development of the organs and MJ.

Etiology Irregular diet Post-disease Constitutional weakness
Often related to the parents/caregivers. Malnutrition can also be due to overeating/overconsumption. Picky eaters often have appetite problems too due to the mono-nature of the diet. Often this is a sweet focus which makes damp which kills the appetite. Sweet can cause a bit of an addiction and a wish to exclude other flavors. American sweets tend to be way sweeter than in other cultures too. Post-disease: A bit more of a secondary cause for this problem. Even after common cold may have poor appetite. Constitutional weakness: Definitley 2ndary – small appetite, even from infancy. Can influence development.

Pathogenesis Dysfunction of SP and ST

Poor transformation & transportation SP & ST injury
Regulation of SP & ST Improper Diet Unwilling to eat Lack of appetite SP /ST qi Deficiency Poor transformation & transportation SP & ST injury Improper nursing SP / ST yin Deficiency Cooperation between waiter and chef has been impaired.

Diagnosis Long duration
Pale face, thin body form, but normal activities Disease history Duration of longer than 1 month, consider there’s something wrong with the appetite. Activity normal tends to point to primary lack of appetite. Disease history – diagnose by exclusion for pure lack of appetite treatment. If another cause, don’t treat this way!

1. Irregularity of Sp & ST Symptoms-poor appetite, no thought for food or drink, no taste in eating or drinking, refusal to et or drink. Eat a bit more can cause epigastric and abdominal distension. A lusterless facial complexion and thin body T-thin white or greasy thin white coating P-slippery pulse; purplish engorged vein at wind bar. Therapy-Invigorate SP and regulate ST Stomach cannot accept, Spleen cannot digest. Both organs are disordered. Lusterless = pale facial complexion, no shine/Shen to it.

Formula1 –Tiáo Pí Sǎn Cāng Zhù Chén Pí Shén Qū Jī Nèi Jīn Pèi Lán
“regulating Sp powder” = Tiao Pi San Cang zhu dries damp and is very aromatic. Wakens the SP/MJ. Use carefully and use processed one. This is fried with rice/gluten to soften its’ harshness. Chen pi – multi-use herb. Used here to loosen the MJ, make it easier to move the Qi here in both upward and downward directions. Kind of like loosening the ground to make it more workable. Also resolves phlegm which forms because poor transportation of Qi. Shen Qu = 6 types of grains or more to promote digestion. Warning: contains gluten, so watch for Celiac and gluten intolerant pt’s. Ji Nei Jin = chicken gizzard. digestion herb to promote both digestion and appetite. High in amino acids – hard to release this herb because it is fat soluble. Often fried in vinegar to release the active components. In China Violet’s grandparents would dry it then fry it in vinegar. Also cooked in very hot sand in China for the same purpose. Ground into a fine powder, along with shan yao, mai ya, gui ya, mixed into kanji. Pei Lan = mild and aromatic to waken MJ. Eliminates damp too. Try to choose the mildest flavors when you choose MJ herbs. Bad taste in the mouth doesn’t exactly promote appetite.

Modifications： Severe abdominal distension: Mù Xiāng、Lái Fú Zǐ；
Yellow greasy coating: Huò Xiāng、Yì Yǐ Rén Severe ab dist = qi stagnation severe. Mu xiang = used processed form. This is the norm in ped’s. Makes them mild. Wei mu xiang is commonly used – wet paper bag wrapped around the herb, then put it into warm ashes after a fire. This form of baking absorbs a bit of the oil and will make the herb much milder. Lai fu zi = very good to break stagnation. When you are tonifying Qi, lai fu zi is thus contraindicated because the 2 actions are working against each other. That’s why you don’t use it with ren shen. Lai fu zi is fried to make it milder. “When you see seeds, break them. When you see seeds, fry them.” Try the herb yourself before giving it to your patients! Yellow greasy coating Huo xiang and yi yi ren commonly used in foods. Yi yi ren used in porridge.

Formula 2-Bù Huàn Jīn Zhèng Qì Sǎn
Hòu Po Huò Xiāng Gān Cǎo Bàn Xià Cāng Zhù Chén Pí Shēng Jiāng Dà Zǎo Huò Xiāng Píng Wèi Sǎn Bu = no, huan = exchange, jin = gold Strengthens MJ qi so much you wouldn’t exchange it for gold! Based on Ping Wei San. Invented for long distance travelers who cannot adapt to local foods/conditions and it impacts the appetite/digestion. Also called Huo Xiang Ping Wei San Huo xiang and ban xia strengthens the descending St qi function to help the appetite. Ban xia also helps resolve phlegm. Also use burned ashes (from local trees) or earth in China – take it with you to the new environment, mix it into water and drink it. Gives you the local microbes you are used to which settles the MJ.

2. SP / ST qi deficiency Symptoms- Unwilling to eat, eat without delicious feeling, eat little, thin body form, pale complexion, lassitude. Or loose stools with undigested food. T- pale with thin white coating P- forceless pulse, a visible blue vein at the root of the nose. Therapy-Invigorate SP and tonify qi More focus on the xu of transformation. MJ can’t cook the food, which is why the stool contains undigested food. Tonify the qi.

Formula 1- Shēn Líng Bái Zhù Sǎn Rén Shēn Fú Líng Bái Zhù Shān Yào
Lián Zǐ Biǎn Dòu Yì Yǐ Rén Shā Rén Jié Gěng Chǎo Gān Cǎo Dà Zǎo soup Shen Ling Bai Zhu San to tonify Qi plus resolve dampness accumulation. Very little taste to it. Sha ren = a bit spicy and a bit aromatic, but only a bit. All other herbs very bland. Fei Er Fen, a rice cereal in China, has this formula built into it.

Modifications Abdominal distension: take out Gān Cǎo，add Mù Xiāng、Xiāng Fù； Spontaneous sweating :Huáng Qí、Fáng Fēng、Mǔ Lì Gan cao is a good harmonizer, but can make distention in the belly worse. Mu xiang and xiang fu will move the qi. Spontaneous sweating = lung qi usually, but mj xu cannot transform/transport so can = spontaneous sweating. If over 2 years old and sweating during sleeping, can be related to xu or other problems. Sweating a lot due to even mild movement also. When a kid sweats makes them colder and more likely to get wind invasions. Often see this in back/neck area. In China parents will usually put a dry clean towel in this area and change that out without undressing the kid. Huang qi helps with this qi xu a lot. Fang feng and mu li good to add for this also. Use duan mu li – shell is burned, makes a lot of small holes in it so that contact surface of the herb is enlarged, so can absorb more of the sweat in the body. Mu Li San = for spontaneous sweating, contains Huang qi also.

Formula 2-Yì Gōng Sǎn Rén Shēn Fú Líng Bái Zhù Chén Pí Gān Cǎo
Yi Gong San good for almost any MJ problem related to appetite. Good rx for kids due to small amt of herbs, best for kids under 3. Shen Ling Bai Du San might be the better choice for kids older than 3.

3. SP/ST yin insufficiency
Symptoms- A dry mouth and a tendency to drink a lot yet no desire to eat food, dry skin, dry stools, T-a mirror-like or shiny tongue with peeled fur and red tongue with a scanty coating and scanty fluids P-thin rapid pulse. Therapy- Nourish SP & ST Many of these kids want to drink juice, don’t really want solid foods.

Formula- Yǎng Wèi Zēng Yè Tāng
Xuán Shēn Mài Dōng Shēng Dì Shí Hú Bái Sháo Yù Zhú Gān Cǎo Nourish stomach and promote body fluids decoction. Based on Zeng Ye Tang, the first 3 herbs in blue. Yin deficiency of MJ = stomach while Qi xu of MJ = spleen. These are all yin and body fluid nourishing herbs. Not good for qi xu with dampness.

Modifications SP qi deficiency :Shān Yào、Biǎn Dòu；
Thirst: Lú Gēn、Tiān Huā Fěn ； Constipation: Huǒ Má Rén、Guā Lóu Rén Sp qi xu: shan yao is very mild and non-cloying. Can be used as food also. Tonifies Lu, Sp, Ki qi. Bai bian dou tonifies MJ qi, but focuses on elimination of dampness. Good to keep herbs on previous slide from producing too much damp. Gua lou ren more often used in ped’s than huo ma ren.

Other treatments Tuina
chiropractic therapy knead and massage the muscles along the Spine Pediatric tui na great to improve digestion. Focuses on the belly and some on the fingers/palms. Kneading/pinching the spine – bottom up is tonifying, top down is more eliminating. Works best up to the age of 11 – not so good after that. Per Dr. Wu, don’t do spinal pinch on adults.

Prevention Right nursing, correct bad habits. Find out the causes　　

Pediatric Diarrhea

Introduction 1.Concept 2. Onset Season Age: <2 years Prognosis
Increase in frequency, loose and/or watery stools. When in combination, this = diarrhea. More easily occurs in summer/autumn. Prognosis if purely st/sp, tx’ right, = good. Can easily trx to childhood malnutrition/ convulsions if not treated

Etiology Irregular diet Invasion of external pathogens
Constitutional deficiency Pathogens include bad food/water, external cold, etc. External pathogens can sink inside and cause diarrhea (taiyin ds, i.e.).

Pathogenesis Middle Jiao disorder
According to Neijing, the diarrhea happens when the spleen Qi does not ascend but descend. The turbid Qi does not descend, it may causes fullness, abdominal distention, gas and bloating, etc. MJ Qi problem. Sp can’t bring up the essence, drops down though the intestines. Long term diarrhea flushes the nutritents through the system without absorption.

Exogenous factors SP fails to transforme and transporrte Fluid into damp Improper Diet Downward together with turbid in LI Injury of SP & ST Diarrhea SP &ST deficiency Food into obstruction ST/MJ fails to digest SP & K yang deficiency

Diagnosis Frequency of bowel movement Stools Color Stools Quality
Stools Smell Disease history Compare with Dysentery These are things you need to ask about. Frequency: find out what is normal for the kid – ask the provider. If 3-5+ times this is not normal. Stool color when not normal is usually yellow or greenish. Looks like a sort of egg drop soup. Quality: usually lose or watery. Smell: foul or not at all? Strong and foul will be excess. Less smell = xu. Disease history: ate improper food? Recovering from illness? Long term poor appetite? Dysentery has blood, pus, tenesmus and pain. Mucus is whitish yellow color, looks like nasal discharge. This is not the same as diarrhea. Diapers make this a little harder to dx because diapers absorb liquid. Potty trained kids are easier, especially if they have a light or white bowl in the chair.

Herbs commonly used for digestive disorders
Herbs for removing food stagnation Shan Zha, Shen Qu, Gu Ya, Mai Ya, Ji Nei Jin, Lai Fu Zi Herbs for moving Qi and improving transportation Chen Pi, (Hou Po), Zhi Shi/Ke, Da Fu Pi, Xiang Fu, Chai Hu, Mu Xiang Herbs for remove dampness and phlegm from middle Jiao Huo Xiang, Hou Po, Cang Zhu, Cao Dou Kou, Ban Xia, Fu Ling, Ze Xie, Yi Yi Ren, Sha Ren Herbs for removing heat and dampness from middle Jiao Lian Qiao, Huang Lian, Zhi Zi, Huang Bai, Qin Pi, Herbs for stabilize and bind Wu Wei Zi, Wu Mei Herbs for tonify Qi and nourish Yin Dang Shen, Bai Shu, Gan Cao, Huang Qi, Sha Shen, Mai Dong, Yu Zhu, Bai Bian Dou Shan zha: good for meat stagnation. Don’t give on an empty stomach. Better to take after meals. Shen qu: exterior wind cold as well as food stagnation. Gu ya and Mai ya: together with shan zha these are called The Three Fairies and rock for kid digestion problems. Usually fried until brown for a child who has food stagnation. “Jiao San Xian” Ji Nei Jin: strong to eliminate food yu. Animal product. Chen Pi always the first choice to move qi/transportation. Can find it in grocery stores – tangerine peel. When you eat a tangerine, hang the peel in a well ventilated place. Chop it into small pc’s after dried and add it to food. Huo po: only use when stagnation very severe. Zhi shi and Zhi ke: usually use zhi ke cuz the other too harsh. Hou po, cang zhu, and cao dou kou very strong Ban xia commonly used, esp jing ban xia – ban xia + ginger juice. Very mild, but doesn’t exist over here. Can use Jiang ban xia for this. Fa ban xia for coughing. Fu ling, ze xie, yi yi ren for dampness Sha ren: cardamom. Cook with it. Smash it into oatmeal for instance, or make it into a cookie. Toss in some chen pi. Lian qiao, huang lian, zhi zi: huang lian usually not for young kids because is so bitter. If child is older, may be able to negotiate with them. Huang bai and qin pi will clr heat elim damp Wu wei zi and wu mei for long term diarrhea to stabilize and astrine. Unless patient has severe diarrhea killing off qi and yin, don’t use that last category. Too much tonifying is not a good thing. Only use with deficiency. Note lack of ren shen in the set – dang shen better for kids usually.

1. Food stagnation Symptoms-Abdominal pain and distention, pain relieved by diarrhea, sour, foul-smelling stools, bad breath, acid eructation, possible desire to vomit, no thought for food or milk, restless sleep, possible night-crying, T-thick, slimy or slight yellow tongue fur, P-a slippery pulse or a purplish, sluggish purplish vein at the wind bar. Therapy-Eliminate food stagnation, lift clear qi to stop diarrhea Hard epigastrium often. Night crying due to full abdomen.

Formula-Bǎo Hé Wán Jiāo Shān Zhā Shén Qū Bàn Xià Fú Líng Chén Pí
Lián Qiào Chǎo Lái Fú Zǐ Chǎo Mài Yá Bao He Wan is the classic for eliminating food stagnation. This is a short term use formula, not long term! This is an eliminating formula, not a supplement. Has Mai Ya – watch out for celiac disease.

Obvious abdominal pain & distention: Mù Xiāng、Hòu Po
Vomiting: Shēng Jiāng

2. Wind cold invasion Symptoms-A somber white facial complexion, lassitude of the spirit, chilled limbs, abdominal pain, intestinal noises, clear, watery stools with no foul odor, possible aversion to cold with fever, T-thin, white or white, slimy tongue fur, P- floating tight pulse. Therapy-Expel wind cold, warm middle jiao to stop diarrhea Exterior pathogen going interior, to taiyin layer.

Huò Xiāng Zhèng Qì use Sū Gěng
Formula-Huò Xiāng Zhèng Qì Sǎn Huò Xiāng Zǐ Sū Yè Bái Zhǐ Chén Pí Bàn Xià Qū Fú Líng Bái Zhù Dà Fù Pí Hòu Po Jié Gěng Zhì Gān Cǎo Huò Xiāng Zhèng Qì use Sū Gěng Èr Bǎi Èr Chén and Hòu Pí Both expels the remaining pathogen and also treats the internal aspects. Focuses more on the interior dampness. Most herbs here deal with damp in MJ, vomiting, diarrhea.

Severe interior cold: Gān Jiāng
Food stagnation: Shān Zhā

3. Damp heat Symptoms-Watery, thin stools colored deep yellow with a foul odor, possible explosive discharge, redness and burning around the anus, occasional abdominal pain, devitalized desire for food, possible nausea, fever or no fever, oral thirst, short, yellow urine, bodily fatigue, T-red tongue body with yellow coating P-slippery rappid Therapy-Clear heat, eliminate dampness to stop diarrhea

Formula-Gé Gēn Qín Lián Tāng
Huáng Lián Huáng Qín Zhì Gān Cǎo Ge gen lifts. Huangs for damp heat, zhi gan cao is harmonizing. Board exam loves Shang Han Lun formulas and this is one of ‘em.

Modification Heat > damp: Huá Shí、Jīn Yín Huā、Lián Qiào
Damp>heat: Yì Yǐ Rén、Fú Líng、Chē Qián Zǐ Abdominal distention: Hòu Po、Mù Xiāng Determine which is more prominent: heat or damp.

4. Spleen Deficiency Symptoms-Enduring diarrhea which does not heal, loose stools, undigested water and grains, diarrhea after eating, light colored stools with no foul odor, a sallow yellow facial complexion, emaciated, thin muscles and flesh, lassitude of the spirit, listlessness. T- a pale tongue thin with white fur P-slow slippery pulse; blue vein at the root of the nose Therapy- Tonify spleen qi, and lift qi to stop diarrhea Chronic.

Formula-Shēn Líng Bái Zhū Sǎn Fú Líng Rén Shēn Zhì Gān Cǎo Bái Zhù
Shān Yào Lián Zǐ Bái Biǎn Dòu Yì Yǐ Rén Shā Rén Jié Gěng Shēn Líng Bái Zhū Lián Zǐ Gěng Shān Yào Biǎn Dòu and Èr Rén Appetite (see previous) and diarrhea as well

Modification Severe SP damp, with greasy coating: Huò Xiāng、Pèi Lán
Poor appetite: Shén Qū、Mài Yá Abdominal distension: Hòu Po、Mù Xiāng

5. Spleen Kidney yang deficiency
Symptoms-Enduring diarrhea which will not stop, if severe, possible anal prolapse, diarrhea after eating, clear, watery stools, undigested food in the stools, a cold body and chilled limbs, a somber white facial complexion, lassitude of the essence spirit, T-pale tongue body with white coating P-deep thin pulse; or a blue vein at the root of the nose. Therapy-Tonify spleen and wam kidneys, consolidate to stop diarrhea Don’t see this much.

Formula 1- Fù Zǐ Lǐ Zhōng Tāng ( Prepared Aconite Pills to Regulate the Middle)
Gān Jiāng Fù Zǐ Rén Shēn Bái Zhù Zhì Gān Cǎo Generally don’t’ use fu zi, but this is the only herb that rescues the Ki yang. Use this Rx once until Yang qi is restored, then quit it!! And only for severe cases.

Formula 2-Sì Shén Wán Formula 1+ Formula 2 Ròu Dòu Kòu Chǎo Bǔ Gǔ Zhī
Wǔ Wèi Zǐ Wú Zhū Yú Formula 1+ Formula 2 Early morning diarrhea related to Ki xu. Generally combine this with the previous formula. The former treats the yang xu, this astringes.

Modification Prolapsed of rectum: Huáng Qí、ShēngMá；
Long term unstoppable diarrhea: Hē Zǐ、Chì Shí Zhī、Yǔ Yú Liáng Chronic, chronic, chronic! This is never for exterior related problems. Chi shi zhi is like clay – the concept is similar to building an earthen dam to hold in the water. Yu yu liang – Yu was a guy who stopped the Great Flood in china – he built a dam to divert the water and save the people. The earth he used is said to stop diarrhea. Not available in the US.

7. Damaged yin fluid Symptoms-Enduring diarrhea which has damaged yin fluids, lassitude of the essence spirit, vexation and agitation, dry, parched skin, sunken eyes and fontanel, diarrhea of yellow water, short, scanty urination, dry mouth, red lips, T-crimson tongue body lack of fluid P-thin and hollow pulse Therapy- astringent yin by applying sour and sweet flavor herbs Severe diarrhea can damage the electrolytes/fluids.

Formula-Rén Shēn Wū Méi Tāng
Lián Zǐ Zhì Gān Cǎo Wū Méi Mù Guā Shān Yào Astringent formula.

Modification Long term unstoppable diarrhea: Shān Zhā Tàn、Chì Shí Zhī、Yǔ Yú Liáng Thirsty desire for water: Shí Hú、Yù Zhú Shan zha tan is carbonized.

8. Damage of yang Symptoms-Enduring severe diarrhea which has damaged yang qi. Watery stools, high frequent bowel movements, lassitude of the essence spirit, pale or greenish gray complexion, weak breathe, cold spontaneous sweating T-pale tongue body with white coating P-deep minute pulse Therapy- warm yang to rescue from yang collapse Yang prolapse.

Formula- Shēn Fù Lóng Mǔ Jiù Nì Tāng
Rén Shēn Fù Zǐ Lóng Gǔ Mǔ Lì Bái Sháo Zhì Gān Cǎo Rescuing formula for emergencies. We’ll probably never see these patients in the US.

Other therapy External treatment with herbs
Acupuncture & Moxibustion and Tuina

DīngXiāng２g，Wú Zhū Yú30g，black pepper 30pc，
Grind into powder １～３g per day, mix with vinegar, put on umbilicus Wind-cold attack type, SP deficiency type

T=red with y.greasy coat P=slippery
Male 5 yo Pt has diarrhea after eating mutton grill 2 d ago. Diarrhea 5-6 x, smelly yellow watery stools. N/V. Yellow scanty urine, thirst w/desire for water, ab dist, borborygmus (damp). T=red with y.greasy coat P=slippery Ge gen qin lian tang: Ge gen 10g, huang lian 3g, huang qin 10g, shan zha 15g, shen qi 15g, ce qian zi 15g. 1 bag, 2 days.

Enuresis

Introduction 1.Concept 2. Onset Age: >3 years Boys > Girls
Under 3 years old bed wetting/urinating at night is normal. After the age of 3 they should be able to control the muscles. If can’t, there’s a problem and it has nothing to do with self-control or willfullness. Boys more commonly bed wet than girls. Girls develop and mature more quickly than boys, so that makes sense. Some cultures start potty training as soon as the kid can sit up on their own. This is not such a good idea even if it’s more convenient or less embarrassing for parents.

Etiology Congenital factors Emotion disorders Diet
Congenital factors Slow/late dev of kidney system. Emotions If scared during the day will have night urine. Some kids dream they have to go to the bathroom and can’t find one. Also consider these as emotional. Diet Don’t give water prior to bed. This is more of a habit change.

Pathogenesis The kidneys failed to hold urine

Differentiation and treatment
1. Kidney qi deconsolidation Symptoms-Night time enuresis 1-2 or more times each night, frequent, clear urination, a pale, facial complexion, a tendency to low back or knee soreness or weakness, possible chilled limbs and a fear of cold, T-pale tongue body with thin white coating P-deep thin forceless pulse Therapy-Warm and supplement kidney yang, secure and astringe the urination Qi can’t hold. Urine is clear.

Formula 1- Jīn Suǒ Gù Jīng Wán
Shā Yuàn Jí Lí Qiàn Shí Lián Xū Lóng Gǔ Mǔ Lì This is a previously learned formula. Sha yuan ji li or sha yuan zi. Commonly used for Ki probs

Formula 2- Sāng Piāo Xiāo Sǎn Sāng Piāo Xiāo Lóng Gǔ Cù Guī Bǎn
Yuǎn Zhì Shí Chāng Pú Rén Shen Fú Shén Dāng Guī Also previously studied in other classes.

Formula 3- Suō Quán Wán Yì Zhì Rén Wū Yào Shān Yào
Helps warm kidneys and tonify Ki qi to consolidate. You can choose between these 3 formulas for enuresis.

Modification Fatigue, poor appetite, loose stools: Dǎng Shēn，Fú Líng，BáiShù，Shān Zhā Poor IQ: Rén Shēn，Shí Chāng Pú，Yuǎn Zhì Poor IQ: more congenital problems usually.

2. Spleen / Lung Qi Deficiency Symptoms-Night time enuresis, shortness of breath, disinclination to speak, lassitude of the spirit, lack of strength, a somber white facial complexion, devitalized appetite, loose stools, spontaneous perspiration, T-pale tongue with white fur, P- Thin and forceless Therapy- Bank origin and boost the Qi, secure and astringe the urination MJ qi xu

Formula – Bǔ Zhōng Yì Qì Tāng
Huáng Qí Rén Shēn Bái Zhú Zhì Gān Cǎo Dāng Guī Chén Pí Shēng Má Chái Hú Bu zhong not only holds up organs, but also substance that is leaking out of the body. Mj and Lung xu.

Modification Spontaneous sweating: Duàn Mǔ Lì，Wǔ Wèi Zǐ
Obese due to phlegm accumulation: Cāng Shù，Shān Zhā，Bàn Xià Obesity is phlegm = lots of obese pts don’t eat that much, but still gain weight b/c MJ can’t extract nutrients, but instead trx stuff into phlegm/fat.

3. Liver Channel Damp-heat Symptoms-Slippage of a small amount of urine, which smells foul and is colored relatively yellow, emotional tension and agitation, talking in their sleep, bruxism during sleep, red lips, T- red tongue body with yellow or yellow greasy coating P-wiry rapid pulse. Therapy-Drain the liver and clear heat Usually have emotional tension, talk in sleep, etc.

Formula- Lóng Dǎn Xiè Gān Tāng
Lóng Dǎn Cǎo Huáng Qín Zhī Zǐ Mù Tōng Chē Qián Zǐ Zé Xiè Shēng Di Huáng Dāng Guī Gān Cǎo Lóng Dǎn Xiè Gān Zhī Qín Chái Shēng Di Chē Qián Zé Xiè Kāi Mù Tōng Gān Cǎo Dāng Guī Xià LV damp heat. Be careful w/coldness of these herbs and side fx.

Modifications Bad sleep: Huáng Lián，Zhú Yè，Lián Qiào
Severe smelling urine, yellow greasy coating: Huáng Bǎi， Huá Shí Bad sleep = heart

Other treatments Patent formula Empirical Recipes External treatment
Acupuncture and moxibustion

K deficiency & phlegm covering type.
YìZhì Rén12g，Má Huáng Shí Chāng Pú ea.10g，Sāng Piāo Xiāo 15g，Pig Bladder 1 Cook pig bladder 30min first, then decoct together with rest herbs 30 min 2 times per day, 4~8 bags K deficiency & phlegm covering type. Eating organs is not that common here – pig bladder is a hard sell to American patients. However, if you have a certain organ problem, you eat that organ from an animal to tonify your own.

Grind into powder, mix with vinegar, put on umbilicus
Wǔ Bèi Zǐ, Hé Shǒu Wū ea. 3g Grind into powder, mix with vinegar, put on umbilicus 1 time per night, 3~5 nights K deficiency type This is for ki xu type. wu bei zi is astringent.

Attention Deficit Disorder
Can’t rely on acupuncture and herbs, but are helpful in managing the condition.

Etiology Congenital factors Poor body constitution Poor diet

Pathogenesis Deficient Yin failed to hold yang and yang is floating
Too active, too yang b/c yang qi overacts. Yin qi can’t keep it in check.

1. Spleen Deficiency, liver hyperactivity Symptoms-Uncontrollable fidgeting, emotional tension, easy anger, poor sleep, fatigue, diminished appetite, easily developing diarrhea in response to emotional stress, T-thin white tongue coating P- wiry pulse. Therapy-Fortify the spleen and harmonize the liver

Fomrula-Yì Gān Sǎn Chǎo Bái Zhú Fú Líng Dāng Guī Chuān Xiōng Gōu Téng
Chái Hú Gān Cǎo Controls earth, so also controls wood.

2. Heart/Spleen insufficiency Symptoms-A sallow or somber white facial complexion, pale nails and pale lips, fatigue, insomnia, heart palpitations, shortness of breath, a poor appetite, a tendency to loose stools, poor memory, T- fat, pale tongue with thin, white fur P- thin , weak pulse Therapy-tonify the spleen and supplement the heart, supplement the Qi and nourish the blood More signs of weakness.

Fomrula-Guī Pí Tāng Huáng Qí Lóng Yǎn Ròu Rén Shēn Bái Zhú Dāng Guī
Fú Shen Zhì Yuǎn Zhì Suān Zǎo Rén Mù Xiāng Zhì Gān Cǎo

3. Yin deficiency, yang hyperactivity Symptoms-Besides tending to be thin, children with this pattern also have a red tongue with diminished fur or a pale tongue with a red tip. Their pulses are fine and rapid and they tend to suffer from insomnia, heart palpitations, agitation, dizziness, ringing in the ears, possible low back pain, possible bed-wetting at night, flushed cheeks, and possible night sweats. Therapy-Supplement the kidneys and enrich Yin, subdue yang and quiet the spirit More congenital type related to Kidney.

Zuǒ Guī Wán Zhōng Yòng Guī Lù Niú Tù Zhū Gǒu Shān Yào Suǐ
Formula 1-Zuǒ Guī Wán Shú Di Huáng Shān Yào Shān Zhū Yú Gōu Qǐ Zǐ Chuān Niú Xī Tù Sī Zǐ Lù Jiǎo Jiāo Guī Jiāo Zuǒ Guī Wán Zhōng Yòng Guī Lù Niú Tù Zhū Gǒu Shān Yào Suǐ Strengths yin to control yang

Formula 2-Shēng Mài Sǎn Rén Shēn Mài Mén Dōng Wǔ Wèi Zǐ
Tonfies both qi and yin.

4. Phlegm confounding the portals of the heart and heat harassing the heart spirit Symptoms-Easy anger or pronounced irritability, vexation and restlessness, possible nausea, possible profuse phlegm, chest fullness and oppression, a bitter taste in the mouth when waking up in the morning, T- tongue with red edges and slimy, yellow fur P- wiry, slippery, rapid pulse. Therapy-Remove heat-phlegm and calm Shen Usually secondary, not congenital. 2nd heaven problem.

Formula-Huáng Lián Wēn Dǎn Tāng Bàn Xià Chén Pí Zhú Rú Zhǐ Shí Fú Líng
Zhì Gān Cǎo Dà Zǎo Huáng Lián Wēn Dǎn Tāng Zhōng use ÈrChén Zhǐ Shí Zhú Rú and ShēngJiāng

5. Blood stasis obstructing the channels and malnourishment of the portals Symptoms-Hyperactivity plus a history of birth trauma with intracranial hemorrheage, a dull, dark facial complexion, easy anger over nothing T- dark red tongue P- choppy pulse Therapy-Quicken the blood and dispel stasis Can cover the orifice, cause weird behavior.

Formula-TōngQiào Huó XuèTāng Chì Sháo Chuān Xiōng Táo Rén Hóng Huā
Dà Zǎo Cōng Bái ShēngJ iāng Shè Xiāng Tōng Qiào Huó Xuè Táo HóngShè Chì Sháo Chuān Xiōng Cōng Jiāng Zǎo Our test is next week. Know the general info of Ped’s in TCM – insuff organs, char’s of kids, diagnosis. There’s a chart on the portal for formulas and what to use when. Red formulas are from Formulas % of the q’s about ingred’s are from these. Q’s all M/C. 2 cases, still M/C – choose disease, correct diff, mods. More emphasis on Lung problems – asthma, cough – since these are more often seen. Less on spleen, least on Kidney.

TCM Pediatrics General Introduction

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