pediatric class hand out 2008

7/25/2019 Pediatric Class Hand Out 2008

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Pediatrics class one

Introduction:

Pediatrics of TCM studies the growing of children and prevention and treatment of

infants and childrens diseases.

The treatment of children has undergone evolutionary changes in Chinese medicine.Chinese pediatric dates back several thousand years. Pediatric treatment was mentioned

in the Nei Jing. n the twelfth century !ong dynasty" the famous child specialist" #ian $i"

wrote the first pediatric te%tbook that recogni&ed children as uni'ue beings with

distinctive physiology and pathophysiology of diseases that merit different diagnoses andtreatment from adults. (uring the Ming dynasty and the last dynasty) #ing dynasty in

the fourteenth to the beginning of twentieth century " pediatric flourished with

formulation of specific herbal and TuiNa or acupuncture protocols for children" and

introduction of preventive measures.nfants and children have uni'ue physiological functions and pathophysiology of

illnesses. The first class discusses general pediatric physiology and pathophysiology"followed by the characteristic in diagnosis and treatment of pediatric diseases.

Age stages ( Stages from birth to 12 years old)

1. From birth to 28 days old (e!born stage)

n this age" mainly there are low temperature" or delivery in*ure such as head haematoma"

tetanus neonatorium" etc . Newborn may has respiratory tract infection" even sei&ure.

2. From 28 day to 1 year old (infant stage)

n this stage" is a fast physical growth stage. +fter , months old" infants are easy to catchcold" and some infection diseases. +lso with improper feed" easy to have digestionproblem" such as diarrhea" vomiting" dyspepsia" infantile malnutrition. -c&ema.

". 1 year old to " years old (#oddler stage)

-%cept infection diseases of respiratory system and digestion system" delayed growingdisease as five kinds of retardation in standing" walking" hairgrowing" tooth eruption and

the faculty of speech.

$. " year old to % years old (&reschooler stage)

mportant stage for psychological growth" e%cept diseases of respiratory and digestion"epilepsy" wetbed occur.

/. From % years old to 12 years old(Pu&il stage0

1rom immature to mature in physical and psychological development' diseasesaresimilar as adult" edema" asthma" autism" attention deficit disorder or attention deficit

hyperactivity.

haracteristic of &hysiology and &atho&hysiology

The general physiology and pathology of children and childhood illnesses can be

classified ad follows2

3eneral physiology of children


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4P56- $+N3 ma%imum $ang.

4$75N3 $+N3 +N( $75N3 $N

4C8-+6 9!C-6+8 #

3eneral pathophysiology of childhood illnesses

-asy onset fragile and immature organs" pathogenic evils enter easily

6apid transformation : disease progression and changes occur 'uickly6apid recovery

Physiology

Pure yang

The doctrines of &ure yangmetaphor fast growth of children" looking like the rising !un"

vigorous. The first characteristic of physiology is

1. igorous body !ith fast gro!th. The term 4pure yang does not imply that the child

is devoid of yin. The child has special $ang #i" which is not include in adults theprocess of growth and development. Pure yang refers to the fact that the child has

pure or ma%imum potential for growth. Just as a seed or a young tree has the full

potential of becoming a full grown tree" the &ygote has the fullest potential of

becoming a human being.*oung yang and young yin

The doctrines of young yin and young yang metaphors the child s skin is tender and ;ei#i is weak. The internal organs are delicate and immature and #i within them is

insufficient. !o the second characteristic is

2. +rgans delicate and immature and insufficiency of ,i and blood and essence.

The physiological functions :both $in and $ang of the internal organs are not well

developed.

$oung yin and young yang also means pure


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insufficiency condition and gradually enrich. !ome diseases related with delayed

development in children are caused by kidney insufficiency.

0ier yin is insufficient' and lier yang tend to hy&eractiity. Childs is easy to havefever and sei&ure>convulsion0" epilepsy" attention deficit hyperactivity disorder.

eart blood deficiency' s&irit unsettle. Child 4s problems is to develop into coma" and

night crying and anemia are common childs diseases.@. a&id #ransformation: hild3s diseases are easy to hae syndrome change.

7nce the pathogen enters" because of the delicate #i and fluid balance" Ayoung

yang and young yinB" disease processes undergo easy and rapid transformationform cold syndrome to heat syndrome" e%cess syndrome to deficiency syndrome"

deficiency to e%cess" or even the simultaneous e%haustion of both yin and yang.

. a&id recoery: ;ithpure yang >vigorous #i0 and clear visceral #i" childs

illnesses are more responded to the proper treatment. Children tend to recoverrapidly from illnesses.

4iagnosis

Ins&ection is more im&ortant diagnosis method in &ediatric.Inspect face and five senses. Pay attention on color and vitality" facial inspection in

children stress on special facial area.

Shan Gen, root of mountain :between eyebrows. !han 3en" Aroot of mountainB" is

the area at the root of the bridge of the nose between two eyes. This area is the

below the $intang point. 3reenish veins visible on the face indicate week spleenin infants and small children. The more prominent the vein" the weaker is the

spleen. 9eins with bluish tinge indicate kidney involvement" possibility kidney

weakness in constitution.

Yintang:is related with lung. 6ed and dry skin in children indicates heart and

lung internal heat. (ark and blackish is a sign for precoma.

6ight cheek indicates lung" left cheek indicates liver.1orehead indicates heart.Nose indicates spleen and chins indicates kidney.

Inspect tongue" food accumulation show thick tongue" geographic tongue indicate kidneydeficiency" or stomach yin deficiency.

Pediatric tongue-play symptom

Inspect Two Yin

Inspect sin rash and eruption: mostly indicates heat!fire in "lood or damp-heat in spleen

and liver. #rom the distri"ution and color of the sin rash and eruption, we can evaluatethe severity of the illnesses and differentiate diseases.

$rythematous, maculopapular rash usually is viral e%anthema" measles" rubella"or scarlet fever in acute condition which is blood heat. n chronic condition" is

purpura caused by blood heat or #i deficiency.

%esicular rash is varicella, i.e., chickenpo%" in Chinese medicine" it is damp :heat

febrile diseases.

&ives are due to blood heat.


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Special inspection: %essel of Three 'ars at the Tiger(s )outh

Chinese pediatricians have inspected the vein at the base of the side of the palmar surface

of the inde% finger>Du kou !an 3uan0 in children under age " to determine severity ofillness. t is located between the thumb and inde% finger when both are fully e%tended.

The three bars are the three *oints of the inde% finger. 8ook for any visible vein.

*ind "ar is at the metacarpophalageal >MCP0 *oint.

+i "ar is at the pro%imal interphalangeal >PP0 *oint.

ife "ar is at the distal interphalangeal >(P0 *oint.

8ook at the depth" color" si&e" and location" for indications of heat" cold" deficiency"

e%cess" progression" and seriousness.

0istening and Smelling

istening voice and crying, cough.

Smelling "reath, vomit, stool and urine.

In5uiring

3enerally" pediatrician need to know from in'uiring about chief complaint" history ofpresent history" detailed dietary history" sleep" activities" prenatal and perinatal history"

past medical history" review of systems" family history" and social history.

Pal&ation

Pulse2 pulse diagnosis can be done in children over years of age >the vein on the finger

is e%amined prior to age 0. n young children" the three position of the pulse may be tooclose to be palpated by individual fingers" so that the e%aminer can use the thumb to get

an overall impression of all three positions. En older children" it is often possible for the

e%aminer to place fingers close together for threefinger palpation.

3enerally" a much more simplified pulsetaking is used in children than adult2 pulses are

classified as strong or weak" fast or slow" superficial or deep" regular or irregular. !trongpulses are seen in e%cess conditions F weak pulses in deficient conditionsF fast pulses in

heat" slow in cold conditionsF superficial pulse in e%terior conditions whereas a deeppulse signifies penetration into the interior.

The pulse rate in children is faster than adults and varies with age as follows2

Newborn2 =@G=HG beatsI per breath0

= year 2 ==G=@G>,I per breath0

H, year 2==G>, per breath0

year2 KG >/ per breath0

=H year2 same as adult.

'ody palpation: is done at the superficial and the deep level, mainly on sin, head,a"domen, palms and soles.

!uperficial palpation can feel the skin of child for subtle temperature differences.

(eep and firm palpation can find inside abnormal appearance.

Sin temperature:;armer indicates e%cess heat or yin deficiency>especially on palms

and soles0" lower temperature>especially palms" sole" abdomen" back0 indicates

deficiency.


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#ontanelles:babiess fontanelles should feel soft. The posterior fontanelle usually closes

at @ months of age" and the anterior fontanelle closes between =@ and = months of age.

(elayed closure may reflect kidney essence deficiency" a bulging fontanelle may indicateincreased intracranial pressure as in meningitis" which is damp heat of the brain. +

sunken fontanelle may be associated with dehydration" which correlates to yin >fluid0

deficiency or yang e%cess.ec and armpitcheck for glands >lymph nodes02 children usually have palpable glands

in the cervical" postauricular areas because of fre'uent 56" sore throat" and ear infection

>e%terior windheat syndrome0.Nontender and smooth feeling is normal condition. Lut nontender nodes are also

considered to be sites of phlegm accumulation where 'i flow is sluggish" and are often

found in chronic illnesses. 6ed" swollen" tender glands indicates presence of heat or

to%in.

#reatment

1. Prescri&tion should be done in time' correctly.

Lecause the characteristic of changing and transforming rapidly in disease process"treatment for children should be provided in time. ncorrectly treatment in*ure childrens

health more serious than adult because the young yin and young yang body constitution.Pediatrician should be very careful to do diagnosis and treatment.

2. 4on3t oer/dosage.

;ith the constitution of delicating" vigorous" childrens illnesses are more responded tothe treatment. !o when treating childrens problem" be cautious to the herb which are

e%treme bitter" cold" pungent" hot tastes. (ont use to%in herb. -ach visit" prescript herb

formula for shorter period >less than H days0 overdosage may in*ure heng #i.

". onert dosage bet!een adult and child.

Newborn is =


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Parting6&ushing Fu *in/yang and rubbing the abdomen

=. location2 on the abdomen

@. Manipulation2 Partingpushing obli'uely down with the face of the thumbs or ribbedsurface of the inde%" middle" ring and little fingers simultaneously from hongwan

point to both sides is called Apartingpushing 1u $inyang. 6ubbing the abdomen

with the palm or the four fingers is called Arubbing the abdomenB Palmrubbingclockwise mean reduce" otherwise" means reinforcing.

. 1unction2 regulating 'i" promoting digestion" for abdomeinal pain" abdominal

distention" ingestion" nausea" vomiting" food retention in stomach" rubbing theabdomen by reduce method can treat constipation.

,i7iegu

=. 8ocation2 the line from the fourth lumbar vertebra to caudal vertebra.

@. Manipulation2 >=0 pushup #i*iegu2 Push straightly from coccy% up to the fourthlumbar vertebra with the radial surface of the thumb or ribbed surface of inde% and

middle fingers. Dave function of warming yang and relieving diarrhea. >@0. Push

down #i*iegu2 push from the fourth lumbar vertebra to the end of coccy% with the

radial surface of the thumb or the faces of inde% and middle fingers. Dave thefunction of e%pelling pathogenic heat to treat constipation.

and assage: 7ld saying 2 A +ll the channels and collaterals of children converge inthe hands.B

Points of spleen" liver" heart" lung" and kidney" large intestine" small intestine.

Nippingkneading !ihengwen for infantile malnutrition.Nippingkneading Oiaohengwen for reduce fever" relieving distention.

?neading hang%iaohengwen.

Clearing ;ei*ing.

+rcpushing Lanmen.Pushing from Lanmen to Dengwen.

Pushing from Dengwen to Lanmen

?neading Neilaogong.!huidilaomingyue>fishing for the Moon in the water0.

+rc)pushing Neibagua.

Nippingkneading Oiaotiao%in.?neading ong*in.

Partingpushing (ahengwen.

Nipping !hi%uan.

Nippingkneading -rshanmenNippingkneading -rma.

?neading ;ailaogong

?neading $iwofeng.Pushing !anguan.

Pushing 8iufu.

Clearing Tianheshui.

i 9i thera&y (S&inal Pinch &ull)

Techniue:begin at the sacrum with one hand on each side of the spine. 3rip the skin

with both of therapist thumbs and inde% fingers. 3ently lift up and begin moving along


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the spine. Continuously rolling the skin up and lifting it away from the spine. Continue

along the length of the spine to the base of the neck. / times for one treatment. 7nce

day" , treatments for one course.+ction2 regulate yin" yang" 'i" and bloodF harmoni&e organs" promote smooth meridian

function" tonify deficiency.

Pric Sifeng

Techniue:prick to s'uee&e out a small amount of yellowish viscous fluid at the location

of palm of hand" midpoint of lines at the second segment of all four fingers.+ction2 poor appetite" malnutrition and indigestion syndrome in children.

Pediatric class t!o

old

Cold is caused by attack of si% evils" especially wind cold or wind heat. Manifest feverand chilly" running nose" cough" etc. 7ccur in four seasons" more in spring and winter.

(uring the disease process" it may have complicated cases such as convulsion" dyspepsia"phlegm syndrome" etc.

Children who catch cold need treatment to fast recovery. !ome children suffer from

fre'uently catching cold. To them" the purpose of treatment is that strengthening the bodyresistance and prevents the cold recurrence.

Pathogenic factors and &athogenesis

Main pathogenic factors2 wind cold" wind heat" or summer heat with dampness.

Through mouth and nose" affect lung organ. 7bstruction of the lung'i will cause thesymptoms of running nose and stuff nose and cough. ncoordination of $ing #i>nutrient

#i0 and ;ei #i>protective #i0 cause fever and chilly.

Lecause of pure yang and young yang and young yin constitution" with insufficiency ofliver" during cold with high fever" convulsion>sei&ure0 may occur. ;ith insufficiency of

spleen" some children may combine with food accumulation and have symptoms of

distension of abdomen and vomiting and diarrhea. Pathogenic factor enter deeper"affecting more lungs function" manifested cough with lots of phlegm.

;ith deficiency of ;ei 'i and lung 'i and spleen 'i" failure of superficial'i to protect the

body against disease" some children repeatedly catch cold.

4iagnosis

=. Main symptoms2 fever" chilly" stuff nose and running nose" snee&e" itching of throat or

sore throat. 7r accompany with cough. f having complicating symptoms may

companies with vomiting" diarrhea" distension of abdomen" or high fever withconvulsion.

@. 7ccurring in four seasons" always occurring when suddenly change of weather"

abnormal cold weather or hot weather.. f symptom is more severe" and with epidemic spread" it is flu. 1lu treatment is

similar as cold.


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H. f patient often catch cold more than twice a month" it is deficiency cold. 1or

deficiency cold" not only treat the child when he catches cold" should also treat the

child before he catch the cold./. !hould differentiate cold from dyspnea and cough due to pneumonia" measles" and

chickenpo%.

4ifferentiation and #reatment1. old due to !ind cold

anifestation: fever with chilly"nosweating" headache" stuff nose and running nose"

snee&e" cough" absence of thirsty" thin white tongue coating" superficial and tense pulse

#reatment &rinci&le: relieving the e%terior syndrome with pungent and warm nature of

herbs.

Formula: odified 9ing Fang ai 4u san

Ingredient: 'iang Duo" chai hu" 'ian hu" &hi ke" fu ling" *ing *ie" fang feng" *ie geng"chuan %iong" gan cao.

Deadache2 add ge gen" bai &hi.

9omiting2 add Lan Oia" &i su.

1lu with high fever" add (a #ing yie" Lan 8an 3en" Pu 3ong $ing. 7r using hai ;e 9ie9i #ang> Cai hu" ge gen" gan cao" huang 'in" 'iang huo" bai &hi" shao yao" *ie geng0.

+ther treatment:

u&&ing: on back" along foot tai yang meridian.

!imple formula2 Cong Chi Tang for mild case of cold due to wind cold. >Chinese green

onion stalk and fermented soybean.

2. old due to !ind heat

anifestation2 more severe fever" aversion to wind" sweating" but fever not relief after

sweating. Deadache" stuff nose" or yellowish nose discharge" cough" thick sputum or thick

yellow sputum" sore throat" thirsty" red tongue" thin white or thin yellow and dry coating"superficial and rapid pulse.

#reatment: elieing the e


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#reatment: -liminating summer heat from su&erficies of the body by dia&horesis

Formula: =in 9ia =iang 0u *in.

Ingredient: Oiang ru" $in hua" Lian dou hua" hou po" lian 'iao";ith dampness factor" has nausea and yellow greasy tongue coating" add Pei 8an" Duo

Oiang.

(iarrhea symptom" add 3e gen" Duang #in" and Duang 8ian.+ther treatment

Pediatric assage

7pening Tianmen" Partingpushing ?angong" ?neading Taiyang>-%tra@0" ?neading-rhougaogu and conducting Duangfeng 6udong

Modification2 Cold due to wind cold2 ?neading -rshanmen and pushing !anguan.

Cold due to wind heat2 clearing 1ei*ing and Tianheshui and pushing Tianshugu.

;ith sputum2 ?neading 6upang and 6ugen and rubbing Oielei.;ith stagnated food2 6einforcing Pi*ing" kneading Lanmen" +rcpushing Lagua and

rubbing the abdomen.

;ith fear2 Clearing 3an*ing and pinchingkneading Lanmen" arcpushing Lagua and

rubbing the abdomen.;ith cough2 Pushingkneading Tan&hong and kneading 1eishu.

$. deficiency cold

anifestation: fever but not very high" recurrence" spontaneous sweating" pale

comple%ion" aversion to wind and cold" blocking of nose and running nose" tiredness"

poor appetite" or cough" light red tongue color and delicated tongue" thin white coating"thready and weak pulse.

#reatment: 6egulating $ing and ;ei to treat disharmony between ying and wei.

Formula: uang ,i ;ui >hi ?u ?u #ang

Ingredient: Duang 'i" 3ui &hi" Lai shao" !heng Jiang" 3an cao" (a ao.Modification2 aversion to cold and stuff nose" add Jing *ie" 1ang feng.

Cough" add Oing ren" he Lei Mu" #ian Du.

;ith deficiency of 'i and yin" irregular fever" night sweating" cough" dry mouth" redtongue and less coating" add $u hu" (an pi" !ha shen" Lai bu.

om&lication sym&toms

1. !ith fear: !ymptoms as cold symptom accompanied with nightcry due to fright"restlessness in sleep" evenconvulsion with hyperphoria. *in ,iao San' add 9u ua'

;ou #eng' Shi 9ue ing' an 4ui.

2. ?ith stagnated food. !ymptoms as cold symptoms accompanied with distention of

abdomen" belching with food smell. -ven vomiting" loose bowel" thick and greasytongue coating" rapid pulse. +dd !hen 'u" Mai $a" !han ha" hi ke" 8ai 1u i.

". ?ith s&utum:more phlegm" even short breath with phlegm sound in the throat and

trachea. cold phlegm" add -r chen #ang &lus Su >i@ heat phlegm" add ai ;e ,iao'

Sang ai Pi' #ing 0i >i.

ough

Cough can be a symptom in upper respiratory tract infection" but it is a mainly symptom.

Mostly cough is caused by e%opathogen factors" which affect lung. !ome cough is

caused by endogenous factors.

n western medicine" it is mostly related with trachitis and bronchitis.


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Pathogenic factors and &athogenesis

Main pathogenic factors2 e%opathogenic factors as wind" cold" summer heat" wetness"dryness and fire.

+ffecting organ is lung" second is spleen.

PathogenesisF e%opathogenic factor" mainly wind" often combined with cold or heat"affect lung" lung 'i is unable to dispersing" so cough occur.

;ind cold syndrome can have symptoms of stuff nose and running nose with thin clear

discharge.;indheat syndrome can have symptoms of dryness of nose or with thick nose discharge.

;ind dryness syndrome may manifest dry cough" dry throat and lips.

n endogenous factors" Phlegm is produced in the spleen" stored in the lung and lung 'i is

unable to disperse and descend" so cough occurs.8iver fire steam fluid to form phlegm and stay in lung also cause cough.

Deatfire in heart channel steam fluid to form phlegm cause cough.

8ong term cough can e%haust lung 'i and lung yin" Loth 'i and yin deficiency make

cough worst and difficult to cure.4iagnosis:=. Main symptom is cough" with or without e%opathogenic symptoms" with or without

phlegm. Mostly at beginning" catch cold" after cold symptoms subsidence" cough

become patientss main suffering.

@. !hould differentiate cough from pertussis>whooping cough0" asthma due topneumonia.

4ifferentiation and treatment

!hould differentiate cough due to e%opathogenic factors or cough due to internal in*ure.

+lso should differentiate e%cess type or deficiency type" cold type or heat type.Treatment principle2 for e%opathogenic cough" dispel e%opathogenic factors and

promoting the dispersing and descending function of lung 'i. 1or cough due to internal

in*ure" focus on which organs have been involved" according to the differentiation todecide the treatment plan.

ough due to e


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anifestation: cough" yellow and thick phlegm" which difficult to cough out" thirsty"

sore throat" yellow thick nose discharge" fever" sweating" headache" aversion to wind" red

tongue with yellow thin coating" supperficial and rapid pulse.

#reatment: (ispel wind and clear away lung heat

Formula: Sang 9u *in

Ingredients: !ang yie" Ju hua" Jie geng" 8ian 'iao" Oing ren" Lo he" 3an cao" 8u gen.!evere cough with thirsty and sore throat" add Ma huang" !heng shi gao.

More heat symptoms" add hi mu" Duang 'in" $u %ing cao"

More sore throat" add Ouan shen" she gan" Nu bang &i.More phlegm" add he bei mu" 3ua lou" Ting 8i &i.

ough due to internal in7ure

1. Phlegm heat ty&e cough

anifestation: cough with profuse amount of phlegm" yellow and thick and difficult tocough out. -ven short of breath" phlegm sound in the throat" or accompanied by fever"

thirsty" restlessness" short and dark of urine" constipation" red tongue with yellow coating"

slippery and rapid pulse.

#reatment: lear a!ay lung heat and dissole &hlegm.Formula: ,ing 9in ua #an #ang

Ingredients: !han hi"hi mu" Duang 'in" 3ua lou" he Lei mu" !ang Lai pi" Ju hong"1u ling" Jie geng" Mai dong" 3an cao.

;ith a lot of phlegm" add Ting li &i" (ai ge san" Tian hu Duang" Tian Nian Oing" hu li.

;ith ribs and chest pain due to severe cough" add hi ke" $u *in" Chai hu.;ith constipation" add 3ua lou ren.

;ith nose bleeding" add Lai Mao gen" (an pi.

6ed and dry tongue" add !ha shen" more dossage of Mai dong.

2. Phlegm/dam&ness ty&e cough

anifestation: Cough with profuse amount of phlegm" white and thin phlegm"

accompanied with fullness of chest" poor appetite" tiredness" light red tongue white

coating" slippery pulse.

#reatment: eliminating dam&ness and eliminating &hlegm

Formula: -r hen #ang

Ingredients: Lan %ia" Chen pi" 1u ling" 3an cao.1or profuse phlegm" add Tian Nan Oing" Lai fu &i.

1or fullness of chest" add Dou po" !u geng.

Cold phlegm with foam phlegm" add Oi Oin and ;u wei &i" or using Oiao #ing 8ong

Tang.;ith food accumulation2 add !hen 'u" Mai $a" !han &ha.

". ,i deficiency cough

anifestation: chronic cough" mostly in the morning" white thin phlegm" palecomple%ion" spontaneous perspiration" aversion to cold" shortness of breath" low and

weak voice" poor appetite" light delicated tongue with thin white coating" thready and

weak pulse.

#reatment: Strengthen s&leen 5i

Formula: en shen ?u !ei i tang

Ingredients: 6en shen>(ang shen0" Lai hu" 1u ling" 3an cao" ;u wei &i" Mai dong"

!heng Jiang" (a ao.


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1or dissolving phlegm" add Lan %ia" Chen pi.

1or spontaneous sweating and aversion to cold" add Duang 'i" gui &hi" Lai shao.

8ong term cough" add ;u mei" ke &i" and Lai Lu.1or cold symptom" add 3an *iang.

$. *in deficiency cough

anifestation: dry cough without phlegm"or scanty phlegm and difficult to cough out"dry throat and thirsty" itching of throat" hoarse voice" or hot sensation of five center" night

sweating" red tongue with scanty coating" thready and rapid pulse.

#reatment: ourishing and moisture lung yin

Formula: Sha shen mai dong tang

Ingredients: !ha shen" Mai dong" $u &hu" gan cao" !ang yie" Lian dou" Tian hua fen.

More yin deficiency symptom" add !heng di" Ouan shen.

More lung heat symptom" add &hi mu.Llood in the phlegm" add Mao gen" 7u *ie" - *iao.

Night sweating" add yin chai hu" #ing hao" Lie *ia" (i gu pi.

#i and yin deficiency with spontaneous sweating" short of breath" scanty tongue coating"

add ;u wei &i" Duang 'i" $u &hu" 1u ling" hi gan cao.Chronic dry cough with reddish and dry of throat" add Ouan shen" !heng di" Ma bo" Lan

lan gen" gan cao" *ie gen.

Cough and asthma due to pneumonia

Cough and asthma due to pneumonia is a common respiratory disease in pediatric. t is

caused by attacking of e%opathogen" enter into deeper lung. !ymptoms have fever" cough"short of breath" flaring of noses. n severe case" may occur pale comple%ion" cyanosis.

This disease have a sudden onset" change very fast" collapse of heart yang may suddenly

occur.

Pathogenic factors and &athogenesisPathogenic factors: wind cold or wind heat" invading lung through skin and month and

nose. !ome cases are subse'uent miseals" pertussis" 8ung collaterals is blocking and lung'i fail the function of dispersing and downward.

This disease can be very severe cases with violent Oie 'i and heng 'i deficiency.

+ffecting heart" may cause blood stasis in heart channel." even cause heart yang collapse.+ffecting spleen function may manifest distension of abdomen" constipation. +ffecting

liver may have convulsion" coma" affecting kidney may disturb the function of reception

of air" to have dyspnea.

4iagnosis

=. !udden onset" mild case manifest fever" cough" sputum sound in the throat. !evere

case have short of breath" flaring of nares.@. !evere case" patients have asthma" irritability" pale comple%ion" cyanosis. -ven coldlimbs" 1u pulse>very deep pulse0" or have high fever" coma" convulsion" restlessness.

. 1or newborn baby" may only manifest refusing to have milk" tiredness" foam out of

mouth. Oray can make final diagnosis.!hould differentiate from cold and common cough" also should differentiate from allergic

asthma.


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!hould differentiate from cold and common cough" also should differentiate from allergic

asthma.


(ifferentiate wind cold or wind heat. (ifferentiate phlegm in the dominating position or

heat in the dominating position. (ifferentiate the serious degree of patients condition.

(ifferentiate deteriorated case from common case.Treatment principle is focus on facilitating the flow of the lung 'i to relieve asthma and

clearing away heat and dissolving phlegm. +ccording to the differentiation" to use

regulating 'i" removing blood stasis" or strengthening 'i and nourishing yin.

ommon case

1. 0ung 5i blocing by !ind cold

anifestation: aversion to cold" fever" no sweating" cough with white thinner phlegm"

even short of breath" light red tongue thin white coating" superficial and tense pulse.

#reatment &rinci&le: entilating lung !ith &ungent and !arm nature herbs

Formula: San Ao #ang

Ingredients: Ma huang" Oing ren" 3an cao" !heng *iang.

+dd Jing *ie" (ou chi for relieving e%terior syndrome.+dd !u &i" Chen pi" Lan %ia" lai fu &i dissolving phlegm.

Deat wrapped by cold2 add 3ui &hi" !hi 3ao.

2. 0ung 5i blocing by !ind heat

anifestation: 1ever' aversion to wind" thirsty" cough with thick and yellow phlegm"congestion of throat" red tongue with thin yellow coating" superficial and rapid pulse.-ven high fever" irritability and restlessness" short of breath and flaring of nares" no tear

and nose discharge" constipation" red tongue with yellow coating" rapid and surge pulse.

#reatment &rinci&le: entilating lung !ith &ungent and cool nature of herbs

Formula: *in ,iao San and a =ing Shi ;an #ang

Ingredients: *in ,iao San $in hua" 8ian 'iao" hu yie" Jing *ie" Nu bang &i" Lo he" (an

(ou chi" Jie geng" 8u gen" 3an cao.

a =ing Shi ;an #ang: Ma huang" Oing 6en" !hi 3ao" 3an Cao.!ever cough with phlegm" add he Lei Mu" hu 8i" Tian hu Duang.

More heat symptoms" add Duang #in" !han hi &i" Lan lan gen.

;ith food accumulation2 add 8ai 1u &i" (a fu pi" #uan 3ua lou.

". 0ung 5i blocing by &hlegm heat

anifestation: !udden onset" asthma" flaring of nares" phlegm sound in the throat" fever"

irritability and restlessness" even cyanose" light red and purple tongue color" white thick

and greasy coating" slippery and rapid pulse.

#reatment &rinci&le: remoing heat from the lung and relieing asthma.

Formula: #ing 0i 4a >ao =ie Fei #ang and ?u hu #ang

Ting 8i &i" purging the heat accumulated in the lung.;u hu tang 2 Ma Oing !hi 3an Tang" add green tea.

More phlegm" add hu li" Tian &hu huang.

More heat" add Duang 'in.Constipation" distension of abdomen" add (a huang" Mang Oiao.

Cyanose" add (ang 3ui" Dong Dua" chi shao.

$. ody resistance !eaened !hile &athogenic factors remain.

1) 0ung heat due to yin deficiency


14/33

anifestation: 8ow fever" night sweating" flushed face" bright red as cherry lips" dry

cough" red dry tongue without coating or map coating" thready and rapid pulse.

#reatment: clearing a!ay heat and nourishing lung

Formula: Sha shen mai dong tang

!ha shen" yu &hu" mai dong" hua fen" sang yie" bian dou" gan cao.

1or low fever" add &hi mu" huang 'in" #ing hao" Lie Jia" (i gu pi.1or chronic cough" add Lai bu" !ang Lai pi" ?e &i" Pi La yie.

8ow appetite" add Lian dou" 3an cao.

2) ,i deficiency of lung and s&leen

anifestation2 ;avedlow fever" pale face" perspiration easyly" cough" without strength"

phlegm staying in the throat" poor appetite" light red tongue with white moisture coating"

thready and soft pulse.

#reatment: #onify 5i and strengthen s&leen function

Formula: en shen !u !ei i tang

Ingredients: 6en shen" bai &hu" fu ling" gan cao to strengthen spleen. ;u wei &i to

collect 8ung 'i.

1or long term cough" add i yuan" Lai Lu" ?uan dong hua.1or waved low fever caused by irregulate of $ing 'i and ;ei 'i. +dd 8ong gu" Mu li" 3ui

&hi and Lai shao.1or perspiration" add Duang 'i.

1or poor appetite" add shan &ha" !hen 'u" Mai ya.

1or chronic diarrhea" add Lian (ou" !han yao" Mu %iang" ?e &i.

4eteriorate case

1. deficiency and de&letion of heart yang

anifestation: sudden pale face" cyanose" of lips and blue purperlish of e%tremities"difficult to breath" cold limbs" irritability" liver swelling" light purple tongue color with

white coating" weak and rapid pulse.

#reatment:warm heart yang and rescue patient from collapse

Formula: odified Shen Fu 0ong u 9iu i #ang

ngredients2 6en shen and 1u &i to warm yang. 8ong gu and Mu li to collect perspiration"

Lai shao and 3an cao to regulate $ing and keep yin.1or cyanose and enlarge of liver" add (ang gui" Dong hua" (an shen to activate blood

circulation.

1or accompanied with phlegm and heat" add $uan &hi" shi cang pu..

2. Inasion of ,ueyin by &athogen

anifestation: Digh fever" coma or delirium" convulsion of limbs" lock*aw" stiffness of

neck" upward staring" red tongue with yellow greasy coating" thready and rapid pulse.

#reatment:calming the liver to stop the wind. 6emoving heat from the heart to restoreto consciousness.

Formula: 0ing *ang ;ou #eng #ang and u huang ,ing =in ?an.

Ingredients: 8ing yang *iao" 3ou teng" 1u shen" !ang yie" Chuan bei mu" shen di" Ju hua"Lai shao" !heng 3an cao" Oian hu ru.

1or coma" phlegm" add $u *in" (an Nan %ing" Tian &hu huang.

+ther #reatment:

Acu&uncture: (ingchuan" !tHG" L=" 6en=I.


15/33

u&&ing treatment:

Cupping on the surface of below scuple bone" once a day" / to =G minutes each time" /

days a course. t is for later stage of pneumonia with moist rales.1or serious case" should do the combination of ;estern medicine and Chinese medicine.

Asthma

+sthma is the most common cause of chronic illness in childhood. n recent years"

prevalence of asthma is increasing worldwide" especially in children under =@ years ofage. n Chinese" it calls asxiao chuan,/iaomeans the whee&ing sound" chuan means

the pathological breath state. The characteristic is paro%ysmal laryngeal stridor" short of

breath" e%halation is longer than inhalation" even difficult to flat sleep. Chinese medicine

treatment can reduce the degree of asthma symptoms and the fre'uency of the attacking.1inally asthma child get remission.

This problem is related with bronchial asthma.

Pathogenic factors and &athogenesis-ndo&athic cause: latent phlegm. +nd irregular function of spleen" lung and kidney.

#rigger cause or &redis&osing cause: includee%ogenous pathogenic factors assi% evils

and season change" some specific smell" or overeating sour" sweet" or spice food"overwork" emotional stress.

8atent phlegm is formed due to the irregular function of spleen and lung and kidney.

!pleen is source of phlegm. ?idney deficiency" failing to manage the water metabolism is

root cause for latent phlegm formation. 8ong standing stagnation of phlegm becomelatent phlegm" stay deep inside of the body. ;ith the lung


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". #reatment &rinci&le.(uring attack" main treatment is focus on eliminating the

pathogenic factor for secondary syndrome. Letween attack" strengthen the body

resistance" tonify lung 'i or strengthen spleen" and kidney. 1or complicated syndromeof deficiency and e%cess" according to the differentiation" do the combination of

strengthening the body resistance with eliminating pathogenic factors.

Attac stage1. Asthma due to cold

anifestation: cough" asthma" whooping in the throat" frothy sputum" aversion to cold"

no sweating" running nose" cold limbs" light red tongue with white greasy coating"superficial and slippery pulse.

#reatment: !arm lung to dis&el cold' dissole &hlegm to reliee asthma

Formula: =iao ,ing long #ang or She ;an a uang #ang

Ingredients: =iao ,ing 0ong #ang: 3an Jiang" 3ui hi" Ma Duang" !hao $ao" hi 3anCao" Oi Oing" Lan Oia" ;u ;ei i"

She ;an a uang #ang: !he 3an" Ma Duang" i $uan" ?uan (ong Dua" Lan Oia" Oi

Oing" ;u ;ei i" !heng Jiang" (a ao.

Oiao #ing 8ong Tang is good for e%terior cold with interior water retention. Dave thefunction of diaphoresis.

!he 3an Ma Duang Tang is good for the asthma with whooping" without obvious e%teriorsyndrome.

1or phlegmdampness" add Dou Po" Lai Jie i" !u i.

1or adversely riseup 'i" add (ai he !hi.;ith dry stool" add 3ua 8ou" 8ai 1u i.

2. eat asthma

anifestation: cough and asthma" yellow thick sputum" whooping" fullness chest" body

hot" reddish face" dry mouth" red throat" dark urine" constipation" yellow greasy tonguecoating" slippery and rapid pulse.

#reatment: lear a!ay heat and &hlegm' reliee asthma and cough.

Formula: a =ing Shi ;ao #ang or 4ing huan #ang

Ingredients:

a =ing Shi ;ao #ang: Ma Duang" Oing 6en" !hi 3ao" 3an Cao.

4ing huan #ang: Lai 3uo" Ma Duang" !ang Lai Pi" !u i" Oing 6en" Duang #in"?uan (ong Dua" Lan Oia" 3an Cao.

Loth formulas for heat type asthma. Ma Oing !hi 3an Tang is good for heat asthma with

e%terior syndrome. (ing Chuan Tang is good for whooping asthma of interior heat

phlegm.1or more heat symptoms" add $u Oing Cao.

1or more phlegm" add Tian hu Duang" Ting 8i i.

;ith constipation" add 3ua lou" (a Duang.

". om&licated syndrome of cold and heat

anifestation: cough and asthma with whooping" aversion to cold" fever" running nose

and snee&e" yellow thick phlegm" thirsty" constipation" red tongue thin white coating"slippery and rapid pulse.

#reatment: 4ia&horesis to reliee e


17/33

Ingredients: Ma Duang" 3ui hi" 3an Cao" Oing 6en" !hi 3ao" !heng Jiang" (a ao.

1or more heat2 add Duang 'in.

1or with whooping" add !he 3an" !ang Lai Pi.1or more phlegm" add Lan Oia" Chen Pi" !u i. 7r Lai Jie i" Ting 8i i.

1or severe asthma" add (i long.

1or phlegm heat" add 4ai ;e San( ,ing 4ai' ai ;e ,iao).$. om&licated syndrome of deficiency and eDuan Mai0 pulse without strength.

#reatment: strengthen s&leen and dissole &hlegm

Formula: 0iu 9un >i #ang

Ingredients: (ang !hen" Lai hu" 1u 8ing" 3an Cao" Lan Oia" Chen Pi.8oose stool" add Lian (ou" Mu Oiang" Pao Jiang.

Poor appetite" add !hen #u" Mai $a" Jiao !han ha.

". Bidney deficiency

anifestation: +version to cold" cold limbs" short of breath while movement" pale

comple%ion" spontaneous perspiration" low back and knee ache" enuresis or too much

night urination" light red tongue with thin white coating" or red tongue with map coating"

deep thready pulse.

#reatment: #onify idney

Formula: 9in ;ui Shen ,i ?an

Ingredients: 1u i" 3ui hi" 3an (i Duang" !han hu $u" !han $ao" 1u 8ing" e Oie"(an Pi.

1or both deficiency of $in and $ang2 use e he 4a >ao ?an( )1or more night urination" add $i hi 6en" Tu !i i.

+ther treatment:

-


18/33

ngredients2 Lai Jie i" $uan Du !uo" @= g for each" 3an !ui" Oi Oing =@ g for each.

3round to fine powder" divide into part. Mi% it with fresh ginger to make paster. -very

=G day to use the paster to put on 1ei !hu" Oin !hu" 3e !hu" Tan hong" before skin haveblister to take off it> about @ hours0. Lest time is on hotest summer G days> !hang 1u"

hong 1u" and Mo 1u0.

Acu&uncture:(uring attack stage" select (ingChuan" Tian Tu" Nei 3uan. f cough with profuse phlegm"

add Tan hong" 1eng 8ong.

Letween attack period" select (a hui" 1ei shu" u !an 8i" !hen !hu" 3uan $uan" Pi !hu.-ach time" choose to H points" slight do acupuncture with mo%ibustion" once every

other day.

Pediatric class three

4iarrhea

(iarrhea is defined as an alternation in normal bowel movement characteri&ed by

increase in the water content" in volume" and increase in fre'uency to more than threestools per day. +cute diarrhea is an episode of diarrhea of less than or e'ual to =H days in

duration. Persistent diarrhea is diarrhea of more than =H days duration" whereas chronicdiarrhea lasts more than G days. (iarrhea is a significant cause of pediatric morbidity

and mortality. (ehydration" malnutrition are ma*or complication.

n western medicine" pediatric diarrhea is related with indigestion" infectious diarrhea.

-tiology and &athogenesis

!i% evils invading" internal in*ure due to diet.

!pleen deficiency constitution are main reasons to cause diarrhea.

8ong term diarrhea also can e%haust #i and $in" cause depletion of #i and $in" or stirring

internal wind" cause chronic infantile convulsion" or spleen fails to transforming food

essence" 'i and blood deficiency" cause infantile malnutrition.

4iagnosis

=. increase the fre'uency of bowel movement" to / times daily even more than =Gtimes a day" light yellow color as egg soup or brown color with stink smell" or with a

little mucus" or accompany by nausea" vomiting" abdomen pain" fever thirsty etc.

@. 6uling out dysentery. (ysentery has more abdomen pain" tenesmus" or pusblood

stool. !tool e%amination can make diagnosis.


#he ey of differentiation

=. differentiating the cause.@. (ifferentiating degree.

. (ifferentiating deficiency and e%cess.

#reatment &rinci&le

-


19/33

ommon syndrome

1. 4iarrhea due to im&ro&er diet

anifestation: loosestool containing indigestion milk or food with strong sour smell" to times of bowel movement daily" abdominal pain before bowel movement" refusing to

feed" abdominal distension and refusing to be touch" belching" or vomiting" light red

tongue thick greasy coating and yellow greasy coating.#reatment &rinci&le:promoting digestion and removing stagnated food.

Formula: =iao 0u ?an and 4a An ?an

Ingredients of =iao 0u ?an: Oiang 1u" !hen #u" Mai $a" Chen Pi" !ha 6en" hi 3anCao.

Ingredients of 4a An ?an: Lai hu" !han ha" !hen #u" 8ai 1u i" Lan Oia" 1u 8ing"

Chen Pi" 8ian #iao.

2. diarrhea due to !ind cold

anifestation: 8oose stool" lighter in color" with foam" to , times daily" intestinal

gurgling sound " accompanied with running nose" cough" itching of throat" light red

tongue" thin coating.

#reatment &rinci&le: dispel wind and cold" dissolve dampness.Formula: uo =iang >heng ,i SanIngredients: Duo Oiang" i !u $ie" Lai hi" 1u 8ing" (a 1u Pi" Lai hu" Lan Oia #u"Chen Pi" Dou Po" Jie 3eng" hi 3an Cao.

". diarrhea due to dam&ness heat

anifestation: watery stool" or as egg soup" violent diarrhea more than ten times daily"abdominal cramp" more strong smell stool" low appetite" thirsty" irritability" lacking of

vital" fever or without fever" shortness of urination" yellow thick coating.

#reatment &rinci&le: clear heat and dissolve dampness

Formula: ;e ;en uang ,in uang 0ian #ang

Ingredients: 3e3en" Duang #in" Duang 8ian" hi 3an Cao.

$. diarrhea due to s&leen deficiency

anifestation: loosestool" after eating" have bowel movement" light color and withoutsmell" accompanied with sallow comple%ion" skinny body shape" fatigue" light red tongue

with teeth mark" white coating" thready pulse.

#reatment &rinci&le: strengthenspleen and promoting transportation function of spleen.

Formula: Shen 0ing ai >hu San

Ingredients: 6en shen" 1u 8ing" Lai hu" Lian (ou" Chen Pi" !han $ao" 8ian i 6ou"

!ha 6en" $i $i 6en" Jie 3eng" 3an Cao.

C. diarrhea due to yang deficiency of s&leen and idney

anifestation: Chronicdiarrhea"loose stool" or with food" to / times" or accompanied

by prolapse of the anus" cold trunk and cold limbs" pale face" lack of vitality" sleep

without totally close eye" light red tongue" white coating" deep thready pulse.

#reatment: strengthen spleen and warm kidney.

Formula: Fu >i 0i >hong #ang and Si Shen ?an

Fu >i 0i >hong #ang: 1u i" (ang !hen" Lai hu" 3an Jiang" 3an Cao.

Si Shen ?an: ;u;ei i" Lu 3u hi" ;u hu $u" 6ou (ou ?ou.

4eteriorated case

1. im&airment of ,i and *in


20/33

anifestation: violent diarrhea" accompanied by lack of vitality" fatigue" sunk fontanel"

abdomen caved in as a boat shape" dry skin" skinny" irritability" cry without tear" thirsty"

short of urine" or no urination" red tongue less moisture" less coating or without coating"thready and rapid pulse.

#reatment: re&lenish 5i and nourish *in.

Formula: en Shen ?u ei #angIngredient: 6en shen" ;u Mei" Mu 3ua" !han $ao" 8ian i 6ou" hi 3an Cao.

2. e


21/33

nfantile dyspepsia without proper treatment and delay treatment can develop into

infantile malnutrition.

(yspepsia has e%cess type and deficiency type. -%cess type is related with overeating"damage the function of spleen and stomach" so food accumulation. (eficiency type is

caused by spleen deficiency and failing to transport and transform food" so food

accumulation.4iagnosis=. 8ow appetite" or refuse to eat" accompanied by distension of epigastrium and

abdomen" vomiting" loose stool" stink smell" or constipation.@. rritability" cry in night" or fever.

. ;ith the history of improper feeding.

H. Need to rule out anore%ia" and infantile malnutrition.

4ifferentiation and treatment:

=. (ifferentiating deficiency and e%cess

@. (ifferentiating in*ures by milk" or in*ures by food.

1or e%cess type" main treatment is eliminating undigested food. 1or complicated case of

deficiency combined with e%cess" treatment is promoting spleen function and removingstagnated food.

1. Food or mil accumulation

anifestation: low appetite" or no appetite" distension of epigastrium and abdomen"

refuse to pressure" or accompanied by eructation with fetid odor" nausea" vomiting"

irritability" cry" low fever" more hot around abdomen" stink stool" light red tongue withwhite thick coating.

#reatment: eliminate undigested food.Formula: =iao u ?an. +r ao e ?an.

Oiao 6u ;an2 Oiang 1u" !hen #u" Mai $a" Chen Pi" !ha 6en" hi 3an Cao.Lao De ;an2 !han a" 8iu #u" Lan Oia" 1u 8ing" Chen Pi" 8ian #iao" 8ai 1u i.

2. accumulation !ith s&leen deficiency

anifestation: tiredness" sallow comple%ion" skinny" no appetite" distension ofepigastrium after eating" prefer to prone position during sleep" vomiting with fetid odor"

loose stool @ or times daily" with undigested food or milk" white thicker tongue fur.

#reatment: !trengthen spleen and remove stagnated food.

Formula: 9ian Pi ?an ( Pill for Strengthen s&leen)

6en !hen" Lai hu" Chen Pi" Mai $a" !han a" hi !hi" !hen #u.

+ther treatment

-


22/33

Clearingreinforcing Pi*ing" kneading Lanmen" clearing ;ei*ing" arcpushing Lagua"

partingpushing 1u yinyang" rubbing the umbilicus" foulagingrubbing the

hypochondrium" and pressingkneading usanli.

Abdominal pain

+bdominal pain can be a perple%ing problem for the pediatrician. t accounts for the

ma*ority of visits make by children and adolescents. t can range form having no

significant pathology to being a life threatening" surgical emergency. Chinese medicine"mostly provide the treatments for some nonemergency abdominal pain. n these cases" the

causes of abdominal pain are cold attack" food accumulation" deficient cold of angfu

organs" and #i stagnation and blood stagnation.

4ifferentiation and treatment2(ifferentiate the nature of pain2

(ifferentiate the degree" and inducing and trigger factors2

1. -hong #ang:3ui hi" Lai !hao" 3an Cao" !heng Jiang" (a hao" $i Tang

0i >hong #ang:(ang !hen" Lai hu" 3an Jiang" hi 3an Cao.

$. ,i stagnation and blood stasis syndromeanifestation: stable' unmovable abdominal pain" or have abdominal mass" dark lipsand purplish spots on the tongue.

#reatment:regulate 'i and eliminate blood stasis

Prescri&tion:!hao 1u hu $u Tang

Ingredient:Oiao Dun Oiang" 3an Jiang" $uan Du !uo" Mo $ao" (ang 3ui" Chuan

Oiong" 6ou 3ui" Chi !hao" Pu Duang" ;u 8ing hi

+ther treatments:


23/33

Acu&uncture and mo


24/33

H. ;ith the history of improper feeding.

/. (ifferentiating with infantile anore%ia. nfantile anore%ia without emaciation.


#he ey of differentiation

=. differentiating the cause.

@. (ifferentiating the degree of the disease.. (ifferentiating the complication. infantile oculopathy due to malnutrition">yan gan0"

aphthae in children>%in gan0" infantile malnutrition with swelling" infantile

malnutrition with abdominal distension" infantile malnutrition with diarrhea" infantilemalnutrition with fever" infantile malnutrition with dampness" infantile malnutrition

with thirst" infantile malnutrition with cough" etc. n the last stage" patient may occur

the critical condition of e%haustion of yin and depletion of yang.

#reatment &rinci&le

;ith food accumulation" should strengthen spleen and remove stagnation of food. n

dry malnutrition stage" should tonify the 'i and blood.

ommon case

ild case of infantile malnutritionanifestation:

#reatment2 strengthen spleen function.1ormula2 i !heng Jian Pi ;an> nourishment and strengthen spleen pill0

ngredient2 Lai hu" $i $i ren" 6en !hen" Jie 3en" !ha ha" !hen #u" !han $ao" Mai $a"

hi !hi" 1u 8ing" Duang 8ian" Lai ?ou 6en" e Oie" hi #iao" Duo Oiang" hi 3an Cao"8ian i 6ou" Lian (ou.

Infantile malnutrition !ith stagnated food

anifestation:.

#reatment2 strengthen spleen and remove stagnated food.

Formula: Fei -r ?an

Ingredient: 6en !hen" 1u 8ing" Lai hu" Duang 8iang" Du Duang 8ian" !hi Jun i" !hen

#u" Mai $a" !han ha" 8u Dui" 3an Cao.

Infantile malnutrition !ith dryness

anifestation:

#reatment:tonify 'i and nourish blood

Formula2 a >hen #ang.

om&lications:

This happen in the late stage" not only impairment of spleen and stomach" but also other

organs are involved to cause the complications.

infantile oculo&athy( eye gan)

anifestation:

#reatment:Nourish liver to improve eyesight.

Formula:!hi Du $ie 3uang ;an

Ingredients:!hi Du" Tian Men (ong" Mai Men (ong" 6en !hen" 1u 8ing" !hou (i

Duang" !heng (i Duang" Niu Oi" Oing 6en" 3ou #i i" Cao Jue Ming" Chuan Oiong" OiJiao" Lai Ji 8i" 8ing $ang Jiao" hi #iao" ;u ;ei i" #ing Oiang i" 3an Cao" 1ang

1eng" 6ou Cong 6ong" Duang 8ian" !han $ao" Tu !i i.

A&hthae in children

anifestation2


25/33

#reatment:clear away heart fire.

Formula:Modified Oie Oin (ao Chi Tang.

Ingredient: Mu Tong" !heng (i Duang" Duang 8ian" !heng 3an Cao" (eng Oin Cao.1or shortness and brown color urination" add Dua !hi" Tan hu $ie.

Infantile malnutrition !ith s!elling

anifestation:#reatment:strengthen spleen and warmer yang and improve swelling.

Formula:Modified hen ;u Tang

Ingredient:1u i" Lai hu" 1u 8ing" Lai !hao" !heng Jiang.

+ther treatment:

- eye gan0

-*an ;an)" add clearing 3an*ing and kneading !hen*ing.

1or cough and asthma" add clearing 1ei*ing" pushingkneading Tan&hong and kneading

1eishu.

Infantile anore


26/33

-%cept poor appetite and less amount of intake" generally patient grow normal" f get

worst" affect patientQs normal growing" it may develop to infantile malnutrition.

4ifferentiation and treatment:

1. S&leen/stomach incoordination

anifestation:

#reatment:promoting spleen function and regulate stomach.Formula: odified #iao Pi San

Ingredient: Cang hu" Chen Pi" !ha ha" Ji Nei Jin" Pei 8an.

2. ,i deficiency of s&leen and stomach

anifestation:

#reatment2 strengthen spleen and replenish 'i.

Formula: odified Shen 0ing ai >hu San.

Ingredient: 6en !hen" Lai hu" 1u 8ing" 3an Cao" $i $i 6en" Jie 3eng" !han $ao" LaiLian (ou" 8ian i 6ou" !ha 6en" (a ao.

". *in deficiency of s&leen and stomach

anifestation:

#reatment: nourish yin of spleen and stomachFormula: odified *ang ?ei >eng *ie #angIngredient: !hi Du" ;u Mei" Lei !ha !hen" $u hu" 3an Cao" Lai !hao.

+ther treatment:

-focal" local0" and unclassified sei&ures. -ach class has a long list ofdifferentials that have comple% dimensions. Chinese medicine decrypts generali&ed

sei&ure)grand Mal sei&ure in Duang (i Nei Jing. Chinese herb medicine and acupuncture

have been applied to the disease treatment with long history. Treatment is directed towardprevention of recurrence.

Aetiology and Pathology


27/33

ongenital factor: during pregnancy" have fright which affect foetus" cause adversely

disturbance of 'i and blood. Congenital kidney yin deficiency and the resultant liver yang

e%cess which stirs up wind. Causing tonicclonic movement in e%tremities.

Stubborn &hlegm blocing u&/orifice: spleen deficiency" produce phlegm" a weak

spleen is often associated with e%cess liver yang" which can stir up internal wind" phlegm

obstructs sensory orifices and phlegm can obstructs the heart orifices and Amists themindB causing unconsciousness.

lood stasis blocing: in*ure head during delivery" or in*ure head by fallen down" blood

stasis block in the uporifice" disturb sprit and cause epilepsy.

After conulsion: repeatedly convulsion" damage brain function by the accumulation of

wind and phlegm" develop to epilepsy.

4iagnosis

=. symptoms2 characteristic symptoms in sei&ure" sudden loss of consciousness" foam onthe lips" eyes staring upward" and convulsion>tonicclonic movement in e%tremities0.

@. 1or mild case" may *ust momentary loss of attention with eyes staring directly

forward" or in part of body" muscle convulsion.

. !ome patients with hereditary family history or history of lack of o%ygen duringdelivery" or in*ure during delivery.

H. -lectroencephalograph show the epilepsy Qs wave shape.


Seiure stage

1. e&ile&sy due to fright

anifestation2 duringor before attack" stick tongue out" cry by fright" face suddenly red

and suddenly white" fright" thin white tongue coating" string and slippery pulse.

#reatment: tran5uiliing the mind

Formula: modified >hen 9ing ?an

Ingredient: 1u !hen" Mai (ong" hu !ha" $uan hi" Cang Pu" ao 6en" Niu Duang"

Duang 8ian" 3ou Teng" hen hu" (an Nan Oing" Tian hu Duang" Oi Jiao> !hui Niu

Jiao0" 3an Cao.1or severe epilepsy attack" add #uan Oie" ;u 3ong" Jiang Can.

1or phlegm symptom" add Chuan Lei Mu" !ha 6en.

1or headache" add Tian Ma" Ju Dua" Lai !hao.1or dry mouth and red tongue" add !heng (i" 3ui Lan.

2. e&ile&sy due to !ind stirring u&

anifestation: during attack" loss of consciousness" eyes staring upward vacantly"

reddish face" finger convulsion" stiffness of neck" white greasy tongue coating" string andslippery pulse.

#reatment: Calming the endopathic wind to treat epilepsy

Formula: odified 4ing 9ian ?an

Ingredient: Tian Ma" Chuan Lei Mu" (an Nan Oing" Jiang Lan Oia" Chen Pi" 1u 8ing"

1u !hen" (an !hen" Mai Men (ong" Cang Pu" $uan hi" #uan Oie" Jiang Can" Du Lo"

Chen !ha" hu 8i" Jiang hi >ginger *uice0" 3an Cao.;ith heart fire" irritability" add Duang 8ian" !han hi i" hu $ie.

1or headache due to liver fire" add 8ong (an Cao" Ju Dua.

1or convulsion" add ;u 3ong" Jiang Can.

1or stiffness of neck" add 3ou Teng" !hi Jue Ming.


28/33

". e&ile&sy due to accumulation of &hlegm

anifestation: (uring attack" gurgling noises or foaming at the mouth" eyes starring

directly forward" confusion" lusterless comple%ion" white greasy tongue coating" stringand slippery pulse.

#reatment: remoe &hlegm and inducing resuscitation

Formula: odified 4i #an #angIngredient: Lan Oia" Ju Dong" 1u 8ing" 3an Cao" hu 6u" hi !hi" !heng Jiang" hi

Nan Oing" 6en !heng" !hi Cang Pu.

1or convulsion" add #uan Oie" ;u 3ong.1or poor appetite" fullness of abdomen" add !hen #u" 8ai 1u i.

$. e&ile&sy due to blood stasis

anifestation: with history of head in*ure" often headache" during attack" di&&iness"

unconsciousness" convulsion" dry and hard stool" thinner shape" s'uamous and dry skin"blue comple%ion" red tongue purple spots" thready and hesitant pulse.

#reatment: actiate blood circulation and remoe blood stasis' inducing

resuscitation

Formula: #ong ,iao uo =ue #angIngredient: Chi !hao" Chuan Oiong" Tao 6en" Dong Dua" !heng Jiang" Dong ao" 8ao

Cong" !he Oiang.1or convulsion" add #uan Oie" (i 8ong.

1or more blood stasis" add (ang 3ui" !an #i" (an !hen" !hi Oiao !an.

et!een seiure

1. eao ?an

Ingredient: i De Che" 3ui Lan" !hou (i Duang" !han $ao" Tian Men (ong" Mai Men

(ong" Niu Oi" (u hong" Duang Lai" !ha 6en" 1u 8ing.

Acu&uncture:

=. (u@," 8H" !hi%uan" P," ?=

@. (u=H" 8H" DI" L=/" !tHG" mo%a2(u@G" !t,


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assage: partpushing $in$ang" pushing !anguan" pushing 8iufu" pushing spleen

channel" kneading hegu" arcpushing Neibagua" kneading cong*in" kneading ?unlun.

Attention deficit hy&eractiity disorder+ttention deficit hyperactivity disorder>+(D(0 is the most common neurodevelopmental

disorder of children" a disease in western medicine. t mainly manifests hyperactivity"

inattentive" and impulsive symptoms. The child is inability to manifest selfcontrol" toac'uire appropriate social skills" to organi&e timeF all of which in turn lead to

hyperactivity" learning disability" aggression" an%iety" and other primary and comorbid

characteristics. +(D( more commonly affects boys.

The cause of this disease is related with genetic disposition" birth in*ury" various foods"including e%cess sugar" artificial colors" additives and preservatives" environmental

chemicals" molds" and fungi" and neurodevelopmental to%ins such as heavy metals"

Aetiology and &athogenesis

Congenital weakness2 liver and kidney deficiency?idney" the foundation of marrow" is the basis of all brainRmarrow function.

8iver yang overacting correlates to 4purposelessB hyperacitivty and physical aggressive.!pleen is specifically involved with memory of facts and data" with concentration"

therefore with academic learning.

Deart house the !hen"sprit" heart yin deficiency disturbs the !hen.Lirth in*ures or trauma2 blood stasis due to birth in*ures or trauma" blocking the blood

flow. Llood fail to nourish brain and nourish the liver and kidney" so cause the distracted.

(uring growing" $in essence of kidney is relatively insufficient" imbalance of $in and

yang" overactivity of yang.

4iagnosis

=. nattention2 often makes careless mistakes in schoolwork" or other activities" often has

difficulty sustaining attention in tasks or play" often does not seem to listen whenspoken to directly" often does not follow through on instructions.

@. Dyperactivity2 often runs about or climbs e%cessively in situations in which it is

inappropriateF often talks e%cessivelyF. impulsivity2 often blurts out answers before 'uestions have been completedF often has

difficulty awaiting turnF often interrupts or intrudes on others.


1. Insufficient of heart and idney

anifestation:poor memory" lack of selfcontrol and lack of concentration during class"

over hyper" accompanied by low backache" tiredness" darkish comple%ion" thin white

coating" thready and soft pulse.

#reatment &rinci&le: replenish 'i of heart and kidney

Formula: odified Bong Sheng >hen >hong 4an

Ingredients: 3ui Lan" 8ong 3u" $uan hi" !hi Cang Pu.(ream sleep" add ao 6en" De !hou ;u.

;etbed" add $i hi 6en" ;u $ao" !ang Piao Oiao.

rritability" add hen hu Mu" 3ou Teng.

#i and blood deficiency" add Duang #i" (ang 3ui" !hou (i Duang.


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Purple lips and dry hair" add (an !hen" Dong Dua" $i Mu Cao.

2. Bidney deficiency !ith oer actiity of lier *ang

anifestation: over hyper" frustrated" hot temper" irritability" difficult to concentration"accompanied by hot sensation of five center" night sweating" constipation" red tongue thin

coating" thready and string pulse.

#reatment &rinci&le: nourish kidney and liverFormula: ,i 9u 4i uang ?annsomnia" add !uan ao 6en" ;u ;ei i.

Night sweating" add 1u Oiao Mai" 8ong 3u" Mu 8i.rritability" add !hi Jue Ming" 3ou Teng.

Constipation" add Duo Ma 6en.

". insufficient of heart and s&leen

anifestation: lack of concentration" fatigue" skinny or puffy body shape" over hyperbut with good temper" light sleep" poor memory" accompanied by spontaneous

perspiration" improper diet" sallow comple%ion" light red and delicate tongue and less

coating or thin coating" weak pulse.

#reatment &rinci&le2 Nourish heart and strengthen spleen" replenish 'i and tran'uillise.Formula: ;ui Pi #ang' &lus ;an ai 4a >ao #ang8ack of concentration" add $i hi 6en" 8ong 3u.8ight sleep" add ;u ;ei i" $ie Jiao Teng.

Poor memory and clumsy" and thick greasy tongue coating" add Lan Oia" Chen Pi" !hi

Cang Pu.

-nuresis (?et bed)

-nuresis is defined as inappropriate or involuntary voiding during the night at an agewhen urinary control should be achieved. f a child is over / years olds" still wet bed

often occur" we consider it as problem.

Aetiology and &athogenesis

Bidney deficiency: kidney deficiency with deficiency cold in low warmer" can cause wet

bed" because kidney fail to consolidate urination.

,i deficiency of s&leen and lung: 8ung locates in upper warmer" 8ung" spleen andkidney work together to finish the water metabolism. #i deficiency of lung and spleen

will cause the dysfunction of regulation of body fluid by three warmer" the wet bed

occurs

Accumulated heat in the lier: 8iver 'i stagnation with accumulated heat" or dampness"dysfunction in dispersing" affect 8ow warmer" and 5rinary bladder.

4iagnosis

=. over / years olds.@. ;et bed every other night" or every night" even over @ times a night.

. 5rine test in lab is normal.

H. n some sick children" Oray can find occult cleft spine >anatomic anomaly0.

4ifferentiation and #reatment:

1. unconsolidated of the Bidney/5i


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anifestation: wet bed" even a few times a night" long and clear urine" deep sleep and

difficult to wake him or her up" accompanied by fatigue" pale comple%ion" cold limbs"

low back ache" poor memory" fearfulness and insecurity. Pale tongue" thready pulse.

#reatment Princi&le: ;arm and tonify kidney yang" and consolidate urination.

Formula: Sang Piao =iao San' &lus ;u #i ?an

Ingredient of Sang Piao =iao San: !ang Piao Oiao" $uan hi" Cang Pu" 8ong 3u" 6en!hen" 1u !hen" (ang 3ui" 3ui Lan.

Ingredient of ;u #i ?an: !hou (i Duang" Tu !i i" Lai hu" ;u ;ei i" $i hi 6en"

Po 3u hi" 1u i" 1u 8ing" Jiu Cai i.?idney $ang deficiency" add 8u 6ong.

?idney $in deficiency" add !han hu $u.

Too many times wed bed in one night" add Chi !hi hi.

(eep sleep and difficult to wake up" add !hi Cang Pu" Ma Duang" or (an Nan Oing" andLan Oia.

2. ,i deficiency 0ung and S&leen

anifestation: ;et bed" spontaneous perspiration" sallow comple%ion" shortness of

breath" and aversion to speak" poor appetite" loose stool" light red tongue and thin coating"thready pulse.

#reatment Princi&le2 6eplenish 'i and strengthen spleen to consolidate urination

Formula: u >hong *i ,i #ang' &lus Suo ,uan ?an

Ingredient of u >hong *i ,i #ang.

Ingredient of Suo ,uan ?an: !han $ao" ;u $ao" $i hi 6en.Dard to wake up" add !hi Cang Pu" Ma Duang.

". accumulated heat in the lier

anifestation: wet bed" small amount" strong smell" yellow color" hot temper" dream

sleep" red lips" red tongue yellow coating" string and thready pulse.

#reatment &rinci&le: clear away heat" dispersing stagnated 'i and control urination

Formula: Shen Shi i ,uan ?an

Ingredient: $i hi 6en" 1u 8ing" Lai hu" 8ian i Oin" hi i" Lai !hao $ao.;ith yellow thick coating" add Duang Lai" Dua !hi. +r 0ong 4an =ie ;an #ang.

8ong standing" and thinner body shape" kidney yin in*ured" add >hi ai 4i ug ?an.

#ui a:

1. -ssential &rescri&tion: reinforcing Pi*ing" 1ei and !hen*ing" kneading -rma and

;ailaogong" pushing !anguan" pressingkneading Laihui>(u @G0" kneading (antian"

pressingkneading !henshu>5L@0" scrubbing the lumbosacraF portion" and pressing

kneading !anyin*iao.2. odification:Pushing (achang for patients with diarrheaF arcpushing Neibagua for

patients with anore%ia and abdominal distensionF and kneading !hending for patients

with spontaneous perspiration and night sweat.

o6en H0" !henshu>L@0" !anyin*iao>!p,0.

#raining:


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Chickenpox

+cute infection disease is caused by the infection of varicella&oster virus. Manifest

fever" appear papulae eruption" herpes and scab on the skin and mucosa. Children" who

are at age of = to , years old" may be more vulnerable to be affected. Most cases happen

in spring and winter seasons.

Aetiology and pathogenesis

!easonal pathogens" attack body through mouth and nose. ;ith disease process" seasonal

pathogens and dampness accumulation in lung and spleen" affect muscle and skin"occurring papulae eruption" herpes and scab on the skin and mucosa.

Diagnosis

+t beginning" there is fever" running nose" or cough" poor appetite. 7ne or two days later"start to have papulae eruption" and then herpes" with itching" final form scab and drop off

without scar.

Dierentiation and treatmentMain treatment principle is clearing away heat and to%in" and eliminating dampness.(ont use warm nature herbs

1. mild case due to !ind heat

anifestation:mild fever" running nose" and cough" snee&e" after one or two days"occurring papulae eruption" herpes" and scab" which scattered on face and trunk. Derpes

with clear and bright li'uid. Thin white tongue coating" superficial and rapid pulse.

#reatment &rinci&le: dis&el !ind and clear a!ay heat to


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=0. ?u !hen" Mang Oiao G grams for each" 1u Ping =/ grams" cooking for wash" twice a

day. 1or chickenpo% with itching.

@0. #ing (ai !an" mi%ed with sesame oil" put on the affected skin.0 Oi 8ei !an" Ling Pen !an" hu Duang !an" choose one product" for month ulcer.

@. patent herb product

an 0an ;eng e

pediatric class hand out 2008

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