Table Of ContentDr. Zhong’s
PEDIATRIC
ESSENTIALS
A Clinical Guide for Treating Children in the Traditional Chinese
Medicine Clinic
Dr. Zhong Bai Song PhD, LAc
Edited by Michael Johnston L.Ac., M.S.O.M.
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DR. ZHONG’S PEDIATRIC ESSENTIALS
A CLINICAL GUIDE FOR TREATING CHILDREN IN THE
TRADITIONAL CHINESE MEDICINE CLINIC
Copyright © 2016 Dr. Zhong Bai Song Ph.D, L.A.c.
All rights reserved. No part of this book may be used or reproduced by any
means, graphic, electronic, or mechanical, including photocopying,
recording, taping or by any information storage retrieval system without
the written permission of the author except in the case of brief quotations
embodied in critical articles and reviews.
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iUniverse rev. date: 06/22/2016
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CONTENTS
A Brief History of Pediatrics of TCM
Characteristics of Pediatric Physiology and Pathology
Development, Growth and Care
Characteristics in the Pediatric Clinic
Diseases of the newborn infant
Diseases of the Respiratory System
Diseases and Syndromes of the Spleen and Stomach
Diseases and Syndromes of the Heart and Liver
Diseases and Syndromes of Kidney
Infectious Diseases
Parasitosis
Other Disorders
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PREFACE
After learning, practicing, researching and teaching TCM pediatrics for
more than 30 years I decided to publish this book based on my experience.
I obtained my Bachelor of medicine in Luzhou Medical College, and
Master’s degree after studying with one of China’s most famous TCM
pediatricians, Professor Xiao Zhengan. Then I obtained my Ph.D. studying
with one of the most prominent physicians of integrative pediatric and
internal medicine in Sichuan Province, Dr. Wu Kangheng. I have read
most of the TCM classics in Chinese and current TCM pediatrics works in
English. I feel there are not many works that broadly and deeply introduce
TCM pediatrics in theory and practice. This is why I have spent the last
seven years writing this book. In this book, we will do our best to
introduce TCM pediatrics integrating the following:
(1) Classical theory and clinical experience of TCM pediatrics.
(2) Theory of the classics, current TCM and Western medical science.
(3) Classic diseases as well as modern diseases that have occurred in recent
years. Emphasis was put on the classic diseases, but we will explore
modern diseases and how they pertain to TCM pediatric theory.
(4) Treatment and prevention of disease.
(5) Treatments using medication and non-drug therapies. Classical TCM
therapy is introduced, while traditional non-drug therapies, such as
acupuncture, Tuina, topical therapy and the author’s experience also are
introduced.
I sincerely thank those who made significant contributions to this book
without your help and dedication this project would not have been
possible. Many thanks to Marie Fruchenicht L.Ac, Sameul Leong L.Ac.,
Gregory Sparkman L.Ac., Dr. Benjamin Hsu, Jianyi Hou, Lily Yang and
Stella M. Stoufer.
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A Brief History of Pediatrics of TCM
TCM pediatrics is a clinical science that researches the growth,
development, nursing, conservation, prevention and therapy of children’s
diseases within the context of Traditional Chinese medicine. It has a rich
history, medical books and records reliably document the early
identification of diseases and their therapies.
Bian Que was the first pediatrician in Chinese history. Historical records
dating (104-91 BCE) state that “The medical techniques of Bian
Que were legendary. He went to Xian Yang where people love children,
and became a pediatrician.”
The earliest children’s medical records were written by Chun Yu Yin
based on his clinical experience. There were records about pediatrics in
many other medical books as well. The Huang Di Nei Jing Su Wen
(Yellow Emperor’s Canon on Internal Medicine and the Plain Questions)
on vacuity and repletion states: “The Yellow Emperor asked Qi Bo when
one has just given birth to a baby and contracts fever with a very tiny
pulse, what does it imply?” Qi Bo replied “the patient may survive when
his feet are warm, and will die when his feet are cold.” The Yellow
Emperor asked “if a baby is attacked by wind-heat with the symptom of
making sounds during respiration, opening his mouth and lifting his
shoulders to breathe, what will happen to him?” Qi Bo said “when his
pulse is floating and slow, he may survive; if his pulse is rapid, he will
die.” The Su Wen on extraordinary diseases states: “Some people have
epilepsy since they were born, what is this disease and how does it come
about?” Qi Bo said “it is called infantile epilepsy, it happens because the
mother became severely frightened while the baby was still in her womb,
her Qi reversed upwards and failed to come down, and the assembling of
the fright caused the baby to have epilepsy when he was born.” In a
section of the Ling Shu (The Spiritual Pivot) titled Determine the Disease
by Taking Pulse states: “When an infant has a disease with his hair
standing upward, he will die. If he has a green vein bulging around his ear,
it shows he has spasm pain.” The Ling Shu on the progress of overweight
and slim physiques states “The muscles of an infant are soft, he has little
blood and his Qi is weaker”. All of these books have information related to
the physiology and pulse of children. In 1972 volumes of silk scrolls were
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discovered at an archeological site in Ma Wang Dui in Hunan province.
This tomb was originally sealed in 168 BCE. Among the many documents
found there, were nineteen volumes of formulas for women and children in
the Han Shu Yi Wen Zhi (The Treatise on Literature) in 32-92 BCE. These
records included information on kids suffering from seizures and
convulsions. All of the above, and more, are considered to be the writings
that formed the beginnings of TCM pediatrics. With the developments in
society and TCM, during the Jin, Sui, and Tang dynasties (3rd -10th
Centuries) TCM pediatrics followed a certain protocol. The children’s
diseases were put into categories, and there were more than 100 formulas
created for children. There were abundant theories on pediatric health,
which were more applicable. There are six volumes of pediatrics in the
Zhu Bing Yuan Huo Lun (General Treatise on the Causes and symptoms of
diseases) by Chao Yuan-fang in 610B.C. and this discussed 255
syndromes of children. It also talked about children’s nursing and the
etiology of diseases in detail. There are nine chapters about pediatric
diseases and 325 formulas in the Bie Ji Qian Jin Yao Fang (Thousand
Ducat Formulas) by Sun Si Miao in 652 CE. Dr. Wang Tao in his book,
Wai Tai Mi Yao (Secret and Importance of Medicine) in 752 CE puts the
children’s syndromes into 86 categories and records 400 formulas for
pediatrics.
At the end of the Tang dynasty, the earliest known book on TCM
pediatrics was written, Lu Xin Jing (Classic of Fontanel). This book first
characterized a child’s constitution as pure yang. This book also discusses
methods of pulse taking and therapies to treat convulsions, epilepsy,
malnutrition and dysentery. The Medical Education Bureau was created by
the national government during the Tang dynasty, 618-907. There were
five departments, internal medicine, surgery, pediatrics, ENT and Tuina.
After the students completed medical school and passed their exams they
interned with medical doctors for five years. At that point they would
choose a specialty such as pediatrics. These were the pioneers of
pediatrics.
The Formation of TCM Pediatrics
With the development of scientific techniques during the Song dynasty
(960~1279), there were many experts and specialized subjects regarding
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pediatrics, which became the foundation of TCM pediatrics. In the Song
dynasty, there were many works that discussed the characteristics of
pediatrics, such as the features of physiology, pathology, diagnosis and
treatment.
The main developments include the following:
The diagnostic methods of Pediatrics Zang Fu differentiation were
established.
The diagnostic methods unique to Pediatrics were developed. Observations of
the face and index vein were covered.
The therapies in pediatrics were rich and colorful. Xiao Er Yue Zheng Zhi
Jue (The Keys to Differentiation and Treatment of Children’s Diseases)
comprehensively points out the theories of TCM pediatrics.
Dr. Qian Yi (1032~1113) made the following contributions to TCM
pediatrics:
Dr. Qian summarized the children’s physiological features of the Zang and
Fu organs as fragile, immature and imperfect, and their pathological features
as Yi Xu Yi Shi (being subject to vacuity and repletion) and Yi Han Yi Re
(being subject to cold and heat).
He focused on inspection within the four diagnostics of TCM, especially on
the signs of complexion and eyes.
He founded the pediatric differentiation principles of the Zang Fu, and
created formulas such as Xie Bai San (Purge the White Powder), Xie Huang
San (Purge the Yellow Powder), Dao Chi San (Guide the Red Powder), Xie
Qing Wan (Purge the Green Powder) and Liu Wei Di Huang Wan (Six-
ingredient pill with rehmannia) these formulas remain clinically effective
today.
He discussed measles, smallpox, convulsions and malnutrition. These were
considered the four difficult diseases in ancient China. He also distinguished
among measles, smallpox and chickenpox.
He advocated treating acute and chronic convulsions differently. He
suggested that acute convulsions should be treated by cooling and purging,
and chronic convulsions by warming and supplementing.
He summarized all malnutrition diseases as disorders of the spleen and
stomach, due to yin, blood and body fluid damage. Dr. Qian Yi and his
work became the foundation of TCM pediatrics. Measles and smallpox
spread widely in the Song dynasty. There was academic debate about how
to treat them with either warming or cooling therapies. The earliest
monograph for smallpox and measles were written by Dr. Dong Ji in his
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work Xiao Er Ban Zhen Bei Ji Fang Lun (Pediatric Macula and Rashes for
Emergency) in 1093. In this book he wrote that it is good to treat warm
disorders related to the macula and rashes with cold and cool herbs, such
as Bai Hu Tang (White Tiger Decoction), he warned against the use of
warming and supplementing herbs for these kinds of issues. Later on, Dr.
Cheng Wen Zhong, in 1251, boldly used the warm and replenishing herbs
for warm disorders related to macula and rashes. He found that Fu Zi
(radix aconiti carmichaeli) and Rou Gui (cinnamon bark) were useful for
these disorders when they were due to yang exhaustion. There were many
more developments in other pediatric works about pediatrics’ unique
diagnostic qualities, inspection of the index vein, surgery, therapy, and
preventive medicine all related to children. For example, in the book You
You Xin Shu (New Pediatrics), in 1330 the unique diagnostic method of
inspecting the index vein was founded. In the Xiao Er Wei Sheng Zhong
Wei Fan Lun (General Hygiene of Pediatrics) in 1156, eleven shapes of the
index vein were recorded. It discussed many hereditary malformations,
such as cleft palate, syndactyly, polydactyly, renal agenesis, and dwarfism.
His book introduced some surgical operations for cleft palate, syndactyly,
polydactyly and abnormal fingers. This book also recognized that newborn
tetanus is the same disease as adult tetanus, and that this was due to
incorrect cutting of the umbilical cord with a cold knife. He recommended
using moxa to burn the umbilical cord of a newborn in order to prevent
tetanus, and putting herbs on the umbilicus. This is an effective way to
prevent tetanus in newborns and he created topical therapies to help
children.
Development of TCM Pediatrics
TCM pediatrics became more refined during the Jin (1115~1234), Yuan
(1271~1368), Ming (1368~1644) and Qing (1636~1912) dynasties. Dr.
Wan Quan put forward the school of children’s tendency to vacuity of the
lungs, spleen and kidneys, and surplus of the heart and liver in his three
works, Yu Ying Jia Mi (Family Secret for Children’s Conservation), 1541,
Pian Yu Xin Shu (Piece of Experience of Pediatrics) 1578, and You Ke Fa
Hui (Education of Pediatrics) 1579. These help to explain the
characteristics of pediatric pathology and diagnosis. Dr. Wu Tang in his
work Wen Bing Tiao Bian Jie Er Nan (Difficulties in Pediatrics of
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