Understanding paediatric conditions
“fa bing rong yi, chuan bian xun su.” (Children easily become ill, and their illnesses quickly become serious.)
“zang fu qing ling, yi qu kang fu.” ([Children’s] yin and yang organs are clear and spirited. They easily and quickly regain their health.) (1 p4-5)
Children are energetically dynamic beings. While this means illnesses may take hold and flourish quickly, it thankfully also means that they can recover quickly and typically require far less intervention (including quantities of herbal aides) than adults.
How do conditions affecting children work in TCM?
As with adults, TCM treats the child as a whole, taking into account the state of their bodies, minds, spirits and lifestyle. We view their digestive, respiratory, immune and nervous systems as immature and prone to disruption. In particular, the digestive system, of which so much is asked in childhood in terms of metabolism and growth, is seen as pivotal to a child’s wellbeing. A disturbance in this area, known as the spleen/ stomach system in TCM, can and often does have a knock-on effect to all other systems. This impacts both physical and psychological processes and is found at the root of most paediatric maladies, from eczema to asthma, recurrent colds to behavioural challenges.
In particular, digestive issues impact the respiratory system in young children. This occurs in several ways. The spleen and stomach are responsible for extracting qi from the food we eat and this provides energy to the Lung system. If this process is weakened, the lungs will be, likewise. Secondly, our immunity (wei qi) is built upon energy derived from digestion and the air we breathe. Where wei qi is insufficient, the child will be prone to catching colds and these, in turn, further weaken the lungs. Finally, and perhaps most importantly, the spleen and stomach are responsible for transforming and transporting food and fluids. When this is impacted, turbidity and fluids accumulate and lead to the formation of ‘dampness’ and phlegm. In TCM we say that “the spleen is the source of phlegm and the lungs are the storehouse of phlegm”. As such, we see a direct link between typical childhood conditions such as frequent loose stools and chronic coughs or stuffy noses. We also believe that the lungs express themselves through the skin. Not only does this explain why children with skin conditions so often have concurrent digestive complaints, but also the known connection between paediatric asthma and eczema.
Needless to say, TCM views a suitable diet and sound eating habits as central to the treatment and prevention of many childhood complaints and imperative for fostering well-being and long-term health in our little ones.
Understanding the root
Some of the more common TCM paediatric patterns include:
Spleen qi deficiency
This is the primary chronic paediatric pattern that we see in western clinics and the root of many conditions in childhood. It often presents with chronic diarrhea (especially after eating) or constipation (qi cannot move the stools), lethargy, fussy eating, poor appetite, a pale face, poor muscle tone, a pale tongue and a weak pulse. It stems from one or a combination of: weak constitution, prolonged accumulation disorder (see below), recurrent illness, frequent use of antibiotics, insufficient rest, overstimulation (including TV), poor diet or overeating.
If spleen qi deficiency leads to dampness, as it so often will, there will also be a chronic runny nose. If spleen qi deficiency is combined with or has led to lung qi deficiency, immunity (wei qi) will be low and there will be frequent colds. Unfortunately, these further deplete the child leading to greater qi deficiency and, therefore, lower immunity and so on. Lung and spleen weakness is also the basis for many allergies, skin conditions and asthma.
This disorder manifests in very red cheeks, a tinge of green around the mouth, a bloated belly, poor appetite, abdominal pain that is worse for pressure and eating and better after having a bowel movement, foul-smelling stools, irregular bowel movements (eg. days of constipation, followed by days of loose stools), restlessness, bad breath, vomiting of undigested food, irritability and a stuffy nose. It may also be involved in cases of intestinal parasites. Here, food stagnation – typically from overeating, the overconsumption of hard to digest foods or eating when overexcited – has led to qi stagnation resulting in distension, pain and uneven emotions. The internal blockage generates heat and this is reflected in the ruddy cheeks and explosive nature. This is an incredibly common pattern in young children and because of the interconnection of the digestive and respiratory systems, may also be at the root of some cough and asthma cases.
These are also frequently seen in small children, occurring when infectious diseases are not adequately resolved and the child is left with a condition of chronic phlegm in their system resulting in persistent phlegm, tiredness, character changes, swollen glands and mild symptoms from the original disease (eg sore throat, earache) that become more pronounced when the child is tired.
“The lingering pathogenic factor can be likened to rocks on the sea bed. When the tide of energy is low, the rocks appear.” (1 p47)
This pattern typically results where the child has been unable to adequately rest until they are fully recovered and may also happen after the use of antibiotics (which clear heat but not dampness/ phlegm and may weaken the digestive system, thus generating more damp and phlegm). If left untreated, the pathogen may extend throughout the individual’s life and in to old age. Common recurrent conditions that may be attributed to a lingering pathogenic factor include chronic tonsillitis, ear infections, urinary tract infections and cough (1,2,3).
Other factors in common childhood diseases
- Constitutional weakness (kidney deficiency, in TCM) can lead to slow physical and mental development, timidity and conditions such as early-onset asthma and early-onset vision problems (4).
- Invasion of external pathogenic factors (colds, flues, infectious diseases): wind, cold, dryness, heat, summer heat, dampness
- Lack of exercise
- Emotional factors including an emotionally-strained home environment
Signs and symptoms
Some common conditions seen in young children:
- Swollen glands
Because of their stature and dynamic natures, children respond well to very small doses of Chinese herbal medicines. These are typically given in formulas rather than as individual herbs and in decoction form where formulas are composed and modified to meet the needs of the child and its individual constitution. The dosage for children must be lowered and this may be done by either using the same amount of water to cook the herbs and smaller amounts of each herb or by using the standard adult doses and cooking the decoction as usual but administering very small quantities of the tea via a dropper (2). Michael Tierra of East West School of Planetary Herbology offers an array of techniques for making herbs more palatable for children in his article, It Doesn’t Have to Taste Bad!: Administering Herbal Medicines to Children. It is not advised that parents prescribe TCM herbs or formulas for their children. Always seek out a qualified TCM practitioner.
Some common TCM herbs and formulas used in the treatment of children:
Herbs that benefit the digestive system
shan zha (hawthorn fruit) is the primary TCM herb for dispersing food stagnation. It guides out the food accumulation to relieve bloating, pain and gas and can stimulate the appetite.
chen pi (citrus peel) regulates qi flow, dries damp and cuts phlegm to ‘rectify the centre’ (digestion) alleviating abdominal distension, belching, bloating, hiccups, nausea, vomiting, poor appetite and diarrhea. It is also used for cough with copious sputum.
fu ling (poria) is a leading herb for draining dampness and found in most formulas for this purpose. It treats diarrhea from excess or deficiency, promotes urination, strengthens the spleen, harmonises the stomach, transforms phlegm and calms the shen (mind/ spirit).
ban xia (pinellia) is likewise indispensible in many TCM formulas for children, but in particular for those treating phlegm.This may be phlegm gumming up the digestion and leading to nausea and vomiting or for cough with copious sputum. Ban xia must always be prepared to remove its toxicity.
gan jiang (dried ginger) warms the digestion in cases of cold and deficiency leading to abdominal pain, diarrhea or vomiting, stimulates appetite, transforms phlegm and also prevents overcooling from other herbs and is a common addition to many formulas.
xiao hui xiang (fennel) also warms the interior and harmonises the digestion but is very good in cases of pain from cold. May also be dry-fried then wrapped in cloth and applied as a compress to the abdomen for cases of pain and cold sensations (5).
bao he wan (Preserve Harmony Pill) is an eight-herb formula including shan zha, chen pi, fu ling and ban xia and a very popular formulation for accumulation disorder, abdominal distension, pain that is better after a bowel movement, belching, nausea, vomiting and poor appetite due to food stagnation.
qi wei bai zhu san (Seven Flavours Atractylodes Powder) is an expansion of another popular paediatric formula – the classic qi tonic formulation, si jun zi tang (Four Gentleman Decoction),made up of ren shen (ginseng), bai zhu (atractylodes),fu lingand gan cao (licorice). This variation includes the additions ge gen (pueraria), mu xiang (saussurea) and huo xiang (patchouli). Ge gen reinforces the action of stopping diarrhea, mu xiang alleviates abdominal pain and strengthens the spleen and huo xiang transforms dampness, relieving damp obstruction of the middle perpetuating digestive deficiency. Usedfor spleen qi deficiency causing chronic diarrhea, vomiting, loose stools, undigested food in stools, fatigue, weakness, poor appetite, cold limbs and a pale tongue.
Herbs that benefit the respiratory system
jin yin hua (honeysuckle) clears wind and heat from early warm febrile disease, treats red and sore eyes and throats and along with several other heat-clearing herbs such as lian qiao (forsythia) was found to kill the streptococcus bacteria of strep throat in laboratory tests (2). These are the leading herbs in the classic formula yin qiao san (Honeysuckle and Forsythia powder), the go-to formula for the early stages of ‘hot’ colds and flues where fever and sore throat are the predominant symptoms.
For wind-heat common colds with fever where cough predominates, sang ju yin (Mulberry leaf and Chrysanthemum decoction) is prescribed to clear heat, open the lungs and stop cough.
bo he (mint) and ju hua (chrysanthemum flower) are two more common, though milder, cooling herbs for releasing exterior wind-heat and are found in many cold and flu formulas including yin qiao san (bo he) and sang ju yin (both). A poultice of steeped and pressed ju hua may be placed on the eyes to benefit irritation and inflammation from conjunctivitis and bo he tea is a great, palatable home remedy at the onset mild ‘hot’ colds.
xing ren (apricot seed), also found in sang ju yin, is a leading herb for stopping cough and wheezing from either hot or cold conditions and especially dry coughs and is also excellent for constipation. This herb is slightly toxic and must be prepared appropriately to remove toxicity.
xin yi hua (magnolia flower) is pungent and warm, releases the exterior, unblocks nasal passages and is used to treat sinusitis, nasal discharge and sinus headaches.
yu ping feng san (Jade Windscreen Powder)is a powerful formula for building immunity and often used as a preventative treatment for colds and flues, allergies and allergic asthma.
Herbs that benefit the nervous system
suan zao ren (jujube seeds) is a popular sedative herb that alleviates irritability, insomnia and anxiety. The tonic properties of suan zao ren lend it to safe use in children but as it can moisten the bowels it will often be dry-fried (chao suan zao ren) to protect against this action and should never be used if there are loose stools. It is the primary herb in the classic formula, suan zao ren tang (Sour Jujube Decoction), used widely in TCM to calm and treat insomnia.
yuan zhi (polygala) ‘quiets the spirit’ by nourishing the heart and clearing phlegm that is disturbing the mind. It can also help to stop cough with copious sputum.
he huan hua (Persian silk tree flower) is also used to calm the spirit, especially in cases of qi stagnation where stomach qi has been affected causing poor appetite.
gou teng (gambir), tian ma (gastrodia) are often used together to counter-agitation and tension by subduing ‘internal wind’ and curbing ascendant energy (common in young children) to anchor and ground a child’s spirit.
Avoid excess cold, raw greasy, fatty, sweet (including juices), bananas, soy, wheat and dairy foods, bananas, particularly in cases of loose stools and or a runny nose.
Opt for warm, easily digested foods, especially in cases of spleen qi deficiency where a clear, bland diet is encouraged and culinary herbs such as fennel (xiao hui xiang), cardamon (sha ren), ginger (gan jiang) and cinnamon (gui zhi) may be added to food. (2)
Gentle circular abdominal massage clockwise, following the direction of the large intestine, is beneficial for stagnation (food stagnation and constipation) and anti-clockwise benefits diarrhea.
In cases of fever, massage repeatedly, but gently, down the centre of the spine.
Acupressure, applying pressure to acupuncture points in place of needles, can be a very effective form of therapy for young children.
Japanese shonishin acupuncture uses a variety of tools apart from needles and very gentle techniques to stimulate acupuncture points and is particularly suitable to young children who respond well to minimal intervention.
Laser acupuncture is another gentle, non-invasive alternative to traditional acupuncture that is widely used for young children.
Other acupuncture practices for young children, of which there are many, include moxibustion over the navel, sometimes over a slice of ginger, to move stagnation and warm the digestion and gua sha (spooning/ rubbing) along the shoulders and back of the neck to reduce fever.
- Barlow T, Scott J. Acupuncture in the Treatment of Children. 3rd ed. Seattle/ Hove: Eastland Press Inc./ Chinese Medicine Publications; 1999.
- Flaws B. Keeping Your Child Healthy with Chinese Medicine. Boulder: Blue Poppy Press; 1996.
- Scott J. Natrural Medicine for Children. London: Gaia Books; 1990.
- Maciocia G. Diagnosis in Chinese Medicine: a Comprehensive Guide. Edinburgh: Elsevier Limited; 2004.
- Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. 2nd ed. Washington: Eastland Press; 1993.