Five intellectual and five physical development disability Wu Chi Wu Ruan

“Five retardations” refers to delays in standing, walking, hair growth, tooth eruption and speech faculties.

“Five kinds of flaccidity” refers to flaccidity of head and neck, mouth, hand, foot, and muscles.

This disease mostly occurs in children under 3 years old, especially in those from 6 months to 1 year of age.

Modern medicine usually diagnosis Infantile cerebral palsy (CP) which refers to syndromes associated with non-progressive brain damage as well as developmental defects present in the prenatal and infant periods; the main clinical manifestations include motor dysfunction and postural disorders.

Classification of Patterns and Treatment

Liver-Kidney Depletion

Signs and Symptoms

Slow development in sitting, standing and walking significantly behind normal children of the same age; there may be inability to walk at 4 or 5 years old or with abnormal hair and teeth development. They may present with weakness and asthenia of the neck and drooping head, sluggish responses, large fontanelle, easily fatigued, weak limbs, restless sleep,  a thin body build.

The tongue is pale with less coating, the pulse is deep thready and powerless, and the finger venules are light.

Treatment Principles

Supplement the kidney and boost marrow, nourish the liver and strengthen tendons

Acupuncture

GB 34 (yáng líng quán) KD 3, LV3

SP 6 (san yin jiao) ST 36 (zú sān lĭ)

Apply moxibustion on both ankles

Heart and Spleen Deficiency

Signs and Symptoms

Patients with this pattern present with speech retardation, mental sluggishness and retardation, often accompanied by difficulties in standing and walking, delayed hair growth, limb weakness, flaccid muscles, fatigue and weakness, drooling saliva, weak suckling and chewing, poor appetite and constipation.

The tongue is enlarged and pale with a thin coating. The pulse is thready, weak, the finger venules are pale.

Treatment Principles

Fortify the spleen and nourish the heart, replenish qi and blood.

Acupuncture

GB 34 (yáng líng quán) KD 3

SP 9 (yīn líng quán) ST 36 (zú sān lĭ)

Apply moxibustion on both ankles

Phlegm –Stasis Blockage

Signs and Symptoms

Patients with this pattern present with deafness and aphasia, sluggish responses, unconsciousness, involuntary movements, drooling, gurgling in the throat, stiff joints, muscle weakness, or seizures.

The tongue is enlarged with ecchymosis and greasy coating.

The pulse is deep, choppy or slippery, and the finger venules are dark with stasis.

Treatment Principles

Clear up phlegm and open the orifices, invigorate blood and unblock the collaterals.

Acupuncture

SP 10 

BL17

ST40

SP 9 (yīn líng quán)

ST 36 (zú sān lĭ)

For drooping wrist, add SJ 5 (wài guān) and SJ 4 (yáng chí).

Prevention and Nursing Care

(1)Couples with a history of family genetic disease are advised to have DNA tests to monitor the health of the fetus.

(2)Pregnant mothers are advised to avoid extreme emotional disturbance, have a rich nutritional intake.

(3) Cerebral palsy is a deficiency pattern disease, so dietary regulation is essential. Food should be both nutritious and easily digestible.

(4) Massage with squeezing and rubbing methods on flaccid limbs to prevent muscle atrophy.

Infantile Edema   Xiao er shui zhong /Pediatric Edema

Edema is caused by extra fluid trapped within the body’s tissues, leading to swelling.

When there is excess fluid trapped within tissues of the body, edema – or swelling – can result. This condition can affect any part of a child’s body, but it most commonly occurs in the hands, arms, feet, ankles and legs.

In Modern medicine is usually belong to Nephrotic syndrome (NS) .

Nephrotic syndrome (NS) is a condition produced by gross protein loss in the urine leading to hypoproteinemia and often hyperlipidemia, also resulting in edema.

NS can be caused by various disorders generally involving a glomerular cause, in which there is increased glomerular basement membrane capillary permeability to albumin which allows for large amounts of protein to be excreted through the urine. The clinical characteristics are massive proteinuria, hypoalbuminemia, hyperlipidemia, and evident edema.

Classification of Patterns and Treatments

1. Root Patterns

Lung-Spleen Qi Deficiency

Signs and Symptoms

Manifestations include generalized edema especially of the face and eyelids, scanty urine,

pale complexion, shortness of breath, fatigue, poor appetite, loose stools, spontaneous sweating, susceptibility to common colds, or dyspnea, wheezing and cough. The tongue is pale and enlarged; the pulse is deficient and weak.

Treatment Principles

Boost qi and fortify the spleen, diffuse the lung and promote urination

Acupuncture:

SP3, SP9,BL13, BL20

Spleen Deficiency with Damp Encumbrance

Signs and Symptoms

Manifestations include generalized edema especially in the limbs and trunk, a sallow yellow complexion, fatigue, lack of strength, poor appetite, loose stools, and scanty urine; there may also be abdominal distention, chest stuffiness and cold limbs.

The tongue is pale and enlarged with a thin and white coating; the pulse is deep and wiry.

Treatment Principles

Fortify the spleen and drain dampness

Acupuncture:

 SP3, SP9,Ren9, ST4

Spleen-Kidney Yang Deficiency

Signs and Symptoms

Manifestations include obvious general pitting edema especially at the waist, abdomen and lower limbs, a pale dull complexion, aversion to cold and cold extremities, fatigue, preference to lie down, scanty and difficult urination, possibly associated with hydrothorax, ascites,

poor appetite, loose stools, nausea, and vomiting. The tongue is pale and enlarged or tooth-marked with a white slippery coating; the pulse is deep thready and forceless.

Treatment Principles

Warm the kidney and fortify the spleen, transform qi and drain water.

Acupuncture:

SP9,DU4, BL20, KD3

Liver-Kidney Yin Deficiency

Signs and Symptoms

Manifestations include fluctuating mild or severe edema, headache, dizziness, restlessness, dry mouth and throat, a hot feeling in the palms and soles, flushed complexion, dry eyes or blurred vision,  insomnia, and profuse sweating.

The tongue is red tongue with little coating; the pulse is rapid, wiry and thready.

Treatment Principles

Nourish yin and supplement the kidney, pacify the liver and subdue yang, and drain water

Acupuncture:

KD6, LV3, SP6, BL60

2. Branch Patterns

External Contraction of Wind

Signs and Symptoms

Manifestations include fever, aversion to wind with or without sweating, head and body pain, nasal discharge, and cough, or with wheezing, shortness of breath, or sore throat and swollen painful tonsils.

The tongue has a thin coating; the pulse is floating.

Treatment Principles

Diffuse the lung and dispel wind, and drain water

Acupuncture:

LI4, LU7,DU4, GB20

Water-Dampness

Signs and Symptoms

Manifestations include extensive generalized edema (anasarca) with the skin stretched and shiny over the swollen area in some cases. Other signs may include abdominal distention, ascites, water accumulation in the intestines with borborygmus; there may be chest stuffiness, shortness of breath, epigastric stuffiness and fullness, or with asthmatic coughing and scanty urination.

The pulse is deep.

Treatment Principles

Supplement qi, fortify the spleen, expel water and relieve swelling.

In general, treatment focuses on the main signs and symptoms.

Acupuncture:

GB20, LI4, Ren9, LU7

Damp-Heat

Signs and Symptoms

Manifestations include furuncles, boils on the skin; or a sticky sensation and bitter taste in the mouth, thirst with no desire to drink, epigastric stuffiness, and poor appetite; or frequent scanty urination with a sensation of incompletion or burning heat or stabbing pain and dark turbid urine with down bearing-distention and lower abdominal discomfort.

The tongue is red with a yellow greasy coating; there is a rapid and slippery pulse.

Treatment Principles

Clear heat and drain dampness.

Acupuncture:

LI11, SP9, Ren9, Ren3

Prevention and Nursing Care

1.Keep the skin, external genital organs, or urethra orifice clean to prevent infections in the skin and urinary tract.

1.Convulsions     jing feng

Infantile convulsions are a common, acute and serious disorder clinically marked by seizures and unconsciousness that may occur as a result of many pediatric conditions, with a high incidence among infants and young children aged one to 5 years old.

In Western medicine, convulsive/seizure disorders are common emergency conditions in pediatric clinical practice occurring often during many primary diseases, and there are many possible causes involved, often complex.

Acute Infantile Convulsions

Acute infantile convulsions with sudden onset are more common in externally contracted febrile diseases, and they are characterized by the four patterns of heat, phlegm, fright and wind.

They often present with high fever, convulsive seizures and unconsciousness as the main clinical symptoms, and are often caused by invasion of seasonal pathogens, accumulation of damp-heat internally and sudden attack of fright and

nervousness.

Classifications of Patterns and Treatments

Wind-Heat Generating Wind

Signs and Symptoms

Manifestations include acute onset, fever, headache, nasal congestion, runny nose, cough, and sore throat, followed by loss of consciousness and convulsions.

The tongue has a thin and white coating or thin and yellow coating; the pulses are floating and rapid.

Acupuncture

DU 26 (rén zhōng) LI 4 (hé gŭ) LV 3 (tài chōng)

DU 14 (dà zhuī) EX-UE 11 (shí xuān)

Needle all points with drainage, retain the needles for 5-15 minutes or do not retain the needle.

Treat once or twice daily, with 3 times as one treatment course.

Both Qi and Ying Heat

Signs and Symptoms

This pattern is more common in midsummer manifesting with acute onset, high fever with profuse sweating, headache, neck rigidity, nausea, vomiting, convulsions, thirst and constipation. The tongue is red with a yellow coating and the pulse is wiry and rapid.

For children with a severe condition, there is persistent high fever, repeated convulsions and mental confusion.

The tongue is red with a yellow and greasy coating and the pulse is slippery and rapid.

Treatment Principles

Clear heat, extinguish wind and open the

orifices

Acupuncture

DU 26 (rén zhōng) LI 4 (hé gŭ)

PC 6 (nèi guān) LV 3 (tài chōng)

LI 11 (qū chí) SP10

Needle all points with drainage, retain for 20-30 min or do not retain the needles.

Treat once or twice daily, with 3 times as one treatment course.

Pathogens Invading Inward into the Heart and Liver

Signs and Symptoms

There is a sudden onset, persistent high fever, with thirst, delirium, coma, repeated convulsions and eyes staring upward.

The tongue is red with a yellow and greasy coating; the pulse is rapid.

Treatment Principles

Clear heart heat and open the orifices, pacify the liver and extinguish wind

Acupuncture

DU 26 (rén zhōng) LI 4 (hé gŭ)

HT 7 (shén mén) LV 3 (tài chōng)

LI 11 (qū chí)

Needle all points with drainage, retain for 20-30 min or do not retain the needles.

Treat once or twice daily, with 3 times as one treatment course.

Damp-Heat Epidemic Toxin

Signs and Symptoms

Manifestations include a persistent high fever, repeated convulsions, loss of consciousness, delirium, abdominal pain, vomiting, and sticky stools or stools containing pus and blood.

The tongue is red with a yellow greasy coating;

the pulse is slippery and rapid.

Treatment Principles

Clear heat and resolve dampness, resolve toxins and extinguish wind

Acupuncture

DU 26 (rén zhōng) ST 40 (fēng lóng) LI 4 (hé gŭ)

PC 6 (nèi guān) LV 3 (tài chōng)

LI 11 (qū chí)

Needle all points with drainage,  do not retain the needles.

Convulsions due to Fright and Fear

Signs and Symptoms

Manifestations include fright with restlessness after sudden attacks of fright and fear, a trembling body, preferring to be held close, and frightened cries at night or night terrors, possible convulsions, mental confusion.

The pulse is irregular;

the venules are purple and stagnant.

Treatment Principles

Suppress fright and calm the mind, pacify the liver and extinguish wind

Acupuncture

DU 26 (rén zhōng) LI 4 (hé gŭ)

PC 6 (nèi guān) LV 3 (tài chōng)

KD3 (tài xī),

Needle all points with drainage, retain for 20-30 min or do not retain the needles.

Treat once or twice daily, with 3 times as one treatment course.

Chronic Infantile Convulsions

Chronic infantile convulsions have a longer duration and slower oncoming force with less powerful spasms, and intermittent repeated attacks.

They are more difficult to resolve and often accompanied by coma or paralysis.

chronic infantile convulsions generally show a weakening of the spleen-stomach or spleen-kidney yang deficiency which causes spleen deficiency and liver hyperactivity or extreme deficiency producing wind.

Spleen Deficiency and Liver Hyperactivity

Signs and Symptoms

Manifestations include listlessness, sallow yellow complexion, no desire to eat, and loose stools;

occasionally there is borborygmus, cold limbs.

mild twitching and jerking of arms and legs, shaking head and rolling eyes

The tongue is pale with a white coating; the pulse is deep and weak.

Treatment Principles

Warm the middle and fortify the spleen, relax the liver and rectify the spleen.

Acupuncture and Moxibustion

BL 20 (pí shù) BL 21 (wèi shù) RN 12 (zhōng wăn)

RN 6 (qì hăi) ST 36 (zú sān lĭ) LV 3 (tài chōng)

Needle LV 3 (tài chōng) with rotation and drainage, apply supplementation to all others.

Moxibustion

GV 14 (dà zhuī) BL 20 (pí shù) GV 4 (mìng mén)

RN 4 (guān yuán) RN 6 (qì hăi) GV 20 (băi huì)

ST 36 (zú sān lĭ)

Apply once daily, with 5 times as one treatment course.

Spleen-Kidney Yang Decline

Signs and Symptoms

This pattern manifests with sleeping with the eyes half open, a lusterless or gray and dull complexion, cold air from the mouth and nose, cold sweat on the forehead, cold of the four limbs, clear urine, loose stools, and slight tremors of the hands and feet.

The tongue is pale with a thin white coating; the pulse is deep and faint.

Treatment Principles

Warm and supplement the spleen and kidney, restore yang to rescue collapse

Acupuncture and Moxibustion

BL 20 (pí shù) BL 23 (shèn shù) LV 13 (zhāng mén)

RN 4 (guān yuán) EX-HN 3 (yìn táng) SP 6 (sān yīn jiāo)

Needle all points with supplementation.

Moxibustion

DU 14 (dà zhuī) BL 20 (pí shù) DU 4 (mìng mén)

RN 4 (guān yuán) RN 6 (qì hăi) DU 20 (băi huì)

ST 36 (zú sān lĭ)

Wind Stirring due to Yin Deficiency

Signs and Symptoms

Manifestations include a fatigued spirit, a withered face and body, a sallow yellow complexion or hot flashes, and low fever, a hot feeling in palms and soles, frequent sweating, dry hard stools, limb spasms or rigidity, and alternating light to strong seizures.

The tongue is crimson and slightly dry with little or no coating;

there is a thready and rapid pulse.

Treatment Principles

Enrich yin and subdue yang, enrich the kidney and nourish the liver

Acupuncture and Moxibustion

RN 4 (guān yuán) DU 20 (băi huì) BL 18 (gān shù)

BL 23 (shèn shù) LV 8 (qū quán) SP 6 (sān yīn jiāo)

KI 3 (tài xī) LV 3 (tài chōng)

Needle all points with supplementation; add moxibustion after needling.

Treat once daily, with 5 times as one treatment course.

Prevention and Nursing Care

a. If the child has a history of febrile convulsions, immediately give cooling and antipyretic drugs in the early stage of the fever.

b. Have scheduled vaccinations to avoid seasonal pathogens.

c. Pay attention to food hygiene; avoid falls

d. During convulsions, do not restrain forcefully to prevent fractures. Children should lay flat, head lateral with a tongue depressor wrapped with gauze between the upper and lower teeth to prevent them from biting their tongue.

Sweating Han Zheng

Sweating syndrome (hàn zhèng) refers to excessive or profuse sweating generalized or localized to specific parts of the body, It most often occurs in children under 5 years.

In modern medicine, child sweating syndrome usually involves a dysfunction of the autonomic nervous system which may result from many causes.

Classification of Patterns and Treatments

Insecurity of Lung-Wei

Signs and Symptoms

These cases present with predominan spontaneous sweating; sweating of the head, shoulders and back that is worse when active. There is also mental fatigue, lack of strength, lusterless complexion and susceptibility to cold. The tongue is pale with a thin white coating and there is a thready weak pulse.

Treatment Principles

Boost qi and consolidate the exterior

Acupuncture

LI 4 (hé gŭ) KI 7 (fù liū) BL 13 (fèi shù)

DU 14 (dà zhuī) LU 7 (liè quē) ST 36 (zú sān lĭ)

Needle LI 4 (hé gŭ) with drainage and KI 7 (fù liū) with supplementation to check sweating, or use moxibustion. This is the basic formula for treating sweating. Needle every point for 2-3 minutes with 20 minutes retention; once daily, 7 times as on treatment course for 1-2 courses.

Qi and Yin Insufficiency

Signs and Symptoms

Excessive night sweating is the main symptom, often accompanied by spontaneous sweating, emaciation, profuse sweating, irritability, and insomnia; or with low fever, dry mouth, a hot feeling in the palms and soles, crying without strength, and light red lips. The tongue is pale with a peeled or scant coating, there is a rapid thready pulse.

Treatment Principles

Boost qi and nourish yin

Acupuncture

LI 4 (hé gŭ) KI 7 (fù liū) RN 6 (qì hăi)

KI 3 (tài xī) HT 6 (yīn xì) KI 6 (zhào hăi)

ST 36 (zú sān lĭ)

Damp-Heat Steaming the Body

Signs and Symptoms

Spontaneous sweating or night sweating in the head or limbs with hot skin, yellow sweating stains, foul breath, thirst without desire to drink and yellow urine.

The tongue is red with a greasy yellow coating, and there is a slippery rapid pulse.

Treatment Principles

Clear heat and drain damp

 tonify the spleen

Acupuncture

LI 4 (hé gŭ) KI 7 (fù liū) LI 11 (qū chí)

SJ 5 (wài guān) SP 9 (yīn líng quán) BL 40 (wĕi zhōng)

Prevention and Nursing Care

(1) Encourage appropriate outdoor activities and physical exercises to strengthen the child’s physique.

(2) Take extra care after illness to avoid direct exposure to wind.

(3) Pay attention to personal hygiene, change clothes and quilts regularly, keep the skin clean and dry, wipe sweat with soft towels or gauze.

Purpura  Zi dian

Henoch-Schönlein Purpura(HSP)/

Anaphylactoid Purpura

Henoch-Schönlein purpura (HSP) is a condition that involves swelling (inflammation) of small blood vessels. The swollen blood vessels leak into the skin, joints, intestines, and kidneys. HSP is seen most often in children between ages 2 and 6. The disease can happen in siblings of the same family. Most children with HSP recover fully. But some children may have kidney problems.

HSP is an autoimmune disorder. This is when the body’s immune system attacks the body’s own cells and organs. With HSP, this immune response may be caused by an upper respiratory tract infection. Other immune triggers may include an allergic reaction, medicine, injury, or being out in cold weather.

Common symptoms in child:

A rash caused by blood leaking into the skin

Blood leaking into mucous membranes, internal organs, and other tissues Joint pain and swelling (arthritis) Belly (abdominal) pain Bleeding in the digestive tract, which includes the mouth, esophagus, stomach, and intestines, Swollen kidneys, Swelling just below the skin.

 A brain disorder.

Classification of Patterns and Treatment

Wind-Heat Damaging the Collaterals

Signs and Symptoms

acute onset, beginning with a fever, sore throat, followed by bright red purpuric skin lesions of various sizes mainly scattered on the lower limbs and buttocks often with itching. Patients may have swollen painful joints, abdominal pain, bloody stools and hematuria.The tongue is red with a yellow thin coating. The pulse is floating and rapid.

Treatment Principles

Disperse wind and expell pathogens, clear heat

Acupressure:

LI4, GB20 ,DU14, SJ5

15-20 minutes each point once daily,

10 times as one treatment course.

Bleeding due to Blood Heat

Signs and Symptoms

acute onset and skin lesions with densely

distributed ecchymoses, which may even be confluent as bright red petechiae. There may be spitting blood, bloody stools and hematuria. The blood is bright red or purplish-red. The patient may also have symptoms of vexation, thirst, constipation or associated abdominal pain and a fever. The tongue is red and the pulse is rapid and forceful.

Treatment Principles

Clear heat and remove toxin, cool blood and stanch bleeding

Acupressure:

LI4, LI11 ,DU14, SJ5

15-20 minutes each point once daily,

10 times as one treatment course.

Failure of Qi to Contain Blood

Signs and Symptoms

Patients with this pattern have a slow onset and prolonged disease course. They present with recurrent light-colored purpuric spots and petechiae, visual or microscopic hematuria, sallow complexion, mental fatigue, lack of strength, poor appetite, dizziness.

The tongue is pale with a thin coating.

The pulse is thready and forceless.

Treatment Principles

Fortify the spleen, nourish the heart, boost qi, and contain blood

Acupressure:

SP3, ST36 ,Ren6, DU20

Moxibustion

DU4,  Ren8 Apply ginger slice moxibustion with a moxa cone.

15-20 minutes each point once daily,

10 times as one treatment course.

Hyperactive Fire due to Yin Deficiency

Signs and Symptoms

Patients with this pattern have an intermittent onset with dark-purple purpura, or the purpura disappears but microscopic hematuria is visible, low fever, night sweating,vexation, poor sleep, dry stools and yellow-red urine.

The tongue is glossy-red with a scanty coating. The pulse is thready and rapid.

Treatment Principles

Nourish yin and reduce fire, cool blood and stanch bleeding

Acupressure:

DU14, LI11 ,SP10, SP6

15-20 minutes each point once daily,

10 times as one treatment course.

Prevention and Nursing Care

a. The child needs to exercise regularly to strengthen the constitution and avoiding catching colds to prevent upper respiratory tract infections.

b. Treat chronic infections such as tonsillitis, tooth decay, sinusitis, and parasites.

c. During the acute stage, or with a large amount of bleeding, the patient should have bed rest and restricted daily movement.

2. Rubella   Feng Sha

Rubella (fēng zhĕn) is a contagious and acute eruptive disease caused by the rubella

virus, characterized clinically by mild fever, cough, a generalized sand grain-sized rosy

maculopapular rash and enlargement of the post-auricular and sub-occipital lymph nodes.

Classification of Patterns and Treatments

Pathogens invading lung-wei

Signs and Symptoms

fever, aversion to wind, sneezing, nasal discharge, mild cough, fatigue, poor appetite, and rash appearing on head, face and trunk, then spreading quickly and covering the limbs. The rash is small, sparse, slightly itchy and evenly distributed, and usually fades after two or three days. The post-auricular and sub-occipital lymph nodes are swollen and tender.

The tongue is red with a thin white or yellow coating and there is a floating and rapid pulse.

Treatment Principles:

Scatter wind, release the exterior and clear heat.

Acupuncture:

LI-4 (he gu)

TB-5 (wai guan)

LU-7 (lie que)

GV-14 (da zhui),

 LI-11 (qu chi)

Pathogens attacking qi and ying levels

Signs and Symptoms

This presents as high fever, thirst, vexation and crying, a densely distributed bright

red or dark purple rash which may become confluent or in large scarlet areas; also scanty

yellow urine and constipation.

The tongue is red with a rough yellow coating, and the pulse is surging and rapid.

Treatment Principles

Clear heat from the qi level, cool the ying level and resolve toxins.

Acupuncture:

LI-11 (qu chi)

LI-4 (he gu)

GV-14 (da zhui)

SP-10 (xue hai)

Prevention Nursing Care

(1) Susceptible children should avoid exposure to the public during the rubella epidemic season.

(2) Preventive inoculations of the rubella vaccine is recommended.

(3) Pregnant women should avoid exposure to rubella especially within the first three months of pregnancy, but also during the entire gestational period.

(4) Sick children should have enough rest, keep warm and drink plenty of water.

3. Scarlatina Dan Sha

Scarlatina is another acute, infectious disease marked by fever, swelling, sore throat, and a diffuse, bright red skin rash all over the body.

scarlatina is a bacterial infection. It is most common in the winter and spring, and it most commonly affects children between 2-8 years of age.

Scarlatina may develop into rheumatic fever and damage the heart or develop into acute nephritis.

Treatment based on pattern discrimination:

1. Evils assailing & entering the lung defensive

Main symptoms: Fever which goes from low to high, slight aversion to chill, oral thirst, headache, vomiting, cough, a swollen, sore throat, ulcerative tonsillitis, flushed red skin, bright red rash,

a red tongue with thin, white or yellow fur,

a blue-green purplish finger vein,

a floating, rapid pulse

Treatment principles:

Diffuse the lungs and out-thrust the rash clear heat

Acupuncture

Da Zhui (GV 14).

Feng Chi (GB 20).

Lie Que (Lu 7)

He Gu (LI 4)

2. Evil toxins entering the qi level

Main symptoms: High fever which does not resolve, a flushed, red face, oral thirst with a desire to drink, swelling, pain, erosion, and ulceration of the throat, a densely

packed, bright red or purple rash, dry stools, diminished, reddish yellow urination, if severe, spirit clouding and delirious speech,

a dark red or scarlet red tongue with thorns and deep yellow, coarse tongue fur,

a rapid, forceful pulse

Treatment principles:

Clear the heat drain fire

and resolve toxins

Acupuncture

Bleeding Jin Jin (M-HN-20a) and Yu Ye (M-HN-20b). Needle or bleed Da Zhui (GV 14).

Needle Feng Chi (GB 20).

If there is high fever and convulsions or spirit clouding and delirious speech, bleed Shi Xuan (M-UE-1-5).

3. Yin vacuity with lingering heat

Main symptoms: If high fever has gone on for some time, this may consume and exhaust the healthy yin fluids of the body. Therefore, towards the tail end or recuperative

phase of this disease, there may be a gradual diminishing of high fever or a lingering low-grade fever, gradual dispersion of the skin rash, dry skin with scaling and peeling, diminished sore throat, thirst, dry lips, dry cough, constipation,

a red tongue with scanty fluids, and

a fine, rapid pulse.

Treatment principles:

Nourish yin and engender fluids, clear heat and moisten the throat

Acupuncture

Da Zhui (GV 14).

Qu Chi (LI 11)

San Yin Jiao (Sp 6).

Prevention and Nursing Care

1.Control the spread of infection and isolate the patient for 6-7.

2.Cut off the transmission route, the patient's secretions should be strictly disinfected. It is recommended to wear masks, and not in public places during the popular season.

3.During acute fever, one should stay in bed and rest for 3 weeks.

4.Pay attention to protect the skin clean, avoid scratching to prevent infection.

Chicken Pox  Shui Dou

Chickenpox is a common childhood disease characterized by an acute highly infectious rash caused by a seasonal pathogen and clinically marked by the development of a fever followed by an itchy dark red rash which develops into blisters and then scabs, sometimes affecting the mucous membranes.

This condition is commonly referred to as chickenpox or varicella in Western medicine. Chickenpox is an early childhood disease caused by the varicella-zoster virus (V-ZV); a herpes virus transmitted by airborne droplets. The symptoms are mild in most children.  

Classification of Patterns and Treatments

1. Pathogens Attacking Lung-wei

Signs and Symptoms

Manifestations include a slight or absent fever, nasal congestion with discharge, sneezing, coughing, rash appearing 1-2 days after onset, a sparse, itchy, ruddy/red moist, vesicular rash with clear fluid and a flushed surrounding base. The new lesions will erupt one after

another with more eruptions on the trunk.

The tongue tip is red with a thin white coating;

the pulse is floating and rapid.

Treatment Principle

Scatter wind , clear heat, drain dampness and resolve toxins

Acupuncture:

LU7 (lie que), LI-11 (qu chi)

GB-20 (feng chi), BL-12 (feng men).

In weak children it may be beneficial to tonify the qi with ST-36 (zu san li).

2. Pathogens Blazing in Qi and Ying Levels

Signs and Symptoms

Manifestations include strong fever without abatement, irritability or restlessness, thirst with a desire to drink, facial flushing, red eyes, a dark purple densely distributed skin rash, blisters with turbid fluid, and possible hemorrhagic rash and purpura.

There are also dry stools and short voiding of dark yellow urine.

The tongue is red or crimson with a rough dry yellow coating;

the pulse is rapid and powerful.

Treatment Principle

Clear heat from the qi level, cool the ying level, resolve toxins and eliminate dampness

Acupuncture:

LU7 (lie que), LI-4 (he gu)

GB-20 (feng chi), DU-14(da zhi)

ST-40(feng long)

Prevention and Nursing Care

(1) Avoid public places during chickenpox epidemics.

(2) It has been suggested that susceptible pregnant women exposed to the virus should be given varicella-zoster immune globulin (ZIG) as passive immunization.

(3) Control infection sources; children with chickenpox are usually excluded from school.

(4) To reduce the risk of secondary infections, keep the skin clean, frequently change underclothing, and trim the fingernails or use gloves to prevent scratching of the lesions.

Whooping Cough  Dun Ke

whooping cough, also known as Pertussis, is a highly contagious respiratory disease. In Western medicine pertussis is caused by the bacterium Bordetella pertussis.

Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After cough often needs to take deep breaths, which result in a “whooping” sound. Pertussis can affect people of all ages, but only a danger to children under three years of age.

PATTERNS & SYMPTOMS

First Stage (10-20 days)

cough begins with exterior pattern symptoms, but quickly leads to wheezing and coughing with foamy sputum

Tongue coating: thin, white

Pulse: floating, with strength

Treatment principle:

disperse wind, descend lung qi to and transform the phlegm

Acupuncture:

LU7 (lie que), LI-4 (he gu)

GB-20 (feng chi)

In weak children it may be beneficial to tonify the qi with ST-36 (zu san li).

If the back is tender to palpation or the Lungs are weak, add BL-12 (feng men).

Second Stage (40-60 days)

1. Phlegm-cold binds up the Lungs

• much convulsive coughing, followed by characteristic asthma;

• much mucus in the Lungs, sputum is more liquid

• convulsive cough is relieved by vomiting

• clear nasal discharge

Tongue coating: white, greasy

Pulse: floating, tight

Treatment principle:

warm and disperse the Lung qi, stop the cough, and transform the phlegm

Acupuncture:

BL-13 (fei shu) Strengthens the Lungs and directs Lung qi downward

CV-12 (zhong wan) Transforms the phlegm

CV-17 (shan zhong) Transforms the phlegm

Method: moxibustion may be used, especially moxibustion on garlic

2. Phlegm-heat injures the Lungs

• sputum is sticky, thick, difficult to bring up

• sputum may be flecked with blood

• epistaxis/bleeding from nose

• mouth dry, thirst with desire to drink

Tongue coating: yellow, dry

Pulse: slippery, rapid

Acpuncture:

PC-6 (nei guan) and LI-4 (he gu), with LU-7 (lie que), or with LU-9 (tai yuan).

LI-ll (Quchi) to clear the phlegm-heat.

use a triangular needle to withdraw a few drops of blood

Second Stage (40-60 days)

3. Lung and Spleen qi deficiency

• cough and voice weak, without strength

• small amount of watery sputum

• shortness of breath

• pale looking

• very thin

• history of poor appetite

Tongue: pale, wet

 Pulse: weak or soft

Treatment principle:

tonify the Lungs and the Spleen Qi

Acupuncture:

LU9 (tai yuan) ST36(zu san li)

SP6 (san yin jiao) BL13(fei shu)

4. Yin deficiency

• dry cough without strength

• hot soles and palms

• restlessness, wakes up at night

• irritability

• night sweats

• red cheeks

• lips dry

Tongue: thin, yellow coating

Pulse: rapid, forceless

 Finger vein: thin, purple

Third Stage (after 60 days)

1. Lung and Spleen qi deficiency

shortness of breath, voice weak,

cough with small amount of sputum

pale looking

very thin

poor appetite

Tongue: pale, wet

Pulse: weak

Treatment principle:

Tonifies Spleen qi Tonifies Lung qi

Use a tonifying technique with moxibustion:

LU-9 (tai yuan)

LU-5 (chi ze)

ST-36 (zu san li)

BL-13 (fei shu),

2. Yin deficiency

• night sweats

• hot soles and palms

• restlessness, wakes up at night

• irritability

• red cheeks

• lips dry

Tongue: thin, yellow coating

Pulse: rapid, forceless

Finger vein: thin, purple

Treatment principle:

Nourish the yin and moisten the Lungs

Acupuncture:

LU-9 (tai yuan)

BL-43 (gao huang shu)

BL-23 (shen shu)

 KD-3 (tai xi)

Prevention and Nursing Care:

1. Control the source of infection: isolate the child. Especially in the early and convulsive cough period. Those who meet children should be quarantined and observed for 21 days.

2. Regular immunizations

3. Avoid public places during Whooping Cough epidemics.

4. The room should be sunny. Well ventilated, quiet environment, avoid dust, smoke and eating irritation to induce cough.

Mumps Zha Sai

Mumps, also known as Epidemic parotitis,  is an acute infectious disease. In caused by the paramyxovirus Virus.

characterized by fever, swelling and a pervading pain on one or both sides of the face and the lower cheek.

In TCM, the condition is commonly referred to as zhà sāi.

Mumps is an acute respiratory infectious disease mainly found in children over 3 years old and teenagers.

Diagnosis

(1) History of exposure to mumps 2-3 weeks before onset.

(2) The early symptoms last about 24 hours, including low-grade fever, headache, low appetite. These are usually followed by earache and swelling of the parotid salivary glands that will center upon the auricular lobes, spreading out with no definite borders. The glands on one side of the face often swell up 2-3 days before the other side, although it is common for only one side to be affected.

Classification of Patterns and Treatments

1.Pathogens Invading Shaoyang

Signs and Symptoms

Manifestations include a slight fever and aversion to cold, diffuse swelling and pain on one or both sides of the parotid regions and uncomfortable chewing, or with headache, red throat and a poor appetite.

The tongue is red with a thin white or thin yellow coating; the pulse is superficial and rapid.

Treatment Principles

Scatter wind and clear heat, disperse swelling and dissipate masses

Acupuncture

SJ 17 (yì fēng) ST 6 (jiá chē) LI 4 (hé gǔ)

LU 7 (lie que) GB20 (feng chi)

Needle all points with drainage and strong stimulation for 30 minutes.

Treat once daily.

2. Heat-Toxin Accumulation

Signs and Symptoms

Manifestations include a high fever, pain and hard swelling on one or both sides of the parotid region worsened by pressure, difficulty opening the mouth and chewing, restlessness, headache, sore throat with redness, profuse thirst and a desire to drink, poor appetite, vomiting, swollen and painful submandibular glands, constipation, and decreased

yellow urine.

The tongue is red with a yellow coating;

the pulse is slippery and rapid.

Treatment Principle

Clear heat and resolve toxins, soften hardness and dissipate masses

Acupuncture

SJ 17 (yì fēng) ST 6 (jiá chē) LI 4 (hé gǔ)

SJ 5 (wài guān) SJ 1 (guān chōng)

Needle all points with drainage and strong stimulation for 30 minutes.

Treat once daily. Other methods include point bloodletting therapy.

Prevention and Nursing Care

(1)A susceptible child should avoid public places during a mumps epidemic.

(2)14 months after birth, children can be given the live attenuated mump vaccine or a measles-mumps-rubella vaccine.

(3)Children who have not suffered from mumps can be given parotitis immunoglobulins for prevention.

(4)Infants with mumps should be separated from others until parotid region swelling and distention has disappeared for 3 days.

Fetal Jaundice  Tai Huang

Neonatal jaundice is a disorder characterized by a yellow discoloration of the skin, mucous membranes and whites of the eyes (sclera) in a newborn infant. It is called tāi huáng

(yellow fetus) in Chinese medicine.

Neonatal jaundice is classified into two types: physiological jaundice and pathological jaundice, which encompasses a large variety of diseases and physiological variations involving the increased serum bilirubin in neonates.

Physiological or Pathological jaundice?

Physiological jaundice is usually detectable with clinical jaundice 2-3 days after birth. In full-term infants it often disappears spontaneously within 10-14 days.

Pathological jaundice is usually detectable as a clinical jaundice during the first 24 hours of life and has a prolonged duration lasting over 2 to 3 weeks. It can also become apparent if the jaundice is continually increasing with a deepening color, or the jaundice may disappear

and recur again, or it may occur at one week after birth or up to several weeks after birth.

ETIOLOGY

The causes of neonatal jaundice relate mainly to retention of dampness before birth.

The pregnant mother is invaded by dampness that accumulates and transforms into heat or cold, which is then transmitted to the fetus.

The fetus/infant spleen and stomach are insufficient in transporting and transforming, which leads to irregular qi movement, retained dampness steaming the liver and gallbladder, and the liver failing to govern free coursing. This results in a leaking of gallbladder fluid that causes yellowing of the skin and eyes.

Classification of Patterns and Treatment

Common Patterns

1. Retention and Steaming of Damp-Heat

Signs and Symptoms

Manifestations include bright yellow skin, cheeks and eyes, crying loudly, inadequate suckling of milk, or fever, constipation and deep yellow urine.

The tongue is red with a yellow and greasy coating.

Treatment Principles

Clear heat, drain dampness, relieve jaundice.

Acupuncture:

LI 11 (qū chí)   LI 4 (hé gŭ)

ST 36 (zú sān lĭ) ST 40 (feng long)

2. Cold-Damp Obstruction and Stagnation

Signs and Symptoms

Manifestations include dark, yellow skin and eyes, spiritless and lassitude, lack of warmth in the limbs, loose and pale gray stools and reduced urination.

The tongue is pale with a white and greasy coating.

Treatment Principles

Warm the middle jiao and drain dampness.

Acupuncture:

ST 36 (zú sān lĭ) ST 40 (feng long)

SP 6 (san yin jiao) DU4 (ming men)

Moxibustion

BL 23 (shèn shù) RN 4 (guān yuán) RN 6 (qì hăi) DU 20 (băi huì)

3. Jaundice due to Stasis and Accumulation

Signs and Symptoms

Manifestations include a gradually increasing dark yellow and lusterless skin and eyes, stiff abdominal mass below the costal region, abdominal distention with obvious blue veins or the presence of ecchymosis and non-traumatic hemorrhage, dark red lips and stasis spots on the tongue.

Treatment Principles

Dissolve stasis and remove accumulation

Acupuncture:

LI 4 (hé gŭ) LV3 (tai chong)

BL17 (ge shu) SP10 (xue hai)

Prevention and Nursing Care

a. Pay attention to dietary hygiene during pregnancy. It is important to avoid drugs, alcohol, pungent and heat-natured foods.

b. Pregnant mothers who have a history of hepatitis or have previously delivered infants with pathological jaundice, should be examined carefully before delivery.

c. Pay close attention to detect the changes in skin color and monitor the time of onset and decline in the newborn patient with jaundice.

Erysipelas Chi you dan

Erysipelas (Chi You Dan) is a common newborn with red skin like a cloud-shape, and migration disease.

This disease is called erysipelas in western medicine. Those who occur in newborns are called neonatal erysipelas.

It caused by skin infections, umbilical problems, or hip eczema.

The disease can occur all year round, but the incidence is higher in summer and autumn.

Cause

The main reason leading to the occurrence is exogenous wind-heat and evil poison. Poor care and damaged skin. Invasion by external evil.

1. Wind, fire and hot poison

Syndrome manifestations are more common in the buttocks, local redness, swelling and burning, like clouds, may be migratory, strong heat, irritability, or have vomiting, diarrhea, constipation.

red tongue, yellow or greasy fur,

Treatment Principle:

Clearing away heat and detoxifying.

Acupuncture:

LI 11 (qū chí)   LI 4 (hé gŭ)

ST 36 (zú sān lĭ) DU14 (da zhui)

2. Poison spreads the heart and liver

Symptoms: local skin redness, swelling, pain, fever, irritability, dizziness, dry lips,

red tongue, less fur,

purple fingerprints.

Treatment Principle:

Clear heat and detoxify, extinguish wind

Acupuncture:

LI 11 (qū chí)   LI 4 (hé gŭ)

DU14 (da zhui) GB20 (feng chi)

Prevention and Nursing Care

1. Keep skin clean, dry, and keep buttocks clean.

2 Pay attention to the area and migration of Chi you dan to prevent complications. 3. Children with high fever should pay attention to supplementing water and vitamins.