From a newborn baby to an adult, all systems are developing, not only in size or weight, but their function also matures and modifies at different life stages, until the end of adolescence. This ongoing development of organs and systems is reflected in the amount of common diseases that children get, especially for the immune system, leading many diseases with microorganism infections [[1]].

 

Common cold and influenza (flu)

Common coldThe cold is most likely what a child will have to deal with at some point, especially for infants and preschool children because they haven’t yet developed resistance to most of the viruses that cause a cold [[2]]. Both common cold and flu are caused by virus infections. Since these viruses are best proliferated in 33–35 °C, and the virus defense capacity of our immune system becomes weaker at a lower body temperature [[3],[4]], these virus will proliferate once they get into the upper respiratory tract and we will get “cold” symptoms including sneezing, runny nose, coughs, headaches, fever and muscle aches (Fig. 1, [[5]]). There is currently no cure for the common cold and flu. Fortunately, our body’s immune system can fight off the virus most of the time [[6],[7]]. Treatments in western medicine are bed rest and fluids to let the immune system fight off the cold virus while easing the discomforts it causes. Over the counter medications may also help combat some symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen and ibuprofen are used to alleviate the fever an well as acting as an analgesic, while guaifenesin and dextromethorphan are used for their expectorant and antitussive properties. Eventually, the cold will run its course and the child will get better on their own [5]. This sharply contrasts the traditional Chinese medicine (TCM) approach, which mainly splits colds into two categories: wind cold and wind heat. Wind cold is when one develops a cold from chilly wind, while wind heat is caused by the opposite. The two different types present with slightly different symptoms and require different approaches in treatment. Wind cold normally presents with fever, chills, and inability to get warm, a productive cough with clear mucus, stiff neck and shoulders, occipital headache, and bradycardia. Treatment involves sweating therapy because it warms while simultaneously detoxifying the body. This is accompanied with warm miso soup made with the white part of the spring onion and ginger. However, if wind cold is allowed to persist without treatment for a few days, then it may present with the inability to sweat, which will render the first line treatment ineffective. If this is the case, then treatment involves an ephedra decoction, which is concentrated ephedra (Ma Huang Tang (麻黄汤); Ma Huang is currently not scheduled in Australia and hence, it’s illegal to use it. See below for its substitutes)combined with licorice. The ephedrine will open the airways while stimulating the body to sweat, while the licorice modulates the ephedrine and has anti-inflammatory and antitussive properties. When the pernicious influence of the wind combines with heat, the fever is worse than the chills. The primary symptom is a sore throat with swollen, headache, irritability, fever and tachycardia. The cough is usually dry or nonproductive, with occasional expectoration of yellow mucus. Treatment normally involves Yin Qiao San (银翘散), but if the fever is severe, then Zhong Gan Ling (重感灵) is preferred. If sore throat severe, then Chuan Xin Lian (穿心莲) Antiphlogistic Tablets can be added to the treatment [[8]]).

 

Chickenpox

ChickenpoxChickenpox is a disease primarily associated with children, particularly among those under age 12 [[9]]. When most people think of chickenpox, they picture a child with those characteristic red bumps scratching himself to death. Although there exists a vaccine for chickenpox, choosing not to get it could cause the disease to be contracted fairly easily. The chickenpox virus is an offset of the herpes virus that may not show symptoms for years after initial contraction [7]. The distinguishing symptom of chickenpox is a rash consisting of red bumps (Fig.2, [[10]]) that spreads across the entire body over the course of several days. These bumps will eventually turn into blisters and produce itchiness. If the child scratches too much, these blisters may break, opening the body to more foreign invaders. Treatment includes hydrocortisone or oatmeal baths to soothe the itching, as well as NSAIDs if the fever rises above 38°C (or 101°F). The child should also be quarantined to ensure that the highly contagious disease does not spread, especially to adults where it could develop into shingles. In TCM, for the chickenpox with mild symptoms (sparse and light rashes, thin blisters as bright dews with less redness), the wind-heat evil is mild. The treatment for that will be the formulas with wind-scattering, heat-clearing and detoxifying functions. For the chickenpox with severe symptoms (large area of red pox, thick blisters with cloudy fluid inside), the toxic heat is flourishing, deep to nutrient Qi and defensive Qi. Then the treatment of heat-clearing, nutrient Qi-cooling and detoxifying formulas will be used [[11]]. TCM treatment could get similar or better effectiveness as intravenous aspirin on controling fever and drying up blisters [[12]]. According to the TCM theory, a great formula to help children overcoming Chickenpox quicker is Chai Hu Gui Zhi Gan Jiang Tang (柴胡桂枝干姜汤) or a simple Xiao Chai Hu Tang (小柴胡汤). If the blisters mature, perhaps a modified version of one of those formulas to address the rash is helpful [[13],[14]].

 

Asthma/respiratory tract infection

AsthmaAsthma is a chronic condition in which inflammation of the bronchi causes trouble breathing, and occasionally, complete closure of the airways (Fig.3. [[15]]. Currently the cause of asthma is unclear, although environmental and genetic factors may be at play. Many environmental factors have been associated with the asthma’s development and exacerbation including allergens, bacterial and virus infections in the respiratory tract [[16]]. The onset of child asthma is seen mostly at 1-6 years old and 95% induction is due to the respiratory tract infection [[17]]. Symptoms include shortness of breath, wheezing, coughing, and tightness in the chest. For immediate relief in the event of an asthma attack, Short-acting beta2-adrenoceptor agonists (SABAs) such as Salbutamol remain first line treatment. It is delivered into the respiratory tract via inhalation. For long term management, corticosteroids, Long-acting beta-adrenoceptor agonists (LABAs), leukotriene antagonists, and mast cell stabilizers are used. These medications all reduce the inflammation in the airways, leading to less restricted airflow [14]. In the TCM theory of asthma, the attack of the disease is caused by both internal and external reasons. The internal responsibility is the internal retention of phlegm and fluid, related to the organs of lung, spleen and kidney. The external factor is mainly outside evil (exogenous pathogens) invasion. Child lung is delicate, his spleen and kidney are insufficient at functions. The deficient lung causes the failure of defense against outside evil. Pathogens injure the pulmonary collaterals, leading body fluid condensed into the phlegm. Dysfunction of the spleen in transport produces dampness and phlegm, leading the phlegm storage up in the lung. The kidney weakness can’t transform water into clear fluid, leading the phlegm formation up in the lung [15]. Therefore, the treatment is to warm the lung and cold, eliminate phlegm and relieve asthma for the cold type asthma. Ventilate the lung, eliminate evil heat, eliminate phlegm and relieve asthma for the hot type asthma. Invigorate Qi (vital energy) and consolidate the exterior, strengthen the spleen and replenish Qi, tonify kidney, strengthen spleen and consolidate the constitution for deficiency type of asthma [[18]]. In a study, Ding Chuan Tang (定喘汤, DCT), a formula long used for the opening of the airways, was tested on children with asthma in a randomized, double-blind clinical trial. Children were given 6 grams of DCT or placebo daily for 12 weeks. At the end of the study, airway hyper-responsiveness was significantly improved for the treatment group. This suggested that DCT resulted in more stable airways with less side effects [[19]]. Ding Chuan Tang contains Ma Huang (麻黄) and Kuan Dong Hua (款冬花) which are both not legally available in Australia. To substitute Ma Huang, you could use Zi Su Ye (紫苏叶) and to replace Kuan Dong Hua, either the cough herbs can be given at a higher dosage or based on the presentation, Pi Pa Ye (枇杷叶), Ting Li Zi (葶苈子) or Zi Su Zi (紫苏子) can be added [[20],[21],[22]].

 

Gastroenteritis

Gastroenteritis is an inflammation of the gastrointestinal tract, usually resulting in vomiting, diarrhea, and abdominal pain, which usually begin 12–72 hours after contracting the infectious agent. In children, most cases are caused by the virus (70% of cases, mostly under age 2 [[23]]) and bacteria (15% of cases), although parasitic and non-infectious causes are possible. Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene. Gastroenteritis is usually an acute and self-limiting disease that does not require medication—normally treated with rehydration and rest. However, in severe cases, antiemetics such as ondansetron or antibiotics may be used [[24]]. In TCM, gastroenteritis is caused by gastrointestinal dampness and heat; retention of food in the stomach and intestine; and deficiency of the spleen and stomach. Therefore, the treatments are clearing heat and removing dampness, regulating Qi to stop diarrhea; remove retention and pacify the stomach, regulating the stomach descending adverse Qi; strengthening spleen and subduing the advice of Qi, pacify the stomach and stop diarrhea [[25]]. Berberine is a traditional Chinese medicine used for a long time in china. It is one of the most important alkaloids that contains in the TCM herbs of Huang Lian (黄连) and Huang Bai (黄柏). It shows a significant inhibitory effect of bacteria, including dysentery bacillus, Mycobacterium tuberculosis, pneumococcus, typhoid and diphtheria bacilli. It is widely used to treat bacterial gastroenteritis, diarrhea and other gastrointestinal diseases [[26]]. According to the TCM theory, depending on the presentation formulas such as Xie Xin Tang (泻心汤), Ban Xia Xie Xin Tang (半夏泻心汤), Sheng Jiang Xie Xin Tang (生姜泻心汤) are very capable formulas to help bring about a quick recovery [[27],[28],[29]].

 

Urinary tract infection

A urinary tract infection (UTI) occurs when the kidneys (pyelonephritis), ureters (ureteritis), bladder (cystitis), or urethra (urethritis) become infected. By age 5, about 8% of girls and 1%-2% of boys have had at least one UTI. It is usually caused by E coli, but can also be viral or fungal. Its clinical symptoms are mainly frequent/urgent/painful urination, fever, lower abdominal or lower back pain or discomfort. Some kids experience UTIs again and again — these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. Because most urinary tract infections are bacterial, normal course of treatment involves antibiotics [[30],[31]]. TCM believes that UTI (belongs to the category of stranguria in TCM) is mainly due to the heat and dampness in the lower Jiao and heat accumulation in the bladder. It mostly begins from the dampness and heat in the bladder—its disease is in the bladder. The dampness and heat will damage Yin when the disease last for a long time and lead Yin deficiency—its disease is in the kidney. In addition, stranguria is related to blood stasis. The treatment of TCM is removing damp-heat, treating stranguria and diuretic, promoting blood circulation and removing blood stasis [[32]]. Some formula examples are: Ba Zheng San (八正散), Wu Ling San (五苓散), Gua Lou Qu Mai Wan (栝楼瞿麦丸) or Tao He Cheng Qi Tang (桃核承气汤) which all can be helpful depending on the severity of the symptoms and the dominance of heat or dampness [[33],[34],[35],[36]].

 

References:

[1] Child immune: http://www.who.int/ceh/capacity/Children_are_not_little_adults.pdf

[2] Cold age: http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=risk-factors

[3]Rhinovirus: https://en.wikipedia.org/wiki/Rhinovirus

[4] Emi Takashita et al: Intrinsic Temperature Sensitivity of Influenza C Virus Hemagglutinin-Esterase-Fusion Protein. J Virol. 2013 January; 87(2): 1288.

[5] Cold western treatments: http://health.nytimes.com/health/guides/disease/common-cold/overview.html

[6] Cold vs flu: http://www.diffen.com/difference/Common_Cold_vs_Flu

[7] Common cold: http://www.essentialkids.com.au/health/family-health/the-az-of-common-illnesses-in-school-children-20111101-1msw1.html

[8] Cold TCM treatments: http://health.howstuffworks.com/wellness/natural-medicine/chinese/how-to-treat-the-common-cold-with-traditional-chinese-medicine.htm

[9] Chickenpox age: http://kidshealth.org/parent/infections/bacterial_viral/chicken_pox.html

[10] Chickenpox picture: http://www.google.com/search?q=Chicken+pox&rlz=1I7GGLD_en&source=lnms&tbm=isch&sa=X&ei=dzjsUYvcDoyA8gTe8oDICQ&ved=0CAcQ_AUoAQ&biw=1521&bih=828

[11] Chickenpox TCM treatment: http://www.haodf.com/zhuanjiaguandian/haodf_64738267.htm

[12] Chickenpox TCM treatment compare: http://www.goldenneedleonline.com/library/2009/07/28/treating-chickenpox-with-tcm/

[13] Chai Hu Gui Zhi Gan Jiang Tang: http://baike.baidu.com/view/1529506.htm

[14] Xiao Chai Hu Tang: http://baike.baidu.com/view/239144.htm

[15] Asthma picture: http://www.google.com/search?q=Chicken+pox&rlz=1I7GGLD_en&source=lnms&tbm=isch&sa=X&ei=dzjsUYvcDoyA8gTe8oDICQ&ved=0CAcQ_AUoAQ&biw=1521&bih=828#rlz=1I7GGLD_en&tbm=isch&sa=1&q=Asthma&oq=Asthma&gs_l=img.12…0.0.4.263524.0.0.0.0.0.0.0.0..0.0….0…1c..21.img.LyAsI1V5R0w&bav=on.2,or.r_qf.&bvm=bv.49478099,d.eWU&fp=2828360c57a8431b&biw=1521&bih=828&imgdii=_

[16] Asthma cause: http://en.wikipedia.org/wiki/Asthma

[17] Asthma induction: http://www.qqyy.com/jibing/erke/110226/31f22.html

[18] TCM treatment for asthma: http://www.xywy.com/zy/fk/zyek/297855.html

[19] CK Chan et al: Ding Chuan Tang, a Chinese herb decoction, could improve airway hyper-responsiveness in stabilized asthmatic children: a randomized, double-blind clinical trial. Pediatr Allergy Immunol, August 1, 2006; 17(5): 316-22.

[20] Zi Su Ye: http://baike.baidu.com/view/925.htm

[21] Pi Pa Ye: http://baike.baidu.com/view/37573.htm

[22] Ting Li Zi: http://baike.baidu.com/view/54168.htm

[23] Gestroenteritis age: http://www.med126.com/tcm/2009/20090113022947_77178.shtml

[24] Gastroenteritis: http://en.wikipedia.org/wiki/Gastroenteritis

[25] TCM treatment for Gastroenteritis: http://jingyan.baidu.com/article/2fb0ba4060bf6d00f2ec5fa4.html

[26] Berberine: http://baike.baidu.com/view/60462.htm

[27] Xie Xin Tang: http://baike.baidu.com/view/286717.htm

[28] Ban Xia Xie Xin Tang: http://baike.baidu.com/view/128212.htm

[29] Sheng Jiang Xie Xin Tang: http://baike.baidu.com/view/286251.htm

[30] UTI age: http://kidshealth.org/parent/infections/bacterial_viral/recurrent_uti_infections.html

[31] UTI: https://en.wikipedia.org/wiki/Urinary_tract_infection

[32] UTI TCM: http://www.xywy.com/zyys/zynk/mnxt/20070621/49982.html

[33] Ba Zheng San: http://baike.baidu.com/view/230300.htm

[34] Wu Ling San: http://baike.baidu.com/view/230283.htm

[35] Gua Lou Qu Mai Wan: http://baike.baidu.com/view/1460485.htm

[36] Tao He Cheng Qi Tang: http://baike.baidu.com/view/238176.htm