Common childhood conditions part II of II

Common childhood conditions part II of II

In addition to the weakness of child immune defense to the microorganisms during the development, the whole body is facing the challenges in the interactions of material metabolism to the outside world.

 

Allergies

AllergiesThe medical term of allergy is defined as the Type I hypersensitivity disorder of the immune system [[i]]. The rapid inflammatory response of the Type I hypersensitivity involves a type of antibody called Immunoglobulin E (IgE) and certain white blood cells called mast cells and basophils. It can cause many diseases, such as asthma, allergic rhinitis, allergic otitis media, etc. [[ii],[iii]]  The lay term “Allergy” may include any discomfort or illness caused by the reactions of our immune system to foreign materials, which includes other types of hypersensitivity, such as rheumatoid arthritis (Type III), contact dermatitis (Type IV), etc. [[iv]]. The risk factors for allergy are from both sides of host (our body) and environment. Host factors include heredity, gender, race, and age. The environmental factors include microorganisms, environmental pollution and foods [1] (Fig. 1, [[v]]). Allergies in infants and children are common. Food allergies affect about 6% to 8% of children under age 5 [[vi]]. By age 6, 42% children have symptoms of upper respiratory allergies [[vii]]. If both parents have allergies, their (biological) child has a 75% chance of having allergies [[viii]]. The symptoms and signs of allergy include runny nose, nasal stuffiness, sneezing, nose rubbing, sniffling, Itchy, runny eyes, skin rashes, swollen, hives, fever, eczema, asthma, stomach pain, diarrhea, vomiting, headache, etc. [[ix], [x], [xi]]  The treatment of allergy includes finding/avoiding the allergens and releasing the symptoms by medications such as antihistamines, glucocorticoids, and anti-leukotrienes. In addition to avoiding the environmental factors, TCM pays more attention to the adjustment of the host. According to TCM theory, the appearance of an allergic reaction is the sign—the pathological change resulted from  the inside and outside pathogenic factors; while the system disability is the origin—the disorder of the internal environment stability and adaptability [[xii]]. An allergy is associated with the specific physical constitution. There are two allergic constitutions: heat and cold. The heat constitution is prone to an allergic reaction to increased temperature. TCM believes that “Heat can drive wind”. A “wind” is a kind of an allergic reaction, such as itchy skin when in heat. On the contrary, the person with cold constitution is easy to allergic to cold temperature. The outside cold is considered as a “cold evil”. When the cold evil invades the respiratory tract, the body’s Yang will expel the evil out. Sneezing and runny nose are the process of expelling the cold evil out. As long as the chill is out, the allergic reaction will stop [[xiii]]. Therefore, the TCM treatment strategy is scattering wind, clearing heat (for heat constitution) or expelling cold (for cold constitution), and drying wet. Here is an example of a formula for an allergy from the well-known doctor Chen Yu Zhu (祝谌予): Fang Feng (防风)、Chai Hu (柴胡)、Hu Mei (乌梅)、Wu Wei Zi (五味子),for allergy treatment with modifications. For the one with wind cold, add Gui Zhi (桂枝)、Ma Huang (麻黄)、Sheng Ma (升麻) and Jing Jie (荆芥);For the one with wind heat, add Ju Hua (菊花)、Chan Yi (蝉衣)、Yi Hua (银花) and Be He (薄荷);For the one with blood heat, add Dan Pi (丹皮)、Zi Cao (紫草)、Bai Mao Gen (白茅根);For the one with heat evil in the interior, add Lian Qiao (连翘)、Yin Hua (银花)、Gan Cao (甘草)、Pu Gong Ying (蒲公英)、Zi Hua Di Ding (紫花地丁) and Ban Lan Geng (板蓝根) [[xiv]]. In allergy treatment, it’s important to treat the Taiyin (Lung, Spleen) realm as the effective function of these two organs (according to TCM theory), the problem will be  treated at the at the root. This means, that during the active stage of the allergic reaction the formula can focus on the “wind-evil” (the branch) where as during the latent stage, Taiyin should be supported. There are many formuls to consider, some examples are: Yu Ping Feng San (玉屏风散), Gui Zhi Tang (桂枝汤), Li Zhong Wan (理中丸), Si Ni Tang (四逆汤).

 

Eczema in Children

EczemaEczema often refers to as atopic dermatitis. It also refers to as allergic skin disease in lay term. The eczema in Children most commonly presents before the age of 5. About 60% of patients will experience symptoms of atopic dermatitis by age 1 (Fig. 2, [[xv]], and another 30% will experience symptoms by age 5. It is a non-contagious inflammatory skin condition [[xvi]]. The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors [[xvii]]. Children born into families that have a history of allergic diseases such as asthma or hay fever are at an increased risk for eczema developing [16]. The main environmental factors to cause the eczema in children are the intake foods (especially cow’s milk, egg, wheat, fish, soy and peanuts), inhalation (especially house dust, mite and grass pollen), and direct contact (such as soap, bubble bath, sweat, saliva, clothes, metals and pets). Initially the children suffering from skin redness, rash, then rough skin and scaling.  The child’s skin feels like touching on sandpaper. The hot and wet environments or situations can make the eczema performance significantly [15,[xviii],[xix],[xx]]. The treatment of allergy includes removing the environmental factors, the use of ointments, lotions, steroid creams, oral antihistamines, steroids and antibiotics if involving infections. In TCM, the infant and toddler eczema refers to “milk tinea”. It is caused by endogenous damp toxin, exogenous wind evil and loss of spleen functions. Therefore, the appearance of an eczema often reflects the child’s dyspepsia [[xxi]]. In clinic, the infant and toddler eczema can be divided into two categories: (1) Damp-heat flourishing in the interior: flushing skin, red papules and vesicles, the outflow mucus on the broken blister and scabs after the dryness, red eye, red tongue, a tongue with thin yellow greasy coating, and slippery and rapid pulse. (2) Blood dryness and wind prevailing: dry and rough skin, itching, scratching white dander, dry stool, often accompanied by a thirsty throat, restless sleep, thin coating of tongue with less fluid, and thready and rapid pulse. The treatment for the first situation (damp-heat): clear away heat and promote diuresis, dispel wind and arrest itching by Xiao Feng San (消风散) with modifications. The treatment for the second situation (blood dryness): nourishing blood and Ying, dispelling wind and moistening dryness by Si Wu Tang (四物汤) and San Miao Wan (三妙丸) with modifications [[xxii]]. In addition, it was very effective for the eczema in children to scrub gently the affected area with the water boiling juice from Qing Li Cao (清沥草), 3 times a day for a few days. One of the main topical treatments for an active stage of eczema is Qing Dai Gao (青黛膏), Dian Dao San (颠倒散) or San Huang Xi Ji (三黄洗剂), depending on the exact presentation of the condition.

 

ADHD

ADHDAttention deficit hyperactive disorder, or ADHD, is a mental disorder that has been affecting more and more people throughout the world. It is diagnosed with inattentiveness, hyperactivity, and impulsiveness that go beyond what would be considered for a normal child (Fig. 3, [[xxiii]]). These symptoms must emerge before 12 years of age for a diagnosis to be made. Children diagnosed with ADHD have trouble focusing and sitting still for long periods of time, as well as acting impulsively upon their first thought without thinking things through. This will impact the child’s home, social, and, especially so, school life, as children with ADHD usually do poorly in school. Currently, the causes of ADHD remain an area of controversy – risks factors involve genetics, executive function, environment, diet and social. The pathophysiology of the ADHD brain may or may not be changed. Treatment, which is controversial, involves stimulant (Adderall) and non-stimulant (atomoxetine) medications, as well as psychotherapy ([xxiv], [xxv]). TCM believes that the imbalance of Yin and Yang is one of the basic pathological abnormal consciousness of ADHD. Its specific performance reflects in the disorders of visceral function, involving the four viscera of heart, liver, spleen and kidney. In clinic, ADHD is divided into three types: (1) Kidney-Yin deficiency and liver-Yang hyperactivity: Dysphoria with feverish sensation in the chest, palms and sole, or burning cheeks; less shiny on nails and hair; dry mouth and throat; night sweats; preferring cold diet; red tongue with less or no coating; thready and rapid pulse. (2) Qi deficiency of heart and spleen: Unwholesome complexion, thin body shape; dreaminess, a light sleeper; poor food intake, pale tongue with scalloped edges, thin and white coating; thready and weak pulse. (3) Accumulation of damp-heat inside, phlegm-fire disturbing heart: Restless, chest tightness and epigastric fullness and pain; bitter taste in mouth and anorexia; thirsty and desiring for drinking; abundant phlegm, yellow urine, dry stool; red tongue with yellow greasy coating; slippery and rapid pulse. The treatment strategies are (1) Nourishing the liver and kidney, nourishing Yin and Yang, calming the mind and promoting mentality; (2) nourishing Qi and invigorating the spleen, nourishing the heart and tranquilizing the mind; (3) clearing heat and purging fire, removing dampness and resolving phlegm [[xxvi]]. Some studies showed that the total effective rate on ADHD by TCM treatment reached 86%-94% for children’s IQ tests or academic records, although there is no significant difference between the herbs and western medicine (Ritalin), the TCM group had less side effects than the western medicine group [[xxvii],[xxviii]]. As many factors are to consider for ADHD, it’s vital to see a qualified Chinese medicine practitioner to determine an effective treatment approach for your child.

 

References:


[xxvi] ADHD diagnosis and treatment by TCM: http://baike.baidu.com/view/564071.htm