Childhood Asthma

Eczema and Asthma Part 2 - Childhood Asthma

Jimi Windmills

Introduction

In part two, we will look at childhood asthma, first exploring some fundamental differences between the physiology of children compared to adults, and the importance of inspection as a diagnostic technique in paediatrics. We will then compare the treatment of asthma in children to the treatment of asthma in adults, with reference to Scott and Barlow’s text on paediatric acupuncture, and other relevant texts and articles.

Physiology of Children

There are many aspects in which the physiology of children differs from that of adults. For a large part, this centres on the development of a well functioning digestive system. The spleen coordinates and drives the entire digestive process, and since, as Scott and Barlow point out, before birth, a baby has received all its nourishment from its mother, it has never had to rely on the proper functioning of its own mechanisms for generating Qi. This results in immense pressure on the spleen, as it tries to take all the food coming into the body for the first time, and convert it into Qi and Blood. This makes children particularly susceptible to disorders involving the spleen (Scott and Barlow 1999: 3-4).

Children are often Yin deficient. This is evidenced by their susceptibility to Hot diseases, fevers and convulsions. Children are Yang in nature, compared to adults, they are always moving, and always changing (Scott and Barlow 1999: 4). Given their propensity for rapid change, children are particularly vulnerable to changes in diet, succumb rapidly to viruses, and are affected quickly by hot or cold weather. When sickness takes hold, progression of the disease is often frighteningly rapid, quickly developing fevers, acute diarrhoea leading to dehydration, or chest infections that transform into pneumonia, threatening the child’s life (Scott and Barlow 1999: 4-5).

While it is certainly true that children get sick easily, and progression of disease can be very fast, it is reassuring that they also respond very quickly to all manner of treatment (Scott and Barlow 1999: 5). This capacity to be influenced easily by external forces holds true for the impact of the seven emotions on children, who having little awareness of their emotional state, are directly involved in the emotional affairs of their parents, and others close around them. Stress, anxiety and frustration in the parents are quickly mirrored by their children. In saying this, it is important to clarify that in general, children do not suffer from Qi stagnation as a result of repressing emotions. Patterns that look like Liver Qi Stagnation or Yang rising, are most often food stagnation and accumulation disorder. The most common sign of liver involvement is stirring of Liver Wind causing febrile convulsions (Scott and Barlow 1999: 5).

The Importance of Inspection

It is difficult to take a child’s pulse, and often they are unable to speak for themselves because they have not learned how, or are too shy. Sometimes an otherwise verbal child might be inhibited in a clinical setting. This makes asking (the parents), and inspection, particularly of the child’s face, the two most important methods for diagnosing children. Inspection is the most important of the four diagnostic methods for several reasons. It does not rely on subjective information provided by an anxious parent, or unwell child, who may or may not fully grasp the meanings of the questions. Inspection is the best way to assess the overall level of Qi of a child, and the vividness of the colours of the face in an immediate clue to the health of the child. It also provides a way to gauge the efficacy of previous treatments, as the child will appear healthier and more Qi-full (Scott and Barlow 1999: 58-60). The face of a child is the most important area for inspection. By looking at the face, particularly focusing on the eyes, and the quality of the Shen, a practitioner is able to assess the child's spirit, and make a prognosis on the recovery. The colour of the face also provides key diagnostic information, and is often more reflective of the health of the child, than either the tongue or the pulse. Other important aspects of inspection are the movement of the child, inspection of the orifices, and the finger vein. The finger vein is located on the radial side of the index finger, and when present can be interpreted diagnostically (Scott and Barlow 1999: 59-61).

Asthma – Treatment in children and Adults

Asthma patterns in children under 5 years of age are very different from those seen in older children and in adults, according to Scott and Barlow. When a child under 5 has asthma two factors will always be present: Phlegm and Lung deficiency. In a majority of cases there will also be an underlying lingering pathogen (1999: 229). Scott and Barlow assert that the most common aetiology of asthma is repeated use of antibiotics to treat acute coughs. Their pattern of asthma in children under 5 is accumulation of Phlegm in the Lungs, with underlying Lung and Spleen Qi deficiency, complicated by a lingering pathogenic factor. They describe the pathogenesis of the disease as beginning with accumulation of food which restricts the flow of Qi, this generates Phlegm which accumulates in the Lungs. The Lungs become deficient and combined with the already deficient Spleen, leads to asthma. This pattern can be complicated by a lingering pathogen, which may be Hot or Cold in nature (Scott and Barlow 1999: 230-1). As the signs and symptoms listed in Scott and Barlow are extensive, they will be supplied in Appendix 1.

Scott and Barlow’s stress that in this pattern with Phlegm, Lung deficiency and a lingering pathogenic factor, that it is important to treat the Lungs and the Phlegm first, and not treat the lingering pathogen until there is a reduction of Phlegm and an increase in Lung Qi.

From Scott and Barlow:

• The main points are Lu5, Lu7, Lu9, Ren12, Ren22 and St40¹.
• For Phlegm with accumulation disorder add Si Feng (M-UE-9)².
• Lung and Spleen Qi deficiency (normal and hyperactive) add Sp6 and St36.
• Lingering pathogenic factor (cold) add Bai Lao (M-HN-30), Bl12, Bl20, Bl18, Bladder points can also have moxa applied, along with moxa at Ren12³.
• Lingering pathogenic factor (hot) add Lv2, Lu10, and apply a dispersing technique to the main points, particularly Lu5 and Lu7 (1999: 233-4).

The aetiology of asthma in adults begins with Wind-Heat or Wind-Cold repeatedly invading the body, and settling in the Lungs where it impedes the flow of Lung Qi, which results in the accumulation of Phlegm. Similar to Scott and Barlow’s pattern for children, Maciocia also identifies improper diet injuring the spleen as being a contributor to the production of Phlegm. Another aetiological factor is weak constitution. A child who suffers a long illness, will develop Lung and Spleen deficiencies, impeding the transformation of fluids and leading to the production of Phlegm. While Scott and Barlow assert that adult patterns of asthma are very different to those of young children, Maciocia's, aetiology and pathogenesis seems quite similar. Asthma, according to Maciocia, can be split into two categories, acute phase, and chronic phase. Acute phase can be further subdivided into Cold Phlegm and Hot Phlegm patterns. Acute phase treatment happens during an attack, or between attacks during a period in which they occur frequently. Maciocia's differentiating features are listed in Appendix 2. The treatment principal for Cold Phlegm is to warm the Lungs, scatter Cold, resolve Phlegm, and relieve breathlessness (Maciocia 1994: 176). The point prescription is Lu7, Bl13, Lu1, Lu6, Ren22, Ren17, St40, Pc6, reducing or even technique, and moxa (Maciocia 1994: 176). The treatment principle and points for Hot Phlegm is to clear Heat, restore the descending of Lung Qi, resolve Phlegm and stop wheezing. Lu5, Lu10, Lu6, Bl13, Lu1, LI11, Pc5, St40, Ren22 (Maciocia 1994: 176).

Recent Research

In a research article published in the Journal of Traditional Chinese Medicine children diagnosed with bronchial asthma were treated using acupuncture and herbs. In the article there is very little mentioned about the pattern diagnosis, this was a common failing among most of the articles I located to do with acupuncture, there were very few dealing specifically with acupuncture to treat asthma exclusively in children. The article, Clinical Research of Acupoint Application for "Treatment of Winterdisease in Summer" Used to Prevent and Treat Bronchial Asthma in Children, was particularly interesting in that it placed a big emphasis on the season in which the treatment took place. This was an element that was not present at all in the works of Scott and Barlow, or Maciocia. In this article, points were chosen (all of which seem reasonable, in the absence of a treatment principle), including Bl13, Bl43, Dingchuan, Ren22, Ren17, Du14, Ren4, Ren8, Bl26, and Pc6, many of these were used in the other protocols previously explored, however points specifically to clear Phlegm, a pathological component in each of the other authors works, are notable in their absence. These points were needled on the hottest days in summer, and on the coldest days of winter. The authors of the study also prescribed herbal treatment.

Conclusion

In this second part of the assignment, we looked at childhood asthma, and some of the most important differences between the physiology of children compared with that of adults. We saw that the most important element of diagnosis in paediatrics is inspection, especially of the face. We then compared the treatment of asthma in children to the treatment of asthma in adults, and saw that they were quite similar. Finally we took a brief look at a research article, which in comparison to our other two texts outlined a unique method of treatment for paediatric asthma using acupuncture.

1 Scott and Barlow caution not to use St40 in cases where the patient is extremely Phlegmy for fear of provoking asthma attack. Use Ren22 and Ren12 for the first few treatments.

2 Like ST40 we are cautioned again against the use of Si Feng in cases of extreme phlegm, since the point can release a lot of heat and Phlegm into the system and make the patient worse. Again use Ren 22 and Ren12 until a lot of the Phlegm has cleared.

3 Do not treat lingering pathogenic factor until Phlegm had been resolved and deficiency almost completely tonified.

Bibliography

Crawford, M 1998, 'The Acupuncture Treatment of Skin Diseases By Dr Gu Yue Hua', Journal of Chinese Medicine, No. 26.

Maciocia, G 1994, The Practise of Chinese Medicine, Churchill Livingstone, New York.

Scott, J and Barlow, T 1999, Acupuncture in the Treatment of Children, Eastland Press, Seattle.

Wen, BL, Liu, BY, Peng, J, Wang, XF, Xiang, XX, Liu, XF, Hu, JQ, Lu, F, He, LY, Zhu, WZ, Fang, YG, Wang, Y 2012, 'Clinical Research of Acupoint Application for "Treatment of Winterdisease in Summer" Used to Prevent and Treat Bronchial Asthma in Children', Journal of Traditional Chinese Medicine, Vol. 32 No. 1 pp. 31-39. Viewed 29 October 2012 http://www.sciencedirect.com.ezproxy.endeavour.edu.au:2048/science/article/pii/S0254627212600284.

Yan, CL, and Zhu YL 2005, The Treatment of External Diseases with Acupuncture and Moxibustion, Blue Poppy Press, Boulder.

Zhang, ZD, Deng, YQ, Zhang, Y, Han, Y, Lin, L, Chao, EX 2010, 'TCM Differential Treatment of Cough Variant Asthma', Journal of Traditional Chinese Medicine, Vol. 30, No. 1 pp. 60-63.