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:
- 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.
