Midterm Flashcards
Who is considered the Father or Saint of Pediatrics? What book did he write?
Qian Yi
The Key to Diagnosis and Treatment of Children’s Diseases
When did the Saint of Pediatrics live?
Qian Yi lived from 1032-1113, roughly 1000 years ago, during the Song dynasty
Who was the first pediatric doctor?
Bian Que
500-400 BC, Warring States period
What are the classics of TCM?
Huang Di Nei Jing Su Wen
(consists of Su Wen Basic Questions and Ling Shu Spiritual Pivot written 425-220BCE during the Warring States)
Nan Jing: The Yellow Emperor’s Canon of 81 Difficult Issues (100CE)
Shen Nong Ben Cao Jing: Classic of Materia Medica (25-220 CE) consist of 365 medicinals
Shanghan Lun: Treatise on Cold Damage written by Zhang Zhongjing before 220 CE, end of Han Dynasty
What is the earliest pediatric book?
The Cranial Fontanelle Classic: Pure Yang Constitution, Pediatric Pulse and Fontanelle Diagnostic Method
When did Sun Si Mao live and what did he do?
581-682 AD
Most important doctor of the Tang Dynasty
Wrote “Important Formulas Worth 1000 Gold Pieces for Emergency” which included 5300 formulas
He identified the 13 Ghost Points for psychological illness
Standardized Cun measurements
Wrote the first code of Chinese medical ethics influenced by Taoist principles based on Compassion, Justice, Beneficence and Humility
When was the Grand Compendium of Pediatrics written?
1750 by Chen Fu Zheng
Introduced the finger diagnosis combined with 8 principles
What are the 7 Age Stages of pediatrics?
- Fetus
- Newborn
- Infant
- Toddler
- Young Child
- School Age
- Adolescent
Fetus Stage
Starts from the moment of conception to 10 months (40 weeks)
The most critical stages are the first 12 weeks and then after 28 weeks.
The mother’s nourishment and mental health is the focus and is mostly treated with herbs.
Careful not to use herbs that move blood or qi.
Can use acupuncture but only cautiously not to cause a miscarriage by moving too much blood and Qi.
Newborn Stage
Starts at birth and ends at 28 days. This is the TENDER or fragile stage where the baby is easily injured.
Give herbs to the baby if needed because it will be a critical illness if needed.
Use 1/6 the amount of herbs.
NO acupuncture or Tui Na.
Infection and viruses are the most dangerous at this stage.
Infant Stage
From 28 days to 1 year old.
Head grows, organs developing. Weight 3X and Height 1.5X meaning rapid development.
Spleen/Stomach and Lungs are very weak.
Crawling at 3-4 months. Most dangerous is choking or falling on head.
Can do Tui Na above 6 months.
Focus on nourishment of the mom if breastfeeding. Encourage her to avoid caffeine and spicy food.
Give herbs to mom usually or use 1/3 amount if giving to infant.
Toddler Stage
From 1-3 years old.
Learning to walk. Developing speech and personality. Transitioning to solid food.
Spleen is still weak. Still easily catch respiratory infection.
Fontanelle should close 12-18 months.
Neurological issues will present at this age.
Digestive issues and respiratory still prevalent.
Use 1/2 the amount of herbs!
Early Child Stage
3-5 years old (or 3-7 depending on source)
Not a lot of hormonal or gender differentiation.
Can do Tui Na
Give herbs to kids
Development of teeth an important indicator. Give Liu Wei Di Huang Wan if not developing.
School Age
7-12 in girls, 8-13 in boys
Primary teeth come in.
Continue to develop quickly. Brain development almost the same as an adult. More abstract thinking and communicating.
Give herbs directly. 2/3 the adult dose after age of 6 until puberty.
Pediatric Tui Na applicable.
Puberty Stage
Could start anywhere from 10 to 14 for girls and 12-16 for boys. Goes all the way to 18 in Alberta.
In TCM it is 14 for girls and 16 for boys.
Girls at 14, Ren Mai will flow same as Chong Mai. Menses will start.
Boys at 16: Kidney Qi will rise, Tian will be produced and they can ejaculate.
Tian Gui is the Heavenly Essence that allows puberty to happen. It is a substance of the body triggered by Kidney Qi, helps or promotes development of the body. It is related to hormones and the pituitary gland.
All the changes of puberty, menstrual cycle, reproductive functions beginning.
Herbs given in the same ratio as for adults.
Acupuncture is applicable and Tui Na.
Liver Qi Stagnation and mental/emotional issues more prevalent.
What are the two main statements about Pediatric physiology?
- The organs are tender and not well formed.
- Children are full of vitality and rapidly developing.
Explain what it means that “Organs are tender and not well formed”?
- The Zang Fu are not fully developed yet, particularly the LU, SP and KI. They cannot function fully.
- You cannot prescribe the same amount of medicine as for an adult.
- Kidney Qi is in charge of pushing forward the development of the body.
- Qi of the organs is always deficient. There is not yet enough essence, qi, blood, body fluid, marrow, muscle etc.
Wu Ju Tong?
Explain what is meant by “Full of vitality and rapid development”.
There is rapid development in terms of function and physiology.
The constitution of pediatric patients before 3 years old is Pure Yang (proposed by Fontanelle Classic).
What does it mean that children are Pure Yang? What kind of disorders are they more prone to?
We can see their yang nature in the fact that they are energetic, always moving like puppies! The disease state and type of disease will also change rapidly because of this yang energy. These patients can recover quickly but they also contract disease easily as they are vulnerable to external factors.
In terms of clinical practice significance, we see that these patients are prone to heat related disorders like fever, nose bleeds and irritability. They will experience a lot of wind-heat syndromes, phlegm, and rashes. Particularly the Heart and Liver will be in excess and affected by heat. Heart is the fire of the body so the extra heat and yang will affect the heart. You can also have Liver Qi Stagnation transforming into fire. Wood generates fire, further contributing to this excess. This explains why their emotions are always switching as their yang nature creates heat in those organs. Irritability manifests in screaming temper tantrums, but this can quickly switch to crying or laughing. In clinical practice then it is important to think about sedating the Heart and Liver. Some cases will also require tonification of the Spleen, Lung and/or Kidney as the qi of these organs is drained by the demands of development.
Give examples of illness that children are prone to because of deficiency?
Lungs are deficient so you will see respiratory problems like asthma.
Spleen is deficient so you will see digestive problems like vomiting and food stagnation.
The Kidneys are deficient so you may see problems related to development and fast consumption of Kidney Qi and Yin leading to night sweats.
What is the main difference in diagnosis between adults and pediatric patients?
- Their physiology is different so we will have a different lens and focus while asking questions.
- Need to visualize rashes and fontanelle and ask parents what the genitals look like.
- We use the index finger instead of the radial pulse.
- For auscultation we need to feel the fontanelle and the abdomen.
Why do we check the index finger instead of the radial pulse in children?
The pathway of the lung meridian goes to the index finger. The lung meridian controls the 100 vessels so all of the organs will be reflected here.
What are some major categories to consider when thinking about pathogens that will affect children?
- External pathogens
- Breastmilk and food
- Issues of heavenly essence
- Emotions
- Accidents (burns, poisons, falls, broken bones)
- Remember that most of the 6 EPF’s will evolve into heat because of Yang nature
What categories pertain to Heavenly Essence?
Genes
Spiritual/Sexual life
Habits
Overwork
Emotions
What diseases might be related to the Kidneys?
For children, neurodevelopmental disorders like ADHD and autism.
For seniors it might be neurodegenerative disorders like Alzheimer’s and Parkinsons.
Wind trembling and dizziness is related to?
Liver
Most pain, skin rashes and ulcers are related to?
Heart
Most damp edema and abdominal distention are related to?
Spleen
