TCM for ChildrenRobert Helmer, D.TCM September 1, 2015
As a practitioner of Traditional Chinese Medicine, one of my greatest achievements is the ability to provide relief for children suffering with illnesses. By using the TCM theories and treatments that have been established over the past 2,000 years, I regularly accomplish this goal. Including the health complaints of children, Chinese medicine provides great insight to many health problems that have not been satisfactorily addressed by modern Western medicine.
Pediatrics is one of the oldest specialties within Chinese medicine and dates from the early first millennium. Books written over 1,800 years ago contain chapters specifically related to pediatrics. Qian Yi was one of the earliest and most famous Chinese pediatric specialists and he lived in the Song Dynasty (approximately 900-1,000 years ago). Qian Yi wrote the first book solely devoted to pediatrics in Chinese medical literature. This doctor pointed out the unique characteristics of infants and young children and he introduced new methods of diagnosis and treatment based on those characteristics.
Since that time, there has been continuous development in the diagnosis and treatment of children’s diseases. This article introduces the reader to the basic concepts of TCM paediatrics including how to diagnose and treat a child using TCM.
WHAT IS TRADITIONAL CHINESE MEDICINE (TCM)?
• It is a style of Chinese medicine taught at 30 provincial medical colleges in China
• Over 2,000 years old – the oldest, continuously practised professional medicine in the world
• Used by 1/4 of the world’s population in 90 different countries
• Although partly based on folk medicine, TCM as a style is a highly sophisticated literate medicine
• Approximately 30,000 volumes of existing Chinese medical literature were written before the 20th century and thousands since then
• In addition, TCM journals in China publish 100,000 articles per year. Most of these articles are clinical audits on the effectiveness of certain treatments for certain diseases
• Treat and assess each person as a unique individual (not based entirely on a disease or symptom)
• Healing is based on the restoration of harmony and balance within the body
• TCM Forms of Treatment: Chinese Herbal Medicine, Acupuncture, Dietary Therapy, Exercise (physical and mental) and Tui Na (Chinese Massage)
• Pediatrics is one of the oldest specialties within Chinese medicine.
TCM AND CHILDREN
The last 100 generations of Chinese doctors have discovered various characteristics that are common in all children. Moreover, according to TCM, children are not just considered miniature adults but they are also believed to be immature both physically and functionally. Most common pediatric complaints are due to this immaturity. Chinese medicine states that because children’s bodies are immature and therefore inherently weak, they are susceptible to diseases that affect the lungs such as colds, coughs, allergies and asthma and the spleen (or digestive complaints) such as colic, vomiting, diarrhea, indigestion, and stomach aches. Furthermore, TCM doctors discovered that there is a close relationship between the lungs and spleen. For example, in clinical practice it is common for respiratory problems to either begin or be aggravated by faulty digestion due to an improper diet. Another observation paediatric specialists noted was that children easily and quickly return to health when the root of their illness is addressed.
DIGESTION AND DIET – THE KEY TO MOST CHILDHOOD HEALTH PROBLEMS
In TCM, the digestion is comprised of the spleen and stomach. There is a statement of fact in Chinese medicine that the “children’s spleen is insufficient.” This statement particularly applies to children younger than six years of age because this is the average age a person’s digestion matures. The immature digestion combined with an improper diet accounts for the most commonly encountered paediatric complaints including: colic, ear infections, eczema, cough, swollen glands, allergies and asthma. Because children’s digestion is weak, they have difficulty effectively separating the food they consume into “clear” (i.e. nutrients) and “turbid” or waste (i.e. urine and stool).
Normally, if the body is functioning efficiently, these separated nutrients are combined with the air we breathe to form qi (energy) and blood in the body. If the digestion is impaired or immature, the individual will not produce as much qi and blood and one implication of this is they will need to sleep more. This is evident in children, especially infants, because they require more sleep than adults. A weak digestion that is due to an inability to separate “clear” and “turbid” may also lead to an accumulation of “turbid” materials in the body. This accumulation takes place due to the immature digestion’s inability to excrete waste as efficiently as possible. This “turbid” material may collect in the stomach and intestines and affect their functioning, causing abdominal distension, stomach aches, constipation, diarrhea and/or vomiting. When this “turbid” substance accumulates in the body, it is referred to in TCM as dampness and ultimately phlegm when congealed. If dampness is present in the body, it may manifest as diarrhea, vomiting or skin conditions such as eczema.
Phlegm is therefore a byproduct of a weak digestion. However, once it is produced, it has a tendency to accumulate in the lungs. This is supported by the statement of fact in TCM that says “the lungs are the place where phlegm is stored.” According to TCM, symptoms of phlegm in the lungs include a stuffy or runny nose, sneezing, coughing and even asthmatic wheezing.
In summary, most of the commonly encountered pediatric diseases are either:
1. upper respiratory complaints such as cough, common cold, asthma and allergies which are indications of phlegm in the lungs or
2. digestive tract complaints such as colic, diarrhea, stomach aches and vomiting which are caused by a weak digestion.
Since phlegm is a byproduct of a weak digestion, one can say the root of all the above mentioned health complaints is a child’s immature and therefore faulty digestion.
In terms of preventing and treating health problems in infants and children, diet is extremely important (for more information see Dietary Therapy below). Regardless of the treatment chosen, most children’s diseases should surround regulating and strengthening the digestion.
TCM DIAGNOSIS OF (BABIES AND) CHILDREN
Upon the child’s initial visit, the Chinese practitioner will try to determine the following:
1. Whether the child is abnormally hot or cold
2. Whether the child’s qi is sufficient or deficient
3. Whether there is some substance that needs to be eliminated from the body.
A thorough examination by a TCM doctor includes observation, listening/smelling, palpation (i.e. feeling) and questioning (the child and caregiver). Observations include looking at the child’s eyes, tongue, skin color and the vein at the base of the index finger (when less than three years old) to determine whether the disease is; hot or cold, replete or vacuous, how far it has progressed and how serious the condition is.
As well, the practitioner will listen to the quality of the child’s breathing, voice and speech. Smelling includes asking the parents whether any of the following are abnormal in smell: stool, urine, breath, etc.
The palpation aspect of the examination includes feeling whether the child feels hot or cold, has a firm or distended abdomen and the pulse in a child more than three years of age. Ultimately, the most important aspect is the questioning of the child’s past medical history including their main complaints. Some questions are the same as a Western doctor might ask while others are specific to Chinese medicine. Questions include: When did the illness begin? What are the main symptoms? How is your child’s appetite, energy, mood, sleep, phlegm? What treatments have you tried and what treatment is your child currently on?
COMMON TREATMENT METHODS FOR CHILDREN
In TCM, there are four primary methods of treating children (and adults): Dietary Therapy, Chinese Herbal Medicine, Chinese Pediatric Massage and Acupuncture.
• Chinese Herbal Medicine
Chinese Herbal Medicine is one of the most sophisticated herbal medicine systems in the world. Typically, combinations of more than 10 ingredients are used in formulas correlated to an individual’s pattern of disharmony. The formulas are crafted together to act synergistically and every ingredient is designed to accomplish a part of the overall process of restoring balance.
Chinese herbs include roots, barks, fruits, berries, twigs, stems, leaves and flowers from the plant kingdom. As well, Chinese herbs may also encompass ingredients from the animal and mineral kingdoms. Chinese herbal medicine is great for both the preventive and remedial treatment of illnesses. There are a number of formulas that have been used by Chinese doctors for 2,000 years to improve the general health of children. Preventive herbal formulas may be used to inhibit chronic or recurrent tonsillitis, ear infections, cough, asthma etc.. The dosage and type of formula is modified as the person’s illness changes.
There are a number of ways that Chinese herbal medicine can be dispensed for children. There are pills, powders, tinctures and teas. Any liquid form of Chinese medicine may be conveniently and effectively administered via an eye dropper. When prescribed and dispensed by a qualified practitioner of TCM, Chinese herbal medicine is safe with few or no side effects.
• Dietary Therapy
Seeing that digestion plays such a pivotal role in the health and well-being of infants and young children, their diet is extremely important in preventing and treating the most commonly encountered children’s diseases. The same diet that the average parent in Western society has been led to believe to be healthy for infants and children can be problematic according to TCM. Most pediatric diseases can be either completely eliminated or markedly improved if a child’s diet is modified.
Human breast milk is the single best food for babies and is the right consistency and temperature. Breast milk has too many benefits to list in this short article, but is well known to lower the incidence of many diseases including asthma, eczema and allergies to name a few. When children are overfed, their stomachs and spleens are inundated with more food than they can efficiently handle and this may lead to digestive system discomfort, such as colic. Feeding on a schedule and in smaller amounts can significantly decrease colic, earaches, coughs, and colds in young children.
Proper introduction of solid foods is an important stage in the child’s development and (if done properly) can prevent various diseases from taking place. Limiting sweets and dairy foods is also important for a child’s health. According to TCM, sweets damage the spleen (or digestion), while dairy products are too dampening. Fruit juices contain a lot of sugar and should be decreased or eliminated from the child’s diet. In general, the amount of sugar any child eats must be monitored by their parents. No child can eat whatever they wish and still remain entirely healthy. The majority of food a child eats should be cooked because cooked foods are easier for them to digest due to their immature digestion. Children should be fed whole foods with a high percentage of vegetables, fruits, grains and complex carbohydrates and smaller amounts of meats, eggs and dairy products.
• Pediatric Massage
Pediatric massage, or Tui-na, can be a highly effective modality for treating commonly encountered pediatric diseases. It is gentle, safe and without side effects. Chinese pediatric massage is specifically designed to prevent and treat pediatric disorders and uses specialized techniques and pressure points that are particularly beneficial for children. Chinese pediatric massage is useful for treating children up to eight years of age. However, the younger the child is, the more effective pediatric massage can be.
There are certain combinations of specific massage techniques for the purpose of rebalancing particular patterns of disharmony within the child. Usually, a Chinese pediatric massage treatment will last 20-30 minutes and most techniques are performed while the child is clothed. The frequency of massage depends on whether the condition is chronic or acute. Pediatric Tui-na is soothing and relaxing for the child and does not cause pain or discomfort.
Moreover, there are specific massage techniques that may be used to strengthen the child’s immune system. Parents can also learn basic Tui-na massage techniques to use with their children at home. Massage is a great way to care for your child and is also an excellent way to bond with them.
In general, acupuncture is not often used in the treatment of children especially under six years of age. In TCM, the primary modalities used in pediatrics by the Chinese doctor are herbal medicine and massage. Acupuncture may be used in treating serious or emergency conditions. It is important to understand that the needles used in acupuncture are extremely fine (as fine as a strand of horse hair) and rather painless when compared to the hypodermic needles used in modern medicine.
To lessen any anxiety that may accompany a child’s first acupuncture treatment, the acupuncturist may use acupuncture points on the child’s back that are out of the child’s view. Others stimulate the needle for a moment or two after insertion and then immediately remove it in comparison to adult patients where the needles are left in for 20-30 minutes. Also, fewer needles are used when treating children with acupuncture in comparison to an adult with a similar condition.
• Other Modalities
In TCM, other modalities that are occasionally used with children include herbal washes, creams, ointments, plasters, eye, ear and nose drops, inhalants, cupping and moxibustion.
Moxibustion is the burning of a dried herb on, over or near various acupuncture points of the body. This form of treatment is mainly used to warm up areas of the body that are too cold or to strengthen specific organs of the body. Moxa is often used to treat vacuous and deficient conditions. The area where moxibustion is used becomes slightly red and warm to the touch but is not painful and does not blister or burn. Children often find this procedure quite relaxing and calming.
Regardless of the form of treatment that is chosen, it is important to remember that children’s health can change at a faster rate than adults. In most situations, the amount of treatment needed for a child is not as extensive as what would be required for an adult. However, when treating children, their condition must be looked at with special care and clinical visits should be made at smaller intervals.
Unlike modern medicine, TCM pediatricians believe early treatment is important in all situations. Early treatment reduces the length of treatment needed and prevents any further complications. Other recommendations to prevent illness in TCM include making sure your child receives adequate rest, exercise and fresh air. Ultimately, no child can flourish and be truly healthy in body and mind without a great amount of love and support. Appropriate boundaries also need to be clear and consistent in order for a child to be well-balanced and well-adjusted.
Antibiotics are a very valuable component of modern medicine when used correctly and in moderation. The problem is that antibiotics are regularly over-prescribed and erroneously prescribed for conditions they do not treat. Antibiotics should be used if there is a truly serious and potentially life threatening situation. The problem can be found in that although antibiotics kill disease producing bacteria, they also kill off the good bacteria in the body upon which our health is founded.
According to TCM, antibiotics are “very cold” in nature and easily harm the digestion. Since antibiotics harm the digestion and a child’s digestion is already immature, they can aggravate and cause many diseases. Signs of antibiotics harming the digestion include loose stool, gas, diarrhea and abdominal distension. According to TCM, the spleen (i.e. digestion) is associated with the production of energy in the body, and if it becomes weak, it may lead to fatigue, cold hands and feet, reduced appetite, pale or sallow complexion, weak immunity and increased dampness and phlegm. Therefore, wrong or overuse of antibiotics may lead to a damaged spleen with repeated susceptibility to diseases such as ear infections, tonsillitis, various allergies and an abnormal production of phlegm and mucus (i.e. colds, coughs and asthma).
If an individual has a strong digestion, they sometimes can be treated with antibiotics and return to a normal level of health without side effects or lingering repercussions. Those with a weak digestion such as young children or those who have used antibiotics repeatedly have weakened their spleen further thus infections reoccur. Ultimately, more antibiotics are given to treat the reoccurring infections and the cycle continues to repeat itself. Research demonstrates that viral infections are more common in children than bacterial infections (that antibiotics treat) and TCM’s ability to treat viral infections indicates another reason why TCM should be used in children’s health instead of antibiotics.
Antibiotics should only be used when truly necessary and if there is an infection or other health problem, one should first try a milder, less drastic method of treatment, like Chinese medicine. If these treatments do not work (which they usually do), the child’s condition is serious or there is the likelihood (not just the outside chance) of serious long-term damage, then yes, that is the time that antibiotics are truly and correctly warranted.
TEN CHILDREN’S HEALTH PROBLEMS THAT TCM CAN TREAT EFFECTIVELY:
3. Eczema and other skin problems
5. Hyperactivity (i.e. ADHD, ADD, etc.)
6. Digestion problems (i.e. colic, constipation, diarrhea etc.)
8. Ear infections
9. Common cold
10. Strep throat and Tonsillitis
The various modalities (herbal medicine, acupuncture, Chinese massage and dietary therapy) of TCM have been providing children with solutions to their health problems for more than 2,000 years. This form of Asian medicine, is the oldest and second largest medical system in the world today and is used by one quarter of the entire world’s population. Unlike modern medicine, this time-tested professional medicine treats and assesses each person as an individual (not based entirely on a disease or symptom). Traditional Chinese Medicine is a noninvasive healing modality that facilitates the body’s natural ability to heal itself by restoring harmony and balance to the entire individual.
With regard to children’s health, Chinese medicine provides great insight into many health problems not addressed completely or satisfactorily by modern Western medicine. Paediatrics is one of the oldest specialties within Chinese medicine and dates from the early first millennium. Since that time, there has been continuous development in the diagnosis and treatment of children’s diseases. This article has introduced the reader to the basic concepts of TCM paediatrics.
TCM (more often than not) is superior to modern medicine in the treatment of chronic diseases. The diseases discussed in this article are good examples of where Chinese medicine can offer substantial clinical benefits to patients who have been unresponsive to other forms of treatment. The TCM treatment of these diseases have less side effects and unlike modern medicine, are curative not palliative, as they aim to eliminate the pathology of the disease instead of controlling or suppressing the symptoms. In most chronic diseases, Western medicine at best can only temporarily alleviate the symptoms of these diseases using various medications. However, in addition to the lack of effectiveness of these treatments, there are also possible side effects of repeated or long-term use of these medications.
Any long-term treatment of disease has to have properties that will make the user want to continue using it. That means it must be:
• Effective and provide relief of symptoms
• Safe, with few unwanted side effects
• Easy to use
When prescribed appropriately, TCM accomplishes the above criteria. From my experience, the compliance of taking the Chinese herbal medicine in children depends on the method of administration and the encouragement of the parents for their child to continue taking their medicine.
The information included in this article is very empowering for parents of children who are unwell because it provides them with the hope that there is a solution to their child’s illness, thus, no need for their child to suffer any longer. Compared to modern medicine, TCM is user friendly, gentle and free from side-effects, therefore, making it an excellent choice for keeping children healthy. In addition, the child will be able to avoid many of the downfalls of modern medicine and prevent future illness through the use of this time-honoured tradition.
Robert Helmer graduated from the Institute of Traditional Chinese Medicine in 1998 and several years later became the first person to specialize in the treatment of children in Ontario, using TCM. Robert is a well-respected teacher, author, and practitioner of Chinese Medicine. His post-graduate studies and work in pediatrics led him to work in China (on four occasions) as well as in England, Germany, U.S., and Canada. For more information, please contact him by email at email@example.com