Introduction
During the pediatric rotation, teachers recommended beginner-level pediatric readings.
Related Information
Author: Ma Rong
Publisher: People’s Medical Publishing House
Publication Date: April 2013
Pages: 172
Price: 27.00 yuan
ISBN: 9787117169721
For details, see 李少川儿科经验集 (豆瓣)
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Excerpt
Section 1: Diagnosis and Treatment of Pediatric Cold and Fever
Pediatric colds and fever are common illnesses that occur throughout the year, especially in the winter and spring seasons. Generally speaking, the treatment is effective and quick; however, due to the immature physique and poor tolerance of children, even slight negligence in treatment may easily lead to complications. Therefore, accurate syndrome differentiation and decisive medication are necessary to skillfully manage the illness and avoid mistakes. Below is a brief summary of the experienced teacher’s treatment methods.
(1) Mildly pungent and slightly bitter herbs to disperse the exterior, bitter and pungent herbs to clear the interior
One characteristic of pediatric colds is that after contracting the six excesses (Liu Yin), heat easily transfers internally. The syndrome differentiation of the “six channels” and “three burners” is not as clear-cut as in adult colds. Once onset occurs, in addition to symptoms like fever, cough, nasal congestion, and runny nose, it often comes with red lips, irritability, and sore throat. Using only remedies such as “Sang Ju” and “Yin Qiao” usually results in minimal efficacy. Clinically, the teacher often uses a combination of Yin Qiao San and Da Chai Hu Tang, modifying them as needed, focusing on mildly pungent and bitter herbs, and bitter and pungent herbs that clear the interior, achieving satisfactory results. The usual formula includes: mint, mustard seeds, fermented soybean, roasted mountain gardenia fruit, forsythia, honeysuckle, Bupleurum, Scutellaria, pinellia, fresh reed root, bitter tuber, bitter orange, sixfold malt, and licorice. If constipation with abdominal pain occurs, add heated Jun (likely a typo for heated army?) and Magnolia bark, aiming to regulate the stomach and conduct the Yangming meridian to relieve constipation. If cough and asthma are prominent with turbid phlegm obstruction, add ephedra, apricot kernels, and raw gypsum to expel heat and clear the lungs for calming asthma. If fever persists and worsens in the afternoon, add Moutan cortex and Artemisia annua to cool the blood and nourish Yin. If there is a summer-heat pathogen mixed with dampness, causing epigastric distension and greasy tongue coating, add Agastache, Eupatorium, talcum, and Tokoro rhizome to aromatic resolve turbidity and clear damp-heat.
(2) Pathogenic factors lodged in membranes, continuous high fever; suitable to open membranes and clear turbidity
Besides the ease of internal heat transformation, pediatric colds often involve food accumulation transforming into fire and damp-phlegm obstructing the membrane source (moyuan). Clinically, besides persistent high fever, patients often show chest fullness and discomfort, restlessness, irritability or nausea, abdominal fullness and distension, thirst without desire to drink, red tongue with thick white greasy coating. The teacher often uses a modified Da Yuan Yin to open membranes and clear turbidity, gaining efficacy. Generally, the formula avoids tsaoko to prevent excessive pungency and dryness; red peony instead of Hang peony to avoid constricting Yin and retaining pathogens. The usual formula includes: mint, Bupleurum, pinellia, Scutellaria, Magnolia bark, betel nut, Anemarrhena, red peony, reed root, Artemisia annua, and Liu Yi San (six-one powder). For headache and aversion to cold, add Notopterygium and Fang Feng to disperse the exterior. For intense fire-heat, add honeysuckle and forsythia to clear heat and detoxify. For constipation, add heated Jun (again likely a typo) to eliminate bowel heat.
(3) Weak body exterior contraction with fever; should tonify Qi and support Zheng, expel pathogens
Children with congenital deficiency or acquired spleen-stomach disorder — such as premature birth, improper feeding, rickets, anemia, etc. — often suffer from continuous, lingering fever when contracting pathogenic factors. This is due to deficiency of upright Qi with lingering pathogens, leading to exterior pathogens being unable to be expelled. Clinically, patients often show no fever, no sweat, nasal congestion with heavy sounding breath, cough without sputum, fatigue, pale complexion with little luster. The teacher often uses a modified Qian’s Renshen Baidu San to benefit Qi, support uprightness, and expel pathogens, achieving good results. The usual formula includes: Codonopsis, Poria, pinellia, Angelica pubescens, Notopterygium, Chuanxiong, bitter orange, mint, aged tangerine peel, bitter tuber, Peucedanum, licorice. Clinical experience shows this formula not only is effective for weak children with external cold and fever, but also for cases of weak pneumonia unresponsive to antibiotics, as well as patients with prolonged diarrhea, metabolic disorders, and exterior symptoms — acting as a “reversing the tide to save the boat” effect.