Xingui Yang and Sen Lin
Abstract:This article focuses on discussing pediatric constipation. In pediatric tui na for the treatment of constipation it seems life the disease is in the large intestine, yet, the key to the pathology is actually disharmony in the functions of the child’s organs, such as the spleen, stomach, lung, and liver, and a breakdown of large intestinal conveyance. These factors, in combination with children’s typically low intake of green vegetables, fruit, and water, this causes pediatric constipation, which is primarily treated clinically using simultaneous supplementation and drainage tui na manipulation techniques. The main treatment principles employed are fortifying the spleen, harmonizing the stomach, moving qi, and freeing the stool, along with appropriate point prescriptions. These are the main treatment methods for treating pediatric constipation by solving the root cause of the problem.
Keywords:pediatric constipation, lung, spleen, liver, large intestine, pediatric tui na
Constipation is a common and frequently occurring pediatric illness. As living standards have improved, diets and lifestyles have changed, and there has been a gradual upward trend in the number of children with constipation. Pediatric constipation is a complex of symptoms that include loss of appetite, abdominal distention and pain, umbilical pain, restless sleep, and in severe cases possibly anal prolapse or anal fissure. It may cause the child to be afraid of passing stool, which will increase the abdominal distention and pain, and lead to emotional upset. It can have a negative impact on the child’s physical and mental health, growth, and development.
Children have unique physiological and pathological characteristics, therefore, tui na treatment for pediatric constipation is different from that used for adults. In adults one simply uses heat-clearing techniques, but this will often backfire with children. The author’s realizations, which are based on many years of clinical experience treating pediatric constipation, are as follows.
The causes and pathologies of pediatric constipation have been discussed extensively since ancient times by various experts. For instance, Youke Tiejing ［The Iron Mirror of Pediatrics］states: “The lung and large intestine contain heat; heat leads to a lack of fluids and blockage of stool”. Bai Wen ［One Hundred Questions］says: “Constipation is when there is heat in the interior of the lung, which flows into the large intestine to cause constipation and blockage; this is excess heat”. Chaoshi Bingyuan ［Chao’s Origins of Disease］ states: “In children with constipation, the cause is heat in the organs that overwhelms the large intestine. The stomach is the sea of water and grain; the essence of water and grain transforms into blood and qi, while the waste matter moves along the large intestine. If the triple burner and five viscera are not harmonized, hot qi will return to the large intestine. If the heat is in excess, then there will be constipation”.
In the field of modern TCM, it is believed that pediatric constipation is closely related to improper diet because children tend to dislike drinking water as well as eating green vegetables and fruit, in addition to other dietary irregularities. Since the spleen is the source of engendering transformation of qi and blood, it is the “root of later heaven” that sustains the life activities of the body as well as the transformation and engendering of qi, blood, and fluids. Therefore, since “the spleen is often insufficient” it causes food not be transformed into the subtle essences of water and grain to be absorbed and used by the body; water cannot be transformed into fluids to be absorbed as nutrients by the body and stagnates in the intestines, transforming into dampness and heat over time. Moreover, the spleen and stomach are the pivot of the qi dynamic’s upbearing and downbearing. The movements of the large and small intestines are controlled by the moving and transforming functions of the spleen qi; a disorder of the upbearing and downbearing of spleen qi in which the turbid qi fails to bear downward will cause constipation. The lung and large intestine have an interior-exterior relationship; if there is heat in the lung this can engender heat in the large intestine, causing the large intestine to fail convey the stool. Congestion of lung qi can cause disharmony in the upbearing and downbearing of the qi dynamic, leading to disordered intestinal function and constipation. The liver governs free coursing and it can regulate the qi dynamic throughout the body. It can promote the movement and transformation functions of the spleen and stomach as well as the conveyance function of the large intestine, and it aids the large intestine in excretion. In children, the liver is often in superabundance. The liver corresponds to wood, and it controls movement and upbearing. In chapter 8 of Su Wen ［Plain Questions］, entitled “Treatise on the Arcane Book of the Orchid Chamber in the Spirit Tower”, the liver holds the office of general. Children tend to exhibit emotional instability and irritability. Because the liver governs free coursing, free flow, upbearing, and effusion, children who are spoiled by their parents may develop capricious and irritable personalities. Thus, if children do not get their way, they may start wailing or throw a temper tantrum, which can intensify the liver fire to the point of causing liver qi constraint that can transform into heat. Heat damaging the fluids causes disharmony in the intestines that leads to constipation. Because in children “the spleen is often insufficient and the liver is often in superabundance”, abnormalities in the function of these two organs in a child’s body can cause disease. Due to the liver’s excess upbearing and discharging, the yang qi rises up and restrains the spleen earth. The spleen was insufficient to start with; restrained by the liver, it loses its function of movement and transformation, causing pediatric constipation. This is why phenomena such as crankiness and poor appetite are commonly seen in children in clinical practice. Chapter 3 of Su Wen ［Plain Questions］, “Treatise on Vital Qi Connecting with Heaven”, says: “The yang qi, in extreme anger, will make the qi of the body move recklessly and blood will rush up to the head, causing the person to experience a sudden reversal ［of qi flow］. ” The movement of blood and the transportation and metabolism of fluids also depend on the upbearing, downbearing, and inward and outward movements of qi, so qi constraint and poor fluid transportation and metabolism lead to pediatric constipation. Therefore, in pediatric constipation, although the disease is in the large intestine, the pathomechanism has a close relationship with the lung, spleen, and liver that cannot be overlooked.
Tui na is performed using simultaneous supplementation and drainage; the main treatment principles are coursing the liver and rectifying the qi, fortifying the spleen, and harmonizing the stomach.
There are many causes of pediatric constipation, which are often diagnosed in folk medicine as heat, qi, or insufficiency, among others. When performing tui na, the manipulation techniques used include those that fortify the spleen, rectify qi, and nourish yin. In the past, most treatments focused on drainage methods, but spleen insufficiency is a physiological characteristic in children. From a young age, the author studied tui na with her uncle and started using drainage methods to treat constipation. When tui na was performed, patients would improve, but as soon as the manipulations stopped, they would relapse. This was mainly due to overlooking children’s spleen insufficiency, which caused the point prescriptions and tui na treatment to yield unsatisfactory results because they did not address the root cause of pediatric constipation. The author has combined the folk TCM diagnosis and treatment methods passed down from her uncle with the physiological and pathological characteristics of children, namely that “the spleen is often insufficient, and the liver is often in superabundance”. Pediatric tui na should supplement that which is insufficient and reduce that which is in superabundance. In clinical practice, one should use simultaneous supplementation and drainage manipulation techniques, with fortifying the spleen and moving qi as the main treatment principles. This has yielded ideal results in the course of treatment.
The basic manipulation techniques are summarized as follows:
In cases with repletion constipation: focus on clearing, supplementing, enriching yin, and unblocking the stool. Clear and supplement the large intestine1, clear the liver2, clear the lung3, supplement the spleen4, move water into earth5, and knead Erma6 and Yongquan ［KD-1］.
In cases with insufficiency constipation: focus on supplementing insufficiency and moistening the intestines to unblock the stool. Clear and supplement the spleen, massage Erma, supplement the kidney7, and massage Wailao8.
The combined use of these manipulation techniques will fortify the spleen without causing congestion, move qi without damaging it, clear heat without damaging the central burner, moisten dryness without creating greasy obstructions, and unblock the stool safely. This method can treat constipation without harming the child’s digestive system and can strengthen the digestive functions. It can be regarded as a gentle and effective new tui na treatment method for pediatric constipation.
Typical case
Hai, male, 1 year and 10 months of age, was treated on December 6th, 2011. Chief complaint: constipation with hard stool like sheep droppings. Glycerin enemas had been administered for 15 months. At times, he also had abdominal distention and pain, poor appetite, and restless sleep. The tongue body was pale red with white, greasy fur. This pattern is the spleen failing to move and transform, poor execution of the qi dynamic, and the large intestine failing to perform its function of conveyance. Therefore, tui na treatment focused on fortifying the spleen, harmonizing the stomach, rectifying qi, and unblocking the stool. The point prescription involved supplementing the spleen, moving Neibagua9, and clearing the large intestine. Initially, treatment was done twice a day; after 3 days, it was done once daily. After a week, Hai’s stool was completely normal and glycerin enemas were no longer needed.
In clinical tui na practice, pediatric constipation is relatively common. The majority of cases are due to improper feeding, dietary intemperance, or other diseases affecting the normal movement and transformation functions of the spleen and stomach. When these movement and transformation functions are in disharmony, the qi dynamic will not run smoothly. Therefore, when performing tui na, drainage should be combined with enriching yin to unblock the stool, and fortifying the spleen and harmonizing the stomach should be combined with moving qi to unblock the stool, treating the branch and root simultaneously. Using manipulation techniques such as supplementing the spleen, clearing heat and supplementing the large intestine, Bagua, and Banmen10 to treat pediatric constipation can yield results that exceed expectations.
Recurring common cold
Wang, a 5-year-old male, was treated on April 26th, 2015. He had experienced recurring common colds for 3 years, catching cold more than10 times a year. At the time of treatment, he had a cold with a fever of 38.5 degrees Celsius that had persisted for several days. His body was thin and weak, and his face was dull yellow in color. He also had sneezing, a runny nose with yellow mucus, coughing, decreased intake of food, and constipation. His tongue was red with yellow fur. His fingertips were purple and stagnant. This pattern is a subtype of wind-heat common cold. The treatment method was fortifying the spleen and diffusing the exterior evil. The treatment included opening Tianmen11, pushing Kangong12, kneading Taiyang, clearing Tianhe13, supplementing the spleen, clearing the liver channel, and clearing the lung channel. This was done once a day for 7 days as 1 course of treatment. The child’s symptoms completely disappeared; after continuous treatment for 1 month, his immunity improved significantly and he no longer experienced recurring common colds.
Night sweating
Li, a 2-year-old female, had her first intake on April 18th, 2015.
Clinical presentation: the patient would start sweating when she fell asleep, producing beads of sweat the size of soybeans, mostly on her head, face, and back. This had been occurring every day for more than 1 year. Western medicine was ineffective, and the child would not tolerate Chinese herbal medicine, acupuncture, or moxibustion, so she was brought to the tui na clinic. Accompanying symptoms included frequent low-grade fevers, listlessness of essence-spirit, and low food intake. The tongue body was pale red with thin white fur. Treatment principles were harmonizing construction and defense, nourishing yin, and clearing heat. Treatment involved supplementing the spleen channel, moving Bagua, Banmen, kneading Baihui ［GV-20］, supplementing the kidney, and kneading Shending14. After 1 course of massage treatment, symptoms gradually decreased in severity; after 3 courses of treatment, the patient was cured.
Pediatric enuresis
On July 5th, 2015, Chen, a 6-year-old male, was treated for nocturnal enuresis. His parents reported that every night he would wet the bed 2 to 3 times. His face was white, with a fatigued spirit and lack of strength. His four limbs were cold and he had a poor appetite.
The tongue body was pale with thin white fur. The treatment methods used were supplementing the spleen and kidney and securing the urine. The treatment used Baihui ［GV-20］, Renzhong ［GV-26］, supplementing the kidney channel, Sanyinjiao ［SP-6］, and Dantian15, once daily. After 1 course of treatment, the enuresis decreased in frequency. After 3 courses of treatment, the enuresis stopped and after 2 reinforcing courses of treatment, he was cured.
Pediatric anorexia
Wang was a 7-year-old female with a 3-year history of anorexia. Her body was small and thin, and her face was dull yellow in color. She liked to eat snacks. She had a runny nose with turbid mucus and phlegm, low food intake, thin stool, normal urination, and no issues with sleep. The tongue body was dull red with red sides and tip. The fur was yellow and geographic. The fingertips were purple and stagnant.
The treatment method was fortifying the spleen and harmonizing the stomach, enriching yin, and clearing heat. The treatment involved opening Tianmen, pushing Kangong, kneading Erhougaogu16, Taiyang, supplementing the spleen, moving Neibagua, kneading Banmen, and kneading Erma. After 3 days, the runny nose symptoms were basically gone and the geographic tongue fur had mostly resolved. After a final reinforcing treatment, the patient was cured.
Conclusion
In the clinical practice of pediatric tui na, we have found that the reasons why pediatric illnesses tend to recur are all due to parents’ giving an improper diet, and poor lifestyle, and clothing choices. It is said that health is “30 percent treatment, 70 percent maintenance”; parents’ care and maintenance is an important part of this. Children’s spleen and stomach are insufficient and weak, and their organs are delicate. If they eat too much, the spleen and stomach will be damaged, causing improper function of the spleen and stomach’s movement and transportation in the center burner, and obstructing the activities of qi and blood. Pediatric tui na treatment stimulates the channels and network vessels as well as acupuncture points to activate the body’s self-healing system and adjust organ functions, thereby achieving the ability to resist disease and fend off external evils. Tui na treatment can effectively replace medication and decrease the amount of damage that medication causes to the body, enabling more children to benefit.
Authors:
Yang Xingui is the president of the Zhang Zhongjing School of Chinese Medicine Research Institute in Henan province and a fifth-generation Yang TCM practitioner.
Lin Sen is a TCM practitioner and vice-president of the Zhang Zhongjing School of Chinese Medicine Research Institute in Henan province. Lin is also an assessor for China’s National Occupational Skills Testing Authority, a seventh-generation Lin TCM practitioner, inheritor of Huang Baoju’s Huang scalp acupuncture intangible cultural heritage, inheritor of TCM master and professor Tang Zuxuan’s academic legacy, and a practitioner of Han-Tang Five-Qi Five-Element acupuncture.
Translator’s Notes:
1. Clear and supplement the large intestine: in pediatric tui na, the large intestine point is the radial side of the index finger where the flesh of the palm meets that of the back of the hand. To clear the large intestine, push from the base of the index finger to the fingertip. To supplement the large intestine, push from the tip of the index finger to its base. Clearing and supplementing the large intestine means pushing back and forth from the fingertip to the base of the finger.
2.Clear the liver: in pediatric tui na, the liver channel is on the palmar aspect of the index finger. To clear the liver, push from the base of the palmar aspect of the index finger to the fingertip.
3. Clear the lung: in pediatric tui na, the lung channel is on the palmar aspect of the ring finger. To clear the lung, push from the base of the palmar aspect of the ring finger to the fingertip.
4. Supplement the spleen: in pediatric tui na, the spleen channel point is located on the pad of the distal phalanx of the thumb. To supplement the spleen, push along the radial side of the thumb from the tip to the base.
5. Move water into earth: use the moving technique (i.e. light, gentle, slow circular movements) from the kidney channel point on the palmar surface of the child’s little finger, across the ulnar side and root of the palm, to the spleen channel point on the palmar surface of the thumb.
6. Erma: this point is found on the dorsal aspect of the hand in a depression between and distal to the heads of the fourth and fifth metacarpal bones.
7. Supplement the kidney: in pediatric tui na, the kidney channel point is on the ulnar side of the palmar aspect of the little finger. To supplement the kidney, push from the fingertip to the root of the little finger.
8. Wailao (Wailaogong): This point is found in the center of the dorsal aspect of the hand.
9. Neibagua: this point is on the center of the palmar surface of the hand, and consists of a circle around the center of the palm with a radius equal to the distance from the center of the palm to the point between the inner 2/3 and outer 1/3 of the base of the middle finger.
10. Banmen: this point is located on the palmar surface of the hand slightly below the center of the flat pale area of flesh below the thumb.
11. Opening Tianmen: the point Tianmen is the straight line from between the eyebrows to the anterior hairline. To open Tianmen, alternate using the thumbs of both hands to push up from between the eyebrows to the anterior hairline.
12. Kangong: this point is the horizontal line from between the eyebrows to the end of the eyebrow.
13. Clearing Tianhe: this point is found on the center line of the flexor aspect of the forearm. It is a straight line from the center of the wrist crease to the center of the elbow crease. To clear Tianhe, push from the center of the wrist crease to the center of the elbow crease.
14. Shending: this point is found at the tip of the little finger.
15. Dantian: this point is located on the lower abdomen between 2 and 3 cun below the umbilicus.
16. Erhougaogu: This point (literally “protruding bone behind the ear”) is located within the hairline behind the ear, in the depression below the posterior border of the mastoid process.
