Pediatric Acupuncture

367 Pages·2002·20.88 MB·English

by  May Loo

With love for my daughters Alyssaand Alexandra,
and my aging Mother
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I
Foreword
Asconventional medicine moves into the 21st century, consumers can expect a
variety of changes that will both improve and move healthcare to an exciting
and new plateau. Sophisticated technologies exist for evaluating brain
(dys)function duringspecifiedbehavioral tasking. Synthetically produced medi
cations are beingtested inarange ofareas, from keepingarterial shunts open to
enhancing neuronal synaptic capabilities and potentially reversing dementia.
Along with these changes, however, also comes another kind of medicine that
has its origins dating back thousands of years. It encompasses a multitude of
techniques that havecome under various descriptions including "holistic, alter
native, complementary, naturopathic or botanical medicine". Many therapies,
which are part of theselarger categories: a) are increasingly utilized bypatients
both in the USAand abroad; b) are being reimbursed by insurance companies;
c)are the subject of much discussions bygovernments throughout the world
interested in providing optimal healthcare to their constituents. One such ther
apy technique, medical acupuncture, is the feature of this book. The patient
population discussed and reviewed-ehildren-presents a unique opportunity
to begin to better understand at a clinical and more importantly an integrative
level,ways for healthcare and medicine to provide for a more balanced, thor
ough and potentially efficacioustreatment opportunity.
Historically acupuncture has been used for many medical conditions. Until
recently it was lessimportant to understand how or why it worked than it was
to report on its usefulness, including patient "satisfaction". With the advent of
modern medicine pushing for a more focused scientific-evidence base, a chal
lenge has gone out to all therapies, both conventional and non-conventional,
essentially to prove that they deliver what they say they can-efficacious out
comes-along with an eyetoward cost and safety issues.Although it has been
difficult understanding how sticking a needle in the skin (and potentially acti
vating and driving a so-called energy force of "Qi" to balance dysfunctional
systems) might relate to Western healthcare, pre-clinical research iscurrently
demonstrating that this stimulation isin fact activating specificbrain pathways
and centers that have their connections with the autonomic and peripheral
nervous system(s)-areas directly relevant and tied to much of medical physiol
ogy.Thus, acupuncture issimply more than just folklore or a "placebo acting
event"; severalrespected research conferences at NIH have lent scientificcredi
bilityto and suggested acupuncture's usefulness in treating specificmedical dis
orders such as nausea and pain. Noteworthy though, there will always be a
recognizable and ongoing debate between Western scientists who demand that
any clinical procedure beproven through a large number ofpatientsenrolled in
clinical trials and those Eastern clinicians who stress the larger importance of
tailoring treatment(s) to the individual. Bothgroups need to listen to and learn
from each other. Medical programs such asthe one at the Universityof Arizona
now formally teach many of the same principles of integration that are
viII Foreword
reviewedin this book. Conventional medicineisaware that accommodation is
not enough. With evidencenow accumulating thatacupuncture aswellasother
"alternative or complementary" techniques can be "proven" to be medically
helpfuland safe,allopathic physiciansand healthcare providers are goingto be
required to understand its basicprinciples iffor no other reason than to make
sensiblereferrals. Today's consumer ismuch more health-driven and expects a
degree of sophistication on the part of their provider that all tools are readily
made available to maximizethe deliveryof good and complete healthcare. But
beyond sophistication alsoliesasecond importantgoal ofproviding for amore
ethnically focused medicine, sensitive to all patients' healthcare concerns and
needs.
Against this backdrop Pediatric Acupuncture by May Loo MD has just the
right balanceofdescriptors ofconventionaland Chinesemedicine.Allchapters
are well organized and easy to follow. Chapter 7 on "Pediatric acupuncture
modalities and treatmentprotocols" isespeciallyimportant becauseitaccurate
lydetails information about acupuncture needles,and associated techniques of
electricstimulators, magnets, and lasers along with the current position of the
Food and Drug Administrationtoward usage.Also,the sectionon dietary man
agement eloquently describesthe important bridge between health and preven
tion as viewedfrom two different cultures. Providers should consider carefully
the usefulness of much of this material for integrative potential in their own
practices. There is presented throughout the book the important distinction
betweenWestern and Chinese medicinecomponents and the ways they should
beviewedin the context of the total medical-diagnostic-treatment continuum.
The tables and figuresclearlyillustrate easy-to-follow information, linking tar
getorgans and acupuncture points sothat the healthcare provider haseasy-to
visualizepictures ofsometimesdifficulttextual descriptions.
Who says that "East is East and West is West and never the twain shall
meet"? This book provides a resounding "No." Rather, conventional and
Chinese medicine can and should when clinically necessary use each other's
strengths. One example of co-integration and utilization of acupuncture with
allopathic medicinecould be the example of reducing dosage of medication (to
avoid or reduce unwanted side-effectsincertain patients) or the tapering down
of medication dosage and its eventual replacement with acupuncture for
continuation oflastingtreatment benefit,cost, and safety.Or, insome patients,
simply using acupuncture as appropriate, standard care. The seminal goal still
remainsto maximizetreatment benefit.
Pediatric Acupuncture should be in the library and used byany dedicated
physicianor healthcare provider interested ingivingthe bestand the mostcom
plete quality of care to patients. It will be a relevant addition to any medical
practice as well as to students learning more about a "new" and "old" but
importantcomponentof healthcare-integrative medicine.Ihighlyrecommend
this book for such purposes.
John Spencer
Acknowledgements
With thanks to my many teachers, East and West, who have imparted their
knowledge and wisdom; to Gail Wright and Inta Ozols for their patience and
support; and to my sister Margaret for her help with the innumerable refer
ences.Thanks to myfamily for their love, which sustained me throughout the
writing ofthe manuscript.
1
Introduction
Look, it cannot beseen,itisbeyond form.
Listen, it cannot beheard, itisbeyondsound.
Grasp, it cannotbeheld, it isintangible.. .
It iscalledindefinable, and beyondimagination.
Stand before itand thereisno beginning.
Follow itand thereisno end.
Stay with theancient Tao, move with the present.
Knowing theancient beginning isthe essenceofTao.
Tao TeChing-Lao Tsu
Chinese pediatrics isan ancient healing art that was mentioned as early as the
first century Be in the Nei ling (The Inner Classics). The roots of Western
pediatrics were planted in the writings of Plato and Aristotle, but it
was not until the twentieth century that pediatrics became a major subspe
cialty. Chinese treatment of children continues to follow the teachings of
Traditional Chinese Medicine (TCM), based on the Taoist view of man as a
being of nature that follows the laws of nature. The child, as the adult, is an
individual, whole entity consisting of energetic, physical, emotional, and spiri
tual beings. So many of those beings have no solid form, cannot be seen or
heard with even the most sophisticated technological instruments. Western
pediatrics, together with Western medicine, has made phenomenal scientific
strides and uncovered massive informationon the bioanatomicand biochemical
aspects of children. This knowledge engendered a more segmental view of the
child, as pediatrics branches into over a dozen subspecialties, each focusing on
one physical aspectof the child.
This book is based on more than 25 years' experience in working with chil
dren. Having been trained both as a Western pediatrician and as a Chinese
medical practitioner, I have been able to appreciate the immense value each
school of healing has to offer. Although neither discipline has a complete pic
ture of children, their approaches complement each other. The purpose of this
book is to integrate Western knowledge and modern technology with ancient
Chinese wisdom for a more comprehensive understanding of the pediatric
population. Up-to-date evidence-based information isinterpreted in the light of
ancient concepts. Having had post-doctoral training in developmental pedi
atrics, I have also proposed an original theory of childhood development, inte
grating the teachings of Freud and Piaget with the FiveElements.
This book is intended for pediatric practitioners with training in either or
both TCM and Western pediatrics. The Chinese acupuncturistcan benefit from
learning Western factual information about children. The Western pediatrician
2 Pediatricacupuncture
can benefit from viewingchildren from anotherperspective, especiallyincondi
tions thatare bafflingto Westernscience.The MD acupuncturistcan seefor the
first time the integration of two major schools of pediatric healing. In order to
accommodate the diversity of readers, this book reviews the basic physiology
and pathophysiology of both Western and Chinese pediatrics. In addition, I
have learned in teaching MD and DO acupuncturists around the country, that
many of the basic concepts in Chinese medicine are difficult for the Western,
scientific mind to comprehend. Therefore, some of the chapters are written in
simple, easy to understand, less technical language; sometimes using simple
metaphors to help illustrate importantconcepts. In order to avoid the confusion
ofthe same terminology for the various organs,the Chinese organswill becap
italized. Illustrations of the meridians are included in the appendix. The reader
isencouraged to read more basic textbooks for background information, and
for description and location of acupuncture points.
When we "follow the ancient Tao, move with the present," we expand our
pediatric knowledge and pavethe way to raising healthier and happierchildren.
The Chinese medicine background information discussed throughout the
book isa composite of material obtained from the author's education and ex
periences, and from the "General and Chinese Medicine Texts and References"
list inthe bibliography on p. 346.
2 History of Pediatrics:
East and West
The treatmentof children has undergone evolutionarychanges in both Chinese
and Western medicine. Chinese pediatrics dates back several thousand years,
and has preserved many basic principles throughout the ages. Bycomparison,
Westernpediatrics isarelativelynewfield,but hasrapidly becomecomplexand
segmentalized with numerous subspecialties.
Pediatrics massage, Tui Na, was mentioned in the Neiling,l the classical
acupuncture textbook that dates to the firstcentury Be. However, children were
generally considered as adults until the Han Dynasty in the late 200 AD, when
medical textbooks began to include separatechapters on treatmentof children.
In the twelfth century Song Dynasty, 1031-1113 AD, the famous child special
ist, Qian Yi, wrote the first pediatric textbook that recognized children as
unique beingswith distinctive physiology and pathophysiology of diseases that
merit different diagnoses and treatment from adults.
During the Ming Dynasty in the fourteenth to the seventeenth centuries,
pediatrics flourished with formulation of specificherbal and acupuncture pro
tocols for children, and introduction of preventive measures. In 1534, Wang
Luan's You Ke Lei Cui (A Collection ofPediatric Cases) was a comprehensive
text that described the pulse, treatment principles, acupuncture protocols, and
herbal formulas for individual pediatric diseases. The distinguished imperial
physician, Xue Liang-Wu wrote Bao Ying Cuo Yao (Essentials for the Care &
Protection ofInfants) in 1556, which stressed the importance of adjusting the
dosage of herbal formulas for children according to their age and size. One of
themost famous MingDynasty pediatricians, WanMi-zhai, introduced prevent
ivepediatric measures, such as exposing children to sunlight and fresh air, pro
tecting them from being frightened, avoiding overfeeding them or giving them
too much medication.
During the last dynasty, the Qing Dynasty (1644-1911), many famous pedi
atric textbooks were written. Some of them are still being used as references
today: You Ke Liang Fang(Fine Formulas in Pediatrics) and Dou Zhen Liang
Fang(FineFormulas for Poxes & Rashes).
The twentieth century witnessed the publication of hundreds of pediatric
textbooks and the establishment of Pediatric Departments in TCM hospitals.
In 1999 and 2000, Iwas invited to lecture at the Xinhua Hospital in Shanghai
and the University Hospital in Beijing.I also had the opportunity to tour other
TCM pediatrics clinics and hospital wards. Iwas impressed by the preserva
tion of ancient principles in the evaluation of children, such as examining the
vein on the index finger to assess severity of illness. I learned about newer
treatment modalities for children, and was especially delighted at the integra
tion of Chinese and Western pediatrics. Some hospitalized children were
receiving Western treatments, such as intravenous antibiotics, along with
.. PedIatricacupuncture
acupuncture and herbs. Preventive pediatrics ispracticed following the ancient
wisdom of "winter disease, summer cure," so that seasonal conditions-such
as asthma-are treated during the summer before symptoms occur in later
months. In China and many other Asian countries, acupuncture is being used
to treat an entire spectrum of childhood illnesses, ranging from mild respira
tory ailments to neurological disorders such as cerebral palsy and autism.
However, pediatric acupuncture isonly slowly being introduced to Europe and
the United States.
Western pediatrics, on the other hand, is prevalent throughout the world,
even though it has a very short history compared to its Chinese counterpart.
While Chinese medicine began to recognize children as distinct from adults in
200 AD, Western medicine considered the child as an homunculus, a miniature
adult, until the 1920s. In 1934, pediatrics became a subspecialty and has been
growing at a phenomenal pace. Over a dozen subspecialties have been added
over the past three decades, including pediatric nephrology (1974), neonatal
medicine (1975), pediatric hematology and ontology (1974) and pediatric
gastroenterology (1990).2 Preventivemedicine remains the mainstay of general
pediatrics, with regularly scheduled wellchild visits, especially in the first two
years of life.The pediatrician monitors nutrition,growth parametersand devel
opmental milestones; performs routine physical examinations and laboratory
studies, and administersimmunizationsas the essentialcomponents during well
baby check-ups and physical examinations. Technological and medical
advances enable the early diagnosis of congenital and hereditary abnormalities
prenatally and shortly after birth, such as Down syndrome and hypothy
roidism; the resuscitation of tiny premature babies of only a few hundred
grams; and the prolongation of conditions that range from cystic fibrosis to
childhood cancers. The majority of "bread-and-butter" pediatrics consist of
treatment of viral illnesses, bacterial infections, and various skin rashes.
Although there are pediatric medications that are specific for children, with
incrementaldosagescalculated accordingto ageor body weight, the majority of
medications have very little data for young children under age 12. Dosages are
frequently givenas 1/2or 1/3ofadultdosages.
The increasingly stressful lifestyleduring the past decades has resulted inan
increased incidence of "adult" conditions, such as hypertension and depres
sion, in children. Complex neurodevelopmental conditions such as attention
deficit disorder often necessitate a multidisciplinary approach by the pediatri
cian, psychologist, behavioral and educational therapist. In spite of modern
technological advances and voluminous information about the physical aspect
of disease entities, many pediatric conditions continue to be puzzling to
Western medicine. Recent surveysindicate that alternative and complementary
medicine, including acupuncture, are gaining increasing acceptance in the
treatment of children.! This book hopes to introduce an integrative approach
to children, to combine bioanatomic and biochemical information with the
ancient wisdom of bioenergetics, for a more comprehensive understanding
of all aspects of children: the energetic, physical, emotional, and spiritual
aspects.