Pediatric+Cough

=Bronchitis - Cough - Ke Sou= Pelargonium sidoides extract (EPs 7630) reduces symptoms of acute bronchitis in adults (level 1 [likely reliable] evidence) based on randomized trial 217 patients aged 18-66 years with acute bronchitis randomized to EPs 7630 vs. placebo 30 drops 3 times daily for 7 days mean reduction in BSS at 7 days was 7.2 points with EPs 7630 vs. 4.9 points with placebo (p < 0.0001) Reference - Curr Med Res Opin 2007 Feb;23(2):323

insufficient evidence to recommend Chinese medicinal herbs based on Cochrane review systematic review of randomized trials evaluating Chinese medicinal herbs in patients with uncomplicated acute bronchitis no trials met inclusion criteria for review all trials included in earlier version of Cochrane review were excluded for not using a random allocation method 1 study with 300 patients reported that Huoke granules associated with shorter duration of cough, fever and sputum compared to penicillin and Xiaoer Shangfeng Zhike tangjiang syrup, but study lacked allocation concealment and blinding and trial authors may have conflict of interest Reference - systematic review last updated 2007 Oct 9 (Cochrane Library 2008 Issue 1:CD004560)

Bronchitis / Cough is due to lung Qi up surging, the Qi can't descend meaning the lung cannot complete it's descending function. It is mainly due to exterior pathogen invasion of the lung and the spleen. -External Causes Of Bronchitis: p132 and 133 -Flaws Wind Cold - Xing Su San: Zi Su Ye (Perillia), Xing Ren (Pinellia), Qian Hu (Pseucedani), Jie Geng (Platycodi), Gan Cao (Glycerrhiza), Chen Pi, Zhi Ke (Aurantium), Ban Xia (Pinellia), Fu Ling (Poria) External Wind Cold and Interior Heat -(fever, phlegm, …) Xing Su San Add - Huang Qin, Pi Pa Ye, Ban Lan Gen Wind Heat - Sang Ju Yin Lung Heat - Huang Qin, Yi Xing Cao Sore Throat - Xuan Shen, Shi Gan, Niu Bang Zi Phlegm - Gua Lou, Zhe Bei Mu, Ting Li Zi

-Internal Causes Of Bronchitis Phlegm Heat - Qing Jing Hua Tian Tang Phlegm - Dai Gu San High fever and very sore throat: Zhi Zi (Gardenia), Ban Lan Gen (Isatis) effectiveness Dr. So: Li4, Lu7, GV14, Bl12, 13, indirect moxa? Chest pain -Lu9 CV22, Ah si Chest, Lu5 St40 – retained long time Li11, Bl54 (40) Dry cough Triangular N L11 Herbs: Pong Fah, Hung Jao (red dates), - dry cough Pie Pah Yiet 7, Mih Yao? – honey dates, Duck egg - bluish, hard boiled

Case: 3 yo girl with bronchitis – green phlegm -10 weeks! and green goopy eyes. Fever 99, Waking with fits of coughing every night. High neutrophils, low lymphs = bacterial, high monocytes, did culture and sens – whooping cough? Mono negative. Respiratory tincture* with glycerinate – Vit C and Hydrastis, ElderberryC tablets Tickle points: St40, Lu5, CV18, CV22, ding chuan Heart teddy bear as good patient prize and xylitol gum.
 * Huang Qin, elder, thyme, yin chiao, yerba santa, hyssop, fennel, poplar, Jie Geng (Khella, coleus - asthma)

Khella : The whole fruit has traditionally been used to treat respiratory system diseases such as asthma, bronchitis, emphysema and whooping cough, as well as cardiovascular disorders, premenstrual syndrome (PMS), liver and gall bladder disorders and to stimulate diuresis. Its purported effect is related to its antispasmodic action on smaller bronchial muscles, coronary arteries and urinary tract tubules. Mid–East Herb

Differentiate Bronchitis With: Whooping cough and Pneumonia A. Whooping Cough - Pertussis“Dun Ke” spasmodic cough, intermittent, red face, may vomit at end of coughing episode. Organs Involved: ciliated respiratory epithelium of bronchi Who is most affected: infants and young children usually only severe < 1 9 cases of severe pertussis reported in infants < 7 weeks of age, 6 were fatal (Eur J Pediatr 2000 Dec;159(12):898 in Pediatric Notes 2001 Jan 4;25(1):1) in adults - causes persistent cough, often prolonged paroxysmal coughing attacks worse at night, dyspnea during coughing, tingling in throat; diagnosis highly suggested in cough > 14 days (J Resp Dis 1995;16(10):876, JAMA 1995 Apr 5;273(13):1044)

Incidence/Prevalence: kills up to 1% world's children, increasing incidence up to 25% coughs lasting > 1 week have been attributed to pertussis (Arch Intern Med 1991 Aug; 151 (8) 15% incidence in pertussis vaccine trial, 25% of about 5,000 episodes of cough > 7 days had pertussis confirmed by laboratory methods (Scand J Infect Dis 1999;31(3):281

Bordetella infections common, even in an immunized population; prospective study of 584 outpatients with paroxysmal cough seen at 32 health centers in Finland (where 98% population has had 4 doses of pertussis vaccine), nasopharyngeal swabs collected; 26.2% had Bordetella infection by culture or PCR (60.8% B. pertussis, 32% B. parapertussis infection, 7.2% both) (JAMA 1998 Aug 19;280(7):635) in Australia only 52% of infants aged 3 months to 5 years were fully immunized in 1995, 6,468 cases of pertussis reported in the first 10 months of 1997 (Australian and New Zealand Journal of Public Health 1998;22:17 in BMJ 1998 Sep 26;317(7162):894) incidence of pertussis may be much higher than reported; telephone survey of 2,020 parents of children aged 5-14 years, 22% reported children having cough lasting at least 2 weeks in preceding 12 months, 283 (14%) had additional symptoms meeting CDC case definition for pertussis; only 1.2% had physician-diagnosed pertussis (347 per 100,000), and only 29 per 100,000 based on reported cases in this age range, geographic area and time period (Respirology 2005 Jun;10(3):359)

increasing incidence in US increasing incidence in US in adolescents and adults from 1990 to 1996, although improvement in diagnosis and reporting is an important contributing factor (Clin Infect Dis 1999 Jun;28(6):1230 in Pediatric Notes 1999 Jul 8;23(27):105) average annual incidence in US from 1997-2000 was 2.7 per 100,000 population (MMWR 2002 Feb;51(4):73 in JAMA 2002 Feb 27;287(8):977), increased incidence mostly among adults and adolescents (J Watch 2002 Mar 15;22(6):44) increasing incidence among infants; cases per 100,000 infant population in US were 34.2 in 1980s and 51.1 in 1990s (JAMA 2003 Dec 10;290(22):2968) rate of hospitalization for pertussis among infants aged 6 months or younger in US per 100,000 live births increased from 64.7 in 1994-1998 to 77.9 in 1999-2003 (MMWR 2005 Oct 14;5(40):1027) cases reported to CDC were 1,730 in 1980 and 8,296 in 2002 (MMWR 2003 Dec 19;52(RR-17)JAMA

Pertusis is treated with TCM, but is not without risk. Vaccination changes rates of complication. The worst complication is anaphalaxis and brain damage, and even death. So it is good to weigh the protective evidence of vaccination vs the side-effects of the vaccine. We don’t actually know if vaccines have longterm health risks. The US congress created a Vaccine Injury Compensation Program. Uncontestably there does seem to be some risk. Since there is some risk, I tell parents to read mothering Magazine’s article on vaccines in 2004 -In the Wake of Vaccines -By Barbara Loe Fisher Issue 126, September/October 2004 –I personally don’t recommend vaccines unless parents are thoroughly investigated. Parents need to educate themselves.

TCM Pertussis: Spasmodic cough lasting a long duration followed by extreme inhale. Begins with wind cold or wind heat symptoms turning to heat which blocks the lungs. Cough is usually aggravated at night and has an incubation period of 1-3 weeks Chinese Medicine Treatment Of Whooping Cough: (Dyna Med P67) A. First stage: Mild fever, sneezing and runny nose (clear fluid) aversion to draft and chill, no perspiration, headaches, thin Mild wind heat: Sang Ju Yin: Sang Ye –Morus, Ju Hua, Lian Qiao, Bo He, Jie Geng, Xing Ren – Semen Armeniacae, Lu Gen -Phragmatis, Gan Cao Severe Heat: Ma Xing Shi Gan Tan Mild wind cold: Xing Su San Severe Cold: Hua Gai San

B. Second Stage: Spasmodic cough, thick pastier, phlegm which is not easily spit up, cough worsr at night, with a distinctive whooping sound at the end of a coughing episode, temporary relief is found with expectoration of phlegm and/or coughing up food r bloody phlegm T: Red with yellow coat, P: fast and slippery. Rx - Sang Bai Pi Tang ( Can add+ Ting LI Da Zao Xie Fei Tang) Sang Bai Pi, Huang Qin, Chuan Bei Mu, Ban Xia, Zi Su Zi, Xing Ren, Huang Lian, Shan Zhi Zi

C. Decline and debility stage: 1. Decline and Debility Stage – decrease in frequency and severity if coughing. Dry hacking cough, little phlegm, dry throat, and thirst T: Red with peeled coat P: rapid and thread Sha Shen Mai Dong Tang: Bei sha shen, Mai men dong, Tian hua fen, Yu zhu, Sang Ye, GanCao floating tight pulse 2. Feeble cough with thin phlegm, SOB, Tired, poor appetite, T: pale with a white coat P: rapid and weak Ren Shen, Wu Wei Zi Tang: Ren Shen, Bai Zhu, Fu Ling, Mai men dong, Zhi Gan Cao, Sheng Jing, Da Zao

Lung and Spleen Qi Deficiency - Ren Shen Wu Wei Zi Tang Lung Yin Deficiency - Sha Shen Mai Men Dong Tang Early stage - Acupuncture Common cold symptoms, Wind/Cold or Wind/Heat, cough starts, cough becomes frequent and worse at night P/T – expel pathogenic factors, promote Lungs function Acupuncture – hand Taiyin & yangming, Lu 7, LI 4, SJ 5, BL 12, ST 40 - fever- LI 11, Du 14 - cough- Ren 22 Spasming Cough stage Acupuncture – Lu 5, 6, 7, ST 36, BL 12, 13, Ren 17, LI 4 - blood in phlegm- BL 17, Lu 10 - nosebleed- LI 20, Du 23

Recovery stage -strengthen Lung and Spleen Acupuncture – hand Taiyin, foot yangming, BL 13, 20, Lu 9, ST 36, KI 3, SP 6, BL 43 (yuan) Alternative Treatment Methods tapping then cupping along Bladder meridian auricular- sympathetic, LU, bronchioles

Tonsillitis - slide 290

B. Pneumonia- Initial stage – Lobar Main symptoms - Fever, Cough, Shortness of Breath, Rapid breathing, Nostril Flaring. Severe - pale purple complexion. An external pathogen invades the body blocking the lung meridian and the lung is unable to disperse and descend. Lasting high fever, shortness of breath, nostril flaring Treatment Principle: Bai Hu Tang – clears heat Shigao 24g Zhimu- Anemarrhena 12g Jingmi –rice 15g Gancao 9g Jinyinhua – Lonicera (strengthen heat clearing ability) 18g Lianqiao- Forsythia 12g “ Gualou –Trichosanthes 15g Chuanbiemu- Fritillaria 6g (cough and asthma) Xingren- Prunus 9g (moisten – reducing cough and asthma) Lugen- Phragmitis Cirrhosa 30g – “

If pain in chest – Yujin –Tumeric 9g Lasting Fever – Huang Qin 9g, Huanglian 6g, Pugongying 15g, -clear heat and fever Constipation – Dahuang 6g, Mangxiao (powder infused last) 6g, Irritability & insomnia Zhizi –gardenia 9g, Suansaoren –Ziziphus12g, Fuling 12g Bloody sputum due to excess heat impairing blood vessel, add Baimaogen –Imperata 15g, and Baiji – Blebtilla Striatae12g Spontaneous sweating, soft voice, lassitude, Pale tongue, and weak pulse, due to impairment of lung qi caused by phlegm heat: Huang qi -9g Nightsweats, malar flush, 5 palms hot, red tongue, with sparse coat, thread rapid pulse due to impairment of lung yin caused by lung yin xu caused by phlegm heat. – Sha shen Glehnia 9g and Maimendong –Ophiopogon 12g

-Ban Xia Hou Pu Tang Decreases Pneumonia Mortality in Elderly One hundred forty elderly Japanese patients with dementia, cerebrovascular disease, Alzheimer's and Parkinson disease participated. Forty-seven patients were administered Banxia Houpu Tang and 48 took placebos for 12 months. No adverse side effects were documented in the group taking the herbs, and this group had a significantly lower incidence of pneumonia & mortality rate than did controls. Iwasaki, Kato, Am Geriatric Society. 1 December 2007; 55(12):203

Chinese Medicine Treatment of Pneumonia other formulas: Wind Cold: Fever with no perspiration, cough, SOB, no thirst, thin and white phlegm T: thin white greasy or greasy white - San Ao Tang With profuse phlegm: Lai Fu Zi, Ban Xia With Interior heat Da Qing Long Tang

Phlegm - Chen Pi, Lai Fu Zi Wind Heat – fever with sweating, thirst, cough, with sticky yellow phlegm: T: red, yellow thin coat P: floating and tight Yin Qiao San + Ma Xing Shi Gan Tang With severe cough and profuse phlegm: Gua Lu Pi, Chuan Bei Mu, Lai Fu Zi With heavy heat: Huang Qin, Zhi Zi, Yu Xing Cao, Ban Lan Gen With constipation: Sang Bai Pi, Zhi Da Huang

Phlegm Heat - Fever, restlessness, cough, difficulty breathing, nasal flaring, flushed face, thirst, the sound of phlegm in the throat, stuffy chest. T: red, yellow coat P: rapid and slippery Ting Li Da Zao Xie Feng + Wu Hu Tang With severe heat: Huang Qin, Lian Qiao With Profuse phlegm: Chuan Bei Mu, Tian Zhu Huang, Zhu Li With Purple lip and face: Dan Shen, Dang Gui, Chi Shao Yao

Toxic heat - San Huang Shi Gao Tang Yin Deficiency With Lung Heat – Tidal Fever night sweats, flushed face, red lips, dry cough without phlegm, T: Dry red, slim, no coat P: thread and rapid Sha Shen Mai Men Dong Tang With severe heat: Huang Qin With severe cough: Chuan Bei Mu With poor appetite: Shan Sha, Mai Ya Lung And Spleen Qi Deficiency – Low grade fever, comes and goes, pale face, spontaneous sweats, feeble cough, rattle sound in throat, fatigue, poor appetite, loose stool T: Pale, white phlegm P: thready Ren Shen Wu Wei Zi Tang

Heart Yang collapse – Somber, white face and complexion, cyanotic lips, SOB, cold limbs, restlessness T: Purple, white coat P: Faint, weak and rapid Shen Fu Tang Mu Jiu Ni Tang With Qi and Yin Xu: Sheng Mai Yin Blood Stagnation: Dang Gui, Hong Hua, Dan Shen Pathogens attacking the Liver with Delirium – High fever, agitation, delirious speech, spasms, tremor of the four limbs, teeth clenched tightly, eyes staring upward, neck rigid T: Dark, red P: Wiry, rapid Ling Jiao Gou Teng Tang + Niu Huang Qing Xin Wan