Thursday, March 1, 2012

Treating Children with Oriental Medicine

When I went through my academic training in Oriental medicine, pediatric acupuncture was neither mentioned nor offered as part of the curriculum, even as an elective. I discovered it quite by chance in the mid-1990s.
I have been treating children for five years, and teaching a pediatric acupuncture class for three. The following is a brief sharing of some very special experiences.
The first thing that amazed me when I started treating children was how simple it is. One of my first patients was a three week-old baby who came down with a cough after a long flight across the globe. The baby's parents had first tried homeopathy without results, and were about to take their baby girl to a medical doctor when they heard about me. I really hadn't had any experience, but I didn't see any harm in trying. I gave the little girl a shoni-shin session emphasizing the lung channel and booked another two appointments for the same week. It only took five minutes to perform the treatment on such a tiny baby. When the parents came back for the next session, they had noticed a marked improvement in the baby's cough. After the second session, the cough was completely gone. We did two more follow-ups and I assume there was no recurrence of the cough, since the parents did not come back to see me and referred many other parents with sick babies to me.
This could have been beginner's luck, but it did show me how fast and how well children can respond to that kind of treatment. It also gave me the chance to see many more children, and a lot more challenges with each case. Each challenge was also an opportunity for further digging and research in the field of pediatrics.
Through treating little ones, I became aware that most of the patterns we carry into our adult lives actually start at a very early age. Psychologists already have written volumes on the impact of emotional traumas in childhood, especially sexual abuse and violence. What they have not emphasized is that simply living in an atmosphere of constant neglect, stress, tension or conflicts can create traumatic experiences. These experiences affect the child emotionally, and each emotional pattern will in time affect the child physically. I've seen children as young as one year old suffer from major emotional imbalances.
These imbalances turn into the defense mechanisms we all develop in order to get what we want (or simply to cope with life). In terms of health, these defense mechanisms often lock us into reactionary patters such as "me against the world," which do not serve our well-being. These reinforce our sense of separation from the universe and tend to create tension, contraction and struggles. The attitude we adopt toward pain and illness is often a major contributor to the progression of an illness. When we feel at peace and at home within and without, we can relax and drop our guards. The qi then naturally flows smoothly and easily. By age three, a child's constitutional tendencies and personality are already in place, along with the type of physical ailments they will be prone to. Strengthening the child's own healing abilities in these weaker areas can make an invaluable contribution to their future health. Recognizing their strengths and respecting their limitations can offer both parent and child an opportunity for empowerment and self-discovery in their own natural state of health.
Treating children continuously renews my sense of wonder at this ancient art of acupuncture and how its principles are applied in practice. Of all people, children reflect most closely the theory of the five phases and its correspondences. Children are amazing examples of the dynamic balance of the law of yin & yang and its interrelationships. During the first two years of life, children's emotions are pure and uninhibited; hence, their qi flows freely and is readily accessible. In pathology, the symptoms they exhibit are always a clear reflection of what's going on inside. Of course, it's up to the practitioner to read those symptoms correctly. Small children cannot and do not need to tell us what's wrong. The brightness of shen in their eyes; the color on their face and body; the texture and temperature of their skin; and many other signs speak loudly for them. Feedback I've often received from students in my pediatric class or clinic is that they really get to see how acupuncture works because children respond so fast to treatment. Sometimes during treatment, or when the child comes back for a second visit, the changes are obvious and visible. If nothing has happened, I know that we didn't get the initial diagnosis right.
There are several different methods within Oriental medicine for treating children, such as TCM, shoni-shin or tuina. These modalities have one common denominator: they all speak about the differences between children and adults, especially in the first seven years of life. Understanding these differences is a must in successfully treating children. Children are not small versions of adults. Their energetics are totally unique due to the fact that their systems are still developing and in a constant process of growth. By age seven or eight, the child's meridian system is finally developed, and his/her personality is crystallized. Some classics say that only then can acupuncture needles that penetrate the skin be used on children without fear, although tuina or shoni-shin can still be very effective. In the teenage years, especially at the onset of puberty, one can no longer apply the principles unique to children.
In addition to the energetic differences between children and adults, another major difference that arises is the need to involve and educate the parents. You are treating through a third party. If the parent is your ally, the success rate of your treatments will be much higher. For example, making sure a child takes his/her herbs regularly is wholly dependent on the parent's willingness to administer them, even if it means forcing the child at times. Diet and lifestyle are often direct contributors to ill health. Making changes in these areas can be very challenging and might be at odds with the family's beliefs. Unless the parents see that what you're doing is creating a radical improvement in the child's health, they may not be willing to follow up with the many sessions it will take to truly bring a child back to health, especially in the case of chronic diseases.
Educating the parent and creating a good rapport with the child is indeed the first step. Next, you must decide on the modality to use.
Tuina, a form of Chinese bodywork, is a great healing tool for children who need to be touched. It is effective and nurturing in the management of many chronic disorders. The drawback is that it takes longer to administer treatment, and many children tend to be restless and impatient. Also, tuina's scope of practice is limited and not the treatment of choice for febrile or acute illnesses.
Shoni-shin offers a wonderful alternative. It is my favorite modality and truly works wonders for common respiratory and digestive ailments. Even if it can't help a child with a more complicated picture, it is still beneficial for the nervous system. It can enhance circulation and relaxation, thereby improving health in general. Shoni-shin is a form of bodywork that makes use of small metal tools designed to bring qi to the surface, help it move by "spreading" it along the channels, and stimulate specific acupuncture points. There are about a half-dozen different tools in a shoni-shin kit, none of which penetrate the skin. Children usually love holding the tool for you, or playing with the other tools you are not using, or trying to guess which tool you are using without seeing it. A shoni-shin treatment can be performed in 10 to 20 minutes depending on the age of the child and the severity of the illness. Even a very guarded or frightened child will usually warm up to the idea of shoni-shin, and many actually look forward to it as a kind of game that you, the doctor, are playing with them.
Using acupuncture needles is always a last recourse, but there are situations when it's absolutely necessary. Tuina or shoni-shin are not recommended when treating skin rashes or conditions where the skin is compromised. When the child is overly tired, restless or so hyperactive that he/she cannot sit still through a treatment, it is best to use needles. I try never to use more than two or three points per session, and there is no retention on the points for children under 10. For high fevers, bleeding tends to be the best modality; for cold situations, moxa therapy is a must.
Children are very sensitive to herbal products and supplements. Often, these should be the first choice of action at the onset of viral or bacterial infections, except for severe or emergency situations. One of the most common reasons for children to get started on a course of antibiotics is otitis media or strep throat. Stronger or luckier children will get better after the first course and move on, but many others will start a cycle of course after course of antibiotics because the infection refuses to go away, or more often goes away and then comes back after a few weeks or months. Enough has been written about the harm that frequent or long-term antibiotic use can do to the body. This scenario is present in the majority of cases I see in my practice. If the child has a weak digestive system, he/she also tends to develop all kinds of food or environmental allergies. After just one shoni-shin session, a change of diet and a few days of taking herbs, the change in the child's energy and facial color is often spectacular.
It is important to establish a good relationship with your little patients because you will have to treat them more often than grownups: at least two to three times a week for an acute disorder. Often, two or three treatments are enough to bring children back to health, as they respond quite rapidly to energetic treatments. In fact, if a child in an acute stage of illness has not responded positively within three days to whatever modality I'm using, I infer that he or she needs something else and refer out.
In the case of a more chronic illness, which is definitely the majority of our cases, the child should be treated once or twice week at the very least for two to three months, even if the child seems to be fully recovered after only a few sessions. Although it is somewhat of a hardship for parents to take the time to bring the child in, it should be impressed upon them that even if things change quickly on the outside, it takes time to re-establish the inner balance of the child and to strengthen his/her own ability to stay healthy.
In addition to the need for follow-up treatments, you have to make the parents aware of other factors that may contribute to the child's disorder. Dietary and emotional factors tend to top the list. Bad posture acquired from too many hours spent in front of the TV; video games or some type of electronic stimulation; and a lack of fresh air and exercise, play a major role in ill health. Parents not spending enough quality time with their children because of work constraints is another contributor to illness. Daycare facilities cannot replace the care and attention of a loving family member.
Although science and hygiene have helped us conquer many disorders, our nervous system has become a source of new ills because there is such an overload of sensory stimulation in urban settings and because the pace of living has become so hectic. Children, who are by nature more sensitive and vulnerable, are the most disturbed by the increasing complications of modern life. These and the other factors mentioned earlier have increased the incidence of stress-related pathologies in childhood, including ADD and hyperactivity. Because of the gentle balancing action the ancient art of acupuncture has on the emotional and physical body, this type of treatment can be a way to help children better cope with the many demands put upon their physiology.
Holistic medicine means integrating the spiritual, emotional, mental and physical aspects of our beings. When we treat children with Oriental medicine, we infuse them with the awareness that bodies and minds are connected. The mind drives the body. A peaceful mind allows the body to take the rest it needs when it needs it, allowing the body to regenerate and heal. For too many of us, the mind constantly remains on fast idle, even after we've turned off the engine.
I want to stress that it is not my intention to advocate Oriental medicine over Western medicine in the treatment of children. Both have their places and their limitations. Educating both practitioners and parents can increase discrimination of what form of care should be used and when. Western medicine is best for interventions in a life-or-death situation, emergency care, or very acute and severe disorders. It is the best, and can even be miraculous, when structural disorders or congenital malformations require a surgical procedure. For many common childhood disorders, stress-related pathologies or chronic conditions, however, long-term care with strong drugs or antibiotics tends to complicate the picture and undermine the child's ability to tap into his/her own reservoir of healing energy.
Treating children is not everybody's cup of tea. You need to enjoy being around them and their chaos. You need to be able to take yourself back to that place of innocence and irrationality where the mind hasn't yet learned to discriminate between fantasy and reality. It takes a special affinity to establish a rapport of trust with your little patient. Trust is essential for your treatments to have a lasting effect. When a child is closed, resistant, or simply says no to the treatment, you cannot use force or rationally argue with a child. You can only entice, coax or simply be patient. Children like to be seen and respected as individuals. When a child has already been hurt or their trust has been betrayed, he/she will be fearful and guarded. In this case, I may use the first session just to gather the necessary information from the parent and make contact with the child from a distance. This allows the child to check me out. The next time around, I can move closer into the child's space. However, most children are naturally open, trusting, uncomplicated and receptive. This is why it is such a joy to work with them.
It is my hope that more parents and practitioners will make the right inquiries concerning the treatment of children with Oriental medicine. Our journey starts from day one, and it's never too early to tackle health from a different perspective: a perspective that honors our connection with nature, respects the human spirit, and empowers us to take greater responsibility for our own well-being.

Pediatric Acupuncture - treating common childhood ailments

Treating a child with traditional Chinese medicine (TCM) therapies presents its own challenges and rewards. As Oriental medicine specialist Mitch Lehman points out, among the latter is the deep satisfaction of bringing families together to experience the power of childhood healing firsthand.

Some are sick. Some are gravely ill. Some are scared. Some are not only unafraid, but they’re quick to allay the fears of their parents. All are very young, and all come to have their symptoms soothed, or even to be healed.

For Mitch Lehman, L.Ac., treating children with acupuncture and other therapies from the practice of traditional Chinese medicine is more than carrying on a tradition that stretches back thousands of years. It’s a matter of being here now with a very young person who’s in pain.

“I have treated children going through chemotherapy, children with cystic fibrosis, and children battling ADHD and much more,” he says.

“I’ve been with kids who are facing very serious conditions. And what I’ve been part of, in terms of sharing in the experience of healing, has been amazing.”

It’s not that children come to Lehman’s clinic — Select Health of San Diego (www.san-diego-acupuncture.com) — anxious to get started with acupuncture or to taste therapeutic Chinese herbal concoctions. To the contrary, there’s a lot to overcome at first.

Getting Over the Hurdles

After 2,800 hours of school and 7,000 hours of clinical training, Lehman opened his own clinic in 1997 and has been in practice ever since. Today, his practice includes treating autoimmune disease
patients, fertility and gynecology, post-traumatic stress disorder and addictions, and, of course, pediatrics.

“My pediatrics instructor, Alex Tiberi, got his assistants deeply involved in working with children from the start,” Lehman explains. “He would mark the points for e-stim, and we would do the actual work hands-on.”

Pediatric acupuncture doesn’t jump right in with acupuncture needles. Instead, most pediatric patients start with e-stimulation, a process that uses small-voltage electrical stimulation at key acupuncture points. “You can’t start young children off with needles without a lot of preparation,” he says. “With young children, I usually begin with e-stimulation, which doesn’t hurt at all, and can even be kind of pleasant. Of course, e-stim doesn’t work with older children, so I gradually introduce the idea of needles to them — by using them on myself or on their parents, so they can see how we react to them. That gives them something tangible to go with.”

Building Trust

“A big challenge with pediatric patients is the fear of the unknown,” Lehman says. “We all deal with that, even as adults, but for a child it’s even more intense.”

Children and their parents come to Lehman and find what looks like a medical clinic. “They’re a little nervous, because they naturally associate medical clinics with not feeling good, or even pain,” he says. “So I find that I have to develop a rapport with the child, to build a sense of trust through my honesty and by showing the child that I respect his or her opinion and will respond to any needs.”

That means if it hurts, Lehman stops whatever he’s doing and proceeds more gradually. “Trust is something we keep building together,” he says.

Sharp Points

And then there’s that fear of needles. “I have to gauge their nonverbal reactions to the needles, too,” Lehman says. “I’m communicating that what I’m doing is a good thing for the child, so he understands that this really is good for him. And if it gets too intense, I’ll back off with what I’m doing and give him relief.”

One three-year-old Lehman treats has taken to calling the herbal formula Lehman prescribes for him “those yucky tasting herbs.” And they are certainly that, Lehman laughs.

“He’s right,” Lehman says, “but he takes it anyway, and he doesn’t make a big deal out of it.”

Tough Cases

One current case Lehman is working with is that of a 10-year-old boy with Tourette’s syndrome. TCM views Tourette’s as a “tremor-related” disease, as Lehman explains, in the same category with Parkinson’s and other conditions related to the concept of “wind.” “In Western medicine, Parkinson’s and Tourette’s have nothing to do with each other,” Lehman explains. “But TCM views them as being similar, and the treatment is thus similar.”

Tourette’s is a terrible, and often-misunderstood, disorder. Lehman’s patient is at that age when symptoms begin to intensify in most patients, and the prognosis is not good most of the time. Treatment is limited to strong prescription medications that carry harsh side effects. But Lehman and the patient’s family have worked closely together to forestall, at least, the need for medication. “At this point, his symptoms would be getting progressively worse without any treatment,” Lehman says. “But he’s actually stabilized in terms of symptoms.”

Lehman says the young lad isn’t crazy about the idea of needles, but he’s making adjustments as he goes. “Right now, I’ve got him using a couple of ear needles, and his parents are very involved in helping him maintain their use between visits. They are very involved in his care and have really educated themselves on all the nuances of dealing with Tourette’s.”

That gets to the heart of a concept central to TCM and Lehman’s practice. “I work as part of a team with my patients and parents,” he says. “Everyone is crucial to healing in TCM. It’s all interrelated — a part of who we are as family members, neighbors in towns and cities, members of communities, clients and vendors to each other, and so on. Interrelationship is at the heart of TCM. We all have to be doing what we are doing, and doing it in harmony.”

The Youthful Spirit of Healing

That’s what amazes Lehman about his young patients: They are very active in their own healing.

Lehman has even seen that in his sickest patients. “No matter what they are fighting — even kids with cystic fibrosis or cancer — they are still kids, and they want to be kids. I’ve seen even the sickest kids respond to the treatment with this spark of life, this vigor to really live. It is a joy to see that. So even though I can’t necessarily cure a child in a case like that, I can be a part of the effort to restore her energy and zest for living. That’s precious to each of us, whether we’re sick or well.”

Acupuncture aids Children's patients

Study confirms successful treatment of chronic pain
Despite the fact that acupuncture is widely practiced in the U.S. and more than one-third of pain treatment centers provide acupuncture as a therapy, it is used very rarely in the treatment of children. For the past two years, however, Children’s Hospital Boston has operated one of the most active pediatric medical acupuncture services in the country. And according to a recent, year-long study conducted at Children’s, the therapy has proven successful in treating chronic pain conditions without side effects.
Yuan-Chi Lin, MD, MPH, FAAP, director of Children’s Medical Acupuncture Service and author of the study, treats more than chronic pain. His clinic treats patients for, among other things, postoperative surgery and dental pain; sinusitis, bronchitis and asthma; gastritis, colitis, hiccups and constipation.
Traditional Chinese medicine explains the efficacy of this 3,000-year-old therapy by its ability to restore balance to “Qi” (pronounced “chee”) as it flows through a complex system of meridians throughout the body.
Research into the neurobiological process stimulated by acupuncture suggests that its analgesic effects rely on production of endogenous opioid peptides, such as the endorphins and enkephalins, and stimulation of the endogenous descending inhibitory pathways.
While acupuncture, which is performed by inserting special hair-thin needles into the skin at specific sites, doesn’t reverse the pathology of disease, it has proven tremendously helpful in managing illness. “The goal in my clinic is to decrease children’s pain and symptoms so that they may participate in activities at school, in sports and with their peers,” says Dr. Lin.
Dr. Lin resists labeling acupuncture an “alternative therapy,” preferring “complementary therapy” since integrating the procedure with Western medicine can prove beneficial.
As a pediatrician, anesthesiologist and pain specialist, Dr. Lin has a unique opportunity to integrate acupuncture with more common therapies. Adding acupuncture sessions to antihistamine treatments, for example, can achieve comparable results to higher doses of the medication alone, while decreasing side effects such as drowsiness. Similarly, post-operative acupuncture can reduce the nausea and vomiting caused by narcotic painkillers.
The biggest challenge in pediatric acupuncture is addressing children’s fear of needles. Most children experience some degree of needle phobia, making them more hesitant to try acupuncture than adults. To deal with this issue, Dr. Lin often spends 45 minutes to an hour with first-time patients and their families to make them completely comfortable with the procedure. The size of the needle is about a quarter of the diameter of the regular 22-gauge IV needles most children have come into contact with, and the tip of the needle is blunt. Dr. Lin carefully explains the process and can demonstrate it on a child’s toy animal or even on his own hand. Once a child is amenable to acupuncture, he or she is usually surprised to find that the discomfort is minimal.

The benefits of Acupuncture for children

If children can overcome his fear of needles, children can get much benefit from acupuncture therapy for children. In adults, acupuncture therapy has many scientifically proven benefits. One of the benefits have been proved that, among others, relieve pain, as Revealed in the research experts at the University Of Rochester, New York.

But to do so in children, most parents would feel if her baby does not have the heart to be pierced. Not to mention if his son had a phobia about needles, then the All Things associated with skewers piercing sounds very creepy.

Although most children are Afraid of needles, most of Them Will be surprised Pls Itself Felt That it did not hurt acupuncture for children, said Kathi Kemper, MD of the American Academy of Pediatrics.

According to Dr. Kemper, acupuncture needles are very small so it does not feel Pls stuck into the correct point by adequately trained therapists. Needles are also not cause damage to the skin and underlying tissues, Because of the size and technique already taken into account.

Speaking of the benefits of acupuncture for children, a recent study in the New York Eye and Ear Infirmary showed acupuncture That Could be Called Often Overcome amblyiopia or lazy eye syndrome. This syndrome makes the ability to see the between right and left eyes are not balanced.

Other studies have also proved that acupuncture can relieve Convergence Attention and Hyperactivity Disorder in children or ADHD in children. While the baby, this therapy is also proven quite effective to relieve colic baby crying on the attack (severe pain).

In young teens, a research conducted Yuan-Chi Lin, MD at Children's Hospital; Boston also proved that acupuncture can relieve pain. Of the approximately 243 children was experiencing pain with the intensity of 7 (scale 1-10), pain intensity after acupuncture therapy Decreased to 3.

THE TREATMENT OF CHILDREN BY ACUPUNCTURE

An Interview with Julian Scott by Peter Deadman

Peter: You've been running the Children's Clinic for two years. Do you want to say
something about how it started, and how you first started treating children with
acupuncture?
Julian: Yes certainly. When I was first trained at East Grinstead, or Gerrard's Cross as
it was then, I was told not to treat children under the age of seven, because it would
interfere too much with their energy. Now that was right for me at the time, because I
was really very inexperienced, straight out of acupuncture school. At that time my
children were very young and started on their childhood illnesses. If you see your
children suffering, say from a high fever, it's very difficult to stand by and do nothing.
Actually what precipitated it was that my eldest son had measles and had a very high
fever with it, and I thought, well if I don't do something, his energy is going to be a
great deal more disturbed by the measles.So I laid in and treated the poor fellow. I'm
afraid it hurt him terribly because my needle technique wasn't very good, but I treated
him at nine o'clock and at eleven o'clock the fever had gone down and he was his
normal self, and I was just so thankful for acupuncture. As well as being thankful I
thought, well this is a wonderful way of treating children and as you know - you have
children too - anyone who has children meets other people with children and you get
talking over the school gate or something like that, and very soon I was treating other
children with similar problems. Very soon there was a trail of children coming up to
my door, snivelling with some disease, and going away snivelling because I treated
them with acupuncture. So that was how I started.
Peter: Apart from just practising on your own and other children, how did you further
develop your knowledge and understanding?
Julian: Well to begin with it was largely by treating my own and other children and
extending the principles of treating adults to treating children. I was given a great
boost going to China in 1981/2 where we treated a number of children in the clinic.
That gave me great confidence. Also, shortly after that I learnt Chinese and was able to
read the Chinese books on paediatrics myself and this has opened a huge field for me.
Peter: What particularly did you learn in China as far as treating children is concerned.
Were children of all ages coming into the clinic?
Julian: Mostly very young children, about a year old. It gave me confidence really,
seeing people with centuries of tradition behind them treating children. I thought well
I'm actually doing it right.
Peter: Did they always use acupuncture?
Julian: Well we were in an acupuncture clinic, so we always used acupuncture.
Peter: Never massage?
Julian: No, it wasn't a massage clinic. Treating Chinese children of course is different.
The Chinese call the paediatric department the 'mute department' because the children
don't say anything. They just sit there and when you put the needles in they might
grunt slightly but that's as far as it goes. I wouldn't call the paediatric department in
the West a mute department.
Peter: You mean they complain more or just chatter more?
Julian: They run around, they ask you all sorts of questions like about the funny shape
of your face or why your shoelaces aren't done up, and they complain like anything
when you put the needles in.
Peter: So you started to treat more and more children in your own practice and then
decided to set up the children's clinic.
Julian: It was a long-cherished dream. For many years I thought of setting up a
children's clinic. There are many problems treating children in a normal practice. One
is that the children rush around, charge around, and break the place up, and if you've
got anything at all delicate, anything you love, you don't want to expose it to
hyperactive children. So I wanted to have a place where the children could be more
free to run around and have some toys and things. And secondly, the time you need
most help in treating children is when you've got least money at all. You've got several
hungry mouths to feed maybe, and only one income which is probably not very large,
and I knew that a lot of people couldn't come to acupuncture simply because they
couldn't afford it. That was the other main reason for setting up the clinic - to make
acupuncture available for people who couldn't afford full private fees.
Peter: So how did you set about dealing with the financial question?
Julian: Well I give a little of my time and a colleague, Tim Martin gives a little of his,
and we're busy fund-raising so that we can spend more time doing it.
Peter: You set the clinic up as a charity. Does it receive any funding from anybody?
Julian: There's a slow trickle at present but we haven't made any big appeals yet,
although we hope to.
Peter: How much time do you put in each week?
Julian: It's only one afternoon a week - it's not enough, by any means, because it means
that one is restricted to treating chronic diseases. Children's diseases change so rapidly
- it may not be there one moment, and another moment its very very serious and a few
hours later it's completely gone. It would be nice to be able to treat any day of the week
and any time of the day. But it's a start - half a day a week. And actually we can treat a
lot of children in that time. I've treated nearly three hundred children in the two years.
Peter: So how many children do you treat in an afternoon?
Julian: Between ten and twenty.
Peter: And what kind of problems are you treating?
Julian: Well as you know Brighton is a very damp place so we see a lot of catarrhal
problems. Hyperactivity comes quite high, and insomnia which brings parents to their
knees very quickly and they'll soon consider alternative medicine even if they've never
thought of it before. All in all we see a wide range of problems.
Peter: What kind of response from treatment are you observing?
Julian: Absolutely wonderful - it's actually beyond my expectations. I think there are
very few children who go away without having had some help. There are one or two
who don't seem to respond at all, but generally the speed at which they respond and
the success rate really amazes me.
Peter: Have most of the children brought to you been treated with Western medicine
first?
Julian: Yes I'd say they've all been through the Western medicine system and come out
the other end. One of the commonest types of illness we treat is the so-called
pathogenic factor remaining. This is where children get chronic diseases like recurrent
tonsillitis, chronic otitis media, chronic recurrent bronchitis and so on. A lot of these
children will have taken antibiotics, for example with bronchitis. A month later they'll
get another cold or cough which will quickly go onto the chest and they'll be given
more antibiotics and this goes on in a continuing cycle. Now one mustn't knock
antibiotics because they may actually be keeping these children alive. They might have
died in previous times. On the other hand it's not really a very good situation to be in.
It can easily lead to asthma or some other illness because the lungs are weakened. But
it responds very very well to Chinese medicine - this condition known as pathogenic
factor remaining. I suppose the idea is present in the alternative medicine field in
homoeopathy where they recognise it as a miasm. In fact Hahnemann's original
miasms were just this and they didn't relate to any hereditary illness. It was some
illness that you got that you hadn't completely expelled. So we see a lot of these and
acupuncture is very helpful in getting rid of them.
Peter: You say that children in England complain about the pain of acupuncture, is that
ever a real hindrance in treatment?
Julian: Well sometimes it is, but usually they just complain a lot at the same time as
offering out their hand or leg quite freely - whilst screaming blue murder.
Peter: How about the parents, are they ever a problem in this respect?
Julian: Yes sometimes. We had one parent who fainted although the child didn't mind
at all. Generally though, the response from parents has been very positive, and actually
they're amazed on the whole how little acupuncture hurts and what a gentle therapy it
is, because one treatment with acupuncture can be less traumatic and painful than one
test in Western medicine.
Peter: How much do the parents pay at the clinic?
Julian: A nominal two pounds at present.
Peter: I know that you also prescribe herbs for children, can you say a bit about that?
Julian: Yes, I've prescribed herbs for adults for many years and it was a natural
extension for me to treat children with herbs as well as acupuncture. These are
Western herbs, although my thinking is always in terms of Chinese medicine. I make a
diagnosis in terms of Chinese medicine, then choose the treatment - either herbs or
acupuncture. I think it's true to say I've built up my own understanding of the
functions of Western herbs in terms of Chinese medicine. I don't think of herbs so
much as stimulants or relaxants in the way a western herbalist might, but more in
terms of tonifying spleen-qi, resolving phlegm and so on.
Peter: You give the herbs mainly as an adjunct to acupuncture treatment?
Julian: Mainly as an adjunct, although there are some problems that don't really
respond very well to acupuncture, and respond marvellously to herbs, for example
chronic tonsillitis. You can treat it with acupuncture but it may take twenty or thirty
treatments and the children get pretty fed up after a few treatments. Give them one
herb and they take it over two, three, four months and it cures it with much less effort
from everybody.
Peter: What's the average number of treatments that you give?
Julian: Well how long is a piece of string? I suppose three or four treatments on
average. Sometimes it's just one treatment. The other day we had some very worried
parents come in with a child with a very bad case of eczema. Actually one of the worst
that I've seen - covered from head to foot with suppurating eczema. I shook my head
and said this is one of the worst cases I've seen - better book in a great number of
appointments. They didn't turn up the next week and I thought oh dear, what have I
said - I hope I haven't upset them too much. Anyway I happened to see the father in
the street and I asked him how the child had got on, and he said "Oh! It was cured of
course, I knew it would be".
Peter: You refer in your book that we will come onto in a minute to some experience in
treating congenital problems in children. You say for example that holes in the heart
can be cured. Does that derive from your experience?
Julian: Yes. We've treated one or two rare syndromes which are said in Western
medicine to be congenital and incurable. One was a deficiency of some pancreatic
enzyme which gives rise to lots of rather weird signs later on in life, for example the
hip becomes malformed. But the main current problem was that the digestion was no
good at all. We treated that successfully. On the other hand of course there are some
which are not treated successfully, for example a child was missing some muscles and
the acupuncture didn't cause the muscles to grow. But I think that sometimes miracles
happen when you least expect them. As far as holes in the heart are concerned I did
have one baby with a very small hole that was not large enough for them to consider
operating. It's well known in Western medicine that very small holes in the heart can
repair themselves. Before the acupuncture she had a hole in the heart and after the
acupuncture - a month or two later - there was no hole in the heart so I think it
certainly speeded up the process of repair. At first my mind went completely blank
and I said I haven't got the slightest idea what to do, and then when I came back to
earth again I thought well I must just use the straightforward principles that I've learnt
- do a diagnosis in terms of the differentiation of syndromes and treat according to
that, and that was the basis of the treatment. In this case it was spleen-qi xu and
retention of phlegm-damp.
Peter: Coming on to your book now, you've written a fairly substantial book - a
textbook - on the treatment of children by acupuncture which is due to be published in
the spring. Why did you decide to write a book?
Julian: I decided to write a book to help others to use such a wonderful method of
treatment, and in this way reach people and encourage them to treat children with
acupuncture. I think it's true to say that in the West there are a lot of forces pulling us
away from TCM. There are just three or four good textbooks on acupuncture - that's
nothing - and we're bombarded with all sorts of information from people like
homoeopathic practitioners, psycho-linguistic experts, herbalists, naturopaths,
dieticians. All of these are firmly rooted in the Western tradition. Sometimes if you get
a difficult case there's nowhere to turn to - there's no book that says anything about it
to help you understand it, so you have to turn to people rooted in the Western
tradition. These are all forces pulling us away from TCM. I think this was how it came
about that we had these various schools of acupuncture in this country. It's because
when the schools were founded, the stream of information from China was only a
trickle and the brave people who were practising acupuncture at that time - to whom
we're all grateful - had to supplement it with Western ideas, and I think this is how the
Leamington school has grown up here, with the emphasis on emotions as a cause of
disease. It's very much a Western idea, as is the Western idea of the spirit. Not a crass
materialistic Western approach - it's a fine approach - but it's a Western approach.
Peter: Do you not feel that this contribution is valuable in the development of
acupuncture and Chinese medicine - this emphasis on the emotions and the spirit?
Julian: I think it's very valuable but it's not TCM and I think that there's a huge body of
information on TCM and the use of acupuncture, on the use and meaning of the points
and so on which most people don't have access to.
Peter: Looking back on the last two years of running the children's clinic what do you
feel are the main things that you've learnt?
Julian: I've learnt an enormous amount - it's so stimulating. One of the most exciting
things has been about the reality of Qi in the body. When you learn acupuncture for
the first time, you go through yin-yang, the Qi, the blood, the body fluids, the five
elements, the differentiation of syndromes etc. and they're all treated in the same way,
and what for me has been very exciting is discovering that the Qi is absolutely real.
Yin-yang, I'm not sure whether it's real or whether it's just a way of looking at the
world. For example the Indians often divide things into three, the Chinese into two -
these are ways of putting order into an otherwise chaotic world. This is certainly true
of the five elements - it's a way of finding some order in the outside world. It's
certainly true of the differentiation of syndromes too. But the Qi is real - it's something
you can actually feel.
Peter: Why do you feel you've learnt this more from treating children than from
treating adults?
Julian: Well it's happened at the same time. It's partly that for children the Qi is much
more real. It's much more important for them. Their bodies are hardly formed - in a
new-born baby the Qi is much more important than the body. Also you can see in
clinical practice how they draw the Qi from their mother. The mother actually gives
them a continuing supply of Qi when they're ill and it's been fascinating for me to
watch this. How does the Qi get from the mother to the child? It comes from the
mother's chest direct to the child, and it finds its natural expression in the mother
giving milk to the child; but actually as well as the milk, the Qi comes out through the
chest to the new-born baby. If something goes wrong there, for example if the mother
witholds the Qi, or hasn't got any, then maybe the baby won't grow - it actually needs
the Qi from its mother.
Peter: So the Qi can be imparted by the mother even if she's not breast-feeding. Do you
think it can be witheld even if she is breast-feeding?
Julian: Yes, in fact I've used the word mother in this context, but when it comes to
giving Qi one should use the term 'mothering parent' which sometimes can be the
father - the father can be giving the Qi and the mother the milk. As the child grows
older and doesn't need the milk, the source of the Qi from the parent should descend
to somewhere around the stomach area, which is why a lot of people get middle-aged
spread - the Qi is taken from the middle region and given to the children. I'm not
saying that's the only reason for middle-aged spread, for example if you overwork
then you get spleen weakness, but this is a definite link between the child and the
parent. It's interesting what happens if the Qi doesn't descend and the source of Qi
stays up in the chest. The bad effects as far as the mother is concerned is that she can
get mastitis, and in severe cases even cancer, due to stagnation of Qi. They've got this
love which they want to pour out to somebody and there's nobody there to receive it,
so it gets stuck in the chest.
Peter: So you're saying that the kind of love the parent gives the child has to change as
the child gets older, and if the parent can't develop to that stage it can create problems
for the parent.
Julian: It can create problems for the parent and for the child. If the Qi remains
stagnant in the mother's chest it can easily become stagnant in the child's chest too,
because they're living in the same house, and this can be a source of asthma. You can
see this in everyday life as a smothering love. We've all experienced this in being
crushed against auntie's bosom - it's a terrifying experience. I've come to understand
this from seeing parents and children in distress. What's interesting is that you can feel
it on the pulse. If the child is in distress you will feel the mother's pulse very strong
near the bone on both sides, corresponding to the Qi in the chest - strong and slippery.
Peter: Can you tell me about any other things you have found?
Julian: There's some other weird things that I find - I suppose they're rather
controversial - for example birth itself. It's actually such a privilege to be in a position
to see a baby so soon after it's been born - to be continually in the presence of a mother
with a child. One of the odd things which comes up is that children who are very much
wanted by the parents, for one reason or another, or children that are planned, often
seem to come out less healthy. They seem to be dragged into the world by the action of
the parents at a time when they're not really ready for it. I'm thinking of one child
where the mother wanted and wanted the child, and finally when the child came its
energy was really weak. But they had already had two children before, that were not
planned. The stork came uninvited for those two and they were fine, but this one who
came to order as it were, came before it was really ready. I've seen this several times
now, and it's very peculiar. To me it shows the extraordinary perversity of the world,
that the children who come when they're not really wanted are the healthy ones, but
then you make them unhealthy because they're not really wanted, and the children
who are desperately wanted come in not so healthy. The other thing I've learnt is about
causes of disease - it's something that is not really mentioned in the books about
treating adults, but is mentioned in treating children, and that's the pathogenic factor
remaining which I talked about before. Often at about the age of seven some recurrent
disease such as tonsillitis or bronchitis appears to go - the child becomes much
stronger, but very often the pathogenic factor is still there and can stay for the rest of
somebody's life. In the healthy years, in the twenties and thirties it will show probably
just as a restlessness, or a character trait - maybe they're just rather lethargic people or
over-active and rather pushing and aggressive personalities. You might think that it's
just their personality, which it may be, but very often you can trace it back to a febrile
disease in childhood. In later years it may give rise to all manner of diseases - yin-xu
problems, damp problems, arthritis and so on.
Peter: So effective treatment of children is very important for the life of the adult.
Coming now to your plans for the future, how do you see the future development of
the children's clinic. What would you like to see?
Julian: Well I'd like to see it open for seven days a week, twenty-four hours a day, but
that's not going to happen in the short term. I'd love to see an acupuncture hospital. I
think acupuncture is ideal for hospitals. Its action is so quick you can get in there and
do something. Even if you're not absolutely sure of the diagnosis, you can do
something and that will give you some breathing space. Very often you can cure acute
problems almost instantly with acupuncture. But there are many steps before a
hospital can happen. Not least we have to train many people in the treatment of
children by acupuncture.

Treating Children with Acupuncture

Most people do not think of acupuncture when they’re seeking health treatment for their kids, but as more and more parents are discovering, it can be a remarkable way to alter the course of a single illness, a chronic condition, and even a child’s life. Instead of masking symptoms or waiting for them to go away, acupuncture treatments stimulate deep healing that can change the way a body functions – improving health conditions in ways that are safe, virtually painless, and without side effects.
Many parents seek acupuncture or herbal treatment for their child’s recurring health problems that have failed to respond to more conventional treatment: chronic ear infections, chronic cough, sleep disorders, fatigue, asthma, bed-wetting, hyperactivity, attention deficit disorder, constipation, diarrhea, and frequent colds are the disorders most commonly treated with acupuncture, but it can also help kids with anxiety, crossed eyes, epilepsy, eczema, and certain learning problems, among other things. Increasingly common, too, are kids whose parents simply want a treatment with less risk and fewer side effects than the medications or surgeries that are often recommended.
How is it that kids can respond to low-tech treatments like acupuncture and herbs when
specialists and modern drugs have failed to help? The answer lies in Chinese Medicine’s
ability to treat not just symptoms, but also to identify and treat the underlying conditions that allowed illness to develop in the first place.
Since young children are so responsive to their surroundings, they are quite vulnerable to any unusual conditions in their lives. Seemingly mild stressors like food that is hard to digest, temperature changes, new school or childcare situations, trouble with siblings, etc. can easily create subtle imbalances that quickly result in not-so-subtle symptoms. If not completely rebalanced, these symptoms can then contribute to persistent and/or spiraling health problems like chronic ear infections, asthma, and sleep difficulties.
Practitioners of Chinese medicine will attempt to identify one of several patterns of imbalance that lead up to the child’s current condition. Did the child have a history of paleness, fatigue, weak cough, whiny behavior, and / or pickiness over food? Such behaviors point to an underlying deficiency of qi, which the body has been unable to produce in sufficient amounts to ward off illness.
Alternatively, the child may have a predominantly excess condition, in which a backlog of
incompletely transformed food and drink leads to congestion or stagnation and a child who is phlegmy, congested, and may have a cough, oozing rashes, or pimply skin, abdominal pain, and smelly stools. Whatever the illness, basic differentiations like these will be essential for effective treatment, leading the practitioner to a clearer understanding of the patterns of imbalance as well as strategies for treatment.
The logistics of actually treating a child with Chinese Medicine require a good dose of
flexibility and an understanding of children’s needs at different ages. Few children before the age of 8 or 9 are able to lie still for more than a few minutes, so they will generally sit in a parent’s lap, or lie down for five or ten minutes when they are old enough. The acupuncturist will insert a single needle, manipulate it for a few seconds, then remove it before inserting the next one. A typical treatment might last about 3 minutes, with the rest of the visit devoted to talking about the child’s progress and reviewing suggested dietary and lifestyle recommendations. In addition to acupuncture, Chinese herbal formulas are often prescribed to continue and amplify the effect of the acupuncture treatment. These can be given in pill form, liquid tinctures, or syrups.
It can be astounding to witness a child’s response to acupuncture and herbal treatment. Not only do their immediate health problems often resolve, but they can also be set on firmer footing for a healthier and happier childhood as a result.

Safety and efficacy of acupuncture in children: a review of the evidence.


Acupuncture has been used therapeutically in China for thousands of years and is growing in prominence in Europe and the United States. In a recent review of complementary and alternative medicine use in the US population, an estimated 2.1 million people or 1.1% of the population sought acupuncture care during the past 12 months. Four percent of the US population used acupuncture at any time in their lives. We reviewed 31 different published journal articles, including 23 randomized controlled clinical trials and 8 meta-analysis/systematic reviews. We found evidence of some efficacy and low risk associated with acupuncture in pediatrics. From all the conditions we reviewed, the most extensive research has looked into acupuncture's role in managing postoperative and chemotherapy-induced nausea/vomiting. Postoperatively, there is far more evidence of acupuncture's efficacy for pediatrics than for children treated with chemotherapy. Acupuncture seems to be most effective in preventing postoperative induced nausea in children. For adults, research shows that acupuncture can inhibit chemotherapy-related acute vomiting, but conclusions about its effects in pediatrics cannot be made on the basis of the available published clinical trials data to date. Besides nausea and vomiting, research conducted in pain has yielded the most convincing results on acupuncture efficacy. Musculoskeletal and cancer-related pain commonly affects children and adults, but unfortunately, mostly adult studies have been conducted thus far. Because the manifestations of pain can be different in children than in adults, data cannot be extrapolated from adult research. Systematic reviews have shown that existing data often lack adequate control groups and sample sizes. Vas et al, Alimi et al, and Mehling et al demonstrated some relief for adults treated with acupuncture but we could not find any well-conducted randomized controlled studies that looked at pediatrics and acupuncture exclusively. Pain is often unresolved from drug therapy, thus there is a need for more studies in this setting. For seasonal allergic rhinitis, we reviewed studies conducted by Ng et al and Xue et al in children and adults, respectively. Both populations showed some relief of symptoms through acupuncture, but questions remain about treatment logistics. Additionally, there are limited indications that acupuncture may help cure children afflicted with nocturnal enuresis. Systematic reviews show that current published trials have suffered from low trial quality, including small sample sizes. Other areas of pediatric afflictions we reviewed that suffer from lack of research include asthma, other neurologic conditions, gastrointestinal disorders, and addiction. Acupuncture has become a dominant complementary and alternative modality in clinical practice today, but its associated risk has been questioned. The National Institutes of Health Consensus Statement states "one of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted procedures for the same conditions." A review of serious adverse events by White et al found the risk of a major complication occurring to have an incidence between 1:10,000 and 1:100,000, which is considered "very low." Another study found that the risk of a serious adverse event occurring from acupuncture therapy is the same as taking penicillin. The safety of acupuncture is a serious concern, particularly in pediatrics. Because acupuncture's mechanism is not known, the use of needles in children becomes questionable. For example, acupoints on the vertex of infants should not be needled when the fontanel is not closed. It is also advisable to apply few needles or delay treatment to the children who have overeaten, are overfatigued, or are very weak. Through our review of pediatric adverse events, we found a 1.55 risk of adverse events occurring in 100 treatments of acupuncture that coincides with the low risk detailed in the studies mentioned previously. The actual risk to an individual patient is hard to determine because certain patients, such as an immunosuppressed patient, can be predisposed to an increased risk, acupuncturist's qualifications differ, and practices vary in certain parts of the world. Nevertheless, it seems acupuncture is a safe complementary/alternative medicine modality for pediatric patients on the basis of the data we reviewed.

Preparing Your Practice for Pediatric Acupuncture

Kids love acupuncture. I swear its true! Right now pediatric acupuncture is gaining momentum as many parents realize that acupuncture is a natural, safe and effective treatment not only for themselves, but for their children too.

According to the 2007 National Health Interview Survey (NHIS), acupuncture users increased by 1 million people from 2002 to 2007 and in 2006 approximately 3.1 million adults and 150,000 children used acupuncture. In addition, the 2007 NHIS found that children were five times more likely to use CAM therapies if their parents used them.1

I view this trend as an opportunity for the acupuncture and Oriental medicine community to enlighten an entire generation of kids to the benefits of acupuncture. An increasing number of children are growing up with acupuncture as a routine part of their healthcare, which will be instrumental in making acupuncture the treatment of choice at the onset of pain or illness instead of a treatment of last resort.

Recent studies have linked the decrease in many childhood illnesses such as ADHD and colick to the use of acupuncture. Doctors at Rush University Medical Center in Chicago have also pointed out that acupuncture is in fact effective for pain and nausea in children suffering from serios chronic illnesses.

Pediatric Acupuncture The benefits to treating children in your practice go above and beyond simply helping a child. Helping children is highly rewarding on its own, but being a part of treating a child with an illness such as asthma can be a life changing experience for you and them. Asthma and other chronic illnesses account for countless hospital visits and missed days of school -- not to mention sports and other social activities they are unable to participate in due to illness. Restoring the health of a chronically ill child gives a new dimension and richness to their life that they may have never had before.

Many of us took a few pediatric classes and internships during our Master's program, but making a successful transition into pediatrics in private practice may take some time and a little extra training. It may even seem a little daunting at first, but as you gain more experience and confidence it will become second nature. I've outlined a few steps you can take to prepare yourself and your office for little patients.

Assess Your Office

The first place to start is an assessment of your office. Is it kid-friendly? Is your front desk staff comfortable with children? It is important to make sure that your office is relatively baby proof, that your decor is not dangerous. You must make sure hazards like electrical outlets are covered. Have a small basket of toys available, books to read and crayons and paper in the lobby area. At the end of the treatment stickers or hand stamps can provide a perfect reward for cooperative behavior during treatment.

The paperwork you have for adults may not give you all the vital information you need for kids. I recommend that you have pediatric paperwork for children under the age of 14, which asks questions about the mother's pregnancy, labor and delivery, vaccination status, and more child specific questions about appetite, digestion, energy, immune function, growth, etc. You must also have the parents sign paperwork giving their consent to treat a minor.

Be Open

Being flexible is extremely beneficial when it comes to the treatment of children. Many kids tolerate acupuncture well, but some will be resistant to anything having to do with needles. In the beginning, it is more important to build rapport with the child than to force needles upon them. Given time, trust and plenty of encouragement most children will eventually try acupuncture. In the meantime, microcurrent therapy, cold laser therapy and shonishin will produce a similar therapeutic effect as the needles. Make sure parents are informed that these other modalities will require their child to hold still while the selected device is placed on the acupuncture point for 15 - 60 seconds.

Children aren't just little people. They suffer from a variety of qi imbalances and infectious illnesses that don't normally affect adults. Because of this, additional training is absolutely vital to effectively treat the wider variety of illnesses you will encounter. Physical exam skills are also critically important since babies and children cannot always communicate why they're sick.

You'll need to look in ears and listen to lungs to properly diagnose and treat what is wrong. If these skills are rusty, I recommend taking additional courses like Pediatric Physical Exams, Diagnosis and Red Flags which is offered by the Holistic Pediatrics Association.

You may also want to take additional classes to learn how to effectively treat some of the most common pediatric problems like asthma, allergies, ADD/ADHD, acute otitis media (ear infections), and digestive problems. Knowing what you can and cannot treat with acupuncture and when to refer to a medical doctor is essential, but with extra training you'll have the confidence you need to make the correct diagnosis and refer out as appropriate.

Most importantly you must love kids to be successful in pediatrics! Working with kids can be rewarding, challenging and at times frustrating, but when your energy reflects your desire to help them heal many of these challenges can be overcome.

Children and Acupuncture

Acupuncture is the ancient Chinese practice of inserting very fine needles into the skin to relieve pain and treat diseases. Since many children are terrified of needles, acupuncture is not commonly offered for children. But at Kernan Hospital in the Woodlawn area of Baltimore, children over the age of 8 are treated with acupuncture. Children under age 8 can receive acupressure or Chinese massage known as Tui Na.
"Acupuncture offers another dimension of care in addition to traditional medicine," says Dr. Lixing Lao, a licensed acupuncturist with the Complementary Program at Kernan Hospital and an associate professor of family medicine at the University of Maryland School of Medicine. He adds, "Children respond very well to the treatment, often better than adults."
The Chinese believe that there is an energy flow called Qi running throughout the body, and that acupuncture restores the balance of this energy flow, therefore eliminating the pain or symptoms of a disorder. There is limited Western scientific explanation as to how acupuncture works. The University of Maryland's Complementary Medicine Program is currently researching its mechanism of action.
Acupuncture is used to treat a variety of illnesses, including attention deficit hyperactivity disorder, arthritis, back pain, asthma, upset stomachs and depression. The number of sessions needed varies, depending on the disorder. "For a temporary condition like diarrhea or fever, only one or two treatments may be needed. Other problems like an eating disorder or depression may require 10 sessions or more. We usually take a break and then begin acupuncture again," says Dr. Lao. Each session lasts approximately 20 minutes.
Almost two years ago, research from Children's Hospital in Boston touted the benefits of acupuncture. Seventy percent of children who took part in the study said acupuncture did indeed help their symptoms. Fifty-five percent of their parents agreed. Only one child said acupuncture worsened the symptoms. Most of the children were being treated with acupuncture for migraine headaches.