Complete Work on Children’s Diseases insight into diagnosis and treatment of cough in infants and children

Jie Wang, Yu Wang, Zheng Yu, Wei Yang

1 Shaanxi University of Chinese Medicine, Xianyang 712046, Shaanxi Province, China

2 Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China

Abstract“ Complete Work on Children’s Diseases” by Chen Fuzheng in the Qing Dynasty is a book that integrates the achievements of pediatrics in the past dynasties. It has strong clinical experience in the diagnosis and treatment of infants and young children’s cough. Many effective prescriptions listed are used by later generations of physicians. It is still used and researched by contemporary physicians, which has important practical value. This article summarizes the clinical experience in the diagnosis and treatment of cough in infants and young children, and believes that Chen Fuzheng attributed the onset of cough in infants and young children to the invasion of foreign pathogens, disturbing the qi, insufficient endowment, and improper care, emphasizing that external feelings are first blamed on cold and heat. The weakness of the spleen and kidney is related to parental upbringing and mistreatment of quack doctors. According to the characteristics of the main symptoms of cough, the first focus is to distinguish between cold and heat, deficiency and excess, and the severity of the disease needs to be evaluated. The concentrated time of the cough attack can also provide a reference for the differentiation of symptoms. Cough is located in the lungs, and it is easy to affect other internal organs. According to the symptoms of concurrent symptoms, it can be diagnosed according to the five internal organs and cough. Infants and young children are encouraged to use fingerprints. At the time of treatment, the initial symptoms of cough should be evacuated urgently. The first recommendation is Ginseng Baidu Powder, and it is pointed out that the cough symptoms may temporarily worsen when the prescription is effective for the first time; after taking several doses, add nourishing yin moisturizing medicine to prevent the overdose of pungent taste having dispersing effect which injures the yin; do not use cold and cold medicine or yin medicine at the initial stage of coughing, so as to block the pathogen or cause adverse symptoms. For five zang cough, Qingfei Decoction, Qingning Powder, Jijin Sudan,Orange Peel Decoction, Liuwei Dihuang Pills, and Ginseng Wuweizi Decoction are applied for chronic cough, and take care of the spleen and stomach, and take spleen and stomach medicines throughout the course of the disease. For infants with chronic coughs, it is recommended that mothers and children take the medicine together, and the nursing mothers should avoid them at the same time, so as to avoid hurting the baby and having a profound impact on future generations.

Key words: Infant cough; “Complete Work on Children’s Diseases”; Chen Fuzheng; Congenital endowment; Four periods for regular illness; Neonatal cough

Introduction

Chen Fuzheng, whose name is Feixia, lived about 1736-1755[1]. He is well-trained in medicine and Taoism and is good at diagnosis and treatment of pediatric diseases.The representative work “Complete Work on Children’s Diseases”[2]has six volumes, first published in the fifteenth year of Qianlong in the Qing Dynasty (1750 AD), and has been widely circulated. This book brings together the great achievements of Chinese pediatrics in all dynasties,and combines Chen Fuzheng’s clinical experience. “Refer to each other’s examination and order, save the essence,distinguish right from wrong, add clinical findings, and attach experience to the prescription”[3], the rationale is clear, and the selection of prescriptions is precise and appropriate. Many of the prescriptions and medicines have good effects, and the achievements are quite excellent.

Cough is a common disease of infants and young children.“Complete Work on Children’s Diseases” has outstanding features in the diagnosis and treatment of infants and young children’s cough, which is very practical. The book emphasizes that infants and young children are immature, and coughs are mostly caused by cold and heat,weak endowments, and improper care. During medical examinations, the emphasis is on fingerprint diagnosis and pulse diagnosis of infants and young children,emphasizing the identification of cold and heat, as well as deficiency and excess, which is quite innovative. In the treatment, the five organs cough is divided into different treatments, and folk prescriptions are widely used, spleen and stomach invigorating products are slightly added, and the current disadvantages of avoiding strong medicines and cold medicines, and good use of pungent, calm,ascending Ginseng Baidu Powder, there are many effective clinical syndromes.

Causes of Cough in Infants and Young Children

Invasion of external pathogen and disturbance of Qi

Feeling spring temperature, summer heat, autumn dryness,and winter cold can cause normal illnesses in four periods,and feeling non-timely pathogens can cause coughing by disturbing the Qi. Among them, cold and heat pathogens are the most common cause of lung injury. “Complete Work on Children’s Diseases--Syndrome and Treatment of Cough”[2]pointed out: “If you drink cold in the form of cold, you will hurt the lungs. If your child’s clothes are too thin and drink cold, the lungs will be injured by cold...the heat also injuries the lung. If your clothes are too thick,you will hurt the lungs by the heat.” Just as the “Suwen--Cough Theory” said, the fur is first exposed to pathogen,and the pharynx is congested, which makes coughing.

Chen Fuzheng attributed the cause of cough in infants and young children to cold and heat, which is different from that in Pediatrics of Traditional Chinese Medicine, which divides cough into external and internal injuries, and then into cold and heat. The reason may be due to the small age of the children mentioned in the book. If it is mentioned many times in the treatment that the medication should be taken by mother and children and should not be consumed by nursing mothers, it can be inferred that it is mainly infants and young children. “Infant body is not mature, where does internal injury come from?” The causes of internal injury, coughing, such as alcohol, lust,exhaustion, are not related to infants and young children.In coughs caused by external pathogens attacking the lungs, the two pathogens of cold and heat are the most common causes in children. Therefore, for the exogenous causes of cough in infants and young children, Chen Fuzheng is primarily responsible for cold and heat. It will be effective.

Insufficient endowment and carelessness

“Complete Work on Children’s Diseases”[2]said: “The gasification of heaven and earth is ancient and modern,and the endowment is thin and thick.” It is proposed that the endowment of infants and young children is related to the gasification of heaven and earth. In the ancient times,the heaven and the earth were full of vitality, the wind was prosperous and righteous, the harmony was overflowing,and the baby’s endowment was extremely heavy. The body is injured, and the endowment becomes thinner.

The endowment of infants and young children is related to their parents. The father is responsible for yang, and the mother is responsible for yin. The father has the injury of wanton indulgence and addiction to drinking, the mother has too much thoughts and the loss of physical exertion;in addition, the parents with “ointment” and who are stunned by profit, “heart-spraying”, “scheming holders”,and “chigao fate-stalkers”, are tired of mind and fatigue, so that the essence is exhausted, and the native endowment of the fetus is thin. The children’s kidney cough and chronic cough and spleen deficiency proposed by Chen Fuzheng are all related to children’s inadequate congenital endowment and invasion of external pathogens. This is similar to the etiology and pathogenesis of yin deficiency,lung-heat syndrome and lung-spleen-qi deficiency in internal injury coughs in “Pediatrics of Traditional Chinese Medicine”. However, “Pediatrics of Traditional Chinese Medicine” contains phlegm heat and phlegm dampness in internal injury coughs. The congenital weakness of the spleen and lung in children or the acquired injury leads to the endogenous sputum, which is different from the cough caused by Chen Fuzheng’s insufficient congenital endowment.

In addition, the baby’s tender posture, less protection can easily hurt the larvae. As stated in the “Complete Work on Children’s Diseases--Frightening Wind and Conflict”[2]: “Children say that there are very few babies with wind,cold and dampness, but they don’t know that wind, cold and dampness are the only ones to have breasts...” Once the nursing mother is a little careless, and the baby is thin and cold, when sitting slightly or lying improperly, the wind and cold attrack, and it would be a cough; another nursing mother was too careful to surround the baby in the inner room, too warm and occasional sweating, the Xuanfu lost the division, and external pathogen enters the body and causes the disease; more quack doctors mistakenly believe that the baby is a pure yang body, a group of yang fire,cold medications cause damage to the baby’s spleen and stomach, and yang damage; more arrogant use of robbery prescriptions, poisonous and inferior, evasively damage the true essence, or engaged in the ancient prescription, do not know how to work, severely injure the body, and cause deficiency and cowardice cannot be remedied.

Subtype Discrimination of Cough in Infants and Young Children

Cough is the main symptom of the disease. During the diagnosis, doctors often distinguish it based on the characteristics of the main symptoms, concurrent symptoms, and comprehensive consideration of infant fingerprint diagnosis and pulse diagnosis.

Subtype identification according to the characteristics of cough

Cough first focuses on distinguishing cold and heat, as well as deficiency and deficiency. “Complete Work on Children’s Diseases--Cough Syndrome and Treatment in Infants and Children”[2]emphasizes: “Patients with solid lungs, coughing and holding the head, red face and reversing food; Those with hot lungs will have fishy and thick phlegm, full body heat and panting, dry nose and flushed face, pinched eyebrows and eyebrows.”

Severe cough needs to be evaluated. For example,“Coughing for a long time, chest pain, mouth vomiting pus, bloody smell, this lung fire is congested, has become carbuncle”[2], the prognosis is poor if the cough develops from cough to pulmonary carbuncle; if “coughing phlegm and salivation” occurs, congestion and convulsions are more difficult to treat”[2], “head shakes eyes and looks upwards, closes eyes and groans, swaying hands and feet,shoulder rest and chest protrusion, phlegm in the throat,no milk in the mouth , Panting and cold hands and feet, all have death certificates”[2], the disease is dangerous.

Distinguishing from the time of concentration of coughing, if the cough is concentrated in the early morning, it is mostly caused by dietary accumulation in the triple burn; the cough concentrated in the early morning is mostly phlegm fire; the cough concentrated in the morning is mostly stomach fire; the cough concentrated in the afternoon is mostly yin deficiency;people who cough at dusk, mostly fire floating in the lungs, can be clinically applied to the diagnosis of people with repeated coughs.

Distinguish according to the performance of concurrent symptoms

Pathogen invades from the outside, first invades the lungs,but not only in the lungs. “Su Wen · Cough Theory” puts forward: The internal organs are all coughing, not just the lungs. Chen Fuzheng believes that the disease of infants and young children’s cough is mainly in the lungs, and it is easy to see other viscera lesions at the same time. For example, “Complete Work on Children’s Diseases--Cough Syndrome and Treatment”[2]puts forward: “For those who cough due to sputum, sputum is more important, and the main treatment is in the spleen; those who move sputum due to cough, the cough is more severe, and the main treatment is in the lungs.”

Regarding the description of the complication of cough in the five internal organs, there is a slight difference between“Complete Work on Children’s Diseases” and “The Yellow Emperor’s Internal Classic”. “Complete Work on Children’s Diseases” attaches great importance to the main symptoms of cough and the inspection of the complexion, and the contents are more suitable for the diagnosis of cough in infants and young children. If you cough and reverse your breath, wheeze and have sputum, your complexion is white, most of which are pulmonary cough; cough and there is sound in your throat, red face, fever, upset, or sore throat, hoarse voice, it is a heart cough; cough and pale face, phlegm and salivation cause convulsions, staring straight ahead, it is liver cough; coughing and spitting,excessive salivation, corpus luteum, or vomiting milk,it is spleen cough; prolonged cough, spitting, darkening complexion is definitely a kidney cough. Although the cough in “Pediatrics of Traditional Chinese Medicine” is not divided into five internal organs cough, some doctors agree with this method. For example, Zhang Fulu et al[4]divided children’s cough into five internal organs cough treatment, and achieved satisfactory results.

Discrimination based on fingerprint diagnosis and pulse diagnosis

Chen Fuzheng believes that between the full moon and the age of three, children are prone to crying, excitement,and emotional instability. Therefore, the pulse status will be erratic. Therefore, infants and young children should check their fingerprints first. Fingerprint examination was first seen in the Tang Dynasty, and Qian Yi in the Song Dynasty developed further, extracting the main points of “lightness, heavy qi, and life-threatening”, which has clinical guiding significance. However, later generations of physicians either blindly opposed the theory of fingerprints, or overemphasized the theory of fingerprints,leading the fingerprint diagnosis method to become more cumbersome and difficult to practically use.

Chen Fuzheng believes that the two kinds of one-sided understandings are due to the failure to understand fingerprint diagnosis correctly. He extracted fingerprint diagnosis “three-pass position song”, “floating and sinking sub-table and inner songs”, “red and purple distinguishing cold and hot songs”, “light stagnation, definite virtual and real songs”, and “patterns”. “The main disease song”has a profound impact on later generations of pediatric physicians. Infants and young children can distinguish the cough from the inside and outside, cold and heat, as well as deficiency and actuality based on fingerprint diagnosis.This method still has clinical value.

Children between three and five years old are suitable for diagnosis by pulse diagnosis. Chen Fuzheng simplified the pulse diagnosis of children on the basis of his advanced clinical experience, emphasizing the use of ups and downs,delays to determine the appearance and interior, cold and heat, and strength and weakness to determine the deficiency and solidity. Compared with the “Huang Di Nei Jing”, the size and emergency of the pulse diagnosis of children are more important and has practical value.

Treatment of Cough in Infants and Young Children

Those with exterior symptoms should be evacuated urgently, and Ginseng Baidu Powder is the first choice

Chinese medicine believes that people who are sick on the skin can sweat it. The first cough of infants and young children is mostly a manifestation, and prescriptions of ascending and dispelling should be used. Ginseng Baidu Powder is a recipe in “Taiping Huimin Mixture Prescription”. Chen Fuzheng also added Nepeta Sui, who understands the appearance of wind, and Fangfeng, which is known as “Wind Medicine Lotion”, and praised this recipe. It is “the first divine prescription for coughing door.”

Chen Fuzheng pointed out that the following three points should be paid attention to when applying this formula to treat infants and young children’s cough. One is that children who take this prescription for the first time may have a worse cough. Because Ginseng Baidu Powder regulates the qi, eliminates pathogens, excretes the sputum that is difficult to discharge in the small lumens of the lower lungs, and strengthens the expectoration reflex. Therefore, when the initial administration takes effect, the cough may temporarily worsen. When the sputum exhausts, the cough symptoms will be reduced or disappeared, so the clinical application needs to be distinguished from the progress of the cough. The second is that children with the initial cough should not suddenly use cold and cold medicines and yin medicines. They should first use traditional Chinese medicines with the effect of ascending and dispersing, and then add yin medicines as appropriate after the sputum is relieved.Because of the cold-induced coagulation, it is easy to block the lung orifices, and the yin nourishing drugs are more sticky. The temperament of infants and young children is not strong, it is difficult to transport and transform, and the power of the drug cannot be dispersed, which will lead to adverse symptoms. Third, those with dryness in the lungs and cough should add adenophores, Ophiopogon japonicus, Polygonatum odoratum, Shengdi and other products that nourish and moisturize the dryness of the lungs after taking this prescription. Because the medicine of this prescription is more pungent and scattered, and the lungs are delicate and extremely dry, long-term use of Xinsan prescriptions may damage the lung yin. His experience is still common in pediatrics of Chinese medicine.

Ginseng Baidu Powder extracts South peppermint,Beifangfeng, Nepeta spike, Bupleurum, Chuanqianghuo,Chuanduhuo to relieve wind, relieve dampness and relieve pain, with the power of Zhengchuanxiong to promote qi and blood, bud Platycodon grandiflorum, Xinqianhu,Baiyunling, Chen Zhihui has the power of promoting lungs, lowering qi, resolving phlegm and strengthening spleen, cleansing forsythia, cooling blood and relieving pharynx, and preparing dryness of various medicines.Ginger is used as a guide, and licorice is used to reconcile.Tonic, its function is the most subtle, it can solve the worries of the brigade’s Xinsanyao that consumes gas and blood and fears death. Clinically, because of different processing methods, red ginseng is often used in raw sun-dried ginseng. Red ginseng has a warmer medicinal property, which can increase vitality; raw sun-dried ginseng is not as warm as red ginseng, and is longer than calm qi. Studies have shown[5]that the warm nature of red ginseng is easy to help Yang heat, thereby breaking the balance of the body’s Yin and Yang secrets, leading to the phenomenon of “getting fire”. Infants and young children are juvenile yin and juvenile yang, so ginseng should be raw sun-dried ginseng. Moreover, ginseng has the effects of nourishing spleen soil to help transport and transforming, nourishing Yuanyang to benefit the five internal organs, nourishing qi and nourishing body fluid to help medicinal power, and aiding vitality to prevent external pathogen[6], and a small amount of it is beneficial.

The latest research also shows that this prescription is suitable for COVID-19 in the early stage, incubation period and suspected patients, mild patients, especially the elderly, the young and the weak, and the patients with underlying diseases[7]. The addition and subtraction of Ginseng Baidu Powder may regulate chemotactic cytokines, increase blood oxygen saturation, inhibit inflammation-related signal pathways such as STAT,MAPK, NFκB, PIK3K, IL-6, and achieve multicomponent-multi-target-multi-pathway The anticoronavirus effect that inhibits the formation of cytokine storm[8]. Current medical research has found that Ginseng Baidu Powder can also be used to treat diseases such as ulcerative colitis[9], irritable bowel syndrome[10], and pediatric eczema[11], with definite curative effect.

Cough is divided into five internal organs, the spleen and stomach are the most important

“Complete Work on Children’s Diseases” selects several cough prescriptions for infants and young children, which are used to treat different subtypes of cough, and most of them are highly respected by later generations of doctors.Such as Qingfei Decoction, made of Chuan Fritillaria,Xinqianhu, Mulberry Bark, Jingzhimu, Nanmint, Nepeta,Bupleurum, Chen Fructus, Bud Platycodon, Jinjing Gum,Roasted Licorice, Baiyunling, Barley Composed of winter and white platycodon, are used to treat lung and cough.Qingning powder, medicinal sweet Tingli, roasted licorice,ginger, jujube, mulberry bark, red tuckahoe, plantago seed,treats heart cough. It integrates Jin Su Dan, medicinal Jibai Fu, Jingquan Scorpion, Plum Blossom Borneol, Tomorrow Ma, Ming Frankincense, Dai Ochre, Nine System Niudan Star, Straight Silkworm, Red Gold Foil, and Real Musk. It is used to cure liver cough. Tangerine Peel Soup is composed of ginseng, citrus aurantium, roasted licorice, Pinellia ternata, bud platycodon, ginger, jujube, Baiyunling, true broad-peel, inula, asarum, and is used to treat spleen and cough. Liuwei Dihuang Pills made from Fen Danpi, Xuan Alisma, Dahuaidi, Jingzao Pi, Huai Yam, and Baiyunling are used to treat kidney cough. Ginseng schisandra decoction is used to treat chronic cough. It is composed of ginger, bleaching technique, Baiyunling, jujube, northern schisandra, schisandra, ginseng, roasted licorice, etc.

Some of these prescriptions can be seen in modern research reports. For example, Zhao Bei et al[12]used Qingfei Decoction to treat children’s bronchiolitis, and found that this prescription can relieve symptoms such as coughing and shortness of breath in children, and the effect is significant; Zhang Xiang[13]compared Qingning San with Xiaoer Hulu San , The treatment of cough caused by phlegm-heat in children, the result is that the therapeutic effect of Qingning San is better than that of Xiaoer Hulu San; Chen Fuzheng’s orange peel soup is now used to treat hiccups, vomiting[14]and other diseases,and the effect is significant; Dong Tingyao[15]The use of Jijinsudan to treat febrile convulsions in children and prevent the recurrence of febrile convulsions have achieved satisfactory results; “Jingyue Quanshu” discusses that coughs of internal injuries often originate from the Yin, and because the Yin is damaged at the bottom, the Yang is lonely at the top. , The water is dry, the lungs are dry, it is itchy, and the itching is the cough, which indicates that the kidney cough in children is related to the lack of congenital endowment. Liu Hong[16]used Liuwei Dihuang Wan to treat the kidney cough of yin deficiency cough and achieved satisfaction. Efficacy; Xi Feng et al[17]found that Ginseng Wuweizi Decoction can promote the improvement of symptoms and immune function in children with Mycoplasma pneumoniae pneumonia with lung and spleen Qi deficiency syndrome, improve clinical efficacy, and lower serum IL-6 and TNF-α levels.

“Complete Work on Children’s Diseases--Do not Take Medicine Deliberately”[2]mentioned: “Every child has the spleen and stomach self-elimination...The spleen and stomach are injured, only the spleen and stomach are strengthened, and the spleen and stomach are strengthened, and the spleen and stomach are strengthened.” It shows that Chen Fuzheng attaches importance to the function of the spleen and stomach.Throughout Chen Fuzheng’s cough selection, he focused on strengthening the spleen and stomach while clarifying the lungs and relieving the surface. In the early, middle,and late stages of infant coughing, the prescriptions were formulated with Poria, Atractylodes, and licorice.“Chinese Materia Medica”[18]says: “Baifuling permeates dampness and diuresis, strengthens the spleen and stomach”. Atractylodes macrocephala is warm, sweet and bitter, and has the effects of nourishing qi, invigorating the spleen, drying dampness and diuresis[19]. Roasted licorice is sweet and flat in nature and taste, and has the effect of replenishing the spleen and stomach[19]. Chen Fuzheng believes that once Zhongzhou is built, children will go to Zhengan naturally. The wide application of these spleen and stomach medicines reflects Chen Fuzheng’s emphasis on the function of the spleen and stomach in infants.

Treatment of neonatal cough

One day and night is called Zuì (zuì), and a baby is called Bai Zuì over a hundred days. In this book, Chen Fuzheng discusses neonatal cough as a special case of infants with chronic cough, and proposes that the neonatal cough may be caused by wind and cold, or caused by improper breastfeeding. It is because the baby is tender and the stomach is qi. It’s hard to cure because of sweating with medicine. Whooping cough is completely different from the name of whooping cough in modern medicine. The latter refers to the clinically paroxysmal and spastic cough caused by Bacillus pertussis, with cock-like roars at the end of the cough[20].

Chen Fuzheng pointed out that neonatal cough was caused by improper maintenance, wind-cold or qi reversal, and it was difficult to treat because of the qi of the breast and the stomach, which could not overcome the medicine,and the source of sweat was difficult to resolve. For this kind of disease, Chen Fuzheng suggested that mothers and children should take the medicine together, and the nursing mother should not take the medicine together.The medicine is light, convenient to take and reduces the wounds of the child. The treatment method is exquisite.Chen Fuzheng used the method of taking the same medicine for both mother and child to treat the coma and convulsion caused by the wrong treatment of the son of a friend, so that the convulsion and acne were prevented by one dose of medicine. It is worthy of the attention and reference of today’s pediatricians.

Discussion

Cough is a common symptom of infants and young children. Because the causes of coughing in infants and young children are complex and diverse, and the body of infants and young children is delicate and difficult to overcome, the treatment is quite tricky. Modern medicine believes that cough is a typical symptom of multiple respiratory diseases, such as colds, bronchitis, pneumonia,bronchiolitis, bronchial asthma, etc. It is usually treated with anti-inflammatory, anti-infective, phlegm and coughreducing, anti-allergic treatments according to the cause.It is easy to produce drug resistance and cause certain damage to the immunity of infants and young children,and it is difficult to achieve satisfactory results. In the middle of the Qing Dynasty, many physicians practiced Qian Yi in the Song Dynasty[21]“Children have a pure body of yang, and it is easy to transform Yang when they are cold.” It is similar to the current situation of pediatrics.“Children and Children’s Integration” is struggling to choke the tide and complain about the current malpractices. Its academic propositions trigger thinking,and I hope to share with you.

Since the beginning of the 21stcentury, people’s lives have become more prosperous, the dietary structure has changed, the intake of high oils and fats has increased while the intake of whole grains has decreased, coupled with the increasing pace of modern life, physical and mental pressure has increased. Living in this state for a long time, the endowment of the pregnant fetus will be weak. Therefore, in order to reduce the incidence of infant diseases, it is recommended to prepare before and after pregnancy to protect the fetal endowment; after birth, infants and young children are mature but not complete, long and unrealistic. It is recommended to breastfeed scientifically and take reasonable care, such as the tolerance advocated by Chen Fuzheng. Three-point hunger, seven-point fullness, frequent rubbing, etc., to ensure the healthy growth of infants and young children.If you encounter a cough in an infant, you can refer to the experience of “Infant and Child Integration” when you go to the doctor, carefully differentiate the symptoms and choose the prescription, take the measures according to the individual and the time, flexibly, ensure the curative effect and take precautions.