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Ancient Chinese literature documented that the pediatrician appeared as early as in Spring and Autumn Period. Historical Record — Bian Que Biographies ( Shĭ Jì — Biăn Què Cāng Gōng Liè Zhuàn, 史记·扁鹊仓公列传) stated,“Bian Que ...was told that people in Qin State were very fond of children,he then became a pediatrician”.The earliest existing medical book Prescription for Fifty-two Diseases ( Wŭ Shí Ér Bìng Fāng, 五十二病方) recorded about “infantile epilepsy”and “infantile convulsion”. The Yellow Emperor’s Inner Classic ( Huáng Dì Nèi Jīng, 黄帝内经) also recorded children’s physical characteristics,diseases diagnosis and prognosis. The Spiritual Pivot — Nishun Feishou ( Líng Shū — Nì Shùn Féi Shòu, 灵枢·逆顺肥瘦) claimed “Infants have fragile muscles,deficient blood and insufficient qi”. Plain Questions — On the Theory of Deficiency and Excess ( Sù Wèn — Tōng Píng Xū Shí Lùn, 素问·通评虚实论) claimed that “What is the prognosis if an infant has got a fever condition and a suspended and thready pulse? Qi Bo said: if his hands and feet are warm,the prognosis is good;if his hands and feet are cold,then he is going to die”; and that “if a baby is attacked by windheat and has symptoms of panting,rales and lifted shoulders,what is the pulse manifestation? Qi Bo said: For a baby with panting,rales and lifting shoulders,the pulse is excess and large.If the pulse is moderate,the prognosis is favorable; if the pulse is rapid,it is life-threatening.” These statements are of great significance for later physicians to recognize children’s physiological and pathological characteristics,and diagnosis and treatment of diseases.
From Qin and Han Dynasties to Northern and Southern Dynasty,pediatric medicine was further developed on the basis of The Yellow Emperor’s Inner Classic ( Huáng Dì Nèi Jīng ).A famous physician,Chun Yu-yi recorded in Collection of Diagnosis ( Zhěn Jí, 诊籍) an infant with qì gé bìng (hiccups) treated with Xià Qì Tāng (Qi-Descending Decoction),which is the earliest pediatric case recorded in literature. Records of Three Kingdoms — Biography of Hua Tuo ( Sān Guó Zhì — Huà Tuó Zhuàn, 三国志·华佗传)recorded that Hua Tuo,a famous doctor in Eastern Han Dynasty,employed Sì Wù Nǚ Wăn Wán (Four Ingredients Pill , 四物女宛丸) to treat a two-year-old baby with diarrhea.In late Eastern Han Dynasty,Zhang Zhong-jing wrote On Cold Damage and Miscellaneous Disease ( Shāng Hán Zá Bìng Lùn, 伤寒杂病论) and pointed out syndrome differentiation and treating principles which had a profound influence and was of guiding significance to the theory and clinical practice of pediatrics in Chinese medicine,laid the foundation for children’s zang-fu differentiation system founded by Qian Yi in Song Dynasty. Pulse Classic ( Mài Jīng, 脉经) written by Wang Shu-he in Western Jin Dynasty recorded for the first time infantile pulse-taking therapy,claiming that “it is a normal manifestation when the pulse of a child beats eight times and the pulse is thready and rapid”,and also mentioned for the first time “growth fever”. Book of Sui — Records of Classic Works ( Suí Shū —Jīng Jí Zhì, 隋书·经籍志) recorded that medical branches appeared in medical books of Northern and Southern Dynasty,such as pediatrics,obstetrics,and gynecology; meanwhile,there were some pediatric monographs: Classic of Infant Physiognomy ( Xiàng Ér Jīng, 相儿经) by Yan Zhu, Materia Medica for Children ( Xiăo Ér Yòng Yào Běn Căo, 小儿用药本草) of two volumes by Wang Mo-chao, Miscellaneous Prescriptions for One Hundred Children’s Diseases ( Liáo Shào Xiăo Băi Bìng Zá Fāng, 疗少小百病杂方) of 37 volumes by Xu Shu-xiang,all of which unfortunately has been lost in history.
During Sui and Tang Dynasties,medical specialists are responsible for teaching medicine in Imperial Medical Academy where department of pediatrics was set for 5 years,which promoted the development of pediatrics.
In Sui Dynasty, Treatise on Causes and Manifestations of Various Diseases ( Zhū Bìng Yuán Hòu Lùn, 诸病源候论) compiled by Chao Yuanfang is the earliest monograph on pediatric etiology and patterns.Six volumes in this book discussed 255 patterns associated with children’s diseases.Chao divided children’s external diseases into cold damage and seasonal epidemics,with zang-fu differentiation applied to internal diseases.The book also suggested some correct methods of child rearing,like“the babies ...don’t need to be covered with thick clothing...they should be allowed to breathe fresh air and have sun exposure ...and ingest breast milk appropriately”.
Sun Si-miao,a great physician and pharmaceutist in Tang Dynasty,believing in “to keep people prosperous,raising children is first and foremost.Without healthy children,there would be no adults”,listed and discussed women’s and children’s diseases in two volumes in his book Important Prescriptions Worth a Thousand Gold Pieces for Emergencies ( Bèi Jí Qiān Jīn Yào Fāng, 备急千金要方).In this book,children’s diseases from newborns nursing to cold damage and miscellaneous diseases were listed in 9 categories with more than 300 formulas.Dosage forms involved emulsions,medicinal porridge,hot compression preparation,varnish and liniment in addition to decoction,pills,powder,plaster and pillets.The book supplemented Treatise on Causes and Manifestations of Various Diseases ( Zhū Bìng Yuán Hòu Lùn, 诸病源候论) with mere theory and no formulas and is an important historical literature on Chinese medicine pediatrics.
Fontanelle and Skull Classic ( Lú Xìn Jīng, 颅囟经) is the earliest surviving pediatric monograph,known as “Ancestor of Pediatrics”.Research indicates that it was anonymously written on witchcrafts between the end of Tang Dynasty and the beginning of Song Dynasty.The book holds that children belong to “pure yang”,discusses infantile pulse-taking methods,fontanelle diagnostic methods as well as therapies on Jīng (infantile convulsion), xián (epilepsy), gān (malnutrition), lì (dysentery),and huŏ dān (fire Dan,erysipelas),and records 56 formulas including 28 formulas for external application.
In North Song Dynasty,Qian Yi,courtesy name Zhongyang,specialized in pediatrics for more than 40 years and was expert in it.His academic achievements were collected and compiled by his student,Yan Ji-zhong,in a form of a book, Key to Medicines and Pa tt erns of Children’s Disease ( Xiăo Ér Yào Zhèng Zhí Jué, 小儿药证直诀) containing 3 volumes.The first volume discussed the treatment methods of pulse patterns,the second listed 23 medical records,and the third recorded formulas.In this book,the physiological characteristics of children were summarized as “delicate and immature organs,an easy interchange between excess and deficiency,and between cold and heat”; among the four diagnostic methods,priority was given to inspection,including facial signs ( Miàn Shàng Zhèng ),and eye signs( Mù Nèi Zhèng ); Qian Yi pioneered the pediatric differentiation system of five zang ,suggesting differentiation guidelines such as“heart governing convulsion,liver governing wind,spleen governing tiredness,lung governing panting,and kidney governing deficiency”,which have been the most important differentiation methods in pediatrics; different patterns of cold,heat,excess and deficiency were distinguished in treatment; he worked out therapeutic principles and methods,creating modifications of old formulas and developing new formulas; he created five zang tonic and purgative formulas,e.g. dăo chì săn (redness-removing powder), xiè bái săn (white-draining powder), dì huáng wán (Rehmannia pill), bái zhú săn (Rhizoma Atractylodis Powder), yì gōng săn (Special Achievement Powder).The book listed 134 formulas,among which there were 70 pill formulas,45 powder formulas,6 paste formulas,6 decoction formulas and 7 formulas for external use.Many formulas are still used in practice today,most of which are pill and powder formulas,convenient for children and practical application of pediatrics.In addition,the book recorded in detail four chief diseases in pediatrics: measles,smallpox,convulsion and malnutrition,suggesting that “acute convulsions should be treated with cold and purging medicines while chronic convulsions with warm and supplementing medicines”,“infantile malnutrition is often companied with spleen and stomach diseases”.Qian Yi has made great contributions to the development of TCM pediatrics and is extolled as“Saint of Pediatrics”. Complete Library in the Four Branches of Literature — Contents and Summary ( Sì Kù Quán Shū — Mù Lù Tí Yào, 四库全书·目录提要) said that pediatric formulas had been rare in history until Qian Yi who specialized in pediatrics,and whose book was known as the founder of pediatrics; the introduction of the book alone can bring life back.
In Northern Song Dynasty,smallpox,measles and other infectious diseases were prevalent everywhere.Dong Ji,a famous physician from Shandong province,was specialized in cold-cool treatment methods,and compiled Emergency Formulas for Children’s Rashes ( Xiăo Ér Bān Zhěn Bèi Jí Fāng Lùn, 小儿斑疹备急方论),which was the first monograph on smallpox and measles,and recorded treatments with Bái Hǔ Tāng (White Tiger Decoction) and herbs as Qīng Dài (Indigo Naturalis), Dà Huáng (Radix et Rhizoma Rhei) and so on.In South Song Dynasty, New Book of Pediatrics ( Yòu Yòu Xīn Shū, 幼幼新书) compiled by Liu Fang contained 40 volumes,collecting pre-Song Dynasty pediatric achievements,was then the most comprehensive scientific monograph in the world.Later soon, Discussions on Formulas for Healthy Children ( Xiăo Ér Wèi Shēng Zǒng Wēi Lùn Fāng, 小儿卫生总微论方)was published by anonymous authors.The book collected and discussed extensively kinds of children’s diseases,claiming that umbilical wind was a result of improper cutting of the umbilical cord at birth,the same as tetanus in adults,thus urging people to cauterize the umbilical cord to prevent umbilical wind.
Chen Wen-zhong,a famous physician in Southern Song dynasty,wrote Discussion on Formulas for Children’s Pox ( Xiăo Ér Dòu Zhěn Fāng Lùn, 小儿痘疹方论) and Children’s Diseases: Sources and Remedies ( Xiăo Ér Bìng Yuán Fāng Lùn, 小儿病源方论),advocating nursing the original yang of children.He was proficient in treating unfavorable pattern of pediatric pox induced by deficient and weak yang qi by warm-supplementing and toxin-expressing method and was the founder of the school of warm and supplementing treatment.Regarding pox and pediatric rashes,the debates between Chen Wen-zhong school of warm-supplementation and Qian Yi and Dong Ji school of cold-cooling acted to enrich the theoretical and practical framework of pediatrics of treatments on syndrome differentiation,and to promote the development of Chinese medicine pediatrics.
In short,by Song Dynasty,with the establishment of pediatric medical system,appearance of pediatric monographs and professional pediatricians represented by Qian Yi and Chen Wen-zhong,as well as the increasing knowledge of children development,health care,treatments and diagnosis,Chinese medicine pediatrics had become an independent discipline with a complete academic system.
Jin and Yuan Dynasties saw the prosperous development of TCM when there were many famous physicians with their own advantages.The ideas of Liu Wan-su,Zhang Congzheng,Li Dong-yuan and Zhu Dan-xi not only promoted the development of Chinese medicine,but also contributed to the development of pediatrics.Liu Wan-su said,“When infants become ill,most illness belong to heat type and few to cold type since their physiques belong to pure yang”.He advocated cold-cooling methods for heat diseases,applying Liáng Gé Săn (Diaphragm-Cooling Powder,凉膈散) in pediatrics; Zhang Congzheng excelled at treating heat diseases with purgative methods,providing examples for“treating disease of the upper part by managing the lower” for children’s diseases; Li Dong-yuan was fond of warming and tonifying,attached much importance to harmonizing spleen-stomach,which had much influence on pediatric spleen-stomach diseases of later generations;Zhu Dan-xi held that “Yang qi is often superabundant while yin qi is often insufficient” in children,preferring yin-nourishment methods.
Zeng Shi-rong,a physician in Yuan Dynasty,practiced medicine for 60 years and compiled The Essential Book for Saving Children ( Huó Yòu Xīn Shū, 活幼心书) (3 volumes) and Discussions on Saving Children ( Huó Yòu Kǒu Yì, 活幼口议) (20 volumes),which presented three academic features.Firstly,he discussed the various newborn diseases comprehensively.Secondly,he gave an elaborate and significant generalization about causes,patterns,pulses and treatments of common pediatric diseases.For example,he summarized acute convulsions as “4 patterns and 8 symptoms” with treatment methods including calming fright,preventing wind,abating heat and resolving phlegm.Thirdly,in The Essential Book for Saving Children (Huó Yòu Xīn Shū, 活幼心书 ) ,he wrote some seven-character verses which made it easy for beginners to learn and facilitated the popularization of pediatric knowledge.
In the early Ming Dynasty, Pocket Prescriptions for Children’s diseases ( Xiù Zhēn Xiăo Ér Fāng, 袖珍小儿方) written by Xu Yong-xuan,nourished experiences in pediatrics before Ming Dynasty,including 72 categories and 624 formulas,with complete patterns and treatments. Reflections on Complete Pediatrics ( Quán Yòu Xīn Jiàn, 全幼心鉴) by Kou Ping was also an outstanding pediatric monograph,which gave a detailed account of pediatrician’s rules,infantile physiology,caring and nursing,diagnosis and treatments,especially of inspection on faces and fingerprints.Lu Bo-si wrote One Hundred Questions on Children’s Diseases ( Yīng Tóng Băi Wèn, 婴童百问)(10 volumes),which listed children’s diseases into questions,dealing with causes and treatments at length along with over 800 formulas.Xue Kai and his son Xue Yi specializing in pediatrics,wrote The Essentials of Infant Care ( Băo Yīng Cuō Yào, 保婴撮要) (20 volumes)which documented more than 200 pediatric diseases,recorded 70 diseases associated with pediatric surgery,ophthalmology,otolaryngology,dentistry and stomatology,anorectum,dermatology,bone fractures.Medication on syndrome differentiation was precise,endotherapy combined with external treatment,surgery applied if necessary.This book made a great contribution to the formation of Pediatric Surgery.
Wan Quan,courtesy name Mi-zhai,a great prolific physician,wrote Family Secrets for Nursing Infants ( Yù Yīng Jiā Mì, 育婴家秘), Elaboration on Pediatrics ( Yòu Kē Fā Huī, 幼科发挥), Teachings on Pox ( Dòu Zhěn Xīn Fă, 痘疹心法), Enlightening Treatise on Children’s Diseases ( Piàn Yù Xīn Shū, 片玉心书), Enlightening Treatise on Pox ( Piàn Yù Doù Zhěn, 片玉痘疹) and others,whose academic achievements have a great influence on later generations.He proposed the “four child-nursing methods” in different stages of rearing children,i.e.“prepregnancy care is to find the original qi,care during pregnancy to protect the original qi,care during the perinatal stage to decrease diseases,and care after birth to prevent diseases”.On the basis of “ zang-fu syndrome differentiation asthenia-sthenia” advocated by Qian Yi,Wan Quan set forth “of five zang organs,the liver is often superabundant,the spleen insufficient and the kidney insufficient” “the heart is often superabundant while the lung insufficient”,that is,the physiological and pathological theory on “two superabundances and three insufficiencies”,which enriched the basic theories of pediatrics.He emphasized stomach qi protection,stressing that “spleen and stomach are the root of people and should be regulated while children’s spleens tend to be insufficient and therefore should especially get recuperated”.He also stated that “regulation methods do not depend on physicians only,but on breast nursing adjusting,diet control,and cautiousness of medication,which tend to protect spleen and stomach for the purpose to consolidate the root”,which is of great clinical significance for pediatric healthcare and disease prevention.
The Grand Compendium of Materia Medica ( Běn Căo Gāng Mù, 本草纲目) by Li Shi-zhen collected a great number of medicinals for prevention and treatment of pediatric diseases.Wang Ken-tang summarized the ideas of pediatric practitioners and his own opinions in his book Standards for Diagnosis and Treatment — Pediatrics ( Zhèng Zhì Zhǔn Shéng —Yòu Kē, 证治准绳·幼科) with a distinct,orderly and incisive analysis with extensive contents and a balance layout.Zhang Jie-bin in his book The Complete Works of [Zhang] Jing-yue —Pediatrics ( Jǐng Yuè Quán Shū — Xiăo Ér Zé, 景岳全书·小儿则) claimed that the essentials of syndrome differentiation were to focus on the aspects of exterior and interior,cold and heat,deficiency and excess.He also held that “children’s yang is not superabundant,and yin is often insufficient”,“qi of zang-fu organs is light and agile and responsive to various treatments”.
In Qing Dynasty,pediatric physician Xia Yu-zhu wrote Iron Mirror of Pediatrics ( Yòu Kē Tiě Jìng, 幼科铁镜) and thought inspection more important.He stated that “the outside manifestations are caused by factors inside the body”,suggesting that people could identify deficiency or excess and cold or heat of the zang-fu organs by inspecting the complexion and orifices.In treatment,he preferred tuina,and used a distinct method of “13 scorches of fire” to treat umbilical wind and convulsions. The Golden Mirror of the Medical Tradition — Essential Teachings on Pediatrics ( Yī Zōng Jīn Jiàn — Yòu Kē Xīn Fă Yào Jué, 医宗金鉴·幼科心法要诀) was compiled by the Qing Dynasty Imperial court.It extensively collected and classified the clinical practice of pediatrics before the Qing Dynasty.The arguments were incisive,appropriate,clear and coherent,suitable for both practice and teaching.During Emperor Yong Zheng period of Qing Dynasty,the Complete Recording of Medicine — Pediatrics ( Yī Bù Quán Lù — Ér Kē, 医部全录·儿科) compiled by Chen Meng-lei contained two parts of 100 volumes,featuring ancient pediatric medical literature of more than 120 kinds. The Complete Book of Measles ( Má Kē Huó Rén Quán Shū, 麻科活人全书) by Xie Yu-qiong was a monograph on measles elaborating syndrome differentiation and treatment of the complications of measles. Correction of Errors in Medical Works ( Yī Lín Găi Cuò, 医林改错)by Wang Qing-ren recorded information on body anatomy in children,making it clear that“inspiration and memory lies not in the heart but in the brain”,explaining the experience of invigorating blood and dissolving stasis,and creating some well-known formulas like Xuè Fǔ Zhú Yū Tāng (Blood Mansion Stasis-Expelling Decoction),which promotes the research and development of the therapy of invigorating blood and dissolving stasis.
Chen Fu-zheng,pseudonym Fei-xia,is one of the representative pediatricians in Qing Dynasty and author of the Grand Compendium of Pediatrics ( Yòu Yòu Jí Chéng, 幼幼集成),in which he elaborated the meaning of finger veins,claiming “superficial and deep venules indicate exterior and interior patterns; red and purple venules indicate cold or heat patterns; pale and stagnated venules indicate deficiency or excess”; he set up the theory of the infantile convulsions,promoting the research and development of convulsion theory; he advocated the concept of fetal education,stressing “natural endowment” “fetal care”; he emphasized the eight principles in syndrome differentiation and give priority to spleen and stomach in treatment; he extensively collected treating methods,especially formulas for external treatment.The book contained more than 20 methods,180 formulas and 150 medical drugs for external use,and is actually a combination pediatric classic of great practical value in clinic.
Wu Ju-tong was not only a master of warm diseases,but also a pediatrician.He wrote Systematic Differentiation of Warm Diseases — Resolving children’s Diseases ( Wēn Bìng Tiáo Biàn — Jiě Ér Nán, 温病条辨·解儿难) and described children’s constitutional characteristics as “unfilled infantile yang and undeveloped infantile yin”,pathological features as the increased susceptibility to disease with a greater tendency of transmission and change.As for the clinical medication,he stated that “greasy medicinals have greater tendency to cause stagnation while moderate medicinals might harm the child’s body”.He expounded infantile warm diseases according to six qi (natural climatic factors) causing diseases,pattern identification from sanjiao ,and treating diseases from the root,which complemented the defense-qi-nutrient-blood theory by Ye Gui.Both made a great contribution to the formation and development of infantile warm diseases and had great influence on the treatment of children’s heat diseases (including many infectious diseases) for later generations.
During the Ming and Qing Dynasties,smallpox,measles and other infectious diseases were prevalent,and the pediatricians accumulated valuable experiences in the diagnosis and treatment process,and wrote extensively monographs of pox.During this period,inoculation against smallpox was widespread. Wide collections of Discussions on Smallpox Formulas ( Bó Jí Xī Dòu Fāng Lùn, 博集稀痘方论) (1577) by Guo Zi-zhang recorded Formulas for Smallpox ( Xī Dòu Fāng ). Essays from San Gang ( Sān Gāng Shí Lüè, 三冈识略) (1653) recorded Dòu Yī Fă (variolation through clothes).Yu Mao-kun in Explanation of Mirror Song for Smallpox ( Dòu Zhěn Jīn Jìng Fù Jí Jiě, 痘疹金镜赋集解) (1727) recorded that during the Longqing period (1567–1572) of the Ming Dynasty,the method of variolation was popularized in Taiping county of Ning Guo prefecture and soon prevailed throughout. New Treatise on Smallpox Vaccinaiton ( Zhòng Dòu Xīn Shū, 种痘新书) (1741) by Zhang Yan recorded Jia Miao (佳苗) for artificial inoculation. Jia Miao was actually Shu Miao ,a more reliable source of vaccine.In Teachings on Smallpox Vaccination ( Zhòng Dòu Xīn Fă, 种痘心法) by Zhu Yi-liang of Qing Dynasty,it was recorded that“the longer the vaccine is spread,the purer the extract will be.If the artificial selection is mature enough,fire-toxin will be eliminated and the essential effect then remained,which will be completely safe without any harm.If the initial vaccine is inoculated 7 times successively,it will be Shu Miao after careful selection and extraction.” Such processing is basically in line with the principles and requirements of modern vaccine preparation. Shu Miao was vaccines that removed the toxin and retained the antigenicity.Chinese variolation was later spreaded to Russia,Korea,Japan,Turkey and other countries and became the world’s pioneer in the development of immunology.
In the late Qing Dynasty,with the western medicine into China,some pediatricians first suggested absorbing the advantages of western medicine and integrating western and Chinese medicine to develop traditional Chinese medicine.He Bing-yuan in New Writings on Pediatric Diagnosis ( Xīn Zuăn Ér Kē Zhěn Duàn Xué, 新纂小儿诊断学),in addition to traditional Chinese medicine,introduced examination diagnosis,used to check the mouth,changes of temperature and external genitalia and so on; Yun Tie-qiao in New Treatise on Infant Care ( Băo Chì Xīn Shū, 保赤新书) advocated Chinese medicine as main body,learning scientific methods for sorting; Gu Mingsheng compiled Complete Compendium of Pediatrics in Western and Chinese Medicine ( Zhōng Xī Hé Zuăn Yòu Kē Dà Quán, 中西合纂幼科大全).All of the books had a certain influence at the time.During the period of the Republic of China,pediatric diseases became epidemic and many physicians sought old codes and records,integrated new knowledge.For example,Xu Xiao-pu was well-known for using yang-warming medicinals to restore yang and rescue collapse and therefore sav-ing many severe cases.
Important Chinese medicine pediatric monographs are listed in table 1—1.