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Differential diagnosis of the pediatric disease mainly includes syndrome differentiation of eight principles, zang-fu ,defense-qi-nutrientblood,triple-energizer,six-meridian,qi blood and body fluid,and disease causes.Although the methods and contents of pediatric syndrome differentiation are consistent with other disciplines,there are still some characteristics in the specific application.
Because of the physiological and pathological characteristics of children,and the prevalence of “easily cold or heat” and “easily deficient or excessive”,the changes between cold and heat,deficiency and excess may easily occur;therefore,corresponding treatment based on timely,accurate and flexible differentiation must be taken according to the infant’s condition changes.In the differential diagnosis of pediatric diseases,principal syndrome and accompanying symptoms and signs should be first found out in the complicated disease.During treatment,the principal syndrome must be solved as the main purpose while the accompanying symptoms and signs should be also taken into consideration,and at the same time,attention should be paid to the mutual transformation between the two.Since the childhood diseases are most urgent and change quickly,and are more perplexing due to intermingling cold and heat,deficiency and excess,it is particularly important to combine syndrome differentiation and disease differentiation,which is able to grasp the law of disease development,notice the different characteristics of different diseases,and meanwhile take into account the individual differences of children,and pay attention to the common syndromes in different stages of different diseases.Combination of syndrome differentiation and disease differentiation is the most common diagnostic method in pediatrics of Chinese medicine.
Commonly used differential diagnostic methods of pediatric disease are mainly syndrome differentiation of zang-fu ,eight principals,defense-qi-nutrient-blood,qi blood and body fluid,and disease causes.
Children are pathologically prone to be attacked by patterns of deficiency and excess,cold and heat,the syndrome tends to be complicated and difficult to distinguish,and what’s more,the four diagnostic methods cannot apply to them completely,and there are little subjective and objective symptoms and signs for identification,so in the eight-principle syndrome differentiation,the first step is to distinguish cold or heat pattern,to distinguish deficiency or excess pattern for critical cases.Whether it is a cold or heat pattern depends on colors of mouth,tongue and throat,and changes of urine and stools.Whether it is a deficiency or excess pattern depends on the severity of the disease,duration of the course,changes of spirit and complexion,temperature,pulse,breath,blood pressure,crying and postnatal conditions.
It takes the physiological function and the pathological features of the five- zang ,six- fu and extra viscera as a basis for clinical differ-ential analysis,to analyze the clinical data obtained on the four diagnostic methods to determine the disease etiology and pathogenesis,position and characteristics of clear lesions,and then return to the viscera to the final.Therefore,the differentiation of zang-fu organs is one of the most important methods of syndrome differentiation in pediatrics.
a.Differentiation on lung and large intestine diseases The lung dominates qi,and controls respiration,governs ascent,dispersion,purification and descent as well as regulate water passage.The lung is related to skin and body hair in the exterior and opens into the nose.Its meridian is internally and externally related to the large intestine meridian of hand-yangming.It says in Key to Diagnosis and Treatment of Children’s Diseases — Visceral Dominations ( Xiăo Ér Yào Zhèng Zhí Jué — Wǔ Zàng Suǒ Zhǔ ,小儿药证直诀·五脏所主) that“The lung governs breathing.Excess syndrome manifests as distress,rapid and difficult breathing,some with a desire for water,while others without; deficiency syndrome manifests as hiccups or a long breath.” Pathological changes of lung and large intestine diseases usually manifest as respiratory dysfunction,disturbance in dispersion and purification of lung qi,delinquency in the regulation of water passages and in the transmission of the large intestine.Symptoms appear such as fever,aversion to wind,sneezing,nasal congestion,flaring of the nose,nasal discharge,cough,shortness of breath,breathlessness,phlegm rale,expectoration,laryngalgia,dysuria,constipation,enterorrhea,and proctoptosis.
Because children’s lungs are delicate,more diseases of pulmonary system will occur to them and develop easily,which leads to more critical and lingering conditions.As young children are immature in yin and yang,the pediatric lung diseases manifest as more heat syndromes,more accompanied symptoms and signs,more deteriorated cases,and susceptibility to yin fluid consumption.
b.Differentiation on spleen and stomach diseases The spleen is located in middle energizer and is the officer of the granary,a place water and food assembling.Its meridian connects with the stomach to which it is internally and externally related.The spleen governs transportation and transformation,controls blood and dominate muscles and limbs,and opens into the mouth,manifesting on the lips.The spleen governs rise of the clear while the stomach governs descent of the turbid; the spleen likes dryness and dislikes dampness while the stomach likes moistness and dislikes dryness.The spleen and the stomach are the acquired foundation,the source of generating qi and blood,and the hinge of qi ascent and descent.It says in Key to Diagnosis and Treatment of Children’s Diseases — Visceral Dominations that “The spleen governs sleepiness.Excess syndrome manifests as drowsiness,fever,drinking water; deficiency syndrome manifests as vomiting,diarrhea and generation of wind.” Pathological changes of spleen-stomach diseases usually manifest as abnormal reception,transportation,and transformation of water and food,loss of sources of generation and transformation,qi-blood deficiency,disorder of qi movement,water-dampness retention,phlegm-turbidity inside,milk and food stagnation,and blood out of control.Symptoms appear such as red lips,cleft lips,swollen lips,contracted lips,aphtha,red swollen or ulcerated gum,poor appetite,nausea and vomiting,abdominal pain,abdominal distension,eructation,constipation,enterorrhea,excessive phlegm,epistaxis,purpura,sallow complexion,drowsiness and somnolence,dropsy skin,angular salivation,gaunt muscle,and sleeping with eyes open.
The spleen in young children is often in insufficiency and the stomach is small and weak,so they are susceptible to injury due to diet and have spleen-stomach diseases.Commonly seen patterns include dysfunction of the spleen in transportation,retention of heat in the spleen and stomach,dampness blocking in spleen pertaining to earth (dampness blocking in middle- jiao ),dyspepsia in stomach cavity,stomach yin deficiency,deficiency-weakness of spleen qi,and spleen yang insufficiency.
c.Differentiation on heart and small intestine diseases The heart is the monarch organ among the zang-fu organs,governs the mind,controls the blood and vessels.It opens into the tongue,manifesting on the face,associating with sweat in secretion,and its meridian connects with the small intestine to which it is internally and externally related.The heart is a vital viscus like a king of the body,pertaining to yang and governing fire,functioning as promoting the blood circulation in the vessels of the body and dominating the mental activities of the human mind.The heart is situated in the thorax and enveloped by the pericardium.It says in Key to Diagnosis and Treatment of Children’s Diseases — Visceral Dominations that “Infantile convulsion is ascribed to heart.Excess syndrome manifests as crying,fever,desire for drinking water and tics; deficiency manifests as restlessness while lying in bed.” Pathological changes of heart and small intestine diseases usually manifest as abnormal blood circulation,consciousness disorder,a disease in tongue,and changes in sweat,pulses,and urine.Symptoms include loss of consciousness,delirium,dysphoria,dreaminess,fright,behavioral disorder,red complexion,hot urination,erosion of tongue,wagging tongue,frequent protrusion of tongue,black and blue lips,tongue and nails,dysphoria with feverish sensation in chest,palms and soles,bleeding,purpura,and profuse sweating.
The heart qi in young children is liable to hyperactivity.If the heart gets diseased,such symptoms will occur up-flaming of heart fire,pathogens invading the pericardium,phlegmfire disturbing heart,deficiency of both heart qi and yin,heart-yang deficiency and heart blood stasis.
d.Differentiation on liver and gallbladder diseases The liver is located in the right hypochondriac region,stores blood governs free flow of qi,controls tendons and opens into the eyes,manifesting on nails.The liver meridian connects with the gallbladder to which it is internally and externally related.It is closely related to the smooth movement of qi in the whole body,the normal activities of the mind and the emotion,the normal circulation of the blood and the normal acceptance and transportation of the spleen and stomach.The liver likes acting freely and is averse to depression.It says in Key to Diagnosis and Treatment of Children’s Diseases — Visceral Dominations that “The liver governs wind.Excess syndrome manifests as involuntary staring,shouting loudly,yawning,nape spasm,and whooping distress; deficiency syndrome manifests as grinding teeth,shortness of breath.Heat syndrome leads to generating qi externally while dampness leads to generating qi internally.” Pathological changes of liver and gallbladder usually manifest as an abnormal free flow of qi,liver failing to store blood,yin-blood deficiency,dystrophy of tendons and vessels,eyes absent of nourishment,and disorders of eating,digesting and absorbing.Symptoms include red eye,looking steadily,cross-eye,headache,dizziness,stiffness,convulsion,opisthotonos,twisted mouth squint eye,bitter taste,acid regurgitation,chill-heat alternating,hypochondriac pain,jaundice,grinding teeth,irritability,insomnia and dreaminess,spasm of muscles and vessels,inconvenient flexing,lusterless nails,swelling with bearing-down pain of one testis,retracted testis,swollen testis and abdominal pain.
The liver of young children is often in superabundance,so diseases of liver and gallbladder are commonly seen in patterns of liver gallbladder dampness-heat,liver heat leading to stirring wind,liver yin insufficiency.
e.Differentiation on kidney and bladder diseases The kidney is situated at either side of the lumbus which is the house of kidney.The kidney is an innate foundation,stores essence,governs water,receives qi,dominates the bone,produces marrow,and opens into the ears,anus,and urethra,manifesting on hair.The kidney meridian connects with the bladder,to which it is internally and externally related.It plays an important role in fluid metabolism,growth,and development.Pathological changes of kidney and bladder usually manifest as dysfunction of storing essence,governing water,and receiving qi,growth and development disabilities,abnormal reproduction,fluid metabolism,brain,marrow,bone and auditory perception.Symptoms include five kinds of retardation,five weaknesses,infantile metopism,pigeon chest,tortoise back,dripping urination,enuresis,edema,scanty dark urine,clear urine in large amounts,tinnitus,deafness,delayed dentition,dry and withered hair,and longtime breathing.
It says in Key to Diagnosis and Treatment of Children’s Diseases — Visceral Dominations that“The kidney governs deficiency without excess pattern.Only herpes become darkened and sunken in kidney excess.” The kidney of children is often insufficient,in addition to those who have congenital deficiency,so the clinical pediatric kidney patterns are mainly deficiency,such as patterns of kidney qi deficiency,kidney yang deficiency,kidney yin deficiency; intermingled deficiency and excess is in the minority; bladder lesions are mostly in damp heat pattern.
It applies to kinds of epidemic febrile diseases,and it is the basic method of syndrome differentiation of febrile diseases in children.
It deepens and specifies the eight principal syndromes differentiation in different levels of qi,blood and body fluid,and also is an indispensable supplement to the disease cause syndrome differentiation,often combined with viscera and application.
The etiology of Chinese medicine includes the pathological products during the disease process such as phlegm,blood stasis and indigestion,in addition to six exogenous pathogenic excesses (wind,cold,summer-heat,dampness,dryness and fire),pestilence,seven internal pathogenic emotions(joy,anger,anxiety,thought,fear and fright),improper diet,overstrain and other factors.It also has important significance for pediatrics.
There are other methods of syndrome differentiation such as triple-energizer syndrome differentiation and six-meridian syndrome differentiation and so on.
The above methods are based on the basic theories of yin and yang,visceral manifestation,qi,blood,essence and body fluid,etiology and pathogenesis and so on.Only with good flexibility in the use of these differential methods which assimilate and complement each other,will the syndrome differentiation be perfect and accurate,and the clinical efficacy continues to get improved.