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The incidence of upper and lower respiratory tract infections within a year beyond the normal range is called recurrent respiratory infection (RRI).Upper respiratory tract infection includes rhinitis,pharyngitis,tonsillitis;lower respiratory tract infection includes bronchitis,bronchiolitis, pneumonia and other diseases.
The disease is more common in children aged 6 months to 6 years old,of whom the incidence rate is the highest among children aged 1–3 years.In winter and spring,when the temperature changes violently,the disease is easy to occur,and there is a trend of natural remission in summer,and the frequency of infection before and after school age is obviously reduced.If RRI is persistent,it is prone to chronic rhinitis,chronic cough and nephritis,rheumatism and other diseases,seriously affecting the growth and development of children and physical and mental health.RRI belongs to “spontaneous sweating and susceptibility to external pathogens” in Chinese medicine,and these patients are often called “susceptible children” or “children with RRI”.
The causes include inadequate endowment,improper feeding,improper drug use,inappropriate nursing,and intrinsic body heat.The locations of RRI mainly involve the lung,spleen,and kidney and the pathogenesis lies in the extreme deficiency and excess: deficiency is a deficiency of healthy qi combined with an insecurity of defensive qi; excess refers to pathogenic heat lingering within the body,resulting in RRI.If it persists for a long time and the healthy qi is deficient,the patients’ resistance will decrease,resulting in other diseases.
Children born to sickly pregnant mothers,twins,those of premature birth,or with frail fetal or postnatal qi,and those with flaccid muscles and loose interstitial striae,all may lack resistance to pathogenic qi invasion.
Insufficient breast milk supply,artificial feeding,improper milk changes,inappropriate retention introduction of solid food,or food preferences,anorexia,refined diet,insufficient intake,weak spleen and stomach,earth failing to generate metal,and lung-spleen qi deficiency,may all result in attacks by exogenous pathogenic factors.Addiction to uncooked and cold food,or fatty,sweet,heavy and greasy,may lead to injury of the spleen and stomach,and vulnerability to exogenous attack.
A lack of outdoor activity and exposure to sunlight resulting in a delicate skin,insecurity of defensive qi,and poor adaptability to cold.If parents can not dress the children right according to the changes in the weather or seasons,especially young children themselves produce heat and have poor heat dissipation ability,children with too little clothing are susceptible to wind and cold,while children with too much clothing are susceptible to exogenous attack if they are exposed to wind when sweating.
Overeating high-fat,greasy,pungent and roasted foods lead to heat accumulation in lung and stomach or excessive heat in stomach and intestines,or residual pathogens after heat syndromes,and there are also syndromes of endoretention retention of dampheat due to living in damp places.Children with congenital excessive heat are susceptible to new affections,stagnating inside and leading to the onset of diseases.
Overdoses of diaphoretics may injure defensive-yang,resulting in defensive exterior failing to defend,and a susceptibility to external pathogens attacks.
According to the age,potential cause and location,RRI is divided into repeated upper respiratory tract infection and repeated lower respiratory tract infection,and the latter can be divided into recurrent tracheobronchitis and recurrent pneumonia.According to the criteria established by the Respiratory Science unit of Pediatric Branch of Chinese Medical Association of Sciences in 2007,see table 6–2.
Mucous Snivel Known as “allergic rhinitis” or “allergic rhinitis” in Western medicine,clinically characterized by sudden and recurrent rhinocnesmus,frequent sneezing,runny nose,and nasal obstruction,and similar to cold,accompanied by itchy eyes and other eye contact allergy; associated with wormwood and pollen; children often have family history of allergies and allergic rhinitis.
a.Differentiating deficiency and excess
Deficiency syndrome is characterized by weak and thin physique,profuse sweating,shortness of breath,fatigue,lack of strength,anorexia,growth retardation and so on;excess syndromes by strong constitution,usually addicted to fatty,sweet,heavy and greasy food,reddish tongue,foul breath,or sores in the mouth,and dry stools.
Table 6–2 Diagnosis of RRI
b.Differentiating zang and fu
Deficiency of healthy qi mainly refers to a qi-yin deficiency of lung,spleen,and kidney.Lung qi deficiency includes spontaneous perspiration,qi weakness,short breath and unwilling to speak; spleen qi deficiency includes lusterless and yellow complexion,anorexia,poor appetite,fatigue and lack of strength; kidney qi deficiency includes growth retardation,bones weakness or deformity.Children with qi deficiency present as pale complexion,short breath,no desire to speak,low and faint voice,pale and tender tongue with indentation in the margin,and thready and weak pulse; children with yin deficiency present as feverishness in palms and soles,low fever,spontaneous perspiration,dry throat,red tongue with little coating,and thready and rapid pulse.Pathogen excess is mostly lung-stomach excess heat syndrome,manifesting as the reddish throat,foul breath,or sores in the mouth,and dry stools; while stomach-intestine heat accumulation syndrome has symptoms as foul breath,dry stools,abdominal distension,and thick tongue coatings.
The disease is mainly the deficiency syndrome,so the treatment should be based on reinforcing deficiency,and the key point is to seize the opportunity of medication,either invigorating the spleen and reinforcing the lung,or supplementing qi and nourishing yin,so that “the healthy qi is retained inside and the pathogens cannot attack”.For excess syndrome,it is better to clear away the lung and stomach.
◆ Lung-spleen Deficiency
Signs and Symptoms: recurrent external contractions,short breath,profuse sweating,pale lips and mouth,yellow and lusterless complexion,poor appetite,irregular bowels,reddish tongue,thready and weak pulse,light-colored finger venules.
Essentials: recurrent external contractions,profuse sweating,shortage of qi with no desire to speak,poor appetite,reddish tongue.
Treatment Principles: Fortify the spleen and reinforcing the lung.
Formula: Modified Yù Píng Fēng Săn (Jade Wind-Barrier Powder,玉屏风散) from Catego-rized Collection of Medical Formulas ( Yī Fāng Lèi Jù ,医方类聚).
Medicinals: huáng qí (Radix Astragali), bái zhú (Rhizoma Atractylodis Macrocephalae), fáng fēng (Radix Saposhnikoviae), dăng shēn (Radix Codonopsis), shān yào (Rhizoma Dioscoreae), duàn mǔ lì (calcined Concha Ostreae),and chén pí (Pericarpium Citri Reticulatae).
Modifications: For profuse sweating,add wǔ wèi zǐ (Fructus Schisandrae Chinensis), fú xiăo mài (Fructus Tritici Levis) and má huáng gēn (Radix et Rhizoma Ephedrae); for poor appetite,add jī nèi jīn (Endothelium Corneum Gigeriae Galli), jiāo mài yá (Fructus Hordei Germinatus Praepareta),and jiāo shān zhā (Fructus Crataegi Praepareta); for loose stools,add yì yǐ rén (Semen Coicis) and fú líng (Poria).
◆ Qi-yin Deficiency
Signs and Symptoms: recurrent external contractions,hot palms,and soles,or low fever,night sweating,dry mouth,mental fatigue,lack of strength,poor appetite,dry stools,red tongue with little or peeled coating,thready and weak pulse,and reddish finger venules.
Essentials: recurrent external contractions,hot palms,and soles,night sweating,mental fatigue,poor appetite,dry stools,red tongue with little or peeled coating.
Treatment Principles: Supplement qi and nourish yin.
Formula: Modified Shēng Mài Săn (Pulse-Engendering Powder,生脉散) from Origins of Medicine ( Yī Xué Qǐ Yuán ,医学启源).
Medicinals: tài zǐ shēn (Radix Pseudostellariae), mài dōng (Radix Ophiopogonis), wǔ wèi zǐ (Fructus Schisandrae Chinensis), bái zhú (Rhizoma Atractylodis Macrocephalae), fú líng (Poria), mǔ lì (Concha Ostreae),and jī nèi jīn (Endothelium Corneum Gigeriae Galli).
Modifications: For qi deficiency,add huáng qí (Radix Astragali); for poor appetite,add shā rén (Fructus Amomi) and chăo gǔ yá (stirfried Fructus Setariae Germinatus); for profuse sweating,add fú xiăo mài (Fructus Tritici Levis) and má huáng gēn (Radix et Rhizoma Ephedrae); for dry mouth,add tiān huā fěn (Radix Trichosanthis) and shí hú (Caulis Dendrobii); for feverishness in palms and soles or mild fever,add dì gǔ pí (Cortex Lycii) and mǔ dān pí (Cortex Moutan); for dry stools,add má zǐ rén (Fructus Cannabis), băi zǐ rén (Semen Platycladi) and guā lóu zǐ (Semen Trichosanthis).
◆ Lung-stomach Excess Heat
Signs and Symptoms: recurrent external contraction,reddish throat,fetid breath,sores in mouth and tongue,profuse and sticky sweating,sleeplessness,dry stool,red tongue with a yellow coating,slippery and rapid pulse.
Essentials: recurrent external contraction,profuse and sticky sweating,reddish throat,fetid breath,dry stool and red tongue.
Treatment Principles: Clear away lung and stomach
Formula: Modified Liáng Gé Săn (Diaphragm-Cooling Powder,凉膈散) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
Medicinals: lián qiáo (Fructus Forsythiae), dàn dòu chǐ (Semen Sojae Praeparatum), huáng qín (Radix Scutellariae), niú bàng zǐ (Fructus Arctii), bò he (Herba Menthae), shēng shí gāo (Gypsum Fibrosum), dà huáng (Radix et Rhizoma Rhei), dàn zhú yè (Herba Lophatheri), lú gēn (Rhizoma Phragmitis),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For reddish throat,add pàng dà hăi (Semen Sterculiae Lychnophorae)and jīn guǒ lăn (Radix Tinosporae); for antiadoncus,add zhè bèi mǔ (Bulbus Fritillariae Thunbergii), chì sháo (Radix Paeoniae Rubra)and xuán shēn (Radix Scrophulariae); for sores in mouth and tongue,add zhī zǐ (Fructus Gardeniae) and tōng căo (Medulla Tetrapanacis);for thick coating,add jiāo shān zhā (Fructus Crataegi Praeparatus) and jī nèi jīn (Endothelium Corneum Gigeriae Galli).
◆ Chinese Patent Medicines
1. Tóng Kāng Piàn (Children Health Tablet,童康片) for the syndrome of lung-spleen deficiency.
2. Yù Píng Fēng Kē Lì (Jade Wind-Barrier Granule,玉屏风颗粒) for the syndrome of lungspleen deficiency.
3. Huái Qǐ Huáng Kē Lì (Sophora,Lycium Berry,and Rehmannia Granule,槐杞黄颗粒) for syndrome qi-yin deficiency.
4. Fáng Găn Kǒu Fú Yè (Infection Prevention Liquid,防感口服液) for syndrome qi-yin deficiency.
5. Qīng Jiàng Piàn (Heat-Clearing Tablet,清降片) for the syndrome of lung-stomach excess heat.
◆ Chiropractic Therapy
Chiropractic therapy with the functions of regulating yin and yang,qi and blood,harmonizing zang and fu organs,and dredging channels and collaterals,can improve the immunity of children,enhance physical fitness,and prevent recurrent respiratory tract infection.It is performed once a day,5 days a week,4 weeks for 1 course.
◆ Plastering Therapy
During dog-days and the third nine-day period after the winter solstice,grind into powder gān suì (Radix Kansui), xì xīn (Radix et Rhizoma Asari), bái jiè zǐ (Semen Sinapis), yán hú suǒ (Rhizoma Corydalis) and shēng jiāng (Rhizoma Zingiberis Recens),mix the powder to paste with ginger pop (or Vaseline),then paste it with aseptic dressing onto BL 13 ( fèi shù ), gāo huāng (inter cardiodiaphragmatic part),RN 17 ( dàn zhōng ),RN 22( tiān tū ),for 2–4 hours a time.
1.Pay attention to the environment and personal hygiene,indoor air circulation,frequent outdoor activities,clothing replacement any time,gradually adapt to climate changes,and avoid overcooling or overheating.
2.Do not go to public places during the influenza epidemic.When there is a member with flu in the family,the room can be fumigated with vinegar: vinegar 2–5 mL per cubic meter of space with doubled water,placed in the container to heat to full gasification.This is performed once a day,for 3–5 days.
3.Actively prevent and control all kinds of chronic diseases,such as vitamin D defi-ciency rickets,malnutrition,anemia,etc.
4.Vaccination on time to enhance the disease resistance.
5.When sweating more,dry it with a dry towel; avoid exposure to cold wind,especially when taking a shower.
6.Develop good habits,ensure adequate sleep,and keep smaller but more frequent meals with more digestible and high nutritional diet.
1.Why is it easy for children to have accompanied symptoms while catching a cold? Why is wind-heat type cold the most common one?
2.How to treat patients according to syndrome differentiation in combination with the sound of a cough,characteristics of sputum and the cough time?
3.Why are there deteriorated cases of the heart yang deficiency since pneumonia locates in the lung?
4.Why does infantile asthma occur young but linger a long time?
5.How to prevent recurrent respiratory infection?