The name of the disease and syndrome comes from the Zhongzang Sutra. Refers to diarrhea in children, with white and thin stools. Clinical symptoms are often accompanied by abdominal distension, abdominal pain, pale lips, etc. It is caused by spleen and stomach qi deficiency, abnormal transportation and transformation, and excessive water and dampness. The treatment should be to invigorate the spleen and reduce dampness, and use Atractylodes Pills (Atractylodes, Angelicae, White Peony, and Acostalis) from "Zhongzang Jing".
Diarrhea in children
Name of disease and syndrome. It means that the child's stool is thin, even watery, more frequent, or watery with undigested milk and mucus. It is often caused by external wind-cold or summer-heat, internal damage to milk and food, resulting in abnormal transportation and transformation of the spleen and stomach. It can also occur due to physical weakness or chronic spleen deficiency, and inability to transport and transform the middle burner. It is generally divided into wind-cold diarrhea, summer-heat diarrhea, food-injury diarrhea, spleen-deficiency diarrhea, and spleen-kidney yang deficiency diarrhea. See each article for details. If the condition worsens, it can cause damage to yin, damage to yang, or damage to both yin and yang. Treatment should be to restrain yin and consolidate yang, or if both are used simultaneously.
Overview
Diarrhea is a common disease in children characterized by increased stool frequency and thin or watery stool. This disease can occur throughout the year, with a higher incidence rate in summer and autumn. Diarrhea occurring in different seasons has different symptoms. The incidence rate is high in children under 2 years old. Because infants and young children often have insufficient spleens, they are prone to external evils, damage to milk and food, or deficiency of spleen and kidney qi and yang, which can lead to spleen disease and diarrhea. In mild cases, proper treatment will lead to a good prognosis; in severe cases, excessive diarrhea can easily lead to damage to both qi and yin, or even exhaustion of yin and yang; in cases of prolonged diarrhea that does not heal, it is easy to turn into malnutrition syndrome.
Diagnosis
(1) Diagnostic criteria
1. Diagnostic criteria of traditional Chinese medicine
(1) Medical history: irregular feeding, A history of eating unclean food or experiencing food evil.
(2) Main symptoms: increased stool frequency, 3-5 times a day, up to 10 times or more, light yellow, egg-shaped or brown and smelly, may have a small amount of mucus or be accompanied by Nausea, vomiting, abdominal pain, fever, thirst and other symptoms.
(3) Main signs: Severe diarrhea and vomiting may include short urine, elevated body temperature, polydipsia, dry skin, sunken fontanels, sunken eyes, crying without tears, cherry-red lips, Take deep, long breaths.
(4) Auxiliary examination: Stool microscopy may reveal fat globules and a small number of red and white blood cells. Stool pathogen examination may reveal the growth of pathogenic Escherichia coli, or the isolation of rotavirus, etc. Severe diarrhea may be accompanied by There is dehydration, acid-base balance imbalance and electrolyte imbalance.
2. Western medicine diagnostic criteria
(1) The stool properties change, showing loose stools, watery stools, mucus or pus stools.
(2) The frequency of bowel movements is more than usual.
(2) Stages of the disease
1. Acute phase: the duration of the disease is within 2 weeks
2. The protracted phase: the duration of the disease is 2 weeks to 2 months
3. Chronic phase: the duration of the disease is more than 2 months
(3) Disease classification
1. Mild form: no dehydration or poisoning symptoms.
2. Medium: Mild to moderate dehydration or mild poisoning symptoms.
3. Severe: severe dehydration or obvious symptoms of poisoning.
(4) Symptom diagnosis
1. Wind-cold diarrhea syndrome: light-colored stools with foam, no obvious odor, abdominal pain, bowel sounds, or nasal congestion, runny nose, and body fluids Heat, white and greasy tongue coating, slippery and strong pulse.
2. Damp-heat diarrhea syndrome: turbid lower bowels, thick and sticky smell, difficulty in defecation, like dysentery but not dysentery, frequent and small amounts, red anus, fever or no fever, Thirst with no desire to drink, abdominal distension, yellow face, red lips, red tongue with thick yellow greasy coating, light fingerprints, and wet pulse.
3. Symptoms of diarrhea caused by food damage: sour and smelly stools, or ovum-like stools, distended abdomen, bad breath and indigestion, abdominal pain and crying before diarrhea, often accompanied by nausea and vomiting, thick and greasy tongue coating, slippery and weak pulse .
4. Cold-dampness diarrhea syndrome: stool as thin as ice, light yellow but not smelly, abdominal distension and bowel sounds, light mouth and no thirst, pale lips and tongue, not wanting to breastfeed or vomiting after eating, short urine , yellow face, abdominal pain, mental fatigue, white and thick greasy tongue coating, light fingerprints, and moist pulse.
5. Diarrhea due to spleen deficiency: persistent or recurring diarrhea, thin or watery stools with milk flaps or indigestible food residues, fatigue and indigestion, pale complexion, loose tongue The texture is light, the coating is thin and greasy, and the pulse is weak.
6. Diarrhea due to spleen and kidney yang deficiency: loose stools, unresolved grains, emaciated body, or a swollen face, lack of warmth in the limbs, pale tongue with white coating, thin and weak pulse. < /p>
Prescription: Antidiarrheal No. 1 (prescription).
② Damp-heat diarrhea syndrome
Treatment method: clear the intestines and relieve heat, resolve dampness and stop diarrhea.
Prescription: Zhidiarrhea No. 2 (tested prescription).
③Syndrome of diarrhea caused by food damage
Treatment method: regulate the spleen and stomach, digest food and resolve stagnation.
Prescription: Tiaozhong No. 1 (tested prescription)
④Cold-dampness syndrome
Treatment: Warm the spleen and dry dampness, exude dampness and stop diarrhea.
Prescription: Guizhi plus ginseng decoction combined with Wuling powder, cinnamon twig, Codonopsis pilosula (or ginseng), fried Atractylodes, Zhigancao, Polyporus, Poria, Alisma, tangerine peel, Magnolia officinalis, Huoli Incense, Myrobalan, Paojiang.
⑤ Spleen deficiency and diarrhea syndrome
Treatment method: Strengthen the spleen and replenish qi, help transport and stop diarrhea.
Prescription: Tiaozhong No. 2 (tested prescription).
⑥Syndrome of spleen and kidney yang deficiency and diarrhea
Treatment method: warm the spleen and kidneys, strengthen astringency and stop diarrhea.
Prescription: Aconite Lizhong Pills and Sishen Pills are combined to prepare aconite, Codonopsis root, fried Atractylodes, dried ginger, licorice, psoralen, nutmeg, Schisandra chinensis, Evodia, ginger, and jujube.
Massage treatment
① Wind-cold diarrhea: rub a nest of wind, rub the labor palace, cleanse and nourish the large intestine, etc., once a day.
② Damp-heat diarrhea: clear the spleen meridian, clear the large intestine, push down the seven joints, clear the small intestine, push the Jimen, massage Zusanli, rub the abdomen, rub the navel, rub the Tianshu, etc., daily 1 time.
③Diarrhea due to food injury: Reinforcing the spleen meridian, clearing the large intestine, rubbing the abdomen, rubbing the panmen, carrying the Eight Diagrams, etc., once a day. Or use Bagua to clear the stomach, nourish the spleen, clear the large intestine, move earth into water, facilitate urination, rub it smoothly to strengthen the body, push up the seven joints, rub for three miles, push up Chengshan, push and rub to stop diarrhea.
④ Cold-dampness diarrhea: Replenish the large intestine, replenish the spleen meridian, push the three passes, rub the foreign labor palace, rub the wind, rub the turtle tail, push up the seven joints, take the belly horn, etc., daily 1 time.
③ Damp-heat diarrhea:
⑤ Spleen deficiency diarrhea: Replenish the spleen soil, replenish the large intestine, pinch the spine, massage the abdomen, push the three passes, move the Bagua inside, massage Zusanli, push up Qijiegu, etc., once a day.
External treatment method
(1) Traditional Chinese medicine enema method
According to different syndrome types, prepare corresponding traditional Chinese medicine decoction, and control the temperature of the medicine at 36-37 °C, the dose is 1-2ml/kg·times, and the enema is retained. Contraindications: Patients with perianal, oral and rectal diseases.
(2) Application therapy: This therapy can adjust gastrointestinal function, promote absorption, and has the effects of warming the middle and dispersing cold, strengthening the spleen and drying dampness, astringing the intestines and stopping diarrhea. The corresponding preparations are as follows:
Nuannum Powder (TCM preparation): warms the middle and dispels cold, and is used for cold diarrhea.
Xie Li Ping (TCM preparation): clears away heat and stops diarrhea, used for thermal diarrhea.
Prepare the above medicines into paste medicine cakes according to a certain proportion. Take one portion according to the child’s syndrome type, place it on the child’s umbilicus, and fix it with medical adhesive tape. Apply 6 pieces each time —8 hours, once a day.
(3) Acupuncture therapy
①Acupuncture
Conventional acupoint selection: Zhixie point, Zusanli, Sanyinjiao.
For fever, add Quchi; for vomiting, add Neiguan and Zhongwan; for abdominal distension, add Tianshu; for food injury, add stabbing at four seams.
Specific techniques: Use the purgative method for excessive symptoms, and the tonic method for deficient symptoms, once a day.
②Moxibustion method: The child lies in a supine position, light the moxibustion stick, 2-3cm away from the skin, and moxibustion until the skin is red and hot, for about 15-20 minutes. Moxibustion on Shenjue, Zhongwan, Tianshu and Zusanli points respectively. If food stagnation is obvious, Pishu, Weishu and other points can be added; for those with spleen and kidney yang deficiency, Shenshu can be added once a day. Or use a multifunctional moxibustion instrument for treatment.
(4) Electromagnetic wave therapy
Diarrhea due to spleen deficiency and spleen and kidney yang deficiency can be treated with a specific electromagnetic wave therapy device.
Basic treatment
(1) Patients with mild dehydration should be given ORS oral rehydration salts; those with moderate or above dehydration should be given intravenous rehydration.
(2) Those whose body temperature exceeds 38.5℃ should be given oral ibuprofen suspension or acetaminophen drops to cool down.
(3) Patients with bacterial infection should be treated with antibiotics.
5. Nursing
(1) Properly control diet to reduce the burden on the spleen and stomach. Children with severe vomiting and diarrhea or diarrhea caused by food damage are temporarily fasted, and then gradually increase the amount of food they eat as their condition improves. Avoid greasy, cold, contaminated and difficult-to-digest foods.
(2) Keep the skin clean and dry and change diapers frequently. After each bowel movement, wash your buttocks with warm water to prevent red buttocks.
(3) Closely observe changes in the condition and detect diarrhea changes as early as possible.
Precautions
1. Treatment of complications
(1) Dehydration (Yin damage): Under the premise of traditional Chinese medicine or comprehensive treatment, correctly grasp the rehydration therapy. Oral rehydration salts are given for mild cases, and laboratory tests are used to determine the nature and degree of dehydration in severe cases, and water and electrolyte imbalances can be corrected in a timely manner. In traditional Chinese medicine, Lianmei Decoction can be used to sour and sweet to restrain yin.
(2) Acidosis: Correct acidosis based on blood gas analysis. Calculate the appropriate amount of sodium bicarbonate or sodium lactate according to the relevant formula.
(3) Hypokalemia: Supplement potassium in time.
2. In addition to treatment for diarrhea, diet control is very important. Children with mild symptoms should appropriately reduce breast-feeding. Children with severe symptoms must fast for 6 to 12 hours at the beginning. Breast-feeding can be resumed as the condition improves. and eating rice soup and easily digestible food. Keep the skin on your buttocks clean and dry to avoid red buttocks. People with red buttocks can use coptis oil for external use.
3. For infectious diarrhea, anti-infective drugs should be used rationally.