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Case Based Pediatrics Pacific Symposium 2017 Case Based Pediatrics David W. Miller, M.D., L.Ac. East-West Integrated Medicine, LLC Fellow American Academy of Pediatrics 4361 N. Lincoln Ave., Chicago, IL 60618 www.eastwestintmed.com Diplomate of Oriental Medicine (NCCAOM) 773.960.8901 www.imneducation.com [email protected] TJ 14 yo male, CC Anxiety and sleep walking • Diagnostic Keys: • Affect • Maternal Affect • Sleep walking characteristic • Complexion • Speech patterns • Root • Patterns manifesting • Context for the root – Hun, 8 extras, ming/yun/karma, constitution, resources/positive attributes, nourishment • Treatment strategies (possible) -note – cognitive reframing/cognitive exploration • Herbs • Outcome The Three Hun 3 Tai Guang (“Eminent Light”): Upper Dantian, below GV-20. Highest expression of Yin and Yang energies in human form. Strives for Physical, mental, emotional, and spiritual purity. Shang Ling (“Pleasant Soul”): Middle Dantian. Linked to the 5 Agents. The expression of the Hun concerned with compassion towards others. Yu Jing (“Hidden Essence”): Lower Dantian. Produces our desires for enjoying the pleasures and comforts of life. Functions of the Hun 4 Functions of the Hun 5 • Control sleep and dreaming • Assist the Shen in mental activities • Maintain balance in one’s emotional life (under leadership of the Shen) • Open in the eyes • Influence courage • Control planning and sense of direction • Control spirit travel • Upon death, the Hun report the actions, thoughts, and deeds of an individual to the spirits of destiny to determine the person’s degree of cultivated virtue J.A. Johnson, Chinese Medical Qigong Therapy The Seven Po 6 Four of the Seven Po Demons 7 • Flying Poison (or Quick Evil): Suddenly explodes with rage or venomous thoughts of evil intention (e.g. “I’ll kill you for that”) • Unclean Evil (Shame): Entices by tempting and luring an individual into a place or situation from which escape is difficult, and then creates stress in the form of guilt, which generates shame. This spirit creates a feeling of being discredited, dishonored, or disgraced (e.g. “I’m worthless”, “No one ever has or will love me.”) • The Fallen Arrow: generates the foregone conclusion that attempting goals is fruitless (e.g. “Why even try? I’ll never make it.”) • The Yin Bird (or Night Tormentor): harasses the individual causing him or her to experience extreme pain and severe anguish (e.g. nightmares and restless sleep). 8 Functions of the Po 9 • Somatic expressions of the Eternal Soul • Responsible for physiologic processes in childhood • Related to weeping and crying • Closely linked to breathing • Connected to sexuality on the level of sensation • Leave the body via the anus upon death The body language of power Qi Gong Exploring LI 15 as meeting point of LI/Yang Ming with Yang Qiao The Body Language of Victory An athlete’s primal reaction to victory is often a dominance threat display. Published on January 12, 2014 by Christopher Bergland in The Athlete's Way The researchers believe that from the perspective of evolutionary psychology, the reflex of dominance threat display stems from a biological drive to establish order, hierarchy, and status in society. http://www.psychologytoday.com/blog/the-athletes-way/201401/the-body-language-victory Ming and Yun • These vessels, especially the Chong, touch upon both Fate (Ming) and Destiny (Yun) • Fate (Ming) is pre-given – your hand of cards • Destiny (Yun) – how you play your hand • Consider – genetics vs. epigenetics • It is believed that working with the 8 Extras gives the opportunity to alter both Ming and Yun. 15 Strengths 16 Shen Yi Po Zhi Hun http://www.naturalvet.org/tcvm.htm Permutation: 4 year old boy with anxiety and adhd • Diagnostic Keys: • Affect • Behavior • Maternal Affect • Root • Patterns manifesting The Extraordinary Vessels: Chong • The Chong Mai aka Penetrating Vessel aka Thrusting Vessel synthesizes the activities of all other vessels, though is influenced at a deep level by the energies in the Du Mai and Ren Mai. • Per Yuen: Translation of original characters for “Chong) equate to “moving something heavy”, i.e. Jing. • Involved in the continuation of lineage (Represented by Spleen 4, opening point, Gong Sun, Grandfather Grandchild) The Extraordinary Vessels: Chong Represents a synthesis between Ren and Du, Yin and Yang Jarret, L. Chong Mai The Extraordinary Vessels: Chong • Formation is mostly complete in the first 6-8 years of life, but the first 2-3 years are the most important time in its development (includes gestation) http://myrexpedition.wordpress.com/2012/09/02/children-in-a-multicultural- context/ Permutation: 12 year old girl with anxiety and urinary sx • History • Recent surgery • Grandmother • Clarify the Shen Excess Heat in the Small Intestine (Heart Fire Transmits to Small Intestine) Signs: • Treatment Principle: • Irritability with a sensation of Heat in the chest • Clear Heart and Small Intestine fire • Thirst with a desire to drink cold beverages • Points: • Red face • Fever • SI 2 (Qiangu) Etiology/Pathology: Clears Small Intestine Heat, for burning • May be sores around the mouth urination from Small Intestine pattern • Dark, scanty urine This is Interior Excess Heat. Heart Fire is • SI 5 (Yanggu) • Rough urination Clears Small Intestine Heat and calms Shen, • Fidgeting transmitted to the Small Gives clarity and sense of direction Intestine, the Yang Organ • Warm sensations in the chest • Ht 5 (Tongli) • Sores on the tongue related to the Heart. Clear Heat Fire • Painful urination (stabbing) Emotional problems • Ht 8 (Shaofu) • Urination short and hesitant such as anxiety and Clear Heat Fire • Hematuria excessive stress can • ST 39 (Xiajuxu) • Oliguria predispose a person to Lower Sea point of Small Intestine, Stops • Maybe blood in the urine this pattern. abdominal pain • Sluggish urination • Method • Irritability • Sedate all points. No Moxa. http://www.americandragon.com/Herb%20Formulas%20copy/DaoChi(Re)San.html https://www.sacredlotus.com/go/diagnosis-chinese-medicine/get/zang-fu-small-intestine-patterns-tcm Dao Chi San Pharmaceutical Pin Yin Dosage Actions Latin Rx. Rehmanniae Sheng Di Huang 5-30g Cools Heart Fire, nourishes Yin, cools Blood and generates Fluids. Caulis Akebiae Mu Tong 3-12g Clears Heat from the Heart channel and clears Heat and promotes urination through the Small Intestine channel. With Dan Zhu Ye and Sheng Di Huang, for mouth ulcers, burning throat pain, irritability and insomnia due to Heart Fire. Hb. Lophatheri Dan Zhu Ye 3-10g Alleviates irritability by clearing Heat from the Heart. With Mu Tong and Sheng Di Huang, for Heat in the Heart channel manifesting as chest Heat and irritability, mouth and tongue sores and dark, scanty urine. Rx. Glycyrrhizae Gan Cao (Shao) 3-10g The tips treat painful urinary dysfunction, (tips) relieve toxicity and harmonize. http://www.americandragon.com/Herb%20Formulas%20copy/DaoChi(Re)San.html Clarify the Shen Talking to you and I think taking the Clear and Calm made a huge difference…[she] seems able to move to homework now as well, and does not feel as stuck--she is much more relaxed. I think your explanation of her dreams was perhaps the most crucial for her... Huang Di Nei Jing Su Wen, Ch 8 Sacred Teachings (Ni): “If the Spirit is clear, all the functions of the other organs will be normal.” Ch 77 Five Failings of Physicians: “The second failing occurs in treatment. When a physician neglects a patient’s emotional experiences, which can affect the patient’s health greatly, and indiscriminately tonifies or sedates the patient, the consequence is further injury to the patient.” Permutation: 8 year old boy with anxiety and allergies • History • Brain Behav Immun. 2017 May;62:212-218. doi: 10.1016/j.bbi.2017.01.021. Epub 2017 Feb 1. • Peripheral inflammatory cytokines and immune balance in Generalised Anxiety Disorder: Case-controlled study. • Hou R1, Garner M2, Holmes C3, Osmond C4, Teeling J5, Lau L3, Baldwin DS6. • Author information • Abstract • INTRODUCTION: • Previous investigations have demonstrated that major depression is associated with particular patterns of cytokine signalling. The primary aim of this study was to examine peripheral pro-inflammatory and anti-inflammatory cytokines and immune balance in Generalised Anxiety Disorder (GAD). • METHODS: • A case-controlled cross-sectional study design was employed: 54 patients with GAD and 64 healthy controls were recruited. Participants completed self-report measures of anxiety and depression. Two pro-inflammatory and two anti-inflammatory cytokines were measured using multiplex technology. • RESULTS: • Case-control logistic regression analyses revealed significant differences in serum levels of IL-10, TNF-α, and IFN-γ between GAD and control groups after adjusting for age, gender, body mass index, smoking and alcohol consumption: these group differences were independent of the presence or degree of depression. Comparison of pro-inflammatory to anti-inflammatory cytokine ratios indicated that there were significantly higher ratios of TNF-α/IL10, TNF-α/IL4, IFN-γ/IL10, and IFN-γ/IL4 in the GAD group compared to the control group. • CONCLUSIONS: • This study is the first to investigate both pro- and anti-inflammatory cytokines and their balance in patients with GAD in comparison to healthy controls. The findings indicate a relatively increased pro-inflammatory response and decreased anti-inflammatory response and provide the first demonstration of an altered cytokine balance in GAD. Serum cytokine levels in GAD were independent
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