10 Pattern-based Root Treatment: Meridian Therapy Applied to Children Selecting the primary pattern in children often needs to be done quite differently. Abdominal diagnosis can be difficult to do, or is unclear. On babies and small children, the whole abdomen often feels full, rounded, and springy with unclear or no regional differences; on older children the abdomen is often ticklish. Either of these can make abdominal diagnosis difficult for the inexperienced practitioner. Pulse diagnosis can also be difficult to do, or be very unclear. Babies and small children will not stay still, and in addition, the positional and depth differences are hard to discriminate because the region where you palpate the arteries is very small. Altogether this makes pulse diagnosis on babies and small children difficult. Even when you are able to palpate the pulses, you generally cannot spend much time palpating the pulses on children; many young children are not very patient and will not stay very still for longer periods of time. A simpler and easier approach is needed. To do this we take advantage of the fact that babies and young children will tend to manifest symptoms that arise out of their constitutional tendencies. As people age, lifestyle issues start triggering problems in addition to those associated with their constitutional tendency, so that the clinical patterns become more complex. On babies and young children this is not usually the case and we can take the symptoms as a reasonable indicator of the pattern to focus on. Lung vacuity pattern: breathing problems; skin problems; easily catching cold, and so on; allergic constitution. Spleen vacuity pattern: digestive problems; nourishment problems (the child that is underdeveloped, “failure to thrive”). Liver vacuity pattern: behavioral problems; sleep problems; muscle spasm or spasticity problems. Kidney vacuity pattern: birth defects; physical or mental development problems; slow development; cold feet, urinary problems such as bed wetting. As children become older (age 6 or so and older) we are usually able to apply the other diagnostic methods and follow and identify the changing conditions. Thus, while this simple rule for making a diagnosis based on symptoms can still be followed, sometimes one finds through palpation diagnosis an evolved pattern already, due to lifestyle and other factors. Obviously, things are not always this simple. There are, of course, patients with more complex conditions, due to having more complex constitutional tendencies, early influence of lifestyle issues, influence of medications, or other medical interventions like surgery. The symptom and medical history pictures are more complex and one has to think through the possible pattern and eventually choose one for treatment. What is described above covers basic details of selecting the primary pattern, but, depending on the child (age, maturity, condition) and your skills, it may be useful to also treat the secondary pattern and even the yang channels. In an adult, after supplementing, for example, LU-9 and SP-3 to address the primary pattern of lung vacuity pattern, LR-3 may also be drained as well as TB-5 and BL-58. The decision to drain each point is based on finding relative strength with hardness in the pulse position depths corresponding to each channel (left deeper guan pulse, right surface chi pulse, and left surface chi pulse). The decision in each case is not based on location or nature of the symptoms, but instead only on the pulse findings. As one can imagine, in children where pulse diagnosis can be very difficult because of the factors discussed above, these judgments can be very difficult to make. It is enough to apply treatment to the two main points for the primary pattern and stop there. This, when well performed, is enough. Those with experience using the Meridian Therapy system of acupuncture in normal clinical practice, may find that the additional judgments of which yin channel is involved as secondary pattern and which yang channels show disturbance are easier to make. Then application of treatment to appropriate additional points can be done. But for those who have no prior experience with these methods and judgments, it is better to stay away from trying to do this until you have completed a course of training in Meridian Therapy and developed an understanding of what the pulse changes feel like that indicate application of draining techniques. As described in Chapter 4, it is better to apply less treatment in order to regulate the dose of treatment. Unless one is really clear about such steps of treatment, do not do them; stick with the simplified treatment of the primary pattern. The usual point combinations for the four patterns are listed above. These are based on a systematic interpretation of Nan Jing (Classic of Difficulties) Chapter 69 theory and confirmed through clinical experience. The theory predicts which channels to apply the supplementation technique to and on which points to apply treatment on those channels. In the lung vacuity pattern, lung and spleen channels are vacuous, thus treatment is directed to both of these, and usually LU-9 (the mother/supplementation point). But it may be advantageous to modify the points on the targeted channels using other clinical ideas. There are many theories of point selection, just as there are many schools and styles of acupuncture (Birch and Felt 1999). A simple theory that complements the basic Meridian Therapy model comes from Nan Jing Chapter 68. This chapter talks about the use of the five shu points according to certain symptomatic manifestations, which we can extend into modern clinical practice—see Table 10.1. Some of these indications are clear. For the child with fever use the ying-spring points instead of the usual points, for example LU-10 and SP-2 instead of the usual LU-9 and SP-3 for the lung vacuity pattern patient. But clinical experience has shown us that we can extend these indications, partly as extended interpretations of what the Nan Jing describes and partly based on their five phase correspondences. Table 10.2 lists examples of how we might extend selection of acupoints from Table 10.1.
Diagnosis to Select the Primary Pattern in Children
Typical Symptoms Associated with Each of the Four Patterns
Typical Examples of the Four Patterns
The 10-week-old baby who will not settle or sleep well, cries a lot, is typically a liver sho-type pattern (see Case 1, Chapter 21). In this case some basic pulse information was accessible, the left deep pulses felt weaker than the right deep pulses, supporting the selection of the liver pattern. No clear signs were apparent on the abdomen.
The 4½-year-old child who repeatedly catches cold, has chronic nasal congestion/infection, and tends to develop cough easily is a typical lung vacuity pattern patient (see Case 2 in Chapter 26). The pulse of the right wrist at a deeper level will generally appear weaker than the same depth pulse on the left wrist.
Examples of More Complex Patterns
The 5-year-old hospitalized patient with very severe and serious digestive disturbance due to an improperly developed gastrointestinal system (see Case 1, Chapter 27). This patient had both spleen (digestive problems) and kidney (developmental disorder) patterns, and both patterns needed to be treated. While the pulse diagnostic information was accessible, it was not possible to palpate the abdomen and complete a normal (adult) assessment. The pulse findings helped differentiate how to focus the treatment as a primary spleen pattern (spleen and heart pulses weak) with kidney secondary pattern (kidney pulse weak).
The 12-year-old boy with a long history of severe atopic dermatitis. While the child may have started out as a lung-vacuity-type patient, the extensive use of steroid creams eventually triggered signs and manifestation of the kidney vacuity pattern (see Case 1, p. 127). Since the boy was more mature it was possible to obtain other diagnostic information to make this decision. The pulse, abdominal, and other palpation findings supported the identification of which pattern to treat. At first he was treated as a lung pattern, but later it became clear that kidney pattern was better for him.
Diagnosis to Select Additional Steps of Root Treatment
Modifying Point Selection for Treatment of the Primary Patterns
Acupoint | Indications |
Jing-well | Feeling fullness and discomfort below the sternum |
Ying-spring | Fever or feelings of body heat |
Shu-stream | Joint pains or heaviness of the body |
Jin g-river | Cough, alternating fever and chills |
He-sea | Counterflow qi, leakage of fluids such as diarrhea |
Examples of Modified Point Selections
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