Paediatrics According to Body Type

I remember my first Chinese medicine class at university on paediatrics 15 years ago. The introduction was – “A child is not a smaller version of an adult.” And in the text, there was a small person, and a large person next to each other, just in case we weren’t sure exactly.

I thought this was absolutely ridiculous and kind of insulting. I mean, do they think I don’t know what a child looks like? However, I began to understand it wasn’t physical appearance as the image portrayed, but the physiological functioning difference, sensitivity, fragility and speed at which disease develops and changes.

As pediatric disorders can be daunting for the uninitiated, we will introduce 15 major classical formulas and their associated ‘body types’ and common uses according to classical medicine using the applications outlined by Dr Huang Huang.

1.0 Xiao Chai Hu Tang

Chai Hu 6, Huang Qin 3, Ren Shen 3, Ban Xia 6, Zhi Gan Cao 3, Sheng Jiang 3, Da Zao 9

• Body type is often thin
• Facial color yellow or pale with a lack of brightness
• Often allergic illnesses
• Eyes often small and long
• Catches cold easily and fever lasts a few days
• Difficult to cure, recurrent, long term disorders are common.
• Personality tends to being introverted and depressed as opposed to Ban Xia type who is more outgoing and engaged.

Paragraph 96 of the shang han lun: “for alternating chills and fever, a sense of discomfort and fullness in the chest and ribs,being dejected with no desire to eat, irritability of the heart and a tendency to vomit.”

1. Chest and hypochondriac fullness and discomfort, or stiffness and fullness beneath the ribs, or focal distention and fullness in the subcostal region.
2. Alternating fever and chills
3. Irritability in the chest with a desire to vomit and lack of desire or inability to eat.
4. A wiry, thin and wiry, slippery and wiry, or sinking and wiry pulse.
5. A tongue coating that is yellow, yellow and white mixed together, pale yellow, or yellow and greasy.

Common applications:

• Cold with fever and enlarged lymph nodes
• Tonsilitis with abscess
• Allergic rhinitis
• Bronchitis
• Bronchial asthma
• Urticaria, eczema, dermatitis
• Nasal polyps
• Middle ear infection, sinusitis, otitis media

Formula variations:

1. Fever: Add Lian Qiao
2. Allergic Rhinitis: Congestion, rhinitis, sneezing: XCHT + Xin Yi Hua, Wu Wei Zi, Shi Gao. Add Lian Qiao, Zhi Zi, Huang Bai (if yellow mucous). If itchy eyes and runny nose: Jing Jie and Fang Feng.
3. Asthma & Cough: Add Hou Po, Fu Ling, Wu Wei Zi (sour herbs like wu wei zi are very effective at astringing the lung qi and are anti-allergenic – including wu mei and vinegar. Wu wei zi use: thin mucous, cough, heavy panting, dizziness with sweating, dark vision)
4. Cough with thin mucous (like water): Gan Jiang
5. Urticaria: Common in children with milk allergies. Common in 2-7 year olds. Add Jing Jie 10g, Fang Feng 10g (itching), Shi Gao 10g (if sweating with big thirst), Increase Chai Hu does if fever. Dr Huang doesn’t use Sheng Di generally for hives and urticaria, but for other skin conditions like eczema as the pathogen is in the skin level, not the blood level).
6. Otitis Media: Eustachian tube is shorter and more horizontal than in adults so reflux of food aprticles up the tube to the ear is more common. Symptoms of pain, tinnitus, fluid coming out, loss of hearing, babies rubbing their ear. Use XCHT + Lian Qiao (special for otitis media), Zhi Zi, Huang Bai (for yellow discharge).
7. Muscular Dystrophy: Depends on severity, but can help alleviate symptoms and prevent muscle wasting.

Case study from Dr Huang Huang

Case #1: Cough & fever 6 year old child, cold & fever for a week, 3 days before – bleeding, platelets very low. Purpura due to low platelets & related to common cold, tonsils swollen

Xiao Chai Hu Tang with Sheng Di & Lian Qiao

Chai hu 15, Huang Qin 10, Ban Xia 10, Sheng Gan Cao 5, Lian qiao 30, Sheng Di 30, Gan Jiang 5 slices, Hong Zao 15

Sheng Di & Lian Qiao is useful for bleeding and bleeding is a specific indication for Sheng Di.

Case #2: Tonsillitis 5 years old

Cough & yellow phlegm for 2 months worse in morning & before sleep, yellow nasal mucus, thick tongue fur, easily allergic

Chai hu 15, Huang qin 10, Ban xia 10, Dang shen 10, Gan cao 5, Jie geng 10 (yellow mucous), Zhi zi 10, Huang bai 5 (yellow mucous), Lian qiao 15 (yellow discharge), Zhi ke 10 (dry stool), Bai shao 10 (dry stool), Gan Jiang 5, Hong Zao 15

2.0 Chai Hu Jia Long Gu Mu Li Tang

Chai Hu 12, Huang Qin 9, Ren Shen 6, Gui Zhi 9, Fu Ling 9, Ban Xia 9, Da Huang 6, Long Gu 9, Mu Li 9, Sheng Jiang 6, Da Zao 12, Qian Dian/Dai Zhe Shi (optional) 9

This formula is for the child who is a Chai Hu type but has more pronounced feelings of depression or other psychological issues. It calms the spirit, stops fright and resolves depression.

Body Type

Average body physique, Pale facial colour, Cold fingers and toes, Tightness under the ribs

Common Uses

Convulsions, Poor brain development, Hyperactivity, Insomnia