Chinese Clinical Medicine - Paediatric conditions - Essay Example

Traditional Chinese Medicine Introduction Among other pediatric conditions including asthma, warts, and infantile eczema, insomnia is also a condition among children that occurs as a result of various causes. The causes for pediatric insomnia are diverse and include therapeutic and behavioral problems or a combination of both that results in the development of the condition. Although insomnia in children can be defined in a similar way as that in adults, the indications of insomnia are different among children. From an analytical viewpoint, insomnia in children is characterized by difficulty in falling asleep, refusal to go to bed, or periodic or extended waking during the night (Owens & Mindell 2011). Traditional Chinese Medicine has long been used for the treatment of various child conditions including hyperactivity, diarrhea, indigestion, (Ecklund n.d.) and has also been proved to beneficial for reducing sleep issues among children as well as adults. Conventional Chinese techniques and methodologies have evolved over centuries to improve its medicinal practices such as acupuncture, herbal medicines, tai chi, dietary treatments, and other massage and therapies (Ecklund n.d.). Seldom will children ever complain of having sleep issues and such a condition will probably be observed by their parents so as to identify sleep interruption in the clinical circumstances. Also, parents of lower age groups are more likely and ready to observe behavioral issues that may identify sleep disruptions among children. However, as the age increases, parents may be less likely to identify sleep issues among their children. For these reasons, the diagnosis of insomnia among children is more difficult as compared to adults (Owens & Mindell 2011). The importance of sleep issues among parents along with other cultural factors is also important in determining the likelihood and willingness of parents to spot sleep problems in their children. The theories of traditional Chinese medicine provide an effective way of treating children’s illnesses and conditions. Techniques such as tai chi and acupuncture are of vital importance for treating sleeplessness among children and adults. Pediatric acupuncture has allowed an improvement in the symptoms of patients suffering from sleeplessness. David Mayor, who reviewed May Loo’s book Pediatric Acupuncture speaks about using western medicine and traditional Chinese medicine as a unifying technique so as to provide an even effective methods of reducing symptoms that meets the requirements of today’s children (Mayor 2003). Since children now face a new environment and are exposed to new factors like technology, fast food, and pollutants, ancient beliefs and views have been presented as altered versions that answer to the needs of today’s children (Mayor 2003). Literature Review The classic text regarding sleeplessness and acupuncture is Ling Shu: Or the Spiritual Pivot translated by Jing-Nuan Wu. According to the text, human beings compose of Qi which encircles all emotions, bodily fluids, blood, muscles, bones, and other components that are always circulating around the body (Wu 2002). Since it is always moving, we as human beings are always in a state of renewal and this change continues throughout our lives. Children being small and delicate have only started their lives and are therefore regarded as physically and functionally immature. Wei Qi circulates through our body many times a day then travels within the deeper layers of the body and circulates many times at night. By doing so, it completes several cycles around the body traveling through the channels inside the body and finally arriving at the corner of the eye allowing a person to wake up (Wu 2002). Although raw, the text refers to the cycle of sleep and waking as affected by the circulation of Qi around the body that stimulates waking and sleep. Yin and yang also work synchronously thereby impacting the control of the sleep cycle. In the day, the concentration of Qi is high in the channels that connect muscles and bones thereby managing muscle movement. The circulation of Qi within the muscles allows them to relax which induces an individual to fall asleep. As Qi moves to the internal parts of the muscles, blood follows and enables the muscles to become relaxed. The circulation of the fluid in the internal and external parts allows a person to fall asleep and that is why acupuncture for insomnia focuses on needling those points in the interior side that will allow blood to flow causing the muscles to become relaxed and this helps in inducing sleep (Wu 2002). Owen and Mindell’s journal article Pediatric Insomnia describe many forms of pediatric insomnia among children including behavioral insomnia of childhood (BIC) (2011). BIC is symbolized by bedtime issues and waking in the middle of the night as indicated by parents of insomniatic children. Although the different types of BIC may exist together, the authors explain it as individual conditions. BIC-SOA (Behavioral Insomnia of childhood, sleep onset association type) refers to repeated and extended periods of waking at night that require parental interference in order to enable a child to return to sleep (Owens & Mindell 2011). Four diagnostic requirements have been outlined in the article which includes: Extended sleep commencement that may require specific actions, challenging sleep commencement actions, great delay in sleep in the absence of these situations, and the requirement of intervention from the parents or caregivers (Owens & Mindell 2011). Various internal and external environmental factors also impact that likelihood of a child having trouble going to sleep independently and is more common if the involvement of parent is great in making a child go to sleep, for example, co-sleeping. BIC-LST (Behavioral Insomnia of Childhood, limit setting type) is symbolized by the unwillingness of children to go to bed during bedtime. These include vocal complaining, refusals, and repeated insistence during bedtime instead of waking at night. These actions result in delay of sleep commencement as children exhibit an opposing behavior. The diagnostic requirements include: problems in falling asleep or keeping up sleep, refusing or delaying going to bed, absence of or inadequate limit setting regarding bedtime and sleeping attitude by the parents. If sleep among such children commences late, this leads to insufficient sleep for the child. BIS-C (Behavioral Insomnia of Childhood, Combined Type) in children presents both bedtime refusal and waking at night (Owens & Mindell 2011). The most common literature present for treating insomnia is by means of needling at specific acu-points through acupuncture. Although many describe acupuncture to be effective in treating insomnia and having fewer side effects, it is generally not used to treat insomnia among children. More common methods include TCM herbal massage and medicines. There do exist, however, few forms of acupuncture that are suitable for children. One such form is Shoni-Shin, which uses a combination of small metal instruments in order to bring Qi to the surface thereby improving circulation (Ecklund n.d.). The circulation of Qi in the internal parts of the sinew channels causes the muscles to relax thereby improving sleep onset. The main reason for using the Shoni-Shin technique of acupuncture on children is due to its non-invasive nature that does not pierce through the skin. Among adults, normal acupuncture proved to be very effective in reducing negative symptoms of insomnia which were not resolved from previous attempts of other modern treatments (Tukmachi n.d.). Two cases of insomnia including a women and a man suffering from insomnia were treated using manual and electrical acupuncture where the patients responded well to the acupuncture treatment who had previously responded poorly to modern treatment with minimal or no effect on symptoms (Tukmachi n.d.). Another combination of TCM and WM is proposed by May Loo in her book that is relevant for children of today (Mayor 2003). She argues that since children of today lead different lives than before, traditional methods have to be modified so as to better deal with pediatric conditions. The addition of fast food into our lives, advancements in video entertainment and technology, and pollution has affected children in unforeseeable ways. In order to carry out pediatric acupuncture, many methods of acupuncture from various traditions have been combined to treat a wide range of illnesses among children (Mayor 2003). Therefore, there is probably more literature available for treating pediatric insomnia through acupuncture and tai chi is more effective for reducing symptoms of insomnia among older individuals. The literature presents the critical role of qi in the internal and external muscular areas and muscular relaxation thereby helping a person to fall asleep. The classical TCM text regarding insomnia and acupuncture provide information regarding the important role of qi in maintaining the sleep cycle. Hence, most TCM methods revolve around improving the circulation of qi in the internal areas of muscles so as to result in their relaxation. Acupuncture of specific points around the sinew channels stimulates the flow of qi in the internal parts of muscles thereby improving sleep and reducing the symptoms of sleeplessness. Acupuncture is focused on treating the flow of bodily fluids improving the cycle of sleep. Treatment of children’s conditions including insomnia, eczema, hyperactivity, asthma, and allergies have resulted in quick responses making TCM therapies and treatments to be productive. Discussion Insomnia among children is common although it may hardly ever be diagnosed by parents due to its imperceptible nature. The literature presents deep research regarding the types of behavioral insomnia among children that include refusal to sleep and awaking at night. The most common TCM treatment for insomnia appears to be acupuncture and tai chi. However, invasive needle penetration may prove to be impossible among children. Other acupuncture techniques including Shoni-Shin are non-invasive and use a variety of different tools in order to improve qi circulation. The ancient text on TCM treatment and acupuncture specifically mentions that the circulation of qi in internal areas around the muscle which enhances relaxation of muscles and induces sleep. In acupuncture the treatment involves the placing of needles at those points particularly the sinew channels between muscles and bones to allow better circulation of qi thereby reducing the symptoms of sleeplessness. This is possible among adults and not on children especially those under the ages of 6. Other TCM methods including dietary improvements, herbal massages, and therapies are more suitable among children as they are less risky and are more likely to be acceptable among parents for treatment. Although pediatric insomnia may be difficult to diagnose, it should be treated immediately so as to prevent it from developing into a chronic form which children can rarely get over. TCM treatment recommends therapies and acupuncture, however, western medicine involves a behavioral plan of action aimed at reducing unwanted bedtime behaviors and improving limit setting by the parents thereby triggering children to go to sleep at the appropriate time (Owens & Mindell 2011). Some strategies include parent setting a regular routine for bedtime so that children are put to bed early and develop a consistent habit. This would reduce the refusal behavior and encourage a child to fall asleep independently. While it is true that TCM has proven to be effective in the treatment of a number of conditions, a research had hypothesized its effectiveness in primary care to be lacking as compared to western medicine (WM). A study was carried out on patients under TCM and WM treatment in order to analyze the differences in effectiveness of the two methods. The participants were made to fill a questionnaire asking about their complaint, social demography, and so on. Scores were then calculated and the outcome was observed as differences in the scores. A statistical test for validity allowed the comparison of scores for TCM and WM. The results showed a greater number of patients from WM clinics to be showing improvements as compared to WM patients however correlation of the baseline for two scores did not show much difference. Hence, no significant difference in the effectiveness of the two methods was found in the primary care from TCM and WM (Wong, Lam, Li, Ho, Fai & Li 2011). Although the concepts of TCM has been quite famous including acupuncture and herbal medicines, research has shown poor effectiveness of these methods due to the complicated nature of its theories. Also, the fact that classical texts are difficult to translate has made the application of TCM concepts difficult. From the translated classical texts that are available, the theories are often hard to comprehend and present a challenge for the researchers who are looking for proof of its effectiveness. In order to prove a definite effectiveness of TCM methodologies more research is required so as to come down to a final conclusion. In comparison, western medicine has an advantage due to the availability of various technologically advanced techniques, activities, and machinery for diagnosis and treatment. However Chinese medicines are derived from natural and herbal sources, which is why they are free from side effects and rarely do they pose a risk. Even needling during acupuncture only has an insignificant known side effect. A greater risk results from the use of unhygienic and non-sterile instruments but not from the methodology. There are still aspects in TCM that have to be further evaluated including herbs, prescriptions, and other advanced concepts even though some have been already incorporated into modern medicine. There are some concepts that are outdated therefore some theoretical aspects of TCM should be upheld while those that require further research should be discarded for the time being. An integrative approach of modifying TCM to meet the requirements of modern times and using TCM along with WM seem to be a useful ways of recognizing relevant and applicable concepts (Dong 2013). Conclusion Although TCM provides many techniques for the diagnosis and treatment of insomnia among children, more research is required to find out the effectiveness of Shoni-Shin acupuncture in children. Also, other techniques apart from herbal medicines, dietary changes, and herbal therapies should be considered including behavioral strategies to resolve symptoms occurring as a result of sleeplessness. An integrative approach involving both WM and TCM should be considered to provide a better resolution of symptoms resulting from insomnia. It should not be ignored that insomnia among adults have shown to be treated by acupuncture and patients have shown good response to TCM treatment. Also, the tai chi method which involves slow motion exercises and movements has resulted in the reduction of insomnia symptoms. Although there are methods that have been customized to suit treatment of children, it is more beneficial to use strategic approach of treating pediatric insomnia than to opt for TCM techniques. TCM cannot be used for the diagnosis of pediatric insomnia and is to be identified by means of parental observation. However, treatment using TCM is possible through pediatric acupuncture or other methods such as therapies, massage, and changes in diet. The concepts regarding qi seem to involve physical as well as spiritual components and the classical text Ling Shu presents a complicated theory regarding the circulation of qi within the body channels around muscles. Research efforts should link the reality of qi using scientific explanations through which TCM techniques result in the improvement of insomnia and other conditions. So, the effectiveness of TCM and strategic approach in treating insomnia should be evaluated so as to provide a sound conclusion. References Dong, J. 2013. The Relationship between Traditional Chinese Medicine and Modern Medicine. Evidence-Based Complementary and Alternative Medicine 2013. Ecklund, LL. n.d. Treating Children with Traditional Chinese Medicine [Online] Available at: https://www.pacificcollege.edu/acupuncture-massage-news/articles/540-treating-children-with-traditional-chinese-medicine.html [Accessed: 15 Oct 2013]. Mayor, D. 2003. Book Reviews: Pediatric Acupuncture. European Journal of Oriental Medicine 4(3). Owens, JA & Mindell, JA. 2011. Pediatric Insomnia. Pediatric Clinics of North America 58( 3), pp. 555-569. Tukmachi, E. n.d. Acupuncture Therapy in Diseases Failing to Respond to Western Medicine: Six Case Reports. The Journal of Chinese Medicine [Online] Available at: http://www.jcm.co.uk/sample-articles/product/catalog/product/view/7994/acupuncture-therapy-in-diseases-failing-to-respond-to-western-medicine-six-case-reports/ [Accessed: 15 Oct 2013]. Wong, W, Lam, LK, Li, R, Ho, SH, Fai, LK & Li, Z. 2011. A comparison of the effectiveness between Western medicine and Chinese medicine outpatient consultations in primary care. Complementary Therapies In Medicine 19(5), pp. 264-275. Wu, JN. 2002. Ling Shu: Or the Spiritual Pivot. Hawaii: University of Hawaii Press. Read More