Measles Measles & Chinese MedicineMeasles is an acute and infectious disease mostly occurring in children, which is marked by fever,

cough, nasal stuffiness and discharge, lacrimation, small, brightred spots on the buccal mucosa and skin rashes. Etiology and Pathogenesis Physiologically, the lungs are connected with the skin and hair, and have their orifice at the nose. The spleen is responsible for the normal activity of the extremities and muscles. When the lungs are involved, symptoms of lung-wei disorder such as fever, cough, nasal discharge and sneezing appear. When the evil further attacks the spleen from the lungs and extends to qifen from weifen, the healthy qi will expel the evil from the interior to the superficies and the skin rash will erupt thoroughly so that the evil is eliminate, and the case has a favorable prognosis. However, if the healthy qi fails to dispel the evil or the predominant heat changes into fire, the skin rash cannot erupt thoroughly, and the prognosis is unfavorable. This may lead to various critical conditions. In cases where the evil blocking the lungs leads to failure of descending of lung-qi, dyspneic cough may ensue. In cases where fire attacks the throat, hoarseness, cough and even dyspnea may occur. If the heart and liver are involved, there may appear coma, delirium and convulsions. In a few cases where the primordial qi is insufficient and heat is accumulated, there may appear symptoms of collapse-syndrome, such as pallor, deadly cold limbs, listlessness and fading pulse. Syndrome Differentiation and Therapeutic principles A. Syndrome differentiation (a) Case with favorable prognosis: Fever but not too high, slight sweating, mild cough, good spirit, consciousness, no dyspnea, bright-red skin rashes appearing three to four days after fever and beginning from the postauricular hairline and gradually and evenly distributing to the face, neck, trunk, limbs and finally the hands and feet, later becoming dull red and disappearing in the above sequence after three to five days, cough relieved and appetite returned as the fever subsides. (b) Deteriorated case: Skin rash failing to appear after fever for four to five days or appearing instantaneously or lasting for a long period or erupting without a regular sequence, dark purplish or dark or pale in color, merging together to form masses and accompanies by high fever, irritability, coma, delirium, convulsions, dyspneic cough, hoarseness or even cyanosis, dyspnea and deadly cold limbs. B. Therapeutic principles Letting out evil, eliminating toxic materials and nourishing yin are the three main therapeutic principles for measles. As stated by ancient physicians: "Measles evil is a yang evil which should be treated by letting out and by cooling." Hence, the drugs with acrid-cool properties should be applied in the early stage to let out the skin eruptions. During the eruption period, clearing away heat and toxic materials is the main principles, but the acrid-cool drugs should be supplemented at the beginning to promote a thorough eruption of the skin rash and the sweet-cool drugs should be used in the late eruption period to nourish yin and clear away the remaining heat. But in applying the above therapies, it should be emphasized that consumption of body fluids should be avoided in applying the measures of promoting eruption, overuse of drugs of cold and cool nature is inadvisable for clearing heat and toxic materials, and indiscriminate use of greasy tonics is contraindicated for nourishing yin. Classification and Treatment A. Case with favorable prognosis (a) Early febrile period (from the beginning of ever to the appearance of skin rash, about three days) Manifestation: Fever, mild chilliness, nasal stuffiness and discharge, cough, sneezing, redness of

eyes, lacrimation, photophobia, poor appetite, loose stool, oliguria, flushed cheeks, Kophik's spots, thin and white or yellowish tongue coating and floating and rapid pulse. Therapeutic principles: Let out evil, clear away heat, and release the stagnated lung-qi. Prescription: The Modified Powder of Forsythiae and Lonicerae Fructus Forsythiae 10 g Flos Lonicerae 10 g Fructus Arctii 3 g Radix Peucedani 10 g Periostracum Cicadae 6 g Semen Sojae Praeparatum 10 g Herba Lophatheri 6 g Radix Platycodi 5 g Rhizoma Phragmitis 10 g Remarks: Add Radix Puerariae (10 g) and Rhizoma Cimicifugae (3 g) for cases with severe diarrhea. Add Herba Spirodelae (10 g) for cases with high fever and no sweating. Add Semen Armeniacae Amarum (10 g) for cases with severe cough. (b) The eruption period (from the beginning to thorough eruption of the skin rash, about three to five days) Manifestations: Continuous high fever, redness of eyes and lips, irritability, thirst, severe cough, mental fatigue, oliguria with deep yellow and gradually increasing and merging together, red tongue with yellow and greasy or dry coating and full and rapid pulse. Therapeutic principles: Clear away heat and toxic materials, and let out skin eruptions. Prescription: The Modified Decoction for Clearing Away Heat and Letting Evil Out Flos Lonicerae 10 g Fructus Forsythiae 10 g Folium Mori 10 g Fructus Arctii 10 g Radix Arnebiae seu Lithospermi 10 g Radix Puerariae 10 g Rhizoma Phragmitis 10 g Radix Glycyrrhizae 3 g Remarks: Add Gypsum Fibrosum (30 g, decocted first), Rhizoma Anemarrhenae (5 g) and Radix Trichosanthis (10 g) for cases with high fever and thirst. Add Periostracum Cicadae (6 g), Herba Menthae (3 g) and Herba Spirodelae (10 g) for those with indistinct skin eruption. Add Radix Rehmanniae (10 g), Cortex Moutan Radicis (10 g), and Flos Carthami (3 g) for those with dark purplish rashes merging together. Add Semen Armeniacae Amarum (10 g), Radix Platycodi (3 g) and Cortex Mori Radicis (10 g) for those with severe cough. (c) The late eruption period (from thorough eruption to disappearance of rash, about five to seven days) Manifestations: Rash gradually disappearing in the sequence of eruption, fever subsided, cough relieved, appetite, increased, stool and urine returned to normal, furfuraceous desquamation and chromatosis appearing on the skin, red and dry tongue with little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin with sweet-cool drugs and remaining heat. Prescription: The Modified Decoction of Adenophorae Strictae and Ophiopogonis Radix Adenophorae Strictae 10 g Radix Ophiopogonis 10 g Rhizoma Polygonati Odorati 10 g Radix Trichosanthis 10 g Semen Dolichoris 10 g Folium Mori 10 g Folium Eriobotryae Praeparata 10 g Radix Glycyrrhizae 3 g emarks: Add Cortex Lycii Radicis (10 g) and Radix Scutellariae (6 g) for cases with remaining heat. Add Endothelium Corneum Gigeriae Galli (6 g), Fructus Hordei Germinatus (fried, 10 g) and Fructus Oryzae Germinatus (fried, 10 g) for those with poor appetite. B. Deteriorated case (a) Evil invading the lungs Manifestations: Rashes eruption indistinctly or disappearing instantaneously or appearing densely and purplish, continuous high fever, irritability, cough, dyspnea, moving of alae nasi, cyanotic lips, red and dry tongue with yellow coating, and rapid pulse. Therapeutic principles: Clear away heat and toxic materials, and release the stagnated lung-qi. Prescription: The Modified Decoction of Ephedrae, Armeniacae Amarum, Glycyrrhizae and Gypsum Fibrosum Herba Ephedrae 3 g Semen Armeniacae Amarum 10 g Gypsum Fibrosum 30 g Radix Glycyrrhizae 3 g Radix Peucedani 10 g Radix Scutellariae 6 g Radix Isatidis 10 g Fructus Perillae 10 g Remarks: Add Herba Menthae (3 g), Periostracum Cicadae (6 g) and Herba Spirodelae (6 g) for cases with indistinct rashes or instantaneous disappearance of rashes. Add Radix Arnebiae seu Lithospermi (10 g) and Cortex Moutan Radicis (10 g) for those with dense and purplish rashes. Add Bulbus Fritillariae Thunbergii (10 g) and Concretis Silicea Bambusae (10 g) for those with profuse expectoration. (b) Heat attacking the throat Manifestations: Swelling and pain of the throat, hoarseness, cough with heavy voice, wheezing sounds in the throat, red tongue with yellow coating and rapid pulse. Therapeutic principles: Clear away heat and toxic materials, and ease the throat. Prescription: Decoction of Clearing the Throat and Eliminating Phlegm Radix Scrophulariae 10 g Fructus Arctii 10 g

Fructus Trichosanthis 10 g Rhizoma Belamcandae 6 g Bulbus Fritillariae Thunbergii 10 g Fructus Aristolochiae 10 g Radix Paeoniae Rubra 10 g Radix Platycodi 5 g Radix Glycyrrhizae 3 g Remarks: Pill of Six Miraculous Drugs, one pill for each year of age, thrice daily. Add Radix et Rhizoma Rhei (3 g, decocted later) and Natrii Sulfas (6 g, mixed with the decoction) for those with constipation. For serious cases with signs of laryngeal obstruction such as pallor, irritability, dyspnea, cyanosis, etc., other measures including tracheotomy may be applied. (c) Retention of heat in the heart and liver Manifestations: High fever, irritability, coma, delirium or even convulsion rashes becoming purplish red and densely distributed all over the body and failing to disappear, or disappearing instantaneously, crimson tongue and wiry, thready and rapid pulse. Therapeutic principles: Clear away heat and toxic materials, suppress wind, and wake up patient from unconsciousness. Prescription: The Modified Decoction of Cornu Saigae Tataricae and Uncariae cum Uncis Cornu Saigae Tataricae 1 g Ramulus Uncariae cum Uncis 10 g Folium Mori 10 g Lignum Pini Poriaferum 10 g Radix Rehmanniae 10 g Cortex Moutan Radicis 10 g Folium Isatidis 10 g Radix Scutellariae 10 g Bulbus Fritillariae Cirrhosae 6 g Scorpio 1.5 g Remarks: Purple Snow Pill, 1.5 grams twice daily, or Calculus Bovis Bolus for Resurrection, half bolus twice a day. Add Rhizoma Acori Graminei (10 g), Radix Curcumae (10 g) and Rhizoma Arisaema cum Bile (6 g) or Bolus of Precious Drugs (half bolus twice a day) for cases with deep coma. C. Collapse of yang-qi Manifestations: Sudden lowering of body temperature, profuse sweating, pale or blue-gray complexion, shortness of breath, deadly cold limbs, pale and indistinct skin rashes, pale tongue with white coating and fading pulse. Therapeutic principles: Recuperate the depleted yang, and rescue the patient from danger. Prescription: Decoction of Ginseng, Aconiti Lateralis Praeparata, etc. Radix Ginseng (mixed with the decoction) 10 g Radix Aconiti Lateralis Praeparata 10 g Os Draconis 15 g Concha Ostreae 15 g Experiential Prescriptions

A. Rhizoma Phragmitis (30-60 g); prepared as decoction for daily drinking; applicable to cases during the early febrile period and the eruption period. B. Fresh Herba Coriandri Sativi (30 g), Herba Spirodelae (30 g), yellow wine (60 g) and water (q.s.); prepared as decoction for bathing; applicable to cases during the early febrile period and the beginning of eruption period.

CONVULSION INFANTIL Octubre 16, 2009 Se denomina tambin espasmo infantil. Es una enfermedad comn en pediatra. Los ataques duran solo unos segundos, pero pueden repetirse muchas veces en el da. Se limitan a los primeros tres anos de vida. Suele ser evidente una lesin cerebral. La medicina tradicional china lo denomina convulsin aguda. El espasmo se debe a muchas causas, y la ms importante de stas es la infeccin. Adems, tambin puede ser causada por trastornos metablicos, por intoxicacin, epilepsia, lesiones cerebrales expansivas, defectos cerebrales (con-gnitos, del desarrollo), anafilaxia, etc. Por otra parte, hay algunos nios que convulsionan por hiper-pirexia. Se llama espasmo de fiebre. Por lo comn, desaparece espontneamente antes de que el nio llegue a la edad escolar. La medicina tradicional china estima que la convulsin aguda pertenece a los sndromes de yang, exceso y calor patgeno porque la preponderancia del fuego aviva al viento. TRATAMIENTO Mtodo: Se aplica acupuntura con agujas filiformes y sangra acupuntural. Prescripcin: Shixuan (Extra.), renzhong (Du. 26), hegu (IG 4) y taichong (H. 3). Explicacin: Se da punciones rpidas en los puntos shixuan y renzhong. Se punza el hegu y taichong, se rota y martillea las agujas un momento y se las retira, y luego se toma y oprime los puntos con la mano para que sangren. Experiencias clnicas: Se informa sobre 90 casos de convulsin infantil tratados con sangra en el shixuan. Resultados: efecto notable, 73 casos; mejoramiento, 16 casos; efecto nulo, 1 caso; y eficacia total, 98,9%. 76 de estos nios sufran convulsin por hiperpirexia a causa de infeccin, bronconeumo-na, sarampin, amigdalitis aguda, disentera bacteriana aguda, etc. Luego de la sangra en el shixuan, todos ellos mejoraron en distinto grado: efecto notable en 73 casos y mejoramiento en 3. Se opt tambin por el renzhong, hegu y taichong para tratar a 62 casos de convulsin por hiperpirexia mediante la sangra. Eran 17 nios y 45 nias, entre ellos y ellas, 30 menores de 1 ao, 18 de 1-2 aos, 9 de 2-3 aos, y 5 de 3-5 aos. 41 fueron curados luego de 1 sesin y 7 luego de 2 sesiones; 12 se aliviaron despus de 1-3 sesiones; y 2 no respondieron al tratamiento (el autor considera como casos nulos aquellos que sufrieron accesos luego de 3 sesiones). Caso registrado: Paciente Wang, femenino, 6 aos de edad. Fue llevada al mdico por primera vez el 9 de junio de 1967. La madre refiri que la nia tena fiebre y dolor de cabeza desde haca 2 das y que esa misma maana vomit sin cesar y convulsion varias veces. Examen: fiebre de 39,8C, cuello rgido, ojos cerrados, piernas rgidas, rodillas a veces flexiona-das, inquietud, inconsciencia, materia fecal seca, amarilla y de poca cantidad. Hemograma: 36.000 leucocitos/mm3. Diagnstico preliminar por medio de puncin lumbar: Meningitis cerebroespinal epidmica. A las 7 de la misma noche empez el tratamiento. La acupuntura se concentr en disipar el calor y eliminar el viento. Le tomaron el baihui, dazhui, yongquan, neiting (E. 44), houxi (ID 3), shen-mai (V. 62), chize (P. 5) y taichong. Y tambin le hicieron sangra en los puntos shixuan. A las dos horas de la acupuntura, la nia dej de convulsionar. Fue un total de 6 sesiones de esta terapia esa misma noche. La fiebre baj a las 6 de la maana, y a las 10 la pequea pudo comer y ponerse de pie. La acupuntura continu por otros 3 das hasta la desaparicin de todos los sntomas.

Explicaciones adicionales: 1. Tanto la acupuntura como la sangra acupuntural tienen ciertos efectos para la convulsin infantil provocada por distintas causas. Conforme a la observacin clnica, son singularmente eficaces en convulsiones por fiebre. 2. Aunque la convulsin infantil como complicacin de fiebre alta puede producirse por diversos factores etiolgicos, generalmente es consecuencia de la invasin del fuego de la vescula biliar que el viento avivado por el calor hace subir por el meridiano shaoyang. En este caso es apremiante aplicar la acupuntura para aliviar la convulsin. Si el paciente se convulsiona repetidas veces mientras su fiebre no cede, entonces hace falta tratamiento y terapia antipirtica al mismo tiempo para poder conseguir su curacin. 3. Al nio pequeo en estado grave hay que aplicarle un conjunto de medidas de socorro. Para su tratamiento el concurso de la acupuntura y moxibustin ayuda a elevar el efecto teraputico.