Najom Article: Special Series, Treating Children

July 2015 NAJOM
Miracles with Shonishin and Paediatric Acupuncture
by Katrianna Heigelmann

Many of us practitioners shy away from treating children. I was no exception, following the words of the famous physician Sun Si Miao (Tang 618-907): “better to treat 10 men than 1 woman, better to treat 10 women than 1 baby.”
The breakthrough usually happens when one becomes a parent and reaches out for more infor- mation and training in the treatment of children. Pediatrics class at a TCM college is just not enough. I found in my journey as an acupuncturist and mother that acupuncture, especially Japanese- style, offers much for our little ones.
Although chapters of the Jin Gui Yao Lue (Essentials of the Golden Cabinet) and Mai Jing Pulse Classics of the Han Dynasty were applied to pediatrics, the Song Dynasty Physician Qian Yi (circa 1032-1113) wrote the rst actual pediatrics manual. Qian Yi recognized children as unique beings with distinctive physiologies and pathophysiologies requiring special diagnosis and treatment. His work contained the very famous formula Liu Wei Di Huang Wan for kidney yin de ciency. Today, this formula is also used in geriatric medicine.(Flaws )
When it comes to working with children, I noticed while observing my teacher and inspiration, Ikeda Masakazu Sensei, that his method consists of root treatment, the use of shonishin tools, and techniques of meridian stimulation pertinent to the chief complaint and the child’s developmental stage. In his book, The Practice of Japanese Acu- puncture and Moxibustion (pages 272-277) Ikeda Sensei lists effective branch treatment points for fevers, cough, asthma, vomiting, diarrhea, nervousness, and truancy.
In a 2010 seminar, Sensei treated my then seven- month-old daughter Stella. She was tired and cranky with bit of cough after the long ight from Africa to the seminar in San Francisco. Sensei treated her with SP-3, PC-7 and tapping around the GB and TB meridians on her skull (administered with a teishin and needle handle) as well as some tapping along the BL channel. Stella was smiling the whole time, happy to be on camera, chirping to Sensei and looking right at him. Next day she was free of her cough, in a good mood and – to my great surprise – there was a rst tooth stick- ing out about 2mm from her gum. I was in awe, especially at the fact that a teething baby slept right through the night!

Now, the whole treatment did not take longer than 15 minutes and was very effective. This was a big transition point: I decided to gather as many books, DVDs, and articles on kids’ acupuncture as I could and just start treating the little ones. It helped immensely to see Ikeda Sensei often treating kids at seminars.
This also led me to the purchase of many pediatric acupuncture texts and a DVD by Miki Shima OMD. The DVD is a compendium of common children’s disorders: he cites useful kampo medicine, red ags, when to refer the child to a pediatrician. I especially loved the section on shonishin tools and their applications.
In 2011, I traveled to a seminar given by the brilliant teacher Kiiko Matsumoto Sensei in London, UK. The topic was gynecology. I took my daughter to all my seminars so I could continue learning and not give up the bene ts of breastfeeding her. Again during the plane trip, she developed a dry cough, gastric symptoms with diarrhea and vomiting, lack of appetite, some fever, and lack of thirst.
I was very worried as I went to the seminar, and at the rst coffee break I approached Sensei with my baby and the friend helping me with Stella dur- ing the workshop. I asked the teacher for advice. Sensei took one look at the baby and me, and said: “tiger warmer Ren 12.” I was grateful for the advice and left, thinking, “hmm this treatment seems so very simple. It cannot possibly work.” I took my daughter to a hospital. As she was not considered an emergency case, we had to wait for four hours in a room full of sick and uncomfortable babies just like Stella. I’d had enough: we left the hospital and went straight to our hotel. I warmed up a borrowed tiger warmer and started to warm her Ren 12. My friend left to get an electrolyte solution to hydrate my daughter. When she came back 30 minutes later, Stella was already feeling better: she nursed, ate, had the hydrating drops, and fell asleep. She woke up the next day with no symptoms!
There are some important principles in treating children. My “go tos” are Ikeda Sensei’s chapter on children’s diseases (in his Introduction to Japanese Acupuncture), Bob Flaws’ A Handbook of TCM Pediatrics; Jullian Scott and Theresa Bur- low’s Acupuncture in the Treatment of Children, and Steven Birch’s Shonishin: Japanese Pediatric Acupuncture.
The following is a list gleaned from these writings of TCM physiological characteristics considered important for treatment with classical oriental medicine, using shonishin, regular acupuncture, or herbal medicine (kampo or TCM style).

• “Children’s esh is Fragile, their Blood is scanty, and their Qi is weak” (from the Ling Shu, 200 BCE, in Flaws).
• Children have insuf cient spleen qi and underdeveloped digestive systems.
• The viscera and bowels are tender and delicate and the form qi is not full. Chinese pediatrics is based heavily on Li Dong Yuan’s School of tonifying earth. In utero, babies receive all they need from the mother’s blood; from birth they need to learn to nurse and digest food.
• The above process takes time and there are uncomfortable symptoms such as spitting milk, colic or gas, all some extent normal, but treated well with shonishin.
• Due to their rapid development, children have a very yang constitution, and therefore it’s said “children’s yin is often insuf cient” (similar to pregnancy).
• Children have a greater susceptibility to ill- ness: their “organs are fragile and soft and qi easily looses its path.
• Three main viscera responsible for the major- ity of pediatric diseases are the spleen, lungs (the ‘tender’ organ) and liver.
• Children’s shen is sensitive and unstable: “because of cowardly spirit qi, they easily become emotionally upset.”
• Children’s “liver often has illness.” There can be a surplus of liver wind and a tendency towards convulsions. (In Flaws and Scott, derived from Zhu Dan Xi, Jin-Yuan Dynasty).
• Disease progression is rapid. Children are susceptible to illness, which then rapidly transmits and changes (Scott). Thus some infections manifest with high fever, convul- sions, a lack of shen, and coughs that can turn into pneumonia or meningitis. In such circumstances, the child should be seen im- mediately by a western physician.
• Recovery is rapid. “Yin and Yang organs are clear and spirited. They easily and quickly regain their health.” (Scott)
• “Treat the mother to treat the child.” (Scott) If the mother is stressed and tired the baby will pick up these emotions and become cranky, feeding off her state.
Diagnosis by Looking
• Facial complexion/color and shen.
• Body movement: does it correspond to the developmental stage?
• The ori ces: tongue, ear, nose, throat, as well as anus and urethra (i.e. for the presence of diaper rash or other infections).
17. 

NAJOM Volume 22 number 64

• Index finger vein (San Guan or Three Gates – “Wind, Qi, and Life” from Ming Dynasty/ Zheng Jiu Da Cheng). (Scott)
  
• Shan Gen – the area (and vein) at the root of the nose bridge, between the eyes. If the “Root of the Mountain” is darkened it can indicate birth trauma or a tendency towards diabetes.
  Generally in China, the treatment of children falls under gynecology and therefore focuses more on herbs than acupuncture.(Flaws) A pediatric tuina has developed, with techniques, acupuncture points, and body regions speci c to children. In Japan, a very unique pediatric style (particularly shonisin) has also developed. Some of the tools resemble Chinese gua sha technques and some, like teishin or enshin, are unique to Japan.
  Summary
  My goal in this article to encourage acupuncturists to expand their study and clinical use of pediat- ric acupuncture even though it is not easy! The treatment itself takes less time and uses fewer points and materials, however, when pediatric acupuncture is applied correctly, it can make a world of difference in a child’s health and even a healthy child can bene t from its support in each developmental stage. It is dif cult at rst to trust your skills and learn to interact with a child in the clinic environment. However, once those skills are attained, treatment of children is very rewarding. Both little ones and their parents can gain a whole lot from the treatments.
  Case Study
  In 2012, I treated an eight-year-old boy who came in with a long list of diagnoses that included gastroenteritis, a post infectious auto-immune disorder, sensory processing disorder, ADHD, anxiety, and suspected dysautonomia.
  

He was born six weeks prematurely. He was given all required vaccines (his GP recommended a u vaccine every year because his grandmother was recovering from cancer and her immune system was weak). He had had double pneumonia twice (aged two and three), an infection of an esophagus at age four. Few scars on knees, head, above right eye, left index nger. At the age of six he travelled to Mexico and experienced sudden intense stomach and abdominal pain, no cause found (I suspected parasitic infection but I met this boy two years after the event). He was treated by several physi- cians who prescribed six different medications to manage his symptoms.
When we started acupuncture treatments, the patient suffered constipation, lack of appetite, stomach pain, indigestion, heart burn, intestinal gas, pressure in the chest, shortness of breath, headaches, nausea, eczema, skin rashes. He had a dif cult time concentrating at school, experienced episodes of hyperactivity followed by periods of listlessness. Lacking independence, he clung to his mother.
Treatment was initially for lung de ciency liver excess and blood stasis as a root treatment (KI-7, LU-5, LR-4, LR-8 tapping around LR-13), abdominal shonishin with stick-on moxa and/or tiger warmer at CV-12, CV-4, ST-25, along the bladder line back-shu areas around heart, liver, kidney: over time, as the hara improved (right side softened) the treatment shifted more to spleen de ciency, liver excess, blood stasis (PC-7, Sp3, LR-8 and/ or LR-4), tapping the bladder meridian around heart, liver, spleen, sometimes kidney, enshin on the stomach and large intestine meridians in a nourishing fashion.
Within three months the boy was able to reduce his medications, and within a less than a year of fairly regular sessions he was able to come off the ADHD and anxiety medications as well.

He receives periodic treatment (now for liver excess): I believe it will take time as his medica- tions weakened the liver over time. He is slightly overweight and craves junk food, does not want to cooperate with dietary change. He is very good school-wise now and has become more social.
References
• Ikeda M. 2005. The Practice of Japanese Acu- puncture and Moxibustion. Seattle: Eastland Press.
• Flaws B. 2009. A Handbook of TCM Pediatrics: A Practitioner’s Guide to the Care & Treatment of Common Childhood Diseases. Blue Poppy Press.
• Scott J, Barlow T. 1999. Acupuncture in the Treatment of Children. Seattle: Eastland Press.
• Shima M. 2006. SHONISHIN – Japanese Pediatric Acupuncture and Herbology (DVD). Corte Madera: JAAF Productions.
• Wernicke T. 2014. Shonishin: The Art of Non- Invasive Paediatric Acupuncture. London: Singing Dragon.
• Birch S. 2011. Shonishin: Japanese Pediatric Acupuncture. Thieme.
Katrianna Heigelmann, BSc, Dr. TCM, lives in Victoria, Canada. She graduated in 1999 from the ICTCM of Vancouver and since 2005 has fully immersed herself in the study and practice Japanese acupuncture. If you are interested in sharing more Japanese acupuncture and shon- ishin experiences, she invites you to contact her at inspireacupuncture@shaw.ca.

18

July 2015 NAJOM Interacting with Children
in the Clinic
by Shuto Junko
When an acupuncturist states that they are not good with shonishin (acupuncture on children), the most common reason for it is that children cry at the thought of needles. How you interact with the child becomes the most important factor in facilitating continued treatments.
Once a practitioner creates a rapport with the child, treatments will become effortless, pick- ing up rhythm on its own. The parents will also feel more at ease and will entrust you with their child. With acupuncture treatments on children, a synergistic effect with medical treatments is a possibility as well.
Theoretically, this reasoning is understandable, but children are much more complex, powerful, and dynamic than any theory. They have their own ideas and have the power to pull adults into their world.
Enjoying that creative energy is great if you are just interacting with children, but if you want to interact with them as a practitioner, a certain degree of technique and skill will be needed.
Daishi-ryu Shonishin has three major topics taught in lectures: rst, persuading the parents; second, diagnosis and treatment; third, building a rapport.
Then what kind of technique and skill is needed?
1. Preventing a Child from Crying
Before a child opens the door to your clinic, be ready mentally.
Pretend that you are at the front desk for an errand and check how the child is acting in the waiting room.
The child him/herself would probably be look- ing around curiously as well. Once they nish examining the surroundings, the practitioner should move to a spot not too close, but in the child’s line of sight.
Do not make eye contact with the child and act as though you have no interest in the child.
If the child is acting in a way that shows worry, do not talk to them. Children brimming with curios- ity usually hold interest in the kids’ play area, therefore having the child relax and wait in the play area while the parent guardian writes the medical forms is one method.

Once the child feels comfortable enough, the practitioner should observe the child and take note of any physical signs on their face, such as expression and colour, swelling of the veins sur- rounding the forehead, the look of muscles sur- rounding the eye, redness of the conjunctiva, area around the nose, and cheeks, development of the muscles of the arms and legs. Unlike adults, signs of weakening organs are hardly seen, but stress and heightening of emotions are easy to observe.
However, when the child faces towards you, stop your observation and idly play with objects near you. To the child, a white-coated practitioner is a symbol of fear. Do not try to make eye contact.
If the child seems to be clinging to their parent guardian, simply give a written note to the parent that explains that if the child cries it will make the treatment dif cult and to stay in the waiting room until the child is used to the atmosphere of the clinic. Some children are very sensitive to the word ‘cry’ and passing a written note is more ef cient.
2. Calling a Child into the Treatment Room
When the time comes for the treatment, calling the name of the child can sometimes startle them and end with tears. What I usually do in this case is to ask the child if they would like to play with the toy or game they have with them in the treatment room. Most of the time this works, but in case the child still looks uncomfortable, give them a few more minutes and converse with them.
If it is their second visit it is okay to call on the child more directly, but the key point is to talk to the child as much as possible on the rst visit to prevent them from crying.
3. If the Child Seems Uneasy
Have the mother or father carry their child so he/ she is facing the parent. Start treatment from the back, so the child does not see the practitioner. Treatments on the stomach and auscultation should be done when half way through the treat- ment when you see the opportunity. If the needle treatment hurts or tickles at this time, the child will dislike it and may become unwilling, so be very careful. The next step is to talk to the child using happy and cheerful topics.
For example, for a two-year-old, bring up Blues Clues or Wonder Pets, or food items such as candy and ice cream. Most children are very straight- forward and will respond to your questions or conversation. Once they have started to feel less afraid and their body is feeling better, the treat- ment will be over. It is very important to let them know that this is not a scary place.

In the case of infants, do not seem or feel panicked as infants now by nature when they are in good hands. Making noises rather than words seem to work best with infants. Try using random noises, smile, and converse in simple gestures.
4. Encourage Conversation Between Parent and Child
When the patient becomes a little older, the parents sometimes exclaim that their child does not normally talk too much, but once they come to the clinic they talk about many things. This may be the result of their heart’s feeling at ease after physically feeling better through the treat- ment. Some children periodically tell us their true opinions. When they do, do not question them but rather let them know that you are listening. After they nish, give them a smile that says “thanks for telling me!”
These simple ordinary conversations create a strong trust between the patient and practitioner.
5. Make Sure to Produce a Result
It is hard to make a signi cant difference in the main complaint every single treatment but the practitioner should explain to the child the objective of each treatment. I always start by let- ting the child know about the difference in their face color and expression, skin, auscultation, or anything that I nd during that treatment. Next I go on to telling them other goals that supple- ment their treatments. For example increasing the average body temperature by 0.5 degrees or more, decreasing the number of colds they catch each month, and solving constipation problems. Telling the patient about these supplemental goals allows for a detailed image of how close they are to resolving their main complaint. In reality it is very hard to resolve the main complaint in just a few treatments. However evaluating the progress and explaining progress to the parents and the child is very important.
Translated by Mizutani Chiyo
Shuto Junko graduated from the Osaka Chris- tian College in Child Education and from Osaka Shinkyu Senmon Gakko. In 1997, she established the Shuto acupuncture clinic and became a lecturer and vice-president at the Daishi-ryu Shoni Hari association headquarters. In 1990, she began performing shonishin treatments at the Heiwa kindergarten twice a month.

19.