by Harriet Beinfield, L.Ac., and Efrem Korngold, L.Ac., O.M.D.

Kan Herbal Crossroads: November 2005

New pediatric formulas have been added to the Chinese Modular Solutions system, creating Gentle Warriors, herbal medicine for children. These are safe and effective remedies that support and protect the welfare of children by addressing the most common respiratory, digestive, dermatological, and psychological childhood disorders. Gentle Warriors comprise a simple and comprehensive repertoire for managing a wide array of acute and chronic pediatric ailments, and may be used for adult patients as well.

In conventional pediatrics, antibiotics are life-saving when necessary, but are commonly over-prescribed for non-serious and self-limiting illnesses like otitis media, bronchitis, sinusitis, pharyngitis, gastroenteritis, urethritis, and dermatitis. Earaches are the most frequent trigger for pediatric visits, and the standard treatment is amoxicillin, even though studies show that antibiotics do not effectively reduce the incidence of ear infections. Of the 235 million doses of antibiotics given each year, the Center for Disease Control estimates between 20 and 50 percent are unnecessary. Over-prescription of antibiotics undermines resistance to infection and promotes recurrence. Repeated use can cause yeast overgrowth, diarrhea, indigestion, and mal-absorption.

Gentle Warriors provide alternative solutions to pediatric problems without adverse effects. They are mild tasting liquid extracts that are easy for children to swallow. Before resorting to pharmaceutical interventions, the following eleven formulas are appropriate:

• Windbreaker: earaches, sinusitis, sore throat, colds, flu, allergies
• Chest Relief: cough, laryngitis, phlegm
• Pipe Cleaner: bronchitis, painful cough, tenacious phlegm
• Open Air: acute asthma, wheezing
• Deep Breath: chronic asthma, wheezing
• Grow and Thrive: frail, weak digestion, poor appetite, low resistance
• Tummy Tamer: indigestion, gastroenteritis
• Easy Going: indigestion, constipation
• Belly Binder: indigestion, diarrhea
• Fire Fighter: rash, hives, impetigo, bites, stings
• Quiet Calm: agitated, nervous, cranky, hyperactive, troubled sleep

Gentle Warriors Triumph

Two pediatricians from New York wrote letters in March of 2001 applauding the effectiveness of another original Gentle Warriors formula, Chest Relief. Dr. Larry Baskind M.D. writes,

"I prescribed Chest Relief to a hundred or more children and used the product for every member of my family. There have been no adverse effects reported to me. I'm certain that there would have been, because my patients' parents are quick to call when, for example, they experience rashes or gastrointestinal upset while taking antibiotics.

On the contrary, I have found that Chest Relief, as well as other Chinese Modular Solutions products, have been extraordinarily safe and effective. Here is my logic as a practitioner who cares deeply about his patients, deeply enough to spend many, many hours and late nights and vacations researching "alternative" medicines to offer what I consider the best and safest remedies to my patients and their families. I have great respect for conventional medicine and practice typical Western pediatric medicine. I support immunization and tend to use antibiotics for acute, febrile ear infections.

Last year the Working Group Advisory Committee to the CDC issued a statement about using restraint and discrimination in prescribing antibiotics for ear infections. The CDC the year before recommended a policy of "watchful waiting," suggesting that pediatricians not use antibiotics for uncomplicated ear effusions and non-strep pharyngitis. While this is prudent on scientific grounds, where does this leave the practitioner?

"Well, Mrs. Jones, I'm glad to inform you that Johnny doesn't have an ear infection, strep throat, or any infection treatable by antibiotics today. Unfortunately, since studies have failed to demonstrate any benefit in using decongestants, antihistamines, or any other preparations for symptomatic relief, I can only recommend that you watch for the development of a more serious infection that I can then treat with an antibiotic." I know this sounds facetious, but it is not really. This is the clinical scenario of a policy of "watchful waiting." I would like to add that I think this is fine, and certainly safer than prescribing antibiotics promiscuously with the attendant complications.

But I have to say that I would like to do more for my patients. I would prefer that they don't develop the bacterial complications of routine viral illnesses and I would like them to feel better as quickly as possible. To this end, I have researched herbs and other remedies, and sought out reputable manufacturers like Kan. I believe and have found that certain "alternative" medicines offer a safe and effective therapeutic approach to what are considered mild and benign childhood diseases. We have used Chest Relief in a variety of clinical situations, especially in asthmatics that tend to wheeze with minor upper respiratory infections. As is the current standard of care, we provide them with nebulizers and peak flow devices and instruct them on using Albuterol, and when to begin steroids, but we would prefer not to have to start this sequence. We have found that giving Chest Relief early in the course of an upper respiratory infection may attenuate or prevent a serious asthmatic exacerbation.

I have one last example about another formula, Windbreaker. A few weeks ago, my associate consulted with one of the ENT specialists at our hospital. He seemed to be a bit surly, and when asked about this, he blurted out: "Why don't you send any of your [myringotomy] tube cases to us?" My associate was taken aback, but then searched his memory for recent cases of persistent otitis media that required myringotomy tube placement. He couldn't recall any, and I can only think of one child I've seen this winter who had tubes put in. This is somewhat unusual for a practice as large as ours (over 12,000 patients). I believe that a good part of this is our adherence to the principle of restraint with antibiotics and our implementation of alternative medicine protocols like Windbreaker and garlic oil for chronic otitis and persistent middle ear effusions (as well as our policy of careful follow up and hearing testing in these cases.)

Chest Relief and Windbreaker have proven to be effective and safe medicines in clinical use. I would like to add that they are some of the few herbal medicines that children will actually take without a major protest. This includes my highly discriminating sons." Larry Baskind, MD, FAAP

When appropriate, these formulas can be used as first-line treatments, often obviating the need for pharmaceutical interventions like antibiotics, antihistamines, decongestants, cough suppressants, bronchodilators, steroids, stimulants, sedatives, or anti-depressants. Gentle Warriors also provides complementary support for children receiving conventional care by mitigating side effects and diminishing reliance on prescription or over-the-counter drugs.

Many pediatric disorders are a result of disharmonious interactions between the Stomach, Lungs, and Heart. Additionally, in some children who are failing to thrive, weakness of the Kidney (insufficiency of pre-natal Qi) may be a factor contributing to inadequate immunity, poor digestion and assimilation, hypersensitivity of the nervous system, and delayed development of cognitive and motor skills.

Children's resistance to noxious influences and their ability to adjust to the natural changes occurring within them as they grow is intimately related to their capacity to eat, digest, rest, and be adequately nurtured emotionally and mentally within a predictable, tranquil and stable environment. Even healthy infants and toddlers up to the age of four have immature digestive, respiratory, nervous and immune systems that, when under duress, lead to a host of common ailments. The cases on the following pages are representative of a few of these patterns.

Parents can now have the option of using herbal medicine or antibiotics

A 2002 newspaper article titled "Revisiting traditional remedies--Doctors beginning to recommend herbal cures for a variety of ailments," highlighted the use of the Gentle Warriors formula, Windbreaker, by a San Francisco pediatrician.

"When my husband came home from the doctor's office with a Chinese herbal medicine, Windbreaker, to cure our 3-year-old's persistent cough, I shook my head. "Couldn't they have given you any real medicine?" I asked. But at the moment, it was all I had, so I squeezed 10 drops of the brown stuff into Marisa's orange juice and handed it to her. The cough that had persisted for well over a month was gone. Maybe there was something to this herbal stuff."

"I don't want to give her medicine she doesn't need, but I want to make her feel better," said Dr. James Schwanke, the pediatrician who had prescribed the Windbreaker. "All pediatricians are being coached to give fewer and fewer antibiotics, because (more antibiotics) lower kids' resistance."

Windbreaker, which lists flowers, roots and herbs on the label, is an Americanized name for a traditional Chinese treatment, Schwanke explained. In the Chinese system, mucus is related to wind, Schwanke said, and drying up the mucus "breaks" it.

Schwanke said his interest in Windbreaker and a handful of other Chinese herbal medicines began about 10 years ago, when Efrem Korngold, a "crusader for Chinese herbal medicine," gave him some samples.

"At first I wasn't terribly interested," Schwanke said. "Eventually, for my own sinus problems, I turned to Chinese herbs." Impressed with the results, he said, he tried it on his own kids for their sinus and ear infections about seven years ago, when his youngest was 3. It worked well with her, and he began prescribing it to patients, giving them the option of the Chinese herbal medicines or antibiotics.

Windbreaker helps treat children in the early stages of illness, with a cough, runny nose and lethargy, showing that a cold or flu may be developing. It stimulates the body's healing reactions and reduces mucus." -Jan Goben, May 19, 2002 (San Francisco Chronicle)

Clinical cases using Gentle Warriors and Chinese Modular Solutions

Each of the eleven pediatric remedies can be administered as stand alone prescriptions, combined with other Gentle Warriors formulas, or with appropriate formulas from the Chinese Modular Solutions repertoire. For that matter, adults can equally benefit from all of these formulas.

When treating children according to an underlying syndrome (for example a liver-lung disharmony in an asthmatic child, or a kidney-heart disharmony in a nervous and fearful child), it may be effective to combine one or more of the pediatric formulas with a formula that Harmonizes or Strengthens. For example, a tense child with food sensitivities and indigestion will have a prescription that might include Tummy Tamer and Quiet Calm, combined with Harmonize Liver-Spleen. For the nervous, fearful child who has difficulty falling asleep, a good prescription might include Quiet Calm and Harmonize Kidney-Heart. A cautious, quiet, introspective child with skin problems could be treated with a combination of Fire Fighter and Harmonize Spleen-Kidney if dampness is present, or with Harmonize Kidney-Heart if nervousness and anxiety are problems. The Gentle Warriors constitute a foundation pediatric pharmacy.

CASE 1

A two-year-old girl with chronic eczema at the elbows and knees began to sprout a bright red rash that spread to her ears, neck, chest, torso, and arms. Both parents had a history of allergies and the father also had skin problems. The child did not have any other significant health problems, although her mother had suspicions that certain foods aggravate her eczema (sugar, wheat, dairy, and soy).

Sensitive and worried, the child became easily upset and frightened during the examination. Her tongue appeared healthy, with a slightly thickened white fur; and the digital vein on her index finger was unremarkable, not extending beyond the knuckle. Based on her emotional fragility--she was teary, clinging closely to her mother--and the bright red rash that seemed to worsen rapidly, she showed signs of being a Fire Type. Fire types are sensitive and expressive, emotionally and physically, showing their disharmonies on their skinÑwearing their hearts on their sleeves. They tend to generate excess Heat due to the excitability, hypersensitivity, and hyperactivity of their nervous systems. Heat invades the Blood if it is not adequately dispelled through the skin, lungs, or urine, and then rashes can develop. This child needs cooling and calming. Firefighter and Quiet Calm were prescribed in the following ratio:

• Firefighter 40cc
• Quiet Calm 20cc
• Dose: 2 droppers 3 times per day

She returned after one week. At that time the rash cleared about 85%, remaining only at the elbows and knees. The child was happier, less fearful, and less itchy. Because of her parents' allergies, it was recommended that she eliminate sugar, wheat and dairy from her diet while continuing with the same herbal prescription. One month later, the eczema had disappeared completely, with only minor recurrences triggered by eating sweets, wheat, or dairy.

This young girl is typical of commonly seen childhood eczema. There is a familial predisposition to allergies and specific food intolerances in an otherwise healthy, robust child. With only Firefighter and Quiet Calm, 80% of the problem was relieved, and with the addition of appropriate dietary modifications, the condition remitted 100%.

CASE 2

A nine-year-old boy with chronic headaches and bellyaches had a tendency toward constipation. As a toddler, he had eczema on his face and was somewhat allergic. He had had a peanut allergy that was successfully treated with homeopathic remedies. The headaches and bellyaches tended to occur during school, presumably due to worry and anxiety. He had frequent bouts of indigestion, especially from oily foods.

This robust, slightly chubby, shy and affable boy had a tongue with good color and shape, with slightly sticky yellow fur in the center, and fine herringbone cracks along the central groove. The outstanding quality on his pulse was a fine vibration overall and a thin-feeble quality at the Stomach position. His manner was friendly, responsive and accommodating, in spite of any qualms he may have had about receiving acupuncture or taking herbs. Together with his somewhat fleshy body, these are hallmarks of the Earth Type.

His headaches and bellyaches are triggered by social challenges at school--worrying about social dynamics is another characteristic of Earth Types. The root of his problems seem related to weakness of the Stomach Qi, as evidenced by the appearance of his tongue and the quality of his Stomach pulse. Headaches in children are often a consequence of indigestion, combined with emotional and mental tension: a vibration on the pulse is clear evidence of nervous system strain, probably as a result of ongoing anxiety. The initial prescription included:

• Easy Going 40cc
• Quiet Calm 20cc
• Dose: 3 droppers 3 times per day

By the second visit, the constipation had cleared up and the headaches and bellyaches had diminished in frequency and severity. Since constipation was no longer a problem, the second prescription was modified to include:

• Tummy Tamer 40cc
• Quiet Calm 20cc
• Dose: 3 droppers 3 times per day

On the occasion of the third visit, his headaches and bellyaches had become so mild and infrequent that they no longer bothered him.

CASE 3

An autistic fourteen-year-old boy has been a patient for two years. His neuro-developmental traits include lack of language (verbal utterances but no word acquisition), repeated hand biting, difficulty making social contact, nervousness, agitation, and oppositional behavior when thwarted or restrained. His father originally sought treatment for his chronic sinusitis, nosebleeds, and frequent colds. He was being managed with Topamax (an anti-seizure drug prescribed to supposedly help language acquisition and reduce acting-out behavior), Nasonex (a steroid nasal spray) and Allegra (an anti-histamine). In addition he follows the DAN protocol (Defeat Autism Now) that includes digestive enzymes, EPA/DHA (fish oil), mega vitamins and minerals.

Initially, examination revealed a pre-adolescent slightly overweight boy who was under-developed in his musculature and body shape. This suggested that along with his cognitive delays, he was also slow in maturing physically. His tongue appeared flabby, with teeth marks, and thickened, yellow fur. His pulse was tense overall, especially at the Liver position, inflated and pounding at the Lung position, tight at the Stomach position, and deep and thin at both Kidney positions. While not being particularly upset by the examination process, he resisted my touch, often pushing my hand away, refusing to make eye contact, and often attempting to get up off the treatment table. The general impression was that of a Wood Type child, with a congenital weakness of the Kidneys along with secondary deficiency of the Stomach and Lung Qi. The initial prescription was:

• Windbreaker 40cc
• Grow and Thrive 40cc
• Harmonize Liver-Spleen 20cc
• Harmonize Lung-Liver 20cc
• Dose: 4 droppers 3 times per day

This combination treats the Wood constitution while also addressing the deficiencies of Post-natal and Pre-natal Qi, and the vulnerability to External Wind-Cold and Wind-Heat syndromes. Along with this, I suggested discontinuing Nasonex as well as eliminating dairy, wheat, corn, soy and citrus (especially oranges), the most common sensitizing foods.

He responded well to the first prescription: sinus congestion decreased, and he didn't require the nasal spray, and his bed-wetting was less frequent. By the sixth visit in the spring, he had more hay fever, so his prescription was modified to include:

• Windbreaker 40cc
• Tummy Tamer 20cc
• Purge Heat 20cc
• Harmonize Liver-Spleen 20cc
• Harmonize Lung-Liver 20cc
• Dose: 4 droppers 3 times per day

This combination dramatically reduced his congestion, sneezing, itchy eyes, cough and irritability. His sleep improved, and he was bed-wetting only once or twice a week, doing less biting, and becoming more vocal. His mood also improved: he was less irritable, frustrated, oppositional and less fatigued at school (required fewer naps).

His treatments have been continuous now, 2-4 times per month, for over two years, and he has changed dramatically. He has not developed language, but he is a happier, friendlier person, who seldom has sinusitis or catches cold, is rarely fatigued, and is thus able to keep up with a busy schedule of instruction, occupational therapy, and other activities. His body is developing into that of a normal, healthy adolescent, with more definition, shape and muscle tone. His difficulties are consonant with being a rapidly changing teenager who has surplus energy and the urge to expand his world. Although these changes sometimes cause interpersonal problems at home and at school, adding Quiet Calm to his prescription seems to take the edge off of his characteristic tension and nervousness.

CASE 4

A seven-year-old boy had a recurring asthmatic cough that developed after a prolonged bout with bronchitis. His symptoms were triggered by colds or hay fever when he was tired or distressed. He appeared nervous and tense during his first visit, with difficulty sitting or lying still, although he was talkative and happy to interact and be examined. His tongue was somewhat thin with good color, and slightly red at the tip, and his pulse was slightly pounding, and unusually tense for a child.

His mother said that he was easily frustrated and angry, and that they were having difficulty with their relationship: he was having trouble following rules and being cooperative--typical tendencies of a Wood Type. He is a smart and energetic boy who demands freedom to move around and a lot of physical activity in order to be happy. This was challenging for her because she preferred things to be orderly, peaceful and congenial--typical characteristics of a Metal Type. There seemed to be more and more friction between the two of them--conflict between Wood and Metal.

This boy was wary of receiving acupuncture because of a prior experience that had frightened him. Instead, the treatment consisted of 10 minutes of gentle gua sha (skin scraping therapy) applied to his upper back. This mild treatment triggered an intense emotional catharsis (Wood Types characteristically recover quickly from emotional upsets), after which he felt happier and was considerably more at ease. His pattern reflects a disharmony between the Liver and Lung Networks, so he received the following prescription:

• Open Air 20cc
• Harmonize Lung-Liver 20cc
• Strengthen Lung 20cc
• Dose: 3 droppers 3 times per day

Returning in two weeks, he was much improved, but his emotional volatility continued, and this appeared to increase his susceptibility to asthmatic episodes, with or without accompanying colds or allergies. So his prescription was modified as follows:

• Open Air 20cc
• Harmonize Lung and Liver 20cc
• Quiet Calm 20cc
• Dose: 3 droppers 3 times per day

After one month, he rarely experienced asthmatic symptoms and was getting along much better with his mother. After further dialogue, his mother realized that she was a Metal Type and that there was a great potential for conflict between the two of them because of their inherently opposite ways of responding to the world. This insight helped her gain a better understanding of her son's character, explaining to her why he reacted in the ways that he did. As a consequence, she developed different strategies and their relationship improved enormously. This is in accord with the Chinese medicine principle that maintains: when the child is ailing, attend to the mother.

PROTOCOLS

Asthma

Wheezing, tight chest, difficulty exhaling:

• Base Formula: Open Air
• With additional symptoms add:
• Cough: Chest Relief
• Tenacious phlegm, chest pain: Pipe Cleaner
• Triggered by allergens: Enviroshield
• Triggered by catching a cold: Windbreaker

Wheezing, tight chest, weakness, difficulty inhaling:

• Base Formula: Deep Breath
• With additional symptoms add:
• Cough: Chest Relief
• Excessive phlegm: Purge Phlegm
• Triggered by hunger or fatigue: Grow and Thrive
• Triggered by cold, damp air: Purge External Wind
• Frail: Strengthen Lung + Grow and Thrive

Allergies

Sneezing, stuffy/runny nose, itchy eyes, nose, throat:

• Base Formula: Windbreaker + Enviroshield
• With additional symptoms add:
• Cough: Chest Relief
• Wheezing: Open Air
• Phlegm: Purge Phlegm
• Sinusitis: Head Clear

Hives, eczema, rash, acne:

• Base Formula: Fire Fighter

Psychological and Cognitive Complaints

Agitated, nervous, troubled sleep:

• Base Formula: Quiet Calm
• With additional symptoms add:
• Night terrors: Comfort Shen
• Overheated, restless: Purge Heat
• Dry, thirsty: Tonify Moisture
• Sensitive, nervous, tired: Grow and Thrive

Inattentive, distractible, hyperactive:

• Base Formula: Quiet Calm
• With additional symptoms add:
• Unfocused, dreamy: Harmonize Spleen-Kidney + Harmonize Kidney-Heart
• Excitable, emotional: Harmonize Kidney-Heart + Harmonize Heart-Lung
• Irritable, moody: Harmonize Liver-Spleen + Harmonize Lung-Liver

Spasms:

• Base Formula: Quiet Calm
• With additional symptoms add:
• Seizures: Purge Internal Wind
• Pain: Tension Solution

Upper Respiratory Illness

Sneezing, runny nose, watery eyes, stuffed ears, cough:

• Base Formula: Windbreaker + Chest Relief
• With additional symptoms add:
• Fever (>102¡ F/39¡C): Purge Heat
• Flu (fever, chills, aches, tired, weak): Bug Beater
• Sore throat: Phlogisticlean
• Rash: Fire Fighter
• Earache: Purge Heat + Phlogisticlean
• Prolific phlegm: Purge Phlegm
• Painful bronchial or croupy cough: Pipe Cleaner
• Headache or neck ache: Purge External Wind
• Sinusitis: Head Clear
• Susceptible to catching colds: Strengthen Lung

Gastro-intestinal Ailments

• Indigestion: Tummy Tamer
• Diarrhea: Belly Binder
• Constipation: Easy Going
• Poor appetite, failure to thrive: Grow and Thrive
• Gastro-Intestinal complaints w/common cold: add Windbreaker to any of the above formulas

Gastro-Intestinal flu:

• Base Formula: Tummy Tamer + Purge Damp Heat With additional symptoms add: Diarrhea: Belly Binder + Purge Damp Heat Constipation: Easy Going + Purge Damp Heat