Moshe: At the basis of the understanding of a child’s mental state is their individual balance of jing and shen. The jing reflects the basic structure of the child’s constitution and potential and the shen the emotional, cognitive and spiritual manifestations of that – the balance between hun po, yi and zhi.
It is interesting that in Chinese medicine, anxiety was not originally considered a disease category, but rather was added later. The disease categories that correlate to anxiety are jing ji – palpitations and fear; and zheng chong – panic throbbing. Both include a state of fear, but are also connected with a physical sensation like palpitations or a sensation of throbbing.
According to Geovanni, there is another common pattern that corresponds to anxiety, which is rebellious qi of the chong mai – li ji or internal urgency; a feeling of the energy going up, causing anxiety and restlessness.
I would consider another pattern that is very common nowadays among children and that is yin fire. Yin fire is a pattern of vacuity manifesting with symptoms of a weak spleen, but the heart and pericardium are affected by heat, causing anxiety, sleep issues and irritability. This heat originates from a misaligned ministerial fire. Commonly also seen are symptoms of heat above and cold below.
As Stephen mentioned, Chinese medicine’s ability to shift the issue toward a more embodied experience by addressing the movement of blood and qi makes it more tangible for the child.
Stephen: Yes, the rise in “Alienation-Inflammation” [introduced in part 1] results from the disembodied world our children are currently living in. This fundamental disconnect affects “zong qi” (ancestral qi), which resides in the dan zhong, also known as the “sea of qi,” one of the four seas (si hai) fundamental to healthy growth. As the Neijing classic Lingshu 33 says, “Humans have four seas and twelve channels, and all the channels pour into these four seas.”
We are microcosms of the world. One has only to look at the state of disruption on planet Earth to understand what anxieties a child is sensing. As I say repeatedly in our course, children are the “canaries in the coal mine” alerting us to what’s happening around us.
The four seas [the sea of qi, sea of blood (vessels), sea of fluids and grains, sea of marrow] are naturally all interrelated and should be considered as fundamental to re-establish a sense of security and sanity when treating someone who is drowning in a deep sea of chronic emotional distress. When we are cut off from our zong-ancestral lineage, the sea of qi is disturbed, and as the classics say, there is a sensation of excess fullness in the chest with red face or alternatively, shortness of breath, and one is unable to speak due to deficiency.
I see so many children with disturbed breathwork due to anxiety in my clinic. It’s one of the very first things I notice. It’s as if they have locked their diaphragm to brace for impact. Coupled with the pupils being dilated, the signs of chronic fight/flight are obvious.
Moshe: The typical anxious patient will present with a hyper-elevated sympathetic nervous system as mentioned above, the fear showing up in the eyes; the shen shows itself with anxious eyes. I also frequently see younger anxious children will commonly have difficulty regulating their senses (sensory regulation issues) or regulating the emotions or even regulating the immune system (manifesting as allergies). All the above symptoms are closely related to the environment of the “too fast,” “too quickly” society we live in.
I am treating an 8-year-old who is very anxious. He came to see me because he developed a tic after a strep infection. Here again, the main reason for bringing him in was not anxiousness, but his anxiety was an apparent part of his treatment. I had to explain to him every little detail of the treatment for him to be able to accept it. It was amazing to see him start to relax as I massaged his nei ba gua while I was explaining slowly about the process of treatment.
The point I wanted to bring up with this case is that sometimes touch could be your access to the zhong qi. The connection through touch enables a grounding and a rooting of the zhong qi.
Stephen: Exactly, Moshe! Once you have established a sense of connection with a child who has signs of chronic underlying anxiety, I use “the four seas” as a basis for acupuncture or tuina treatment.
Before needling, warming one of your hands or a parent’s hand (PC 8: Laogong) and place it on Ren 17 while placing the other on Ren 6 (Qi hHai) and gently guiding the child to breath softly into the belly (dantian) to release the diaphragm. I also use low-frequency tuning forks on these two acupoints, focusing on the long, slow exhale while playing a game of having the child tell me when they stop sensing the vibration to re-establish an awareness of what natural grounded breathing feels like.
Next, the sea of water and grains needs to be addressed. Poor diet in children in the U.S. contributes to a host of disorders including anxiety and ADHD.
Lingshu 33 states that when the sea of water and grains is in excess, there is a feeling of abdominal fullness and when it is deficient, the patient is always hungry, yet unable to ingest food. Signs of this may be an excessively picky eater who has an extremely limited repertoire of diet; or conversely, a child who seems always hungry, craving sweets and overly processed foods.
The Lingshi states that when the sea of blood/vessels is disordered, there are symptoms of excess (dullness, heaviness) or deficiency (feeling like the body is being squeezed). When the sea of marrow (brain) is disordered, there are symptoms of excess (hyperactivity) or deficiency (the brain spins, there are visual and auditory impairments).
A four seas treatment is designed to establish a coherent grounding for any patient you sense is suffering from underlying long-standing disturbances in the jingshen body-mind-spirit. Points like St 36, Ren 17, UB 11, Du 16, and Du 20 can all be helpful massage points for parents to learn in supporting their chronically anxious child, and these points can be a baseline for your own acupuncture treatment of children.
Moshe: I cannot stress enough the importance of talking to your pediatric patients about the importance of diet and their health, both physically and mentally. It is important because of the effect diet has on the four seas, but also because I think diet is one of the main reasons children develop yin fire – because at the root of yin fire is vacuity of the center.
As an example, I had a case recently of a child who came to see me complaining of constipation. As we were going into treatment, the parent declared “Other than constipation this child is super healthy.” Further questioning and diagnosis revealed he has many sensory issues and is a very picky eater, as well as very anxious. It was very clear to me to see the relationship between his symptoms.
He would not eat any vegetables, mostly carbs, sandwiches and processed foods, although the mother tried to make “healthy choices” of these kinds of foods. We see here that at the root of his issues is the weak spleen, but there is also this fire that is causing the sensory issues, as well as the anxiousness.
Editor’s Note: If you’d like to learn more about the unique ways Chinese medicine can help children grow and thrive in their lives, Stephen and Moshe are offering in-person teachings and recorded pediatric courses. For more information, visit www.jingshenpediatrics.com. Part 1 of their conversation appeared in the May issue.
Moshe Heller has been practicing and teaching Chinese medicine for the past 30 years and is a graduate of Pacific College, San Diego. He is the former academic dean and has chaired the department of Oriental medicine, herbal medicine and clinic at Pacific College, New York. He currently maintains a busy practice in New York City.
Dr. Stephen Cowan is a board-certified pediatrician with more than 35 years of clinical experience working with children. He has a subspecialty in developmental pediatrics and is a fellow in the American Academy of Pediatrics, serving as a member of the AAP section on developmental disabilities. As a longtime student of Chinese medicine and taichi, Dr. Cowan has developed a unique holistic approach to empowering children.
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