Back to School - A TCM Clinician's Perspective
Here we are at the end of summer, and as a TCM clinician with a large focus on family members and family systems, including pediatrics, I am looking ahead to the upcoming school year to prepare parents and children for the experience. We want our children to be able to sleep well, think clearly, and be ready to learn new information as the school year begins. What are the smallest interventions I can suggest to my patients that will provide the greatest benefit? As TCM practitioners, we want to make sure to use the right treatment, at the right time, and in the right context based on the unique constitution of the individual seeking healing and change.
Supporting the Immune System
As soon as I think about sending children back to school, I consider whether they will benefit from Jade Windscreen Formula / Yu Ping Feng Wan. If it is appropriate for their constitutional TCM pattern, I have children start taking it at the end of summer before school begins. Plum Flower’s teapills are wonderful for children, particularly for those who have trouble swallowing pills, because they almost go down by themselves. This is a particularly useful formula for children who are frequently vulnerable to illness and who invariably seem to contract the worst version of whatever external pathogen is going around! Traditional TCM formula functions for Yu Ping Feng Wan are to Stabilize the Exterior, Strengthen the Spleen, and, of course, to Strengthen the Wei Qi.
Each year at this time, when the air cools and temperatures shift, I remember and pay homage to the practical clinical tips that I learned while studying with Miriam Lee in the 1980s. Miriam was an early pioneer for our profession and the author of Insights of a Senior Acupuncturist and translator of Master Dong’s Acupuncture: An Ancient Alternative Clinical Style in Modern Clinical Practice. She was arrested for practicing medicine without a license after former Governor Reagan vetoed a bill to legalize acupuncture in California and taught at an off-site student clinic during the early years of the American College of Traditional Chinese Medicine (ACTCM).
Miriam taught me to have parents combine pear juice and water at a 50/50 ratio, or to make steamed pears with cinnamon to moisten and support the lungs, which can be damaged by the seasonal dryness in the fall. Remembering our Yin and Yang pairing of the Lung and Large Intestine, this also helps to gently moisten the bowels. The combination of pears and cinnamon moistens more effectively because the two together become neutral in temperature. Pears are inherently cooling and as we steam them, we change their physical nature, which is then warmed by adding cinnamon. This transforms the cooling nature of pears in order to moisten the lungs and bowels. If the bowels are moving efficiently, this in turn alleviates congestion in the lungs if it is present.
The best way to illustrate this concept is to look at a newborn’s tongue. There will likely be a medium thick white coating on the tongue. After the baby poops, look at the baby's tongue again. You will likely see significantly less coating on the tongue. With older children, or teens and adults, if you see a medium thick tongue coating alongside clinical signs of Phlegm Heat in the Lungs, often accompanied by an exterior Wind Cold invasion, you may want to try Clear Mountain Air / Ding Chuan Wan teapills to address it. This is also appropriate for children who tend to have “vulnerable” lungs which are delicate and easily damaged, presenting with cough and slight wheezing, since the formula descends and disperses Lung Qi, Clears Heat, dissolves Phlegm and restores the downward flow of Lung Qi. It is a mild formula that is one of my favorites to either catch that cough at the beginning stages, or address symptoms that are just persistent and “annoying”. If the child has postnasal drainage, I will often prescribe Pe Min Kan Wan if the patient is not allergic to Xin yi hua. It is also a terrific and mild formula that disperses Wind, clears Heat, transforms Phlegm and benefits the nose. I often find that combining Clear Mountain Air teapills with Pe Min Kan Wan can provide a huge support for parents and families when their child returns from daycare or preschool, or when students are back in school playing and socializing with friends in close proximity.
For children with chronic sinus challenges, Pe Min Kan Wan alone can be transformative. This helps the child not to wake up frequently with coughing from the postnasal drip that often accompanies fall allergies. It also alleviates the constant throat clearing, which is not only uncomfortable, but can be disruptive in a classroom setting. Using this in conjunction with your favorite eucalyptus chest rub on the throat and under the philtrum will open the nasal passages and transform phlegm. If there is cough, you can also put it on the child’s sternum and on their backs. Remember - the lungs are large. Doing these things decreases upper respiratory congestion and increases the child’s ease and well-being while the symptoms are resolved.
During this time of year, I also discuss with parents who live in a climate that becomes cooler and colder to make sure their kids have and wear wool socks. I learned this after spending two summers working in the fishing industry in Alaska where it became readily apparent that cotton is useless when it becomes wet! When we wear cotton socks and go inside, our feet get warm and sweaty because the heat is on in the building. Then, when we go back outside, our feet are now wet inside our shoes, resulting in cold and wet feet. Cold and wet feet damage the Kidneys starting at KD 1 and also affect KD 3 and KD 6. Wearing wool socks is one way to protect that Qi/Lifeforce that helps children stay healthy and strong.
In addition to wearing wool socks, I encourage parents to teach their children to soak their feet in warm to hot water with a cup of Epsom salts. This is something I was also taught to do by Miriam Lee. When we soak our feet up to SP 6 or to the top of a crew sock, we are placing heat under the “cooking pot” and supporting our digestive fire as well as the Kidneys. We are also warming the Liver and helping the Liver Yang to be rooted, thereby discouraging it from rising. Soaking the feet in this manner also automatically relaxes our Achilles tendons which reflexively relaxes the neck and cervical spine. If you have not tried this, I encourage you to do it tonight! The goal is to always use the smallest intervention that leads to the greatest change.
Let’s talk about ear pain in small children, which is something I commonly encounter in the clinic. Children often present with excess conditions that are mercurial; their cheeks get hot and then cool. The child’s symptoms come and go and are disruptive but may not be severe. A common refrain I hear from parents is that “my child feels well during the day and then they have earaches, more congestion, get warm and have tummy aches.” Here Xiao Chai Hu Tang / Wan is often an ally - however you can get it into the little one. This versatile formula has so many applications! To remind us: Xiao Chai Hu Tang harmonizes the Shao Yang and works to treat symptoms that match the TCM pattern of simultaneous or alternating disharmony of the interior and the exterior - often after exposure to wind. We understand that this formula “harmonizes the interior-exterior, deficiency-excess, excess-deficiency and cold-heat”. (Bensky and Bartlett, “Therapeutic Experiences of Pu Fu-Zhou”) Professor Mark Frost, LAc. wrote a beautiful article on the uses of Xiao Chai Hu Tang that I encourage you to read.
For persistent ear pain or fluid, we can also teach the parent how to do acupressure on SJ 17, GB 2, and the SCM region. Also, if appropriate, we would see if using a eucalyptus chest rub in front of the ear, behind the ear as well as on the SCM muscle is effective. We do this because eucalyptus transforms Phlegm and opens tubules. It can also be valuable to warm salt in a cast iron pan, put it in that odd single sock (because young children always have one unmatched single sock!), tie it with a rubber band or string, test it to make sure it’s not too hot, and lay it behind the child’s ear where it hurts. The warm salt will feel good to the child, decreasing the pain and the sensation of pressure from congested fluid.
Supporting State of Mind
In addition to supporting the immune system, we can also support children’s state of mind. There are many students who are still anxious about going back to school; either because of Covid, their parents, or their schools and school systems' response to Covid. Also, it is just stressful to go back to school! The changes that occurred during the pandemic and trauma they may have experienced may also have taken a toll. I am finding that this is a very specific and clear reason why Xiao Yao Wan, the Free and Easy Wanderer, is our most prescribed formula. It works for many of our patients. Additionally, when students are experiencing anxiety; whether they are four years old, eight years old, teenagers or college students, all the things suggested above will help them to heal. These suggestions are tangible ways children can put systems in place so they can take steps to manage their anxiety and/or physical illness themselves.
Of course, we always want to make sure we are doing our differential TCM diagnosis, thereby using the appropriate formula for the appropriate presentation.
Supporting Self-care Practices
Personally, I am a big fan of using self-care and providing students, no matter their age, with tools they can use at home. It’s incredibly empowering for them to take some responsibility for their own care and learn how they can be part of their own healing. As we support students, young and old, we can also point out how their choices make an impact on their health. Proper self-care practices make a huge difference in peoples’ physical and mental health. Being a trusted and supportive adult in the life of a child is an extraordinary thing.
For digestive issues and anxiety, using Curing Pills can be an incredible treatment for children who tolerate them well - the pills are tiny and often are a great way to teach the life skill of swallowing pills as long as the person giving them is a trusted adult guardian and they were prescribed by your licensed and certified TCM herbalist. Curing Pills are also appropriate for older kids and teens who may have a pattern of increased anxiety that is adversely affecting their digestive system. I know many practitioners have witnessed children saying to their parents, “I need to go get some acupuncture” or “I need more herbal medicine because it helps me feel better.” Additionally, we need to consider that we may be working with children and teens who are taking pharmacological medications and may need to adjust our plan to ensure we do not interfere with, or give herbal medicine that has the same function as the pharmacological medications prescribed.
Another small self-care intervention is to make certain that our students all have water bottles that they can manage themselves. For children with digestive issues who tend to have headaches, may have earaches, who may overheat, or tend to anxiety, dizziness, constipation or irritable bowels, it is important that they are drinking their water with some form of electrolyte powder added. The number of young people who have come into my practice with migraine headaches, who have been profoundly supported just by drinking water with electrolytes, by using foot soaks as noted above, or practicing intentional breathwork, such as 4-7-8 breathing technique is significant. I feel it is so significant that it’s time to really look at how to suggest easily incorporated lifestyle changes for a meaningful difference early in childhood, alongside our beloved herbal medicine and acupuncture.
The last piece to share that I regularly discuss with parents and guardians of children and teens is about warming foods. I remind them that if their body were an ATM, when we eat something cold, it’s an automatic withdrawal from our energy bank. When we eat something warm, it gives us the energy to digest the food that is coming, and when we eat food at room temperature, it’s neutral. I encourage vegetarians to please remove their salad from the refrigerator 15 minutes before they eat it in order to warm the physical temperature of salad, which is cold in nature. I encourage folks to use a ginger vinaigrette to warm the nature of the salad and to put the dressing on 15 minutes before they eat. As we know from Chinese medicine, marinating is cooking! I also encourage parents and guardians to think about warming foods, like lentil soup, ginger and scallions, chicken soup for those who are not vegetarian, and bone broth.
The most important thing we can do as providers is to work within the context and framework of the belief system of the unique person in front of us; using the smallest thing to create the greatest change, and to make sure that we are using the right remedy, at the right time, in the right context. These are all ways that we can support, not only our own children, but our patients and their children. These small additions will make a big difference to our patients and their children as they return to school.