Firstly, we introduce several concepts of dwarfism and growth retardation, and point out the similarities and differences between each concept, so as to facilitate the correct diagnosis and differential diagnosis in the clinic. According to the current clinical situation, we analyze the advantages and limitations of growth hormone in the treatment of dwarfism, seek for the integrated treatment method of Chinese and western medicine which can complement with growth hormone from the progress of Chinese medicine and nutrition in the treatment of dwarfism, and summarize the experience of the integrated intervention of Chinese and western medicine for the treatment of dwarfism and short stature in the clinical work. 1.Related concepts 1.1 Dwarfism: It refers to the height is lower than the normal reference value of the same age and gender -2SD or the 3rd percentile. 1.2 Growth hormone deficiency: a growth disorder due to the lack of synthesis and secretion of growth hormone by the pituitary gland, or due to the abnormal structure of growth hormone. 1.3 Growth hormone deficiency dwarfism: a combination of 1 and 2 above. 1.4 Idiopathic dwarfism (ISS): short stature with normal growth hormone levels and no underlying pathology. It is a diagnosis of exclusion. With the development and wide application of genetic testing technology, more ISS is found to have functional defects in the hypothalamus-GH-IGF-1 axis and is no longer classified as ISS. Including: familial short stature; delayed pubertal development of somatic nature; unexplained short stature with no obvious genetic characteristics. 1.5 Nutritional dwarf (malnutritional dwarf): due to a variety of diseases or poor dietary habits resulting in insufficient nutritional intake or absorption disorders. Generally in the dwarf before the occurrence of l ~ 2 years has been weight gain, followed by the presentation of growth slowdown, the important characteristic is weight behind more than the height behind. Blood growth hormone is elevated, but insulin-like growth factor-l is low as its important characteristic, showing the growth hormone resistance state in malnutrition. Prevalence of nutritional dwarfism: From November 1998 to June 2006, children with short stature who visited the Short Stature Specialty of the Department of Child Health in Fujian Maternal and Child Health Hospital were evaluated according to the NCHS (National Center for Health Statistics) recommended by the WHO as the reference population. It was found that 752 belonged to the category of dwarfism, with the following causes of short stature: smaller than fetal age (4.65%), somatic growth retardation (13.30%), familial short stature (10.64%), growth hormone deficiency (9.97%), late-onset hypothyroidism (3.46%), congenital ovarian hypoplasia (4.79%), and nutritional deficiencies of short stature (47.87%). 1.6 Growth retardation: Growth retardation includes slow growth rate per unit of time in addition to short height. Slow growth is defined as a growth rate that is lower than that of a child of the same age and sex (-2 standard deviations) or an annual increase in height that is less than that of a normal child: less than 7 cm/year before 3 years of age; less than 5 cm/year between 3 years of age and puberty; less than 6 cm/year during puberty; and growth retardation up to 3 years of age, which may be later on referred to as dwarfism. The six countries with a high global prevalence of growth retardation are Afghanistan, Burundi, Ethiopia, Madagascar, Timor-Leste, and Yemen. The prevalence of growth retardation among children under 5 years of age in these countries is 50 per cent or higher, and in Afghanistan it is as high as 59 per cent. The top 10 countries with the highest number of stunted children are India, China, Nigeria, Pakistan, Indonesia, Bangladesh, Ethiopia, the Democratic Republic of the Congo, the Philippines and Tanzania. The most common cause of growth retardation in economically disadvantaged countries is poverty-related malnutrition; in developed countries, nutritional growth retardation is mainly seen in children with eating disorders (anorexia, paraphagia, xerophagia, etc.). China’s preschool children are the second most malnourished and stunted in the world: in 2006, the United Nations Children’s Fund (UNICEF) claimed that at least 12.7 million children in China suffered from “stunted growth”. A survey conducted by the Chinese Center for Disease Control and Prevention (CDC) in 2010 showed that the national rate of “growth retardation” among children under 5 years old was 9.9%. In cities and towns, the rate was 3.4 percent, while in rural areas it was as high as 12.1 percent. The issue of children’s height was first raised in the 2011-2020 Program for the Development of Chinese Children. It is required that the rate of children’s growth retardation be reduced to 7% within ten years. 1.7 Short stature: Children’s height is lower than the average height of the same ethnic group, the same region, the same age and the same sex minus 1 standard deviation, or the height value between the 50th percentile and the 3rd percentile is short stature. 2, growth hormone treatment of growth hormone deficiency, idiopathic dwarfism advantages and limitations As early as 1920, the existence of growth hormone was discovered, young animals once the pituitary gland is removed, growth and development will stop. Scientists had hoped to use growth hormone extracted from animal pituitary glands to treat human diseases, but to no avail. It turned out that the molecular structure of the species difference is difficult to cross, the amino acid sequence of animal growth hormone is different from that of human beings, and it is simply impossible to play a physiological function in the human body. Later, after decades of efforts, people synthesized the DNA fragment of human growth hormone, using molecular cloning technology to amplify and clone, to obtain the complete gene of human growth hormone. Then the plasmid is implanted into Escherichia coli, and recombinant human growth hormone, the target product, can be obtained after culture, fermentation and post-treatment. The U.S. FDA has approved recombinant human growth hormone for the treatment of growth hormone deficiency since 1985, and it is the only effective drug to promote the height growth of this type of children. Due to the high safety of the drug, in 2003, the FDA also approved the drug for the treatment of idiopathic dwarfism, and now, the indications have been gradually expanded to include Turner syndrome, renal insufficiency and other causes of childhood dwarfism. The above factors affect the “sustainable treatment” of many children in the later stages of life, which also affects the final efficacy and lifelong height. According to the statistics of the Chinese Medical Association, the total number of children aged 4-15 years with stunted growth and development is about 7 million, and at present, less than 30,000 patients actually receive reasonable treatment every year. At the same time, growth hormone treatment is also limited by bone age and other factors, the following cases need to stop growth hormone treatment: 1, the height after treatment is greater than the normal adult height-2SD; 2, close to the adult height, that is, the growth rate is less than 50px/year; 3, the bone age of the boy is greater than 16 years old, the bone age of the girl is greater than 14 years old. In fact, there are many parents and children with height greater than the mean value of -2SD but lower than the mean value is not yet their expectations, especially the height of -1SD or so children, still want to play in the epiphysis before the complete closure of the maximum growth potential. These are problems that cannot be solved by medical growth hormone alone. Some children may have temporary physiologic low growth hormone secretion before puberty. In fact, these children are not truly growth hormone deficient, and their growth hormone secretion will reach normal levels again at puberty. In fact, these children are not truly growth hormone deficient, and their growth hormone secretion reaches normal levels by puberty. These children may be treated with growth hormone in an irrational manner. The mechanism of linear growth is complex and is not solely a function of growth hormone. Although growth hormone is the core of the growth-promoting hormone axis, it is involved in no less than a dozen growth-regulating links, and a defect in any one of these links can lead to growth disorders. Recent advances in molecular biology have led to the discovery of the underlying molecular pathology, which includes not only peptides directly related to growth promotion and their receptor gene variants, but also transcription factors and post-receptor pathway abnormalities. Nutrition, in turn, is inextricably linked to the regulation of the growth-promoting hormone axis, and disease can affect the growth-promoting hormone axis both through its effects on nutrition and through the disease itself. There has been a great deal of research on how nutrition plays a role in linear growth. 3, Nutrition and Traditional Chinese Medicine Treatment of Growth Retardation and Malnutritional Dwarfism Research Progress 3.1 Energy/Protein Children with energy-protein malnutrition often suffer from weight loss and inadequate height growth. Animal experiments have confirmed that even short-term (48-72h) fasting can cause a decrease in the longitudinal growth rate of bones; the height of the growth plate, the number of chondrocytes in each column of the proliferative layer and hypertrophic layer, and the height of the terminal hypertrophic chondrocytes are decreased and disorganized. Population studies of the effects of energy/protein on linear growth were mostly conducted in developing countries in the 1970s. Most studies showed that increased energy intake in both normal and stunted children increased body weight only and had no effect on linear growth. However, some studies have found the opposite, such as the long-term intervention trial in Guatemala, which found that supplementation with both energy and protein promoted linear growth, but growth did not reach desired levels. The relationship between nutrition and linear growth is less well documented in developed countries. In 2005, it was reported that in children with idiopathic dwarfism in developed countries, energy intake was positively correlated with growth rate prior to and during the first year of treatment with growth hormone; other studies have shown that children in developed countries with eating disorders have shorter average heights than controls . These results suggest that the relationship between single energy/protein intake and linear growth is uncertain. 3.2 Micronutrients Studies suggest that the above micronutrient deficiencies are present in children with growth retardation, but the effect of supplementation with a single nutrient or a combination of nutrients is highly inconsistent.KVRadhakrishna et al. 2013 showed that zinc supplementation in normal term infants from 4 months of age until 18 months of age significantly increased skinfold thickness, but had no effect on linear growth. Since the conclusions on the effect of micronutrient interventions on linear growth are not entirely consistent, Meta-analysis of the available intervention studies is necessary. Meta-analysis on micronutrients and linear growth was first reported in 2002, when KHBrown et al. evaluated the relationship between zinc supplementation and growth in children by analyzing 33 studies of children (n=2637) within 18 years of age. The results showed that zinc supplementation had a mild to moderate effect in improving height, especially in younger children who had growth retardation at the beginning of the study. Another Meta-analysis in 2004 showed that single supplementation with iron and VitA was not effective in improving growth and that combined supplementation with multiple micronutrients may be beneficial for growth. Since then, as micronutrient interventions have become a cost-effective strategy for improving child health, studies examining their effects on growth have become widespread and have even resulted in multicenter, international studies. 2009 Meta-analysis evaluated the literature of randomized, controlled studies of micronutrient interventions in children up to the age of 5 years using either a single micronutrient or a combination of micronutrient interventions, and included a total of 27 trials of iron interventions, 17 trials of VitA intervention trials 17, and zinc intervention trials 43. The results showed that, consistent with other Meta-analyses, iron and VitA did not improve linear growth; whereas zinc supplementation had no significant effect on height or weight gain, except for a weak effect on improving weight for length; and 20 combined micronutrient intervention studies (all containing zinc) were analyzed, suggesting that multiple micronutrient supplementation could help improve linear growth. In 2011, A Imdad et al. analyzed a total of 36 studies of zinc supplementation in children <5 years of age in developing countries, and preventive administration of zinc alone had a linear growth-promoting effect in children up to 5 years of age. In the same period, URamakrishnan et al. analyzed the benefits of multiple dimensional nutrients (more than three micronutrients) in children within 5 years of age, in which 45 controlled studies and six Meta-analyses were analyzed, two of the Meta-analyses and some of the intervention trials mentioned that multiple micronutrient supplementation was more effective than single nutrient or placebo to increase linear growth, especially in micronutrient widely deficient areas. This suggests that more attention may need to be paid to the relationship between micronutrients and linear growth with respect to zinc and the combined use of multiple micronutrients. 3.3 Research on combined nutritional and herbal medicine interventions A Korean scholar conducted a combined nutritional supplement, herbal medicine extract and control study on 216 crossbred piglets. RESULTS: Both comprehensive nutritional supplements and (P<0.01< span="">) traditional Chinese medicine extracts resulted in a significant increase in spine length (P<0.01< span="">). The herbal extracts were effective in regulating growth hormone secretion in young pigs.In a study at Wonkwang University School of Medicine, Korea, 1999-2001, 157 cases of nutritional dwarfism (87 males, 5-14 years old, mean 11.2±2.4 years old; 70 females, 4-12 years old, mean 10.2±2.0 years old) were excluded from diseases such as growth hormone deficiency. (The mean growth curves were 5.79 cm/year for boys and 5.87 cm/year for girls. There was a significant increase in lumbar spine BMD: boys after six months (from baseline 0.60±0.090.66±0.10, P<0.001; girls after six months from baseline 0.63±0.11 to 0.70±0.16, P<0.01). 4. The experience and outlook of comprehensive intervention of Chinese and Western medicine in the treatment of dwarfism, growth retardation and short stature 4.1 Chinese medicine's understanding of dwarfism and growth retardation The kidney is the foundation of the innate nature, and the main bone produces marrow, and the growth and development of the bone relies on the enrichment of the kidney essence and the kidney qi; the kidney qi is divided into yin and yang, and an imbalance of yin and yang can result in the play of the role of the kidney qi, which will affect the growth of the child. Spleen is the foundation of the latter day, the main transportation, water and grain essence micro-generation of qi and blood. Spleen qi healthy, normal transportation, then the qi and blood biochemistry have a source; spleen loss of healthy transportation, then the qi and blood biochemistry lack of source, the five organs are not nourished, can lead to growth and developmental delays. Liver blood, in the body and tendon, liver blood, liver essence is sufficient, the tendon to get its nourishment, if the liver blood is weak, then the tendons and bones are lost in the glory of nourishment. The heart hides the god, the main blood, if the heart blood deficiency, the god is not nourished, sleeplessness at night, will also affect the growth of children. Chen Qi believes that the root cause of dwarfism is kidney and spleen deficiency. The key to treating this disease is to benefit the kidney and support the spleen. Treatment is given to tonify the kidney and the ground yellow pill plus reduction to warm the kidney yang, benefit the kidney and fill the essence; given to the four gentleman soup plus flavor to benefit the qi and tonify the middle, support the spleen to help transport. Qian Shangtun tried to evaluate the therapeutic effect of Chinese traditional medicines for strengthening the spleen and tonifying the kidneys by looking at the changes in the length and weight of the hind limb bones as well as the bone mineral density of young rats to young rats. It was found that the spleen and kidney group (Astragalus, oyster, etc.) dominated the bone weight index, suggesting that strengthening the spleen and stomach is beneficial to the absorption of organic and inorganic substances in the process of bone growth, which is conducive to the construction of bone; and the spleen and kidney group (Astragalus, Lycium barbarum, hawthorn, etc.) dominated the bone length index, suggesting that the growth of bone depends on the synergistic effect of the innate essence and the innate essence. 4.2 Clinical efficacy observation of Chinese herbal medicine and comprehensive intervention in the treatment of idiopathic dwarfism of backward bone age 155 children were from the growth and development clinic of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from September 2008 to March 2011, and were in line with the backward bone age type of pediatric idiopathic dwarfism. Key points of diagnosis: children with backward bone age are mostly characterized by spleen and kidney yang deficiency. Treatment principle: warming the kidney and marrow, strengthening the spleen and qi, supplemented by benefiting the liver and stomach, and calming the mind. RESULTS: 4.3 Research and experience about Chinese medicine intervention in treating dwarfism and short stature The identification and treatment of dwarfism and growth retardation, pediatric tongue coating is the key to identification. Kidney yang deficiency: thinning and yellowing of hair, cold limbs and fear of cold, pale and fat tongue, little moss, use tonifying kidney dihuang pill. Liver yin deficiency, kidney yin deficiency: hot hands and feet, hot flashes and night sweating, red tongue, less moss and flower peeling, with six flavors of dihuang pill. Deficiency of middle qi and loss of spleen transportation (deficiency of spleen and stomach qi): yellowish color, lack of appetite, loose stools or constipation, pale tongue, thin white moss, use Si Jun Zi Tang and Yi Gong San with additive and subtractive measures. Proprietary Chinese medicines: tonifying the middle and benefiting the qi granules, ginseng ling baizhu granules. Stagnation injuring the spleen, dampness and heat in the spleen and stomach: heat in the hands and feet, teeth grinding, excessive sweating in the head, rotten and sour stools, yellowish and greasy tongue, eliminate stagnation and guide stagnation, with the addition of Fei'er Pill and the subtraction of Baohe Pill. Spleen and stomach heat stagnation, heat knot injury: diarrhea and heat to generate fluid, clearing the stomach scattered plus subtractions. In recent years, the Department of Pediatrics of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine has summarized several commonly used traditional Chinese medicine prescriptions for different situations. For children with normal bone age and short bones, Chinese herbal medicine prescription: cornelian cherry, raspberry, cuscuta and so on. The Chinese herbal medicine prescription for children with short bones is: Cornu Cervi Pantotrichum, Cortex Phellodendron Bark and so on. Spleen and kidney deficiency evidence of idiopathic dwarfism Remedy: Poria, Chinese yam, Rhizoma Atractylodis Macrocephalae, Radix et Rhizoma Ginseng, etc. Partial short stature spleen and kidney qi deficiency evidence Chinese herbal prescription: tai zi ginseng, atractylodes macrocephala, white lotus seed, shen qu and so on. 4.4 Dietary guidance for children with various types of short stature and growth retardation Five nutritious foods that are beneficial to children's height: milk, sardines, spinach, carrots, oranges. Yogurt should not be consumed for a long period of time, breast milk and formula are suitable for infants and young children, and pure milk is suitable for older children. Light taste, less salt, less oil, less sweets, do not eat fried, frozen, puffed food, do not drink carbonated beverages. Soybean products and nuts should be eaten regularly. Can not take meat as the main food, meat metabolism is easy to cause calcium loss. Drink more plain water every day. Before, during and after meals, drink less water, soup, and liquid and semi-liquid diet such as thin rice. You can't always take thin rice, rice porridge or noodles as the main food. The amount of food is moderate, eat 8 or 9% full, not picky, not partiality, dinner should not be too full, do not eat late-night snacks. Cultivate your child's habit of self-feeding, let your child enjoy eating, don't force him/her to eat. Cultivate the habit of chewing, chew solid food 20-30 times, do not swallow. 4.5 Comprehensive Nutritional Supplementation 4.5.1 6 months - 36 months: Infant Nutrition Pack. A complementary nutrient supplement containing a high density of multivitamins and minerals based on a food matrix. Includes vitamin A, B vitamins, vitamin C, vitamin D, folic acid, calcium, iron and zinc. The National Standards Committee and the Ministry of Health issued a standard (GB/T22570-2008) in December 2008. It was implemented on March 1, 2009. The results of the 2001-2007 study showed that the length of children at 24 months of age was 1.3 centimeters higher than that of those who did not take the supplements; the rate of anemia in children after 1-2 cycles of supplementation was reduced from 34.8% to 18.5%; children's 24 months' IQ was 1.3 to 4.7 points higher than without supplementation; at the end of the period, children were followed up to 6 years of age, and their IQ advantage was maintained up to 6 years of age could be 3.1 to 4.5 points higher. 4.5.2 Above 3 years old: Xiao Shan Cun, Xiao Jia Wei of Shan Cun, Xiao Shi Er Kang, supplementing the calcium needed for children's growth, but also rich in carotene, B1, VC, VD and other multi-vitamin groups. 4.5.3 Shanghai production "Gol capsule" - Fudan University School of Medicine (formerly Shanghai Medical University), pharmacology, pharmacy, biochemistry, nutrition, health and other dozens of nationally renowned experts and professors to develop. Each 100g contains: Lysine 18~28g, Calcium 18~28g, Zinc 0.58~0.5g, Vitamin B6 0.14~0.17g. 4.5.4 Medical food "Igloo" solid drink 4.5.5 Chlorella--Chlorella Chlorella cells are rich in protein, essential amino acids, polysaccharides, fatty acids, and rich in a variety of vitamins, as well as iron, calcium, zinc, potassium and other elements, with a comprehensive and balanced nutritional value. Chlorella cells are rich in proteins, essential amino acids, sugars, fatty acids, vitamins, iron, calcium, zinc, potassium and other elements, with a comprehensive and balanced nutritional value. Containing unique growth factor (CGF), 20g of Chlorella powder contains vitamins and minerals equivalent to the content of 1kg of ordinary vegetables. Chlorella has been used as green health food and feed additives in Japan, the United States and Taiwan for nearly 40 years. According to the United States National Aeronautics and Space Administration nearly 30 years of human spaceflight food research to determine, chlorella can for astronauts to improve the necessary oxygen and food. Chlorella genus of protein nuclei in Chlorella has been listed as a new resource food by China's Ministry of Health. In 1966, Dr. Yamagishi of Japan had chosen elementary school children of both sexes totaling 1000, let them take chlorella every day for 12 months; at the same time, 1000 male and female schoolchildren who did not take chlorella as a control group. The result found that the children who took chlorella and CGF were more than the non-given group in endurance, physical strength, intelligence, height, and their academic performance was also much better. This proves that Chlorella and CGF are the best organic green active nutritional food for growing and developing adolescents and children. 5. Summary 5.1 Growth hormone treatment of dwarfism has obvious advantages, but there are limitations. Chinese medicine has precise efficacy in diagnosis and treatment, good compliance, saves medical cost, and can be used flexibly with growth hormone as a good supplement and alternative. 5.2 Chinese medicines (including proprietary Chinese medicines) also have side effects and should not be abused. Particular attention should be paid to the effect of kidney tonic Chinese medicines on bone age, which deserves further in-depth study. 5.3 For children with dwarfism, their influencing factors should be analyzed in detail: especially the acquired factors such as nutrition, exercise, sleep, stress, etc. The so-called "idiopathic dwarfism" often has a cause. Nutritional dwarfism, growth retardation should focus on comprehensive nutritional therapy, rather than simply choose to apply growth hormone. 5.4 Short stature is not an indication for growth hormone, it is an "undiseased disease", and the integrated intervention of Chinese and Western medicine is an appropriate choice.