Cerebral palsy is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, mainly manifesting as motor disorders and postural abnormalities. Cerebral palsy is one of the most serious diseases that cause disabilities in children, which seriously affects the quality of life of the affected children and causes heavy mental and economic burdens to the society and families. There are many treatment methods for cerebral palsy, and TCM treatment is gaining more and more attention from scholars and medical practitioners at home and abroad because of its simplicity and effectiveness. We are now reviewing the main ancient literature of TCM pediatrics to enrich and improve the understanding of ancient TCM on the name, etiology and treatment of cerebral palsy.
1. The name of the disease is recorded
The name of cerebral palsy is not found in ancient Chinese medical texts. However, the clinical manifestations of this disease have been recognized for a long time, and according to the clinical symptoms, this disease can be included in the categories of “five delays”, “five softnesses”, “five hardnesses” and “fetal weakness” in Chinese medicine. Fetus cowardice” and other categories.
As early as the end of Eastern Han Dynasty, the “Cranial Chimney Classic” had a record of “late walking”. In the “Treatise on the Origin of Diseases”, Chao Yuanfang also has “the teeth do not grow” and “cannot walk for several years”. In the “Treatise on the Origin of the Diseases”, there are also “the teeth do not grow”, “cannot walk for several years”, “hair does not grow”, “cannot speak for four or five years”, and other disease categories. In the Song Dynasty, the “Straight Guide to Pediatric Medicine and Evidence” also has similar discussions on the five delays, such as “growing up does not work, walking makes the feet soft, teeth do not grow for a long time, birth is not solid, hair does not grow for a long time, birth is not black”. The “Taiping Shenghui Fang” further records “late speech”, “late walking”, “late hair”, and “no growth of teeth”. The prescriptions for the treatment of such symptoms as “late speech,” “late movement,” “late hair,” and “no growth of teeth. Five late as the official name of the disease, is the Qing Dynasty Wu Qian and other people collectively compiled the “Medical Zong Jinjian”, the author of the author of all the treatises on late together, and “five late” disease crown: “children five late evidence, because the parents are weak qi and blood, congenital deficiencies, resulting in the child born tendons and bones weak, walking and walking Difficult to walk, teeth do not grow quickly, sitting can not be stable, to be all kidney gas deficiency of the reason. It is a result of deficiency of kidney energy. Details of each article. Qing? Zhang Lu in the “Zhang’s medical general” also clearly pointed out: “five late, standing late, walking late, late teeth, late hair, late speech is also”.
The name of the disease “five softnesses” has not been discussed in medical books before the Song Dynasty, but most doctors included it in the comprehensive discussion of diseases such as “fetal weakness”, “fetal weakness”, or late evidence. The description of the “five softnesses” was earlier described in the “New Book of Young Children” of the Song Dynasty, “The five softnesses of children are not treated: soft hands, soft neck, soft feet, soft waist, and soft back”. The name of “five softnesses” was first seen in the book “Live Young Heart” by Zeng Shirong in the Yuan Dynasty, and it was pointed out that “head, neck, hands, feet and body softness are called five softnesses”. It is also distinguished from “fetal weakness”, “fetal weakness” and “late evidence”. The content of the “five softnesses” discussed by many later medical practitioners also varies. For example, in The Golden Guide to Medical Science, it means “softness of the head, softness of the hands, softness of the feet, softness of the mouth, and softness of the muscles”. While the Qing Dynasty “young children integrated” said “head soft, body soft, mouth soft, muscle soft, hands and feet soft” and so on. The “100 Questions for Infants” says “five soft, soft head, soft neck, soft hands, soft feet, soft muscles are also”. Although the discussion varies, but all inseparable from the head, item, hands, feet, muscles, mouth these parts.
The name “five hard” was first published in the Ming Dynasty in the “infant hundred questions? Volume 3”, “five hard is tilted head to take the gas, difficult to move, gas congestion pain, even between the chest and diaphragm, hands and feet heart like cold and hard, this is wind disease difficult to treat”, the head and neck hard, hard chest and diaphragm, hard hands, hard feet and hard heart and abdomen called five hard; ancient medical books on the content of the five hard discussion is not consistent, but also basically according to the classification of the above disease and called it; the Qing Dynasty “young children In the Qing dynasty, “Young Children’s Integration”, the name of the five hardnesses is “hand hardness, foot hardness, waist hardness, meat hardness and neck hardness”. In the “Outline of Pediatrics”, “five hardnesses are also known as five, the child tilts his head, chokes the air, the hands and feet are firm, the mouth is tight, and the meat is hard”.
2. Etiology and pathogenesis
Some of them are based on the deficiency of heart, liver and kidney, some are based on the deficiency of heart and spleen, some think it is due to the deficiency of fetal endowment, and some think it is due to the inappropriate regulation.
2.1 Congenital deficiency
Congenital deficiency refers to the lack of fetal endowment or adverse stimulation. If the parents are physically weak, the essence of exhaustion. If the fetus is not well endowed, the liver and kidneys are damaged by the fingerprints and the essence and blood cannot be injected into the tendons and bones.
For example, in “The Golden Guide to Medical Science”, “Most of the children’s five delays are due to the parents’ weakness in qi and blood and the loss of heaven, resulting in the child’s tendons and bones being weak at birth, difficulty in walking, teeth not growing quickly, and inability to sit steadily, all due to the lack of kidney qi. Zhang’s medical general: “five late, …… good by the parents essence and blood deficiency, kidney weakness, can not be honored and natural. If long can not stand, standing and bone soft, big can not walk, walk is tendon soft, all liver and kidney qi and blood is not full, tendons and bones atrophy weak reason”.
The book “live young heart” is a clearer introduction to the congenital causes of five soft: “Dai’s theory of five softness, the name is fetal weakness, good from the father’s essence deficiency, the mother’s blood is weak. This is true! I think there are cases where the mother’s blood has been cold for a long time, and the mother has been given medicine to make up for it, where the mother is sick, where the father is lustful and greedy for wine, where the gas is weak, where the father is old and sees the child later, where the sun and moon are not enough, or where the abortifacient is not removed and the child is conceived. …… I love that after birth, the essence is not full, the tendons and bones are impotent and weak, the muscles are weak and thin, and the look is faint and slow, and only when the six sexes are invaded, the head, arms, legs and body become soft, which is called the five softnesses. Qing “young children integrated? head and neck fontanel evidence treatment”: “there is a child born under the neck will be soft, fetal gas is also insufficient, by the endowment of the parents of the kidney yuan deficiency defeat”.
The medical compendium? The birth of the fetal disease “that the main cause of the five hard is” child fetus in the cold, born under can not be protected, and then hurt in the wind “, this statement is really insightful;” infant theory: “the child was born, the body skin like stone hard, named five hard, fetal poison condensation so that the cold and sound does not sound death”. The fetal toxin may be related to the modern term intrauterine infection. The “Infant Protection Summary? Volume 3? Five hard” is attributed to congenital liver and kidney deficiency: “If the hand fist contracture, endowed with liver weakness, resulting in two knee contracture, two hands stretching powerless, …… foot fist contracture, endowed with kidney deficiency, blood gas is not honored, toe fist contraction, can not stretch”.
The “Young Children Integration? This is consistent with the modern description of the causes of cerebral palsy: “The fetus is sluggish …… because it is not born in the twilight of the parents, that is, in a pregnant woman with many births. When the fetus is formed, the essence is already poured out, and after the fetus is born, it is difficult for the qi and blood to grow and nourish, so that the fetus is born weak”.
2.2 Acquired disorders
Acquired disorder refers to the young children due to improper care, diet; or disease, improper management; or the impact of medicine, or fall injury, resulting in the internal organs dysfunction, qi and blood deficiency, the hundred veins and tendons lose their moistening and disease. Weakness of the spleen and stomach: weakness of the spleen and stomach, insufficient biochemistry of qi and blood, resulting in weakness and inability to resist evil, and the onset of disease caused by evil.
The Medical Zong Jinjian: “and the foot Shaoyin for the kidney, its Hua in the hair, if the Shaoyin blood is not enough, that is, can not be glorified in the hair, …… and there is a frightening evil into the heart gas, to four or five years old still can not speak”.
The book of sincerity? On the line late”: “bone belongs to the kidney, kidney deficiency is the knee bone is not yet formed and line late, this endowment in the innate, one or two of ten. To if born within a week, the heavy curtain deep closed, do not see the wind and sun, and the end of the day embrace, tendons and bones have not been spread, this day cherished too much, two or three out of ten. The most important thing is that the person who has been born with the disease is the one who has to drink the milk, or eat too much fat and sweet, then the noma is invaded, and the blood is exhausted day by day, six or seven out of ten.
The “infant protection summary” cloud: “hands and feet soft, the spleen is the main limbs, is the lack of gas in the state, can not nourish the limbs, so the meat less skin wide, diet is not for the skin also ……”. Or as the “evidence of treatment standard? The “Young Branch” points out that “this or typhoid or vomiting or diarrhea, taking advantage of the deficiency of evil toxins, penetrating the liver vein, invaded by heat, the foot causes the tendons to be soft and long or hands and feet soft and can not lift, or neck soft and can not lift”. The “Summary of Infant Protection” believes that the head is soft because “the internal organs, bones and veins are deficient, and the gas is insufficient”. It is suggested that the formation of this disease is related to the deficiency of the essence of the internal organs.
The “Summary of baby protection” also pointed out the pathogenesis and treatment of five hard: “five hard, tilting the head to take the gas, difficult to move, gas congestion for pain, even in the chest and diaphragm, feet and hands and cold heart. This Yang Qi does not camp in the four end also …… this evidence from the liver and spleen two organs suffer from the disease, when the spleen to pacify the liver”, Xun is the empirical theory. There are also five hard causes attributed to the internal wind, “medical compendium”: “on the five hard that is the genus, by the so-called violent strong straight, all belong to the wind is also”.
3.Treatment
Comprehensive ancient medical literature, five late five soft five hard treatment is mainly based on drugs. Five late to nourish the kidneys as the main treatment, the use of drugs to add or subtract Dihuang pill, “the key to the heart of the infant science”: “children are endowed with a deficiency of qi and blood, tendons and bones are weak and difficult to move, teeth are not born hair thinning, body sitting unstable language late. The main treatment is to add the flavor of Dihuang, and to tonic the middle and benefit the qi following the phase of the doctor, the evil multiplied by the heart qi calamus good, blood deficiency hair late chicory win appropriate”. The “Young Children Integration”: “Dihuang Pill …… or endowment deficiency, solve the cranial loss of voice, five late five soft, kidney and liver chancre. All the evidence of liver and kidney deficiency, it is appropriate to use this to nourish the source of chemistry, its function can not be described”.
The treatment of five softnesses in ancient texts reflects the idea of “treating impotence by taking only Yangming”. Five soft”: “The heart is the main blood, the liver is the main tendon, the spleen is the main flesh, the lung is the main gas, the kidney is the main bone, these five are endowed with five organs of the gas, weakness can not nourish the full reach, so the bones and veins are not strong, limb impotence, the source of its total return to the stomach. The stomach is the sea of water and grain, the source of the five viscera and the source of the six internal organs”, advocating the use of “tonifying and benefiting Qi Tang to nourish the source of transformation. The main reason for this is the weakness of the innate Qi of the five viscera, the lack of source of Qi and blood biochemistry in the latter, the deficiency of Yangming Qi and blood, which makes it difficult to operate the essence to the meridians, and causes the loss of nourishment of the five viscera and the loss of muscle filling. The treatment is based on nourishing the spleen and stomach, supplemented by tonifying the kidney essence, and the treatment of the five softnesses is based on this, reflecting the idea of “treating impotence by taking Yangming alone”.
The treatment of the five hardnesses reflects the principle of “suppressing wood and supporting earth”. Volume 3: “The scriptures say: the spleen is the master of the limbs. Also said: the spleen is the master of all yin. Today, the hands and feet cold and hard, only Yin without Yang, so it is difficult to treat. If the tendons are green and urgent, wood multiplied by earth position, urgent use of six jun, gun ginger, cinnamon, Chai Hu, Sheng Ma, in order to restore its true energy. …… this disease from the liver and spleen two organs suffer from the disease, when the spleen to pacify the liver”.
In addition, many doctors from the “wind” to treat the five hard, the “Guide to Infant Medicine”: “Yang Qi does not camp in the four end and become five hard. …… heavy person to small renewal of life soup to dredge its wind for good, light person Wu medicine Shun Qi San to regulate its gas should be tested. If the liver wood multiplied by the spleen, less food and weak qi, plus flavor six gentleman soup, internal and external treatment, its wonderful without end. The original formula is mainly used to treat the evidence of wind in the meridians.
The treatment of fetal stage fright is based on strengthening the spleen and regulating qi. The treatment of fetal fear is based on strengthening the spleen and regulating qi. The fetal disease theory: “fetal stage fright …… if the postnatal conditioning is appropriate, ten can be preserved one or two. It can be helped by toning Yuan San”. The source of pediatric disease formula? The fetal weakness: “children because of fetal endowment weakness, if the failure to treat, after will be slow alarm wind and difficult to heal. It is advisable to take Chang Sheng Wan in advance”.
In addition to oral medication, there are also some external treatments for Wuchi, such as the “General Microbiology of Children’s Health”: “For children who are unable to walk since they are small to five years old, moxibustion should be applied to each of the two feet and ankles for three strokes”.
4. Prognosis
The prognosis of the disease varies among medical doctors. The Book of the Living Young Heart? The “Five Soft” clearly points out: “If there is a birth, it is like the grass in the shallow soil of the yin ground, although there is a occurrence but the smooth mushrooming is little. Also like the cultivation of trees, shaking its roots and into the few carry on. From this point of view, infants are weak and intolerant of cold and heat, even if adults, there are many diseases”. The “standard rules of evidence and treatment? The “Young Branch”: “head, hands and feet three soft, and take Dihuangwan. …… will cause the head, arms, hands and feet body soft, is called five soft. The treatment with the transfer of Yuan San, tonic kidney Dihuang Wan, gradually recuperate, day after day is safe, if the drug does not work, but also for the invalid”. The medical compendium” cloud: “five-year-old children refuse to walk, soft feet and wonky life, small may wish to glory Wei Qi, grow up should be meat from birth.