Jake Paul Fratkin, OMD, L.Ac.
Several years ago, I introduced CHILDREN’S EAR FORMULA to the Golden Flower repertoire of products. Although actual ear infection is quite rare (but over-diagnosed by many pediatricians[i]), the formula we made is quite effective, often causing pediatric ear pain to disappear even after one dose[ii]. We started that product as a powder, to be reconstituted into a liquid. This proved to be a barrier to enough parents that Golden Flower pursued developing the product as a non-alcohol syrup with a good taste.
With the success of CHILDREN’S EAR FORMULA, Golden Flower approached me about expanding their pediatric line, all of which would be offered in syrup form. I have been in clinical practice 33 years, and pediatrics has always been a strong part of what I do, today accounting for 35% of my patient load. When I studied in Beijing in 1987-1988, I did advanced specialization in the pediatric department (along with respiratory and internal medicine). I learned how to prescribe for children, and how to manage children to get good compliance.
Over the past number of years, I slowly developed several formulas that seem to work for common pediatric conditions that came into the clinic. I made these as tinctures, and found that I was using them over and over. One was for common cold, one was for acute cough, and one was immune enhancement and prevention of illness. Adding in CHILDREN’S EAR FORMULA, I feel that these four formulas address the great majority of pediatric cases, especially for those emergency calls where something is needed right away.
Now that Golden Flower has asked me to offer an expanded line of pediatric formulas, I am clear that these three new products, plus the ear infection formula, will meet the needs of practitioners treating common complaints in children. I have used them for years and am convinced, through my own clinical experience, that each of the formulas is very effective.
I’d like to say a word about manufacturing, dosing and compliance. For each 2 oz. bottle, we are providing 50 grams of raw herb. This is much stronger then most herbal extracted-tinctures available on the market. I have insisted on strong dosage in order to offer effectiveness in fewer doses. The formulas are made in an FDA approved, GMP facility in the United States, and the individual herbs used are tested and certified in the USA as to purity (meaning no heavy metals, no pharmaceuticals). Whole dried herbs are powdered and extracted without alcohol and with glycerin. To my knowledge, these make Golden Flower children’s formulas the only liquid herbal line without alcohol. Golden Flower has carefully evaluated various flavorings (using real children!), and has come up with a pleasant flavor. These liquids can be taken straight or added to juice or water.[iii]
Dosing is given every 3 to 4 hours as needed for the common cold, cough and ear formulas. For the immune enhancement and prevention formula, dosing is given once or twice a day. As for amounts, I recommend 1 teaspoon (6 ml) for children five and above. For children younger then five, use a pediatric syringe or eye-dropper (one eye-dropper squirt is about 1 ml). For infants under one year, 1 to 1.5 ml is given as a dose. For children between 1 and 4, give 1 ml per year of age, plus 0.5 ml. Accordingly, a one year-old would get 1.5 ml; a two year-old would get 2.5 ml; a three year-old would get 3.5 ml; and a four year-old would get 4.5 ml. You can vary this according to your own judgment, based on age and size of the child.
For infants and toddlers up to 3 years-old, lie them on their back, and gently squeeze a little from the pediatric syringe into the back of their throat, allowing them to swallow. They may make a face, but once they swallow, they will forgive and forget. If they are seated or held in the arms, there is a possibility of blocking the medicine with their tongue, so lying on their back is best. Some infants may vomit the medicine. In these cases, give small amounts spaced out over time. Remember, medicine that has been vomited is medicine not consumed. You will need to repeat the dose at some point.
Once kids are two or three, they can take the medicine by pediatric syringe or by teaspoon in a seated position. Following with water or juice helps take the taste away. Even though it is sweeter then most herbal medicine, it is still thick and concentrated, and a follow-up of liquid will help. I think it is best to tell the child that this is medicine, not food or treats, and to expect some bad taste. When forewarned, they are more willing and forgiving. Tell them the taste will chase away the bad bugs causing their cough or illness. But impress upon the parents to be strong – they should not forgo giving the medicine because their child makes a bad face or comment. Colds that go untreated often end up in cough, which can hang in there for several weeks.
I would now like to discuss each formula in a little detail.
CHILDREN’S CLEAR AND RELEASE FORMULA is a formula for common cold, and it can also be used for fever due to viral infection. It combines herbs from various antiviral formulas, including Gan Mao Lin, Yin Qiao San and Zhong Gan Ling. The actual formula is as follows:
Mao Dong Qing (Radix Ilicis Pubescendis) 17 %
Lian Qiao (Fructus Forsythia) 10
Jin Yin Hua (Flos Lonicera) 10
Ju Hua (Flos Chrysanthemum) 8
Niu Bang Zi (Fructus Arctium) 7
Xin Yi Hua (Flos Magnolia) 7
Sang Ye (Folium Morus) 7
Lu Gen (Rhizoma Phragmites) 7
Ge Gen (Radix Pueraria) 7
Xuan Shen (Radix Scrophularia) 7
Man Jing Zi (Fructus Viticis) 7
Gan Cao (Radix Glycyrrhiza) 6
In this prescription, herbs from Clear Heat Resolve Toxin category are used to combat viruses that cause common cold. These include mao dong qing, lian qiao and jin yin hua, and comprise 37% of the formula. Herbal formulas that do not aggressively address the causative virus are mediocre in effect, and are the reason why Gan Mao Ling and Zhong Gan Ling are so effective against viruses that cause upper respiratory infections.
Other herbs in the formula address specific symptoms. Ju hua, xin yi hua and man jing zi bring the formula to the nasal area, and are used to control drippy nose, sinus congestion and sneezing. Niu bang zi is specific for sore throat; sang ye addresses dry early cough; lu gen reduces fever and relieves sore throat; ge gen relaxes tightness in the neck and shoulders, and helps push trapped wind out; xuan shen is used for heat toxins in the lymphatics. Gan cao harmonizes the prescription, which means it takes herbs with different functions and directions to work together as a unified formula. It also helps to sweeten the formula.
My herbal approach is to address the variety of symptoms that arise when a child first develops a cold, but before it has manifested into a cough. It is to be used from the earliest signs – glazed eyes, drippy nose, sneezing, slight fever – as well as expressed complaints such as sore throat and headache. If the cold is caught early enough, one or two doses should knock it out. If one starts late, even 24 hours later, the viral cold is more difficult to dislodge, but I would continue using it until cough starts, when you should move on to CHILDREN’S LUNG CLEAR.
CHILDREN’S LUNG CLEAR FORMULA. Some time ago I wrote an article on the seven stages of acute cough[iv]. In this article I went to lengths to advise practitioners to carefully differentiate the exact stage of a cough, and to give an appropriate formula. In acute pediatric cough, the stages that come into the clinic most frequently are #2 Lung Fire, #3 Profuse Phlegm-Heat, and #4 Sticky Phlegm-Heat, with this last stage the most common presentation. The Lung Fire stage is an early presentation, and comes and goes within 24 hours before it changes to #3 or #4. Lung Fire is harsh, barky and non-productive, and is seen in croup. Most parents do not bring their child in at this point. They bring their child in once the cough is established and they realize it is not going away. It is very important to impress upon parents that early common cold should be treated right away, and also, if the cold turns into a cough, the child should be seen before the cough becomes entrenched. Cough can be stubborn, even with Chinese herbs.
At any rate, parents usually bring the child in when the cough is harsh and constant. It may or may not be productive, and on occasion has a rattle quality. Children tend to swallow their phlegm, so it is difficult to know if it is productive, but a stethoscope will help reveal what is going on inside the lung. Questioning the parent or child is helpful – how long have they been coughing? Do they cough at night? How often? Do their lungs hurt when they cough?
95% of coughs are viral in nature[v] and will respond to Chinese herbal formulas that include addressing the viral component. Do not be put off by a Western diagnosis of “pneumonia” or “walking pneumonia”. These are always viral events that will respond to the herbal medicines. (MDs insist on antibiotics for possible “secondary” infections, but this is bogus and harmful to the patient.)
Our formula addresses the sticky-viral stage as well as the more productive, rattley phlegm-heat stage, which are the two stages most commonly seen. Some practitioners believe early cough to be wind-cold invasion, and think of formulas like Xiao Qing long Tang, but this is not the case clinically, and counterproductive. Harsh cough is always due to heat, and even if precipitated by cold, it quickly turns to heat in the lung. Viral toxins either are the causative agent, or come into production as the lung is injured, and by the time children come into the clinic, both heat and toxic viral heat present.
CHILDREN’S LUNG CLEAR FORMULA consists of the following herbs.
Zhe Bei Mu (Bulbus Fritillaria Thunbergium) 13 %
She Gan (Rhizoma Belamcanda) 13
Qian Hu (Radix Peucedanum) 11
Gua Lou Ren (Semen Trichosanthes) 10
Sang Bai Pi (Radix Cortex Morus Alba) 9
Zhi Zi (Fructus Gardenia) 9
Huang Qin (Radix Scutellaria Baicalenses) 9
Zhi Ke (Fructus Citrus Aurantium) 9
Xing Ren (Semen Prunus Armeniaca) 9
Jie Geng (Radix Platycodon) 9
Our strategy is to clear lung heat and viral toxins, and address accumulation of phlegm-heat. The lead herb, she gan, not only clears phlegm-heat, but is also very good for sore throat. It has been shown to have strong antiviral effects.[vi] Other herbs that clear lung heat include zhi zi and huang qin. The formula addresses lung phlegm-heat by combining zhe bei mu, qian hu and gua lou ren. Jie geng reinforces transformation of phlegm, and helps lead the formula to the lungs. Sang bai pi and xing ren clear lung heat to resolve cough. Zhi ke relaxes costal tension, and helps lead lung qi downwards. I have found it to be a very effective formula for pediatric cough.
CHILDREN’S JADE DEFENSE FORMULA is a variation of Yu Ping Feng San, in a syrup form that children can easily take. Clinically, I use this formula for several different applications. Foremost is for recovery following an illness. Fever and cough deplete the body of its zheng qi, even in young children, and it is important to replenish qi after a cold, cough, or other acute sickness. Secondly, I use it when a parent asks me what can I do to boost their child’s immune system, especially when sickness is running rampant at day-care or school. Here, I advise taking a dose once or twice a day. The formula can safely be taken for a long time. The third application is before and during allergy season. Taking the formula for 2-4 weeks prior to the onset of known pollen allergies boosts both wei and ying qi, making allergy season much less of a problem. During pollen allergies, I always combine this formula with something symptomatic for nasal symptoms, such as Bi Yan Pian. The formula for CHILDREN’S JADE DEFENSE FORMULA is:
Huang Qi (Radix Astragalus Membranaceus) 35%
Fang Feng (Radix Ledebouriella Divaricata) 25
Bai Zhu (Rhizome Atractylodes Macrocephala) 20
Ju Hua (Flos Chrysanthemum) 20
The original Yu Ping Feng San, at least in this dosing, is credited to Zhu Danxi in 1481.[vii] I have modified the formula by adding ju hua to reinforce taking the formula to the exterior and the upper respiratory system. The idea of boosting the immune system, in TCM terms, involves strengthening the wei qi. Wei qi is not an independent energy; it is a variant of ying qi, the energy that circulates in the acupuncture channels. Ying qi is nutritive qi; it has a centripetal or concentric energy, and is destined for its associated organ. The wei qi is the more yang, energetic aspect of ying qi that radiates outwards from the meridian. By radiating through lymphatic and interstitial fluid, it energizes agents of the body’s immune system to search and destroy pathogenic viruses and bacteria. CHILDREN’S JADE DEFENSE FORMULA first creates ying qi using bai zhu; huang qi creates and reinforces the centrifugal wei qi; fang feng and ju hua help lead the wei qi to the exterior. It is a remarkably effective formula, despite the few ingredients chosen.
CHILDREN’S EAR FORMULA, which was release a number of years ago, is used for acute or chronic middle ear infection (otitis media). Ear infection appears with acute, sharp pain, and this formula addresses microbial infection with accumulation of turbid damp. Most MD diagnosed ear infections that don’t show pain are due to upper respiratory infections and fever, where the ear canal will show as red. Those cases should respond to CLEAR AND RELEASE FORMULA. Ear infections with pain are effectively addressed by CHILDREN’S EAR FORMULA. Herbs used are:
Huo Xiang (Herba Agastache) 10 %
Fu Ling (Poria) 10
Ju Hua (Flos Chrysanthemum) 8
Huang Lian (Rhizoma Coptis)8
Lian Qiao (Fructus Forsythia)8
Chi Shao (Radix Paeonia Rubra) 8
Qian Hu (Radix Peucedanum)8
Bai Zhi (Radix Angelica Dahurica)7
Chai Hu (Radix Bupleurum)7
Zhe Bei Mu (Bulbus Fritillaria Thunbergium)7
Ban Xia (Rhizoma Pinellia Preparatum) 7
Man Jing Zi (Fructus Vitex) 7
Sheng Jiang (Rhizoma Zingiberis) 5
Here, we begin by clearing turbid damp and phlegm from the middle and inner ear. Huo xiang is the best herb for this, and it is reinforced with fu ling, qian hu, zhe bei mu and ban xia. Herbs that fight microbial infection include huang lian and lian qiao. Herbs that bring the formula to the zinner ear include ju hua, bai zhi and man jing zi. Borrowing from xiao chai hu tang, we combine chai hu, ban xia, and sheng jiang, which infiltrate the lymphatic system surrounding the inner and middle ear. Chi shao is used to increase circulation in the middle andinner ear and relieve pain. Collectively, the formula clears and descends turbid damp, and clears heat and resolves toxins. For acute, painful ear infection, with or without fever, the formula is appropriate and effective.
We believe that these four formulas – for common cold and fever, cough, immune enhancement, and ear infection – cover many of the acute presentations that affect children. These formulas can be used until the children can swallow pills, and which time a variety of pills are available. They are safe and effective, and a welcome relief to the routine recommendations for antibiotics that are offered at the pediatrician’s office.
Jake Paul Fratkin, OMD, L.Ac. trained in Korean and Japanese acupuncture since 1975, and Chinese herbal medicine since 1982. He spent a year in Beijing hospitals specializing in internal disorders and pediatrics. Dr. Fratkin is the author of Chinese Herbal Patent Medicines: The Clinical Desk Reference, a compendium of 1250 Chinese herbal products available in the United States, and the editor-organizer of Wu and Fischer’s Practical Therapeutics of Traditional Chinese Medicine, Paradigm Publications, 1997. He is the recipient of ACUPUNCTURIST OF THE YEAR, 1999, by the AAAOM and TEACHER OF THE YEAR, 2006, American Association of Teachers of Acupuncture and Oriental Medicine (AATAOM). Jake lives and practices in Boulder, Colorado.
[i]Most so-called ear infections diagnosed in the pediatrician’s office are not local infections at all, but part of the signs and symptoms of an upper respiratory infection in children under age 4. In a URI, the ear canal becomes red due to general elevated fever. The puffiness of the ear canal is due to stagnation of fluids in the middle and inner ear, again due to elevated fever rather than accumulation of bacterial pus. Rarely, unresolved URI can result in an ear infection, but not when the URI is effectively treated with Chinese herbal formulas for common cold. In any case, prescription of antibiotics is unnecessary and in fact harmful.
[ii] For more information on treatment of ear infection, see two articles previously published by Golden Flower:
[iii] The manufacturer describes the process: “The whole herbs are ground, and are then water extracted in a double extraction process where the herb is first macerated in cold water, followed by a long slow pressure and heat water extraction process to digest and extract all the naturally occurring compounds from the cell structure of the plant. This allows the active naturally occurring phytochemical compounds to be bioavailable and is immediately absorbed when taken. After a concentration phase, natural vegetable glycerin from coconut is added to preserve and sweeten (without caloric consequence) and it is made into a syrup.”
[v] “Most coughs in children are brought on by the viruses that cause colds and the flu. Rarely, pertussis (whooping cough) or pneumonia is the cause of a prolonged cough.” Department of Health, Oregon. www.patient.co.uk/showdoc/23069192. Also, “Antibiotics don’t work for acute bronchitis. Now we have strong evidence saying that it shouldn’t be used for this purpose.” The Lancet, May 11, 2002;359:1648-1654.
[vi] See John Chen, Tina Chen, Chinese Medical Herbology and Pharmacology, Art of Medicine Press, 2004, p.218.
[vii] Zhu Zhen-Heng (Danxi), dan xi xin fa, “Dan-Xi’s Essential Teachings”; Zhu Dan-Xi, 1481. Scheid et al argue that the formula predates Zhu, with earlier mentioning in 1213. See Scheid, Bensky, Ellis and Barolet, Chinese Herbal Medicine Formulas and Strategies, 2nd Edition, Eastland Press, 2009; p. 326-327.
© Copyright 2010 Jake Paul Fratkin. All Rights Reserved.