Herbal Treatment of Disease III
Pediatrics
In China pediatrics is the easiest way to become famous. Children are easily cured. One
bag of herbs is like magic. Conversely the most difficult is gerontology.
Bian Que (4th Century BC) was described as a god or man with birds wings. He was the
first recorded pediatrician in history.
Qian Yi (1032-1132) Xiao Er Yao Zheng Zhi Jue A Collection of Essential Pediatric
Patterns & Treatments
o Invented Liu Wei Di Huang Wan for the 5 delays: stand, walk, teeth, hair/fontanel,
speaking,
o Dao Chi San HT huo restlessness, concentrated occasionally painful urine
o Xia Bai San – LU re, low grade fever, ke sou xue
o Invented 5 Zang DD for children
o Facial observation in diagnosis
o Conclusion in characteristics or features in pathologies
o Focused on SP/ST in pediatrics
o Focused on various dosages for flavor in powder or pill form
Violet’s project - Promote digestion formula, patients who don’t want to eat. Did not taste
good – ji nei jin. Was ultimately made into tablets but they were too big. Eventually they
were made into chewables, and different shapes.
Physiology
o Li organs are tender & fragile – physically not developed
o Qi is not full – functional, easily attacked by biao pathogens
o TCM may start at fetal stage
o Newborns (0-28 days) – the most fragile time. In China you do not take them into
crowded places or to family for “show & tell.”
o Infants (28 days to 1 year) – time of fastest growth, 3xs body weight, limbs grow
1.5xs their length, circumference of head grows by 50%.
o Toddlers – may start adult foods
o 1-3 years – changes in diet, SP/ST problems, take care of their teeth
o Preschool – onset of diseases lower than age 1-3. They should actually be
exposed to other children & their germs. May show signs of malnutrition, picky
eaters. Asthma may start and treatments should be started.
o 7-11 girls, 7-13 boys – other diseases: arthritis, nephropathies, asthma, teeth
changes (good time for correction) until 17-18. Menarchy for girls, boys start to
have more genital development.
o Under 16 can generally be treated as children
o Children have a “pure yang constitution” – fast, quick development
Etiology
o Congenital Factors: Down’s due to age of parents; not taking care of fetus
during pregnancy, esp. the first trimester. No alcohol! Unfortunately some
women don’t know they are pregnant in the first trimester.
o Biao Factors: environmental pollution, microwaves, older TVs, electric blankets;
laptops, cell phones – electric magnetic fields accumulate & influence the
developing fetus. In China there are many inventions that block these waves such
as specialized dresses. Even placing a cell phone under it will stop reception!
Falls in the last trimester can cause brain damage. Yang pathogenic factors – feng,
huo, re.
o Diet, Emotional Factors, Injury
o Medical Factors: western medicines, side effects: LV/KI. Here we treat a lot of
nephropathy – typical steroid Cushing’s syndrome (full moon face)
Pathology
o Easily susceptible to disease which then transmits and changes rapidly
o Children’s internal organ Qi is clear and effective; therefore, they easily and
quickly return to health
o Li Zang are clear & effective – easily return to health. Children “change” bian3
every 32nd day (10x’s), and manifests as a non-pathological fever. There 5
“steaming” zheng1 on the 64th day. Biggest developments happen on the 64th &
128th days where they sleep a lot.
Xu
o
o
o
o
LU: Premies – sick often
SP: post natal jing, children need appropriate nutrients for growth
KI: original yin & yang are stored here – nephropathy, enuresis
Yin
Shi
o LV: quick growth “the tree that goes to the top of the head,” jueyin mai goes
directly to the top of the head. Convulsions due to shi aspect of the LV
o HT: re is easily generated into the HT, high fever, chills, darker urine
o Yang
Diagnosis
o Observation: the most important aspect
o Shen & color
o Greenish color change between eyes (BL 1 area) “root of the mountain” may
indicate onset of convulsion, vessels here shrink causing yu. Chronic gu yu also
show a greenish color.
o Malnutrition may show huang around the nose.
o KI manifests around the chin
o Huang: SP, weak constitution, xu, improper diet, shi1
o Qing: LV, feng, tong, yu xue, convulsion
o Red: HT, re, convulsion
o Bai: LU, xu, han
o Wu: han, tong, shui, malignant situation
o Listening & smelling
o Palpation
Observe Body Form
Head, Neck, Fontanel
o Within 2 months a baby should have enough strength to hold their head up.
o Chinese Rhyme about months: 1 cry, 2 smile, 3 head up, 4 turn, 5 grasp, 6, 7 sit, 8
crawl, 9 stand
o Anterior fontanel closes at 12 to 18 months. Delays are usually related to yuan
or jing xu. Occasionally there will be early closure, which inhibits brain growth
and is quite painful.
o Posterior fontanels 25% naturally close at birth, the rest will close at 2 to 4
months
Trunk
o Deformity, rashes, breathing during pneumonia or severe respiratory disorders the
abdomen sinks vs. expands
Limbs, skin, hair, nails
Sprouts & Orifices
o Eyes, nose, teeth, throat, cheeks
o Tongue: white thick coat in the center is normal if they are still drinking milk.
o Ears: look for infection
o Two lower orifice: a slight amount of blood at birth is normal from the vagina.
Some boys may have breasts, due to their mother’s hormones, but they will
vanish shortly. Diaper rash, red butt (give them diaper free time so their skin can
breathe during an assessment). Diapers until age 2 is OK, as the muscles of
urination do not develop completely until then. And this may avoid an emotional
association with normal bodily functions.
o Stools: yellowish greenish, frequent at first is normal from breast milk feeding.
Bottle feeding tends to be more dry.
o Urine
Index Finger Veins
o Feng Guan wind bar: proximal – biao, mild. (the area between the metacarpal
phalangeal joint and the proximal inter-phalangeal joint): indicates acute stage,
superficial and beginning of a disease and therefore it has a better prognosis
o Qi Guan qi bar: mid - less severe, middle stage of disease. (between the proximal
and distal inter-phalangealjoints): indicates the middle stage of a disease and the
prognosis is not as good.
o Ming Guan life bar: distal – severe, one vein through all three gates. (from the
distal interphalangeal joint to the tip of the index finger): indicates the severe
stage of a disease and the prognosis is worse.
o Rub proximal to distal then observe
o Biao – difficult to assess
Check the color of the veins
o Fresh red: external excessive cold
o Purple red: external or internal excessive heat
o syndrome
o Green color: pain and panic or fear
o Dark purple or black purple: food stagnation,
o particularly for blood stagnation
o Light or pale red: deficient cold
o Light or pale yellow: Inner wind due to spleen
o deficiency
o Light or pale purple: deficient heat
o Fluency – xu
o Sluggish – shi
Listening & Smelling
o Crying – low voice xu, loudly
o Breath – deep, shallow, phlegmy (babies don’t know how to cough)
o Ke sou
o Language – speaking on time, speech difficulty. Multi language families take a
little longer to decide what language to speak
o Smelling – parents know this one well
o Inquiring – mute
Age
New born
< 1y
2～3y
4～7y
9～l4y
Breathe(/min)
40~45
30～40
25～30
20～25
18～20
Pulse(/min)
120~140
110~120
100~120
80~100
70~90
B：P
1:3
1:3~4
1:3~4
1:4
1:4
Palpation
o Fontanel – use caution to evaluate closure
o Skin – eruptions
o Chest
o Abdomen – press for malformation or constipation
Pulse
o
o
o
o
Age >3 y: Use your thumb over three positions
Superficial/deep
Slow/rapid
With strength/without
Treatment Principles
o Be careful with extremely bitter, han, acrid, re, toxic, harsh. No chuan xin lian.
o
o
o
o
Once the treatment works do not continue
Mild herbs in the same category
Rx must be convenient: tincture, chewables, cookies
Do not prescribe without sx! May cause premature problems.
Li/Biao – Tui Na
Other
o
o
o
o
Inhalation: sprays
Drops
Herb bags: historically hung on the belt
Bathing: Dragon boat festival – fresh yi qiang hao & shi chang pu – used in the
summer once as a preventative.
o Warm ironing: re bags and rub on the belly promotes digestion & alleviates xu
han
Dose (Relative to adult)
o Newborn 1/6
o < 1 year, 1/3
o 1-6 years, ½
o 7-12 years, 2/3
o Over 12 = adult
Administration
o < 1y 100ml
o 1~3y 100-250ml
o >3y 250-500ml
10/28/10
Know pulse diagnosis age: index finger under 3 yrs, thumb for 3 to 8
Ke2 – sound but no phlegm, Sou4 –
Pediatric Cough Ke Sou Slide 35
Season, Age: <3 y, characteristics, prognosis
Etiology
1. Biao attack  WC, WH  skin, mouth, nose  LU  dysfunction of dispersing
& descending; obstruction of qi tract. [Jing Fang Bai Du San, Sang Ju Yin]
2. Li invasion  a. SP dysfunction  source of tan  tan  tan re, tan shi 
adversely upward qi due to qi obstruction  ke sou; b. weak constitution 
susceptible to biao pathogenic factors  injury of SP/LU  dysfunction of
descending  Ke Sou. [Qing Qi Hua Tan Wan, Liu An Jian, Er Chen Tang]
3. SP/LU Qi xu due to poor body constitution
Shang Jiao Xuan Bi Tang, Sha Shen Mai Men Dong, Liu Jun Zi Tang.
Key Points for Diagnosis
o The sound of ke sou
o The amount of tan
o The color of tan – sometimes huang tan is not always obvious
o Overfeeding overloads the SP, which transforms into damp re & tan.
o Grayish dark nodules are also considered re.
Consider the taste of herbs before choosing them.
Biao cao
o Ma huang rong – the plant “joints” are removed, difficult to manufacture, and the
difference is minimal but safer. To enhance the function of moving into the LU –
use zhi (honey roasted)
o Zi su ye, Jing jie, fang feng
o Qiang huo – strengthen function of dispersing
o Xi xin – severe han accumulation, not common in children even in Dr. Song’s
practice
o Sheng jiang, Bo he
o Chai hu – has been developed into injectible form in China since Violet was a kid,
excellent at reducing fever in biao attack. No side effects
o Yu xing cao – excess re pneumonia is treated well with an injectable form
o Qing hao – large doses help to control fever
Descend LU Qi
o Chen pi – soothe qi, eliminate tan
o Zhi ke - gentle
o Lai fu zi (radish seed) – eliminate yu, soothe qi, resolve tan. Tastes & smells bad
o Hou po
Resolve Tan
o Qian hu, bei mu
o gua lou ke (peel) – peels usually affect the biao parts of the body
o Dan nan xing – severe tan re
o Ban xia – jing ban xia in China – combines fa ban xia (regular) & jiang ban xia
(ginger processed) to make a milder form
o tian nan xing – tan han
o xuan fu hua - descend
o jie geng – han tan
Ke sou & wheeze
o Xing ren, zi wan, kuan dong hua, su zi, pi pa ye, sang bai pi
Dampness
o Fu ling, du huo
Remove Re
o Chao zhi zi – slightly less cold
o Shi gao – feverish situation, minor role, not easily absorbed & digested. Plants
are preferred for younger kids
o Lu gen (phragmatis root) – mild, promo jing ye
o Huang qin, lian qiao
o Yu xing cao
Moisten LU
o Sha shen, mai men dong, yu zhu (polygonatum root)
Bu LU
o Ren shen – strong
o Huang qi, dang shen, Gan cao, bai zhu
Feng han ke sou
Jīng Fáng Bài Dú Sǎn
Sāng Jú Yǐn
Qīng Qì Huà Tán Wán
Modification
o A lot of phlegm and fast breathing: Yú Xīng Cǎo, Sāng Bái Pí
o Sticky plegm which is difficult being coughed out: reduce Bàn Xià, add Qīng Dài,
Hǎi Gé Fěn, Shā Shēn
Liù Ān Jiān Six Ingredient Peaceful Formula
Er Chen Tang (no wu mei), xing ren, bai jie zi
Xin Zhi Liù Ān Jiān Newly Changed: chen pi  (hua) ju huang (grapefruit peel) resolves
tan, fa ban xia  jing ban xia, bai jie zi  ting li zi purges the LU
In Gentle Warrior there can be up to 20 or more ingredients. Children are not that
complicated and do not need all of this.
Gan cao is not commonly used
Pediatric Asthma xiǎo chuǎn
- Season, – Body constitution, – Stimulators
Etiology
Internal factors
• poor body constitution with lung, spleen and KI Qi Xu, as well as retention of phlegm
and dampness
– External factors
• Invasion of external pathogens, such as wind, cold, dampness and dryness, etc,
attacking the lungs
• Cold food or spicy food
Pathogenesis
• Rebelling lung Qi with retention of phlegm
• Wheezing is called Xiào while dyspnea is called Chuǎn. Dyspnea may be seen in other
diseases but the wheezing must have dyspnea.
See Chart p23
The best time (golden time) for treating and curing asthma in children is preschool age (5
or 6). Before this time their zang-fu are not quite developed and good results are not
easily acquired. There is more involvement with other children.
Diagnosis
o Main Sx
o Repetitive onset: weather change, diet
o Disease history: family
o Compare with pneumonia: both show wheezing, asthma does not necessarily have
a high fever
Treatment
In acute stage, one should treat the excess in the lungs while in the remission stage, one
should tonify lung, spleen and kidneys. It’s therefore called treat the upper in acute stage
and treat the lower in chronic stage.
• Prevent the dampness and phlegm is another important issue. Avoid cold food or heavy
greasy products.
Address excess
Prevent further damp: foods – mutton, bacon, smoked foods
Dìng Chuǎn Tāng
Modifications
o Severe heat: Yú Xīng Cǎo；
o A lot of phlegm: Zhú Lì (processed bamboo) bamboo is heated and drops of sap
pour out
o Constipation: Quán Guā Lóu, Dà Huáng – jiao Dà Huáng is used often for
children
Yù Píng Fēng Sǎn
Children tend to sweat easily because this function is not completely developed
Modifications
o Heavy sweating: Lóng Gǔ, Mǔ Lì – duan is better; Fú Xiǎo Mài – cc: celiac
o Thirst, fever in palms and feet, red tongue body with peeling coat: Shā Shēn、
Mài Dōng, Wǔ Wèi Zǐ
Liù Jūn Zǐ Tāng
Modifications
o Loose stools: Mù Xiāng, Shā Rén
o Poor appetite: Jiāo Shān Zhā – focuses more on the MJ, Shén Qū, Chǎo Gǔ Yá,
Chǎo Mài Yá
Jīn Guì Shèn Qì Wán
Modifications
o Yin & yang deficiency: Rén Shēn, Gé Jiè, Xiān Líng Pí, Wǔ Wèi Zǐ
o T: Red body with peeling coat: remove Fù Zǐ, Ròu Guì, add Wǔ Wèi Zǐ
o Night urine: Yì Zhì Rén, Tù Sī Zǐ
Asthma prevention
August 1-10, 11-20, 21-30. Treatments are done over three consecutive years. Ask
patients to come in at least once during these three time frames.
• Bái Jiè Zǐ (grind), Yán Hú Suǒ ea 21g, GānSuì, Xì Xīn 12g powder, divide into 3
bags, every 10 days per bag.
• Ginger juice mix the powder as large as 5 cents coin.
• paste on BL13, BL15, BL17, REN17 - adults 2～4h, children 1~2h
Meridian qi is very active at this time and will bring herbal treatments throughout the
body. This is why you would treat winter diseases in the summer time. Widely used in
China
11/04/10
If a child has a developmental delay acupuncture and herbs do not help significantly.
Rather the assistance of the whole family 24/7 in educating and assisting the child in
learning to care for itself and ADLs may show a bigger promise in development
over the years.
In China’s cities people cherish their children and want to give them everything they
see in advertisements. In the country side they are raised to be free.
Lack of Appetite 33
Onset
– Season – Summer re
– Age: 1~6 years
– Prognosis – if it is simply a lack of appetite Px is good. If it is due to another disease.
Resolve the disease first.
Etiology
• Irregular diet – to much ice-cream in summer
• Post-disease – poor appetite, even after gan mao, usually related to UJ problems, LU/ST.
Maluse of qing re herbs can easily damage their qi.
• Constitutional weakness – some babies are just weaker in their SP/ST.
Pathogenesis
• Dysfunction of SP and ST
Chart p35: Improper Diet, Improper nursing  SP & ST injury,  2. Regulation of
SP/ST, 2. SP / ST yin Deficiency 3. SP /ST qi Deficiency  Unwilling to eat, Poor
Transformation & transportation  Lack of appetite
Diagnosis
• Long duration
• Pale face, thin body form, but normal activities
• Disease history
In China it is routine to get rid of roundworms. Kids start off with pale face, white
circles on face (manifestation circles). Oral medicines are given and the next day the
baby will usually poop them out. The herbs do not kill the parasites instead they are
immobilized or puts them into a coma.
Tiáo Pí Sǎn Adjust the SP Decoction
Irregularity of SP/ST
o Chao cāng zhù – aromatic, can also use bai zhù to strengthen SP
o Chén Pí, Shén Qū
o Jī Nèi Jīn – should be vinegar fried to make amino acids easier to be utilized &
easier to be powdered. At home it is dried in the sun, powdered and added to kids
food in small quantities
o Pèi Lán – slightly aromatic, elminates dampness, disperses qi
Modifications
o Severe abdominal distension: Mù Xiāng、Lái
o Fú Zǐ；
–
Yellow greasy coating: Huò Xiāng、Yì Yǐ Rén
Promote digestion herbs are usually best when dry fried.
Yì Gōng Sǎn
One of the most commonly used formulas in pediatric digestive disorders
Yǎng Wèi Zēng Yè Tāng
Modifications
SP qi xu:Sh ānY ào、BiǎnD òu；
Thirst: Lú Gēn、TiānHu ā Fěn；
Constipation: Huǒ Má Rén is not usually used in children unless necessary, other nuts
should be an option), Guā LóuR én
Other treatments
– Tuina
– Chiropractic therapy
Knead and massage the muscles along the Spine – moving downward promotes digestion
and eliminates stagnation, moving upward lifts the yang
Prevention
• Right nursing, correct bad habits. – Educate the parents to change the malnursing habits
they may have.
• Find out the causes – some kids have chronic appetite. Malnursing o potential diease.
Pediatric Diarrhea xie xie
Onset
– Season – common in summer & autumn
– Age: <2 years
Etiology
• Irregular diet
• Invasion of external pathogens – usually damp re
• Constitutional deficiency – congenital weakness of SP/ST, unable to digest food
transforms in to turbidity. The worst type is when SP xu turns into KI xu  severe.
Pathogenesis
• Middle Jiao disorder
• According to Neijing, the diarrhea happens when the spleen Qi does not ascend but
descends. The turbid Qi does not descend, it may causes fullness, abdominal distention,
gas and bloating, etc.
See chart p41
Diagnosis
• Frequency of bowel movement - 3-5xs per day, for babies 3xs might be normal.
• Stools Quality – * Dan hua tang.
• Stools Smell, Color
• Disease history
• Compare with Dysentery – mucous or xue, WBCs, RBCs are highly increased as well
as bacteria.
If the child has xie xie 10xs /day send them to the emergency room to prevent further loss
of jin ye.
* Dan hua tang/egg flower soup – blend egg and stir into boiling water
Herbs commonly used for digestive disorders
• Herbs for removing food yu – Shan Zha: meat, Shen Qu, Gu Ya, Mai Ya, Ji Nei Jin: yu,
Lai Fu Zi. Scorch them.
• Herbs for moving Qi and improving transportation – Chen Pi, (HouPo), Zhi Shi/Ke, Da
Fu Pi, Xiang Fu, Chai Hu, Mu Xiang. Tangerine peels can be stored in the fridge for later,
just remove the white parts.
• Herbs for remove dampness and phlegm from middle Jiao – Huo Xiang, Hou Po, Cang
Zhu, Cao Dou Kou, Ban Xia, Fu Ling, Ze Xie, Yi Yi Ren, Sha Ren
• Herbs for removing heat and dampness from middle Jiao – Lian Qiao, Huang Lian, Zhi
Zi, Huang Bai, Qin Pi
• Herbs for stabilize and bind – Wu Wei Zi, Wu Mei
• Herbs for tonify Qi and nourish Yin – Dang Shen, Bai Shu, Gan Cao, Huang Qi, Sha
Shen, Mai Dong, Yu Zhu, Bai Bian Dou, tai zi shen
Bǎo Hé Wán
Gu yu
Modifications
o Obvious abdominal pain & distention: Mù Xiāng, HòuPo
o Vomiting: Shēng Jiāng
Huò Xiāng Zhèng Qì Sǎn
WC invasion - Gan mao does not stay in the LU system
Huò Xiāng Zhèng Qì Ye – liquid, Huò Xiāng Zhèng Qì shui – in alcohol, stronger
Children usually take the one without alcohol
Modified
• Severe interior cold: Gān Jiāng
• Food stagnation: Shān Zhā
Gé Gēn Qín Lián Tāng
Damp Re - Originally for Taiyang disease sinking downward
Modification
– Heat > damp: Huá Shí, Jīn Yín Huā, Lián Qiào
– Damp>heat: Yì Yǐ Rén、Fú Líng、Chē Qián Zǐ
– Abdominal distention: HòuPo、Mù Xiāng
Shēn Líng Bái Zhū Sǎn
SP xu
Modification
– Severe SP damp, with greasy coating: Huò Xiān, PèiL án
– Poor appetite: Shén Qū, Mài Yá
- Abdominal distension: HòuPo, Mù Xiāng
Other therapy
External treatment with herbs
Dīng Xiāng ２g, Wú Zhū Yú 30g, black pepper 30pc
Grind into powder １～３g per day, mix with vinegar, put on umbilicus
Wind-cold attack type, SP deficiency type
Acupuncture & Moxibustionand Tuina
Enuresis
Onset
– Age: >3 years, esp. >5 years
– Boys > Girls
Etiology
• Congenital factors
• Emotion disorders
• Diet
Pathogenesis
• The kidneys failed to hold urine
Bǔ Zhōng Yì Qì Tāng
SP/LU Xu – may be obese
Modification
– Spontaneous sweating: DuànM ǔ Lì, Wǔ Wèi Zǐ
– Obese due to phlegm accumulation: Cāng Shù, Shān Zhā, Bàn Xià
Lóng Dǎn Xiè Gān Tāng
Zhu ye is safe and grows a lot – HT re, poor sleep make tea
Modifications
– Bad sleep: Huáng Lián, Zhú Yè, Lián Qiào
– Severe smelling urine, yellow greasy coating: Huáng Bǎi, Huá Shí
Other treatments
• Patent formula
• Empirical Recipes
• Yì Zhì Rén12g, Má Huáng Shí Chāng Pú ea.10g, Sāng Piāo Xiāo 15g, Pig Bladder 1
• Cook pig bladder 30min first, then decoct together with rest herbs 30 min
• 2 times per day, 4~8 bags
• K deficiency & phlegm covering type.
• External treatment
• Acupuncture and moxibustion
Attention Deficit Disorder
• Congenital factors – might not have good eye contact as babies
• Poor body constitution
• Poor diet
Pathogenesis
• Deficient Yin failed to hold yang and yang
is floating
Test
Multiple choice
5 ask for ingredients
2 cases from those discussed on class + Additional herbs
Review general intro – pulse,
FYI
Jing Cycles found in the Nei Jing - Ch One
Female Jing Cycles of Seven
o A woman's Kidney energy becomes prosperous at seven years of age (1x7).
o Her menstruation appears as the ren (sea of yin) channel flows and
the chong (sea of blood) channel becomes prosperous at the age of 14 (2x7).
o Her Kidney qi reaches a balanced state, and her teeth are completely developed at
the age of 21 (3x7).
o Her vital energy and blood are substantial, her four limbs are strong and the body
is at optimal condition at the age of 28 (4x7).
o Her peak condition declines gradually. The yang ming channel is depleted, her
face withers and her hair begins to fall out at the age of 35 (5x7).
o Her three yang channels, tai yang, yang ming and shao yang, begin to decline.
Her face complexion wanes and her hair turn white at the age of 42 (6x7).
o The ren and chong channels are both declining, her menstruation ends, her
physique turns old and feeble, and she can no longer conceive at the age of 49
(7x7).
Male Jing Cycles of Eight
o A man's Kidney energy is prosperous, his hair develops and his teeth emerge at
the age of eight (1x 8).
o His Kidney energy grows and is filled with vital energy, and he is able to let his
sperm out at the age of 16 (2x8).
o His Kidney energy is developed, his extremities are strong, and all of his teeth are
developed by the age of 24 (3x8).
o His body has developed to its best condition, and his extremities and muscles are
very strong at the age of 32 (4x8).
o His Kidney energy begins to decline, his hair falls out and his teeth begin to
whither at the age of 40 (5x8).
o His Kidney energy declines more, the yang energy of the entire body declines, his
complexion becomes withered and his hair turns white at the age of 48 (6x8).
o His Liver energy declines as a result of Kidney deficiency; the tendons become
rigid and fail to be nimble at the age of 56 (7x8).
o His essence and vital energy is weak, as are his bones and tendons. His teeth fall
out and his body becomes decrepit at the age of 64 (8x8).