Parental use of the term "Hot Qi" to describe symptoms in their children in Hong Kong: a cross sectional survey "Hot Qi" in children
1Department of Paediatrics, Kwong Wah Hospital, 20 Waterloo Road, Kowloon, Hong Kong
2Department of Physiotherapy, Kwong Wah Hospital, 20 Waterloo Road, Kowloon, Hong Kong
the use of herbal beverages "five-flower- tea" (a combination of several flowers such as Chrysanthemum morifolii, Lonicera japonica, Bombax malabaricum, Sophora japonica, and Plumeria rubra) (57.6%) or selfheal fruit spike (Prunella vulgaris) (42.4%).
Background
The Chinese term "Hot Qi" is often used by parents to describe symptoms in their children. The current study was carried out to estimate the prevalence of using the Chinese term "Hot Qi" to describe symptoms in children by their parents and the symptomatology of "Hot Qi".
Method
A cross sectional survey by face-to-face interview with a semi-structured questionnaire was carried out in a public hospital and a private clinic in Hong Kong. The parental use of the term "Hot Qi", the symptoms of "Hot Qi" and the remedies used for "Hot Qi" were asked.
Results
1060 pairs of children and parents were interviewed. 903 (85.1%) of parents claimed that they had employed the term "Hot Qi" to describe their children's symptoms. Age of children and place of birth of parents were the predictors of parents using the term "Hot Qi". Eye discharge (37.2%), sore throat (33.9%), halitosis(32.8%), constipation(31.0%), and irritable (21.2%) were the top five symptoms of "Hot Qi" in children. The top five remedies for "Hot Qi" were the increased consumption of water (86.8%), fruit (72.5%), soup (70.5%), and the use of herbal beverages "five-flower- tea" (a combination of several flowers such as Chrysanthemum morifolii, Lonicera japonica, Bombax malabaricum, Sophora japonica, and Plumeria rubra) (57.6%) or selfheal fruit spike (Prunella vulgaris) (42.4%).
Conclusion
"Hot Qi" is often used by Chinese parents to describe symptoms in their children in Hong Kong. Place of birth of parents and age of the children are main factors for parents to apply the term "Hot Qi" to describe symptoms of their children. The common symptoms of "Hot Qi" suggest infections or allergy.
As an ex-British colony in China, Hong Kong sees a thriving practice in both Western and Traditional Chinese medicine (TCM). Chinese often adopt the jargons of TCM to describe the symptoms. It is the authors' observation that the Chinese term "Hot Qi" is often used by parents to describe symptoms in their children. The term "Hot" is used by TCM practitioners to describe a phenomenon but not a diagnosis per se. [1,2] A better understanding of the meaning of "Hot Qi" would help western medical practitioners working with Chinese patients. So far, there has been no published data on this phenomenon. Parental use of the term "Hot Qi" to describe symptoms is not limited to those residing in Asia, but also for Asian immigrants in around the world. Understanding patient's symptom by health professionals helps to avert problems and misunderstanding, improve satisfaction for all parties and lead to better outcomes. [3]
The current study was undertaken to find out the frequency of using the term "Hot Qi" in parents and the symptomatology of the term "Hot Qi". This included a questionnaire on the symptoms and treatments for "Hot Qi". We hypothesized that the term "Hot Qi" was used among the majority of Hong Kong Chinese parents to describe symptoms in their children and the usage was governed by the cultural background of parents and status of children, e.g. age and gender.
Subjects
All parents of patients who were in-patients or attending outpatient clinics of our department, a private paediatric clinic, as well as the nursing and secretarial staff of this hospital were recruited for the study. Parents were approached individually by one of the authors (FYK) and the purpose of the survey was explained. A semi-structured interview based on the questionnaire (see Additional file 1) was conducted in Cantonese. Exclusion criteria include non-Chinese speakers and absence of parents.
The current study did not involve any medical intervention nor invasive intervention to the subjects and no ethical approval was deemed necessary under Hong Kong ethical framework.
"Hot Qi" questionnaire
Parents were asked to express their view on the term "Hot Qi" as used on their children, one child per parent, based on a questionnaire (appendix 1). This questionnaire was developed by DKN and DC (a registered TCM practitioner). "Hot Qi" was investigated with the question: "Have you ever used the term "Hot Qi" to describe your child?" Parents who answered "yes" were asked to volunteer symptoms of "Hot Qi" that their children displayed and the remedies used.
Statistics
All analysis was done with statistical software (Statistical Package for the Social Science, release 11.0.4 for Macintosh; SPSS; Chicago, IL). All continuous data were presented as mean and standard deviation. Age of children was compared between those who used the term "Hot Qi" and those who did not by Mann-Whitney U test. The categorical variables, included age group of parents, gender of parents, education level of parents, place of birth of parents, household income, gender of children were compared by Chi-squared test. Variables with significant difference between the two groups of parents were entered into a forward logistic regression model to predict the use of "Hot Qi" in parents. The demographical predictors of "Hot Qi" with adjusted odds ratio significantly larger than one were reported. Top five symptoms of "Hot Qi" and Top five remedies of "Hot Qi" were reported.
In those who reported use of the term "Hot Qi", we compared the mean age of children between those used and those who did not use a specific remedy by unpaired t-test. "Consumption of herbal products" was defined as any positive answer for "Five-flower-tea" (a combination of several flowers such as Chrysanthemum morifolii, Lonicera japonica, Bombax malabaricum, Sophora japonica, and Plumeria rubra), "selfheal fruit spike" (Prunella vulgaris), appetite stimulant (A brew from malt, juncus, and bomboo leaves), Abrus herb (Abrus precatorius), Turtle Jelly, Mulberry leaf & Chrysanthemum flower tea, Bo Ying Compound (a generic TCM product with the ingredients: Moschus, Calculus Bovis, Borneolum syntheticum, Margarita, Lapis micae aureus, Alumen, Succinum, Herba ephedrae, Arisaema cum bile, Concretio silicea bambusae, Rhizoma paridis, Radix saposhnikoviae, Rhizoma pinelliae, Bulbus Fritillariae cirrhosae, Scorpion, Rhizoma coptidis, Bombyx batryticatus, Ramulus uncariae cum Uncis, Radix curcumae, Herba menthae, Rhizoma gastrodiae, Periostracum cicadae), 24 taste herb tea, instant chrysanthemum tea and "Yin Chiao Chieh Tu Pien" (a generic TCM product with the ingredients: honeysuckle flower, forsythia fruit, platycodon root, peppermint, bamboo leaf, licorice root, schizonepeta, burdock root and black soybean). All significance tests were two sided, and a p < 0.05 was considered statistically significant.
1106 pairs of children and parents were approached for the survey and 46 parents refused to be interviewed. (Total number of parent interviewed: 1060, response rate = 96.8%) Nine hundred and three parents (85.2%) claimed that they had employed the term "Hot Qi" to describe their children's symptoms. Characteristics of the two groups of parents that used or did not use the term "Hot Qi' by parents were listed in Table 1.
There was no significant difference in gender, education level, and monthly household income distribution between the group of parents who employed the term "Hot Qi" and those who did not. Among children whose parents employed the term "Hot Qi" to describe them, there were 469 girls (44.2%) and mean age were 8.5 years (SD = 6.6). The children whose parents have used the term "Hot Qi" were significantly older. The frequency of the use of the term "Hot Qi" increased with older children. (Figure 1)
In univariate analysis (Table 1), age of parents, place of birth of parents and age of children were significantly associated with the frequency of using the term "Hot Qi". They were further analyzed by logistic regression analysis (Table 2) and only place of birth and age of children were significantly associated with the frequency of using the term "Hot Qi". Parents who were born in Hong Kong were 1.53 times more likely to use the term 'Hot Qi' to describe their children than parents born in mainland China and older children were more likely to be labeled as having "Hot Qi". Children older than or equal to 2-year were 6.79 times (95% CI = 4.73 to 9.76) more likely to report "Hot Qi" than children younger than 2-year.
Symptoms of "Hot Qi" and remedies used
Symptoms of "Hot Qi" were summarized in Fig. 2. Among the symptoms of "Hot Qi" : eye discharge (37.2%), sore throat (33.9%), halitosis (32.8%), constipation (31.0%), and irritability (21.2%) were most frequently mentioned by parents. (Figure 2)
We studied the reasons for irritability in children (Table 3) because irritability is very likely to be secondary to other symptoms in children. Dry eye, nasal obstruction, poor appetite, dry mouth and dry throat were significantly associated with irritability in children reported to have Hot Qi.
Remedies used by parents for improving each of the aforementioned symptoms of "Hot Qi" were summarized in Table 4. The top five remedies were the increased consumption of water (86.8%), fruit (72.5%), soup (70.5%), the use of herbal beverages "five-flower-tea" (57.6%) and "selfheal fruit spike" (42.3%). Other commonly used remedies include the herbal beverage "Milk-Appetite Stimulant".
The types of remedies given by parents were affected by the ages of their children (Table 4). Children given herbal beverages such as "five-flower-tea" and "selfheal fruit spike", abrus herbs, turtle jelly, mulberry leaf / chrysanthemum tea, instant chrysanthemum tea, and "24-taste-herb-tea", consumption of fruit, and soup were significantly older than those not given. In the contrary, children given remedies such as "Milk-Appetite stimulant", mix milk with rice water, and "Bo yin compound" were significantly younger.
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