Curative Effect Observation on Tuina Therapy for Spleen-deficiency Infantile Diarrhea

Shen Yi-jing, Chen Zhi-wei, Jin Yi-cheng

Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

Curative Effect Observation on Tuina Therapy for Spleen-deficiency Infantile Diarrhea

Shen Yi-jing, Chen Zhi-wei, Jin Yi-cheng

Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

Objective: To observe the clinical effect of tuina for spleen deficiency infantile diarrhea.

Methods: A total of 60 cases were randomized into a treatment group and a control group (30 in each group). Tuina manipulations were employed in the treatment group, whereas medication was administered in the control group. The between-group clinical effects were compared after one course of treatment.

Results:The recovery rate was 20.0% in the treatment group, versus 3.3% in the control group, showing a statistical significance (P＜0.05). After treatment, there were between-group statistical differences (P＜0.05) in infants’ main accompanying symptoms such as complexion, spirit, vomiting, and abdominal pain.

Conclusion: Tuina is effective for infantile diarrhea due to spleen deficiency.

Tuina; Massage; Spleen Deficiency; Diarrhea, Infantile

Infantile diarrhea is a common condition characterized by an increased frequency in bowel movements with loose/watery stools. Infantile diarrhea due to spleen deficiency is often persistent or recurrent, coupled with loose/watery stools containing milk or undigested food residues. We treated 30 cases with the “Four-step” tuina therapy and compared with the effect of medication. The report is now summarized as follows.

1 Clinical Data

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria in Western medicine

This is based on the stipulations in relevant literature[1]: loose, watery, mucous, or purulent/bloody stools, increased frequency of bowel movements and diarrhea lasting for more than 2 weeks.

1.1.2 Diagnostic criteria in Chinese medicine

This is based on the stipulations in theGuiding Principles for Clinical Study of New Chinese Medicines[2].

Major symptom: Persistent or recurrent loose/watery stools containing milk or undigested food residues.

Minor symptoms: Low spirit, a poor appetite, lusterless complexion, a pale tongue with thin greasy coating and a weak pulse.

1.2 Inclusion criteria

Those who met the diagnostic criteria in Chinese and Western medicine, aged ＜6 years old; the infants’ guardians willingly signed the informed consent.

1.3 Exclusion criteria

Those who failed to meet the above diagnostic criteria; having mental disorders or complications of primary cardiovascular, kidney and hematopoietic system; having an allergic constitution or being allergic to multiple drugs; suffering from food poisoning; suffering from severe dehydration and poisoning symptoms; and those who failed to meet the inclusion criteria or did not receive required treatments, making curative effects evaluation impossible.

1.4 Statistical method

The SPSS 13.0 version software was used for data processing,t-test for measurement data and () for expression. The Chi-square test was used for rate comparison.

1.5 General materials

A total of 63 outpatients cases who met the inclusion criteria were all treated at the Pediatric Tuina Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine between March 2007 and April 2008. By using the SPSS 13.0 version software, these cases were randomized into a treatment group of 32 cases and a control group of 31 cases. There were no betweengroup statistical differences in general materials (P＞0.05), and the two groups were therefore comparable (table 1).

During the treatment, 2 cases in the treatment group and 1 case in the control group dropped out. The clinical procedures in the two groups are illustrated in Fig.1.

Table 1. Between-group comparison of general materials ()

Table 1. Between-group comparison of general materials ()

GroupsnGender Male Female Age (month) Duration (day) Treatment 32 18 14 14.43±12.77 22.20±11.21 Control 31 18 13 15.33±13.06 20.40±6.21

2 Treatment Methods

2.1 Treatment group

The “Four-step” tuina manipulations were applied to infants in the treatment group.

The 1st step: Bu-Reinforcing Pijing and Dachang. Place the infant in a supine position and then circularly push the pad of the thumb and radial aspect of the index finger for 500 times respectively (Fig.2 and Fig.3).

The 2nd step: Mo-Rubbing the abdomen circularly. Place the infant in a supine position and then rub the abdomen circularly in an anticlockwise direction for 5 min (Fig.4).

Fig.1 Flow chart of clinical procedures in two groups

The 3rd step: Rou-Kneading Guiwei and Tui-Pushing up Qijiegu (the low seven segments of vertebra). Place the infants in a prone position. An-Press and Rou-Knead the coccyx for 100 times and Tui-Push up Qijiegu for 100 times (Fig.5 and Fig.6).

The 4th step: Nie-Pinching the spine. Place the infant in a prone position and lift-pinch the skin from the coccyx to Dazhui (GV 14) along the bilateral lines of the Bladder Meridian (Fig.7).

Fig.2 Bu-Reinforcing Pijing

2.2 Control group

Infants in the control group took Chinese patent medicine Ying’er Su, Cefaclor for Suspension and Montmorillonite Powder orally with warm water. Doses for Ying’er Su (0.5 g per sack): infants aged 1-6 years old took 0.5-1 g for each dose; infants within 1 year took 0.25 g for each dose. Doses for Cefaclor for Suspension: 20-40 mg/(kg·bw) in 3 divided times (once every 8 h). Doses for Montmorillonite Powder (3 g per sack): infants within 1 year took 3 g a day; infants aged 1-2 years old took 3-6 g a day; infants ＞ 2 years old took6-8 g a day. The daily dose was taken in 3 separate times.

The treatment was conducted once a day, 5 successive days made up one course of treatment. The curative effects were statistically analyzed after one course of treatment.

Fig.3 Bu-Reinforcing Dachang

Fig.4 Mo-Rubbing the abdomen circularly

Fig.5 Rou-Kneading Guiwei

Fig.6 Tui-Pushing up Qijiegu

Fig.7 Nie-Pinching the spine

3 Results

3.1 Curative effect criteria

This is based on the relevant curative effect criteria for infantile diarrhea stipulated in theGuiding Principles for Clinical Study of New Chinese Medicines[2].

Clinical recovery: The frequency, property and symptoms completely return to normal.

Marked effect: The frequencies are significantly reduced to approximately 2-3 times a day, coupled with substantial relief of signs and symptoms.

Improvement: Reduced frequencies, improved property of stools and relief of major symptoms.

Failure: Signs and symptoms remain unchanged.

3.2 Treatment outcome

3.2.1 Comparison of curative effect between the two groups

As for the treatment group, 6 cases obtained clinical recovery, 18 cases with marked effect, 6 cases with improvement and the recovery rate was 20.0%, versus 1case with clinical recovery, 14 cases with marked effect, 15 cases with improvement and 3.3% of recovery rate in the control group. There was statistical difference in recovery rate between the two groups (P＜0.05), indicating that the effect in the treatment group was better than that in the control group.

3.2.2 Comparison of main accompanying symptom scores between the two groups

After treatment, main accompanying symptoms in the two groups were scored according to the symptom grading and scoring[2](table 2). The results haven shown that the treatment group had a better effect in diet than the control group (P＜0.05), (table 3), indicating that tuina has advantages over medicine in improving the infants’ gastrointestinal functions.

Table 2. Symptom grading and scoring

Table 3. Comparison of main accompanying symptom scores after treatment between the two groups (, point)

Table 3. Comparison of main accompanying symptom scores after treatment between the two groups (, point)

Note: Compared with the control group, 1)P＜0.05

Symptoms Treatment group Control group Diet 0.17±0.371)0.47±0.51 Complexion 0.33±0.47 0.37±0.49 Spirit 0.10±0.30 0.17±0.38 Vomiting 0.13±0.35 0.10±0.31 Abdominal pain 0.13±0.35 0.07±0.25

4 Discussion

Diarrhea is the second commonest pediatric condition, only next to respiratory tract infection. It is particularly difficult to manage chronic intractable infantile diarrhea. Persistent infantile diarrhea may cause listlessness, weight loss and slow growth. Compromised immunity may further result in other secondary conditions. In severe cases, it may even affect the infants’ later growth and development. Considering the constitutional spleen deficiency in infants, chronic intractable diarrhea can damage their spleen and stomach. Incomplete treatment of acute diarrhea, abuse of antibiotics or inappropriate nursing may all contribute to chronic intractable diarrhea.

In modern medicine, chronic intractable pediatric diarrhea is a group of diseases with diverse etiologies. Its causative factors may include: imperfect development of the digestive system, low gastric acidity, poor anti-infection ability, poor food intolerance due to insufficient secretion and low activity of digestive enzyme, overload of the digestive system due to high demand for adequate nutrients for growth and development, poor regulation on the digestive tract due to incomplete development of the nervous system and susceptibility to gastrointestinal disorder or infection due to immature immune system.

In Chinese medicine, infantile diarrhea is mostly caused by contraction of external pathogenic factors coupled with improper diet and resultant weakness of the spleen and stomach. It often begins with an excess pattern and over time, transforms into a deficient pattern. According to Chinese medical theory, the stomach decomposes water and food, while the spleen transports and transforms nutrients. Undigested food plus poorly distributed nutrients result in dampness retention, which in turn obstruct ascending of clear yang and cause downward flow of dampness and subsequently, diarrhea. Despite the varying causes of diarrhea, these causes can be generalized into spleen deficiency with dampness. Since the spleen (earth) likes dryness but dislikes dampness, spleen deficiency can cause retention of water-dampness and thus result in diarrhea. Infants are susceptible to diarrhea because their spleen and stomach are easily damaged by external pathogens and improper diet.

Clinical studies have proven that Bu-Reinforcing Pijing and Tui-Pushing Dachang, which was conducted in the treatment group, are important manipulations for infantile diarrhea[3-4]. Modern medicine holds that incompletely digested food may produce toxic substances to accelerate the gastrointestinal motility. The abdomen houses the spleen, stomach, and large/small intestine, especially the colon. The ascending colon travels upward to the transverse colon along the right-side posterior wall of the abdomen and then shifts to the descending colon. This makes the contents in the colon moving in a clockwise direction. Circularly anticlockwise Mo-Rubbing the abdomen(against the motility of the large intestine) can directly slow down the gastrointestinal motility, lengthen the emptying of the contents, increase the water absorption and thus alter the property of stools. Since circularly Mo-Rubbing the abdomen can strengthen the spleen, harmonize the stomach, regulate qi and benefit digestion, it has been proved effective for infantile diarrhea, vomiting, nausea, constipation, abdominal distension and a poor appetite[5-7]. Rou-Kneading Guiwei point (located in the depression below the coccyx) can regulate the Governor Vessel, boost qi, harmonize the intestines, and work for diarrhea or constipation. Tui-Pushing up Qijiegu can warm yang and antidiarrhea. Anatomically, Guiwei is a local point to the anus, and Rou-Kneading Guiwei can adjust the contraction of anal sphincter and thus regulate the bowel movements. Since the coccygeal nerve lies within Qijiegu and its filum terminale are distributed over the two lower orifices (perineum), Tui-Pushing up Qijiegu can regulate the rectum and anal sphincter, thus controlling bowel movements and influencing the spinal cord regulating center. Chinese medicine holds that spine pinching can balance yin and yang, regulate the Zang-fu organs, promote circulation of qi and blood and dredge meridians. Modern clinical trials have proved that Nie-Pinching the spine can effectively increase gastric secretion, enhance gastric motility and strengthen gastrointestinal digestion on protein and starch. Nie-Pinching the spine alone can also obtain significant effect for infantile diarrhea[8-16].

Tuina manipulation has been extensively used for chronic intractable infantile diarrhea. It has distinctive advantages over point injection, acupuncture and oral Chinese and Western medicine. In summary, tuina is safe, low-cost, painless and effective for infantile diarrhea, and it is of great significance to conduct further investigation and study for its clinical application.

[1] Fang HY, Fang HS. Diagnosis and treatment advance in infantile diarrhea. Xiandai Shiyong Yixue, 2003, 15(10): 607-610.

[2] Ministry of Health of the People’s Republic of China. Guiding Principles for Clinical Study of New Chinese Medicines. Beijing: China Medico-Pharmaceutical Science & Technology Publishing House, 2002 273-275.

[3] Chen LX. Tuina therapy based on Bu-Reinforcing Pijing for infantile diarrhea: a report of 60 cases. Shiyong Yixue Zazhi, 2002, 19(2): 142.

[4] Wang JL. Tuina therapy for 50 cases of infantile diarrhea. Shaanxi Zhongyi, 2008, 29(2): 213-214.

[5] Wang CH. Clinical observation on circular Mo-Rubbing abdomen plus Nie-Pinching the spine and Tui-Pushing the back for 40 cases of infantile diarrhea. Anmo Yu Daoyin, 1996, (2): 30.

[6] Chen LC. Observation on the efficacy of rapid needling plus massage in treating infantile diarrhea. Shanghai Zhenjiu Zazhi, 2011, 30(7): 447-449.

[7] Xu J, Deng HY, Jing L, Zhou S. Therapeutic observation on treatment of infantile diarrhea with tuina on differentiation of acupoints. J Acupunct Tuina Sci, 2007, 5(3): 188-190.

[8] Chen HL. Clinical application of Nie-Pinching the spine in pediatrics. Xiandai Zhongxiyi Jiehe Zazhi, 2006, 15(11): 1497-1498.

[9] Ma XN. Nie-Pinching the spine for 116 cases of infantile diarrhea. Zhongyi Waizhi Zazhi, 2006, 15(6): 62.

[10] Wu QL. Nie-Pinching the spine for 38 cases of simple infantile diarrhea. Shanghai Zhenjiu Zazhi, 2008, 27(7): 47.

[11] Sun AZ, Zhang QY. Nie-pinching the spine for chronic infantile diarrhea. Zhongguo Minjian Liaofa, 2003, 11(12): 20-21.

[12] Wang JY, Liu WD, Liu CM. Clinical observation of infantile persisting diarrhea treated by spine-pinching manipulation plus moxibustion. J Acupunct Tuina Sci, 2003, 1(6): 17-19.

[13] Tian QL. Treatment 55 cases of infantile diarrhea with tuina plus auricular sticking therapy. Shanghai Zhenjiu Zazhi, 2008, 27(1): 33.

[14] Huang QF. Metrological analysis and evaluation of acupuncture-moxibustion treatment for diarrhea in modern literature. J Acupunct Tuina Sci, 2007, 5(5): 265-269.

[15] Song WJ, Huang L, Li ZP. Treatment of 128 cases of lientery with acupuncture-moxibustion and pinching the spine. Shanghai Zhenjiu Zazhi, 2007, 26(10): 18.

[16] Lǚ JZ, Cheng B. Treatment of 62 cases of infantile diarrhea by tuina. J Acupunct Tuina Sci, 2009, 7(3): 163-165.

Translator: Han Chou-ping

R244.1

A

Date: October 15, 2012

Author: Shen Yi-jing, M.M., resident. E-mail: dr_shen@139.com

Chen Zhi-wei, vice chief physician. E-mail: chenzw2005@163.com