Acupuncture Combined with Tuina Treatment for Infantile Diarrhea

Chen Li-Chang

Acupuncture Department, Weifang City Hospital of Traditional Chinese Medicine, Shandong 261041, China

Acupuncture Combined with Tuina Treatment for Infantile Diarrhea

Chen Li-Chang

Acupuncture Department, Weifang City Hospital of Traditional Chinese Medicine, Shandong 261041, China

Objective: To observe the effect of acupuncture combined with Tuina for infantile diarrhea.

Methods: One hundred and twenty patients met the inclusion criteria were randomly divided into two groups at the ratio of 2:1, and there were 80 cases in the treatment group while 40 cases in the control group. The patients in the treatment group were treated with acupuncture combined with tuina, while those in the control group were treated with medication. The effects of two groups were compared after a 3-day treatment.

Results: The total effective rate was 97.5% in the treatment group, versus 87.5% in the control group, and the difference was statistically significant (P＜0.05). After 48-hour treatments, the antidiarrheal effect of the treatment group was better than that of the control group (P＜0.05).

Conclusion: Acupuncture combined tuina treatment is effective for infantile diarrhea and works fast.

Acupuncture Therapy; Tuina; Massage; Diarrhea, Infantile; Pricking Needling

Infantile diarrhea is a common pediatric gastrointestinal disease caused by various factors, and it is seriously harmful to the physical and mental health of infants and young children. There are a lot of clinical treatment methods for this disease, but if the treatment is not timely, the children easily suffer from dehydration, electrolyte imbalance and acid-base imbalance, or even hypovolemic shock, and circulatory failure, which can lead to death. Because of the young ages of the patients, how to use medication is a problem for a clinical doctor, for the medication’s side effects often more or less affect the normal development in children, thus the use of medication needs to be cautious. According to the traditional Chinese medicine theories of holism concept and syndrome differentiation and treatment, we treated 80 infantile cases with diarrhea with acupuncture combined with tuina therapy, comparing with the effect of 40 cases treated with medication. The report is as follows.

1 Clinical Material

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria of Western medicine

They are referred to the diagnostic criteria in thePediatrics[1].

1.1.2 Diagnostic criteria of traditional Chinese medicine

Diagnostic criteria of traditional Chinese medicine are referred to theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes inTraditional Chinese Medicine[2]andPediatrics of Traditional Chinese Medicine[3]. Generally, the patients have a history of improper and unclean diet, contracting wind and cold, or seasonal pathogens; the patients’stool frequency increased significantly, even up to 10 times a day or more, and the stools are usually pale yellow or like clear water, mixing with or without milk block, or food which has not been digested, like egg drop soup, or the stools’ color is brown and smelly, mixed with a small amount of mucus. And the patients may also have complicated symptoms of nausea, vomiting, abdominal pain, fever, thirst and so on; and the severe patients present with cherry lips, long deep breath, abdominal detention, as well as dehydration symptoms including scant urine, hyperthermia, vexation and thirst, fatigue and lack of strength, sunken fontanelle, orbit subsidence, and crying without tears.

According to traditional Chinese medicine syndrome differentiation, it was divided into four types w including damp-heat syndrome, wind-cold syndrome, improper diet syndrome, as well as spleen deficiency syndrome[2,4].

Damp-heat syndrome: The patients’ stools were watery, brown-colored and smelly with or without mucus, complicated with anal burning, scanty dark urine, fever, thirst, red tongue, yellow greasy moss, and a fast pulse.

Wind-cold syndrome: The patients had pale stools with foam, but there was no significant odor, as well as abdominal pain and bowel sounds, which may be associated with nasal congestion, snivel, and fever. And the patients got greasy tongue coating and slippery strong pulse.

Improper diet syndrome: The patients’ stools were sour and smelly, or smelt like decayed eggs. They also had abdominal fullness, smelly breath and poor appetite. Most of them had complications of nausea and vomiting. Their tongues had thick and greasy coating, and the pulses were slippery and strong.

Spleen deficiency syndrome: The patients suffered from chronic or repeated diarrhea with thin or watery stools, mixing with milk curd and undigested food residue. And they also presented with metal fatigue, poor appetite and pale face. Their tongues were pale with thin and greasy coating, and the pulses were weak.

1.2 Inclusion criteria

The inclusion criteria complied with the above Western and traditional Chinese medicine diagnostic criteria; the patients needed be younger than 3 years; and their parents joined the study voluntarily and promised to obey the requirements of this study.

1.3 Exclusion criteria

The patients who did not meet the Western and traditional Chinese medicine diagnostic criteria; or those were older than 3 years; or those quit the treatment during the study.

1.4 Statistical methods

The SPSS 13.0 version statistical package was used for all the statistical analyses. All measurement data were expressed in terms of (), the efficacies before and after treatments were compared by a pairedt-test, so as the comparison of different groups. Multiple groups’ paired comparisons were analyzed by One-way ANOVA. The numeration data were analyzed by the Chi-square test.

1.5 General materials

One hundred and twenty cases who met the inclusion criteria mentioned above were all from the Department of Acupuncture and Pediatrics, Weifang City Hospital of Traditional Chinese Medicine, and they were randomly divided into a treatment group of 80 patients and a control group of 40 patients at a 2:1 ratio. The clinical flow is showed in Fig.1.

Before treatment, the differences of general material between the two groups including gender, age, duration of disease, illness state and traditional Chinese medicine syndrome differentiation were not statistically significant (P＞0.05), indicating that the two groups were comparable (table 1).

2 Methods

On the base of the dehydration condition of the two groups, they were given rehydration therapy. According to the results of serum electrolytes and blood gas examinations, they were supplied reasonably with deficient ingredients to correct their acid-base imbalance and electrolyte imbalance. During the study, all cases avoided using antibiotics and astringent and antidiarrheal medication. The children needed to be offered with light or easily digestible food, while thebabies were fed with lactose-free dairy products instead of milk food. If the children vomited frequently, they were fasted but given waster.

Table 1. Comparisons of the general materials between the two groups (case)

2.1 Treatment group

2.1.1 Acupuncture therapy

Acupoints: Bilateral Shaoshang (LU 11) and Taibai (SP 3).

Operation: After routine disinfection on skin of the acupoint, the sterile filiform needles of 0.25 mm in diameter and 25 mm in length were used to prick the acupoints to bleed, until the blood turn into bright red from dark red. And the treatment needed to be operated once a day.

2.1.2 Tuina manipulations[5-6]

Tuina manipulations were done according with the traditional Chinese medicine syndrome differentiation (Fig.2).

Damp-heat syndrome: The operation included Fen-Parting Yinyang, Qing-Clearing Dachang, Qing-Clearing Xiaochang, Yun-Moving earth to water, Bu-Tonifying Pijing, Qia-Pinching Shizhijie, Tui-Pushing up Sanguan, Qing-Clearing down Liufu, Mo-Rubbing abdomen and Nie-Pinching the spine.

Wind-cold syndrome: The operation included Fen-Parting Yinyang, Qing-Clearing Dachang, Qing-Clearing Xiaochang, Yun-Moving earth to water, Bu-Tonifying Pijing, Qia-Pinching Shizhijie, Tui-Pushing up Sanguan, Qing-Clearing down Liufu, Mo-Rubbing abdomen, Rou-Kneading navel and Guiwei, Tui-Pushing up along Qijiegu and Nie-Pinching the spine.

Improper diet syndrome: The operation included Rou-Kneading Zusanli (ST 36), Fen-Parting Yinyang, Qing-Clearing Dachang, Qing-Clearing Xiaochang, Yun-Moving earth to water, Bu-Tonifying Pijing, Mo-Rubbing abdomen, Rou-Kneading navel and Guiwei, Tui-Pushing up along Qijiegu and Nie-Pinching the spine.

Spleen deficiency syndrome: The operation included Rou-Kneading Guiwei, Tui-Pushing up along Qijiegu, Fen-Parting Yinyang, Nie-Pinching the spine, Bu-Tonifying Dachang and Qing-Clearing Xiaochang, Yun-Moving earth to water, Bu-Tonifying Pijing, Rou-Kneading Banmen. Qia-Pinching Shizhijie, and Mo-Rubbing abdomen.

Each of these acupoints was massaged 100 times, and the treatment was once a day.

Fig.2 Points on the upper limbs

2.2 Control group

The cases in the control group orally took Montmorillonite powder (produced by Boffo-Ipsen Tianjin Pharmaceutical Co., Ltd., 3 g per pack). The patients who were less than 1 year old took 1/3 package each time, those who were1 to 2 years old, took 1/3 to 1/2 of a package each time, and those who were 2 to 3 years old, took 1/2 to 1 package each time. They needed to take 3 times a day mixing with heated water between meals, and a package was flushed by 50 mL water, and the initial dose was doubled.

The treatment efficacies of both groups were evaluated after 3-day treatments.

3 Therapeutic Efficacy Observation

3.1 Therapeutic efficacy criteria

They are referred to theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[2].

Recovery: Diarrhea stops within 3-day treatments, stool frequency turns normal, appetite and mental condition as well as urine are normal.

Marked effect: Stool frequency decreases within 3-day treatments (2/3 off), and there is forming stool, whose texture turns viscous, and increased urination.

Effective: Stool frequency decreases 1/2 within 3-day treatments, and the stool consistency improved.

Invalid: There was no stool frequency decrease and no improved stool consistency within 3-day treatments.

3.2 Results

3.2.1 Comparison of the clinical efficacy between the two groups

The total effective rate of the treatment group was 97.5%, versus 87.5% in control group, and there was statistical difference between the two groups (P＜0.05), indicating that the total effective rate of the treatment group is higher than that of the control group (table 2).

Table 2. Comparison of the clinical efficacy between the two groups (case)

3.2.2 Comparison of anti-diarrhea effect between the two groups

In the treatment group, after 48-hour treatments, 25 cases stopped diarrhea; in the control group, four cases stopped diarrhea after 48-hour treatments, and the difference was statistically significant (P＜0.05), suggesting that the anti-diarrhea effect of the treatment should be better than the control group (table 3).

Table 3. Anti-diarrhea effects comparison of the two groups (case)

4 Discussion

The incidence of diarrhea in children is associated with children’s physiological characteristics, infection, diet, and immune factors. According to traditional Chinese medicine theory, it is believed that pediatric diarrhea occurred mostly because of invasion of exogenous pathogen, improper diet and weakness of the stomach and spleen[7-9]. Its primary lesions lie in the stomach and spleen. The fundamental pathogenesis is retention of Dampness in the Spleen and damp abundance due to deficiency of spleen. For the etiology and pathogenesis of the children diarrhea mentioned above, our treatment principles were to tonify spleen to eliminating dampness[10-11]. The tuina manipulations composed with tonifying plus clearing damp-heat to achieve mild reinforcing-reducing. And Bu-Tonifying Dachang and Pijing, Yun-Moving earth to water, Mo-Rubbing abdomen and Nie-Pinching the spine can strengthen the spleen and stomach, which focus on regulating qi movement, avoiding qi retention due to tonifying, and achieving spleen-ascending and stomachdescending, and this is mild reinforcing. And the clearing damp-heat and expelling dampness with mild manipulation such as Qing-Clearing Dachang and Xiaochang can reduce without hurting vital qi, which means that it is mild reducing; and Nie-Pinching the spine, Mo-Rubbing abdomen, An-Pressing and Rou-Kneading Sanyinjiao (SP 6) and Zusanli (ST 36) can activating spleen and regulating stomach. Taibai (SP 3) is the Yuan-Primary point of the Spleen Meridian, which can activate spleen for eliminating dampness, for that the clear qi can spontaneously ascend caused by spleen activation, this is the saying of treating disease aiming at its pathogenesis. Shaoshang (LU 11) is the Jing-Well point of the Lung Meridian, which is interior-exteriorly related with the large intestine, stabbing into it till bleeding can reduce the damp-heat qi in the intestine, and this is a symptomatic treatment. Combination of acupuncture and tuina can treat both the manifestation and the root causes of disease, combine reinforcing and reducing, and aim at the pathogenesis. Besides, it is a simple technology can work fast. It is easy to be mastered without adverse reactions and easily be accepted by children. So, it is the ideal method for treating infantile diarrhea because it gives full play to the traditional characteristics of traditional Chinese medicine[12-13].

[1] Yang XQ, Yi ZW. Pediatrics. Beijing: People's Medical Publishing House, 2006: 461.

[2] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 108-109.

[3] Wang SC. Pediatrics of Traditional Chinese Medicine. Beijing: China Press of Traditional Chinese Medicine, 2002: 102-104.

[4] Shanghai Municipal Health Bureau. Shanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine. 2nd Edition. Shanghai: Publishing House of Shanghai University of Traditional Chinese Medicine, 2003: 245.

[5] 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.

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

[7] Ruan W, Chen ZW, Yan JT. “Four-step Massage” in treating childhood spleen-deficiency diarrhea. J Acupunct Tuina Sci, 2006, 4(5): 271-273.

[8] Wu QL. Thirty-eight cases with infantile simple diarrhea treated by Nie-Pinching the spine. Shanghai Zhenjiu Zazhi, 2008, 27(7): 47.

[9] Yang ZW. One hundred cases with infantile diarrhea treated by acupuncture. Shanghai Zhenjiu Zazhi, 1998, 17 (6): 11.

[10] Hao MZ. Eighty-two cases with infantile diarrhea treated by half needling method. Shanghai Zhenjiu Zazhi, 2009, 28 (9): 539.

[11] Zhou ZT, Lin XS. Effect observation of point injection and moxibustion combination treating infantile diarrhea. Shanghai Zhenjiu Zazhi, 2003, 22(10): 17-18.

[12] Wang QY, Yuan Q, Feng JQ, Luo GF, Jin R. Observation on a comparison of quick needling and retained needle for treating 60 cerebral palsy cases. Shanghai Zhenjiu Zazhi, 2004, 23(12): 15-17.

[13] Tian QL. Acupuncture therapy for infantile diarrhea. Shanghai Zhenjiu Zazhi, 2006, 25(5): 39-40.

Translator: Deng Ying

R246.2

A

Date: November 8, 2012

Author: Chen Li-chang，associate chief physician. E-mail: wfszyyrlzyb@163.com