Clinical Efficacy And Safety Evaluation Of Massage Based On Evidence-based Medicine In The Treatment Of Infantile Diarrhea

Objective:Based on the method of evidence-based medicine,this study conducted a meta-analysis of the clinical study on massage alone or combined with other therapies in pediatric diarrhea,so as to provide evidence for treating pediatric diarrhea in Tuina.Method:Relevant literatures included in CNKI,VIP,WanFang Data,EMbase,CBM,PubMed and Chinese excellent master's and doctoral degree graduation theses were searched by computer since January 1,1997 solstice and May 31,2018.After the literatures were screened and extracted in strict accordance with inclusion and exclusion criteria,the included literatures were evaluated according to Cochrane evaluation manual.RevMan5.3.5 software was used for Meta analysis of clinical research literature.Result:1.Through literature review,it was found that the most common five syndromes were spleen deficiency type,damp-heat type,injury and food type,cold-dampness type,spleen and kidney Yang deficiency type.2.Totally 40 RCTS were included,including 4011 children.The experimental group was treated with pediatric Tuina alone or combined with other therapies,while the control group was treated with conventional western medicine1)In terms of clinical efficacy,Tuina therapy alone or combination with other therapies for pediatric diarrhea has more advantages than conventional western medicine [OR=3.42,95%ci(2.20,5.30),P<0.00001] [OR=3.16,95%ci(2.08,4.82),P<0.000 01],which can improve the effective rate and cure rate of diarrhea in children.2)Tuina therapy alone or combinnation with other therapies can improve TCM syndromes,and the effective rate of the experimental group was higher than that of conventional western medicine treatment [OR=4.35,95%ci(1.68,11.26),P=0.002].After treatment,some children's spleen and stomach syndromes completely disappeared [OR=2.63,95%ci(1.47,4.70),P=0.001].However,due to the small number of included studies,its effect may be exaggerated.3)Compared with the control group,Tuina therapy alone or combination with other therapies could significantly reduce the total clinical symptom integral of the children [MD=-2.32,95%ci(,2.42,-2.22),P<0.000 01],improve the stool characteristics [MD=-0.21,95%ci(-0.52,0.11),P=0.002],and reduce the number of defecation [MD=-0.86,95%ci(-1.37,-0.36),P <0.0001],indicating that Tuina could adjust the balance of Yin and Yang of the viscera and promote the recovery of spleen and stomach functions in the children.4)In terms of safety evaluation,13 of the studies included adverse reactions as an observation index.In one of the articles,2 patients were mildly allergic to the application materials due to acupoint application(warm umbilical patch).After the infusion patch was replaced,the allergic symptoms disappeared without other serious adverse reactions.One of the Paper reports that the Tuina process 1 cases in short skin flush after using talcum powder,after the switch to medium,the skin flush was relieved and the course of treatment was successfully completed.It can be seen that the selection of medium(lubricant)in the process of Tuina in addition to timely local materials due to the disease,but also to consider the physical factors of children,in order to ensure the efficacy and safety of pediatric tuina.Conclusion:1)Pediatric tuina therapy alone or with conventional western medicine therapy has good clinical efficacy in Pediatric diarrhea,compared with conventional western medicine treatment can quickly reduce clinical symptoms integral,reduce defecate frequency,improve the character of stool,and less adverse reactions,and easily accepted by children and their families,However,partial literatures included were biased,may exaggerate the effect,reliability and authenticity of the results still need further study.2)Pediatric tuina has been widely used as monotherapy,main therapy or adjuvant therapy in pediatric clinic due to its advantages of green safety,no side effects and good compliance,In recent years,both at the national level and at the community level,the development of pediatric tuina is booming,which is of great significance to reduce the abuse of antibiotics,protect the health of infants and children,and improve the quality of the population.But at the same time,due to regional differences and historical reasons,pediatric tuina schools with their own characteristics and styles have been formed in different regions.At present,the practitioners and institutions in the pediatric tuina industry are uneven,which makes the research on the mechanism of action of pediatric tuina and the benign development of the industry have some resistance.3)In recent years,with the continuous popularization of evidence-based medicine research and the real world research,using the method of evidence-based medicine to with multi-aspects understand the application status and the problems existing in the application of pediatric massage and other TCM external therapies in pediatric clinical research,and to a certain external treatment in effectiveness to make objective evaluation of a disease,can provide a reference for the choice of clinical treatment decisions in the future.However,due to the limitation of the quality and quantity of the included studies,the above conclusions still need to be verified by more high-quality clinical studies and practices.