Tuina for children with acute diarrhea: an evidence-based clinical guideline_Chinese Journal of Evidence-Based Medicine

Authors：

GE Long ^1,2,3,4,5 , CAO Xiao ⁶ , ZHANG Qian ⁶ , WANG Qi ¹ , YANG Qiuyu ⁶ , XIE Qianwen ⁷ , HOU Liangying ¹ , ZHOU Qi ^2,3,4,5 , GUO Xinfeng ⁷ , CAI Jianqiong ⁷ , LIU Shaonan ⁷ , YANG Lihong ⁷ , YANG Kehu ^2,3,4,5,8 , CHEN Yaolong ^2,3,4,5,8 , LI Huanan ⁹ , GEI Meifei ¹⁰ , XU Li ¹¹ , QIU Liyi ¹² , WAN Lisheng ¹³ , SUN Wuquan ¹⁴ , WANG Yufeng ¹⁵ , LIN Xiuhua ¹⁶ , WANG Lixin ¹⁵ ,  WU Darong ^7,17 , on behalf of Trustworthy Traditional Chinese Medicine Recommendations (TCM Recs) Working Group ?

1. Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou 730000, P.R.China;
2. WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, P.R.China;
3. Department of Guidelines and Standards, Lanzhou University Institute of Health Data Science, Lanzhou 73000, P.R.China;
4. Key Laboratory of Evidence-based Medicine and Clinical Transformation in Gansu Province, Lanzhou 730000, P.R.China;
5. GRADE Chinese Centre, Lanzhou University, Lanzhou 730000, P.R.China;
6. Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou 730000, P.R.China;
7. State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, P.R.China;
8. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P.R.China;
9. First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, P.R.China;
10. Haici Medical Group of Qingdao City, Qingdao 266033, P.R.China;
11. The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, P.R.China;
12. Beijing Massage Hospital, Beijing 100035, P.R.China;
13. Shenzhen Children’s Hospital, Shenzhen 518038, P.R.China;
14. Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, P.R.China;
15. The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130117, P.R.China;
16. Foshan City Nanhai District Maternity and Child Health Hospital, Foshan 528212, P.R.China;
17. Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou 510120, P.R.China;

Corresponding?author：

WU Darong, Email: darongwu@gzucm.edu.cn

Keywords：

Tuina; Children; Acute diarrhea; Guideline

DOI：

10.7507/1672-2531.202102098

Video：

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Abstract Full text Figures/Tables Video References Cited by

Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.

Citation： GE Long, CAO Xiao, ZHANG Qian, WANG Qi, YANG Qiuyu, XIE Qianwen, HOU Liangying, ZHOU Qi, GUO Xinfeng, CAI Jianqiong, LIU Shaonan, YANG Lihong, YANG Kehu, CHEN Yaolong, LI Huanan, GEI Meifei, XU Li, QIU Liyi, WAN Lisheng, SUN Wuquan, WANG Yufeng, LIN Xiuhua, WANG Lixin, WU Darong, on behalf of Trustworthy Traditional Chinese Medicine Recommendations (TCM Recs) Working Group ?. Tuina for children with acute diarrhea: an evidence-based clinical guideline. Chinese Journal of Evidence-Based Medicine, 2021, 21(7): 745-753. doi: 10.7507/1672-2531.202102098 Copy

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7.	Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the global burden of disease study 2017. Lancet, 2020, 395(10239): 1779-1801.
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12.	彭玉. 推拿手法治療嬰幼兒急性腹瀉病技術. 中國鄉村醫藥, 2020, 27(19): 77-78.
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28.	周鴻雁, 徐秀敏. 中醫推拿療法對腹瀉患兒免疫功能和炎性因子的影響. 實用中醫內科雜志, 2020, 34(4): 69-72.
29.	郭安余. 推拿聯合媽咪愛治療小兒腹瀉臨床觀察. 中華養生保健, 2020, 38(9): 175-176.
30.	李江全, 徐珊, 汪受傳, 等. 推拿治療小兒泄瀉 271 例臨床研究. 中華中醫藥學會兒科分會: 第三十次學術大會論文匯編, 2013: 4.
31.	楊元平, 張艷梅. 推拿治療小兒非感染性腹瀉臨床研究. 中醫學報, 2013, 28(11): 1763, 1765.
32.	湯偉, 符明進, 李洲進. 劉氏小兒推拿法治療小兒傷食瀉 45 例. 湖南中醫雜志, 2011, 27(5): 73-74.
33.	王華強. 中醫推拿按摩治療小兒消化不良性腹瀉的臨床療效觀察. 智慧健康, 2020, 6(11): 195-196.
34.	高桂奇. 推拿治療嬰幼兒輪狀病毒性腸炎臨床觀察. 中醫藥臨床雜志, 2005, 17(3): 267-268.
35.	李明. 辨證分型推拿治療對腹瀉患兒的臨床效果及胃腸激素產生的影響. 中國醫學創新, 2020, 17(4): 93-96.
36.	唐英, 尚清, 嚴曉慧. 益氣補脾手法治療小兒脾虛腹瀉臨床研究. 中醫學報, 2014, 29(3): 444-445.
37.	孫士丹. 三字經流派推拿治療小兒泄瀉(濕熱型)的臨床療效觀察. 福州: 福建中醫藥大學, 2012.
38.	尤曉燕. 推拿治療嬰幼兒腹瀉 32 例療效觀察. 中國中西醫結合兒科學, 2013, 5(5): 423-424, 425.
39.	王軍. 中醫推拿按摩治療小兒消化不良性腹瀉的臨床效果. 醫學食療與健康, 2020, 18(1): 41-42.
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1. 陳秀珍, 劉靜, 張佳娟. 中醫治未病實踐指南·藥膳干預小兒脾虛質(制訂). 中醫兒科雜志, 2017, 13(4): 6-9.
2. 韓新民, 汪受傳, 虞舜, 等. 小兒泄瀉中醫診療指南. 中醫兒科雜志, 2008, 4(4): 1-3.
3. 劉明軍, 王金貴. 小兒推拿學. 北京: 中國中醫藥出版社, 2016: 82.
4. 房敏, 宋柏林. 推拿學. 北京: 中國中醫藥出版社, 2018: 40.
5. 陳潔, 萬朝敏, 孫梅, 等. 中國兒童急性感染性腹瀉病臨床實踐指南. 中華兒科雜志, 2016, 54(7): 483-488.
6. WHO. Diarrhea disease. Available at: http://www.who.int/mediacentre/factsheets/fs330/en/.
7. Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the global burden of disease study 2017. Lancet, 2020, 395(10239): 1779-1801.
8. 公共衛生科學數據中心. 其他感染性腹瀉病. Available at: http://www.phsciencedata.cn/Share/index.html?766c8437-9d73-4360-aa40-47c420767105.
9. 楊立華, 傅曉鳳, 譚為, 等. 1 587 例小兒感染性腹瀉流行病學特點與防控對策分析. 現代醫學與健康研究(電子版), 2020, 4(7): 79-80.
10. 王青云. 《兒童急性感染性腹瀉病診療規范(2020 年版)》印發. 中醫藥管理雜志, 2020, 28(18): 78.
11. 于洪君, 段曉征. 小兒推拿治療兒童腹瀉研究進展. 中國中醫藥現代遠程教育, 2020, 18(22): 125-127.
12. 彭玉. 推拿手法治療嬰幼兒急性腹瀉病技術. 中國鄉村醫藥, 2020, 27(19): 77-78.
13. WHO. WHO handbook for guideline development (second edition). Available at: https://apps.who.int/medicinedocs/en/m/abstract/Js22083en/.
14. Schünemann H, Bro?ek J, Guyatt GH, et al. GRADE handbook for grading quality of evidence and strength of recommendations. Available at: www.guidelinedevelopment.org/handbook.
15. AGREE. AGREEⅡ user’s manual and 23 item instrument. Available at: https://www.agreetrust.org/resource-centre/agree-ii/.
16. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
17. Institute of Medicine. Practice guidelines we can trust. Washington, DC: National Academies Press, 2011.
18. 來保勇. 推拿治療小兒腹瀉的循證證據分析與評價. 北京: 北京中醫藥大學, 2019.
19. 楊秋玉, 曹曉, 張遷, 等. 推拿治療小兒急性腹瀉的系統評價和Meta分析. 中國循證醫學雜志, 2021, 21(7): 832-838.
20. Cochrane Training. Cochrane handbook for systematic reviews of interventions. Available at: https://training.cochrane.org/cochrane-handbook-systematic-reviews-interventions.
21. Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 21 part 2. Test accuracy: inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables. J Clin Epidemiol, 2020, 122: 142-152.
22. Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty across a body of evidence for test accuracy. J Clin Epidemiol, 2020, 122: 129-141.
23. Vernooij RW, Alonso-Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines (CheckUp). PLoS Med, 2017, 14(1): e1002207.
24. 倪鑫, 王寶西, 王荃, 等. 兒童急性感染性腹瀉病診療規范(2020 年版). 中國醫藥科學, 2020, 10(21): 249-256.
25. Lu T, Yin L, Chen R, et al. Chinese pediatric Tuina on children with acute diarrhea: a randomized sham-controlled trial. Health Qual Life Outcomes, 2021, 19(1): 4.
26. 李正. 推拿治療傷食型非感染性小兒腹瀉的臨床研究. 濟南: 山東中醫藥大學, 2009.
27. 梁錦俊. 虛實推拿治療小兒急性非細菌感染性腹瀉的臨床研究. 廣州: 廣州中醫藥大學, 2010.
28. 周鴻雁, 徐秀敏. 中醫推拿療法對腹瀉患兒免疫功能和炎性因子的影響. 實用中醫內科雜志, 2020, 34(4): 69-72.
29. 郭安余. 推拿聯合媽咪愛治療小兒腹瀉臨床觀察. 中華養生保健, 2020, 38(9): 175-176.
30. 李江全, 徐珊, 汪受傳, 等. 推拿治療小兒泄瀉 271 例臨床研究. 中華中醫藥學會兒科分會: 第三十次學術大會論文匯編, 2013: 4.
31. 楊元平, 張艷梅. 推拿治療小兒非感染性腹瀉臨床研究. 中醫學報, 2013, 28(11): 1763, 1765.
32. 湯偉, 符明進, 李洲進. 劉氏小兒推拿法治療小兒傷食瀉 45 例. 湖南中醫雜志, 2011, 27(5): 73-74.
33. 王華強. 中醫推拿按摩治療小兒消化不良性腹瀉的臨床療效觀察. 智慧健康, 2020, 6(11): 195-196.
34. 高桂奇. 推拿治療嬰幼兒輪狀病毒性腸炎臨床觀察. 中醫藥臨床雜志, 2005, 17(3): 267-268.
35. 李明. 辨證分型推拿治療對腹瀉患兒的臨床效果及胃腸激素產生的影響. 中國醫學創新, 2020, 17(4): 93-96.
36. 唐英, 尚清, 嚴曉慧. 益氣補脾手法治療小兒脾虛腹瀉臨床研究. 中醫學報, 2014, 29(3): 444-445.
37. 孫士丹. 三字經流派推拿治療小兒泄瀉(濕熱型)的臨床療效觀察. 福州: 福建中醫藥大學, 2012.
38. 尤曉燕. 推拿治療嬰幼兒腹瀉 32 例療效觀察. 中國中西醫結合兒科學, 2013, 5(5): 423-424, 425.
39. 王軍. 中醫推拿按摩治療小兒消化不良性腹瀉的臨床效果. 醫學食療與健康, 2020, 18(1): 41-42.
40. 周可林, 國生, 董碩, 等. 基于數據挖掘技術探討推拿手法在腹瀉治療中的選穴配伍規律. 北京中醫藥, 2020, 39(10): 1082-1086.
41. 國務院辦公廳. 關于印發中醫藥健康服務發展規劃(2015-2020 年)的通知. Available at: http://www.gov.cn/zhengce/content/2015-05/07/content_9704.html.
42. 國家醫療保障局. 關于政協十三屆全國委員會第三次會議第 4 267 號(社會管理類 368 號)提案答復的函醫保函. Available at: http://www.nhsa.gov.cn/art/2020/10/27/art_26_3785.html.
43. 國家中醫藥管理局. 對十二屆全國人大三次會議第 5 704 號建議的答復. Available at: http://bgs.satcm.gov.cn/gongzuodongtai/2018-03-24/1670.html.
44. 國家中醫藥管理局. 關于政協十三屆全國委員會第三次會議第 2 501 號(醫療體育類 366 號)提案答復的函. Available at: http://bgs.satcm.gov.cn/gongzuodongtai/2020-12-10/18939.html.
45. 國家中醫藥管理局. 中醫醫療技術手冊 2013 普及版匯編. Available at: http://www.satcm.gov.cn/yizhengsi/gongzuodongtai/2018-03-24/2690.html.

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Tuina for children with acute diarrhea: an evidence-based clinical guideline

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