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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4.	房敏, 宋柏林. 推拿学. 北京: 中国中医药出版社, 2018: 40.
5.	陈洁, 万朝敏, 孙梅, 等. 中国儿童急性感染性腹泻病临床实践指南. 中华儿科杂志, 2016, 54(7): 483-488.
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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.
8.	公共卫生科学数据中心. 其他感染性腹泻病. Available at: http://www.phsciencedata.cn/Share/index.html?766c8437-9d73-4360-aa40-47c420767105.
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12.	彭玉. 推拿手法治疗婴幼儿急性腹泻病技术. 中国乡村医药, 2020, 27(19): 77-78.
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19.	杨秋玉, 曹晓, 张迁, 等. 推拿治疗小儿急性腹泻的系统评价和Meta分析. 中国循证医学杂志, 2021, 21(7): 832-838.
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27.	梁锦俊. 虚实推拿治疗小儿急性非细菌感染性腹泻的临床研究. 广州: 广州中医药大学, 2010.
28.	周鸿雁, 徐秀敏. 中医推拿疗法对腹泻患儿免疫功能和炎性因子的影响. 实用中医内科杂志, 2020, 34(4): 69-72.
29.	郭安余. 推拿联合妈咪爱治疗小儿腹泻临床观察. 中华养生保健, 2020, 38(9): 175-176.
30.	李江全, 徐珊, 汪受传, 等. 推拿治疗小儿泄泻 271 例临床研究. 中华中医药学会儿科分会: 第三十次学术大会论文汇编, 2013: 4.
31.	杨元平, 张艳梅. 推拿治疗小儿非感染性腹泻临床研究. 中医学报, 2013, 28(11): 1763, 1765.
32.	汤伟, 符明进, 李洲进. 刘氏小儿推拿法治疗小儿伤食泻 45 例. 湖南中医杂志, 2011, 27(5): 73-74.
33.	王华强. 中医推拿按摩治疗小儿消化不良性腹泻的临床疗效观察. 智慧健康, 2020, 6(11): 195-196.
34.	高桂奇. 推拿治疗婴幼儿轮状病毒性肠炎临床观察. 中医药临床杂志, 2005, 17(3): 267-268.
35.	李明. 辨证分型推拿治疗对腹泻患儿的临床效果及胃肠激素产生的影响. 中国医学创新, 2020, 17(4): 93-96.
36.	唐英, 尚清, 严晓慧. 益气补脾手法治疗小儿脾虚腹泻临床研究. 中医学报, 2014, 29(3): 444-445.
37.	孙士丹. 三字经流派推拿治疗小儿泄泻(湿热型)的临床疗效观察. 福州: 福建中医药大学, 2012.
38.	尤晓燕. 推拿治疗婴幼儿腹泻 32 例疗效观察. 中国中西医结合儿科学, 2013, 5(5): 423-424, 425.
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40.	周可林, 国生, 董硕, 等. 基于数据挖掘技术探讨推拿手法在腹泻治疗中的选穴配伍规律. 北京中医药, 2020, 39(10): 1082-1086.
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42.	国家医疗保障局. 关于政协十三届全国委员会第三次会议第 4 267 号(社会管理类 368 号)提案答复的函医保函. Available at: http://www.nhsa.gov.cn/art/2020/10/27/art_26_3785.html.
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44.	国家中医药管理局. 关于政协十三届全国委员会第三次会议第 2 501 号(医疗体育类 366 号)提案答复的函. Available at: http://bgs.satcm.gov.cn/gongzuodongtai/2020-12-10/18939.html.
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1. 陈秀珍, 刘静, 张佳娟. 中医治未病实践指南·药膳干预小儿脾虚质(制订). 中医儿科杂志, 2017, 13(4): 6-9.
2. 韩新民, 汪受传, 虞舜, 等. 小儿泄泻中医诊疗指南. 中医儿科杂志, 2008, 4(4): 1-3.
3. 刘明军, 王金贵. 小儿推拿学. 北京: 中国中医药出版社, 2016: 82.
4. 房敏, 宋柏林. 推拿学. 北京: 中国中医药出版社, 2018: 40.
5. 陈洁, 万朝敏, 孙梅, 等. 中国儿童急性感染性腹泻病临床实践指南. 中华儿科杂志, 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. 公共卫生科学数据中心. 其他感染性腹泻病. Available at: http://www.phsciencedata.cn/Share/index.html?766c8437-9d73-4360-aa40-47c420767105.
9. 杨立华, 傅晓凤, 谭为, 等. 1 587 例小儿感染性腹泻流行病学特点与防控对策分析. 现代医学与健康研究(电子版), 2020, 4(7): 79-80.
10. 王青云. 《儿童急性感染性腹泻病诊疗规范(2020 年版)》印发. 中医药管理杂志, 2020, 28(18): 78.
11. 于洪君, 段晓征. 小儿推拿治疗儿童腹泻研究进展. 中国中医药现代远程教育, 2020, 18(22): 125-127.
12. 彭玉. 推拿手法治疗婴幼儿急性腹泻病技术. 中国乡村医药, 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, Brożek 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, Marušic 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. 来保勇. 推拿治疗小儿腹泻的循证证据分析与评价. 北京: 北京中医药大学, 2019.
19. 杨秋玉, 曹晓, 张迁, 等. 推拿治疗小儿急性腹泻的系统评价和Meta分析. 中国循证医学杂志, 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, 王宝西, 王荃, 等. 儿童急性感染性腹泻病诊疗规范(2020 年版). 中国医药科学, 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. 推拿治疗伤食型非感染性小儿腹泻的临床研究. 济南: 山东中医药大学, 2009.
27. 梁锦俊. 虚实推拿治疗小儿急性非细菌感染性腹泻的临床研究. 广州: 广州中医药大学, 2010.
28. 周鸿雁, 徐秀敏. 中医推拿疗法对腹泻患儿免疫功能和炎性因子的影响. 实用中医内科杂志, 2020, 34(4): 69-72.
29. 郭安余. 推拿联合妈咪爱治疗小儿腹泻临床观察. 中华养生保健, 2020, 38(9): 175-176.
30. 李江全, 徐珊, 汪受传, 等. 推拿治疗小儿泄泻 271 例临床研究. 中华中医药学会儿科分会: 第三十次学术大会论文汇编, 2013: 4.
31. 杨元平, 张艳梅. 推拿治疗小儿非感染性腹泻临床研究. 中医学报, 2013, 28(11): 1763, 1765.
32. 汤伟, 符明进, 李洲进. 刘氏小儿推拿法治疗小儿伤食泻 45 例. 湖南中医杂志, 2011, 27(5): 73-74.
33. 王华强. 中医推拿按摩治疗小儿消化不良性腹泻的临床疗效观察. 智慧健康, 2020, 6(11): 195-196.
34. 高桂奇. 推拿治疗婴幼儿轮状病毒性肠炎临床观察. 中医药临床杂志, 2005, 17(3): 267-268.
35. 李明. 辨证分型推拿治疗对腹泻患儿的临床效果及胃肠激素产生的影响. 中国医学创新, 2020, 17(4): 93-96.
36. 唐英, 尚清, 严晓慧. 益气补脾手法治疗小儿脾虚腹泻临床研究. 中医学报, 2014, 29(3): 444-445.
37. 孙士丹. 三字经流派推拿治疗小儿泄泻(湿热型)的临床疗效观察. 福州: 福建中医药大学, 2012.
38. 尤晓燕. 推拿治疗婴幼儿腹泻 32 例疗效观察. 中国中西医结合儿科学, 2013, 5(5): 423-424, 425.
39. 王军. 中医推拿按摩治疗小儿消化不良性腹泻的临床效果. 医学食疗与健康, 2020, 18(1): 41-42.
40. 周可林, 国生, 董硕, 等. 基于数据挖掘技术探讨推拿手法在腹泻治疗中的选穴配伍规律. 北京中医药, 2020, 39(10): 1082-1086.
41. 国务院办公厅. 关于印发中医药健康服务发展规划(2015-2020 年)的通知. Available at: http://www.gov.cn/zhengce/content/2015-05/07/content_9704.html.
42. 国家医疗保障局. 关于政协十三届全国委员会第三次会议第 4 267 号(社会管理类 368 号)提案答复的函医保函. Available at: http://www.nhsa.gov.cn/art/2020/10/27/art_26_3785.html.
43. 国家中医药管理局. 对十二届全国人大三次会议第 5 704 号建议的答复. Available at: http://bgs.satcm.gov.cn/gongzuodongtai/2018-03-24/1670.html.
44. 国家中医药管理局. 关于政协十三届全国委员会第三次会议第 2 501 号(医疗体育类 366 号)提案答复的函. Available at: http://bgs.satcm.gov.cn/gongzuodongtai/2020-12-10/18939.html.
45. 国家中医药管理局. 中医医疗技术手册 2013 普及版汇编. Available at: http://www.satcm.gov.cn/yizhengsi/gongzuodongtai/2018-03-24/2690.html.

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Chinese Journal of Evidence-Based Medicine

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