【摘要】目的：讨论健脾捏脊推拿法对治疗小儿厌食症的临床观察。方法：40例厌食症患儿按随机数字表法分为推拿组和对照组，每组各20例。治疗组采用健脾捏脊推拿法，1天1次，每次治疗20分钟，一周5次，1周为一个疗程，共4个疗程。对照组采用口服枯草杆菌二联活菌颗粒,连续治疗4个疗程后，对比分析两组治疗效果。结果：与治疗前相比，治疗组食欲、食量、面色、腹胀、大便、烦急症状均得到改善，差异有统计学意义(P＜0.05)；与治疗前相比，对照组食欲、食量症状均的到改善，差异有统计学意义(P＜0.05)，其面色、腹胀、大便、烦急症状改善不明显，差异无统计学意义(P＞0.05)。治疗4疗程后，治疗组较对照组食欲、食量、面色、大便、腹胀症状改善明显，差异有统计学意义(P＜0.05)。治疗组总效率95.0%，对照组总有效率60.0%，两组总有效率差异有统计学意义(P＜0.05)。结论：健脾捏脊推拿法对治疗小儿厌食症的疗效优于口服枯草杆菌二联活菌颗粒。
【关键词】健脾；捏脊；小儿推拿；厌食症；枯草杆菌二联活菌颗粒
Clinical Observation of JianPi and NieJi Tuina Therapy for Children with Anorexia
【Abstract】Objective: To discuss the clinical efficacy of JianPi and NieJi tuina therapy in treating kids’ anorexia. Methods: Forty children with anorexia were divided randomly into experimental group(20tablets) and control group (20tablets) .The treatment group was intervened by JianPi and NieJi tuina therapy once a day, 20 minutes each time, 5 times a week, 1 week for a course of treatment, 4 courses. Children in control group have been taking Bacillus subtilis.The therapeutic efficacies were compared and analyzed after treatment for 4 successive courses. Results: Compared with no cure before, the treatment group′s symptoms such as appetite, Capacity for eating, complexion, ventosity, dejecta and sentiment were improved ,and the difference was of statistical significance (P<0.05); while the control group′s symptoms such as the appetite, Capacity for eating were improved , and the difference was of statistical significance (P<0.05),but symptoms like complexion, ventosity, dejecta and sentiment were of no significant improvement. and the difference was not of statistical significance(P>0.05).After 4 courses treatment, the massage group’s curative effect for diseases like the appetite, Capacity for eating, complexion,ventosity and dejecta is much better than that of the control group (P<0.05). The total effective rate of treatment group was 95.0% ,while the effective rate of control group was 60.0% .The difference between two groups was statistically significant (P＜0.05).Conclusion: JianPi and NieJituina therapy can have a better therapeutic efficacy in treating children with anorexia compared to oral administration of Bacillus subtilis.
【Keywords】:Tonifying Spleen;ChiropacticThreapy; Pediatric Tuina;anorexia; Bacillus subtilis.
Anorexia in children is characterized by long-term loss of appetite, reduced food intake, lack of greed for food, and even feel disgusting for it, but the spirit is still good. Anorexia is also accompanied by facelessness, thin and short body of children, and it is one of the most common diseases in childhood. Studies have shown that the morbidity of anorexia in children in China is about 12% to 34%[1] ,and the incidence rate is still rising in recent years. Long-term anorexia leads to growth retardation,short stature, low immunity, malnutrition, anemia and other diseases, and such symptoms also have been seen much frequently than that of normal children of the same age. Therefore, in order to find an effective way to treat the anorexia in children,we observed the clinical efficacy of JianPi and NieJituina therapy for children with anorexia, and compared it with oral Bacillus subtilis. Now, the report is shown as follows：
1.Clinical Material
1.1 General data
Forty Infantile Anorexia who were in line with the inclusion criteria were selected and divided into the treatment group and the control group by the random number table method, 20 cases in each group. There was no distinct difference between the two groups in the baseline of gender, age and disease duration , which was comparable.For much details please see Table1.
Table 1.Baseline comparison between the two groups
.png)
1.2 Diagnostic criteria
The diagnostic criteria were based on the Criteria of Thirteenth Five-Year Plan Pediatrics of Traditional Chinese Medicine edited by Ma Rong[2]:major symptoms include Long-term no appetite, less food intake, obvious weight loss, a lusterless complexion and a low body height, and may have belching, dysentery, convulsions; stool irregularities, but the spirit is acceptable. Age is limited to 1 to 6 years old, The anorexia lasted for at least 2 months. Simultaneously, Anorexia which caused by other diseases are excluded.
1.3 Exclusion criteria
Tuina contraindications,such as skin damage,infection, eczema;and complicated with severe primary diseases such as cardiovascular, liver,kidney and hematopoietic system dysfunction and mental illness;children who are unable to complete the entire treatment process,have poor compliance or are participating other clinical trials.
2 Treatment Methods
2.1 Treatment group
Adopting Jian Pi and NieJi tuina therapy and the specific operation steps are as follows:①The child takes the supine position or sit on parent’s lap, supplement Feijing 300times,
supplement pi jing300 times, tonify Shenjing 300 times, clear Ganjing 100 times, clear Xinjing 100 times,Rou- knead banmen100times, Rou-knead nei ba gua 100 times, Rou-knead zusanli(ST36),
Pinch sifeng；and zhongwan(RN12)100 times;②The child takes a prone position, the doctors rub Infantile back with palm 5 times. Rou-knead and Ca-rub Feishu (BL 13), Pishu (BL 20), and Shen
shu (BL 23)respectively for 30 seconds, Nie-pinch spine for 4 times and Na-grasp Jianjing (GB 21) for3-5times, Rou-knead guiwei 50 times, Tui-push shangqijiegu100 times, Rubbing lumbosacral section with heat.③The child takes the supine position, rubbing abdomen 3minutes, shocking abdomen 1minutes,Na-Rou abdomen 50 times, Hit back 10 times. Treatment duration: The massage medium uses talcum powder, once a day, 20 minutes each time, 5 times a week, 1 week for a course, totally4 courses.
2.2 Control group
Treated with Mommy Love (Bacillus subtilis granules) (Beijing Han mei Pharmaceutical Co., Ltd., Sinopharm S20020037), orally, 1 bag/time, 2 times/day. 5 days for a course and totally 4 courses.
3 Therapeutic Observation
3.1 Observation items
Pediatric anorexia symptom grading standard, Reference《Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine》［3］The symptoms and signs were scored by 4 levels, and the scoring criteria are shown in Table 2.
Table 2. Criteria for scoring symptoms and signs
.png)
3.2 Criteria of clinical efficacy
The clinical efficacy was evaluated based on the improvement rate of the total score of symptoms and signs. Improvement rate of total score ＝ (Pre- treatment total score － Post-treatment total score) ÷ Pre-treatment total score × 100%.
Clinical recovery: total score improvement rate ≥ 95%;
Markedly effective: total score improvement rate≥ 70%, < 95%
Effective: total score improvement rate≥ 30%, <70%
Invalid: total score improvement rate< 30%.
3.3 Statistical analysis
The SPSS 21.0 version software was applied to analyze data ,Chi-square test was adopted for counting data. Measurement data in normal distribution with homogeneity of variance were expressed as mean±standard deviation (), and analyzed by t-test.There is a statistically significant difference when P<0.05.
3.4 Results
3.4.1 Comparative analysis of symptoms
Compared with no any treatment before, the treatment group′symptoms such as the appetite, capacity for eating, complexion, ventosity, dejecta and sentiment were improved ,and the difference was of statistical significance (P<0.05). Compared with no medical treatment, the control group′symptoms such as the appetite, Capacity for eating were improved , and the difference was of statistical significance (P<0.05),complexion, ventosity, dejecta and sentiment were not improved obviously, and the difference was not statistically significant (P>0.05). After treatment for 4 courses, the symptoms such as the appetite, capacity for eating, complexion, ventosity and dejecta were significantly improved in the massage group compared with the control group (P<0.05).
.png)
Note: Intra-group comparison, 1) P＜0.05; Intra-group comparison, 2 )P＞0.05;compared with the control group after treatment,3) P＜0.05;compared with the control group after treatment,4) P＞0.05.
3.4.2 clinical efficacies
The total effective rate of treatment group was 95.0% ,while the effective percentage of control group was 60.0%,and the difference was of statistical significance (P＜0.05).
Table 4.The clinical efficacy between the two groups
.png)
4.Discussion
Children, for their special body structure, often have unsound function of spleen. The main reasons for anorexia are diet incontinence, always eating junk food and not eating on time, which develop partial eclipse or eating irregularities. In recent years, the incidence rate of anorexia in children has become higher and higher. Therefore, it is particularly important to seek safe and effective treatment.
The results of this study show that: JianPi and NieJi tuina therapy has a good effect on improving the appetite, capacity for eating, complexion, ventosity, dejecta of children with anorexia. The total effective rate of the treatment group was 95%, and the control group′s was 60%.. The effective percentage of the experimental group was superior to the control group, which indicate that JianPi and NieJi tuina therapy is superior to the oral taking Bacillus subtilis.
Infantile WuJing points, SiFeng points, BanMen points, NeiBaGua points have the effect of eliminating food accumulation and helping build the fuction of pi.《LiZheng massage》:Using the palm of your hand and rubbing abdomen cure over-sickness;zusanli(ST36) belongs to urinary bladder channel of foot tiayang(UB)which can help spleen and stomach be strong, improve the digestive function of children. NieJi is mainlyused to stimulate the Du Meridian and UB, and the Du Meridian is the yang of the Governor of the Sea of the Yangmai. UB is the place where the Wuzang LiuFu points are located, which is closely related to the viscera. NieJi tuina therapy regulates the body's qi and blood and the effects of organs. JianPi and NieJi tuina therapy can weaken the symptoms of anorexia in children and the possible reason for that may be related to the ability of massage which are good to promote the secretion of appetite factors such as Ghrelin, NPY and enhance gastrointestinal motility. The Research shows[4],The treatment of anorexia in children with abdomen chiropractic has significant clinical efficacy, which can effectively enhance the gastric motility of children, shorten the time required for gastric emptying, and improve the intestinal mucosal absorption function of children. The massage is a method of stimulating the acupoints of body surface by hand which can achieve the effect similar to the acupuncture and moxibustion treatment. Fu's [5] study showed that acupuncture at SiFeng can effectively promote the secretion of ghrelin and NPY, inhibit the production of Leptin, and improve the appetite of children. Studies have reported that the mechanism of chiropractic regulation of gastrointestinal function may change the concentration of neuropeptides such as Ghrelin and VIP[6].Therefore, we speculate that it is possible to promote the secretion of ghrelin and NPY by massage, so as to improve the anorexia symptoms of children, but how to promote the secretion of appetite factors, that is the mechanism which remains a further study.
Reference:
[1] Zhuang Haiyan.The etiology, pathogenesis and treatment of anorexia in children [J]. Clinical Research in Traditional Chinese Medicine, 2016, 8 ( 17): 14.
[2] Ma Rong.Traditional Chinese Medicine Pediatrics.10th Edition[M] Beijing: China Traditional Chinese Medicine Press, 2016.
[3] Zheng Yu. Guiding Principles for Clinical Research of New Drugs in China (Trial) [M]Beijing: China Medical Science Press, 2002: 269.
[4]SUN Bo.Curative Effect of Rubbing Abdomen and Spinal Pinching on Children with Spleen Qi Deficiency Type of Anorexia and The Influence on Intestinal Mucosa Absorption Function [J]Chinese Archives of tradmonal Chinese Medicine .2018:36（8）:1901-1903.
[5]Fu Mei Yuan.Impacts on the Appetite Regulating Factors of Infantile an Orexia Treated with Acupuncture at Si Feng.Chinese Acupuncture and Moxibustion 2013.33(2):117-120.
[6]LI Xue chao.Influence of Chiropractic Therapy on Contents of Ghrelin and Vasoactive Intestinal Peptide in Rabbit with Bradygastria. [J]Chinese Journal of Traditional Chinese Medicine and Pharmacy.2016.31(2):637-639.