Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China.

OBJECTIVE: To determine the effectiveness of pediatric Tuina (PT) in preventing recurrent acute respiratory tract infections (ARTIs) in children. METHODS: This is a retrospective cohort study based on the electronic medical records of children with recurrent ARTIs in 2016. Children were divided into a PT group or a non-PT group, according to whether they had received PT or not in 2016. The primary outcome was the number of ARTI episodes in 2017 and 2018. The secondary outcomes were the number of ARTIs leading to outpatient department visits and outpatient antibiotic prescriptions due to ARTIs in the same time period. Negative binomial regressions were used to detect the association between PT and the outcomes. RESULTS: A total of 2303 children were included in the analysis, including 94 in the PT group and 2209 in the non-PT group. Children who received PT six or more times in 2016 had fewer episodes of ARTIs in 2017 [incidence rate ratio (IRR): 0.59, 95% confidence interval (CI) (0.42-0.84)] and 2018 [IRR: 0.58, 95% CI (0.36-0.94)] and fewer outpatient department visits due to ARTIs in 2017 [IRR: 0.56, 95% CI (0.38-0.83)] than children who had not received PT in 2016. There was no significant difference in the number of outpatient antibiotic prescriptions between the two groups. CONCLUSIONS: Receiving PT six or more times within one year is associated with a decrease in recurrent ARTIs in children in the following two years. Randomized controlled trials are needed for effect evaluation prior to establishing PT as a method for preventing recurrent ARTIs among children.

Chinese pediatric Tuina can prevent premature infant feeding intolerance and is conducive to weight gain: a prospective randomized controlled study.

Objective: Preterm birth is one of the most important health problems in the world. Feeding intolerance is one of the most common and serious complications of premature infant. The purpose of this study was to explore the effect of Chinese pediatric Tuina on the prevention of feeding intolerance in favour of weight gain in premature infants. Methods: A prospective randomized controlled study was conducted in the Department of Neonatology in our hospital. Premature infants were recruited and randomly assigned to an intervention group or a control group. Premature infants in the intervention group received a Chinese pediatric Tuina intervention by professional chiropractors, while premature infants in the control group received standard care. The incidence of feeding intolerance and weight gain situation were compared between the two groups. Result: After 1 week of intervention, the body weight (2.5±0.5 vs 2.0±0.4, p=0.038), head circumference (32.8±1.7 vs 29.9±1.4, p=0.041), albumin (34.6±5.8 vs 28.4±6.1, p-0.026) and prealbumin (155.8±35.2 vs 113.6±36.8, p=0.021) of preterm infants in the intervention group were significantly better than those in the control group. The incidence of feeding intolerance (7 vs 15, p=0.032) in the intervention group was significantly lower than that in the control group. Although there were no statistically significant differences (P>0.05), the incidences of gastrointestinal bleeding, necrotizing enterocolitis, and liver insufficiency were lower in the intervention group than in the control group. Conclusion: Chinese pediatric Tuina can effectively prevent the occurrence of feeding intolerance in premature infants and be conducive to the weight gain and improving nutritional status of premature infants.

Pediatric tuina for allergic rhinitis in children: A systematic review and meta-analysis of randomized controlled trials.

Aim: To evaluate the clinical efficacy of pediatric tuina for allergic rhinitis treatment in children. Methods: Three English, four Chinese, one Japanese, and two Korean databases were searched for relevant literature published till February 2021, and eligible randomized controlled trials (RCTs) were included for analysis. Data were screened and extracted independently using predesigned forms. The methodological quality evaluation was performed using the tool of Cochrane bias risk assessment, and meta-analysis was performed through Review Manager 5.3. Results: A total of 12 RCTs, which included 716 children, were selected for meta-analysis. Compared with Chinese herbal medicine, acupuncture, Western medicine, and other therapies, pediatric tuina alone or in combination with other treatments had a higher clinical effectiveness (relative risk = 1.16, 95% confidence interval [CI] = 1.08-1.25) in treating children with allergic rhinitis. Pediatric tuina also effectively improved the following signs and symptoms of allergic rhinitis in children: nasal congestion (mean difference [MD] = -0.44, 95% CI = -0.70 to -0.19), runny nose (MD = -0.39, 95% CI = -0.55 to -0.23), sneezing (MD = -0.23, 95% CI = -0.38 to -0.08), and turbinate swelling (MD = -0.26, 95% CI = -0.48 to -0.04); all differences were statistically significant. Conclusions: The present study provided favorable evidence for the treatment of allergic rhinitis in children with pediatric tuina. However, owing to the impact of research quality, this evidence needs to be validated via strictly designed clinical trials.

Pediatric Tuina for functional constipation in children: study protocol for a randomized controlled trail.

BACKGROUND: Functional constipation (FC) is a common functional gastrointestinal disorder, which brings many negative impacts to the children's daily life. Pediatric Tuina has been proved to be a potential therapy for FC. However, the evidence for its effectiveness and safety is insufficient due to the lack of high-quality study. This study aims to evaluate the efficacy and safety of pediatric Tuina for children with FC. METHODS/DESIGN: This study is a randomized, controlled, multicentre, clinical trial. We will include 176 children with FC from five hospitals. The participants will be randomly allocated into two groups: the pediatric Tuina group and the Medilac-Vita group. This study will include a 1-week actual treatment period and a 2-week follow-up period. Primary outcomes are weekly spontaneous bowel movements and weekly complete spontaneous bowel movements. The secondary outcomes are effective rate, stool form, distress sensation, and glycerine enema rate. The assessment will be performed each week. Adverse event will be monitored in the treatment period and follow-up period. DISCUSSION: This study is designed to evaluate the efficacy and safety of pediatric Tuina for children with FC, and we hypothesize that pediatric Tuina is more effective than probiotics. It will provide reliable evidence and support for the treatment of FC by pediatric Tuina. TRIAL REGISTRATION: This protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2100046485). .

Pediatric Tuina in children with autism spectrum disorder: a study protocol for a randomized controlled trial.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by repetitive stereotypical behavior and communication deficits. Currently, it lacks a specific clinical treatment method. Pediatric Tuina is a recent therapy in traditional Chinese medicine (TCM) and has been used to treat children with ASD. Nonetheless, it remains uncommon given the lack of large-scale evidence-based medical studies. This study aims to compare the efficacy of Tuina and conventional treatment in children with ASD. METHODS: Eligible children will be randomly assigned to either the pediatric Tuina plus conventional treatment group or to the conventional treatment alone group based on a random table at a ratio of 1:1. The effectiveness of the Tuina intervention for ASD will be evaluated by a third-party organization. The pre- and post-intervention scores on the Childhood Autism Rating Scale comprised the primary outcome, whereas pre- and post-intervention scores on the Autism Treatment Evaluation Checklist were the secondary outcomes to assess improvement in symptoms. Baseline values of the participants will be determined at the time of registration. Outcomes will be evaluated after the 30th treatment session. The follow-up period will last for 6 months after treatment. DISCUSSION: This study will evaluate the effectiveness and safety of Tuina in the treatment of ASD. The results of this study could provide reliable evidence to improve the management of patients with ASD. TRIAL REGISTRATION: Chinese Clinical Trial Registry (CHICTR), ChiCTR2000040452 . Registered on 28 November 2020.

Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma / 针灸推拿医学（英文版）

Objective: To observe and evaluate the clinical efficacy and safety of using pediatric Tuina (Chinese therapeutic massage), Tui-Pushing chest-back manipulation, in treating children with cough variant asthma (CVA).Methods: Seventy-two kids with CVA were divided into two groups using the random number table method, with 36 cases in each group. The control group received the conventional Tuina treatment, and the observation group received additional Tui-Pushing chest-back manipulation. The clinical efficacy and adverse reactions were observed and recorded for the two groups. Results: After three treatment courses, compared with the control group, the observation group showed advantages in the total effective rate, reducing the number and intensity of cough and improving the nature of cough (P<0.05). However, at the one-month follow-up, there were no significant differences between the two groups in these parameters (P>0.05). Regarding the adverse reaction rate, there was no significant between-group difference (P>0.05). Conclusion: It is effective and safe to use pediatric Tuina, Tui-Pushing chest-back manipulation, plus the conventional treatment protocol to treat CVA in children.

Clinical observation of pediatric Tuina plus oral Chinese medication for pediatric anorexia due to spleen failing in transportation / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of pediatric Tuina (Chinese therapeutic massage) plus oral administration of Chinese medication for pediatric anorexia due to spleen failing in transportation. Methods: A total of 94 children with anorexia due to spleen failing in transportation were randomized into an observation group and a control group by the random number table method at a ratio of 1:1, with 47 cases in each group. The control group was treated with modified Bu Huan Jin Zheng Qi San, and the observation group was treated with additional Tuina manipulation of Yun Shui Ru Tu based on the treatment in the control group. After 4 weeks of treatment, the clinical efficacy of the two groups was observed, and the traditional Chinese medicine (TCM) symptom score, serum leptin, neuropeptide Y, and serum zinc and calcium levels were compared. Results: After 4 weeks of treatment, the total effective rate of the observation group was 87.2％, and that of the control group was 74.5％. The difference between the two groups was statistically significant (P<0.05). After treatment, the TCM symptom scores in both groups decreased significantly (P<0.05), and the scores in the observation group were lower than those in the control group (P<0.05). After treatment, the serum leptin level in both groups decreased, and the level in the observation group was lower than that in the control group (P<0.05). The serum neuropeptide Y, zinc, and calcium levels in both groups increased after treatment, and the levels in the observation group were higher than those in the control group (P<0.05). Conclusion: Tuina manipulation of Yun Shui Ru Tu plus oral administration of Chinese medication is significantly effective in treating pediatric anorexia due to spleen failing in transportation, which can improve the appetite of children and improve the symptoms of anorexia, and the curative effect is better than that of oral administration of Chinese medication alone.

Huguosi Hospital of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100036, China / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus Shen Ling Bai Zhu San for pediatric diarrhea due to spleen deficiency.Methods: A total of 105 children with diarrhea due to spleen deficiency were selected and randomized into two groups by the random number table method. Fifty-two cases in the control group were treated with oral Shen Ling Bai Zhu San, and 53 cases in the observation group were treated with additional Tuina treatment. The clinical efficacy was evaluated after treatment, and the changes of traditional Chinese medicine (TCM) symptom scores were observed. Results: During the trial, there were three dropouts in the observation group, and two in the control group. After the treatment, the total effective rate was 100.0％ in the observation group, and 90.0％ in the control group. The difference between the two groups was statistically significant (P<0.05). The scores of primary and secondary symptoms, and the total scores of TCM symptoms in both groups were significantly lower than those before treatment (P<0.05). And the scores of primary and secondary symptoms, and the total score of TCM symptoms in the observation group after treatment were lower than those in the control group (P<0.05). There were no obvious adverse reactions in either group during the treatment. Conclusion: Tuina plus Shen Ling Bai Zhu San has a better therapeutic effect in treating pediatric diarrhea due to spleen deficiency than Shen Ling Bai Zhu San alone.

Chinese pediatric Tuina on children with acute diarrhea: a randomized sham-controlled trial.

BACKGROUND: Pediatric Tuina has been widely used in children with acute diarrhea in China. However, due to the lack of high-quality clinical evidence, the benefit of Tuina as a therapy is not clear. We aimed to assess the effect of pediatric Tuina compared with sham Tuina as an add-on therapy in addition to usual care for 0-6-year-old children with acute diarrhea. METHODS: Eighty-six participants aged 0-6 years with acute diarrhea were randomized to receive pediatric Tuina plus usual care (n = 43) or sham Tuina plus usual care (n = 43). The primary outcomes were days of diarrhea from baseline and times of diarrhea on day 3. Secondary outcomes included a global change rating (GCR) and the number of days when the stool characteristics returned to normal. Adverse events were assessed. RESULTS: Pediatric Tuina was associated with a reduction in times of diarrhea on day 3 compared with sham Tuina in both ITT (crude RR, 0.73 [95% CI, 0.59-0.91]) and PP analyses (crude RR, 0.66 [95% CI, 0.53-0.83]). However, the results were not significant when we adjusted for social demographic and clinical characteristics. No significant difference was found between groups in days of diarrhea, global change rating, or number of days when the stool characteristics returned to normal. CONCLUSIONS: In children aged 0-6 years with acute diarrhea, pediatric Tuina showed significant effects in terms of reducing times of diarrhea compared with sham Tuina. Studies with larger sample sizes and adjusted trial designs are warranted to further evaluate the effect of pediatric Tuina therapy. TRIAL REGISTRATION: Clinicaltrials.gov, Identifier: NCT03005821 , Data of registration: 2016-12-29.

Therapeutic efficacy observation of Tuina manipulation for pediatric adenoid hypertrophy / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) manipulation for pediatric adenoid hypertrophy (AH). Methods: A total of 60 children with AH were randomized into an observation group and a medication group, with 30 cases in each group. The observation group was treated with pediatric Tuina treatment, and the medication group was treated with 0.05％ mometasone furoate nasal spray. The changes of main clinical symptom score, quality of life (QOL) score and X-ray nasopharynx lateral film were observed, and the clinical efficacy was evaluated. Results: The total effective rate of the observation group was 90.0％, and that of the medication group was 66.7％. The difference between the two groups was statistically significant (P<0.05). After treatment, the A/N value [ratio of adenoid thickness (A) and nasopharyngeal cavity width (N)] of posterior nasopharyngeal lateral film did not show significant change in either group (P>0.05). After treatment, the clinical symptom scores in both groups decreased, and the intra-group differences were statistically significant (P<0.001), but there was no statistical difference between the two groups (P>0.05). After treatment, the QOL scores of children in both groups decreased, and the intra-group differences were statistically significant (P<0.001), and the difference between the two groups was statistically significant (P<0.001). Conclusion: Tuina manipulation is effective in treating pediatric AH, and produces a better effect in improving traditional Chinese medicine symptoms and QOL than 0.05％ mometasone furoate nasal spray.

Clinical efficacy observation on pediatric massage for chronic cough in children / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of pediatric massage (tuina) for chronic cough in children. Methods: A total of 96 cases were randomized into a control group and an observation group, with 48 cases in each group. Cases in the control group received routine pediatric massage manipulations. Cases in the observation group received additional Mo-rubbing abdomen manipulation. The treatment was done 3 times a week and 12 times made up a treatment session. The cough symptom scores were evaluated before treatment and after 3, 6, 9 and 12 treatments respectively. Results: There were 8 dropouts in the observation group and 5 dropouts in the control group. Before treatment, there was no statistical difference in coughing score between the two groups (P>0.05). After 9 times of treatment, the total coughing scores were significantly reduced in both groups (both P<0.05); however, there were no statistical differences between the two groups in the score differences between before treatment and after 3, 6 and 9 times of treatment (all P>0.05). After 12 times of treatment, the total coughing scores were significantly reduced in both groups (both P<0.05), along with a statistical difference between the two groups in the score difference between before treatment and after 12 times of treatment (P<0.05). There was a statistical difference between the two groups in overall response (P<0.05). The total effective rate in the observation group was 92.5％, versus 86.0％ in the control group, showing a statistical difference (P<0.05). Conclusion: The routine pediatric massage manipulations alone or in combination with Mo-rubbing abdomen manipulation both can significantly improve chronic cough in children; however, the combination obtains a better effect.

Pediatric tuina for the treatment of attention deficit hyperactivity disorder (ADHD) symptoms in preschool children: study protocol for a pilot randomized controlled trial.

BACKGROUND: Medication and behavior therapy are the conventional treatments for attention deficit hyperactivity disorder (ADHD), but they have limitations for preschool children. Evidence suggests that pediatric tuina, which is a modality of traditional Chinese medicine, might have beneficial effects on this condition. OBJECTIVE: To assess the feasibility of conducting an RCT in terms of recruitment, use, and acceptability of the parent-administered pediatric tuina for ADHD symptoms in preschoolers. METHODS: It is a single-center, two-arm, parallel, open-label, pilot randomized controlled trial (RCT). Sixty children with pre-specified ADHD symptoms (hyperactivity, anxiety, and sleep disturbance) together with one of their parents will be recruited and randomized into two groups at a 1:1 ratio. Parents in the parent-administered tuina group (intervention group, n = 30) will attend an online training program to learn pediatric tuina skills for ADHD symptoms and conduct this treatment on their children at home. Parents in the parent-child interaction group (comparison group, n = 30) will attend an online training about progressive muscle relaxation exercise and do this exercise with their children at home. Additional teaching materials will be provided to the participants in both groups. Both interventions should be carried out every other day during a 2-month treatment period, with each time around 20 min. Assessment will be performed at baseline, week 4, and week 8. The primary outcome measure is the Swanson, Nolan, and Pelham parent scale; the secondary outcomes include preschool anxiety scale, children's sleep habits questionnaire, and parental stress scale. A process evaluation embedded within the outcome evaluation will be performed. Differences in the scale scores and test parameters between groups will be examined using a linear mixed-effects model. Qualitative data will be analyzed using thematic content analysis, facilitated by QSR NVivo. DISCUSSION: This study will provide evidence on the acceptability and feasibility of pediatric tuina for ADHD in preschool children. The process evaluation will help to better understand the facilitators and barriers of the intervention functioning. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (Identifier: NCT04237259 ) on 14 February 2020. Protocol version: 2; date, 23 June 2020.

Pediatric tuina for the treatment of anorexia in children under 14 years: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Pediatric tuina is used to prevent and treat disease by employing various manipulative techniques on specific parts of the body, appropriate to the child's specific physiological and pathological characteristics. OBJECTIVE: To evaluate the effects and safety of pediatric tuina as a non-pharmaceutical therapy for anorexia in children under 14 years. METHODS: Randomized controlled trials (RCTs) comparing pediatric tuina with medicine for anorexia were included in this review. Six electronic databases were searched from inception to June 2019. Two authors independently extracted data and assessed the risk of bias. Significant effective rate (defined as appetite improved and food intake returning to 3/4 or more of normal intake) was used as primary outcome. Secondary outcomes included food intake, compliance and adverse events. Trial sequential analysis (TSA) was used to calculate the required information size in a meta-analysis and to detect the robustness of the results. Certainty of the evidence was assessed using the online GRADEpro tool. RESULTS: Of the included 28 RCTs involving 2650 children, the majority had a high or unclear risk of bias in terms of allocation concealment, blinding, and selective reporting. All trials compared tuina with western medicine or Chinese herbs. For significant effective rate, meta-analysis showed that tuina was superior to western medicine (risk ratio (RR) 1.68, 95 % confidence interval (CI) [1.35, 2.08]) and Chinese herbs (RR 1.36, 95 % CI [1.19, 1.55]). For food intake, 9 trials evaluated it in the form of score (1 points, 2 points, 4 points and 6 points) calculated according to the reduction degree of food intake. Six points represented the most serious. Meta-analysis showed tuina was superior to western medicine (mean difference (MD) -0.88, 95 % CI [-1.27, -0.50]) and Chinese herbs (MD -0.69, 95 % CI [-1.00, -0.38]) on lightening the reduction degree of food intake. Two trials reported compliance and six trials reported no adverse events occurred in pediatric tuina group. TSA for significant effective rate demonstrated that the pooled data had insufficient power regarding both numbers of trials and participants. CONCLUSIONS: Low certainty of evidence suggested pediatric tuina was beneficial and safe for the treatment of anorexia in children under 14 years. Furthermore well-designed RCTs with adequate sample sizes are needed.

Therapeutic observation on lung-clearing and spleen-strengthening tuina in children with exogenous cough / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of lung-clearing and spleen-strengthening tuina on exogenous cough in children. Methods: A total of 77 children with exogenous cough that met the inclusion criteria were randomly divided into a treatment group and a control group according to the random number table, with 39 cases in the treatment group and 38 cases in the control group. The routine lung-clearing manipulation was used in the two groups, while the spleen- strengthening manipulation was added in the treatment group. Both groups were treated once a day, 5 times as a course of treatment. After one course of treatment, the symptom score and clinical efficacy were observed. Results: There were one dropout in the treatment group and 2 dropouts in the control group. Therefore, a total of 74 cases were finally included in the analysis, with 38 cases in the treatment group and 36 cases in the control group. After treatment, there was a statistically significant difference in cough score between the two groups (P<0.05). There was a statistically significant difference in the score of poor appetite between the two groups (P<0.05). After treatment, the total effective rate was 89.5％ in the treatment group versus 75.0％ in the control group, showing a statistically significant difference (P<0.05). Conclusion: The therapeutic efficacy of lung-clearing spleen-strengthening manipulation is better than that of lung-clearing tuina manipulation alone for children with exogenous cough; regulating spleen and stomach can improve the curative efficacy of exogenous cough in children.

Manipulation parameter optimization in Liu's back tuina therapy for kids' cough variant asthma in remission stage / 针灸推拿医学（英文版）

Objective: To determine the optimal manipulation parameters in Liu's back tuina therapy for remission-stage cough variant asthma (CVA) in kids. Methods: A 5-factor 3-level L18(37) orthogonal design was adopted. The experimental factors and levels were selected: A, the number of times of Rou-kneading Feishu (BL 13); B, the frequency of Rou-kneading Feishu (BL 13); C, the number of times of Tui-pushing in a '介'-like pattern; D, the frequency of Tui-pushing in a '介'-like pattern; E, the intensity of red color after Ca-scrubbing Feishu (BL 13) with salt. A1, A2 and A3 stood for 10 times, 20 times and 30 times, respectively; B1, B2 and B3 stood for 200 times/min, 240 times/min and 280 times/min, respectively; C1, C2 and C3 stood for 50 times, 75 times and 100 times, respectively; D1, D2 and D3 stood for 150 times/min, 175 times/min and 200 times/min, respectively; E1, E2 and E3 stood for pinkish, bright red and dark red, respectively. A total of 108 kids with CVA in remission stage were divided into 18 groups using the random number table method, with 6 cases in each group. Changes in the cough score and fractional exhaled nitric oxide (FENO) level were observed after 15-day treatment. Results: The cough score and FENO level changed significantly in every group after treatment (all P<0.01). By the effect in improving cough score, the factors were listed as D, B, A, C and E in descending order; the most optimal manipulation parameter combination was group 17 (A3B2C1D3E1); the second optimal parameter combinations were group 7 (A3B1C2D1E3), group 13 (A2B1C2D3E1) and group 14 (A2B2C3D1E2). Regarding the effect in down-regulating the level of FENO, the factors were listed as C, A, E, B and D in descending order; the most optimal manipulation parameter combination was group 13 (A2B1C2D3E1); the second optimal parameter combinations were group 18 (A3B3C2D1E2), group 16 (A3B1C3D2E3) and group 14 (A2B2C3D1E2).Conclusion: Two most effective manipulation parameter combinations were selected out of 18 different parameter combinations in Liu's back tuina therapy for remission-stage CVA in kids. Doctors can choose an appropriate manipulation based on the symptom features of the disease.

Chinese pediatric Tuina on children with acute diarrhea: study protocol for a randomized sham-controlled trial.

BACKGROUND: Acute pediatric diarrhea is one of the most common causes of morbidity and mortality worldwide and seriously affects the health of children. Previous studies have shown that pediatric Tuina, a traditional Chinese medicine therapy, has potential therapeutic benefits for acute pediatric diarrhea. However, the evidence for its effectiveness is insufficient due to the lack of high-quality clinical studies. Our aim is to evaluate the efficacy of Chinese pediatric Tuina for children aged 0-6 years with acute diarrhea. METHODS/DESIGN: This study is a randomized, double-blind, sham-controlled trial. We will include 122 children with acute diarrhea from Dongguan Kanghua Hospital in Guangdong province, China. The patients will be allocated into either the pediatric Tuina group or the sham Tuina group in a 1:1 ratio. The treatment will last for 3 days followed by an 11-day follow-up period. Both groups will receive usual care. In addition, the experimental group will receive 15-25 min of Chinese pediatric Tuina, while the control group will receive 15-25 min of sham pediatric Tuina. Both groups will receive treatments once per day, for 3 consecutive days. Primary outcome measures are diarrhea days from baseline and diarrhea times on the third day. Secondary outcome measures are the global change rating and period of days when the stool character changes to normal. Safety assessments will be monitored during each visit. DISCUSSION: This clinical trial is designed to evaluate the efficacy of pediatric Tuina for children with acute diarrhea. We expect results to provide solid evidence and support for pediatric Tuina as an appropriate treatment for children with acute diarrhea. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03005821. Registered on 29 December 2016.

Efficacy observation on pediatric tuina plus Chinese medicine for exogenous fever in children / 针灸推拿医学（英文版）

Objective: To observe the clinical effects of pediatric tuina plus Chinese medicine for exogenous fever in children. Methods: A total of 150 children withexogenous fever were randomly divided based on the random digital table into a control group (75 cases) and a treatment group (75 cases). The control group was treated with oral Xiao'er Chaigui Tuire Keli (<1 year old, 0.5 bag/time; 1-3 years old, 1 bag/time; 4-6 years old, 1.5 bags/time), 4 times/day. The treatment group was treated with pediatric tuina plus the intervention of the control group. The amount and usage of Chinese medicine were the same as those of the control group; tuina was conducted 1 time/day. The clinical effects and adverse reactions were observed after 3 d of treatment in both groups. The recurrence was observed within 7 d after the end of treatment. Results: The total effective rate was 92.0％ in the treatment group and 81.3％ in the control group. The difference between the two groups was statistically significant (P<0.05). There were no obvious adverse reactions in the two groups after treatment. The recurrence rate was 1.5％ in the treatment group and 13.1％ in the control group. The difference in the recurrence rate between the two groups was statistically significant (P<0.05). Conclusion: Pediatric tuina plus Chinese medicine is effective in treating children with exogenous fever.

Therapeutic observation of Tui-pushing Wujing plus Chinese patent medicine for infantile diarrhea due to spleen deficiency / 针灸推拿医学（英文版）

Objective: To observe the therapeutic efficacy of pediatric tuina plus Chinese patent medicine for preschool kids with diarrhea due to spleen deficiency. Methods:Ninety-two eligible kids were divided into a tuina plus Chinese patent medicine and a Chinese patent medicine group by the random number table, with 46 cases in each group. The Chinese patent medicine group was intervened by oral administration of Qi Wei Bai Zhu San (Seven-ingredientAtractylodes MacrocephalaPowder); the tuina plus Chinese patent medicine group was additionally given pediatric tuina therapy once a day, 20 min each time. Efficacy and safety were evaluated after 7-day treatment in both groups, and a 14-day follow-up was conducted. Results:After treatment, the symptom scores all changed significantly in the two groups (allP<0.05). After intervention, the symptom scores in the tuina plus Chinese patent medicine group were significantly different from those in the Chinese patent medicine group (allP<0.05). The total effective rate was 78.3％ in the Chinese patent medicine group, versus 89.1％ in the tuina plus Chinese patent medicine group, and the between-group difference was statistically significant (P<0.05). Three cases got a relapse in the Chinese patent medicine group, versus one case in the tuina plus Chinese patent medicine group, and the between-group difference was statistically insignificant (P>0.05). The two groups each had one case of vomiting, which were treated properly and turned better. No other adverse reactions occurred. Conclusion: Tuina plus Chinese patent medicine and Chinese patent medicine alone both are effective for diarrhea due to spleen deficiencyin kids, but the combined therapy can produce more significant efficacy.

Clinical observation of treatment of infantile diarrhea due to spleen deficiency using five-step pediatric tuina of Huxiang school / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of treating infantile diarrhea due to spleen deficiency with five-step pediatric tuina of Huxiang school. Methods:Using a randomized controlled trial design, sixty eligible kids with diarrhea due to spleen deficiency were randomized into an observation group and a control group, with 30 cases in each group. The observation group was intervened by the five-step pediatric tuina method of Huxiang school, and the control group received conventional tuina treatment. The intervention was conducted once a day, consecutive 5-day treatment as 1 course, at a 2-day interval between courses, successively for a total of 4 courses. Changes in the primary and secondary symptoms of diarrhea due to spleen deficiency were observed, and the clinical efficacy was evaluated. Results: After treatment, the scores of primary and secondary symptoms and the general score of diarrhea due to spleen deficiency were improved; the improvements in fecal form and frequency, decreased appetite, bloating after meals and fatigue and sluggishness were more significant in the observation group than in the control group. Conclusion: The five-step pediatric tuina method of Huxiang school and conventional tuina both can improve the primary and secondary symptoms in infantile diarrhea due to spleen deficiency, while the former one can produce more significant efficacy.

Clinical experience of Xiangxi Liu's infantile tuina for exogenous fever in children / 针灸推拿医学（英文版）

Xiangxi (the western part of Hunan province) Liu's infantile tuina,as one main school of current infantile tuina in China,highlights the compatibility of the specific points of Wujing in children,the idea of treatment by syndrome differentiation,and produces unique efficacy in the treatment of common diseases in children.Exogenous fever in children can be treated with this method with excellent efficacy.Based on the clinical experience and effective cases treated by this tuina school,the authors elaborated the clinical thought and experience from the perspective view of tuina,for the promotion of Xiangxi Liu's infantile tuina in clinic.