推拿干预小儿脾虚疾病临床疗效类相关文献研究

The Clinical Research into Literature on Clinical Efficiency of Massage on Pediatric Spleen Deficiency Diseases

目的:研究推拿干预小儿脾虚型疾病临床疗效类文献中诊断标准、疗效评定标准的来源及推拿治疗小儿脾虚型疾病的常用推拿穴位,评价推拿治疗小儿脾虚质临床疗效类文献的文献质量。方法:在《中国期刊全文数据库》《medline》《维普中文科技期刊数据库》,以"小儿推拿""脾虚""泄泻""厌食"等为关键词进行检索,收集近25年国内外期刊公开发表的推拿治疗小儿脾虚病的临床疗效观察类文献,并对其中的诊断标准、疗效评定标准及治疗常用的推拿穴位进行统计分析,并对符合纳入标准的文献采用中医文献依据分级标准进行文献质量评价。结果:小儿脾虚型疾病文献中诊断标准和疗效评定标准最多来源于《中医病证疗效诊断标准》,疗效评定标准分级多为3级;62篇文献中涉及治疗疗程的49篇,采用中医证候量化积分进行疗效评定的有4篇,对其中非流派的脾虚型疾病的20篇文献中小儿推拿穴位进行统计,排名前10的穴位依次是:补脾经、补大肠、捏脊、摩腹、推三关、推上七节骨、按揉足三里、推板门、揉脐、揉龟尾;62篇文献中文献依据分级一级文献7篇,二级文献26篇,三级和四级文献0篇,五级文献29篇,推荐强度依次是A级0篇,B级7篇,C级26篇,D级0篇,E级29篇。结论:临床上缺乏小儿脾虚质的明确诊断标准和疗效评定标准,大多数散在于各个疾病中并以临床表现为主要诊断标准;小儿推拿因地域和流派的不同,补泻手法及治疗疗程不统一;文献质量总体来说不高,有待规范化和提高。

Objective： To research on sources of diagnostic criteria,clinical efficacy,efficacy evaluation criteria,and the commonlyused massage points of literature on treating pediatric spleen deficiency diseases,evaluate the quality of the literature on the clinical efficiency of massage therapy for children with spleen deficiency diseases. Methods： Using ＂ pediatric massage＂, ＂ spleen deficiency＂ ＂ diarrhea＂ ＂ anorexia＂ as the keyword in the ＂ Chinese Journal Full-text Database＂ ＂ Medline＂ ＂ VIP Chinese Technology Periodical Database＂ for searching,collecting the literature on clinical efficacy of massage on children with spleen deficiency diseases published at home and abroad in the past 25 years,statistically analyzing their diagnostic criteria,efficacy evaluation criteria,and the commonly-used massage points,then literature quality evaluation was done for those which meet the inclusion criteria of the literature according to TCM literature classification criteria. Results： Most of the diagnostic criteria and efficacy evaluation criteria of the literature on children with spleen deficiency diseases derive from the Efficiency-Diagnosis Criteria of TCM Syndromes; The grading of curative effect evaluation standard has 3 grades; 49 among 62 articles are on designing treatment course,and 4 among them are on efficacy evaluation according to quantitative integration of TCM syndrome. Among them,pediatric massage points in 20 articles are analyzed,and it is found out that the top 10 points are as follows： the meridians for nourishing the spleen,the points for nourishing the large intestine,abdominal massage,pushing three reflections,pushing the upper seven joint bones,rubbing Zusanli（ ST 36）,pushing door of anterior portion of the sole adjacent to the big toe,kneading the navel,and rubbing Guiwei point. Among 62 articles,according to classification criteria,7 articles belong to the first level,26 the second level,0the third level,0 the fourth level,and 29 the fifth level; According to the recommendation intensity,0 belong to Grade A,7 Grade B,26 Grade C,0 Grade D,and 29 Grade E. Conclusion： There is lack of clear diagnostic criteria and the evaluation standard of clinical pediatric spleen deficiency disease,and most of them are scattered in various disease and the clinical manifestations as the main criteria for the diagnosis of infantile massage. Due to geographical and different schools,reinforcing and reducing method and treatment course of treatment are not unified. Generally speaking,the related literature quality is not high and needs to be standardized and improved.