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Review of Latest Traditional Chinese Medicine Clinical Studies on Pediatric Tic Disorder with Tuina Treatment

Article information

J Korean Med. 2021;42(3):139-152
Publication date (electronic) : 2021 September 01
doi : https://doi.org/10.13048/jkm.21030
Jem Ma Parkorcid_icon
Jem Ma Korean Medicine Clinic
Correspondence to: Park Jem Ma, 2nd fl. 203ho Galhyunlo, Eunpyung-gu, Seoul, Republic of Korea, Tel: +82-2-352-1075, Fax: +82-70-4324-1075, Email: dabestda@gmail.com
Received 2021 June 4; Revised 2021 June 30; Accepted 2021 July 28.

Abstract

Objectives

The purpose of this review is to investigate the latest traditional Chinese medicine clinical studies on pediatric tic disorder with Tuina treatment and propose the directions of future studies and clinical applications.

Methods

To obtain data from CNKI, set the field by ‘中醫學’, ‘中藥’, ‘中西醫結合’ and used keywords ‘抽动障碍’, ‘抽動穢語綜合’, ‘小兒抽动’, ‘兒童抽动’ and ‘推拿’, ‘導引’, ‘按摩’, ‘Tuina’, ‘massage’ in cross combination way.

Results

12 clinical studies were selected. These studies were analyzed by author & year, subjects, diagnostic criterion, evaluation criterion, syndrome differentiation, treatment period, methods& results, frequent acupoints and assessment of the quality of studies. All of reports achieved effective therapeutic results on the pediatric tic disorder with Tuina treatment.

Conclusion

Tuina treatment has a positive effect and are easily accepted by children who have fear and rejection to traditional Korean Medicine such as acupuncture and Herbal remedy. It is also safe and simple to operate. So the Tuina treatment is worthy to disseminate potential for further development in the treatment of pediatric tic disorders.

Keywords: Pediatric tic disorder; Traditional Chinese medicine; Tuina treatment; Massage
Fig. 1

Flow chart of trial selection process.

Fig. 2

Body Acupoints of TM treatment.

(The illustration sources were referred from ‘SOS Encyclopedia of child massage’, 2016 publisher Bookdodum.)

Summary of Characteristics of Traditional Chinese Medicine Clinical Studies

Therapeutic Acupoints of Tuina Treatment and Frequency

Summary of Articles’ Quality by Jadad Quality Assessment Scale

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Article information Continued

Copyright © 2021 The Society of Korean Medicine all rights reserved

Fig. 1

Fig. 1

Flow chart of trial selection process.

Fig. 2

Fig. 2

Body Acupoints of TM treatment.

(The illustration sources were referred from ‘SOS Encyclopedia of child massage’, 2016 publisher Bookdodum.)

Table 1

Summary of Characteristics of Traditional Chinese Medicine Clinical Studies

Author (year) Subject Diagnosis Criterion syndrome differentiation methods Treatment period Evaluation criterion Results
Mi JQ15) (2018) 72 Practical Chinese medicine pediatrics, Diagnosis of traditional Chinese medicine 暴受惊恐 TM only 3 months YGTSS 60 cases were markedly effective, effective rate 83%, 11 cases improvement rate 15%, 1 case(1.3%) was invalid
Chen YH16) (2018) 27 DSM-4, Chinese medicine pediatrics 脾虚肝亢证 TM only 1 week YGTSS Single massage therapy had no significant effect but Three-time massage therapy had a good short-term effect.
Du YR11) (2016) 72 (T: 36, C: 36) Diagnostic criteria for pediatric diseases, Pediatrics of traditional Chinese medicine 肝郁脾虚风动 T: TM + HM (Soyosangagambang; 逍遙散加減方)
C: tiapride hydrochloride		 60 days YGTSS Total effective rate T: 91.2%, C: 75%
The curative effect was better than that of the control group (P < 0.05).
The side effect rate was lower than that of the control group (P < 0.01)
Zeng YY12) (2016) 60 (T: 30, C: 30) NM, Diagnosis from other clinic, clinical examination Atlanto-axial Subluxation T: TM + BA
C: tiapride hydrochloride		 6 months YGTSS Total effective rate T: 93.33%, C:73.33%
The difference between the two groups was statistically significant (P < 0.05)
Qin ZH14) (2017) 110 (T: 54, C: 56) DSM-4, Diagnosis of medical imaging Atlanto-axial Subluxation T: TM + BA
C: tiapride hydrochloride		 6 months YGTSS Total effective rate T: 92.6%, C: 80.4%
The difference between the two groups was statistically significant (P < 0.05)
So, both methods are effective and curative rate of atlanto-axial dislocation 100% in T.
He T18) (2019) Before 70 (T: 35, C: 35) After 64 (T: 32, C: 32) DSM-5, Pediatrics of Traditional Chinese Medicine 肝风内动, 神机失守 T: TM only
C: tiapride hydrochloride		 12 weeks YGTSS Both methods are significant but the therapeutic effect of the treatment group was better than that of the control group during the follow-up period(end treatment, after 4weeks), and long lasting.
The difference was statistically significant (P<0.05)
Yang XY22) (2020) 90 (T: 45, C: 45) Handbook of diagnosis and statistics of mental disorders, Chinese medicine pediatrics 小儿脏腑不足 心络脾胃壅滞 T: TM only
C: Haloperidon hydrochloride		 28 days (4 weeks) YGTSS Haloperidol was also relatively therapeutic, but the TM treatment was more effective.
The score of vocal tic was significantly lower than C. (P<0.05)
Mi JQ15) (2018) 72 Practical Chinese medicine pediatrics, Diagnosis of traditional Chinese medicine 暴受惊恐 TM only 3 months YGTSS 60 cases were markedly effective, effective rate 83%, 11 cases improvement rate 15%, 1 case(1.3%) was invalid
Chen YH16) (2018) 27 DSM-4, Chinese medicine pediatrics 脾虚肝亢证 TM only 1 week YGTSS Single massage therapy had no significant effect but Three-time massage therapy had a good short-term effect.
Du YR11) (2016) 72 (T: 36, C: 36) Diagnostic criteria for pediatric diseases, Pediatrics of traditional Chinese medicine 肝郁脾虚风动 T: TM + HM (Soyosangagambang; 逍遙散加減方)
C: tiapride hydrochloride		 60 days YGTSS Total effective rate T: 91.2%, C: 75%
The curative effect was better than that of the control group (P < 0.05).
The side effect rate was lower than that of the control group (P < 0.01)
Zeng YY12) (2016) 60 (T: 30, C: 30) NM, Diagnosis from other clinic, clinical examination Atlanto-axial Subluxation T: TM + BA
C: tiapride hydrochloride		 6 months YGTSS Total effective rate T: 93.33%, C:73.33%
The difference between the two groups was statistically significant (P < 0.05)
Qin ZH14) (2017) 110 (T: 54, C: 56) DSM-4, Diagnosis of medical imaging Atlanto-axial Subluxation T: TM + BA
C: tiapride hydrochloride		 6 months YGTSS Total effective rate T: 92.6%, C: 80.4%
The difference between the two groups was statistically significant (P < 0.05)
So, both methods are effective and curative rate of atlanto-axial dislocation 100% in T.
He T18) (2019) Before 70 (T: 35, C: 35) After 64 (T: 32, C: 32) DSM-5, Pediatrics of Traditional Chinese Medicine 肝风内动, 神机失守 T: TM only
C: tiapride hydrochloride		 12 weeks YGTSS Both methods are significant but the therapeutic effect of the treatment group was better than that of the control group during the follow-up period(end treatment, after 4weeks), and long lasting.
The difference was statistically significant (P<0.05)
Yang XY22) (2020) 90 (T: 45, C: 45) Handbook of diagnosis and statistics of mental disorders, Chinese medicine pediatrics 小儿脏腑不足 心络脾胃壅滞 T: TM only
C: Haloperidon hydrochloride		 28 days (4 weeks) YGTSS Haloperidol was also relatively therapeutic, but the TM treatment was more effective.
The score of vocal tic was significantly lower than C. (P<0.05)

Table 2

Therapeutic Acupoints of Tuina Treatment and Frequency

Body part Frequent acupoints Frequency
Head, Face 風池 8
百會 7
贊竹, 坎宮 6
四神聪 6
風府 6
天門 5
太陽 5
迎香 4
頰居, 地倉 下關 2
人中 1
承浆 1
Neck 天柱 4
百劳 4
Arm 曲池 2
天河水 (瀉法) 1
內關 1
Hand 小天心 5
合谷, 少商, 商阳 3
板門 2
精宁穴 1
內八卦 (逆方向) 1
内劳宫 1
Fingers 清肝经 (肝經 瀉法) 6
補脾經 (脾經 補法 ) 4
清心经 (心經 瀉法) 3
清肺经 (肺經 瀉法) 2
五指節 2
四横纹 2
補腎經 (腎經 補法) 1
Back 大椎至长强脊柱 10
脾俞 6
肝俞 6
肩井 6
腎兪 5
心兪 2
肺兪 2
胃兪 1
膽兪 1
屛風 1
Chest 膻中 3
天突 2
Abdomen whole belly 6
中脘 2
天樞 1
Leg 足三里 7
豊隆 4
陽陵泉 3
Foot 太衝 2
湧泉 2
公孫 1

Table 3

Summary of Articles’ Quality by Jadad Quality Assessment Scale

Du11) (2016) Zeng12) (2016) Mi13) (2017) Qin14) (2017) Mi15) (2018) Chen16) (2018) Xu17) (2019) He18) (2019) Shen19) (2020) Du20) (2020) He21) (2020) Yang22) (2020)
1. Is the study randomized? 1 1 1 1 1 0 1 1 1 1 1 1
2. Is the randomization procedure appropriate and reported in th study? 0 1 0 1 0 0 1 0 0 0 0 1
3. Is the study double blind? 0 0 0 0 0 0 0 0 0 0 0 0
4. Is the double blinding methold appropriate and reported in the study? 0 0 0 0 0 0 0 0 0 0 0 0
5. Are the reasons for patient withdrawals and dropouts described for each treatment group? 0 0 0 0 0 0 0 1 0 0 0 0
Total Score 1 2 1 1 1 0 2 2 1 1 1 2