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J. Acupunct. Tuina. Sci. 2010, 8 (1): 62-66 DOI: 10.1007/s11726-010-0062-3

Literature Review

Study of a List of Modern Diseases Treated by Tuina Therapy in China

XU Yan-long (徐彦龙) 1 , XU Xiu-mei (徐秀梅) 2 , DU Yuan-hao (杜元灏) 1 1 Tianjin University of Traditional Chinese Medicine, Tianjin 300193, P. R. China 2 Tianjin Yongjiu Hospital, Tianjin 300451, P. R. China

摘要目的:归纳中国现代推拿临床的治疗病症,总结现代推拿临床病谱。方法:采 用文献研究法,对《中国生物医学光盘数据库》中 19782008 年针灸临床疗效观察类论 文报道的病症按系统进行分析归纳,并统计每一个病症被报道的论文篇数(即频次)结果: 通过文献研究,得到 365 16 类推拿病谱,包括西医病 255 种,西医症状 57 种,中医 病症 53 种。结论:推拿疗法适应证广,值得临床推广应用。 【关键词】推拿;按摩;文献计量学 【AbstractObjective: To analyze and summarize disease and syndromes which can be treated by tuina therapy. Methods: Using literature researching methods to analyze and summarize diseases and symptoms treated clinically by tuina in order to observe the therapeutic effects from Chinese Biomedicine Optical Disk Database (CBM) from 1978 to 2008. The frequency (number) of reported cases for each disease and syndrome was calculated. Results:

The list of diseases for tuina therapy included 365 kinds of 16 classifications, including 255 Western medicine diseases, 57 symptoms of Western medicine and 53 traditional Chinese medicine (TCM) syndromes. Conclusion: Tuina is an effective and widely used therapy in the clinic. Key WordsTuina; Massage; Literature Metrology CLC NumberR244.1 Document CodeA

With increase of international exchange, acupuncture and tuina therapies are now widely used outside of China. Which diseases can tuina therapy treat? What are the main diseases treated through tuina? The answers to these questions are keys to the knowledge and understanding of tuina therapy worldwide. Consequently, this study was undertaken to obtain the list of diseases treated by tuina therapy through searching and analyzing the relevant data in China in the last 30 years.

1 Literature Research Methods

1.1 Source of the literature The Chinese Biomedicine Optical Disk Database (CBM), established by the Information Research

Institute of the Chinese Academy of Medical Sciences, was adopted for this research.

1.2 Literature retrieval 1.2.1 Literature collection The keywords were Tuina, Anmo and Nieji, which were found through subject retrieval initially. They were obtained according to the retrieval program composition of the CBM, in order to completely collect the literature related to tuina. An extensive caliber searching method was employed in this procedure, that is to say, a word was input in the search bar (searching in the caption and content freely), and then three different keywords (Tuina, Anmo and Nieji) were added. We respectively attained the bibliographical reference for each of the keywords from 1978 to 2008. NoteExpress2.0 version was used to import all the papers, and to screen the caption, abstract and key words to choose

Author: XU Yan-long (1982- ), male, master of medicine Correspondence Author: DU Yuan-hao (1964- ), male, professor, chief physician

62 © Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010

J. Acupunct. Tuina. Sci. 2010, 8 (1): 62-66

the suitable papers. The full article was enrolled when all required information had been included in the paper according to the inclusive and exclusive criteria.

1.2.2 Inclusion criteria [1]

The papers related to tuina therapy, with a special interest in its therapeutic effect; the papers all compared the therapeutic effect before and after tuina treatment. Each case had more than 10 subjects.

1.2.3 Exclusion criteria

Case reports were excluded; animal experiments and systematic reviews were excluded; papers not relating to clinical therapeutic effect of tuina therapy were excluded; papers without a standard disease name or a clear diagnosis were excluded.

1.2.4 Statistical methods [1]

The nomenclature of the disease was based on Western medicine, while the nomenclature of the syndrome was based on TCM. Considering the feature of TCM theses, the list was classified according to the disease diagnosis of Western medicine, the symptom diagnosis in Western medicine and the TCM syndrome diagnosis. Following the International Classification of Diseases (ICD 10) issued by World Health Organization (WHO) [2] , the list of diseases treated by tuina therapy was then divided into 16 categories. The frequency of disease was estimated and the disease or syndrome that only appeared once in the whole review would be excluded.

2 Results

Three hundred and sixty-five kinds of conditions and diseases in 16 categories were attained from the literature, including 255 diseases of Western medicine, 57 symptoms of Western medicine and 53 TCM syndromes .

2.1 Infectious and parasitic diseases There were 12 kinds of conditions and diseases in this category, including rotavirus enteritis (14: this number indicates the frequency, similarly hereinafter), ascariasis (13), virus hepatitis (12), infantile paralysis and lingering effects (9), infantile fungal enteritis (9), herpes zoster (8), type-b encephalitis (5), whooping cough (4), epidemic

parotitis (4), infantile viral encephalitis (4), infantile dysentery (4), and infantile measles (2).

2.2 Neoplasms

There were 6 kinds of conditions and diseases in this category, including breast cancer (4), liver cancer (3), mastofibroma (2), hysteromyoma (2), adverse reactions after radiotherapy and chemo- therapy (13) and cancer pain (6).

2.3 Diseases of the ear and mastoid process There were 5 kinds of conditions and diseases in this category, including otitis media (11), meniere's syndrome (6), deaf mutism (3), deafness (21) and tinnitus (22).

2.4 Diseases of the respiratory system

There were 23 kinds of conditions and diseases in this category, including asthma (65), allergic rhinitis (27), recurrent respiratory infection in children (25), pneumonia (18), upper respiratory tract infection (14), chronic rhinitis (13), bronchitis (13), sinusitis (12), chronic laryngitis (8), chronic pharyngitis (7), premature apnea (7), chronic obstructive pulmonary disease (6), tonsillitis (6), disease of vocal cords (3), neonatal asphyxia (6), hiccup (84), common cold (19), fever (45), cough (29), cough and dyspnea in children (15), aphonia (10), epistaxis (3), and dry pharynx (2).

2.5 Diseases of the musculoskeletal system and connective tissue There were 86 kinds of conditions and diseases in this category, including lumbar intervertebral disc protrusion (3 945), cervical spondylosis (2 406), periarthritis of shoulder (1 253), osteoarthritis of knee (329), facet joint disorders (297), third lumbar transverse process syndrome (211), torticollis (209), piriformis injury syndrome (184), external humeral epicondylitis (147), fascitis (91), sacroiliac joint seam wrong (79), ankylosing spondylitis (56), chondromalacia patellae (53), peritendinitis (45), synovitis (45), myotenositis (42), rheumatoid arthritis (38), infantile talipes equinovarus (29), subluxation of the atlantoaxial joint (28), osteonecrosis of the femoral head (25), bursitis (24), ganglionic cyst (19), infrapatellar fat pad lesions (21), scalenus syndrome (15), cervico-brachial syndrome (15), chondritis (13), carotid-cardiac

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 62-66

syndrome (13), infantile gluteus contracture (12), myofascial pain syndrome (11), systremma (11), sarcitis (11), hypertrophic spondylitis (8), scapulocostal syndrome (7), rhomboideus syndrome (5), impact shoulder syndrome (5), sprained back (5), sacroiliac sprain (5), muscle contracture syndrome (4), cervical lumber syndrome (4), infraspinatus muscle syndrome (4), fibrositis (3), lumbar triangle syndrome (3), neck stomach syndrome (3), supraspinal syndesmitis (3), atlanto-occipital fascia contracture syndrome (3), unit adductor syndrome (3), periostitis (3), long head of biceps tendon slip (3), osteitis condensans ilium (2), caudal injury syndrome (2), gout (2), iliotibial tract injuries (2), progressive muscular dystrophy (2), traumatic neck syndrome (2), epiphysitis (2), tarsal sinus syndrome (2), patella tendonitis (2), post orthopedics operation syndrome (142), stiff joint (94), lumbar muscle strain (82), spinal stenosis (55), spondylolisthesis (52), hyperosteogeny (51), arthralgia (43), lumbar facet joint synovial incaceration (38), joint dysfunction (30), scoliosis (17), osteoporosis (16), coccyalgia (11), infantile congenital deformity of hand-foot (7), lumbar instability syndrome (4), laryngeal myasthenia (3), omobrachial pain syndrome (2), epiphyseal separation (2), popliteal cyst (2), stiff neck (156), low back pain (142), lumbago with leg pain (132), talalgia (89), cervical-lumbar-leg pain (58), bi syndrome-impediment (29), lumbosacral pain (16), impact tendon pain (13), lumbodorsal pain (11), shoulder-dorsal pain (8), and post-elbow hematoma (4).

2.6 Mental and behavioral disorders There were 22 kinds of conditions and diseases in this category, including somnipathy (254), sex disorders (42), chronic fatigue syndrome (35), neurasthenia (30), dementia (24), irritable bowel syndrome (24), hyperkinetic disorder (14), functional disturbances of gastrointestinal tract (12), abstinence syndrome (8), anxiety disorders (7), depression (6), cardiac neurosis (6), hysteria (5), athletic syndrome (5), mental retardation (5), schizophrenia (3), tic disorder (3), neurosis (2), nocturnal restlessness in infants (21), shock syndrome in children (4), globus hystericus (4) and depression syndrome (2).

2.7 Diseases of the genitourinary system

There were 30 kinds of conditions and diseases in this category, including chronic prostatitis (225), acute mastitis (112), dysmenorrheal (99), cyclomas- topathy (29), urolithiasis (26), perimeno-pausal syndrome (22), ureteral calculus (19), chronic pelvic inflammatory disease (18), prostatic hyperplasia (15), prostatic hypertrophy (8), male infertility (7), chronic pelvic pain syndrome (7), chronic nephritis (6), chronic cavitas pelvic pain syndrome (4), amenorrhea (4), delayed semen liquefaction (3), female infertility (2), urinary tract infection (2), kidney stone (2), premenstrual tension syndrome (2), uroschesis (185), urinary incontinence (11), renal colic (7), prostatalgia (4), post-extracorporeal- lithotripsy complications (3), enuresis (144), mammary abscess (31), dysuria and urine retention (10), infantile neurological frequent urination (7), and menoxenia (6).

2.8 Endocrine, nutritional and metabolic diseases

There were 6 kinds of conditions and diseases in this category, including diabetes mellitus and its complications (95), obesity (67), rickets (8), hyper- thyroidism (3), hyperlipidemia (2) and prematurely graying hair (2).

2.9 Diseases of the skin and subcutaneous tissue

There were 11 kinds of conditions and diseases in this category, including scleredema neonatorum (123), chloasma (43), acne vulgaris (39), cicatricial alopecia (17), chromatosis (6), infant eczema (3), urticaria (3), psoriasis (2), neurodermatitis (2), vitiligo (2), and cicatrix of skin (10).

2.10 Diseases of the nervous system There were 47 kinds of conditions and diseases in this category, including bell’s palsy (355), cerebral palsy in children (262), headache (140), migraine (105), brachial plexus paralysis (81), sciatica (71), post-zoster neuralgia (47), epithelial gluteal nerve injury (46), tension headache (33), angioneurotic headache (22), facial spasm (19), occipital neuralgia (17), vertebra arteria basilaris syndrome (15), carpal tunnel syndrome (15), trigeminal neuralgia (14), restless legs syndrome (14), thoracic outlet syndrome (13), epithelial gluteal neuritis (13), common peroneal nerve injury (10), parkinsonism (9), lateral femoral cutaneous neuritis (9), radial

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 62-66

nerve injury (8), paraplegia (8), polyneuritis (8), intercostal neuralgia (7), plantar tunnel syndrome (6), supraorbital neuralgia (6), guillain-barre syndrome (6), epilepsy (6), hydrocephalus (5), tarsal tunnel syndrome (4), syndrome of posterior ramus of lumbar nerve (3), phantom limb syndrome with pain (3), myasthenia gravis (2), motor neuron disease (2), atypical facial pain (2), hemiplegia (51), peripheral nerve injury (26), peripheral entrapment neuropathies (17), infantile ataxia (12), vegetative state (10), ophthalmoplegia (3), ilioinguinal nerve pain (3), fainting (3), dizziness (52), infantile convulsion (17) and infantile flaccidity (3).

2.11 Diseases of the digestive system

There were 46 kinds of conditions and diseases in this category, including dysfunction of tempor- omandibular joint (75), intestinal obstruction (58), gastroptosis (50), infantile simple indigestion (48), chronic colitis (33), chronic gastritis (30), choleli- thiasis (24), cholecystitis and cholangitis (16), infantile oral ulceration (18), anal fissure (14), stomach volvulus (11), peptic ulcer (11), acute gastroenteritis (10), hernia (9), infantile enteritis (8), achalasia of cardia (4), acute pancreatitis (3), appendicitis (3), periodontitis (2), gingivitis (2), anal cryptitis (2), infantile anorexia (205), post- operative complications of abdominal operation (98), infantile intussusception (38), jaundice (18), biliary colic (16), infantile malnutrition (12), gastrointestinal spasm (9), infantile intestinal colic (5), intestinal adhesion (4), cirrhosis of liver (3), prolapse of gastric mucosa (2), diarrhea (1 129), constipation (280), abdominal pain (58), malnutritional stagnation in children (58), epigastralgia (50), vomiting (21), abdominal distention (16), toothache (7), infantile proctoptosis (5), perspiration syndrome (spontaneous perspi- ration, night sweat, hyperhidrosis) (5), infantile regurgitation (4), infantile drooling (4), flank and costalgia (2) and infantile indigestion (2).

2.12 Diseases of blood and blood-forming organs

There were 2 kinds of conditions and diseases in this category, including leucopenia (3) and infantile iron deficiency anemia (16).

2.13 Diseases of the circulatory system

There were 13 kinds of conditions and diseases in this category, including cerebrovascular disease and complications (398), hypertension (100), coronary

heart disease (57), arrhythmia (43), hemorrhoids (18), deep venous thrombosis of lower limbs (6), thromboangiitis obliterans (4), raynaud’s disease (4), atherosclerosis (4), myocardial infarction (2), paroxysmal supraventricular tachycardia (16), angina pectoris (9) and varicose veins (5).

2.14 Diseases of the eye and its adnexa

There were 15 kinds of conditions and diseases in this category, including myopia (99), neonatal dacryocystitis (64), congenital obstruction of naso- lacrimal duct (18), amblyopia (13), glaucoma (12), blepharitis (7), optic atrophy (7), strabismus (3), visual fatigue syndrome (3), conjunctivitis (3), pigmentary degeneration of retina (2), retinal arterial obstruction (2), postoperative complications of eye operation (42), xeroma (10) and blepharoptosis (2).

2.15 Perinatal diseases

There were 12 kinds of conditions and diseases in this category, including syndrome after cesarean section (29), hemorrhage during cesarean section (12), post-partum pubic symphysis diastasis (3), drug-induced abortion and its complications (2), post-partum hemorrhage (59), insufficient lactation (31), galactostasis (17), labor pain (17), perineal injury during delivery (3), vomiting during pregnancy (10), post-partum mastodynia (10), and post-partum chills (3).

2.16 Trauma, poisoning and others

There were 29 kinds of conditions and diseases in this category, including bone fracture and its complications (682), acute lumbar muscle sprain (315), dislocation of the joint (214), sprained ankle (133), brain trauma and its complications (64), ligament injury (36), spinal cord injury (25), chest and hypochondrium trauma (24), wrong seam joints (21), complications after injection (17), hypoxic- ischemic encephalopathy (13), drug side effects (11), decubitus (11), summer fever in children (9), meniscus injury (8), exercise-induced damage (7), chilblain (7), sunstroke (6), neonatal cold injury syndrome (5), toxic encephalopathy (2), motion sickness (2), organophosphorous poisoning and heavy metal poisoning (2), acute sprain of carpal joint (2), traumatic gonarthritis (2), soft tissue injury (251), muscle damage (76), articular strain (26), post-burn syndrome (18) and post-injury limb swelling (2).

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 62-66

3 Discussion

There are many databases in China, but the author chose CBM as the source of literature retrieval for the following reasons. First, it is the complete and the earliest developed medical database in China, enrolling 3 500 000 papers in total from 1 600 kinds of biomedical journals and conference papers since 1978. Subsequently, all the bibliographical references were indexed to the Mesh of U.S.A National Library of Medicine, the Subject Headings of Traditional Chinese Medicine issued by Institute of Information on Traditional Chinese Medicine, and the medical classification of Chinese Library Classification. The CBM retrieval system has a good compatibility with Pubmed. It is featured by multi-searching portal, flexible searching methods, and various assistant searching functions including subjects, classification, journal and author, et al. Thus it can satisfy both simple and complex retrievals for achieving high recall and precision ratios. From the first result, we can see that the disease spectrum focused on diseases of musculoskeletal system and connective tissue (86 kinds), nervous system 47 kinds, digestive system 46 kinds, genitourinary system (30 kinds), trauma, poisoning and others (29 kinds), which is related to the clinical situation and determined by the characteristics of tuina therapy. This paper did not highlight the pediatric diseases, a very important part of tuina therapy. Because of this methodological method is

to normalize the disease names and to record the occurrence frequency. In the process of the literature analysis, the author found that at least 40% of data relating to tuina therapy were for children. So if children were the subject, the author would put "infant" or "children" before the disease name for differentiation. In this disease list of tuina therapy, 365 kinds in 16 categories were attained and 20 931 papers were included in the research. But the author reported that in some papers tuina therapy functioned as a compliment to other therapies. Additionally, many papers appeared with unofficial disease names and the quality was poor, which indicated that the quality of tuina doctors and researchers need to be improved. The list of diseases treated by tuina therapy needs to be expanded and the clinical effect needs to be improved, as well as the procedure of diagnosis and treatment needing to be standardized.


[1] DU Yuan-hao, LI Jing, SUN Dong-wei, et al. Study on Modern Disease spectrum of Acupuncture and Moxibustion Therapy in China. Chinese Acupuncture & Moxibustion, 2007, 27(5): 373-378. [2] International Classification of Diseases Cooperation Center of WHO of Consonancy hospital, Compilation. International Statistical Classification on Disease and Relevant Health Problems. Beijing: The People Public Health Publishing Company, 1996: 89-800.

Received Date: October 15, 2009

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