# Traditional Chinese Medicine Moxibustion in the Treatment of Infantile Diarrhea

Authors: Ziming Li
Journal: Computational Intelligence and Neuroscience
 (2022)

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## Abstract

The main contribution of this research paper is to summarize the results of Meta-analysis of moxibustion in the treatment of infantile diarrhea which is one the common disease and requires considerable attention from the research community and funding organizations. In order to verify that the proposed scheme has merits, a comprehensive searching methodology was adopted by considering various databases such as China Biomedical Literature Database (CBM), China National Knowledge Network Infrastructure (CNKI), Wanfang Database, Pub Med Database, Google Academic, and Cochrane Library. It is important to note that a powerful computer has been utilized to carry out this searching. Finally, only those literature contents are selected which meet the inclusion criteria. Likewise, exclusion criteria was used to exclude irrelevant contents of the literature. RevMan 5.3 was used to analyze the collected data and after reading the titles and abstracts, 29 well-designed studies were selected. Through searching the full text, reading literature, and quality evaluation, 17 papers were finally included. Response rates were reported in all 17 studies, and subgroup analysis was performed based on whether or not other therapies were combined. 7 studies compared the effectiveness of simple moxibustion and conventional therapy in the treatment of infantile diarrhea, and the results showed statistically significant differences [OR = 4.01, 95% CI (2.03, 7.84),P<0.0001]; 10 studies compared the effectiveness of moxibustion combined with other therapies and conventional therapies in the treatment of diarrhea in children, and the results showed that the difference had general meaning [OR = 4.45, 95% CI (2.83, 7.10), P<0.00001]. The funnel plot (in Figure) showed that the distribution of included studies was asymmetrical on both sides of the baseline, which could be considered as publication bias. Traditional Chinese medicine moxibustion could effectively relieve the symptoms of infantile diarrhea, and the effect was significant.


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## Body

## 1. Introduction

Diarrhea is a digestive tract syndrome caused by multiple pathogens and factors. Likewise, it is fairly common, and it affects almost everyone at least once a year. Your face will be loose and runny if you have diarrhea. The cause is usually unclear, and it clears up on its own within a few days. Bacteria can lead to diarrhea. Diarrhea might cause dehydration, which is a serious adverse effect. Its main symptoms include excessive secretion and absorption disorder of intestinal mucosa, excessive intestinal peristalsis, change of normal intestinal habits, thinness of feces, and abnormal components [1]. Infantile diarrhea is a clinical syndrome caused by multiple pathogens and factors, which is characterized by the increased number of stools and changes in the characteristics of stools [2]. Infantile diarrhea in children is common in infants and young children, with a high incidence of disease. The main cause is the incomplete development of physical function in children, excessive diet, and improper feeding, resulting in the weakness of the spleen and stomach in children, resulting in a significant decline in digestive function. Because the food was not digested, the child showed increased stool frequency, abdominal distension, diarrhea, and loss of appetite [3]. When children maintain diarrhea for a long time, it will cause indigestion and various nutrition-related diseases, which will affect the growth of children [4]. Apart from it, a prolonged diarrhea may cause serious consequences and may severely effects the health status of the children. A large number of moxibustion treatments and medical cases are recorded in ancient books of Chinese medicine. Traditional Chinese medicine masters in the past dynasties all have their unique views on moxibustion, and there are a large number of related medical cases about the use of moxibustion for diarrhea [5]. Moxibustion treatment for infantile diarrhea in Traditional Chinese medicine has proven efficacy, is easy to use, safe, and painless and is well accepted by children and their families [6].In this paper, we have conducted a Meta-analysis of the existing Traditional Chinese medicine moxibustion, especially in the treatment process of infantile diarrhea. As diarrhea is assumed as the most common and crucial disease for human beings in general and children in particular. Therefore, we are interested in finding a reliable and efficient treatment plan for the diarrhea disease, especially children.The rest of the paper is organized as follows.In Section2, i.e., Materials and Methods, we have described in detail how a group of patients or individuals are divided into various groups and the criteria that is used for the separation of the patients into groups. In addition, why some patients are not allowed or excluded from the experimental study is described. What we have achieved through these experiments are presented in the graphical format in the Results section i.e., Section 3. In addition, a detailed discussion of those results is also provided in Section 4. Finally, conclusion remarks are given at the end in Section 5.


## 2. Materials and Methods

### 2.1. Literature Inclusion and Exclusion Criteria

The inclusion and exclusion criteria were as follows:Inclusion Criteria. ① In the literature, the experimental group was moxibustion therapy or moxibustion combined with other therapies whereas the control group was other therapies except for moxibustion therapy; ② all publicly published randomized controlled trials or semirandomized controlled trials of moxibustion in the treatment of pediatric diarrhea, whether or not using a blind method; ③ the age, gender, and origin of the children were not limited, and diarrhea met all the diagnostic criteria of pediatric diarrhea at home and abroad.Exclusion Criteria. ① The data were incomplete or there are obvious statistical errors; ② the paper was repeatedly published or the full text was not available; ③ pathological reports, cases, reviews, and so on.


### 2.2. Literature Retrieval Method

Retrieve literature by database retrieval and keyword retrieval:(1)
Retrieve Database. In this study, the relevant original pieces of literature published in Chinese databases were systematically searched, including Pub Med, Wanfang, CNKI, CBM, Google Academic, and Cochrane Library. The retrieval time was from the establishment of the database to November 2020. These databases were searched through a dedicated and preferably efficient computer system which is programmed such that the concerned exclusion and inclusion criteria are matched or rules for these criteria are followed.(2)
Retrieve Key Words. Using the method of “subject words + free words,” the Chinese retrieval key words included: “infantile diarrhea,” “Traditional Chinese medicine moxibustion,” and “random.” The key word is an interesting feature, especially for the searching of databases or other records in the online repositories.


### 2.3. Literature Quality Evaluation and Literature Extraction

Methodological quality was evaluated according to the modified Jadad scale, which included random method, allocation concealment, blind check-out, and lost followup. The Jadad scale, often known as Jadad scoring or the Oxford quality score system, is a mechanism for evaluating a clinical trial’s methodological quality independently. It was named after Colombian physician Alex Jadad, who established a technique for assigning a score of zero to five to such studies in 1996 (rigorous). The total score of the evaluation scale was 7 points, with 1–3 points representing low quality research and 4–7 points representing high quality research.Three researchers independently screened and extracted according to the pre-established inclusion and exclusion criteria (the researchers were all graduate students who had systematically studied evidence-based medicine courses) and checked the inclusion results. If there was a disagreement, it would be discussed or decided by the fourth researcher. The extraction content mainly includes ① Baseline level; ② Basic information of the included literature; ③ Quality of included studies; ④ The source and number of cases included; ⑤ Intervention measures; ⑥ Measurement index; ⑦ Outcome indicators.


### 2.4. Statistical Method

For the statistical analysis, we have utilized the Rev Man 5.3 software which is extremely useful for the problem at hand. A heterogeneity test was conducted for the included studies, and the degree of heterogeneity was observed according toI2 value. If P>0.1, I2 < 50%, it was considered that there was homogeneity among the studies, and the fixed effect model was used; If P<0.1, when I2 ≥ 50%, the random effects model was used when consistency was considered among studies and merging was needed; if P<0.1, and I2 ≥ 50% and the source of heterogeneity could not be determined. Meta-analysis was not performed and descriptive analysis was used.


## 2.1. Literature Inclusion and Exclusion Criteria

The inclusion and exclusion criteria were as follows:Inclusion Criteria. ① In the literature, the experimental group was moxibustion therapy or moxibustion combined with other therapies whereas the control group was other therapies except for moxibustion therapy; ② all publicly published randomized controlled trials or semirandomized controlled trials of moxibustion in the treatment of pediatric diarrhea, whether or not using a blind method; ③ the age, gender, and origin of the children were not limited, and diarrhea met all the diagnostic criteria of pediatric diarrhea at home and abroad.Exclusion Criteria. ① The data were incomplete or there are obvious statistical errors; ② the paper was repeatedly published or the full text was not available; ③ pathological reports, cases, reviews, and so on.


## 2.2. Literature Retrieval Method

Retrieve literature by database retrieval and keyword retrieval:(1)
Retrieve Database. In this study, the relevant original pieces of literature published in Chinese databases were systematically searched, including Pub Med, Wanfang, CNKI, CBM, Google Academic, and Cochrane Library. The retrieval time was from the establishment of the database to November 2020. These databases were searched through a dedicated and preferably efficient computer system which is programmed such that the concerned exclusion and inclusion criteria are matched or rules for these criteria are followed.(2)
Retrieve Key Words. Using the method of “subject words + free words,” the Chinese retrieval key words included: “infantile diarrhea,” “Traditional Chinese medicine moxibustion,” and “random.” The key word is an interesting feature, especially for the searching of databases or other records in the online repositories.


## 2.3. Literature Quality Evaluation and Literature Extraction

Methodological quality was evaluated according to the modified Jadad scale, which included random method, allocation concealment, blind check-out, and lost followup. The Jadad scale, often known as Jadad scoring or the Oxford quality score system, is a mechanism for evaluating a clinical trial’s methodological quality independently. It was named after Colombian physician Alex Jadad, who established a technique for assigning a score of zero to five to such studies in 1996 (rigorous). The total score of the evaluation scale was 7 points, with 1–3 points representing low quality research and 4–7 points representing high quality research.Three researchers independently screened and extracted according to the pre-established inclusion and exclusion criteria (the researchers were all graduate students who had systematically studied evidence-based medicine courses) and checked the inclusion results. If there was a disagreement, it would be discussed or decided by the fourth researcher. The extraction content mainly includes ① Baseline level; ② Basic information of the included literature; ③ Quality of included studies; ④ The source and number of cases included; ⑤ Intervention measures; ⑥ Measurement index; ⑦ Outcome indicators.


## 2.4. Statistical Method

For the statistical analysis, we have utilized the Rev Man 5.3 software which is extremely useful for the problem at hand. A heterogeneity test was conducted for the included studies, and the degree of heterogeneity was observed according toI2 value. If P>0.1, I2 < 50%, it was considered that there was homogeneity among the studies, and the fixed effect model was used; If P<0.1, when I2 ≥ 50%, the random effects model was used when consistency was considered among studies and merging was needed; if P<0.1, and I2 ≥ 50% and the source of heterogeneity could not be determined. Meta-analysis was not performed and descriptive analysis was used.


## 3. Results

In this section, we are going to describe in detail that what is the output of the proposed scheme when applied to the actual data? In addition, the results of the proposed study are thoroughly evaluated and are presented in both tabular and textual form. For simplicity, these are divided into numerous subsections which are given below.


### 3.1. Basic Characteristics of the Included Literature and Method Quality Assessment

A total of 215 related pieces of literature were retrieved. 138 pieces of literature were repeatedly published and obviously did not meet the inclusion criteria were excluded, and 73 pieces of literature were preliminarily screened. After reading the titles and abstracts, 29 well-designed studies were selected. Through searching the full text, reading literature, and quality evaluation, 17 papers were finally included. Basic characteristics of the included literature and method quality assessment were shown in Table1.Table 1
Basic characteristics of the included literature and method quality-02 assessment.
LiteratureCasesInterventionsOutcome indicatorsExperimental groupControl groupExperimental groupControl groupPeriod of treatmentAcupuncture pointXu [7]3030MoxibustionMontmorillonite powder20 min/time, 14dShenque①Xu et al. [8]7575Spleen-tonifying qi powder + cistanche moxibustionSymptomatic treatment15 min/time, 12dShenque, Tianshu②Fang et al. [9]4343Ziwuliuzhu acupoint moxibustionConventional treatment4dShenque②⑤Zhai et al. [10]3838Moxibustion + western medicineConventional western medicine10 min/time, 10dShenque①②Huang et al. [11]104105Ginger aconite cake + moxibustionConventional treatment15 min/time, 7dQihai, Tianshu②⑥Jiang [12]5555Moxibustion + western medicineConventional western medicine15 min/time, 7dShenque, Zusanli①Meng and Zhitao [13]3939Moxibustion + Western medicineConventional western medicine20 min/time, 7dShenque③④⑥Zhong [14]5050MoxibustionConventional treatment30 min/time, 11dShenque, Guanyuan②⑤⑥Dai et al. [15]2626Moxibustion + Western medicineConventional western medicine10 min/time, 9dShenque①⑤⑦Cui et al. [16]5050MoxibustionConventional treatment25 min/time, 11dZhong wan,Shenque, Qihai, Guanyuan①②Chen et al. [17]5050MoxibustionPaste30 min/time, 10dFengchi, Shenque①Li and Gai [18]2828MoxibustionPaste15 min/time, 10dShenque①⑤⑥⑦Zhang [19]7070MoxibustionAntidiarrheal stick30 min/time, 7dShenque, Qihai, Guanyuan①Liu [20]5555MoxibustionConventional treatment25 min/time,10dPiyu①③④Zhang [21]3030Moxibustion + massageConventional treatment30 min/time, 9dShenque②③④Hu [22]8181Ziwuliu moxibustion + antidiarrheal ointmentConventional treatment25 min/time, 10dShenque, Zhongwan①②Zhu [23]4242Moxibustion + western medicinePaste30 min/time, 10dShenque, Tianshu①②⑤Note: the equilibria between groups wereP>0.05. Outcome indicators:① total effective rate; ②TCM syndrome scores; ③ the improvement time of stool; ④ abdominal pain relief time; ⑤ the time needed to reduce fever; ⑥ treatment time; ⑦ relief time of vomiting; ⑧ diarrhea relief time.


### 3.2. Result of Meta-Analysis

Response rates were reported in all 17 studies, and subgroup analysis was performed based on whether or not other therapies were combined. 7 studies compared the effectiveness of simple moxibustion and conventional therapy in the treatment of infantile diarrhea, and the results showed statistically significant differences [OR = 4.01, 95% CI (2.03, 7.84),P<0.0001]; 10 studies compared the effectiveness of moxibustion combined with other therapies and conventional therapies in the treatment of diarrhea in children, and the results showed that the difference had general meaning [OR = 4.45, 95% CI (2.83, 7.10), P<0.00001]. The funnel plot (Figure 1) showed that the distribution of included studies was asymmetrical on both sides of the baseline, which could be considered as publication bias. The result of the Meta-analysis was shown in Table 2.Figure 1
Funnel plot.Table 2
Result of Meta-analysis.
LiteratureRandom methodBlind methodAllocation concealmentBaseline similarityExit/lostXu MeifangRandomWithout mentionWithout mentionConsistentWithout mentionXu Zao Lin et al.RandomMentionWithout mentionConsistentWithout mentionFang LinaRandomWithout mentionSequence of admissionConsistentWithout mentionZhai HongminComputer extractionWithout mentionWithout mentionConsistentWithout mentionHuang Rixiang et al.RandomWithout mentionWithout mentionConsistentWithout mentionJiang YuanyuanRandomWithout mentionSequence of visitsConsistentWithout mentionMeng LixianRandomWithout mentionWithout mentionConsistentWithout mentionZhong LingRandom number tableWithout mentionWithout mentionConsistentWithout mentionDai Juan et al.Method of lotteryWithout mentionSequence of admissionConsistentMentionWei Cui et al.Random number tableWithout mentionWithout mentionConsistentWithout mentionChen Yanxia et al.RandomWithout mentionWithout mentionConsistentWithout mentionLi Meng et al.Random number tableWithout mentionWithout mentionConsistentWithout mentionZhang ZhaoguoRandomWithout mentionWithout mentionConsistentMentionLiu XingxiangRandomWithout mentionSequence of visitsConsistentWithout mentionZhang LiqiaoRandom number tableMentionWithout mentionConsistentWithout mentionHu DaipingRandomWithout mentionWithout mentionConsistentWithout mentionZhu QunleiRandomWithout mentionWithout mentionConsistentWithout mentionFunnel plot was shown in Figure1.


## 3.1. Basic Characteristics of the Included Literature and Method Quality Assessment

A total of 215 related pieces of literature were retrieved. 138 pieces of literature were repeatedly published and obviously did not meet the inclusion criteria were excluded, and 73 pieces of literature were preliminarily screened. After reading the titles and abstracts, 29 well-designed studies were selected. Through searching the full text, reading literature, and quality evaluation, 17 papers were finally included. Basic characteristics of the included literature and method quality assessment were shown in Table1.Table 1
Basic characteristics of the included literature and method quality-02 assessment.
LiteratureCasesInterventionsOutcome indicatorsExperimental groupControl groupExperimental groupControl groupPeriod of treatmentAcupuncture pointXu [7]3030MoxibustionMontmorillonite powder20 min/time, 14dShenque①Xu et al. [8]7575Spleen-tonifying qi powder + cistanche moxibustionSymptomatic treatment15 min/time, 12dShenque, Tianshu②Fang et al. [9]4343Ziwuliuzhu acupoint moxibustionConventional treatment4dShenque②⑤Zhai et al. [10]3838Moxibustion + western medicineConventional western medicine10 min/time, 10dShenque①②Huang et al. [11]104105Ginger aconite cake + moxibustionConventional treatment15 min/time, 7dQihai, Tianshu②⑥Jiang [12]5555Moxibustion + western medicineConventional western medicine15 min/time, 7dShenque, Zusanli①Meng and Zhitao [13]3939Moxibustion + Western medicineConventional western medicine20 min/time, 7dShenque③④⑥Zhong [14]5050MoxibustionConventional treatment30 min/time, 11dShenque, Guanyuan②⑤⑥Dai et al. [15]2626Moxibustion + Western medicineConventional western medicine10 min/time, 9dShenque①⑤⑦Cui et al. [16]5050MoxibustionConventional treatment25 min/time, 11dZhong wan,Shenque, Qihai, Guanyuan①②Chen et al. [17]5050MoxibustionPaste30 min/time, 10dFengchi, Shenque①Li and Gai [18]2828MoxibustionPaste15 min/time, 10dShenque①⑤⑥⑦Zhang [19]7070MoxibustionAntidiarrheal stick30 min/time, 7dShenque, Qihai, Guanyuan①Liu [20]5555MoxibustionConventional treatment25 min/time,10dPiyu①③④Zhang [21]3030Moxibustion + massageConventional treatment30 min/time, 9dShenque②③④Hu [22]8181Ziwuliu moxibustion + antidiarrheal ointmentConventional treatment25 min/time, 10dShenque, Zhongwan①②Zhu [23]4242Moxibustion + western medicinePaste30 min/time, 10dShenque, Tianshu①②⑤Note: the equilibria between groups wereP>0.05. Outcome indicators:① total effective rate; ②TCM syndrome scores; ③ the improvement time of stool; ④ abdominal pain relief time; ⑤ the time needed to reduce fever; ⑥ treatment time; ⑦ relief time of vomiting; ⑧ diarrhea relief time.


## 3.2. Result of Meta-Analysis

Response rates were reported in all 17 studies, and subgroup analysis was performed based on whether or not other therapies were combined. 7 studies compared the effectiveness of simple moxibustion and conventional therapy in the treatment of infantile diarrhea, and the results showed statistically significant differences [OR = 4.01, 95% CI (2.03, 7.84),P<0.0001]; 10 studies compared the effectiveness of moxibustion combined with other therapies and conventional therapies in the treatment of diarrhea in children, and the results showed that the difference had general meaning [OR = 4.45, 95% CI (2.83, 7.10), P<0.00001]. The funnel plot (Figure 1) showed that the distribution of included studies was asymmetrical on both sides of the baseline, which could be considered as publication bias. The result of the Meta-analysis was shown in Table 2.Figure 1
Funnel plot.Table 2
Result of Meta-analysis.
LiteratureRandom methodBlind methodAllocation concealmentBaseline similarityExit/lostXu MeifangRandomWithout mentionWithout mentionConsistentWithout mentionXu Zao Lin et al.RandomMentionWithout mentionConsistentWithout mentionFang LinaRandomWithout mentionSequence of admissionConsistentWithout mentionZhai HongminComputer extractionWithout mentionWithout mentionConsistentWithout mentionHuang Rixiang et al.RandomWithout mentionWithout mentionConsistentWithout mentionJiang YuanyuanRandomWithout mentionSequence of visitsConsistentWithout mentionMeng LixianRandomWithout mentionWithout mentionConsistentWithout mentionZhong LingRandom number tableWithout mentionWithout mentionConsistentWithout mentionDai Juan et al.Method of lotteryWithout mentionSequence of admissionConsistentMentionWei Cui et al.Random number tableWithout mentionWithout mentionConsistentWithout mentionChen Yanxia et al.RandomWithout mentionWithout mentionConsistentWithout mentionLi Meng et al.Random number tableWithout mentionWithout mentionConsistentWithout mentionZhang ZhaoguoRandomWithout mentionWithout mentionConsistentMentionLiu XingxiangRandomWithout mentionSequence of visitsConsistentWithout mentionZhang LiqiaoRandom number tableMentionWithout mentionConsistentWithout mentionHu DaipingRandomWithout mentionWithout mentionConsistentWithout mentionZhu QunleiRandomWithout mentionWithout mentionConsistentWithout mentionFunnel plot was shown in Figure1.


## 4. Discussion

Infantile diarrhea is a common digestive tract disease in pediatrics. It is mainly caused by a poor diet which damages the spleen and stomach, or by the invasion of the lung and stomach caused by the evil of wind and cold [24]. In the theory of Traditional Chinese medicine, children with diarrhea belong to “diarrhea,” spleen and stomach function damage, temper disorder, blood deficiency, spleen, and stomach weakness [25]. In modern medical theory, due to the children’s younger age, immature spleen and stomach function, the digestive ability is limited, digestive enzyme secretion is insufficient, and digestive system disorders, forming a vicious circle [26]. Traditional Chinese medicine moxibustion is made of moxa stick or moxa stick with moxa as the main material. After lighting, the moxa stick is smoked and ironed or warmed to burn the body surface acupoints. By stimulating the activity of Qi to adjust the body’s disordered physiological and biochemical functions, so as to achieve the purpose of disease prevention and treatment of a treatment method [27]. Traditional Chinese moxibustion has the function of warming the middle and dispersing cold, strengthening the spleen and strengthening the kidney, reducing dampness and stopping diarrhea, improving the immunity of the body, and improving the weak constitution [28]. Traditional Chinese medicine moxibustion can stimulate Qi and adjust the disorder of physiological function, before moxibustion, the symptoms of children are differentiated to determine the specific syndrome type, implementing symptomatic treatment, by selecting appropriate acupoints and stimulating acupoints, to make the digestive function of children return to normal [29, 30]. In recent years, the clinical treatment effect of Traditional Chinese moxibustion on diarrhea has become a hot research topic, especially since 2011, the research process has been rapidly accelerated [31]. Comparative analysis of the clinical efficacy of moxibustion and its comprehensive therapy on different types of diarrhea found that Traditional Chinese moxibustion for children with diarrhea treatment effect is better, can effectively shorten the course of the disease’s quick recovery, reduce the inconvenience of children's intake of drugs, and significantly alleviate the symptoms of diarrhea in children [32].


## 5. Conclusion

In this study, we have carefully read the titles and abstracts of approximately twenty-nine articles, which are available in the literature. However, the selection of these articles is based on a dedicated mechanism, i.e., inclusion and exclusion criteria, which are described in the proposed section. In the next step, we have searched the full text, reading literature, and quality evaluation through which we were able to select seventeen papers. Response rates were reported in all 17 studies, and subgroup analysis was performed based on whether or not other therapies were combined. 7 studies compared the effectiveness of simple moxibustion and conventional therapy in the treatment of infantile diarrhea, and the results showed statistically significant differences [OR = 4.01, 95% CI (2.03, 7.84),P<0.0001]; 10 studies compared the effectiveness of moxibustion combined with other therapies and conventional therapies in the treatment of diarrhea in children, and the results showed that the difference had general meaning [OR = 4.45, 95% CI (2.83, 7.10), P<0.00001]. The funnel plot (Figure 1) showed that the distribution of included studies was asymmetrical on both sides of the baseline, which could be considered as publication bias.Finally, Traditional Chinese medicine moxibustion could effectively relieve the symptoms of infantile diarrhea and the effect was significant as we have observed through experiments.



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*Source: 9749606-2022-06-30.xml*