Lyu Cheng,Yun Ning,Wen-Jiao Li,Han Wang,Chang-De Jin

1Graduate College,Tianjin University of Traditional Chinese Medicine,Tianjin,China; 2School of Nursing,Tianjin University Traditional Chinese Medicine,Tianjin,China.

Abstract

Keywords:Inner Bagua;Children;Massage;Digestive system illness;Respiratory system disease

Introduction

Pediatric massage is one of the external treatment methods that can improve children's constitution and immunity by regulating the viscera,dredging the meridians,regulating Qi and blood,and balancing Yin and Yang [1].Pediatric massage can not only improve physical fitness and immunity,but also has some effects on the acute common diseases such as fever,vomiting,cold,diarrhea,and chronic recurrent diseases [2].Different from these acupoints in adults,the main message of children acupoints are on abdomen,palm or chest.As it is said that “most of children meridians converge in two palms”.The specific massage acupoints are especially concentrated in the two palms of children.Inner Bagua acupoints,located on the palm and back of the hand,are the commonly used acupoints in pediatric massage,which have the function of regulating Qi and eliminating phlegm (a kind pathologic fluid in TCM theory) and improving digestion.The position of inner Bagua acupoints correspond to the reaction of ascending colon,descending colon,small intestine,spleen and stomach.Therefore,the stimulation of the hand can achieve the regulation of these organs [3].This article attempts to elaborate and summarize the origin,location massage methods and clinical application of the inner Bagua acupoints to provide a basis for advocating and disseminating pediatric massage.

Origin and functions of inner Bagua acupoints

There are three main theories about the origin of acupoints at inner Bagua acupoints.The first is based on analogy theory.The second is the orientation theory,which considers acupoints in palm corresponds the attributes of each orientation to the Bagua,respectiving five elements (the basic materials in tradional Chinese medicine theory) and the viscera (the basic organs in traditonal Chinese medicine theory).The third is from the doctrine Taoism (the only indigenous religion in China),which holds that things have a cycle law of repetition.The characteristics of this theory are embodied in the interconnection and interaction between the viscera and the operation of the inner Bagua acupoints[4].TCM hold that inner Bagua acupoints have the functions of regulating vital energy and stomach Qi and dispelling phlegm,for which these acupoints were used for the treatment of digestive system and respiratory diseases.Modern researches [5,6] show that pushing inner Bagua acupoints can promote gastric motility,meanwhile,effectively reduce histamine and other components in peripheral blood.

The position of inner Bagua acupoints

According to the ancient book entitledZhenjiu Dachengwritten by Jizhou Yang and published in 1601 C.E.(Ming dynasty of China),Bagua acupoints are located on the palm and back of the hand,which are called inner Bagua and external Bagua acupointts [4].However,physicians of past dynasties have different opinions on the location of inner Bagua acupoints in different genders.At present,regardless of children's gender,inner Bagua acupoints are used on children's left hand[7].The center of the palm of the left hand is the center of the circle,and two-thirds of the length from the center of the circle to the root of the middle finger is the radius.The inner Bagua acupoints are evenly distributed on the circle.The medical book entitled Baochi massage method recorded that the south(below the middle finger)is Li acupoint,symmetrical to it near the wrist is Kan acupoint (North),Zhen and Dui acupoints were at the 90 degrees of Li acupoint,which are on the radial(East)and ulnar(West)sides of the hand,respectively.on the circle of the four acupoints,the northwest is Qian acupoint,the northeast is Gen acupoint,the southeast is Xun acupint,the southwest is Kun acupoint[8].The acupoints were shown in Figure 1.

Figure 1 The location of inner Bagua acupoints

Below the middle finger on the south (S) is Li acupoint,symmetrical to it near the wrist is Kan acupoint (north);Zhen and Dui acupoints are at 90 degrees of Li acupoint,which are on the radial(east)and ulnar(west)sides of the hand,respectively.On the circle of the four acupoints,the northwest is Qian acupoint,the northeast is Gen acupoint,the southeast is Xun acupint,the southwest is Kun acupoint.

The manipulation of inner Bagua acupoints massage

There are three kinds of inner Bagua acupoints message methods: clockwise massage,counterclockwise massage and partial massage.Clockwise massage of inner Bagua acupoints:the operator holds the child's left hand with the palm facing upwardand push from the inner side or outer edge of the thumb accoding to clockwise direction as Qian-Kan-Gen-Zhen-Li-Xun-Li [9].The difference between counterclockwise massage and clockwise massage is that the order of massage points is different.But the starting point is same.Counterclockwise massage of inner Bagua acupoints has the effect of relieving cough and asthma,reducing adverse reactions of stomach and stopping vomiting [10].The order of partial massage is Qian-Kan-Gen-Zhen or Xun-Li-Kun-Dui acupoints and others.Different partial massage has different effects.For example,massaging Qian-Kan-Gun-Zhen can keep spirit up.Massaging Xun-Li-Kun-Dui can stabilize emotions[10].In general,the number of massage inner Bagua acupoints is about 200-300 times.Massage time is determined according to the severity of the illness of the child,and no specific restrictions [11-14].Besides massage clockwise,there are kneading and pinching methods in inner Bagua acupoints,but they are not commonly used in clinic[10].

Clinical application

Respiratory diseases

Cough.Chronic cough is a common respiratory symptom in children.Cough syndrome types are diverse,usually divided into exogenous and endogenous cough according to pathogenic factors.The younger the age of children,the greater the effects of massage.Massage has obvious therapeutic effects on all kinds of cough.There are many schools of massage in China,but there is no unified massage technique for children's cough[15].Wang Jet al.analyzed massage prescription for children cough and found that acupoints with the functions of regulating Qi were often selected for children cough and the inner Bagua acupoints were the fourth common acupoints in pediatric massage,the acupuncture point combination of inner Bagua acupoints and lung meridian ranks the second in the core acupuncture point combination [16].Wang YPet al.treated the control group with TCM and treated the experimental group with message inner Bagua acupoints (Kan),liver meridian,lung meridian,Tanzhong(RN17) to treat children's cough [17].The effective rate was 97.44%in the experimental group and 76.92% in the control group.Niu RM used the inner Bagua acupoints massage combined with the method tonifying Spleen(one of the basic organs in traditonal Chinese medicine theory)to treat children's cough after infection,and the children receiving Chinese patent medicineXiaoji Zhikeoral liquid as the control.The results showed that the overall effective rate of the experimental group was 91.6%,higher than that of the control group (72.1%) [11].Fu JNet al.massage 64 children with cough after cold with invigorating spleen meridian,clearing lung meridian,and inner Bagua acupoints once a day,for two weeks,and achieved an 84.3%total effective rate.

Asthma.Asthma has acute stage and remission stage and syndrome type is divided into cold asthma and hot asthma[19].Massage of inner Bagua acupoints is beneficial to broad chest and lung,relieve cough and phlegm,counterclockwise massage to relieve asthma,and adjust the balance of Yin and Yang.It is the main point for treating cough and asthma [20].Xu WL treated the experimental group combined Budesonide aerosol inhalation and inner Bagua acupoints massage clockwise.The control group was treated with Budesonide aerosol inhalation alone.The results showed that the experimental group was superior to the control group in improving symptom score and reducing recurrence frequency during treatment [21].Tian FLet al.divided 160 children into treatment group and control group.The control group was given routine atomization treatment,while the treatment group was given pediatric massage on the basis of the control group.Massage prescription includes clockwise massage the inner Bagua acupoints for 10 minutes.The final results showed that the inefficiency rate of the control group was 22.4%,while that of the treatment group was only 9.1%[6].Therefore,it can be seen that inner Bagua acupoints also have important application value in the treatment of bronchial asthma in children.

Repeated respiratory tract infections.Repeated respiratory tract infection in children is one of the common diseases in pediatrics [22].Repeated respiratory tract infections in children lead to a decline in quality of life due to repeated attacks and prolonged recovery [23].Pang Jet al.through the analysis of massage prescriptions for children with recurrent respiratory tract infections,found that spine,Zusanli (ST36),Lung meridian,Spleen meridian,inner Bagua acupoints,Feishu(BL13)were the main points for the treatment of children with recurrent respiratory tract infections [24].Massage of internal Bagua acupoints can have the effects of reducing cough and asthma [23].Zheng MJ used the massage prescription to prevent and treat recurrent respiratory tract infection.The results showed that there were 26 effective cases,13 effective cases and 1 ineffective case in 40 children,indicating that the massage prescription could significantly improve the symptoms of children with recurrent respiratory tract infection [25].Xia Tet al.used massage to prevent and treat recurrent respiratory tract infection.The results showed that the total effective rate of the experimental group with massage was 97%,and that of the control group with jade screen was 74% [22].As one of the key acupoints of massage prescription,inner Bagua acupoints play a key role.

Diseases of digestive system

Indigestion.Children dyspepsia can lead to deficiency of digestive function and food accumulation [26].Massage of internal Bagua acupoints can strengthen gastrointestinal motility,promote the secretion of digestive juice and help digestion [27].Yang QX and others divided 65 children with functional dyspepsia into inner Bagua massage group and drug group.The effective rate was 95.7%and 84.4%,respectively,and massage can obviously increase children's appetite [27,28].Ding Songet al.randomly divided 88 children with indigestion food into the experimental group and the control group.Massage internal Bagua acupionts etc,the control group took Huaji oral liquid; the effective rate of the digestion and depression group was 97.7%,and the control group was 84.1%[28].

Anositia.Massage for infantile anorexia has shown great advantages for the curative effect and easy operation.Liu Ket al.screened 286 massage prescriptions for infantile anorexia and found that the core acupoints were spine,spleen meridian,abdomen,inner Bagua acupoints,Zusanli (ST36) and Banmen acupoint [29].Ji LYet al.massage inner Bagua using small circular motions in Children with anorexia and found that the total effective rate was 94.55%in the experimental group and 87.04%in the control group which use spine massage [30].In Peng JH's study,massage was compared with oral liquid.Through massaging inner Bagua acupoints combined with kneading Banmen acupoint,spine,pushing Sihengwen acupoint.Studies have shown that massage can improve symptom score,appetite and appetite score.However,the subjective perception indicators such as anxiety and abdominal distension did not improve significantly[30].

Conclusion

This article preliminarily summarized the application status of inner Bagua acupoints in pediatric massage.Inner Bagua acupoints are the commonly used acupoints in pediatric massage,which has a unique curative effect on many diseases of digestive and respiratory system in children.