Application of traditional Chinese medicine integrated therapy based on Tuina and herbal medicine in pediatric diarrhea

Abstract

This review examines the distinct mechanisms of Tuina massage and topical herbal medicine in pediatric diarrhea management, focusing on their independent regulation of gastrointestinal metabolism and barrier function. Tuina therapy primarily enhances gastrointestinal motility through the stimulation of targeted acupoints such as Tianshu (ST25) and Shenque (CV8), activating vagal efferent pathways to normalize motility hormones including motilin while suppressing pro-inflammatory cytokines such interleukin-6 and tumor necrosis factor-alpha. It further reinforces mucosal defense by inhibiting mast cell degranulation and augmenting microcirculation via nitric oxide-mediated vasodilation. Herbal medicine containing bioactive compounds from Atractylodes macrocephala and Poria cocos directly restores intestinal barrier integrity by upregulating tight junction proteins occludin and zonula occludens-1, inhibiting epithelial apoptosis, and stimulating MUC2 production. These formulations additionally reprogram enterocyte metabolism by reactivating mitochondrial tricarboxylic acid cycle flux and modulating short-chain fatty acid profiles, with the independent prebiotic effects enhancing commensal butyrate production. Tuina primarily modulates neuroimmune pathways and motility, and herbal medicine directly targets epithelial repair and metabolism. These therapeutic pathways may address core diarrhea pathophysiology, providing holistic complementary therapies. Standardized protocols and interdisciplinary research are urgently needed for clinical translation.

Keywords: Pediatric; Diarrhea; Traditional Chinese medicine; Tuina; Herbal medicine

Core Tip: This review elucidates the distinct mechanisms by which integrated traditional Chinese medicine therapies Tuina massage and topical herbal medicine ameliorate pediatric diarrhea. We highlight that Tuina primarily modulates neuro-immune pathways to regulate motility and inflammation, while herbal applications directly restore intestinal barrier integrity and reprogram enterocyte metabolism. Crucially, this work synthesizes evidence for their synergistic action in repairing the gut barrier, a core pathophysiological defect, providing a mechanistic foundation for non-pharmacological, holistic complementary strategies in children.