Abstract
Background
Pneumonia impairs lung development, structure, and function during children’s critical growth stages. Traditional Chinese Medicine (TCM) boosts constitution, yet the efficacy of TCM meridian massage for post-pneumonia lung function improvement remains unclear. This study investigates its role as an adjuvant therapy for lung function recovery in post-discharge children with Mycoplasma pneumoniae pneumonia (MMP).
Methods
Sixty-four MMP children with abnormal lung function at discharge (Jan 2023–Dec 2024) were randomized to treatment (n = 32) or control (n = 32) groups. The treatment group received meridian massage (3 sessions/week for 1 month) with three acupoint categories: lung-ventilating/cough-relieving (Feishu BL13, Danzhong CV17), phlegm-resolving (Tiantu CV22, Fenglong ST40), and spleen-lung-nourishing (Zusanli ST36, Pishu BL20). The control group only underwent lung function re-evaluation 1 month post-discharge. Data were analyzed via Prism® 10.0.
Results
Twenty-five treatment and 31 control patients completed follow-up finally. Baseline mixed-type lung function abnormalities and key parameters (e.g., FVC, FEV1) were comparable (p ≥ 0.05). At 1month post-discharge, recovery rates were 88.8% (22/25) vs. 41.9% (13/31) in the two groups, respectively. The treatment group showed superior improvements in large (FVC, FEV1, PEF) and small (MEF25, MEF50, MEF75, MMEF) airway parameters (p < 0.05), with no difference in FEV1/FVC (p > 0.05).
Conclusions
Meridian massage safely and effectively promotes lung function recovery in post-MMP children through anti-inflammatory immune modulation and meridian-zang-fu regulation. It provides a novel therapeutic option for post-pneumonia lung dysfunction and evidence-based support for preventing long-term pulmonary sequelae.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12887-026-06605-z.
Keywords: Childhood pneumonia, Meridian massage, Lung function, Mycoplasma pneumoniae pneumonia, Clinical study
Introduction
Pediatric pneumonia, predominantly bronchopneumonia, is a common respiratory disorder that impairs lung development, structure, and function during critical growth stages [1, 2]. Children’s lung function correlates closely with adult lung function, future cardiorespiratory disease burden, and all-cause mortality risk [3], making lung function-improving interventions clinically significant. While most cases are manageable, our prior study found 40.6% of pneumonia children had airway dysfunction 1-week post-discharge, linked to pathogens (especially syncytial virus (RSV)) [4], necessitating post-discharge lung function monitoring. Given the global burden of early childhood pneumonia and the long-term significance of lung function, understanding pneumonia’s impact on lung development is crucial. Currently, Western medical interventions for persistent post-pneumonia lung function abnormalities in children are understudied.
In Traditional Chinese Medicine (TCM), children feature immature zang-fu organs, inadequate constitutional qi, and poor pathogen resistance, making them highly susceptible to exogenous pathogens that primarily target the vulnerable lung upon invading through the mouth, nose, skin, or hair follicles. TCM holds that pediatric pneumonia stems from insufficient lung-spleen qi impairing defensive capacity; subsequent exogenous pathogen invasion disrupts the lung’s dispersion and descent functions, leading to phlegm-heat obstruction in the lung [5, 6]. TCM has unique advantages in enhancing physical constitution. As a conventional, clinically validated therapy for common pediatric diseases, TCM meridian massage also achieves notable results in pediatric healthcare and disease prevention, gaining wide parental acceptance. As a non-invasive external therapy integrating TCM meridian massage theory with tactile stimulation, it targets meridians (key pathways for regulating qi and blood) via precise acupoint manipulations (pressing, kneading, pushing). It avoids drug-induced side effects, regulates zang-fu functions, and shows promising potential for treating respiratory diseases [7, 8]. The primary objective of this study is to explore the clinical effectiveness of TCM meridian massage as a complementary treatment for facilitating lung function restoration in MMP children exhibiting respiratory impairment at discharge, providing evidence-based support for its clinical application in improving post-pneumonia lung function abnormalities in children.
Methods
Patients
A sum of 92 children suffering from pneumonia and airway disorders were admitted to the Department of Pediatrics of the first author’s institution between January 2023 and December 2024, among whom 64 were diagnosed with MMP and all met the diagnostic criteria for bronchiolitis [9]. The Ethics Committee of the primary author’s institution granted approval for this study. Subjects were randomly assigned by means of a computer-produced random number table, and a single-blind design was adopted after guardians received a full explanation and provided written informed consent.
Inclusion criteria
1)All children were hospitalized with pneumonia, and etiological examination confirmed MMP infection; 2) Lung function tests at discharge indicated abnormal results; 3) Children in the treatment group attended regular outpatient follow-up, received meridian massage therapy three times a week, and underwent re-evaluation of lung function one month later.
Exclusion criteria
1)Persistent acute respiratory infection symptoms after discharge; 2) Recurrence of respiratory infection post-discharge; 3) Related complications, namely asthma, bronchiectasis, and congenital airway or lung dysplasia;4) Rejection of study participation or failure to complete the required lung function tests.
Grouping
64 consecutive cases with abnormal lung function were enrolled as study subjects. A total of 64 patients were randomized into two groups of 32-treatment and control, whereby the treatment group received meridian massage three times a week after discharge and underwent re-evaluation of lung function at the end of the month post-discharge, and the control group only underwent re-evaluation of lung function one month later. The detailed study protocol is illustrated in Fig. 1.
Fig. 1.
Study Flowchart
Treatment
Meridian massage was performed individually by Drs. Z.L. and M.S.L., who received standardized long-term training prior to the study, in accordance with the outpatient schedule, and the therapist has the qualification for TCM treatment.
Specific meridian massage procedures for the treatment group were standardized as follows:
1. Lung-Ventilating & Cough-Relieving
Aim: Unblock lung meridian qi and alleviate dry or paroxysmal residual cough.
Feishu (BL13): Gently press and knead with the pulps of the thumb, index, and middle fingers for 1–2 min (until slight skin redness appears, without causing the child to cry).
Danzhong (CV17): Clockwise knead with the palm root or finger pulps for 1–2 min, or push toward the nipples 50–100 times with a consistent force.
Efficacy: Soothe the chest, regulate qi movement, relieve cough, resolve phlegm, and alleviate chest tightness.
2. Phlegm-Resolving & Respiratory-Clearing
Aim: Loosen thick phlegm, promote its excretion, and reduce residual lung secretions.
Tiantu (CV22): Ultra-gently press and knead with the middle finger pulp for 30–50 s, or push downward 1–2 horizontal fingers from the suprasternal fossa 30 times (strictly avoiding tracheal compression).
Fenglong (ST40): Press and knead with the thumb pulp for 1–2 min at an intensity tolerable to the child.
Efficacy: Regulate qi, resolve phlegm, and promote expectoration; Fenglong (a key phlegm-resolving acupoint) reduces phlegm production by regulating spleen-stomach (transportation and transformation) function.
3. Spleen-Lung-Nourishing & Constitution-Enhancing
Aim: Improve weak spleen-stomach function, nourish lung qi, enhance immune resistance, and prevent disease recurrence.
Zusanli (ST36): Bilaterally press and knead with the thumb pulp for 1–2 min (until slight soreness is felt; skin redness is acceptable for infants).
Pishu (BL20): Gently press and knead with the pulps of the thumb, index, and middle fingers for 1–2 min with uniform pressure.
Efficacy: Invigorate the spleen and stomach, replenish qi, improve appetite and fatigue; enhance lung defense function, reduce the source of phlegm production, and promote nutrient absorption to facilitate lung tissue recovery.
Data collection
In accordance with the guidelines of the European Respiratory Society/American Thoracic Society, children over 6 years old received pulmonary ventilation function testing [10]. Lung function parameters were categorized based on their percentage of predicted values. Normal lung function was characterized by Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 s (FEV1), and Peak Expiratory Flow (PEF) values of ≥ 80%, as well as an FEV1/FVC ratio > 80%. Similarly, Mid-expiratory Flow (MEF), FEF50, and FEF75 were regarded as normal if they exceeded 65%. Large Airway Disorder (LAD) was identified by an FEV1/FVC ratio < 0.80, whereas Small Airway Dysfunction (SAD) was confirmed when at least two of the following indices (FEF25, FEF50, FEF75) fell below 65%. Patients exhibiting either LAD or SAD were classified as having Airway Disorder (AD). Baseline measurements were established using lung function data obtained at discharge, and all results are expressed as the ratio of measured to predicted values.
During hospitalization, chest radiological examinations were performed to identify lobar consolidation, pleural fluid accumulation, and additional pathological findings. Microbiological tests were conducted to detect pathogens, including the utilization of multiplex PCR to screen for 22 prevalent respiratory pathogens in pharyngeal swabs, sputum, and blood cultures, complemented by serological assays and pathogen identification in bronchoalveolar lavage fluid (BALF). A patient was considered infected with a specific pathogen if pharyngeal swab PCR or sputum culture was positive for that pathogen during hospitalization, accompanied by acute respiratory infection symptoms. Patients were considered to have no pulmonary complications in the absence of hypoxemia, pulmonary consolidation, or atelectasis during the inpatient stay due to respiratory infection.
Statistical analyses
Statistical analyses and graphical representation were conducted utilizing Prism® 10.0 software (GraphPad, USA). Continuous variables were presented as mean ± standard deviation (x ± s) and analyzed via independent samples t-tests, whereas categorical data were reported as frequencies (%) and compared using chi-square (χ²) tests. Statistical significance was defined as a p-value < 0.05.
Results
Baseline characteristics
Ultimately, 25 cases in the treatment group completed all treatments and follow-up lung function tests, including 14 males and 11 females, with an average age of 8.44 ± 1.47 years (range: 6–11 years). 31 cases completing follow-up (17 males and 14 females, mean age: 8.26 ± 1.48 years, range: 6–11 years) in the control group. Baseline demographics, including age, gender, and other characteristics, were well-balanced between the two groups (p > 0.05), confirming their comparability. Five patients in the treatment group experienced mild skin irritation during massage, which resolved spontaneously after adjustments to the massage technique (e.g., reducing pressure and optimizing manipulation frequency).
Baseline lung function
The final analysis comprised 56 pediatric patients diagnosed with MMP. Baseline lung function tests at discharge showed that all patients had airway abnormalities. Among the 31 cases in the control group, only 3 (9.7%, 3/31) had normal large airway function, with the remainder exhibiting small airway dysfunction, consistent with mixed-type airway abnormalities. In the treatment group, 2 (8.0%, 2/25) had normal large airway function, while all others had small airway dysfunction. There were no significant differences in baseline pulmonary function indices (FVC, FEV1, FEV1/FVC, PEF, MEF25, MEF50, MEF75, and MMEF (75/25)) between the two cohorts (p ≥ 0.05) (the data not shown).
Lung function changes at one month after discharge
One month after discharge, 13 cases (41.9%, 13/31) in the control group had recovered from abnormal lung function, compared with 22 cases (88.8%, 22/25) in the treatment group. Recovery rates differed significantly between the two groups (χ² = 14.68, p < 0.001).
Regarding large airway function, the treatment group exhibited significantly higher values for FVC, FEV1, and PEF compared to the control group (p < 0.05). However, no statistically significant difference was observed in the FEV1/FVC ratio between the cohorts (p > 0.05) (ΔLF%: FVC t(df=54) = 2.996, p = 0.004; FEV1 t(df=54) = 3.047, p = 0.004; FEV1/FVC t(df=54) = 1.227, p = 0.225; PEF t(df=54) = 2.728, p = 0.009) (Fig. 3; Table 1).
Fig. 3.
Violin Plots of Small Airway Lung Function Parameters in the Treatment and Control Groups One Month After Discharge. Note: Violin plots showing the distribution of small airway function parameters (MEF25, MEF50, MEF75, MMEF (75/25)) in the two groups. The width of each violin represents the density of data points at that value. p < 0.05 indicates a statistically significant difference between groups
Table 1.
Comparison of the parameters of lung function between the two group at the end of the first month
| Parameters (%) |
Control group n = 31 |
Treatment group n = 25 |
P value |
|---|---|---|---|
| FVC | 78.10 ± 11.83 | 86.72 ± 9.12 | 0.004 |
| FEV1 | 76.27 ± 11.82 | 86.56 ± 13.42 | 0.004 |
| FEV1/FVC | 94.67 ± 7.43 | 97.46 ± 10.20 | 0.225 |
| PEF | 74.78 ± 13.81 | 83.80 ± 10.09 | 0.009 |
| MEF25 | 60.32 ± 11.27 | 67.99 ± 12.52 | 0.019 |
| MEF50 | 63.16 ± 12.71 | 71.63 ± 7.20 | 0.005 |
| MEF75 | 66.22 ± 11.31 | 72.76 ± 12.56 | 0.046 |
| MMEF (75/25) | 63.71 ± 13.36 | 72.63 ± 12.72 | 0.014 |
FVC forced vital capacity, FEV1 forced expiratory volume in 1 s, PEF peak expiratory flow, MEF mid-expiratory flow, MMEF maximal mid-expiratory flow. Continuous variables are expressed as mean ± standard deviation (SD), while categorical data are presented as frequencies (ranges). Statistical significance was set at p < 0.05
Fig. 2.
Violin Plots of Large Airway Lung Function Parameters in the Treatment and Control Groups One Month After Discharge. Note: Violin plots showing the distribution of large airway function parameters (FVC, FEV1, FEV1/FVC, PEF) in the two groups. The width of each violin represents the density of data points at that value. p < 0.05 indicates a statistically significant difference between groups
For small airway function parameters, ΔLF% differed significantly between the two groups (p < 0.05) (MEF25 t(df=54) = 2.409, p = 0.019; MEF50 t(df=54) = 2.965, p = 0.005; MEF75 t(df=54) = 2.047, p = 0.046; MMEF (75/25) t(df=54) = 2.537, p = 0.014) (Fig. 3; Table 1).
Discussion
Children’s respiratory systems are immature at birth, with lung gas exchange surface area, volume, and alveolar structure continuing to develop until early adulthood, confirmed by animal studies [11]. Childhood pneumonia impacts lung structure and function during this critical period, being a well-recognized an increased risk of adult chronic obstructive pulmonary disease (COPD) [12]. Evidence indicates that severe pneumonia or infection with specific pathogens significantly increases the risk of persistent airway dysfunction [13, 14]. Abnormal lung function induced by pneumonia can persist from childhood to adulthood, typically manifesting as decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) [13, 15]. However, there is a relative scarcity of research on changes in small airway function following pneumonia [16]. Our previous multi-center study found 40.6% of pneumonia children had airway abnormalities one-week post-discharge, closely linked to pathogens (especially RSV) [4], but follow-up limitations prevented evaluating long-term lung function impacts.
As a prominent etiological agent of childhood community-acquired pneumonia, Mycoplasma pneumoniae pneumonia (MMP) contributes to 10%-20% of such infections. It occurs year-round, threatening children’s health, with incidence unrelated to gender but peaking among preschoolers and school-age children (5-year-olds and above have a 50% infection rate) [12]. Though usually self-limiting, conventional treatment may leave recurrent or persistent lung lesions (mosaic sign, bronchiectasis on imaging) [17], leading to recurrent infections, long-term adult lung function impairment, and asthma association [18]. MMP progression is tied to immune responses (especially innate immunity ) [19], with immune-mediated inflammation as the primary lung injury mechanism in some children [20].
In modern clinical practice, macrolide antibiotics (e.g., azithromycin) are first-line for MMP, with proven efficacy. However, azithromycin has gastrointestinal and hepatotoxic side effects precluding long-term use, with prolonged courses and slow symptom improvement [21]. Novel alternatives are being explored, with TCM injections emerging as a research focus [22, 23]. Prepared via modern extraction of Chinese medicinal herbs, they offer rapid onset and high bioavailability [14]. Shenfu Injection (SFI), composed of aconitine-type alkaloids and ginsenosides [24], has warming yang and qi-benefiting effects [25]. A study showed SFI combined with azithromycin may offset monotherapy shortcomings, improving immunity, reducing inflammation, enhancing efficacy, and shortening courses [26].
In the present study, baseline lung function tests at discharge revealed that nearly all children with MMP had mixed-type lung function abnormalities, with very few exhibiting isolated large or small airway dysfunction. Currently, there are no published studies specifically focusing on interventions to improve pathogen-induced post-pneumonia airway dysfunction. After one month of standardized meridian massage, 88.8% (22/25) of the treatment group recovered from abnormal lung function, compared with only 41.9% (13/31) of the control group, indicating that meridian massage exerts a definite and significant therapeutic effect on lung function recovery in children after MMP.
In TCM theory, pediatric pneumonia falls under “feiyan” (pneumonia with dyspnea and cough), where fluid retention transforms into phlegm via heat or cold pathogens. Clinical TCM treatment focuses on ventilating the lung to relieve asthma, clearing heat, and resolving phlegm, but young children have poor compliance with oral preparations and suboptimal nebulized therapy efficacy due to inadequate cooperation. Thus, therapies with good compliance and proven efficacy are urgently needed. Meridian regulation [27] based on TCM theory and children’s physiological status, takes meridian massage as the core intervention. Applying standardized pediatric massage techniques to specific meridians aims to “replenish deficiencies, reduce excesses, and regulate imbalance,” enhancing constitution and facilitating recovery.
Pediatric meridian massage is a characteristic TCM external therapy. Guided by zang-fu and meridian theory, it stimulates acupoints and meridians via standardized techniques to dredge meridians, promote qi and blood circulation, and enhance pathogen resistance. Tang Dynasty’s “King of Medicine” Sun Simiao first advocated it for pediatric health, as recorded in Qianjin Yaofang: “Even if a child is not ill, massage the fontanel, palms, and soles with ointment daily to prevent wind and cold”—reflecting TCM’s “preventing disease before its onset” concept. Proven effective for various pediatric diseases, it leverages children’s delicate skin sensitivity to tactile stimulation, enabling signal transmission to zang-fu organs to modify pathological states [28]. Animal experiments show the “chest and back pushing method” alleviates cough and nose rubbing in rats, regulating the IL-4/STAT6 pathway to reduce IL-4, inhibit STAT6 phosphorylation, shift Th1/Th2 balance, and improve airway immune homeostasis [29]; chiropractic reduces allergic airway inflammation in immature rats, optimizes gut microbiota, and enhances immune tolerance [30]. Clinical trials demonstrate massage increases TLR1/TLR2 and decreases TLR4 in macrophages, improving immune regulation [31], while tuina and spine-kneading boost children’s overall immunity [31, 32].
The present study confirms meridian massage, as an adjuvant therapy for post-pneumonia abnormal lung function in children, significantly improves lung function. Potential mechanisms include: (1) Anti-inflammatory and immune regulation: Reducing serum pro-inflammatory cytokines (IL-6, CRP, TNF-α) to inhibit excessive inflammation [8], regulating T cell subset balance, enhancing mucosal immunity, and lowering respiratory infection incidence [27]. (2) Meridian and zang-fu regulation: Stimulating lung-spleen meridians achieves “ventilating the lung to relieve asthma and invigorating the spleen to resolve phlegm” [7],—e.g., clearing the lung meridian eliminates lung heat, while spine-kneading dredges Du (abdomen)/Bladder meridians to enhance lung-spleen function [7]. (3) Safety and compliance: Free of drug adverse reactions, well-tolerated, and easier to administer than oral TCM preparations, suiting infants [7]. (4) Direct physical stimulation: Massage techniques promote thoracic expansion and contraction, improving lung ventilation.
Several limitations of this study warrant consideration. First, the sample size was modest. Second, single-center data collection may introduce selection bias. Third, the follow-up period is relatively short, precluding assessment of the long-term prognosis of lung function after MMP and the sustained effects of meridian massage.
Conclusions
Our findings demonstrate that 88.8% of children with MMP achieved lung function recovery after one month of adjuvant meridian massage therapy. This provides a novel therapeutic method and theoretical insight for managing post-MMP abnormal lung function in children, crucial for evidence-based strategies to prevent or reduce long-term pulmonary sequelae in pneumonia-recovered children. Future research should conduct large-scale, multi-center randomized controlled trials with long-term follow-up to validate TCM meridian massage’s sustained efficacy, and explore its role in preventing post-MMP long-term pulmonary sequelae.
Supplementary Information
Acknowledgements
Not applicable.
Authors’ contributions
Z.L. and M.S.L. conceptualized the study, drafted the manuscript, and performed the meridian massage intervention. Z.B., L.Z.W., X.J., and D.J.S. analyzed the data. All authors contributed to the critical revision of the manuscript and approved the final version.
Funding
This research was supported by the Training Program for Senior Inherited Talents of Traditional Chinese Medicine (Grant No.: PDZY-2024-1214).
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study protocol was approved by the Ethics Committee of Pudong New Area People’s Hospital of Shanghai (Approval No.: 2025-LW-18).
Consent for publication
All authors have read and agreed to the published version of the manuscript.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.