灸神闕穴可提高針刺治療腹瀉型腸易激綜合征的療效

1、J. Acupunct. Tuina. Sci. 2014, 12 (6: 362-365 DOI: 10.1007/s11726-014-0806-6CLINICAL STUDYMoxibustion on Shenque (CV 8 Improves Effect of Acupuncture for Diarrhea-predominantIrritable Bowel SyndromeLiu Xiao-xiaAcupuncture Department of Kunshan Bacheng Peoples Hospital, Jiangsu 215311, ChinaAuthor: L

2、iu Xiao-xia, attending physician.E-mail: jingyue8698 CLC Number: R246.1Document Code: AAbstractObjective: To observe the clinical effect of acupuncture and moxibustion on diarrhea-predominant irritable bowel syndrome (IBS-D.Methods: A total of 60 IBS-D patients were randomly allocated into a treatme

3、nt group and a control group, 30 in each group. Patients in the treatment group were treated with acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8, whereas patients in the control group only received acupuncture treatment. Six days made up a course of treatment, and

4、 the clinical effects were statistically analyzed after 4 courses.Results: The overall response rate in the treatment group was 96.7%, versus 76.7% in the control group, showing a statistical significance (P<0.05. In the intra-group comparison of the symptom scores after treatment, there were sta

5、tistical differences in both groups (both P<0.01, and in the inter-group comparison, the difference was statistically significant (P<0.05.Conclusion: Acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8 can obtain better effect for ISB-D than acupuncture alone.Key

6、 WordsAcupuncture Therapy; Acupuncture-moxibustion Therapy; Indirect Moxibustion; Diarrhea; Irritable Bowel SyndromeIrritable bowel syndrome (IBS is a functional gastrointestinal disorder and associated with abnormal intestinal motility and abnormalities in the gastrointestinal nervous system. With

7、its high incidence, persistent/ intermittent IBS can greatly affect patients work and quality of life. Clinically IBS can be classified as diarrhea predominant (IBS-D, constipation predominant (IBS-C, or with alternating stool pattern (IBS-A. The IBS-D is more common than the other two types. Over t

8、he recent years, weve treated IBS-D with acupuncture plus ginger and salt-partitioned moxibustion. The results are now summarized as follows.1 Clinical Materials1.1 Diagnostic criteria1.1.1 Diagnosis in Western medicineIBS can be diagnosed according to the Rome II criteria1: at least 12 weeks (unnec

9、essarily consecutive in the preceding 12 months, of灸神闕穴可提高針刺治療腹瀉型腸易激綜合征的療效柳曉霞昆山市巴城人民醫(yī)院針灸科,江蘇215311,中國(guó)【摘要】目的:觀察針灸治療腹瀉型腸易激綜合征(irritable bowel syndrome, IBS的臨床療效。方法:將60例腹瀉型IBS患者隨機(jī)分為治療組和對(duì)照組,每組30例。治療組采用針刺配合隔姜隔鹽灸神闕治療,對(duì)照組僅采用與治療組相同的針刺治療。6天為1個(gè)療程,共治療4個(gè)療程后觀察臨床療效。結(jié)果:治療組總有效率為96.7%,對(duì)照組為76.7%,兩組差異具有統(tǒng)計(jì)學(xué)意義(P<0.05

10、;治療后,治療組各項(xiàng)癥狀評(píng)分與治療前有統(tǒng)計(jì)學(xué)差異(均P<0.01,與對(duì)照組亦有統(tǒng)計(jì)學(xué)差異(均P< 0.05。結(jié)論:針刺配合隔姜隔鹽灸神闕治療腹瀉型IBS療效優(yōu)于單純針刺治療?！娟P(guān)鍵詞】針刺療法;針灸療法;間接灸;腹瀉;腸易激綜合征腸易激綜合征(irritable bowel syndrome, IBS是一組胃腸功能紊亂綜合征,它與腸道動(dòng)力學(xué)異常及內(nèi)臟感受異常有關(guān)。該病發(fā)病率高,可持續(xù)或間歇發(fā)作,嚴(yán)重影響了患者的工作和生活質(zhì)量。臨床上將IBS分為3型,即腹瀉型、便秘型和交替型(腹瀉和便秘交替,其中腹瀉型最為多見。筆者近年來采取針刺配合隔姜隔鹽灸治療腹瀉型腸易激綜合征,現(xiàn)總結(jié)報(bào)告如下。

11、1 臨床資料1.1診斷標(biāo)準(zhǔn)1.1.1 西醫(yī)診斷標(biāo)準(zhǔn)根據(jù)IBS的羅馬診斷標(biāo)準(zhǔn)1。在12個(gè)月內(nèi)至少有12星期(不必是連續(xù)的的腹部不適或腹痛,并具有如下癥狀中的2項(xiàng)或2項(xiàng)以上:排便后緩解;癥狀發(fā)作時(shí)大便頻率異常;癥狀發(fā)作時(shí)大便性狀異常(硬便,稀或水樣便。腹泄型IBS還應(yīng)同時(shí)具備以下癥狀中的至少一項(xiàng):排便每日多于3次;松散(糊狀或水樣 便;大便急迫感。1.1.2 中醫(yī)診斷標(biāo)準(zhǔn)參照腸易激綜合征中西醫(yī)結(jié)合診治方案中IBS的診斷依據(jù)2,將IBS分為三種類型。肝郁脾虛型:主癥為腹痛即瀉,瀉后痛減(常因情緒波動(dòng)而發(fā)作,少腹拘急。次癥為腸鳴矢氣,便下黏液,情志抑郁,善太息,急躁易怒,納呆腹脹,舌苔薄白,脈弦。脾胃

12、虛弱型:主癥為餐后即瀉,大便時(shí)溏時(shí)泄,夾帶黏液;食少納差;食后腹脹,脘悶不舒。次癥為腹部隱痛,喜按,腹脹腸鳴,神疲懶言,肢倦乏力,面色萎黃;舌質(zhì)淡,舌體胖有齒痕,苔白,脈細(xì)弱。脾腎陽(yáng)虛型:主癥為晨起腹瀉,完谷不化;腹部冷痛。次癥為形寒肢冷,腰膝酸軟,舌淡胖,苔白滑,脈沉細(xì)。1.2納入標(biāo)準(zhǔn)符合上述中西醫(yī)診斷標(biāo)準(zhǔn);病程6個(gè)月以上;年齡1865歲;獲得知情同意并排除其他病變。1.3排除標(biāo)準(zhǔn)具有腸道器質(zhì)性病變者;同時(shí)使用藥物治療可能影響結(jié)果判定者;合并有心腦血管、肝、腎和造血系統(tǒng)等嚴(yán)重的器質(zhì)性原發(fā)性疾病以及精神病患者;妊娠或哺乳期患者;未按要求治療或中途放棄治療者。1.4 統(tǒng)計(jì)方法數(shù)據(jù)處理和統(tǒng)計(jì)分析使

13、用SPSS13.0軟件,計(jì)量資料均以均數(shù)±標(biāo)準(zhǔn)差(x±s表示,組間比較及自身對(duì)照用t檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn)。P<0.05為差異有統(tǒng)計(jì)學(xué)意義。1.5 一般資料共納入60例患者,均為昆山市巴城人民醫(yī)院針灸科2009年7月至2013年7月的門診患者。全部病人均經(jīng)過大便常規(guī)、真菌涂片、結(jié)腸鏡檢查均未見異常,完全排除腸道器質(zhì)性病變。將60例患者按就診順序隨機(jī)分為治療組和對(duì)照組,每組30例。兩組患者的年齡、性別、病程比較,差異均無統(tǒng)計(jì)學(xué)意義(P>0.05,說明兩組具有可比性(表1。表1. 兩組患者一般資料比較組別n性別(例數(shù) 平均年齡(x±s, 歲平均病程(x

14、±s, 月男女治療組30 8 22 49.7±5.0 85.2±2.4 對(duì)照組30 11 19 51.0±5.0 86.7±2.62 治療方法2.1 治療組2.1.1針刺主穴:中脘(CV 12,天樞(雙(ST 25,關(guān)元(CV 4,足三里(雙(ST 36,上巨虛(雙(ST 37,脾俞(雙(BL 20,大腸俞(雙(BL 25。配穴:脾胃虛弱者加胃俞(BL 21;肝郁脾虛者加肝俞(BL 18、行間(LR 2;脾腎陽(yáng)虛者加腎俞(BL 23。操作:囑患者俯臥位,針刺脾俞(BL 20、大腸俞(BL 25、胃俞(BL 21、肝俞(BL 18、腎俞(BL 2

15、3,得氣后起針,不留針。再囑患者仰臥位,直刺余穴11.5寸,施捻轉(zhuǎn)提插補(bǔ)瀉法,平補(bǔ)平瀉,以局部感覺酸脹麻或(和肢體部穴位向腹部放射為度;得氣后每隔10 min行針1次,留針30 min。同時(shí)加TDP腹部照射。2.1.2 灸法穴位:神闕(CV 8。操作:患者仰臥位。醫(yī)者將食用鹽填滿患者肚臍,把生姜切成厚度為0.7-0.8 cm的片,要求其最小直徑不小于4 cm。用牙簽在姜片上戳數(shù)個(gè)小孔,將艾絨捏成底面直徑約3 cm、高約3 cm 的圓錐體,置于姜片之上,再將姜片和艾絨置于填滿食鹽的神闕穴上,點(diǎn)燃艾絨,待其全部燃盡后更換,連續(xù)灸2壯。每日針灸治療1次,6次為1個(gè)療程,療程間休息1 d,共治療4個(gè)療

16、程。2.2 對(duì)照組對(duì)照組患者僅予與治療組相同的針刺治療,取穴、操作方法及療程均與治療組相同。針刺后用TDP腹部照射。治療期間兩組病例均禁用影響胃腸功能的藥物,并囑患者注意調(diào)暢精神,保持情緒穩(wěn)定,避免進(jìn)食刺激性食物。治療結(jié)束后進(jìn)行療效統(tǒng)計(jì)。3 療效觀察3.1 觀察指標(biāo)根據(jù)相關(guān)文獻(xiàn)對(duì)腹痛、腹瀉等癥狀進(jìn)行分級(jí)評(píng)分3。0分:無癥狀。1分:癥狀輕微,對(duì)日常生活無影響。2分:癥狀較重,對(duì)日常生活有一定程度影響。3分:癥狀嚴(yán)重,不能從事日?；顒?dòng)。3.2 療效評(píng)定標(biāo)準(zhǔn)顯效:臨床癥狀消失,大便次數(shù)正常,性狀正常,觀察3個(gè)月無復(fù)發(fā)。有效:癥狀基本消失,3個(gè)月內(nèi)有復(fù)發(fā),但程度和癥狀較治療前明顯減輕。無效:癥狀無明顯

17、改善。3.3 治療結(jié)果3.3.1 臨床療效比較兩組總有效率差異有統(tǒng)計(jì)學(xué)意義(P<0.05,提示治療組療效優(yōu)于對(duì)照組(表2。表2. 兩組臨床療效比較(例數(shù)組別n 顯效有效無效總有效率(%治療組30 20 9 1 96.71對(duì)照組30 11 12 7 76.7注:與對(duì)照組比較,1P<0.053.3.2臨床癥狀積分比較治療后,兩組患者癥狀評(píng)分均與本組治療前有統(tǒng)計(jì)學(xué)差異(P<0.01;組間癥狀評(píng)分亦有統(tǒng)計(jì)學(xué)差異(P<0.05。說明兩組患者癥狀均有改善,但治療組患者改善情況優(yōu)于對(duì)照組(表3。表3. 兩組治療前后癥狀評(píng)分變化比較(x±s, 分組別n 時(shí)間腹痛腹瀉大便性狀異

18、常比率日排便次數(shù)治療組30治療前 1.30±0.37 1.03±0.29 0.67±0.15 4.52±1.33治療后0.58±0.19120.56±0.26120.22±0.0812 1.77±0.5212對(duì)照組30治療前 1.33±0.35 1.09±0.35 0.65±0.16 4.76±1.27治療后0.82±0.2610.70±0.2510.44±0.081 2.43±0.561注:與本組治療前比較,1 P<0.01;與

19、對(duì)照組治療后比較,2 P<0.054 討論IBS病因和發(fā)病機(jī)制復(fù)雜,迄今為止尚不完全清楚。研究認(rèn)為IBS的致病原因可能不局限于消化道本身,其與腦-腸軸神經(jīng)系統(tǒng)調(diào)控紊亂具有關(guān)聯(lián)性中文翻譯稿4。據(jù)相關(guān)報(bào)道,患者內(nèi)分泌失調(diào)、胃腸道菌群失調(diào)、消化吸收不良、患者精神緊張等都會(huì)引發(fā)或者加重胃腸方面的癥狀5?，F(xiàn)代醫(yī)學(xué)對(duì)本病尚缺乏比較科學(xué)有效的藥物及治療方法。針刺療法是通過腧穴配伍和針刺手法使刺激信號(hào)通過穴位、經(jīng)絡(luò)傳導(dǎo)途徑對(duì)機(jī)體生理功能起雙向良性調(diào)節(jié)作用,使失常的腸管運(yùn)動(dòng)機(jī)能恢復(fù)正常,達(dá)到治療疾病的目的6。有學(xué)者發(fā)現(xiàn)針刺對(duì)胃腸激素如胃泌素、胃動(dòng)素有明顯的調(diào)節(jié)作用7-8。研究認(rèn)為針灸治療IBS不僅可以緩解患者的腹痛、腹脹和大便性狀改變等臨床癥狀和體征,且能降低其內(nèi)臟高敏感性9-10。腹瀉型IBS屬于中醫(yī)學(xué)“泄瀉”范疇,根據(jù)腹瀉