针药结合耳穴贴压治疗肝肾阴虚型小儿多动症的临床研究
|
摘要
目的：
本课题采用临床科研方法学,进行随机对照研究,以针药结合耳穴贴压和中西药结合治疗为对照,观察针药结合耳穴贴压治疗肝肾阴虚型多动症患儿的临床疗效,旨在探讨针药结合耳穴贴压、中西药结合两种疗法治疗肝肾阴虚型多动症患儿的临床疗效的差异及其作用机理,为临床治疗小儿多动症提供依据。
方法：
2011年11月至2013年1月期间台湾明师中医诊所(经临床诊断为儿童多动症且符合纳入病例标准)的患儿63例,男性35例,女性28例。按1：1的比例随机分配至针药结合耳穴贴压组和中西药,其其中32例作为治疗组(针灸中药结合耳穴贴压治疗),31例作为对照组(中西药治疗)。西医诊断标准参照美国精神病学会制定的《精神障碍诊断和统计手册,DSM—IV》第四版,具体诊断标准所制定的有关儿童注意缺陷多动障碍的诊断标准,中医诊断标准采用参照《全国中医学会ADD研究协作组评分量表》制订的“中医虚证辨证参考标准”等有关小儿多动症内容制定肝肾阴虚辨证标准进行诊断。所有符合纳入标准病例按设计要求观察、治疗。疗程两个月。针刺：每周针刺3次,共治疗两个月；耳穴贴压：一周贴压三次,共治疗两个月；中药治疗：周5次,周末停服,共治疗两个月；西药(哌醋甲酯缓释片)：开始每次口服5mg,1日2次,共治疗两个月。疗效观察具体项目包括：全国中医学会ADD研究协作组评分量表》中肝肾阴虚证中医证候评分标准、Achenbach儿童行为量表Conners儿童行为量表、文测验联合型(Combined Raven's Test, CRT)。疗效评定标准主要照《全国中医学会ADD研究协作组评分量表》中中医证候疗效判定标准及《最新国内外疾病诊疗标准》中制定的注意缺陷与多动障碍症状的临床疗效标准及Conners量表的减分率。
数据分析采用统计软件SPSS17.0。计量资料用均数±标准差((?)±S)表示,计数资料用构成比(%)表示；计量资料组间比较采用t检验,自身前后比较用配对t检验或Wilcoxon配对秩和检验。分类资料组间比较采用X2检验,等级资料组间比较采用Ridit分析。假设检验统一使用双侧检验,给出检验统计量及其对应的P值,以P≤0.05有统计学意义,P≤0.01有显著性统计学意义。
结果：
治疗前针药结合耳穴贴压组、中西药组的性别、年龄、年龄构成、病程、中医症状积分、CBCL儿童行为量表总评分、多动指数评分、智力测定(瑞文测验联合型)评分得分经分析均无统计学意义,说明两组之间的临床基线资料具有可比性。疗效观察指标及疗效评定结果总结如下：
①中医症状各项评分
针药结合耳穴贴压组治疗前后各中医症状积分除面色、自汗外,其余各项得分相比较差异有统计学意义(P<0.05),其中在改善肝肾阴虚型多动症患儿多动不宁、学习效率低、少睡多梦及夜惊、手足心热、盗汗方面疗效显著(P<0.01)；中西药组疗前后各中医症状积分相比较,多动不宁、注意力不集中、学习效率低、心悸头晕、口干差异有统计学意义(P<0.05)。
②中医症状总积分
治疗一个疗程后,针药结合耳穴贴压组的中医症状总积分比中西药组得分减少,差异有统计学意义(P<0.05)；两个疗程后,两组之间的肝肾阴虚型中医症状总积分比较仍有统计学意义(P<0.01)。无论在短期疗效还是长期疗效方面,针药结合耳穴贴压对于改善肝肾阴虚型多动症患儿的中医症状的临床效果比中西药治疗更为显著。
③CBCL儿童行为量表评分
治疗一个疗程后,针药结合耳穴贴压组CBCL儿童行为量表评分值比治疗前提高(P<0.05),治疗两个疗程后患儿的行为情况得到明显改善(P<0.01)中西药组方面,治疗一疗程后行为量表评分数值虽有提升,但无统计学差异,治疗两个疗程后患儿的行为情况可得到一定程度的好转(P<0.05)。经两个疗程的治疗后,两组对于改善肝肾阴虚型多动症患儿的CBCL儿童行为量表评分均有一定疗效,但以针药结合耳穴贴压治疗的效果最为显著。
两个疗程治疗后,两组病例在CBCL儿童行为量表的各项社会能力部分比较方面,对于改善肝肾阴虚型多动症患儿的活动情况,针药结合耳穴贴压组比中西药组的得分明显提高,两组差异有显著统计学意义(P<0.01)；社交情况、学校情况方面,两组得分相比较,差异不明显。
④多动指数评分
治疗一疗程后,在改善肝肾阴虚型多动症患儿的多动指数方面,中西药组的多动指数评分虽比针药结合耳穴贴压组有所减少,但差异无统计学意义(P>0.05)。治疗两疗程后,针药结合耳穴贴压组的多动指数明显比中西药组减少,差异具有统计学意义。从远期疗效来看,在改善肝肾阴虚型多动症患儿的多动指数方面,针药结合耳穴贴压治疗比中西药结合治疗效果较佳。
⑤智力测定(瑞文测验联合型)评分
一个疗程的治疗后,针药结合耳穴贴压组、中西药组智力测定(瑞文测验联合型)评分无明显差异(P>0.05)；两个疗程的治疗后,针药结合耳穴贴压组与中西药结合组比较智力情况评分改善幅度较大(P<0.01)。对于改善肝肾阴虚型注意缺陷多动障碍患儿的智力情况方面,短期治疗两种疗法差异不明显,治疗两个疗程后,针药结合耳穴贴压治疗对于改善注意缺陷多动障碍患儿的智力效果比中西药结合治疗效果较佳。
⑥中医证候疗效
针药结合耳穴贴压组临床控制人数4人、占12.50%,显效人数17人、占53.13%,有效人数9人、占28.12%,无效人数2人,占6.25%,总有效人数30人,总效率为93.75%；中西药组临床控制人数1人、占3.23%,显效人数10人、占32.26%,有效人数24人、占45.16%,无效人数6人,占19.35%,总有效人数25人,总效率为80.64%。提示：在改善缺肝肾阴虚型注意缺陷多动障碍患儿的中医证候疗效方面,针药结合耳穴贴压治疗与中西药治疗相比较,临床疗效较佳,能够较好改善注意缺陷多动障碍患儿多动不宁、注意力不集中、少睡多梦、夜惊、心悸头晕、手足心热、口干等中医症候。
⑦注意缺陷与多动障碍症状疗效
针药结合耳穴贴压组痊愈人数3人、占9.375%,显效人数18人、占56.25%,有效人数8人、占25.00%,无效人数3人,占9.375%,总有效人数29人,总效率为90.63%；中西药组痊愈人数2人、占6.45%,显效人数9人、占29.03%,有效人数13人、占41.94%,无效人数7人,占22.58%,总有效人数24人,总效率为77.42%。提示：在改善缺肝肾阴虚型多动症患儿注意缺陷与多动障碍症状疗效方面,针药结合耳穴贴压治疗与中西药治疗相比较,临床疗效较佳。
结论：
本研究旨在探讨针药结合耳穴贴压、中西药结合两种疗法治疗肝肾阴虚型多动症患儿的临床疗效的差异及其作用机理,为临床治疗小儿多动症提供依据。研究结果针药结合耳穴贴压组和中西药组对肝肾阴虚型多动症患儿都有比较显著的疗效,能明显改善患者的临床症状方面,包括肝肾阴虚症状(少睡多梦及夜惊、手足心热、盗汗、口感)、社会活动能力、多动指数、智力等；中西药治疗虽然对于改善患儿的多动指数、社会活动能力、自控力、学习理解能力等方面有一定疗效,但短期治疗效果效果不尽如人意。相比之下,针药结合耳穴贴压疗法在肝肾阴虚型多动症患儿的JCBCL儿童行为量表评分、多动指数评分及中医症候各项症状的等方面较中西药治疗、具有更大的优势。针药结合耳穴贴压治疗小儿多动症,临床疗效显著,远期疗效明显,患者容易接受,是一种有效、便捷、经济、疗效持久、无毒副作用的治疗方法。
Objecti ve
The subject used the clinical research methodology, conducted a randomized controlled study, acupuncture combined with earacupoint application and Chinese herbs, Chinese herbs and western medicine treatment for the control and observation of acupuncture and Chinese herbs combined with auricular acupressure clinical efficacy for the treatment of liver and kidney in children with ADHD to investigate the acupuncture combined with earacupoint application and Chinese herbs, Chinese and Western medicine is a combination of two therapy for liver-kidney in children with ADHD clinical efficacy differences and their mechanism of action, provide the basis for the clinical treatment of children with ADHD.
Methods
The patients were selected from clinic during November2011to January2013.63cases of children with ADHD in Taiwan during the Chinese medicine clinics were clinically diagnosed,35males and28females. The ratio of1:1randomly assigned to acupuncture combined with auricular pressure group and western medicine, of which32cases the treatment group (acupuncture medicine combined with auricular pressure treatment),31cases as the control group (in western medicine). Western diagnostic criteria with reference to the "mental disorders by the American Psychiatric Association Diagnostic and Statistical Manual, the DSM-IV, Fourth Edition, specific diagnostic criteria developed for children with attention deficit hyperactivity disorder diagnostic criteria, TCM diagnostic criteria refer to" National Traditional Chinese Medicine Society ADD study Group Rating Scale "developed" Chinese deficiency syndrome reference standard "of children with ADHD develop liver and kidney syndrome standard for diagnosis. All met the inclusion criteria of cases according to design requirements observed treatment. The total ourse is two months. Acupuncture:acupuncture three times a week, were treated for two months; the auricular acupressure:taping and pressing three times a week, were treated for two months; medicine treatment:5times a week, the weekend stop taking, were treated for two months; western medicine (methylphenidate sustained-release tablets):for each oral5mg,2times a day, were treated for two months. The efficacy of specific projects include:liver kidney yin TCM syndrome scoring criteria in the National Institute of Traditional Chinese Medicine ADD Study Group Rating Scale, Achenbach Children's Behavior Scale Conners Child Behavior Checklist paper tests combined (Combined Raven's Test, CRT). The evaluation standard according to the National Association of Traditional Chinese Medicine the ADD research collaboration group rating scale of TCM syndromes criteria and the latest domestic and foreign disease diagnostic criteria developed with attention deficit hyperactivity disorder symptoms of clinical efficacy standards and Conners amount the table reduction rate.
Data analysis used SPSS17.0software for statistical analysis. Measurement data used in forming the mean±standard deviation (X±S), and the count data used in forming ration (%);measurement data groups were compared using the t-test their own before and after using paired t test or Wilcoxon paired rank sum test. Segment information groups were compared usingχ2test, the Level data sets were compared using analysis Ridit. Hypothesis testing unified use of two-sided test, the test statistic is given and the corresponding P values, to P≤0.05was statistically significant, P≤0.01there is a significant statistical significance.
Results
①hinese medicine symptoms of the score
Acupuncture combined with auricular pressure before and after treatment scores of TCM in addition to looking, spontaneous perspiration, the rest of the score compared difference was statistically significant (P<0.05), which improve liver and kidney in children with attention deficit hyperactivity disorder hyperactivityrestless, learning efficiency is low, less sleep and more dreams and night terrors, dysphoria hot, night sweats side effect is significant (P<0.01); comparison of Chinese and Western medicine group before and after treatment scores of TCM, restless hyperactivity, inattentionlearning efficiency, palpitations, dizziness, dry mouth, the difference was statistically significant (P<0.05).
②CM symptoms total score
After a course of treatment, acupuncture combined with auricular pressure group TCM total symptom score than in western medicine group score be reduced, the difference was statistically significant (P<0.05); between the two groups after two courses, liver-kidneyTCM total symptom score remained statistically significant (P<0.01). Both in terms of short-term efficacy or long-term efficacy of acupuncture combined with auricular acupressure clinical effect of Chinese medicine for improving liver and kidney in children with ADHD symptoms more significant than in western medicine.
③BCL child behavior checklist ratings
A course of treatment, acupuncture combined with auricular pressure group CBCL Child Behavior Checklist scores than before treatment (P<0.05) after two courses of treatment of children with behavior has been significantly improved (P<0.01) in the western medicine groupaspects, although the behavior after a course of treatment scale score value increase, but no significant difference after two courses of treatment of children with behavior some improvement (P<0.05) can be obtained. After two courses of treatment, the two groups for children with ADHD improve liver-kidney CBCL Child Behavior Scale score have a certain effect, but the most significant effect of acupuncture combined with auricular pressure treatment.
Two courses of treatment, the two groups of patients in terms of the social competence section compares the CBCL Child Behavior Checklist for improving the activities of the liver-kidney in children with ADHD, acupuncture combined with auricular the pressure group than in the western medicine group of score significantly improved, the difference was statistically significant (P <0.01); social situation, the school, the two sets of scores compared, no significant difference.
④yperactivity index
After a course of treatment, improve liver and kidney in children with ADHD hyperactivity index In group A, the hyperactivity index score than acupuncture and Chinese herbs combined with auricular pressure group decreased, but the difference was not statistically significant (P>0.05). After two courses of treatment, acupuncture combined with auricular pressure group hyperactivity index was significantly lower than western medicine group, a statistically significant difference. Judging from the long-term efficacy, improve liver and kidney in children with ADHD hyperactivity index, acupuncture combined with auricular acupressure treatment than western medicine combined with a better therapeutic effect.
⑤ntellectual determination
After a course of treatment, acupuncture combined with auricular pressure group in western medicine group intelligence test (Raven joint) score was no significant difference (P>0.05); two courses of treatment, acupuncture combined with auricular pressure grouprating improvement was greater (P<0.01) compared with western medicine group intelligence. For improving liver-kidney attention deficit hyperactivity disorder in children with intellectual obvious differences in short-term treatment of two therapy after two courses of treatment, acupuncture combined with auricular pressure treatment to improve attention deficit hyperactivity disorder intelligence is better than the Chinese and Western medicine combined treatment was better.
⑥he efficacy of TCM syndromes
Acupuncture combined with auricular pressure were clinically number of people, accounting for12.50%, effective number of17, accounting for53.13%, the effective number of nine people, accounting for28.12%, the number of invalid, accounting for6.25%, the total effective number of30people, The total efficiency of93.75%;1in group A clinical control number, accounting for3.23%, markedly less than10persons, accounting for32.26%, the effective number of24people, accounting for45.16%, the number of invalid, accounting for19.35%, the total effective number of25The people, the total efficiency of80.64%. The significant efficiency by Ridit analysis, Z=2.45, statistically significant (P<0.05), acupuncture combined with auricular pressure group TCM syndromes than in western medicine group. Tip:to improve the lack of attention deficit hyperactivity disorder of liver-kidney TCM syndromes, acupuncture combined with auricular pressure treatment compared with western medicine, better clinical efficacy, better able to improve attention deficit hyperactivity disorder hyperactivity, restless, can not concentrate, less sleep and more dreams, night terrors, heart palpitations, dizziness, dysphoria hot, dry mouth TCM symptoms.
⑦ttention deficit hayperactivity disorder symptoms efficacy
Acupuncture combined with the auricular pressure group recovered in the number of3, accounting for9.375%, markedly the number of18, accounting for56.25%, the effective number of8people, accounting for25.00%, the number of invalid, accounting for9.375%, the total effective number of29people, with a totalefficiency of90.63%; Chinese and Western medicine group recovered2people, accounting for6.45%, effective number9, accounting for29.03%, the effective number of13, accounting for41.94%, the number of invalid, accounting for22.58%, the total effective number of24people, The total efficiency of77.42%. The significant efficiency by Ridit analysis, Z=1.37, statistically significant (P<0.05), acupuncture combined with auricular pressure group to improve attention deficit hyperactivity disorder symptoms more effective than western medicine group. Tip:improve the lack of liver-kidney ADHD in children with attention deficit hyperactivity disorder symptoms efficacy, acupuncture combined with auricular acupressure treatment compared with western medicine, better clinical efficacy.
Conclusion
The purpose of this study is to investigate the difference of the clinical efficacy of acupuncture combined with auricular acupressure, Chinese and Western medicine is a combination of two therapy for liver and kidney in children with ADHD and its mechanism of action, provide the basis for the clinical treatment of children with ADHD. Results acupuncture combined with auricular pressure group and western medicine group liver and kidney in children with ADHD have a significant effect, can significantly improve the clinical symptoms, including symptoms of liver and kidney (less sleep and more dreams and night terrors, dysphoria hot, sweating, taste), social skills, hyperactivity index, intellectual; Chinese and Western medicine treatment for improving children with hyperactivity index, social skills, self-control, learning ability to understand certain effect, but the effect of short-term therapeutic effect is not satisfactory. In contrast, acupuncture combined with auricular acupressure liver-kidney in children with ADHD JCBCL Child Behavior Scale score, hyperactivity index scores and TCM syndrome symptoms compared to the Chinese and Western medicine treatment, with greater advantages. Acupuncture combined with auricular acupressure treatment of children with attention deficit hyperactivity disorder, the clinical efficacy significantly, the long-term effect is obvious, easily accepted by patients is an effective, convenient, economic, lasting effect, non-toxic side effects of treatment.
本课题采用临床科研方法学,进行随机对照研究,以针药结合耳穴贴压和中西药结合治疗为对照,观察针药结合耳穴贴压治疗肝肾阴虚型多动症患儿的临床疗效,旨在探讨针药结合耳穴贴压、中西药结合两种疗法治疗肝肾阴虚型多动症患儿的临床疗效的差异及其作用机理,为临床治疗小儿多动症提供依据。
方法：
2011年11月至2013年1月期间台湾明师中医诊所(经临床诊断为儿童多动症且符合纳入病例标准)的患儿63例,男性35例,女性28例。按1：1的比例随机分配至针药结合耳穴贴压组和中西药,其其中32例作为治疗组(针灸中药结合耳穴贴压治疗),31例作为对照组(中西药治疗)。西医诊断标准参照美国精神病学会制定的《精神障碍诊断和统计手册,DSM—IV》第四版,具体诊断标准所制定的有关儿童注意缺陷多动障碍的诊断标准,中医诊断标准采用参照《全国中医学会ADD研究协作组评分量表》制订的“中医虚证辨证参考标准”等有关小儿多动症内容制定肝肾阴虚辨证标准进行诊断。所有符合纳入标准病例按设计要求观察、治疗。疗程两个月。针刺：每周针刺3次,共治疗两个月；耳穴贴压：一周贴压三次,共治疗两个月；中药治疗：周5次,周末停服,共治疗两个月；西药(哌醋甲酯缓释片)：开始每次口服5mg,1日2次,共治疗两个月。疗效观察具体项目包括：全国中医学会ADD研究协作组评分量表》中肝肾阴虚证中医证候评分标准、Achenbach儿童行为量表Conners儿童行为量表、文测验联合型(Combined Raven's Test, CRT)。疗效评定标准主要照《全国中医学会ADD研究协作组评分量表》中中医证候疗效判定标准及《最新国内外疾病诊疗标准》中制定的注意缺陷与多动障碍症状的临床疗效标准及Conners量表的减分率。
数据分析采用统计软件SPSS17.0。计量资料用均数±标准差((?)±S)表示,计数资料用构成比(%)表示；计量资料组间比较采用t检验,自身前后比较用配对t检验或Wilcoxon配对秩和检验。分类资料组间比较采用X2检验,等级资料组间比较采用Ridit分析。假设检验统一使用双侧检验,给出检验统计量及其对应的P值,以P≤0.05有统计学意义,P≤0.01有显著性统计学意义。
结果：
治疗前针药结合耳穴贴压组、中西药组的性别、年龄、年龄构成、病程、中医症状积分、CBCL儿童行为量表总评分、多动指数评分、智力测定(瑞文测验联合型)评分得分经分析均无统计学意义,说明两组之间的临床基线资料具有可比性。疗效观察指标及疗效评定结果总结如下：
①中医症状各项评分
针药结合耳穴贴压组治疗前后各中医症状积分除面色、自汗外,其余各项得分相比较差异有统计学意义(P<0.05),其中在改善肝肾阴虚型多动症患儿多动不宁、学习效率低、少睡多梦及夜惊、手足心热、盗汗方面疗效显著(P<0.01)；中西药组疗前后各中医症状积分相比较,多动不宁、注意力不集中、学习效率低、心悸头晕、口干差异有统计学意义(P<0.05)。
②中医症状总积分
治疗一个疗程后,针药结合耳穴贴压组的中医症状总积分比中西药组得分减少,差异有统计学意义(P<0.05)；两个疗程后,两组之间的肝肾阴虚型中医症状总积分比较仍有统计学意义(P<0.01)。无论在短期疗效还是长期疗效方面,针药结合耳穴贴压对于改善肝肾阴虚型多动症患儿的中医症状的临床效果比中西药治疗更为显著。
③CBCL儿童行为量表评分
治疗一个疗程后,针药结合耳穴贴压组CBCL儿童行为量表评分值比治疗前提高(P<0.05),治疗两个疗程后患儿的行为情况得到明显改善(P<0.01)中西药组方面,治疗一疗程后行为量表评分数值虽有提升,但无统计学差异,治疗两个疗程后患儿的行为情况可得到一定程度的好转(P<0.05)。经两个疗程的治疗后,两组对于改善肝肾阴虚型多动症患儿的CBCL儿童行为量表评分均有一定疗效,但以针药结合耳穴贴压治疗的效果最为显著。
两个疗程治疗后,两组病例在CBCL儿童行为量表的各项社会能力部分比较方面,对于改善肝肾阴虚型多动症患儿的活动情况,针药结合耳穴贴压组比中西药组的得分明显提高,两组差异有显著统计学意义(P<0.01)；社交情况、学校情况方面,两组得分相比较,差异不明显。
④多动指数评分
治疗一疗程后,在改善肝肾阴虚型多动症患儿的多动指数方面,中西药组的多动指数评分虽比针药结合耳穴贴压组有所减少,但差异无统计学意义(P>0.05)。治疗两疗程后,针药结合耳穴贴压组的多动指数明显比中西药组减少,差异具有统计学意义。从远期疗效来看,在改善肝肾阴虚型多动症患儿的多动指数方面,针药结合耳穴贴压治疗比中西药结合治疗效果较佳。
⑤智力测定(瑞文测验联合型)评分
一个疗程的治疗后,针药结合耳穴贴压组、中西药组智力测定(瑞文测验联合型)评分无明显差异(P>0.05)；两个疗程的治疗后,针药结合耳穴贴压组与中西药结合组比较智力情况评分改善幅度较大(P<0.01)。对于改善肝肾阴虚型注意缺陷多动障碍患儿的智力情况方面,短期治疗两种疗法差异不明显,治疗两个疗程后,针药结合耳穴贴压治疗对于改善注意缺陷多动障碍患儿的智力效果比中西药结合治疗效果较佳。
⑥中医证候疗效
针药结合耳穴贴压组临床控制人数4人、占12.50%,显效人数17人、占53.13%,有效人数9人、占28.12%,无效人数2人,占6.25%,总有效人数30人,总效率为93.75%；中西药组临床控制人数1人、占3.23%,显效人数10人、占32.26%,有效人数24人、占45.16%,无效人数6人,占19.35%,总有效人数25人,总效率为80.64%。提示：在改善缺肝肾阴虚型注意缺陷多动障碍患儿的中医证候疗效方面,针药结合耳穴贴压治疗与中西药治疗相比较,临床疗效较佳,能够较好改善注意缺陷多动障碍患儿多动不宁、注意力不集中、少睡多梦、夜惊、心悸头晕、手足心热、口干等中医症候。
⑦注意缺陷与多动障碍症状疗效
针药结合耳穴贴压组痊愈人数3人、占9.375%,显效人数18人、占56.25%,有效人数8人、占25.00%,无效人数3人,占9.375%,总有效人数29人,总效率为90.63%；中西药组痊愈人数2人、占6.45%,显效人数9人、占29.03%,有效人数13人、占41.94%,无效人数7人,占22.58%,总有效人数24人,总效率为77.42%。提示：在改善缺肝肾阴虚型多动症患儿注意缺陷与多动障碍症状疗效方面,针药结合耳穴贴压治疗与中西药治疗相比较,临床疗效较佳。
结论：
本研究旨在探讨针药结合耳穴贴压、中西药结合两种疗法治疗肝肾阴虚型多动症患儿的临床疗效的差异及其作用机理,为临床治疗小儿多动症提供依据。研究结果针药结合耳穴贴压组和中西药组对肝肾阴虚型多动症患儿都有比较显著的疗效,能明显改善患者的临床症状方面,包括肝肾阴虚症状(少睡多梦及夜惊、手足心热、盗汗、口感)、社会活动能力、多动指数、智力等；中西药治疗虽然对于改善患儿的多动指数、社会活动能力、自控力、学习理解能力等方面有一定疗效,但短期治疗效果效果不尽如人意。相比之下,针药结合耳穴贴压疗法在肝肾阴虚型多动症患儿的JCBCL儿童行为量表评分、多动指数评分及中医症候各项症状的等方面较中西药治疗、具有更大的优势。针药结合耳穴贴压治疗小儿多动症,临床疗效显著,远期疗效明显,患者容易接受,是一种有效、便捷、经济、疗效持久、无毒副作用的治疗方法。
Objecti ve
The subject used the clinical research methodology, conducted a randomized controlled study, acupuncture combined with earacupoint application and Chinese herbs, Chinese herbs and western medicine treatment for the control and observation of acupuncture and Chinese herbs combined with auricular acupressure clinical efficacy for the treatment of liver and kidney in children with ADHD to investigate the acupuncture combined with earacupoint application and Chinese herbs, Chinese and Western medicine is a combination of two therapy for liver-kidney in children with ADHD clinical efficacy differences and their mechanism of action, provide the basis for the clinical treatment of children with ADHD.
Methods
The patients were selected from clinic during November2011to January2013.63cases of children with ADHD in Taiwan during the Chinese medicine clinics were clinically diagnosed,35males and28females. The ratio of1:1randomly assigned to acupuncture combined with auricular pressure group and western medicine, of which32cases the treatment group (acupuncture medicine combined with auricular pressure treatment),31cases as the control group (in western medicine). Western diagnostic criteria with reference to the "mental disorders by the American Psychiatric Association Diagnostic and Statistical Manual, the DSM-IV, Fourth Edition, specific diagnostic criteria developed for children with attention deficit hyperactivity disorder diagnostic criteria, TCM diagnostic criteria refer to" National Traditional Chinese Medicine Society ADD study Group Rating Scale "developed" Chinese deficiency syndrome reference standard "of children with ADHD develop liver and kidney syndrome standard for diagnosis. All met the inclusion criteria of cases according to design requirements observed treatment. The total ourse is two months. Acupuncture:acupuncture three times a week, were treated for two months; the auricular acupressure:taping and pressing three times a week, were treated for two months; medicine treatment:5times a week, the weekend stop taking, were treated for two months; western medicine (methylphenidate sustained-release tablets):for each oral5mg,2times a day, were treated for two months. The efficacy of specific projects include:liver kidney yin TCM syndrome scoring criteria in the National Institute of Traditional Chinese Medicine ADD Study Group Rating Scale, Achenbach Children's Behavior Scale Conners Child Behavior Checklist paper tests combined (Combined Raven's Test, CRT). The evaluation standard according to the National Association of Traditional Chinese Medicine the ADD research collaboration group rating scale of TCM syndromes criteria and the latest domestic and foreign disease diagnostic criteria developed with attention deficit hyperactivity disorder symptoms of clinical efficacy standards and Conners amount the table reduction rate.
Data analysis used SPSS17.0software for statistical analysis. Measurement data used in forming the mean±standard deviation (X±S), and the count data used in forming ration (%);measurement data groups were compared using the t-test their own before and after using paired t test or Wilcoxon paired rank sum test. Segment information groups were compared usingχ2test, the Level data sets were compared using analysis Ridit. Hypothesis testing unified use of two-sided test, the test statistic is given and the corresponding P values, to P≤0.05was statistically significant, P≤0.01there is a significant statistical significance.
Results
①hinese medicine symptoms of the score
Acupuncture combined with auricular pressure before and after treatment scores of TCM in addition to looking, spontaneous perspiration, the rest of the score compared difference was statistically significant (P<0.05), which improve liver and kidney in children with attention deficit hyperactivity disorder hyperactivityrestless, learning efficiency is low, less sleep and more dreams and night terrors, dysphoria hot, night sweats side effect is significant (P<0.01); comparison of Chinese and Western medicine group before and after treatment scores of TCM, restless hyperactivity, inattentionlearning efficiency, palpitations, dizziness, dry mouth, the difference was statistically significant (P<0.05).
②CM symptoms total score
After a course of treatment, acupuncture combined with auricular pressure group TCM total symptom score than in western medicine group score be reduced, the difference was statistically significant (P<0.05); between the two groups after two courses, liver-kidneyTCM total symptom score remained statistically significant (P<0.01). Both in terms of short-term efficacy or long-term efficacy of acupuncture combined with auricular acupressure clinical effect of Chinese medicine for improving liver and kidney in children with ADHD symptoms more significant than in western medicine.
③BCL child behavior checklist ratings
A course of treatment, acupuncture combined with auricular pressure group CBCL Child Behavior Checklist scores than before treatment (P<0.05) after two courses of treatment of children with behavior has been significantly improved (P<0.01) in the western medicine groupaspects, although the behavior after a course of treatment scale score value increase, but no significant difference after two courses of treatment of children with behavior some improvement (P<0.05) can be obtained. After two courses of treatment, the two groups for children with ADHD improve liver-kidney CBCL Child Behavior Scale score have a certain effect, but the most significant effect of acupuncture combined with auricular pressure treatment.
Two courses of treatment, the two groups of patients in terms of the social competence section compares the CBCL Child Behavior Checklist for improving the activities of the liver-kidney in children with ADHD, acupuncture combined with auricular the pressure group than in the western medicine group of score significantly improved, the difference was statistically significant (P <0.01); social situation, the school, the two sets of scores compared, no significant difference.
④yperactivity index
After a course of treatment, improve liver and kidney in children with ADHD hyperactivity index In group A, the hyperactivity index score than acupuncture and Chinese herbs combined with auricular pressure group decreased, but the difference was not statistically significant (P>0.05). After two courses of treatment, acupuncture combined with auricular pressure group hyperactivity index was significantly lower than western medicine group, a statistically significant difference. Judging from the long-term efficacy, improve liver and kidney in children with ADHD hyperactivity index, acupuncture combined with auricular acupressure treatment than western medicine combined with a better therapeutic effect.
⑤ntellectual determination
After a course of treatment, acupuncture combined with auricular pressure group in western medicine group intelligence test (Raven joint) score was no significant difference (P>0.05); two courses of treatment, acupuncture combined with auricular pressure grouprating improvement was greater (P<0.01) compared with western medicine group intelligence. For improving liver-kidney attention deficit hyperactivity disorder in children with intellectual obvious differences in short-term treatment of two therapy after two courses of treatment, acupuncture combined with auricular pressure treatment to improve attention deficit hyperactivity disorder intelligence is better than the Chinese and Western medicine combined treatment was better.
⑥he efficacy of TCM syndromes
Acupuncture combined with auricular pressure were clinically number of people, accounting for12.50%, effective number of17, accounting for53.13%, the effective number of nine people, accounting for28.12%, the number of invalid, accounting for6.25%, the total effective number of30people, The total efficiency of93.75%;1in group A clinical control number, accounting for3.23%, markedly less than10persons, accounting for32.26%, the effective number of24people, accounting for45.16%, the number of invalid, accounting for19.35%, the total effective number of25The people, the total efficiency of80.64%. The significant efficiency by Ridit analysis, Z=2.45, statistically significant (P<0.05), acupuncture combined with auricular pressure group TCM syndromes than in western medicine group. Tip:to improve the lack of attention deficit hyperactivity disorder of liver-kidney TCM syndromes, acupuncture combined with auricular pressure treatment compared with western medicine, better clinical efficacy, better able to improve attention deficit hyperactivity disorder hyperactivity, restless, can not concentrate, less sleep and more dreams, night terrors, heart palpitations, dizziness, dysphoria hot, dry mouth TCM symptoms.
⑦ttention deficit hayperactivity disorder symptoms efficacy
Acupuncture combined with the auricular pressure group recovered in the number of3, accounting for9.375%, markedly the number of18, accounting for56.25%, the effective number of8people, accounting for25.00%, the number of invalid, accounting for9.375%, the total effective number of29people, with a totalefficiency of90.63%; Chinese and Western medicine group recovered2people, accounting for6.45%, effective number9, accounting for29.03%, the effective number of13, accounting for41.94%, the number of invalid, accounting for22.58%, the total effective number of24people, The total efficiency of77.42%. The significant efficiency by Ridit analysis, Z=1.37, statistically significant (P<0.05), acupuncture combined with auricular pressure group to improve attention deficit hyperactivity disorder symptoms more effective than western medicine group. Tip:improve the lack of liver-kidney ADHD in children with attention deficit hyperactivity disorder symptoms efficacy, acupuncture combined with auricular acupressure treatment compared with western medicine, better clinical efficacy.
Conclusion
The purpose of this study is to investigate the difference of the clinical efficacy of acupuncture combined with auricular acupressure, Chinese and Western medicine is a combination of two therapy for liver and kidney in children with ADHD and its mechanism of action, provide the basis for the clinical treatment of children with ADHD. Results acupuncture combined with auricular pressure group and western medicine group liver and kidney in children with ADHD have a significant effect, can significantly improve the clinical symptoms, including symptoms of liver and kidney (less sleep and more dreams and night terrors, dysphoria hot, sweating, taste), social skills, hyperactivity index, intellectual; Chinese and Western medicine treatment for improving children with hyperactivity index, social skills, self-control, learning ability to understand certain effect, but the effect of short-term therapeutic effect is not satisfactory. In contrast, acupuncture combined with auricular acupressure liver-kidney in children with ADHD JCBCL Child Behavior Scale score, hyperactivity index scores and TCM syndrome symptoms compared to the Chinese and Western medicine treatment, with greater advantages. Acupuncture combined with auricular acupressure treatment of children with attention deficit hyperactivity disorder, the clinical efficacy significantly, the long-term effect is obvious, easily accepted by patients is an effective, convenient, economic, lasting effect, non-toxic side effects of treatment.
引文
[1]孟爽,王春梅.注意缺陷多动障碍研究综述[J].北方文学,2012,(5)：239.
[2]阿斯木古丽·克力木,孔杜斯,卡迪丽亚·吾马尔.儿童多动症的病因和影响因素研究[J].中国妇幼保健,2012,27(34)：5510-5512.
[3]Tannock R. Attention deficit hyperactivity disorder:advances in cognitive, neurobiological, and genetic research[J]. J Child Psychol Psychiat,1998,39:65-99.
[4]王玉水.儿童注意力缺陷多动症中医诊治研究[J].医学综述,2006,12(14)：895-897.
[5]李晓东.小儿多动症的中医辨证分型[J].中医儿科杂志,2007,3(6)：35-36.
[6]黎欣,夏隆江.儿童多动症证候分布规律的研究[J].陕西中医,2007,3(6)：35-36.
[7]张永玺.儿童多动症辨证分型及治疗[J].甘肃中医学院学报,1993,10(1)：36.
[8]芦红伟.儿童多动症的中医辨证与防治[J].甘肃科技纵横,2006,35(4)：235.
[9]胡虞志,余剑强.儿童注意缺陷多动障碍的研究[M].国外医学社会医学分册,1999,16(2)：62-66.
[10]罗秋燕.靳三针疗法治疗注意缺陷多动障碍临床与实验研究.博士论文.广州中医药大学,2009.
[11]饶延华,古天明,章顺悦.儿童青少年注意力缺陷障碍合并品行障碍的流行病学研究[J].中国社会医学学报,2010,27(6)：360-362.
[12]周克英,高美好,杨春何.深圳市小学儿童注意力缺陷多动障碍流行病学调查[J].中国当代儿科杂志,2012,14(9)：689-691.
[13]王丽敏,应长青,李德安.哈尔滨市动力区7-10岁儿童多动症流行病学调查[J].中国行为医学科学,1997,6(4)：284-286.
[14]杜德业,李伟明,陈镜松.广州城区儿童多动症流行病学分析[J].广东医学,2003,24(3)：299-302.
[15]陈顺珍,曾芳,唐辉屏,等.桂林市儿童注意缺陷多动障碍的流行病学调查及相关因素分析[J].中国临床心理学杂志,2004,12(4)：386-370.
[16]阿依奴尔吾买尔,杜亚松,金文岚,等.上海市闸北区学龄前儿童注意缺陷多动障碍患病率及症状分布特征的研究[J].中国医疗设备,2012,27(4)：32-37.
[17]梁东,王云,李春怀,等.长春市中心区6-18岁学生注意缺陷多动障碍流行病学调查[J].中国妇幼保健,2009,24(4)：522-524.
[18]江毅,张蔓丽,杨在东,等.儿童注意缺陷多动障碍行为相关因素的调查[J].中国医药导报,2011,8(7)：129-131.
[19]高磊,关明杰,许秀举.儿童多动症及其影响因素的研究进展[J].包头医学院学报,2011,27(5)：96-98.
[20]黄柏青,苏东霞,洪峻峰.儿童注意缺陷多动障碍与家庭环境的关系[J].中国全科医学杂志,2000,3(5)：384-385.
[21]陈晶,陈燕惠.儿童注意缺陷多动障碍的病‘因学研究进展[J].中国妇幼健康研究,2008,19(5)：474-476.
[22]林蓉.儿童注意缺陷多动障碍病因学研究进展[J].中国学校卫生,2011,32(2)：253-254.
[23]熊忠贵,金涛,徐海青,等.儿童注意缺陷多动障碍中枢神经递质的对照研究[J].中国妇幼保 健,2008,23(16)：2229-2231.
[24]赵志民,杜亚松.注意缺陷多动障碍的功能神经成像研究[J].国外医学精神病学分册,2004,31(1)：43-47.
[25]赵子军,徐改玲,甄龙,等.注意缺陷／多动障碍儿童临床特征与单胺类神经递质研究[J].临床精神医学杂志,2010,20(5)：293-296.
[26]钱秋谨,王玉凤.注意缺陷多动障碍与遗传[J].实用儿科临床杂志,2010,25(12)：869-870.
[27]赵爱玲,程道猛,苏林雁.注意缺陷多动障碍与单胺类神经递质基因[J].国外医学精神病学分册,2004,31(1)：47-49.
[28]李泽华,钱秋谨,刘璐,等.BAIAP2基因多态与儿童注意缺陷多动障碍共患学习困难的关联分析[J].中国心理卫生杂志,2012,26(6)：429-434.
[29]邹时朴,胡淑珍,李维君,等.血铅水平与儿童注意力及行为的相关研究[J].中国学校卫生,2008,29(11)：1004-1005.
[30]杨波,招强光,翁坤荣.儿童注意缺陷多动障碍与微量元素锌、铅关系[J].实用预防医学,2009,16(6)：1857-1859.
[31]黄健红,周才,司徒坚墉,等.儿童注意缺陷多动障碍与微量元素的关系[J].实用医学杂志,2008,24(14)：2443-2445.
[32]高铁英,喻书彻,史秀兰,等.儿童ADHD视听整合持续操作测验的诊断意义及与血铅、铁、锌相关研究[J].中国儿童保健杂志,2005,13(1)：33-35.
[33]金星明.儿童注意缺陷多动障碍治疗进展[J].中国儿童保健杂志,2007,15(2)：111-114.
[34]麻宏伟.儿童注意缺陷多动障碍诊断及治疗[J].实用儿科临床杂志,2007,22(11)：805-809.
[35]周淑新,王伟刚.儿童注意缺陷多动症治疗新对策[J].中国全科医学,2009,12(10)：1771-1774.
[36]陈秀娟,李智平.儿童注意缺陷多动障碍的药物治疗[J].中国新药与临床杂志,2009,28(7)：491-494.
[37]邹莹,赵江.儿童注意缺陷与多动障碍的治疗进展[J].现代实用医学,2012,24(8)：958-960.
[38]刘敏娜,王敏,黄哲,等.结构式游戏治疗对注意缺陷多动障碍儿童生活质量的干预研究[J].中国儿童保健杂志,2010,18(1)：31-33.
[39]刘静.醒脑开窍针刺法治疗注意力缺陷多动症临床疗效观察[J].天津中医药,2013,30(1)：54-56.
[40]周庆翀,刘署鹏,范郁山.沿皮浅刺法治疗小儿多动症41例[J].针灸临床杂志,2010,26(7)：38-40.
[41]许学兵,刘红娇,彭剑虹,等.针刺与西药治疗小儿多动症对比观察[J].中国针灸,2007,27(12)：904-906.
[42]Huang Bo-ming, Yu Chen-Hsien, Li Zhong-ren. Clinical Observation on Acupuncture Intervention for Children with Attention Deficit Hyperactivity Disorder [J]. Journal of Acupuncture and Tuina Science,2012,10(5):300-304.
[43]孟建国,周红军,马小允,等.针刺治疗儿童多动症60例[J].中医儿科杂志,2009,5(1)：41-42.
[44]张玉夫.耳穴治疗小儿多动症的临床观察[J].中医外治杂志,1995,(2)：43.
[45]刘敏.耳穴按压治疗儿童多动症40例临床观察[J].浙江中医杂志,2007,42(9)：533-534.
[46]周黎明,曹银喜.耳—体穴导电加耳穴压丸治疗儿童多动症498例[J].针灸临床杂志,1996, 12(7)：58.
[47]罗荣芬,何明.耳穴压丸治疗儿童多动症28例[J].中医外治杂志,2011,20(4)：54.
[48]张骠,谈忠, 潘仁智,等.多动安口服液治疗儿童多动症的临床观察及其生化机制研究[J].中医药学刊,2006,24(2)：268-271.
[49]刘成全,韩新民,朱先康,等.清心平肝、豁痰开窍法治疗注意缺陷多动障碍30例临床研究[J].新中医,2010,42(12)：44-46.
[50]郝阳春,咸丽.中药治疗小儿多动症20例[J].辽宁中医杂志,2005,32(7)：700.
[51]王玲.知柏地黄丸加减治疗阴虚阳亢儿童多动症60例[J].中医学报,2010,25(2)：324-325.
[52]李红.张家维教授针灸治疗小儿多动症380例临床研究[J].上海针灸杂志,2004,23(8)：23-25.
[53]刘芳琴,田小刚.芍药甘草汤加味配合耳穴按压治疗儿童多动症47例[J].甘肃中医,2008,21(7)：33-34.
[54]程远钊,崔丽娟,曹永贺.穴位针刺及耳穴贴压治疗小儿多动症32例疗效观察[J].医学信息内·外科版,2009,22(10)：909-910.
[55]李建龙,陈沛源,陈霄,等.针刺配合口服中药治疗儿童多动症临床疗效观察[J].中国中西医结合儿科学,2010,2(1)：25-26.
[56]孟秀会,张清华.针刺配合西药治疗儿童多动症疗效观察[J].上海针灸杂志,2012,31(10)：732-733.
[57]李云玲,古桂雄.儿童注意缺陷多动障碍诊断和治疗的研究[J].国外医学妇幼保健分册,2004,16(2)：68-70.
[58]方积乾.卫生统计学[M].北京：人民卫生出版社,2006,5：456.
[59]彭增福.靳三针疗法[M].上海：上海科学技术文献出版社,2000,1.
[60]石学敏.针灸学[M].北京：中国中医药出版社出版社,2002,8：220-222.
[61]苏渊.孩子为何注意力不集中——儿童多动症的诊断与治疗[M].北京：人民军医出版社,1995,1.
[62]刘张.注意缺陷多动障碍患儿行为及适应行为的研究.硕士论文.大连医科大学,2009.
[63]徐韬园.Conners儿童行为问卷[J]上海精神医学,1990：42-46
[64]余启超.中药宁神颗粒治疗儿童注意缺陷多动障碍(阴虚阳亢证)的临床研究.硕士论文.湖北中医药大学,2010.
[65]袁秀洪,罗学荣,邓云龙,等.儿童注意缺陷多动障碍流行病学调查回顾[J].国际精神病学杂志,2007,34(2)：115-119.
[66]盖笑松,兰公瑞,刘希平.国内注意缺陷／多动障碍儿童干预效果的元分析[J].心理学报,2008,40(11)：1190-1196.
[67]弓艳玲,李永佳,牛晨媛,等.从风、痰、虚论治小儿多动症[J].甘肃中医,2007,20(6)：27-28.
[68]刘建德.靳三针为主治疗儿童多动症临床研究.博士论文.广州中医药大学,2009.
[69]袁青,韩德雄,邓晶晶,等.靳三针与治神[J].辽宁中医药大学学报,2009,11(5)：13-14.
[70]邢锦秀,刘春霞.关于耳穴的理论研究[J].吉林中医药,1996,(6)：39-40.
[71]王文莉,范华.中药滋阴化痰法配合耳穴埋压治疗儿童多动症50例[J].吉林中医药,2003,44(8)：609.
[72]何祖书,何厚璋.针刺耳穴治疗小儿多动症28例[J].中国民间疗法,1997,44(8)：609.
[2]阿斯木古丽·克力木,孔杜斯,卡迪丽亚·吾马尔.儿童多动症的病因和影响因素研究[J].中国妇幼保健,2012,27(34)：5510-5512.
[3]Tannock R. Attention deficit hyperactivity disorder:advances in cognitive, neurobiological, and genetic research[J]. J Child Psychol Psychiat,1998,39:65-99.
[4]王玉水.儿童注意力缺陷多动症中医诊治研究[J].医学综述,2006,12(14)：895-897.
[5]李晓东.小儿多动症的中医辨证分型[J].中医儿科杂志,2007,3(6)：35-36.
[6]黎欣,夏隆江.儿童多动症证候分布规律的研究[J].陕西中医,2007,3(6)：35-36.
[7]张永玺.儿童多动症辨证分型及治疗[J].甘肃中医学院学报,1993,10(1)：36.
[8]芦红伟.儿童多动症的中医辨证与防治[J].甘肃科技纵横,2006,35(4)：235.
[9]胡虞志,余剑强.儿童注意缺陷多动障碍的研究[M].国外医学社会医学分册,1999,16(2)：62-66.
[10]罗秋燕.靳三针疗法治疗注意缺陷多动障碍临床与实验研究.博士论文.广州中医药大学,2009.
[11]饶延华,古天明,章顺悦.儿童青少年注意力缺陷障碍合并品行障碍的流行病学研究[J].中国社会医学学报,2010,27(6)：360-362.
[12]周克英,高美好,杨春何.深圳市小学儿童注意力缺陷多动障碍流行病学调查[J].中国当代儿科杂志,2012,14(9)：689-691.
[13]王丽敏,应长青,李德安.哈尔滨市动力区7-10岁儿童多动症流行病学调查[J].中国行为医学科学,1997,6(4)：284-286.
[14]杜德业,李伟明,陈镜松.广州城区儿童多动症流行病学分析[J].广东医学,2003,24(3)：299-302.
[15]陈顺珍,曾芳,唐辉屏,等.桂林市儿童注意缺陷多动障碍的流行病学调查及相关因素分析[J].中国临床心理学杂志,2004,12(4)：386-370.
[16]阿依奴尔吾买尔,杜亚松,金文岚,等.上海市闸北区学龄前儿童注意缺陷多动障碍患病率及症状分布特征的研究[J].中国医疗设备,2012,27(4)：32-37.
[17]梁东,王云,李春怀,等.长春市中心区6-18岁学生注意缺陷多动障碍流行病学调查[J].中国妇幼保健,2009,24(4)：522-524.
[18]江毅,张蔓丽,杨在东,等.儿童注意缺陷多动障碍行为相关因素的调查[J].中国医药导报,2011,8(7)：129-131.
[19]高磊,关明杰,许秀举.儿童多动症及其影响因素的研究进展[J].包头医学院学报,2011,27(5)：96-98.
[20]黄柏青,苏东霞,洪峻峰.儿童注意缺陷多动障碍与家庭环境的关系[J].中国全科医学杂志,2000,3(5)：384-385.
[21]陈晶,陈燕惠.儿童注意缺陷多动障碍的病‘因学研究进展[J].中国妇幼健康研究,2008,19(5)：474-476.
[22]林蓉.儿童注意缺陷多动障碍病因学研究进展[J].中国学校卫生,2011,32(2)：253-254.
[23]熊忠贵,金涛,徐海青,等.儿童注意缺陷多动障碍中枢神经递质的对照研究[J].中国妇幼保 健,2008,23(16)：2229-2231.
[24]赵志民,杜亚松.注意缺陷多动障碍的功能神经成像研究[J].国外医学精神病学分册,2004,31(1)：43-47.
[25]赵子军,徐改玲,甄龙,等.注意缺陷／多动障碍儿童临床特征与单胺类神经递质研究[J].临床精神医学杂志,2010,20(5)：293-296.
[26]钱秋谨,王玉凤.注意缺陷多动障碍与遗传[J].实用儿科临床杂志,2010,25(12)：869-870.
[27]赵爱玲,程道猛,苏林雁.注意缺陷多动障碍与单胺类神经递质基因[J].国外医学精神病学分册,2004,31(1)：47-49.
[28]李泽华,钱秋谨,刘璐,等.BAIAP2基因多态与儿童注意缺陷多动障碍共患学习困难的关联分析[J].中国心理卫生杂志,2012,26(6)：429-434.
[29]邹时朴,胡淑珍,李维君,等.血铅水平与儿童注意力及行为的相关研究[J].中国学校卫生,2008,29(11)：1004-1005.
[30]杨波,招强光,翁坤荣.儿童注意缺陷多动障碍与微量元素锌、铅关系[J].实用预防医学,2009,16(6)：1857-1859.
[31]黄健红,周才,司徒坚墉,等.儿童注意缺陷多动障碍与微量元素的关系[J].实用医学杂志,2008,24(14)：2443-2445.
[32]高铁英,喻书彻,史秀兰,等.儿童ADHD视听整合持续操作测验的诊断意义及与血铅、铁、锌相关研究[J].中国儿童保健杂志,2005,13(1)：33-35.
[33]金星明.儿童注意缺陷多动障碍治疗进展[J].中国儿童保健杂志,2007,15(2)：111-114.
[34]麻宏伟.儿童注意缺陷多动障碍诊断及治疗[J].实用儿科临床杂志,2007,22(11)：805-809.
[35]周淑新,王伟刚.儿童注意缺陷多动症治疗新对策[J].中国全科医学,2009,12(10)：1771-1774.
[36]陈秀娟,李智平.儿童注意缺陷多动障碍的药物治疗[J].中国新药与临床杂志,2009,28(7)：491-494.
[37]邹莹,赵江.儿童注意缺陷与多动障碍的治疗进展[J].现代实用医学,2012,24(8)：958-960.
[38]刘敏娜,王敏,黄哲,等.结构式游戏治疗对注意缺陷多动障碍儿童生活质量的干预研究[J].中国儿童保健杂志,2010,18(1)：31-33.
[39]刘静.醒脑开窍针刺法治疗注意力缺陷多动症临床疗效观察[J].天津中医药,2013,30(1)：54-56.
[40]周庆翀,刘署鹏,范郁山.沿皮浅刺法治疗小儿多动症41例[J].针灸临床杂志,2010,26(7)：38-40.
[41]许学兵,刘红娇,彭剑虹,等.针刺与西药治疗小儿多动症对比观察[J].中国针灸,2007,27(12)：904-906.
[42]Huang Bo-ming, Yu Chen-Hsien, Li Zhong-ren. Clinical Observation on Acupuncture Intervention for Children with Attention Deficit Hyperactivity Disorder [J]. Journal of Acupuncture and Tuina Science,2012,10(5):300-304.
[43]孟建国,周红军,马小允,等.针刺治疗儿童多动症60例[J].中医儿科杂志,2009,5(1)：41-42.
[44]张玉夫.耳穴治疗小儿多动症的临床观察[J].中医外治杂志,1995,(2)：43.
[45]刘敏.耳穴按压治疗儿童多动症40例临床观察[J].浙江中医杂志,2007,42(9)：533-534.
[46]周黎明,曹银喜.耳—体穴导电加耳穴压丸治疗儿童多动症498例[J].针灸临床杂志,1996, 12(7)：58.
[47]罗荣芬,何明.耳穴压丸治疗儿童多动症28例[J].中医外治杂志,2011,20(4)：54.
[48]张骠,谈忠, 潘仁智,等.多动安口服液治疗儿童多动症的临床观察及其生化机制研究[J].中医药学刊,2006,24(2)：268-271.
[49]刘成全,韩新民,朱先康,等.清心平肝、豁痰开窍法治疗注意缺陷多动障碍30例临床研究[J].新中医,2010,42(12)：44-46.
[50]郝阳春,咸丽.中药治疗小儿多动症20例[J].辽宁中医杂志,2005,32(7)：700.
[51]王玲.知柏地黄丸加减治疗阴虚阳亢儿童多动症60例[J].中医学报,2010,25(2)：324-325.
[52]李红.张家维教授针灸治疗小儿多动症380例临床研究[J].上海针灸杂志,2004,23(8)：23-25.
[53]刘芳琴,田小刚.芍药甘草汤加味配合耳穴按压治疗儿童多动症47例[J].甘肃中医,2008,21(7)：33-34.
[54]程远钊,崔丽娟,曹永贺.穴位针刺及耳穴贴压治疗小儿多动症32例疗效观察[J].医学信息内·外科版,2009,22(10)：909-910.
[55]李建龙,陈沛源,陈霄,等.针刺配合口服中药治疗儿童多动症临床疗效观察[J].中国中西医结合儿科学,2010,2(1)：25-26.
[56]孟秀会,张清华.针刺配合西药治疗儿童多动症疗效观察[J].上海针灸杂志,2012,31(10)：732-733.
[57]李云玲,古桂雄.儿童注意缺陷多动障碍诊断和治疗的研究[J].国外医学妇幼保健分册,2004,16(2)：68-70.
[58]方积乾.卫生统计学[M].北京：人民卫生出版社,2006,5：456.
[59]彭增福.靳三针疗法[M].上海：上海科学技术文献出版社,2000,1.
[60]石学敏.针灸学[M].北京：中国中医药出版社出版社,2002,8：220-222.
[61]苏渊.孩子为何注意力不集中——儿童多动症的诊断与治疗[M].北京：人民军医出版社,1995,1.
[62]刘张.注意缺陷多动障碍患儿行为及适应行为的研究.硕士论文.大连医科大学,2009.
[63]徐韬园.Conners儿童行为问卷[J]上海精神医学,1990：42-46
[64]余启超.中药宁神颗粒治疗儿童注意缺陷多动障碍(阴虚阳亢证)的临床研究.硕士论文.湖北中医药大学,2010.
[65]袁秀洪,罗学荣,邓云龙,等.儿童注意缺陷多动障碍流行病学调查回顾[J].国际精神病学杂志,2007,34(2)：115-119.
[66]盖笑松,兰公瑞,刘希平.国内注意缺陷／多动障碍儿童干预效果的元分析[J].心理学报,2008,40(11)：1190-1196.
[67]弓艳玲,李永佳,牛晨媛,等.从风、痰、虚论治小儿多动症[J].甘肃中医,2007,20(6)：27-28.
[68]刘建德.靳三针为主治疗儿童多动症临床研究.博士论文.广州中医药大学,2009.
[69]袁青,韩德雄,邓晶晶,等.靳三针与治神[J].辽宁中医药大学学报,2009,11(5)：13-14.
[70]邢锦秀,刘春霞.关于耳穴的理论研究[J].吉林中医药,1996,(6)：39-40.
[71]王文莉,范华.中药滋阴化痰法配合耳穴埋压治疗儿童多动症50例[J].吉林中医药,2003,44(8)：609.
[72]何祖书,何厚璋.针刺耳穴治疗小儿多动症28例[J].中国民间疗法,1997,44(8)：609.