针灸治疗肥胖病临床回顾性研究
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摘要
[目的]
观察在中医“辨证论治”的基本理论指导下选取主穴和配穴针刺法治疗单纯性肥胖症患者的临床疗效,探讨针刺疗法对单纯性肥胖症患者的治疗效果,并为临床提供治疗依据。
[方法]
对近5年(2004年1月至2009年12月)在新加坡广惠肇留医院中医门诊中心(KWONG WAI SHIU HOSPITAL TCM CENTRE)针灸治疗单纯性肥胖的患者为研究对象,进行系统性回顾性调查研究；对胃肠实热、肝郁气带、脾虚湿盛、气虚血瘀等四个证型的单纯性肥胖针灸治疗的病例进行比较研究,对辨证论治的临床病例作出总结和归纳。观察主穴和配穴频率的出现,作为主穴,频率出现较高的穴位依次是那些穴位,作为配穴,出现频率较高的穴位依次是那些穴位；所选穴位的归经大多那些经脉；临床分型以那些证型较常见,而那些穴位分别是四个证型的单纯性肥胖中频率出现较多的穴位,这也从另一角度提示我们,治疗这四个证型肥胖患者的时候,在处方上选择一些具有清胃泄火通腑、健脾涤痰祛湿、调畅经络气机的穴位来治疗。观察患者治疗前后体重、体重指数、体围。并深入探讨针灸治疗单纯性肥胖病的有效性。采用社会科学统计软件包(SPSS17)来分析结果。
[结果]
1肥胖患者不同证型在穴位选取的频率分布,总共涉的30个穴位,其中频率出现最高的腧穴是基本主穴(1)腹部八穴围针(即中脘、下脘、气海、关元、天枢、大横)(2)交会穴(即带脉、五枢、维道、足临泣)(3)体针(即风市、足三里、三阴交)和支沟,共25.9%,其次是太白、合谷、太冲、公孙,各出现的频率为7.4%,接下来是丰隆、血海、曲泉、阳陵泉、太溪、水道、内庭、上巨虚、曲池、梁丘、水分、阴陵泉各占3.7%。
2在经络的选取方面以人体足部经络最多,穴位在任脉上的频率出现最高,其次是足阳明胃经和足太阴脾经。具有益气健脾、扶正固体,滋补强壮的作用,提示治疗时要关注肥胖患者修复自身的正气,调节机体阴阳的基本观念。
3肥胖患者不同体重指数(BMI)观察,治疗前以体重指数BMI23.0-27.9(超重)和体重指数BMI28.0-32.9(1度肥胖)患者最多(85.9%),经针刺治疗后疗效显著,达到体重指数(BMI)18.5-22.9正常值的有71.2%.说明经30次针刺治疗后能有效降低体重指数(BMI)。
4临床以胃肠湿热型患者最多,疗效最好,总有效率达到100.0%.接着是肝郁气滞型,96.4%,这两型都是实证。其次是脾虚湿盛型总有效率是65.2%。气虚血瘀型效果较差治总有效率是54.3%。实证的疗效好于虚证,P<0.01。说明针灸治疗肥胖症能有效地改善各证型的病情和体重指数。各症型疗效比较依次为：胃肠湿热型>肝郁气滞型>脾虚湿盛型>气虚血瘀型。
[结论]针刺疗法可有效降低单纯性肥胖症患者BMI和体重。而四个证型的单纯性肥胖症患者治疗后以胃肠湿热型疗效最好,其次是肝郁气滞型,脾虚湿盛型与气虚血瘀型效果不明显。总结出实证的疗效好于虚证。
[Objective]
Observe the efficacy rate of applying main and secondary acupuncture point with guidance of basis theory of Traditional Chinese Medicine syndrome of differentiation for treatment of simple obesity patients, determine the efficacy rate upon treatment, as well as provide guidance on clinical research.
[Method]
Retrospective of the past 5 years(January 2004 to December 2009) of simple obesity patient of SINGAPORE KWONG WAI SHIU HOSPITAL TCM CENTRE into four groups include accumulation of heat in the Intestines and Stomach; Stagnation of Liver Qi; Excess dampness due to deficiency of spleen and Stagnation of Blood due to deficiency of qi,226 cases in total. Give an objective evaluation and justifiable conclusion on efficacy of acupuncture treatment amongst categorized groups to analyze and conclude the effects of acupuncture treatment for simple obesity patients. Summarized by statistics to analysis:
Determine which of the main and secondary acupuncture points and meridian as well as the obesity categories having highest appearing frequency. From another view point highlighted that while apply treatment to these 4 groups of obesity patients, that is to select acupuncture point which able to disperse heat, eliminate sputum and dampness as well as able to regulate the meridian system. Analysis before and after treatment of body weight, body mass index, body circumference by apply the statistical method of analysis (SPSS17) to probe into efficacy of acupuncture treatment for simple obesity.
[Results]
1) There are 30 acupuncture points in total frequently distributed among the Simple obese patients of different syndromes. The principal acupuncture points are determined by the most appearing frequency. (1) Eight acupoints surrounding the abdominal (i.e. Zhongwan, Xiawan, Qihai, Guanyuan, Tainshu, Daheng) (2) The intersection points (i.e. Daimai, Wushu, Weidao, Zulinqi) (3) Body acupuncture points (i.e. Fengshi, Zusanli, Sanyinjiao) and Zhigou were 25.9%, follow by Taibai, Hegu, Taichong, Gongsun, the occurrence frequency are 7.4%, follow by Fenglong, Xuehai, Ququan, Yanglingquan, Taixi, Shuidao, Neiting, Shangjuzu, Quchi, Liangqiu, Shuifen, Yinlingquan at 3.7% each.
2) In term of acupuncture point selection, Foot Meridian acupuncture points were selected the most. Follow by acupuncture points on the Stomach Meridian of foot yangming and Spleen Meridian of foot Taiying. Consists of function on vitalizing Qi, hence strengthen spleen meridian system. This simulated that patients in the treatment of self-righteousness needed to pay more attention to repair and regulate the body's yin and yang of the basic concepts.
3) As observed and analyzed by SPSS17, majority of patients (85.9%) consists of body mass index (BMI) ranging from 23.0-27.9 (overweight) and 28.0-32.9 (1 degree of obesity) prior to treatment. There is signaficant improvement after acupuncture treatment, the normal rate consists of 71.2%, which means patient managed to reduce their BMI to the normal range of 18.5-22.9 after underwent 30 times of acupuncture treatment.
4) the patients who categorized under accumulation of heat in the Intestines and Stomach has gain the greatest achievement of 100% efficacy, Secondly is the group categorized under Stagnation of Liver Qi achieved an efficacy rate of 96.4%, both group are belonging to Sthenia syndrome. It followed by the group categorized under excess dampness due to deficiency of spleen, achieved an efficacy rate of 65.2%, lastly is the group categorized under Stagnation of blood due to deficiency of qi, achieved an efficacy rate of 54.3%, this two group are belonging to Asthenia syndrome. The result has proven that the group belonging to Sthenia syndrome has achieved greater efficacy as compare to the group belonging to Asthenia syndrome, P<0.01. The result proven that apply acupuncture treatment to obesity patient has significant improvement on body health and BMI. Compare among each category, the sequent is:accumulation of heat in the Intestines and Stomach> Stagnation of Liver Qi> excess dampness due to deficiency of spleen> Stagnation of blood due to deficiency of qi.
[Conclusion]
Acupuncture therapy can effectively reduce BMI and body weight of patients with simple obesity. Amongst 4 groups, the patients who categorized under accumulation of heat in the Intestines and Stomach has the highest efficacy rate, Secondly is the group categorized under Stagnation of Liver Qi, There is no significant improve for the group categorized under excess dampness due to deficiency of spleen and the group categorized under Stagnation of Blood due to deficiency of qi. The result has proven that the group belonging to Sthenia syndrome has achieved greater efficacy as compare to the group belonging to Asthenia syndrome.
观察在中医“辨证论治”的基本理论指导下选取主穴和配穴针刺法治疗单纯性肥胖症患者的临床疗效,探讨针刺疗法对单纯性肥胖症患者的治疗效果,并为临床提供治疗依据。
[方法]
对近5年(2004年1月至2009年12月)在新加坡广惠肇留医院中医门诊中心(KWONG WAI SHIU HOSPITAL TCM CENTRE)针灸治疗单纯性肥胖的患者为研究对象,进行系统性回顾性调查研究；对胃肠实热、肝郁气带、脾虚湿盛、气虚血瘀等四个证型的单纯性肥胖针灸治疗的病例进行比较研究,对辨证论治的临床病例作出总结和归纳。观察主穴和配穴频率的出现,作为主穴,频率出现较高的穴位依次是那些穴位,作为配穴,出现频率较高的穴位依次是那些穴位；所选穴位的归经大多那些经脉；临床分型以那些证型较常见,而那些穴位分别是四个证型的单纯性肥胖中频率出现较多的穴位,这也从另一角度提示我们,治疗这四个证型肥胖患者的时候,在处方上选择一些具有清胃泄火通腑、健脾涤痰祛湿、调畅经络气机的穴位来治疗。观察患者治疗前后体重、体重指数、体围。并深入探讨针灸治疗单纯性肥胖病的有效性。采用社会科学统计软件包(SPSS17)来分析结果。
[结果]
1肥胖患者不同证型在穴位选取的频率分布,总共涉的30个穴位,其中频率出现最高的腧穴是基本主穴(1)腹部八穴围针(即中脘、下脘、气海、关元、天枢、大横)(2)交会穴(即带脉、五枢、维道、足临泣)(3)体针(即风市、足三里、三阴交)和支沟,共25.9%,其次是太白、合谷、太冲、公孙,各出现的频率为7.4%,接下来是丰隆、血海、曲泉、阳陵泉、太溪、水道、内庭、上巨虚、曲池、梁丘、水分、阴陵泉各占3.7%。
2在经络的选取方面以人体足部经络最多,穴位在任脉上的频率出现最高,其次是足阳明胃经和足太阴脾经。具有益气健脾、扶正固体,滋补强壮的作用,提示治疗时要关注肥胖患者修复自身的正气,调节机体阴阳的基本观念。
3肥胖患者不同体重指数(BMI)观察,治疗前以体重指数BMI23.0-27.9(超重)和体重指数BMI28.0-32.9(1度肥胖)患者最多(85.9%),经针刺治疗后疗效显著,达到体重指数(BMI)18.5-22.9正常值的有71.2%.说明经30次针刺治疗后能有效降低体重指数(BMI)。
4临床以胃肠湿热型患者最多,疗效最好,总有效率达到100.0%.接着是肝郁气滞型,96.4%,这两型都是实证。其次是脾虚湿盛型总有效率是65.2%。气虚血瘀型效果较差治总有效率是54.3%。实证的疗效好于虚证,P<0.01。说明针灸治疗肥胖症能有效地改善各证型的病情和体重指数。各症型疗效比较依次为：胃肠湿热型>肝郁气滞型>脾虚湿盛型>气虚血瘀型。
[结论]针刺疗法可有效降低单纯性肥胖症患者BMI和体重。而四个证型的单纯性肥胖症患者治疗后以胃肠湿热型疗效最好,其次是肝郁气滞型,脾虚湿盛型与气虚血瘀型效果不明显。总结出实证的疗效好于虚证。
[Objective]
Observe the efficacy rate of applying main and secondary acupuncture point with guidance of basis theory of Traditional Chinese Medicine syndrome of differentiation for treatment of simple obesity patients, determine the efficacy rate upon treatment, as well as provide guidance on clinical research.
[Method]
Retrospective of the past 5 years(January 2004 to December 2009) of simple obesity patient of SINGAPORE KWONG WAI SHIU HOSPITAL TCM CENTRE into four groups include accumulation of heat in the Intestines and Stomach; Stagnation of Liver Qi; Excess dampness due to deficiency of spleen and Stagnation of Blood due to deficiency of qi,226 cases in total. Give an objective evaluation and justifiable conclusion on efficacy of acupuncture treatment amongst categorized groups to analyze and conclude the effects of acupuncture treatment for simple obesity patients. Summarized by statistics to analysis:
Determine which of the main and secondary acupuncture points and meridian as well as the obesity categories having highest appearing frequency. From another view point highlighted that while apply treatment to these 4 groups of obesity patients, that is to select acupuncture point which able to disperse heat, eliminate sputum and dampness as well as able to regulate the meridian system. Analysis before and after treatment of body weight, body mass index, body circumference by apply the statistical method of analysis (SPSS17) to probe into efficacy of acupuncture treatment for simple obesity.
[Results]
1) There are 30 acupuncture points in total frequently distributed among the Simple obese patients of different syndromes. The principal acupuncture points are determined by the most appearing frequency. (1) Eight acupoints surrounding the abdominal (i.e. Zhongwan, Xiawan, Qihai, Guanyuan, Tainshu, Daheng) (2) The intersection points (i.e. Daimai, Wushu, Weidao, Zulinqi) (3) Body acupuncture points (i.e. Fengshi, Zusanli, Sanyinjiao) and Zhigou were 25.9%, follow by Taibai, Hegu, Taichong, Gongsun, the occurrence frequency are 7.4%, follow by Fenglong, Xuehai, Ququan, Yanglingquan, Taixi, Shuidao, Neiting, Shangjuzu, Quchi, Liangqiu, Shuifen, Yinlingquan at 3.7% each.
2) In term of acupuncture point selection, Foot Meridian acupuncture points were selected the most. Follow by acupuncture points on the Stomach Meridian of foot yangming and Spleen Meridian of foot Taiying. Consists of function on vitalizing Qi, hence strengthen spleen meridian system. This simulated that patients in the treatment of self-righteousness needed to pay more attention to repair and regulate the body's yin and yang of the basic concepts.
3) As observed and analyzed by SPSS17, majority of patients (85.9%) consists of body mass index (BMI) ranging from 23.0-27.9 (overweight) and 28.0-32.9 (1 degree of obesity) prior to treatment. There is signaficant improvement after acupuncture treatment, the normal rate consists of 71.2%, which means patient managed to reduce their BMI to the normal range of 18.5-22.9 after underwent 30 times of acupuncture treatment.
4) the patients who categorized under accumulation of heat in the Intestines and Stomach has gain the greatest achievement of 100% efficacy, Secondly is the group categorized under Stagnation of Liver Qi achieved an efficacy rate of 96.4%, both group are belonging to Sthenia syndrome. It followed by the group categorized under excess dampness due to deficiency of spleen, achieved an efficacy rate of 65.2%, lastly is the group categorized under Stagnation of blood due to deficiency of qi, achieved an efficacy rate of 54.3%, this two group are belonging to Asthenia syndrome. The result has proven that the group belonging to Sthenia syndrome has achieved greater efficacy as compare to the group belonging to Asthenia syndrome, P<0.01. The result proven that apply acupuncture treatment to obesity patient has significant improvement on body health and BMI. Compare among each category, the sequent is:accumulation of heat in the Intestines and Stomach> Stagnation of Liver Qi> excess dampness due to deficiency of spleen> Stagnation of blood due to deficiency of qi.
[Conclusion]
Acupuncture therapy can effectively reduce BMI and body weight of patients with simple obesity. Amongst 4 groups, the patients who categorized under accumulation of heat in the Intestines and Stomach has the highest efficacy rate, Secondly is the group categorized under Stagnation of Liver Qi, There is no significant improve for the group categorized under excess dampness due to deficiency of spleen and the group categorized under Stagnation of Blood due to deficiency of qi. The result has proven that the group belonging to Sthenia syndrome has achieved greater efficacy as compare to the group belonging to Asthenia syndrome.
引文
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