【作者】 周德钊；

【导师】 张宏；

【作者基本信息】 广州中医药大学 ， 中医学， 2011， 博士

【摘要】 一、研究目的：Internet网是上世纪九十年代的新生事物,近年来,随着Internet网络的迅速普及,青少年快速接受网络的同时,也因为沉溺网络而引发的心理、生理、道德、行为越轨甚至违法犯罪的问题正迅速增多,已成为日益突出的社会难题。随着网络不断普及,我国网络成瘾患者数量不断增加。网络成瘾像酗酒、吸毒和赌博等不良嗜好一样,引发心理、行为问题,进而导致家庭危机、工作和学习效率下降、失业甚至犯罪等社会问题。对网络成瘾综合征的治疗,目前多数采用认知行为疗法及参考精神疾病的治疗方式,如封闭式隔离网络、军事体育训练、个性化心理辅导、团体心理治疗、镇静剂、抗抑郁、抗焦虑等。目前中医在网络成瘾综合征的治疗中应用还不够广泛,缺乏统一的辨证及治疗原则,针灸作为一种传统治疗手段,已初步在临床得到使用,且疗效显著。本研究通过观察针刺及耳压结合心理及药物与单纯心理及药物治疗网络成瘾综合征的临床疗效,为临床针刺及耳压治疗网络成瘾综合征提供循证医学证据。并根据中医理论对网络成瘾综合征进行病因病机的理论分析,提出网络成瘾综合征的中医致病及针灸治疗的机理。二、研究方法：1、临床研究方法查阅并整理网络成瘾综合征相关的临床研究资料,参考并博采各临床研究所采用的研究方法、诊断标准、疗效评价及统计方法之所长,结合实际情况,制订出科学先进、切实可行的的研究方案。临床病例均来自广州白云心理医院青少年心理科住院患者,2010年3月至2010年12月共收集61例符合纳入标准的网络成瘾综合征患者纳入研究,按患者入院顺序采用数字随机的方法,按1：1的比例,分为治疗组31例和对照组30例。个性心理辅导由广州白云心理医院专业心理医生实施,每周一次,一次约两个小时；团体心理治疗每周两次,每次三个课时。精神类药物由精神科医生根据患者症状处方：抗抑郁药物艾司西酞普兰(10mg/次,1次/日),抗焦虑药物劳拉西泮(1-2mg/次,2次/日)等。对照组采用心理及药物治疗,治疗组是在对照组治疗的基础上加针刺及耳压治疗。针刺基本处方为：四神聪神庭本神(双)印堂内关(双)神门(双)三阴交(双),并进行临床随证加减,耳压处方为：心肝肾交感神门皮质下三焦内分泌。六周为一个疗程,每周一、三、五下午治疗三次,共18次治疗。治疗前后使用中文网络成瘾量表、病情程度分级表、SCL-90、汉密尔顿抑郁量表、汉密尔顿焦虑量表进行评价,所收集的数据使用SPSS13.0统计软件进行统计分析。2、理论研究方法理论研究主要查阅了《黄帝内经》、《中医基础理论》、《中国传统精神病理学》等书籍,整理了有关心神(元神、识神、欲神)、心神与气血的关系、情志致病、现代心理学、生理学等相关理论,并将这些理论用于网络成瘾综合征的病因病机分析及临床治疗的指导。三、研究结果：1、临床研究结果(1)治疗组病例31例,基本治愈20例,显效5例,有效3例,无效3例,治疗总有效率为90.32%,基本治愈率为64.52%；对照组病例30例,基本治愈13例,显效3例,有效6例,无效8例,治疗总有效率为73.33%,基本治愈率为43.33%。两组治疗总有效率和基本治愈率对比有统计学差异(P<0.05),说明针刺加耳压治疗网络成瘾综合征有效,能提高临床的治愈率和有效率。(2)治疗组SCL-90量表总分、躯体化症状、抑郁、焦虑、偏执、精神症状,汉密尔顿抑郁量表、汉密尔顿焦虑量表在治疗后得分与对照组治疗后得分比较有显著性差异(P<0.05)。说明了针刺加耳压在降低患者总体不适、躯体症状、抑郁、焦虑、偏执及精神症状方面具有优势,能显著改善患者抑郁及焦虑症状。(3)无论治疗组还是对照组,有求治要求患者的疗效明显优于无求治要求患者,生活自理能力无明显受损者疗效明显优于生活处理能力明显受损者。而患者的网龄、病情严重度与疗效均无显著相关性(P>0.05)。2、理论研究结果元神是先天之神,对人体起最高主宰作用,藏于心,既是元气的功能体现,又能调节和控制元气的运动和作用,是胚胎发育和后天生命活动的本原主宰者。识神调节和控制人的精神意识、思维情感等。欲神是各种内在深藏的欲求冲动,其之动亦常干扰元神,我们可以把欲神理解为人的本能欲求,它通常在识神的引动下激发,进而扰乱元神,造成元神的虚耗。本文认为“欲神”是导致了网络成瘾的根源,网络能满足人的各种欲望,是网络成瘾的根源。弗洛伊德认为：死与攻击是人的本能,他称为塔那托斯(Thanatos,希腊神话中的死神)。而网络游戏中提供的攻击性,是网络成瘾的又一个根源。网络成瘾可耗伤脏腑气血并造成元神的损伤。游戏者被网络游戏所吸引,长时间的上网游戏,识神与欲神的活动必然过度。识神和欲神的过度活动均可干扰元神,造成元神虚耗,进而耗伤气血,同时用神过度,则心血消耗太多,易致心血亏虚,神劳过度,心血不继,也将导致神伤,加之青少年气血、元神发育尚不足,元神受伤在所难免。元神受伤,使得元神对脏腑的支配能力下降,进而造成脏腑功能下降,这可能是网络成瘾患者表现为情绪低落、神情淡漠、精神麻木,对外界事物不感兴趣等症状的病因。针灸对网络成瘾综合征的治疗,主要是针对患者气机紊乱、神志受伤,通过针灸调节气血的功能来治神,即恢复元神的正常功能。重点在于激发正气、调理元神。而调气和治神,正是针灸治疗疾病之精髓所在。四、研究结论：1、临床研究结论(1)针刺加耳压结合心理及药物治疗网络成瘾综合征可提高网络成瘾综合征的基本治愈率和总有效率,明显改善患者的精神症状(治疗组SCL-90量表总分、总阳性项目数、人际关系敏感、抑郁、焦虑、精神症状、其它等因子,汉密尔顿抑郁量表、汉密尔顿焦虑量表得分均明显优于对照组)。(2)网络成瘾综合征患者是否有求治要求及生活自理能力是否明显受损与疗效存在相关性,是影响疗效的重要因素。(3)网络成瘾综合征患者的网龄、病情严重度与疗效是否存在相关性,结论尚不明确,还有待进一步研究。2、理论研究结论目前中医在理论上对网络成瘾综合征的研究不多,已有学者提出该病应归于神志病或情志病。笔者在本文中尝试用中医的心神理论及气血理论来解释该病的病因病机,通过针刺及耳压的治疗方法应用于临床治疗,并取得了确切的疗效。但由于笔者中医理论功底尚浅,研究之中不足之处甚多,期待后来者的进一步研究。更多还原

【Abstract】 ObjectiveInternet is a new phenomenon in 1990s. Recently, with the popularity of the Internet, while the youngsters are receiving the Internet quickly, it also brings some psychological, physiological, moral problems, or even illegal actions and crime actions, which are outstanding but troublesome social problems. As the university of the Internet, the Internet Addiction patients are on the increase. Just like overdrinking, drug-taking, gambling or other harmful habits, Internet addiction can also cause the psychological and behavior troubles, which will result to family crisis, decrease the working and studying efficiency, lead to unemployment even crime etc..The treatment of Internet Addiction, mainly, adopting the cognitive action therapy and consulting the treatment of psychosis, such as closing and isolating from the Internet, military training, psychological guidance, collective psychological guidance, taking calm drug, antidepressant, antianxity, etc.. Nowadays, it is not very popular to use traditional Chinese medicine in the treatment of Internet Addiction, which also lack a unifiedly identificated and curing principles. However, acupuncture, as a traditional therapy, has been put into use preliminary and received a remarkable effect.Through observing the effect of acupuncture, pressing of the auricular point combined with psychotherapy and pharmacotherapy in the treatment of Internet Addiction Syndrome in clinical treatment, to provide medical evidence for this method. Furthermore, according to the theoretical analysis on the reasons and mechanism of disease of Internet Addiction Syndrome in Chinese Medical, the writer comes up with the acupuncture healing mechanism.Methods1.Means of clinical treatment research Consulting and arranging the clinical research meterials of Internet Addiction Syndrome and absorbing the advantage of study method, diagnostic criteria, curative effect evaluation and statistic techniques. And combining with the actual conditions to work out a scientific and workable study method.The clinical cases are patients from Guangzhou Baiyun Psychology Hospital adolescent mental section. From March to December 2010, a total of 61 qualified patients were recruited into the research. By the admitted order and using the stochastic method, in a ratio of 1:1, the patients were divided into two groups-the treatment group (31 persons) and the comparison group (30 persons).Individual psychology counselling was implemented by professional psychologist from Guangzhou Baiyun Psychology Hospital. The counselling lasts 2 hours, and once a week. The team psychology treatment was conducted twice a week,3 hours every time. Mental medicines were prescribed by psychiatric doctors, and the prescription are:escitalopram (10mg/once, once a day), used to antidepressant;Lorazepam Tablets (1-2mg/once, twice a day), used to anti-anxiety etc.. Psychological and medical treatment was used in the comparison group, in addition, the treatment group also had acupuncture and auricular point press. The main points for acupuncture were as follows:EX-HN, DU 24, GB 13(double), EX-HN 3, PC 6 (double), HT 7(double), the times of acupunctures variates with the clinical conditions. The points for auricular point press are:heart, liver, kidney, Sympathetic Nerve, Ear Shenmen, subcortex, Central Rim, Sanjiao, Endocrine. The treatment were conducted in Monday, Thursday, Friday, totally 18 times.During the treatment, Chinese Internet addiction volume table, Degree of disease volume table, SCL-90, HAMD, HAMA were used to evaluate, and all the collected data were analysed by the SPSS13.0 software.2. Theoretical MethodsTo conduct the theoretical research, the writer mainly consulted these books such as Huangdi Neijing, Fundamental Theory of Traditional Chinese Medicine, The Traditional Mental Psychopathology etc., and sorted out the relevant theories about the relationship of spirit (original spirit, recognizant spirit, orectic spirit), qi and blood, disease caused by emotions and ambitions, in addition, to apply these theories to the analysis of the causes of the internet addiction syndrome. Result1. Conclusion of clinical treatment(1) In treatment group, there are 31 patients, in which 20 are cured,5 had the obvious effects,3 had effects,3 had no use. The cure rate is 90.32%, and the basic curative rate is 64.52%. In comparison group, there are 30 patients, in which 13 are cured,3 had the obvious effects,6 had effects, 8 had no use. The cure rate is 73.33%, and the basic curative rate is 43.33%. Statistics discrepancy(<0.05) of total efficient rate and basic curativerate exists between the two groups.(2)Discrepancy obviously exists between the two groups before and after test scores in such aspects as aggregate score of SCL-90, the positive number, interpersonal sensitivity, depression, anxiety, mental symptom, HAMD, HAMA.(3)Relevance obviously exists between the level of impairment, the healing effect and the patients’requirement for treatment, the self living abilities (P<0.05); The length of surfing the Internet has no relevance with the healing effect (P>0.05); The seriousness of the disease has no obvious relevance with the healing effect (P>0.05); in the comparison group, the seriousness of the disease has no obvious discrepancy with the midium disease (P>0.05), but obvious discrepancy exists in the healing effects between medium and the heavy, the light and the heavy patients (P<0.05).2. Conclusion of theoretical studyOn the base of the relevant theories about the relationship of spirit (original spirit, recognizant spirit, orectic spirit), qi and blood, disease caused by emotions and ambitions, the writer comes up with the idea that disorder of qi and blood of the Internet addicts are caused by the extremeness of emotions and ambitions, consequently, regulating the qi and curing the spirit are the core of healing the internet addiction syndrome by acupuncture.Conclusion1. Conclusion of clinical treatment(1) The method of acupuncture and pressing the auricular point with the assistance of medicine can improve the fundamental curative rate and the overall efficiency, which also ameliorate the mental symptom such as SCL-90, HAMD, HAMA.(2) Wether the internet addiction syndrome patients seek treatment or if they can live by themselves are relevant, which are the important factors. (3) There are no clear evidence that wether age, the level of severity of the patient have correlation, which requires further studies.2. Conclusion of theoretical studyCurrently, in addition to some scholars having addressed that the disease should be owed to conscious or emotional illness, the theoretical studies on Internet Addiction Syndrome are very limited. In this essay, the writer try to use the theory of spirit and the theory of qi and blood to explain the pathogenesis of the disease. Furthermore, to apply to clinical treatment, the writer make use of acupuncture and pressing the auricular point, which have achieved a certain success. However, because of the writer’s limited knowledge of Chinese Medical theory, the inadequacies of this study require further studies later on.更多还原