【作者】 宫锦汝；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 中医学， 2011， 博士

【摘要】 一、研究目的本文将对脐疗法在儿科中的应用规律进行研究,期望通过系统收集整理文献中有关脐疗法的内容以及在儿科中的临床研究类文章,总结归纳出脐疗法在儿科中的应用规律。具体研究包括脐疗法在儿科中的优势疾病系统、优势病种及常用药物、优势操作系统、常用赋形剂、脐疗新剂型及新的操作方法等,为脐疗法提供更可靠的依据,能够更好的指导脐疗在儿科临床中的应用；评估脐疗法在儿科中的临床研究类文献的质量,同时对近20年研究状况进行统计,以期分析脐疗法在儿科中的发展趋势；探寻应用于儿科疾病的相对成熟的市售脐疗产品,为脐疗法在儿科中的推广应用提供支持。二、研究方法脐疗法在儿科中应用规律的文献收集方面,对清代及清代以前的文章以脐疗法专著《中华脐疗大全》、《中华脐疗大成》、《中医脐疗大全》三本书为主要参考,主要运用计算机检索《中华医典》升级版为主并配合手工查阅方式。对现代文章以中国知识资源总库即中国知网,中国生物医学文献服务系统(CBM)为检索源,收录1978-2010年33年间在国内中文医学期刊公开发表的脐疗在儿科中的临床研究类文章。共得到1978-2010年有效统计的临床研究类文献593篇。在系统的收集和整理了古今脐疗法文献以及在儿科中应用的文章的基础上,采用传统文献学和现代统计学相结合的方法,对古今脐疗法在儿科中的应用规律进行了研究。三、研究成果(一)脐疗法文献和内容研究本文对脐疗法的渊源沿革、研究现状、操作方法、作用机理、用药特点等进行了整理研究。(二)古代文献中脐疗法在儿科中的应用规律1.临证广泛,病种繁多2.方法灵活,随证而施3.剂型多样,时有叠加4.辨证论治,清代突显5.善于调理小儿脾系及肾系病证6.神阙穴禁针(三)现代文献中脐疗法在儿科中的应用规律1.脐疗法在儿科中的优势疾病系统是脾系病证。脐疗法对儿科中脾系病证的临床文献高居脐疗优势疾病系统的榜首,占据626篇文献中的417篇,占总文献量的67%；说明脐疗法在儿科中的应用,主要优势集中在脾系病证。2.脐疗法在儿科中的优势病种是泄泻、厌食、遗尿、痛经。脐疗法对泄泻的临床报道高居脐疗法优势病种的榜首,占有总文献量的51.6%,占文献总量的一半以上。此外,厌食、遗尿、痛经所占的文献量也相对较高,这说明脐疗法在这三种疾病方面也有相对明显的优势。3.脐疗法在儿科各疾病系统中的优势病种。脾系病证中的厌食占脾系病证中的10.79%,说明在脾系病证中,除了泄泻是可以优先考虑的病种外,厌食也是一种值得考虑的疾病；肺系病证中,哮喘、荨麻疹、过敏性鼻炎占有比较明显的优势；肾系病证中的遗尿,月经病中的痛经,新生儿病中的脐部疾患,心肝病证中的失眠都在各自的疾病系统中,占有比较明显的优势,是脐疗法治疗这些疾病系统的优势病种。4.脐疗法在儿科中的优势操作系统是敷贴脐部。5.脐疗法在儿科中的各操作系统所对应的优势疾病系统以及优势病种。敷贴脐部在脾系病证、肺系病证中应用较多,尤其是脾系病证中的泄泻、厌食,肺系病证中的哮喘、荨麻疹、过敏性鼻炎；按摩脐部法只用于脾系病证,且善于治疗泄泻病；脐部拔罐法只用于肺系病证,且善于治疗过敏性鼻炎；熨脐疗法善于治疗脾系病证,首先是泄泻病,其次是便秘；灸脐疗法首先善于治疗泄泻病,其次是痛经。6.敷贴脐部中最擅长使用软膏。敷贴脐部中,软膏类的临床使用文献最多,所治疗的疾病种类最广泛,平均到每种疾病所使用的软膏类文献达10.48次。7.赋形剂使用频率较高的是醋、酒和水。现代临床上也会用到的有氮酮和二甲基亚砜等。8.脐疗法治疗标注儿科中前3种优势病种(泄泻、厌食、遗尿)使用频次较高的药物。治疗泄泻病时,丁香、吴茱萸、肉桂的使用频次明显高于别的药物,其他频次较高的药物有苍术、五倍子、木香、干姜、白术、黄连、胡椒、车前子、小茴香、藿香等；治疗小儿厌食时,砂仁、苍术、白术、鸡内金、丁香、莱菔子、肉桂、山楂、槟榔等药物的出现频次较高,治疗小儿遗尿时,益智仁、五倍子、桑螵蛸、肉桂等药物的出现频次较高。9.脐疗法所治儿科病种的平均有效率情况。本文对超过5篇(包括5篇)的临床儿科脐疗文献进行平均有效率的统计,结果显示,平均有效率在90%-95%的病种有：术后疾病、腹痛、过敏性鼻炎、厌食、泄泻、便秘；平均有效率在95%以上的病种有：痛经、遗尿、荨麻疹、感冒、哮喘、汗证、脐部疾患、疳积。10.脐疗法在儿科中临床研究类文献的质量评价及发展趋势。虽然本次研究的脐疗法在儿科中临床研究类文献的质量不高。但是,临床文献报道基本显示出上升的趋势,与此同时,含有随机对照的文章越来越多,脐疗法的临床应用文献的质量也越来越高,此外,单纯脐疗法的应用越来越少,两种中医疗法和中西医结合疗法的应用越来越多,尤其是两种中医疗法的应用增加的更为明显。11.脐疗法在治疗儿科疾病时,常用到的市售产品有多种,一种是类似于膏药的的剂型,如巴布贴剂、丁桂儿脐贴、复方丁香开胃贴、巴布膏、儿泻宁、儿泻康贴膜、温灸贴、脐宝、纳米腹泻贴。另一种是可以经常用到脐疗法中的产品,如云南白药。还有一些中成药、中药免煎颗粒甚至是西药,只要根据临床病症,辨证准确,都可以在中医理论指导下,使用脐疗法来治疗相关疾病。四、研究结论(一)古今脐疗法的异同点1.共同点：(1)古今脐疗法都包含的操作方法有敷贴脐部、灸脐疗法、熨脐疗法、脐部拔罐法、按摩脐部法,这些方法随着时代的发展,时至今日,依然是临床上常用的脐疗操作方法,尤其是敷贴脐部法。(2)古今脐疗法都擅长使用赋形剂,常见的赋形剂有醋、酒、水、鸡蛋清等,虽然时代已经发展,但是这些赋形剂仍然是现代临床上常用的药物。(3)古今脐疗法所治疗的疾病范围都很广泛,涉及到内、外、妇、儿、五官等各个学科,所治疗的病种也很繁多,如泄泻、哮喘、厌食、遗尿等。(4)古今脐疗法都使用较多的剂型是干粉、软膏、膏药,这些剂型在古今临床上都发挥着不可替代的作用,尤其是干粉、软膏的使用越来越多。2.不同点：(1)现代操作方法又增加了运用仪器作用于脐部、针刺脐部法、脐部磁疗法。(2)赋形剂的选择方面,现代比古代更加丰富,如氮酮、二甲基亚砜、酒精等。(3)有些古代的脐疗法因安全、卫生等因素已经很少使用,如雄鸡罨脐法,牛粪敷脐法。(4)有些脐疗方法已经很少使用,如鲜药敷贴。(5)现代可见针刺神阙穴的临床报道。(6)医疗仪器运用广泛。(7)脐疗新剂型不断出现。(二)古今脐疗法在儿科应用规律中的异同点1.共同点：(1)都擅长治疗儿科脾系病证,其次是肾系病证；(2)都比较擅长治疗儿科泄泻；(3)在各类操作系统中,都善于使用敷贴脐部法,而且此法当中,比较擅长使用软膏类剂型；(4)所治疗的疾病种类都很繁多；(5)都比较善于使用赋形剂。2.不同点：(1)古代脐疗法当中,神阙穴是禁针的,而现代文献当中,已经有针刺神阙的成功医案；(2)古代脐疗操作方法和剂型在儿科中的应用没有现代的丰富,随着医疗仪器设备、制药工艺等的发展,现代增加了运用仪器作用于脐部、脐部磁疗法、巴布剂等新的操作方法和剂型；(3)古代脐疗法治疗儿科疾病时,会较多的使用鲜药,现代文献中很少出现这样的记载；(4)辨证论治这条中医治病原则在清代的文献记载中,比较突显,而现代运用脐疗法治疗儿科疾病时,统计的626篇文献当中,只有53篇使用了辨证论治原则。(三)针刺神阙穴的可行性探讨神阙穴是否可针刺一直是个比较有争议的话题,本文尝试着对其进行了针刺可行性的探讨。更多还原

【Abstract】 1 ObjectiveThe article will do research on the application regularity of navel therapies in pediatrics. It will summarize the regularity through the way of collecting the contents about navel therapies and articles about clinical effect in pediatrics. The research on navel therapies in pediatrics will contain superiority disease system, superiority sickness plants and the commonly used medicine, the superiority operating system, the commonly used excipient, the navel cures the new dosage-form, the new operating procedure, and so on. It can provide a more reliable basis for the navel therapy. And also it can give the better instructions to navel therapies in pediatrics. It will appraise the articles quality and analyse the navel therapies trend by statisticsing the articles in the recent 20 years. It will provide the support for the application of navel therapies in pediatrics by finding the relatively mature navel products in market, which used in pediatrics diseases.2 MethodsAuthor uses kinds of methods to collect literatures about navel therapies in pediatrics. First, the article mainly refers to "The Chinese Navel Cures Comprehensive work", "the Chinese Navel Cures Accomplishment", "Chinese medicine Navel Cures Comprehensive work" before the Qing Dynasty. Second, it uses the computer to search the promotion version of "Chinese Medicine Standard" primarily. And it uses the manual way to consult too. Third, the modern articles about navel therapies in pediatrics are taken from the CNKI、CBM, which are published in the domestic Chinese medical journal public publication from 1978 to 2010. There are 593 articles which meet the standards during 33years. To collect and collate the literature of ancient and modern therapies, this article deeply study the origin of evolution, status, operation method, mechanism, drug characteristics, etc.. And using the method of combining traditional literature and modern statistics, the application regularity of navel therapies based on ancient and modern documents in pediatrics are studied.3 Results(1) Research on the Navel Therapies’Literatures and ContentsThe article does the research on navel therapies’origin evolution, research status, operation method, mechanism, drug administering characteristics, and so on.(2) Rules of Navel Therapies Based on Ancient Documents in Pediatrics(Ⅰ) Diagnoses is widely, and sickness is variously.(Ⅱ) The method is flexible, and it executes along with the card.(Ⅲ) The dosage-form is diverse, and sometimes it will superimpose.(Ⅳ) Pattern is identified, and it is prominent in the Qing Dynasty.(Ⅴ) It is good at recuperating the young child spleen department andkidney department’s disease.(Ⅵ)It is to forbid acupuncting "shenque"(3) Rules of Navel Therapies Based on Modern Documents in Pediatrics(Ⅰ) The spleen diseases are the superiority disease system in pediatrics based on navel therapies. The clinical literatures which involved to the spleen disease in pediatrics based on navel therapies hold first in the superiority disease system. It has 417 literatures in 626. The proportion is 67%. It is explained that navel therapies’superiority in pediatrics is the spleen diseases.(Ⅱ) Diarrhea, anorexia, enuresis, dysmenorrheal are the advantages diseases in pediatrics based on navel therapies. The clinical literatures which involved to diarrhea in pediatrics based on navel therapies hold first in the superiority sickness plants system. The proportion is 51.6%, which exceeds half of the literatures. In addition, anorexia, enuresis and dysmenorrheal takes more percents. It indicated that navel therapies have the relative superiority in these three vigorous sickness aspects.(Ⅲ) There are superiority sickness plants in their respective disease system in pediatrics based on navel therapies. Anorexia holds 10.79% in the spleen diseases, Which indicates that anorexia is also a worth pondering disease besides diarrhea. Asthma, urticaria, allergic rhinitis hold the obvious superiority in the lung diseases. Enuresis in the kidney diseases, dysmenorrhea in the emmeniopathy, umbilical diseases in the Neonatal disease, insomnia in the heart and liver vigorous sickness have the relative superiority in their respective disease system, which are superiority sickness plants in their respective disease system based on navel therapies.(IV) Shenque point application is the superiority operating system in pediatrics based on navel therapies.(V) There are superiority sickness plants and superiority disease system in their respective operating system in pediatrics based on navel therapies. Shenque point application has a broad application in the spleen、lung diseases, especially diarrhea and anorexia in the spleen diseases, asthma, urticaria and allergic rhinitis in the lung diseases. Kneading navel region is only used in the spleen diseases, and it is good at treating the diarrhea sickness. Cupping navel region is only used in the lung diseases, and it is good at treating the allergic rhinitis. Ironing navel region is good at treating the spleen diseases. It is good at diarrhea sickness. The constipation is the next one. Moxibustion in the navel region is good at treating the diarrhea sickness. Dysmenorrheal is the next one.(VI) Shenque point application mostly uses ointment. The literatures referring ointment is the most ones. And the types of diseases treated are also the most ones. Average, the ointment used for each disease is up to 10.48 times.(VII) vinegar, wine and water are mostly used as excipient. Laurocapram and dimethyl sulfoxide are also used in modern clinical.(VIII) The article gives the drugs used higher frequently in the former three kinds of diseases (diarrhea, anorexia, enuresis). When treating diarrhea, flos caryophylli, fructus evodiae, cortex cinnamomi are used more than rhizoma atractylodis, calli chinensis, radix aucklandiae, rhizoma zingiberis, rhizoma atractylodis macrocephalae, rhizoma coptidis, rhizoma coptidis, fructus piperis, semen plantaginis, fructus foeniculi, herba pogostemonis, and so on. When treating infantile anorexia, fructus amomi, rhizoma atractylodis, rhizoma atractylodis macrocephalae, endothelium corneum gigeriae galli, flos caryophylli, semen raphani, cortex cinnamomi, fructus crataegi and semen arecae are used more. When treating infantile enuresis, fructus alpiniae oxyphyllae, calli chinensis, ootheca mantidis, cortex cinnamomi are used more.(Ⅸ) The article gives the average efficiency statistics of the literatures, which referring navel therapies more than 5 (including 5) times. It shows that the diseases whose average efficiency is from 90% to 95% are operative diseases, abdominal pain, allergic rhinitis, anorexia, diarrhea, constipation, whose average efficiency is more than 95% are dysmenorrheal, enuresis, urticaria, common cold, asthma, perspiration syndrome, umbilical diseases, infantile malnutrition.(Ⅹ) The articles quality and trend of navel therapies in pediatrics Although the articles quality is not high in pediatrics, but the trends about navel therapies in pediatrics are arising. At the same time, the literatures containing randomized controlled are becoming more and more. And the quality of the literatures is becoming higher. Besides, the application of a simple navel therapies become less and less. While, the application of integrated traditional Chinese and western medicine therapy become more and more. Especially, the application of two Chinese medicine therapy is more apparent.(Ⅺ) When treading the diseases in pediatrics, many kinds of products can be used. One kind is formulation, for example, cataplasm, Ding Guier the navel pastes, compound clove promoting appetite pastes, cataplasma, warming moxibustion pastes, nanometer diarrhea pastes. Another kind is usually used in navel therapies, for example, yunnan white drug. As long as it is diagnosed according to the basis of clinical symptoms, syndrome and accurate, Chinese patent medicine, traditional chinese medicine exempt decoction particles, even the western medicine can be used to cure disease in navel therapies, under the guidance of the traditional Chinese medicine theory.4 Conclusion(1) The Differences between Ancient and Modern Navel Therapies(Ⅰ) The Same PointsFirst, the operation methods used in the accident and modern navel therapies are Shenque point application, Moxibustion in the navel region, Ironing navel region, Cupping navel region, Kneading navel region. With the development of these methods, today, they are still commonly used in clinical treatment, especially Shenque point application. Second, they are good at using excipient, for example, vinegar, wine, water, egg white. Third, they can care many kinds of diseases, for example, internal medicine, surgical department, gynecology, paediatrics, phthalmology and otorhinolaryngology. And they can care many diseases, for example, diarrhea, asthma, anorexia, enuresis. Forth, the mostly used formulation in accident and modern clinic are dry powder, ointment and plaster. They play an irreplaceable role in accident and modern clinic, especially dry powder and ointment.(Ⅱ) The Different PointsFirst, in the modern methods, it increases the methods of using instrument on navel region, Acupuncturing navel region and umbilicus magnetotherapy. Second, excipient can be selected more abundantly., for example, laurocapram, dimethyl sulfoxide, alcohol. Third, some methods are used less because of safety, heath and other factors, for example, compress umbilicus, cattle manure navel administration. Forth, some methods such as fresh herbal medicines navel administration are used less. Fifth, the modern acupuncturing shenque point is use in clinical. Sixth, medical instruments are used widely. Seventh, New formulation appears usually.(2) The Differences of Application Regularity between Ancient and Modern Navel Therapies in Pediatrics(Ⅰ) The Same PointsFirst, both of them do well in the spleen diseases as well as Kidney diseases in pediatrics. Second, both of them are good at curing diarrhea in pediatrics. Third, In various operating systems, they are good at using Shenque point application. And ointment is used the most. Forth, they can cure many kinds of diseases. Fifth, they are good at using excipient.(Ⅱ) The Different PointsFirst, in the ancient navel therapies, Shenque point is forbidden to acupuncture. While in the modern navel therapies, it is already to be used successful. Second, the ancient operation methods and formulations are not richer than the modern ones. With the development of medical equipment and pharmaceutical technology, instrument on navel region, umbilicus magnetotherapy and cataplasm are used in the modern. Third, in the ancient, fresh herbal medicines are used, but in the modern, they are not selected. Forth, according to the literatures, the principles of pattern identification are used more in the Qing Dynasty. But in the modern, only 53 of 626 articles use the principles of pattern identification.(3) The Feasibility of Acupuncturing ShenqueShenque whether can use the method of acupuncture has been a more controversial topic, this article attempts to discuss the possibility.更多还原