【作者】 邱荣鹏；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 本论文包括文献研究和临床试验研究两大部分。文献研究部分：随着健身气功的普及,具有调心、调神、调息作用的健身气功也越来越多的应用于疾病的防治且有着较好的疗效。此部分是在系统整理中医学对纤维肌痛综合征(Fibromyalgia Syndrome, FS)的认识和西医学的相关研究进展,并结合对健身气功·易筋经的认识基础上,对FS的发生机制、评定及治疗方法进行总结,对选择健身气功·易筋经作为原发性FS的干预手段提供理论基础,从而为设计临床试验,确定有效的观察指标及制定完善的试验方法奠定基础。临床研究部分：目的：通过观察原发性FS治疗前后各相关指标的变化,评价健身气功·易筋经对FS的影响并探讨相关机理。方法：将59名患者随机分为口服西药组(简称为药组,20人)、口服西药加易筋经组(简称为药加易组,19人)、易筋经锻炼组(简称为易组,20人)共三组。药组服用德利能糖衣锭,从每日10mg开始,根据病人耐受情况,每10天增加10mg,至30mg为止。睡前一次口服,连服3个月；同时给予行为认知疗法。药加易组口服药物的药名、剂量及服法同药组,且给予相同的行为认知疗法。除服药和行为认知疗法外,还辅以易筋经锻炼,每日锻练2次,每次锻炼约1小时,连续练习3个月。易组不服用FS相关药物,只是通过行为认知疗法加上易筋经锻炼方法给予治疗,行为认知疗法和锻炼方法同药加易组。比较各组视觉类比疼痛量表(VAS)、汉密顿抑郁量表(HAMD)、Athens失眠量表以观察患者疼痛、抑郁、失眠等主要症状和体征的变化,并通过纤维肌痛综合征影响问卷(FIQ)进行评分,同时计算患者的疼痛点个数,同时针对治疗方法可能出现的副作用进行评价。通过治疗前后评分值或数值的改变,判断各主要症状和体征的改善程度及整体疗效情况。结果：在疼痛指数、痛点个数、失眠量表评分、抑郁量表评分、FIQ评分上,药组、易组和药加易组在治疗前后均有明显改善,且药加易组治疗效果最优,与药组及易组均有显著差异。易组与药组比较,在疼痛指数、痛点个数变化上无显著差异；在失眠量表评分、抑郁量表评分的变化上药组显著优于易组；在最终疗效的评价(FIQ评分)上,易组与药组无显著差异。在副作用方面,易组无一例产生副作用,与药加易组和药组均有显著差异,而药加易组副作用产生率要低于药组且有显著性差异。结论：易筋经锻炼可以增强口服西药加行为认知疗法的疗效,并且可以适当的减少德利能的副作用,因此口服德利能加行为认知疗法辅以易筋经锻炼是治疗原发性FS较好的选择。同时,行为认知疗法和易筋经锻炼结合虽然总体上疗效要略差于同时服用德利能的治疗方法,但因为其无副作用,因此也可作为FS临床治疗的一个选择。更多还原

【Abstract】 This dissertation includes two parts, i.e. literature research and clinical research.Literature research:with its popularity, health qigong, which has the functions of adjusting mind, spirit and breath, has been applied to prevention and treatment of diseases and has achieved good effects. This part is focused on cognition on relative literatures to sum up pathogenesis, evaluation and approaches to treatment on Fibromyalgia Syndrome (FS) as well as the review of Health qigong-Yijinjing. The design of clinical research, observing data and experimental method were established based on these literatures.Clinical reseach:Objective:to evaluate the influence of Health qigong-Yijinjing on primary FS by observing the change of data concerned.Method:59 patients with primary FS were divided into 3 groups including medication group (M, n=20), medication and Yijinjing exercise (MY, n=19) and Yijinjing exercise group (Y, n=20). Group M took Amitriptyline HCl, once daily for 3 months, and accepted cognitive-behavioral therapy. Group MY accepted the same intervention methods as group M and Yijinjing exercise, twice daily for 3 months. Group Y had Yijinjing exercise and accepted cognitive-behavioral therapy same as Group MY without any meidcation. Visual analog scale (VAS), Hamilton depression scale (HAMD) and Athens insomnia scale (AIS) were used to evaluate the change of patients’ main symptoms and signs. Moreover, Fibromyalgia impact questionnaire (FIQ), the number of tender points and potential side effects were evaluated. The efficacy was evaluated by the data above.Result:For three groups, there were significant changes after respective intervention in terms of the scores of VAS, HAMD, AIS, FIQ and the number of tender points. Group MY achieved the best efficacy and had significant difference, comparing group M and Y. There was no significant difference between group M and Y in terms of the scores of VAS and FIQ and the number of tender points. As for the scores of HAMD and AIS, the efficacy of group M is obviously better than group Y. There was significant difference among group M, MY and Y. There was no side effect occurred in group Y. Group MY had obviously lower occurrence than group M.Conclusion:Health qigong-Yijinjing exercise could enhance the efficacy of medication and cognitive-behavioral therapy and reduce the side effect of Amitriptyline, therefore it is a better choice for patients with primary FS to take Amitriptyline, cognitive-behavioral therapy and Yijinjing exercise. Although the efficacy of cognitive-behavioral therapy and Yijinjing exercise, which had no side effect, was a little worse than that of the combination of the three interventions, it can be a choice for FS.更多还原