【作者】 李骏霖；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 研究目的：应用温针结合拔罐方法治疗单纯性肥胖的临床观察,并对此方法与传统单纯针刺疗法对单纯性肥胖的客观疗效进行总结比较,以期对此作出系统、客观、科学的疗效评价,试图探究一个行之有效、经济安全的治疗单纯性肥胖的优佳方法。研究方法：1.病例选择：将56例符合研究要求的单纯性肥胖病患者,采用随机数字表法随机分成两组：治疗组(温针结合拔罐组)和对照组(单纯针刺组),其中治疗组27例,对照组29例。2.治疗方法：两组病例患者的病情、病程、年龄等基本情况具有可比性。(1)治疗组取穴：主穴：脐周八穴(水分、阴交、天枢(双)、水道(双)、大横(双))。配穴：辨证选穴,脾虚湿阻证可加丰隆、阴陵泉；胃热湿阻证可加曲池、内庭；肝郁气滞证可加太冲、支沟；阴虚内热证可加内庭、三阴交；脾肾阳虚证可加太溪、足三里。主穴采用温针疗法,患者取仰卧位,常规消毒后,医者手持毫针直刺入0.8-1寸,针刺得气后,取约2cm长的艾条一段,套在针柄之上,艾条的尾端距皮肤2-3cm,留针30分钟后起针；配穴采用普通针刺法；腹部起针后,患者取俯卧位,在背部搽适量万花油,用闪火法将罐吸住,在背部正中督脉及两侧膀胱经上来回推拉罐数次,至皮肤潮红即可起罐,一般约5分钟。(2)对照组取穴同治疗组；治疗方法采用普通针刺法,患者取仰卧位,穴位常规消毒后,针具选用华佗牌30号,1.5寸的毫针,以上穴位均直刺或斜刺入上述穴位0.5-1.0寸,得气后施行平补平泻手法,每5分钟行针1次,共留针30分钟后出针。3.疗程：以上疗法均隔日操作1次,每周操作3次后休息1天,4周为一疗程,分别于治疗4周后及8周后观察并评估疗效。疗效评定包括：肥胖度、体重指数(BMI)、脂肪百分率(F%)、腰臀比值等指标评分。研究结果：(1)两组病例治疗前、后肥胖度的比较组内比较：两组病例治疗4周后及治疗8周后与治疗前比较,差异均有统计学意义(P<O.05)；治疗8周后与治疗4周后比较,差异有统计学意义(P<O.05)。组间比较：治疗组与对照组比较,治疗4周后,差异无统计学意义(P>0.05)；治疗8周后,差异有统计学意义(P<0.05)。(2)两组病例治疗前、后体重指数的比较组内比较：两组病例治疗4周后及治疗8周后与治疗前比较,差异均有统计学意义(P<0.05)；治疗8周后与治疗4周后比较,治疗组差异有统计学意义(P<0.05),对照组差异无统计学意义(P>O.05)。组间比较：治疗组与对照组比较,治疗4周后,差异无统计学意义(P>0.05)；治疗8周后,差异有统计学意义(P<0.05)。(3)两组病例治疗前、后脂肪百分率(F%)的比较组内比较：(1)治疗组：男性患者：治疗8周后与治疗前比较,差异有统计学意义(P<0.05)；女性患者：治疗8周后与治疗前比较及治疗4周后比较,差异均有统计学意义(P<0.05)。(2)对照组：男性患者：治疗8周后与治疗前比较,差异有统计学意义(P<0.05)；女性患者：治疗4周后、治疗8周后与治疗前比较,差异均有统计学意义(P<0.05),治疗8周后与治疗4周后比较,差异有统计学意义(P<0.05)。组间比较：治疗组与对照组比较,男性患者：治疗4周后及治疗8周后,差异无统计学意义(P<0.05)；女性患者：治疗4周后,两组差异无统计学意义(P>0.05)；治疗8周后,两组差异无统计学意义(P>0.05)。(4)两组病例治疗前、后腰臀比的比较组内比较：两组病例治疗8周后与治疗前比较,差异有统计学意义(P<0.05)；两组病例治疗4周后与治疗前比较及治疗8周后与治疗4周后比较,差异均无统计学意义(P>0.05)。组间比较：治疗组与对照组比较,治疗4周后及治疗8周后,差异均无统计学意义。(5)疗效评定结果及比较治疗组总有效率均为85.19%,对照组总有效率75.86%,结果证实温针结合拔罐和常规针刺治疗单纯性肥胖均有良好的疗效,两组结果经x2检验,两组有效率之间差异有显著性意义(P<0.05),表明治疗组采用的方法临床疗效明显优于对照组。研究结论：(1)温针结合拔罐和常规针刺治疗单纯性肥胖均有良好的疗效。(2)温针结合拔罐治疗组和常规针刺对照组两组间的疗效比较两组间的差异显著,提示本法治疗单纯性肥胖疗效更佳,值得临床推广应用。更多还原

【Abstract】 ObjectiveTo observe the clinical effects of treating simple obesity by the therapy of Warm Needle-Moxibustion combined with Cupping, meanwhile to compare the clinical effects of the therapy of Warm Needle-Moxibustion combined with Cupping and conventional acupuncture methods. Try to find a effective, economic and safe way to treat the such patients. The effective method can light the side effect of medical, decrease the recurrence rate, elevate the life quality and survival rate, lessen the patients’economic burden and so on.Methods:1. Fifty-six cases of simple obesity received the treatment who met the clinical research requirements were randomly divided into two groups, which including Warm Needle-Moxibustion combined with Cupping group (Treatment group,27cases), conventional acupuncture group (control group,29cases).2. The information of the patients of two groups, such as duration, age and other basic situations have no significant differences.(1) Treatment group Acupoint:The eight acupoints around the navel (Shuifen point, Yinjiao point, Tianshu point (Bilateral), Shuidao point (Bilateral), Daheng point (Bilateral)). Syndrome in spleen dysfunction due to dampness choosing Fenglong point and Yinlingqun point as coordinated points; Syndrome in Heat in stomach and dampness choosing Quchi point and Neiting point as coordinated points; Syndrome Qi Stagnation Due to Depression of the Liver choosing Taichong point and Zhigou point as coordinated points; Syndrome of endogenous heat due to yin deficiency choosing Neiting point and Sanyinjiao point as coordinated points; Syndrome of spleen-kidney yang deficiency choosing Taixi point and Zusanli point as coordinated points. The main points take the method of Warm Needle-Moxibustion, the other points take the conventional acupuncture methods. After the acupuncture treatment, patients take supine position, paint Appropriate Dieda wanhua oil on the back, and cupping on patients back.(2)Control group Acupoint:The same as the treatment group. these points all take the conventional acupuncture methods.3. Period of treatment:The frequency is once2days, three times a week,4weeks is one course, the observation time is4weeks and8weeks. The index include body weight, fatness, BMI, F%and WHR.Results:1. FatnessCompared in group:After4weeks and8weeks therapies, compared with scores before the treatment, there were significant difference in the two groups. Compared the score after4weeks with the score after8weeks, there were significant differences as well.Compared between groups:Compared between the two groups, after4weeks therapies, there were no significant differences. however, after8weeks therapies, there were significant differences.2. BMICompared in group:After4weeks and8weeks therapies, compared with scores before the treatment, there were significant difference in the two groups. Compared the score after4weeks with the score after8weeks, there were significant differences in the Treatment group. But there were no significant differences in the Control groupCompared between groups:Compared between the two groups, after4weeks therapies, there were no significant differences, however, after8weeks therapies, there were significant differences3. F%Compared in group:(1) Treatment group Male:After8weeks therapies, compared with scores before the treatment, there were significant differences. Female:After8weeks therapies, compared with scores before the treatment and after4weeks therapies, there were significant difference.(2) Control group Male:After8weeks therapies, compared with scores before the treatment, there were significant differences. Female:After4weeks and8weeks therapies, compared with scores before the treatment, there were significant difference. Compared the score after4weeks with the score after8weeks, there were significant differences as well.Compared between groups:After4weeks and8weeks therapies, compared with scores before the treatment, there were no significant difference.4. WHRCompared in group:After8weeks therapies, compared with scores before the treatment, there were significant difference in the two groups. Compared the score after4weeks with the score before treatment and the score after8weeks, there were no significant differences in the two groups.Compared between groups:Compared between the two groups, after4weeks and8weeks therapies, there were no significant differences5. The therapy of warm Needle-Moxibustion combined with Cupping and that of the conventional acupuncture all have good curative effect. The total effective rate is:the warm-needle acupuncture85.19%; the control group75.86%. It has the statistically significant (P<0.05), which shows the therapy of warm Needle-Moxibustion combined with Cupping has the better effect.Conelusion1. The two methods of warm Needle-Moxibustion combined with Cupping and the conventional acupuncture are effective in treating simple obesity.2. The curative effect of the two methods has significant differences between them, that is to say, the method of warm Needle-Moxibustion combined with Cupping is more effective than conventional acupuncture.更多还原