【作者】 曾炳昌；

【导师】 张宏；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2008， 博士

【摘要】 目的:本研究观察穴位埋药线合并中药治疗单纯性肥胖症,既继承运用了普通针刺疗去的特性,其作用效果也一样,并具备针刺“静以留之”的长期作用,又融入中药辨正论治的精神,是针药并用的完全结合。本研究首次以穴位埋药线合并中药治疗单纯生肥胖症,不论在选穴或用药均是以中医药辨证论治的特色,皆在为临床治疗单纯性把胖症提供一种疗效确切、简、便、廉、验的治疗方法。方法:参考第三届肥胖病研究学术会议上制定的“单纯性肥胖病的中西医结合诊断、疗效标准”选择符合单纯性肥胖诊断标准者,进行诊断。对符合纳入标准的病例,依据肥胖患者的志愿分为两组,治疗组为穴位埋药线合并中药组,对照组为中药组。对照组:依中医辨证分型应用中药治疗,予6倍浓缩科学中药胶囊(0.5克/粒)3粒/次,每日3次饭前服用,14周为一疗程。治疗组:在中药治疗方面(同对照组)加穴位埋药线,取穴为主穴(辨病取穴)各证型通用,辅穴(辨证取穴)。每次依辩证分型选取7～10个穴位进行穴位埋药线,每次治疗均单侧取穴,左右交替使用,每2周埋线1次,7次为一疗程。分别于治疗前,治疗后对相关指标进行观察。操作方法:令患者俯卧,暴露埋线部位,在穴位上用龙胆紫做定位注记,局部严格常规消毒,采用一次性医用穿刺针,将已制备之羊肠药线2公分长,放入穿刺针针管前端,对准所选穴位快速刺透表皮,得气后,缓缓边推针芯边退针管,将羊肠药线留在穴内,出针后盖无菌棉球,按压片刻以防出血,贴防水胶布固定保护,防止感染。共收集单纯性肥胖症患者173人,依患者志愿得治疗组96人和对照组77人。于疗程结束后,对各项观察指标所得结果进行统计分析。疗效标准:参考第二届中西医结合肥胖症学术会议制定的肥胖症疗效评定标准,分别和总体计算改善率评定疗效。结果:采用t检验和卡方检验对照两组基线情况比较进行分析,可知治疗前两组患者在性别、年龄、病程、肥胖程度,均无显着差异(P＞0.05),具有可比性。治疗组总有效率为88.54%,对照组总有效率为77.92%,两组显效与有效例数分布不同(P＜0.05)。治疗组的总有效例数主要集中于“显效”,而对照组的总有效例数平均于“显效”和“有效”,治疗组的显效率高于对照组。分别观察两组治疗后体重、BMI、体脂肪、内脏脂肪都有明显下降,有统计学意义(P＜0.05),两组治疗后体重、BMI、体脂肪、内脏脂肪的变化差值相比较(P＞0.05),治疗组在体重、BMI、体脂肪、内脏脂肪的改变优于对照组。观察两组治疗后胸围、腰围、臀围的变化,发现治疗组、对照组治疗前后的胸围与腰围存在差异(P＜0.05),臀围存在显着差异(P＜0.05)。两组治疗后胸围、腰围、臀围的变化差值相比较(P＞0.05),说明治疗组在胸围、腰围、臀围的改变优于对照组。通过对TG、TC、HDL-cho、LDL-cho、Leptin五个指标治疗前后变化的对比,我们发现两组在治疗后TG、TC、HDL-cho、LDL-cho、Leptin的五个指标均有显着差异(P＜0.05)。两组在治疗后TG、TC、HDL-cho、LDL-cho、Leptin的变化差值相比较,TG(P＜0.05)、LDL-cho、Leptin、TC(P＞0.05)、HDL-cho(P＜0.05)。穴位埋药线合并中药组与单纯中药组对单纯性肥胖患者均有疗效,且穴位埋药线合并中药组治疗比单纯中药组治疗收效快速。临床实验结果显示,两组之肥胖度、体重指数在治疗前后相比较,皆有明显降低。体重改变总平均数为5.395(kg),达显效之标准。分开比较两组之肥胖度、体重指数改变量,亦有显着差异。而在肥胖指标治疗效果上,穴位埋药线合并中药组优于单纯中药组。穴位埋药线合并中药组体重下降平均数为5.8(kg),达显效之标准;单纯中药组体重下降平均数为5.1(kg),亦达显效之标准。结论:用穴位埋药线合并中药治疗单纯性肥胖症有一定的优势,通过消脂减肥,增强机体代谢的方式,达到健康减肥的目的。穴位埋药线具有针刺疗法相同的疗效,治疗次数和每次治疗针数明显少于普通针刺疗法,民众接受度高,坚持完成疗程的比例也比传统针刺提高许多,其优点是简、便、廉、验,且毒副作用小,对于当前急速增加的肥胖人口,穴位埋药线合并中药减肥不但可减轻重量,且可使机体恢复健康,将为临床提供值得推广的治疗方法。更多还原

【Abstract】 Objective: This research observes the effects upon treating primary obesity with combination of catgut implantation at acupoint and Chinese native medicine treatment. This catgut implantation at acupoint not only possesses the effects that ordinary acupuncture technique had, it also prolongs the duration of the acupuncture effect. This technique is integration between acupuncture and Chinese medication and follows the process of diagnosis and treatment in traditional Chinese medicine. This is the first study to combine the catgut implantation at acupoint and traditional Chinese medication. We also use the process of diagnosis and treatment of Chinese medicine to decide the acupuncture point and the remedy for each individual patient. We hope this new technique would provide another precise, simple, convincement, and inexpensive treatment for the primary obesity.Method: We select our patient according to the medical diagnosis and treatment standard for primary obesity which was set up at third session of obesity research academic conference. We then divided the patients into two groups according to patient’s will. The first group is medicated-thread-burying acupuncture technique combined with Chinese medication; and the second one is pure Chinese medication. In the group with pure Chinese medication, the patients received six times concentrated scientific Chinese medicine capsule three times a day (before each meal), three capsules a time (0.5g for each capsule), and total 14 weeks for each cycle. In the group of acupuncture combined Chinese medicine, the patients also received the same medication with the same dosage and durations. They also received acupuncture at the same time. There is primary acupuncture point (chosen according to the disease type) and the secondary acupuncture point (chosen according to the symptoms). We choose 7～10 unilateral acupuncture points to perform catgut implantation at acupoint according to disease character and change the left and right points in turns every two weeks for seven cycles. We then observed and recorded the changes in targeted values before and after the treatment. The procedure: Make patient lay face downward and expose the puncture points. We then mark the puncture points with gentian violet. After strictly disinfect the puncture points, we put the 2 cm medicated-catgut in the disposable puncture needle tip and aim at the puncture point. After the patient is ready, we puncture the skin very quickly and push the needle core while slowly pulling out the needle tube. This method would leave the catgut inside the acupuncture point. After the puncture needles removed, we use sterile cotton ball to perform local compression which was fixed by water-proof medical tapes to prevent further bleeding and infection. We total collect 173 patients who are suffered from primary obesity. 96 patients were in the acupuncture combined Chinese medicine group and the other 77 patients were in the pure Chinese medicine group. We then analyze statistically all the target values. Therapeutic standard was referred to standard of effective evaluation in treating obesity which was set up at the second session of cooperation of Chinese and Western medicine obesity academic conference.Result: We use T-test and chi-square test to compare the baseline differences between two groups. There is no obvious differences found in patients age, sex, disease course, and obesity degree (P>0. 05). The total effectiveness rate in acupuncture combined Chinese medicine group is 85.54%. It was 77.92% in the pure medication group. There is difference in the number distribution between significantly effective and effective cases (P<0. 05). In the catgut implantation at acupoint combined with Chinese medication the total effective case numbers are mainly in the category of significantly effective. But the total effective case numbers in pure Chinese medicine are distributed in significantly effective and effective categories both. The numbers of significantly effective case in catgut implantation at acupoint combined with Chinese medication group is more than the pure Chinese medicine group. There is significant decrease in body weight, body mass index, body fat ratio, internal organ fat ratio in each group (P<0. 05). Comparing the post-treatment changing value in body weight, body mass index, body fat ratio, and internal organ fat ratio in two groups, The catgut implantation at acupoint combined with Chinese medication group is better than the pure Chinese medicine group(P >0. 05).Compare the chest, waist, and buttock width before and after treatment, we found there is difference between theses two groups in chest and waist width(P<0. 05). There is significant difference in the buttock width (P<0. 05). Comparing the post-treatment changing value in chest, waist, and buttock width in two groups, The catgut implantation at acupoint combined with Chinese medication group is better than the pure Chinese medicine group(P>0. 05).We also found there is significant difference in the target values of TG、TC、HDL-cho、LDL-cho、Leptin before and after treatment (P<0. 05). Comparing the post-treatment changing value inTG、TC、HDL-cho、LDL-cho、Leptin in two groups, TG (P<0.05)、LDL-cho Leptin、TC (P>0.05)、HDL-cho (P<0.05) all showed better effect in catgut implantation at acupoint combined with Chinese medication group.The catgut implantation at acupoint combined with Chinese medication and pure Chinese medication both seem to be effective in treating obesity. But the catgut implantation at acupoint combined with Chinese medication if far more fast and effective than pure. Chinese medicine. The clinical study showed obviously decrease in severity of obesity and body mass index. The average body weight lost Is 5.395 kg, which is significantly effective.Comparing the changed values in severity of obesity and body mass index, there is also significant difference. However, catgut implantation at acupoint combined with Chinese medication is far better than pure Chinese medicine group. The average weight lost in catgut implantation at acupoint combined with Chinese medication is 5.8kg, which if significantly effective. But the average weight lost in pure Chinese medicine is only 5.1 kg. But it is significantly effective also.Conclusion: The catgut implantation at acupoint for treating the obesity is effective and beneficial. It not only decreases the fat accumulation but also enhances the metabolism and increase the fat catabolism.Catgut implantation at acupoint is as effective as the ordinary acupuncture. But the puncture frequency and needle number for each treatment obviously to be short to the ordinary acupuncture treatment. It’s more acceptable to patients. The proportion of completing the treatment course also enhanced. It is simple, convenient, inexpensive, and lees side effects. Currently, facing the rapidly increases obese population, combined Chinese medication could not only lose weight but also improve the health condition. It would be a good treatment in our clinical practice and worth further promotion.更多还原