针灸加药物治疗气滞血瘀型肥胖症临床研究

【作者】 杨士萱；

【导师】 许能贵；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2008， 博士

【摘要】 1.目的:随着社会的不断进步,人们生活水平的不断提高,肥胖人数急剧上升,肥胖不仅给生活带来诸多不便,影响身心健康甚剧,且易导致高脂血症、糖尿病、冠心病及脑卒中等并发症。由于肥胖症及其症的发病率逐年上升,已成为本世纪危害人类健康的全球性疾病。世界卫生组织在1997年明确宣布肥胖是一种疾病,并指出肥胖是当今全球侵蚀人类健康的流行病之一,是一个主要的公共卫生问题。肥胖与艾滋病、吸毒、酗酒已并列世界性四大医学社会问题。因此,积极防治肥胖已成为当前预防医学领域中一个刻不容缓的研究课题。肥胖症目前西医主要透过行为和药物治疗,而治疗药物各有不同的作用特点,如食欲抑制剂和脂肪酶抑制剂等,长期服用均有明显副作用。中医药疗法在此方面已具明显优势,而针灸更是公认的一种“绿色”疗法,对肥胖症的临床治疗上获得满意的疗效,更具兼简、便、廉、效、安全、无毒副作用之优点,值得临床更深入的研究探讨与推广。在进行本研究之前收集了许多有关肥胖症的文献资料,加上临床中的观察,发现目前台湾的肥胖症的证型中,以「气滞血瘀」型为多。因此,拟以针灸结合桃核承气汤来治疗「气滞血瘀」型的肥胖症。针灸具有疏通经络的功效,桃核承气汤《伤寒论》在临床上则用于治疗多种血瘀疾病,具有活血化瘀,清热泻下的功能,再依体质证型,予以疏肝理气之药治疗肥胖症。本课题针对女性运用针灸加药物治疗「气滞血瘀」型的肥胖症的作用,进行严密的观察论证,以探求其改善肥胖症的机制。本研究旨在观察单纯性肥胖者针刺减重效应,以体重、腰围、臀围、血脂代谢的变化及治疗结束后复胖之观察评估,来揭示针刺减肥的机理,探寻针刺减重的最佳适应症,并藉此研究过程,建立患者健康的生活习惯,提高减重动机,有效预防肥胖症。2.方法:根据诊断标准选择病患,将60例气滞血瘀型的肥胖症患者,以随机单盲的方式,将研究对象分为以下三组:A组:电针合并中药制剂治疗组20例B组:单纯电针刺激治疗组20例C组:单纯中药制剂治疗组20例编入A及B组者,每周定期接受三次电针刺激,每次30分钟共8周;编入为A及C组者每周看诊取药一次,每天三次饭后服用,七天份之药。取穴:临证治疗以任脉和脾、胃经经穴为主穴,根据其脂肪堆积部位的不同,随症进行取穴。在腹部穴位、脂肪堆积较多处以电针机行电流持续刺激,所有穴位留针30分钟,加远红外线照射腹部。每周治疗三次,间隔1～2日针刺1次,一个月为一疗程,需连续治疗二个疗程。治疗疗程结束后,每个月至少回诊一次,连续观察三至六个月。减肥中药制剂:桃核承气汤(《伤寒论》)9克。每日三次,每次3克,于饭后温开水送服。观察指标:肥胖指针(包括体重、脂肪百分率(F%)、体重指数、腰围、臀围、腰臀比);血脂检查(包括三酸甘油酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C));空腹血糖(GLU)。本实验研究数据采用SPSS12.0 for Windows中文版软件处理,以描述性统计、成对样本t检定与oneway-anova作变异数同构型检测方法,P-value 0.05以下表示有显着差异性。再以Tukey HSD法作事后多重比较检定。3.结果:(1)肥胖症患者A、B、C三组的体重下降疗效比较上:A组采用针药合并治疗,体重下降至少5公斤,达到显效的有12人(60%);体重下降至少3公斤而未达5公斤,达到有效的有7人(35%);体重下降少于3公斤,未达到疗效的有1人(5%)。B组采用电针治疗,体重下降至少5公斤以上,达到显效的有8人(40%);体重下降至少3公斤而未达5公斤,达到有效的有10人(50%);体重下降少于3公斤,未达到疗效的有2人(10%)。C组采用药物治疗,体重下降至少5公斤,达到显效的有5人(25%);体重下降至少3公斤而未达5公斤,达到有效的有8人(40%);体重下降少于3公斤,未达到疗效的有7人(35%)。A、B、C三组的体重下降疗效的总有效率达83.3%。(2)肥胖症患者A、B、C三组的腰围下降疗效比较上:A组采用针药合并治疗,腰围下降至少8公分以上,达到显效的有7人(35%);腰围下降至少4公分以上,达到有效的有12人(60%);腰围下降在4公分以下,未达到疗效的有1人(5%)。B组采用电针治疗,腰围下降至少8公分以上,达到显效的有5人(25%);腰围下降至少4公分以上,达到有效的有13人(65%);腰围下降在4公分以下,未达到疗效的有2人(10%)。C组采用药物治疗,腰围下降至少8公分以上,达到显效的有2人(10%);腰围下降至少4公分以上,达到有效的有12人(60%);腰围下降在4公分以下,未达到疗效的有6人(30%)。A、B、C三组的腰围下降疗效的总有效率达85%。(3)肥胖症患者A、B、C三组的体重指数(BMI)下降疗效比较上:A组采用针药合并治疗,BMI下降≥4,达到显效的有3人(15%);BMI下降＜4~≥2,达到有效的有16人(80%);BMI下降＜2,未达到疗效的有1人(5%)。B组采用电针治疗,BMI下降≥4,达到显效的有2人(10%);BMI下降＜4~≥2,达到有效的有16人(80%);BMI下降＜2,未达到疗效的有2人(10%)。C组采用药物治疗,BMI下降≥4,达到显效的有1人(5%);BMI下降＜4~≥2,达到有效的有12人(60%);BMI下降＜2,未达到疗效的有7人(35%)。A、B、C三组的体重指数(BMI)下降疗效的总有效率达83.3%。(4)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后体重经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后体重无差异之虚无假设,可知治疗前后体重有差异,且均有显着下降。(5)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后腰围经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后腰围无差异之虚无假设,可知治疗前后腰围有差异,且均有显着下降。(6)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后臀围经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后臀围无差异之虚无假设,可知治疗前后臀围有差异,且均有显着下降。(7)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后腰臀比(WHR)经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后腰臀比(WHR)无差异之虚无假设,可知治疗前后腰臀比(WHR)有差异,且均有显着下降。(8)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后体重指数(BMI)经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后体重指数(BMI)无差异之虚无假设,可知治疗前后体重指数(BMI)有差异,且均有显着下降。(9)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后脂肪百分比(F%)经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后脂肪百分比(F%)无差异之虚无假设,可知治疗前后脂肪百分比(F%)有差异,且均有显着下降。(10)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后总胆固醇经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后总胆固醇无差异之虚无假设,可知治疗前后总胆固醇有差异,且均有显着下降。(11)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后三酸甘油酯经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后三酸甘油酯无差异之虚无假设,可知治疗前后总胆固醇有差异,且均有显着下降。(12)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后高密度脂蛋白经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后高密度脂蛋白无差异之虚无假设,可知治疗前后高密度脂蛋白有差异,且均有显着升高。(13)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后低密度脂蛋白经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后低密度脂蛋白无差异之虚无假设,可知治疗前后低密度脂蛋白有差异,且均有显着下降。(14)肥胖症患者A、B、C三组经成对样本T检定分析后发现,结论如下:A、B、C三组治疗前后血醣经成对样本T检定后发现,显着性为0.000,故拒绝HO:治疗前后血醣无差异之虚无假设,可知治疗前后血醣有差异,且均有显着下降。4.结论:(1)在「体重差0-8」的变数下,A组与C组之显着性皆小于显着水准0.05,故可得知A组与C组之体重下降平均差异很显着,且因A组与C组的差为正数,可推论A组治疗方法可能优于C组;A组体重下降平均数为5.60(kg),达显效之标准;B组体重下降平均数为4.49(kg),达有效之标准;C组体重下降平均数为3.82(kg),达有效之标准。故利用电针合并中药制剂治疗是最安全、有效、经济的减肥方法之一。(2)在「腰围差0-8」的变数下,A组与C组之显着性皆小于显着水准0.05,故可得知A组与C组之腰围差治疗平均差异很显着,且因A组与C组的差为正数,可推论A组治疗方法可能优于C组;A组腰围下降平均数为7.73(cm),达有效之标准;B组腰围下降平均数为5.88(cm),达有效之标准;C组腰围下降平均数为5.10(cm),达有效之标准。(3)在「臀围差0-8」的变数下,A组与C组之显着性皆小于显着水准0.05,故可得知A组与C组之臀围差治疗平均差异很显着,且因A组与C组的差为正数,可推论A组治疗方法可能优于C组;(4)在「T.C.差」的变量下,A组与C组之显着性皆小于显着水准0.05,故可得知A组与C组之总胆固醇差治疗平均差异很显着,且因A组与C组的差为正数,可推论A组治疗方法可能优于C组。(5)根据实验文献报导,肥胖的程度越重,出现高脂血症的机率越大,平均总胆固醇、中性脂肪、低密度脂蛋白的浓度增加,高密度脂蛋白的浓度减少,这种现象青年肥胖患者比老年肥胖患者表现得更明显。成人肥胖患者体重减少,其脂质代谢也得到改善。(6)腹围对肥胖的影响:反映肥胖程度以及腹部脂肪堆积的指标如体重指数(BMI)、腰围(WC)和腰臀比(WHR)与腹内脂肪面积呈显着正相关,尤以腰围WC的相关性最好。因此,这些指标也常被用来预测高血压、高脂血症、冠心病等相关疾病的发病危险性。此次实验统计三组之腰围、臀围在治疗前与治疗后相比较之下,皆有显着差异,每一组接受治疗后明显下降。三组之腰臀比在治疗前与治疗后相比较之下,皆有显着差异,每一组接受治疗后明显下降。(7)本次临床研究发现电针合并中药制剂治疗、单纯电针刺激治疗或单纯中药制剂治疗肥胖症都可达到满意的减重疗效。更印证减轻体重能有效治疗肥胖及其延伸的相关慢性代谢性疾病,并取得了良好的临床治疗效果。但减重后的体重反弹在肥胖治疗中较多存在,严重影响了肥胖患者减重的积极性与意愿,也使人们普遍意识到防止减重后的体重反弹是比减重本身更困难的一件事情。应深入探讨减重后体重反弹的病因机制将有利于寻找防止体重反弹的治疗策略。(8)对于肥胖患者来说,因为针灸是通过激发自身的调节机制来调整肥胖机体紊乱的内分泌及能量代谢功能的,从而使长期疗效有所保证,并可改善种种并发症。由于认知调节系统的存在,饮食控制和运动都难以坚持;而药物、手术又有副作用。相比之下,针灸则具有很大的优势:如无需一定的适应症;无毒副作用;美体塑身也可接受;可长期治疗等。同时针灸还具有简单、经济、安全等特点。故已为广大患者所接受。(9)瘀血内生是肥胖合并症的关键。选用《伤寒论》桃核承气汤泻热逐瘀,治疗气滞血虚型的肥胖症患者,在本研究实验中亦取得明显疗效。减重已是全民运动,更是一个必须从小即应长期监控的过程,希望肥胖症的临床研究,能为病患寻找出更有效及副作用少的减重治疗方式,减少肥胖症对身体所带来的危害,并进而能有效维持减重、促进健康。更多还原

【Abstract】 Objective:At present, the incidence of obesity goes up year after year. Traditional Chinese Medicine has evident predominance in curing it. Acupuncture, as a safe therapeutics, has good curative effect in clinic. This research will observe the effect of acupuncture and Peach Kernel Decoction (Taohe Chengqi Tang) for Ordering the Qi in curng qi stagnation and blood stasis syndrome of obesity. Methods:Divide 60 patients chosen according to the diagnosis standard into three groups:Group A: Electroacupuncture (EA) and Chinese Medicine, 20 casesGroup B: Electroacupuncture, 20 casesGroup C: Chinese Medicine, 20 casesAcupoints: Choose acupoints of the Ren Meridian, the Spleen Meridian and the Stomach Meridian as the main points, and then change the points according to the fat parts.Observing object: obesity exponential (including weight, Fat%, weight exponential, waistline, stern line, WHR); blood fat (including TG, TC, HDL-C, LDL-C, GLU). Results:(1) The descending effect of weight of the three groups:Group A: The obvious effect number is 12 (60%) whose weight goes down at least 5 kg; the effect number is 7 (35%) whose weight goes down at least 3 kg; the inefficacious number is 1 (5%) whose weight goes down less than 3 kg.Group B: The obvious effect number is 8 (40%) whose weight goes down at least 5 kg; the effect number is 10 (50%) whose weight goes down at least 3 kg; the inefficacious number is 2 (10%) whose weight goes down less than 3 kg. Group C: The obvious effect number is 5 (25%) whose weight goes down at least 5 kg; the effect number is 8 (40%) whose weight goes down at least 3 kg; the inefficacious number is 7 (35%) whose weight goes down less than 3 kg.The general effect rate of weight is 83.3% of the three groups.(2) The descending effect of waistline of the three groups:Group A: The obvious effect number is 7 (35%) whose waistline goes down at least 8 centimeters; the effect number is 12 (60%) whose waistline goes down at least 4 centimeters; the inefficacious number is 1 (5%) whose waistline goes down less than 4 centimeters.Group B: The obvious effect number is 5 (25%) whose waistline goes down at least 8 centimeters; the effect number is 13 (65%) whose waistline goes down at least 4 centimeters; the inefficacious number is 2 (10%) whose waistline goes down less than 4 centimeters.Group C: The obvious effect number is 2 (10%) whose waistline goes down at least 8 centimeters; the effect number is 12 (60%) whose waistline goes down at least 4 centimeters; the inefficacious number is 6 (30%) whose waistline goes down less than 4 centimeters.The general effect rate of waistline is 85% of the three groups.(3) The descending effect of BMI of the three groups:Group A: The obvious effect number is 3 (15%) whose BMI goes down more than 4; the effect number is 16 (80%) whose BMI goes down more than 2; the inefficacious number is 1 (5%) whose BMI goes down less than 2.Group B: The obvious effect number is 2 (10%) whose BMI goes down more than 4; the effect number is 16 (80%) whose BMI goes down more than 2; the inefficacious number is 2 (10%) whose BMI goes down less than 2.Group C: The obvious effect number is 1 (5%) whose BMI goes down more than 4; the effect number is 12 (60%) whose BMI goes down more than 2; the inefficacious number is 7 (35%) whose BMI goes down less than 2.The general effect rate of BMI is 83.3% of the three groups.(4) Compared with the weight before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(5)Compared with the waistline before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(6)Compared with the stern line before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(7)Compared with the WHR before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(8)Compared with the BMI before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(9)Compared with the F% before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(10)Compared with the TC before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(11)DCompared with the TG before and after treatment of group A、B and C, we can find there are differences which are obvious decline. (12)Compared with the HDL-C before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(13)Compared with the LDL-C before and after treatment of group A、B and C, we can find there are differences which are obvious decline.(14)Compared with the GLU before and after treatment of group A、B and C, we can find there are differences which are obvious decline.Conclusion:(1) The average differences of weight descending between group A and group C, and the effect of group A is better than group C. The average of weight descending of group A is 5.6 kg, which is to the standard of obvious effect; the average of weight descending of group B is 4.49 kg, which is to the standard of effect; the average of weight descending of group C is 3.82 kg, which is to the standard of effect. So, EA and Chinese Medicine is one of the most effective, the most safe and the most economical methods.(2)The average differences of waistline descending between group A and group C, and the effect of group A is better than group C. The average of weight descending of group A is 7.73 cm, which is to the standard of obvious effect; the average of weight descending of group B is 5.88 cm, which is to the standard of effect; the average of weight descending of group C is 5.10 cm, which is to the standard of effect. So, EA and Chinese Medicine is one of the most effective, the safest and the most economical methods.(3) The average differences of stern line descending between group A and group C, and the effect of group A is better than group C.(4) The average differences of TC descending between group A and group C, and the effect of group A is better than group C.This research finds that EA and Chinese Medicine, EA, or Chinese Medicine has good effect in curing obesity. Because medicine has side-effects, acupuncture is the best choice. Also, acupuncture is so easy, economical, and safe that most people like it. Blood stasis of endogenesis is the key point of obesity symptom. Peach Kernel Decoction (Taohe Chengqi Tang) can rush heat down and expel stasis, and has good effect in curing qi stagnation and blood stasis syndrome of obesity.更多还原