【作者】 骆纪谨；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的:随着人们生活水平的提高,以及饮食结构的不合理,肥胖症的发病率迅速增高。患病率与日俱增,肥胖症不但影响美观,造成生活的不便,而且是高血压、动脉硬化、冠心病、糖尿病、高脂血症等疾病的重要发病基础,肥胖症严重地影响人类的身体健康。因此,肥胖症的防治日益受到人们的重视。针灸减肥因其具有方便、经济、有效而且无副作用等优点,越来越受到人们的关注,并日益广泛应用于临床。本研究应用俞募配穴针刺治疗脾虚湿阻与肝郁气滞型单纯性肥胖的临床研究,观察比较俞募穴体针与脾胃经穴针刺疗法的疗效,找出疗效更好的针刺减肥方法,表明这一配穴方法较单用俞穴或募穴是否具有更好疗效,应在中医辨证基础上加予配穴,也应结合传统补泻手法,强调得气才能达到治疗效应,形成合理的针灸处方,开展了本研究。方法:在广州中医药大学第一附属医院及惠州市人民医院康复减肥中心就诊的66例脾虚湿阻型、肝郁气滞型肥胖症病人,随机分为二组,每组33例患者,分别给予俞募穴体针与脾胃经体针疗法。治疗组:俞募穴体针组,脾虚湿阻型:选脾俞、章门为主穴,配足三里、丰隆等;肝郁气滞型:选肝俞、期门为主穴,配太冲、太溪等;对照组:脾、胃经穴体针组,选中脘、天枢、阴陵泉、三阴交为主穴,配足三里等。同时再配合局部围刺与临证加减穴位处方。临证加减处方:肠燥便秘者体穴加天枢、支沟;易饥饿者,加合谷、足三里;痰湿甚者,加丰隆、阴陵泉,自动发胖者,加肾俞、三阴交;月经不调者,加归来;产后肥胖,加曲泉、石门;下肢浮肿者,加水分、阴陵泉;肝郁气滞甚者,加太冲、三阴交,临床局部肥胖甚者再配合围刺手法与临证加减穴位处方。治疗组给予俞募配穴针刺治疗脾虚湿阻与肝郁气滞型肥胖,两种证型均以俞穴募穴交替治疗,俞穴以补法为主,募穴以泻法为主,针刺深度依肥胖患者的高矮胖瘦而定,首先在患者针刺部位,进行常规消毒,取1.5寸针灸针直刺或斜剌后,强调得气并行提插、捻转之补泻手法,针刺后每次留针20-30分钟,10次为一疗程;第二疗程开始改为隔日一次,10次为一疗程;第三疗程改为一周一次,时间一个月;总共治疗3个疗程。对照组给予脾、胃经穴针刺治疗,针刺方法、疗程与治疗组相同:首先在患者针刺部位,进行常规消毒,取1.5寸针灸针直刺或斜刺后,强调得气并行提插、捻转之补泻手法,针刺后每次留针20-30分钟,每日1次,连续10次为一疗程;第二疗程改为隔日一次,10次为一疗程;第三疗程改为一周一次,时间一个月;总共治疗三个疗程。结果:经过3个疗程的治疗,治疗组:临床控制9例,显效14例,有效6例,无效4例,总有效率29例(87.88%)。对照组:临床控制3例,显效10例,有效8例,无效12例,总有效率21例(63.64%)。以上病例收集均随访6个月,疗效稳定。提示俞募穴体针组及脾胃经穴体针组,治疗总有效率以俞募穴体针疗法最好,在肥胖症指标上,治疗前后体重差及体重指数差和上臂周长差,二组治疗统计学上均无明显差异,无统计学意义(P＞0.05)。俞募穴体针组治疗前后腰围差、腹围差及臀围差,与脾胃经体针组比较,差异有统计学意义(P＜0.05)。在症状改善方面,由图5、6可知,俞募配穴体针组:脾虚湿阻与肝郁气滞型患者治疗后症状改善最明显,均有统计学意义(P＜0.01)。结论:俞募配穴是常用的配穴方法之一,本研究以俞募配穴针刺治疗脾虚湿阻与肝郁气滞型肥胖症,无论是俞募配穴体针治疗或脾、胃经体针治疗均具有满意疗效,但在主要症状与肥胖症评价指标方面的改善上,俞募配穴体针疗法更有效。由图5、6表明,针刺治疗脾虚湿阻与肝郁气滞型肥胖患者的前后主要症状积分改善,又以肝郁气滞型肥胖症的俞募穴针刺疗效最显著。人们在使用各种各样的方法进行减肥,民以食为天,饮食过多是肥胖症的主因之一。经络是人体气血运行的通路,腧穴是人体脏腑经络气血输注于体表的特殊部位,通过针刺治疗刺激体表腧穴,以达到治疗疾病的目的。肝主疏泄,脾主运化,肝脾二脏同属中焦,在生理上有着密切关系。脾主运化,有赖于肝气疏泄,肝的功能正常,疏泄调畅,则脾运健旺;若脾运失健或脾虚湿蕴,也会影响于肝,致肝失疏泄,为“木克土”或“木乘土”;另一方面为“土侮木”。俞穴是五脏六腑之气输注于背部的特定穴位,募穴是脏腑之气汇集之处,通过经络中医辨证,选以肝脾俞募穴及健脾疏肝之足三里、丰隆、太冲、太溪等配穴针刺治疗单纯性肥胖,可通调脾之运化,肝之疏泄,以达健脾益气、疏肝解郁。所以,脾虚湿阻与肝郁气滞型肥胖患者,经俞募配穴针刺治疗之后,临床疗效显著,同时顺利达成减肥的目的。俞募配穴可疏通气机,而针刺治疗能直接刺激经络,疏导经络气机,通过刺激经脉调理脏腑经络气滞,相对来说比补脏腑虚更快见效,因此,俞募配穴针刺治疗脾虚湿阻与肝郁气滞型肥胖两个分型,以肝郁气滞型肥胖疗效最显著。更多还原

【Abstract】 Objective:With the life is better and better,the structure of bite and sup is more and more rational,obesity is more and more familiar.Obesity not only affects posture,making life discommodity,but also it is the important basis of hypertension,arteriosclerosis,coronary heart disease,diabetes,high lipoprotein disease,etc.Obesity seriously affects human’ s health.So, prevention and cure obesity is more and more regarded.Because acupuncture is facility,economy,effective,and with no side-effect,acupuncture is paying more and more attention in treatingadiposis,and it is used in clinic more and more widely.The clinical study is about treating obesity of syndromes in spleen dysfunction due to dampness and liver-qi stagnation with acupuncturing back-Shu and front-Mu points to observe the effects and find the best method to cure obesity.It shows that the effect of this methods is better than that of using shu-back points or front-mu points only.So differentiation of syndromes with cooperated acupoints,adding traditional reinforcing and reducing methods can achieve the function of treatment and form the reasonable acupuncture prescription to develop the research.Methods:Sixty-six cases of simple obesities who are in the acupuncture clinic in the First Appertain Hospital of Guangzhou University of TCM and Huizhou People Hospital are divided into 2 groups averagely which have 33 patients.Patients of syndromes in spleen dysfunction due to dampness and liver-qi stagnation are treated with acupuncturing back-Shu and front-Mu points and points in the spleen and stomach meridians.The treatment group:back-Shu and front-Mu points group,syndromes in spleen dysfunction due to dampness using Pishu(U.B.20),Zhangmen(Liv.13) as main points,coordinated with Zusanli(St.36)、Fenglong(St.40)ect.Syndromes in liver-qi stagnation using Ganshu(U.B.18)、Qimen(Liv.14) as main points,coordinated with Taichong(Liv.3)、Taixi(K.3)ect.The control group:The acupoints in the spleen and stomach meridians using Zhongwan(Ren.12)、Tianshu(St.25)、Yinlingquan(SP.9)、Sanyinjiao(Sp.6) as main points,coordinated with Zusanli(St.36)ect.According to the syndromes:constipation with intestine dryness adding Tianshu(St.25) and Zhigou(S.J.6);Zusanli(St.36) and Hegu(L.I.4) will be added if one is easily hungry;Fenglong(St.40)and Yinlingquan(SP.9) wil be added if one is in phlegm-damp type;Shenshu(U.B.23) and Sanyinjiao(Sp.6) will be added if one is self-fatness;Guilai(St.29) will be added in patients of irregular menstruation;Ququan(Liv8),Shimen(Ren.5) wil be added to patients of swelling;syndromes of liver-qi stagnation will use Taichong(Liv.3) and Sanyinjiao(Sp.6).local fatness will use surrounding needling and adding points according to differentiation of syndromes.The treatment group uses the therapy of needling back-Shu and front-Mu points,with exchanges between the points.Needling the places with 1.5 cun needle straightly after sweetening the body,using the methods of reinforcing and reducing methods.Body needles will be used everyday and will be settle for 20 to 30 minutes,ten times will be the first period of treatment,and the from the second period,it will be used every other day,and it is 10 times as a period.In the third period,one time per week,it will be treated 3 periods. The control group will be treated with acupuncture the points in the spleen and stomach meridians with the same methods as the treatment group.Results:After 3 period of treatment,the patients who are in treatment group:better available,available and invalidation is respectively 9,14,6,4.The patients of the control group is 3,10,8,12.The total efficiency of the 2 groups are respectively 87.88%and 63.64%.At the end of follow of 6 months,the effect is steady.It shows the total efficiency of back-shu and front-mu points is better than the points of the spleen and stomach meridian,but there is no obvious difference in statistics. On the curative targets including obesity indices as the difference of avoirdupois and BMI,there is no significant difference.But on the difference of the kummerbund and the girth of thigh,there are significant difference compared to the body needle group and the ear needle group.Compared to the back-shuand front-mu points,the difference of the girth of stern and abdomen in the points of the spleen and stomach meridian is obviously difference. What’ s more,symptom in spleen dysfunction due to dampness and liver-qi stagnation with acupuncturing back-Shu and front-Mu points is obviously difference from chart 5 and 6.Conclusions:Using back-shu and front-mu points is a kind of cooperating points method.Whether acupuncturing back-Shu and front-Mu points or the points of the spleen and stomach meridian have good effects in treating obesity,but acupuncturing back-Shu and front-Mu points is better in improving the obesity indices,especially in syndromes of spleen dysfunction due to dampness and liver-qi stagnation from chart 5 and 6.People thinks eating foods as the most important thing but when they use different kinds of methods to lose weight,eating too much is one of the leading causes of obesity.Meridians of the body’s vital energy pathways to run,the body’s organs Acupoints meridian qi and blood transfusion in the special parts of the body surface,through the acupuncture treatment to stimulate acupoints surface in order to achieve the purpose of treating disease.Liver controlls dispersion,spleen governs transportation,and liver and spleen are in the second dirty coke,in closely related physiological.Spleen governs transport and depends on the liver controlling dispersion,liver function to normal, smooth dispersion,the spleen shipped healthy and vigorous;if spleen loses transfer or is in dampness,which can also affect the liver,so it is caused by missing liver dispersion,as "the wood limits the soil" or "the wood is superior to the soil";on the other hand,"soil attacks the wood"The back-shu points are infusion organs of the specific acupuncture points on the back,raise the gas hole is viscera converge,through the TCM meridians,Yu election to raise points of liver and spleen and liver of Jianpi Zusanli,HongLeong,tooChong,and so too the river with simple obesity treated with acupuncture points,leading to the delivery of transfer of spleen and liver of dispersion to achieve tonifing the qi and spleen,regulate the stagnation of liver-qi.Therefore,dampness stagnation in spleen dysfunction and liver-qi stagnation in patients with obesity,as Yu points raised with acupuncture treatment,a significant clinical effect,at the same time achieve the purpose of weight loss.Back-Shu and Front-Mu points can be assigned to clear the air machine, which can directly stimulate the acupuncture meridian therapy to regulate meridian qi through meridians to stimulate the qi meridians conditioning organs,organs make up relatively empty faster than the results,therefore, with back-Shu and Front-Mu point needle Treatment of Spleen Dampness barbed Liver depression and Qi stagnation and two sub-type obesity to stagnation of liver Qi stagnation obesity the most significant effect.更多还原