三伏天穴位敷贴治疗小儿虚性哮喘的临床对照研究

【作者】 张景琛；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的(objective):近年来由于文明进步所带来的环境污染及饮食习惯改变等种种原因,过敏疾病在台湾全岛似乎有逐年增加的趋势,其中小儿支气管哮喘更是为许多小朋友们带来健康上莫大的威胁。支气管哮喘病是当今世界最常见的慢性气道疾患。全世界哮喘病人可能达到1亿人以上,而近20多年来,哮喘的发病率不断的上升,尤其是儿童哮喘的发病率上升更为明显,根据调查统计西方国家儿童和青年的哮喘发病率已从4%上升至10%,澳大利亚哮喘发病率从1982年的12.9%上升到1992年的19.3%；纽西兰从1975年的26.2%上升到1989年的34.0%；挪威从1981年的3.4%上升到1993年的8.0%。而亚洲也不惶多让,日本从1967年的0.5%上升到1993年的4.6%；印度尼西亚从1984年的2.3%上升到1992年的8.2%；新加坡从1967年的4%上升至1991年的20.8%；香港从1992年的6.6%上升至1995年的11.3%；广州从1988年的2.4%上升至1995年的3.5%；上海从1979年的0.75%上升至1989年的3.56%。同样的台北市小儿罹患过敏性气喘也快速增加中,根据已故前长庚儿童医院院长谢贵雄教授统计数据显示,民国六十四年台北市小儿(7-15岁>支气管哮喘的盛行率为1.3%,到民国八十三年盛行率已高达10.8%,而根据台北市卫生局委托联合医院所做最新的调查,气喘的盛行率已到20.34%<96年>,而且每年还在增加中,因此,可预见未来小儿支气管哮喘盛行率只会更高而已,哮喘病已经成为严重的公共卫生问题而受到世界各国的关注,1998年12月11日已经被命名为第一个世界哮喘日,藉此引起公众对哮喘病的重视。小儿支气管哮喘的发作是由于外在或内在的过敏原或非过敏原的因素,致使支气管发生可逆性的阻塞为特点的疾病,临床上表现出反复性、阵发性的支气管痉挛而致呼吸急促、咳嗽、咳泡沫痰以及肺部伴有喘鸣声等主要症状的疾病,若不及早治疗或控制,往往会影响到小孩的活动和学习能力,相对的也妨害了小孩的成长发育,因此小儿支气管哮喘是我们需要非常重视的一个小孩疾病。虽然西医在控制小儿支气管哮喘方面较为快速,但其副作用大且长期疗效不佳,因而寻求中医治疗的病患不少,中医治疗的方式很多,有口服中药、针灸、穴位埋线、穴位注射、穴位敷贴、推拿…等等,虽然治疗方法这么多,但很多小孩接受度不佳或不能按时服药而影响了疗效,为取得小儿容易接受且副作用较小的治疗方法,采取穴位敷贴的治疗方式,这一种治疗方式过去许多医书就有记载它的疗效,现利用这一方式来治疗小儿支气管哮喘,并利用夏季三伏天天气最炎热的时候敷贴,达到温阳益气,消除肺中内伏寒邪,补益人体阳气的作用,希望能提供一种有效且有科学方法证明的治疗法,以嘉惠日益增加罹患支气管哮喘的小孩们。方法(methods):以新长庚中医联合诊所门诊中筛选5--18岁儿童诊断为支气管哮喘者<气喘>120例为研究对象,随机将病例分为4组,每组30例,分组观察如下：<1>背部穴位敷贴组：取穴大椎、风门<双)、肺俞(双>；将药膏分别贴于穴位上,后以透气胶带固定,贴4小时(以小孩皮肤的忍受程度为准),初伏天起开始贴,中伏、末伏天各续贴1次,使用药物为桂枝末30%、附子末30%、白芥子末20%、苏子末10%、细辛末10%按此比率用生姜汁调成膏状。<2)足底穴位敷贴组：取足底涌泉(双>；将药膏分别贴于穴位上,后以透气胶带固定,贴4小时<以小孩皮肤的忍受程度为准),初伏天起开始贴,中伏、末伏天各续贴1次,使用药物为桂枝末30%、附子末30%、白芥子末20%、苏子末10%、细辛末10%按此比率用生姜汁调成膏状。<3>药物组：取伤寒论射干麻黄汤缩药粉为处方；每日服用3次,5-10岁每次服用2.5克,11-18岁每次服用3克,时间为1个月。(4>远红外线热敷组：使用天眼远红外线仪(功率800W、4-14μm),以身柱穴为中心点对背部照射15分钟,每周1次,时间为1个月。结果(results):背部穴位敷贴组：临床显效3例,有效23例,无效4例,总有效率86.7%；足底穴位敷贴组：分别为3例、22例、4例,总有效率86.2%；药物组分别为3例、20例、6例,总有效率79.3%；红外线热敷组分别为0例、8例、20例,总有效率28.57%；四组临床疗效比较,经Ridit分析,背部穴位敷贴组、足底穴位敷贴组、药物组组间比较,差异无统计学意义(P>0.05>,三组疗效优于红外线热敷组(P<0.05)。提示：四组临床疗效Ridit值95%可信区间比较,背部穴位敷贴组>足底穴位敷贴组>药物组>红外线热敷组。结论(conclusions):本次研究结果显示,穴位敷贴组较药物组和远红外线组经统计学的分析,疗效有显着的差异,可以说穴位敷贴疗法治疗小儿虚性支气管哮喘,是一种简单易行,病童痛苦少且易于接受的治疗方法,作为中医临床上治疗小儿虚性支气管哮喘的一种很好选择方式；同样是穴位敷贴,足底穴位敷贴组和背部穴位敷贴组两组疗效差异不大,可归纳出一个要点,用穴位敷贴治疗小儿虚性支气管哮喘,提振身体的阳气<抵御邪气能力)和引气归原是同样重要的；临床上小儿支气管哮喘病患常有夜尿<尿床>的症状,从足底穴位敷贴组的疗效观察,对于夜尿有明显的改善现象,值得临床上多加运用；以远红外线来治疗小儿虚性支气管哮喘,经统计显示并不如当初所预期的会有较佳的疗效,结论是尚无法取代穴位敷贴的方式来治疗小儿虚寒性支气管哮喘；利用夏季三伏天天气最炎热的时候,在有关的俞穴上敷以辛温逐痰走窜的中药,达到补益人体阳气,并消除肺中内伏寒邪,这种依据中医”冬病夏治”的观念,对于入秋后易于发作的支气管哮喘能取得防治的效果,这是一个很重要的观念；过去认为穴位敷贴疗法要使皮肤起水泡才会有疗效,本研究中所采用的方式和皮肤的接触面积小,敷贴的时间不长,使用的药物亦不属于过度刺激的药物,从实验中观察到穴位敷贴疗法运用于小儿身上并不需要强烈的刺激,让其皮肤受到伤害；运用穴位敷贴来治疗小儿支气管哮喘,主要还是依据中医经络系统治病的原理；目前西医治疗小儿支气管哮喘以抗气管发炎为主,首选是激素的治疗,然而激素的长期应用可能产生不可避免的副作用,使病童家属常有疑义而怯步,所以选择穴位敷贴来治疗小儿支气管哮喘是一种良好的治疗方式,很值得推广运用的。更多还原

【Abstract】 Objective:For the past few years, hypersensitive diseases has shown the tendency of increasing in the whole island of Taiwan year by year because of the reasons, such as environmental pollution, and changes of eating habits, etc, brought by the progress of civilization. Among them, bronchial asthma in children has great threat on the health of many kids.Nowadays, ronchial asthma is a kind of chronic airway diseases that is the most commonly seen in the world, the total number of patients with asthma in the whole world has reached 100 millions. However, in the last 20 years and more, the morbility of asthma has raised continuously, especially for that of asthma in children. According to the investigations and statistics, the morbility of asthma in children and youth in western countries has changed from 4% to 10%, the morbility of asthma in Australia rose from 12.9% in 1982 to 19.3% in 1992,26.2% in 1975 to 34.0% in 1989 in New Zealand, and 3.4% in 1981 to 8.0% in 1993 in Norway. While, the condition of Asia is also not optimistic, the morbility of asthma in Japan went from 0.5% in 1967 up to 4.6% in 1993,2.3% in 1984 to 8.2% in 1992 in Indonesia,4% in 1967 to 20.8% in 1991 in Singapore,6.6% in 1992 to 11.3% in 1995 in Hong Kong,2.4% in 1988 to 3.5% in 1995 in Guangzhou, and 0.75% in 1979 to 3.56% in 1989 in Shanghai. At the same time, the morbility of allergic asthma in children in Taipei is increasing rapidly. The statistic data of the deceased president of Cheng Kung Children’s Hospital, professor Xie Guixiong, showed that, in 1975, the incidence of bronchial asthma in children (7 to 15 years old) in Taipei was 1.3%, while it reached 10.8% in 1994. According to the latest investigation of Taipei City Hospital entrusted by Taipei City Health Administration, the incidence of asthma has risen to 20.34%(1996), and it’s still in increasing. Therefore, it can be predicted that the incidence of bronchial asthma in children would be higher, and asthma has become a serious public health problem and been paid attention to in different countries of the world. Dec, 11,1998 was named as the first world asthma day, so as to evoke the attention of the public on asthma.The attack of bronchial asthma in children is due to the exterior or interior allergen or non-allergen factors, which result in the reversible obstruction of the bronchus. In clinic, its main symptoms include short of breath, cough, frothy sputum and wheezing rale of the lung caused by the repeated and paroxysmal bronchial spasm. If it is not treated or controlled as soon as possible, it often affects the ability of children’s activity and study ability, and also retards the growth of children correspondingly. For this reason, bronchial asthma in children is a kind disease that we should lay emphasis on. Although western medicine could control bronchial asthma in children very fast, it has great side effects, and the long-term effect is not so good. So there are many patients turning to the treatment of Traditional Chinese Medicine (TCM). There are various ways of TCM treatment, for instance, oral taking herbs, acupuncture, catgut implantation at acupoint, acupoint injection, point application and massage, etc. Even though there are so many therapies, a lot of children could not accept properly or take medicine on time, and therefore having a negative impact on the effect. In order to make the children easy to accept and with little side effect, point application was applied. The effect of this therapy was recorded in many medical books in the past. Now we use this way to deal with bronchial asthma in children, and it is used in dog-days of summer that is the hottest time, so as to achieve the function of warming Yang and invigorating Qi, removing the latent cold evil in the lung. Hope to provide a kind of effective and scientific therapy to benefit the children with bronchial asthma.Methods:About 120 children with bronchial asthma (short of breath) from 5 to 18 years old in the clinic were chosen as the study objects, and they were randomly divided into 4 groups, each group includes 30 cases. Different observations are as following:1. Point application on the back group:Da Zhui, Feng Men (both), Fei Shu (both) were selected, applied the plaster on the points respectively, fixed by air permeable adhesive tape, and sticked for 4 hour (according to the tolerance level of the skin of children). It began on the first dog-days, and continues once on middle dog-days and end dog-days respectively. The herbs was Guizhi powder 30%, Fuzi powder 30%, Baijiezi powder 20%, Suzi powder 10% and Xixin powder 10%, and they were mixed by ginger juice to the ointment according to the ratio.2. Point application on the sole of feet group:Yongquan (both), applied the plaster on the points respectively, fixed by air permeable adhesive tape, and sticked for 4 hour (according to the tolerance level of the skin of children). It began on the first dog-days, and continues once on middle dog-days and end dog-days respectively. The herbs was Guizhi powder 30%, Fuzi powder 30%, Baijiezi powder 20%, Suzi powder 10% and Xixin powder 10%, and they were mixed by ginger juice to the ointment according to the ratio.3. Medicine group:Took the concentrated powder of She Gan Ma Huang Tang in Shang Han Lun as the prescription,3 times per day,2.5g for 5-10 children each time,3g for 11-18 children each time, continue for 1 month.4. Extreme infra-red ray group:Tian Yan Extreme Infra-red Ray Instrument was used (power 800W,4-14μm), irradiated for about 15min, taking Shen Zhu point as the centre, once a week for 1 month.Results:Point application on the back group:3 cases showed clinical obvious effect,23 cases were effective,4 cases were invalid, total effective rate was 86.7%. Point application on the sole of feet group:the obviously effective, the effective and the invalid were 3 cases,22 cases and 4 cases respectively, total effective rate is 86.2%. Medicine group:they were 3 cases,20 cases and 6 cases, total effective rate was 79.3%. Extreme infra-red ray group:they were 0 case,8 cases and 20 cases, total effective rate was 28.57%. Comparing the clinical effects of the four groups, by Ridit analysis, the comparisons among point application on the back group, point application on the sole of feet group and medicine group showed no statistical meaning (P>0.05), and the effect of each of the three groups was better than that of extreme infra-red ray group (P<0.05).Indication:The clinical effect comparison of the Ridit value 95% confidence interval of the four groups:point application on the back group> point application on the sole of feet group> medicine group> extreme infra-red ray group.Conclusions:The results of this study indicate that the effect has obvious differences in the point application group, comparing with those of the medicine group and the extreme infra-red ray group by statistical analysis. It can be seen that point application therapy is a kind of simple, easily performing, little suffering and easily acceptable method to treat bronchial asthma in children due to deficiency. It’s a good way in clinic of TCM. Although both of them used point application, the difference of point application on the sole of feet and that on the back is not so big, which can results in two conclusions:first, for point application to deal with bronchial asthma in children due to deficiency, the selection of points is very important; secondly, conducting the Qi back to its source is an essential idea in treating bronchial asthma in children due to deficiency. The children with bronchial asthma due to deficiency have the constitution of kidney deficiency (deficiency in origin) in some extent. Kidney is the congenital foundation, and this kind of constitution with kidney deficiency could be considered that these children have allergic constitution in congenital. The statistics indicate that the effect of using extreme infra-red ray to treat bronchial asthma in children due to deficiency is not as good as it was predicted, and the conclusion is that it could not take the place of point application yet. During the hottest time of the dog-days in summer, applying pungent-warm herbs with the function of expelling phlegm and scurrying on the related points invigorate the Yang Qi of human body, and remove the latent cold evil inside the lung. The idea based on treating winter diseases in summer is very important to the prevention and treatment of bronchial asthma that is easy to attack in autumn. It was thought that only bubbles on the skin occurred, could the point application be effective. In this study, the way that was used has little contacting area with the skin, the time is not very long, and the herbs do not belong to those with excessive stimulations. The result is that point application on children does not need strong stimulation, which may hurt the skin. Point application in treating bronchial asthma in children is mainly based on the theory of meridian system of TCM. Currently, western medicine dealing with bronchial asthma in children is mainly performed by resisting the inflammation of trachea, and the first selection is hormone. However, long time of using hormone may bring about inevitable side effects, which make the family of the diseased children hesitate, so point application is a good selection to treat bronchial asthma in children, and it’s worthy of spreading and using.更多还原