【作者】 张向飞；

【导师】 黄穗平；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 研究背景及目的慢性胃炎是胃黏膜受到多种因素长期损伤后引起的慢性炎症。最常见原因是幽门螺杆菌感染,发病随年龄而增加,多数以胃窦为主的全胃炎,后期以胃黏膜固有腺体萎缩和肠化为主要病理特点,其症状无特异性,体征多不明显。慢性浅表性胃炎的发病率居各种胃病之首,该病病程较长,病情易反复,对人类健康及生活质量影响较大,西医对该病的病因及发病机制有一定认识,治疗方面也多以对症治疗为主缺乏特异性,因而疗效欠佳。中医在辨证论治基础上采用内服与外用相结合的治疗方法提高临床疗效,减少复发,提高患者依从性。自本世纪末以来,随着人类疾病谱的改变及对化学性药物危害性的认识,人们已逐渐意识到传统医学的重要性,一股回归自然、崇尚自然疗法的热潮正在兴起。灸法是重要的传统医学外治疗法之一,其简、便、廉、验的特点广泛应用于临床各科。艾灸治疗脾胃虚弱(含虚寒)型慢性胃炎临床疗效显著。但是随着医院规模的发展,传统的灸法耗费人力,不能满足日益增多的住院病人的治疗。所以很多新型使用方便、低成本、易推广的灸疗仪器越来越多的研制出来,艾灸箱就是其中的一种,这样在保证临床疗效的情况下又提高了临床工作效率。本课题主要观察艾箱灸联合加味香砂六君子汤治疗脾胃虚弱(含虚寒)型慢性浅表性胃炎的临床疗效及初步探讨其可能的作用机理。方法将128例符合纳入标准的患者随机分为治疗组和对照组。治疗组64例：内服香砂六君子汤加减,水煎服,日一剂；并联合使用艾箱灸灸中脘、气海、双足三里,日一次,时间30min。对照组64例：服用香砂六君子汤加减,水煎服,日一剂。疗程均为2周。参考《中药新药临床研究指导原则》设计调查问卷,对治疗前后临床症状进行评分。试验结束后对所有临床资料进行汇总,建立数据库,进行数据管理,采用SPSS 13.0软件进行统计分析。结果临床症状疗效(显效率)比较：治疗组在改善胃脘隐痛、上腹胀、体倦乏力、食少纳呆等症状方面优于对照组(P<0.05),对大便稀烂、排便无力、嗳气、泛酸改善与对照组相比无显著性差异(P>0.05),两组对泛酸症状的改善疗效均欠佳。总疗效比较：治疗组治愈38例(59.4%),显效22例(34.4%),有效3例(4.6%),无效1例(1.6%),总有效率(98.4%),总显效率(93.8%)；对照组：治愈27例(42.9%),显效15例(23.8%),有效14例(22.2%),无效7例(11.1%),总有效率(88.9%),总显效率(66.7%)。经R×C表X2检验,X2=10.67,P=0.0011<0.05,两组比较差异有统计学意义。结论艾箱灸联合香砂六君子汤治疗脾胃虚弱(含虚寒)型慢性浅表性胃炎具有确切疗效,艾灸箱施灸面积大,火力集中,灸后作用明显,其较传统艾灸节省人力,操作方便,易于控制温度,安全性高,可提高临床工作效率,值得临床进一步推广应用。更多还原

【Abstract】 Background and ObjectivesChronic gastritis is a chronic inflammation of gastric mucosa with a long-term injury by a variety of factors. The most common cause of chronic gastric is Helicobater pylori infection; its incidence increases with age; most of which with antral gastritis basis, late to the inherent glandular atrophy and intestinal mucosa into the main pathological features of nonspecific symptoms and most of the signs were not obvious.The incidence of chronic superficial gastritisis higher than any other stomach trouble, which has a longer disease course, also, it is easily repeated, thereby, it has greatly influenced on human health and quality of life. Western medicine has a certain understanding on the etiology and pathogenesis of it, however, symptomatic treatment is the main mean which is lack of specificity with poor efficacy. TCM is based on therapy with syndrome differentiation;oral use combining with external use can improve its efficacy and reduce its recurrence, which can improve patient’s compliance. Since the end of this century, along with changes in the human disease spectrum and the chemical understanding of the dangers of drugs, people have gradually realized the importance of traditional medicine;and therefore, an return to nature, respect for natural therapies is emerging.Moxibustion is an important external therapy of traditional medicine, which is simple, convenient, inexpensive and effective. Moxibustion is a highly targeted treatment for spleen deficiency in chronic superficial gastritisis. As the scale of the development of the hospital, the traditional labor-intensive moxibustion can not meet the growing number of inpatients treated.Many easy use,low cost, easy promotion moxibustion instruments are developed, so as to ensure the clinical efficacy, and moxibustion with moxa box is one of them.To explore the clinical effect of moxibustion with moxa box coordinating with Xiangsha Liujunzi Tang for chronic superficial gastritisis of spleen deficiency and discuss its mechanism.MethodsThe 128 cases of patients who met the inclusion criteria were randomly divided into control group and treatment group.There were 64 cases in each group. The control group was treated by decotion solution from Xiangsha Liujunzi Tang quaque die, while treatment group added moxibustion with moxa box for Zhongwan, Qihai, Zusanli (two sides) lasting 30min once a day. The course of treatment was two weeks for both of the two groups.Before and after treatment, the clinical symptom score was used to evaluate by designing the questionnaire survey with cross-sectional survey method reference to "the guiding principles of Chinese medicine clinical research new drugs". After the treatment we summarized all the clinical datas, and then, we analyzed them with SPSS 13.0 software.ResultClinical symptom (significant efficiency) comparison:there were significant changes(P<0.05) compared treatment group with control group for epigastric dull pain, upper abdominal distension, tired body fatigue, poor appetite, although there were not significant changes (P>0.05) for pantothenic acid.Comparisons of the total effect:there were 38cases (59.4%) curative, 22cases(34.4%) sinificant,3cases (4.6%) effective, lcases (1.6%) invalid in treatment group, and the total effective rate was 98.4% while total sinificant rate was 93.8%. There were 27cases(42.9%) curative,15 cases(23.8%) sinificant,14 cases(22.2%) effective,7cases (11.1%) invalid in control group, and the total effective rate was 88.9% while total significant rate was 66.7%. Analyzed by X2 efficiencyP=0.001＜0.05, significant differences was found between the two group.ConclusionThere is exact efficacy for chronic superficial gastritis with spleen deficiency for moxibustion with moxa box. Moxibustion with moxa box has many advantages, such as concentrated firepower, obvious effect after moxibustion, more labor-saving, easy operation and temperature control, safe, clinical efficacy improvement compared with traditional moxibustion, which is worthy of further promotion.更多还原