针药并用治疗慢性胃炎的临床观察

【作者】 金玟锡；

【导师】 王丽平；

【作者基本信息】 北京中医药大学 ， 中医临床， 2012， 硕士

【摘要】 慢性胃炎是一种胃粘膜慢性炎症。在中国成人慢性胃炎患病率为50%以上。临床主要表现为非特异性的消化不良,可反复发作或长期存在。现代医学对慢性胃炎的病因与发病机制有一定认识,但治疗缺乏特异性,而且临床症状并不能有效缓解。本病属中医“胃脘痛”,“胃痞”,“呃逆”,“嘈杂”等范畴。“胃脘痛”之名最早见于《内经》,“木郁发之,民病胃脘当心而痛”。《伤寒论》“满而不痛此为痞”。《景岳全书》“嘈杂一证,或作或止,其为病也,则腹中空空,若无一物,似饥非饥,似辣非辣,似痛非痛,而胸膈懊侬,莫可名状。”中医治疗慢性胃炎的方法很多,安全可靠,无副作用,疗效好,尤其在改善临床症状方面显出独特优势。其中中药和针灸疗法在临床上对慢性胃炎的治疗方法较多,不同组合也很多,为了充分发挥中药与针灸的共同作用,将名中医经验之方“许氏和化汤”与针灸名家之方“王氏老十针”,推举出来。“许氏和化汤”出自于许彭龄主任医师之手,他秉承家学,运用《黄帝内经》及仲景酸甘化阴、辛甘化阳之说,在临床脾胃病的治疗中,注重药物性味的配合与转化特点(即和化思想)。许老遵从治病必求于本的治疗原则,集多年临床经验之大成,强调应用和化法调理脾胃功能。以和化阴阳、调整脏腑、调补虚实、调畅气机,调和寒热、调理三焦为主旨,创立和化汤。药用黄芪、干姜、甘草、半夏、吴茱萸、黄连、肉苁蓉、诃子。许老强调,临证之时,可根据脏腑阴阳寒热的偏盛偏衰之不同,标本虚实缓急之各异,方中对药相配之比亦可不同,抓住主要矛盾,辩证用药,随证加减药物剂量,配伍化裁,如此即可取得良好的疗效。“王氏老十针”出自于北京中医医院王乐亭之手,王老从多年医治肠胃病实践中,总结出“治其本,以胃为先”的学术观点,根据《脾胃论》中的调中益气汤和补中益气汤方义,设计了“老十针”,治疗肠胃病面效果显著。《素问·太阴阳明论篇》云：“脾者,土也,治中央。”脾为土脏,灌溉四旁,主运化升清,将水谷精微上输至心、肺,通过心肺化生气血营养全身。脾胃主一身之气机,脾升胃降,升降平衡,一身之气机才可正常运行。明代戴思恭认为“胃为水谷之海,法天地,生万物,…….五脏六腑皆禀之以为主,荣卫天真皆有谷气以充大。”脾气生发向上,则元气才能充沛,人体始有生生之机。所谓有胃气则生,无胃气则死。中医治疗中强调“治病必求其本”。在以上文献研究的基础上,我们选择了“许氏和化汤”和“王氏老十针”两者联合应用,来观察治疗慢性胃炎的临床疗效,探求针药最佳组合与治疗慢性胃炎疗效的相关性。研究目的：本研究将60名符合慢性胃炎诊断标准的病人,采用随机对照的方法,将“许氏和化汤”与“王氏老十针”作为最佳组合进行为期28天的临床观察,为了使观察具有科学性,规范了诊断标准与评价标准(国内公认),以期得到具有说服力的试验结果；为今后最佳组合的临床研究,提供可参考的依据与思路。研究方法：慢性胃炎的诊断标准参照全国慢性胃炎研讨会2004年发布的《全国慢性胃炎研讨会共识意见》；中医证候诊断标准参照中国中西医结合学会消化系统疾病专业委员会2003年发布的《慢性胃炎的中西医结合诊治方案》中肝胃不和证,脾胃虚弱证,脾胃湿热证,胃阴不足证,胃络瘀血证等。本研究采用随机对照实验研究设计方案,将60例符合纳入标准(均经过西医诊断并附有胃镜检查报告者)和排除标准的患者,随机分为治疗组和对照组,各为30例。治疗组采用“许氏和化汤加减”加“王氏老十针”即：上脘,中脘,下脘,气海,天枢(双),内关(双),足三里(双)；肝脾不和加公孙(双)；脾胃虚弱加太白(双)；脾胃湿热加阴陵泉(双),丰隆(双)；胃阴不足加血海(双),内庭(双)；胃络瘀血加历兑(双),商阳(双)放血。“许氏和化汤”每日一剂,针刺每周治疗2次(每周三,六各治疗1次),共治疗28d。对照组采用单纯服用“许氏和化汤”,每日一次,共治疗28d。评价标准：症状评分标准参照中华人民共和国卫生部制定的《中药新药临床研究指导原则》；疗效评判标准参考《慢性胃炎中西医结合诊断、辩证和疗效标准》(试行)。两组病人治疗前进行第一次评价,28天后进行第二次评价,最后结束实验。最后用Excel软件采集数据,用统计学软件SPSS13.0进行数据分析。研究结果：1.两组进行组内治疗前后主要症状表现的对比,数据显示P=0.01<0.05,提示两组均可明显改善慢性胃炎的临床症候。2.两组进行组间对比,数据显示P=0.01<0.05,提示治疗组主要症状改善优于对照组,说明针药合用的优势组合治疗慢性胃炎的疗效优于单纯中药优化组。3.总体疗效评价：治疗组治愈3例,显效12例,有效12例,无效3例,总有效率为90.00%；对照组治愈2例,显效7例,有效16例,无效5例,总有效率为83.33%。说明两种治疗方法均有效。4.两组进行组间疗效比较,治疗组治愈率为10.00%,愈显率为50.00%,总有效率为90.00%；对照组治愈率为6.67%,愈显效率为30.00%,总有效率为83.33%。两组愈显率经X2检验,P=0.04<0.05,两组差异有统计学意义,治疗组疗效优于对照组；两组总有效率经X2检验,P=0.44>0.05,两组无明显统计学意义。结论：本研究采用随机对照方法进行“许氏和化汤”与“老十针”治疗慢性胃炎的对比研究,观察并评价两种疗法在临床疗效、改善患者主要症状的效果,两种疗法都可以明显改善患者胃脘痛,上腹胀满及饮食减少等症状,但治疗组疗效稍优于对照组,另外治疗组(“许氏和化汤”为基础,加“老十针”疗法)愈显率优于对照组(单纯服用“许氏和化汤”),这为日后针对慢性胃炎的治疗提供了的科学依据,也值得更加深入的研究和推广。本课题的创新点在于首次将两两优势组合(许氏和化法以及王氏老十针)用于临床观察,通过科学的随机对照设计方案,得出可信的实验结果,充分发挥中药治其内,针灸疗其外,内外合力,共奏调和阴阳之效。更多还原

【Abstract】 Chronic Gastritis is an inflammation of gastric mucosa. It is estimated that over50%of the adult in China are suffering from chronic gastritis. The main clinical manifestations of chronic gastritis are nonspecific indigestion. The disease may reoccur repeatedly for a long period of time. Modern medicines have obtained certain understanding of its causes and pathological mechanism. However the treatments they come up with are lack of specificity and not effective enough. Chronic Gastritis pertains to the category of Epigastria pain’,’Gastric ruffian’,’Hiccup’,’Noisy’in Chinese Traditional Medicine(TCM).The name of "Epigastria pain" was first appeared in ((NeiJing)). Chinese medicine has different types of treatment for chronic gastritis, and it is safe, has no side effect, satisfable curative effect, particularly in improving clinical symptom shows unique advantage. The traditional Chinese medicine and acupuncture therapy in the clinical treatment of chronic gastritis has many treatments, and also different combinations."Xu’s harmony decoction" and "Wang’s old ten needles" are one of famous treatment in Traditional Chinese medicine treatment for chronic gastritis, as it is the best combination of Chinese medicine and acupuncture."Xu’s harmony decoction" was invented by a chief Chinese physician Xu Peng Ling’s hand which he inherited from the family. Dr Xu has complied to a Chinese Medical treatment theory "treating a disease, first treat the main Pathogeny." Through many years of clinical experience, Dr. Xu has emphasized harmony method for balancing the spleen and stomach’s function. Harmony treatment means by balancing Yin and Yang, control organs and Qi movements, adjusts cold and heat energy inside human body, from this theory invented the Harmony decoction. Prescription:Astragalus, dried ginger, licorice, pinellia, Evodia, Coptis, Cistanche, Myrobalan."Wang’s old ten needles" acupuncture treatment was invented from Beijing Chinese Medicine Hospital Wang. Through many years of studies and experiment Dr.Wang has summarized his viewpoint as "treating the main pathogeny, cure stomach comes first" According to TIAOZHONGYIQITANG and BUZHONGYIQITANG’s treatment theories in 《Spleen and stomach theory》, Dr.Wang designed the "Old Ten needles" acupuncture treatment, and its clinical efficiency was proved for Gastrointestinal diseases.According to the quotes written above, we have selected "Xu’s harmony decoction" and "Wang’s old ten needles" combination, to observe the clinical curative effect of treating chronic gastritis, explore the best combination with acupuncture and medicine in treating chronic gastritis clinical correlation. Objective:The case study of60chronic gastritis patients with diagnostic criteria, using a randomized with controlled method;"Xu’s harmony decoction" and "Wang’s old ten needles" as the best combination of traditional Chinese medicine and acupuncture and moxibustion;28days of clinical observation. In order to make a scientific observation, standardized diagnostic criteria and evaluation criteria (nationally recognized), also for obtaining a convincing test results; for the future of the optimal combination of clinical research, provide reference basis and train of thought.Methods:The diagnosis of chronic gastritis standards are quoted by "The National Symposium of Chronic Gastritis" held in2004.TCM syndrome diagnosis standard referred to "Chronic gastritis with integrated traditional Chinese and Western medicine treatment program" held in2003, which have divided into five different groups. Liver stomach disharmony; Weakness of the spleen and stomach; Spleen stomach damp heat; Stomach Yin deficiency; Blood stasis in stomach meridian.This study was designed for randomized controlled experimental methods, total60chronic gastritis patients matches the inclusion criteria (After the diagnosis of Western medicine with gastro scope examination report) and the exclusion criteria of the patients, were randomly divided into treatment group and control group with30patients in each group. The treatment group was treated by "Xu’s harmony decoction" and "Wang’s old ten needles" which includes Shangwan, Zhongwan, Xiawan, Qihai, Tianshu(double), Neiguan(double), Zusanli(double);disharmony between liver and spleen added Gongsun(double); the weakness of spleen and stomach added Taibai(double); spleen stomach damp heat added Yinlingquan(double), Fenglong(double); Stomach Yin deficiency added Xuehai(double), Neiting(double); Blood stasis in stomach meridian added bloodletting on Lidui(double),Shangyang(double). Xu’s harmony decoction was dosed daily, Wang’s old ten needles acupuncture (2times per week, every Wednesday, Saturday) were treated with28days in total.Evaluation criteria:symptom score standard was quoted by The people’s Republic of China Ministry of health to develop "guiding principles of clinical research on new drugs of traditional Chinese medicine"; the curative effect judgment standard referred to "Chronic gastritis by integrated traditional and Western medicine diagnosis, dialectical and curative effect standard"(for Trial Implementation). Before treatment as the first evaluation; after28 days as a final evaluation. Finally, using Excel software data collection, using statistical software SPSS13.0was used for data analysis.Results:1. Both treatment and control groups’before and after treatment the main symptoms of contrast, the data proves that P=0.01<0.05, the two group clearly proved the clinical syndrome of chronic gastritis has improved.2. Comparison between two groups, the data proves that P=0.01<0.05, main symptoms improved prompt treatment group was superior to the control group. Therefore the combined use of acupuncture and Chinese medicine has advantages in the treatment of chronic gastritis curative effect compare to single use of Chinese medicine in optimization.3. Total curative effect evaluation:In treatment group3cases were cured, markedly effective for12cases, effective for12cases, ineffective for3cases, the total effective rate was90%; in the control group2cases were cured, markedly effective for7cases, effective for16cases, ineffective for5cases. The total effective rate was83.33%. The two treatments were effective.4. Comparison of curative effect in each group:In treatment group, the cure rate was10%, markedly effective rate was50%, the total effective rate was90%; in the control group, the cure rate was6.67%, markedly effective rate was30%, total effective rate was83.33%. Two groups’markedly efficiency was rated by X2test, P=0.04<0.05, showed a significant difference between two groups, the treatment group is more effective than control group; two groups’total efficiency was rated by X2test, P=0.44>0.05, the two groups showed no statistical significance.Conclusion:This study used a randomized controlled method for "Xu’s harmomy Decoction" and "Wang’s old ten needles" treatment of chronic gastritis by comparative study, observe and evaluate the clinical curative effect of two kinds of therapy in patients with primary symptoms, improvements and the effect. Two different therapies can significantly improve patients with epigastric pain, epigastric fullness and diet to reduce symptoms, but treatment the observation group was slightly better than the controls, and the treatment group ("Xu’s harmomy Decoction" with "Wang’s old ten needles") greater rate than those in the control group (simply taking "Xu’s harmomy Decoction"), which later in response to chronic gastritis treatment provides scientific basis, are worthy of further research and extension. The subject of innovation lies in the first two advantage combination ("Xu’s harmomy Decoction"and"Wang’s old ten needles") for clinical observation, through scientific randomized controlled design, achieved credible experimental results, give full play to the role of Chinese traditional medicine for internal treatment, acupuncture and moxibustion for external treatment, controlling both internal and external could balance yin and Yang.更多还原