长蛇灸疗法现代文献分析及改良长蛇灸结合针刺治疗脾肾阳虚型慢性疲劳综合征的疗效观察

发布时间：2018-06-11 21:45

本文选题：长蛇灸 + 改良长蛇灸　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：1、本研究通过对长蛇灸疗法现代临床文献进行收集整理统计分析,总结长蛇灸疗法适宜病症和寻求长蛇灸疗法的操作规律,为长蛇灸疗法临床应用及进一步的临床研究提供理论依据。2、通过对长蛇灸适宜病症一慢性疲劳综合征进行不同时间点的临床疗效观察,研究改良长蛇灸结合针刺对慢性疲劳综合征脾肾阳虚证候及症状的时效性,为临床治疗该病提供新方法、新思路。方法：1、文献分析：计算机检索中国生物医学文献数据库(CBM)、中国知识资源总库即中国知网(CNKI)中的中国学术期刊全文数据库、中国优秀硕博士学位论文全文数据库、相关会议论文,Cochrane Library, Pubmed,维普期刊全文数据库(VIP),万方数据资源系统(WF)。查找有关长蛇灸疗法的临床研究文献,再按照文献的纳入及排除标准,对文献进行人工阅读并进行筛选,获得所研究的文献。按国际疾病分类与编码系统(ICD-10)及《中华人民共和国国家标准·中医临床诊疗术语·疾病部分》对长蛇灸治疗的病症进行命名和分类统计。并将文献所获得的有效信息：篇名、作者、文献类型、期刊名称、著作年代、疾病名称、所属系统、证型、治疗组/对照组名称、施术部位、铺灸药物、施灸时间、疗程、疗效评价、有效率等内容录入EXCEL,建立数据库进行统计分析。2、临床研究：选择符合纳入标准的脾肾阳虚型慢性疲劳综合征患者39例,采用改良长蛇灸结合常规针刺治疗,每周治疗3次,2周为一疗程,连续治疗四个疗程后进行疗效评定,通过观察每个疗程后脾肾阳虚证候量表、疲劳严重程度量表(FSS)、躯体和心理健康报告(SPHERE)积分变化评估疗效。结果：1、文献分析：本次文献分析共纳入165篇合格文献,得到了11类病症系统,36种病症。排行前三的病症系统及文献构成比依次为：其中肌肉骨骼和结缔组织疾病系统文献占64.85%,占绝大多数,其下依次为呼吸系统疾病11.52%、精神和行为障碍6.06%。按病症多少排序,肌肉骨骼系统和结缔组织疾病病症种数最多,占25%,其后依次为呼吸系统疾病16.67%、消化系统疾病13.89%,泌尿生殖系统疾病11.11%,长蛇灸优势病症有5种：强直性脊柱炎、类风湿关节炎、腰椎间盘突出症、慢性阻塞性肺疾病、产后身痛。长蛇灸优势证型为：寒湿凝滞证、肾阳虚证、肺肾气虚证、脾肾两虚证、气虚证、肾虚寒凝证、气虚外感证。隔灸材料以姜、蒜、肉桂、麝香、丁香、细辛、川芎、斑蝥、附子、川乌为主。长蛇灸疗法操作时间以2-3壮居多,分钟数以30-60min为主。最常用的治疗疗程为1月1次,共3个月,其次为1周1次,共3个月。2、临床研究：(1)各疗程间比较,脾肾阳虚量表积分、疲劳严重程度量表积分、躯体和心理健康报告积分,P0.01,差异有显著统计学意义。(2)各疗程与治疗前比较,脾肾阳虚量表积分、疲劳严重程度量表积分、躯体和心理健康报告积分,P0.01,差异有显著统计学意义。(3)各疗程与上一疗程比较,只有2个疗程与3个疗程间比较躯体和心理健康报告积分T=1.476,P=0.1480.05,差异无显著统计学意义,其余量表及疗程间比较P均0.01,差异有显著统计学意义。(4)疗程间脾肾阳虚量表各症状积分比较：①脾肾阳虚量表各症状中畏寒肢冷、倦怠乏力、气短懒言、食少纳呆、腰膝酸软、腰部冷痛、脘腹胀满、夜尿清长积分P=0.0000.01,差异有显著统计学意义。大便不实积分P=0.1630.05,差异无统计学意义。②治疗1个疗程、2个疗程、3个疗程、4个疗程过后畏寒肢冷、倦怠乏力、气短懒言、食少纳呆、腰膝酸软、腰部冷痛、脘腹胀满、夜尿清长积分均P0.05,差异有统计学意义。大便不实到治疗3个疗程后积分P=0.0490.05,差异有统计学意义。治疗4个疗程后大便不实积分P=0.0710.05,差异无统计学意义。③治疗在1个疗程到2个疗程之间,倦怠乏力、气短懒言、腰部冷痛积分P0.05,差异有统计学意义,畏寒肢冷、食少纳呆、腰膝酸软、脘腹胀满、大便不实、夜尿清长积分均P0.05,差异无统计学意义。2个疗程到3个疗程之间,只有腰膝酸软积分P0.05,差异有统计学意义,余均无统计学意义。3个疗程到4个疗程之间,倦怠乏力、气短懒言、食少纳呆积分P0.05,差异有统计学意义,余均无统计学意义。结论：1、文献分析：长蛇灸治疗的疾病多集中在肌肉骨骼系统和结缔组织疾病、呼吸系统疾病、精神和行为障碍、消化系统疾病、泌尿生殖系统疾病等系统。长蛇灸适宜证型以阳虚证、寒证、气虚证为主,主要涉及脏腑为肺、脾、肾三脏。2、临床研究：改良长蛇灸结合针刺治疗脾肾阳虚型慢性疲劳综合征在脾肾阳虚症状、疲劳程度及躯体和心理健康程度上有明显的改善,起效时间为2周,疗程与疗效成正相关,值得进一步研究和临床推广运用。
[Abstract]:Objective: 1, through collecting and sorting out the modern clinical literature of the long snake moxibustion therapy, this study summarizes the appropriate disease of the long snake moxibustion therapy and the operation rule of the long snake moxibustion therapy. It provides the theoretical basis for the clinical application and further clinical study of the long snake moxibustion therapy, and through the chronic fatigue syndrome, which is suitable for the disease of the long snake moxibustion, a chronic fatigue syndrome. To observe the clinical effect of different time points, study the timeliness of the modified long snake moxibustion combined with acupuncture on the syndrome and symptoms of spleen and kidney yang deficiency syndrome of chronic fatigue syndrome and provide a new method for clinical treatment of the disease. Methods: 1, literature analysis: computer retrieval of Chinese Biomedical Literature Database (CBM), China's general repository of knowledge resources: The full text database of Chinese academic journals in CNKI, the full text database of Chinese outstanding doctoral dissertations, the full text database of important Chinese Conference papers, Cochrane Library, Pubmed, VP journal full text database (VIP), and the Wanfang Data Resource System (WF). Find out the clinical literature on the long snake moxibustion therapy, and then according to the literature According to the international disease classification and coding system (ICD-10) and the national standard of People's Republic of China, the clinical diagnosis and treatment term of traditional Chinese medicine and the disease part, the disease was named and classified according to the international disease classification and coding system (the national standard for clinical diagnosis and treatment of traditional Chinese medicine). Information: the name, the author, the type of literature, the name of the journal, the name of the disease, the name of the disease, the system, the syndrome type, the name of the treatment group / control group, the site of the treatment, the moxibustion medicine, the time of moxibustion, the course of treatment, the evaluation of the curative effect, the efficiency and so on, and set up a database for the statistical analysis of the.2, and the clinical study: selecting the spleen kidney Yang that conforms to the standard of the spleen and kidney. 39 cases of asthenia chronic fatigue syndrome were treated with modified long snake moxibustion combined with conventional acupuncture, 3 times a week and 2 weeks as a course of treatment. After four courses of continuous treatment, the curative effect was evaluated. After observing the syndrome of spleen and kidney yang deficiency syndrome after each course, the fatigue severity scale (FSS), and the changes of body and mental health report (SPHERE) were evaluated. Results: the results were as follows: 1. The literature analysis: the literature analysis included 165 qualified literature, 11 kinds of disease system and 36 diseases. The first three disease system and the document composition ratio were in turn: the literature of the musculoskeletal and connective tissue disease system accounted for 64.85%, the most of them were respiratory diseases 11.52%, semen. The number of deity and behavioral disorders 6.06%. was ranked according to the number of disease, the number of musculoskeletal system and connective tissue disease was the most, accounting for 25%, followed by respiratory system disease 16.67%, digestive system disease 13.89%, urogenital system disease 11.11%, long snake moxibustion advantage disease 5 kinds: strong direct spondylitis, rheumatoid arthritis, lumbar disc herniation, Chronic obstructive pulmonary disease, postpartum body pain. The dominant syndrome of long snake moxibustion is: cold dampness stagnation syndrome, kidney yang deficiency syndrome, lung kidney qi deficiency syndrome, spleen kidney two deficiency syndrome, Qi deficiency syndrome, kidney deficiency cold setting syndrome, Qi deficiency syndrome, Qi deficiency external sensation syndrome. The partition moxibustion materials are ginger, garlic, cinnamon, musk, lilac, asarum, Rhizoma Chuanxiong, cantharis, Sichuan Wu. The time of the long snake moxibustion therapy is 2-3 strong and more than Zhuang. The number of clocks was 30-60min mainly. The most commonly used treatment course was 1 times in January, 3 months in total, followed by 1 times for 1 weeks, and a total of 3 months.2. Clinical study: (1) comparison between various courses, integral of spleen and kidney yang deficiency scale, integral of fatigue severity scale, integral of body and mental health report, P0.01, significant statistical significance. (2) comparison of various courses and before treatment, Spleen kidney yang deficiency scale integral, fatigue severity scale integral, body and mental health report score, P0.01, the difference has significant statistical significance. (3) compared with the last course of treatment, only 2 courses and 3 courses of physical and mental health report score T=1.476, P=0.1480.05, the difference is not significant statistical significance, the rest of the scale and the The difference between P was 0.01, and the difference was statistically significant. (4) the scores of the symptoms of the spleen kidney yang deficiency scale were compared: (1) the symptoms of spleen kidney yang deficiency were cold, tired, short of breath, short of breath, lack of appetite, low back and knee, cold pain in the waist, abdominal distention, and long integral P=0.0000.01 of nocturnal urine. The difference has significant statistical significance. 1 courses of treatment, 2 courses of treatment, 3 courses, 4 courses of cold limbs cold, fatigue, short sluggish, short, low back and knee, low back and knee, low back pain, abdominal distention, abdominal distention, night urine, and the difference have statistical significance. The 1 course of treatment was not true to the 3 course of treatment after 3 courses. 90.05, the difference was statistically significant. After 4 courses of treatment, the difference of P=0.0710.05 was not statistically significant. (3) the difference was statistically significant between the 1 courses and the 2 courses. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant, the cold limbs were cold, the food was short, the waist and knees were soft, the abdominal distention was full, the stool was not true and the nocturia was long clear. The scores were all P0.05, the difference was not statistically significant between.2 courses to 3 courses of treatment, only the waist and the knee soft score P0.05, the difference was statistically significant, but there was no statistical significance between.3 courses and 4 courses, fatigue, shortness, shortness of breath and lazy words, food less than P0.05, the difference was statistically significant. Conclusion: 1, literature Analysis: the disease of long snake moxibustion is mainly concentrated in the system of musculoskeletal system and connective tissue diseases, respiratory diseases, mental and behavioral disorders, digestive system diseases, and urogenital system diseases. The suitable syndromes of long snake moxibustion are Yang deficiency syndrome, cold syndrome and Qi deficiency syndrome mainly, mainly involving the three Zang organs of the Zang Fu organs as lung, spleen and kidney,.2, clinical research: improvement The treatment of chronic fatigue syndrome of spleen kidney yang deficiency syndrome with long snake moxibustion combined with acupuncture has obviously improved in spleen and kidney yang deficiency syndrome, fatigue degree and physical and mental health. The onset time is 2 weeks, and the course of treatment is positively related to the curative effect. It is worth further research and clinical application.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246

【参考文献】