摘要
便秘是指由于大肠传导失常,导致大便秘结,排便周期延长;或周期不长,但粪质干结,排出艰难;或粪质不硬,虽有便意,但便而不畅的病证。西医认为便秘与不合理的饮食习惯,不良的排便习惯,局部器质性病变致解剖结构异常,神经肌肉病变,结肠运动缓慢,以及精神和心理等多种因素有关。治疗多使用导泻剂对症处理,改善症状为主。
中医治疗本病有着独特的优势,历代相关方药、医案医话层出不穷。其总病机为脾胃升降失常,大肠传导失司,具体可归结为热秘、冷秘、虚秘、实秘四种。
目的:本课题采用中药穴位敷贴治疗便秘,旨在通过前瞻性随机对照试验研究,证明穴位敷贴治便秘的有效性、安全性及可推广性,为临床寻找一种使用方便、疗效快捷、无毒副作用、适于推广应用的治疗便秘的方法。
方法:诊断标准根据1993年卫生部发布的《中药新药临床研究指导原则》制定。将42例患者随机分为2组,其中治疗组22例,对照组20例。治疗组所选药物为大黄、三棱、莪术、冰片等。取穴为天枢、关元、气海。将上述药物按3:3:3:1的比例研成粉末,加甘油调成膏状,制成大小约1.5×1.5cm,厚度约0.3cm,敷于上述穴位上用胶布固定。每日1次,每次6—8小时。对照组口服苁蓉通便口服液,每日3次,每次1支。两组均治疗7日后进行总体疗效评定。
结果:治疗组22人,痊愈4人,显效10人,有效4人,无效4人;对照组20人,痊愈1人,显效6人,有效3人,无效10人。经统计学比较,有显著性差异(P<0.05)。治疗组疗效优于对照组;两组首次排便时间比较,治疗组5.1±2.8(h),对照组10.1±7.3(h),二组组间对比经统计学处理有显著性差异(P<0.05);说明二种方法均有确切疗效,但治疗组在促进快速排便方面优于对照组;两组治疗前后症状积分分别进行比较,其差异有显著性意义(P<0.05);两组治疗后的症状积分比较,其差异无显著性意义(P>0.05)。说明两种方法在改善临床症状方面均有效,且两组疗效相当。不良反应方面,仅1例出现皮疹,余无不良反应。
结论:中药穴位敷贴除具有一般外治法的优势外,还能以中医理论为指导,灵活辨证施治,兼有药物和针灸穴位两方面的作用。穴位敷贴治疗便秘具有确切的疗效,是一种使用方便、疗效快捷、无毒副作用、适于推广应用的方法。
Constipation refers to the condition in which dry stool is difficult to defecate and defecation time is prolonged caused by malfunction of intestine to discharge. In west medicine, the disease is categorize as habitual constipation, senile drainage difficulty, weakness of abdominal muscles, dysfunction of colonic tension, malnutrition, obstruction of colon stricture of anus, and constipation caused by neurological, psychical and medicinal factors. The treatment is only allopathy with catharsis.Traditional Chinese Medicine has unique predominance for this disease, and correlative drugs, recipes, medical notes have been appearing endlessly in all ages. It' s pathogenesis is spleen stomach disturbance in ascending and descending, malfunction of intestine to discharge, and can be differentiated into hot type, cold type, deficiency type and excess type.In this subject it was used as a method for constipation that plaster application of Chinese Herb on acupoints, with the purpose of proving the validity, security and propagability of plaster application, getting a sort of effective, immediate , innocuous , and propagable means for constipation by forward looking randomly control test research.Method: The diagnostic criteria is based on the clinical research loadstar of Chinese new herb issued in 1993 by Ministry of Public Health. Forty two cases were divided into two group randomly, and there were 22 cases in treat group, 20 cases in control group. The recipe of cure group contain Dahuang, Sanleng, Ezhu and Bingpian, The acupoints include Tianshu, Qihai, Guangyuan. Dry
and pulverize above drugs, mix in proper of 3 .' 3 .' 3 .' 1, then whisk with glycerin to make it into paste, finally cut into 1.5X1. 5cm in size, 0.3cm in thickness, paste on aforesaid acupoint, fix it with adhesive plaster. Keep it on the skin for 6 to 8 hours once day. The cases of control group oral Congrong Tongbian Koufuye with the frequency of t. i. d. Evaluate the total efficiency after seven days.Result.- There were four cases cured, ten were significantly improved, four were in effect and four were non-effective among 22 cases in cure group, and there were one case cured, six were significantly improved, three were in effect, ten were non-effective among twenty cases in control group;There were significant difference between two groups (p<0. 05) .The first time of defecation , cure group is 5. 1±2. 8 (h) , control group is 10. 1+7. 3 (h) showed significant difference ,too (p<0.05) .This signified that both of this two methods have curative effect, and cure group outgone control group in quickening defecation. The comparison between two groups in symptom integral before and after the treatment make significant sense (p<0.05);While the symptom integral after the treatment between two groups made no significant differences P>0. 05);This shows that both of the two means are effect in ameliorating clinical symptom. There is no adverse reaction but rash in 1 case of treat group.Conclusion: The plaster application of Chinese Herb on acupoints possesses these predominance: flexible diagnosis and treatment on the basis of an overall analysis of the illness and the patient' s condition supervised by traditional Chinese medicine theory, two-sided acting accompanied with Chinese herb and acupuncture besides of the predominance of general external treatment. This method possess definite curative effect in the treatment of constipation, and it is a sort of effective, immediate , innocuous , and propagable method.
引文
[1] 便秘诊治暂行标准,中华医学杂志,2000;80(7):491.
[2] 刘汶,张声生,李乾构.慢性功能性便秘研究进展.中国中西医结合消化杂志,2003,11(6):382.
[3] 魏艳静,卞红磊,赵发.便秘的国内流行病学研究进展.疾病控制杂志,2004;8(5):449.
[4] 同[1].
[5] 王永炎.中医内科学,上海:上海科学技术出版社,1997年6月,第一版:200.
[6] 吴荣发.肛肠病便秘的中医辨证治疗体会.四川中医,2001;019(002):9.
[7] 陆修坤.老年便秘诊治体会.江苏中医,1996;17(12):23.
[8] 宋素青.麻子仁丸加减治疗习惯性便秘32例.新中医,2003;035(007):56.
[9] 陶霞生.益气通幽汤治疗老年便秘48例.浙江中医杂志,1997;32(3):106.
[10] 杨晓海.从肾虚血瘀论治老年便秘68例.辽宁中医杂志,1996,23(2):23.
[11] 梁小夏.益气活血通秘汤治疗老年便秘39例.河南中医,1997:17(5):295.
[12] 刘仍海,张燕生,张书信等.中药外敷治疗结肠慢输型便秘的临床与实验研究.北京中医药大学学报,2000;23(1):65.
[13] 韩华明,韩增平.针刺治疗便秘91例.上海针灸杂志,1996:15(1):46.
[14] 张春玲,刘子云.针刺配合中药治疗结肠慢运输型便秘58例.针灸临床杂志,2002;18(4):18.
[15] 许凯声.商阳点刺放血治疗便秘56例.中国针灸,1998,18(4):218.
[16] 沈海明.针刺治疗习惯性便秘85例.四川中医,2002;20(8):76.
[17] 袁海燕.耳穴贴压治疗便秘35例.中国针灸,1999;19(1):1826.
[18] 闵学进.耳压法辨证取穴治疗便秘52例临床观察.中医药研究,1999;15(1):18.
[19] 林忆平.辨证耳压治疗老年性便秘58例.中国针灸,2000;20(5):289.
[20] 雍梅.耳穴贴压法治疗体位性便秘的临床观察.辽宁中医学院学报,2002;4(2):127.
[21] 王秀珍.指压点穴加按摩治习惯性便秘.中国针灸,2002;22(8):541.
[22] 汪红根,沈玉明.穴位埋线治疗老年习惯性便秘50例.中医外治杂志,2001;10(6):41.
[23] 杨梅坤,穴位注射加电针治疗习惯性便秘60例.四川中医,1998;16(5):52.
[24] 郭纯艳,王庆昕.针灸与中药辨证施治治疗便秘.针灸临床杂志,1999:15(11):12.
[25] 杜丽芬,针药并用治疗老年顽固性便秘105例.新疆中医药,1998;6(1):30.
[26] 伦新.生大黄粉神阙贴敷治疗中风便秘75例.中国中西医结合杂志.2000;20(2):119.
[27] 刘克齐,许莺燕.穴位敷贴治疗习惯性便秘48例.中医外治杂志,1997;6(3):47.
[28] 崔秀婷,卢燕许,吴宝琴.腹部贴穴治疗习惯性便秘56例.中医外治杂志,2000;9(4):54.
[29] 李世芳.腹舒膏穴位贴敷治疗便秘30例.新药与临床,1990;(3):170.
[30] 葛美芳.大黄穴贴治疗老年人功能性便秘.浙江中西医结合杂志,2003;13(10):618.
[31] 于举明,姚桂芳,王东英.通补汤结合中药外敷治疗老年习惯性便秘.中国肛肠病杂志,2002;23(2):43.
[32] 刘敏.生大黄粉贴敷神阙穴治疗肿瘤患者便秘的观察.护理学杂志,2001;16(2):99.
[33] 张静慧.大黄贴穴治疗小儿便秘80例疗效观察.现代中西医结合杂志,2001;10(22):193.
[34] 张丽敏,惠伟,孙著芬.通便散敷脐及按摩治疗婴幼儿便秘42例.中医外治杂志,1999;8(3):47.
[35] 王敏英,张敏娟,汤朝阳.中药敷脐治疗顽固性便秘.现代康复,2000;4(4):636.
[36] 焦平,耿少怡,梁素贞.通便散敷脐治疗小儿食积便秘108例.中医外治杂志,2000;9(5):28.
[37] 孙宏丽.中药敷脐治疗中风后大便秘结38例.实用中医内科杂志,2003;17(4):315.
[38] 陈睿.神阙穴贴敷治疗便秘.中国针灸,2002;22(8):540.
[39] 武晓利,郭春玲,杨晓华.神阙穴治疗老年人习惯性便秘40例.中国针灸,1996;16(10):27.
[40] 同[27].
[41] 同[28].
[42] 同[27].
[43] 同[30].
[44] 同[31].
[45] 同[39].
[46] 同[34].
[47] 中华人民共和国卫生部.中药新药临床研究指导原则,北京:1993年,第1版:50.
[48] 同[47].
[49] 同[47].
[50] 刘强,吕志平.中药经皮给药制剂的进展及发展趋势.中医外治杂志,2004:13(1):31.
[51] 赵立岩.经络学说在中药透皮治疗中的作用.中国针灸,1995;13(6):335.
[52] 李玉敏.大黄的药理作用机理探讨.河南医药信息,2002:10(6):37.
