摘要
研究背景：
肥胖症是临床上的常见病、多发病,主要分为单纯性肥胖症和继发性肥胖症,而单纯性肥胖无明确病因,可能与遗传、饮食和运动习惯等因素有关,指不伴有显著的神经、内分泌、形态及功能变化；继发性肥胖病是因其它疾病所发生造成肥胖,根据引起肥胖的原因,又可将继发性肥胖分为下丘脑性肥胖、垂体性肥胖、甲状腺功能低下性肥胖、库欣综合征导致的肥胖、性腺功能低下性肥胖等。肥胖常与II型糖尿病、心脑血管疾病、高血压、高脂血症等疾病有明显的相关。我国的超重和肥胖发病情况与此类似,且呈现出日益增高及多龄化、低龄化倾向。肥胖已影响到2亿以上中国人的健康,预计未来数十年我国的肥胖人群还将迅速上升。
目前西医治疗单纯性肥胖症主要方法为膳食控制和运动治疗,并加以一定的药物治疗,但饮食调理和运动治疗在减轻体重方面效果不甚明显,患者也难以持之以恒,而西药减肥疗法不良反应明显,对中枢和消化系统均有不同程度的影响,以致一些药物已被限用。针灸疗法无明显的毒副作用、便捷、疗效显著,已逐渐成为临床上治疗单纯性肥胖症的常用疗法。通过穴位埋线的持久刺激与耳穴贴压调理脏腑两者的优势结合用于治疗单纯性肥胖症,使患者减轻体重,调整血糖、血脂状态,提高生活质量,并有助于深入认识肥胖的发生机制,为寻找有效的肥胖防治措施提供依据。
目的：
本课题采用临床科研方法学,进行单纯性肥胖症患者的临床随机对照研究,以穴位埋线结合耳穴贴压治疗与穴位埋线、常规针刺为对照,观察穴位埋线结合耳穴贴压治疗单纯性肥胖症的临床疗效,旨在探讨穴位埋线、耳穴贴压、针刺治疗单纯性肥胖症的临床疗效,以及对肥胖症患者血脂、血糖的影响,为治疗单纯性肥胖症提供一定的研究依据。
方法：
病例来源为91名病例来源于台湾九曲堂中医诊所病人,病例收集时间为2012年1月-2013年3月。符合单纯性肥胖症病例筛选标准者,共收集91例,其中31例作为穴位埋线结合耳穴贴压组,30例作为穴位埋线组,30例作为常规组。西医诊断标准参照1997年全国第5届肥胖病研究学术会议修订的《单纯性肥胖病的诊断及疗效评定标准》,中医辨证分型标准参照1989年第二次全国中西医结合肥胖症学术会议标准将肥胖症分为4型(全国中西医结合第二次肥胖症学术会议论文集[C].北京,中国学术出版社,1989.)。穴位埋线每2周埋线一次,耳穴贴压每周贴压3次,针刺一周治疗3次,4周为一疗程,共两个疗程。疗效观察具体项目包括：测量体重、臂围、腰围、腹围、臀围、股围、腰／臀比值、脂肪百分率(F%)等肥胖指标,体重指数(BMI),单纯性肥胖患者生活质量评定采用WHO生存质量测定量表(WHOQOL-BREF)。肥胖症疗效评定标准主要参考1992全国第三届肥胖病研究学术会议及WHO制定的亚洲成年人肥胖的评定标准。
数据分析采用统计软件SPSS17.0。计量资料用均数±标准差(x-±S)表示,计数资料用构成比(%)表示；计量资料组间比较采用F检验,组间两两比较用LSD检验法,自身前后比较用配对t检验或Wilcoxon配对秩和检验。分类资料组间比较采用x2检验,等级资料组间比较采用Kruskal-Wallis H秩和检验。
结果：
①在体重比较方面
治疗4周后,穴位埋线结合耳穴贴压组与治疗前比较体重有下降,体重减少有统计学意义(P<0.05)；穴位埋线组、常规针刺组的体重与治疗前相比虽有减少,但无统计学意义(P>0.05)。治疗8周后,穴位埋线结合耳穴贴压组的体重比治疗前明显减轻,有显著统计学差异(P<0.01)；穴位埋线组、常规针刺组体重比治疗前减轻(P<0.05),穴位埋线疗法比针刺疗法下降的幅度大,但两者差异无统计学意义。提示：在控制肥胖症患者体重方面,穴位埋线结合耳穴贴压治疗在治疗4周后可减少单纯性肥胖患者的体重,在治疗8周后,疗效更为明显；而单一的针灸疗法,如穴位埋线、针刺治疗单纯性肥胖症患者在治疗4周后体重下降不明显,但治疗8周后体重可有大幅度的减轻。
②在体重指数方面
治疗4周后,穴位埋线结合耳穴贴压组的体重指数(BMI)与治疗前相比,差异有统计学意义(P<0.05),治疗8周后,其体重指数(BMI)显著减少(P<0.01)；穴位埋线组、常规针刺组在治疗4周后,体重指数(BMI)与治疗前相比改善幅度不大,治疗8周后,两组与治疗前相比均有不同程度的下降(P<0.05)。提示：穴位埋线结合耳穴贴压在治疗4周后即可改善单纯性肥胖症患者的体重指数(BMI),在长期疗效方面,即治疗8周后下降的程度更明显；而穴位埋线、常规针刺治疗在短期疗效不明显,治疗8周后可减少单纯性肥胖症患者的体重指数(BMI)。
③在脂肪百分比(F%)方面
治疗4周后,穴位埋线结合耳穴贴压组脂肪百分比治疗前有所减少(P<0.05),治疗8周后,穴位埋线结合耳穴贴压组的脂肪百分比(F%)与治疗前相比,减少有显著统计学意义(P<0.01),穴位埋线组、常规针刺组与治疗前相比,脂肪百分比(F%)下降有统计学意义(P<0.05)。提示：在改善单纯性肥胖症患者脂肪百分比(F%)方面,穴位埋线结合耳穴贴压治疗在8周的疗程后下降幅度明显；4周疗程的穴位埋线、常规针刺治疗对于降低单纯性肥胖症患者脂肪百分比的疗效不明显,而在长期疗效方面,即8周治疗后改善程度显著。
④在臂围、腹围、腰围、臀围、股围、腰臀比方面
治疗4周后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组的臂围与治疗前相比,差异均无统计学意义(P>0.05)。治疗8周后,三组臂围与治疗前相比,均有不同程度的减少,差异具有统计学意义(P<0.05),其中以穴位埋线结合耳穴贴压组减少最为显著。提示：在短期疗效方面,三组对单纯性肥胖症患者的臂围均无明显改善作用,治疗8周后,三组在一定程度上可减少单纯性肥胖症患者的臂围。
经过4周治疗后,在腹围改善情况方面,三组与治疗前相比虽有减少,但均无统计学意义(P>0.05)。治疗8周后,三组的腹围较治疗前均有不同程度的下降(P<0.05)。提示：治疗4周后,三组对单纯性肥胖症患者的腹围均无明显改善作用,治疗8周后,三组在一定程度上可减少单纯性肥胖症患者的腹围。
治疗8周后,三组的腰围与治疗前相比,均有不同程度减少(P<0.05),其中以穴位埋线结合耳穴贴压组减少最为明显。提示：穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组对于改善单纯性肥胖症患者的腰围有一定作用,但短期疗效改善情况不明显。
治疗4周后,穴位埋线结合耳穴贴压组臀围比治疗前减少(P<0.05),而穴位埋线组、常规针刺组与治疗前相比无明显差异(P>0.05)。8周治疗后,三组臀围与治疗前相比,减少具有统计学差异(P<0.05)。提示：经过8周的治疗后,三组对于减少肥胖症患者的臀围均有不同程度的效果。
治疗8周后,位埋线结合耳穴贴压组、穴位埋线组、常规针刺组的股围与治疗前相比具有统计学差异(P<0.05)。提示：经过8周治疗后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组可以减少肥胖症患者的股围。
治疗4周后,三组腰臀比与治疗前比较,均无统计学差异(P<0.05)。治疗8周后,穴位埋线结合耳穴贴压组腰臀比减少有统计学差异(P<0.05),但穴位埋线组、常规针刺组与治疗前相比无明显改善(P<0.05)。提示：穴位埋线结合耳穴贴压可改善肥胖症患者的腰臀比,而单一疗法(穴位埋线、针刺治疗)作用不明显。
⑤生存质量评分(WHOQOL-BREF)比较方面
治疗4周后,三组生存质量评分组间差异无统计学意义(P>0.05)；治疗8周后,穴位埋线结合耳穴贴压组的生存质量评分比穴位埋线组、常规针刺组明显提高(P<0.05)。提示：三组治疗对于提高患者的生存质量(WHOQOL-BREF)均有一定的改善作用,其中以穴位埋线结合耳穴贴压的效果尤佳。
⑥空腹血糖比较方面
4周治疗后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组三组空腹血糖与治疗前相比无统计学意义(P>0.05)。治疗8周后,穴位埋线结合耳穴贴压组、常规针刺组的空腹血糖与治疗前相比,减少具有统计学差异(P<0.05)；穴位埋线组与治疗前相比差异不明显(P>0.05)。提示：在降低单纯性肥胖症患者的空腹血糖方面,在治疗8周后,穴位埋线结合耳穴贴压、针刺治疗对肥胖患者空腹血糖的具有一定减少作用。
⑦空腹胰岛素比较方面
4周及8周治疗后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组三组空腹胰岛素与治疗前相比无统计学意义(P>0.05)。提示：在降低单纯性肥胖症患者的空腹胰岛素方面,三组的疗效无明显作用。
⑧血总胆固醇比较方面
4周治疗后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组三组血总胆固醇与治疗前相比无统计学意义(P>0.05)。治疗8周后,三组血总胆固醇比治疗前有所降低,差异有统计学意义(P<0.05)。提示：在治疗8周后,三组在降低单纯性肥胖症患者的血总胆固醇方面具有一定疗效。
⑨血甘油三酯比较方面
4周治疗后,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组三组甘油三酯与治疗前相比无统计学意义(P>0.05)。治疗8周后,三组血甘油三酯比治疗前差异有统计学意义(P<0.05)。提示：在治疗8周后,三组在降低单纯性肥胖症患者的血甘油三酯方面具有一定疗效。
⑩在肥胖症临床疗效方面
穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组治疗后经Kruskal Walls H秩和检验,H=23.09,P=0.037,三组之间有统计学差异(P<0.05),穴位埋线结合耳穴贴压组总有效率为90.3%,穴位埋线组总有效率为70.0%,常规针刺组总有效率为66.7%。提示穴位埋线结合耳穴贴压疗法治疗单纯性肥胖症患者与穴位埋线针治疗、常规针刺治疗相比较,临床疗效更为显著。
结论：
综合以上研究结果,穴位埋线结合耳穴贴压组、穴位埋线组、常规针刺组对单纯性肥胖症都有不同程度的临床疗效,能明显降低患者的体重指数、脂肪百分比、腹围、腰围、股围、臀围等肥胖指标；对肥胖症患者的生存质量具有良性的调整作用,并对单纯性肥胖症患者的空腹血糖、血清总胆固醇以及血清甘油三酯这些生化指标具有一定的改善作用。其中,穴位埋线结合耳穴贴压组的肥胖症的临床总有效率显著高于穴位埋线组、常规针刺组,在改善上述肥胖指标、血糖、血脂以及生存质量等方面较单一疗法具有更大的优势。该疗法无需服药,患者无副作用,疗效明显,且作用持久,值得临床推广。
Background
Obesity is a common clinical disease, is divided into simple obesity and secondary obesity, simple obesity without a clear cause may be related to genetics, diet and exercise habits and other factors, means not associated withsignificant neurological, endocrine, morphological and functional changes; secondary obesity is obesity caused due to other diseases that occur, according to the cause of the obesity secondary to obesity, but also divided into hypothalamic obesity, pituitary obesity, thyroiddysfunction, obesity, Cushing's syndrome caused by obesity, gonadal dysfunction obesity. Obesity is often a significant correlation with type2diabetes, cardiovascular disease, hypertension, hyperlipidemia, and other diseases. Of overweight and obesity incidence is similar, showing increasingly higher and multi-age, younger age trend. Obesity has affected the health of more than200million Chinese people, obesity is expected the next few years our country will also rising rapidly.
Western medicine treats simple obesity diet control and exercise therapy, and be certain drug treatment, conditioning diet and exercise therapy in reducing the effect of body weight was not significant, the patient is also difficult to persevere, and western medicine weight loss therapy adverse reactions, central and digestive system in varying degrees, so that some drugs has been restricted. Acupuncture without significant side effects, convenient, a significant effect, has gradually become the most commonly used treatment for the clinical treatment of simple obesity. Paste through the the catgut embedding of lasting stimulation and auricular pressure regulating organs of both a combination for the treatment of simple obesity patients lose weight, adjust blood sugar, blood lipid status, quality of life, and contributed to a better understanding of obesity mechanism to provide the basis for to find effective obesity prevention and treatment measures.
Objective
The study used the clinical research methodology, randomized controlled clinical study in patients with simple obesity, catgut embedding combined with auricular pressure treatment and catgut embedding, the routine acupuncture as a control, observe the simple catgut embedding combined with auricular pressure treatmentthe clinical efficacy of obesity to investigate the catgut embedding, auricular acupressure, acupuncture for treatment of simple obesity clinical efficacy, as well as the impact of obesity, blood lipids, blood glucose, for the treatment of simple obesity researchbasis.
Methods
Cases from91cases from Taiwan Zhengkai Wen Chinese medicine clinic patients, case collection time for the January2012March2013. Of cases of simple obesity screening criteria, collected a total of91cases, of which31cases as catgut embedding combined with auricular pressure group,30cases as catgut embedding group and30cases as a regular group. Western diagnostic criteria with reference to the19975th National Obesity Research Conference revised simple obesity diagnosis and efficacy evaluation standard, TCM Syndrome Standard second reference to the1989National Integrative Medicine Obesity Conference standard obesity divided into4types (National Integrative Medicine the second obesity Conference Proceedings [C] Beijing, China academic Press,1989). Catgut embedding embedding every two weeks once the auricular acupressure pressure of3times weekly stickers, acupuncture treatment a week, for4weeks as a course of treatment, a total of two courses. The efficacy of specific projects include:measurement of body weight, arm circumference, waist circumference, waist circumference, hip circumference, thigh circumference, waist/hip ratio, fat percentage (F%) and other indicators of obesity, body mass index (BMI), Obese quality of life assessed using the WHO quality of Life scale (WHOQOL-BREF). Obesity evaluation standard reference1992Third National Obesity Research Conference and WHO to develop Asian adult obesity assessment standards.
Results
①The comparison of body weight
After4weeks of treatment, the catgut embedding combined with auricular pressure group compared with before treatment weight decreased, weight loss was statistically significant (P<0.05); catgut embedding group, the weight of the routine acupuncture group compared with before treatmentreduce, but not statistically significant (P>0.05). After8weeks of treatment, the catgut embedding combined with auricular pressure group significantly reduced body weight than before treatment, there was a significant difference (P<0.01); catgut embedding group routine acupuncture group weight than before treatment (P<0.05lighter), embedding therapy than the decrease of acupuncture, but the difference was not statistically significant.It suggested that in the control of body weight in patients with obesity, catgut embedding combined with auricular acupressure treatment after4weeks of treatment can reduce weight, simple obesity patients after8weeks of treatment, the effect is more obvious; single acupuncture therapy, such as catgut embedding, after4weeks of treatment, acupuncture treatment of patients with simple obesity weight loss is not obvious, but after8weeks of treatment, body weight can have a significant reduction.
②The comparison of body mass index (BMI)
After4weeks of treatment, combined with catgut embedding the auricular pressure group The body mass index (BMI) compared with before treatment, the difference was statistically significant (P<0.05) after8weeks of treatment, body mass index (BMI) was significantly reduced (P<0.01); catgut embedding group routine acupuncture group after4weeks of treatment, body mass index (BMI) compared with before treatment to improve marginally, after8weeks of treatment, the two groups before treatment were comparedthe extent of the decrease (P<0.05). It suggested that catgut embedding combined the auricular acupressure improve after4weeks of treatment, patients with simple obesity body mass index (BMI), in terms of long-term efficacy, that is, the extent of decline after8weeks of treatment is more obvious; catgut embedding routine acupuncture treatment in the short-term treatment was stopped after eight weeks of treatment can reduce the body mass index (BMI) of the patients with simple obesity.
③The comparison of fat percentage (F%)
After4weeks of treatment, catgut embedding combined the auricular pressure group fat percentage decreased (P<0.05) before treatment, after8weeks treatment, combined with catgut embedding to auricular pressure group fat percentage (F%) and treatment before phasethan the decrease was statistically significant (P<0.01), catgut embedding group routine acupuncture group compared with before treatment, fat percentage (F%) decrease was statistical ly significant (P<0.05). It suggested that improve the patients with simple obesity fat percentage (F%), catgut embedding combined with auricular acupressure treatment decreased more significantly after the8-week course of treatment; the catgut embedding of4weeks of treatment, routine acupuncture treatment for reducing simple the percentage of fat in patients with obesity treatment was stopped, and in the long-term efficacy, significant improvement after8weeks of treatment.
④The comparison of arm circumference, abdominal circumference, waist circumference, hip circumference, femoral circumference, the waist/hip ratio
After4weeks of treatment, the catgut embedding combined with auricular pressure group, catgut embedding group, the arm circumference pre-treatment of the routine acupuncture group, the difference was not statistically significant (P>0.05). After8weeks of treatment, three sets of arm circumference compared with before treatment, have different levels of reduction in the difference was statistically significant (P<0.05), which catgut embedding combined with the auricular pressure groups to reduce the most significant. Tip:in the short-term efficacy of the three groups of patients with simple obesity arm circumference were not significantly improve the role, after8weeks of treatment, the three groups of patients with simple obesity can be reduced to some extent, arm circumference.
After4weeks of treatment, the abdominal circumference to improve the situation in the three groups, although reduced compared with before treatment, but were not statistically significant (P>0.05). After8weeks of treatment, the three groups have different levels of abdominal circumference than before treatment decreased (P<0.05). Tip:after4weeks of treatment, the three groups of patients with simple obesity abdominal circumference was no significant improvement after8weeks of treatment, three groups of patients with simple obesity can be reduced to some extent, abdominal circumference.
After8weeks of treatment, three groups of waist circumference compared with before treatment, were reduced to varying degrees (P<0.05), which catgut embedding combined with auricular pressure group decreased the most. Tip: catgut embedding combined with auricular pressure group, catgut embedding group routine acupuncture group for improving the waist of patients with simple obesity, but the short-term effect is not obvious to improve the situation.
After4weeks of treatment, catgut embedding combined the auricular pressure group hips lower than before treatment (P<0.05), and catgut embedding group routine acupuncture group compared with before treatment was no significant difference (P>0.05). After8weeks of treatment, the three groups of the hip compared with before treatment, to reduce a significant difference (P<0.05). Tip:After8weeks of treatment, the three groups have varying degrees of effectiveness in reducing obesity in patients with hip.
After8weeks of treatment, the bit embedding combined with auricular pressure group, catgut embedding group, a significant difference (P<0.05) compared to the routine acupuncture group thigh circumference before treatment. Tip:after8weeks of treatment, catgut embedding auricular pressure group, catgut embedding group routine acupuncture group obese patients can reduce thigh circumference.
After4weeks of treatment, three groups waist-to-hip ratio compared with before treatment, were not statistically different (P>0.05). After8weeks of treatment, the catgut embedding combined auricular pressure groups waist-to-hip ratio to reduce significant difference (P<0.05), but catgut embedding group routine acupuncture group before treatment compared to no significant improvement (P>0.05). Tip:catgut embedding combined with auricular acupressure can improve obesity in patients with waist-hip ratio, and monotherapy (the catgut embedding, acupuncture treatment) is not obvious.
⑤Comparison of the life quality (WHOQOL-BREF)
After4weeks of treatment, the three groups of quality of life score between the difference was not statistically significant (P>0.05); quality of life score after8weeks of treatment, catgut embedding combined with auricular pressure group than catgut embedding group routine acupuncture groupsignificantly improved (P<0.05). Tip:three groups of treatment to improve the patient's quality of life (WHOQOL-BREF) have some improvement, which catgut embedding combined effect of auricular acupressure plus.
⑥The comparison of fasting blood sugar
After4weeks of treatment, catgut embedding combined with auricular pressure group, catgut embedding group routine acupuncture group fasting blood glucose compared with before treatment was not statistically significant (P> 0.05). After8weeks of treatment, the catgut embedding combined with auricular pressure group, the routine acupuncture group fasting blood glucose compared with before treatment, to reduce a significant difference (P<0.05); catgut embedding group before treatment was not significantly different compared to (P>0.05). Tip:reduce fasting blood glucose of patients with simple obesity after8weeks of treatment, catgut embedding combined with auricular acupressure, acupuncture treatment of obese patients fasting blood glucose with a certain role in reducing the.
⑦The comparison of fasting insulin
4and8weeks after treatment, catgut embedding combined with auricular pressure group, catgut embedding group routine acupuncture group three groups of fasting insulin compared with before treatment was not statistically significant (P>0.05). Tip:no significant effect in reducing fasting insulin in patients with simple obesity, the efficacy of three groups.
⑧The comparison of blood total cholesterol
After4weeks of treatment, catgut embedding combined with auricular pressure group, total blood cholesterol of catgut embedding group routine acupuncture group compared with before treatment was not statistically significant (P>0.05). After8weeks of treatment, the three groups total blood cholesterol decreased than before treatment, the difference was statistically significant (P<0.05). Tip:After8weeks of treatment, three groups in reducing total blood cholesterol for patients with simple obesity has a certain effect.
⑨The comparison of blood triglyceride
After4weeks of treatment, the catgut embedding combined with auricular pressure groups, three groups of triglycerides catgut embedding group routine acupuncture group compared with before treatment was not statistically significant (P>0.05). After8weeks of treatment, three sets of blood triglycerides than before treatment difference was statistically significant (P<0.05). Tip:After8weeks of treatment, three groups have a certain effect in reducing blood triglyceride patients with simple obesity.
⑩The comparison of obesity clinical efficacy
Catgut embedding combined the auricular pressure group, catgut embedding group routine acupuncture group after treatment by Kruskal Wallis H rank sum test, H=23.09, P=0.037, significant difference between the three groups (P<0.05), catgut embedding combined with auricular pressure group, the total effective rate was90.3%, the catgut embedding total effective rate was70.0%, routine acupuncture group total effective rate was66.7%. Tip catgut embedding combined with the auricular pressure therapy for patients with simple obesity with catgut embedding acupuncture treatment, compared to conventional acupuncture therapy, the more significant clinical efficacy.
Conclusion
Based on the above findings, catgut embedding combined with auricular pressure group, catgut embedding group routine acupuncture group with simple obesity have varying degrees of clinical efficacy, can significantly reduce the patient's body mass index, fat percentage, waist circumference, waist, thigh circumference, hip circumference and obesity indicators; benign role in the adjustment of the quality of life of obese patients, and patients with simple obesity fasting blood glucose, serum total cholesterol and serum triglycerides these biochemical indicators have some improvementeffect. Catgut embedding combined the auricular pressure group Obesity clinical total effective rate was significantly higher than catgut embedding group routine acupuncture group, to improve the obesity index, blood sugar, cholesterol and quality of life compared to the monotherapy big advantage. The therapy without medication, patients with no side effects, effective, and lasting effect, worthy of promotion.
引文
[1]吴丹凌,周胜红.针灸治疗单纯性肥胖取穴规律的研究[J].针灸临床杂志,2013,29(1)：53-54.
[2]张稀,魏清琳.针灸治疗单纯性肥胖症综述[J].针灸临床杂志,2011,27(7)：81-82.
[3]童娟,姚红,陈健雄,等.腹针疗法治疗单纯性肥胖临床疗效观察[J].针刺研究,2006,31(3)：176-177.
[4]孔凡涵,孔祥琳.刍议中医对肥胖的认识及早期辨治干预的意义[J].中国中医药现代远程教育,2010,8(21)：7-9.
[5]刘长波,陈如.浅论《内经》肥胖三分法的临床意义[J].广州中医药大学学报,2000,17(2)：129-133.
[6]崔博乐,李怡,张军,等.论肥胖与代谢综合征的中医学认识[J].北京中医药,2009,28(1)：32-33.
[7]宰军华,李松伟.肥胖症中医病机探讨[J].河南中医,2005,25(1)：44-45.
[8]于婷婷.头体针配穴法治疗单纯性肥胖的临床研究.硕十论文.黑龙江中医药大学,2010.
[9]马文军,许燕君,郭汝宁.超重肥胖流行病学研究进展[J].国外医学·社会医学分册,2002,19(3)：127-129.
[10]邓颖,高亚礼,吴先萍,等.四川城乡成人超重、肥胖流行病学分析[J].现代预防医学,2007,34(18)：3487-3489.
[11]鹿子龙,马吉祥,郭晓雷,等.2007年山东省居民中心性肥胖流行病学调查分析[J].中华疾病控制杂志,2010,14(12)：1182-1184.
[12]饶华祥,侯玉英,赵淑芳,等.山西省城乡居民超重和肥胖流行病学调查[J].中国公共卫生,2008,24(1)：108-109.
[13]洪忻,殷晓梅,梁亚琼,等.南京地区社会经济状况和超重肥胖的流行病学研究[J].现代预防医学,2007,34(21)：4035-4041.
[14]梁迎接,刘丽丹.成人肥胖症病因及危险因素研究进展[J].现代临床护理,2012,11(5)：82-83.
[15]Frayling TM, Timpson NJ, Weedon MN, et al. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity[J]. Science,2007,316 (5826):889-894.
[16]赵亚薇.部分肥胖基因研究进展[J].甘肃医药,2010,29(6)：615-618.
[17]Masuzake H, Ogawa Y,Isse N,et al.Human obese gene expression. Adipocyte-specific expression and regional differences in the adipose tissue[J]. Diabetes,1995,44 (7):855-858.
[18]刘蜜,姜萍.饮食诱导肥胖及肥胖抵抗与脂肪细胞因子[J].中国比较医学杂志,2009,19(6)：62-65.
[19]Levin BE, Triscari J, Hogan S, et al. Resistance to diet induced obesity:food intake, pancreatic sympathetic tone, and insulin[J]. Physiol,2008,11 (2):102-105.
[20]赵金勇,王朝晖,戴娜.CT定量测定探讨单纯性肥胖与脂肪肝的关系[J].中国病案,2013,14(2)：79-80.
[21]蔺威鸣,王国秀,袁超,等.肥胖与消瘦人群饮食规律、生活习惯调查[J].疾病控制杂志,2008,12(1)：14-16.
[22]张景龙,王梅.行为疗法治疗单纯性肥胖症研究现状[J].中国体育科技,2006,42(2)：77-80.
[23]Hill JO, Commerford R. Physical activity, fat balance, and energy balance[J]. Int J Sport Nutr 2006,6:80-92.
[24]何仁,王丽,屈统友.肥胖症的药物治疗及其研究进展[J].海峡药学,2011,23(1)：88-90.
[25]刘颖,田浩明.肥胖症药物治疗现状[J].中国实用内科杂志,2012,32(10)：738-740.
[26]Chon S, Park C,Koh G, et al. The effect of orlistat in obese patients with type 2 diabetes:benef it on abdominal obesity and glycemic control [J]. J Korean Soc Study Obes, 2004,13:281-292.
[27]陈秀清.肥胖症及其药物治疗[J].中国医药指南,2010,8(32)：36.
[28]吴静,高小亚.肥胖的药物治疗进展[J].医学综述,2006,12(11)：693.
[29]孔莹,滕伟,辛明.俞募配穴针刺法治疗单纯性肥胖40例[J].针灸临床杂志,2009,25(1)：37-38.
[30]马松楠,叶晨琳,邹伟.进火补针法治疗脾虚湿阻型单纯性肥胖[J].针灸临床杂志,2012,28(3)：38-40.
[31]马广昊,顾群,赵向超,等.电针透刺治疗单纯性肥胖150例临床观察[J].吉林中医药,2012,32(1)：89-91.
[32]赵煜,刘军,刘耀,等.健脾化湿涤痰针刺法治疗单纯性肥胖的临床研究[J].四川中医,2011,29(4)：123-125.
[33]李红艳.穴位埋线治疗单纯性肥胖的优势研究[J]中国医药指南,2012,10(27)：409-410.
[34]谢长才,孙健,于涛,等.穴位埋线治疗单纯性肥胖量效关系的临床研究[J].中国中医基础医学杂志,2012,18(11)：1250-1256.
[35]冯斌,熊芳丽.腰腹群针埋线治疗单纯性肥胖临床观察[J].中医临床研究,2012,4(20)：32-33.
[36]杨涛,欧桂珍.穴位埋线为主治疗单纯性肥胖症60例[J].上海针灸杂志,2003,22(2)：35.
[37]王燕珍.耳穴贴压治疗单纯性肥胖50例疗效观察[J].山西中医学院学报,2011,12(1)：46-47.
[38]孙培华.耳穴辨证贴压治疗单纯性肥胖症168例[J].上海针灸杂志,2005,24(2)：25.
[39]张忠志,马峰峻,马野.耳针治疗418例单纯肥胖的效果观察[J].黑龙江医药科学,2001,24(8)：75-76
[40]李琳,陈又新.耳穴贴压治疗单纯性肥胖[J].中国临床康复,2003,(18)：2585.
[41]LI Xiang-li, LI Xiang-li, JIANG Hai-ling. Observation on therapeutic effects of simple obesity treated with needling and quick cupping therapy at the selected eight points around umbilicus [J]. World Journal of Acupuncture-Moxibustion,2010,20 (1):13-18.
[42]李彩云,李月亭.腹针治疗单纯性肥胖56例[J].中国民间疗法,2011,19(4)：16.
[43]赵云虎,李华贵,杨军.电磁罐治疗单纯性肥胖[J].中国针灸,2002,S1：62.
[44]谭立明,王勇,刘更.灸法治疗单纯性肥胖108例[J].河北中医药学报,2008,23(3)：39.
[45]李海燕,郑玉琴.电针配合耳压、药罐治疗单纯性肥胖疗效观察[J].上海针灸杂志,2012,31(4)：222-224.
[46]ZHANG Xin-xin, TANG Xiao-dong, LI Wei-hong. Twenty-eight cases of simple obesity of spleen and kidney yang de fi ciency pattern/syndrome in females treated with electroacupuncture and isolated-medicinal moxibustion [J]. World Journal of Acupuncture-Moxibustion,2012,22 (3):65-68.
[47]施茵,张琳珊,赵琛,等.温针灸和电针治疗脾虚型单纯性肥胖症的对照研究[J].中国针灸,2005,25(7)：465-466.
[48]崔艳华.穴位埋线配合耳穴贴压治疗单纯性肥胖的疗效分析[J].中国当代医药,2012,19(4)：112-114.
[49]LIANG Jia, WU Ji-hong, LU Hai-bo, et al. Effects of electroacupuncture combined with auricular plaster on F% and waist-hip ratio in simple obesity patients [J]. World Journal of Acupuncture-Moxibustion,2010,20(2):12-16.
[50]卜彤文,田新乐,王少锦,等.不同疗法治疗单纯性肥胖的疗效比较与分析[J].中国针灸,2007,27(5)：337-338.
[51]卜彤文,刘薇,田新乐.针灸治疗单纯性肥胖症的机理研究[J].四川中医,2007,25(2)：106-107.
[52]罗华丽,李荣亨.电针对单纯性肥胖瘦素及脂联素的影响[J].针刺研究,2007,32(4)：264-267.
[53]杨春壮,马英,徐永良,等.针刺对单纯性肥胖大鼠血清瘦素含量和下丘脑瘦素受体表达的影响[J].针刺研究,2007,32(6)：384-388.
[54]胡晓斌,鄢燕.穴位埋线对56例单纯性肥胖患者血脂的影响[J].光明中医,2011,26(11)：2266-2267.
[55]徐佳,曲惠卿,方海琳.电针配合耳穴贴压对肥胖伴多囊卵巢综合征患者血清胰岛素及睾酮的影响[J].中国针灸,2009,29(6)：441-443.
[56]高磊,孔显娟,石现.电针和穴位埋线对单纯性肥胖大鼠脂质代谢基因PPAR-mRNA表达及相关脂代谢酶的影响[J].中国针灸,2011,31(6)：538-538.
[57]韩海荣,刘德全.针药并用对单纯性肥胖大鼠血清瘦素及下丘脑NPY基因表达的影响[J].针灸临床杂志,2012,28(5)：71-73.
[58]刘志诚,施小波,李嘉,等.针灸对单纯性肥胖患者下丘脑一垂体一肾上腺轴的作用[J].中西医结合杂志,1990,10(11)：656-659.
[59]方正清,尹刚,许冠荪.单纯性肥胖大鼠胃肠电变化及针刺的调制作用[J].中国中医药科技,2005,12(4)：203-204.
[60]危北海,贾葆鹏.单纯性肥胖病的诊断及疗效评定标准[J].中国中西医结合杂志,1998,18(5)：317-319.
[61]全国中西医结合第二次肥胖症学术会议论文集[C].北京,中国学术出版社,1989.
[62]王启才.针灸治疗学[M].北京：中国中医药出版社,2003.8.
[63]祝建龙,方瑜,杨柏灿.肥胖的中医病证探析[J].上海中医药杂志,2011,45(5)：17-19.
[64]李明宪.耳穴贴压治疗单纯肥胖症作用及机理研究.博十论文.广州中医药大学,2012.
[65]赵强,冯伟.针灸治疗单纯性肥胖取穴规律的临床研究[J].天津中医药大学学报,2011,30(2)：95-97.
[66]郑心怡.针灸治疗肥胖症的机理综述[J].福建中医学院学报,2005,15(1)：59.
[67]王海荣,尹丽丽,李春梅,等.穴位埋线治疗肥胖症临床及机理研究进展[J].陕西中医,2011,32(3)：374-376.
[68]杨春壮.针刺对单纯性肥胖的作用机理及肥胖相关胰岛素抵抗影响的实验研究.博十论文.黑龙江中医药大学,2005.
[69]林师彬.温针灸治疗脾虚湿阻型单纯性肥胖症的临床研究.博十论文.广州中医药大学,2012.