冯氏捏脊手法治疗小儿缺铁性贫血（脾胃虚弱型）的临床研究
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摘要
目的：通过整理与研究，提供冯氏捏脊手法的技术操作规范，用以治疗小儿缺铁性贫血的应用研究，以提高中医临床医疗技术水平，便于推广应用。
方法：临床研究采用2002年国家药品监督管理局制定的《中药新药治疗小儿缺铁性贫血的临床指导原则》、1994年国家中医药管理局制定的“中医病证诊断疗效标准”和“1988年10月，全国小儿血液病学术会议修订（洛阳）制定的小儿缺铁性贫血诊断标准”，对治疗前、后的症候改善进行量化积分，包括面色、食欲、神疲乏力、大便、唇、舌色五项分别计分。其中治疗组采用冯氏捏脊手法，前两周，每日捏一次，后两周，隔天捏，共计四周。对照组口服富马酸铁咀嚼片20mg/kg/d，分三次口服，治疗四周。观察治疗前后面色、食欲、体力、大便及唇、舌色、脉象（或指纹），以及血常规、血清铁蛋白、尿木糖试验、尿淀粉酶试验及锌原卟啉值的指标变化。通过随机、对照的方法观察病例62例，治疗组与对照组按1:1的比例,随机分组治疗组32例，对照组30例。
结果与讨论：捏脊手法治疗小儿缺铁性贫血临床疗效主要体现在：①捏脊手法治疗小儿缺铁性贫血总有效率达90.6%，对照组经补铁治疗小儿缺铁性贫血总有效率达93.3%，两组总有效率比较无显著性差异（P>0.05）。②捏脊可明显改善小儿缺铁性贫血的临床症状，面色、食欲、神疲乏力、大便、唇、舌色的改善效果非常显著（P<0.01）。对照组经补铁治疗对面色、神疲乏力、唇、舌色有明显改善（P<0.01），但对食欲、大便，治疗后无显著性变化（P>0.05）。疗后两组中医症状改善比较经统计学处理，面色、神疲乏力无显著性差异（P>0.05），食欲、大便、唇、舌色三项，两组比较，差异显著（P<0.05）。③可明显改善中医症候，两组疗前、疗后中医症候积分改善比较差异非常显著（P<0.01），但疗后治疗组优于对照组。④捏脊可明显提高D-木糖吸收率，治疗组疗后D-木糖值有非常显著的提高（P<0.01），使脾虚型小儿缺铁性贫血的肠吸收功能明显改善，而对照组疗后无明显差异（P>0.05）；疗后组间比较差异非常显著（P<0.01）。⑤捏脊可提高尿淀粉酶的活性，捏脊组治疗前后尿淀粉酶比较，差异非常显著（P<0.01）；对照组治疗前后尿淀粉酶无明显改善（P>0.05）。捏脊使胰脏分泌淀粉酶的功能增强，可改变消化系统的功能障碍。⑥两组对血清铁蛋白均有非常显著性增加（P<0.01），疗后两组间比较亦无显著性差异（P>0.05）。⑦两组锌原卟啉治疗后均有显著性下降（P<0.01），疗后组间锌原卟啉值比较无显著性差异（P>0.05）。⑧两组疗后红细胞平均体积、红细胞平均血红蛋白、红细胞平均血红蛋白浓度、红细胞体积分布宽度均有非常显著性改善（P<0.01）。
Purpose: On the basis of arranging and studying, regulations for technical operations of Feng's Chiropractic Technique is provided to treat pediatric iron-deficiency anemia, to improve the clinical level of TCM, and convenient for application and dissemination.
Method: According to "the Clinical Guiding Rules of Treating Pediatric Iron-deficiency Anemia with New Drugs of TCM", laid down by State Drug Administration in 2002, "the Rules of Diagnosis and Curative Effect of TCM Disorder", established by the State Administration of TCM in 1994;and "the Diagnosis Rules of Pediatric Iron-deficiency Anemia", set down by the National Scientific Conference of Pediatric Blood Disease(Luoyang)in Oct.1988,the clinical research adopted the method of accumulating points in quantifying the improvement of syndrome before and after therapy, separately counting the five items of complexion, appetite, physical strength, stool, lips and colour of tongue. The treatment group adopted Feng's Chiropractic Technique for four weeks: once a day during the first two weeks, and one time every two days during the second two weeks. The comparing group took Ferrous Fumarate Chewable Tablets three times a day orally for four weeks. Observing the change of complexion, appetite, physical strength, stool, colour of lips and tongue, pulse tracings (or fingerprint), and the index of blood routine examination, serum ferritin, urine xylose test, urine diastase test and zinc porphyrinogen before and after therapy. The total 62 observing cases are divided into groups randomly. The proportion of treatment group to comparing group is 1:1. So there are 32 cases in the treatment group and the comparing group had 30cases.
Result and discussion: Through random and comparing method, the clinical observation of 62 children with iron-deficiency anemia indicates that the effective rate which chiropractic treats pediatric iron-deficiency anemia is 90.6%.
The clinical curative effect is:
1. The effective rate which chiropractic treats pediatric iron-deficiency anemia is 90.6%.The effective rate which the comparing group treats pediatric iron-deficiency anemia through enriching the iron is 93.3%. There is not marked difference between the effective rate of the treatment group from that of the comparing group (P>0.05).
The chiropractic measure can clearly improve the clinical symptoms, such as: complexion, appetite, physical strength, stool, color of lips and tongue (P<0.01). Complexion, color of lips and tongue and physical strength of the comparing group through the treatment of enriching iron improved greatly (P<0.01), and other items, such as stool, had not noticeable improvement before and after therapy(P>0.05)..After therapy, the TCM symptom has been proved statistically that there isn't marked difference in physical strength and
2. complexion(P>0.05),apparent difference in appetite ,stool and color of lips and tongue (P<0.05).
3. Improving the accumulating points of TCM symptom clearly. There is much apparent difference in the accumulating points of TCM symptom before and after therapy for the treatment group (P<0.01).There is not obvious improvement in the accumulating points of TCM symptom before and after therapy for the comparing group(P>0.05).There is much evident difference in the accumulating points of TCM symptom between the treatment group form the comparing group through the statistical method (t test)(P<0.01).
4. Chiropractic can clearly improve the absorbance of D-xylose. The D-xylose value of the treatment group after therapy is improved clearly than before (P<0.01),so the intestinal absorption function of the children with iron-deficiency and insufficiency of the spleen is improved clearly. There is much apparent difference between the chiropractic group from the comparing group after therapy(P<0.01).
5. Chiropractic can improve the activity of urine diastase. There is marked difference in urine diastase of the chiropractic group before and after therapy(P<0.01).The urine diastase of the comparing group after therapy is not cl
方法：临床研究采用2002年国家药品监督管理局制定的《中药新药治疗小儿缺铁性贫血的临床指导原则》、1994年国家中医药管理局制定的“中医病证诊断疗效标准”和“1988年10月，全国小儿血液病学术会议修订（洛阳）制定的小儿缺铁性贫血诊断标准”，对治疗前、后的症候改善进行量化积分，包括面色、食欲、神疲乏力、大便、唇、舌色五项分别计分。其中治疗组采用冯氏捏脊手法，前两周，每日捏一次，后两周，隔天捏，共计四周。对照组口服富马酸铁咀嚼片20mg/kg/d，分三次口服，治疗四周。观察治疗前后面色、食欲、体力、大便及唇、舌色、脉象（或指纹），以及血常规、血清铁蛋白、尿木糖试验、尿淀粉酶试验及锌原卟啉值的指标变化。通过随机、对照的方法观察病例62例，治疗组与对照组按1:1的比例,随机分组治疗组32例，对照组30例。
结果与讨论：捏脊手法治疗小儿缺铁性贫血临床疗效主要体现在：①捏脊手法治疗小儿缺铁性贫血总有效率达90.6%，对照组经补铁治疗小儿缺铁性贫血总有效率达93.3%，两组总有效率比较无显著性差异（P>0.05）。②捏脊可明显改善小儿缺铁性贫血的临床症状，面色、食欲、神疲乏力、大便、唇、舌色的改善效果非常显著（P<0.01）。对照组经补铁治疗对面色、神疲乏力、唇、舌色有明显改善（P<0.01），但对食欲、大便，治疗后无显著性变化（P>0.05）。疗后两组中医症状改善比较经统计学处理，面色、神疲乏力无显著性差异（P>0.05），食欲、大便、唇、舌色三项，两组比较，差异显著（P<0.05）。③可明显改善中医症候，两组疗前、疗后中医症候积分改善比较差异非常显著（P<0.01），但疗后治疗组优于对照组。④捏脊可明显提高D-木糖吸收率，治疗组疗后D-木糖值有非常显著的提高（P<0.01），使脾虚型小儿缺铁性贫血的肠吸收功能明显改善，而对照组疗后无明显差异（P>0.05）；疗后组间比较差异非常显著（P<0.01）。⑤捏脊可提高尿淀粉酶的活性，捏脊组治疗前后尿淀粉酶比较，差异非常显著（P<0.01）；对照组治疗前后尿淀粉酶无明显改善（P>0.05）。捏脊使胰脏分泌淀粉酶的功能增强，可改变消化系统的功能障碍。⑥两组对血清铁蛋白均有非常显著性增加（P<0.01），疗后两组间比较亦无显著性差异（P>0.05）。⑦两组锌原卟啉治疗后均有显著性下降（P<0.01），疗后组间锌原卟啉值比较无显著性差异（P>0.05）。⑧两组疗后红细胞平均体积、红细胞平均血红蛋白、红细胞平均血红蛋白浓度、红细胞体积分布宽度均有非常显著性改善（P<0.01）。
Purpose: On the basis of arranging and studying, regulations for technical operations of Feng's Chiropractic Technique is provided to treat pediatric iron-deficiency anemia, to improve the clinical level of TCM, and convenient for application and dissemination.
Method: According to "the Clinical Guiding Rules of Treating Pediatric Iron-deficiency Anemia with New Drugs of TCM", laid down by State Drug Administration in 2002, "the Rules of Diagnosis and Curative Effect of TCM Disorder", established by the State Administration of TCM in 1994;and "the Diagnosis Rules of Pediatric Iron-deficiency Anemia", set down by the National Scientific Conference of Pediatric Blood Disease(Luoyang)in Oct.1988,the clinical research adopted the method of accumulating points in quantifying the improvement of syndrome before and after therapy, separately counting the five items of complexion, appetite, physical strength, stool, lips and colour of tongue. The treatment group adopted Feng's Chiropractic Technique for four weeks: once a day during the first two weeks, and one time every two days during the second two weeks. The comparing group took Ferrous Fumarate Chewable Tablets three times a day orally for four weeks. Observing the change of complexion, appetite, physical strength, stool, colour of lips and tongue, pulse tracings (or fingerprint), and the index of blood routine examination, serum ferritin, urine xylose test, urine diastase test and zinc porphyrinogen before and after therapy. The total 62 observing cases are divided into groups randomly. The proportion of treatment group to comparing group is 1:1. So there are 32 cases in the treatment group and the comparing group had 30cases.
Result and discussion: Through random and comparing method, the clinical observation of 62 children with iron-deficiency anemia indicates that the effective rate which chiropractic treats pediatric iron-deficiency anemia is 90.6%.
The clinical curative effect is:
1. The effective rate which chiropractic treats pediatric iron-deficiency anemia is 90.6%.The effective rate which the comparing group treats pediatric iron-deficiency anemia through enriching the iron is 93.3%. There is not marked difference between the effective rate of the treatment group from that of the comparing group (P>0.05).
The chiropractic measure can clearly improve the clinical symptoms, such as: complexion, appetite, physical strength, stool, color of lips and tongue (P<0.01). Complexion, color of lips and tongue and physical strength of the comparing group through the treatment of enriching iron improved greatly (P<0.01), and other items, such as stool, had not noticeable improvement before and after therapy(P>0.05)..After therapy, the TCM symptom has been proved statistically that there isn't marked difference in physical strength and
2. complexion(P>0.05),apparent difference in appetite ,stool and color of lips and tongue (P<0.05).
3. Improving the accumulating points of TCM symptom clearly. There is much apparent difference in the accumulating points of TCM symptom before and after therapy for the treatment group (P<0.01).There is not obvious improvement in the accumulating points of TCM symptom before and after therapy for the comparing group(P>0.05).There is much evident difference in the accumulating points of TCM symptom between the treatment group form the comparing group through the statistical method (t test)(P<0.01).
4. Chiropractic can clearly improve the absorbance of D-xylose. The D-xylose value of the treatment group after therapy is improved clearly than before (P<0.01),so the intestinal absorption function of the children with iron-deficiency and insufficiency of the spleen is improved clearly. There is much apparent difference between the chiropractic group from the comparing group after therapy(P<0.01).
5. Chiropractic can improve the activity of urine diastase. There is marked difference in urine diastase of the chiropractic group before and after therapy(P<0.01).The urine diastase of the comparing group after therapy is not cl
引文
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2. 宋文秀，周振业编著.贫血基础与临床，第一版.天津：天津科学技术出版社，1994，97，26.
3. 叶广俊主编.现代儿童少年卫生学，第一版. 人民卫生出版社，1999.
4. Ketelhut R, Messerl: H, left ventricular hypertrophy: An independent risk factor, Cardiovascu Pharm acd, 1991, 17:59.
5. 章煜.缺铁、缺铁性贫血对小儿的影响及其对策.上海预防医学杂志，1997，9（9）：393-394.
6. 居建云，杨育林.儿童少年缺铁性贫血相关因素及危害.中国校医，1997，11（4）：314-316.
7. 杨红，等.中学生缺铁性贫血影响因素的条件logistic回归分析.中国学校卫生，1993，14（2）：68-70.
8. Aukett MA, Parks YA, Scott PH, et al: Treatment with iron increases weighte gain and phychomotor development［J］.Arch Dis Child, 1986;61(9):849-857.
9. 朱玲琍，古桂雄，祝佩鸣，等.健康儿童铁营养状况与身心发育的研究［J］.中华血液杂志，1990；11（6）：291-293.
10. 衣明纪，马爱国.缺铁性贫血对婴幼儿体格生长及智能行为发育的影响.实用儿科临床杂志，2002，17（2）：128-130.
11. 于汀.缺铁性贫血对人体的危害.上海预防医学杂志，1997，9（9）：389.
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2. 宋文秀，周振业编著.贫血基础与临床，第一版.天津：天津科学技术出版社，1994，97，26.
3. 叶广俊主编.现代儿童少年卫生学，第一版. 人民卫生出版社，1999.
4. Ketelhut R, Messerl: H, left ventricular hypertrophy: An independent risk factor, Cardiovascu Pharm acd, 1991, 17:59.
5. 章煜.缺铁、缺铁性贫血对小儿的影响及其对策.上海预防医学杂志，1997，9（9）：393-394.
6. 居建云，杨育林.儿童少年缺铁性贫血相关因素及危害.中国校医，1997，11（4）：314-316.
7. 杨红，等.中学生缺铁性贫血影响因素的条件logistic回归分析.中国学校卫生，1993，14（2）：68-70.
8. Aukett MA, Parks YA, Scott PH, et al: Treatment with iron increases weighte gain and phychomotor development［J］.Arch Dis Child, 1986;61(9):849-857.
9. 朱玲琍，古桂雄，祝佩鸣，等.健康儿童铁营养状况与身心发育的研究［J］.中华血液杂志，1990；11（6）：291-293.
10. 衣明纪，马爱国.缺铁性贫血对婴幼儿体格生长及智能行为发育的影响.实用儿科临床杂志，2002，17（2）：128-130.
11. 于汀.缺铁性贫血对人体的危害.上海预防医学杂志，1997，9（9）：389.
12. 刘湘云，林传家，薛沁冰，等.儿童保健学.南京：江苏科学技术出版社，1989，294-301.
13. Lozoff B, Jim enexE, Woif AW: Long-term development al outcome of infants with deficiency. ［Engl］Med, 1991,32(5):687.
14. 邓会芬，等.缺铁性贫血对少年儿童学习和运动能力的影响.中国行为医学科学，2000，9（2）：115-116.
15. International nutritional anemia consultative group, Measurements of iron status; Washington DC; TNACG, 1985.
16. 王明圣，等.缺铁性贫血小儿免疫球蛋白和T淋巴细胞亚群的变化.中华血液杂志，1995，16（5）：260-261.
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18. 张美喻，廖清奎，潘思潭.小儿缺铁性贫血与免疫.中华儿科杂志，1982，20（3）：140.
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