靳三针结合健脑粉、智力训练治疗儿童智力低下的临床观察
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摘要
研究目的:
     探讨施行靳三针结合健脑粉、智力训练治疗儿童智力低下的临床康复疗效。
     研究方法:
     观察二陈中医康复院及马来西亚儿童教育研究中心60例符合纳入标准并确诊为智力低下儿童患者,随机分配为康复组30例与训练组30例。治疗时康复组给予靳三针结合健脑粉、智力训练进行康复治疗措施;训练组则给予智力训练而已。两组治疗前给予智力测验做一个基本脑力评估,治疗一个疗程后再给予一个智力评估,观察康复进展。两组预后的评价采用评分,两组在治疗前评估1次,一个疗程后即1个月,必须完成12个疗程,即1年为1个治疗期。治疗前给予评估1次,治疗后再完成再给予评估一次。计算智力评分差值,然后再进行10项观察量表综合康复疗效计算总评价。
     康复组采用综合康复治疗方法:A)针刺:取靳三针头皮针:智三针、四神针、颞三针及脑三针(即靳教授的弱智四项)作为基础治疗提高智力。约定病人一个星期治疗3次,每次30分钟。操作时请求父母亲陪伴并固定病患以预防挣扎而造成的损伤。针刺使用华佗牌不锈钢一次性针灸针(0.32*25mm-50mm),俗称1寸针,75%酒精皮肤常规消毒后沿皮刺,由前向后方平刺0.8寸,以捻针手法进针,之后快速捻转2-3分钟,予电针,留针期间用断续波,留针30分钟,期间无行任何手法;出针再以捻针手法捻出,出针时用干棉球按压出针,再按压一会儿防止皮下血肿或皮下出血。在证型方面的穴位加减分成三种:1)肝肾亏损症型造成发育迟缓,a)不会说话或表达不清者配舌三针和足智针;b)四肢运动障碍、小肌肉不发达及自理能力差者给予双侧手三针和足三针,针用平补平泻达到刺激作用即可。2)心脾两虚症型,造成阴虚阳盛出现多动、烦躁者,配定神针和手智针,针用补法。3)痰瘀阻滞症型,因痰气郁结,阴阳失调造成痰火上扰引发癫痫者,配痫三针和十三鬼穴,如人中、少商、风府、劳宫、曲池等)再加丰隆穴,针用泻法。B)中药方《健脑粉》组成,以醒脑开窍,补肾填精,调补肝肾为主之中药组合成。内有益智仁、五味子、党参、石菖蒲、龙骨、远志、龟板、枸杞子、酸枣仁和熟地。每日服用2g,早晚1次,每次lg。根据患者体质辨证论治,分成三种辨证配方,每个星期以四诊八钢,望闻问切辩患者的体质证型才给予辩证配方。三种辩证配方为:1)肝肾亏损症型:六味地黄汤,每日9g,早中晚各服1次,每次3g;2)心脾两虚症型:归脾汤,每日9g,早中晚各服1次,每次3g;3)痰瘀阻滞症型:二陈汤,每日9g,早中晚各服1次,每次3g。若有癫痫发作者,则辩证为肝火上扰则二陈汤配与镇肝熄风汤服之。C)康复智力训练:采用马来西亚儿童教育研究中心的康复智力训练的教案训练,亦是参考及选自儿童青少年精神教育文件之参考表格(Adolescent and Adult Psychoeducational Profile, AAPEP),主要内容包括5个大领域,即:1)注意力和记忆力训练:2)粗动作和精细动作强化训练;3)玩耍的技巧和认知能力的训练;4)口语交流能力训练;5)独立生活能力和社会交往能力训练。
     对照组,亦称为康复智力训练对照组则以一般西医康复训练一样,但统一规划与治疗组的智力训练一致,此详细内容附上在论文里。此治疗以4周为一疗程,共12疗程。最后分别观察靳三针结合健脑粉、钾力训练治疗组及单纯康复智力训练对照组治疗前和治疗后患者的情况,包括问诊、查体及相关实验室检查。两组采用统一的评价标准。在疗程前后有专人进行《瑞文测试》和《靳瑞教授的10项观察指标》填写、各评估1次进行评定后计算总评价,并分析原因。
     结果:
     ①在治疗前脑力功能及智力测验无显著差异(P>0.05)。经治疗12个疗程后,两组的脑力功能及智力测验有显著差异(P<0.05),而康复组比训练组的效果更明显(P<0.01)。至治疗后一年,两组仍有差异。
     ②在治疗前康复组的平均年龄4.86岁,有27例是男童,3例是女童:智力训练对照组的平均年龄是5.23岁,有28例是男童,2例是女童。治疗前康复组与智力训练对照组患者基本资料(年龄、病症、智商)方面比较,差异均无统计学意义(P>0.05)表明组间基线条件一致,具有可比性。但是性别则明显有统计学差异(P<0.05),男性患童多于女性患童,无可比性,因此将来可以往是否是男性的染色体导致智力低下为主要原因此方向进行研究。
     ③瑞文智力测试评分:康复组:治疗前29.79±21.72,治疗后50.95±30.92,治疗前后比较有显著统计学意义(P<0.05);智力训练对照组:治疗前28.95±20.29,治疗后29.29±20.62治疗前后比较无统计学意义(P>0.05)
     ④靳教授的10项观察指标:康复组30例,治疗前:<6项25例,6-7项5例,治疗后:<6项18例,6-7项7例,7-8项4例,8-9项1例;智力训练对照组,治疗前:<6项26例,6-7项4例,治疗后:<6项25例,6-7项5例。两组在靳教授的10项观察指标治疗前后比较有显著统计学意义(P<0.05)。
     结论:
     ①综合康复治疗:靳三针结合健脑粉、智力训练治疗智力低下儿童,与常规单纯给予智力训练或个别训练或康复训练的疗效评分统计学有显著意义。
     ②本次研究观察展现出统一模式再配伍儿童体质证型给予治疗提升儿童智力低下临床康复过程疗效显著,具有可发展性及创新性。
     ③此临床康复过程需要高质量的三角关系配合,即家长信任及坚持配合治疗,完成疗程;智力训练老师按部就班依照康复智力训练教导,定期完成训练;最后配合综合靳三针和健脑粉医疗。
     ④提示靳三针可能是治疗此类证型的优势选择及儿童智力低下可规范式地给予治疗。
Objective
     To investigate the comprehensive treatment and rehabilitation of children mental retardation so as to greater influence their functional prognosis.
     Methods
     60patients under observation, which were determined to fit the standards for MR, were randomly selected to participate in30patients for rehabilitation or30patients for IQ training groups. During the course of treatment, the rehabilitation group in its initial stage underwent a course of treatment that was careful selected and analysis by giving IQ test in advance. The methods used in rehabilitation group treatment included Jin three needles, Chinese herbs prescriptions for activate the brain cells purposes and IQ training. Observation group used only IQ training courses. After one session of treatment was carried out, that was a month, total12sessions of treatments need to complete to fulfilled the whole1st trial session of treatments, after the1s trial session of treatments completed another IQ test will be applied. To evaluate the functional prognosis of the two groups a standardized brain power nerves system assessment was used. Both groups at the beginning of treatment and after the course session of12months of treatment received an evaluation, then after1st trial session of treatments a final assessment was made. Computation was conducted to assess the difference in values, and then a composite of the early and later assessment results was compiled and analyzed.
     Comprehensive treatments included three parts of treatments, that is: A)Acupuncture points:The3-Points for intelligence, Four Spirit Points, The3-Points in the temporal area, The3-Occipital Points (as Prof Jin names them Mental Retardation four items) for rebuild intelligence foundation profound. Each patient makes a commitment to take3times acupuncture treatments in a week, each time took30minutes. During the treatment it is necessary to request children's parents to hold their kids for preventing them struggl ing and hurt themselves or acu-points during the treatment. Hua Tuo Brand one Lime used needles,0.32*25mm-50mm, normally called one inch needle will he used, normal standard hygiene sterilized with75%alcohol at the acupoint places and then needled perpendicular to the transverse plane subcutaneous1y along with the skull, from front towards back to a depth of0.8inch, needled with twirling the needles and then speed up for2-3minutes, then use electro-stimulation for30minutes, there are no manually stimulation take while the electro take place. Twirling the needles again while removi ng the needles, used a dry cotton to press while removing it and press harder after removed to prevent from bleeding. Syndrome differentiation divide into three:1) Development delay due to deficiency of kidney and liver essence and two symptoms show like a)speech delay can choose The3-Tongue Points and The3-Intellect Points on the foot, b) big motor skill, small motor skill and daily living activities deficiency can choose both side The3-Arm Points and The3-Leg Points moderate stimulate will do.2) Deficiency essence of heart and spleen shows lack of Yin and over level of Yang will come wi th symptoms like hyperactive, frustration choose The Stabilizing the Shen Points and The3-Intellect points on the hand with Bu manual tecnic.3) Flame and Clock congested come with symptoms imbalance of Yin and Yang and congested of Qi then at last epilepsy appears. Choose The3-Fpilepsy Points and Thirteen Ghost Points, eg Ren Zhong, Shao Shang, Feng Fu, Lao Cong and Qu Chi etc. Also add Feng Long to straighten the effectiveness. B) Brain Powder Herbs Prescription: To activate brain cells and build up foundation of kidney and liver, activate the nerves systems, choose Fructus Alpiniae Oxyphyllae, Fructus Schisandrae Chinensis, Radix Codonopsis Pilosulae, Rhizoma Acori Graminei, Os Draconis, Radix Polygalae, Plastrum Chinemys Reevesii Testudinis, Fructus Lycium Barbarum, Semen Ziziphi Spinosae, Radix Rehmanniac Glutinosa Praeparata. Take twice in a day, each time take1g, a day total will take2g. According to the symptoms of the patients divide into three syndrome differentiation, each week will use TCM diagnosis method to analysis and accompany with side prescription. Three side syndromes are:1)Development delay due to deficiency of kidney and liver essence, accompany with Liu Wei Di Huang Tang, three times in a a day, each time3g, total9g in a day.2) Deficiency essence of heart and spleen shows lack of Yin and over level of Yang, accompany with side prescription Gui Pi Tang, three times in a a day, each time3g, total9g in a day.3)Flame and Clock congested come with symptoms imbalance of Yin and Yang and congested of Qi, accompany with side prescription Er Chen Tang, three times in a a day, each time3g, total9g in a day. If occurs epilepsy and diagnosed ascendance of the heat of the liver, then Zhen Gan Xi Feng Tang it is.
     Rehabilitation IQ Training:Used C. E. Motivation Training Centre's Rehabilitation IQ Training Program, also shared by Adolescent and Adult Psychoeducational Profile, AAPEP. It has included five big range, that is1) Attention and memory traini ng,2) Big and small motor skill training,3) Analysis and cognitive skill training,4)Speech and verbal skill training,5)Daily living activities and social skill ability training.
     Comparison group only apply rehabilitation IQ training just as all western medication applied, the details has illustrate in the thesis. This treatment is3times in a week,4weeks as1session and12sessions as1course. Finally clinical observation on combination treatment of Jin3-needles with Brain Powder Presription and Rehabilitation IQ Training compare with only Rehabilitation IQ Training. All standardized diagnosis procedure and check up will apply before and after the treatment course. Results
     ①After12months treatment the IQ test of the two groups was clearly differenciate; there was a significant difference in the condition of the patient from the begi nning to the course end (P<0.05). Further the comparison of the condition between the rehabilitation and IQ training groups was even more significant (P<0.01). There was still even a significant difference between the two groups after another following up months.
     ②Before treatment Comprehensive Rehabilitation Group (CR group) average age is4.86old,27cases were boys,3cases were girls, comparison group average age is5.23old,28cases were boys,2cases were girls. General info of the patients before the treatments are likely the same (age, syntoms, IQ),no significant difference (P>0.05). The sex of the patients was a significant difference in the condition of the patient from the beginning of the course (P<0.05), boys more than girls, it can be another research for investigate whether boys DNA can affect low IQ in future.
     ③Raven International IQ test:CR group29.79±21.72before the treatment,50.95±30.92after the treatment, there was a significant difference (P<0.05) before and after treatment in CR group; comparison group28.95±20.29before the treatment,29.29±20.62after the treatment, there was no significant difference (P>0.05) before and after the treatment for comparison group.
     (4)10Observation Rates of Prof. Jin:30cases of CR group,<6rates for25cases,6-7rates5cases total before the treatment, after the treatment <6ratesl8cases,6-7rates7cases,7-8rates4cases,8-9rateslcase; comparison group score <6rates26cases,6-7rates4cases before the treatment and after the treatment were <6rates25cases,6-7rates5cases. Two groups shows a significant difference (P<0.05).
     Conclusion
     ①Combi nat ion Jin'3-needle, Brain Powder and Rehabili tat ion IQ training has proof more sufficient and significant effect to help mental retardation children compare with only Rehabilitation IQ training.
     ②The use of comprehensive rehabilitative treatment is the most newest and effective method to facilitate greater brain power, raise the level of the nerves system connection and help the patient to return to primary education system and social.
     ③The primary mechanism of treatment is to increase the blood supply through promotion of blood circulation and strengthen the rehabilitation of the nerves system especially in the area of the brain cells that dysfunctional but it has to have commitment from the parents and high cooperation from the conduct rehabilitation teacher.
     ?This research also shows that Jin'3-needles is sufficient and much effective with a standardize treatment for mental retardation children.
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