针刺治疗轻中度抑郁症的临床研究
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摘要
抑郁症是情感性精神障碍的主要类型,是一种以显著而持久的心境低落为特征的综合征。抑郁症作为一个全球性的主要精神问题,严重危害人类的身心健康,因其不对身体造成直接危害而常常被忽视。WHO估计全球约有抑郁患者3.4亿,美国每年有1100万人患临床抑郁症,患者的自杀率为10%-15%,受此症的影响,每年大约损失200亿美元。国内调查资料显示,抑郁症的自杀率比一般人群约高20倍。预测到2020年,抑郁症将成为仅次于癌症患者的第二大致残因素。精神病学新近研究表明,抑郁症的患病率已超过心脑血管疾病和肿瘤,跃居发达国家的第一位。在天人相应、整体观念指导下的中医治疗优势越来越得到体现。抑郁症是一种典型的由生物、心理、社会等多种因素作用而致的疾病。而靶点明确、作用单一的西药不可避免的存在一些缺点,相对而言,具有多层次、多靶点、重视个体的中医针刺疗法更有一定的优势。因此,在临床实践的基础上,采用循证医学的思维方法,深入对抑郁症病因病机、演变规律的研究,总结出最佳有效经济的治疗方案,充分发挥中医药对疾病个体化,整体治疗的优势,制定出具有中医特色,实用性强的治疗方案,提出治疗和预防抑郁症的发生及发展的最佳方案。
实验目的:通过随机对照原则观察针刺治疗轻中度抑郁症的临床疗效。
实验方法:应用针刺百会、四神聪、丰隆等穴治疗30例轻中度抑郁症患者,并与对照组口服氟西汀(百忧解)30例患者比较疗效,疗程均为6周。治疗前后分别进行汉密尔顿抑郁量表(HAMD)评分,汉密尔顿焦虑量表(HAMA)评分,临床总体评定量表(CGI)评定, TESS副反应量表评定和中医证候积分量表评定。随访4周,进行汉密尔顿抑郁量表(HMAD)评分。
结果:经6周治疗后,针刺治疗组有效率为73.33%,西药对照组有效率为76.67%。经统计学处理,针刺组与西药组临床疗效比较差异无显著性意义(P>0.05),针刺组比西药组副反应少,复发率低。
结论:
1.针刺组与口服西药氟西汀组均能改善痰气郁结型轻中度抑郁症患者的临床症状。
2.针刺组与口服西药氟西汀组疗效相当,但针刺组无副作用,操作方法简单,复发率低。
3.本研究表明,针刺治疗痰气郁结型轻中度抑郁症可以作为临床治疗轻中度抑郁症比较可行的治疗方案,汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、临床总体评定量表(CGI)评定、中医证候积分量表评定和TESS副反应量表评定,可以作为轻中度抑郁症的疗效评价体系。
Depression is the main type of mood disorder which characterizes a significant and long一lasting state of low morbid syndrome. Depression is a major global mental health problem that causes serious physical and mental health of crimes against humanity, because they can not cause direct harm to the body and often be ignored. WHO has estimated that about 340 million patients are suffering from depression. In the United States, each year 11 million people are suffering from clinical depression, the suicide rate of patients is 10%~15%,subject to the impact of this disease, the annual loss is about is 20 times higher than the general population. Forecast by 2020,depression will be come the second largest disability factor beyond the Cancer patients. Recently, Psychiatry studies have shown that the prevalence rate of depression is higher than cardiovascular, cerebrovascular diseases and cancer, staying at the first rank of developed countries. In addition, since the beginning of the global financial problem, economic recession, debt problem, small and medium- sized faces closure, the increasing unemployment rate, the further reduction of GDP, GNP, personal income and the decline in the quality of life, all those pressures may direct burden on people’s physical and mental health, causing drastically increase the number of depression patient outside of more than expected. Thus, we must face it seriously. So,In clinical practice, based on the use of evidence-based medicine way of thinking, depth of depression pathogenesis, evolution of the research, summarizes the best treatment options and effective economy, give full play to the disease individualized medicine, the overall treatment advantage, and work out with Chinese characteristics, and practical treatment options, proposed treatment and prevention of the occurrence and development of depression, the best option.
Purpose: Randomized controlled by observing the principles of acupuncture treatment of
mild to moderate clinical depression. Method:Application of acupuncture Baihui, Sishencong, Fenglong and other points 30 cases of mild to moderate depression, and with the control group, fluoxetine (Baiyoujie) Comparative efficacy of 30 patients, treatment lasted 6 weeks. Respectively before and after treatment Hamilton Depression Rating Scale (HAMD) score, Hamilton Anxiety Scale (HAMA) score, Clinical Global Assessment Scale (CGI) assessment, TESS side effects rating scale and the amount of TCM syndromes Table assessment. Followed up for 4 weeks, the Hamilton Depression Rating Scale (HMAD) score.
Results:After 6 weeks of treatment, the acupuncture treatment group was 73.33%, comparison group, the effective rate was 76.67%. The statistical treatment, the acupuncture group compared with the western medicine group showed no clinical effect was significant (P> 0.05), acupuncture group than in the western medicine group fewer side effects, recurrence rate.
Conclusion:
1. Acupuncture group and the fluoxetine group of oral medicine can improve gas stagnation sputum of mild to moderate depression in patients with clinical symptoms.
2. Acupuncture group and the efficacy of oral medicine rather the fluoxetine group, but the acupuncture group had no side effects, methods of operation is simple, low recurrence rate.
3. This study showed that acupuncture treatment of mild to moderate phlegm stagnation gas can be used as clinical treatment of depression of mild to moderate depression, treatment options more feasible, Hamilton Depression Rating Scale (HAMD) score, Hamilton Anxiety Scale (HAMA) score, Clinical Global Assessment Scale (CGI) assessment, TCM syndrome score rating scale and rating scale TESS side effects can be mild to moderate depression as an effect evaluation system.
实验目的:通过随机对照原则观察针刺治疗轻中度抑郁症的临床疗效。
实验方法:应用针刺百会、四神聪、丰隆等穴治疗30例轻中度抑郁症患者,并与对照组口服氟西汀(百忧解)30例患者比较疗效,疗程均为6周。治疗前后分别进行汉密尔顿抑郁量表(HAMD)评分,汉密尔顿焦虑量表(HAMA)评分,临床总体评定量表(CGI)评定, TESS副反应量表评定和中医证候积分量表评定。随访4周,进行汉密尔顿抑郁量表(HMAD)评分。
结果:经6周治疗后,针刺治疗组有效率为73.33%,西药对照组有效率为76.67%。经统计学处理,针刺组与西药组临床疗效比较差异无显著性意义(P>0.05),针刺组比西药组副反应少,复发率低。
结论:
1.针刺组与口服西药氟西汀组均能改善痰气郁结型轻中度抑郁症患者的临床症状。
2.针刺组与口服西药氟西汀组疗效相当,但针刺组无副作用,操作方法简单,复发率低。
3.本研究表明,针刺治疗痰气郁结型轻中度抑郁症可以作为临床治疗轻中度抑郁症比较可行的治疗方案,汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、临床总体评定量表(CGI)评定、中医证候积分量表评定和TESS副反应量表评定,可以作为轻中度抑郁症的疗效评价体系。
Depression is the main type of mood disorder which characterizes a significant and long一lasting state of low morbid syndrome. Depression is a major global mental health problem that causes serious physical and mental health of crimes against humanity, because they can not cause direct harm to the body and often be ignored. WHO has estimated that about 340 million patients are suffering from depression. In the United States, each year 11 million people are suffering from clinical depression, the suicide rate of patients is 10%~15%,subject to the impact of this disease, the annual loss is about is 20 times higher than the general population. Forecast by 2020,depression will be come the second largest disability factor beyond the Cancer patients. Recently, Psychiatry studies have shown that the prevalence rate of depression is higher than cardiovascular, cerebrovascular diseases and cancer, staying at the first rank of developed countries. In addition, since the beginning of the global financial problem, economic recession, debt problem, small and medium- sized faces closure, the increasing unemployment rate, the further reduction of GDP, GNP, personal income and the decline in the quality of life, all those pressures may direct burden on people’s physical and mental health, causing drastically increase the number of depression patient outside of more than expected. Thus, we must face it seriously. So,In clinical practice, based on the use of evidence-based medicine way of thinking, depth of depression pathogenesis, evolution of the research, summarizes the best treatment options and effective economy, give full play to the disease individualized medicine, the overall treatment advantage, and work out with Chinese characteristics, and practical treatment options, proposed treatment and prevention of the occurrence and development of depression, the best option.
Purpose: Randomized controlled by observing the principles of acupuncture treatment of
mild to moderate clinical depression. Method:Application of acupuncture Baihui, Sishencong, Fenglong and other points 30 cases of mild to moderate depression, and with the control group, fluoxetine (Baiyoujie) Comparative efficacy of 30 patients, treatment lasted 6 weeks. Respectively before and after treatment Hamilton Depression Rating Scale (HAMD) score, Hamilton Anxiety Scale (HAMA) score, Clinical Global Assessment Scale (CGI) assessment, TESS side effects rating scale and the amount of TCM syndromes Table assessment. Followed up for 4 weeks, the Hamilton Depression Rating Scale (HMAD) score.
Results:After 6 weeks of treatment, the acupuncture treatment group was 73.33%, comparison group, the effective rate was 76.67%. The statistical treatment, the acupuncture group compared with the western medicine group showed no clinical effect was significant (P> 0.05), acupuncture group than in the western medicine group fewer side effects, recurrence rate.
Conclusion:
1. Acupuncture group and the fluoxetine group of oral medicine can improve gas stagnation sputum of mild to moderate depression in patients with clinical symptoms.
2. Acupuncture group and the efficacy of oral medicine rather the fluoxetine group, but the acupuncture group had no side effects, methods of operation is simple, low recurrence rate.
3. This study showed that acupuncture treatment of mild to moderate phlegm stagnation gas can be used as clinical treatment of depression of mild to moderate depression, treatment options more feasible, Hamilton Depression Rating Scale (HAMD) score, Hamilton Anxiety Scale (HAMA) score, Clinical Global Assessment Scale (CGI) assessment, TCM syndrome score rating scale and rating scale TESS side effects can be mild to moderate depression as an effect evaluation system.
引文
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[6]赵后锋,朱晶,叶育宏.文拉法辛缓释剂与西酞普兰治疗抑郁症对照研究[J].中国实用神经疾病杂志,2008,11(9):55-57.
[7]李仲平,王陶冶,熊爱莲,等.越鞠升降汤治疗轻中度抑郁症36例[J].辽宁中医杂志,2010,37(8):1522-1523.
[8]殷立荣,张海涛.自拟柴麦合欢汤治疗抑郁症60例临床体会[J].实用心脑肺血管病杂志,2010,18(7):974.
[9]姚红军.越鞠丸联合百忧解治疗抑郁症48例[J].临床医学,2008, 28(12):114.
[10]陈明,李静,郭雅明.解郁丸与米安色林治疗抑郁症90例临床对照观察[J].中国民康医学,2010,22(11):1461-1462.
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[17]韩毳,李学武,李晓泓,等.电针对慢性应激抑郁模型大鼠海马BDNF的影响[J].中国中医基础医学杂志,2001,7(7):535-537.
[18]刘述霞,王秀花,刘秀丽,等.电针治疗抑郁症118例[J].中医研究,2010,23(9): 76-77.
[19]钟志国,律东.加味越鞠丸结合腹针治疗抑郁症临床观察[J].四川中医,2008, 26(5):54-55.
[20]何小东,王欣君.针药结合治疗抑郁症54例疗效观察[J].中国临床研究,2010, 23(7):628-629.
[21]李振,宁飞,张子丽,等.舒肝解郁纳干法针刺治疗抑郁症临床研究[J].中国中医药信息杂志,2009,16(11):64-65.
[22]韩鹏,胡新颖.调神养心针法治疗抑郁症的临床研究[J].针灸临床杂志,2010, 26(8):20-21.
[23]曹湘萍.穴位埋线治疗抑郁症的临床观察[J].临床合理用药,2010,3(17):76-77.
[24]张丽蓉,唐燕.针刺加腹式呼吸治疗抑郁症疗效观察[J].上海针灸杂志, 2010,29(6): 360-361.
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[2]张郭莺,杨彦春.雌激素、单胺递质与抑郁症[J].国际精神病学杂志, 2005, 32(3): 150-152.
[3]戴建国,陈琳,赵玉男,等.基于星形胶质细胞靶点的抑郁症发病机制研究进展[J].中国药理学通报,2010,26(9):1132-1134.
[4]贾永涛,马继东.奎硫平合并舍曲林治疗抑郁症的对照研究[J].中国民康医学, 2010,22(9):1107-1108.
[5]朴峰春,伊峰.曲唑酮与阿米替林治疗抑郁症临床对比分析[J].中国冶金工业医学杂志,2010,27(4):466-467.
[6]赵后锋,朱晶,叶育宏.文拉法辛缓释剂与西酞普兰治疗抑郁症对照研究[J].中国实用神经疾病杂志,2008,11(9):55-57.
[7]李仲平,王陶冶,熊爱莲,等.越鞠升降汤治疗轻中度抑郁症36例[J].辽宁中医杂志,2010,37(8):1522-1523.
[8]殷立荣,张海涛.自拟柴麦合欢汤治疗抑郁症60例临床体会[J].实用心脑肺血管病杂志,2010,18(7):974.
[9]姚红军.越鞠丸联合百忧解治疗抑郁症48例[J].临床医学,2008, 28(12):114.
[10]陈明,李静,郭雅明.解郁丸与米安色林治疗抑郁症90例临床对照观察[J].中国民康医学,2010,22(11):1461-1462.
[11]段武钢,祝家胜,曾德志,等.解郁安神汤联合西酞普兰治疗抑郁症的对照研究[J].时珍国医国药,2010,21(8):2078-2079.
[12]曹辰虹.以督脉为主治疗抑郁症[J].河南中医,2010,30(7):699-700.
[13]叶国传.针刺治疗抑郁症36例[ J].上海针灸杂志,2000,19(6): 30
[14]田华张,张春燕,彭志贤.头针合背俞穴治疗抑郁症临床疗效观察[J].中国民族民间医药,2010,14:173-174
[15]李丽萍,华金双,兰敬昀,等.针刺百会和太冲穴对慢性应激抑郁模型大鼠细胞因子的影响[J].针灸临床杂志, 2006,22(9):49-50
[16]李丽萍,兰敬昀,华金双,等.针刺百会和太冲穴对慢性应激抑郁模型大鼠下丘脑-垂体-肾上腺轴的影响[J].中医药学报,2006,34(2): 52-53.
[17]韩毳,李学武,李晓泓,等.电针对慢性应激抑郁模型大鼠海马BDNF的影响[J].中国中医基础医学杂志,2001,7(7):535-537.
[18]刘述霞,王秀花,刘秀丽,等.电针治疗抑郁症118例[J].中医研究,2010,23(9): 76-77.
[19]钟志国,律东.加味越鞠丸结合腹针治疗抑郁症临床观察[J].四川中医,2008, 26(5):54-55.
[20]何小东,王欣君.针药结合治疗抑郁症54例疗效观察[J].中国临床研究,2010, 23(7):628-629.
[21]李振,宁飞,张子丽,等.舒肝解郁纳干法针刺治疗抑郁症临床研究[J].中国中医药信息杂志,2009,16(11):64-65.
[22]韩鹏,胡新颖.调神养心针法治疗抑郁症的临床研究[J].针灸临床杂志,2010, 26(8):20-21.
[23]曹湘萍.穴位埋线治疗抑郁症的临床观察[J].临床合理用药,2010,3(17):76-77.
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