摘要
目的
观察耳尖放血治疗风热感冒发热的临床疗效。
方法
本研究采用随机对照试验方法进行临床试验,共有合格受试者64例。治疗组32例;对照组32例。治疗组耳尖放血,治疗方法:选穴、耳尖穴:耳尖穴的部位将耳轮转向耳屏对折时,耳廓上尖端处即是。操作方法:按摩耳尖部使其充血,常规75%酒精棉球消毒皮肤,左手拇、食指夹捏,固定耳廓上端,右手指三棱针,对准耳尖穴迅速点刺,针尖刺入约1-3毫米深,以双手拇、食指轻挤针眼四周,使之出血如豆大,以棉球吸去,如此反复放血8滴。对照组:中成药:感冒退热冲剂。药物组成:大青叶、板蓝根、连翘、拳参。用法用量:冲剂,袋装每袋10克。每日2-3次,每次1袋;6岁以上儿童用1/2袋,每日2次;6岁以下儿童用1/3袋,每日2次,温开水冲服。试验期间均不得使用有治疗作用的其他药物治疗。治疗组与对照组疗程均为5天。
结果
两组治疗前各指标比较,差异均无统计学意义。提示影响两组预后的主要因素具有均衡性。
总疗效比较:两组总疗效比较,治疗组近期临床痊愈率为50%,显效率为31.3%,有效率为9.4%,近期临床痊愈率及显效率为81.3%,总有效率为90.6%;对照组近期临床痊愈率为28.1%,显效率为28.1%,有效率为25%,近期临床痊愈率及显效率为56.2%,总有效率为81.2%。两组比较(z=2.14,P=0.03),差异有统计学意义。
两组治疗5天后咳嗽改善程度(z=1.97,P=0.04)、口渴改善程度比较(z=2.89,P=0.00),差异有统计学意义。
两组治疗5天后恶寒、汗出、发热、、改善程度比较,差异无统计学意义。
两组治疗5天后咳嗽(χ2=4.14,P=0.041)、恶寒(χ2=7.27,P=0.007)、发热(χ2=6.34,P=0.01)、口渴(χ2=4.51,P=0.03)、咽痛(χ2=4.46,P=0.03)、咽部充血(χ2=4.14,P=0.04)、胸透肺纹理增粗(χ2=4.66,P=0.03)等消失率比较,差异有意义性意义。两组治疗5天后胸闷、汗出、鼻塞、喷嚏、便干、尿短赤、肺部听诊呼吸音较粗或少许干湿啰音、扁桃体红肿等消失率比较,差异无统计学意义。
不良事件观察,治疗组治疗后无不良反应。对照组用药后无不良反应。
结论
通过以上的临床研究和文献分析,可以得出如下结论:
两组中医证候疗效比较,治疗组疗效优于对照组。耳尖刺血疗法的损伤极小、痛苦小、安全无任何副作用,患者易于接受,放血微量,经济实惠,操作简单、极易掌握运用和推广;显效快,一些急性症状常出现即时效果;适用范围广,具有一法多病,一穴多病的特点。
Objective
To evaluate objectively efficacy of clinical therapeutic effect and safety of Erjian(HX6,7i) bloodletting therapy for exogenous fever, a randomized controlled trial was undertaken.
Methods
All study objects were patients with exogenous fever. Cases source:64 patients from You Sheng Chinese clinic were selected June,2008 to December, 2009. Therapeutic methods:for group of Erjian (HX6,7i) bloodletting: selection points and Erjian(HX6,7i) points allocation:at the superior apex of anteriority folded part of helix. Operation methods:massage the apex satyri to hyperemia, use routine cotton ball of 75% alcohol to disinfect the skin, knead and clip the skin of apex satyri with left thumb and forefinger, fix the superior extremity of auricle, use the three-edged needle by right fingers, aim at the Erjian point and prick fast to the point, about 1-3 mm, then press gently with both thumbs and forefingers circumference of pinpoint to make the blood volume as bean, and use the cotton ball to draw the blood away, repeat exsanguinations until bleeding of 8 drops.
Control group:Chinese patent medicine:Ganmaotuire Chong Ji. Herb Composition:Daqingye、Banglangen、Lianqiao、Quanshen. Usage and dosage:Chong Ji,10 g medicine was packed into each pouch. Adult take one pouch each time and two to three times everyday; child who older than six years use half pouch each and two times everyday; child who younger than six years use 1/3 pouch each time and two times everyday. Take medicine after mixing with warm water. Patients with syndrome of deficiency and cold of spleen and stomach are forbidden to take the medicine. The medicine was manufactured by Yuehua pharmaceutical factory in Guang Zhou. Any other drugs that have therapeutic effect are forbidden to take during the trial. The course is 5 days of both groups.
Results
The research adapted methods of random and control to take clinical trial, and there were total 64 qualified patients including 32 cases in the trial group and 32 cases in the control group. Before treatment, all indices between two groups had no significant difference, indicating the main factors that would affect the prognosis between two groups are comparable. Total efficacy comparison:in the treatment group, the recent clinical recovery rate was 50%, excellence rate was 31.3%, and effective rate was 9.4%, recent clinical recovery plus excellence rate was 81.3% and total rate was 90.6%; while in the control group, the rate was 28.1%,28.1%,56.2% and 81.2% relatively. Comparison between two groups showed difference of significance (z=2.14, P=0.03). After five days'treatment, improvement degree of cough and thirsty symptoms had significant difference between two groups (z=2.89, P=0.00) however, improvement degree of aversion to cold, sweating and fever symptoms showed no significant difference. After treatment of five days, disappearance rate of cough (χ2=4.14,P=0.041), aversion to cold (χ2=7.27, P=0.007), fever (χ2=6.34, P=0.01), thirsty (χ2=4.51,P=0.03) pharyngalgia (χ2=4.46, P=0.03), hyperemia of pharyngeal portion (χ2=4.14, P=0.04), thick lung making by chest X-rays (χ2=4.66, P=0.03)between two groups had significant difference. While disappearance rate of chest distress, sweating, nasal obstruction, sneezing, dry stool, short and red urine, auscultation of lung breath sound showing fairly rough or a little of dry and moist rales, flare of tonsil, had no significant difference between two groups.
Safety test:pre-treatment and post-treatment, there were no abnormal changes of blood routine, urine routine, stool routine, function of liver and kidney, electrocardiogram in both groups. Adverse evens observation showed no adverse reaction in both groups.
Conclusions
By the above analysis of clinical research and literature, conclusions could come to as below:
Comparison with efficacy of Chinese medicine syndrome between two groups suggested the therapeutic effect of trial group is better than that in the control group. Erjian bloodletting Therapy had slight injury, suffering less, safe and without adverse effect, which could be accepted easily by patients, the method had other advantages such as microamount bleeding, economical and beneficial, simple operation and very easy to apply and popularize; the method could take effect fast and have immediately effect on some emergent symptoms; Erjian bleeding method's applicability was large and had characteristics of one method to treat multiple diseases and one point to therapy multiple diseases.
引文
[1]何明俭.病毒唑治疗病毒性上呼吸道感染30例疗效观察[J].广州医药,1996,27(5):62-63.
[2]马胜善,李国保.利巴韦林治疗急性病毒性上呼吸道感染[J].江苏临床医学杂志,2002,6(3):237.
[3]陈雅珠.利巴韦林氯化钠注射液治疗病毒性上呼吸道感染60例[J].天津药学,2001,13(4):60.
[4]武建国.病毒唑滴鼻治疗病毒性上呼吸道感染疗效观察[J].陕西医学杂志,1997,26(12):734.
[5]于春华.利巴韦林滴鼻液治疗早期病毒性上呼吸道感染疗效观察[J].山东医药工业,2001,20(3):42.
[6]王雷.α-干扰素滴鼻治疗病毒性上呼吸道感染疗效观察[J].职业与健康,2000,16(12): 151.
[7]林玉娟.小剂量干扰素治疗病毒性上呼吸道感染疗效观察[J].广东医学院学报,1993,11(4):220-221.
[8]项红霞.臣功再欣治疗急性上呼吸道感染临床研究[J].现代诊断与治疗,2003,13(3):146-147.
[9]张宇明.臣功再欣治疗小儿病毒性上呼吸道感染发热92例[J].医学理论与实践,2005,18(6):659.
[10]王孟昭,张波.流行性感冒的抗病毒药物治疗[J].中国医院用药评价与分析,2003,3(4):250-252.
[11]张伟红,梁宏芝.金刚烷胺治疗上呼吸道感染的疗效观察[J].哈尔滨医药,1998,18(1):10-11.
[12]刘耘,哈斯也提.潘生丁治疗病毒性上呼吸道感染70例疗效观察[J].新疆医学,2004,34:110.
[13]冯婉玉.双嘧达莫临床药理新作用[J].中国医药情报,1995,1(4):243-247.
[14]席俊婷.病毒灵防治急性病毒性上呼吸道感染初步探讨[J].临床茎萃,1994,9(12):551-552.
[15]苏立庆.阿司匹林的临床应用[J].天津药学,2001,13:14-15.
[16]胡皓夫.发热的概念与解热、抗炎免疫药的临床应用[J].中国实用儿科杂志,1999,14(6):371-372.
[17]张慧琴.对乙酰氨基酚栓治疗A,JL发热疗效观察及护理[J].山东医药,2003,43(20):51-52.
[18]沈红,李建红.布洛芬混悬液退热临床疗效观察[J].浙江中西医结合杂志,2003,13(7):443-444.
[19]栾俊强,欧尔兰.布洛芬混悬液治疗小儿急性感染伴高热疗效分析[J].新疆医科大学学报,2004,27(4):423.
[20]宫德鸿,张立平.布洛芬混悬液治疗小儿急性上呼吸道感染并高热疗效观察[J].现代医药卫生,2004,20(10):875-876.
[21]张怀领.吲哚美辛保留灌肠治疗小儿发热1986例次[J].中国基层医药,2003,12(10):1337.
[22]王彦华,吴翠萍,闫秀琴.耳尖放血辅助治疗外感发热50例[J].中国中医药科技,2003,10(4):240.
[23]黎碧婵,黄晓利.耳尖放血、穴位注射佐治小儿感发热的临床观察[J].医学创新研究,2008,5(14):7.
[24]王燕军,李春兰.耳尖放血治疗小儿外感发热126例[J].辽宁中医杂志,2006,33(2):194.
[25]王占慧.耳尖放血加大椎拔罐治疗感冒发热35例[J].Shanghai J Acu-mox,2005,24(2):16.
[26]袁远芬.耳尖穴刺络放血治疗高热35例治疗观察[J].贵阳中医学院学报,2005,27(1):47-48.
[27]林香惜.耳尖放血治疗小儿高热的疗效观察[J].国际医药卫生导报,2001,8:79.
[28]陈依.敦煌遗书中的耳穴与耳孔灸法[J].中华医史杂志,1995,25(3):156.
[29]黄丽春.耳穴诊断学[M].科学技术文献出版社,2004:95.
[30]张阿娜,杜雪莉.耳尖放血治疗麦粒肿78例[J].实用中医药杂志,1999,15(10):34.
[31]孙跃进.耳尖放血治疗早期睑腺炎[M].中国中医急症,2001,10(3):177.
[32]何琦.耳尖穴点刺放血治疗麦粒肿[J].贵阳中医学院学报,1992,14(3):39.
[33]戴秀萍,陈芬萍,郑梅英,等.耳尖放血的眼科应用[J].中国针灸,1996,11:52.
[34]马元.耳尖施灸治疗胬肉攀睛[J].上海针灸杂志,1994,13(5):238.
[35]裴良才.耳尖放血对预防流行性出血性结膜炎的观察[J].中国中医眼科杂志,1995,3:179.
[36]熊银松,田建群.火柴灸耳尖穴治疗流行性腮腺炎100例[J].中级医刊,1995,30(10):47.
[37]李思康,张传宝.耳尖点刺放血治疗流行性腮腺炎89例[J].辽宁中医杂志,1998,1:37.
[38]薛继岚.耳尖放血治疗高血压[J].中国针灸,1991,(1):32.
[39]吴广伟,林矛,陈志斌.耳尖放血治疗高血压306例[J].上海针灸杂志,1997,16(2):
21.
[40]陈华德.针刺配合耳尖放血治疗肝阳上亢证34例[J].湖南中医药导报,2001,7(2):68.
[41]Dieterich.针刺加耳尖放血治疗高血压[J].上海针灸杂志,2000,19(2):9.
[42]陈华德,王种敏,方针.耳尖放血对高血压肝阳上亢证大鼠NO的影响[J].中医药学刊,2004,22(5):817.
[43]王聊敏,陈华德.耳尖放血法与耳尖电刺激法即时降压效应的比较研究[J].中医药学刊,2004,22(7):1207.
[44]陈华德,方针,王狮敏.耳尖放血疗法治疗高血压病肝阳上亢证的实验研究明[J].中西医结合心脑血管病杂志,2003,1(9):521.
[45]陈华德,方针,王狲敏.耳尖放血治疗高血压病肝阳上亢证疗效观察[J].中国针灸,2004,24(4):229.
[46]罗建昌,陈华德.耳尖放血治疗高血压即时疗效观察[J].上海针灸杂志,2004,23(4):26.
[47]徐凤洲,刘学荣,刘忠荣,等.电针耳尖穴对窒息家兔血压和呼吸作用实验及临床研究[J].针刺研究,1992,(1):36.
[48]董兵,凌显风,陈静操,等,电针高血压病人耳尖穴与降压点穴作用的比较[J].针灸学报,1990,(4):15.
[49]刘忠荣,徐风洲,陆忠呜.电针自然呼吸和窒息家兔耳尖穴对膈神经放电的影响[J].泸州医学院学报,1991,14(3):186.
[50]刘忠荣,徐风洲,陆忠鸣.电针自然呼吸和窒息家兔耳尖穴对膈神经放电的影响[J].针灸学报,1991,(4):17.
[51]王彦华.耳尖放血辅助治疗外感发热50例[J].中国中医药科技,2003,10(4):240.
[52]袁远芬.耳尖穴刺络放血治疗高热35例治疗观察[J].贵阳中医学院学报,2005,27(1):47.
[53]郭焱,杨建新,张翠莲.三棱针点刺用于癌症高热患者的疗效观察[J].北京中医药大学学报,2002,25(2):74.
[54]钱云,赵连珠.耳尖放血退热的实验观察[J].北京中医药大学学报(中医临床版),1994,1:20.
[55]尤佳.耳尖放血治疗急性卡他性扁桃体炎85例[J].医学理论与实践,2002,15(9):1047.
[56]乔玉玲,田丰.耳尖放血并耳穴贴苏子治疗牙痛57例临床观察[J].中国社区医师,2005,21(16):32.
[57]邓炳海,王桂梅,迟振,等.冷光紫外线照射并耳尖放血治疗口腔溃疡56例[J].中华物理医学与康复杂志,2003,25(1):45.
[58]常虹.耳尖放血合耳穴压丸治疗过敏性鼻炎38例[J].中国民间疗法,2000,8(9):16.
[59]宋宇.耳尖配合大椎点刺放血治疗痤疮85例[J].上海针灸杂志,2002,21(1):29.
[60]赵广琼,张信江,李均.斯奇康注射液结合耳尖穴放血治疗扁平疣临床疗效分析[J].遵义医学院学报,2001,24(5):407.
[61]黄文珍.穴注耳尖血治疗头痛60例[J].中国针灸增刊,1994:197.
[62]曾卫蜂.耳尖放血治疗为主治疗失眠57例[J].中国针灸,1989,(3):7.
[63]赵瑞雪.眼针配合耳尖放血治疗失眠32例疗效观察[J].中国针灸,1997,17(2):120.
[64]徐爱华,李衍杭.耳穴压豆配合耳尖放血治疗周围性面瘫[J].山东中医杂志,1995,14(4):178.
[65]李玮,赵玉霞.耳尖穴针刺放血治疗脑梗死临床疗效观察及对血浆内皮素的影响[J].泰山医学院学报,2005,26(1):51.
[66]李春阳.耳尖放血治疗肛周脓肿155例[J].中国民间疗法,2005,13(1):19.
[67]何玲,刘智斌.耳穴贴压更年期烘热汗出32例[J].陕西中医,2002,23(11):1022.
[68]相永梅,董威.耳尖放血加耳穴贴压治疗更年期综合征106例观察[J].中国针灸,2000,20:207-208.
[69]耳尖穴刺络放血治疗高热35例治疗观察[J].贵阳中医学院学报,2005,27(1):47-48.
[70]王彦华,闫秀琴,吴翠萍.针刺耳尖穴放血退热临床疗效观察[J].中国初级卫生保健,2009,23(4):81.
[71]苗艳红,江培忠,宿秀峰.点刺耳尖穴配合内服中药治疗流行性腮腺炎178例疗效观察[J].中国社区医师,2008,24(356):49.
[72]吴清波.耳尖穴放血在治疗急性结膜炎中的疗效观察[J].中华今日医学杂志,3(13):63.