针刺配合中药治疗肝郁脾虚型慢性疲劳综合征疗效观察
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摘要
目的观察针刺背俞穴配合解郁健脾通经汤治疗肝郁脾虚型慢性疲劳综合征临床疗效。方法 86例肝郁脾虚型慢性疲劳综合征患者随机分为治疗组和对照组,每组43例。对照组采用口服解郁健脾通经汤治疗,治疗组在对照组基础上给予针刺背俞穴治疗。观察两组治疗前后临床症状分级量化积分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、T淋巴细胞亚群水平、血清白细胞介素-2(IL-2)与干扰素-?(IFN-?)水平变化,并比较两组临床疗效。结果治疗组总有效率为90.7%,高于对照组的72.1%(P<0.05)。两组治疗后临床症状分级量化积分、SAS评分、SDS评分均低于同组治疗前(P<0.05),治疗组低于对照组(P<0.05)。两组治疗后CD3﹢、CD4﹢、CD4﹢/CD8﹢测定值均高于同组治疗前(P<0.05),治疗组高于对照组(P<0.05)。两组治疗后血清IL-2、IFN-?水平均高于同组治疗前(P<0.05),治疗组高于对照组(P<0.05)。结论肝郁脾虚型慢性疲劳综合征患者采取针刺背俞穴配合解郁健脾通经汤进行治疗,可显著提高临床疗效,明显降低患者焦虑、抑郁程度,并可有效调节T淋巴细胞亚群、血清IL-2与IFN-?水平。
Objective To observe the clinical efficacy of acupuncture at back-Shu points plus Jieyu Jianpi Tongjing decoction(a formula for anti-depression, reinforcing spleen and unblocking meridians) in treating chronic fatigue syndrome due to liver-depression and spleen-deficiency. Method Eighty-six patients with chronic fatigue syndrome due to liver-depression and spleen-deficiency were randomized into a treatment group and a control group, with 43 cases in each group. The control group was intervened by oral administration of Jieyu Jianpi Tongjing decoction, while the treatment group was additionally given acupuncture at back-Shu points. The two groups were observed before and after treatment to measure changes in the scores of clinical symptom grading quantification, Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS), and the levels of T-lymphocyte subsets, and interleukin(IL)-2 and interferon(IFN)–? in serum. The clinical efficacies of the two groups were also compared. Result The total effective rate was 90.7% in the treatment group, significantly higher than 72.1% in the control group(P<0.05). The clinical symptom grading quantification score and the scores of SAS and SDS dropped after treatment in both groups(P<0.05),and the treatment group was lower than the control group(P<0.05). The levels of CD3﹢, CD4﹢ and CD4﹢/CD8﹢increased after treatment in the two groups(P<0.05), and the treatment group was higher than the control group(P<0.05). The levels of IL-2 and IFN–? in serum increased after treatment in the two groups(P<0.05), and the treatment group was higher than the control group(P<0.05). Conclusion Acupuncture at back-Shu points plus Jieyu Jianpi Tongjing decoction can significantly improve the clinical efficacy in treating patients with chronic fatigue syndrome due to liver-depression and spleen deficiency. It can obviously mitigate anxiety and depression, and effectively regulate the levels of T-lymphocyte subsets, and IL-2 and IFN-? in serum.
Objective To observe the clinical efficacy of acupuncture at back-Shu points plus Jieyu Jianpi Tongjing decoction(a formula for anti-depression, reinforcing spleen and unblocking meridians) in treating chronic fatigue syndrome due to liver-depression and spleen-deficiency. Method Eighty-six patients with chronic fatigue syndrome due to liver-depression and spleen-deficiency were randomized into a treatment group and a control group, with 43 cases in each group. The control group was intervened by oral administration of Jieyu Jianpi Tongjing decoction, while the treatment group was additionally given acupuncture at back-Shu points. The two groups were observed before and after treatment to measure changes in the scores of clinical symptom grading quantification, Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS), and the levels of T-lymphocyte subsets, and interleukin(IL)-2 and interferon(IFN)–? in serum. The clinical efficacies of the two groups were also compared. Result The total effective rate was 90.7% in the treatment group, significantly higher than 72.1% in the control group(P<0.05). The clinical symptom grading quantification score and the scores of SAS and SDS dropped after treatment in both groups(P<0.05),and the treatment group was lower than the control group(P<0.05). The levels of CD3﹢, CD4﹢ and CD4﹢/CD8﹢increased after treatment in the two groups(P<0.05), and the treatment group was higher than the control group(P<0.05). The levels of IL-2 and IFN–? in serum increased after treatment in the two groups(P<0.05), and the treatment group was higher than the control group(P<0.05). Conclusion Acupuncture at back-Shu points plus Jieyu Jianpi Tongjing decoction can significantly improve the clinical efficacy in treating patients with chronic fatigue syndrome due to liver-depression and spleen deficiency. It can obviously mitigate anxiety and depression, and effectively regulate the levels of T-lymphocyte subsets, and IL-2 and IFN-? in serum.
引文
[1]熊杉,张如祥,刘良生.针刺配合推拿膀胱经对慢性疲劳综合征患者血清细胞因子的影响[J].湖北中医药大学学报,2015,17(2):39-41.
[2]陈兴华,汪洋,张丽美,等.六味地黄丸穴位贴敷治疗慢性疲劳综合征临床研究[J].辽宁中医杂志,2014,41(9):1952-1954.
[3]刘洋,彭玉清,葛辛,等.浅谈整体观下慢性疲劳综合征的五脏论治[J].浙江中医药大学学报,2016,40(9):677-678,681.
[4]Fukada K,Straus SE,Hickie I,et al.The chronic fatigue syndrome:a comprehensive approach to its definition and study.International Chronic Fatigue Syndrome Study Group[J].Ann Intern Med,1994,121(12):953-959.
[5]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:213-215.
[6]刘倩.中医诊治慢性疲劳综合征的疗效标准探讨[J].国外医学(中医中药分册),1993,15(6):15.
[7]段泉泉,胜利.焦虑及抑郁自评量表的临床效度[J].中国心理卫生杂志,2012,26(9):676-679.
[8]Bested AC,Marshall LM.Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:an evidence-based approach to diagnosis and management by clinicians[J].Rev Environ Health,2015,30(4):223-249.
[9]Yamano E,Kataoka Y.New Diagnostic Biomarkers for Chronic Fatigue Syndrome[J].Brain Nerve,2018,70(1):27-34.
[10]Avellaneda Fernández A,Pérez Martín A,Izquierdo Martínez M,et al.Chronic fatigue syndrome:aetiology,diagnosis and treatment[J].BMC Psychiatry,2009,9Suppl 1:S1.
[11]Smith ME,Haney E,McDonagh M,et al.Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop[J].Ann Intern Med,2015,162(12):841-850.
[12]Geraghty KJ,Blease C.Cognitive behavioural therapy in the treatment of chronic fatigue syndrome:A narrative review on efficacy and informed consent[J].J Health Psychol,2018,23(1):127-138.
[13]Goudsmit E,Howes S.Bias,misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment[J].J Health Psychol,2017,22(9):1159-1167.
[14]Espejo JA,García-Escudero M,Oltra E.Unraveling the Molecular Determinants of Manual Therapy:An Approach to Integrative Therapeutics for the Treatment of Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis[J].Int J Mol Sci,2018,19(9).pii:E2673.
[15]White PD,Goldsmith KA,Johnson AL,et al.Comparison of adaptive pacing therapy,cognitive behaviour therapy,graded exercise therapy,and specialist medical care for chronic fatigue syndrome(PACE):a randomised trial[J].Lancet,2011,377(9768):823-836.
[16]仇璐娜.慢性疲劳综合征的中医研究[J].医学信息,2018,31(21):48-50.
[17]王颖珊,聂斌,廖咏枝,等.针刺配合下丹田灸治疗阳虚型慢性疲劳综合征临床疗效观察[J].辽宁中医药大学学报,2018,20(12):129-131.
[18]张林平,戴必胜,欧阳资章.瑶药抗疲方对慢性疲劳综合征大鼠血清SOD活性和血液流变学的影响[J].西部中医药,2018,31(10):8-10.
[19]陈兴华,张丽美,蔡海琼,等.四逆散加减穴位贴敷治疗肝郁脾虚型慢性疲劳综合征的临床研究[J].针灸临床杂志,2014,30(6):5-8.
[20]郭丰存,郭燕洁.中西医结合治疗慢性疲劳综合征临床研究[J].中医学报,2015,30(1):133-135.
[21]庞军,王雄将,雷龙鸣,等.中医外治法干预慢性疲劳综合征的研究概况[J].辽宁中医杂志,2017,44(10):2226-2229.
[22]刘爱霞,王雅娟,丁梅,等.健脾解郁消疲膏治疗青年慢性疲劳综合征40例临床观察[J].河北中医,2014,36(11):1625-1626.
[23]郭向军,苗茂.俞募配穴针灸治疗慢性疲劳综合征的效果观察[J].临床医药文献电子杂志,2017,4(64):12499.
[24]谭惠娟,罗婷婷,瞿玉竹,等.基于数据挖掘的针灸治疗慢性疲劳综合征腧穴运用规律[J].中国中医基础医学杂志,2017,23(2):242-244,298.
[25]刘京丽.五脏俞现代临床应用研究[J].长春中医药大学学报,2016,32(5):1098-1100.
[26]张宝文,翟恒,苑迅.针灸治疗慢性疲劳综合征临床研究现况[J].辽宁中医药大学学报,2017,19(10):178-180.
[27]祁元刚,宋守江,窦志强,等.柴胡加龙骨牡蛎汤联合针刺背俞穴治疗慢性疲劳综合征[J].中国针灸,2017,37(11):1187-1190.
[28]高静,庞敏.温胆汤合四逆散治疗肝郁脾虚型疲劳综合征的临床研究[J].中医药信息,2016,33(1):72-75.
[29]Bakken IJ,Tveito K,Gunnes N,et al.Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis:a population-based registry study from Norway 2008-2012[J].BMC Med,2014,12:167.
[30]胡琼,周娴芳,王超,等.推拿背腰部膀胱经穴对慢性疲劳综合征IFN-?、TNF-?含量的影响[J].湖北中医药大学学报,2016,18(4):18-21.
[31]邢圣杰,金晨曦,冯勤勤,等.升阳益胃颗粒对慢性疲劳大鼠血清白介素2、?-干扰素和肿瘤坏死因子?的影响观察[J].医药论坛杂志,2018,39(4):4-7.
[32]罗玳红,黄琼,吕细华,等.扶阳灸对脾肾阳虚型慢性疲劳综合征患者血清白细胞介素2、?-干扰素水平的影响[J].河北中医,2017,39(11):1726-1729.
[2]陈兴华,汪洋,张丽美,等.六味地黄丸穴位贴敷治疗慢性疲劳综合征临床研究[J].辽宁中医杂志,2014,41(9):1952-1954.
[3]刘洋,彭玉清,葛辛,等.浅谈整体观下慢性疲劳综合征的五脏论治[J].浙江中医药大学学报,2016,40(9):677-678,681.
[4]Fukada K,Straus SE,Hickie I,et al.The chronic fatigue syndrome:a comprehensive approach to its definition and study.International Chronic Fatigue Syndrome Study Group[J].Ann Intern Med,1994,121(12):953-959.
[5]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:213-215.
[6]刘倩.中医诊治慢性疲劳综合征的疗效标准探讨[J].国外医学(中医中药分册),1993,15(6):15.
[7]段泉泉,胜利.焦虑及抑郁自评量表的临床效度[J].中国心理卫生杂志,2012,26(9):676-679.
[8]Bested AC,Marshall LM.Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:an evidence-based approach to diagnosis and management by clinicians[J].Rev Environ Health,2015,30(4):223-249.
[9]Yamano E,Kataoka Y.New Diagnostic Biomarkers for Chronic Fatigue Syndrome[J].Brain Nerve,2018,70(1):27-34.
[10]Avellaneda Fernández A,Pérez Martín A,Izquierdo Martínez M,et al.Chronic fatigue syndrome:aetiology,diagnosis and treatment[J].BMC Psychiatry,2009,9Suppl 1:S1.
[11]Smith ME,Haney E,McDonagh M,et al.Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop[J].Ann Intern Med,2015,162(12):841-850.
[12]Geraghty KJ,Blease C.Cognitive behavioural therapy in the treatment of chronic fatigue syndrome:A narrative review on efficacy and informed consent[J].J Health Psychol,2018,23(1):127-138.
[13]Goudsmit E,Howes S.Bias,misleading information and lack of respect for alternative views have distorted perceptions of myalgic encephalomyelitis/chronic fatigue syndrome and its treatment[J].J Health Psychol,2017,22(9):1159-1167.
[14]Espejo JA,García-Escudero M,Oltra E.Unraveling the Molecular Determinants of Manual Therapy:An Approach to Integrative Therapeutics for the Treatment of Fibromyalgia and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis[J].Int J Mol Sci,2018,19(9).pii:E2673.
[15]White PD,Goldsmith KA,Johnson AL,et al.Comparison of adaptive pacing therapy,cognitive behaviour therapy,graded exercise therapy,and specialist medical care for chronic fatigue syndrome(PACE):a randomised trial[J].Lancet,2011,377(9768):823-836.
[16]仇璐娜.慢性疲劳综合征的中医研究[J].医学信息,2018,31(21):48-50.
[17]王颖珊,聂斌,廖咏枝,等.针刺配合下丹田灸治疗阳虚型慢性疲劳综合征临床疗效观察[J].辽宁中医药大学学报,2018,20(12):129-131.
[18]张林平,戴必胜,欧阳资章.瑶药抗疲方对慢性疲劳综合征大鼠血清SOD活性和血液流变学的影响[J].西部中医药,2018,31(10):8-10.
[19]陈兴华,张丽美,蔡海琼,等.四逆散加减穴位贴敷治疗肝郁脾虚型慢性疲劳综合征的临床研究[J].针灸临床杂志,2014,30(6):5-8.
[20]郭丰存,郭燕洁.中西医结合治疗慢性疲劳综合征临床研究[J].中医学报,2015,30(1):133-135.
[21]庞军,王雄将,雷龙鸣,等.中医外治法干预慢性疲劳综合征的研究概况[J].辽宁中医杂志,2017,44(10):2226-2229.
[22]刘爱霞,王雅娟,丁梅,等.健脾解郁消疲膏治疗青年慢性疲劳综合征40例临床观察[J].河北中医,2014,36(11):1625-1626.
[23]郭向军,苗茂.俞募配穴针灸治疗慢性疲劳综合征的效果观察[J].临床医药文献电子杂志,2017,4(64):12499.
[24]谭惠娟,罗婷婷,瞿玉竹,等.基于数据挖掘的针灸治疗慢性疲劳综合征腧穴运用规律[J].中国中医基础医学杂志,2017,23(2):242-244,298.
[25]刘京丽.五脏俞现代临床应用研究[J].长春中医药大学学报,2016,32(5):1098-1100.
[26]张宝文,翟恒,苑迅.针灸治疗慢性疲劳综合征临床研究现况[J].辽宁中医药大学学报,2017,19(10):178-180.
[27]祁元刚,宋守江,窦志强,等.柴胡加龙骨牡蛎汤联合针刺背俞穴治疗慢性疲劳综合征[J].中国针灸,2017,37(11):1187-1190.
[28]高静,庞敏.温胆汤合四逆散治疗肝郁脾虚型疲劳综合征的临床研究[J].中医药信息,2016,33(1):72-75.
[29]Bakken IJ,Tveito K,Gunnes N,et al.Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis:a population-based registry study from Norway 2008-2012[J].BMC Med,2014,12:167.
[30]胡琼,周娴芳,王超,等.推拿背腰部膀胱经穴对慢性疲劳综合征IFN-?、TNF-?含量的影响[J].湖北中医药大学学报,2016,18(4):18-21.
[31]邢圣杰,金晨曦,冯勤勤,等.升阳益胃颗粒对慢性疲劳大鼠血清白介素2、?-干扰素和肿瘤坏死因子?的影响观察[J].医药论坛杂志,2018,39(4):4-7.
[32]罗玳红,黄琼,吕细华,等.扶阳灸对脾肾阳虚型慢性疲劳综合征患者血清白细胞介素2、?-干扰素水平的影响[J].河北中医,2017,39(11):1726-1729.