摘要
肥胖症(obesity)是指体内脂肪堆积过多和(或)分布异常,体重增加的病理状态,是遗传因素和环境因素共同作用的结果。肥胖症与高血压、高脂血症、冠心病、糖尿病等肥胖相关性疾病(obesity-related disorders, ORD)的发病相关,严重影响患者的身体健康和生活质量,世界卫生组织已将肥胖症列为影响世界健康的十大威胁之一；我国的肥胖症发病亦呈逐年上升趋势,肥胖症的防治是现代医学关注的热点问题。
针灸疗法治疗单纯性肥胖症(simple obesity)疗效确切,且与药物、手术、运动、饮食控制等疗法相比,具有副作用少、经济、可操作性强等优势,已被广泛应用于临床。临床针刺治疗肥胖症多以辨证取穴为主,但是肥胖症本身是一种特殊的病理状态,起病隐袭,进展持续,除体重增加、体型改变外,患者就诊时多以主观感觉症状为主诉,常缺少典型的临床症状和体征,甚或完全没有主观不适或身体机能障碍,故临床辨证客观依据少,证型多而分散,证型之间区分难度大,临床医生运用辨证取穴治疗单纯性肥胖症常常感觉无所适从,更多地是根据经验取穴,或肥胖局部取穴,或肢体远端取穴。
合募配穴是指将六腑的下合穴(lower He-sea point)与本经的募穴(front Mu point)相配的一种取穴、配穴针刺方法。因其特点皆为治疗腑病,所以合募配穴是取两者在主治上的共性,相互协调,增强疗效,以治疗六腑病证为主的一种配穴方法。针灸临床治疗肥胖症可选取的穴位较多,而六腑下合穴、募穴均为各种证型、各种治疗方法的常用穴位,文献统计中其出现频率均较高；但对于募穴配下合穴治疗单纯性肥胖症,尚未见相关报道。本课题选择临床确诊的单纯性肥胖症患者,观察了合募配穴法针刺对单纯性肥胖症患者的治疗作用,并以常规辨证取穴针刺法为对照,观察了六腑合募配穴法针刺对单纯性肥胖症患者体质量指数(body mass index, BMI)、腰围(waist circumference, WC)、体脂百分比(body fat ratio, BFR)的影响。
目的
观察六腑合募配穴法针刺对单纯性肥胖症的治疗作用,以及对单纯性肥胖症患者体质量指数(BMI)、腰围(WC)、体脂百分比(BFR)的影响。
方法
1、临床资料：63例单纯性肥胖症患者分别来自南方医科大学南方医院针灸科、南方医科大学中西医结合医院针灸康复科、香港天佑堂、昊域、良方等中医诊所。所有患者按就诊顺序随机分为两组：治疗组31例(男12女19),肥胖程度分级：轻度13例,中度14例,重度4例；对照组32例(男15女17),肥胖程度分级：轻度14例,中度15例,重度3例。
2、治疗方法：治疗组根据合募配穴原则取六腑下合穴与募穴。包括：足三里、上巨虚、下巨虚、阳陵泉、委中、委阳、中脘、天枢、关元、日月、中极、石门,以上穴位除中脘、关元、中极、石门外,均为双侧取穴。对照组参照《针灸治疗学》常规取穴,并依中医辨证分型配穴治疗。操作：本研究选用环球牌1.5寸32号一次性使用无菌针灸针。治疗组患者取仰卧位,腹部及下肢前、外侧穴位依次常规消毒穴区皮肤进针,行提插捻转手法行针,平补平泻,得气后留针30分钟,期间每隔10分钟行针1次,出针前行针1次,每次治疗共行针4次。出针后患者取俯卧位,以上述针刺手法速刺委中、委阳,行提插捻转手法,得气后出针。对照组患者按常规方法行针刺治疗,除取穴不同外,行针手法、留针时间均同治疗组。疗程安排：隔日治疗1次,每次治疗时间30分钟,15次治疗为1个疗程,共治疗2个疗程。治疗期间要求受试者保持正常饮食及运动习惯。
3、观察方法：所有患者以2个疗程结束即60天为观察期限,于试验前、后分别测量有关的试验指标。身高、体重、腰围采用常规测量方法,根据身高、体重计算体质量指数(BMI),利用身体脂肪测量仪测量体脂百分比(BFR),计算得出每位受试者治疗前后各指标差值。每次治疗后询问患者主观不适感觉,记录针刺不良反应情况。
4、疗效判断：临床疗效的判断参照1987年首届全国中西医结合治疗肥胖症学术会议讨论制订的“单纯性肥胖症疗效标准”。近期临床痊愈：体重下降,体质量指数达正常范围以内,相关临床症状消失；显效：体重下降≥5kg,或体质量指数下降≥4,相关临床症状基本消失；有效：体重下降>2kg而<5kg,体重指数下降≥2而<4,相关临床症状减轻；无效：体重下降<2kg,体质量指数下降<2,相关临床症状未减轻。
5、数据处理：所有试验指标及数据由专人测量、计录和整理后,采用统计软件(SPSS13.0 for windows)进行统计处理,计数资料采用Chi-square检验和Nonparametric Test (2 Independent Samples tests),计量资料组内比较采用Paired-samples T Test,组间计量指标变化的比较采用2 Independent Samples T tests,两组间疗效比较采用Nonparametric Test (2 Independent Samples tests),双侧检验,显著性水准为0.05。
结果
1、两组患者疗效比较：两组患者治疗后的总有效率分别为87.10%和78.13%,统计学分析表明治疗组与对照组疗效差异有显著性(p<0.05),提示合募配穴法治疗单纯性肥胖症疗效优于常规取穴针刺治疗方法。
2、两组患者治疗前后BMI比较：两组患者治疗后BMI值均较治疗前明显降低,组内比较差异有显著性(p<0.01),治疗组治疗后BMI值下降程度较对照组大,组间比较差异有显著性(p<0.05)。
3、两组患者治疗前后WC值比较：组内比较,两组患者治疗后WC值较治疗前均明显降低,差异有显著性(p<0.01)；组间比较,治疗组WC值下降程度较对照组大,差异有显著性(p<0.05)。
4、两组患者治疗前后BFR值比较：组内比较,两组患者治疗后BFR值较治疗前均明显降低,差异有显著性(p<0.01)；组间比较,治疗组BFR值下降程度较对照组大,差异有显著性(p<0.01)。
结论
六腑合募配穴法针刺可降低单纯性肥胖症患者BMI、WC、BFR等肥胖相关指标,减少体内脂肪堆积,减轻肥胖程度,且与常规辨证取穴法比较,六腑合募配穴取穴法客观、规范、取穴组方固定、易于操作施行,可作为单纯性肥胖症的针刺治疗取穴方案。
Obesity is a pathological state with the excessive accumulation and (or) abnormal distribution of body fat which induce weight gain. Genetic and environmental factors together contribute to the development of obesity. Obesity is correlated with hypertension, hyperlipidemia, coronary heart disease, diabetes and other obesity-related diseases (ORD) possitively, and affects the health and quality of life seriously. The World Health Organization (WHO) has listed obesity as one of the top ten threats to the health of people all over the world. Incidence of obesity is also in an upward trend year by year in China, thus the prevention and treatment of obesity has been a hot issue of common concern in modern medical and sociological research.
Acupuncture has been proved to be an effective, economical, and convenient method of treatment to simple obesity, with few side effects, as compared with medicine, surgery, exercise, diet control and other therapy. Acupuncture has been widely used in clinical treatment of obesity. Point selection in acupuncture treatment of obesity is based on clinical differenciation mostly, but obesity itself is a special kind of pathological state with insidious onset, continued progress, in addition to weight gain and body changes. Most patients coming to treatment lack of typical clinical symptoms and signs, or even no subjective discomfort or physical limitation, with less objective evidence of clinical syndrome, syndrome are diversed and scattered, thus difficult to distinguish between the syndromes in TCM way. As a result, the physicians treating obesity with acupuncture are often feel at loss, and in more cases, acupoints selections were based on experience, obese local acupoints, or distal acupoints.
He-Mu point combination refers to the clinical point selection methods which combine points of lower He-sea point of six fu with the front Mu point. Treatment of Fu disease are their common features, so the He-Mu point combination is to take both in attending the common, mutual coordination and enhance the efficacy of the treatment of six internal organs diseases of the main points of a distribution method. Althought lower He and front Mu points are wildly selected in Acupuncture treatment of obesity, there has not been report on treating obesity by combination of 6 Fu lower He and front Mu points. In this study, patients with simple obesity were treated by the method of He-Mu point combination acupuncture, and therapeutic effect as well as influence on body mass index (BMI), waist circumference (WC) and body fat ratio (BFR) was investigated on patients with simple obesity.
Objective:
To investigate the therapeutic effect of Lower He-Front Mu point combination acupuncture on body mass index (BMI), waist circumference (WC) and body fat ratio (BFR) in patients with simple obesity.
Methods:
1. Clinical information:63 patients were from department of acupuncture, Nanfang Hospital, department of acupuncture and rehabilitation, Integrated Traditional Chinese and Western Medicine Hospital, Southern Medical University, Tianyoutang, Haoyu and Liangfang Clinic of Traditional Chinese Medicine, Hongkong. All patients were randomly divided into two groups:31 in treatment group (12 men and 19 women), obesity grade:mild in 13 cases,14 cases of moderate and severe in 4 cases; 32 patients in control group (15 men and 17 women), obesity grade:mild in 4 cases,25 cases of moderate and severe in 3 cases.
2. Treatment methods:Patients in treatment group accepted acupuncture treatment under the principle of Lower He-Front Mu point combination, while those in control group were treated with conventional method of differenciation in TCM way.1.5-inch 32# sterile disposable acupuncture needles (Huanqiu brand) were used in this stuy. Patients in treatment group were treated in supine position and needled in points on the abdomen and inferio part of lower extremities firstly, then posterior part of lower extremities. Control group patients treated by conventional methods of acupuncture. Treatment arrangements:1 treatment every other day,30 minutes each treatment,15 treatments to a course of treatment, and all patients were treated for 2 courses. During treatment, patients were to maintain a normal diet and exercise habits as usual.
3. Main outcomes and observation methods
Height, body weight and waist circumference were measured with conventional methods before and after 30 treatments in each patients. Body mass index (BMI) was caculated according to height and body weight. Body fat ratio (BFR) was messured by machine (OMRON HBF-306). The patients were to report discomfort and adverse reactions after each acupuncture treatment.
4. Therapeutic effective evaluation
Clinical therapeutic effective judgments were made accoding to the Obesity Efficacy Standard established in the First National Conference on Integrative Medicine,1987.
5. Data processing
Differences of BMI, WC and BFR changes within as well as between groups were analyzed with statistical software (SPSS 13.0 for windows), two-tail test, and p<0.05 for the difference was considered as statistically significant.
Results:
1. Total effective rate was 87.10% in treatment group and 78.13% in control group. Further statistical analysis showed that the efficacy of the treatment group and control group was significant different (p<0.01), suggested that He-Mu Combination Points acupuncture is more effective than conventional treatment on obesity.
2. BMI, WC and BFR was compared between and within two groups before and after treatment:BMI, WC and BFR values of the two groups reduced significantly after treatment (p<0.01), which reduced more in treatment group than in control group with significant difference (p<0.01, p<0.05 respectively).
3. Excepte for occasional local minor irritation, soreness and subcutaneous bleeding, no other serious adverse events was reported during the treatment of acupuncture.
Conclusion:
Lower He-Front Mu point combination acupuncture is an effective method in treatment of simple obesity which reduced the BMI, WC and BFR significantly. Compared with the conventional differentiation point selection method,6 Fu He-Mu points combination acupuncture is characterized with standardized set of point selection and easy operating procedure, which surport it to be used as choice of treatment on simple obesity.
引文
1.陈春明,孔灵芝,闻芝梅,等.中国成人超重和肥胖症预防与控制指南[M].卫生部疾病控制司,北京,人民卫生出版社,2006
2. WHO Obesity preventing and managing. The global epidemic report of WHO [R]. Consultation on obesity, Geneva:WHO,1997:9-43
3.中华医学杂志编辑委员会.全国肥胖防治专题学术会议纪要[J].中华医学杂志,2003,83(13)：1183-1184
4.卜彤文,张雅兰.针灸治疗单纯性肥胖症的研究现状[J].中国临床康复,2006,10(39)：150-153
5.刘志诚,洪承鈗,孙志等.针灸治疗单纯性肥胖临床方案制定的基本思路和方法[J].中国针灸,2004,24(2)：129-133
6.危北海,贾葆鹏.单纯性肥胖病的诊断及疗效评定标准[J].中国中西医结合杂志,1998,18(5)：317
7.李学惠,郭效德.对针灸治疗单纯性肥胖的一些思考[J].中国针灸,2009,29(7)：569-574
8.张晓丹,张颖.体针治疗单纯性肥胖症的临床与理论研究[J].中医文献杂志：,2008(3)：45：
9. Reassessment of anthropometric indices of obesity in asia[R]. Asian BMI/Obesity Workshop Meeting in Milan, Jun,1999:2
10.王启才,杨骏,高树中,等.针灸治疗学(新世纪第二版)[M].北京,中国中医药出版社,2007：146
11.叶任高,主编.《内科学》[M].北京,人民卫生出版社,2001：841
12.孙志娟,黄之瑜.肥胖的研究进展[J].生理科学进展,2001,32(1)：41
13.黄琴峰,王正明,齐丽珍.建国以来针灸治疗肥胖病述评[J].上海针灸杂志,2006,25(2)：40-41
14.邰先桃,熊磊,梁昆生.中医治疗肥胖症的研究进展.现代中西医结合杂志.2004,13(14)：1951-1952
15.刘志诚,孙凤岷,韩燕.针刺治疗单纯性肥胖症的实验研究[J].针刺研究,1998,23(1)：69
16.赵玫,刘志诚,苏静.针刺减肥中枢作用的时效关系[J].南京中医药大学学报,1999,15(2)：97
17.孙升云,王凤珍.中医药防治单纯性肥胖的临床研究进展.时珍国医国药.2006,17(3)：331-332
18.翁维良,焦东海.实用中西医结合肥胖病学[M].台北：知音出版社,2000：113
19. Schwarts MW, Woods SC, Jr Porte D. Central nervous system control of food intake [J]. Nature,2000,404:661-667
20.史轶蘩.肥胖症临床诊治手册[M].上海：上海科学技术出版社,2001：35-45
21. Ho SY, Lam TH, Janus ED, et al. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices [J]. Ann Epidemiol,2003(213):683-691
[1]王启才.针灸治疗学[M].北京市：中国中医药出版社,2003.
[2]曾洪玉.针灸治疗单纯性肥胖的体会[J].针灸临床杂志,2005,21(3)：26-27.
[3]汪慧敏,黄志真.针刺治疗局部肥胖[J].中国中医药信息杂志,2003,10(6)：82-83.
[4]王文远,郭笑雪.三点十二穴治疗单纯性腹部肥胖症的临床研究：附65例临床疗效分析[J].针灸临床杂志,1993,9(2)：15-16.
[5]唐庆芬,邓倩萍,徐秋玉.肥三针治疗单纯性肥胖50例疗效观察[J].新中医,2004,36(10)：50-51.
[6]袁青,靳瑞,欧阳博文,等.“肥三针”治疗单纯性肥胖大鼠的实验研究[J].中医药学报,2003,31(6)：34-36.
[7]沈洁,侯庆.针刺华佗夹脊治疗单纯性肥胖疗效观察[J].上海针灸杂志,2000,19(1)：29.
[8]薄智云.腹针对机体稳态的影响[J].北京中医,1993(5)：33-35.
[9]聂莉,詹泽群,杨林泉,等.针刺脐周8穴治疗单纯性肥胖症的临床研究[J].实用中西医结合临床,2007,7(3)：23-25.
[10]王明.针灸减肥临床疗效观察[J].天津中医,2000,17(3)：36.
[11]李季,张彩荣,符佳,等.“胡氏水穴”疗法治疗单纯性肥胖72例临床观察[J].针灸临床杂志,2005,21(6)：33-34.
[12]王森,黄根兰,王培艳,等.针刺水穴治疗单纯性肥胖病疗效观察[J].针灸临床杂志,2005,21(10)：41-42.
[13]魏群利,蔡辉,刘志诚.单纯性肥胖病针刺辨治探要[J].医学研究生学报,2004,17(6)：532-534.
[14]刘志诚,孙凤岷.针刺治疗对单纯性肥胖胃肠实热型患者的良性调整作用探讨[J].中国中西医结合杂志,1995,15(3)：137-140.
[15]徐菁鸿.电热针为主治疗单纯性肥胖症脾虚湿阻型的临床研究[J].2007：1-55,R582-R589,R245-R297.
[16]金瑛,王爱君,薛平,等.温针治疗脾虚湿阻型单纯性肥胖症临床观察[J].上海针灸杂志,2009,28(10)：565-567.
[17]骆纪瑾.俞募配穴针刺治疗脾虚湿阻与肝郁气滞型单纯性肥胖的临床研究[D].广州市：广州中医药大学,2009.
[18]马小平.针灸治疗脾肾阳虚型肥胖患者的临床研究[J].上海针灸杂志,1993,12(2)：56-58.
[19]孔莹,滕伟,辛明,等.俞募配穴针刺法治疗单纯性肥胖40例[J].针灸临床杂志,2009,25(1)：37-38.
[20]张梅.以俞募配穴法为主治疗腹型肥胖的临床研究[J].2005：1-34,R582-R589,R245,R222-R224.
[21]陈桢艳,张红星,张唐法,等.电针加耳穴贴压治疗单纯性肥胖症疗效观察[J].针灸临床杂志,2008,24(1)：3-5.
[22]曲惠卿.针刺对肥胖病患者肾上腺皮质功能及血脂含量的影响[J].中国针灸,1994,14(1)：1-2.
[23]艾炳蔚,张安生,许建阳.肥胖病的针灸治疗及疗效评价[J].武警医学,2004,15(1)：57-59.
[24]柴振江.月经周期减肥法治疗妇女肥胖症的疗效观察[J].上海针灸杂志,2002,21(2)：5-7.