摘要
单纯性肥胖是指无明显病因可循的体内脂肪堆积过多,体质量增加或脂肪分布异常,以肥胖为主要临床症状,可伴有代谢异常表现,主要由遗传及不良生活方式造成,占肥胖人群中的多数。它与高血压、冠心病、糖尿病、脑血管意外等疾病密切相关。治疗单纯性肥胖的重点在于长期控制体重,而不是在短期内快速减轻体重。在众多的治疗方法中,针灸疗法能调节食欲,恢复自主神经平衡指数,符合国际减肥不厌食、不腹泻、降低体重而不降低体力的原则。
第一部分:文献探讨
社会的发展使更多的人趋向于多食少动,焦虑紧张,生活无规律,易导致肝郁气结,肝脾不和,不能疏理气机、调畅血液,不能升清降浊,使体内瘀浊膏脂停留而为血瘀型肥胖。肥胖者血液表现出浓、粘、聚、凝的特点,肥胖与血瘀相互影响,互为因果。肝经穴位大多能理气活血、通淋消肿、调经止痛,推断肝经取穴为主治疗肥胖能改善患者血瘀体质,减轻体重,治疗情绪失调、月经不调、局部疼痛等并发症,降低继发心脑血管病、癌症等重大疾病的风险。
第二部分:临床研究
目的:观察肝经和胃经选穴对血瘀型单纯性肥胖的疗效差异,探讨其原因,总结血瘀型单纯性肥胖的选穴治疗规律。
方法:本研究收集血瘀型单纯性肥胖患者60例,随机分胃经组、肝经组各30例,两组均使用目前国内针灸减肥最为常用的中脘、天枢、足三里、丰隆等穴,胃经治疗组加滑肉门、外陵、水道、梁丘、上巨虚、内庭等穴位,肝经治疗组加期门、章门、曲泉、蠡沟、太冲、肝俞、膈俞等穴位,留针加电,同时腹部照射TCD红外线灯,每次30分钟,每周治疗3次,15次为一疗程,一个疗程结束后,间隔7天再开始第二个疗程,两个疗程完成后对比治疗前后各组肥胖指标、血液流变学指标、症状评分等变化。
结果:肝经组与胃经组均取得一定的疗效,肝经组总有效率为86.7%,胃经组总有效率为63.3%,肝经组疗效优于胃经组(P＜0.05)。肝经组在降低体重、BMI方面,与胃经组相比有显著性差异(P＜0.05);在降低腰臀比方面差异无显著性(P＞0.05),在改善血液流变学指标及部分血液成份方面,肝经组效果明显优于胃经组(P＜0.05),对血瘀型肥胖的主要临床症状如皮肤粘膜色黑、月经不调、局部疼痛等,肝经组疗效明显优于胃经组(P＜0.01)。
结论:肝体阴而用阳,能疏调气血、调畅情志,肝经虽为阴经,同时也体现出“阳”的作用,取其经穴治疗可泄浊散邪、助脾散精、疏利三焦水道等,达到瘀浊膏脂水饮自散,肥胖消除的目的。运用此法治疗血瘀型肥胖,不但可兼顾标本,且经济方便,疗效确切,值得深入研究以推广运用。
Simple obesity and overweight is defined as abnormal or excessive fat accumulation of unknown aetiology that presents a risk to health. Usually, it is accompanied by other symptoms of metabolic disorder. Obesity can occur for many reasons, the main two are unhealthy lifestyle habits and genetic inheritance. Being overweight or obese increases the risk of many diseases and health conditions, such as hypertension, coronary artery disease, diabetes mellitus and stroke. The therapy of simple obesity should focus on long-term control of body weight instead of decreasing the body weight rapidly in short term. Based on the principles of obesity prevention which are reducing weight without hyposthenia, diet without anorexia and diarrheal, acupuncture therapy provides effective impact on body weight reduction by adjusting appetite and balancing autonomic nerves. Therefore, the research of acupuncture therapy is valuated.
Background: With rapid development of human society, the number of people who are living under high pressure and being anxiety is increased. Many people are experiencing overeating and lack of exercises. All of these factors form an unhealthy lifestyle. Using the theories of TCM as framework, unhealthy lifestyle causes stasis of the liver Qi and disharmony between the liver and the spleen, as a result of that, the Qi and blood of the body cannot circulate smoothly, then the fat will accumulate in the body gradually, and the blood-stasis syndrome will be occurred. Moreover, the blood of the obesity patients will become viscous, thicker and the blood flow will be slow and static. It shows that the relationship between obesity and blood-stasis is interrelated. In TCM theories, blood stasis can be treated by adjusting Qi and blood of the liver. Most acu-points of the liver meridian can help the Qi and blood circulate smoothly, induce diuresis to alleviate edema, regulate menses and alley pain. So, we suggest that choosing the acu-points of the liver meridian can treat obesity, can improve the patient's blood-stasis constitution, reduce body weight, adjust emotion, regulate menses, alley pain, and reduce the risk of diseases of the heart, brain and blood vessels.
Objective: To evaluate the effect and probe into the mechanism of choosing the acu-points of the liver meridian to treat simple obesity with blood-stasis syndrome.
Methods: 60 cases of simple obesity with blood-stasis syndrome were randomly divided into two groups—stomach meridian (SM) group and liver meridian (LM) group. Both groups accepted the most frequently-used acu-points in weight reduction, such as ZhongWan, TianShu, ZuSanLi and FengLong, and infared lamp irradiation on belly as a basic treatment. Additionally, SM group accepted the acu-points of stomach meridian, such as HuaRouMen, WaiLing, Suidao, LiangQiu, ShangJuXu, FengLong, and NeiTing; LM group accepted the acu-points of liver meridian, such as QiMen, ZhangMen, QuQuan, LiGou, TaiChong and Ganshu, Geshu. All these treatments were given 3 times (30 minutes per time) a week, and 5 weeks as one period of treatment. Two periods of treatment with a 7-day interval were given totally. The score of symptoms were marked and the indexes of obesity and hemorheology were measured before and after all the treatments.
Results: Total effective rate of the LM group was 86. 7%, much higher than the GM group which was 63.3% (p<0.05). The effects of the LM group on weight reduction, improvement of BMI and hemorheology were superior to the GM group (p<0.05). And the alleviation of the symptoms in the LM group was more remarkable than the GM group (p<0. 01). But the waist-to-hip ratio of both groups had no statistic difference (p>0.05).
Conclusions: Using the acu-points of the liver meridian has remarkable effects on treating simple obesity with blood-stasis syndrome. This treatment can improve the patient's blood-stasis constitution, reduce body weight, regulate menses and alley pain. Those effects are due to the liver meridian function of smoothing Qi and blood.
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[1]卢集森,王琴,刘婉师.减肥茶治疗单纯性肥胖症200例临床观察.中医药学刊,2005,12:45
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