督灸对气虚质功能性便秘的临床疗效与机制研究

摘要/Abstract

摘要： 目的研究督灸在气虚质功能性便秘治疗中的作用及机制。方法病例来源于2022年9月—2023年9月就诊于山东省泰安市中医医院被诊断为气虚质功能性便秘的120例患者。将患者按照随机数表法分为督灸组、西药组、中药组。督灸组：每10天督灸1次,3次为1个疗程,共2个疗程6次督灸。西药组：乳果糖口服液,10 mL/次,3次/d,服用8 d间断2 d,1个月为1个疗程,疗程为2个月。中药组：中药四君子汤口服,早晚各1次,饭后温服200 mL,服用方法同西药组。比较三组临床疗效,三组治疗前后气虚质转化分,患者中医气虚质便秘主症及次症总积分,实验室观察指标血清胃动素（MTL）及血清P物质（SP）水平。结果 2个疗程结束,上督灸组总有效率为87.50%,西药组为72.50%,中药组为75.00%。督灸组气虚质评分显著下降,差异有统计学意义（P<0.05）,西药组和中药组治疗前后差异无统计学意义（P>0.05）。督灸组、西药组、中药组中医便秘主症及次症总积分较治疗前均显著降低,差异有统计学意义（P<0.05）,血清胃动素（MTL）及P物质（SP）水平较治疗前均显著升高,差异有统计学意义（P<0.05）;组间比较,督灸组气虚质转化分、中医便秘主症及次症总积分均显著低于西药组和中药组,差异有统计学意义（P<0.05）,血清胃动素（MTL）及P物质（SP）水平均高于西药组和中药组,差异有统计学意义（P<0.05）;西药组和中药组气虚质转化分、中医便秘主症及次症总积分、血清胃动素（MTL）及P物质（SP）水平差异无统计学意义（P>0.05）。结论督灸组、西药组和中药组对气虚质功能性便秘均有疗效,但督灸组还能纠正气虚质功能性便秘患者体质偏颇状态,改善人体内环境,进一步升高MTL及SP水平。纠正气虚质偏颇状态是从根源上治愈气虚质便秘的靶点。

关键词: 督灸, 气虚质, 便秘, MTL, SP

Abstract: Objective Study the role and mechanism of Du moxibustion in the treatment of functional constipation due to qi deficiency. Methods The cases were sourced from the Outpatient Department of Traditional Chinese Medicine Prevention and Health Care of Tai'an City Traditional Chinese Medicine Hospital in Shandong Province. The treatment period was from September 2022 to September 2023, and 120 patients were diagnosed with Qi deficiency functional constipation. Divide patients into Du moxibustion group, Western medicine group, and Chinese medicine group according to a the random number table method. Du moxibustion group: Du moxibustion once every 10 days, 3 times per course, a total of 2 courses and 6 times of Du moxibustion. Western medicine group: Lactulose oral solution, 10 mL/time, 3 times/day, taken for 8 days with 2 days of interruption, a course of treatment per month for 2 months. Traditional Chinese Medicine Group: Take Sijunzi Tang orally, once in the morning and once in the evening, and take 200 mL warm after meals, using the same method as the Western Medicine Group.Observation indicators: Compare the clinical efficacy of three groups,before and after treatment, the conversion score of Qi deficiency in the three groups, the total score of the main and secondary symptoms of Qi deficiency constipation in patients with traditional Chinese medicine, and the laboratory observation indicators: serum motilin (MTL) and serum substance P (SP) levels. Results After the completion of two treatment courses, the total effective rate was 87.50% in the moxibustion group, 72.50% in the western medicine group, and 75.00% in the traditional Chinese medicine group. The score of Qi deficiency quality significantly decreased in the Du moxibustion group (P<0.05), while there was no statistical significant difference between the Western medicine group and the Chinese medicine group before and after treatment (P>0.05); The total scores of the main and secondary symptoms of traditional Chinese medicine constipation in the Du moxibustion group, Western medicine group, and Chinese medicine group were significantly reduced compared to before treatment (P<0.05), and the levels of serum motilin (MTL) and substance P (SP) were significantly increased compared to before treatment (P<0.05); Compared between groups, the conversion score of Qi deficiency and substance, as well as the total score of main and secondary symptoms of traditional Chinese medicine constipation in the Du moxibustion group were significantly lower than those in the Western medicine group and the Chinese medicine group (P<0.05), and the serum levels of motilin (MTL) and substance P (SP) were higher than those in the Western medicine group and the Chinese medicine group; There was no statistical significant difference between the Western medicine group and the Chinese medicine group in terms of the transformation score of Qi deficiency and substance, the total score of the main and secondary symptoms of traditional Chinese medicine constipation, and the changes in serum motilin (MTL) and substance P (SP) levels. Conclusion The Du moxibustion group, the Western medicine group, and the Chinese medicine group all have therapeutic effects on Qi deficiency functional constipation. However, the Du moxibustion group can also correct the constitutional bias of patients with Qi deficiency functional constipation, improve the internal environment of the human body, and further increase serum levels of motilin (MTL) and substance P (SP). Correcting the biased state of qi deficiency is the target for curing qi deficiency constipation from the root cause.

Key words: du moxibustion, qi deficiency constitution, constipation, MTL, SP

中图分类号:

R212

王茜. 督灸对气虚质功能性便秘的临床疗效与机制研究[J]. 中华养生保健, 2024, 42(13): 1-5.

WANG Qian. Study on the Clinical Effect and Mechanism of Moxibustion on the Du Meridian on Functional Constipation Due to Deficiency of Qi[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(13): 1-5.

参考文献

[1] 张丹,夏志伟功能性便秘的罗马Ⅲ标准[J].中国医刊,2008,43(12):63-64.
[2] 中医体质分类与判定(ZYYXH/T157-2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[3] 陈士新. 中医辨证治疗功能性便秘[M].中医临床研究,2018,10(17):34-37.
[4] 姚乃礼. 中医证候鉴别诊断学[M].北京:人民卫生出版社,2002.
[5] 郑筱藇. 中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:378-380.
[6] 张声生,沈洪,张露,等.便秘中医诊疗专家识意见(2017)[J].中医杂志,2017,58(15):1345-1350.
[7] ZYYXH/T157-2009,中医体质分类与判定[S].
[8] 中华医学会外科学分会肛肠外科学组.便秘症状及疗效评估[J].中华胃肠外科杂志,2005,8(4):355-356.
[9] 刘丛丛,刁双双,李元涛.李国栋辨证治疗慢性功能性便秘经验[J].北京中医药,2016(2):130-131.
[10] 唐伟峰,唐晓军,杨巍.功能性便秘的中西医研究进展[J].世界中西医结合杂志,2015,10(6):880-884.
[11] 刘未艾,刘密,何亚敏,等.功能性胃肠病脑肠狀的研究进展[J].中国中医急症,2012,21(6):951-953.
[12] 杨現,张丹华,陈媛,等.脑肠互动与针刺治疗功能性胃肠病的相关性[J].世界华人消化杂志,2012(6):491-496.
[13] 张颖,保志军,张赣生,等.乳果糖口服液治疗功能性便秘疗效的系统评价[J].中国老年学杂志,2015,35(22):6470-6473.
[14] 戴宁,方燕飞.慢性便秘的药物治疗[J].临床消化病杂志,2013,25(4):235-239.
[15] LINDBERG G, HAMID S S, MALFERTHEINER P, et al.World Gastroenterological Organisation global guidline:Constipation global perspective[J]. Clin Gastroenterol,2011,45(6):483-487.
[16] 张华娟,布小玲.生物反馈治疗功能性排便障碍的效果评价[J].东南大学学报,2014,33(4):497-500.
[17] 田振国,韩宝.2013年中医肛肠学术年会论文集[C].北京:中医古籍出版社,2013:132-137.
[18] 汪章平,郑国荣.中西医结合治疗治疗胃肠动力障碍性疾病的简况[J].实用中医内科杂志,2017,31(5):88-90.
[19] 甘静宜,巩忠福,程桂林,等.四君子汤对胃虚大鼠血清消化酶及胃肠激素的影响[J].中国兽医杂志,2011,47(2):43-45.
[20] 王璐,王杰,刁一芮,等.四君子汤对脾气虚大鼠5-HIAA、MLT表达影响随机平行对照研究[J].实用中医内科杂志,2017,31(8):37-39.
[21] 汤德元,林义明.大黄巴豆煎液灌肠对猪便秘的疗效观察及其药理实验初探[J].中兽医学杂志,1991,35(2):5-7.
[22] 张林,王洪.厚朴的现代药理研究进展[J].内蒙古中医药,2010,29(8):105-107.
[23] 张红,孙明江,王凌.枳实的化学成分及药理作用研究进展[J].中药材,2009,32(11):1787-1790.