【摘要】 目的:探讨调神舒肝针刺法对郁证患者抑郁、焦虑状态的干预作用。方法:选择2001-03/2002-09在天津中医学院附属第一医院针灸部病房及门诊就诊的郁证患者72例。按入院先后顺序,随机分为2组,针刺组40例,对照组32例。对治疗方法选择均获患者或监护人知情同意。①针刺组治则为调神疏肝,针刺穴位:内关、人中、三阴交、百会、印堂、太冲。内关:施捻转提插相结合泻法。人中:雀啄手法,致眼球湿润为度。百会:小幅度高频率捻转补法。印堂:小幅度高频率捻转补法。三阴交:施捻转提插补法。太冲:捻转提插泻法。②对照组常规针刺,取穴:肝腧、期门、阳陵泉、神门、间使。根据辩证或补或泻,或平补平泻。患者就诊时和治疗1个月后填写抑郁自评量表(20个项目,采用4级评分,1～4分表示很少有到绝大部分时间有该项症状。但项目2,5,6,11,12,14,16,17,18,20为反评题,按4～1计分。测试时间范围为最近1周。20个项目评分相加得总分,超过41分为阳性)、Zung焦虑自评量表(20个项目,采用4级评分,1～4分表示很少有到绝大部分时间有该项症状。但项目5,9,13,17,19为反评题,按4～1计分。测试时间范围为最近1周。20个项目评分相加得总分,总分乘以1.25后取整数即得标准分,标准分超过50分为阳性)来客观评估抑郁、焦虑状态及严重程度。抑郁严重指数=总分/80;焦虑严重指数=标准分/80。结果:72例患者全部进入结果分析,无脱落。①两组患者治疗前后抑郁总分比较:针刺组治疗后较治疗前、对照组治疗后显著降低33.40±7.71,52.70±6.80,39.58±8.50(t=7.91,7.61,P<0.05)。②两组患者治疗前后抑郁严重指数比较:针刺组治疗后较治疗前、对照组治疗后显著降低0.40±0.07,0.66±0.09,0.48±0.10(t=7.32,7.14,P<0.05)。③两组患者治疗前后焦虑标准分比较:针刺组治疗后较治疗前、对照组治疗后显著降低27.96±8.35,47.21±5.73,36.00±4.54(t=7.82,7.56,P<0.05)。④两组患者治疗前后焦虑严重指数比较:针刺组治疗后较治疗前、对照组治疗后显著降低0.34±0.09,0.59±0.07,0.45±0.05(t=7.26,7.09,P<0.05)。结论:针刺能改善郁证患者的抑郁、焦虑状态,而调神舒肝针刺疗法从郁证的病因入手,干预效果优于常规针刺疗法。更多还原

【Abstract】 AIM: To explore the intervention effects of tiaoshenshugan acupuncture on the depressive and anxious condition of patients with depression.METHODS: Seventy-two patients with depression, who were treated in the Department of Acupuncture and out-patient clinic, First Affiliated Hospital, Tianjin University of Traditional Chinese Medicine were selected between March 2001 and September 2002 with the agreement of the patients or their guardian. According to the order of hospitalization, they were randomly divided into 2 groups: acupuncture group with 40 cases and control group with 32 cases. 1 The patients in acupuncture group were treated with tiaoshenshugan and darted the points: Neikuan (Luo-Connection Point, P 6), Philtrum, Sanyinjiao (Sp 6), Paihui (Du 20), Yint’ang (Extra) and T’aich’ung (Shu-Stream and Yuan-Source point liv 3). Neikuan: The twirling combined with lifting and thrusting the needle reinforcing reducing method was conducted. Philtrum: The bird-peck needling was performed till the eyeball moist. Paihui: The twirling reinforcing method was done with small range and altofrequency. Yint’ang: The twirling reinforcing method was done with small range and altofrequency. Sanyinjiao: The twirling and lifting and thrusting the needle reinforcing method were conducted. T’aich’ung: The twirling and lifting and thrusting the needle reinforcing method were conducted. 2 The patients in control group were performed routine acupuncture and the points were gained: Ch’ime (Front-Mu Point of the liver, Liv 14), Yanglingch’van (He-Sea point, GB 34), Shenmen (Shu-stream and Yuan-Source Point, H 7) and Chienshih (jing-River Point, P 5). According to differentiation of symptoms and signs, reinforcing or reducing or uniform reinforcing reducing method were conducted. At the moment of diagnosis and one month after treatment, the patients filled out the self rating depressive scale (20 terms, 4 grades, 1-4 points for little symptom to most of time with the symptom, but 2, 5, 6, 11, 12, 14, 16, 17, 18, and 20 terms was anti-assessment question with 4-1 points. The range of test time was the latest one week. The adding of the 20 terms score to gain the total mark, over 41 was positive), and the Zung self rating anxiety scale (20 terms, 4 grade, 1-4 points for little time with the symptom to most of time with the symptom, but 5, 9, 13, 17 and 19 terms was anti-assessment question with 4-1 points. The range of test time was the latest one week. The adding of the 20 terms score to gain the total mark, after the total mark multiplies with 1.25; the integer number was gained to obtain the standard mark which over 50 points for positive.) to assess the depressive and anxiety condition and severity degree objectively. The depressive severity index=total mark/80; The anxiety severity index=standard mark/80.RESULTS: Totally 72 patients were involved in the result analysis without dropping. 1 The comparison of the depressive total mark between the patients in the two groups before and after treatment: It significantly decreased after treatment compared with before treatment in acupuncture group and after treatment in control group[33.40±7.71, 52.70±6.80, 39.58±8.50 (t=7.91, 7.61, P < 0.05)]. 2 The comparison of the depressive severity index before and after treatment in the patients in the two groups: It significantly decreased after treatment compared with before treatment in acupuncture group and after treatment in control group [0.40±0.07, 0.66±0.09, 0.48±0.10 (t=7.32, 7.14, P < 0.05)]. 3The comparison of the anxiety standard mark before and after treatment in the patients in the two groups:It significantly decreased after treatment compared with before treatment in acupuncture group and after treatment in control group [27.96±8.35, 47.21±5.73, 36.00±4.54 (t=7.82, 7.56, P < 0.05)]. 4The comparison of the depressive severity index before and after treatment in the patients in the two groups: It significantly decreased after treatment compared with before treatment in acupuncture group and after treatment in control group [0.34±0.09, 0.59±0.07, 0.45±0.05 (t=7.26, 7.09, P < 0.05)].CONCLUSION: Acupuncture can improve the depressive and anxious condition in patients with depression, while the intervention effect of tiaoshenshugan acupuncture therapy based on the reason of the depression is better than routine acupuncture therapy.更多还原