摄血复疡汤灌肠联合回医按摩与各单用法治疗溃疡性结肠炎的疗效比较

A clinical observation on efficacy of enema of Shexue Fuyang decoction combined with massage of Hui medicine for treatment of patients with ulcerative colitis

目的：探讨中药灌肠联合回医按摩治疗溃疡性结肠炎（UC）的临床疗效。方法采用前瞻性随机对照研究方法，选择2013年1月至2014年12月宁夏回族自治区人民医院中医科收治的UC患者390例。按随机信封法将患者分为西药对照组（88例）、单纯中药灌肠组（102例）、单纯回医按摩组（94）、灌肠联合按摩组（106例）。西药对照组口服柳氮磺吡啶，每次0.75 g，每日3次。单纯中药灌肠组采用自拟中药摄血复疡汤（地榆炭15～20 g，白及15 g，败酱草15～30 g，半枝莲15～30 g，黄连15 g，炙甘草15 g，炒诃子10 g，生山药15～30 g，茜草15 g）保留灌肠，每日1次，采用一大、二慢、三温、四动的原则施行（即：大药量，250 mL；灌药速度慢，在15～20 min内灌完；药液要温，以不烫手为准，一般以39～41℃为宜，灌肠管周围用热水袋加温，以保持药液温度恒定；左侧卧20 min，胸腹位20 min，右侧卧20 min）。单纯回医按摩组采用手掌或拇指、食指根据患者患病部位的大小、深浅、轻重，分别施行按、摩、揉、拿等特殊手法，每次30 min，每日1次。灌肠联合按摩组中药灌肠及回医按摩方法同上，4组疗程均为15 d。疗程结束后观察4组患者的疗效及主要症状改善情况。结果单纯中药灌肠组、单纯回医按摩组、灌肠联合按摩组患者治疗后腹痛、腹泻、里急后重、脓血便、发热等症状积分均较治疗前明显下降，且各组治疗后各积分明显低于西药对照组〔腹痛（分）：0.45±0.75、0.56±0.57、0.35±0.96比1.13±0.86；腹泻（分）：0.76±0.91、0.78±0.69、0.55±0.81比1.43±0.34；里急后重（分）：0.52±0.37、0.44±0.23、0.21±0.13比0.72±0.98；脓血便（分）：0.43±0.34、0.50±0.24、0.52±0.76比0.68±0.44；发热（分）：0.32±0.56、0.35±0.65、0.26±0.45比0.49±0.77；均P＜0.05〕。单纯中药灌肠组、单纯回医按摩组、中药灌肠联合按摩组临床总有效率明显高于西药对照组〔78.4%（80/102）、85.1%（80/94）、93.4%（99/106）比62.5%（55/88），均P＜0.05〕。结论中药摄血复疡汤灌肠联合回医按摩治疗UC的疗效优于单纯口服西药或单纯中药灌肠、回医按摩治疗。

Objective To explore the clinical effect of Chinese medicine enema combined with massage of Hui medicine for treatment of patients with ulcerative colitis （UC）.Methods A prospective randomized controlled trial （RCT） was conducted, 390 patients with UC admitted to Department of Traditional Chinese Medicine （TCM） of Ningxia Hui Autonomous Region People＇s Hospital from January 2013 to December 2014 were enrolled, and they were divided by using random envelope method into the western medicine control group （88 cases）, simple TCM enema group （102 cases）, simple massage of Hui medicine group （94 cases） and enema combined with massage group （106 cases）. The patients in western medicine control group took sulfasalazine orally, once 0.75 g, thrice a day. The simple TCM enema group adopted the self prepared Shexue Fuyang decoction （ingredients： carbonized sanguisorba root 15-20 g, bletilla striata 15 g, patrinia 15-30 g, sculellaria barbata 15-30 g, Chinese goldthread 15 g, radix glycyrrhizae preparata 15 g, Fry terminaliachebuia 10 g, yam 15-30 g, india madder root 15 g） retention enema once a day. The following principles should be followed： firstly, the dose of drug should be large enough （250 mL）, secondly the speed of enema should be relatively slow and it finished in 15-20 minutes, thirdly the temperature of decoction should be kept at moderate degree about 39-41 ℃ （a warm bag being around the enema tube）, and lastly, the patient＇s posture should be changed （lying left-side for 20 minutes, lying at chest-abdomen position for 20 minutes, lying right-side for 20 minutes）. In massage of Hui medicine group, based on the location and size, depth and seriousness of the lesion, the doctor would selectively use palm or index finger to carry out massage manipulations of pressing, fractioning, rubbing or grasping for different disease situations of patients, once 30 minutes pre day. The patients in enema combined massage group were treated with the same methods as above, and the therapeutic course of the four groups was 15 days; at the end of experiment,the therapeutic effects and the improvement of main symptoms in four groups were observed.Results The clinical total effective rates of Chinese medicine enema group, massage of Hui medicine group, enema combined massage group were obviously higher than the rate of western medicine control group [78.4% （80/102）, 85.1% （80/94）, 93.4% （99/106） vs. 62.5% （55/88）, allP 〈 0.05]; the symptom integrals, such as abdominal pain, diarrhea, tenesmus, purulent blood stool, fever, etc. were significantly decreased after treatment in the TCM enema, massage and combined treatment groups, and the integrals of the three treatment groups were obviously lower than those in the western medicine control group （abdominal pain： 0.45±0.75, 0.56±0.57, 0.35±0.96 vs. 1.13±0.86, diarrhea： 0.76±0.91, 0.78±0.69, 0.55±0.81 vs. 1.43±0.34, tenesmus： 0.52±0.37, 0.44±0.23, 0.21±0.13 vs. 0.72±0.98, purulent blood stool： 0.43±0.34, 0.50±0.24, 0.52±0.76 vs. 0.68±0.44, fever： 0.32±0.56, 0.35±0.65, 0.26±0.45 vs. 0.49±0.77, allP 〈 0.05）.Conclusion The therapeutic effects of Shexue Fuyang decoction enema combined with massage of Hui medicine for treatment of patients with UC are better than those of each of the following treatment alone： western medicine, Chinese medicine enema or medical massage treatment.