针灸治疗慢性功能性便秘的临床优势与选穴规律分析

Clinical Advantages and Acupoint Selection of Treatment of Chronic Functional Constipation with Acupuncture Therapy

近年来针刺治疗慢性功能性便秘(CFC)取得了肯定的疗效,并具有见效快、疗程短、经济安全等优势,值得临床推广。笔者整理近年相关文献,对针灸治疗CFC的优势进行总结,以期为临床提供参考。CFC依据病理特征可以分为慢传输型(STC)、出口梗阻型(OCC)和混合型,其中STC为针刺疗法的优势类型。针对STC,针刺不仅可以有效改善便秘症状,还可以改善患者心理不适,具有较好的远期治疗效应,其机制与改善结肠动力、肠道神经系统功能及神经递质分泌等病理环节密切相关,选穴规律为选取结肠所在体表投射部位穴位。针对OCC,针刺结合生物反馈疗法优于单纯采用生物反馈治疗,具有疗程短、起效快的优势,其机制与改善盆底表面肌电和肛管直肠压力有关,选穴规律为选取盆底部位穴位。针灸疗法的上述作用仍需大样本、随机对照多中心的临床试验予以验证。

Abundant clinical practice has showed that acupuncture therapy has some distinct advantages in the treatment of chronic functional constipation（CFC）,such as faster positive effect,shorter course of treatment,long-term post-effect,etc.In the present paper,the authors reviewed progresses of researches in clinical treatment of CFC with acupuncture therapy in recent years.Results of clinical trials indicated that among the 3types（slow transit,outlet obstruction and mixed type）of constipation,acupuncture therapy showed a better effect for slow transit constipation by improving severity,increasing defecation frequency,reducing abdominal distension,easing patients＇ psychological discomfort and raising daily life activity,probably by ameliorating colonic motility,enteric nervous system function and neurotransmitter secretion（vasoactive intestinal peptide,acetylcholine,substance P,nitrix oxide,etc.）.Most of the chosen acupoints（ST 25,SP 15,SP 14,CV 6,BL 25,BL 23,etc.）are located in the projection region of colon.For outlet obstruction defecation,the effect of acupuncture is relatively better for chalasia type,in spite of generally being poorer in the efficacy.Majority of the selected acupoints（GV 1,BL 32,BL 33,BL 30,etc.）are located near the pelvic floor region.In addition,the clinical therapeutic effects of acupuncture need being confirmed by more large sample,multiple centers randomized controlled trials.