脐灸治疗呼吸系统疾病关键技术要点及其临床应用的文献研究

Literature Research on Key Technical Issues and Clinical Application of Umbilical Moxibustion for Treatment of Respiratory Diseases

目的 探讨脐灸疗法在呼吸系统疾病治疗中的技术要点、临床应用特点及规律。方法 检索中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library等国内外数据库收录的脐灸治疗呼吸系统疾病的文献,时限为各数据库建库至2022年1月29日。提取纳入文献的基本特征、脐灸方式、灸粉药物组成、艾灸壮数/长度、艾灸时长、刺激强度、灸后处理、治疗频次、治疗时间及随访时间等信息,进行频数统计分析,基于关联规则和聚类分析对灸粉药物应用规律进行分析,并采用Cochrane手册、Joanna Briggs institute量表对纳入文献进行评价。结果 纳入文献31篇,自2010年起文献发表数量增长较快;涉及呼吸系统疾病共计9种,其中变应性鼻炎最多(21篇,占67.74%)。脐灸方式以隔物灸(26篇)为主(涉及药物贴敷灸、隔药饼灸、隔姜灸、隔盐灸),其次为悬起灸(3篇)、温灸器灸(2篇)。灸粉共涉及药物53种,频次≥3的药物16种(频次共计92次),其中以黄芪(14次,15.22%)、白术(9次,9.78%)、细辛(8次,8.70%)居多;常用药物组合为细辛-麻黄、白术-党参等;截距为21时得到聚类3组:1)细辛、麻黄、肉桂、乌梅、半夏;2)冰片、附子、甘草、麝香;3)党参、干姜、炙甘草、白术、黄芪。施灸方式以艾炷灸(17篇)最常用,其次为艾条灸(13篇)。其中艾炷灸多灸至3壮、10壮(各3篇次),艾灸时长多为90 min (5篇次),刺激强度多以皮肤潮红为度(3篇次),灸后处理多保留灸粉24 h (3篇次),治疗频次多为每周2次(6篇次),治疗时间多为4周(7篇次),随访1个月(5篇次)。在不同疾病中,灸粉选择和治疗操作随病证特点及病种不同有所侧重。纳入文献虽以随机对照研究为主(25篇),仅11篇采用随机数字表法,多数盲法缺失,结局指标受主观因素影响,为高偏倚风险,总体质量较低。结论 脐灸治疗呼吸系统疾病适应症较为广泛,灸粉药物多为辛甘、性温之品,常配辛香促透药物(冰片、麝香、细辛等);治疗操作依据疾病不同而存在差异,总以艾炷灸和艾条灸常用,后者艾灸时长、刺激强度低于前者,多无灸后处理,而治疗频次、随访时间高于前者,治疗时间二者相近。但目前文献的整体质量较低,尚需开展更规范、高质量的研究予以验证。

Objective To explore the main technical issues and clinical application characteristics of umbilical moxibustion in the treatment of respiratory diseases. Methods The literature on umbilical moxibustion in the treatment of respiratory diseases were retrieved from the domestic and foreign databases such as CNKI, Wanfang, VIP, PubMed, Embase and Cochrane Library from the inception date to January 29th, 2022. The basic characteristics, umbilical moxibustion method, powdered herbal material, moxa cone number/size, moxibustion duration, stimulation intensity, post-moxibustion treatment, treatment frequency, duration and follow-up time were extracted and analyzed by frequency statistics. The application charateristics of powdered herbal material were analyzed based on association rules and cluster analysis, and the Cochrane Handbook and the Joanna Briggs scale were used to evaluate the included literature. Results Thirty-one papers were included, and the publication increased rapidly since 2010. Totally, nine respiratory diseases were involved, of which allergic rhinitis was mostly explored(21 papers, 67. 74%). Indirect moxibustion including herbal patching moxibustion, herbal-cake-partitioned moxibustion, moxibustion on ginger, moxibustion on salt(26 papers) was the most commonly used method, followed by suspended moxibustion(3 papers) and moxibustion with moxa burner(2 papers). A total of 53 herbs were involved in the powdered herbal material, with16 herbs of frequency ≥ 3(92 times in total), of which Huangqi(Radix Astragali, 14 times, 15. 22%), Baizhu(Rhizoma Atractylodis Macrocephalae, 9 times, 9. 78%) and Xixin(Radix et Rhizoma Asari, 8 times, 8. 70%) were predominated. The commonly used herbal pairs were Xixin-Mahuang(Herba Ephedrae), and Baizhu-Dangshen(Radix Codonopsis). And three clusters were obtained at an intercept of 21, which were Xixin, Mahuang, Rougui(Cortex Cinnamomi), Wumei(Fructus Mume), and Banxia(Rhizoma Pinelliae);Bingpian(Borneolum Syntheticum), Fuzi(Radix Aconiti Lateralis Praeparata), Gancao(Radix et Rhizoma Glycyrrhizae), and Shexiang(Moschus);Dangshen, Ganjiang(Rhizoma Zingiberis), Zhigancao(Radix et Rhizoma Glycyrrhizae Praeparata cum Melle), Baizhu, and Huangqi. Moxa cone moxibustion(17 papers) was the most commonly used, followed by moxa stick moxibustion(13 papers). In terms of moxa cone moxibustion, 3 and 10 cones were mainly used(3 papers each), and duration was mostly 90 min(5 papers). The stimulation intensity was suitable when there were hot flushes(3 papers), and powdered herbal material was retained for 24 hours after moxibustion treatment(3 papers). The frequency of treatment was 2 times per week(6 papers), and each time was 4 weeks(7 papers), with follow-up of 1month(5 papers). For different diseases, the choice of powdered herbal material and the manipulation therapy of moxibustion were varied based on syndrome differentiation and the type of disease. Although the included papers were mainly randomised controlled trials(25 papers), only 11 papers used the random number table, and blinding was not performed in most trials;the outcomes were subjective with high risk of bias, and the overall quality was assessed to be poor. Conclusion Umbilical moxibustion has a wide range of indications of the respiratory diseases, and the powdered herbal materials with the flavor of acridand sweet and the nature of warm are often used, being supplemented with acrid-aromatics such as Bingpian(Borneolum Syntheticum), Shexiang and Xixin. Manipulation mehtod varies according to different diseases, and moxa cone and moxa stick are commonly used. The latter has a shorter duration and lower stimulation intensity than the former, without post-moxibustion treatment mostly, while the treatment frequency and follow-up time are higher than the former. And the treatment time is similar between moxibustion with moxa cone and moxa stick. In view of the overall low quality of the literature, more standardized and high-quality studies are needed to verify the conclusion.