EVALUATION ON THE THERAPEUTIC EFFECT OF DEEP PUNCTURE OF TIANSHU (ST 25) FOR SLOW TRANSIT CONSTIPATION

Objective: To evaluate the short-term and middle-long-term therapeutic effects of deep puncture of Tianshu (天枢ST 25) for slow transit constipation (STC). Methods: Sixty cases of STC patients were evenly randomized into acupuncture group and medication group. In acupuncture group, electroacupuncture (EA, 20 Hz, continuous waves and tolerable strength) was applied to bilateral Tianshu (ST 25) for 30 min after deep puncture. The treatment was given once daily, 5 sessions every week, two weeks altogether. Patients of control group were ordered to take Lactulose (10 mL/time, b.i.d), two weeks altogether. Cleveland Constipation Score (CCS) and colonic transit time (CCT) were used to evaluate the therapeutic effect. Results: After treatment, both CCS and CCT showed that the therapeutic effect of acupuncture group was significantly superior to that of medication group (P<0.05). Six-months’ follow up showed that the therapeutic effect of acupuncture still maintained in 13 of the 22 cases visited, while that of control group only maintained in 1 of the 19 cases. Conclusion: The therapeutic effect of deep puncture of Tianshu (ST 25) for STC is definite and has a middle-long-term effect. The patients have no any unfavorable reactions.

Effects of Acupuncture at Tianshu(ST25)and Shangjuxu(ST37)on the Intestinal Mucosa and Metabolites of Local Skin Tissues at Tianshu(ST25)in 2,4,6-Trinitrobenzene Sulfonic Acid and Ethanol-induced Rats

Objective:To observe the effect of acupuncture on local skin tissue metabolites of Tianshu(ST25)in rats with Crohn's disease(CD)using metabolomics and to explore the mechanism of acupuncture treatment metabolites and pathway on local skin tissue of Tianshu(ST25).Materials and Methods:Thirty-eight Sprague-Dawley rats were randomly assigned to a normal group(n=14)and a CD modeling group(n=24).Rats in the CD modeling group were administered with 2,4,6-trinitrobenzene sulfonic acid and ethanol enema,in addition to the normal group.Four normal rats and four CD modeling rats were selected at random after model identification was established.Furthermore,CD modeling group rats were randomly assigned to two groups of 10 rats:the model group and acupuncture group.Rats in the acupuncture group underwent acupuncture of Tianshu(ST25)and Shangjuxu(ST37)for 7 days.After the intervention,the colon tissue was collected from each group of rats and the pathological changes were observed through hematoxylin and eosin(HE)staining.The local skin tissues at Tianshu(ST25)of the rats in each group were taken,and the proton nuclear magnetic resonance technique was used to detect the metabonomics of the local skin tissues of Tianshu(ST25)in rats.Results:Compared with the normal group,the following were observed in the model group after HE staining:irregular colon morphology and other pathological changes such as intestinal mucosal hyperemia,edema,ulcers,polyps,and inflammatory cell infiltration.In the acupuncture group,colon tissue structure was relatively complete and layered,the colon gland structure was restored,and inflammatory cell infiltration was significantly improved.The choline,glycerin,glycine,guanidoacetic acid,and proline levels were significantly higher in the model group than in the normal group(P<0.05 or P<0.01).Compared with the model group,the acupuncture group had significantly increased contents of alanine,leucine,L-phenylalanine,and tyrosine in the skin(P<0.05 or P<0.01).Valine,leucine,and L-isoleucine biosynthesis and L-phenylalanine metabolism were the main metabolic pathways involved in the changes in the local skin tissues of the rats in each group,biosynthesis of tyrosine,and tryptophan.Conclusion:The change in the metabolites in the local area of Tianshu(ST25)may be related to intestinal disease.The acupuncture of Tianshu(ST25)can improve intestinal inflammatory reaction in rats with CD,and this finding may be related to the regulation of amino acid metabolites and their pathways in the local acupoint tissues of Tianshu(ST25)by acupuncture.

Extracellular signal-regulated kinase, substance P and neurokinin-1 are involved in the analgesic mechanism of herb-partitioned moxibustion

Herb-partitioned moxibustion can effectively mitigate visceral pain, a major symptom in inflammatory bowel disease, but the analgesic lnechanism is still unclear. Moreover, extracellular signal-regulated kinase, substance P, and neurokinin-1 are involved in formation of central hyperalgesia. Thus, we postulated that the analgesic effect of herb-partitioned moxibustion may be associated with these factors. Accordingly, in this study, we established an inflammatory bowel disease visceral pain model in rat by enema with a mixed solution of 5% trinitrobenzenesulfonic acid and 50% ethanol. Bilateral Tianshu （ST25） and Qihai （CV6） points were selected for herb-partitioned moxi- bustion. Our results showed that herb-partitioned moxibustion improved visceral pain and down-regulated extracellular signal-regulated kinase, substance P, and neurokinin-1 protein and mRNA expression in dorsal root ganglia. These results indicate that down-regulation of extracellular signal-regulated kinase, substance E and neurokinin-1 protein and mRNA may be a central mechanism for the analgesic effect of herb-partitioned moxibustion.

A Systematic Review on Safety of Acupuncture for Chronic Constipation

Objective:The purpose of this study is to systematically evaluate the safety of acupuncture in the treatment of chronic constipation in order to minimize clinical risk.Methods:The Cochrane database,MEDLINE,EMBASE,CBM,CNKI,VIP database and Wanfang database were searched systematically.Randomized controlled trials(RCTs)with safety assessment of acupuncture for chronic constipation were included.The included trial data were independently extracted by two authors and analyzed using Cochrane Collaboration Review Manager software(Rev Man 5.3.5)after bias risk assessment.The primary outcome measure in this systematic review was the incidence of adverse effects.Results:A total of 20 RCTs were included,involving 3,747 patients,and were treated for 2 to 8 weeks.After integrating data from 9 trials comparing acupuncturing Tianshu(ST25)solely with oral lactulose,the incidence of adverse effects in the experimental group was significantly lower than that in the control group(RR 0.38,95%CI 0.23 to 0.64).Seven studies compared deep ST25 with shallow ST25 showed no significant difference in the incidence of adverse effects(RR 1.39,95%CI 0.59 to 3.28).6 studies compared acupuncture a group of points including ST25 with western medicine,result indicated the incidence of adverse effects in the experimental group was significantly lower than that in the control group(RR 0.42,95%CI 0.32 to 0.55).Conclusion:Acupuncture for chronic constipation is generally safe.The operation of deep acupuncture at Tianshu(ST25)should be conducted by professional acupuncturists with certain experience,and individualized deep acupuncture should be used as far as possible.The needle insertion should be slow,without lifting,inserting,twisting and other manipulations.

Clinical Research of Irritable Bowel Syndrome Treated by Electroacupuncture on Tianshu（ST 25）

目的：对电针天枢穴治疗腹泻型肠易激综合征（D—IBS）的，临床疗效进行综合评价，促进电针天枢穴治疗腹泻型肠易激综合征的应用和推广。方法：以随机、对照、单盲的方法，对就诊的103例符合纳入标准的D—IBS患者随机分为电针天枢穴组（聆=53）和电针大横穴组（n=50）。两个疗程后进行疗效统计，两组之间综合疗效比较采用Radit分析。结果：D—IBS的腹泻、腹痛、腹胀或腹部不适、肠鸣、排便急迫感、排便不尽感等症状的发生率分别为1000／0、89．3％、71．8％、74．8％、83．5％、78．6％等；综合疗效分析，电针天枢穴组显效11例，好转34例，无效8例，总有效45例，总有效率84．9％；电针大横穴组显效4例，好转26例，无效20例，总有效30例，总有效率60．0％。两组疗效差异具有统计意义（P〈0．05）。结论：电针天枢穴治疗D—IBS临床疗效优于电针大横穴。

Effect of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV 6) for the treatment of diarrhea-dominant irritable bowel syndrome： a patient-blinded pilot trial with orthogonal design

OBJECTIVE: To investigate the effects of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV6) in patients with diarrhea-dominant irritable bowel syndrome(D-IBS) by assessing predominant factors, and determining the best factor combinations and their interactions. To identify the optimal quantity of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV 6) to achieve optimal efficacy.METHODS: An L9(3~4) orthogonal design was applied to 233 confirmed subjects based on the three most influential factors and the three most frequently used levels. Nine programs were designed.Subjects were assigned to four subgroups according to age and gender; each subject underwent one of the nine programs randomly. We selected Tianshu(ST 25, bilateral) and Qihai(CV 6). The scores of symptoms and the IBS Quality of Life(IBS-QOL) were evaluated after the final treatment.RESULTS: After treatment, clinical symptoms of all patients were significantly improved(P = 0.001).Quality of life also improved significantly(P < 0.05).For all the participants, frequency was the dominating factor regarding symptoms(P = 0.01). Duration was the dominating factor for quality of life(P =0.0001). The best combination for improving symptoms in 30-40-year-old male and female patients was two courses of 10 min each once a day, and for41-50-year-old male and female patients it was three courses of 10 min(males) or 30 min(females)twice a day. The best combination for quality of life was three courses of 20 min once a day. No interaction was found between frequency and course, or frequency and duration.CONCLUSION: Warming moxibustion Tianshu(ST25, bilateral) and Qihai(CV 6) is a promising therapy for D-IBS. To acquire optimal efficacy, the three main factors(duration, frequency and treatment course) of the warming moxibustion should reach a specific quantity and be combined appropriately.

Effects of acupuncture at “Tianshu”(ST25) on electro-activity and mechanical motility of migrating motor complex during jejunal digestion period in rats with detached jejunum

Objective To observe the effects of acupuncture at"Tianshu"(ST 25)on electro-activity and mechanical motility at different phases of migrating motor complex(MMC)during jejunal digestion period in rats with detached jejunum,so as to explore the effect and mechanism of acupuncture on regulating intestinal movement.Methods Sixteen adult SD rats were selected.

深刺天枢治疗老年性便秘近期观察

目的 :评价深刺天枢治疗老年性便秘近期疗效。方法 :采用随机单盲 (盲患者 )安慰对照前瞻性研究方法 ,对照观察深刺天枢和常规深度针刺天枢治疗老年性便秘的近期疗效 ,并初步评价深刺天枢的安全性。结果 :深刺组总有效率 10 0 0 % ,近期治愈率 5 7 7% ;常规针刺组分别是 38 0 %及 0 ,差异具有非常显著性意义 ,而且深刺天枢穴是安全的。结论 :深刺天枢是治疗老年性功能性便秘的较好方法。

不同穴位电针治疗偏头痛效果及其影响因素的研究

目的:比较电针丘墟穴和天枢穴对偏头痛的疗效,探讨影响疗效的因素。方法:将275例患者随机分为试验组138例,采用电针丘墟穴治疗;对照组137例,采用电针天枢穴治疗。观察两组的疗效,并对影响因素进行分析。结果:试验组即时有效率为70.3%,对照组为58.4%,两组比较,P<0.05,治疗4周、随访3个月和6个月疗效比较均P<0.001,电针丘墟穴的效果优于电针天枢穴;电针治疗偏头痛对从事脑力劳动人群、治疗时疼痛评分高、偏头痛发作次数多的人群即时镇痛效果更好;电针治疗偏头痛的长期疗效丘墟穴优于天枢穴。结论:电针丘墟穴治疗偏头痛的疗效优于天枢穴,患者的职业和病情等是影响疗效的因素。

深刺天枢、腹结穴配合电针治疗功能性便秘的临床研究

目的观察深刺天枢、腹结穴配合电针治疗严重功能性便秘的临床疗效。方法将63例严重功能性便秘患者随机分为治疗组33例和对照组30例。治疗组采用深刺天枢、腹结穴配合电针为主治疗,对照组采用假电针治疗。观察两组治疗前后完全自主排便次数(CSBM)、Bristol粪便性状评分(BBS)和便秘患者生活质量(PAC-QOL)评分变化情况。结果治疗组治疗2、4、8星期后及随访4、12星期CSBM与同组治疗前比较,差异均具有统计学意义(P<0.05)。对照组治疗8星期后CSBM与同组治疗前比较,差异具有统计学意义(P<0.05)。治疗组治疗2、4、8星期后及随访4、12星期CSBM与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4、8星期后BSS评分与同组治疗前比较,差异均具有统计学意义(P<0.01,P<0.05)。治疗组治疗2、4、8星期后BSS评分与对照组比较,差异均具有统计学意义(P<0.01,P<0.05)。治疗组治疗后PAC-QOL各项评分(躯体不适、心理社会不适、担心和焦虑、满意度及总分)与同组治疗前比较,差异均具有统计学意义(P<0.05)。对照组治疗后PAC-QOL中躯体不适评分、担心和焦虑评分、满意度评分及总分与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后PAC-QOL各项评分与对照组比较,差异具有统计学意义(P<0.05)。结论深刺天枢、腹结穴配合电针是一种治疗严重功能性便秘的有效方法。

电针深刺天枢穴改善结肠慢传输型便秘患者临床症状及满意度的疗效观察

目的:评价电针深刺天枢穴对结肠慢传输型便秘患者临床症状及满意度改善的有效性及安全性。方法:将结肠慢传输型便秘患者128例,以2:1:1比例随机分为深刺组、西药组及浅刺组。3组均治疗4周,疗后12周及疗后6个月随访,评价各组治疗前、后的排便相关症状、治疗满意度以及电针深刺天枢穴的安全性等。结果:电针深刺天枢穴改善结肠慢传输型便秘患者临床症状的疗效与乳果糖口服液一致,且在某些症状的改善方面较乳果糖口服液有明显优势,可有效改善随访满意度评分,并具有良好的安全性。结论:深刺电针天枢穴对改善结肠慢传输性便秘患者的临床症状及满意度疗效肯定、安全性高,其综合疗效优于国内外推荐的有循证医学证据的一线便秘药物乳果糖口服液,是一种值得临床推广运用的针灸方案。

电针天枢不同配穴对溃疡性结肠炎大鼠结肠黏膜保护作用的研究

目的:通过观察电针天枢加不同配穴对溃疡性结肠炎(UC)结肠黏膜的保护作用,筛选治疗UC活动期较佳的腧穴处方。方法:Wistar大鼠60只,随机分为正常对照组、模型组、电针天枢组、电针天枢+中脘组、电针天枢+上巨虚组、电针天枢+中脘+上巨虚组,每组10只。观察各组大鼠的结肠黏膜损伤指数、血清一氧化氮(NO)、超氧化物歧化酶(SOD)和丙二醛(MDA)变化。结果:模型组溃疡溃疡较大,充血、水肿明显,黏膜损伤指数较高,各电针治疗组均可明显降低黏膜损伤指数;与正常对照组相比,模型组MDA、NO明显增加,SOD明显减低,均有非常显著性差异(P<0.01);各电针治疗组均可明显降低MDA、NO,提高SOD的含量,但各组间存在差异,以天枢+中脘+上巨虚组效果明显。结论:电针天枢加不同配穴对UC大鼠结肠黏膜有明显的保护作用,以天枢、中脘、上巨虚三穴配伍疗效最优。

电针不同部位单穴对大鼠胃运动双向调节效应特征的研究

目的探讨不同部位穴位对胃运动异常大鼠的双向调节效应特征。方法通过在大鼠胃内安置球囊的方法记录胃内压,观察电针天枢、大肠俞、曲池、上巨虚对胃运动异常模型大鼠胃内压的影响。结果在正常生理状态及胃运动增强和胃运动抑制的病理状态下,电针曲池、上巨虚均以促进胃运动为主(P<0.05);而电针天枢均以抑制胃运动为主(P<0.01);电针大肠俞只有在正常及心得安所造成的胃运动兴奋状态下,以抑制胃运动为主(P<0.05);其他状态无明显方向倾向。结论腹部和四肢单穴对胃运动的调节很可能具有定向效应的特征,穴位的双向调节作用并不一定是同一穴位对不同病理状态下内脏器官的双向调节。

深刺天枢穴改善结肠慢传输型便秘临床观察

目的评价深刺天枢穴改善结肠慢传输型便秘(STC)临床症状的疗效。方法 STC患者120例,随机分为深刺组、常规组和西药组。评价三组患者首次自主排便时间及治疗前、治疗4星期后患者便秘评分及相关临床症状评分。结果深刺组改善便秘临床症状评分优于常规组和西药组,差异有统计学意义(P<0.01)。深刺组在改善排便不成功次数及腹痛等症状上优于西药组和常规组,且深刺的即刻效应较好。结论深刺天枢穴对STC临床症状的改善优于西药乳果糖和常规针刺治疗。

独针天枢穴治疗老年顽固性便秘疗效观察

目的观察独针天枢穴治疗老年顽固性便秘的临床疗效。方法将193例老年顽固性便秘患者随机分为A组57例、B组73例和C组63例。A组采用针刺天枢穴治疗,B组采用口服乳果糖口服溶液治疗,C组采用清洁保留灌肠治疗。比较3组临床疗效及疗效维持时间。结果 A组总有效率为89.3%,B组为88.6%,C组为92.1%,3组总有效率比较,差异均无统计学意义(P>0.05)。A组显效及好转患者疗效维持时间与B组和C组比较,差异均具有统计学意义(P<0.01)。结论独针天枢穴是一种治疗老年顽固性便秘的有效方法。

深刺天枢穴治疗结肠慢转运性便秘疗效及安全性评价

目的:评价深刺天枢穴对结肠慢转运性便秘(STC)的近、中期疗效及安全性。方法:STC患者60例,随机分为治疗组和对照组。评价治疗前、治疗2周后和治疗后6个月临床评分及结肠转运时间(CTT),并从临床、检验和影像学角度评价安全性。结果:(1)近期疗效:治疗组临床评分和CTT疗效均优于对照组,差异有显著性(P<0.01)。(2)中期疗效:治疗组治疗后6个月仍有效,疗效明显优于对照组(P<0.01),对照组无效。治疗组患者无不良反应。结论:深刺天枢穴治疗STC近期疗效确切,有一定中期疗效,无不良反应。

电针治疗慢性功能性便秘疗效观察

目的观察电针治疗慢性功能性便秘的临床疗效。方法将80例功能性便秘患者随机分为治疗组和对照组,每组40例。治疗组针刺双侧支沟、天枢及足三里穴,同时在天枢及足三里穴给予电针治疗;对照组采用口服聚乙二醇4000散治疗。治疗2星期后,比较两组治疗前后排便次数、粪便性状的变化,并判定临床疗效。结果两组治疗后大便性状恢复正常率比较,差异具有统计学意义(P<0.05)。两组第1、2星期平均每日排便次数比较,差异均无统计学意义(P>0.05)。治疗组总有效率为95.0%,对照组为65.0%,两组比较差异具有统计学意义(P<0.05)。结论电针是一种治疗慢性功能性便秘的有效方法。

天枢、上巨虚作为基础腧穴治疗胃肠疾病的研究进展

分析总结天枢、上巨虚作为基础腧穴治疗胃肠疾病的临床与基础研究进展,探索合募配穴的临床价值,从而为合募配穴的临床应用提供依据。基于现有文献,天枢与上巨虚作为基础腧穴应用广泛,二者共同作为基础腧穴主要应用于功能性肠病与炎症性肠病的治疗,而在慢性胃炎、功能性消化不良等其他常见消化疾病中应用较少。临床常用的治疗方法为针刺、艾灸、中药穴位贴敷。基于动物实验的疗效机制表明,天枢、上巨虚及其他配穴干预,可调节大鼠兴奋性、抑制性神经递质并改善大鼠体内炎症介质水平,改善功能性便秘症状;抑制中枢敏化,从而缓解大鼠肠易激症状;抑制胃内压和胃运动以减轻功能性腹泻症状;通过降低大鼠延髓孤束核内神经元和星形胶质细胞的阳性免疫产物的高表达水平,并抑制Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核因子κB(NF-κB)信号通路并减少炎症介质的释放以保护溃疡性结肠炎大鼠结肠黏膜组织。在不同胃肠疾病治疗中,天枢、上巨虚所配伍的腧穴有所差异,因此应基于现有证据与临床经验选择最佳腧穴配伍,从而提升临床疗效。

天枢超声电导胃肠宁贴片防治混合痔外剥内扎术后排便困难临床研究

目的:观察天枢超声电导胃肠宁贴片防治混合痔外剥内扎术后排便困难的临床疗效。方法:选取90例行混合痔外剥内扎术治疗的患者,随机分为对照组和治疗组各45例。对照组术后予以常规护理,治疗组在对照组基础上给予天枢超声电导胃肠宁贴片治疗,2组干预时间均为7 d。记录并比较2组首次排便时间,以及术后3 d、7 d的排便疼痛程度、排便顺畅情况和排便持续时间。结果:治疗组术后首次排便时间短于对照组,差异有统计学意义(P<0.05)。术后3 d、7 d,治疗组排便疼痛程度、排便顺畅情况均优于对照组,排便持续时间短于对照组,差异均有统计学意义(P<0.05)。结论:天枢超声电导胃肠宁贴片可改善混合痔外剥内扎术后患者的排便质量,缓解术后疼痛。

电针天枢、腹结穴对功能性便秘患者排便次数和生活质量的影响及疗效评价

目的:观察电针天枢、腹结穴对功能性便秘患者自主排便次数及生活质量的影响及疗效评价。方法:将纳入研究的120例功能性便秘患者,随机分为治疗组(电针组)和对照组(假电针组)。电针组取天枢、腹结穴,假电针组选取双侧天枢旁、腹结旁,两组每周均治疗3次,治疗周期均为4周,随访4周,取周完全自主排便次数(CSBMs)为主要观察指标,便秘患者生活质量量表(PAC-QOL)为次要观察指标,分别于治疗4周和随访4周进行疗效评价。同时我们还观察两组的不良反应。结果:治疗4周和随访4周,两种方法与基线相比均能增加患者CSBMs、改善患者PAC-QOL评分(P<0.05),但电针组疗效明显优于假电针组,差异具有统计学意义(P<0.05)。两组患者安全性无差别。结论:电针天枢、腹结可以有效提高功能性便秘患者自主排便次数,同时提高患者的生活质量,疗效确切,值得在临床中推广应用。