目的:回顾性分析皮肤安全型穴位贴敷方治疗轻型新型冠状病毒肺炎的疗效和安全性。方法:选择轻型新型冠状病毒肺炎口服药物治疗后症状仍加重的患者,在原有药物的基础上给予皮肤安全型穴位贴敷方穴位贴敷治疗,取穴为合谷、大椎、天突,疗程为1天。观察患者治疗前后症状的变化和相关不良反应发生情况。结果:1) 治疗后,鼻塞:有效5例,无效2例,有效率71.4%;发热:有效4例,无效1例,有效率80%;乏力:有效3例,无效2例,有效率60%;腹泻:有效6例,无效1例,有效率85.7%;咳嗽:有效9例,无效6例,有效率60%;咳痰:有效13例,无效4例,有效率76.5%;肌痛:有效4例,无效2例,有效率66.7%;结膜炎:有效5例,无效2例,有效率71.4%;流涕:有效9例,无效1例,有效率90%;味觉减退:有效2例,无效1例,有效率66.7%;嗅觉减退:有效2例,无效1例,有效率66.7%;咽痛:有效9例,无效5例,有效率64.3%;2) 研究过程中,观察组出现4例轻微皮肤症状,均为敷贴材料所致。结论:皮肤安全型穴位贴敷方穴位贴敷治疗轻型新型冠状病毒肺炎安全有效。 Objective: To retrospectively analyze the efficacy and safety of skin safe acupoint application in the treatment of mild novel coronavirus pneumonia. Methods: Select patients with mild novel coronavirus pneumonia whose symptoms are still aggravated after oral drug treatment. On the basis of the original drugs, give skin safe acupoint application formula acupoint application treatment. The acupoints are Hegu, Dazhui and Tiantu, and the course of treatment is 1 day. The changes of symptoms and the occurrence of related adverse reactions were observed before and after treatment. Results: 1) after treatment, nasal congestion: 5 cases were effective, 2 cases were ineffective, and the effective rate was 71.4%; Fever: 4 cases were effective, 1 case was ineffective, and the effective rate was 80%; Asthenia: 3 cases were effective, 2 cases were ineffective, and the effective rate was 60%; Diarrhea: 6 cases were effective, 1 case was ineffective, and the effective rate was 85.7%; Cough: 9 cases were effective, 6 cases were ineffective, and the effective rate was 60%; Expectoration: 13 cases were effective, 4 cases were ineffective, and the effective rate was 76.5%; Myalgia: 4 cases were effective, 2 cases were ineffective, and the effective rate was 66.7%; Conjunctivitis: 5 cases were effective, 2 cases were ineffective, and the effective rate was 71.4%; Runny nose: 9 cases were effective, 1 case was ineffective, and the effective rate was 90%; Hypoesthesia: 2 cases were effective, 1 case was ineffective, and the effective rate was 66.7%; Anosmia: 2 cases were effective, 1 case was ineffective, and the effective rate was 66.7%; Pharyngeal pain: 9 cases were effective, 5 cases were ineffective, and the effective rate was 64.3%; 2) During the study, 4 cases of mild skin symptoms in the observation group were caused by the application materials. Conclusion: Skin safe acupoint application formula is safe and effective in the treatment of light novel coronavirus pneumonia.
目的:回顾性分析皮肤安全型穴位贴敷方治疗轻型新型冠状病毒肺炎的疗效和安全性。方法:选择轻型新型冠状病毒肺炎口服药物治疗后症状仍加重的患者,在原有药物的基础上给予皮肤安全型穴位贴敷方穴位贴敷治疗,取穴为合谷、大椎、天突,疗程为1天。观察患者治疗前后症状的变化和相关不良反应发生情况。结果:1) 治疗后,鼻塞:有效5例,无效2例,有效率71.4%;发热:有效4例,无效1例,有效率80%;乏力:有效3例,无效2例,有效率60%;腹泻:有效6例,无效1例,有效率85.7%;咳嗽:有效9例,无效6例,有效率60%;咳痰:有效13例,无效4例,有效率76.5%;肌痛:有效4例,无效2例,有效率66.7%;结膜炎:有效5例,无效2例,有效率71.4%;流涕:有效9例,无效1例,有效率90%;味觉减退:有效2例,无效1例,有效率66.7%;嗅觉减退:有效2例,无效1例,有效率66.7%;咽痛:有效9例,无效5例,有效率64.3%;2) 研究过程中,观察组出现4例轻微皮肤症状,均为敷贴材料所致。结论:皮肤安全型穴位贴敷方穴位贴敷治疗轻型新型冠状病毒肺炎安全有效。
穴位贴敷,轻型新型冠状病毒肺炎,皮肤安全型穴位贴敷方
Guanghui Qin
Department of Integrated Traditional Chinese and Western Medicine, The Third Affiliated Hospital of Naval Medical University, Shanghai
Received: Aug. 20th, 2022; accepted: Sep. 16th, 2022; published: Sep. 26th, 2022
Objective: To retrospectively analyze the efficacy and safety of skin safe acupoint application in the treatment of mild novel coronavirus pneumonia. Methods: Select patients with mild novel coronavirus pneumonia whose symptoms are still aggravated after oral drug treatment. On the basis of the original drugs, give skin safe acupoint application formula acupoint application treatment. The acupoints are Hegu, Dazhui and Tiantu, and the course of treatment is 1 day. The changes of symptoms and the occurrence of related adverse reactions were observed before and after treatment. Results: 1) after treatment, nasal congestion: 5 cases were effective, 2 cases were ineffective, and the effective rate was 71.4%; Fever: 4 cases were effective, 1 case was ineffective, and the effective rate was 80%; Asthenia: 3 cases were effective, 2 cases were ineffective, and the effective rate was 60%; Diarrhea: 6 cases were effective, 1 case was ineffective, and the effective rate was 85.7%; Cough: 9 cases were effective, 6 cases were ineffective, and the effective rate was 60%; Expectoration: 13 cases were effective, 4 cases were ineffective, and the effective rate was 76.5%; Myalgia: 4 cases were effective, 2 cases were ineffective, and the effective rate was 66.7%; Conjunctivitis: 5 cases were effective, 2 cases were ineffective, and the effective rate was 71.4%; Runny nose: 9 cases were effective, 1 case was ineffective, and the effective rate was 90%; Hypoesthesia: 2 cases were effective, 1 case was ineffective, and the effective rate was 66.7%; Anosmia: 2 cases were effective, 1 case was ineffective, and the effective rate was 66.7%; Pharyngeal pain: 9 cases were effective, 5 cases were ineffective, and the effective rate was 64.3%; 2) During the study, 4 cases of mild skin symptoms in the observation group were caused by the application materials. Conclusion: Skin safe acupoint application formula is safe and effective in the treatment of light novel coronavirus pneumonia.
Keywords:Acupoint Application, Mild Novel Coronavirus Pneumonia, Skin Safe Acupoint Application Formula
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
中药穴位贴敷疗法是采用对皮肤无刺激的中药(皮肤安全型穴位贴敷方)贴敷在相应部位进行治疗的一种中医外治疗法,该疗法在我院临床运用多年,对咳嗽、咳痰、咽痛、鼻塞等疗效较好,治疗成本低廉,操作简单。方舱医院收治的患者主要是无症状感染者和轻型新型冠状病毒肺炎患者,每日有大量患者入院和出院,住院时间短。针对方舱特点,作者精简穴位,取穴为双合谷穴、天突穴、大椎穴,既保证疗效,又能方便操作。另外还给患者提供文字版和视频版的操作方法,患者自行治疗,减轻了医护人员的工作量。现回顾性总结如下.
41例轻型新型冠状病毒感染肺炎患者均为2022年4月22日至2022年5月20日上海国家会展中心方舱医院二分院二、三病区和四病区住院患者,男6例,女35例;年龄最小20岁,最大55岁;在观察的12种症状中,8种症状均加重的有2例,6种症状均加重的有1例,5种症状均加重的有2例,4种症状均加重的有4例,3种症状均加重的有5例,2种症状均加重的有9例,1种症状均加重的有18例。
符合《新型冠状病毒感染的肺炎诊疗方案(试行第九版)》诊断标准 [
1) 符合新冠肺炎诊断标准的轻型 [
1) 皮肤敏感患者;2) 孕妇。
1) 在原有口服药物治疗的基础上加用皮肤安全型穴位贴敷方穴位贴敷治疗。疗程1日。
2) 中药穴位贴敷操作方法
皮肤安全型穴位贴敷方由等量的麻黄、桂枝、杏仁、川芎等四味药物组成。将等量的麻黄、桂枝、杏仁、川芎等四味药物打粉后密封装袋备用,临用时加水调成糊状。采用医用输液贴将黄豆大小的药物敷贴在双合谷穴、天突穴、大椎穴上,每日1次,每次8小时左右。治疗1次。
在问卷星上设计好调查表,患者通过微信扫描填表,数据存储在问卷星上。
1) 疗效指标
主要症状变化情况:咳嗽、咳痰、咽痛、鼻塞、流涕、肌痛、乏力、腹泻、发热、结膜炎、嗅觉障碍、味觉障碍。
2) 安全性指标
患者治疗过程中不良事件发生情况。
比较有效人数与总人数,得出有效率。
1) 鼻塞:有效5例,无效2例,有效率71.4%;
2) 发热:有效4例,无效1例,有效率80%;
3) 乏力:有效3例,无效2例,有效率60%;
4) 腹泻:有效6例,无效1例,有效率85.7%;
5) 咳嗽:有效9例,无效6例,有效率60%;
6) 咳痰:有效13例,无效4例,有效率76.5%;
7) 肌痛:有效4例,无效2例,有效率66.7%;
8) 结膜炎:有效5例,无效2例,有效率71.4%;
9) 流涕:有效9例,无效1例,有效率90%;
10) 味觉减退:有效2例,无效1例,有效率66.7%;
11) 嗅觉减退:有效2例,无效1例,有效率66.7%;
12) 咽痛:有效9例,无效5例,有效率64.3%;
治疗组4例患者出现轻微皮肤刺激症状,范围为输液贴覆盖区域,非药物覆盖区域,判断为输液贴所致皮肤刺激,不需处理。
口服药物治疗症状仍加重的轻型新型冠状病毒肺炎患者,在接受1次皮肤安全型穴位贴敷方穴位贴敷合谷、大椎、天突后,咽痛、鼻塞、咳嗽、咳痰、流涕、肌痛、乏力、腹泻、发热、嗅觉障碍、味觉障碍、结膜炎这12个症状均有一定程度的改善,药物未出现皮肤刺激反应,皮肤安全型穴位贴敷方穴位贴敷治疗轻型新型冠状病毒肺炎安全有效。
皮毛包括皮肤、汗孔、毫毛、腠理等组织结构,覆盖于人身表面,是人体最大的器官。其生理功能有:1) 调节体内外气体交换,辅助肺主气司呼吸:肺合皮毛,皮毛的汗孔也有呼吸吐纳的作用,清代唐宗海《中西汇通医经精义》所述:“皮毛属肺,肺多孔窍以行气,二皮毛尽是孔窍,所以宣肺气,使出于皮毛而卫外也。”2) 调节津液代谢,辅助肺主通调水道:汗由津液所化,皮肤通过出汗的形式来调节人体津液代谢,《灵枢经·五癃津液别篇》记载:“天暑衣厚则腠理开,故汗出,天寒则腠理闭,气湿不行,则下流于膀胱,则为溺与气。”卫气的强弱,腠理的疏密,汗孔的开合,都影响着汗液的分泌、排泄和津液的代谢平衡;3) 抵御外邪侵袭:皮主一身之表,为抵御外邪的重要屏障,《灵枢·百病始生》阐明:“是虚邪之中人也,始于皮肤,皮肤缓则腠理开,开则邪从毛发入。”4) 调节体温:皮肤排泄汗液,是人体体温维持稳定的重要因素,卫气司开合功能正常与否在其中起重要作用。《素问·皮部论》说:“皮者,脉之部也,邪客于皮则腠理开,开则邪入客于络脉,络脉满则注于经脉,经脉满则入舍于腑脏也。”通过皮–络–经–腑–脏的途径,病邪可以进入体内,药物同样可以通过相同的途径进入体内。《素问·五脏生成篇》曰:“诸气者,皆属于肺。”肺的各种生理功能也是通过气去完成的。《理淪骈文》说:“皮肤隔而毛窍通,不见脏腑恰直达脏腑也。”又云:“外治之理即内治之理,外治之药,亦即内治之药,所异者,法耳。”外治法和内治法殊途同源 [
穴位敷贴是在传统中医药理论的指导下,以中医辨证论治和经络学说为主要依据的一种内病外治、治病求本之法,广泛运用于急、慢性呼吸道疾病,除可改善症状外,还在改善肺功能及提高生活质量方面具有较大的优势。该疗法实用性强,不良反应小,操作便捷,属“简、便、廉、验”的中医特色疗法 [
腧穴有接受刺激、防治疾病的作用,《素问五藏生成篇》说:“人有大谷十二分,小溪三百五十四名,少十二腧,此皆卫气之所留止,邪气之所客也,针石缘而去之。”表明腧穴不仅是气血输注的部位,也是邪气所之处,亦是穴位贴敷防治疾病的相应刺激点。通过穴位贴敷刺激以通其经脉,调其气血,使阴阳归于平衡,脏腑趋于和调,从而达到扶正祛邪的目的。根据腧穴的主治特点和规律,取合谷、天突穴、大椎穴为贴敷治疗主穴。其中合谷穴取自手阳明大肠经、与手太阴肺经相表里,在合谷穴的清热解表、疏经活络功效基础之上,采用腧穴的远治作用、正所谓“经络所过、主治所及”,选用任脉天突穴及督脉大椎穴,综合天突穴的宣肺理气、开音利喉之功效,及大椎穴的解表退热、止咳平喘、宁心安神之功效。三穴联合共同发挥了宣肺通窍、平衡阴阳的作用。由上述药物合用来刺激经络,达到宣肺通窍、平衡阴阳的临床效果。
2022年上海发生的新冠疫情,许多病人为无症状或者轻型新型冠状病毒肺炎。其中有部分患者住院2天核酸2次阴性而出院。因此,本文观察1次中药穴位贴敷治疗的疗效。
本次研究显示,中药(皮肤安全型穴位贴敷方)穴位贴敷治疗轻型新型冠状病毒肺炎安全有效。
本研究的不足之处:由于受到方舱内病人数量大、出入院快,医护人员不足等因素影响,故本研究采用回顾性研究分析,且由于样本例数有限,可能导致研究结果存在一定偏倚,确切的临床疗效有待于今后大样本、前瞻性、随机对照临床研究进行评价。
皮肤安全型穴位贴敷方穴位贴敷疗法,安全有效,患者可以自行操作,相比口服药物更受患者欢迎,还可以极大地减轻医生工作量,加快患者出仓,也可以在隔离点、家庭等地方使用,具有极大的推广运用价值。
感谢第三方工作人员、志愿者在本研究中的辛勤付出。
国家中医药管理局“新型冠状病毒感染肺炎中医药应急专项”2022年第五批增设课题(课题名称:中药穴位贴敷治疗新型冠状病毒肺炎无症状感染者的有效性和安全性的临床研究;课题编号:2022ZYLCYJ05-8)。
覃光辉. 皮肤安全型穴位贴敷方治疗轻型新型冠状病毒肺炎的临床观察Clinical Observation on the Treatment of Mild Novel Coronavirus Pneumonia with Skin Safe Acupoint Application Formula[J]. 中医学, 2022, 11(05): 970-975. https://doi.org/10.12677/TCM.2022.115139