Article(id=1322923916242596822, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.06.049, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339240370, onlineDateStr=2026-10-30, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339240370, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339240370, creator=13701087609, updateTime=1793339240370, updator=13701087609, issue=Issue{id=1322923782029062261, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='6', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339208371, creator='13701087609', updateTime=1793340556755, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929437859258468, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929437859258469, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=234, endPage=238, ext={EN=ArticleExt(id=1322923916703970263, articleId=1322923916242596822, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Jiawei Daotan Decoction(加味导痰汤)and Acupoint Application on Lung Rehabilitation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the effect of Jiawei Daotan Decoction(加味导痰汤)and acupoint application on lung rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).

Method

A prospective controlled trial was conducted,selecting 110 patients with acute exacerbation of COPD who visited the hospital.They were randomly divided into two groups,each with 55 cases.The control group received physical therapy.The observation group received physical therapy combined with Jiawei Daotan Decoction and acupoint application.All patients were intervened for 2 weeks as a course of treatment,totally 2 courses.The therapeutic effect after two courses,the lung function indicators and inflammatory factors were evaluated before and after intervention,continuous follow-up and observation were conducted,and adverse reactions were recorded.

Results

There was no statistically significant difference in gender,average age,average onset time,smoking history or hypertension history between the two groups(P>0.05).The total effective rate(85.45%)in the control group was lower than that in the observation group(96.36%),with a statistically significant difference(P<0.05).After intervention,the values of forced vital capacity(FVC),forced expiratory volume in one second(FEV1)and FEV1/FVCincreased in both groups(P<0.05).After intervention,the values of FVC,FEV1 and FEV1/FVC in the observation group were significantly higher than those in the control group(P<0.05).In the two groups,the serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protei(CRP)after intervention decreased(P<0.05).After intervention,the serum levels of TNF-α,IL-6 and CRPin the observation group were lower than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the total adverse reaction rate between the control group(16.36%)and the observation group(14.55%)(P>0.05).

Conclusion

The combination of Jiawei Daotan Decoction and acupoint application can improve the pulmonary rehabilitation effect during acute exacerbation of COPD,which may be related to improving lung function and inhibiting inflammatory reactions,and can be tolerated.

, authors=Haiyan FU, Zhenxian WANG, authorsList=Haiyan FU, Zhenxian WANG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923921619694560, articleId=1322923916242596822, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病急性加重期患者肺康复的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

评估加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期患者肺康复的影响。

方法

进行前瞻性的对照试验,选取就诊的COPD急性加重期患者110例,采用随机摸球分为两组,各有55例。对照组予以胸部物理疗法;在此基础上,观察组予以味导痰汤联合穴位贴敷。以干预2周为1个疗程,总共2个疗程。用药2个疗程后评价疗效,干预前后评价肺功能指标、炎症因子,进行持续随访与观察,记录不良反应。

结果

两组性别、平均年龄、平均发病时间及吸烟史、高血压病史比较,差异无统计学意义(P>0.05)。对照组中总有效率(85.45%)低于观察组(96.36%),差异有统计学意义(P<0.05)。干预后两组最大肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)及FEV1/FVC上升(P<0.05);干预后观察组FVC、FEV1及FEV1/FVC高于对照组,差异有统计学意义(P<0.05)。干预后两组血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)及C反应蛋白(C-reactive protein,CRP)水平下降(P<0.05);干预后观察组血清TNF-α、IL-6及CRP低于对照组,差异有统计学意义(P<0.05)。对照组中总不良率(16.36%)与观察组(14.55%)比较,差异无统计学意义(P>0.05)。

结论

加味导痰汤联合穴位贴敷可以提高COPD急性加重期肺康复效果,可能与改善肺功能及抑制炎症反应有关,可以耐受。

, authors=符海燕, 王振贤, authorsList=符海燕, 王振贤, authorCompany=null, correspAuthors=null, authorNote=

符海燕(1983-),女,海南临高人,主治医师,学士,研究方向:呼吸、心血管疾病。

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符海燕(1983-),女,海南临高人,主治医师,学士,研究方向:呼吸、心血管疾病。

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符海燕(1983-),女,海南临高人,主治医师,学士,研究方向:呼吸、心血管疾病。

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组别例数性别/[例(%)]平均年龄/(岁,±s)平均发病时间/(年,±s)吸烟史/[例(%)]高血压病史/[例(%)]
男女
对照组5530(54.55)25(45.45)59.61±6.129.16±2.3521(38.18)15(27.27)
观察组5532(58.18)23(41.82)60.74±5.709.38±2.1019(34.55)16(29.09)
χ2/t0.1480.7330.3750.1570.045
P值0.7010.4660.7080.6920.832
), ArticleFig(id=1322923925956604919, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=CN, label=表1, caption=

两组慢性阻塞性肺疾病患者基本资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/[例(%)]平均年龄/(岁,±s)平均发病时间/(年,±s)吸烟史/[例(%)]高血压病史/[例(%)]
男女
对照组5530(54.55)25(45.45)59.61±6.129.16±2.3521(38.18)15(27.27)
观察组5532(58.18)23(41.82)60.74±5.709.38±2.1019(34.55)16(29.09)
χ2/t0.1480.7330.3750.1570.045
P值0.7010.4660.7080.6920.832
), ArticleFig(id=1322923926044685304, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数基本治愈显效有效无效总有效
对照组5514(25.45)15(27.27)18(32.73)8(14.55)47(85.45)
观察组5518(32.73)20(36.36)15(27.27)2(3.64)53(96.36)
χ2值3.960
P值0.047
), ArticleFig(id=1322923926233428985, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=CN, label=表2, caption=

两组慢性阻塞性肺疾病患者临床疗效比较

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组别例数基本治愈显效有效无效总有效
对照组5514(25.45)15(27.27)18(32.73)8(14.55)47(85.45)
观察组5518(32.73)20(36.36)15(27.27)2(3.64)53(96.36)
χ2值3.960
P值0.047
), ArticleFig(id=1322923926304732154, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数FVC/(L)FEV1/(L)FEV1/FVC
干预前干预后干预前干预后干预前干预后
对照组551.81±0.272.22±0.37#1.89±0.302.50±0.35#1.02±0.161.17±0.20#
观察组551.83±0.252.85±0.45#1.91±0.323.12±0.39#1.05±0.151.31±0.21#
t值0.2956.2460.2556.6910.7432.692
P值0.7690.0000.7990.0000.4600.009
), ArticleFig(id=1322923926384423931, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=CN, label=表3, caption=

两组慢性阻塞性肺疾病患者干预前后肺功能指标比较(±s)

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组别例数FVC/(L)FEV1/(L)FEV1/FVC
干预前干预后干预前干预后干预前干预后
对照组551.81±0.272.22±0.37#1.89±0.302.50±0.35#1.02±0.161.17±0.20#
观察组551.83±0.252.85±0.45#1.91±0.323.12±0.39#1.05±0.151.31±0.21#
t值0.2956.2460.2556.6910.7432.692
P值0.7690.0000.7990.0000.4600.009
), ArticleFig(id=1322923926640276476, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数TNF-α/(pg/mL)IL-6/(pg/mL)CRP/(mg/L)
干预前干预后干预前干预后干预前干预后
对照组5594.36±7.1064.03±6.37#28.35±4.2719.20±3.81#35.24±6.5716.85±3.02#
观察组5593.85±6.8956.82±5.78#29.01±4.3915.07±3.76#34.86±6.7810.57±2.14#
t值0.2824.5210.5984.2410.2248.714
P值0.7790.0000.5520.0000.8240.000
), ArticleFig(id=1322923926719968253, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=CN, label=表4, caption=

两组慢性阻塞性肺疾病患者干预前后炎症因子指标比较(±s)

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组别例数TNF-α/(pg/mL)IL-6/(pg/mL)CRP/(mg/L)
干预前干预后干预前干预后干预前干预后
对照组5594.36±7.1064.03±6.37#28.35±4.2719.20±3.81#35.24±6.5716.85±3.02#
观察组5593.85±6.8956.82±5.78#29.01±4.3915.07±3.76#34.86±6.7810.57±2.14#
t值0.2824.5210.5984.2410.2248.714
P值0.7790.0000.5520.0000.8240.000
), ArticleFig(id=1322923928443827198, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923916242596822, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数局部红疹恶心呕吐发热声音嘶哑乏力总不良反应
对照组550(0.00)3(5.45)2(3.64)3(5.45)1(1.82)9(16.36)
观察组553(5.45)2(3.64)1(1.82)2(3.64)0(0.00)8(14.55)
χ2值0.070
P值0.792
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两组慢性阻塞性肺疾病患者不良反应比较

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组别例数局部红疹恶心呕吐发热声音嘶哑乏力总不良反应
对照组550(0.00)3(5.45)2(3.64)3(5.45)1(1.82)9(16.36)
观察组553(5.45)2(3.64)1(1.82)2(3.64)0(0.00)8(14.55)
χ2值0.070
P值0.792
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加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病急性加重期患者肺康复的影响
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符海燕 , 王振贤
中华中医药学刊 | 省级项目平台 2025,43(6): 234-238
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中华中医药学刊 |省级项目平台 2025 , 43 (6) : 234 -238
加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病急性加重期患者肺康复的影响
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符海燕, 王振贤
作者信息
  • 海口市中医医院,海南 海口 570216
作者简介:

符海燕(1983-),女,海南临高人,主治医师,学士,研究方向:呼吸、心血管疾病。

Effect of Jiawei Daotan Decoction(加味导痰汤)and Acupoint Application on Lung Rehabilitation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Haiyan FU, Zhenxian WANG
Affiliations
  • Haikou Hospital of Traditional Chinese Medicine,Haikou 570216,Hainan,China
出版时间: 2025-06-10 doi: 10.13193/j.issn.1673-7717.2025.06.049
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目的

评估加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期患者肺康复的影响。

方法

进行前瞻性的对照试验,选取就诊的COPD急性加重期患者110例,采用随机摸球分为两组,各有55例。对照组予以胸部物理疗法;在此基础上,观察组予以味导痰汤联合穴位贴敷。以干预2周为1个疗程,总共2个疗程。用药2个疗程后评价疗效,干预前后评价肺功能指标、炎症因子,进行持续随访与观察,记录不良反应。

结果

两组性别、平均年龄、平均发病时间及吸烟史、高血压病史比较,差异无统计学意义(P>0.05)。对照组中总有效率(85.45%)低于观察组(96.36%),差异有统计学意义(P<0.05)。干预后两组最大肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)及FEV1/FVC上升(P<0.05);干预后观察组FVC、FEV1及FEV1/FVC高于对照组,差异有统计学意义(P<0.05)。干预后两组血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)及C反应蛋白(C-reactive protein,CRP)水平下降(P<0.05);干预后观察组血清TNF-α、IL-6及CRP低于对照组,差异有统计学意义(P<0.05)。对照组中总不良率(16.36%)与观察组(14.55%)比较,差异无统计学意义(P>0.05)。

结论

加味导痰汤联合穴位贴敷可以提高COPD急性加重期肺康复效果,可能与改善肺功能及抑制炎症反应有关,可以耐受。

加味导痰汤  /  穴位贴敷  /  COPD急性加重期  /  肺康复
Objective

To evaluate the effect of Jiawei Daotan Decoction(加味导痰汤)and acupoint application on lung rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).

Method

A prospective controlled trial was conducted,selecting 110 patients with acute exacerbation of COPD who visited the hospital.They were randomly divided into two groups,each with 55 cases.The control group received physical therapy.The observation group received physical therapy combined with Jiawei Daotan Decoction and acupoint application.All patients were intervened for 2 weeks as a course of treatment,totally 2 courses.The therapeutic effect after two courses,the lung function indicators and inflammatory factors were evaluated before and after intervention,continuous follow-up and observation were conducted,and adverse reactions were recorded.

Results

There was no statistically significant difference in gender,average age,average onset time,smoking history or hypertension history between the two groups(P>0.05).The total effective rate(85.45%)in the control group was lower than that in the observation group(96.36%),with a statistically significant difference(P<0.05).After intervention,the values of forced vital capacity(FVC),forced expiratory volume in one second(FEV1)and FEV1/FVCincreased in both groups(P<0.05).After intervention,the values of FVC,FEV1 and FEV1/FVC in the observation group were significantly higher than those in the control group(P<0.05).In the two groups,the serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protei(CRP)after intervention decreased(P<0.05).After intervention,the serum levels of TNF-α,IL-6 and CRPin the observation group were lower than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the total adverse reaction rate between the control group(16.36%)and the observation group(14.55%)(P>0.05).

Conclusion

The combination of Jiawei Daotan Decoction and acupoint application can improve the pulmonary rehabilitation effect during acute exacerbation of COPD,which may be related to improving lung function and inhibiting inflammatory reactions,and can be tolerated.

Jiawei Daotan Decoction(加味导痰汤)  /  acupoint application  /  acute exacerbation of COPD  /  pulmonary rehabilitation
符海燕, 王振贤. 加味导痰汤联合穴位贴敷对慢性阻塞性肺疾病急性加重期患者肺康复的影响. 中华中医药学刊, 2025 , 43 (6) : 234 -238 . DOI: 10.13193/j.issn.1673-7717.2025.06.049
Haiyan FU, Zhenxian WANG. Effect of Jiawei Daotan Decoction(加味导痰汤)and Acupoint Application on Lung Rehabilitation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (6) : 234 -238 . DOI: 10.13193/j.issn.1673-7717.2025.06.049
慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)以气道受限及慢性炎症为特征,据报道我国COPD总发病人数约有1亿人,并且以较快的速度逐年增加,对身体健康造成极大的威胁[1]。本病极易在多种诱因下急性发作,西医对于此尚无特效疗法,无法彻底治愈,通过支气管扩张剂、糖皮质激素、止咳化痰等对症支持治疗,稳定病情,延缓其进一步恶化。随着研究深入,肺康复成为COPD治疗研究的重点内容,也是医学界所追求的主要目标[2],全球协议中指出COPD从肺康复治疗中获益[3],胸部物理治疗是一种操作简便、无创安全的治疗方式,对于肺康复有益,但我国近年来处于逐渐完善阶段。中医是现代医学的组成部分,历代医家对本病进行深入的探讨,如《灵枢·胀论》中载:“肺胀者,虚满而咳喘”;《诸病源候论》亦曰:“肺主于气,邪乘于肺则肺胀,胀则肺管不利,不利则气道涩,故上气喘逆鸣息不通”。现代中医认为COPD病人素体本虚,因外感六淫而触发,急性期以实证居多,痰湿、瘀血均为主要构成证候要素[4]。因此COPD急性期的主要病机为痰瘀壅肺[5]。将多种中医疗法联合应用,整体与局部相结合,可以发挥多靶点、多方位的治疗作用[6]。本次研究以医院COPD急性加重期患者为对象,通过对照试验,客观评价本次综合康复方案的有效性及安全性。报道如下。
本次进行前瞻性的对照试验,选取医院COPD急性加重期患者113例,作为本次研究对象,研究过程中有2例脱落,1例不符合入组标准,最终110例患者配合完成干预。调查资料,男62例、女48例;年龄大小:最小49岁,最大72岁,平均(60.13±5.86)岁;发病时间:最短5年,最长14年,平均(9.86±2.30)年;吸烟史40例,高血压病史31例。采用随机摸球分为两组,各有55例。两组资料比较,差异无统计学意义(P>0.05),具有可比性。见表1。
1)参照《慢性阻塞性肺疾病诊疗指南2021修订版》[7];2)中医诊断:依据《中医病证诊断疗效标准》[8]中“肺胀”诊断要点,主症:咳嗽咳喘、气急、气短,次症:胸部胀满、头闷如裹、咳吐痰涎、面色微黄、萎靡不振,舌淡苔白腻,脉沉滑。主症2项+次症3项+舌脉,即可诊断。
1)具备上述中西医诊断,急性期发作后首次住院治疗,<80岁;2)评估患者意识水平、认知程度及理解力,有能力完成各项检查;3)签订干预治疗知情同意书;4)研究符合医学伦理部门的审查。
1)有气胸、肺心病、肺动脉高压、先心病等心肺疾患,或肝肾代谢不全、营养不良、恶病质;2)接受心肺手术,或外伤、先天发育不全;3)皮肤性疾病如过敏性皮炎、系统性红斑狼疮、紫癜等;4)过敏体质,既往中药过敏或胃肠道不耐受;5)文盲、残疾、精神障碍等无法配合;6)未完成既定的方案疗效,或转院、突发其他并发症。
完善入院相关检查,明确病情,参照急性期的处置原则,注意休息、避免劳累,使用止咳化痰、支气管扩张剂、糖皮质激素等对症治疗,调节电解质、离子紊乱。对于感染征象者,予以抗生素治疗,对于呼吸困难者,予以低流量吸氧,其他对症处理。(1)对照组予以胸部物理疗法。包括体位引流、叩击法、摇振法、呼吸锻炼及咳嗽锻炼,在康复医师指导下进行。(2)在此基础上,观察组予以加味导痰汤联合穴位贴敷。加味导痰汤如下:半夏15 g,天南星10 g,陈皮10 g,白茯苓15 g,川芎10 g,桃仁10 g,丹参10 g,枳壳6 g,竹茹6 g,瓜蒌10 g,地龙6 g,生姜3片,甘草6 g。使用煎药机统一煎煮,煮取400 mL,200 mL/袋,早晚两次服用,1剂/d。穴位贴敷:中药组方(白芥子、紫苏子、莱菔子、延胡索、细辛等),等比例取上述中药,研磨成粉末,加入生姜汁调和,使用1次性穴位敷贴,取穴:肺俞(双侧)、定喘(双侧)、膏肓(双侧)、天突、膻中,4~6 h/次,隔日1次。所有患者以干预2周为1个疗程,总共2个疗程。
用药2个疗程后评价疗效,记录具体症状的改善程度,采用证候积分法,通过中医四诊辨证,记录中医证候,计算中医证候减分率=[(治疗前-治疗后)/治疗前×100%],进行疗效分级。(1)基本治愈:各项症状及体征基本消失,肺功能正常,中医证候减分率>90%;(2)显效:各项症状及体征较之前明显改善,肺功能接近正常,中医证候减分率>75%;(3)有效:各项症状及体征较之前好转,介于显效与无效之间,肺功能改善,中医证候减分率>50%;(4)无效:各项症状及体征较之前无变化,肺功能较差,中医证候减分率≤50%。统计基本治愈、显效和有效人数,视为总有效。
干预前后评价肺功能指标。采用便携式肺功能检测仪(HI-801),嘱呼吸配合,测定最大肺活量(forced vital capacity,FVC)、第1 s用力呼气容积(forced expiratory volume in one second,FEV1)以及FEV1/FVC,连测3次,取平均值。
干预前后评价炎症因子指标。抽取血液样本,送入检验科室常规处理。应用酶联免疫检测方法测定肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)及C反应蛋白(C-reactive protein,CRP)水平,试剂盒由南京建成生物提供。
干预期间及干预结束1周内进行随访与观察,接受血尿常规、离子及心电图检查,每2周1次,必要时辅助其他检查。统计两组不良反应的发生情况,包括局部红疹、恶心呕吐、发热、声音嘶哑、乏力等。
采用SPSS 20.0软件处理。计量资料予以t检验;计数资料予以卡方检验。P<0.05差异有统计学意义。
对照组中总有效率85.45%(47/55),低于观察组96.36%(53/55),差异有统计学意义(P<0.05)。见表2。
干预前两组FVC、FEV1及FEV1/FVC比较,差异无统计学意义(P>0.05)。干预后两组FVC、FEV1及FEV1/FVC上升(P<0.05);干预后观察组FVC、FEV1及FEV1/FVC高于对照组,差异有统计学意义(P<0.05)。见表3。
干预前两组血清TNF-α、IL-6及CRP比较,差异无统计学意义(P>0.05)。干预后两组血清TNF-α、IL-6及CRP下降(P<0.05);干预后观察组血清TNF-α、IL-6及CRP低于对照组,差异有统计学意义(P<0.05)。见表4。
对照组中总不良反应率16.36%(9/55)与观察组14.55%(8/55)比较,差异无统计学意义(P>0.05)。见表5。
现阶段COPD是临床上一类常见病,当其急性期发作,不仅造成明显的呼吸困难、喘息症状,还累及其他器官、系统,造成严重的病理损害[9]。随着现代治疗模式的转变,中医已成为肺系疾病治疗的又一选择,常用的中医疗法包括中药汤剂、穴位贴敷、推拿、针灸等,取得了很好效果[10]。关于COPD的治疗方案越来越综合化和系统化,中医治疗更是如此,如何有效合理配伍,发挥不同中医方案的联用优势,成为中医研究的重点[11]。
关于COPD相关描述及记载很多,与“喘证”“咳嗽”“肺胀”等范畴类似,在长期临床实践中,现代中医大体认同痰湿在COPD的发生、发展及复发、预后方面有着重要意义[12]。其中一方面COPD患者病久体虚,气虚运化水湿乏力,以致素痰伏肺,而痰湿之邪其性重着黏腻,停聚于肺,黏稠难咯,导致肺胀缠绵反复、迁延不愈[13];另一方面,肺脏素有“华盖”之称,其性娇嫩,位于五脏六腑之巅,当外感风寒湿之邪侵袭,首先通过皮毛、肌腠入里,以致肺脏宣发速降失常,则疾病加重[14]。《血证论》曰:“内有瘀血,则阻碍气道,不得升降,气壅则水壅,水壅即为痰饮”,除痰湿之邪,瘀血作为一类重要病理产物,与痰湿伴随而出,“肺朝百脉、主治节”,当痰浊壅肺,肺气郁滞、百脉受损,血脉运行不畅则停聚化为瘀血,伴随发病始终[15]。当COPD发展至后期,素体本虚、痰湿与瘀血相互夹杂,导致病证复杂多变[16]。
中药汤剂历来是治疗COPD的主要疗法,本着“急则治其标、缓则治其本”的原则,组方辨证思路以化痰为主,兼有清热、活血、理气[17-18]。本次采用加味导痰汤,以“导痰汤”为基础进行加减,导痰汤源于《济生方》,功用燥湿祛痰、理气。《医方考》记载:“水饮入胃,无非湿化……,稀则曰饮,稠则曰痰”,脾为生痰之源,茯苓性味甘淡以利湿,半夏性味辛燥以化痰[19],二者相伍既消已成之痰,又杜生痰之源;治痰先治气,气顺则痰消,陈皮燥湿理气[20-21],枳壳性味苦寒,主破气、散痞、泻痰、消积。《别录》曰:“除胸胁痰癖,逐停水,破结实,消胀满,……”,加用二药使气顺则痰消。川芎、桃仁、丹参皆为活血之品,用之使瘀血去、新血生;生姜性味温和,可制半夏之毒,又助半夏燥湿化痰。《医方集解》记载“气有余则为火,液有余则为痰,故治痰者必降其火”,竹茹性味苦寒,其寒能去热、苦能降下,用于痰热内扰之证[22],瓜蒌甘寒而性滑,故长于清热滑痰[23],《本草正》言“性降而润,能降实热痰涎……,定胀喘,润肺止嗽”。地龙性味咸寒,平喘、利尿,现代研究认为地龙具有抗血栓、抗血小板聚集的作用[24]。诸药合用证对COPD急性期的证型特点。
穴位贴敷是中医传统外治法之一,最早见于《五十二病方》,基于中医经络理论、中药理论及整体观、辨证论治而来的。与其他中医疗法比,将穴位贴敷应用于临床实践中,具有操作简便、效果好及安全性高的特点,被广大患者所接受[25]。穴位贴敷可以充分发挥中药与穴位的双重效应,将化痰通络的中药配伍,贴敷于相应腧穴上,可以激发经气,最大限度发挥药物调理气血、平衡阴阳之功效[26-27]。另外穴位贴敷通过局部皮肤发挥作用,减少了西药或中药汤剂对胃肠的刺激作用。本次穴位贴敷药物配伍中白芥子[28]、延胡索、细辛均为通络之品,紫苏子化痰降气、莱菔子主化痰和中,诸药合用起到止咳化痰、平喘之功。曹庆等[29]基于数据挖掘COPD穴位贴敷的选穴规律,发现所用腧穴主要集中在胸、背部。本次采用局部配穴与近处取穴相结合的形式,遵循扶正祛邪、标本兼顾的原则[30]。《素问》中言:“背者胸中之府”,指出背部与胸相邻,存在密切的生理病理关系[31]。肺俞、膏肓均足太阳膀胱经穴位,靠近肺脏,有振奋阳气、温痰化饮之功,《针灸甲乙经》中曾记载“肺胀者,肺俞主之”;《千金方》中论:“膏肓穴,无所不治,主羸瘦虚损,梦中失精,上气咳逆,狂惑忘误”。定喘为经外奇穴,主止咳、定喘,现代研究发现定喘穴穴位注射对哮喘大鼠有干预作用[32]。天突、膻中均为任脉穴位,天突居于气管之上,主化痰降气,膻中居于胸口之中,可以宽胸理气,二穴作为肺系疾病中固定搭配,气顺则痰消[33]。
为充分发挥综合疗法的优势及协同效果,本次研究采用加味导痰汤联合穴位贴敷,发挥不同疗法的作用。结果显示:观察组总有效率96.36%高于对照组85.45%,并且两组总不良率比较,差异并无统计学意义。另外炎症因子和肺功能历来是评价COPD治疗效果及预后的参考指标。肺功能是评估肺气体交换能力的主要依据,肺功能越高提示肺部生理越好、气道通畅。葛姝君等[34]发现COPD患者肺功能的变化与具体症状有着明显关系,喘息、气促越明显,则肺功能就越差。另外COPD从本质上来说是一类慢性炎症疾病,机体多种促炎症因子呈略高或正常,当感染、劳累或气道刺激时,炎症反应级联放大,呈现明显的高表达,对评估病情有重要的意义[35]。本次结果显示观察组肺功能和炎症因子指标的改善程度优于对照组。
可以看出,加味导痰汤联合穴位贴敷可以提高COPD急性加重期肺康复效果,可能与改善肺功能及抑制炎症反应有关,可以耐受。由于本次研究有限,关于中医综合治疗方案在COPD急性加重期的应用价值以及作用机制,仍需要进一步分析。
  • 海南省卫生和计划生育委员会项目(15A200059)
  • 海南省基础与应用基础研究计划项目(818MS137)
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2025年第43卷第6期
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doi: 10.13193/j.issn.1673-7717.2025.06.049
  • 首发时间:2026-10-30
  • 出版时间:2025-06-10
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海南省卫生和计划生育委员会项目(15A200059)
海南省基础与应用基础研究计划项目(818MS137)
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    海口市中医医院,海南 海口 570216
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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