使用穴壓拔罐治療胃食道逆流之療效評估

研究背景胃食道逆流是一種常見的胃部慢性疾病，因其慢性且反覆發作之特性而影響病患生活品質，儘管近代醫學進步，但因其反覆發作特性因此不能輕易藉由外科手術治療。傳統醫學中對於胃食道逆流也有許多種類的治療，氣功點穴拔罐由於不具侵入性且可依適當間隔反覆施行，因此我們想以實證方式驗證穴壓拔罐對於治療胃食道逆流的效益。材料與方法本研究以來自吉錠診所就診且具有參與意願的病人做為研究對象，在門診主治醫師問診之後，於民國107年9~10月間，總共收錄了158位病患。拔罐以『瞬吸可調式吸引力拔罐裝置』施行予與胃消化功能相關的三個穴位，包括中脘穴(CV12)、胸椎第3節(T3)上的穴道和胸椎第7節(T7)上的穴道，並紀錄拔罐後印記以判定病患胃部功能異常的嚴重度（印記嚴重程度分為五級）；以穴壓配合拔罐在三次時間點進行，第一次不給予穴道按壓直接拔罐 (測量I)，約一個月後第二次給予穴壓偵測再配合治療及拔罐 (測量II)，約六個月後第三次給予穴壓偵測再配合治療及拔罐 (測量III)。並以羅吉斯迴歸分析探討治療後六個月個案印記嚴重程度（級數）的變化(測量III相較於測量II)是否會低於第一次給予點穴治療後印記嚴重程度的變化(測量II相較於測量I)，並且檢視治療效益是否會被個人基本人口學變項及胃病相關表癥變項所修飾。另以線性迴歸分析比較印記級數的變化。結果對CV12呈現第II級以上定義為嚴重的情況，測量III相對於測量II在嚴重等級變化的可能性較低但並未達統計上顯著差異(Odds Ratio (OR)為0.53 (95% Confidence Interval (CI): 0.24-1.18)；對T3第III級以上及第IV級以上定義為嚴重者，測量III相對於測量II在嚴重等級變化的可能性較高但並未達統計上顯著差異，其勝算比分別為1.74 (95% CI: 0.77-3.92)及1.11 (95% CI: 0.30-4.02)；對T7第III級以上及第IV級以上定義為嚴重者，測量III相對於測量II在嚴重等級變化的可能性則是具統計上顯著差異較低，其勝算比分別為0.31 (95% CI: 0.13-0.72)及0.15 (95% CI: 0.06-0.38)。上述T7的治療效益在細部的分層分析上發現對女性、大學以下教育程度、其他職業、無胃病史、持續症狀期間超過十年、有胃脹、胃酸逆流症狀、沒有就診者，在第三次穴壓拔罐治療後也都有印記嚴重程度顯著的減輕。另外，連續印記分數的分析可以呈現CV12的治療效益上，且在分層分析上亦有較多分層可呈現出顯著差異，唯此分析結果在T3依然沒有差異。結論本研究以實證的方法證實利用科學化的點穴拔罐方法可以有效改進胃食道逆流的拔罐後印記表癥，尤其在T7穴位上的表現更為明顯。

關鍵字

胃食道逆流；穴壓；拔罐；印記；瞬吸可調式吸引力拔罐裝置；穴位

並列摘要

Background　 GERD is a commonly diagnosed chronic gastric disorder characterized with its prominent nature of high degree of repetitive recurrence which significantly impacts the quality of life. Despite the great advancement in modern medicine, treatment modalities to cure GERD remain limited as surgery is not considered a feasible option in treating GERD due to the disease’s unpredictable recurring nature. As the potential remedy, several non-invasive modalities of Chinese traditional medicine that can be administered repetitively at a defined interval are attempted by the medical community in treating GERD, when newly diagnosed and recurrence. These treatment modalities include Qi, acupressure, and cupping. Hence the intent of this study is to examine the efficacy of acupressure and cupping in treating patients with GERD through empirical research. Material Methodology　 A total of 158 research participants were voluntarily recruited for this research in September and October 2018. The participants were first medically evaluated by the attending physician at the Ji-Ding Clinic. A cupping system of “adjustable immediate suction device” was used to apply the cupping modality on the three acupoints commonly recognized as affecting the human gastric digestive function: Zhongwan CV12 (middle epigastrium), T3 (over the third thoracic spine ), and T7 (over the seventh thoracic spine ). The post-cupping imprints were recorded to determine the severity of gastric functional abnormalities experienced by each participant. For each acupoint treated (C12, T3, and T7), the imprinting data was categorized into levels 1 through 5 to define the severity of gastric functional abnormalities experienced by each research participants based on the coloration observed after each administration of cupping treatment ranging from normal skin color (level I, minimum impairment) to dark ecchymosis (level V, most severely impaired gastric function). The treatment modalities of acupoint identification and acupressure were administered in conjunction with cupping in 2 out of the 3 treatments provided to the participants. Data was collected longitudinally at the first treatment (cupping only without acupressure, measure I), the second treatment (a month after the first treatment, cupping and acupressure, measure II), and the third treatment (6 months after the first treatment, cupping and acupressure, measure III). The efficacy of these traditional modalities in treating GERD is evaluated empirically via statistical analysis. Logistic regression was employed to detect potential improvement on imprinting severity over the treatment duration of 6 months by comparing measure III to measure II to measure I. It is also used to examine whether the treatment efficacy is affected by certain variables including demographic characteristics and disease symptoms. In addition, linear regression was employed to analyze potential changes in imprinting severity levels. Result In the groups of CV12 level II and above (defined as the high severity group), comparing to measure II, measure III showed a lowered severity that is not statistically supported as significant (odds ratio (OR) is 0.53, 95% Confidence Interval (CI): 0.24-1.18); In the groups of T3 level III and above (the high severity group), comparing to measure II, measure III showed a higher severity that is also not considered statistically significant (odds ratio (OR) is 0.74 (95% CI: 0.77-3.92) for level III and 1.11 (95% CI: 0.30-4.02) for level IV); In the groups of T7 level III and above (defined as the high severity group), measure III showed a lowered severity with statistical significance detected (Odd ratio is 0.31 (95% CI: 0.13-0.72) for level III and 0.15 (95% CI: 0.06-0.38) for level IV)。Additional data stratification was conducted to further understand the therapeutic efficacy observed among the T7 group described above. The analysis revealed statistically significant positive impact; however, the observation is not repeated in the T3 group. Conclusion This research was able to empirically validate that acupressure and acupoint cupping treatment modalities, when administered scientifically, may effectively improve the imprinting symptoms experienced by patients diagnosed with GERD. The therapeutic efficacy is specifically prominent when the said treatment modalities are administered on acupoint T7.