擬真雷射針灸改善病患憂鬱症狀效能之研究

研究目的：根據第五版精神疾病診斷及統計手冊(Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5)，憂鬱症(Depressive Disorders)可分為侵擾性情緒失調症(Disruptive Mood Dysregulation Disorder)、持續性憂鬱症(Persistent depressive disorder, PDD)，和(重)鬱症(Maior Depressive Disorder)、經期前情緒低落症(Premenstrual Dysphoric Disorder)、物質/醫藥引發的憂鬱症(Substance/Medication-Induced Depressive Disorder)、另一身體病況引起的憂鬱症(Depressive Disorder Due to Another Medical Condition)、其他特定的憂鬱症(Other Specified Depressive Disorder)、非特定的憂鬱症(Unspecified Depressive Disorder)。其中，較常於臨床試驗討論的是(重)鬱症和持續性憂鬱症。以中醫觀點來看，憂鬱症的中醫證型最常見為「肝氣鬱結、心脾兩虛、痰氣鬱結」…等。回顧文獻發現，針灸作為單一治療憂鬱症是有效的，而且不管是傳統針灸、雷射針灸、電針皆有幫助，亦可加強抗憂鬱藥的效果，或是減少抗憂鬱藥的副作用，而針灸治療憂鬱症機轉可能藉由活化大腦額葉、抑制前額葉神經內分泌的發炎路徑，減少神經發炎…等。臨床上，當建議身心科患者使用針灸治療時，普遍都會因害怕針灸疼痛而遭拒絕。有文獻指出，雷射針灸的抗憂鬱的機轉與針灸相似，可改善憂鬱症患者的預設模式網絡（default mode network, DMN）前後區，刺激DMN前區內側前額葉皮質（medial Prefrontal Cortex, mPFC），調節後部DMN parieto–temporal–limbic cortices區域(屬於反思和扭曲的自我意識）。因此我們選擇非侵入式且無痛的雷射針灸進行研究，並首度使用雷射針灸之提插功能，以了解對於憂鬱症患者的治療效果。材料方法：本研究採用單盲隨機分配，試驗目的在探討擬真雷射針灸儀的提插功能，對憂鬱症狀的改善程度。目前完成20位受試者(其中一人中途退出)，試驗設計分為二組，雷射針灸有提插組，和無提插組，選擇穴位為神門和太衝穴，並使用「王琦九種體質量表」做受試者的體質分析、「貝克憂鬱量表」評估受試前後憂鬱症狀改善程度，試驗固定為一週2次，每次15分鐘，總共2個月16次，研究成果以成對t-檢定(paired t-test)，檢驗接受提插雷射針灸與無提插雷射針灸後，其憂鬱量表分數與雷射針灸前是否具有顯著差異。結果討論：在體質分析方面，以「王琦中醫體質量表」進行統計分析，發現受試者的體質以氣鬱和氣虛最多。在雷射針灸治療方面，檢視雷射針灸治療後與治療前之貝克憂鬱量表後測分數降低情況，發現有提插組受試者的分數下降平均值，為無提插組受試者的的3倍左右；進行雙母體t檢定發現兩者具有顯著差異 (p<0.05)，因此本試驗的結果表示雷射針灸可以減緩憂鬱症狀，且有補泄提插比起無補泄提插的療效有顯著差異。此外，試驗過程中，無受試者出現暈針、疼痛或壓力等不適等副作用，顯示雷射針灸為一種安全且無侵入式的治療方法。

關鍵字

憂鬱症；貝克憂鬱量表；雷射針灸；擬真雷射針灸

並列摘要

Objectives: According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Depressive disorders include disruptive mood, dysregulation disorder, major depressive disorder (major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. There is underlying cause unknown for depression. The pathogenesis of depressive disorders arises from four hypotheses, first, neurotransmitter deficits associated with serotonin, tryptophan (serotonin precursor), noradrenaline, and dopamine, second, regions of the brain associated with structural and functional changes, third, inflammatory and oxidative stress hypothesis--cytokines, and last, neurotrophin hypothesis. Materials and Methods: Complementary and alternative medicine therapies(CAM therapies) are increasingly sought out by people with psychiatric disorders. Especially, Traditional Chinese Medicine (TCM) is one of the commonly CAM therapies for depressive disorder. From a TCM perspective, “Patterns (證型)”, a diagnostic conclusion of the pathological changes at a disease, of depressive disorder are about “liver qi depression肝氣鬱滯證 (19.65%),” “dual deficiency of the heart-spleen心脾兩虛證(7.42%),” and “binding of phlegm and qi痰氣鬱結證(3.64%).” We found that most clinical trials are aimed at disruptive mood, and major depressive disorder by acupuncture, and indicated “Acupuncture is a safe and effective therapy for depressive disorder.” Result and Discussion: In our single-blind, controlled trial, we use the “Emulated laser-acupuncture system,” designed by Dr. Chih-Yu Wang, to treat the depressive symptoms and have a performance evaluation of lifting–thrusting function. There are 20 patients with depression were recruited from New Age Chinese Medicine and Healthcare Clinic. Patients were randomized to one of two arms using a ratio of 1:1 to laser acupuncture with lifting–thrusting function, and laser acupuncture without lifting–thrusting function. The primary outcome was the difference in mean Beck Depression Inventory (BDI-II) scores before the trial with secondary analyses over 8 weeks follow-up. Analysis was by intention-to-treat. BDI-II data were available for 20 patients before the trial and at 8weeks. Patients attended a mean of 16 sessions for laser acupuncture, twice per one week. Both of two laser acupuncture groups have a reduction in mean BDI-II scores at 8 weeks. But, Compared to laser acupuncture without lifting–thrusting function group , there was a most statistically significant reduction in mean BDI-II scores at 8 weeks for laser acupuncture with lifting–thrusting function(p<0.05).There is not associated with serious adverse events. Besides we also use Chinese Medicine Questionnaire, designed by Wang Qi to survey TCM constitutions of our depressive patients, and we found the TCM constitutions of our depressive patients are “Qi depression,” AND “Qi deficiency”. In conclusion, to our knowledge, our study is the first to rigorously evaluate the clinical and economic impact of laser acupuncture with lifting–thrusting function. We have provided evidence that laser acupuncture with lifting–thrusting function is associated with a much significant reduction in symptoms of depression in the short to medium term, and is not associated with serious adverse events. Although, they both have a reduction in mean BDI-II scores.

並列關鍵字

Depression ； Beck Depression Inventory (BDI-II) ； Laser acupuncture ； Emulated laser-acupuncture system

參考文獻

[1]Depression and Other Common Mental Disorders: Global Health Estimates.Geneva:World Health Organization, 2017. Licence: CC BY-NC-SA3.0 IGO.

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