| Objectives:To investigate the distribution pattern of force-sensitive acupoints in patients with irritable bowel syndrome(IBS),and to measure the changes in pain thresholds before and after acupuncture treatment at force-sensitive high-incidence acupoints using a hand-held pain meter;to compare the efficacy of acupuncture at force-sensitive acupoints and traditional acupoints in alleviating the condition of patients with IBS and improving their quality of life and anxiety and depression,with a view to providing a reference basis for clinical optimization of IBS treatment protocols.Methods:Trial 1: Ninety patients with IBS were screened for force-sensitive acupuncture point exploration and the results were recorded in detail.The SPSS 24.0 analysis was used to summarise the areas of high incidence of force-sensitive acupuncture points,the distribution of meridians and the distribution pattern of force-sensitive acupuncture points on the head and face,chest and abdomen,waist and back and extremities of IBS patients.Trial 2: Sixty-seven patients with IBS who presented with five or more force-sensitive acupoints in Trial 1 were included,and the patients were divided into 33 cases in the test group(force-sensitive acupuncture group)and 34 cases in the control group(traditional acupuncture group)using the random number table method and the envelope method.Five force-sensitive acupoints with the highest sensitivity were selected for acupuncture in the test group,and Baihui,Zhonggui,Tianshu,Feosanli and Shangjiuxu were acupunctured in the control group.Patients in both groups were treated 5 times a week consecutively for the first 2 weeks,and once every other day for the second two weeks,3 times a week,once a day for 30 minutes,for 4 weeks,for a total of 16 treatments.Pressure pain thresholds were measured using a hand-held pain meter before and after 4 weeks of treatment in the force sensitive hyperacute area respectively.The primary outcome indicator for this study was the IBS Severity Scale(IBS-SSS)and the secondary outcome indicators were the IBS Quality of Life Scale(IBS-QOL),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)scores and pain thresholds at the force sensitive hyperacute points.All data collected were statistically analysed by SPSS24.0 software.The above scales were assessed at entry,after 4 weeks of treatment and at 4 weeks follow-up after the end of treatment.Results:1.Trial 1 results: A total of 90 patients with IBS were recruited for the study,and force-sensitive acupoints were found in 75 patients,with a total of 43 acupuncture points and 675 frequencies,83.3% of the patients had force-sensitive acupuncture points,with an average of about9 acupuncture points per patient,and 67 patients had 5 or more force-sensitive acupuncture points.The top five acupoint areas in terms of frequency of force-sensitive acupoints in IBS patients were Yinlingquan(42),Baihui(37),Taichong(36),Tianshu(32),and Hegu(29),which were mainly located in the areas innervated by the greater occipital nerve,C6,T10,L3,and L4 ganglia.And the top five meridians in terms of frequency were the Foot Taiyin Spleen Meridian with a total frequency of 124(18.4%),the Foot Yangming Stomach Meridian with a total frequency of 104(15.4%),the Hand Yangming Large Intestine Meridian with a total frequency of 96(14.2%),and the Ren Meridian with a total frequency of76(11.3%).76 frequencies,or 11.3%;and 56 frequencies,or 8.3%,for the foot solar bladder meridian.According to body parts,force sensitive acupoints were distributed in the lower limbs a total of 220 points(32.6%),the lower back 139 points(20.6%),the chest and back 129 points(19.1%),the upper limbs 96 points(14.2%)and the head and face 91 points(13.5%).2.The results of the Trial 2 study showed that:(1)Completion of the trial in both groups: A total of 67 patients with IBS were enrolled in the study and 63 were completed.2 cases were lost due to pain or withdrawal on their own,respectively,and the completion of the trial in both groups was balanced and consistent.The age,gender,duration of disease and outcome indicators of the subjects in each group were consistent at baseline(P > 0.05)and comparable.(2)Recent efficacy(after 4 weeks of treatment): compared with the pre-treatment period,both acupuncture at the force-sensitive acupoint and the traditional acupoint reduced the severity of IBS patients’ morbidity and decreased IBS-SSS,IBS-QOL,HAMD and HAMA scores(P < 0.05);When compared between the two groups after treatment,the magnitude of reduction in IBS-SSS,IBS-QOL,HAMD and HAMA scores by acupuncture at the Li-Min acupoint was significantly greater than that at the traditional acupoint,and the differences were all statistically significant(P <0.05).(3)Long-term efficacy(4 weeks after the end of treatment): Both groups reduced IBS-SSS,IBS-QOL,HAMD and HAMA scores at follow-up compared to the pre-treatment period in this group,with statistically significant differences(p < 0.05).When the two groups were compared between groups at the same time,the reduction in all four scale scores was significantly better in the test group than in the control group(p< 0.05).(4)Analysis of pain thresholds: After 4 weeks of treatment,the pain thresholds of the five pairs of acupoint areas,Yinlingquan,Taichong,Baihui,Tianshu and Hegu,increased,with statistically significant differences before and after treatment(P < 0.05).Conclusion:1.The distribution pattern of force-sensitive acupoints shows that force-sensitive acupoints in IBS patients are mainly located in the lower limbs and lumbar abdomen,with the highest correlation with the spleen meridian,followed by the stomach meridian,large intestine meridian,Ren meridian and bladder meridian;the acupuncture areas with a high frequency of force-sensitive acupoints are Yinlingquan,Baihui,Taichong,Tianshu and Hegu,followed by Dabao,Zusanli,Quchi,Shuaigu and Pishu.And Force-sensitive acupoints in IBS patients are mainly located in the areas innervated by the greater occipital nerve,C6,T10,L3,and L4 nerve segments.2.In terms of clinical efficacy,acupuncture of both force-sensitive and traditional acupuncture points can alleviate the severity of IBS patients and improve quality of life and anxiety and depression,but stimulation of force-sensitive acupuncture points is more effective than traditional acupuncture points in terms of both immediate and long-term efficacy,suggesting that we should pay attention to the exploration and application of acupuncture points in the sensitized state in clinical practice.3.From the pressure pain threshold analysis,the pressure pain threshold of force sensitive acupuncture points increased after treatment.According to the results of the previous study,the pressure pain threshold of IBS patients was lower than that of healthy subjects,it was speculated that the efficacy of force sensitive acupuncture might be related to the increase of pressure pain threshold of acupuncture points,and force sensitive acupuncture could promote the recovery of patients to a healthy state. |
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