| ObjectiveThis study intends to use the published NAMCS survey database to analyze the characteristics of IBS-D in the United States and to understand the current status and trends of IBS-D treatment in the United States.Ling-nan fire needle acupuncture treatment is the author' s Ph.D.advisor,Professor Lin GuoHua' s specialized method of treating patients for decades.The Ling-nan fire needle acupuncture treatement is very effective without the side effects from western medicines.It is widely used in clinical treatment of vairous kinds of diseases including IBS-D.According to the author's reseach based on the NAMCS survey database,the incidence of IBS-D in the United States is high,and it is growing steadily year by year.In terms of treatment,traditional Chinese medicine treatment is rarely used.In order to improve the cure rate of IBS-D,reduce the recurrence rate,improve the quality of life of patients,enrich the treatment of IBS-D in the United States,and promote the use and development of Lingnan fire acupuncture in the United States,a clinical study of Ling-nan fire needle acupuncture treatment of IBS-D spleen and kidney yang deficiency syndrome is performed.MethodsPart 1:Analysis based on the survey data of NAMCS from 2006 to 2014.Based on relevant cases,from basic demographic characteristics,basic h ealth conditions,gastrointestinal complications,extra-digestive tract c omplications,basic medical conditions,relevant tests and examinations,non-pharmacological therapy,drug therapy,admission to health service pr oviders,research with respect to various types of health service provide rs from the logistic regression analysis is performed to understand the c haracteristics of IBS-D in the United States,and the current status and trends of treatment in the United States.Part 2:This study is a clinical trial.Research objects were selected,during the period from January 2018 to January 2019,from patients of the acupuncture clinics and acupuncture and chiropractor rehabilitation center in the first affiliated hospital of Guangzhou University of Traditional Chinese Medicine.Strict inclusion criteria was applied to select 96 eligible patients in the randomized controlled trial.The patients were randomly assigned to three groups A,B,C.The data related to six of the 96 patients was excluded from the final data statistical research because of dissatisfaction of a total number of treatments exceeding a half of the expected number of treatment.The remaining patients are divided into three groups:group A(Ling-nan fire needle group),group B(routine acupuncture group),and group C(western medicine group),30 cases in each group,with a total course of treatment for 4 weeks.The diarrhea symptoms integral scale of traditional Chinese medicine were used,with respect to three kinds of treatments before and after treatment,for evaluation,statistics,comparison and analysis.Follow-up 1 month after the end of treatment was conducted to compare the relapse rate.In this study,three groups were compared before and after treatment.The study is not a blind study,but an open study.Group A(Ling-nan fire needle group):Shenque,Tianshu,Shangjuxu,Dachangshu,Yinlingquan,Shenshu,Mingmen,Guanyuan,Pishu,Zusanli.Suspended moxibustion is used with respect to Shenque acupuncture.Needle selection:a manganese alloy fine fire needle with a diameter of 0.5mm,a needle handle and a needle body both 4cm long.Operation:first disinfect the acupoints with Anil iodine,then apply a small amount of Wanhua oil to the puncture site.Burn the needle tip and body to bright red,using high frequency light quickly point method,shallow point not retaining needle,with a depth of less than 0.1 inch,at a speed of 100 times per minute prick,every point 5 times,applying daub flower oil in the fire needle prick for alleviating patients before and after burning sensation and promote fire needle wound healing,for treatment of twice per week for a total of four weeks.Group B(routine acupuncture group):Shenque,Tianshu,Shangjuxu,Dachangshu,Yinlingquan,Shenshu,Mingmen,Guanyuan,Pishu,Zusanli.Needle selection:1 inch(0.30x25mm)or 1.5 inch(0.30mmx40mm)disposable sterile acupuncture needles of Suzhou Huatuo Brand are uniformly selected for needles,which are produced by Suzhou Medical Supplies Factory Co.,LTD.Operation:adopt the method of alternating acupuncture in supine and prone position.(1)take the supine position:with the fast needle manipulation acupuncture tianshu,on juxu,Yin lingquan,guan yuan,zusanli,shenque acupoint using cyclotron moxibustion method,after insertion of the needle,told the research objects not to easily change the position,so as to avoid adverse events of acupuncture.Manipulated the needle every 3?5 minutes,with the needle retained for 30 minutes after each manipulation.(2)the patient was placed in the prone position,and the acupuncture treatment was performed on large intestine,kidney,mingmen and spleen.After the insertion was completed,the research objects were instructed not to change their positions easily,so as to avoid acupuncture accidents.The needle is manipulated every 3?5 minutes,using line twist turn fill method.Leave the needle for 30 minutes.Performing acupuncture treatment on both the front and back sides of each research object's body is deemed one treatment.Two treatments a week for four weeks.Group C(western medicine group):pivexium bromide tablets(deschute)(France,batch number:H2011022 manufacturer:suwei pharmaceutical)50mg each time,tid,and taken by oral.Do not swallow or smash the tablets during eating.Do not take them in the lying position or before going to sleep.Course of treatment:all patients in the three groups were observed for efficacy during 4 weeks of treatment,followed up after 1 month of treatment,without other therapies during the treatment.Patients were instructed to eat a light diet,avoid spicy,cold and other stimulating foods,avoid fatigue and cold,relax and feel comfortable.ResultsPart 1:1.Demographic characteristics of IBS-D patients in the United States and the correlation between basic health information and illness.We include data from NAMCS between 2006 and 2014.According to the analysis,the increased number of cases in the United States is stable every year.Among them,age,gender,race and payment methods were all significant demographic characteristics(P<0.05),and from the case count,the number of female patients was more than that of males,and it was statistically significant.(P<0.05).However,based on current statistics,there was no significant correlation between the area of IBS-D cases distributed in the United States and IBS-D(P>0.05).There are also significant associations between the inclusion of whole blood analysis and sigmoid colon-coldoscopy in the included cases and whether or not IBS-D was present,and more cases of sigmoid colonoscopy were included in IBS-D cases(OR>1 and P(0.05).In terms of the health care provider's specialist status,the correlation between the health care provider's specialist condition and the IBS-D is significant;in the type of health care provider,which type of health care providers that take the patients has a significant correlation with the fact that whether the patients has IBS-D syndromes.The IBS-D patients are normally seen by physicians(OR>1 and P<0.05);and the other type of patients including medical assistants,nurses/midwives,registration/licenses Nurses and other health care providers did not find a significant association with IBS-D(P>0.05).2.Correlation between disease or symptoms and disease in patients with IBS-D in the United States.Tobacco use,BMI,and diabetes are significant factors in terms of basic health status in patients with IBS-D,and there were fewer IBS-D cases with diabetes(OR<1 and P<0.05);There was no significant correlation between hypertension,hyperlipidemia,and asthma and IBS-D(P>0.05).In terms of gastrointestinal complications,symptoms such as dyspepsia,gastroparesis,bloating,abdominal pain,diarrhea,constipation,and gastroesophageal reflux are significantly associated with IBS-D,and the above symptoms or diseases are in IBD.More common in IBS-D cases(OR>1 and P<0.05).There is a significant correlation between back pain,depression and IBS-D in comorbidities outside the digestive tract,and IBS-D patients have more cases of depression(OR>1 and P<0.05).There was no significant correlation between thyroid dysfunction,chronic fatigue syndrome,allergic rhinitis,bone and joint disease,headache,polyuria/nocturia,and IBS-D(P>0.05).3.Correlation between treatment and illness in American IBS-D patients.In non-drug therapy,there was a significant correlation between diet/nutrition regulation,replacement therapy,psychotherapy and IBS-D(P<0.06),among which IBS-D cases used more diet/nutrition regulation and alternative therapy as non-Medication(OR>1 and P<0.05);no correlation between exercise and acupuncture was found to be associated with IBS-D(P>0.06).In terms of drug therapy,whether prebiotics,antidiarrheals,laxatives,antibiotics,antispasmodics,antidepressants,etc.were significantly associated with IBS-D(P<0.06),and IBS-D cases were more used.Prebiotics,antidiarrheal drugs,laxatives,antispasmodics,antidepressants and other programs as a means of drug treatment(OR>1 and P<0.05),among which prescription antidepressants and solutions for patients with IBS-D between 2006 and 2014 Tinctures are used in more quantities than other drugs.There was no significant correlation between the use of herbal products and IBS-D(P>0.05).Part 2:1.Comparison of baseline data showed that there were no statistically significant differences in age,gender,course of disease,and score of TCM diarrhea scale between the three groups before treatment(P>0.05),which was comparable.2.Overall efficacy:In the three groups of overall clinical efficacy evaluation,the overall efficacies of the three groups of patients are different,and statistically significant(P<0.001).The comparison of overall efficacy between each pair among the three groups of patients suggests that:the comparison between group A and group C,with P<0.001*,is statistically significant,and suggests that the overall efficacy of group A is better than group C;the comparison between group A and group B,with P=0.033<0.05 is statistically significant,and suggests the overall efficacy of group A is better than that of group B;and the comparison between group B and group C,with P=0.027<0.05,is statistically significant,and suggests the overall efficacy of gorup B is better than that of group C.The comparisons collectively suggests the overall efficacy of Ling-nan fire needle acupuncture group is better than conventional acupuncture treatement and western medicine treatment,and the overall efficacy of conventional acupuncture treatment is better than western medicine treatment.3.Accumulative symptom scores:There is a statistically significant difference(P<0.001)between the accumulative symptom scores after treatment for the three groups of symptoms after treatment.In the multiple comparisons of the post-treatment scores of the three groups of patients after the treatment,the accumulatie symptom score of the A group are less than those of the B group(P<0.05)and the C group(P<0.001).However,the difference between the accumulative symptom scores of the B group and the C group after treatment is not statistically significant,suggesting that Ling-nan fire needles can improve overall symptoms compared with conventional acupuncture and western medicine.In the comparison of the accumulative symptom scores of the three groups before and after treatment,the accumulative symptom scores of the three groups are significantly lower after treatment than before treatment(P<0.05),suggesting Ling-nan fire needle,conventional acupuncture and western medicine.These three treatments have a certain effect on improving symptoms.The difference between the three groups of patients before and after treatment was statistically significant(P<0.001).In the multiple comparisons of the post-treatment scores of the three groups of patients after treatment,the total scores of the scores before and after treatment in group A were significantly higher than those in group B(P<0.06)and group C(P<0.001).However,the difference between the scores of symptom scores before and after treatment between group B and group C was not statistically significant,suggesting that Ling-nan fire needle is more effective in improving symptoms than conventional acupuncture and western medicine.4.The improvement of clinical symptoms:the comparison of the scores of the three groups of patients after treatment,can be seen after the treatment of "chills and colds","waist and knee pain","appetite","intestinal" and other four symptoms between the three groups There were differences in the scores(P<0.001).The comparison of the above symptom scores showed that there was no significant difference in the scores of stool diarrhea,abdominal distension and abdominal pain after treatment in the three groups(P>0.05),It is indicated that there is no significant difference in the efficacy of the three regimens for the above symptoms.The scores of the two groups were compared between the two groups(P<0.05),and the difference was statistically significant.Group B and C group.There was no statistical difference(P<0.05).It shows that the treatment plan of Ling-nan fire needle has the most prominent effect on the symptoms of chills,cold limbs and waist and knee pain.There is no difference between conventional acupuncture and western medicine.There were differences between the two groups in the treatment of loss of appetite and bowel symptoms.There were differences between group A and group B and group B and group C(P<0.05).The difference was statistically significant.There was no statistical comparison between group A and group B.Learning differences(P>0.05).It shows that Ling-nan fire needle and conventional acupuncture method have no significant difference in the efficacy of appetite and bowel sounds,but it is better than western medicine.5.Patient IBS-QOL quality of life evaluation.The various scores and the total score of the three groups before and after IBS-QOL quality of life treatment are statistically analyzed,and there is a significant decrease(P<0.06).This suggests that Ling-nan fire needle,ordinary fire needle and western medicine can be significant under the three methods.Improve the quality of life of patients with IBS-D.There were statistical differences in the scores of the three dimensions of anxiety,anxiety,behavioral disorder,physical consciousness,social function,sexual behavior,and interpersonal relationship after treatment(P<0.05).After multiple comparisons,Ling-nan fire acupuncture treatment(group A)scored more on anxiety,behavioral disorder,physical consciousness,social function,sexual behavior,interpersonal relationship and other dimensions than other groups(conventional acupuncture and western medicine treatment).It has advantages and is statistical]y significant(P<0.06).In the total score,there was a statistically significant difference in the total scores of the IBS-QOL scale between the three groups(P<0.05).After multiple comparisons,the total score after the treatment of Ling-nan fire acupuncture was significantly lower than other treatments(P<0.05).).Therefore,it shows that Ling-nan fire needle has more advantages than ordinary fire needle and western medicine treatment in improving the quality of life of patients with IBS-D.There are significant differences in the decline of IBS-QOL quality of life scores between the three groups before and after treatment.There are statistical differences in the scores of the three groups of anxiety,behavioral disorder,physical consciousness,and interpersonal relationship(P<0.05).After multiple comparisons,Ling-nan fire acupuncture treatment(group A)was larger than other groups(conventional acupuncture and western medicine treatment)in the degree of anxiety,behavioral disorder,physical consciousness,and interpersonal relationship scores,and was statistically significant(P<0.05).In the total score,there was a statistically significant difference in the total score of the IBS-QOL scale between the three groups(P<0.06).After multiple comparisons,the total score after the Ling-nan fire acupuncture treatment decreased more than other treatments.Large;suggest that Ling-nan fire needle is better than ordinary fire needle and western medicine treatment in improving the quality of life of patients with IBS-D.6.Long-term efficacy:after 1 month of treatment suspension,the relapse rate of patients' symptoms is significantly lower in group A(7.14%)vs.group B(34.61%)vs.group C(36.36%),and the difference is statistically significant(P<0.05).Pairwise comparison shows that the relapse rates of groups A and B and groups A and C are significantly different(P<0.05).The differences were statistically significant,indicating that the relapse rate with respect to Ling-nan fire acupuncture treatment was less,the long-term curative effect was more stable and long-lasting,and the long-term curative effect of conventional acupuncture and western medicine was poor,and the relapse rate was high and comparable.This is of great significance for improving the quality of life of patients with IBS-D.ConclusionLing-nan fire needle acupuncture treatment,conventional acupuncture and western medicine treatment have certain curative effect on spleen and kidney yang deficiency type(IBS-D),which can improve the clinical symptoms of patients to varying degrees.However,in terms of overall efficacy,Ling-nan fire needle acupuncture treatment is superior to the other two types of therapeutic method.The effect of warming Yang and tonic is especially effective for chills,cold limbs,waist and knee pain and other symptoms of yang deficiency.Moreover,the long-term efficacy of Ling-nan fire needle acupuncture treatment is more stable,and the relapse rate is significantly lower than the other two types of therapeutic methods,and it also shows obvious advantages in the improvement of quality of life.In the United States,Chinese medicine and acupuncture are still not very popular in the treatment of IBS-D.However,Ling-nan fire needle acupuncture treatment has great value and potential of increased popularization in the United States. |
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