子午流注择时杵针在CRC术后癌因性疲乏气血亏虚证患者中的应用研究

Application of Midnight-Noon Flow Doctrine Timed a Pestle Needle in Patients with Qi and Blood Deficiency Syndrome of Cancer-Related Fatigue after CRC Surgery

摘要: 目的：CRC术后患者常伴癌因性疲乏，常常困扰着患者的日常生活，非药物治疗在改善CRC术后患者癌因性疲乏症状、提高其生活质量方面具有潜力。本研究拟运用子午流注择时杵针对CRC术后癌因性疲乏气血亏虚证的患者实施干预，观察其对CRC患者术后癌因性疲乏的有效性及安全性。方法：选取2023年4月~2024年4月成都市某三甲医院肿瘤科、普外科CRC术后癌因性疲乏气血亏虚证住院患者共135例作为研究对象，采用随机数字表法分为对照组、试验组1、试验组2，每组45例，三组患者在年龄、性别、病情等一般资料方面比较，差异无统计学意义(P > 0.05)，具有可比性。对照组给予CRC手术常规护理，试验组1在对照组的基础上给予子午流注择时杵针技术(选择巳时(9:00~11:00)足太阴脾经流注时辰进行施杵(选择百会八阵、神道八阵、腰阳关八阵、河车路脑户至大椎段、至阳至命门段为主穴，神门、三阴交、足三里为配穴)，1次/日，30 min/次，共计7天)，试验组2在对照组的基础上给予杵针技术(施杵方法同试验组1，施杵时间14:00~18:00的任意时间段)，并对干预后患者的疲乏程度、中医证候积分和疗效进行评价。结果：对照组、试验组1、试验组2三组患者在术后及干预后的癌因性疲乏四个维度评分中，试验组1得分均低于试验组2，试验组2得分低于对照组，三组组间比较具有统计学意义(P < 0.05)，且试验组1与试验组2、对照组两两比较，差异均具有统计学意义(P < 0.05)；试验组2与对照组比较，差异具有统计学意义(P < 0.05)。中医证候积分方面，干预后积分均低于干预前，且三组组间比较具有统计学意义(F = 15.305, P < 0.001)。在中医疗效方面，试验组1痊愈3例，显效19例，效果均优于对照组和试验组2，且三组组间比较具有统计学意义(H = 19.952, P < 0.001)。且中医症候积分与中医疗效方面，两两组间比较，试验组1优于试验组2与对照组，说明差异均具有统计学意义(P < 0.05)。结论：子午流注择时杵针可有效改善CRC术后患者的癌因性疲乏，能有效改善患者的气血亏虚中医证候，提高中医疗效，值得临床推广。

Abstract: Objective: Patients undergoing colorectal cancer (CRC) surgery often experience cancer-related fatigue, which significantly impacts their daily lives. Non-pharmacological interventions show potential in alleviating symptoms of cancer-related fatigue and improving patients’ quality of life postoperatively. This study aimed to evaluate the efficacy and safety of applying the Ziwu Liuzhu Timing Acupuncture Technique for patients with CRC-associated cancer-related fatigue and Qi-Blood Deficiency syndrome. Methods: A total of 135 hospitalized patients with CRC-associated cancer-related fatigue and Qi-Blood Deficiency syndrome from the Oncology Department and General Surgery Department of a tertiary hospital in Chengdu between April 2023 and April 2024 were enrolled as study subjects. They were randomly divided into a control group, Trial Group 1, and Trial Group 2 (n = 45 each) using a random number table. No statistically significant differences were observed in baseline characteristics such as age, gender, or disease severity among the groups (P > 0.05), ensuring comparability. The control group received standard postoperative care for CRC patients. Trial Group 1 additionally received Ziwu Liuzhu Timing Acupuncture Therapy (applied during the flow period of the Spleen Meridian at 9:00~11:00 AM; key acupoints included Baihui Bazhen, Shendao Bazhen, Yaoyangguan Bazhen, Heche Lubaohu to Dazhui, and Zhiyang Zhimingmen; supplementary points included Shenmen, Sanyinjiao, and Zusanli; administered once daily for 30 minutes over 7 days). Trial Group 2 received the same acupuncture technique but at any time between 2:00 PM and 6:00 PM. Post-intervention assessments included fatigue severity scores, Traditional Chinese Medicine syndrome scores, and therapeutic outcomes. Results: In terms of the four-dimensional scores for cancer-related fatigue postoperatively and after intervention, all three groups (control group, Trial Group 1, and Trial Group 2) showed statistically significant differences: Trial Group 1 scored lower than Trial Group 2, while Trial Group 2 scored lower than the control group (P < 0.05). Pairwise comparisons between Trial Group 1 and both Trial Group 2 and the control group were also statistically significant (P < 0.05); similarly, Trial Group 2 exhibited a statistically significant difference compared to the control group (P < 0.05). Regarding Traditional Chinese Medicine (TCM) syndrome scores, all groups demonstrated decreased scores post-intervention compared to pre-intervention levels, with statistically significant differences among groups (F = 15.305, P < 0.001). In terms of TCM therapeutic efficacy, Trial Group 1 achieved complete recovery in 3 cases and marked improvement in 19 cases, both significantly superior to the control group and Trial Group 2, with statistically significant differences among groups (H = 19.952, P < 0.001). Furthermore, pairwise comparisons revealed that Trial Group 1 outperformed both Trial Group 2 and the control group in both TCM syndrome scores and therapeutic efficacy, demonstrating statistically significant differences (P < 0.05). Conclusion: The application of Ziwu Liuzhu timing acupuncture can effectively alleviate cancer-related fatigue in colorectal cancer (CRC) patients, improve TCM syndrome manifestations of qi and blood deficiency, and enhance TCM therapeutic efficacy, making it worthy of clinical promotion.