Non-alcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury closely related to insulin resistance and genetic susceptibility, including non-alcoholic simple fatty liver, non-alcoholic steatohepatitis and its related cirrhosis and liver cancer . NAFLD is the most common chronic liver disease in the world, with an adult prevalence of 6.3% to 45.0% [1]. Only epidemiological surveys in Shanghai, Beijing and other regions in my country showed that the adult prevalence rate increased from 15% to more than 31% in the past 10 years. Long-term clinical practice and research have shown that traditional Chinese medicine has an advantageous effect in the treatment of NAFLD, especially the clinical efficacy of traditional Chinese medicine non-pharmaceutical therapies is good, has no side effects, and is easy to accept [4-5].
acupoint embedding therapy is a common clinical method for treating diseases under the guidance of acupuncture and meridian theory. Under the guidance of the acupuncture meridian theory, medical absorbable surgical sutures are buried into the corresponding acupoints, and the acupoints are stimulated for a long time through various factors. This document is a guide to the treatment of NAFLD based on the contents of GB/T 21709.10-2008. It was published by Chinese Society of Traditional Chinese Medicine and the number is T/CACM 1382-2022.
The purpose of this guideline is to ensure the clinical safety and effectiveness of acupuncture-embedded thread treatment NAFLD through the operation technology [8] of acupuncture-embedded thread treatment, and provide new ideas and new methods for the clinical treatment of NAFLD, which is conducive to the promotion and popularization of non-drug therapy in traditional Chinese medicine.
This guide uses the "Suggestions on Clinical Evidence Grading Standards for Traditional Chinese Medicine Clinical Evidence Based on Evidence" [9] as a reference to grading the evidence. The expert group used the modified Delphi method to agree on the recommendation opinions, and followed the grid counting rules of the quantitative system evaluation evidence grading tool (GRADE) to classify recommendation opinions, including: strong recommendation, strong recommendation, weak recommendation, weak recommendation, and no clear recommendation.
This guide provides treatment plans, operating methods and requirements, clinical observation indicators and other contents for acupuncture and buried thread therapy in the treatment of NAFLD. It is suitable for clinical physicians in related departments such as the Department of Traditional Chinese Medicine and Integrated Traditional Chinese Medicine in the General Hospital, the Department of Liver Diseases in the Traditional Chinese Medicine Hospital, the Department of Liver Diseases in the Department of Gastroenterology, the Department of Acupuncture, the Department of , and the Department of in the Department of Primary Hospital of Traditional Chinese Medicine. It is suitable for traditional Chinese medicine clinical treatment for patients aged 16 to 60 and diagnosed with NAFLD. Not suitable for traditional Chinese medicine clinical treatment of NAFLD-related cirrhosis and liver cancer.
18 Selected acupoints
acupoints burying thread to treat NAFLD with the basic principle of replenishing deficiency and eliminating excess. The syndrome differentiation classification is formulated based on the "Consensus Opinions on Experts in Traditional Chinese Medicine Diagnosis and Treatment of NAFLD Chinese Medicine Diagnosis and Treatment (2017)" [10] formulated by the Spleen and Stomach Disease Branch of the Chinese Society of Traditional Chinese Medicine. When selecting acupoints, you should treat them according to the syndrome differentiation, and add or subtract according to the syndrome. You should not select too many main acupoints and matching acupoints each time.
1.1 Syndrome typing
1.1.1 Internal discontinuation of dampness and turbidity
Main symptoms: fullness of the right flank ribs; secondary symptoms: obesity, heavy body, fatigue, chest and abdominal distension, dizziness, nausea; tongue pulse: pale red tongue, white and greasy coating; pulse string slippery.
1.1.2 liver depression and spleen deficiency syndrome
Main symptoms: fullness or pain in the right ribs, which are often induced by worries and depression; secondary symptoms: abdominal distension, loose stools , abdominal pain and diarrhea, fatigue, chest tightness , Shantaixi; tongue pulse: pale tongue with tooth marks, thin white or greasy coating; stringy or stringy pulse.
1.1.3 Consistency of dampness and heat
Main symptoms: swelling and pain in the right flank ribs; secondary symptoms: nausea, vomiting, jaundice , chest and abdomen, heavy sleepiness throughout the body, and dullness; tongue pulse: red tongue, yellow and greasy tongue coating; moist or slippery pulse.
1.1.4 Symptoms of phlegm and stasis
Main symptoms: lumps under the right flank or tingling pain in the right flank ribs; secondary symptoms: dullness in the abdomen, tightness in the chest and abdominal distension, dark complexion; tongue pulse: pale and dark tongue with ecchymosis, greasy coating; stringy and slippery pulse or astringent.
1.2 Main acupoints
Zhongwan, Tianshu (bilateral), Zusanli (bilateral), Ganshu (bilateral), and splenic shu (bilateral) (evidence level: II, strongly recommended [5, 7, 11-19]).
1.3 Acupoint
damp turbidity internal discontinuation: Fenglong (bilateral), Yinlingquan (bilateral), Guanyuan (evidence level: II, strong recommendation [12-13]). Hepatic depression and spleen deficiency syndrome: Daheng (bilateral), Yanglingquan (bilateral), gallbladder shu (bilateral) (evidence level: II, weakly recommended [14-15]).The evidence of damp heat accumulation: Quchi (bilateral), Yinlingquan (bilateral), Fenglong (bilateral) (evidence level: III, weakly recommended [16-17]). Symptoms of phlegm and blood stasis: Blood Sea (bilateral), Diaphragm (bilateral), Fenglong (bilateral) (evidence level: Ⅲ, weakly recommended [4, 18]).
2 Operating supplies, disinfection requirements and specific operating procedures
2.1 Operating supplies
2.1.1 Needle
Select different types and models of disposable sterile thread embedded needles according to the different types and models of operation sites. The outer packaging of the selected needle is not damaged, the needle body is smooth, no curved, and the needle is sharp and no barb.
2.1.2 Line body
Acupoint burial lines commonly used include: medical sheep intestinal lines , collagen lines, and polymer . Lines of different materials and lengths can be selected according to the type of line, operating part and physical constitution. It is recommended to use polylactic glycolate (PGLA) absorbable surgical suture, 1.5 cm long (evidence level: II, strongly recommended [7-9, 11-16]).
2.1.3 Position Select the position of
for patients to take a comfortable and convenient position for doctors. Commonly used positions include lying position and sitting position.
2.1.4 Environmental
The environment is clean and hygienic, avoid pollution, and regularly disinfect ultraviolet rays.
2.2 Disinfection
2.2.1 Device disinfection
Select appropriate disinfection or sterilization methods based on the material, which meets the requirements of GB 15981-1995. Disinfection of disposable medical supplies meets the requirements of GB 15979-2002.
2.2.2 Site disinfection
Use 0.5% iodine at the application site to sterilize from the center to the outer ring. Or wipe with 2% iodine wine and then deiidize with 75% ethanol.
2.2.3 Disinfection of the operator
The doctor uses soapy water to clean and rinse the hands with running water, wipe it with 75% ethanol or 0.5% iodine, and then wear sterile gloves.
2.3 Operation method
2.3.1 Wiring
Use sterile tweezers to clamp the absorbable surgical sutures, so that they can be placed in the front end of the disposable sterile embedded needle tube, and then connect the needle core.
2.3.2 Hold the needle
Press the thumb of the hand to press and fix the skin, hold the thread-burned needle with the thread-body thread-tied finger of the hand, and the right middle finger and ring finger end of the hand are supported next to the operating point.
2.3.3 Insert
Press the thumb and index finger of the hand to tighten the skin on the needle, hold the needle in the hand, and quickly pierce the needle into the skin. After getting angry, the needle is slowly inserted. The depth of the needle is mostly 1.5~3 cm, depending on the patient's body shape and skin condition. See Appendix 1 for common acupuncture needle angle and operation precautions.
2.3.4 After leaving the thread
, you need to get angry under the needle. If the qi is not obvious after the needle tip reaches the acupoint, you can use appropriate lifting, inserting and twisting techniques to take the qi as the degree. When the needle sensation occurs, push the needle core and remove the needle tube while burying the thread into the fat layer or muscle layer.
2.3.5 Removal needle
Follow the following steps: (1) When the thread body is completely buried in the acupoint, the needle has retreated to the shallow layer of the skin. Press it next to the acupoint with one hand with a disinfection dry cotton ball, and quickly pull out the needle with the other hand; (2) If you find bleeding on the needle hole after the needle is discharged, you can press it for several seconds. After the bleeding does not occur, apply medical glue stickers for 2~3 hours.
3 treatment course and follow-up
15 d buried the line once, 6 times are one course. During the treatment period, follow-up should be done once every six months to improve relevant biochemical and imaging examinations (evidence level: III, weakly recommended [19-20]).
4 Notes (strongly recommended [2-3, 9, 12-16, 21])
includes but is not limited to the following aspects.
(1) The operation process remains sterile. (2) Pay attention to the depth of the acupuncture and the angle of the needle when operating to avoid damaging important organs such as the internal organs, spinal cord, large blood vessels and nerve stems, and use them with caution in joints.(3) If a needle break occurs, follow the following steps: ① Instruct the patient to remain calm, maintain the original position, and prevent the needle from entering the deep layer of the body; ② If the needle break is exposed to the outside of the skin, use tweezers to force it out. If the needle break is flush or slightly lower than the skin, you can see that the needle breaking end can be pressed down on both sides of the needle breaking end with the thumb and index finger to expose the needle breaking end, and then use tweezers to force it out; ③ If the needle breaking end completely enters the inside of the body and the surface of the body cannot be reached, surgical methods can be taken out. (4) If a fainting occurs, the operation will be terminated immediately and the treatment will be carried out according to the symptoms of dizziness, which meets the requirements of GB/T 33415-2016. (5) When operating, please note that the thread body is used during the effective period, and the thread body must be completely pushed into the body; if the thread body is exposed, follow the following steps: ① If the thread body is completely exposed to the body during operation, immediately extract the thread body and discard it, and reoperate; ② If the thread head is exposed shortly after operation, you can use your thumb and index finger to lift the skin around it, and the thread head can enter the subcutaneous skin by itself; ③ If the thread head is exposed for a long time after operation, you can use tweezers to pull out the suture. (6) Keep the wound dry, clean and prevent infection after operation. (7) After the operation, conduct regular follow-up and process postoperative reactions in a timely manner. See Appendix 2 for post-treatment reaction treatment methods. (8) After the operation, the diet should be light, spicy and spicy.
5 contraindication certificate (strongly recommended [7, 16, 20, 22-24])
includes but is not limited to the following aspects:
(1) It is not advisable to use the treatment at the skin inflammation, damage, or ulcers; (2) Those suffering from severe skin diseases, severe diabetes and those with low absorption and repair function of skin and subcutaneous tissue caused by various diseases should not use this treatment; (3) Those who are prone to bleeding should not use this treatment; (5) Those who are allergic and scar constitutions should not use this treatment; (6) Those who are mentally nervous, sweating, tired or hungry should not use this treatment; (7) Pregnant women should not use this treatment at the lumbosacral and other acupoints, and should be used with caution during menstruation; (8) Patients with severe liver damage should use it with caution.
68 clinical observation indicators
6.1 Objective indicators
The use of acupuncture thread to participate in the treatment of NAFLD can improve obesity indicators (body quality, BMI, waist circumference, waist-hip ratio , etc.) in NAFLD patients (evidence level: Ⅲ, strong recommendation [12, 19, 25]).
6.2 Traditional Chinese Medicine Syndrome Points
The use of acupuncture threads to participate in the treatment of NAFLD can improve the clinical symptoms and syndromes of TCM in patients with NAFLD to a certain extent (evidence level: Ⅲ, strongly recommended [3, 7, 26]).
6.3 Laboratory index
The use of acupuncture thread to participate in the treatment of NAFLD can improve the AST, ALTh, GGT, TC, TG, TNFα, HDL-C, LDL-C levels in patients with NAFLD (evidence level: Ⅲ, strong recommendation [4, 16, 27-28]); to a certain extent, it can improve the serum leptin level in patients with internal dampness and turbidity syndrome and liver depression and spleen deficiency syndrome (evidence level: Ⅲ, strongly recommended [28]); to a certain extent, it can improve the insulin resistance level in patients with internal dampness and turbidity syndrome and liver depression and spleen deficiency syndrome (evidence level: Ⅲ, strongly recommended [8, 28]).
6.4 Imaging examination
The use of acupuncture thread to participate in the treatment of NAFLD can improve the controlled attenuation parameters (CAP) and cirrhosis (LSM) of liver fat in patients with NAFLD (evidence level: Ⅲ, strongly recommended [22, 29]); to a certain extent, it can improve the liver ultrasound scores of patients with diabetic internal cessation, liver depression and spleen deficiency syndrome, damp heat accumulation syndrome, and phlegm and stasis syndrome (evidence level: Ⅲ, strongly recommended [19, 25]); to a certain extent, it can improve the liver/splenish density ratio (CT value) of patients with liver and spleen syndrome (evidence level: Ⅲ, strongly recommended [7, 30]).
6.5 Adverse reactions and safety evaluation
acupoint embedding treatment may occur within 1 to 5 days after treatment with redness, swelling, pain, nodules, , pinhole infection and fever at the application site (evidence level: Ⅲ, strongly recommended [25, 31]). Therefore, strictly adhere to the sterile operating procedures during the operation, pay close attention to the patient's reaction after the operation to avoid the occurrence of adverse reactions (evidence level: Ⅲ, strongly recommended [21]).
The above specific efficacy evaluation criteria are shown in Appendix 3.
Leading unit: First Affiliated Hospital of Henan University of Traditional Chinese Medicine
Drafting unit: First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Guangxi Province Liuzhou Traditional Chinese Medicine Hospital (Liuzhou Zhuang Medical Hospital), Henan University of Traditional Chinese Medicine Third Affiliated Hospital, Hubei Provincial Hospital of Traditional Chinese Medicine , Hunan Provincial Hospital of Traditional Chinese Medicine (First Affiliated Hospital of Hunan College of Traditional Chinese Medicine), Henan University of Traditional Chinese Medicine , Guangdong Provincial Hospital of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine , Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an Traditional Chinese Medicine Hospital, Shanghai Institute of Acupuncture and Meridians
Main drafters: Zhao Wenxia , Zhou Xiaoling, Zhao Xixin, Xiao Mingzhong, Zeng Yuexiang, Lu Mei, Chen Xiuhua, Li Yong, Chi Xiaoling, Xue Jingdong, Hao Jianmei, Wang Xiaomei, Yang Peiwei, Gu Yajiao, Teng Yingchun, Zhang Feng, Wang Zhen
drafters: Liu Guangwei, Ma Suping, Fei Jinglan, Shao Suju, Liu Xincan, Shao Mingyi, Liu Xiaoyan, Zhang Tao, Yu Dongdong, Lin Hui, Duan Yinghua, Zhang Dongshu, Cheng Yanting, Sun Xuwu, Fan Jiangjun, Zhao Ming, Shao Xianzhi, Zong Yali, Shao Zhilin, Zou Biying, Leiling, He Wenzhong, Jin Qingming, Wu Chenxi, Xiao Demei, Tian Xia, Li Shufang, Shi Huajing, Li Yingwen, Quan Spring Equinox, Hou Jingyue, Zheng Hua, Liu Yijun, Ma Xinwen, Wang Mingyue, Wu Xiling, Song Ziwei, Song Manping, Qin Qingguang
View the original text or download PDF
http://www.lcgdbzz.org/cn/article/doi/10.3969/j.issn.1001-5256.2022.09.008
Citations This article is
Hepatobiliary Disease Branch of the Chinese Society of Traditional Chinese Medicine. Acupoint embedding line treatment of non-alcoholic fatty liver disease traditional Chinese medicine practice guide [J]. Journal of Clinical Hepatobiliary Disease , 2022, 38(9): 1990-1993.
Editor of this article: Xing Xiangyu
Official account editor: Xing Xiangyu
First published on the entire network | "Journal of Clinical Hepatobiliary Disease" 2022 Issue 9 "Integrated Treatment of Cirrhosis and Its Main Complications" Key Number (Executive Editor: Liu Ping)
Comments | Liu Ping: Research progress in the treatment of integrated traditional Chinese and Western medicine in cirrhosis
is all on the official website of "Journal of Clinical Hepatobiliary Disease"
www.lcgdbzz.org
