目的

观察混元灸治疗脾肾阳虚证腹泻型肠易激综合征（IBS-D）的临床疗效。

方法

选取2021年3月至2023年3月在南昌市洪都中医院针灸科、消化科就诊的脾肾阳虚证IBS-D 患者60例。 按照随机数字表法将患者分为Ⅰ组（先灸后西药治疗，30 例）、Ⅱ组（先西药后灸治疗，30 例）。本研究采用随机交叉试验，每例患者均接受混元灸和西药两种治疗方法。 Ⅰ组先采用混元灸治疗，每日1 次，每周5 次，治疗2 周；Ⅱ组先进行口服匹维溴铵片治疗，每次1 片，每日3 次，治疗2 周。 每组均按治疗方法的先后顺序进行，每种治疗方法治疗2 周，两种方法间有2 周的洗脱期。 进行结果统计分析时分别命名为混元灸组和西药组。 观察2 组患者治疗前后症状评分、中医证候积分，并评定临床疗效及安全性。

结果

2 组患者治疗后症状评分、中医症候积分比较，差异具有统计学意义（F ＝24.963、8.522、24.049、27.434、23.946、12.992、371.200，P＜0.05）。 第1 个治疗阶段：混元灸组总有效率86.7%（26/30），西药组总有效率60.0%（18/30），2 组总有效率比较，差异具有统计学意义（χ² ＝5.455，P＜0.05）。 第2 个治疗阶段：混元灸组总有效率83.3%（25/30），西药组总有效率43.3%（13/30），2 组总有效率比较，差异具有统计学意义（χ² ＝10.335，P＜0.05）。

结论

混元灸治疗脾肾阳虚证IBS-D 疗效显著，且安全性良好，值得临床推广应用。

Objective

This study aimed to evaluate the clinical effects and safety of Hunyuan moxibustion in treating diarrhea-predominant irritable bowel syndrome （ IBS-D） with Spleen-Kidney Yang deficiency.

Methods

A total of 60 IBS-D patients with Spleen-Kidney Yang deficiency，who visited the Acupuncture Department and Gastroenterology Department of Nanchang Hongdu Hospital of Traditional Chinese Medicine （TCM） from March 2021 to March 2023 were recruited. Participants were randomly divided into Group I （treated with moxibustion first and then western medicine，30 cases） and Group II （treated with western medicine first and then moxibustion，30 cases）. This study adopted a randomized crossover design，in which each participant received both treatments. Hunyuan moxibustion was administered once daily，five times per week，for two weeks. Western medicine consisted of oral pinaverium bromide tablets （one tablet，three times per day，for two weeks）. A two-week washout period was set between the two treatment phases.When conducting the result statistics and analysis，they were respectively named as the Hunyuan moxibustion group and the western medicine group. Primary outcomes included symptom scores and TCM syndrome scores，assessed before and after treatment. The clinical efficacy and safety of the interventions were also evaluated.

Results

There were statistically significant differences in symptom scores and TCM syndrome scores between the two groups after treatment （F ＝ 24.963，8.522，24.049，27.434，23.946，12.992，371.200，P＜0.05）. In the first treatment stage，the total effective rate of the Hunyuan moxibustion group was 86.7% （26/30），while that of the western medicine group was 60.0% （18/30）. There was a statistically significant difference in the total effective rate between the two groups （χ² ＝5.455，P ＜0.05）. In the second treatment stage，the total effective rate of the Hunyuan moxibustion group was 83.3% （25/30），while that of the western medicine group was 43.3% （13/30）. There was a statistically significant difference in the total effective rate between the two groups （χ² ＝10.335， P ＜0.05）.

Conclusion

Hunyuan moxibustion is an effective and safe treatment for IBS-D with Spleen-Kidney Yang deficiency，demonstrating superior efficacy compared to western medicine. It holds promise for clinical application and further research.