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用浮针针刺后加拔罐放血局部治疗痹痛证的临床疗效

作者:世界针联信息中心 来源:本站原创 点击:44次 更新:2018-04-12

侯幼红,许芳

加拿大好中医药诊所公司

目的:为了观察局部皮下浮针行针扫刺技术及针刺后加拔罐放血法治疗各型痹痛证的临床疗效。

方法:采用皮下浮针痛点行针扫刺技术及针后加用拔罐放血法对67例患各种痹痛证的患者进行治疗观察;其证型包括行痹(12例)、热痹(11例)、痛痹(20例)及(着痹14例),并设10例正常对照组(每次每痛点指压15分钟毕)。治疗组各痛点皮下行针扇形扫刺次后,加拔罐放血1分钟左右;而10例对照组均仅在痛点行局部指压15分钟即毕。2-3次治疗为一个疗程,每周1次,1-2疗程为全部疗程(依临床症状改善情况而定)。患者年龄范围在35-85岁之间,男女比例为31.5。一次性皮下浮针为中国制CE0197型小号针,而真空拔罐器为中国制康慈牌G-18型胶塑罐。并对结果行疗前后的t-检验统计学处理,以p<0.05为差异有显著性。患严重心肺疾病的患者不在此次观察范围之内。

结果:经上述治疗后,止痛消肿的总有效率为92.53±1.25%p<0.01),局部功能改善率90.15±1.01% p<0.05);总有效起效时间为1-2±0.21天,疗后患者生活质量明显提高,并且无1例感染出血等副作用反应发生。

结论:皮下浮针扫刺术是近来发展起来的局部止痛消肿针刺法,在此基础上加用针刺后拔罐放血更增强了止痛消肿的效果,通络活血,且起效时间和临床症状改善率都得到显著的缩短和强化。这是首次进行此种复合性技术治疗的临床报告,实践证明该治疗法具有操作简便、安全有效、起效快和副作用少等特点,不失为一个痹痛证的有效治疗可选方案之一。

关键词:痹痛证     浮针     拔罐

 

(Abstract)                                                                                                                                                             2.

Clinical Effect of Subcutaneous Floating Needling and Following Cupping–Bleeding on the Painful Syndrome (Bi Tong Zheng)

Youhong Hou,   Fang Xu

(Acupuncture-Hou Inc®Canada)

Objectives: Aiming to observe the clinical effect of the compound therapy of subcutaneous floating needling and then cupping-bleeding on the painful syndrome (Bi Tong Zheng).

Methods: Imposing on the technique of the subcutaneous fan-like needling and cupping-bleeding on the painful points to treat locally 67 patients with various types of painful syndrome (Bi Tong Zheng) across the body, including wind Bi anthretis (12 patients), hot bi (11), cold Bi (20) and dampness Bi (14) and 10 no-treated control cases (thumb press for 15 minutes for every point and every treatment). Their age is from 35 to 85 years old, and the gender rate of male : female =3:1.5. The  CED197 small  floating needle ( made in China) was imposed on to make the subcutaneous fan-like needling in painful point, and then used Kangzhi G-18 plastic vacuum cups (made in China) to cupping-bleed for 1 minute. The amount of bleeding was about 1-2 ml for any point and every treatment, and the treatment was worked once a week, and 2- 3 sessions for 1 course, and 1-2 courses for the full therapy according individual responses to the treatment. The statistical analysis was used to compare the different between pre-and post-therapy for the relief of swelling and pain of the syndrome and p<0.05 means the significant different. Those with severe cardic and pulmonary disorders wouldn’t be included in the study.

Result:  After the whole treatment, the result showed that the total relief effect percent of edema and pain of the syndrome was 92.53±1.25% (p<0.01), and locally functional recoverable percent 90.15±1.01% (p<0.05), the effective time 1-2±0. 21 days after the treatment. Meanwhile, their living qualification was improved greatly after the treatment, and no therapeutic side-effect took place during and after the therapy.

                                                                                                                             3.

Conclusion: The subcutaneous floating needling stimulation of painful points for analogical purpose has been developed into the practice since the recent 10 years ago, aiming to eliminate edema and to stop pain (killing pain).The post-needling cupping-bleeding was imposed on to strengthen the effect of eliminating swelling and stopping pain by the way of improving blood and expanding the collaterals locally. The results manifested that the compound effect of the mixed therapy from both the subcutaneous floating needling and the following cupping –bleeding  can increase the effect of reducing edema and pain, and shorten the effective time of the treatment, and improve the clinical recover or cure rate. This is the first report about the technique of compound acupuncture that gains the trait of rapid action, easy manipulation, safety and non-side-effect so far. It’s really one of the nice prescriptions of acupuncture for painful syndrome (Bi Tong Zheng).

Key words:  Painful syndrome (Bi Tong Zheng), Floating needle,  Cupping bleeding

  

(全文)                                                                                                                                                                                                          4.

        痹痛证是一临床多发的疼痛病症,发病部位多在相关的关节周围,内因和外感是发病的诱发因素,常见临床证型包括行痹(风)、热痹(温)、痛痹(寒)和着痹(湿)。每当疼痛发作时,患者的生活和工作都受到了不同程度的影响,身心健康水平也大为下降1。因此,我们采用浮针针刺局部痛点加拔罐放血来治疗67例患有躯体四肢痹痛证的患者,以观察该疗法止痛消肿的治疗效果,达到即刻止痛缓解和最终消除痹痛的目的。

材料与方法

1.     病例:67例患者参与了该项治疗观察,患者年龄范围在35-85岁之间,男女比例为3:1.5;  其证型包括行痹(12例)、热痹(11例)、痛痹(20例)及着痹(14例)并设10例正常对照组。患有严重心肺疾病的患者不被包括在此次观察范围之内。

2.     治疗操作:各证型治疗组在阿什痛点皮下浅行扇形针刺8-10次后,加拔罐放血1分钟左右,术后用抗菌敷料覆盖;而对照组10例患者各被在痛点行局部指压15分钟即毕。2-3次治疗为一个疗程,每周1次,1-2疗程为全部疗程(依临床症状改善情况而定)。

3.     治疗针具:一次性皮下浮针为中国制CE0197型小号针,而真空拔罐器为中国制康慈牌G-18型胶塑罐。

4.     临证指数:采用7分制积分指数标准来评定患者的临床指征,计0-7分段(见表1);各证型以指数的均数(X±SD)来表达;疗后指数分值低说明疗效佳(见表2)。

1. 临证指数7分制积分标准

/*

0

1

2

3

4

5

6

疼痛

-

+

+

+

+

+

+

关节数

-

-

+

+

+

+

+

舌相

-

-


-

+

+

+

脉相

-

-

-

-

-

+

+

全身症状

及活动功能受限**

-

 

-

-

-

-

-

+

+

*以“+”计1分和“—”为无分,各临证指数分段以计分项目阳性(+)累计分为准。

 

                                                                                                                   5.

**全身症状及肢体活动功能受限包括发热、头痛、吐泻、咳喘、行走困难、关节屈伸不得、痉发、神昏和谵妄

5.     毒副反应和中途退出:无一例不良毒副反应发生, 也无因为其它原因而退出治疗的。

6.     统计学处理和分析:并对结果行疗前后的t-检验统计学处理,以p<0.05为差异有显著性。

结果

1.     皮下浮针痛点行针扫刺技术及针后加用拔罐放血法治疗67例患痹痛证的患者止痛疗效:

        参见表2所示,止痛消肿的总有效率为92.53±1.25%p<0.01),局部功能改善率90.15±1.01% p<0.05);总有效起效时间为1-2±0.21天,疗后患者生活质量明显提高。

2.     临床不良副反应:

         整个治疗过程中,无一例患者发生术中后的临床不良反应,餐后才行治疗。

           2.  皮下浮针痛点针刺加拔罐放血法治疗67例痹痛证患者的止痛消肿疗效

证型

例数

                                              治疗                 功能

(   临证指数均数)   ( 临证指数均数)   有效率          改善率

                                                                 %     %

P*

行痹(风)

12

5.12±0.25                  2.74±0.32          86.23±1.32     82.03±1.07    

p<0.05

热痹(温)

11

5.05±0.07                  2.04±0.05         96.20±4.06      96.74±1.19    

p<0.05

痛痹(寒)

20

5.33±0.15                   3.40±0.17         90.65±1.32     89.05±1.32    

p<0.05

着痹(湿)

14

5.10±0.42                  2.90±0.11         88.81±3.01       80.76±5.04  

p<0.05

对照组  

 

总计      

10

 

67

4.03±0.15                   4.01±0.42         1.26±4.09        1.47±1.06   

 

                                                              92.53±1.25       90.15±1.01           

p>0.05

 

p<0.01

*治疗结果行疗前后的t-检验统计学处理,CI >95.05±1.76%P>0.01-0.05为差异有显著性。

 6.讨论

        痹痛症总是由于内伤和外感所诱发的痛证,局部证候为主,但也伴发有全身病理变化和特征性地舌相脉相的改变,是临床多见的病证,其基本病理特征是湿热阻滞、气滞血瘀、风寒阻络、痰湿壅阻、气血虚弱和阴阳两虚(1)

        皮下浮针浅刺技术是近来发展起来的局部止痛消肿针刺法,多用于关节肌肉痹痛症的治疗2。本观察采用该疗法在阿什痛点处行针来治疗4种痹痛证(行痹、热痹、痛痹和着痹);同时,在此基础上加用针刺后拔罐放血的方法以增强全身和局部气血流通和通经助阳的止痛消肿的效果,达到活血化瘀、通络止痛和恢复功能的目的3, 4。在所观察的67例患者中,无一例发生毒副反应和中途退出的失败病例;其止痛消肿的总有效率为92.53±1.25%p<0.01)和局部功能改善率为90.15±1.01% p<0.05),却总有效起效时间为1-2±0.21天,疗后患者生活质量明显提高。且起效时间和临床症状改善率都得到显著的缩短和强化;该技术操作简便,安全性高,疗效肯定。 

       本观察的疗前后临证指数评分是按中医辨证标准来进行的,除了局部和全身的症候外,舌相和脉相也是一个评分的基本指标,各自占有一个分值点(见表1)。4种痹痛症各有特征性的舌相和脉相(右手气关)变化,对临证诊断分型有重要意义,例如,行痹证有苔薄白舌相和浮脉相,热痹证有舌苔黄燥和滑数脉相,痛痹证有舌苔白薄和弦紧脉相,而着痹证有舌苔白腻和濡缓脉相。

         本次治疗观察是首次进行此种复合性技术治疗的临床报告,实践证明该法具有操作安全、可靠有效、起效快速和副作用少等特点,可作为痹痛证的有效治疗可选方案之一。

                                                   参考文献

1. 高丽丽。浅谈痹证的辨证施治。中华现代临床医学杂志。2005 9):22- 23

                                                                                                                              7.

2. 符仲华 著。浮针疗法治疗疼痛手册/。人民卫生出版社出版,北京,第3版,20115-16

 3. 陈可冀 主编。实用血瘀证学。第一版,人民卫生出版社,北京,1999110-126

4. 邱茂良、孔昭遐、邱仙灵 著。针灸治法与处方。上海科技出版社出版,上海,第一版,2009:41-193

 

 

 

作者简介:

侯幼红,男, 结合医学博士,早年从事中医药学抗真菌和抗艾滋病毒感染的临床研究,并同时也进行了一些相关针灸技术治疗过敏性和痛性病证的临床工作。此后,长期在中医医疗机构进行大量的中西结合治疗学的探索性工作,重点放在针灸和中药的疗效方面,取得了一些可贵的积累,有35年余的丰富临床经历和理论基础。


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