半夏泻心汤+针刺联合西替利嗪治疗过敏性鼻炎(脾胃不和)随机平行对照研究
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摘要
[目的]观察半夏泻心汤+针刺联合西替利嗪治疗过敏性鼻炎(脾胃不和)疗效。[方法]使用随机平行对照方法,将65例门诊患者按抛硬币法随机分为两组。对照组30例西替利嗪,5mg/次,2次/d。治疗组35例半夏泻心汤(乌梅20g,制半夏15g,防风、黄芩、干姜各10g,人参6g,苍耳子、辛夷、白芷、蛤蚧、五味子、熟地黄各8g,甘草5g),水煎400mL,1剂/d,3次/d;针刺:取风池、合谷、迎香、印堂、足三里,患者仰卧位,印堂、迎香针尖朝鼻根入针,合谷直刺,风池斜朝着对侧眼球方向直刺入针,足三里补法进针,得气后留针30min,1次/d;西替利嗪治疗同对照组。连续治疗10d为1疗程。观测临床表现、血清IgE、肿瘤坏死因子-α、转化生长因子-β、白细胞介素-10、不良反应。连续治疗3疗程(30d),判定疗效。随访6个月,观测复发率。[结果]治疗组临床痊愈2例,显效23例,有效10例,无效2例,总有效率94.28%;对照组临床痊愈1例,显效13例,有效7例,无效9例,总有效率70.00%;治疗组疗效优于对照组(P<0.05)。血清IgE、TNF-α、TGF-β、IL-10两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。随访6个月,复发率治疗组9.37%(3/32)低于对照组28.57%(6/21)。[结论]半夏泻心汤+针刺联合西替利嗪治疗过敏性鼻炎(脾胃不和),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Banxia Xiexin decoction plus acupuncture combined with cetirizine on allergic rhinitis(Piwei Buhe). [Method] 65 outpatients were randomly divided into two groups according to the order of visiting. The control group consisted of 30 cases of cetirizine, 5 mg/time, 2 times/day. The treatment group consisted of 35 cases of Banxia Xiexin decoction(Wumei 20 g, Zhibanxia 15 g,Fangfeng, Huangqin, Ganjiang each 10 g, Renshen 6 g, Cangerzi, Xiyin, Baizhi, Gejie, Wuweizi, Shudihuang each 8 g, Gancao 5 g), 400 mL of water decoction, 1 dose/d, 3 times a day; Acupuncture: taking Fengchi, Hegu,Yingxiang, Yintang, Zusanli, supine position of patients, Yintang, Yingxiang needle pointing to nose root,catering to gu, direct pricking wind. Pool obliquely into the opposite eye direction straight needle, Zusanli reinforcing needle, after breath retention needle 30 minutes, once a day; Cetirizine treatment with the control group. Continuous treatment for 10 days is a course of treatment. Clinical manifestations, serum IgE, TNFalpha, transforming growth factor-beta, interleukin-10 and adverse reactions were observed. Continuous treatment for 3 courses(30 days) to determine the efficacy. The recurrence rate was observed after 6 months of follow-up. [Result] In the treatment group, 2 cases were cured, 23 cases were markedly effective, 10 cases were effective and 2 cases were ineffective, the total effective rate was 94.28%. In the control group, 1 case was cured, 13 cases were markedly effective, 7 cases were effective and 9 cases were ineffective, the total effective rate was 70.00%. The curative effect of the treatment group was better than that of the control group(P<0.05). Serum IgE, TNF-α, TGF-beta and IL-10 were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01). After 6 months of follow-up,the recurrence rate in the treatment group was 9.37%(3/32) lower than that in the control group 28.57%(6/21).[Conclusion] Banxia Xiexin decoction+acupuncture plus cetirizine is effective in the treatment of allergic rhinitis(Piwei Buhe). It has no serious adverse reactions and is worthy of promotion.
[Objective] To observe the curative effect of Banxia Xiexin decoction plus acupuncture combined with cetirizine on allergic rhinitis(Piwei Buhe). [Method] 65 outpatients were randomly divided into two groups according to the order of visiting. The control group consisted of 30 cases of cetirizine, 5 mg/time, 2 times/day. The treatment group consisted of 35 cases of Banxia Xiexin decoction(Wumei 20 g, Zhibanxia 15 g,Fangfeng, Huangqin, Ganjiang each 10 g, Renshen 6 g, Cangerzi, Xiyin, Baizhi, Gejie, Wuweizi, Shudihuang each 8 g, Gancao 5 g), 400 mL of water decoction, 1 dose/d, 3 times a day; Acupuncture: taking Fengchi, Hegu,Yingxiang, Yintang, Zusanli, supine position of patients, Yintang, Yingxiang needle pointing to nose root,catering to gu, direct pricking wind. Pool obliquely into the opposite eye direction straight needle, Zusanli reinforcing needle, after breath retention needle 30 minutes, once a day; Cetirizine treatment with the control group. Continuous treatment for 10 days is a course of treatment. Clinical manifestations, serum IgE, TNFalpha, transforming growth factor-beta, interleukin-10 and adverse reactions were observed. Continuous treatment for 3 courses(30 days) to determine the efficacy. The recurrence rate was observed after 6 months of follow-up. [Result] In the treatment group, 2 cases were cured, 23 cases were markedly effective, 10 cases were effective and 2 cases were ineffective, the total effective rate was 94.28%. In the control group, 1 case was cured, 13 cases were markedly effective, 7 cases were effective and 9 cases were ineffective, the total effective rate was 70.00%. The curative effect of the treatment group was better than that of the control group(P<0.05). Serum IgE, TNF-α, TGF-beta and IL-10 were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01). After 6 months of follow-up,the recurrence rate in the treatment group was 9.37%(3/32) lower than that in the control group 28.57%(6/21).[Conclusion] Banxia Xiexin decoction+acupuncture plus cetirizine is effective in the treatment of allergic rhinitis(Piwei Buhe). It has no serious adverse reactions and is worthy of promotion.
引文
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[9]周莹.浅析西替利嗪的药理作用及临床应用[J].中国卫生标准管理,2017,8(5):81-82.
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[12]朱歆洁,朱鲁平,程雷.转化生长因子β在过敏性鼻炎发病机制中的作用[J].中华临床免疫和变态反应杂志,2010,4(4):294-299.
[13]孙勇.过敏性鼻炎和哮喘患者血清黏附分子、IL-4、IL-10水平研究[D].青岛:青岛大学,2008.
[14]杨清华.鼻鼽的古文献研究[J].中医文献杂志,2005,22(1):39.
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[17]周滔,张声生.“治未病”思想与脾胃病的防治[J].环球中医药,2009,2(4):265-268.
[18]周永秀.浅谈脾胃与五脏、冲任的关系及治疗法则[J].现代中西医结合杂志,1995,4(2):84.
[19]张仲景.伤寒论[M].钱超尘,郝万山,整理.北京:人民卫生出版社2008:60.
[20]周莉.运用《伤寒论》半夏泻心汤加减验案二则[J].四川中医,2011,29(3):122-123.
[21]郭可威,张连城.半夏泻心汤加减医案三则[J].亚太传统医药2018,14(10):138-139.
[22]林栋,崔岚,刘臣.半夏泻心汤配合针灸治疗过敏性鼻炎42例[J].新中医,2009,41(10):69-70.
[23]尹李虎,卢世秀.卢世秀应用半夏泻心汤治疗呼吸道疾病举隅[J]中医药导报,2017,23(3):116-117.
[24]高学敏.中药学[M].北京:中国中医药出版社,2007.
[25]孙国杰.针灸学[M].上海:上海科学技术出版社,1997.
[26]俞年塘,许成华,鲁静.印堂穴温针灸配合隔姜灸治疗过敏性鼻炎疗效观察[J].上海针灸杂志,2017,36(11):62-64.
[2]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-08-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[3]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2015年,天津)[J].中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24.
[4]国家中医药管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:336.
[5]赵长青,许庚.慢性鼻-鼻窦炎的疗效评定[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):115-116.
[6]顾瑞金.过敏性鼻炎的诊断治疗[J].中国实用儿科杂志,2001,16(9):516-518.
[7]梁灼萍,潘洪珠,徐伟,等.变应性鼻炎患者吸入性过敏原IgE检测结果分析及与临床症状的相关性研究[J].中国中西医结合耳鼻咽喉科杂志,2017,25(5):359-363.
[8]蒙继清,王莉.抗组胺药物在过敏性鼻炎的临床用药情况分析[J].内蒙古医学杂志,2013,45(7):823-825.
[9]周莹.浅析西替利嗪的药理作用及临床应用[J].中国卫生标准管理,2017,8(5):81-82.
[10]江占良,唱文娟.过敏性鼻炎患者血清IL-4与IgE水平及其关系的研究[J].山西职工医学院学报,2000,10(2):14-15.
[11]孙晓丽,褚建国,陈素娟,等.过敏性鼻炎、荨麻疹患者血清IL-4、TNFα的检测[J].检验医学,2003,18(5):311-312.
[12]朱歆洁,朱鲁平,程雷.转化生长因子β在过敏性鼻炎发病机制中的作用[J].中华临床免疫和变态反应杂志,2010,4(4):294-299.
[13]孙勇.过敏性鼻炎和哮喘患者血清黏附分子、IL-4、IL-10水平研究[D].青岛:青岛大学,2008.
[14]杨清华.鼻鼽的古文献研究[J].中医文献杂志,2005,22(1):39.
[15]黄帝内经素问[M].北京:人民卫生出版社,2012:182.
[16]范愈燕,佘文煜,王向东,等.脾胃与鼻鼽发病机制的临床研究[J]北京中医药,2013,32(6):428-430.
[17]周滔,张声生.“治未病”思想与脾胃病的防治[J].环球中医药,2009,2(4):265-268.
[18]周永秀.浅谈脾胃与五脏、冲任的关系及治疗法则[J].现代中西医结合杂志,1995,4(2):84.
[19]张仲景.伤寒论[M].钱超尘,郝万山,整理.北京:人民卫生出版社2008:60.
[20]周莉.运用《伤寒论》半夏泻心汤加减验案二则[J].四川中医,2011,29(3):122-123.
[21]郭可威,张连城.半夏泻心汤加减医案三则[J].亚太传统医药2018,14(10):138-139.
[22]林栋,崔岚,刘臣.半夏泻心汤配合针灸治疗过敏性鼻炎42例[J].新中医,2009,41(10):69-70.
[23]尹李虎,卢世秀.卢世秀应用半夏泻心汤治疗呼吸道疾病举隅[J]中医药导报,2017,23(3):116-117.
[24]高学敏.中药学[M].北京:中国中医药出版社,2007.
[25]孙国杰.针灸学[M].上海:上海科学技术出版社,1997.
[26]俞年塘,许成华,鲁静.印堂穴温针灸配合隔姜灸治疗过敏性鼻炎疗效观察[J].上海针灸杂志,2017,36(11):62-64.