灵龟八法结合靳三针治疗坐骨神经痛的临床研究
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摘要
目的
本研究采用简单随机、对照设计试验方案,以灵龟八法配合靳三针疗法为治疗组,评估其对坐骨神经痛的疗效。并设计两组作为对照组,第一组单纯用靳三针疗法,第二组以常规循经辩证取穴治疗。目的旨在探讨一套简便又能适应香港中医诊所应用,且行之有效的针灸方法,期能减少患者痛苦及生活上带来的不便,同时为以灵龟八法为主的时间针灸理论提供临床依据。
方法
采用简单随机分组法,把患者分成三组,总共九十病例。病例来源自香港药师堂惠柏中医诊所。治疗组三十例以灵龟八法按时取穴配合靳三针治疗；对照组(Ⅰ)以单纯靳三针治疗；对照组(Ⅱ)以常规循经辨证取穴治疗。各组若有中止或剔除病例时,再以随机原则另觅患者补上,直至每组三十病例疗程完满完成为止。全部病例疗程完成后作分组对照比较；另外于各组之中,按西医诊断标准分开根性和干性坐骨神经痛；再按中医辨证分型分成寒湿型、湿热型、瘀血内阻型、肾虚失养型腰腿痛,然后再进行组内比较。
结果
1.VAS结果显示三组的症状均明显低于治疗前(P＜0.01),治疗组之疗效明显优于两对照组(P＜0.01)。
2.JOA score结果显示三组的有效率均为干性比根性高,提示根性比干性难治。以组别之间的疗效比较,治疗组明显优于两对照组(P＜0.05)
3.CODI结果显示,三组在治疗后的症状均明显低于治疗前(P＜0.01)。而治疗组之疗效明显优于两个对照组(P＜0.01),两对照组间疗效无明显差异(P＞0.05)。
4.根据1994年《中医病症诊断疗效标准》,将三组病例辨证后分为寒湿型、湿热型、瘀血内阻型和肾虚失养型作比较,寒湿和湿热疗效较高,瘀血和肾虚较低,提示后二者较难治。但其分别不明显(P＞0.05)。组间疗效比较治疗组明显优于两对照组(P＜0.05)。
结论
本课题在古典时间针灸理论的指导下,结合现代临床经验,古为今用,采用灵龟八法结合靳三针为基础,探讨其对坐骨神经痛的临床疗效及机理,结果显示灵龟八法结合靳三针疗法治疗坐骨神经痛疗效优于单纯靳三针疗法及常规循经针刺。
Objective
This study used simple randomized, controlled trial design method to evaluate the therapeutic effects on sciatical pain. Participants in the treatment group were treated with Jin's trio acupuncture plus the subtle turtle's octonary acupuncture. The first control group used the Jin's trio acupuncture only, while the second control group used regular meridian syndrome differentiation acupuncture. Our purpose is to seek out a simple, pragmatic way that can be suitable for Hong Kong's smaller TCM clinics; so as to alleviate patients'pain and their discomforts in life. At the same time, we hope to provide clinical data for mainstream time acupuncture therapies like the subtle turtle's octonary acupuncture.
Method
90participants were randomly assigned into three groups; each group consisted of30participants.The participants came from MOCM Wai Pak Chinese Medicine Clinic in Hong Kong. The treatment group was treated with the subtle turtle's octonary acupuncture, plus Jin's trio acupuncture therapy. The first control group was treated with Jin's trio acupuncture only; while the second control group the regular meridian syndrome differentiation acupuncture. Participants were randomly replaced if they failed to finish their respective treatment courses. After all3groups'participants had finished their treatment courses, their cases were compared on a group to group basis. Moreover, each case would be further differentiated into radicular sciatica or pseudo sciatica according to modern medicine's standard of diagnosis. Using TCM's syndrome differentiation standard, all cases were again differetiated into4syndromes, namly:the cold dampness, the heat dampness, the blood stasis and the kidney deficiency; we then conduct the intra-group comparisons.
Results
1.The results of the Visual Analogue Scale showed that symptoms of all three groups were significantly lower than that before treatment, with P <0.01. The treatment group was significantly better than the two control groups, with P<0.01.
2. The results of the JOA score showed that, in all3groups, the therapeutic efficacy of pseudo sciatica was better than that of radicular sciatica, suggesting that the latter was more difficult to cure. The treatment group was significantly better than the two control groups, with P<0.05.
3. Oswestry (CODI) result showed that symptoms of all three groups were significantly lower than that before treatment, with P<0.01.The treatment group was significantly better than the two control groups, with P<0.01, whereas the therapeutic efficacy of the two control groups was not significantly different from each other, with P>0.05.
4. According to the standard set by [The standard for TCM diseases' diagnosis and therapeutic results], which was published in China by TCM authority in1994, we differentiated all cases into4syndromes for the sake of intra-group comparisons, namly:The cold dampness, the heat dampness, the blood stasis and the kidney deficiency. We can see that the therapeutic efficacy of cold dampness and heat dampness was better than that of blood stasis and kidney deficiency; suggesting that the latter pair was more difficult to cure. Yet the differences of therapeutic efficacy among the4syndromes were not significant, with P>0.05. As for inter-group comparison, the treatment group was significantly better than that of the two control groups, with P <0.01.
Conclusion
Under the guidance of ancient acupuncture theory, together with modern clinically based evidence, we envisage to use ancient method in a modern way. Based on the subtle turtle's octonary acupuncture and Jin's trio acupuncture, we investigate their therapeutic efficacy on sciatica and analyse its pathogenesis. We conclude that the combined therapeutic efficacy of the subtle turtle's octonary acupuncture and Jin's trio acupuncture is better than that of Jin's trio acupuncture alone, or that of regular meridian syndrome differentiation acupuncture alone.
本研究采用简单随机、对照设计试验方案,以灵龟八法配合靳三针疗法为治疗组,评估其对坐骨神经痛的疗效。并设计两组作为对照组,第一组单纯用靳三针疗法,第二组以常规循经辩证取穴治疗。目的旨在探讨一套简便又能适应香港中医诊所应用,且行之有效的针灸方法,期能减少患者痛苦及生活上带来的不便,同时为以灵龟八法为主的时间针灸理论提供临床依据。
方法
采用简单随机分组法,把患者分成三组,总共九十病例。病例来源自香港药师堂惠柏中医诊所。治疗组三十例以灵龟八法按时取穴配合靳三针治疗；对照组(Ⅰ)以单纯靳三针治疗；对照组(Ⅱ)以常规循经辨证取穴治疗。各组若有中止或剔除病例时,再以随机原则另觅患者补上,直至每组三十病例疗程完满完成为止。全部病例疗程完成后作分组对照比较；另外于各组之中,按西医诊断标准分开根性和干性坐骨神经痛；再按中医辨证分型分成寒湿型、湿热型、瘀血内阻型、肾虚失养型腰腿痛,然后再进行组内比较。
结果
1.VAS结果显示三组的症状均明显低于治疗前(P＜0.01),治疗组之疗效明显优于两对照组(P＜0.01)。
2.JOA score结果显示三组的有效率均为干性比根性高,提示根性比干性难治。以组别之间的疗效比较,治疗组明显优于两对照组(P＜0.05)
3.CODI结果显示,三组在治疗后的症状均明显低于治疗前(P＜0.01)。而治疗组之疗效明显优于两个对照组(P＜0.01),两对照组间疗效无明显差异(P＞0.05)。
4.根据1994年《中医病症诊断疗效标准》,将三组病例辨证后分为寒湿型、湿热型、瘀血内阻型和肾虚失养型作比较,寒湿和湿热疗效较高,瘀血和肾虚较低,提示后二者较难治。但其分别不明显(P＞0.05)。组间疗效比较治疗组明显优于两对照组(P＜0.05)。
结论
本课题在古典时间针灸理论的指导下,结合现代临床经验,古为今用,采用灵龟八法结合靳三针为基础,探讨其对坐骨神经痛的临床疗效及机理,结果显示灵龟八法结合靳三针疗法治疗坐骨神经痛疗效优于单纯靳三针疗法及常规循经针刺。
Objective
This study used simple randomized, controlled trial design method to evaluate the therapeutic effects on sciatical pain. Participants in the treatment group were treated with Jin's trio acupuncture plus the subtle turtle's octonary acupuncture. The first control group used the Jin's trio acupuncture only, while the second control group used regular meridian syndrome differentiation acupuncture. Our purpose is to seek out a simple, pragmatic way that can be suitable for Hong Kong's smaller TCM clinics; so as to alleviate patients'pain and their discomforts in life. At the same time, we hope to provide clinical data for mainstream time acupuncture therapies like the subtle turtle's octonary acupuncture.
Method
90participants were randomly assigned into three groups; each group consisted of30participants.The participants came from MOCM Wai Pak Chinese Medicine Clinic in Hong Kong. The treatment group was treated with the subtle turtle's octonary acupuncture, plus Jin's trio acupuncture therapy. The first control group was treated with Jin's trio acupuncture only; while the second control group the regular meridian syndrome differentiation acupuncture. Participants were randomly replaced if they failed to finish their respective treatment courses. After all3groups'participants had finished their treatment courses, their cases were compared on a group to group basis. Moreover, each case would be further differentiated into radicular sciatica or pseudo sciatica according to modern medicine's standard of diagnosis. Using TCM's syndrome differentiation standard, all cases were again differetiated into4syndromes, namly:the cold dampness, the heat dampness, the blood stasis and the kidney deficiency; we then conduct the intra-group comparisons.
Results
1.The results of the Visual Analogue Scale showed that symptoms of all three groups were significantly lower than that before treatment, with P <0.01. The treatment group was significantly better than the two control groups, with P<0.01.
2. The results of the JOA score showed that, in all3groups, the therapeutic efficacy of pseudo sciatica was better than that of radicular sciatica, suggesting that the latter was more difficult to cure. The treatment group was significantly better than the two control groups, with P<0.05.
3. Oswestry (CODI) result showed that symptoms of all three groups were significantly lower than that before treatment, with P<0.01.The treatment group was significantly better than the two control groups, with P<0.01, whereas the therapeutic efficacy of the two control groups was not significantly different from each other, with P>0.05.
4. According to the standard set by [The standard for TCM diseases' diagnosis and therapeutic results], which was published in China by TCM authority in1994, we differentiated all cases into4syndromes for the sake of intra-group comparisons, namly:The cold dampness, the heat dampness, the blood stasis and the kidney deficiency. We can see that the therapeutic efficacy of cold dampness and heat dampness was better than that of blood stasis and kidney deficiency; suggesting that the latter pair was more difficult to cure. Yet the differences of therapeutic efficacy among the4syndromes were not significant, with P>0.05. As for inter-group comparison, the treatment group was significantly better than that of the two control groups, with P <0.01.
Conclusion
Under the guidance of ancient acupuncture theory, together with modern clinically based evidence, we envisage to use ancient method in a modern way. Based on the subtle turtle's octonary acupuncture and Jin's trio acupuncture, we investigate their therapeutic efficacy on sciatica and analyse its pathogenesis. We conclude that the combined therapeutic efficacy of the subtle turtle's octonary acupuncture and Jin's trio acupuncture is better than that of Jin's trio acupuncture alone, or that of regular meridian syndrome differentiation acupuncture alone.
引文
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