补阳还五汤加虫类药联合针刺治疗中风恢复期(气虚血瘀)随机平行对照研究
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摘要
[目的]观察补阳还五汤加虫类药联合针刺治疗中风恢复期(气虚血瘀)疗效。[方法]使用随机平行对照方法,将42例门诊患者按就诊顺序号随机分为两组。对照组21例针刺,患者仰卧位,局部消毒,选28～32号毫针,取风池、颊车、地仓、人迎、下关、人中,交替使用;八风、昆仑、丰隆、三阴交、足三里、阳陵泉、外关、后溪、合谷、手五里、极泉等,以患侧为主,辅助刺健侧,平补平泻,得气后留针30min,1次/d,疗程间间隔3d。治疗组21例补阳还五汤加虫类(黄芪60g,赤芍15g,桃仁、川芎、生地、地龙、当归、牛膝、延胡索各10g,红花6g,蜈蚣5g,全蝎6g),水煎300mL,早晚温服;半身不遂重,加水蛭、桑枝;言语不利重,加远志、菖蒲;患侧肢体肿胀明显,加薏仁、防已、泽泻、茯苓;大便溏去桃仁,加山药、白术;针刺同对照组。连续治疗7d为1疗程。观测临床表现、中医证候积分、生活质量评分、不良反应。连续治疗3疗程(21d),判定疗效。[结果]治疗组痊愈15例,有效5例,无效1例,总有效率95.24%;对照组痊愈7例,有效8例,无效6例,总有效率71.43%;治疗组疗效优于对照组(P<0.05)。中医证候积分、生活质量评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.05,P<0.01)。[结论]补阳还五汤加虫类药联合针刺治疗中风恢复期(气虚血瘀),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of buyang huanwu decoction combined with insect drugs in the treatment of stroke convalescence(Qi deficiency and blood stasis). [Methods] using the random parallel control method, 42 outpatients were randomly divided into two groups according to the number of visits. In the control group, 21 patients received acupuncture, and the patients were placed in supine position, and local disinfection was performed. 28～32 millineedles were selected. Bafeng, kunlun, fenglong, sanyinjiao,zusanli, yanglingquan, waiguan, houxi, hegu, shouwuli, jiquan, etc., are mainly on the affected side, assisted with acupuncture and rehabilitation on the healthy side, and made plain and supple. The needle is kept for30 min after getting qi, once a day, and the interval between treatment courses is 3 d. In the treatment group,21 cases were treated with buyang huanwu decoction(Huangqi 60 g, Chishao 15 g, Taoren, Chuanxiong,Shengdi, Dilong, Danggui, Niuxi, Yanhusuo each 10 g, Honghua 6 g, Wugong 5 g, Quanxie 6 g). Hemiplegia heavy, add Shuizhi, Sangzhi; words are not good, add Yuanzhi, Shicangpu; affected side limb swelling obvious,add Yiyiren, Fangji, Zexie, Fuling; Loose stool to peach, with Shanyao, Baizhuyu; acupuncture was the same as the control group. Continuous treatment for 7 days for a course of treatment. Clinical manifestations, TCM syndrome score, quality of life score and adverse reactions were observed. Continuous treatment for 3 courses(21 d) to determine the efficacy. [Results] in the treatment group, 15 cases were cured, 5 cases were effective,1 case was ineffective, and the total effective rate was 95.24%. The total effective rate was 71.43%. The efficacy of treatment group was better than that of control group(P<0.05). TCM syndrome score and quality of life score were improved in both groups(P<0.01), and the improvement in the treatment group was better than that in the control group(P<0.05, P<0.01). [Conclusion] buyang huanwu decoction combined with insect drugs and acupuncture in the treatment of stroke convalescence(Qi deficiency and blood stasis) has satisfactory efficacy and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the curative effect of buyang huanwu decoction combined with insect drugs in the treatment of stroke convalescence(Qi deficiency and blood stasis). [Methods] using the random parallel control method, 42 outpatients were randomly divided into two groups according to the number of visits. In the control group, 21 patients received acupuncture, and the patients were placed in supine position, and local disinfection was performed. 28～32 millineedles were selected. Bafeng, kunlun, fenglong, sanyinjiao,zusanli, yanglingquan, waiguan, houxi, hegu, shouwuli, jiquan, etc., are mainly on the affected side, assisted with acupuncture and rehabilitation on the healthy side, and made plain and supple. The needle is kept for30 min after getting qi, once a day, and the interval between treatment courses is 3 d. In the treatment group,21 cases were treated with buyang huanwu decoction(Huangqi 60 g, Chishao 15 g, Taoren, Chuanxiong,Shengdi, Dilong, Danggui, Niuxi, Yanhusuo each 10 g, Honghua 6 g, Wugong 5 g, Quanxie 6 g). Hemiplegia heavy, add Shuizhi, Sangzhi; words are not good, add Yuanzhi, Shicangpu; affected side limb swelling obvious,add Yiyiren, Fangji, Zexie, Fuling; Loose stool to peach, with Shanyao, Baizhuyu; acupuncture was the same as the control group. Continuous treatment for 7 days for a course of treatment. Clinical manifestations, TCM syndrome score, quality of life score and adverse reactions were observed. Continuous treatment for 3 courses(21 d) to determine the efficacy. [Results] in the treatment group, 15 cases were cured, 5 cases were effective,1 case was ineffective, and the total effective rate was 95.24%. The total effective rate was 71.43%. The efficacy of treatment group was better than that of control group(P<0.05). TCM syndrome score and quality of life score were improved in both groups(P<0.01), and the improvement in the treatment group was better than that in the control group(P<0.05, P<0.01). [Conclusion] buyang huanwu decoction combined with insect drugs and acupuncture in the treatment of stroke convalescence(Qi deficiency and blood stasis) has satisfactory efficacy and no serious adverse reactions, which is worthy of promotion.
引文
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[15]高学敏.中药学[M].北京:中国中医药出版社,2007.
[2]徐进华,丁萍,罗玉韵,等.中风恢复期中西医综合治疗临床路径研究[J].中国全科医学,2009,12(11):986-988.
[3]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)[2016-10-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]许予明,谭颂,刘鸣,等.脑血管疾病诊断与治疗临床指南[J].内科急危重症杂志,2005,11(5):243-245.
[5]余小萍,方祝元.中医内科学[M].上海:上海科学技术出版,2018143.
[6]李春波,何燕玲.健康状况调查问卷SF-36的介绍[J].国外医学(精神病学分册),2002,29(2):116-119.
[7]倪进军,李柱.中风病中西医疗效标准的比较[J].河南中医,200121(5):32-33.
[8]黎辉,武紫晖,张晓云.中风病病机与治法方药探析[J].医学信息2018,31(19):158-159.
[9]胡龙涛,蔡芳妮,王亚丽.中风病病因病机探析[J].中西医结合心脑血管病杂志,2017,15(7):883-885.
[10]周群.中风恢复期患者自我效能与生活质量的相关性研究[D].成都:成都中医药大学,2011.
[11]钟长明,林洪茂,刘庆芳,等.针刺与肌张力平衡促通法对中风偏瘫患者早期康复的作用[J].中国康复医学杂志,2001,16(3):180-182.
[12]石学敏.针灸学[M].北京:中国中医药出版社,2007.
[13]段丽梅,殷亚琳.“治风先治血,血行风自灭”在中风病中的运用[J]河南中医,1998,18(4):229-230.
[14]贾波,王均宁.方剂学[M].3版.上海:上海科学技术出版,2018:168.
[15]高学敏.中药学[M].北京:中国中医药出版社,2007.