补肾调肝推拿法治疗神经根型颈椎病的临床研究
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摘要
目的:观察补肾调肝推拿法治疗神经根型颈椎病(Ⅲ、Ⅳ级)的临床疗效并探讨其作用机理。方法:选择神经根型颈椎病(Ⅲ、Ⅳ级)55例,随机分为治疗组28例及对照组27例。其中治疗组行补肾调肝推拿法治疗,对照组行中药乌透酊离子导入法治疗。结果:两组患者治疗前后疼痛积分自身比较有明显差异(p<0.01),治疗后疼痛积分组间比较有明显差异(p<0.01);两组患者治疗前后中医证候自身比较有明显差异(p<0.01),治疗后中医相关证候组间比较无明显差异(p>0.05);两组患者治疗前后临床症状积分自身比较有明显差异(p<0.01),治疗后临床积分组间比较有明显差异(p<0.01);总有效率比较:治疗组为92.9%,对照组为81.5%,两组间比较经Ridit分析,p<0.01,说明补肾调肝推拿法组疗效明显优于中药乌透酊离子导入法组。结论:补肾调肝推拿法和中药乌透酊离子导入法治疗神经根型颈椎病(Ⅲ、Ⅳ级),均可改善疼痛症状,改善中医症候,改善临床症状体征。补肾调肝推拿法疗效优于中药乌透酊离子导入法,但对中医症候改善,两种治疗方法效果无明显区别。补肾调肝推拿法具有操作简单,见效快,无毒副作用,复发率低,治疗费用相对较低,易于被患者接受等特点,可以作为神经根型颈椎病(Ⅲ、Ⅳ级)患者的较好治疗方法,值得大力推广。
Objective: To observe the clinical efficacy and explore the mechanism of Tuina Manipulation of supplementing the kidney and regulating the liver treating cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel).Methods:28 cervical spondylotic adiculopathy (Ⅲ,Ⅳlevel) sufferers were randomly divided into treatment group of 28 cases and control group of 27 cases.The treatment group treated by tuina method of supplementing the kidney and regulating the liver while the control group with Ukraine iontophoresis treatment. Results: It is significant differences in the pain points obtained through self-comparison after the treatment of the two groups (p <0.01).And the pain scores have significant differences between the two groups (p<0.01);there were significant differences in TCM syndrome of self-comparison(p<0.01) while comparison of the two groups has no significant differences (p>0.05); there were significant differences in clinical symptom points of self-comparison after the treatment (p<0.01) and the clinical scores after treatment have significant differences also (p<0.01); the total effective rate showed that the treatment group was 92.9% while 81.5% of the control group. Comparison between the two groups by statistical analysis, p <0.01, which indicats that the curative effect of tuina group was superior to that of Ukraine iontophoresis group. Conclusion: The tuina method of supplementing the kidney and regulating the liver and Chinese medicine Ukraine iontophoresis treatment can both relieve the pain, ameliorate Chinese medicine syndrome and clinical signs and symptoms of cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel). Tuina therapy is more curative than iontophoresis Ukraine therapy, however, it made no differences in ameliorating Chinese medicine symptoms. Tuina method has the characteristics of simpler, quicker-effected ,within non-toxic and side effects, lower recurrence rate, cheap and so on.So it is easier to be accepted, which can be widely popularized in the treatment of cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel).
Objective: To observe the clinical efficacy and explore the mechanism of Tuina Manipulation of supplementing the kidney and regulating the liver treating cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel).Methods:28 cervical spondylotic adiculopathy (Ⅲ,Ⅳlevel) sufferers were randomly divided into treatment group of 28 cases and control group of 27 cases.The treatment group treated by tuina method of supplementing the kidney and regulating the liver while the control group with Ukraine iontophoresis treatment. Results: It is significant differences in the pain points obtained through self-comparison after the treatment of the two groups (p <0.01).And the pain scores have significant differences between the two groups (p<0.01);there were significant differences in TCM syndrome of self-comparison(p<0.01) while comparison of the two groups has no significant differences (p>0.05); there were significant differences in clinical symptom points of self-comparison after the treatment (p<0.01) and the clinical scores after treatment have significant differences also (p<0.01); the total effective rate showed that the treatment group was 92.9% while 81.5% of the control group. Comparison between the two groups by statistical analysis, p <0.01, which indicats that the curative effect of tuina group was superior to that of Ukraine iontophoresis group. Conclusion: The tuina method of supplementing the kidney and regulating the liver and Chinese medicine Ukraine iontophoresis treatment can both relieve the pain, ameliorate Chinese medicine syndrome and clinical signs and symptoms of cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel). Tuina therapy is more curative than iontophoresis Ukraine therapy, however, it made no differences in ameliorating Chinese medicine symptoms. Tuina method has the characteristics of simpler, quicker-effected ,within non-toxic and side effects, lower recurrence rate, cheap and so on.So it is easier to be accepted, which can be widely popularized in the treatment of cervical spondylotic radiculopathy (Ⅲ,Ⅳlevel).
引文
[1]葛宝丰,胃少汀,徐印坎,实用骨科学[M].第二版,北京:人民军医出版社,1999.1462-1465.
[2]赵定鹅,颈椎伤病学[M].上海:上海科技教育出版社,1994,147-191.
[3]孙宇,陆琪宏,第二届颈推病专题座谈会纪要.中华外科杂志, 1993, 31 (8):472.
[4]施祀,要重视对颈椎病的研究.中国中医骨伤科杂志,1999,(7):1-3.
[5]冯天有.中西医结合治疗软组织损伤的临床研究[M].北京:中国科技出版社,2002,14-17.
[6]国家中医药管理局.中医病证诊断疗效标准.南京:南京大学出版社,2000:59-60.
[7]郑筱萸主编.中药新药临床研究指导原则.北京:中国中医药科技出版社,2002:349-353.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:186.
[9]田中靖久.颈部神经根症治疗成绩判定基准[J].日本整形外科学会杂志,1993,67(3):552.
[10]黄帝内经素问.北京:中医古籍出版社.2003
[11]东汉·张仲景.伤寒论.北京:人民卫生出版社.2005.
[12]晋·皇甫谧.针灸甲乙经.北京:人民卫生出版社.2006.
[13]明·王肯堂.证治准绳.北京:人民卫生出版社.2001.
[14]清·吴谦.医宗金鉴.北京:中国古籍出版社.1995
[15]清·程文囿.医述.合肥:安徽科学技术出版社.1983.
[17]清·唐宗海.医经精义.上海:上海古籍出版社.2006.
[18]清·张璐.张氏医通.上海:上海科学技术出版社.1963.
[19]清·钱潢.伤科补要.北京:中国中医药出版社.2004.
[20]宋·严用和.济生方.北京:人民卫生出版社.1956.
[21]清·叶天士.临证指南医案.太原:山西科学技术出版社.2006.
[22]清·林佩琴.类证治裁.上海:第二军医大学出版社.2008.
[23]杨克勤.颈椎病.北京:人民卫生出版社.1993:65.
[24]孙宇、陆琪宏.第二届颈推病专题座谈会纪要.中华外科杂志,1993,31(8):472
[25]党耕田.颈椎病外科治疗中的一些问题[J].中华骨科杂志,1999,19(9):517-518.
[26]冉茂东.颈椎病的生物力学研究综述.辽宁中医杂志.2003, 30(4):327-328.
[27]李家顺,贾连顺.当代颈部外科学.上海:上海科学技术文献出版社.1997:98.
[28]葛宝丰,肯少订,徐印坎.实用骨科学工[M].北京:人民军医出版社,1999: 1462-1465.
[29]赵定麟.颈椎伤病学[M].上海:上海科技教育出版社.1994:154-155.
[30]张伯勋,王岩.现代颈肩腰腿痛诊断与治疗学.北京:北京人民军医出版社.2004:352-353.
[31]余锡明.推拿治疗颈椎病的作用机制.按摩与导引.1989,(3):17.
[32]叶秀兰等.施氏三步九法治疗神经根型颈椎病临床研究.上海中医药杂志.2008,42(4):51-53.
[33]隋孝忠等.神经根型颈椎病机械牵引程度与疗效的关系.中医正骨.1995,7 (5):8.
[34]魏淑珍等.旋转式颈椎牵引治疗颈椎病106例的疗效观察.颈腰痛杂志.1994,15(4):29.
[35]周章武等.颈椎病牵引位置的探讨.中国中医骨伤科.1996,4(1):35.
[36]姜宏等.牵引对颈椎稳定性影响的生物力学研究.中华理疗志.1999,22(2):106
[37]成鹏等.颈椎病牵引疗效分析.中华理疗杂志,1992,15(1):39
[38]邵亚平等.睡眠中仰卧位小重量后伸牵引治疗颈椎病.颈腰痛杂志,1996,17(3):179.
[39]潘之清.实用脊柱病学[M].山东:山东科学技术出版社.1999:256-257.
[40]刘柏龄,马晓春,刘茜.刘柏龄治疗脊柱病经验领要.北京:北京科学技术出版社.2003:72-73.
[41]张志文,冯卫星,张扬立,李福林.中药配合推拿治疗神经根型颈椎病36例.甘肃中医.2008,21(8):34-35.
[42]王希琳.输刺为主治疗神经根型颈椎病疗效观察.中国针灸.2008,28(1):497-498.
[43]岑玉文,杨顺益,庄礼兴.针灸治疗颈椎病的临床疗效观察及机理初探.颈腰痛杂志.2000,21(2):104.
[44]赵德顺,陈永发.针灸治疗颈椎病的临床研究.世界中医骨伤优秀文集[M].北京:中国中医药出版社.1998:185.
[45]刘星,王柏阳,邵继满,祁本杰.针刀治疗神经根型颈椎病化观察30例临床疗效及影像学变.江西中医学院学报.2008,205(2):54-55.
[46]陆珍千,费季翔,刘志诚等.从血浆与尿中儿茶酚胺和它的代谢产物含量说明推拿的镇痛作用.颈腰痛杂志.1994.15(4):199-201.
[1]葛宝丰,胃少汀,徐印坎.实用骨科学[M].北京:人民军医出版社,1999.1462-1465.
[2]丁季峰.推拿大成[M].郑州:河南科技出版社.1997:175-176.
[3]邵宜,许竟武.实用颈腰背痛学[M].北京:人民军医出版社.1992:6.
[4]冉茂东.颈椎病的生物力学研究综述.辽宁中医杂志.2003,30 (4) 327-328.
[5]杨克勤.颈椎病的临床与研究[M].北京:北京出版社.1988:5.
[6]韦贵康,韦坚,周红海等.颈椎病颈曲改变对神经根与椎动脉的影响及手法治疗临床观察.中西医结合学报.2003,1(4):259-261.
[7]冯世庆,杨明杰,孔晓红等.椎动脉支型颈椎病内浆皮素变化.中华骨伤杂志.1997,17(6):387.
[8]施祀,彭宝淦.人工庸香对退变颈椎间盘炎症抑制作用的实验研究.中国中医骨伤科杂志.1997,5(3):1-3.
[9]施祀.中医药治疗颈椎病的研究.世界手法医学杂志.2005,创刊号:1-6.
[10]李保林,张华.推拿疗法治疗神经根型颈椎病86例.国医论坛.2O01,16(1): 3.
[11]米建国.侧卧位手法治疗神经根型颈椎病83例疗效观察.微量元素与健康研究.2008,25(4):68.
[12]王国明,李丽霞,宋永强等.针刺治疗神经根型颈椎病212例临床观察.中国中医药信息杂志.2006,13(6):63.
[13]尚秀葵,孟向文,董红英等.针刺“四天”穴为主治疗神经根型颈椎病临床观察.中国针灸.2002,22(11):732-734.
[14]张铁英,孙琳,黄梅颖.辨经取穴治疗神经根型颈椎病360例疗效观察.针灸临床杂志.2005,21(5):18-19.
[15]李亚伟,骆晓金.养子时刻开穴治疗神经根型颈椎200例.山东中医杂志.2004,23(6):348-349.
[16]滕雨虹,李俊营,滕义和.第二掌骨侧针法治疗神经根型颈椎病32例.针灸技术规范及学术发展研讨会论文集.2006:214-215.
[17]陈粉扣,陈宁.雀啄刺法、温针治疗神经根型颈椎病66例.针灸临床杂志.2003,19(2):38-39.
[18]张洪来,靳瑞.电针与牵引治疗神经根型颈椎病的随机对照研究.中国针灸.2003,23(11):6376-39.
[19]薄智云,牛庆强,朱文罡,等.腹针治疗神经根型颈椎病多中心对照研究.中国针灸.2005,25(6):387-389.
[20]闫海国.动态针刺法治疗神经根型颈椎病疗效观察.辽宁中医杂志.2003,30(7):573.
[21]张长江,董福慧,李金学。颈椎病的中医防治[M].北京:中医古籍出版社.1986:102-109.
[22]韦贵康.软组织损伤与脊柱疾病相关疾病[M].南宁.广西科技出版社.1994:352.
[23]程建明,穆敬平,彭力,敖金波.星状神经节阻滞配合穴位注射治疗神经根型颈椎病疗效观察.上海针灸杂志.2007,26(11):11-12.
[24]罗道珊,陈丹云.穴位注射为主治疗神经根型颈椎病疗效观察.中国针灸.2001,21(3):153-154.
[25]朱明海.手法为主治疗神经根型颈推病78例.华夏医学,2004,17(6):983(2): 42-43.
[26]孙大伟.补肾壮骨汤配合针灸治疗椎动脉型颈椎病45例.实用中医内科杂志.2004,18(2):147-148.
[2]赵定鹅,颈椎伤病学[M].上海:上海科技教育出版社,1994,147-191.
[3]孙宇,陆琪宏,第二届颈推病专题座谈会纪要.中华外科杂志, 1993, 31 (8):472.
[4]施祀,要重视对颈椎病的研究.中国中医骨伤科杂志,1999,(7):1-3.
[5]冯天有.中西医结合治疗软组织损伤的临床研究[M].北京:中国科技出版社,2002,14-17.
[6]国家中医药管理局.中医病证诊断疗效标准.南京:南京大学出版社,2000:59-60.
[7]郑筱萸主编.中药新药临床研究指导原则.北京:中国中医药科技出版社,2002:349-353.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:186.
[9]田中靖久.颈部神经根症治疗成绩判定基准[J].日本整形外科学会杂志,1993,67(3):552.
[10]黄帝内经素问.北京:中医古籍出版社.2003
[11]东汉·张仲景.伤寒论.北京:人民卫生出版社.2005.
[12]晋·皇甫谧.针灸甲乙经.北京:人民卫生出版社.2006.
[13]明·王肯堂.证治准绳.北京:人民卫生出版社.2001.
[14]清·吴谦.医宗金鉴.北京:中国古籍出版社.1995
[15]清·程文囿.医述.合肥:安徽科学技术出版社.1983.
[17]清·唐宗海.医经精义.上海:上海古籍出版社.2006.
[18]清·张璐.张氏医通.上海:上海科学技术出版社.1963.
[19]清·钱潢.伤科补要.北京:中国中医药出版社.2004.
[20]宋·严用和.济生方.北京:人民卫生出版社.1956.
[21]清·叶天士.临证指南医案.太原:山西科学技术出版社.2006.
[22]清·林佩琴.类证治裁.上海:第二军医大学出版社.2008.
[23]杨克勤.颈椎病.北京:人民卫生出版社.1993:65.
[24]孙宇、陆琪宏.第二届颈推病专题座谈会纪要.中华外科杂志,1993,31(8):472
[25]党耕田.颈椎病外科治疗中的一些问题[J].中华骨科杂志,1999,19(9):517-518.
[26]冉茂东.颈椎病的生物力学研究综述.辽宁中医杂志.2003, 30(4):327-328.
[27]李家顺,贾连顺.当代颈部外科学.上海:上海科学技术文献出版社.1997:98.
[28]葛宝丰,肯少订,徐印坎.实用骨科学工[M].北京:人民军医出版社,1999: 1462-1465.
[29]赵定麟.颈椎伤病学[M].上海:上海科技教育出版社.1994:154-155.
[30]张伯勋,王岩.现代颈肩腰腿痛诊断与治疗学.北京:北京人民军医出版社.2004:352-353.
[31]余锡明.推拿治疗颈椎病的作用机制.按摩与导引.1989,(3):17.
[32]叶秀兰等.施氏三步九法治疗神经根型颈椎病临床研究.上海中医药杂志.2008,42(4):51-53.
[33]隋孝忠等.神经根型颈椎病机械牵引程度与疗效的关系.中医正骨.1995,7 (5):8.
[34]魏淑珍等.旋转式颈椎牵引治疗颈椎病106例的疗效观察.颈腰痛杂志.1994,15(4):29.
[35]周章武等.颈椎病牵引位置的探讨.中国中医骨伤科.1996,4(1):35.
[36]姜宏等.牵引对颈椎稳定性影响的生物力学研究.中华理疗志.1999,22(2):106
[37]成鹏等.颈椎病牵引疗效分析.中华理疗杂志,1992,15(1):39
[38]邵亚平等.睡眠中仰卧位小重量后伸牵引治疗颈椎病.颈腰痛杂志,1996,17(3):179.
[39]潘之清.实用脊柱病学[M].山东:山东科学技术出版社.1999:256-257.
[40]刘柏龄,马晓春,刘茜.刘柏龄治疗脊柱病经验领要.北京:北京科学技术出版社.2003:72-73.
[41]张志文,冯卫星,张扬立,李福林.中药配合推拿治疗神经根型颈椎病36例.甘肃中医.2008,21(8):34-35.
[42]王希琳.输刺为主治疗神经根型颈椎病疗效观察.中国针灸.2008,28(1):497-498.
[43]岑玉文,杨顺益,庄礼兴.针灸治疗颈椎病的临床疗效观察及机理初探.颈腰痛杂志.2000,21(2):104.
[44]赵德顺,陈永发.针灸治疗颈椎病的临床研究.世界中医骨伤优秀文集[M].北京:中国中医药出版社.1998:185.
[45]刘星,王柏阳,邵继满,祁本杰.针刀治疗神经根型颈椎病化观察30例临床疗效及影像学变.江西中医学院学报.2008,205(2):54-55.
[46]陆珍千,费季翔,刘志诚等.从血浆与尿中儿茶酚胺和它的代谢产物含量说明推拿的镇痛作用.颈腰痛杂志.1994.15(4):199-201.
[1]葛宝丰,胃少汀,徐印坎.实用骨科学[M].北京:人民军医出版社,1999.1462-1465.
[2]丁季峰.推拿大成[M].郑州:河南科技出版社.1997:175-176.
[3]邵宜,许竟武.实用颈腰背痛学[M].北京:人民军医出版社.1992:6.
[4]冉茂东.颈椎病的生物力学研究综述.辽宁中医杂志.2003,30 (4) 327-328.
[5]杨克勤.颈椎病的临床与研究[M].北京:北京出版社.1988:5.
[6]韦贵康,韦坚,周红海等.颈椎病颈曲改变对神经根与椎动脉的影响及手法治疗临床观察.中西医结合学报.2003,1(4):259-261.
[7]冯世庆,杨明杰,孔晓红等.椎动脉支型颈椎病内浆皮素变化.中华骨伤杂志.1997,17(6):387.
[8]施祀,彭宝淦.人工庸香对退变颈椎间盘炎症抑制作用的实验研究.中国中医骨伤科杂志.1997,5(3):1-3.
[9]施祀.中医药治疗颈椎病的研究.世界手法医学杂志.2005,创刊号:1-6.
[10]李保林,张华.推拿疗法治疗神经根型颈椎病86例.国医论坛.2O01,16(1): 3.
[11]米建国.侧卧位手法治疗神经根型颈椎病83例疗效观察.微量元素与健康研究.2008,25(4):68.
[12]王国明,李丽霞,宋永强等.针刺治疗神经根型颈椎病212例临床观察.中国中医药信息杂志.2006,13(6):63.
[13]尚秀葵,孟向文,董红英等.针刺“四天”穴为主治疗神经根型颈椎病临床观察.中国针灸.2002,22(11):732-734.
[14]张铁英,孙琳,黄梅颖.辨经取穴治疗神经根型颈椎病360例疗效观察.针灸临床杂志.2005,21(5):18-19.
[15]李亚伟,骆晓金.养子时刻开穴治疗神经根型颈椎200例.山东中医杂志.2004,23(6):348-349.
[16]滕雨虹,李俊营,滕义和.第二掌骨侧针法治疗神经根型颈椎病32例.针灸技术规范及学术发展研讨会论文集.2006:214-215.
[17]陈粉扣,陈宁.雀啄刺法、温针治疗神经根型颈椎病66例.针灸临床杂志.2003,19(2):38-39.
[18]张洪来,靳瑞.电针与牵引治疗神经根型颈椎病的随机对照研究.中国针灸.2003,23(11):6376-39.
[19]薄智云,牛庆强,朱文罡,等.腹针治疗神经根型颈椎病多中心对照研究.中国针灸.2005,25(6):387-389.
[20]闫海国.动态针刺法治疗神经根型颈椎病疗效观察.辽宁中医杂志.2003,30(7):573.
[21]张长江,董福慧,李金学。颈椎病的中医防治[M].北京:中医古籍出版社.1986:102-109.
[22]韦贵康.软组织损伤与脊柱疾病相关疾病[M].南宁.广西科技出版社.1994:352.
[23]程建明,穆敬平,彭力,敖金波.星状神经节阻滞配合穴位注射治疗神经根型颈椎病疗效观察.上海针灸杂志.2007,26(11):11-12.
[24]罗道珊,陈丹云.穴位注射为主治疗神经根型颈椎病疗效观察.中国针灸.2001,21(3):153-154.
[25]朱明海.手法为主治疗神经根型颈推病78例.华夏医学,2004,17(6):983(2): 42-43.
[26]孙大伟.补肾壮骨汤配合针灸治疗椎动脉型颈椎病45例.实用中医内科杂志.2004,18(2):147-148.