良导络调节疗法下穴位贴敷复方南星止痛膏治疗膝骨性关节炎的临床研究
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摘要
[背景]良导络疗法是通过选择适当的治疗点来调整全身良导络,使之恢复生理平衡状态的一种方法。对于膝骨关节炎而言临床多见关节疼痛、肿胀、肢体沉重、功能障碍等症状,与中医经络理论中“输穴”所主相似,因此选为良导络疗法的治疗点。穴位贴敷是中医的特色疗法之一,它在消化系统、呼吸系统疾病的治疗方面有着独特的优势,也已有学者将其应用于骨关节炎的治疗中。将良导络疗法与穴位贴敷相结合治疗膝骨关节炎是本研究的创新之处。复方南星止痛膏治疗骨性关节炎具有良好的疗效,已经广泛应用于临床,该药被选为本研究的贴敷药物。
     [目的]本课题从文献研究、临床研究两个方面着手,评价良导络调节疗法穴位贴敷复方南星止痛膏治疗膝骨关节炎的临床疗效,并且探讨其与中医经典理论的联系。
     [方法]本研究为前瞻性、随机、对照研究。总共60例(有效55例)年龄介于40-75岁的江苏省中医院门诊膝骨关节炎患者随机分成治疗组和对照组,治疗组予以良导络调节疗法穴位贴敷复方南星止痛膏治疗,对照组给予常规复方南星止痛膏贴敷治疗。连续用药2周,观察治疗前后的疼痛、僵硬、功能障碍VAS评分、WOMAC指标积分。全部病例治疗观察结束后进行统计分析。
     [结果]良导络测定膝骨关节炎患者的F1脾经、F4膀胱经兴奋,同时伴有F3肾经、F5胆经抑制现象最为明显。各组组内前后比较在疼痛、僵硬、功能障碍单项积分以及WOMAC总分、OA整体评分、总有效率方面都有显著差异(P<0.05),治疗后两组组间比较在疼痛、功能障碍单项积分以及WOMAC总分方面有显著差异(P<0.05)。提示良导络调节疗法穴位贴敷复方南星止痛膏组疗效优于常规复方南星止痛膏贴敷组。
[background] Ryodoraku Regulation Therapy is one of the treatment Methods which can make the Ryodoraku in physiological balance by selecting the appropriate treatment points. To knee osteoarthritis, Joint pain, swelling, limb heavy and dysfunction are comm clinical symptoms which similar with Shu acupuncture point master.So it was selected as the Ryodoraku Regulation Therapy acupuncture point.Acupoint application is one of the features of TCM treatment. It has unique advantages in treatment of the digestive system and respiratory system diseases. And s scholars are also applied it in the treatment of osteoarthritis.Two combining treatment of osteoarthritis of the knee is the study of innovation. Fufangnanxingzhitong Plaster has good therapeutic effect to osteoarthritis and widly used in the clinical.So the application drugs is Fufangnanxingzhitong Plaster.
     [objective] This was a prospective randomized active control trial. To evaluate clinical efficacy of Ryodoraku Regulation Therapy using Fufangnanxingzhitong plaster acupoint application in the treatment of knee osteoarthritis and to assess its relation with classical theory of TCM.
     [Methods] This was a prospective randomized active control trial. A total of60(56effective) participants with OA of knee joints between38and75years old from the outpatient department of Jiangsu Provincial Hospital of TCM were randomly assigned to receive Ryodoraku regulation therapy using Fufangnanxingzhitong plaster acupoint application and regular treatment using Fufangnanxingzhitong plaster of the affected knee joints. All cases were followed clinically for a minimum of2weeks and the main observe VAS indexes of pain, stiffness, dysfunction of WOMAC scores were recorded. The data was statistical analyzed in the end.
     [Conclusion] An integrated approach of Ryodoraku regulation therapy using Fufangnanxing-zhitong plaster acupoint application is better than regular treatment using Fufangnanxingzhitong plaster as an effective treatment which fully embodies the characteristic of TCM in alleviating pain, improving knee disability and quality of life in patients with OA knees with less adverse reaction. It proves that this disease is attributive to deficiency complicated by excess while the endogenous factors are deficiency of the liver and kidneys, and cold-damp invasion of spleen.
引文
[1]何伟,张俐.骨病临床研究[M].北京:北京科学技术出版社,2006:133-137.
    [2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2005:1337-1339.
    [3]苏阳,朱志刚,蔡裕兴,等.广州地区中老年人症状性膝关节骨关节炎流行病学的调查研究[J].中华关节外科杂志(电子版),2010,4(4):438-444.
    [4]Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the preva-lence of arthritis and selected musculoskeletal disorders in the United States [J].Arthritis Rheum,1998,41:778-799.
    [5]冯巍,封彦齐.膝骨性关节炎的治疗进展[J].贵阳中医学院学报,2010,32(3):87.
    [6]谢利民主译.骨关节炎诊断与治疗[M].北京:人民卫生出版社,2008:25.
    [7]郭建刚,李洛宜.论骨性关节炎的发病基础和施治原则[J].新中医,2003,35(4):4.
    [8]张晓玮,郑洪新.骨痪与骨痹辨析[J].中国医药指南,2008,24(6):324.
    [9]周达岸.骨性关节炎的中医发病机制与治疗研究进展[J].中华中医药学刊,2007,25(4):756.
    [10]丁奎,孙材江,王万春,等.膝关节退行性骨关病与骨质疏松的相关关系研究[J].湖南医学,1997,14(6):323-324.
    [11]贺宪,魏春山,蔡智刚.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005,24(2):73-74.
    [12]周京华,李建民.中药治疗膝关节骨性关节炎的临床观察[J].北京中医杂志,2002,21(2):93.
    [13]雷宁波,韩大为.骨性关节炎的中医辨证治疗及其机制[J].中国民族民问医药,2010,5:110.
    [14]牛维,邵敏,黎高明.补肾活血方对膝骨性关节炎模型家兔一氧化氮水平的影响[J].安徽中医学院学报,2005,24(3):26~27.
    [15]江中潮,何洪阳,刘罡,等.骨生注射液对实验性骨性关节炎家兔血浆SOD和MDA的影响[J].中国骨伤,2004,17(10):593~595.
    [16]万荣,杨庆铭,邓廉夫等.黑虎丹治疗兔骨关节炎的实验研究[J].中国骨伤.2001,14(2):86.
    [17]黄枫,唐勇,郑晓辉.补肾强膝方对绝经后妇女膝骨性关节炎的影响[J].中医正骨,2002,14(4):12.
    [18]任超西,赵明山.辨证论治退行性膝关节骨性关节病300例[J].河南中医学院学报,2004,19(1):58.
    [19]杨淑妍.补肾通络汤治疗增生性膝关节炎60例[J].中国实用医药,2010,5(2):182.
    [20]刘鑫,周金桔.通用痛风方加减治疗膝骨关节炎[J].四川中医,2004,24(3):76-77.
    [21]王玉明.女性膝骨关节炎从肝论治90例临床观察.北京中医.2001(6):29.
    [22]肖国文.补肾调肝法治疗膝骨性关节炎的疗效观察[J].中医临床研究,2011,3(22):101-102.
    [23]胡海雁,丛艳,李金萱.骨痹效灵汤治疗膝关节骨性关节炎的临床研究[J].西部药,2011,24(12):57-58.
    [24]解纪惠,刘梅珍,崔丽芹,等.清痹汤治疗膝骨关节炎50例疗效观察[J].河北中医药学报,2010,25(4):20.
    [25]廖军,吕发明,孟庆才.中药热熨Ⅰ号方治疗阳虚寒凝型膝关节骨性关节炎的临床疗效观察[J].新疆医科大学学报,2010,33(8):988-989.
    [26]王影,傅秀珍,邱瑞娟.四子散药熨对膝骨关节炎患者生存质量影响的研究[J].中国民族民间医药,2010,14(3):3-6.
    [27]汪永夫,章洁军,林伟娥.活络煎剂薰洗对膝骨关节炎患者膝关节[J].中国临庆康复,2005,9(6):173-174.
    [28]马治国.强筋祛痹汤熏洗治疗膝骨性关节炎疗效观察[J]].陕西中医,2011,32(12):1631-1632.
    [29]倪明,黄文伟.复方南星止痛膏对膝骨性关节炎,寒湿痹阻证-抗炎止痛作用的研究[J].新中医,2010,42(4):35-36.
    [30]郭六雷,耿初伟,贾守宁.关节止疼散外贴治疗膝关节骨性关节炎100例[J].中医研究.2011,2400:45-46.
    [31]吕陟.奇止消痛贴膏治疗膝关节骨性关节炎的疗效观察[J].当代医学,2011,17(16):106-107.
    [32]章权.膝骨性关节炎的药物治疗进展[J].中国中医骨伤科杂志,2009,1700:71.
    [33]盛太平,冯俊奇,武玉明.中药离子导入治疗膝骨关节炎的影像观察[J].中医正骨,2010,22(10):3-4.
    [34]孙超,冯俊奇,孙军强等.中药离子导入治疗膝骨关节炎75例[J].人民军医,2009,52(6):378.
    [35]李建华,龚利,房敏.推拿对膝骨关节炎患者膝屈伸肌肌张力的影响[J].中国骨伤,2011,24(7):575.
    [36]周鹏.推拿治疗老年性膝骨关节炎108例[J].浙江中医杂志,2010,45(9):669.
    [37]杜引平.齐刺治疗老年性膝骨关节炎50例[J].湖北中医杂志,2002,24(7):49.
    [38]包飞,王慧娟,吴志宏.针灸治疗骨关节炎研究现状及机理分析[J].中国康复理论与实践,2007,13(4):357.
    [39]李常度,黄信勇,杨旭光,等.温针灸治疗虚寒型膝骨关节炎疗效观察[J].中国针灸.2006,26(3):189]
    [40]田力欣,王卫,郭义.国外针灸治疗膝骨关节炎的随机对照研究概览[J].针灸临床杂志,2010,26(06):77.
    [41]White A, FosterNE, CummingsM, et a.l Acupuncture treatment for chronic knee pain:a systematic review[J].Rheumatology (Oxford),2007,46:384-390.
    [42]俞杰,王少杰,白文,等.针刀辨证分型治疗膝关节骨关节炎76例临床观察[J].北京中医药大学学报,2009,32(10):716-718.
    [43]彭溶,温建民,梁朝等.针刀治疗膝骨关节炎疗效评价[J].中国临床医药杂志,2011,23(5):414.]
    [44]朱康利.独活寄生汤加减内服合自拟方外用治疗膝骨性关节炎64例[J].浙江中医药大学学报,2011,35(6):856.
    [45]郑辉,邓灵芝,孙力.“烽火台”疗法结合口服中药治疗风寒湿型膝骨性关节炎32例[J].西部中医药,2011,24(12):75.
    [46]王清桃.中西医结合治疗膝骨性关节炎的临床研究[J].中医药导刊,2008,10(9):1359-1360.
    [47]毛宾尧,张学义,等主编.膝关节外科[M],北京:人民卫生出版社出版,1999:351.
    [48]郭欣宇,马英,曾艳,等.绝经期骨性关节炎患者血浆性激素和细胞因子水平及其与膝关节功能的相关性[J].中国全科医学,2008,11(5B):852-854.
    [49]谭玉林,鲍同柱.骨关节炎关节软骨退变机制的研究进展[J].医学综述,2010,16(15):2259-2260.
    [50]王澍寰.临床骨科学[M].上海:上海科学技术出版社,2005:288.
    [51]Kim HA,LeeYJ, Seong SC,et al.Apoptotic chondrocyte death in human osteoarthritis[J]. JRheumato,l 2000,27(2):455-462.
    [52]袁锋,尹峰.骨性关节炎的病因及治疗进展[J].医学综述,2011,17(6):858.
    [53]肖东亮,赵劲民.骨性关节炎的治疗新进展[J].中国现代医生,2010,48(2):14.
    [54]朱均.美洛昔康治疗膝关节骨性关节炎临床观察.中国基层医药.2005,12(16):1436.
    [55]Towheed TE.A systemaic review of pharmacological therapy in OA. Semin Arthritis Rheum, 1999,26(5),755.
    [56]吴镇权,刘刚,杨昀焯,等.西乐葆治疗120例膝骨关节炎的临床研究[J].中国热带医学,2007,7(6):930-931.
    [57]张军,孙磊.关节镜治疗膝骨性关节炎的临床分析[J].中国矫形外科杂志,2010,18(11):895.
    [58]陈文君,尹绍猛,于新忠.胫骨高位倒L形截骨并外固定架固定治疗膝内翻畸形性骨性关节炎[J].临床骨科杂志,2007,10(5):420.
    [59]孙中华,王发平,胡冰,等.骨钻孔减压配合中药治疗膝骨性关节炎疗效分析[J].2003,15(1):12-13.
    [60]张继春,高石军,陈百成,等.关节镜下自体骨软骨移植修复股骨关节而软骨缺损[J].中华骨科杂志,2004,24(3):158-161.
    [61]李兴铭.人工全膝表面关节置换术治疗老年膝骨关节炎[J].山西医药杂志,2007,36(5):390.
    [62]黄东辉,张琪,杨丰建,等.人工髌股关节置换术治疗髌股关节炎的初步观察[J].中国骨与关节损伤杂志,2009,24(6):484-486.
    [63]Khalifeh MS,Al-Rukibat R,Hananeh W,et al.Investigation of the role of tumour necrosis factor-{alpha},interleukin-l{beta},interleukin-10,nitric oxide and rheumatoid factor-immunoglobulin M in a rat model of arthritis[J].Lab Anim,2009 Oct 26.
    [64]Morisset S, Frisbie DD, Robbins PD, et al.IL-Ira/IGF-1 gene therapy modulates repair of microfractured chondral defects[J].Clin Orthop Relat Res,2007,462:221-228.
    [65]蒋瑞峰摘译.良导络治疗及其有关现状[J].日本医学介绍,1983,4(6):29.
    [66]胡武光.良导络在临床上的应用[J].江苏中医,1958,4:22-23.
    [67]Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis:Osteoarthritis of the knee[J]. Arthritis Rheum,1995,38:1541-46.
    [68]郑筱萸.中药新药临床研究指导原则.北京人民卫生出版社,2002:130—131.
    [69]Bellamy N. Validation study of WOMAC. Rheum,1988,12:1833.
    [70]李春梅编译.日本的针刺与良导络疗法.国外医学中医中药分册,1994,16(3):12-15.
    [71]兵头正义.各种疼痛性疾病良导络测定之特征(日).日良自律,1993,38(7):1-4.

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