疏肝活血法治疗神经性头痛的临床研究
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摘要
研究目的：在继承和总结名老中医赵金铎治疗头痛经验的基础上,结合课题组20余年来对神经性头痛的临床研究,进一步优化、升华,提出以疏肝活血法治疗神经性头痛的方案。本课题是中国中医科学院广安门医院第二批优势病种临床研究项目—神经性头痛从肝调治的诊疗方案研究的子课题,并且已通过伦理委员会评议。
研究方法：参照1988年《国际头痛协会标准》制定反复发作性紧张型头痛诊断标准,参照国家技术监督局《中医临床诊疗术语》国家标准(1997年)制定中医辨证标准(肝郁血瘀证)纳入患者,采取自身前后对照法,采用纯中药组方,突出中医优势。给予疏肝活血止痛汤合剂,此为著名老中医赵金铎的经验方(原方名为自拟活血化瘀汤),处方由柴胡,当归,川芎,生地,赤芍,白芍,丹皮等组成；一日一剂,分两次服,每次100ml；疗程为4周。评价指标包括头痛发作次数、天数、程度、持续时间、中医证候(主证、次证)等。分别在第0、2、4、8周观察以上指标。1个月疗程结束,显效病例随访1个月。试验期间避免使用其他止痛药物。
研究结果：
1.神经性头痛的疗效。服药前后神经性头痛疗效比较,临床治愈1.96%,显效31.37%,有效43.14%,总有效率76.47%,服药后疗效优于服药前。服药4周后,神经性头痛强度计分的比较,头痛发作次数、头痛天数、头痛持续时间、头痛程度、VAS评分、综合评分均优于服药前(P<0.05)。服药结束4周后随访神经性头痛强度计分的比较,头痛发作次数、头痛天数、头痛持续时间、头痛程度、VAS评分、综合评分均优于服药前(P<0.05)。
2.中医证候总疗效。服药前后中医证候疗效比较,临床治愈1.96%,显效15.69%,有效43.14%,总有效率60.78%,服药后疗效优于服药前。服药4周后中医症状计分的比较,头部钝痛、头痛经久不愈、头痛部位固定、头晕、舌象、脉象、证候总分均优于服药前(P<0.05)。服药结束4周后随访中医症状计分的比较,头部钝痛、头痛经久不愈、头痛部位固定、头晕、失眠、舌象、脉象、证候总分均优于服药前(P<0.05)。
3.试验过程中,服用疏肝活血止痛汤的患者无明显不良反应,均较耐受。疗程结束后未出现明显不适。试验前后患者血尿常规、肝肾功、心电图未见异常,安全性检测较为理想。
讨论：综上所述,疏肝活血法治疗神经性头痛在减少头痛的发作次数、持续时间、头痛程度、改善中医证候等方面有很好疗效。同时,中药治疗该病具有安全性高、副作用小的特点。从中医药领域进一步探寻治疗神经性头痛更有效的方法和药物,有着重要的临床和社会价值。
Objective:The efficacy on Tension-type Headache treated with relieving qi stagnancy in liver and activating blood following traditional Chinese medicine.
Methods:Reference to the diagnostic criteria (1988) on recurrent tension-type headache from"International Headache Society standard, "and referring to national standards (1997) of " the term on TCM clinical practice ", choose the patients belonging to the liver depression and blood stasis syndrome. we use before and after self-control law and pure herbal medicine to give prominence to the advantage of traditional Chinese medicine. The patients are given the herbal medicine with relieving qi stagnancy in liver and activating blood, per 100ml, twice a day. Evaluation indicators include the number of headache attacks, days, the extent, duration, TCM-like (the main symptoms, minor symptoms) and so on. The treatment last 4 weeks. Each two week, above indicators are recorded. Markedly effective cases are followed up for 1 more month. Avoid other painkillers in the trial period.
Result:
1. The efficacy of tension-type headache. The total effective rate was 76.47%. After the effect is better than taking medication before. After taking four weeks, nervous headache intensity points of comparison, headache attack frequency, headache days, headache duration, headache levels, VAS scores were better than before taking the comprehensive score (P<0.05); The end of 4 weeks after taking up Headache intensity points of comparison, headache attack frequency, headache days, headache duration, headache levels, VAS scores were better than before taking the comprehensive score(P<0.05).
2. The improvement of traditional Chinese medicine symptoms. The total effective rate was 60.78%. After the effect is better than taking medication before. Traditional Chinese medicine after a four-symptom scores of the comparison, the head dull pain, headache prolonged diseases, and headache fixed site, dizziness, tongue, pulse, symptom score before treatment were better than before (P<0.05); 4 weeks after the end of follow-up medication medicine symptom scores of the comparison, the head dull pain, headache prolonged diseases, and headache fixed site, dizziness, insomnia, tongue, pulse, symptom medication score were better than before(P<0.05).
3. There were no significant adversary reactions in patients during the test process. The conventional tests in patients with ECG, liver function and kidney work were normal.
Conclusion:The treatment of relieving qi stagnancy in liver and activating blood on TTH, in reducing the number of headache attacks, duration, headache and improving symptoms is more effective. At the same time, the safety of Chinese medicine to cure the disease is sure.
研究方法：参照1988年《国际头痛协会标准》制定反复发作性紧张型头痛诊断标准,参照国家技术监督局《中医临床诊疗术语》国家标准(1997年)制定中医辨证标准(肝郁血瘀证)纳入患者,采取自身前后对照法,采用纯中药组方,突出中医优势。给予疏肝活血止痛汤合剂,此为著名老中医赵金铎的经验方(原方名为自拟活血化瘀汤),处方由柴胡,当归,川芎,生地,赤芍,白芍,丹皮等组成；一日一剂,分两次服,每次100ml；疗程为4周。评价指标包括头痛发作次数、天数、程度、持续时间、中医证候(主证、次证)等。分别在第0、2、4、8周观察以上指标。1个月疗程结束,显效病例随访1个月。试验期间避免使用其他止痛药物。
研究结果：
1.神经性头痛的疗效。服药前后神经性头痛疗效比较,临床治愈1.96%,显效31.37%,有效43.14%,总有效率76.47%,服药后疗效优于服药前。服药4周后,神经性头痛强度计分的比较,头痛发作次数、头痛天数、头痛持续时间、头痛程度、VAS评分、综合评分均优于服药前(P<0.05)。服药结束4周后随访神经性头痛强度计分的比较,头痛发作次数、头痛天数、头痛持续时间、头痛程度、VAS评分、综合评分均优于服药前(P<0.05)。
2.中医证候总疗效。服药前后中医证候疗效比较,临床治愈1.96%,显效15.69%,有效43.14%,总有效率60.78%,服药后疗效优于服药前。服药4周后中医症状计分的比较,头部钝痛、头痛经久不愈、头痛部位固定、头晕、舌象、脉象、证候总分均优于服药前(P<0.05)。服药结束4周后随访中医症状计分的比较,头部钝痛、头痛经久不愈、头痛部位固定、头晕、失眠、舌象、脉象、证候总分均优于服药前(P<0.05)。
3.试验过程中,服用疏肝活血止痛汤的患者无明显不良反应,均较耐受。疗程结束后未出现明显不适。试验前后患者血尿常规、肝肾功、心电图未见异常,安全性检测较为理想。
讨论：综上所述,疏肝活血法治疗神经性头痛在减少头痛的发作次数、持续时间、头痛程度、改善中医证候等方面有很好疗效。同时,中药治疗该病具有安全性高、副作用小的特点。从中医药领域进一步探寻治疗神经性头痛更有效的方法和药物,有着重要的临床和社会价值。
Objective:The efficacy on Tension-type Headache treated with relieving qi stagnancy in liver and activating blood following traditional Chinese medicine.
Methods:Reference to the diagnostic criteria (1988) on recurrent tension-type headache from"International Headache Society standard, "and referring to national standards (1997) of " the term on TCM clinical practice ", choose the patients belonging to the liver depression and blood stasis syndrome. we use before and after self-control law and pure herbal medicine to give prominence to the advantage of traditional Chinese medicine. The patients are given the herbal medicine with relieving qi stagnancy in liver and activating blood, per 100ml, twice a day. Evaluation indicators include the number of headache attacks, days, the extent, duration, TCM-like (the main symptoms, minor symptoms) and so on. The treatment last 4 weeks. Each two week, above indicators are recorded. Markedly effective cases are followed up for 1 more month. Avoid other painkillers in the trial period.
Result:
1. The efficacy of tension-type headache. The total effective rate was 76.47%. After the effect is better than taking medication before. After taking four weeks, nervous headache intensity points of comparison, headache attack frequency, headache days, headache duration, headache levels, VAS scores were better than before taking the comprehensive score (P<0.05); The end of 4 weeks after taking up Headache intensity points of comparison, headache attack frequency, headache days, headache duration, headache levels, VAS scores were better than before taking the comprehensive score(P<0.05).
2. The improvement of traditional Chinese medicine symptoms. The total effective rate was 60.78%. After the effect is better than taking medication before. Traditional Chinese medicine after a four-symptom scores of the comparison, the head dull pain, headache prolonged diseases, and headache fixed site, dizziness, tongue, pulse, symptom score before treatment were better than before (P<0.05); 4 weeks after the end of follow-up medication medicine symptom scores of the comparison, the head dull pain, headache prolonged diseases, and headache fixed site, dizziness, insomnia, tongue, pulse, symptom medication score were better than before(P<0.05).
3. There were no significant adversary reactions in patients during the test process. The conventional tests in patients with ECG, liver function and kidney work were normal.
Conclusion:The treatment of relieving qi stagnancy in liver and activating blood on TTH, in reducing the number of headache attacks, duration, headache and improving symptoms is more effective. At the same time, the safety of Chinese medicine to cure the disease is sure.
引文
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[2]. Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache[J]. Neurology,2004, 62:1706-1711.
[3].徐胤聪,张继伟,吴建林.情志伤肝头痛证治[J].山东中医杂志,2008.27(2)：81-83
[4].周一谋.阴阳十一脉灸经,马王堆医书考注[M].天津科学技术出版社,1988：P22.
[5].毛军民.连建伟治疗内伤头痛经验撷英[J].江西中医药,2009,40(3)：26-27.
[6].曹文斌,周伟雄,阎淑丽.解止痛散与阿米替林治疗紧张型头痛的临床对照[J].医药产业资讯,2006,3(14)：32.
[7].刘军玲,刘晓辉.疏肌止痛煎治疗紧张性头痛的疗效观察[J].时珍国医国药,2005,16(6)：564.
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