摘要
背景：
肩关节周围炎是肩关节周围肌肉、肌腱、韧带、滑囊、关节囊等软组织处的慢性无菌性炎症,以肩关节疼痛和肩功能障碍为主要症状,属于中医痹症范畴,俗称五十肩、漏肩风、肩凝症、冻结肩等。其发病率占世界人口的2%-5%,患者多为50岁左右的中老年人,尤其是肝、脾、肾功能虚弱的患者感受风寒或过劳后易于发病。早期的临床表现为肩部微有疼痛,1-2周后疼痛逐渐加重,夜间尤甚,不能向患侧卧,肩部活动逐渐受限以至于肩关节粘连僵硬,活动完全受限,给患者带来很大痛苦,严重影响其生活质量。中医治疗肩周炎方法很多：中药、针灸、按摩、小针刀等,其中针灸治疗操作简单,疗效好,易于掌握,正在被全世界越来越多的针灸师、医生所运在用。但由于肩周炎的许多病患病情复杂,同时患有糖尿病、高血压、失眠等慢性疾病,如何根据肩周炎患者的实际病情,选用安全有效的针灸穴位,使用安全有效的操作方法,取得标本兼治的显著临床效果,这是一个很有意义的研究方向。在查阅了大量针灸文献后选用了董氏奇穴治疗肩周炎。
董氏奇穴又称为董氏针灸源于董其昌先生家传,自成体系,近年来在美国、韩国、中国、台湾等许多国家及地区流行。董氏奇穴在取穴、针法、诊法、理论有其独特之处。如很少在局部取穴,采用远端取穴求得经络的阴阳气血平衡；施针手法简单,不需要采用传统的“弹”、“遥”、“摆”等手法,可减少晕针,使得针灸治疗更为安全；其“脏腑别通”法从阳引阴,从阴引阳,加之运用特殊奇穴每每获得显著的临床疗效。肾关穴是董氏针灸治疗肩痛的特效穴,同时也是补肾要穴,常与患侧四花中穴并用治疗肩痛和肩不能上举。但其临床疗效究竟如何,特别是对肩周炎患者肩关节外展、上举、后伸活动明显受限的肩周炎患者治疗效果如何,至今还没有见到有关方面的随机研究报道。基于大多数肩周炎病人具有虚实相兼、本虚标实的临床症状,既临床表现为脾肾气阴两虚、肝阴虚或气血虚,同时又伴有阳明胃经、少阳胆经气滞血瘀、肝气瘀阻,及肩关节局部的风、寒、湿痹阻。因此在该项临床试验中我选取了董氏奇穴中能够健脾强肾的肾关穴作为治疗肩周炎的主穴,选用了既能增强脾胃功能,又能行气活血的四花中穴为配穴,两穴配合使用以达到较好的治疗肩周炎的临床效果。
本项研究以芝加哥生生健康诊所收集的60名肩周炎患者为研究对象,客观评估针刺肾关穴、四花中穴治疗肩周炎的镇痛效应,及肩关节活动功能的改善程度；观察研究以阴经肾关穴为主穴,以阳经四花穴为配穴的董氏奇穴治疗肩周炎的综合疗效,为安全有效的治疗肩周炎提供进一步的临床依据。
目的：
观察董氏奇穴针灸治疗肩关节周围炎标本兼治的临床疗效,客观评估董氏奇穴肾关、四花中穴治疗肩周炎的有效性、安全性。
方法：
将符合纳入标准的芝加哥生生诊所60例肩周炎患者,按照就诊顺序随机分为观察组(奇穴组)、对照组,各30例。观察组取患侧董氏奇穴的肾关穴(阴陵泉下1.5寸)为主穴,健侧四花中穴(足三里下4.5寸)为配穴,对照组取患侧条口,健侧的阴陵泉穴。两组均每周治疗1次,5次为一疗程,连续治疗两个疗程,共计10次。两个疗程结束后观察治疗结果。所有患者治疗前后肩部疼痛变化程度采用VAS视觉模拟评分进行评估,并对患者治疗前后的肩关节疼痛、肩关节功能活动、临床疗效、生命质量状况进行分析评定。
结果：
1.奇穴组(肾关穴、四花中穴)和对照组(阴陵泉穴、条口穴)自身治疗前后比较,疼痛、功能活动改善明显(P<0.05)。
2.两组患者第一次治疗时,奇穴组和对照组治疗前与针刺15分钟后肩关节疼痛VAS评分比较,奇穴组即时镇痛疗效明显优于对照组(P=0.0001,P<0.05)；第一次治疗前与针刺45分钟后肩关节疼痛VAS评分比较,奇穴组即时镇痛疗效明显优于对照组(P=0.0001,P<0.05),差异有统计学意义。
3.治疗前、后两组肩关节疼痛VAS评分组间比较,奇穴组镇痛疗效优于对照组,差异有统计学意义(P=0.0035,P<0.05)。与治疗前比较,两组治疗后镇痛疗效均优于治疗前,差异有统计学意义(P<0.0001)。
4.两组治疗前、后肩关节功能评分比较,奇穴组与对照组肩关节功能评分,奇穴组优于对照组,差异有统计学意义(P=0.0304,P<0.05)；治疗后奇穴组的前屈、外展评分优于对照组,差异有统计学意义(前屈P=0.003,P<0.05；外展P=0.009,P<0.05),与治疗前比较,两组治疗后肩关节功能评分均优于治疗前(P<0.05)。
5.奇穴组和对照组治疗总有效率均为100%,两组患者治疗后生活质量评分较治疗前均有明显改善(P<0.05)。
结论：
董氏奇穴健侧肾关穴、患侧四花中穴治疗肩周炎临床即时镇痛疗效显著明显优于对照组。
肾关穴、四花中穴对肩关节功能活动改善明显；对肩周炎患者前屈、外展受限疗效显著。
董氏奇穴组和对照组治疗肩周炎均有显著疗效且操作安全,提高肩周炎患者的生活质量效果明显。
Background
Scapulohumeral periarthritis is a chronic inflammation disorder which affects tissues, tendons, ligaments, the capsule and the synovium surrounding the shoulder joint with significant morbidity. The chief clinical symptoms of this condition are pain and restriction of the range of motion of the shoulder. It belongs to "Bi syndrome" in Traditional Chinese Medicine and it is also called adhesive shoulder, frozen shoulder, shoulder at age of50years (50jian), leaky shoulder wind (lou jian feng) among other names. The incidence is about2%-5%in the general population. The age of incidence is commonly around age50with higher incidence rates for individuals with deficient liver, spleen, or kidney functions, at same time attacked by external wind cold, or after over work. The initial symptoms of scapulohumeral periarthritis include slow onset of gradually worsening shoulder pain after1-2weeks, severe pain at night, inability to sleep on the affects side, joint stiffness, and gradual limitation of the range of motion. There is a myriad of treatment for scapulohumeral periarthritis in Traditional Chinese Medicine including Chinese herbs, acupuncture, moxibustion, massage (tuina), and acupotomy. Many techniques of acupuncture and moxibustion are gaining acceptance among doctors and acupuncturist around the world due to the easy of treatment and clinical efficacy. Given the complicated nature of many scapulohumeral periarthritis patients, who have concomitant diabetes, hypertension, insomnia or other chronic diseases, how to select safe and effective acupoints for the treatment of scapulohumeral periarthritis based on body conditions continues to be a significant research topic. Here we examined the Tung's extra points as a treatment modality for scapulohumeral periarthritis.
Tung's extra points, also call Tung's acupuncture, has its roots from Master Dong Qichang's family. In recent years, it has gained popularity around the world, included the United States, South Korea, China and Taiwan. Tung's extra point has unique acupoints selection, needle technique, diagnostic method and theory. Acupoint selection uses the most distant points to balance qi, blood, yin and yang, and seldom use local points. Tung's extra points only use simple techniques, there are no use of traditional needle manipulation techniques such as "tan""yao","bai," this reduces the likelihood of patients fainting and increases the safe of acupuncture and moxibustion treatments. When using one of Tung's extra point theories "zang fu tong bie" which treats diseases by bringing yang from yin and yin from yang in combination with extra points, remarkable clinical effect can be achieved. Tung's extra point Shenguan Xue is a specific point to treat shoulder pain and tonifies the kidneys. When combined with Sihuan Shang or Sihuan Zhong it is empirically effective at treating shoulder pain and frozen shoulder. Until now there has been no randomized clinical trial which assess the combination of Shenguan Xue and Sihuan Zhong Xue to treat scapulohumeral periarthritis, especially for patient with shoulder abduction, flexion and extension limitations. Most scapulohumeral periarthritis patients have clinic symptoms of deficiency with excess such as root deficiency and branch excess, spleen and kidney qi and yin deficiency, liver yin deficiency combine with both yangming stomach channel and shaoyang gallbladder channel qi stagnation and blood stasis, liver qi stagnation and exterior wind cold dampness invading the shoulder. In this study we used Tung's extra point Shenguan Xue as main treatment point which strengthens both the kidney and spleen and Sihua Zhong Xue as an assist point which strengthens both the spleen and stomach and can moves qi and invigorates blood circulation.
Objective
To assess the effectiveness of Tung's extra points as the treatment of scapulohumeral periarthritis. To evaluate the efficacy and safety of Tung's extra points Shenguan Xue and Sihuan Zhong Xue on shoulder pain, range of motion of the shoulder and overall quality of life for patients with scapulohumeral periarthritis.
Method
Sixty patients with scapulohumeral periarthritis who met the inclusion criteria were from Shen Shen Health Harmonize Clinic were included in the study. The patients were randomly divided into two groups:1) observation group (Tung's extra points group)30cases;2) control group (regular acupuncture)30cases. The observation group (Tung's extra points group) was treated by Tung's extra points. The chief point is the healthy side Shenguan Xue, and assistant point is the affected side Sihua Zhong Xue.
The control group is treated with healthy side Yinling Quan Xue and affected side Tiao Kou Xue. Both groups received treatments once a week, for a total of10treatments. Efficacy was evaluated after10treatments by assessing the VAS pain scores, the functional mobility of shoulder and quality of life.
Results
1.Both Tung's extra point group (Shenguan Xue, Sihuan Zhong Xue) and the control group (Yinling Quan Xue, Tiaokou Xue) showed significant improvement pain reduction and range of motion when compared to pre-treatment (P<0.05).
2.During the first treatment after needling for15minutes with only one needle, Tung's extra point group showed significantly reduced shoulder pain when compared to the control group (P<0.0001). During the first treatment after needling for45minutes, there was significant reduction in shoulder pain when compared to pre-treatment for both groups (P<0.0001); Tung's extra point group also showed a statiscally significant pain reduction when compared to the control group (P<0.0001).
3. Comparing with both groups pre/post treatments, there was significant difference in shoulder pain scores (VAS)(P=0.0035, P<0.05); extra point group had obviously improvement in pain score than control group.
4. Compared to shoulder function scores before treatment, there were statistical significant improvement in shoulder function scores post-treatment for both groups; Tung's extra point group showed a statistically greater improvement in shoulder function, especially flexion (P=0.003, P<0.05) and abduction (p=0.0009, P<0.05) compared to the control group.
5. In both groups,100%of patients showed overall improvement.
Conclusion
Tung's extra points using healthy side Shenguan Xue, and affected side Sihuan Zhong Xue can more significantly and promptly alleviate the pain of scapulohumeral periarthritis compared the control group.
Shenguan Xue and Sihuan Zhong Xue can improve shoulder function, especially limited flexion and abduction due to scapulohumeral periarthritis.
Both Tung's extra point group and control group are effective and safety in the treatment of scapulohumeral periarthritis and improve the quality of life for the patients with scapulohumeral periarthritis.
引文
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