【作者】 刘德才；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2008， 博士

【摘要】 目的:本论文系统研究针刺、中药、穴位埋针治疗过敏性鼻炎的临床效果,本文为探讨鼻翼穴埋针与针灸治疗AR的临床疗效,分两部分对AR和进行了理论与临床研究。为针刺、中药、穴位埋针三者结合治疗过敏性鼻炎提供科学的理论依据。方法:根据中华医学会耳鼻咽喉科学分会。1997《变应性鼻炎诊断及评定标准》和国家中医药管理局1994年6月发布的《中医病症诊断疗效标准》中鼻鼽的诊断标准。对符合研究要求的病例随机分为:治疗组、对照1组(针刺结合中药组)、对照2组(单纯中药组)。针刺:印堂、山根、迎香(双)、合谷(双),常规针刺,采用印堂透山根,直刺迎香,诸穴行快速捻转手法,使额部、鼻部出现明显酸胀感,;合谷穴进针后,行提插捻转法使之得气,在得气的基础上,迎香穴采用平补平泻的手法;合谷穴采用泻法,以大指和食指的指腹部向右捻转针身,即大指向后,食指向前,行捻转泻法;每天1次,每周治疗5天,休息2天,一周为一疗程,共4个疗程。埋针:鼻翼穴进行埋针治疗,采用揿针型(图钉型),针身长约0.2～0.3厘米,针柄呈环形,针身与针柄呈垂直状。皮肤严密消毒后,就可进行针刺。用镊子夹住针圈,将针尖对准穴位刺入,使环状针柄平整地留在皮肤上,用胶布固定。留置期间,每隔4小时左右用手按压埋针处1～2分钟,热天一般留置1～2天;冷天可留置3～7天,以加强刺激、增加疗效。一周为一疗程,共4个疗程。中药:应用辛夷清肺饮酌加减,苍耳子12g、鱼腥草30g、鹅不食草20g、麻黄9g、僵蚕12g,若喷嚏多者,加蝉蜕10g、乌梅12g。头胀痛者,加蔓荆子10g、白蒺藜15g。据患者体质之不同,剂量亦随之不同。每日12g,分3次一包4g饭后温水冲服,连续服用4周,一周为一疗程,共4个疗程。疗效判定:根据治疗前后症状和体征记分的总合,改善的百分率按下列公式评定常年性变应性鼻炎的疗效:治疗前总分—治疗后总分/治疗前总分×100%≥51%为显效,50%～21%为有效,≤2%为无效。有效率=显效率+好转率。对三组治疗前后,分别采用症状记分和体征记分,观察三组的疗效差别。治疗结束后,观察疗效与病程之间的关系。结果:三组患者治疗前体征分级、症状分级、症状评分组间进行统计学比较,经方差分析,P＞0.05,差异无统计学意义,提示三组患者治疗前体征分级、症状分级、症状评分无显著差异,具有可比性治疗结束后,体征分级、症状分级、症状评分方面,治疗组疗效优于对照1组、对照2组;对照1组与对照2组的疗效无显著差异。喷嚏症状,治疗前后有显著差异(P＜0.05);组间比较治疗组优于对照1组、对照2组;鼻涕症状,治疗前后有显著差异(P＜0.05);组间比较治疗组优于对照1组、对照2组;鼻堵症状,治疗前后有显著差异(P＜0.05);组间比较治疗组优于对照1组、对照2组;鼻塞症状,治疗治疗前后有显著差异(P＜0.05);组间比较治疗组优于对照1组、对照2组。疗程治疗结束后,治疗组临床显效10例,有效7例,无效3例,总有效率85.0%;对照1组临床显效7例,有效8例,无效5例,总有效率75.5%;对照2组临床显效6例,有效8例,无效6例,总有效率70.0%。治疗组疗效优于对照1组、对照2组;对照1组与对照2组疗效无差异。经过半年后,治疗组临床显效9例,有效5例,无效5例,总有效率73.7%;对照1组临床显效6例,有效5例,无效7例,总有效率61.1%;对照2组临床显效5例,有效6例,无效8例,总有效率57.9%。疗组疗效仍然优于对照1组、对照2组。结论:针刺、中药、埋针三种方法结合治疗常年变应性鼻炎可显著提高临床显效率,而且在症状体征积分的改善上也要优于对照组;随访结果显示,治疗组更能保持疗效的持久性。证实了以宣肺开窍为治疗原则,选取相应的体穴和埋针,采用针、药、埋针方法治疗常年变应性鼻炎具有较好的临床效果,为临床治疗本病提供了新的治疗思路和方法。更多还原

【Abstract】 Objective: In this study, we aim to provide scientific statistics to support the aforementioned. The experiment consists of 2 major sections: (1) a theoretical review of research papers to allow full understanding of the condition from diagnosis, treatment to prognosis, and (2) a clinical experiment to statistically evaluate its effectiveness of a combination of acupuncture applications as compared with single application and pharmacotherapy in the treatment of AR.Method: Diagnostic standards are as defined by the ENT division of the Chinese Medical Association in 1997.Types of AR symptoms in Chinese medicine are classified by Nation’s Chinese Medical Association in June of 1996. The experiment consists of a test groups and 2 control groups. Test Groups、Control Group I、Control Group II. General needling: The chosen acupoints are yin tang, shan gen, ying xiang, and he gu. Point-to-point needling is applied to yin tang and shan gen, where as ying xiang would apply a 90°angle of insertion. Rapid stimulation of the needles after insertion is applied to the remaining local acupoints. A reducing technique is performed at the point he gu. Treatment is daily, five times a week for 4 weeks.Burying-needle: Bi yi is the point chosen for Burying-needle,is 0.2-0.3 . Centimeter’s long, The needle handle assumes annular, The needle body and the needle handle assumes the vertical shape After skin strict disinfection, may carry on the acupunctur , Grips the needle circle with the tweezers, aims at the acupuncture point the needle-tip to prick, Causes the ring-like needle handle to keep on smoothly the skin, is fixed with the adhesive plaster ,every other about 4 hours hold back the depo-acupuncture place 1～2 minutes with the hand, the hot days leave alone generally for 1～2 days, cold season may leave alone for 3～7 days, strengthens the stimulation, to increase the curative effect. One week is a treatment course, altogether 4 treatment courses.Herbal Intake: Patients are given the processed concoction Xin Yi Qing Fei Yin. With varying symptoms, the dosage is adjusted accordingly. The daily dosage is 12g in total, dilute 4g into water per time, 3 times daily for 4 weeks.Results: Patients’ symptoms were recorded, staged, and scored in all 3 groups (Test, Control I, and Control II). After performing analysis, there’s no statistical difference within the groups (p>0.05), indicating that the groups stand no difference before treatment, thus the groups can withstand comparison. After treatment, the test group showed better result than control groups I and II (p<0.05); yet, there’s no statistical difference between the two control groups.Before and after treatment, the symptoms observed include sneezing, nasal dripping, complete and partial nasal congestion. All symptoms significantly improved after treatment in all of the groups. The results of the test group were significantly better than that of the control groups.At the end of the treatment, the test group had 10 patients resulting in good results, 7 satisfactory results and 3 with no improvement at all, attaining an overall effectiveness of 85.0%. Control group I had 7 patients with good results, 5 were satisfactory and 5 with no improvement, attaining an overall effectiveness of 75.5%. As for control group II, 6 patients had good results, 8 were satisfactory, and 6 had no improvement at all, attaining an over effectiveness of 70.0%. The effectiveness of the test group is significantly better than that of the control groups, while the control groups had no significant difference.Six months after treatment, the test group had 5 patients maintaining good results, 5 satisfactory results and 5 with no improvement at all, attaining an overall effectiveness of 73.7%. Control group I had 6 patients who maintained good results, 5 were satisfactory and 7 had no improvement, attaining an overall effectiveness of 61.1%. As for control group II, 5 patients maintained good results, 6 were satisfactory, and 8 had no improvement at all, attaining an over effectiveness of 57.9%. The effectiveness of the test group still is significantly better than that of the control groups. Conclusion: Combining basic needling, burying-needle and herbal intake can greatly increase the effectiveness in the treatment of AR. The test group had significantly better results than the 2 control groups in this experiment. Even after 6 months after treatment, the test group can maintain its effectiveness better than the 2 control groups. Strictly following the theory of enhancing the lung qi and easing congestion in the treatment of AR, we chose acupoints accordingly for acupuncture and Burying-needle, and subsequently the herbal concoction for oral intake. We found that the combination yield positive and statistically better result than just any one of the applications when treating AR.更多还原