【作者】 杨旭光；

【导师】 梁繁荣；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的：通过规范的临床随机对照试验,以偏头痛患者为研究对象,探讨循经取穴针刺治疗偏头痛的临床疗效,拟初步阐明“经穴效应是具有特异性的,其特异性与经脉循行密切相关”的研究假说。方法：1、采用多中心、随机、对照的研究方法,将符合纳入标准的180例偏头痛急性发作期患者,通过中央随机系统随机分为本经取穴组(治疗组)和非经非穴1组(对照1组)和非经非穴2组(对照2组),其中175例获得随机号(5例因网络信号受阻随机错误),163例完成了整个研究过程,脱失、剔除病例12例。治疗组针刺少阳经穴,对照组分别为国内外常用的两种不同的非经非穴选取方法,治疗30min。疗效评价包括针刺治疗前及治疗后0.5h, 1h,2h,4h的VAS评分等。2、采用多中心、随机、对照的研究方法,将符合纳入标准的153例偏头痛患者,通过中央随机系统随机分为本经取穴组(治疗组)和他经取组(对照1组)和非经非穴组(对照2组),其中142例完成了整个研究过程,脱失病例11例。治疗组针刺少阳经穴,对照1组针刺阳明经穴,对照2组针刺非经非穴,穴位均取单侧,左右侧交替使用,每天1次,每次治疗30min,5次一个疗程,疗程期间休息2天,共治疗4个疗程,疗程结束后评价疗效以及疗程结束后4周、12周随访2次。疗效评价标准包括患者治疗前后的头痛天数、头痛影响生活天数、发作次数、VAS评分、偏头痛特异性生活质量量表(MSQ)等指标。结果：1、针刺经穴与非经非穴针刺治疗偏头痛急性发作期的临床随机对照研究①经穴组与非经非穴组比较：针刺治疗后2h、4h的VAS评分,两组比较差异有统计学意义(P<0.05)；针刺治疗后1h、2h、4h的VAS改善值,两组比较差异有统计学意义(P<0.05)；在24h头痛缓解率、24h头痛复发／加重率,受试者总体评价方面,两组比较差异具有统计学意义(P<0.05)。②两个非经非穴组比较：针刺后0.5h、1h、2h 4h的VAS评分,两组比较,差异无统计学意义(p＞0.05)。③三组治疗前后的比较：在VAS评分方面,三组在针刺后0.5h、1h、2h、4h与治疗前比较,差异具有统计学意义(P<0.01)。2、针刺本经穴与他经穴治疗偏头痛的临床随机对照研究①本经取穴组(治疗组)与他经取穴组比较(对照1组)：疗程结束后及疗程结束后4周、12周,在头痛天数、发作次数、头痛程度、生活质量等方面,两组比较差异无统计学意义(P>0.05)。②本经取穴组(治疗组)与非经非穴组(对照2组)比较：疗程结束后4周的头痛天数、疗程结束后12周的发作次数、VAS评分及VAS改善值,疗程结束后4周、12周的伴随症状天数,两组比较差异有统计学意义(P<0.05)。③三组治疗前后的比较：疗程结束后及疗程结束后4周、12周,三组在头痛天数、发作次数、头痛程度、生活质量等方面与治疗前比较,差异有统计学意义(P<0.01)。结论：1、针刺治疗偏头痛急性发作期,在减轻头痛症状方面,经穴组优于非经非穴组。在防治24h头痛复发／加重及受试者总体疗效评价方面,经穴组优于非经非穴。该研究结果表明经穴效应存在特异性。2、两经脉之间中点选取非经非穴与经穴远端选取非经非穴均可以做为非经非穴选取的方法,经穴远端选取更合适。3、循经取穴针刺是防治偏头痛发作的一种有效的治疗方法,可以减少头痛天数、头痛发作次数、头痛程度及提高患者的生活质量。在头痛天数、发作次数、伴随症状天数、头痛程度方面,治疗后4周或12周,本经取穴组优于非经非穴组,而本经取穴组与他经取穴组比较是否有差异,尚需进一步研究证实。4、循经取穴针刺治疗偏头痛的临床疗效肯定,初步表明了“经穴效应是具有特异性的,其特异性与经脉循行密切相关”的假说。更多还原

【Abstract】 Objective:To study whether specific acupoints of Shaoyang meridians achieve better effect than acupoits of Yangming meridians or non-acupoints, we conducted a randomized controlled trial to treat migraine.Methods:1. Study was designed as a multi-center, randomized controlled trial.180 patients meeting the inclusiong criteria,5 of them were randomly assigned incorrectly because mobile messaging was blocked during callback,175 of them completed the callback process and were randomized into three groups. One group received verum acupuncture while subjects in the other two groups were treated with sham acupuncture.There were 163 patients accomplished, whereas 12 patients were missing. Treatment group gave acupuncture at acupoints along Shaoyang meridian bilaterally. The two control groups were given sham acupuncture treatment. Each patient received one session of treatment and was observed over a period of 24 hours. The main outcome measure was the differences in visual analogue scale (VAS) scores before treatment and 0.5,1,2, and 4 hours after treatment.2. It was a multi-center, randomized controlled trial. There were 153 patients with migraine meeting the inclusion criteria, and they were randomized into three groups, 142 accomplished and 11 missing. Treatment group were define as specific acupoints of Shaoyang meridians; The two control groups were define as acupoints of other medrians and non-acupoints control group. Treatment group gave acupuncture at acupoints along Shaoyang meridian. The control group 1 were given gave acupuncture at acupoints along Yangming meridian. The control groups 2 were given sham acupuncture treatment. In each session all acupoints or non-acupoints were punctured by needles and filiformneedles unilaterally, and left and right side are alternatively. Each patient received 20 sessions of treatment totally over a period of 4 weeks, once a day, five times continuously with two days interval in a week. The outcome measure was the differences in the number of days with migraine and frequency of migaine attacks and (VAS) scores, MSQ during 4 weeks before randomization and 4,8, and 16 weeks after randomization.Results:1.①Significant differences in the VAS scores were found at 2h,4h after treatment among three groups(p＜0.05). Moreover, significant difference in the change of VAS scores from baseline were observed in the 1,2,4 hours after treatment among the three groups (P<0.05).②Significant differences were observed in pain relief, relapse, or aggravation within 24 hours after treatment as well as in the general evaluations among the three groups (P<0.05).③fter acupuncturing the acupoints and non-acupoints, each group had obvious pain-relief effect at 0.5,1,2, and 4 hours, however, no significant difference was found between the 2 sham acupuncture groups.2.①There was no significant differences in the number of days with migraine and headache symptoms, frequency of migaine attacks, VAS scores and MSQ scores at 4, 8, and 16 weeks after randomization between treatment group and control groups 1 (P>0.05).②Significant differences in the number of days with migraine were found at 8 weeks after randomization and frequency of migaine attacks at 16 weeks after randomization between treatment group or control groups 1 and sham acupuncture groups (P<0.05). Significant differences in the number of days with headache symptoms were found at 8,16 weeks after randomization between treatment group and sham acupuncture groups (P<0.05); Significant differences in the VAS scores and change from baseline were found at 16 weeks after randomization between treatment group and sham acupuncture groups (P<0.05).③Significant differences in the number of days with migraine and headache symptoms, frequency of migaine attacks, VAS scores and MSQ scores after randomization were found at 4,8, and 16 weeks after randomization after treatment in three groups versus before treatment (P<0.05).Conclusion:1. Verum acupuncture treatment is more effective than sham acupuncture in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation. These findings support the hypothsis that there are specific physiological effects that distinguish genuine acupoints from non-acupoints.2. Sham acupoints can be selected in the middle of two meridians. However, the distal end of meridian acupoints is appropriate.3. Acupuncture treatment may be is one of the effective therapies to prevent migraine in reducing the number of days with migraine and frequency of migaine attacks and improving the migraine-specific quality of life. Verum acupuncture was more effective than sham acupuncture in reducing migaine headaches at 8 weeks after randomization. We need more evidence and investigation, to clarify whether acupuncture is more effective than other medrians (control groups 1) in migaine.4. Acupuncturing at acupoints along the meridians is effective for migraine. This preliminarily explained that acupoints has specific effects, and the effects are allied to the distribution of the meridians.更多还原