【作者】 冯凤珍；

【导师】 李忠仁；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 本研究课题的目的是以新加坡潮湿高的热带海洋性气候、城市化的生活环境、人们偏好生冷食物为背景,其中以寒湿证型的腰腿痛病患为研究对象；本研究试图通过温针灸疗法对寒湿型腰腿痛进行中医辨证论治的理论及临床研究,减轻患者的疼痛,并更有效的防治腰腿痛的疾病。本课题内容包括有：1.探讨中医学对腰腿痛病因病机的认识,明确腰腿痛发病的病位,为温针灸治疗腰腿痛提供理论依据。2.探索中医温针灸治疗腰腿痛的源流及重要性。3.综述及分析现代中医辨证施治腰腿痛的方法。4.探讨温灸法的临床研究概况,治疗机理和展望。5.探讨西医学对坐骨神经痛或腰腿痛的发病机制。6.综述及分析西医治疗腰腿痛的方法及利弊。7.明确临床温针灸治疗腰腿痛的疗效。8.随机、对照性比较两组腰腿痛的患者治疗前、后疼痛疗效及评分量表差异。9.分析温针灸治疗如何改善患者的腰腿痛及远期疗效。方法：本案例随机选择符合诊断标准的寒湿证型腰腿痛患者76例按照入选标准入组,再随机将患者分成温针灸治疗组及TDP+针刺对照组两组,每组各38例,年龄：30-55岁,男性26例,女性50例。依症状循经病位角度取督脉、足太阳膀胱经及足少阳胆经的穴位,如肾俞、次髎、腰阳关、疼痛明显处的阿是穴,患侧环跳、委中或承山或阳陵泉穴等。以温针法在患者腰腿痛明显处附近穴位,于其中上下左右选定4穴实施温灸。隔日1次,10次为1个疗程,共治1个疗程。TDP+针刺对照组选用穴及针法与温针灸治疗组相同,但艾灸则以TDP代替。临床观察后,比较二种疗法分别对于寒湿型腰腿痛的改善程度及总体疗效。治疗后,仍继续观察疗效,并电话追踪随访二个月,以评估二种疗法的远期疗效。结果：研究观察结果显示,温针灸治疗组疗效的总有效率优于TDP+针刺对照组的总有效率,两组疗效经统计学验证有显着意义,P<0.05值,表明温灸效应确实对疗效有重大的影响。疼痛指数疗效评比的结果系由标准视觉模拟评分法(VAS)和腰腿痛评分量表评定而整理出来,治疗前后的疼痛评分差值(x±SD),经统计学t’检验法验证为P<0.001和P<0.05,表明两组差异有显着的意义,即治疗组优于对照组。另外,两组病例经统计学t检验法验证,观察包括性别、年龄、病程等指标。治疗前两组的差异均无显着性差异(P>0.05),提示可比样本空间符合普通性及一般性原则,所取样本并不偏颇。结论：温针灸法有温阳补气、温经通络、消瘀散结、补中益气的作用；温灸能加强针刺治疗寒湿型腰腿痛的效果,兼具有“针”和“灸”二者之长,这证明传统中医学针灸合一的疗法,确实有其临床应用价值及科学的依据。更多还原

【Abstract】 Objective:The thesis is based on the background of tropical humid weather conditions, urbanized living environment and the unique liking of certain food and beverages in Singapore. Especially the type of Han Shi xing yao tui tong patients. To explore the effective and safety of acupuncture-moxibustion base on the theory of TCM, this study which brought according to analysis of literature review, clinical manifestation, the etiology and pathogenesis to relieve pain of Sciatic nerve (yao tui). The thesis contents including:a. To explore the causes and actual point of TCM yao tui tong.b.To explore the importance role of treating yao tui tong by acupuncture-moxibustion.c. To analyse and summarize the theory and treatment of yao tui tong by TCM method.d.To explore the clinical research, manifestation and outlook of acupuncture-moxibustion.e. To explore the causes of Sciatic nerve pain or yao tui tong by western medicine.f. To analyse and summarize an advantage and disadvantage methods and treatment by western medicine.g. Defined the effective clinical treatment of acupuncture-moxibustion on yao tui tong.h. Compare the result of two groups of patients before and after treatment.i. Analyse how did Acupuncture-moxibustion relief or improve the intensity pain of yao tui tong patients and follow-up efficacy comparison.Methods:Clinical effect was observed to analyze the mechanism of acupuncture-moxibustion theory of TCM by selected 2 groups of Han Shi xing yao tui tong patients. The clinic research observes 76 patients who fit the inclusion and exclusion criteria were randomly divided into 38 cases of Trial group (acupuncture-moxibustion) and Control group (acupuncture + TDP) respectively; age:30-55. Applied acupoints are based on TCM Du meridian, Foot Taiyang Bladder meridian and Foot Shaoyang Gallbladder meridian, eg. Shenshu, Ciliao, Yaoyangguan, Huantiao, Weizhong, Chengshan or Yanglingquan etc. The Trial group acupuncture-moxibustion on affected area by choosing 4-5 acupoints. TDP group was using the same acupoint but replace by TDP of moxibustion. The treatment was applied 4 times per week,10 times per course in both groups. To measure and compare the difference changes and effective of 2 groups on Han Shi xing yao tui tong patients before and after treatment. A follow - up of 2 months by telephone after one course of treatment. Results:The results indicate there is a significant difference between the relief of pain and the efficacy of treatment between the Acupuncture-moxibustion Group and Acupuncture+TDP Group. P (0.05. The VAS results of the difference of the level of pain between the two groups had an important significance of P< 0.001. The difference between the yao tui tong (intensity of pain, recuperation of the body movement, the return to the work force..etc) of the two groups had a significance of P< 0.05. The result is Acupuncture-moxibustion Group therapies outweighs the curative effect of Acupuncture + TDP Group treatment. But the difference between the age, sex and duration of illness of the two groups had no significance of P> 0.05.Conclusions:Heat moxibustion intensify the effect of acupuncture therapy, it leads to the conclusion that combination of Acupuncture-moxibustion form a valuable medical resources and treatment of Tradition Chinese Medicine. The clinical research were clearly defined and the research was conducted professionally, efficiently and conclusively.更多还原