【作者】 吴轩宜；

【导师】 符文彬；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的客观评价针灸从心肾论治颈椎病颈痛的临床疗效,为中医脏腑论治颈椎病颈痛提供新的理论。方法1、病源主要来自于广东省中医院针灸科,将符合颈椎病颈痛诊断标准的患者70例,采用简单随机对照试验方法,运用PEMS3.1软件包按1：1的比例随机分为心肾论治组(心肾组)和常规针灸治疗组(常规组)两组,每组各35例,心肾组接受从心肾论治针灸治疗,常规组接受常规针灸治疗。2、治疗方法：(1)心肾组：取穴：百劳(双)、神门(单)、腕骨(单)交替,刺入穴位深度约10-30mm,得气后留针30分钟,每隔10分钟运针一次；直接灸：大椎、心俞(双)及肾俞(双),每穴各五壮；穴位埋皮内针：百劳(双)、心俞(单)及肾俞(单)；(2)常规组：取穴：百劳(双)、中渚(双),刺入穴位深度约10-30mm,得气后留针30分钟,每隔10分钟运针一次；直接灸：大椎、百劳(双)及肩中俞(双),每穴各五壮；穴位埋皮内针：百劳(双)及肩中俞(双)；(3)以上两组均每周进行2-3次治疗,10次治疗为1疗程,完成8次治疗可纳入研究,1疗程结束后观察疗效。3、根据《中医病证诊断疗效标准》评价近期及远期疗效,运用卡方检验比较两组间总体疗效及愈显率,并分别记录两组治疗前、第五次治疗结束、疗程结束及疗程结束一月、三月后NPQ、MCGLII疼痛量表评分,采用SNK-q检验及t检验比较两组治疗前后及两组间的差异。结果1、两组疗程结束时总体疗效比较,经Ridit分析,P>0.05,两组近期总体疗效无显著性差异；经X2检验,两组疗程结束时治愈率、显效率、好转率比较,均P>0.05,两组近期愈显率无显著性差异。两组随访3月总体疗效比较,经Ridit分析,P<0.05,心肾组远期总体疗效优于常规组；随访3月时心肾组愈显率65.63%,常规组愈显率39.4%,经X2检验,P<0.05,差异有显著性意义,心肾组随访3月愈显率明显高于常规组。2、两组NPQ颈痛评分比较,在第五次治疗结束、随访1月、随访3月时常规组NPQ颈痛评分明显高于心肾组,在第五次治疗结束、随访1月时,经t检验,P＜0.05,随访三月时,经t检验,P<0.01,均有显著性差异。两组在治疗第五次结束时、疗程结束时、随访1月及随访3月时NPQ颈痛评分与治疗前比较,经SNK-q检验,P<0.01,有显著性差异,NPQ颈痛评分较治疗前均有明显下降。3、两组MCGILL疼痛评分比较,在疗程结束、随访1月、随访3月时常规组McGILL疼痛评分明显高于心肾组,疗程结束时,经t检验,P<0.05,随访1月、随访3月时,经t检验,P<0.01,均有显著性差异。两组在第五次治疗结束、疗程结束、随访1月及随访3月时McGILL疼痛评分与治疗前比较,经SNK-q检验,P<0.01,有显著性差异,McGILL疼痛评分较治疗前均有明显下降。结论本研究通过心肾论治组与常规针灸治疗组在改善颈椎病颈痛方面进行对比,结果显示两组对颈椎病颈痛均有改善作用,近期疗效无明显差异,远期疗效心肾组优于常规组。更多还原

【Abstract】 ObjectiveTo assess the clinical efficacy of acupuncture and moxibustion for the Neck Pain of Cervical Spondylosis from Treatment of heart and kidney, to shed new light on Traditional Chinese Medicine Treatment of organs for Cervical Spondylosis Neck Pain.MethodsSeventy patients with cervical spondylosis neck pain were randomly divided into two groups with PEM3.1 Software:Treatment of heart and kidney group (Heart and Kidney Group) and general acupuncture treatment group (General Group) with thirty five cases each. Heart and Kidney Group received treatment of heart and kidney while General Group received general acupuncture treatment.Heart and Kidney Group:Choose Bailao (ExHN 15) double, Shenme(HT7) single and Wangu(SI4) single, then penetrate into these points with a depth about 10-30mm, each point retaining the needle for 30 minutes long after getting the Qior the feeling of acupuncture, then manipulating the needle once every 10 min, meanwhile proceed direct moxibustion to Dazhui(DU14), Xinshu(BL15) double, Shenshu (BL23) double five times each, At the end, place intradermal needles at the following ponits:Bailao(ExHN15) double, Xinshu(BL15) single, Shenshu(BL23) single.General Group:Choose Bailao(ExHN15)double and Zhongzhu (SJ3) double, then give direct moxibustion to Dazhui (DU14), Bailao(EXHN15) double, Jianzhongshu (SI15) double, finally inset intradermal needles at Bailao(ExHN 15) double, Jianzhongshu(SI15) double, as all the operations described in the Heart and Kidney Group. Each group received two or three periods of treatment once a week, ten times for a course, then observe therapeutic effect after one course of the treatment.Evaluate Short-term and long-term efficiency based on the Clinical standards for TCM Syndrome Clinic. Use chi-square test to compare the differences of overall efficiency and markedly effective rate between two groups. Patients were examined by NPQ and McGill before treatment, at the end of the fifth treatment, immediately after the course, one month and three months later. Inter-group comparison was made by Variance Analysis. SNK-q test and t-test were used to compare the difference before and after treatment, as well as the difference between the two groups.ResultsThe short-term (immediately after treatment) difference was not significant between the two groups, according to the result of Ridit Analysis(P>0.05). Neither the cured rate nor the markedly effective rate in both groups has significant difference according to X2Analysis(P>0.05). As to the overall efficiency of long-term (three months after treatment) both groups, Heart and Kidney Group overall efficiency is superior to General Group, according to Ridit Analysis(P<0.05), with the rates of 65.63% and 39.4%, separately. Nevertheless, the cured and markedly effective rates of Heart and Kidney Group were much higher than General Group when comparing results of immediately three months after treatment, according to X2 Analysis (P<0.05).The NPQ scores of General Group were higher than Heart and Kidney Group at the end of the fifth treatment, one month and three months after treatment. And there were significant differences between the two groups, at the end of the fifth treatment and one month (P<0.05)and three months (P<0.01) after treatment according to t-test Analysis. The NPQ scores of the fifth treatment, immediately after treatment, one month after treatment and three months after treatment of the two groups were less than they were before the treatment, according to SNK-q Analysis(P<0.01).The McGill scores of General Group were greater than Heart and Kidney Group at the time immediately after treatment, one month after treatment and three months after treatment. And there was significant difference between the two groups, after treatment (P<0.05), one month after treatment and three months after treatment (P<0.01) according to t-test Analysis. The McGill score the fifth end of treatment, immediately after treatment, one month after treatment and three months after treatment of two groups was less than before treatment respectively. There was significant difference between two groups(P< 0.01).ConclusionsOn the release of cervical spondylosis neck pain, both groups have certain therapeutic effect. No significant difference in curative effect, But the long-term effect of Heart and Kidney Group is superior to General Group.更多还原