摘要
目的
以按时取穴为主配合循经辨证取穴进行针刺,观察对腰椎间盘突出症所导致的坐骨神经痛的治疗效果。本研究旨在探讨一种简便有效的疗法,以减少根性坐骨神经痛对患者对生活上带来的困扰,并同时为按时取穴为主法治疗根性坐骨神经痛提供理论依据,以期更好地推广应用于临床。
方法
将广州中医药大学第一附属医院针灸门诊部,符合纳入标准的腰椎间盘突出症患者60例,随机分为治疗组(按时取穴为主配合常规针刺组)30例及对照组(常规针刺组)30例；常规取穴分两型：足少阳经型(大肠俞(双)、秩边、环跳、承扶、风市、阳陵泉、悬钟),足太阳经型(大肠俞(双)、秩边、殷门、委中、承山、悬钟、昆仑),并随证加减配穴。二组均每周治疗3天,休息2天后继续下一周治疗,共治疗3周,疗程21天。治疗前及疗程结束后进行相关临床评定：根据JOA腰椎疾患治疗评分表、疼痛视觉评比表(VAS)、Oswestry功能障碍指数(CODI)、巴氏日常生活功能量表及1994年国家中医药管理局发布的《中医病证诊断疗效标准》对症状改善及疗效进行评价。
结果
两组患者治疗前之JOA腰椎疾患评分、疼痛视觉评比表(VAS)结果、Oswestry功能障碍指数(CODI)结果、巴氏日常生活功能量表结果,无统计学差异(P>0.05)。经治疗后,两组之各项评定结果：
1.JOA腰椎疾患治疗评分表评价结果：治疗组之整体疗效优于对照组(P<0.05)。
2.疼痛视觉评比表(VAS)结果：两组治疗后皆有显着疗效(P<0.01),而且治疗组(6.10±1.03)之疗效优于对照组(4.43±0.94)(P<0.01)。
3. Oswestry功能障碍指数(CODI)结果：两组在治疗后,各症状皆有明显改善(P<0.01),而治疗组之疗效(22.04±9.05)明显优于对照组(12.21±4.56)(P<0.01)。
4.巴氏日常生活功能量表结果：两组在治疗后,症状皆有明显改善(P<0.01),而治疗组之疗效(27.67±2.86)明显优于对照组(14.33±5.53)(P<0.01)。
5.依中医药管理局发布的《中医病证诊断疗效标准》为主分析,治疗前两组症状评分比较无显着性差异(P>0.05)。经治疗后,治疗组30例,痊愈17例、显效11例、有效2例、无效0例；对照组病患30例,痊愈10例、显效8例、有效9例、无效3例；治疗组治疗有效率为100%,对照组治疗有效率为90%,治疗组有效率高于对照组(P<0.05)。
结论
1.常规穴位针刺治疗及按时取穴为主配合常规针刺疗法皆能有效地治疗腰椎间盘突出症所导致的根性坐骨神经痛；
2.以中医药管理局发布的《中医病证诊断疗效标准》及各项评分标准结果显示：按时取穴为主配合常规针刺疗法,治疗腰椎间盘突出症所导致的根性坐骨神经痛的临床疗效优于常规穴位针刺治疗。该法不失为临床上切实可行的治疗方法。
Objective:
A clinical research conducted to expose the therapeutic efficacy on treatment of the sciatic pain by emphasizing on time-acupuncture of the eight confluence points plus syndrome differentiation acupuncture application. By observing the time acupuncture and its alleviating effect on the sciatic pain caused by Lumbar Disc Hernia, this study is to inquire into so as to provide a clinical foundation for time-acupuncture on eight confluence points in the treatment of the sciatic pain.
Method:
60 participants who were diagnosed with the sciatic pain causing by LDH were being invited to join in the study. All participating patient cases were collected from The First Affiliated Hospital of University of Traditional Chinese Medicine and Acupuncture clinic. These patients were randomly picked to form two different categories:the Treatment Group (30 participants) and the Control Group (30 participants). The application of the dominant needles in the Treatment Group:time acupuncture of selective eight confluence points plus the regular points and syndrome differentiation points on the sciatic pain causing by LDH, whereas in the Control Group:only the regular points and syndrome differentiation points for the sciatic pain causing by LDH are applied.
Regular points application:Gallbladder Meridian(Dachangshu(Bilateral), Zhibian(Unilateral), Huantiao, Cheng-fu, Fengshi, Yanglingquan,Xuanzhong); Bladder Meridian(Dachangshu(Bilateral), Zhibian(Unilateral), Yinmen Weizhong, Chengshan, Xuanzhong, Kunlun); Syndrome differentiation points were applied accordingly. The whole clinical experiment contains 3 treatments every week, treating 3 weeks i. e.9 times continuously. Afterward, our result analysis is to carry out base on the clinical outcome measurement schedules, such as JOA、VAS、Oswestry(CODI)、and Barthel Index etc.
Results:
1. The results analysis based on JOA schedule, the Treatment Group showed a better therapy result than that of the Control group(p<0.05).
2. The results analysis based on VAS schedule, the Treatment Group (6.10±1.03) showed a better therapy result than that of the Control group (4.43±0.94) (p<0.05).
3. The results analysis based on Oswestry CODI schedule, the Treatment Group (22.04±9.05) showed a better therapy result than that of the Control group(12.21±4.56)(p<0.05).
4. The results analysis based on Barthel Index schedule, the Treatment Group (27.67±2.86) showed a better therapy result than that of the Control group (14.33±5.53) (p<0.05).
5. According to the analysis based on《The Standard for TCM Diseases and Syndromes therapeutic results》published by Chinese TCM Authority, there was without significant difference(P>0.05) for the syndrome scores of the two group. After treatment cycle, amongst the 30 cases of the Treatment Group,17 cases completely cured、11 cases significantly improved、2 cases improved、0 case no improvement. As for that of the Control Group,10 cases completely cured、8 cases significantly improved、9 cases improved、3 case no improvement. The therapy result of the Treatment Group effectiveness was 100%, while as that of the Control Group was 90%. Thus, the treatment efficacy of the Treatment Group is higher than that of the Control Group (p<0.05).
Conclusion:
1. Both "time-acupuncture plus syndrome differentiation acupuncture" and "syndrome differentiation acupuncture" can effectively cure the sciatic pain caused by LDH.
2. Based on《The Standard for TCM Diseases and Syndromes therapeutic results》and the various scoring schedules,“time-acupuncture plus syndrome differentiation acupuncture”showed a better therapeutic result than that of the "syndrome differentiation acupuncture" in treating the sciatic pain caused by LDH. Thus emphasizing on the time acupuncture is a more feasible treatment scheme clinically.
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