溫通針法聯合桂枝附子湯治療風寒濕型神經根型頸椎病43例臨床觀察

【摘 要】目的：觀察溫通針法聯合桂枝附子湯治療風寒濕型神經根型頸椎病的療效及對疼痛、癥狀體征的影響。方法：將86例風寒濕型神經根型頸椎病患者按照隨機數字表法分為治療組和對照組，每組43例。對照組患者給予桂枝附子湯治療，治療組給予溫通針法聯合桂枝附子湯治療。2組療程均為1個月。觀察2組臨床療效，以及治療前后白三烯B4（LTB4）、脂質過氧化物（LPO）、β內啡肽因子、白細胞介素-1β（IL-1β）水平，采用現時疼痛強度評分（PPI）評價2組患者疼痛情況，采用頸椎病臨床評價量表（CASCS）評價2組患者臨床癥狀、體征及生活質量。結果：治療組顯效31例，有效11例，無效1例，總有效率為96.67%；對照組顯效20例，有效15例，無效8例，總有效率為81.40%。2組比較，差異有統計學意義（P < 0.05）。治療后，2組IL-1β、LPO、LTB4、β內啡肽因子水平，以及PPI評分、CASCS評分較治療前均有改善（P < 0.05），且治療組優于對照組（P < 0.05）。結論：溫通針法聯合桂枝附子湯治療風寒濕型神經根型頸椎病患者，可提高臨床療效，抑制患者炎癥狀態，調節LTB4水平，調節氧自由基代謝紊亂，升高患者β內啡肽因子水平，緩解疼痛，改善臨床癥狀、體征及生活質量。

【關鍵詞】 神經根型頸椎病；風寒濕型；溫通針法；桂枝附子湯；臨床療效

Clinical Observation of 43 Cases of Wind-cold-damp Cervical Spondylotic Radiculopathy Treated by Warming-dredging Acupuncture and Guizhi Fuzi Tang（桂枝附子湯）

ZHANG Man

【ABSTRACT】Objective：To observe the therapeutic effect of warming-dredging acupuncture combined with Guizhi Fuzi Tang（桂枝附子湯）on wind-cold-damp cervical spondylotic radiculopathy，and its effect on pain，symptoms and signs.Methods：Eighty-six cases of wind-cold-damp cervical spondylotic radiculopathy were randomly divided into a treatment group and a control group，43 cases in each group.The patients in the control group were treated with Guizhi Fuzi Tang，while those in the treatment group were treated with warming-dredging acupuncture combined with Guizhi Fuzi Tang.The course of treatment was one month for both groups.The clinical effects of the two groups were observed，as well as the leukotriene B4（LTB4），lipid peroxide（LPO），β endorphin factor，and IL-1β.The PPI was used to evaluate the pain situation of the patients in the two groups，and the clinical symptoms，signs and quality of life of the patients in both groups were evaluated with CASCS.Results：In the treatment group，31 cases were markedly effective，11 cases were effective，1 case was ineffective，and the total effective rate was 96.67%;In the control group，20 cases were markedly effective，15 cases were effective，8 cases were ineffective，and the total effective rate was 81.40%.The difference between the two groups?was statistically significant（P < 0.05）.After treatment，the levels of IL-1β，LPO，LTB4 and β endorphin factor，as well as PPI score and CASCS score in both groups were improved compared with those before treatment（P < 0.05），and the treatment group was better than the control group（P < 0.05）.Conclusion：The combination of warming-dredging acupuncture and Guizhi Fuzi Tang can improve the clinical efficacy，inhibit the inflammatory state，regulate the level of LTB4，regulate the metabolic disorder of oxygen free radicals，increase the level of endorphin factor，relieve pain，and improve clinical symptoms，signs and quality of life of patients with wind-cold-damp cervical spondylotic radiculopathy.

【Keywords】 cervical spondylotic radiculopathy;wind-cold-damp type;warming-dredging acupuncture;

Guizhi Fuzi Tang（桂枝附子湯）;clinical efficacy

頸椎病是臨床常見病，以神經根型較為常見，在頸椎病中占比高達60%～80%，臨床表現為肩頸、上肢等部位劇烈疼痛、麻木，伴隨頸椎功能障礙，嚴重影響患者生活質量［1-2］。神經根型頸椎病（cervical spondylotic radiculopathy，CSR）屬中醫學“項痹”范疇，為本虛標實之證，可因肝腎不足、氣血衰弱等內因，合并外因如風、寒、濕等外邪侵襲，氣血痹阻、筋脈失去濡養所致［3］。目前治療多采取針灸、牽引、理療、手法、封閉、藥物等方法［4］，桂枝附子湯出自《傷寒論》，具有祛風散寒、溫經通絡的功效，溫通針法由已故名老中醫鄭魁山獨創，具有疏通經絡、行氣活血、祛風散寒的功效，故本研究旨在觀察溫通針法聯合桂枝附子湯對風寒濕型CSR患者的影響，現總結報道如下。……