《世界针灸杂志》温针灸膝四穴配合中药治疗中风后膝痛的比较研究
LIU Yong-feng (刘永锋), MAXiao-ming (马晓明), YAN Bing (闫 兵), GOU Yan-hua (缑燕华),
ZHANG Shao-yun (张少芸), RAOXiao-dan (饶晓丹)
Departmentof Acupuncture and Moxibustion, Shenzhen TCM Hospital, Shenzhen 518033,Guangdong Province, China（广东省深圳市中医院针灸科，深圳 518033，中国）
ARTICLE INFO
First author: LIU Yong-feng (1982-), male, attending physician.
Research field: clinical study on acupuncture and moxibustion.
E-mail:medical_study@163.com
* Supported by key laboratory project of Shenzhen technical research anddevelopment funding condition and platform construction plan: CXB201111250113A.
Accepted on June 3,2015
ABSTRACT
Objective Toobserve the clinical efficacy of warm needling on the four knee acupoints inthe treatment of knee pain after stroke on the basis of Chinese herb. Methods Sixty patients with knee pain after strokewere divided into a group A and a group B by random allocation, with 30patients in each group. Patients in the group B only received the treatment byChinese herb, which called Dúhuó Jìshēng Tāng (独活寄生汤 PubescentAngelica and Mistletoe Decoction, add or remove ingredients depending onconditions); patients in the group A additionally received warm needling on thebasis of Chinese herb. Four knee acupoints were selected as master acupointsand Hèdǐng (鹤顶EX-LE 2), Yánglíngquán (阳陵泉 GB 34) and Zúsānlǐ (足三里 ST 36) ascombining acupoints. Perpendicular insertion was conducted on Xuèhǎi (血海SP 10) and Liángqiū (梁丘 ST 34) for approximately 1 cun, and obliqueinsertion on Nèixīyǎn (内膝眼 EX-LE 4) and Dúbí (犊鼻ST 35) forapproximately 1 cun at 45° in inner and upper direction to push needletip into joint cavity. After deqi, moxibustion stick was cut to 1.5 cmlong, ignited, and inserted into the needle handles in the four knee acupoints.1–2 strips were applied. After the moxa cones were burned up, needles wereretained for 10 min. 7 d was a course of treatment and observation lasted forconsecutive four courses. Visual analogue scale (VAS) and Barthel Index (BI)were adopted as observational indices. Clinical efficacy was classified asclinical cured, markedly effective, effective and ineffective according to thestandards described in Guidelines of Clinical Research on Chinese New HerbalMedicine. Results Aftertreatment, total effective rate was 93.3% in the group A, including fullrecovery in 8 cases, markedly effective in 15 cases, effective in 5 cases, andineffective in 2 cases; while the total effective rate was 73.3% in the groupB. The difference between the two groups was statistically significant (P<0.05).In the group A, VAS scores were 6.53 ± 1.39 before treatment and 1.53 ± 0.80after treatment and BI scores were 58.38±8.67 before treatment and67.55 ± 12.99 after treatment; in the group B, VAS scores were 6.63 ± 1.81before treatment and 3.33 ± 0.96 after treatment and BI scores were57.89 ± 9.65 before treatment and 64.87 ± 12.18 after treatment. Both VAS andBI scores were improved significantly in the two groups after treatment and theimprovements were statistically significant (all P<0.05).Furthermore, both VAS and BI scores of group A were superior to that of group B(P<0.05). Conclusion Additional treatment of warm needling on the four knee acupoints on thebasis of Chinese herb can enhance the clinical efficacy in treatment of kneepain after stroke, contribute to the rapid recovery of knee function andimprove the life quality of stroke patients.
KEY WORDS: Warmneedling; the four knee acupoints; knee pain after stroke
ABSTRACT IN CHINESE
[摘要] 目的：观察在中药治疗的基础上配合温针灸膝四穴治疗中风后膝痛的临床疗效。方法：采用随机分配表法将60 例中风后膝痛患者分为观察组和对照组，每组30例。对照组患者只接受中药治疗，药物以独活寄生汤加减，观察组除接受以独活寄生汤加减的中药治疗外还施以温针灸，方法为选取膝四穴为主穴，鹤顶、阳陵泉、足三里为配穴。血海、梁丘直刺1寸左右；内外膝眼斜向内上45°斜刺1寸左右，使针尖深入关节腔内。得气后把灸条切成1.5 cm长，点燃后插在4个主穴的针柄上，施以1、2炷，待艾炷燃烧完后，再留针10min。7 d为一疗程，连续观察4个疗程。采用视觉模拟评分法（VAS）和Barthel指数（BI）作为观察指标，根据《中药新药临床指导研究指导原则》标准评定分为临床痊愈、显效、有效、无效4个级别。结果：经治疗后观察组治愈8例，显效15例，有效5例，无效2例，总有效率为93.3%；对照组总有效率为73.3%，两组比较差异有统计学意义（P＜0.05）。观察组患者治疗前后的VAS评分分别为6.53±1.39、1.53±0.80分，BI评分分别为58.38±8.67、67.55±12.99分；对照组患者治疗前后的VAS评分分别为6.63±1.81、3.33±0.96分，BI评分分别为57.89±9.65、64.87±12.18分。治疗后两组VAS评分和BI评分均显著改善，治疗前后比较差异有统计学意义（均P<0.05）；且观察组VAS 评分和BI评分均优于对照组（均P<0.05）。结论：在中药治疗基础上加用温针灸“膝四穴”,能够提高中风后膝痛的疗效，有助于膝关节功能的迅速恢复，提高中风患者的生活质量。
[关键词] 温针灸 膝四穴 中风后膝痛
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