身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察

朱华亮; 周宗波; 武旭刚; 陆志夫; 刘利涛

doi:10.13422/j.cnki.syfjx.20190932

您当前的位置：

首页 >

文章列表页 >

身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察

经典名方 | 更新时间：2021-02-09

- 身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察
- Clinical Observation of Addition and Subtraction Therapy of Shentong Zhuyutang to Myofascial Pain Syndrome (MPS) with Stagnation of Blood Stasis
- 中国实验方剂学杂志 2019年25卷第9期页码：49-54
- 作者机构：
  
  海口市中医医院，海口　 570216
- 作者简介：
  
  朱华亮，硕士，主治中医师，从事骨伤科疾病的中西医结合治疗工作，E-mail: 274897050@qq.com
  周宗波，主任中医师，从事中医骨科的临床工作，E-mail：2327522122@qq.com
- 基金信息：
  
  海南省卫生计生行业科研项目(15A200057)
- DOI：10.13422/j.cnki.syfjx.20190932
  中图分类号： R289; R274; R274.3; R245
- 收稿日期：2018-09-25，
  
  网络出版日期：2018-12-26，
  
  纸质出版日期：2019-05-05
- 稿件说明：
移动端阅览
朱华亮, 周宗波, 武旭刚, 等. 身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察[J]. 中国实验方剂学杂志, 2019,25(9):49-54.

Hua-liang ZHU, Zong-bo ZHOU, Xu-gang WU, et al. Clinical Observation of Addition and Subtraction Therapy of Shentong Zhuyutang to Myofascial Pain Syndrome (MPS) with Stagnation of Blood Stasis[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(9): 49-54.
朱华亮, 周宗波, 武旭刚, 等. 身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察[J]. 中国实验方剂学杂志, 2019,25(9):49-54. DOI： 10.13422/j.cnki.syfjx.20190932.

Hua-liang ZHU, Zong-bo ZHOU, Xu-gang WU, et al. Clinical Observation of Addition and Subtraction Therapy of Shentong Zhuyutang to Myofascial Pain Syndrome (MPS) with Stagnation of Blood Stasis[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(9): 49-54. DOI： 10.13422/j.cnki.syfjx.20190932.

摘要

目的：

观察身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的近期和远期疗效及作用机制。

方法：

将148例的符合要求的患者采用随机按数字表法分为对照组73例和观察组75例。两组患者均给予电针治疗。对照组口服腰痛胶囊，4粒／次，3次/d。观察组内服身痛逐瘀汤加减，1剂/d。两组均连续治疗6周，并进行16周的随访。于治疗前、治疗后1，2，3，4，5和6周进行评价疼痛视觉模拟评分(VAS)，评价治疗前后日本骨科协会下腰痛评价量表(JOA)，Roland-Morris功能障碍问卷表(RDQ)，身体损害指数评定量表(PⅡ量表)、瘀血阻滞证评分和匹兹堡睡眠质量指数(PSQI)；检测治疗前后血液流变学指标，检测治疗前后血栓素2(TXB

)，6-酮-前列腺素F

(6-keto-PGF

)，并计算TXB

/6-keto-PGF

(T/K)，随访并记录复发情况。

结果：

经秩和检验，观察组临床疗效优于对照组(

＝1.969，

0.01)；经重复测量的方差分析，两组患者在治疗后1，2，3，4，5和6周VAS评分均逐渐降低(

对照

＝5.801，

观察

＝6.649，

0.05)；经配对

检验，观察组在治疗后第2，3，4，5和6周时VAS评分均低于对照组(

0.01)；观察组JOA量表三个维度评分和JOA总分均高于对照组(

0.01)；观察组患者RDQ

PⅡ，PSQI和瘀血阻滞证评分均低于对照组(

0.01)；观察组患者全血黏度(高切、低切)，血浆黏度，纤维蛋白原水平均低于对照组(

0.01)；观察组患者TXB

低于对照组，6-keto-PGF

高于对照组，T/K低于对照组(

0.01)；观察组复发率12%，低于对照组的26.03%(

＝4.745，

0.05)。

结论：

在针刺治疗的基础上，采用身痛逐瘀汤加减内服治疗瘀血阻滞型腰背肌筋膜疼痛综合征患者近期可减轻疼痛，恢复腰部活动功能，远期可减少复发，具有改善血液循环、抗炎、镇痛作用。

Abstract

Objective:

To observe the short and long term effect of addition and subtraction therapy of Shentong Zhuyutang to myofascial pain syndrome (MPS) with stagnation of blood stasis and to investigate its mechanism of action.

Method:

One hundred and forty-eight eligible patients were randomly divided into control group (73 cases) and observation group (75 cases) by random number table. Patients in both groups got electroacupuncture treatment. Patients in control group additionally got Yaotong capsules

4 grains/time

3 times/day. Patients in observation group additionally got addition and subtraction therapy of Shentong Zhuyutang

1 dose/day. The treatment was continued for 6 weeks in both groups

and 16 weeks follow-up was recorded. Before treatment

and at the 1

week after treatment

scores of visual analogue scale (VAS) was graded. Before and after treatment

scores of JOA

Roland-Morris disability questionnaire (RDQ)

body damage index assessment scale (PⅡ scale)

stagnation of blood stasis

and Pittsburgh sleep quality index (PSQI) were graded. Levels of thromboxane 2 (TXB

)

6-ketone-prostaglandin F

(6-keto-PGF

) were detected

and TXB

/6-keto-PGF

was calculated; in addition

the recurrence was recorded and followed up.

Result:

By rank sum test

the clinical efficacy in observation group was better than that in control group (

=1.969

0.01). Analysis of variance of repeated measures indicated that

scores of VAS were decreased gradually at the 1

week in both groups after treatment (

control

=5.801

observation

=6.649

0.05). Paired

-test indicated that scores of VAS in observation group were lower than those in control group at 2

week(

0.01). Scores of three dimensions of JOA scale and total score in observation group were higher than those in control group (

0.01). Scores of RDQ

PⅡ

PSQI

stagnation of blood stasis

whole blood viscosity (high cut and low cut)

plasma viscosity

fibrinogen

TXB

and T/K in observation group were lower than those in control group (

0.01)

and level of 6-keto-PGF

was higher than that in control group (

0.01). In addition

the recurrence rate in observation group was 12%

lower than 26.03% in control group (

=4.745

0.05).

Conclusion:

Based on acupuncture treatment

addition and subtraction therapy of Shentong Zhuyutang can relieve the pain caused by myofascial pain syndrome (MPS) with stagnation of blood stasis

recover lumbar activity function

reduce rate of recurrence

and ameliorate blood circulation

with anti-inflammatory and analgesia effects.

关键词

Keywords

references

周宗波，陆志夫，朱华亮．中西医综合方案治疗腰背肌筋膜炎寒湿瘀阻证的疗效对比分析 [J]. 重庆医学， 2017 , 46 ( 11 ): 1521 - 1524 .

李非，李丽，许强强，等．悬吊运动联合弹拨经筋治疗腰背肌筋膜炎的临床观察 [J]. 康复学报， 2017 , 27 ( 3 ): 18 - 22 .

王瑞荣，马守江．肌筋膜炎性腰腿痛国内研究进展 [J]. 实用医药杂志， 2013 , 30 ( 8 ): 753 - 755 .

刘晓霞，王继龙，魏舒畅，等．超滤对身痛逐瘀汤镇痛抗炎效果的影响 [J]. 中国实验方剂学杂志， 2016 , 22 ( 2 ): 14 - 16 .

张惠珍，王诗忠．身痛逐瘀汤治疗椎间盘退行性下腰痛的机制研究 [J]. 湖南中医杂志， 2014 , 30 ( 10 ): 122 - 123 .

张军，刘秀华．中药熏蒸结合身痛逐瘀汤治疗腰背肌筋膜炎60例 [J]. 光明中医， 2013 , 28 ( 4 ): 714 - 715 .

曹红英，赵强．身痛逐瘀汤治疗淤血腰痛的临床疗效观察 [J]. 齐齐哈尔医学院学报， 2017 , 38 ( 2 ): 200 - 202 .

孙传兴．临床疾病诊断依据治愈好转标准 [M]. 2版．北京：人民军医出版社， 1998 ： 368 - 369 .

国家中医药管理局．中医病证诊断疗效标准 [M]．南京：南京大学出版社， 1994 ： 212 .

Roland M , Fairbank J . The roland-morris disability questionnaire and the oswestry disability questionnaire [J]. Spine , 2000 , 25 ( 24 ): 3115 - 3124 .

余维豪，霍速．介绍一种腰椎功能评定方法 [J]. 中国康复医学杂志， 1998 , 13 ( 5 ): 214 .

路桃影，李艳，夏萍，等．匹兹堡睡眠质量指数的信度及效度分析 [J]. 重庆医学， 2014 , 43 ( 3 ): 260 - 263 .

高巍巍，邹德生，王伍超，等．肌筋膜疼痛综合征的研究进展 [J]. 中国疼痛医学杂志， 2017 , 23 ( 6 ): 455 - 458 .

王志福，俞向梅，龚德贵，等．身痛逐瘀汤对大鼠神经病理性疼痛及脊髓p38 MAPK蛋白表达的影响 [J]. 江西中医药大学学报， 2015 , 27 ( 2 ): 87 - 90 .

王瑛，李绍旦，张印，等．身痛逐瘀汤对一次性力竭运动DOMS大鼠模型血清CK-MM, IL-6的影响 [J]. 成都中医药大学学报， 2016 , 39 ( 4 ): 18 - 22 .

韩崇涛，张继伟．身痛逐瘀汤治疗腰腿痛的临床疗效分析 [J]. 中医临床研究， 2015 , 7 ( 36 ): 93 - 94 .

许源，宿树兰，王团结，等．桂枝的化学成分与药理活性研究进展 [J]. 中药材， 2013 , 36 ( 4 ): 674 - 678 .

邓晓红，黄建华，董竞成．附子药理作用的分子机制研究进展 [J]. 江西中医药大学学报， 2018 , 30 ( 1 ): 121 - 124 .

张利．白芍的药理作用及现代研究进展 [J]. 中医临床研究， 2014 , 6 ( 29 ): 25 - 26 .

何晓凤，张晶，张梅．延胡索化学成分、药理活性及毒副作用研究进展 [J]. 上海中医药杂志， 2017 , 51 ( 11 ): 97 - 100 .

程继伟，王洪伟，郑文杰，等．慢性下腰痛疗效评价方法的应用现状 [J]. 中国修复重建外科杂志， 2014 , 28 ( 1 ): 119 - 122 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

身痛逐瘀汤调控SIRT1/Nrf2信号通路改善大鼠椎间盘退变的作用

身痛逐瘀汤合地龙汤加减治疗腰椎间盘突出症气滞血瘀证的疗效及机制

基于AMPK/Sirt1信号通路探讨身痛逐瘀汤含药血清对膝骨性关节炎大鼠软骨细胞的保护作用

基于超分子“印迹模板”理论分析身痛逐瘀汤基准样品的质量属性

经典名方中没药的本草考证