本文選題：內(nèi)熱針 + 督脈灸��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景 胸背部肌筋膜炎又稱胸背部疼痛綜合癥,是臨床常見(jiàn)的一種胸背部疼痛病癥之一。其主要臨床表現(xiàn)為胸背局部肌肉彌漫性鈍痛、酸脹、觸之僵硬,以兩肩胛間為著。隨著信息時(shí)代的迅猛發(fā)展,電子化設(shè)備如智能手機(jī)、電子化辦公系統(tǒng)等給人們的生活帶來(lái)了極大的便利,但“手機(jī)黨”、“電腦族”、“低頭族”隨處可見(jiàn),其中以年青人為主體。由于人們長(zhǎng)時(shí)間保持同一姿勢(shì),胸背部肌肉緊繃,局部軟組織粘連,久之局部無(wú)菌性炎癥甚至刺激組織形成條索狀結(jié)節(jié),患者出現(xiàn)一系列臨床癥狀。雖然該病不會(huì)危及生命,但疼痛遷延,嚴(yán)重影響患者的生活質(zhì)量。當(dāng)前中醫(yī)藥治療肌筋膜炎的手段多樣,筆者在臨床過(guò)程中遇到了大量胸背部肌筋膜炎的患者,經(jīng)觀察發(fā)現(xiàn):內(nèi)熱針可改促進(jìn)局部血液循環(huán),降低肌肉張力,能夠有效緩解疼痛;督脈灸火力溫和,其滲透力強(qiáng),能有效深入病灶,達(dá)到溫經(jīng)補(bǔ)氣、祛濕除寒的功效。兩種療法聯(lián)合使用,對(duì)胸背部肌筋膜炎有較好的臨床療效。目的 本課題探討內(nèi)熱針聯(lián)合督脈灸治療胸背部肌筋膜炎的臨床療效,為臨床使用該法提供一定參考,并為胸背部肌筋膜炎治療提供新的思路。方法 選取2015年1月至2016年12月十堰太和醫(yī)院康復(fù)科收治的胸背部肌筋膜炎患者90例,隨機(jī)分為3組,每組30名患者。其中以內(nèi)熱針聯(lián)合督脈灸為治療組,以單獨(dú)采用內(nèi)熱針及單獨(dú)采用督脈灸為兩個(gè)對(duì)照組,每組每周治療1次,連續(xù)治療3次。觀察各組治療前后患者有效率、《中醫(yī)藥新臨床指導(dǎo)原則》中規(guī)定的軟組織損傷癥狀評(píng)分表、簡(jiǎn)式McGill疼痛問(wèn)卷評(píng)分、以及治療過(guò)程中的不良反應(yīng),并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.基線比較:治療前督脈灸組、內(nèi)熱針組、治療組三組患者在性別、年齡、病程方面無(wú)差異,具有可比性。2.簡(jiǎn)式McGill疼痛問(wèn)卷疼痛分級(jí)指數(shù)(PRI)比較:治療前三組患者PRI無(wú)差異(p0.05),具有可比性。治療后,治療組PRI顯著低于內(nèi)熱針組(p0.01),治療組與督脈灸組比較差異有統(tǒng)計(jì)學(xué)意義(p0.01)。3.簡(jiǎn)式McGill疼痛問(wèn)卷視覺(jué)模擬定級(jí)(VAS)比較:治療前三組患者VAS無(wú)差異(p0.05),具有可比性。治療后,治療組VAS明顯低于內(nèi)熱針組與督脈灸組,差異有統(tǒng)計(jì)學(xué)意義(p0.01)。4.簡(jiǎn)式McGill疼痛問(wèn)卷現(xiàn)有疼痛強(qiáng)度(PPI)比較:治療前三組患者PPI無(wú)差異(p0.05),具有可比性。治療后,治療組PPI明顯低于內(nèi)熱針組(p0.05);與督脈灸組,差異有統(tǒng)計(jì)學(xué)意義(p0.01)。5.療效比較:治療后,治療組顯效率為86.7%,明顯高于內(nèi)熱針組(66.7%)與督脈灸組(50%),差異均具體統(tǒng)計(jì)學(xué)意義(p0.01)。結(jié)論 本研究表明,經(jīng)過(guò)3次治療,內(nèi)熱針結(jié)合督脈灸治療胸背部肌筋膜炎,較單獨(dú)使用內(nèi)熱針?lè)ɑ蚨矫}灸法更有效,且試驗(yàn)中無(wú)不良反應(yīng)發(fā)生。內(nèi)熱針與督脈灸結(jié)合發(fā)揮了“溫通”的功效,能較好的緩解患者疼痛不適等臨床癥狀,可以有效的改善軟組織損傷情況,說(shuō)明內(nèi)熱針結(jié)合督脈灸能夠簡(jiǎn)單有效的治療胸背肌筋膜炎。
[Abstract]:Background Thoracic back myofascitis, also known as chest and back pain syndrome, is one of the common chest and back pain. The main clinical manifestations are diffuse dull pain, distension, and stiffness of the muscles in the chest and back, between the shoulder blades. With the rapid development of the information age, electronic devices such as smart phone, electronic office system and so on have brought great convenience to people's life, but "mobile phone party", "computer family", "Phubber" are everywhere. Among them, young people are the main body. Because people keep the same posture for a long time, the chest and back muscles are tight, the soft tissue adhesions, the local aseptic inflammation and even stimulates the tissue to form the stripe shape nodule for a long time, the patient appears a series of clinical symptoms. Although the disease is not life-threatening, but the pain continues, seriously affecting the quality of life of patients. There are many ways of treating myofascitis with traditional Chinese medicine at present. The author has encountered a large number of patients with myofascitis of chest and back in the clinical process. After observation, it is found that internal hot acupuncture can promote local blood circulation, reduce muscle tension and relieve pain effectively; Du-meridian moxibustion with mild fire, strong permeability, can effectively penetrate into the focus, achieve the effect of warming the meridian and replenishing qi, dispelling dampness and removing cold. The combination of the two treatments has a good clinical effect on thoracic and back myofascitis. Objective to explore the clinical effect of internal heat acupuncture combined with moxibustion on thoracic back myofascitis, to provide some references for clinical use of this method, and to provide a new idea for the treatment of thoracic back myofascitis. Methods from January 2015 to December 2016, 90 patients with thoracic and back myofascitis were randomly divided into 3 groups with 30 patients in each group. The treatment group was treated with internal heat acupuncture combined with du meridian moxibustion, the control group was treated with internal heat acupuncture alone and du vein moxibustion alone, each group was treated once a week for 3 consecutive times. The effective rate of patients before and after treatment, the soft tissue injury symptom scale stipulated in "New Clinical guiding principles of TCM", the score of simple McGill pain questionnaire, and the adverse reactions in the course of treatment were observed and analyzed statistically. Result 1. Baseline comparison: there were no differences in sex, age and course of disease among the three groups before treatment, such as moxibustion group, internal heat acupuncture group and treatment group. Comparison of pain grading index (Pi) of simple McGill pain questionnaire: there was no difference in PRI between the three groups before treatment (p 0.05), which was comparable. After treatment, the PRI of the treatment group was significantly lower than that of the internal heat acupuncture group (P 0.01), and the difference between the treatment group and the du pulse moxibustion group was statistically significant (p 0.01). Comparison of visual analogue grading with simple McGill pain questionnaire: there was no difference in VAS between the three groups before treatment (p 0.05), which was comparable. After treatment, the VAS in the treatment group was significantly lower than that in the internal heat acupuncture group and the du meridian moxibustion group, and the difference was statistically significant (P 0.01). 4. Comparison of the current pain intensity of the simple McGill pain questionnaire: there was no difference in PPI between the three groups before treatment (p 0.05), which was comparable. After treatment, the PPI in the treatment group was significantly lower than that in the internal heat acupuncture group (P 0.05), and the difference between the treatment group and the du vein moxibustion group was statistically significant (P 0.01). Comparison of curative effect: after treatment, the effective rate of treatment group was 86.7, which was significantly higher than that of internal heat acupuncture group (66.7%) and du meridian moxibustion group (50%). The difference was statistically significant (P 0.01). Conclusion after 3 times of treatment, internal heat acupuncture combined with moxibustion of du vessel is more effective than internal heat acupuncture or moxibustion alone in treating thoracic and back myofascitis, and there is no adverse reaction in the experiment. The combination of internal heat acupuncture and moxibustion of du meridian exerts the effect of "warming through", which can relieve the clinical symptoms such as pain and discomfort of patients, and can effectively improve the condition of soft tissue injury. It shows that internal heat acupuncture combined with moxibustion of du pulse can treat thoracic dorsal myofascitis simply and effectively.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.9

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