本文選題：頸三針 + 緊張性頭痛��； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：靳三針療法是嶺南針灸大師靳瑞教授根據(jù)傳統(tǒng)體針療法而總結(jié)出的特色針灸療法,其涉及的范圍廣泛,內(nèi)有40多個穴組。本研究選取其中的一個穴組“頸三針”治療緊張性頭痛。觀察“頸三針”療法治療緊張性頭痛的臨床療效,與常規(guī)針刺作對照,觀察兩組療法治療緊張性頭痛的臨床療效,探討“頸三針”治病的可能機(jī)理。方法：本研究共納入符合緊張性頭痛診斷標(biāo)準(zhǔn)的患者60例,按照隨機(jī)對照的分組方法,將60例患者分成治療組30例和對照組30例。治療組在常規(guī)針刺選穴的基礎(chǔ)上配合頸三針。具體選穴為頸三針(百勞、大杼、天柱)、太陽、頭維、風(fēng)池、頸夾脊、太沖、足三里、三陰交,再根據(jù)頭痛部位的不同進(jìn)行分經(jīng)加減取穴。穴位常規(guī)消毒后進(jìn)行針刺,風(fēng)池穴針尖朝向鼻尖方向,進(jìn)針不宜過深,約0.8-1.2寸,頸部夾脊穴針尖刺向脊柱,進(jìn)針約1寸,其余穴位采用常規(guī)針刺,進(jìn)針后分別行提插捻轉(zhuǎn)手法,待各穴得氣后,采用電針治療儀(G-6805,Ⅱ型,上海醫(yī)療器械廠),選用連續(xù)波,頻率120次／分,每次治療30分鐘,隔日治療一次。每周三次,2周為一個療程,共治療2個療程。觀察治療前后兩組患者的VAS評分、頭痛積分和PSQI評分的變化進(jìn)行療效評估。臨床數(shù)據(jù)的統(tǒng)計分析采用SPSS19.0進(jìn)行分析。結(jié)果：1.VAS評分比較：治療前,治療組的VAS評分為7.04--+2.37,對照組的VAS評分為6.89±±2.52,經(jīng)t檢驗,差異無統(tǒng)計學(xué)意義(P0.05),說明兩組患者VAS評分無明顯差異,具有可比性,兩組患者治療前疼痛程度相當(dāng)。接受本研究的治療方案后,治療組VAS評分2.21±1.34,對照組VAS評分為3.87±1.58；采用t檢驗分析兩組患者較治療前,VAS評分均明顯下降(P0.05),兩組患者治療后進(jìn)行VAS評分比較,發(fā)現(xiàn)治療組下降更為明顯(P0.01),說明針灸能夠有效改善緊張性頭痛患者的VAS評分,緩解患者疼痛,但是結(jié)合頸三針療法,效果更顯著。2.頭痛積分：治療前,治療組頭痛總積分15.32±3.62,對照組頭痛總積分16.01±3.18,經(jīng)t檢驗分析,差異不顯著,而且兩組患者在頭痛程度積分、發(fā)作次數(shù)積分、持續(xù)時間積分和伴隨癥狀積分上都沒有明顯的差異,具有可比性。治療后,治療組患者的頭痛總積分為5.03±1.53,對照組頭痛總積分為8.95±1.81,經(jīng)統(tǒng)計學(xué)分析,進(jìn)行組內(nèi)的治療前后比較,兩組患者的頭痛總積分、頭痛程度積分、發(fā)作次數(shù)積分、持續(xù)時間積分和伴隨癥狀積分均明顯下降,差異顯著,治療后組間比較,在頭痛總積分、頭痛程度和持續(xù)時間的比較上,治療組較對照組明顯下降(P0.01),有統(tǒng)計學(xué)意義,但是在頭痛的發(fā)作次數(shù)和出現(xiàn)的伴隨癥狀方面,治療組和對照組沒有明顯差異(P0.05)。說明治療組和對照組的治療方法都可以明顯改善緊張性頭痛患者的頭痛程度、頭痛的發(fā)作次數(shù)、持續(xù)時間和相應(yīng)的伴隨癥狀,在改善頭痛程度和持續(xù)時間上,治療組明顯優(yōu)于對照組,而在改善伴隨癥狀和發(fā)作次數(shù)上,兩組療效相當(dāng)。3睡眠情況比較：接受治療前,治療組患者有睡眠障礙和無睡眠障礙的患者各為15例,而對照組有睡眠障礙和無睡眠障礙的患者分別為14例、16例。經(jīng)統(tǒng)計學(xué)分析,差異無統(tǒng)計學(xué)意義,有可比性。經(jīng)治療后,治療組有睡眠障礙的患者為6例,無睡眠障礙患者24例；而對照組有失眠障礙患者為8例,無睡眠障礙患者22例,治療前后組內(nèi)進(jìn)行比較,均有統(tǒng)計學(xué)意義(P0.05)；但治療后組間比較,無明顯差異(P0.05)。說明兩種治療方案均能明顯改善患者的睡眠情況,且在改善睡眠情況上,兩種方法的療效相當(dāng)。4臨床療效比較：經(jīng)過2個療程,為期一個月的治療,治療組30例患者中臨床治愈的有8例(26.67%),顯效的患者有15例(50.00%),有效患者5列(16.67%),無效患者2例(6.66%),對照組患者中臨床治愈4例(13.33%),顯效的患者有10例(33.33%),有臨床效果的患者有10例(13.33%),無效患者6例(20.00%)。治療組的臨床總有效率93.33%,而對照組總有效率80.00%,經(jīng)統(tǒng)計學(xué)分析,提示治療組的臨床療效顯著優(yōu)于對照組(P0.05)。結(jié)論：靳三針療法是嶺南針灸大師靳瑞教授發(fā)明的針灸組穴配方,是嶺南針灸的一個具有代表性的流派。它簡單、易學(xué)、而且實用有效。頸三針作為靳三針療法中的一組常用穴組,在臨床上運(yùn)用廣泛。本研究觀察頸三針治療緊張性頭痛的臨床療效,研究結(jié)果證實,頸三針治療能夠有效的改善患者的VAS評分,減輕疼痛的程度,減少發(fā)作次數(shù)和每次持續(xù)的時間,緩解畏光、嘔吐等伴隨癥狀,且能改善患者的睡眠情況,療效切確,值得臨床推廣。
[Abstract]:Objective: Jin three needle therapy is the characteristic acupuncture therapy of Professor Jin Rui, a master of acupuncture and moxibustion in south of the Five Ridges. It has a wide range of acupuncture and moxibustion therapy in accordance with the traditional body acupuncture therapy. There are more than 40 acupoints in this study. This study selected one of the acupoint group "neck three needles" to treat tension headache. The clinical effect of "neck three needle" therapy on tension headache was observed. Compared with the conventional acupuncture, the clinical effect of two groups of therapy for tension headache was observed and the possible mechanism of "neck three needle" treatment was discussed. Methods: 60 patients were included in this study, and 60 patients were divided into treatment group (30 cases) and control group (30 cases) according to the randomized controlled grouping method. On the basis of the acupuncture point selection, the acupuncture points are combined with the neck three needles. The specific points are selected as the three needles of the neck (hundred labor, the Tianzhu), the sun, the head dimension, the wind pond, the neck pinch ridge, the Tai Chung, the three li and the three yin cross, and then the acupoints are added and reduced according to the different headaches. The acupuncture points of the acupoints are routinely sterilizing, the tip of the acupoint of the Feng Chi point faces the nose tip, and the needle should not be too deep, about 0.8-1. 2 inches, neck pint point needle point pricking to the spine, entering the needle about 1 inches, the rest of the acupuncture point is conventional acupuncture, after entering the needle to insert twisting and twisting, after each point to get gas, the use of electroacupuncture therapy instrument (G-6805, type II, Shanghai medical equipment factory), the use of continuous wave, frequency 120 times / minutes, each treatment for 30 minutes each time. Three times a week, 2 weeks for one, 2 weeks for one A total of 2 courses of treatment were treated. The VAS score of two groups of patients before and after treatment, the change of headache score and PSQI score were evaluated. The statistical analysis of clinical data was analyzed by SPSS19.0. Results: the 1.VAS score was compared: before treatment, the VAS score of the treatment group was 7.04-- +2.37, the VAS score of the control group was 6.89 + 2.52, and the t examination was performed by t. The difference was not statistically significant (P0.05), indicating that there was no significant difference in VAS score between the two groups. The pain degree of the two groups was equal before treatment. After the treatment of this study, the VAS score of the treatment group was 2.21 + 1.34 and the control group was 3.87 + 1.58 in the control group, and the t test was used to analyze the VAS score of the two groups before the treatment. Drop (P0.05), two groups of patients after the treatment of VAS score comparison, found that the treatment group decreased more significantly (P0.01), indicating that acupuncture can effectively improve the VAS score of patients with tension headache and relieve pain, but combined with neck three acupuncture therapy, the effect is more significant.2. headache score: before treatment, the total score of headache in the treatment group is 15.32 + 3.62, the control group head The total pain score was 16.01 + 3.18. The difference was not significant by t test, and there was no significant difference between the two groups in the degree of headache, the score of the attack, the integral of duration and the integral of symptoms. After treatment, the total headache of the patients in the treatment group was 5.03 + 1.53, and the total score of the headache in the control group was 8.95 + 1.81, and the total score of the headache was 8.95 + 1.81. Statistical analysis, before and after the treatment in the group, the total score of headache, the score of the headache, the score of the frequency of the attack, the integral of the duration of the two groups, the integral of the duration of the symptoms were obviously decreased, and the difference was significant. The comparison between the groups after the treatment was compared with the total score of headache, the degree of headache and the duration of the headache, and the treatment group was significantly lower than the control group. The reduction (P0.01) was statistically significant, but there was no significant difference between the treatment group and the control group (P0.05). The treatment group and the control group could significantly improve the degree of headache, the times of headache, the duration of the headache, the duration of the headache, and the corresponding accompanying symptoms. In the improvement of the degree of headache and duration, the treatment group was significantly better than the control group, while in the improvement of the symptoms and the number of episodes, the two groups were comparable to the.3 sleep situation: before the treatment, the patients in the treatment group had 15 patients with sleep disorders and no sleep disorders, while the control group had sleep disorders and no sleep disorders. After treatment, there were 6 cases of sleep disorders in the treatment group, 24 cases without sleep disorder, 8 patients with insomnia and 22 patients without sleep disorders in the control group, and there were statistical significance (P0.05) in the treatment group before and after treatment (P0.05); but the treatment was statistically significant. There was no significant difference between the two groups (P0.05). It showed that all two treatments could significantly improve the patient's sleep condition, and in improving the sleep situation, the effect of the two methods was comparable to the clinical curative effect of.4: after 2 courses of one month, 8 cases (26.67%) were cured in the treatment group and 15 of the patients were clinically cured, and 15 of the effective patients. Cases (50%), effective patients 5 (16.67%), invalid 2 cases (6.66%), 4 cases in the control group, 4 cases (13.33%), 10 patients (33.33%), 10 patients (13.33%) and invalid patients (20%). The total effective rate of the treatment group was 93.33%, and the control group was effective. The clinical effect of the treatment group is significantly better than that of the control group (P0.05). Conclusion: Jin's three needle therapy is an acupuncture group point formula invented by Professor Jin Rui of South of the Five Ridges acupuncture and moxibustion. It is a representative school of acupuncture and moxibustion in south of the Five Ridges. It is simple, easy to learn and practical and effective. The neck three needle is used as a group of commonly used acupoints in Jin's three needles, which is widely used in clinical practice. The results of this study were to observe the clinical efficacy of three cervical needles in the treatment of tension headache. The results of the study proved that the three needle treatment can effectively improve the patient's VAS score, reduce the degree of pain, reduce the number of episodes and duration, alleviate the symptoms of photophobia, vomiting and other symptoms, and can improve the patient's sleep, the curative effect is accurate and worthy of clinical push. Wide.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.6

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