艾灸循经筋阿是穴治疗膝骨性关节炎随机平行对照研究

Random Parallel Controlled Study of Moxibustion on Knee Osteoarthritis with Meridian-Muscle-Lesion Rules

[目的]观察艾灸循经筋阿是穴治疗膝骨性关节炎疗效。[方法]使用随机平行对照方法,将76例(124膝)门诊患者按就诊编号(单双号)抽签随机分为两组。选择仰卧、侧卧或俯卧,充分暴露患膝病变部位,施灸者坐于患者一侧,左手固定其肢体,右手持点燃艾条,采用雀啄灸结合回旋灸,艾条离皮肤约3～5cm,以患者有酸麻等感觉为宜;灸至患者皮肤潮红,局部温热感或灼热感,潮红而不致烫伤,且患者自觉有热感透至膝关节内并扩散至整个膝关节,灸至感传消失为度;取穴4～8个/次,施灸10～15min/穴,先上后下,先左后右。留意患者不适、疼痛主诉,随时调节艾灸点距离;1次/d,7d天为1个疗程。经穴组38例(62膝)按《针灸学》取治疗点:承山、委阳、犊鼻、内膝眼、膝关、阴陵泉、阳陵泉、足三里等。循经筋辩证组38例(62膝)确定循经筋规律性阿是穴,足阳明经筋型,近端髌下、髌外、髌内下;远端维道次、阴廉次、髀关次。足太阳经筋型,近端承山次、承山外、委阳次;远端承扶次、直立次、环跳次。足少阳经筋型,近端阳陵泉次、髎髎次、腓骨小头;远端腰宜次、健跨次、中空次。足三阴经筋型,近端阴陵上、胫骨内髁、膝关次;远端箕门次、五枢次、阴廉次。临床症状、WOMAC骨关节炎指数、膝关节疼痛目测类比评分、不良反应。连续治疗4疗程,判定疗效。[结果]经筋辨证组62膝基本痊愈14膝,显效15膝,有效20膝,无效13膝,总有效率79.03%。经穴组62膝基本痊愈9膝,显效13膝,有效18膝,无效20膝,总有效率67.74%。经筋辨证组改善优于经穴组(P<0.05)。膝关节疼痛目测类比评分均有改善(P<0.05),经筋辨证组改善优于经穴组(P<0.01)。[结论]艾灸对膝骨关节炎镇痛作用明显,循经筋规律确定阿是穴灸法镇痛优于传统经穴灸法。

[Objective]To observe the effect of moxibustion on the reinforcement of Ashi points for treatment of knee osteoarthritis.[Method]Using randomized controlled methods,76 cases（124 knees） clinic patients according to number（single） were randomly divided into two groups.Choose the supine,lateral or prone position,fully exposed knee lesions,moxibustion sat in patients with left hand side,fixed body,his right hand holding the ignited moxa,using sparrow-pecking moxibustion with moxa cyclotron moxibustion,from the skin of about 3～5cm,the patients have tingling feeling is appropriate;moxibustion to patients with skin flushing,local warm feeling or glowing feeling,flushing and not burn patients,and consciously thermal penetration to the knee and spread to the whole knee joint,moxibustion to the sense of mass loss degree;acupuncture 4～8/times,moxibustion 10～15min/point,after the first,after the first left right.Pay attention to patient discomfort,pain,regulating moxibustion point distance at any time;1/d,7d days for 1 courses.Acupuncture group of 38 cases（62 knees） according to ＂ take＂ acupuncture treatment： Chengshan,Wei Yang,Dubi,inner eye of the knee,knee,yinlingquan,Zusanli,Yanglingquan etc..Meridian rib dialectical group 38 cases（62 knees） determine the meridian tendon of Foot Yangming Meridian point,gluten,proximal patellar patellar patellar,outside,inside;distal dimension pass,Yin,biguan time.Foot Taiyang meridian sinews,proximal hill,the mountain,Wei Yang;distal Chengfu,erect,ring.Foot Shaoyang meridians,near the Dragon Boat Festival Ling Quan,Liao Liao,fibular head;distal y time,health across time,hollow times.The three yin meridians of foot tendons,Yin Ling on proximal,medial condyle of the tibia,knee;distal Jimen times,the five pivot,Yin Lian times.The clinical symptoms,WOMAC osteoarthritis index,knee pain visual analogue score,adverse reaction.Continuous 4 courses of treatment,the curative effect.[Results] The meridian sinew dialectical group 62 knee recovered 14 knees,effective in 15 knee,20 knees in 13 knees of effective,invalid,the total effective rate was 79.03%.Acupuncture group of 62 knee recovered 9 knees,effective in 13 knee,18 knees in 20 knees of effective,invalid,the total effective rate was 67.74%.Meridian sinew differentiation group is better than acupuncture group（P0.05）.Knee pain visual analog score were improved（P0.05）,after the muscle differentiation group is better than acupuncture group（P0.01）.[Conclusion]Moxibustion on knee osteoarthritis obvious analgesic effect,meridian tendons of Ashi acupoints analgesia is superior to the traditional moxibustion moxibustion.