针灸治疗偏头痛随机平行对照研究

Study on Acupuncture Treatment of Migraine by Randomized Parallel Control Trial

[目的]观察针灸治疗偏头痛疗效。[方法]使用随机平行对照方法,将90例住院及门诊患者按就诊顺序编号/病志号抽签方法简单随机分为两组。对照组45例,急性发作：麦角胺/咖啡因片2片;缓解期：氟桂利嗪（西比灵）胶囊5mg,2次/d。治疗组45例针灸,风池、百会、太阳、率谷、头维、绝骨,合谷、太冲、阿是穴,风池针尖微下,向鼻尖斜刺0.8~1.2寸,或平刺透风府穴,捻转补法;百会、太阳、率谷、头维平刺0.5~0.8寸,捻转泻法;合谷、太冲直刺0.5~0.8寸,平补平泻;绝骨沿胫骨前缘直刺2~3寸,泻法强刺激;阿是穴（多为搏动处）齐刺,阿是穴平刺0.5~1寸与胆经平行,与其45度角左右旁开0.5寸向阿是穴平刺0.5~1寸;发作期：阿是穴或太阳三菱针点刺出血,常规进针得气后,选择头部2~4个穴连接电针治疗仪（连续波,频率1.5Hz,强度以患者耐受为度）;外感风寒头痛加列缺、风门;外感风热头痛加大椎、外关;肝阳上亢加行间、悬颅;痰浊头痛加中脘、丰隆、阴陵泉;瘀血头痛加血海、三阴交;血虚头痛加脾俞、足三里;肾虚头痛加肾俞、太溪、天柱;视疼痛程度及情志因素可加内关、人中。均连续治疗10天为1疗程,疗程间休息2天,继续下一疗程。观测临床症状、头痛、症状评分、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组临床治愈18例,显效20例,有效4例,无效3例,总有效率93.56%。对照组临床治愈10例,显效15例,有效9例,无效11例,总有效率75.56%。治疗组疗效优于对照组（P〈0.05）。[结论]针灸治疗偏头痛,疗效满意,无严重不良反应,值得推广。

[Objective]Observe the clinical therapeutic effect of acupuncture in the treatment of migraine. [Methods]Using random parallel control method, 90 cases of migraine patients were randomly divided into two groups according their pathography numbers/the visiting sequence numbers by lots. The control group of 45 cases, acute phase：2 pills of ergotamine/caffeine; paracmasis： Flunarizine（5 mg）, 2 times/d. The treatment group of 45 cases were treated by acupuncture with Baihui（DU20）, Fengchi（GB20）, Taiyang（EX-HN5）, Shuaigu（GB8）, Touwei（ST8）, Juegu（GB39）, Hegu（LI4）, Taichong（LR3）and Ashi points. Fengchi：needle tip downward to the apex nasi stick into 0.8~1.2 inch or stick flat toward the opposite Fengchi with reinforcing by entwisting;Baihui Taiyang Shuaigu Touwei：stick flat into 0.5~0.8 inch with reduction by entwisting; Hegu Taichong：stick straightly into 0.5~0.8 inch by uniform reinforcing-reducing method; Juegu：stick straightly into 2~3 inch, reducing method strongly stimulated;Ashi points（most of them were throb points）： triple puncture,stick flat into 0.5~1 inch parallelling to the gallbladder meridian,Stick flat into 0.5 inch from the left-right position which are 0.5 inch away from Ashi points about 45 degrees.Acute phase：prick to Ashi points or Taiyang to cause bleeding with three edged needle.After bring about the desired sensation by conventional inserting needle,select 2~4 acupoints of head to connect the electroacupuncture therapy apparatus（continuous wave, the frequency of 1.5Hz,the patient tolerated strength）.Exogenous wind-cold headache：add Lieque,Fengmen; Exogenous wind-heat headache：add Dazhui, Waiguan; Hyperactivity of liver-yang：add Xingjian,Xuanlu; Phlegm headache：add Zhongwan, Fenglong, Yinlingquan;Haemostasis headache：add Xuehai Sanyinjiao; Blood-insufficiency headache：add Pishu,Zusanli;Kidney-deficiency headache：add Shenshu,Taixi,Tianzhu;Neiguan,Renzhong can be added according to the level of pain and emotional factors.Both of the two groups were treated 10 days as a course of treatment,had two days off,then received the next course.Observed the clinical symptoms,headache,symptoms scores,adverse reaction.Judged the curative effect after 3 courses in total.[Results] The treatment group： 40 cases were markedly effective, 6 cases were effective and there were 2 ineffective cases,total effective rate was 95.83%. The control group： 32 markedly effective cases, 6 effective cases, 10 invalid cases, the total effective rate was 79.17%. The treatment group＇s curative effect was better than that of control group（P〈0.05）.[Conclusion] Acupuncture for migraine headaches has satisfied efficacy, no serious adverse reaction, is worth promoting.