热敏灸治疗变应性鼻炎的临床疗效及其腧穴热敏化规律研究

Clinical Trials for Treatment of Allergic Rhinitis with Heat Sensitive Moxibustion and Its Regularity of Heat-sensitization Acupoint Distribution

目的:观察热敏灸治疗变应性鼻炎(AR)的临床疗效,并寻找其腧穴热敏化规律。方法:AR患者随机分为热敏灸组及针刺组,每组35例。热敏灸组采用艾灸热敏化腧穴,针刺组采用针刺治疗,两组均隔天治疗1次,10次为1个疗程,治疗2个疗程。观察治疗前后AR患者症状、体征评分的变化,比较两组的临床疗效,观察腧穴热敏化的出现率,探讨腧穴、经络、热敏灸感现象分布规律。结果:热敏灸组总有效率为82.86%(29/35),针刺组总有效率为74.29%(26/35),两组临床疗效比较差异无统计学意义(P>0.05)。两组治疗后的症状和体征分级总评分均比本组治疗前降低(P<0.01),其中热敏灸组治疗后较针刺组降低更明显(P<0.05)。两组治疗后的症状(喷嚏、流涕、鼻痒、鼻塞)及体征各分值比治疗前降低(P<0.01)。热敏灸组35例均探查到热敏化腧穴,在总共探查的57个腧穴中,每个患者出现的热敏化腧穴个数不等,出现热敏化频率最高的10个腧穴依次为迎香、印堂、鼻通、上印堂、肺俞、神阙、上星、风池、蝶腭、大椎;热敏化腧穴所归经脉主要分布在于督脉、手阳明大肠经、足太阳膀胱经;在6种热敏灸感形式中,以传热为主,其次为扩热、透热、其他非热感觉(以痒感为主)、表面不(微)热深部热、局部不(微)热远部热。结论:热敏灸治疗AR疗效显著,临床上可优先选取迎香、印堂、鼻通、上印堂、肺俞、神阙、上星、风池、蝶腭、大椎等腧穴进行探查以缩短热敏灸治疗时间、加强艾灸的疗效。

Objective To observe the clinical effect of heat sensitive moxibustion （HSM） and its regularity of acupoint heat-sensitization in the treatment of allergic rhinitis （AR） patients. Methods Seventy patients with AR were randomly divided into HSM and manual acupuncture groups （n = 35/group）. For patients of the HSM group, acupcints Yintang （EX-HN 3）, bilateral Yingxiang （LI 20）, Shangxing （GV 23）, Tongtian （BL 7）, Feishu （BL 13）, Hegu （LI 4）, etc. were used, and for patients of the manual acupuncture group, bilateral LI 20 and LI 4, Bitong （EX-HN 8） and EX-HN 3 were needled and stimulated with uniform reinforcing-reducing needling method. The treatment was conducted once every other day, for 20 days, with 3 days＇ interval between two 10 days. The symptoms of sneezing, running nose, nasal obstruction, and nasal itching were scored as 1, 2 and 3 points according to their severity. The signs of turbinate-nose cavity bottom/nasal septum correlation, morphological state （swelling or not） of inferior nasal concha and color of nasal mucosa, appearance （deviation or polyp） of the middle turbinate and nasal septum were scored as 1, 2 and 3 points according to their severity. The total score equaled to symptom score plus nasal sign score. The distribution of heat sensitization acupoints for effectively improving AR were recorded. Results The total effective rate of 82.86% （29/35） in the HSM group had no marked difference in comparison with that of 74.29% （26/35） in the manual acupuncture group （P〉0.05）. After the treatment, the total scores of symptoms and nasal signs of both HSM and manual acupuncture groups were significantly reduced in comparison with their own individual pre-treatment （P〈0.01）, and those in the HSM group were significantly decrased than those in the manual acupuncture group （P〈0.05）. In 35 patients of the HSM group, among the detected 57 acupoints, the most frequently sensitive acupoints were LI 20, EX-HN 3, EX-HN 8, Shangyintang, BL 13, Shenque（CV 8）, GV 23, Fengchi（GB 20）, Die＊e and Dazhui （GV 14） in sequence, mainly covering the Governor Vessel, Large Intestine Meridian of Hand-yangming（LI）, and Bladder Meridian of Foot-taiyang（BL）, and characterized by heat conduction, heat diffusion, diathermancy, non-thermal （mainly itching） sensation, thermal sensation mainly in the deep tissue and in the distant part rather than in the body surface and the local part. Conclusion HSM has a positive effect on improvement of AR, when applied, acupoints LI 20, EX-HN 3, EX-HN 8, Shangyintang, BL 13, CV 8, GV 23, GB 20, Die＇e and GV 14 are highly recommended.