补阳还五汤加减联合针灸及穴位贴敷治疗带状疱疹后遗神经痛气虚血瘀证

Clinical Observation of Using Modified Buyang Huanwu Decoction Combined with Acupuncture and Acupoint Application in the Treatment of Postherpetic Neuralgia with Qi Deficiency and Blood Stasis Syndrome

目的:观察补阳还五汤加减联合针灸及穴位贴敷治疗带状疱疹后遗神经痛(PHN)气虚血瘀证的疗效。方法:将120例PHN患者随机分为对照组和观察组,每组60例;对照组给予西医常规治疗,观察组在对照组基础上加用补阳还五汤加减联合针灸及穴位贴敷治疗,两组均治疗15天;比较两组临床疗效、疼痛视觉模拟评分(VAS)、气虚血瘀证分级、阿森斯失眠量表(AIS)、皮肤病生活质量指数(DLQI)等评分及血清β-内啡肽(β-EP)、P物质水平变化,并观察两组安全性。结果:观察组治疗总有效率为93.33%,明显大于对照组的78.33%(P<0.05);治疗后,观察组较对照组VAS、气虚血瘀证、AIS、DLQI评分均明显降低(P<0.05);治疗后,观察组较对照组CD3+、CD4+、CD4+/CD8+水平均明显升高(P<0.05),CD8+水平明显降低(P<0.05);治疗后,观察组较对照组血清β-EP水平明显升高(P<0.05),P物质水平明显降低(P<0.05);两组均未见明显不良反应。结论:补阳还五汤加减联合针灸及穴位贴敷治疗PHN疗效显著,可有效调节T淋巴细胞亚群及血清β-EP、P物质水平,减轻疼痛症状,改善气虚血瘀证,提高患者生活质量。

Objective： To observe the effect of Modified Buyang Huanwu Decoction combined with acupuncture and acupoint application in the treatment of postherpetic neuralgia（ PHN） with Qi deficiency and blood stasis syndrome. Methods： 120 patients with PHN were randomly divided into controlled group and observation group,60 cases in each group. The controlled group was treated with routine western medicine,and on the basis,the observation group was additionally treated with Buyang Huanwu Decoction combined with acupuncture and acupoint application. The two groups received 15 days of treatment. The clinical efficacy,pain visual analogue scale（ VAS） score,classification of Qi deficiency and blood stasis syndrome,Athens Insomnia Scale（ AIS）,Dermatology Life Quality Index（ DLQI） score and changes in levels of serum β-endorphin（ β-EP） and substance P were compared between the two groups,and safety was observed. Results： The total treatment effective rate of the observation group was significantly higher than that of the controlled group（ 93. 33% vs 78. 33%）（ P〈0. 05）. After treatment,scores of VAS,Qi deficiency and blood stasis syndrome,AIS and DLQI in the observation group were significantly lower than those in the controlled group（ P〈0. 05）. After treatment,levels of CD3＋,CD4＋and CD4＋/CD8＋in the observation group were significantly higher than while CD8＋levels were significantly lower than those in the controlled group（ P〈0. 05）. After treatment,serum β-EP levels in the observation group were significantly higher than while levels of substance P were significantly lower than those in the controlled group（ P〈0. 05）. There were no obvious adverse reactions in the two groups. Conclusion： Modified Buyang Huanwu Decoction combined with acupuncture and acupoint application is markedly effective in the treatment of PHN. The regimen can effectively regulate levels of T lymphocyte subsets and serum β-EP and substance P,relieve pain and Qi deficiency and blood stasis syndrome,and improve the quality of life of patients.