独活寄生汤加针刺联合西药治疗类风湿性关节炎(肝肾亏虚)随机平行对照研究

Duhuo Jisheng Decoction/独活寄生汤 plus Acupuncture Combined with Western Medicine in the Treatment of Rheumatoid Arthritis(Ganshen Yinxu/肝肾亏虚)Randomized Parallel Controlled Study

[目的]观察独活寄生汤加针刺联合西药治疗类风湿性关节炎(肝肾亏虚)疗效。[方法]使用随机平行对照方法,将114例门诊患者按就诊顺序号抽签随机分为两组。对照组57例甲氨蝶呤,10mg/次,1次/d;美洛昔康,150mg/次,1次/d。治疗组57例独活寄生汤加针刺,独活寄生汤(甘草、细辛各6g,人参、当归、秦艽、肉桂、防风、白芍、川芎、~川牛膝、独活各10g,杜仲15g,桑寄生20g),水煎300mL,1剂/d,早晚饭后30min温服;脾虚加白术、砂仁各5g,湿重加防己、苍术各5g,疼痛重加乳香、川乌各5g;针刺:足三里、关元、气海、脾俞、肾俞、肝俞,关节病变位置循经取穴,髋关节取秩边、环跳、承扶,肩关节部位取肩俞、肩贞、天宗,膝关节取内外膝眼、阳陵泉、血海,30～50mm毫针,指切进针法,得气配穴平补平泻、主穴提插补法,1次/d,30min/次;西药治疗同对照组。连续治疗3个月为1疗程。观测临床表现、血沉、C反应蛋白、类风湿因子、20m步行时长、晨僵时长、不良反应。治疗1疗程(3个月),判定疗效。[结果]ESR、CRP、RF、20m步行时长、晨僵时长两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]独活寄生汤加针刺联合西药治疗类风湿性关节炎(肝肾亏虚),疗效满意,无严重不良反应,值得推广。

[Objective] To observe the curative effect of Duhuo Jisheng decoction plus acupuncture combined with western medicine on rheumatoid arthritis(liver and kidney deficiency).[Method] 114 outpatients were randomly divided into two groups by drawing lots according to the order of visiting. Control group 57 cases of methotrexate, 10 mg/time, once a day;Meloxicam, 150 mg/time, once a day. 57 cases in the treatment group were treated with Duhuo parasitic Decoction plus acupuncture, Duhuo Jisheng decoction(Gnacao, Xixin each 6 g, Renshen, Danggui, Qinjiao, Rougui, Fangfeng, Baishao, Chuanxiong, Chuanxiuxi, Duhuo each 10 g,Duzhong 15 g, Sangjisheng 20 g), water decoction 300 mL, 1 dose/d, warm clothes 30 minutes after breakfast and dinner;spleen deficiency plus Baizhu and Sharen 5 g, wet plus Fangji, Cangzhu each 5 g, pain plus Ruxiang, Chuanwu each 5 g;Acupuncture: Zusanli, Guanyuan, Qihai, Pishu, Shenshu, Ganshu, point selection along meridians, hip joint rank edge, circumferential jump, support, shoulder joint position shoulder, shoulder Zhenzhen, Tianzong, knee joint inside and outside knee eyes, Yanglingquan, Xuehai, 30-50 mm millineedles,finger-cutting needling method, Qi matching acupoint Pingxie, main acupoint lifting and inserting, once a day,30 minutes per time;Western medicine treatment of the same pair;Group photo. Continuous treatment for 3 months is a course of treatment. Clinical manifestations, erythrocyte sedimentation rate, C-reactive protein,rheumatoid factor, 20-meter walking time, morning stiffness time and adverse reactions were observed. One course of treatment(3 months) was used to determine the curative effect.[Results] ESR, CRP, RF, 20-meter walking time and morning stiffness time were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01).[Conclusion] Duhuo Jisheng decoction plus acupuncture combined with western medicine in the treatment of rheumatoid arthritis(liver and kidney deficiency) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.