基于文献的跟痛症针灸诊疗特点分析

Analysis of characteristics of acupuncture diagnosis and treatment based on literature

目的探讨针灸治疗跟痛症的诊疗特点。方法检索中国期刊全文数据库(CNKI)、中国学术期刊数据库(万方数据)、中国生物医学文献服务系统(SinoMed)、中文科技期刊数据库(重庆维普)、PubMed数据库、Embase建库至2017年10月5日,有关针灸治疗跟痛症的文献,提取并总结纳入文献中针灸治疗本病的不同干预措施、辨证特点、选穴、针刺频次、疗程、疗效、随访情况及安全性。结果共纳入文献47篇。针灸治疗跟痛症常用干预措施有小针刀、毫针、穴位注射、电针、火针、温针灸和艾灸,其中涉及小针刀的文献占55.32%(26/47),毫针占21.28%(10/47);针灸治疗跟痛症以辨病选穴为主[93.62%(44/47)];出现频次最高的穴位为阿是穴[68.09%(32/47)];治疗频率方面,小针刀多治疗1次[36.17%(17/47)],毫针以1次/d为多见[17.02%(8/47)];各疗法除小针刀外,多以10次为1疗程[23.40%(11/47)];针灸治疗跟痛症多以疼痛缓解/改善程度评价疗效,有效率最低为69.56%,最高为100%;实施随访的文献占27.66%(13/47);仅1篇文献提及不良反应。结论针灸治疗跟痛症的干预措施以小针刀为最多,其次为毫针;针灸治疗跟痛症多为辨病选穴,常取阿是穴;治疗频率、疗程因干预措施不同而存在差异;针灸治疗本病近期疗效较好,有一定的远期疗效,安全性较好,不良反应少,但疗效评价标准尚不够客观、全面。

Objective To explore the characteristics of diagnosis and treatment of acupuncture and moxibustion for heel pain. Methods We searched the literatures related to heel pain treated by acupuncture and moxibustion in CNKI, WFPD, VIP, CBM, PubMed and Embase, then summarized the intervene measures related to acupuncture and moxibustion, clinical characteristics of syndrome differentiation and acupuncture points selection method, frequency, treatment course, treatment effect, follow-up outcomes and safety. Results A total of 47 articles are included in the acupuncture treatment of heel pain commonly used measures like small needling knife, acupuncture, acupoint injection, electro-acupuncture, fire needling, warm needling and moxibustion. The percentage of article involved in treating heel pain by small needling knife was 55.32%(26/47) and 21.28%(10/47) by acupuncture. The percentage of articles involved in acupuncture points selection method by differentiation of disease was 93.62%(44/47). The main acupuncture points in the 47 articles was ashi acpoint (68.09%, 32/47). The therapy frequency and treatment courses varied from the differences of the acupuncture and moxibustion methods. For small needling knife, the percentage of treating frequency of one time was 36.17%(17/47) and evaluating the curative effect after one treatment was 40.43%(19/47). For acupuncture, the percentage of treating frequency of once a day was 17.02%(8/47) and 23.40%(11/47). The effective rate showed a lot of variation from 69.56%-100% vary by intervene measures. The follow-up rate was not high, only 27.66%(13/47). There was only one literature referring to the adverse reaction. Conclusions The literatures review showed that the small needling knife was the most frequent method, followed by acupuncture. Acupuncture points selection by disease differentiation is the common method. The main acupuncture points applied in heel pain is ashi acupoint. Evaluating the effect after one treatment was common used for small needling knife. Once a day and ten times a therapy course were the common treatment frequency and treatment course for the remaining intervene measures. Acupuncture and moxibustion could show immediate and probable long-term positive effect for heel pain without no severe adverse reactions.