基于“瘀水互患”理论化瘀利水法治疗气滞血瘀型腰椎间盘突出症

Clinical Observation of Huayu Lishui Decoction Treatment of Lumbar Disc Herniation Due to Qi Stagnation and Blood Stasis

目的:基于"瘀水互患"理论探讨运用化瘀利水法治疗气滞血瘀型腰椎间盘突出症(LDH)的临床疗效。方法:将68例气滞血瘀型腰椎间盘突出症患者随机分为两组(治疗组和对照组各34例),对照组给予身痛逐瘀汤(牛膝、地龙、香附、羌活、秦艽、炙甘草、当归、川芎、五灵脂、桃仁、没药、红花),水煎400 mL,1剂/d,饭后30 min温服200 mL,2次/d.治疗组给予自拟化瘀利水方(延胡索、红花、桃仁、川芎、赤芍、白术、桂枝、猪苓、茯苓、泽泻、萆薢、车前子、牛膝、地龙),水煎400 mL,1剂/d,饭后30 min温服200 mL,2次/d.连续治疗14 d为1疗程,共治疗2个疗程。分别在治疗前、治疗1个疗程(14 d)、2个疗程(28 d)及治疗结束后2周随访,记录简化McGill疼痛评分、腰椎Oswedtry功能障碍指数,并在治疗4周结束时评定临床疗效。结果:治疗组和对照组各脱落2例,治疗组出现胃肠道不适4例,对照组出现胃肠道不适5例,所有患者经对症处理后好转,两组未出现其他明显不良反应。与治疗前比较,两组治疗后各个观察时点腰椎各项评分均显著改善,差异有统计学意义(P<0.05)。组间比较,治疗14 d,28 d及治疗结束后2周随访时,治疗组各个观察时点腰椎McGill疼痛积分和腰椎ODI功能评分改善均优于对照组,差异均有统计学意义(P<0.05)。治疗前后不同时间点腰椎McGill疼痛积分的差异有统计学意义,即存在时间效应(F=314.11,P<0.001),时间因素和分组因素存在交互效应(F=3.276,P=0.027)。治疗前后不同时间点腰椎ODI功能评分差异有统计学意义,即存在时间效应(F=429.43,P<0.001),但时间因素和分组因素并不存在交互效应(F=2.564,P=0.063)。治疗组痊愈10例,显效14例,有效4例,无效4例,愈显率为75%(24/32),总有效率为87.5%(28/32)。对照组痊愈8例,显效8例,有效10例,无效6例,愈显率为50.0%(16/32),总有效率为81.25%(26/32)。两组总有效率差异无统计学意义(P>0.05),但两组愈显率差异有统计学意义(P<0.05),化瘀利水方组疗效明显优于身痛逐瘀汤组。结论:气滞血瘀型腰椎间盘突出症的基本病机为血瘀与水湿互结为患,治当以活血化瘀、行气止痛、利水消肿之法。运用化瘀利水法中药内治能标本兼治,短期可消除神经根水肿,改善微循环,缓解腰腿痛症状,疗效满意,是治疗气滞血瘀型腰椎间盘突出症的有效方法,无严重不良反应。

Objective:To study the therapeutic effect of the Huayu Lishui Decoction treatment of Lumbar Disc Herniation due to Qi Stagnation and Blood Stasis with the theory of sudden water mutual disease.Methods:68 with lumbar disc herniation due to Qi Stagnation and Blood Stasis patients were randomly divided into two groups.34 patients in the treatment group and 34 patients in the control group.The control group was given the Shentong Zhuyu decoction:Niuxi,Dilong,Xiangfu,Qianghuo,Qinjiao,Gancao,Danggui,Chuanxiong,Wulingzhi,Taoren,Moyao,Honghua,400 mL,one doses every day,30 min after meal,two times one day.The treatment group was given the Huayu Lishui decoction:Yanhusuo,Honghua,Taoren,Chishao,Chuanxiong,Baizhu,Guizhi,Zhuling,Fuling,Zexie,Bixie,Cheqianzi,Niuxi,Dilong,400 mL,one doses every day,30 min after meal.All patients had been contacted for 2 courses of treatment,each of which included 14 d.Simplified McGill pain score,lumbar Oswestry dability index were recorded before treatment,one course of treatment(14 d),two courses(28 d)and 2 weeks after treatment,and the clinical efficacy was evaluated at the end of 4 weeks.Results:4 patients(2 case in the control group and 2 cases in treatment group)droupped out after 4 weeks treatment.There were 4 cases of gastrointestinal discomfort in the treatment group and 5 cases of gastrointestinal discomfort in the control group.All patients improved after symptomatic treatment.There were no other obvious adverse reactions in the two groups.Compared with those before treatment,the scores of lumbar McGill and lumbar ODI at all the observation time points were significantly improved in the two groups after treatment(P<0.05).There were statistical difference in the changing range of the lumbar McGill and lumbar ODI between the two groups(P<0.05).There was statistical difference in lumbar McGill between different time points.in the other words,there was time effect(F=314.11,P<0.001).There was interaction between time factor and group factor(F=3.276,P=0.027).There was statistical difference in lumbar ODI between different time points,there was time effect(F=429.43,P<0.001),there was no interaction between time factor and group factor(F=2.564,P=0.063).In the treatment group,10 cases were cured,14 cases were markedly effective,4 cases were effective,and 4 cases were ineffective.The cure rate was 75%(24/32),and the total effective rate was 87.5%(28/32).In the control group,8 cases were cured,8 cases were markedly effective,10 cases were effective,and 6 cases were ineffective.The cure rate was 50.0%(16/32),and the total effective rate was 81.25%(26/32).There was no significant difference in the total effective rate between the two groups(P>0.05),but the difference between the two groups was statistically significant(P<0.05).The curative effect of the Huayu Lishui decoction group was significantly better than that of the Shentong Zhuyu decoction group.Conclusion:The basic pathogenesis of lumbar disc herniation with qi stagnation and blood stasis is that blood stasis and water dampness interrelate to each other.Huayu Lishui decoction has good effect on patients with Qi Stagnation and Blood Stasis type lumbar intervertebral disc herniation,because of satisfactory curative effect and no serious adverse reactions.