针刺联合中西药治疗肝风挟瘀型偏头痛的疗效观察

Efficacy Observation of Acupuncture Combined with Chinese and Western Medications for Migraine Due to Liver Wind Carrying Stasis

目的观察针刺联合熄风化瘀定痛汤、西药治疗肝风挟瘀型偏头痛的临床疗效。方法将188例肝风挟瘀型偏头痛患者随机分为甲组、乙组、丙组与丁组,每组47例。甲组给予常规西药治疗,乙组给予针刺联合常规西药,丙组给予熄风化瘀定痛汤联合常规西药,丁组给予针刺联合熄风化瘀定痛汤、常规西药。观察治疗前1个月、治疗第3个月的头痛发作情况[头痛发作次数、持续时间、发作时视觉模拟量表(VAS)评分],治疗前后中医证候积分及血清β-内啡肽(β-EP)、内皮素-1(ET-1)、5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)水平变化,并比较4组临床疗效及不良反应发生情况。结果治疗第3个月4组头痛发作情况均较治疗前1个月降低(P<0.05),丁组低于甲组、乙组、丙组(P<0.01),乙组和丙组均低于甲组(P<0.05),乙组和丙组比较差异无统计学意义(P>0.05)。治疗后4组的中医证候积分比均较治疗前降低(P<0.05),丁组低于甲组、乙组、丙组(P<0.01),乙组和丙组均低于甲组(P<0.05),乙组和丙组差异无统计学意义(P>0.05)。4组治疗后血清β-EP、5-HT水平较治疗前升高(P<0.05),血清ET-1、CGRP水平均较治疗前降低(P<0.05);丁组治疗后血清β-EP、5-HT水平高于甲组、乙组、丙组(P<0.01),乙组和丙组均高于甲组(P<0.05),乙组治疗后和丙组比较差异无统计学意义(P>0.05);丁组治疗后血清ET-1、CGRP水平低于甲组、乙组、丙组(P<0.01),乙组和丙组治疗后均低于甲组(P<0.05),乙组和丙组比较差异无统计学意义(P>0.05)。丁组总有效率高于甲组、乙组、丙组(P<0.01),甲组、乙组、丙组组间比较差异无统计学意义(P>0.05)。4组不良反应发生率比较差异无统计学意义(P>0.05)。结论针刺联合熄风化瘀定痛汤、西药疗法治疗肝风挟瘀型偏头痛患者可明显改善头痛发作情况、减轻病情,并可有效提高血清β-EP、5-HT水平及降低血清ET-1、CGRP水平,疗效显著。

Objective To observe the clinical efficacy of acupuncture plus Xi Feng Hua Yu Ding Tong Tang and Western medication in treating migraine due to liver wind carrying stasis.Method A total of 188 patients with migraine due to liver wind carrying stasis were randomized into group A,group B,group C,and group D,with 47 cases in each group.Group A was offered routine Western medication,group B was given acupuncture plus routine Western medication,group C was given Xi Feng Hua Yu Ding Tong Tang plus routine Western medication,and group D was intervened by acupuncture plus Xi Feng Hua Yu Ding Tong Tang and routine Western medication.The details of the headache attack(headache attack times,duration,and visual analog scale(VAS)score at onset)were observed one month before the treatment and at the 3rd month of treatment.Before and after the treatment,the symptoms score of traditional Chinese medicine(TCM)and the levels of serumβ-endorphin(β-EP),endothelin-1(ET-1),5-hydroxytryptamine(5-HT),and calcitonin gene-related peptide(CGRP)were also observed.The clinical efficacy and adverse reactions were compared among the four groups.Result At the 3rd month of treatment,the headache attack severity reduced compared with that one month before the treatment in the four groups(P<0.05);group D was lower than groups A,B,and C(P<0.01),groups B and C were lower than group A(P<0.05),and group B and group C were statistically equal(P>0.05).The TCM symptoms score dropped after the treatment in all four groups(P<0.05)and was lower in group D than in groups A,B,and C(P<0.01),lower in groups B and C than in group A(P<0.05),while there was no significant difference between groups B and C(P>0.05).The serum levels ofβ-EP and 5-HT increased after the treatment in all four groups(P<0.05),and the serum levels of ET-1 and CGRP declined(P<0.05).After the treatment,group D was higher than groups A,B,and C comparing the serum levels ofβ-EP and 5-HT(P<0.01),groups B and C were higher than group A(P<0.05),and groups B and C were statistically equal(P>0.05).Group D was lower than groups A,B,and C comparing the serum levels of ET-1 and CGRP after the treatment(P<0.01),groups B and C were lower than group A(P<0.05),and there was no significant difference between groups B and C(P>0.05).The total effective rate in group D was higher than that in groups A,B,and C(P<0.01),and there were no significant differences across groups A,B,and C(P>0.05).There were no significant differences in the adverse reaction rate among the four groups(P>0.05).Conclusion In the treatment of migraine due to liver wind carrying stasis,acupuncture combined with Xi Feng Hua Yu Ding Tong Tang and Western mediation can notably improve the headache attack,reduce the severity,and effectively up-regulate the serum levels ofβ-EP and 5-HT and down-regulate the serum levels of ET-1 and CGRP,producing significant efficacy.