国医大师李济仁“寒热”并调思想指导针药结合治疗膝骨关节炎的疗效及优势

Efficacy and advantages of combining acupuncture and herbs in the treatment of knee osteoarthritis based on the thought of“regulating cold and heat”by the national medical master Li Jiren

目的:探讨国医大师李济仁“寒热”治痹思想指导下针药结合对膝骨关节炎阳虚寒凝证的治疗效果,观察其对关节功能和实验室指标的影响。方法:将90例膝骨关节炎阳虚寒凝证患者随机分为中药组、针刺组和针药组,每组30例。中药组给予温络饮加减方口服,针刺组给予针刺治疗,针药组给予中药加针刺治疗。观察3组西安大略和麦克马斯特骨关节炎指数(WOMAC)评分、视觉模拟评分法(VAS)评分治疗前后的变化,并计算各组的总有效率。结果:与针刺组比较,针药组治疗后的WOMAC评分和VAS评分均明显降低,差异有统计学意义(P<0.05);与中药组比较,针药组治疗后的VAS评分明显降低,差异有统计学意义(P<0.01)。针药组的总有效率为100%(30/30),针刺组的总有效率为86.7%(26/30),中药组的总有效率为83.3%(25/30),3组比较,差异有统计学意义(P<0.05)。结论:“寒热”治痹思想指导针药结合治疗阳虚寒凝证膝骨关节炎可有效改善WOMAC评分、VAS评分水平,减轻患者痛苦,提高临床疗效。

Objective:To explore the therapeutic effect of acupuncture combined with herbs on knee osteoarthritis with yang deficiency and cold coagulation syndrome under the guidance of“arthralgia treated with cold and heat”by the national medical master Li Jiren,and to observe its effect on joint function and laboratory indexes.Methods:90 patients with knee osteoarthritis due to yang deficiency and cold coagulation syndrome were randomly divided into traditional Chinese medicine group,acupuncture group and acupuncture-herbs group,with 30 cases in each group.The traditional Chinese medicine group was given modified wenluo formula orally,the acupuncture group was given acupuncture treatment,and the acupuncture-herbs group was given Chinese herbs plus acupuncture treatment.The changes in Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores,visual analogue scale(VAS)scores before and after treatment were observed in the three groups,and the total effective rate of each group was calculated.Results:Compared with the acupuncture group,the WOMAC score and VAS score in the acupuncture-herbs group had a significant reduction after treatment and the difference was statistically significant(P<0.05);compared with the herbal medicine group,the VAS score in the acupuncture-herbs group had a significant reduction after treatment(P<0.01).The total effective rate of the acupuncture-herbs group was 100%(30/30),the total effective rate of the acupuncture group was 86.7%(26/30),and the total effective rate of the Chinese herbs group was 83.3%(25/30).The difference between the 3 groups was statistically significant(P<0.05).Conclusion:The combination of acupuncture and herbs guided by the thought of“arthralgia treated with cold and heat”can effectively improve the WOMAC and VAS scores of osteoarthritis of the knee due to yang deficiency and cold condensation,reduce patients′pain and improve clinical efficacy.