艾灸治疗类风湿关节炎研究进展

Research Progress of Moxa-Moxibustion in the Treatment of Rheumatoid Arthritis

艾灸广泛应用于类风湿关节炎(rheumatoid arthritis, RA)的临床实践中,其可减轻炎症反应、缓解疼痛,具有骨保护作用,对抗风湿药物有增效减毒作用。艾灸治疗RA的施灸方法主要以“温针灸”“麦粒灸”“悬灸”及“长蛇灸”等为主,治疗效果与灸量有关,辰时和酉时施灸疗效可能优于其他时机,常用穴是“肾俞”“足三里”。艾灸治疗RA临床效果显著,不同层面的艾灸方式对RA均有一定效果,但依然存在以下问题:(1)目前,艾灸治疗RA的机制研究多为基于病理表现的作用机制研究,其发病机制尚无明确认知;(2)灸法、灸量、灸时是灸疗满意度的关键因素,三者缺乏统一的研究标准;(3)当前选穴研究方面配伍单一,未充分结合中医整体观念和辨证论治理论;(4)艾灸治疗RA多为动物实验研究,临床观察较少且样本量小,缺少多中心、大样本量的随机对照研究,以致循证医学证据不足。今后,应深入研究本病的具体发病机制,加强艾灸治疗RA的实/试验研究,结合中医理论体系进一步发掘适用于RA人群的灸法、灸量、灸时及穴位配伍,形成较为统一的艾灸操作流程及量效标准。

Moxa-moxibustion is widely used in the clinical practice of rheumatoid arthritis(RA),which can reduce inflammation,relieve pain,protect bones,and have synergistic and attenuating effects on anti-rheumatic drugs.Moxa-moxibustion in the treatment of RA is mainly based on"warming needle moxibustion","wheat-grain-sized cone moxibustion","suspended moxibustion"and"snake moxibustion".The therapeutic effect is related to the amount of moxibustion.The moxibustion effect at Chen time(from 5 am to 7 am)and You time(from 17 pm to 19 pm)may be better than other times.The commonly used acupoints are"Shenshu(BL 23)"and"Zusanli(ST 36)".Moxa-moxibustion has a significant clinical effect in the treatment of RA.Different levels of moxibustion have a certain effect on RA,but there are still some problems:(1)At present,the mechanism of moxa-moxibustion in the treatment of RA is mostly based on the mechanism of action of pathological manifestations,and its pathogenesis is not clearly known at home and abroad;(2)Moxibustion method,moxibustion amount,and moxibustion time are the key factors of moxibustion satisfaction,and the three lack unified research standards;(3)The current research on acupoint selection is single,and it is not fully combined with the overall concept of TCM and the theory of syndrome differentiation and treatment;(4)Moxa-moxibustion treatment of RA is mostly on animal experiment research,with few clinical observations and small sample size,and lack of multi-center,large sample size of randomized controlled trials,resulting in insufficient evidence-based medicine.In the future,it is necessary to further study the specific pathogenesis of the disease,strengthen the experimental research of moxa-moxibustion treatment of RA,and further explore the moxibustion method,moxibustion amount,moxibustion time and acupoint compatibility suitable for RA population combined with the theoretical system of TCM,so as to form a more unified moxa-moxibustion operation process,dosage and effect standard.