皮肤针治疗带状疱疹后遗神经痛研究进展

Research Progress of Postherpetic Neuralgia with Skin Acupuncture

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)病位在皮部,主要累及肝、脾二脏,久则及肾。其发生涉及内、外两个因素,内因有年老体弱、素体亏虚、正气不足、情志内伤、饮食不节等,外因则与外感火毒湿热时邪有关。其病机有虚实两种,实为肝经湿热火毒蕴积与血气搏结,造成局部气血凝滞,经脉瘀阻不通,脏腑气机不畅则痛;虚为正气虚弱,无力抗邪,外感火毒之邪后,余邪未尽日久化火,耗伤阴血,阴血亏虚不能濡养肌肤经脉,不荣则痛。故该病治疗需要兼顾内外虚实,以扶正祛邪、理气活血、通络止痛为主。皮肤针治疗PHN可因势利导、诱邪外出,既能活血祛瘀、通络止痛,又可振奋经气、调节脏腑,常用治疗方法有:皮肤针放血、皮肤针联合普通针刺、皮肤针联合灸法、皮肤针联合中药、皮肤针联合西药等。皮肤针治疗PHN,临床叩刺部位选择主要为局部叩刺,其次是阿是穴、夹脊穴的穴位叩刺。目前,皮肤针治疗PHN的临床研究仍存在以下问题:观察的样本量较小,缺乏多中心、大样本研究;疗效评价以观察性指标为主,缺乏实验室指标观察,实验结果主观性较强,缺乏客观真实性;临床应用型研究多,基础理论型研究少;PHN易复发,病程迁延时间长,部分临床研究仅关注近期疗效,缺少后期随访;治疗主要以缓解疼痛为主,缺乏对患者的心理疏导。建议加强皮肤针治疗PHN的基础研究,注重客观疗效标准,同时注意后期随访及心理疏导,设计更为严谨的科研方案。

Postherpetic neuralgia(PHN) is a disease that is located in the skin and mainly affects the liver and spleen,and prolonged illness can damage the kidney.There are two types of pathogenesis of the disease:excess and deficiency.In terms of excess,it means that the liver meridian dampness-heat leads to fire toxin accumulation struggling with blood and qi,resulting in local qi and blood stagnation,meridians′ stasis obstruction,zang-fu organs′ unsmooth qi movement resulting in pain.In terms of deficiency,it means that weak healthy qi leads to fail to resist pathogens.If a patient is attacked by external pathogens,and the residual pathogen has not been removed for a long time,it can transform into fire consuming yin blood failing to nourish skin and muscles of the meridians,which causes pain.Therefore,the treatment of PHN needs to take into account both internal and external deficiency and excess mainly to reinforce healthy qi and dispel pathogens,regulate qi and activate blood,dredge collaterals and relieve pain.Treating PHN with skin acupuncture can guide and induce pathogens to go out according to the situation,which can not only promote blood circulation,remove blood stasis,dredge collaterals,relieve pain,but also stimulate meridian qi and regulate zang-fu organs.Commonly-used methods include skin acupuncture for bloodletting,skin acupuncture combined with ordinary acupuncture,skin acupuncture combined with moxibustion,skin acupuncture combined with Chinese medicinals,skin acupuncture combined with Western medicine,etc.In the treatment of PHN with skin acupuncture,the choice of clinical tapping site is mainly local,tapping acupuncture,followed by Ashi point and Jiaji(EX-B2).At present,there are still the following problems in the clinical research of skin acupuncture for PHN:The sample size of observation is small,the lack of multi-center,large sample study.The evaluation of curative effect is mainly based on observational indexes,lacks of laboratory index observation,and the experimental results are subjective and lack of objective authenticity.There are more clinical application studies,but fewer basic theory ones.PHN is prone to relapse,and the course of the disease is long.Some clinical studies only focus on the short-term effect and lack of follow-up.The treatment mainly focuses on relieving pain and lacks psychological guidance to patients.Therefore,it is recommended to strengthen the basic research of skin acupuncture for PHN,pay attention to objective efficacy criteria,later follow-up and psychological counseling,and design more rigorous scientific research programs.