“颈部七线”取穴法针刺预防性治疗肝阳上亢型无先兆偏头痛:随机对照试验

Prophylaxis of migraine without aura of liver yang hyperactivity treated with acupuncture at the points selected using the"seven lines of the neck"method:a randomized controlled trial

目的:观察“颈部七线”取穴法针刺预防性治疗肝阳上亢型无先兆偏头痛的临床疗效。方法:将58例缓解期肝阳上亢型无先兆偏头痛患者随机分为观察组(29例,脱落3例)和对照组(29例,脱落4例)。观察组予“颈部七线”取穴法针刺治疗,穴取大椎、风府及双侧风池、供血等;对照组予常规针刺治疗,穴取患侧阿是穴、丝竹空、率谷、太阳等。两组均隔1~2d治疗1次,每周治疗3次,连续治疗8周。分别于治疗前,治疗4、8周后及治疗结束后4周(随访)观察两组患者头痛发作天数、头痛发作次数、疼痛视觉模拟量表(VAS)评分及偏头痛特异性生活质量问卷(MSQ)评分;于治疗前及治疗8周后观察两组患者中医证候积分;并于治疗4、8周后及治疗结束后4周(随访)计算两组患者头痛发作天数与头痛发作次数减半率。结果:治疗4、8周后及随访时,两组患者头痛发作天数及头痛发作次数均较治疗前减少(P<0.01),VAS评分均较治疗前降低(P<0.01);观察组患者随访时头痛发作天数及头痛发作次数少于对照组(P<0.05),治疗8周后及随访时VAS评分低于对照组(P<0.05)。治疗4、8周后及随访时,观察组患者MSQ功能障碍领域和情感领域评分较治疗前升高(P<0.05);治疗8周后及随访时,观察组患者MSQ功能受限领域评分较治疗前升高(P<0.05),对照组患者MSQ功能受限领域、功能障碍领域和情感领域评分较治疗前升高(P<0.05)。治疗8周后,两组患者中医证候积分较治疗前降低(P<0.01)。观察组治疗8周后头痛发作天数减半率及随访时头痛发作次数减半率高于对照组(P<0.05)。结论:“颈部七线”取穴法针刺可减少肝阳上亢型无先兆偏头痛患者头痛发作天数、发作次数及疼痛强度,改善患者中医证候以及生活质量。

Objective To observe the clinical effect of prophylaxis on migraine without aura differentiated as liver yang hyperactivity undergoing acupuncture at the points selected using the"seven lines of the neck"method.Methods Fifty-eight patients with migraine without aura of liver yang hyperactivity at remission stage were randomly divided into an observation group(29 cases,3 cases dropped out)and a control group(29 cases,4 cases dropped out).In the observation group,acupuncture was delivered at Dazhui(GV 14),Fengfu(GV 16),bilateral Fengchi(GB 20),Gongxue(Extra),etc.,selected using the"seven lines of the neck"method.In the control group,conventional acupuncture was applied to ashi point,Sizhukong(TE 23),Shuaigu(GB 8),Taiyang(EX-HN 5)and others on the affected side.The treatment was given once every other day or every two days,3 interventions weekly,for consecutive 8 weeks.Before treatment,after 4 and 8 weeks of treatment,and after 4 weeks of treatment completion(follow-up visit),the days of migraine episodes,the frequency of migraine episodes,the score of visual analogue scale(VAS)for pain intensity,and the score of migraine specific quality of life questionnaire(MSQ)were observed in the patients of the two groups.Before treatment and after 8 weeks of treatment,the score of TCM syndrome was observed.After 4 and 8 weeks of treatment and after 4 weeks of treatment completion(follow-up visit),the response rates of 50% reduction in the days and the frequency of migraine episodes were calculated in the two groups.Results After 4 and 8 weeks of treatment and during follow-up visit,the days and the frequency of migraine episodes were decreased(P<0.01)and VAS scores were declined(P<0.01)when compared with those before treatment in the two groups.The days and the frequency of migraine episodes in the observation group were lower during the follow-up visit(P<0.05)and VAS scores were lower after 8 weeks of treatment and during the follow-up visit(P<0.05)when compared with those in the control group.After 4 and 8 weeks of treatment,and during follow-up visit,the scores of"role function-preventive"and"emotional function"of MSQ were increased in comparison with those before treatment in the observation group(P<0.05).After 8 weeks of treatment and during the follow-up visit,the scores of"role function-restrictive"of MSQ were increased in comparison with those before treatment in the observation group(P<0.05),and the scores of"role function-restrictive""role function-preventive"and"emotional function"were higher when compared with those before treatment in the control group(P<0.05).After 8 weeks of treatment,the scores of TCM syndrome were decreased in comparison with those before treatment in the two groups(P<0.01).In the observation group,the response rate of 50% reduction in the days of migraine episodes after 8 weeks of treatment and that of the frequency of migraine episodes during the follow-up visit were higher than those of the control group(P<0.05).Conclusion Acupuncture at the points selected using the"seven lines of the neck"method can reduce the days and frequency of migraine episodes and pain intensity,ameliorate the syndrome of TCM and improve the quality of life of the patients with migraine without aura of liver yang hyperactivity.