中医外治法治疗过敏性鼻炎(鼻鼽)临床研究简况

Brief Introduction of Clinical Research on Treatment of Allergic Rhinitis(Biqiu/鼻鼽) by External Therapy of Traditional Chinese Medicine

过敏性鼻炎(AR)可归属"鼻鼽"范畴。"内者内治,外者外治",中医外治法历史悠久,治疗AR尤侧重标本兼顾,标则减轻急性期症状,缓则扶正固本,改善过敏体质;疗效可与常用西药相媲美,甚至更优,能改善症状,减少复发率,远期疗效可观。以往国际诊疗指南对针灸持否定态度,随着结合解剖学和针灸刺激蝶腭神经节越来越广泛,2015年美国耳鼻咽喉头颈外科学会AR临床实践指南首次推荐使用针灸治疗AR。针灸既能够减轻症状,提高生活质量,减少复发,又能减少药物使用,降低不良反应,更符合患者意愿。针刺可疏通经络、调和阴阳及扶正祛邪,激发机体自身调节机能,促进释放内源性物质,发挥防治疾病效应。艾灸可与药物结合发挥作用,安全性较高,有效提高疗效,促进生活质量提升;常用隔物灸、雷火灸、热敏灸等,不同灸法均有肯定疗效;选穴多以督脉、膀胱经、鼻局部为主,大椎、肺俞、迎香、足三里应用频次最高。穴位埋线可增强T细胞介导细胞免疫和体液免疫功能,增强NK细胞的细胞毒功能,减弱自身免疫反应。推拿可疏通经络、推行气血、调理脏腑功能,平衡阴阳。自血疗法可有效改善症状,提高疗效。拔罐疗法可激发经气、阳气,使机体正气渐盛,从而达到提高呼吸系统免疫力之功效,临床常与其他外治法联合应用。穴位注射常用穴位有迎香、印堂、风池、足三里等,常用药物有曲安奈德注射液、维生素B12等。穴位贴敷通过经络穴位刺激和经皮给药共同作用提高人体自身免疫力,增强抗病能力,贴敷时间以"三伏""三九"共用最佳,其次为三伏贴,再次为三九贴。临床常几种外治法联合应用,疗效优于单独应用。中医外治法也有一定的不良反应,穴位贴敷过敏、穴位埋线硬结难消等,停止治疗后均可缓解。

Allergic rhinitis(AR)belongs to the category of'Biqiu/鼻鼽'.'Internal treatment,external treat-ment'of traditional Chinese medicine has a long history,especially in the treatment of AR,focusing on both specimens,the standard alleviates acute symptoms,slowly consolidates the root,improve allergic constitution;efficacy can be comparable to commonly used western medicine,or even better,can improve symptoms,reduce recurrence rate,long-term effect is considerable.In the past,the international guidelines for diagnosis and treatment of acupuncture and moxibustion held a negative attitude.With the combination of modern anatomy and acupuncture stimulation of sphenopalatine ganglion becoming more and more widespread,in 2015,the American Society of Otolaryngology Head and Neck Surgery AR Clinical Practice Guidelines first recommended the use of acupuncture and moxibustion for the treatment of AR Acupuncture and moxibustion can not only alleviate symptoms,improve the quality of life,reduce recurrence,but also reduce drug use,reduce adverse reactions,more in line with the wishes of patients.Acupuncture can dredge meridians and collaterals,harmonize Yin and yang,strengthen the body’s self-regulation function,promote the release of endogenous substances,and play a role in disease prevention and treatment.Moxibustion can play a role in combination with medicines,with high safety,effective improvement of curative effect and promotion of quality of life;commonly used partition moxibustion,thunder-fire moxibustion,heatsensitive moxibustion and other moxibustion methods have a positive effect;most of the selected points are Du Meridian,Bladder Meridian and nasal part,Dazhui,Feishu,Yingxiang and Zusanli are most frequently used.Acupoint catgut embedding can enhance T cell mediated cellular immunity and humoral immunity,enhance the cytotoxic function of NK cells,and weaken the autoimmune response.Massage can dredge meridians and collaterals,promote qi and blood,regulate the functions of viscera and organs,and balance yin and yang.Autohemotherapy can effectively improve symptoms and curative effect.Cupping therapy can stimulate meridian qi and Yang qi,and make the body vigorous gradually,so as to improve the immunity of the respiratory system.It is often used in combination with other external therapies in clinic.Common acupoints for acupoint injection include Yingxiang,Yintang,Fengchi,Zusanli,etc.Common medicines include triamcinolone acetonide injection and vitamin B12.Acupoint application can improve the body’s self-immunity and disease resistance through the combination of meridian acupoint stimulation and dermal administration.The best time for application is'three-volt'and'three-nine',followed by'three-volt'and'threenine'stickers.The clinical effect of combined application is better than that of single application.There are also some adverse reactions in the external treatment of TCM,such as allergy at acupoint application,hard knot of Catgut Embedding at acupoint,etc.,which can be alleviated after stopping treatment.