程肖芳++卿伦学++孙艳艳++刘长信++王锡友++于长禾

[摘要] 溫针灸首见于《伤寒论》，随着对温针灸工艺的改进和治疗的需要，形成了5种常见的温针灸疗法。本研究旨在分析影响温针灸特异性疗效因素对温针灸临床疗效的贡献。研究发现温针灸的病种包括骨骼肌肉筋膜疼痛、运动功能受限类疾病、炎症相关内科疾病，以阳虚证、寒实证疗效最佳。粗大针具及其压痛点的密集型针刺法等针刺因素，合适的温度刺激强度、合适的体外留针、进针深至病灶、银针导热、电子控温等温度因素，均可提高温针灸的临床疗效及安全性。但是由于研究方法及报道质量较低、研究结果不一致、操作异质性等因素，临床医生需根据患者实际情况选择温针灸疗法。建议今后临床研究根据循证医学理念，提供温针灸安全性、有效性及卫生经济学评价的证据；实验研究旨在揭示温针灸作用于不同疾病的共性机制和特定疾病的个性机制，并探讨不同温针灸作用机制的异同。

[关键词] 温针灸；内热针；电热针；银质针；临床疗效；安全性；实验研究；临床研究

[中图分类号] R245.8 [文献标识码] A [文章编号] 1673-7210（2017）11（a）-0075-06

Key factors contributing to the clinical effect and safety in warm needling studies： a literature review

CHENG Xiaofang1* QING Lunxue2* SUN Yanyan3 LIU Changxin3 WANG Xiyou3 YU Changhe3

1.Department of Tuina and Pain Management， Longgang Hospital of Traditional Chinese Medicine in Shenzhen City， Guangdong Province， Shenzhen 518172， China； 2.the First Clinical College， Beijing University of Chinese Medicine， Beijing 100700， China； 3.Department of Tuina and Pain Management， Dongzhimen Hospital， Beijing University of Chinese Medicine， Beijing 100700， China

[Abstract] Warm needling is first recorded in Shanghan Lun. As the demand of treatment and the improvement of instruments， five types of warm needling have been developed. This review is aimed at analyzing the factors contributing to the therapeutic effect and safety of warm needling. The results release that the warm needling is good at treating the diseases including musculoskeletal pain， diseases due to motion dysfunction， and inflammation of soft tissue in internal diseases， and especially the diseases with the main TCM patterns like yang deficiency and excessive cold. The factors contributing to the clinical effect and safety are the needling factors such as needles with large diameter and intensive needling with trigger points， and the temperature factors such as proper intense of temperature， proper needle's length outside body， the depth of needling， silver needles as medium， and electronic temperature control. The clinical practitioners have to apply the proper type of warm needling for the patients with pattern identification and medical setting， due to the low quality of methodology and report of clinical trials， heterogeneity of trials and medical practices. Thus， it is suggested that the evaluation of safety， therapeutic effect and medical economics of warm needling should accord to the principle of evidence-based medicine； and the experiment helps to reveal the common and individual mechanism of the warm needling for different diseases， and discusses the difference and same among all types of warm needling.endprint

[Key words] Warm needling； Inner heat needling； Electronic heat needling； Silver needle； Clinical effect； Safety； Experiment； Clinical trial

以中医艾灸为主的热疗是治疗骨骼肌肉疼痛、脏腑疾病的经典方法，但是由于病灶深入人体而艾灸的热量难以有效地传入组织深处，所以临床上常使用针刺结合艾灸的方式治疗上述疾病。加热针具的疗法最早见于《黄帝内经》中“焠刺取痹”，《伤寒论》首提温针灸，但是均为误用温针后引起的变证，且方法不详，高武《针灸聚英》及杨继洲《针灸大成》等书中皆对“火针”“温针灸”有详细记载。……