刘亚林 夏平 冯晶 浦飞飞 杨林

【摘 要】目的：觀察内热针疗法治疗风寒痹阻型腰椎间盘突出症的有效性及安全性，为“内热法理论”提供临床依据。方法：采用随机对照的设计方案，将80例风寒痹阻型腰椎间盘突出症患者随机分为治疗组和对照组，每组40例。治疗组基于内热法采用内热针治疗，对照组采用温针灸治疗。观察2组临床疗效，以及治疗前后中医症状、体征积分，日本骨科协会（JOA）评分，视觉模拟评分法（VAS）评分;同时观察治疗组治疗过程中各时间点生命体征变化情况。结果：治疗组完成39例，其中治愈33例，好转

5例，无效1例，总有效率为97.43%;对照组完成37例，其中治愈24例，好转8例，无效5例，总有效率为86.49%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组腰痛症状、体征积分，JOA评分和VAS评分较治疗前均有改善（P < 0.05），且治疗组优于对照组（P < 0.05）。治疗过程中血氧饱和度监测值比较，差异无统计学意义（P ﹥ 0.05）;麻醉时患者脉率、呼吸频率和血压较前短暂性升高，治疗结束后各指标恢复正常范围;针刺后与治疗前、针刺中比较，差异有统计学意义（P < 0.05）。结论：基于“内热法理论”运用内热针疗法治疗风寒痹阻型腰椎间盘突出症近期疗效肯定，能明显缓解疼痛症状，具有更加便捷、有效的特点，临床应用安全，值得推广。

【关键词】 腰椎间盘突出症;风寒痹阻型;内热法;内热针;临床疗效

【ABSTRACT】Objective：To observe the efficacy and safety of internal heat acupuncture in the treatment of lumbar disc herniation（LDH）of wind-cold obstruction type，and to provide clinical basis for the theory of internal heat therapy.Methods：Eighty cases of LDH of wind-cold obstruction type were randomly divided into a treatment group and a control group，40 cases in each group.The treatment group was treated with internal heat acupuncture based on internal heat method，and the control group was treated with warm acupuncture，observing the clinical effect of the two groups，as well as the scores of symptoms and signs of traditional Chinese medicine before and after treatment，JOA score，and VAS score;and at the same time，observing the changes of vital signs in the treatment group at all time points.Results：Thirty-nine cases were completed in the treatment group，among which 33 cases were recovered，5 cases were improved，1 case was ineffective，and the total effective rate was 97.43%;while in the control group，37 cases were completed ，among which 24 cases were recovered，8 cases were improved，5 cases were ineffective，and the total effective rate was 86.49%.The differencebetween the two groups was statistically significant（P < 0.05）.After treatment，the scores of symptoms and signs，JOA scores and VAS of the two groups were improved（P < 0.05），and the treatment group was better than the control group（P < 0.05）.There was no significant difference in the monitoring value of blood oxygen saturation during the treatment（P ﹥ 0.05）.During anesthesia，the pulse rate，respiratory frequency and blood pressure of the patients were temporarily higher than before and returned to the normal range after treatment.The difference was statistically significant after the acupuncture compared with before and during the treatment（P < 0.05）.Conclusion：Based on the theory of internal heat therapy，the internal heat acupuncture in the treatment of LDH of wind-cold obstruction type has a positive short-term effect，can significantly alleviate the pain symptoms，more convenient，effective and safe，worthy of promotion.

【Keywords】 lumbar Disc herniation;wind-cold obstruction type;internal heat therapy;internal heat acupuncture;clinical efficacy

腰椎间盘突出症（lumbar disc herniation，LDH）是骨伤科临床上高发疾病之一，中医称腰痹病，属“痹证”范畴，临床上常分为气滞血瘀、风寒痹阻和肝肾亏虚3种证型。腰、腿疼痛是LDH常见症状，常引起患者劳动力丧失，严重影响患者的健康和生活质量，其中风寒痹阻型以腰腿冷痛重着，转侧不利，适量活动后稍减，遇寒痛增，得热痛减，膝腿沉重，形寒肢冷等为主要特点。因寒邪凝滞收引，故病程较长、病情易反复，临床治疗常颇为困难。内热法最早载于《黄帝内经》，《灵枢·寿天刚柔》中记载：“热者寒之，劳者温之。”“刺营者出血，刺卫者出气，刺寒痹者内热;刺布衣者，以火焯之。刺大人者，以药熨之。”内热法由此而来[1-2]。刺寒痹者以内热是一种针对病因的治疗方法，内热针疗法是用以治疗软组织源性疼痛的一种密集型针刺治疗方法。……