针刺研究

2013, v.38(03) 234-240

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偏头痛发作期针刺镇痛方案优选研究
Optimized Schemes for Acupuncture Treatment of Migraine during Attack

王京京;吴中朝;胡静;焦玥;郑嘉月;王巧妹;
WANG Jing-jing,WU Zhong-chao,HU Jing,JIAO Yue,ZHENG Jia-yue,WANG Qiao-mei(Institute of Acu-moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China)

摘要(Abstract):

目的:对偏头痛发作期针刺镇痛方案进行优选,指导偏头痛针灸临床决策。方法:以76例发作期偏头痛患者为研究对象,采用正交试验设计,治疗方案根据L9(34)正交表对体穴组合(A)、毫针及电针疗法(B)、耳穴疗法(C)、放血疗法(D)4因素及其各自不同的3水平设计实施。试验过程中同时应用了随机(分层随机、中心随机)和盲法(评价者盲)的方法。采用视觉模拟评分法(VAS)测量头痛强度,根据治疗前及治疗后10min、20min、30min、1h、2h、3h、4h、5h、6h、12h、24h共计12个时点的VAS值变化情况,对不同针刺方案的镇痛效果进行分析。结果:针刺后24h内,4因素对缓解头痛强度的影响由大到小依次为:体穴组合(A)>毫针及电针疗法(B)>放血疗法(D)>耳穴疗法(C)。由正交推导出来的不同时点最佳针刺镇痛方案中,少阳经局部加远端取穴进行毫针刺的疗效最稳定,可作为基础镇痛方案;耳穴电针有助于提高即刻镇痛效果;太阳紫脉加阿是穴放血可巩固镇痛效果。结论:偏头痛发作期最佳针刺镇痛方案为少阳经为主局部加远端取穴进行毫针刺,同时配合耳穴电针以及太阳紫脉和阿是穴放血。
Objective To observe the therapeutic effect of manual acupuncture,electroacupuncture(EA),auricular acu-puncture and bloodletting therapies combined with orthogonal design for migraine patients,so as to select a better scheme for relieving headache.Methods A total of 76 migraine patients in the stage of attack were recruited in the present study and randomly(stratified random and central random) allocated to 9 groups by means of orthogonal experimental design [L9(34),4 factors(F) and three levels(L)].i.e.,F1:body-acupoints combination;F1-L1: regional acupoints [Sizhukong(TE 23),Shuaigu(GB 8),Taiyang(EX-HN 5),etc.] near the focus,F1-L2:regional +distal acupoints [Hegu(LI 4),Taichong(LR 3),etc.] far from the focus,and F1-L3:regional +remote acupoints+those selected according to syndrome differentiation [for instance,Ganshu(BL 18),Yanglingquan(GB 34),Qiuxu(GB 40) and Taixi(KI 3) for hyperactivity of Liver-yang,etc.];F2: manual acupuncture or EA of body acupoints;F2-L1:no acupuncture stimulation,F2-L2:manual acupuncture stimulation,and F2-L3:manual+EA stimulation;F3: auricular acupuncture therapy;F3-L1:no acupuncture stimulation,F3-L2:otopoint-manual acupuncture(Shenmen,Jiaogan,etc.),and F3-L3:otopoint-EA;F4: bloodletting;F4-L1: EX-HN 5+Ashi point bloodletting,F4-L2:EX-HN 5 bloodletting,and F4-L3: no bloodletting.The therapeutic effect of acupuncture was evaluated using Visual Analogue Scale(VAS) and analyzed by investigators who did not participate in the treatment course.Results Within 24 hours after the treatment,the four factors influencing headache relief from bigger to smaller are body-acupoints combination>manual acupuncture or EA stimulation>bloodletting>auricular acupuncture.Among the therapeutic schemes evaluated by orthogonal deduction,the analgesic effect was most stable in the manual acupuncture at regional+distal acupoints group which was recommended to be the ba-sic scheme for migraine.The auricular EA could effectively reduce VAS levels from 10 min to 30 min after stimulation,while bloodletting at Taiyang(EX-HN 5)+Ashi points was effective in relieving migraine from 4 h to 24 h after the treatment,suggesting a long lasting post-therapeutic analgesic effect.Conclusion Manual acupuncture stimulation of the local+distal body acupoints combined with otopoint-EA and bloodletting at Taiyang(EX-HN 5) +Ashi points is the best option for relieving migraine during attack.

关键词(KeyWords): 偏头痛;针刺镇痛;体穴;耳穴;手针;电针;放血;正交试验
Migraine;Acupuncture analgesia;Body acupoints;Auricular acupoints;Manual acupuncture;Electroacupuncture;Bloodletting;Orthogonal test

Abstract:

Keywords:

基金项目(Foundation): 中国中医科学院自主选题项目(No.ZZ 2006084)

作者(Authors): 王京京;吴中朝;胡静;焦玥;郑嘉月;王巧妹;
WANG Jing-jing,WU Zhong-chao,HU Jing,JIAO Yue,ZHENG Jia-yue,WANG Qiao-mei(Institute of Acu-moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China)

DOI: 10.13702/j.1000-0607.2013.03.010

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