黄国付;张红星;徐祖森;李建武;
HUANG Guo-fu,ZHANG Hong-xing,XU Zu-sen1,LI Jian-wu2(Department of Acu-moxibustion,Wuhan Hospital of Integrated Chinese and Western Medicine,Wuhan 430022,China;1Department of Dermatology,Tongji Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430030;2Department of Acu-moxibustion,Wuhan Hospital of Chinese Medicine,Wuhan 430010)

• 1:武汉市中西医结合医院针灸科
• 2:华中科技大学同济医院皮肤科
• 3:武汉市中医医院针灸科

摘要(Abstract)：

目的:比较不同针灸方法治疗带状疱疹(急性期)的疗效。方法:通过多中心临床随机对照试验,将189例急性期带状疱疹患者随机分为5组:基础针刺组、铺棉灸组、火针组、叩刺拔罐组、西药组。基础针刺组取阿是穴(围刺)、夹脊(电针)、支沟(电针)、后溪(电针),铺棉灸组、火针组、叩刺拔罐组在基础针刺组的基础上分别施以铺棉灸、火针、叩刺拔罐,西药组口服盐酸伐昔洛韦胶囊(300mg/次,2次/d)、维生素B1(10mg/次,3次/d),均每日治疗1次,共治疗10d。比较不同方法治疗前后疱疹评价指标(包括止疱时间、结痂时间、脱痂时间)、疼痛强度的变化和综合疗效。结果:在疱疹止疱时间、结痂时间、脱痂时间和综合疗效方面,5组之间的差异均无统计学意义(P>0.05);5组患者疼痛强度比较,治疗第1-6天差异无统计学意义(均P>0.05),治疗第7-10天4个针灸组均明显低于西药组(P<0.05),而4个针灸组间比较差异仍无统计学意义(P>0.05);各组治疗结束时的疼痛强度与本组治疗前比较,差异均有统计学意义(P<0.05)。结论:4种针灸疗法治疗带状疱疹(急性期)疗效基本相当,在疱疹止疱、结痂、脱痂时间及综合疗效等方面与西药疗法无明显差异,但在治疗第7天以后镇痛效果优于西药。
Objective To compare the therapeutic effects of different types of acupuncture therapy on herpes zoster(acute stage).Methods A total of 189 cases of acute herpes zoster outpatients and inpatients were recruited in the present multicenters(3 hospitals) randomized controlled clinical trials.They were divided into(computer-aided random allocation):basic acupuncture(n=36),cotton moxibustion(n=35),fire needle(n=43),tapping-cupping(n=39) and medication(n=36) groups.Ashi-points(around the locus),Jiaji(EX-B 2),Zhigou(SJ 6) and Houxi(SI 3) were used in this study.For patients of the acupuncture group,the abovementioned acupoints were punctured with filiform needles(encircled needling around the affected loci) and also stimulated with electroacupuncture(EA).For patients of the cotton moxibustion group,thin defated dry cotton pieces put over the Ashi-point were ignited,3 times altogether,followed by EA and encircled needling stimulation which were the same to those in the basic acupuncture group.Patients of the fire needle group were treated by pricking the herpes(3-5 in number) with a hot-red needle,followed by EA and encircled needling treatment.Patients of the tapping-cupping group were treated by tapping Ashi-points repeatedly with a percussopunctator and cupping over the pricked region,followed by EA and encircled needling treatment.Patients of the medication group were treated by oral administration of Valaciclovir Hydrochlordide(300 mg/time,twice a day) and vitamin B1(10 mg/time,t.i.d.) for 10 days.The acupuncture-moxibustion treatment was given once daily for 10 days.The time of blister-occurrence cease,scab formation and decrustation was recorded,and pain degree was evaluated using visual analog scale(VAS).The therapeutic effect was assessed according to the related standards.Results There were no significant differences among the 5 groups in the time of blister-occurrence cease,scab formation and decrustation,and in the therapeutic effect(P>0.05).The VAS scores of the 5 groups were decreased gradually and apparently along with the treatment(P<0.05),suggesting a pain relief after the treatment.In comparison with the medication group,the VAS scores of the basic acupuncture group,cotton moxibustion group,fire needle group and tapping-cupping group were significantly lower from the 7th day on following the treatment(P<0.05).Conclusion Acupuncture plus encircled needling and acupuncture plus encircled needling combined with cotton-moxibustion,or with fire needle stimulation,or with tapping and cupping are effective in the treatment of herpes zoster at the acute stage,being comparable to the medication in the clinical curative effect and improvement of blisters,and better than medication in pain relief.

关键词(KeyWords)： 带状疱疹;针灸;临床疗效;视觉模拟评分;疱疹变化
Herpes zoster;Acupuncture;Clinical therapeutic effect;Visual analog scale;Blister changes

Abstract:

Keywords:

基金项目(Foundation): 国家“十一五”科技支撑计划(No.2006BAI 12B07-2)

作者(Authors): 黄国付;张红星;徐祖森;李建武;
HUANG Guo-fu,ZHANG Hong-xing,XU Zu-sen1,LI Jian-wu2(Department of Acu-moxibustion,Wuhan Hospital of Integrated Chinese and Western Medicine,Wuhan 430022,China;1Department of Dermatology,Tongji Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430030;2Department of Acu-moxibustion,Wuhan Hospital of Chinese Medicine,Wuhan 430010)

DOI: 10.13702/j.1000-0607.2012.05.014

参考文献(References)：

• [1]黄国付,杨金梅.不同针灸方法治疗带状疱疹疗效的循证医学研究[J].中国康复医学杂志,2011,26(6):566-569.Huang G F,Yang J M.Evidence-based medical clinical trialsfor treatment of herpes zoster using different acupuncturemethods[J].Zhongguo Kang Fu Yi Xue Za Zhi(Chin J RehabilMed,Chin),2011,26(6):566-569.
• [2]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:186.State Administration of Traditional Chinese Medicine.Stan-dards for Diagnosis and Evaluation on the Curative Effects ofClinical Problems of Chinese Medicine[M](Chin).Nanjing:Nanjing University Press,1994:186.
• [3]Goldman L,Bennett J C.西氏内科学第10分册[M].西安:世界图书出版公司,2004:363.Goldman L,Bennett J C.Cecil Textbook of Internal Medicine(Volume 10)[M](Chin).Xi’an:World Book Press,2004:363.
• [4]吴志华.皮肤性病学[M].广州:广东科技出版社,2006:78.Wu Z H.Dermalology and Venereology[M](Chin).Guang-zhou:Guangdong Science and Technology Press,2006:78.
• [5]王映辉,黄石玺,刘保延,等.火针赞刺法治疗带状疱疹的临床疗效评价研究[J].中国中医基础医学杂志,2009,15(10):774-777.Wang Y H,Huang S X,Liu B Y,et al.Evaluation on clinicaltherapeutic effects of fire needle shallow puncturing on herpeszoster[J].Zhongguo Zhong Yi Ji Chu Yi Xue Za Zhi(Chin JBasic Med Trad Chin Med,Chin),2009,15(10):774-777.
• [6]Sandy M C.Herpes zoster medical and nursing management[J].Clin J Oncol Nurs,2005,9(4):443-446.
• [7]黄雪梅,薛爱国,李秀霞,等.火针配合针刺治疗急性期带状疱疹40例疗效观察[J].湖南中医药导报,2003,9(8):36-37.Huang X M,Xue A G,Li X X,et al.Efficacy observation onacute herpes zoster treated by combination of hot needling andacupuncture[J].Hunan Zhong Yi Yao Dao Bao(Hunan Guid JTrad Chin Med,Chin),2003,9(8):36-37.
• [8]胥林波,任飞,龙绍疆,等.铺棉灸法治疗带状疱疹疗效观察[J].四川中医,2003,21(8):82-83.Xu L B,Ren F,Long S J,et al.Observation on curativeeffect of cotton moxibustion on herpes zoster[J].SichuanZhong Yi(J Sichuan Trad Chin Med,Chin),2003,21(8):82-83.
• [9]陈红英.火罐治疗带状疱疹疗效观察[J].针灸临床杂志,2000,16(7):9.Chen H Y.Observation on curative effect of cupping therapyfor herpes zoster[J].Zhen Jiu Lin Chuang Za Zhi(J Clin Acu-moxi,Chin),2000,16(7):9.
• [10]张红.夹脊穴穴位注射治疗带状疱疹神经痛[J].辽宁中医杂志,1999,26(3):125.Zhang H.Treatment of postherpetic neuralgia by acupoint-injection of Jiaji(EX-B 2)[J].Liaoning Zhong Yi Za Zhi(Liaoning J Trad Chin Med,Chin),1999,26(3):125.
• [11]郑琼美,庄春薇.梅花针刺血拔罐治疗带状疱疹50例疗效观察[J].河北中医,2004,26(5):368.Zheng Q M,Zhuang C W.Observation on therapeutic effectsof plum-blossom needle tapping and cupping combined withbloodletting for 50patients with herpes zoster[J].HebeiZhong Yi(Hebei J Trad Chin Med,Chin),2004,26(5):368.
• [12]丁晓丹.针刺配合TDP治疗带状疱疹59例临床观察[J].中医药导报,2006,12(3):44-45.Ding X D.Clinical observation on the treatment of 59casesof herpes zoster with acupuncture and TDP therapy[J].Zhong Yi Yao Dao Bao(Guid J Trad Chin Med,Chin),2006,12(3):44-45.
• [13]谭奇纹.针刺华佗夹脊穴治疗带状疱疹后遗神经痛疗效观察[J].中国针灸,2004,24(8):537-538.Tan Q W.Observation on therapeutic effect of acupunctureat HuatuoJiaji points(EX-B 2)on herpes zoster residual neu-ralgia[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2004,24(8):537-538.
• [14]马新平,蒋微微.火针拔罐并用治疗带状疱疹后遗神经痛50例[J].实用中医内科杂志,2005,19(5):482.Ma X P,Jiang W W.Combined treatment of 50cases ofpostherpetic neuralgia with fire-needle and cupping therapies[J].Shi Yong Zhong Yi Nei Ke Za Zhi(J Pract Trad Chin In-ter Med,Chin),2005,19(5):482.
• [15]高汉义,张学玲,董秀云.梅花针治疗带状疱疹后遗神经痛临床观察[J].针灸临床杂志,2005,21(2):38-39.Gao H Y,Zhang X L,Dong X Y.Clinical observation ontreatment of postherpetic neuralgia with plum-blossom needletherapy[J].Zhen Jiu Lin Chuang Za Zhi(J Clin Acu-moxi,Chin),2005,21(2):38-39.
• [16]龚明.滚针、拔罐综合治疗带状疱疹后遗痛[J].中国针灸,2000,20(3):190.Gong M.Combined treatment of postherpetic neuralgia byrotating acupuncture needle and cupping[J].Zhongguo ZhenJiu(Chin Acu-moxi,Chin),2000,20(3):190.