[1]高锋 钱红兵 马智佳 尹华斌 徐天人姜宏 李宇卫 李红卫 宋滇文△.基于“络病理论”重用黄芪治疗破裂型腰椎间盘突出症的临床研究[J].中国中医骨伤科杂志,2021,29(10):32-36.
　GAO Feng QIAN Hongbing MA Zhijia YIN Huabin XU TianrenJIANG Hong LI Yuwei LI Hongwei SONG Dianwen.Clinical Study of Large Dose of Astragalus in the Treatment ofRuptured Lumbar Disc Herniation Based on “Collateral-Disease Theory”[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(10):32-36.
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基于“络病理论”重用黄芪治疗破裂型腰椎间盘突出症的临床研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年10期
页码:
32-36
栏目:
临床研究
出版日期:
2021-10-15

文章信息/Info

Title:
Clinical Study of Large Dose of Astragalus in the Treatment ofRuptured Lumbar Disc Herniation Based on “Collateral-Disease Theory”
文章编号:
1005-0205(2021)10-0032-05
作者:
高锋1 钱红兵2 马智佳1 尹华斌3 徐天人1姜宏1 李宇卫1 李红卫1 宋滇文3△
1南京中医药大学附属苏州市中医医院(江苏 苏州,215009)2昆山市中医医院3上海市第一人民医院
Author(s):
GAO Feng1 QIAN Hongbing2 MA Zhijia1 YIN Huabin3 XU Tianren1JIANG Hong1 LI Yuwei1 LI Hongwei1 SONG Dianwen3△
1Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Suzhou 215009, Jiangsu China; 2Kunshan Hospital of Traditional Chinese Medicine,Kunshan 215300, Jiangsu China; 3Shanghai First People’s Hospital, Shanghai 200080, China.
关键词:
络病理论;  补阳还五汤;  腰椎间盘突出症;  破裂型;  黄芪
Keywords:
collateral disease theory;  Buyang Huanwu decoction;  lumbar disc herniation;  the ruptured type;  astragalus
分类号:
R681.5
文献标志码:
A
摘要:
目的:在“络病理论”指导下,采用补阳还五汤加强方,方中生黄芪用量分为轻用和重用,治疗急性期和亚急性期破裂型腰椎间盘突出症,验证重用黄芪的最佳时机及其对腰椎间盘重吸收的影响。方法:将64例符合纳入标准的破裂型腰椎间盘突出症(以下简称破裂型LDH)患者随机分成A组和B组,每组32例; A组方中先轻用黄芪治疗1个月后改为重用黄芪继续治疗1个月,B组方中先重用黄芪治疗1个月后改为轻用黄芪再治疗1个月。各组患者均行直腿抬高功能锻炼; 治疗前、治疗1个月、治疗2个月及停止药物治疗后3～6个月内随访各时间点的JOA下腰痛评分改善率进行比较。同时,复查MRI,比较治疗前和治疗后3～6个月突出物的重吸收情况。结果:最终共有57例患者完成全部治疗和随访。治疗1个月后,B组JOA评分改善率高于A组,且差异有统计学意义(P<0.05)。治疗2个月及停止药物治疗后3～6个月随访,两组的JOA评分改善率比较差异无统计学意义(P>0.05),但与治疗前比较仍获得明显的改善,差异有统计学意义(P<0.05)。通过对比治疗前后MRI检查结果(其中28例接受了增强腰椎MRI,A组16例,B组12例),A组共有3例发生椎间盘突出物重吸收,1例出现突出物环状增强明显强化; B组共有6例发生突出物重吸收,3例出现突出物环状增强明显强化。A组患者的卧床休养时间平均为2.7周,B组为1.6周。结论:破裂型LDH的病程发展中可兼备“久病入络”和“新病入络”的特征,该病急性期是组方重用黄芪的最佳时机。重用黄芪强化了全方“益气活血通络止痛”的综合功效,有效缓解症状,并促进突出椎间盘组织重吸收。
Abstract:
Objective:To verify the best time for large dose of astragalus and its efficacy on resorption of lumbar disc. Under the guidance of the “collateral-disease theory”, the enhanced Buyang Huanwu decoction was adopted to treat acute and subacute ruptured lumbar disc herniation(LDH), and astragalus in the decoction with light dose or large dose. Methods:64 patients with ruptured LDH were randomly divided into group A and group B, 32 cases in each group. In group A, light dose of astragalus was used for the acute stage one month, and then large dose of astragalus was reused for the subacute stage for one month. In group B, large dose of astragalus was used for the acute stage one month and then light dose was reused for the subacute stage for one month. Patients in each group were received straight leg elevation functional exercise. The improvement rate of JOA low back pain score was compared before treatment, 1 month after treatment, 2 months after treatment and 3 to 6 months after stopping the decoction treatment. At the same time, MRI was reexamined to compare the resorption of LDH before and 3 to 6 months after treatment. Results:A total of 57 patients completed all the treatment and follow-up ultimately. After 1 month of treatment, the improvement rate of JOA score in group B was higher than that in group A, and the difference was statistically significant. After 2 months of treatment and 3 to 6 months of follow-up, there was no significant difference in the improvement rate of JOA score between the two groups, but compared with that before treatment, the improvement rate was still significant. By comparing the results of MRI before and after treatment(28 cases received enhanced lumbar MRI, 16 cases in group A and 12 cases in group B), there were 3 cases of herniated intervertebral disc resorption in group A, and 1 case of ring enhancement of herniation.In group B, 6 cases had resorption and 3 cases had ring enhancement of herniation. The average time of bed rest was 2.7 weeks in group A and 1.6 weeks in group B. Conclusion:The course of ruptured LDH has the characteristics of “chronic disease entering the collaterals” and “new disease entering the collaterals”.The acute stage of the disease is the best time for large dose of astragalus, which can strengthen the comprehensive efficacy of “Enriching Qi and activating blood, dredging collaterals and relieving pain”,effectively relieve symptoms, and promote the resorption of herniated intervertebral disc.

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备注/Memo

备注/Memo:
基金项目:上海市综合医院中西医结合专项课题(ZHYY-ZXYJHZX-2-201719)
苏州市科技发展计划项目(SYSD2019220)
△通信作者 E-mail:84992843@qq.com
更新日期/Last Update: 1900-01-01