電針治療無先兆性偏頭痛的臨床研究

The Clinical Curative Effect Appraisal of MiuCifa to Periarthritis Humeroscapularis

林坤成(Kun-Chen Lin) ； 廖炎智(Yan-Chih Liao) ； 李政育(Chen-Yu Lee)

《中國鍼灸學雜誌》 2卷1期 (2014/12) Pp. 49-64

https://doi.org/10.6528/CAMS.2014.0004

摘要

研究背景無先兆性偏頭痛(migraine without aura)是指無眼部先兆，如閃輝、黑朦、霧視、偏盲等明顯先兆症狀的一類偏頭痛，它是偏頭痛中最為常見的類型，約占偏頭痛病人的80%，常表現為在頭痛發作前數小時或數日，可有一些非特異性的前驅症狀。偏頭痛是多發病，常見病之一，特別是，隨著生活節奏的日益緊張，生存壓力的日益加大，偏頭痛的發病率又有所增高，並且累及人群廣泛，影響因素複雜，反復發作，各種療法難以徹底治癒，給患者及其家庭帶來極大的痛苦和沉重的醫藥負擔，同時引發不同程度的心理、社會問題。研究目的雖然針對無先兆性偏頭痛已有多種治療方法，但目前各類治療方法皆有一定的局限性，故需尋找一種效果明顯、副作用低、簡單易行的治療方法。結合無先兆性偏頭痛的發病原因，以及以往在臨床上對本病治療的經驗，採用電針為主這一治療方法，以改進和豐富無先兆性偏頭痛的治療。研究方法選取2008年1月至2009年12月在德昌中醫診所就診病人共147例。依臨床表現，將本病分為三類：頭痛發作時伴隨畏光、畏聲；頭痛發作時伴有噁心、嘔吐；頭痛發作時伴有畏光、畏聲且噁心、嘔吐。每類無先兆性偏頭痛均隨機分成電針治療組及單純針刺對照組兩組，對療效進行綜合評價，同時根據臨床表現和中醫學理論，將每類無先兆性偏頭痛又分成常見的水不涵木、痰熱內阻和肝風上擾三種證型，對電針治療本病不同中醫證型的療效進行分析。研究結果電針組總有效率為72.15%，優於單純針刺組52.94%。採用電針及單純針刺兩組治療後，各症狀比較臨床療效無差異(P＞0.05)。各組治療後的頭痛指數均明顯低於治療前；治療後兩組間頭痛指數比較，差異無顯著性意義(P＞0.05)；兩組差值比較，其差異有統計學意義(P＜0.05)，說明治療組在緩解頭痛指數上優於對照組。選擇絲竹空透率谷、頷厭透懸顱為主穴，水不涵木型配太溪、太沖；痰熱內阻型配豐隆、陰陵泉；肝風上擾型配陽陵泉、太沖；以電針為主進行治療。此法具有平肝潛陽、滋水涵木、祛風化痰通絡的作用，從而使之熄風通絡，補腎填髓，促進腦部血液迴圈，達到止頭痛的目的。結論本研究運用主穴為主，並辨證配穴的電針和針刺的方法治療無先兆性偏頭痛患者，觀察其臨床療效，並探討其療效機制。運用絲竹空透率谷、頷厭透懸顱為主穴，並根據不同證型辨證配穴的以電針為主的療法具有療效確切、實用、無副作用等優勢，值得推廣應用和進一步的療效機理研究。

關鍵字

無先兆性偏頭痛 ； 電針 ； 水不涵木 ； 痰熱內阻 ； 肝風上擾

並列摘要

Background: Migraine is a frequently-occurring disease, one of the common diseases, especially in recent years, with the increasingly intense pace of life, survival growing pressure, migraine headache, there are the higher the incidence of, and involving a broad population, affecting factors are very complex, and the a recurring problem, difficult to completely cure a variety of therapies to give patients and their families great pain and heavy medical burden, while trigger different levels of psychological, social and economic issues. Migraine without aura in migraine headache is the most common type, accounting for 80% of migraine patients. There are many ways the current treatment of migraine, such as the western medicine, Chinese medicine and acupuncture, but because of its pathogenesis is still at the exploratory stage, so that treatment is largely dependent on the pilot. Explore the treatment of the disease pathogenesis and therapeutic mechanism of effective treatment studies are very necessary. Objective: The use of clinical epidemiology methods, choice met the inclusion criteria for migraine without aura patients was studied, using coin on the basis of acupuncture with electro-acupuncture, systematic observation before and after treatment of symptoms, onset of cycle and time, and to explore the approach in the treatment of migraine without aura in operating specifications, scope of application, contraindications, comprehensive analysis and evaluation of the near future, long-term clinical effect. Methods: Select from January 2008 to December 2009 TCM clinics in Taiwan, Dersha Chinese medicine clinics and meet the inclusion criteria of cases of migraine without aura patients with 147 cases. Migraine without aura the clinical manifestations of the disease will be divided into three categories: attacks of headache accompanied by sensitivity to light, fear sound; headache attack accompanied by nausea, vomiting; headache attack accompanied by sensitivity to light, sound fear and nausea, and vomiting . For each type of migraine without aura were randomly divided into electro-acupuncture group and control group, two sets of simple acupuncture. As well as a comprehensive evaluation of efficacy, while based on clinical manifestations and Chinese medicine theory, each type of migraine without aura is divided into a common water is not Han wood, phlegm-heat resistance and liver wind disturbance on the three kinds of syndromes, and electrical Acupuncture treatment of the disease the efficacy of different TCM syndromes were analyzed. Results: The results show that electro-acupuncture group, the total effective rate was 72.15%, better than simple acupuncture group, the total effective rate was 52.94%. Use of electro-acupuncture and simple acupuncture treatment groups after migraine without aura, the symptoms of clinical efficacy compared no significant difference (P＞0.05). Electro-acupuncture group and simple acupuncture group were the late obvious side effects. This study was based on the clinical data of four clinics, three categories of non premonitory migraine patients are divided into three syndromes: shuibuhanmu, tanreneizu, ganfengneirao. To use electroacupuncture observation on TCM different types of effects, the main point is the wind and string music penetration rate of valley temple, Han thoroughly disgust mainly hanging skull hole; water not culvert last point: too Rive and too rushed; type of resistance on the penalty points for: Hong Leong, Yin mausoleum Springs; stirring of invading-point: too rushed, yanglingquan. Treatment results through statistical analysis, found on each type of migraine without aura of two syndromes of differences are not significant significance (P＞0.05). Conclusion: This study shows that the use of the wind and string music penetration rate of valley temple, Han thoroughly disgust mainly hanging skull hole, and according to different syndromes Syndrome with acupuncture point in order to electroacupuncture-based therapies have the effect of accurate, practical, no side effects, etc. advantage, it is worth pushing factory application and further study of the efficacy of the mechanism.

並列關鍵字

Migraine without aura ； Electro-acupuncture ； Water is not Han wood ； Phlegm-heat resistance ； Liver-wind on the disturbance