《金匮要略》中痹症辨证论治的特点

《金匮要略》在《内经》的基础上对痹症进行辨病辨证分析和方药论治,在病因病机上提出＂外因重湿邪＂、＂内因重视肝脾肾＂的观点,在治则上强调＂其在皮者,汗而发之＂,＂但当利其小便＂,＂阳气大虚,当先固阳＂,对正确领会仲景六经辨证论治体系和脏腑辨证论治体系有很大的帮助。     

清痹散外敷联合西药治疗湿热痹阻型急性痛风性关节炎随机平行对照研究

[目的]观察清痹散外敷联合西药治疗湿热痹阻型急性痛风性关节炎疗效。[方法]使用随机平行对照方法,将60例住院患者按就诊先后顺序随机分为两组。对照组30例碳酸氢钠片,0.5g/次,3次/d;饮水2000mL/d、低嘌呤饮食、戒酒;疼痛难以忍受时安康信,120mg,1次/d;扶他林乳胶剂1次/d,外涂。治疗组30例清痹散(石膏、黄柏、冰片等)适量,凉开水:75%医用酒精=3:7比例调成糊状外敷于患处,保鲜膜包裹2h,1次/d;西药治疗同对照组。连续治疗14d为1疗程。观测临床症状、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效13例,有效15例,无效2例,总有效率为93.33%。对照组显效11例,有效13例,无效6例,总有效率为80.00%。治疗组疗效优于对照组(P0.05)。[结论]清痹散外敷联合西药治疗湿热痹阻型急性痛风性关节炎疗效满意,无副作用,值得推广。     

银质针治疗慢性膝关节疼痛的研究进展

银质针在慢性膝关节疼痛治疗中得到了广泛的应用.本文对银质针加温、银质针联合玻璃酸钠、银质针结合三氧、银质针联合拔火罐、银质针为主综合疗法及银质针辨证针刺治疗法的研究进展做了综述,并探讨银质针治疗中的少针与多针、进关节腔与不进关节腔、导热与温针灸及局部治疗与整体治疗等相关问题.     

新止骨增生丸联合TDP神灯照射治疗老年膝关节骨关节炎随机平行对照研究

[目的]观察新止骨增生丸联合TDP神灯照射治疗老年膝关节骨关节炎疗效。[方法]使用随机平行对照方法,将108例门诊患者按抽签随机分为两组。对照组54例TDP神灯照射．时间／次．2次／d。治疗组54例新止骨增生丸,6粒／次,3次／d：TDP神灯照射同对照组。连续治疗4周为1疗程。观测临床症状、X线指标、不良反应。连续治疗3疗程．判定疗效。[结果]治疗组临床控制24例,有效18例,无效12例,总有效率77．80％。对照组临床控制19例,有效16例,无效19例,总有效率64．80％。治疗组疗效优于对照组（P〈0．05）。[结论]新止骨增生丸联合TDP神灯照射治疗老年膝关节骨关节炎疗效满意．无副作用．值得推广。     

刺络放血联合温针与TDP神灯照射治疗膝关节骨性关节炎随机平行对照研究

[目的]观察刺络放血联合温针与TDP神灯照射治疗膝关节骨性关节炎疗效。[方法]使用随机平行对照方法,将80例住院患者按随机数字表分为两组。对照组40例①温针（取穴：内膝眼、外膝眼、血海、梁丘、阳陵泉、阴陵泉、足三里）,患者仰卧,穴位皮肤常规消毒．使用直径0．4mm毫针向患侧膝关节进针得气．行平补平泻法．将长约2cm艾条段插于针柄上点燃施灸,每穴灸3壮,留针30min,1次／d：（2）TDP治疗仪照射。灯距30cm左右,感觉舒适温热感为宜,1次／d。治疗组40例刺络放血,患者俯卧位,委中刺络放血,如委中穴部位有怒张静脉,使用火针点刺破血,如局部无浅表静脉经过,火针浅刺0.3寸。不留针,针后拨火罐使之出血,隔2日治疗1次：温针与TDP神灯照射同对照组。连续治疗10d为1疗程。观测临床症状、关节功能、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈28例,显效6例,有效4例．无效2例,总有效率95．00％。对照组痊愈18例．显效7例．有效8例．无效7例．总有效率82．50％。治疗组疗效优于对照组（P〈0．05）。[结论]刺络放血联合温针与TDP神灯照射治疗膝关节骨性关节炎．疗效满意．无副作用．值得推广。     

筋骨痛宁胶囊口服配合中药薰洗治疗早期膝骨关节炎的疗效观察

目的：观察口服筋骨痛宁胶囊配合中药薰洗治疗早期膝骨关节炎的临床疗效。方法：将符合要求的120例患者随机分为实验组（A组）和对照组（B组）,每组60例。A组采用口服筋骨痛宁胶囊配合中药薰洗治疗;B组患者进行玻璃酸钠关节内注射。治疗1个疗程后进行观察随访,于治疗结束后第12个月时观察记录2组患者疗效积分,评价其临床疗效。结果：A组疗效优于B组,差异有统计学意义（χ2=7.295,P=0.007）。结论：筋骨痛宁胶囊口服配合中药薰洗可有效缓解早期膝骨关节炎患者的临床症状,促进肢体功能恢复。     

关节镜术后应用止痛四物汤治疗膝骨关节炎的疗效观察

目的:观察膝关节镜术后应用止痛四物汤治疗膝骨关节炎的临床疗效。方法:将62例符合标准的膝骨关节炎患者随机分为2组,每组31例。在关节镜下行关节清理术后,Ⅰ组患者口服硫酸氨基葡萄糖片,Ⅱ组患者口服中药止痛四物汤。分别于治疗前、治疗后1个月、3个月及6个月采用膝关节功能计分标准对两组患者的关节功能进行评分。结果:两组患者膝关节功能评分经重复测量方差分析,存在分组效应(F=3.553,P=0.001)和时间效应(F=4.015,P=0.001)。不同时点评分比较:治疗前和治疗后1个月两组间比较,差异无统计学意义(P=0.336,P=0.257);治疗后3个月Ⅱ组评分高于Ⅰ组,差异有统计学意义(P=0.021);治疗后6个月Ⅱ组评分高于Ⅰ组,差异有统计学意义(P=0.008)。结论:膝骨关节炎患者关节镜术后应用硫酸氨基葡萄糖片和止痛四物汤均能缓解膝关节疼痛、改善膝关节功能,但止痛四物汤的中期疗效优于硫酸氨基葡萄糖片。     

Menopausal arthralgia: Fact or fiction

Arthralgia is experienced by more then half of the women around the time of menopause. The causes of joint pain in postmenopausal women can be difficult to determine as the period of menopause coincides with rising incidence of chronic rheumatic conditions such as osteoarthritis. Nevertheless, prevalence of arthralgia does appear to increase in women with menopausal transition and is thought to result from reduction in oestrogen levels. Similar syndrome occurs following sudden withdrawal of hormone replacement therapy or treatment with aromatase inhibitors. Various interactions between sex hormones and pain processing pathways, immune cells and chondrocytes have been demonstrated but undoubtedly require further research. Whilst, at present, no specific treatment exists for menopausal arthralgia, a number of conservative measures may be effective. Hormone replacement therapy (HRT) has been shown to have some benefit in alleviating arthralgia associated with menopausal transition, and can be considered in women who report distressing vasomotor symptoms. Simple analgesia, weight loss and physical exercise should be encouraged particularly in women with underlying osteoarthritis. Finally, other factors commonly associated with chronic pain and menopausal transition such as fatigue, poor sleep, sexual dysfunction and depression need to be addressed.     

Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors

Purpose Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results Forty-four of 97 eligible patients (45.4%) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10% of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.