痹证经筋论治探析

痹证是肌肉、筋骨、关节发生酸痛、麻木、重着、屈伸不利、甚或关节肿大灼热为主要临床表现的疾病,经筋是十二经脉经气濡养筋肉骨节的体系,经筋理论认为经筋结构或功能异常是引起痹痛或加重痹痛的关键,应用"解结法"解除"横络"卡压是经筋理论治疗痹证的重要治则。     

活血通络汤配合舒血宁治疗糖尿病性周围神经病变40例

[目的]观察活血通络汤配合舒血宁治疗糖尿病性周围神经病变疗效。[方法]将80例随机分为两组,均给予饮食控制、合理运动,口服降糖药物或注射胰岛素。对照组40例弥可保片500μg日3次口服。治疗组40例活血通络汤配合舒血宁静滴。两组均治疗60天进行疗效判定。[结果]治疗组显效18例,有效18例,无效4例。对照组显效10例,有效19例,无效1例。总有效率治疗组(90.00%)优于对照组(72.50%)(P<0.05)。[结论]活血通络汤配合舒血宁治疗糖尿病性周围神经病变疗效满意,患者依从性好,值得推广。     

当归四逆汤治疗痹证浅析

当归四逆汤治疗痹证的特点:一是血虚寒凝,肢体经脉气血闭阻,不通则痛的肢体关节疼痛,局部发凉,四肢厥冷的痛痹证;二是血虚寒凝进而引起血脉瘀阻的脉痹证,四肢厥冷,手足青紫,脉细欲绝或无脉症。     

小剂量雷公藤总苷联合甲氨蝶呤对类风湿关节炎患者临床症状、炎性因子及关节功能的影响

目的探讨小剂量雷公藤总苷联合甲氨蝶呤对类风湿关节炎患者临床症状、炎性因子及关节功能的影响。方法选取2017年10月—2018年2月收治的类风湿关节炎68例,根据治疗方法的不同,分为对照组与观察组,每组各34例。对照组予甲氨蝶呤及常规治疗,观察组采用小剂量雷公藤总苷联合甲氨蝶呤及常规治疗。两组均治疗3个月。比较两组治疗前、治疗后临床症状(晨僵时间、关节疼痛程度、双手平均握力、关节压痛数及关节肿胀数)、炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)、类风湿因子(rheumatoid factors,RF)、红细胞沉降率(erythrocyte sedimentation rate,ESR)]、关节功能变化,记录不良反应发生情况。结果与对照组比较,观察组治疗后晨僵时间、关节压痛数、关节肿胀数减少,关节疼痛程度降低,双手平均握力升高,IL-6、ESR、CRP、RF水平降低,差异有统计学意义(P<0.05或P<0.01);与本组治疗前比较,两组治疗后晨僵时间、关节压痛数、关节肿胀数显著减少,关节疼痛程度明显降低,双手平均握力显著升高,IL-6、ESR、CRP、RF水平降低,且观察组治疗后关节功能障碍分级Ⅰ级比例升高及Ⅱ级比例降低,差异有统计学意义(P<0.05或P<0.01)。两组不良反应总发生率比较差异无统计学意义(χ2=1.308,P=0.253),且治疗过程中均未出现严重不良反应,给予对症处理后症状好转。结论小剂量雷公藤总苷联合甲氨蝶呤能更有效改善类风湿关节炎患者的临床症状、炎性因子水平及关节功能,且不良反应发生率低。     

中国首次基孔肯雅热流行患者的临床特点

目的 分析基孔肯雅热患者的临床特点,为防控该病提供借鉴.方法 分析46例确诊为基孔肯雅热的住院患者的临床症状、体征.血常规,生物化学指标以及治疗方案.组间比较采用t检验.结果 46例基孔肯雅热患者中,发热、皮疹及关节痛分别为46、42和41例,分别占100.0%、91.3%和89.1%;15例患者外周血WBC下降,占32.6%,乳酸脱氢酶及血清磷酸肌酸激酶升高比例分别为45.5%(20/44)和28.9%(13/45),3例ALT升高.利巴韦林治疗与单纯对症治疗效果相比,发热时间延长(t=2.588,P=0.013).结论 基孔肯雅热主要表现为发热、皮疹、关节痛,对症治疗预后好,抗病毒治疗对缩短病程可能无益.

Abstract：

Objective To analyze clinical features of patients with chikungunya fever and provide future reference for prevention and control of the disease. Methods Forty-six confirmed chikungunya fever inpatients were included. Their clinical symptoms, signs, blood count, key biochemical indicators and treatments were analyzed. The comparison between groups were done by ttest. Results The percentages of total cases presenting with fever, rash and joint pain were 100. 0% (46/46), 91. 3% (42/46) and 89. 1% (41/46), respectively. Fifteen (32.6%) cases displayed leucopenia. Increases in lactose dehydrogenase (LDH) and creatine kinase (CK) were observed in 45. 5%(20/44) and 28. 9%(13/45) of the cases, respectively. Three cases displayed an increase of alanine aminotransferase (ALT). Administration of ribavarin extend febrile time compared to symptom-relieving treatments (t=2. 588, P = 0. 013). Conclusions Clinical features of chikungunya fever include fever, rash and joint pain. Good prognosis can be resulted from symptom-relieving treatment. Antiviral treatment may not be beneficial to reducing course of disease.     

Exercise and self-management for people with chronic knee,hip or lower back pain: a cluster randomised controlled trial of clinical and cost-effectiveness. Study protocol

Objectives

Chronic musculoskeletal pain and osteoarthritis can significantly limit the functional independence of individuals, and given that 25% of the population experience these problems, the socioeconomic impact is immense. Exercise and self-management have proven benefits for these conditions, but most trials tailor interventions for specific joints. Epidemiological data demonstrates that many older people with degenerative joint problems experience pain and functional difficulty in other joints, seeking further healthcare input when these present. Managing multiple joint presentations simultaneously could potentially reduce the need for repeat visits to healthcare professionals as advice is frequently the same for differing site presentations. This single-blind cluster randomised controlled trial will determine the clinical and cost-effectiveness of an exercise and self-management intervention delivered to people over-50 with either hip, knee or lower back pain, compared to ‘standard’ GP care. A qualitative analysis will also establish the acceptability of the intervention.

Methods

352 people with chronic degenerative musculoskeletal pain of the hip, knee or lower back will be recruited from primary care. GP surgeries will be randomised to either the intervention or control arms. Participants in the intervention arm will receive a 6-week group exercise and self-management programme facilitated by a physiotherapist in primary care. Participants allocated to the control arm will continue under ‘standard’ GP care. The primary outcome measure is the Dysfunction Index of the Short Musculoskeletal Functional Assessment (SMFA).

Analysis

Individual patient responses will be modelled using a mixed effects linear regression, allowing for the clustering effects. Resource use and related intervention costs will be estimated and broader resource use data will be collected using a version of the Client Service Receipt Inventory adapted for musculoskeletal relevance. In addition, a cost-utility analysis will be undertaken to present an estimate of the incremental cost per QALY. A qualitative analysis investigating the acceptability of the intervention to participants and healthcare professionals will also be undertaken and thematically analysed.

Ethics and dissemination

Ethical approval was received from South West 4 REC, identification number 11/SW/0053. Study findings will be disseminated via conference and journal presentation; via arthritis charitable organisations; and through local GP consortia.     

旷惠桃教授诊疗痹证验案2则

痹,即痹阻不通,是指人体机表、经络因感受风、寒、湿、热等引起的以肢体关节及肌肉酸痛、麻木、重着、屈伸不利,甚或关节肿大灼热等为主症的一类病症。现代医学认为凡是引起骨关节,肌肉疼痛的疾病皆可归属为风湿病。旷惠桃教授有40多年的临床经验,长期专攻风湿类疾病,善于活用经方治疗各种顽痹。自创独步汤、养血通痹汤、上中下痛痹方等经验方,治疗风湿类疾病疗效显著。     

艾叶散熏洗治疗踝关节骨性关节炎46例临床观察

[目的]观察艾叶散熏洗治疗踝关节骨性关节炎疗效。[方法]使用前瞻性设计方法,对46例门诊患者使用艾叶散(艾叶、黄连、木香各50g,当归20g,干姜10g,龙骨20g,羌活、威灵仙各60g,狗脊、续断、透骨草、草乌、乳香各30g),75g/次,30min/次,2次/d,患处熏洗。连续治疗3个月为1疗程。观测临床症状、不良反应。治疗1疗程,判定疗效。[结果]优33例,良8例,差5例,优良率89.10%。[结论]艾叶散熏洗治疗踝关节骨性关节炎,疗效满意,无副作用,值得推广。     

“春·秋分贴敷”-时间医学与痹证防治

中医时间医学是利用中医学理论研究时间因素对人体影响的一门科学,从自然界节律变化角度来阐述人生理、病理节律变化,用以诊断疾病,选择有利时间进行治疗和预防。春分、秋分节气作为昼夜时间相等及春秋平分的节气,是自然界阴阳平衡的最佳时机及阴阳对比由量变到质变之期,天人相应,自然界阴阳转化剧烈之时恰是机体的阴阳转化剧烈之时,风湿病阴阳失调的患者,最易在此时节复发加重及传变。结合痹证病因、病机、病理及春分、秋分的节气特点,选择于春分、秋分两个时节进行"春·秋分贴敷"防治痹证。     

痹证辨治十要素

中医辨证治疗痹症历史悠久,疗效确切,包含未病先防-三因制宜、痹证论治-突出辨证、百法归一-标本同治、病证结合-古法今方、经方活用-尊古不拘、局部整体-综合治疗、中西结合-内外兼治、善用乌头-安全高效、调理情志-身心同治、医患协作-以人为本等十个方面,治未病思想贯穿始终,突出辨证,标本同治,活用经方、古方(善用乌头),强调局部与整体结合,与现代医学结合,同时注重与患者沟通协作,调节情志。