标题：加味补阳还五汤联合针灸治疗气虚血瘀型带状疱疹后遗神经痛临床观察

      作者：辛奇遥 1，陈政博 2，董耀荣 3，高希震 1，刘贝 1    1.上海市徐汇区龙华街道社区卫生服务中心，上海 200232；2.上海市长宁区天山中医医院，上海 200051；3.上海市中医医院，上海 200071

      卷次： 2023年34卷18期

      【摘要】 目的 探加味补阳还五汤联合针灸治疗气虚血瘀型带状疱疹后遗神经痛的临床效果。方法 选取2020年7月至2022年7月徐汇区龙华街道社区卫生服务中心收治的72例气虚血瘀型带状疱疹后遗神经痛患者作为研究对象，以双色球法将患者随机分为观察组和对照组各36例。对照组患者予以单纯西药治疗，观察组患者在对照组治疗的基础上联合加味补阳还五汤+揿针+刺络拔罐+针刺治疗，疗程为2个月。治疗后比较两组患者的临床疗效，以及治疗前后的血清γ-干扰素(IFN-γ)、肿瘤坏死因子-α (TNF-α)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)水平和睡眠质量评分[匹兹堡睡眠质量(PSQI)]、焦虑状态评分[广泛性焦虑(GAD-7)]，同时比较两组患者的生活质量评分[生活质量国际通用评分量表(SF-36)]和治疗期间的不良反应发生情况。结果 治疗后，观察组患者的临床总有效率为 97.22%，明显高于对照组的77.78%，差异有统计学意义(P<0.05)；治疗后，两组患者的PSQI、GAD-7评分均降低，且观察组患者的 PSQI为(5.32±1.12)分、GAD-7为(5.32±1.16)分，明显低于对照组的(6.92±1.24)分、(7.65±1.24)分，差异均有统计学意义(P<0.05)；治疗后，两组患者的IFN-γ水平均升高，且观察组为(35.49±3.22) ng/mL，明显高于对照组的(24.62±3.15) ng/mL，而TNF-α、IL-6、IL-10水平均降低，且观察组分别为(30.53±4.26) ng/mL、(6.38±1.49) ng/mL、(5.76±1.08) ng/mL，明显低于对照组的(50.27±4.23) ng/mL、(9.25±1.37) ng/mL、(8.63±1.12) ng/mL，差异均有统计学意义(P<0.05)；治疗后，两组患者的生活质量评分均升高，且观察组明显高于对照组，差异均有统计学意义(P<0.05)；观察组患者治疗期间的不良反应总发生率为 11.11%，略高于对照组的 8.33%，但差异无统计学意义(P>0.05)。结论 针药结合治疗气虚血瘀型带状疱疹后遗神经痛可有效缓解患者疼痛感、改善睡眠质量、炎症反应和神经损伤，提高患者生活质量。
      【关键词】 气虚血瘀型；带状疱疹后遗神经痛；补阳还五汤；针灸；疗效；睡眠质量
      【中图分类号】 R752.1+2 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2682—05

Clinical effect of Jiawei (enhanced) Buyang Huanwu Decoction combined with acupuncture in the treatment ofpostherpetic neuralgia caused by herpes zoster of Qi deficiency and blood stasis type.
XIN Qi-yao 1, CHENZheng-bo 2, DONG Yao-rong 3, GAO Xi-zhen 1, LIU Bei 1. 1. Shanghai Xuhui District Longhua Street Community HealthService Center, Shanghai 200232, CHINA; 2. Shanghai Changning District Tianshan Hospital of Traditional Chinese Medicine,Shanghai 200051, CHINA; 3. Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai 200071, CHINA
【Abstract】 Objective To investigate the clinical effect of acupuncture combined with medicine in the treat-ment of postherpetic neuralgia caused by herpes zoster of Qi deficiency and blood stasis. Methods Seventy-two pa-tients with postherpetic neuralgia caused by herpes zoster of Qi deficiency and blood stasis in Shanghai Xuhui DistrictLonghua Street Community Health Service Center from July 2020 to July 2022 were selected. The patients were random-ly divided into the observation group and the control group, each with 36 cases. Patients in the control group were treat-ed with western medicine alone, and those in the observation group were treated with Jiawei (enhanced) Buyang Huan-wu Decoction+Qin needle (Qinzhen)+pricking and cupping+acupuncture technique on the basis of the control group. Thecourse of treatment lasted 2 months. The efficacy of the two groups was compared, as well as the serum γ-interferon(IFN-γ), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10) levels before and after treatment,sleep quality [Pittsburgh Sleep Quality Index (PSQI) score] score, Generalized Anxiety Disorder 7 (GAD-7) score, qualityof life (SF-36), and adverse reactions during treatment. Results After treatment, the total clinical effective rate of the ob-servation group was 97.22%, significantly higher than 77.78% of the control group (P<0.05). After treatment, PSQI andGAD-7 scores were significantly reduced in the two groups; the scores were (5.32±1.12) points and (5.32±1.16) points inthe observation group, significantly lower than (6.92±1.24) points and (7.65±1.24) points in the control group; the differ-ences were statistically significant (P<0.05). After treatment, IFN-γ levels in the two groups significantly increased, andthe level in the observation group was (35.49±3.22) ng/mL, significantly higher than (24.62±3.15) ng/mL in the controlgroup; TNF-α, IL-6, IL-10 levels in the two groups significantly decreased, and the levels were (30.53±4.26) ng/mL,(6.38±1.49) ng/mL, (5.76±1.08) ng/mL in the observation group, significantly lower than (50.27±4.23) ng/mL, (9.25±1.37) ng/mL, and (8.63±1.12) ) ng/mL in the control group; the differences were statistically significant (P<0.05). Aftertreatment, the scores of all dimensions of quality of life in the two groups were significantly increased, and the scores inthe observation group were significantly higher than those in the control group, with statistically significant differences(P<0.05). There were 3 cases (8.33%) of adverse reactions in the control group and 4 cases (11.11%) in the observationgroup, and the difference was not statistically significant (P>0.05). Conclusion The combination of acupuncture andmedicine in the treatment of postherpetic neuralgia caused by herpes zoster of Qi deficiency and blood stasis type can ef-fectively relieve pain, improve sleeping quality, inflammatory response, nerve damage, and the quality of life of patients.
      【Key words】 Qi deficiency and blood stasis type; Postherpetic neuralgia; Jiawei (enhanced) Buyang Huanwu De-coction; Acupuncture; Curative effect; Sleeping quality