摘要
目的:观察中医综合疗法治疗带状疱疹的临床疗效。方法:将120例患者随机分为对照组和治疗组,每组60例。对照组采用《皮肤性病学(第7版)》中推荐的治疗HZ方案:早期、足量抗病毒治疗(阿昔洛韦等)、对症止痛(吲哚美辛等)、营养神经(弥可保)、局部外用抗病毒药物(阿昔洛韦乳膏等)、局部理疗(如红外线局部照射)等常规西医治疗。治疗组则在对照组治疗的基础上加用中医综合治疗,主要包括:(1)龙胆泻肝汤加减口服,药物组成:龙胆草30 g,柴胡30 g,黄芩30 g,栀子15 g,泽泻30 g,车前子15 g,当归15 g,生地黄15 g,紫草15 g。发于头面者,加牛蒡子30 g,金银花30 g;合并血疱者,加水牛角粉15 g,三七粉6 g;疼痛明显者,加醋乳香30 g,醋没药30 g。(2)新癀片外用:取新癀片4片(皮损面积较大时可增至6片)碾成细粉,将细粉均匀涂撒在皮损局部,外用无菌纱块固定,每日换药3次。(3)点刺拔罐治疗:操作方法:根据患者病损的部位选择坐位或卧位,选取疱疹群中正常皮肤中的阿是穴作为施术部位进行点刺,用体积分数为75%酒精局部消毒,消毒完全后用三棱针点刺选定阿是穴,使局部微微出血为度,点刺完毕后立即在点刺点区域施予闪火法拔罐治疗,火罐吸拔后留置3~5 min或每罐吸出瘀血2~3 m L后,去除火罐,清除患者皮肤和火罐中的瘀血,再次进行消毒后用少量云南白药涂撒于施术部位,并用无菌纱块固定,嘱患者施术后注意休息,勿摩擦或污染施术处,每日1次。以上治疗措施7 d为1个疗程,共治疗2个疗程。治疗后比较两组患者VAS评分,止疱、结痂、止痛时间,临床疗效和带状疱疹后遗神经痛发生率(post-herpetic neuralgina,PHN)等指标。结果:两组患者VAS评分比较:治疗14 d后治疗组VAS评分为(3.80±1.05)分,对照组VAS评分为(4.32±1.21)分,两组比较,差异有统计学意义(P<0.05);两组患者止疱、结痂和止痛时间比较:治疗组的止疱时间、结痂时间和止痛时间分别为(4.12±0.81)d、(5.01±0.93)d和(4.76±0.85)d,均明显低于相应对照组的(7.35±0.92)d、(9.32±1.07)d和(8.19±0.91)d,两组比较,差异有统计学意义(P<0.05);两组患者临床疗效比较:治疗组有效率为95.00%,对照组有效率为75.00%,两组比较,差异有统计学意义(P<0.05);两组患者PHN比较:治疗后3个月,对照组PHN为33.3%,治疗组PHN为11.67%,两组比较,差异有统计学意义(P<0.05)。结论:中医综合疗法能提高带状疱疹的临床疗效,缩短患者止疱、结痂和止痛时间,改善患者疼痛症状,减小带状疱疹后遗神经痛发生率,临床疗效显著。
Objective： To observe the clinical effect of combined Chinese medicine treatment on herpes zoster. Methods： 120 patients were randomly divided into two groups,with 60 patients in the control group and 60 patients in the treatment group. As for the control group,the treatment HZ plan recommended in Dermatovenerology（ Eighth Edition） was employed： in early stage,employed the conventional western medicine treatment plan,adopted sufficient antiviral treatment（ acyclovir）,symptomatically relieved the pain（ indometacin）,nourished the nerve（ mecobalamin intramuscular injection）,and locally adopted the antiviral drugs（ Aciclovir Cream） and physiotherapy（ like local infrared irradiation）. For the treatment group,combined Chinese medicine treatment was adopted based on the conventional treatment for the control group,mainly including：（1）Patients took the modified Longdan Xiegan Tang orally,which was composed of Longdancao（ Gentiana Scabra Bunge） 30 g,Chaihu（ Radix Bupleuri） 30 g,Huangqin（ Scutellaria Baicalensis Georgi） 30 g,Zhizi（ Gardenia Jasminoides Ellis） 15 g,Zexie（ Alisma Plantago-Aquatica Linn.） 30 g,Cheqianzi（ Lantaginis Semen） 15 g,Danggui（ Angelica Sinensis） 15 g,Shengdihuang（ Rehmannia Root） 15 g and Zicao（ Radix Arnebiae）15 g. The prescription was modified by the following according to the symptoms： For patients who got herpes zoster on the head or face,added Niubangzi（ Fructus Arctii） 30 g and Jinyinhuang（ Lonicera Japonica Thunb） 30 g; for patients who got associated hemophysallis,added Shuiniujiaofen（ Cornu Bubali Powder） 15 g and Sanqifen（ Panax Notoginseng Powder） 6 g; for patients who got obvious pain,added Curuxiang（ Vinegar Boswellia Carterii） 30 g and Cumoyao（ Vinegar Myrrh） 30 g.（2）Patients took Xinhuang Tablet externally： triturated 4（ or 6 for relatively large skin damage） Xinhuang tablets,sprinkled the powder on the injured skin evenly,covered with bioclean gauze to fix and change fresh dressing 3 times a day.（3）Pricking and cupping： Operation method： made patient sit or lie down according to the position of the injured skin,pricked the ashi point at the ordinary skin in the herpes group,firstly used the 75% alcohol for topical disinfection,and then pricked the ashi point with three-edged needle until there was a trace of bleeding,and conducted flash-fire cupping at the point soon after the pricking; 3-5 min later or after extracting 2-3 mL of extravasated blood in each cup,removed the cups,cleaned the blood on the skin and in the cups,disinfected the skin again,sprinkled a trace of Yunnan Baiyao on the treated position and covered with bioclean gauze to fix. Enjoined the patient to have a good rest and not to touch or contaminate the treated position. The treatment was conducted once a day,7 days being one course and the treatment should consist of 2 courses. After the treatment,the VAS scores,times of blister clearing,scab forming and pain relieving,clinical effects and occurrence rates of post-herpetic neuralgina（ PHN） between the two groups were compared. Results： Comparison of VAS scores between the two groups： the score of the treatment group after 14 days was（ 3. 80 ± 1. 05） and that of the control group was（ 4. 32 ± 1. 21）; the difference was of statistical significance（ P〈0. 05）. Comparison of times of blister clearing,scab forming and pain relieving between the two groups： the times of blister clearing,scab forming and pain relieving of the treatment group were respectively（ 4. 12 ± 0. 81） d,（ 5. 01 ± 0. 93） d and（ 4. 76 ± 0. 85） d,obviously lower than those of the control group,which were respectively（ 7. 35 ± 0. 92） d,（ 9. 32 ± 1. 07） d and（ 8. 19 ± 0. 91） d; the difference was of statistical significance（ P〈0. 05）. Comparison of clinical effects between the two groups： the effective rate of the treatment group was95. 00% and that of the control group was 75. 00%; the difference was of statistical significance（ P〈0. 05）. Comparison of PHN between the two groups： 3 months after the treatment,the PHN of the control group was 33. 3% and that of the treatment group was11. 67%; the difference was of statistical significance（ P〈0. 05）. Conclusion： The combined Chinese medicine treatment will improve the clinical effect of herpes zoster,reduce the times of blister clearing,scab forming and pain relieving for the patients,relieve the pain and reduce the occurrence rate of PHN,having significant curative effect.
出处
《中医学报》
CAS
2017年第12期2537-2540,共4页
Acta Chinese Medicine
基金
河南省科技攻关项目(112101310229)
关键词
带状疱疹
带状疱疹后遗神经痛
龙胆泻肝汤
新癀片
中医综合疗法
中医药疗法
点刺拔罐疗法
中医外治法
中西医结合
herpes zoster
postherpetic neuralgia
Longdanxiegan Decoction
Xinhuang tablets
TCM therapy
TCM therapy
tradi-tional Chinese medicine comprehensive therapy
TCM therapy
combination of traditional Chinese and Western medicine
