Objective: To compare the clinical efficacy and possible mechanism of warming acupuncture combined with "three steps and seven methods" of tuina and simple "three steps and seven methods" of tuina in treatment of chronic nonspecific low back pain (NLBP) of yang deficiency and cold-dampness blockage.
Methods: A total of 138 patients were randomized into an observation group (69 cases, 5 cases dropped off) and a control group (69 cases, 7 cases dropped off). In the control group, "three steps and seven methods" of tuina was applied. On the basis of the treatment in the control group, warming acupuncture was applied at Shenshu (BL 23), Yaoyangguan (GV 3), Mingmen (GV 4), Weizhong (BL 40) and ashi points. The treatment was given once a day, 6 times a week for 3 weeks in both groups. Before and after treatment, the short form of McGill pain questionnaire (SF-MPQ) score, Oswestry disability index (ODI) score, finger-to-floor distance (FFD), Schober test distance, fear-avoidance beliefs questionnaire (FABQ) score and yang deficiency and cold-dampness blockage score were observed, the serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and thromboxane B2 (TXB2) were detected in both groups. The recurrence rate was evaluated in follow-up of 6 months after treatment.
Results: After treatment, the scores of PRI, PPI, VAS, ODI, FABQ and FFD, yang deficiency and cold-dampness blockage scores were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01); the Schober test distances were increased compared before treatment in both groups (P<0.01), and that in the observation group was larger than the control group (P<0.01). After treatment, the serum levels of TNF-α, IL-1β, IL-6 and TXB2 were decreased compared before treatment in both groups (P<0.01), and those in the observation group were lower than the control group (P<0.01). In follow-up, the recurrence rate was 12.8% (6/47) in the observation group, which was lower than 34.3% (12/35) in the control group (P<0.05).
Conclusion: Warming acupuncture combined with "three steps and seven methods" of tuina can effectively alleviate pain in patients with chronic NLBP of yang deficiency and cold-dampness blockage, improve activity and dysfunction of waist, the clinical efficacy is superior to simple "three steps and seven methods" of tuina, its mechanism may be relate to the inhibition of inflammatory reaction.
目的：比较温针灸联合三步七法推拿与单纯三步七法推拿治疗阳虚寒湿痹阻型慢性非特异性腰痛（NLBP）的临床疗效及其可能机制。方法：将138例患者随机分为观察组（69例，脱落5例）和对照组（69例，脱落7例）。对照组采用三步七法推拿治疗；观察组在对照组基础上联合温针灸治疗，穴取肾俞、腰阳关、命门、委中和阿是穴，两组均每日治疗1次，每周6次，共治疗3周。观察两组治疗前后简化McGill疼痛量表（SF-MPQ）评分、Oswestry功能障碍指数（ODI）评分、指地距离（FFD）、Schober试验距离、恐惧-逃避信念问卷（FABQ）评分和阳虚寒湿痹阻积分，检测治疗前后血清肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-6和血栓素B2（TXB2）水平，并于治疗结束后6个月随访评价两组复发率。结果：治疗后，两组患者PRI、PPI、VAS、ODI、FABQ评分及FFD、阳虚寒湿痹阻积分均较治疗前降低（P<0.01），且观察组低于对照组（P<0.01）；两组Schober试验距离均较治疗前增大（P<0.01），且观察组大于对照组（P<0.01）。治疗后，两组患者血清TNF-α、IL-1β、IL-6和TXB2水平均较治疗前降低（P<0.01），且观察组低于对照组（P<0.01）。随访时，观察组复发率为12.8%（6/47），低于对照组的34.3%（12/35，P<0.05）。结论：温针灸联合三步七法推拿可有效减轻阳虚寒湿痹阻型慢性NLBP疼痛症状，改善患者腰部活动和功能障碍，疗效优于单纯三步七法推拿，其机制可能与抑制炎性反应有关。.
Keywords: chronic nonspecific low back pain; three steps and seven methods; tuina; warming acupuncture; yang deficiency and cold-dampness blockage.