【摘要】 目的 研究中藥汽療儀辨證用藥?kù)F化透皮外治寒濕阻絡(luò)證、寒熱錯(cuò)雜證、痰瘀阻絡(luò)證為主的風(fēng)濕、類風(fēng)濕、強(qiáng)直性脊柱炎、頸肩腰腿痛的臨床療效及安全性。方法 將376例風(fēng)濕、類風(fēng)濕、強(qiáng)直性脊柱炎、頸肩腰腿痛患者隨機(jī)按3∶1比例設(shè)立對(duì)照；治療276例依據(jù)臨床證型分別選用痹復(fù)康Ⅰ、Ⅱ、Ⅲ號(hào)浴劑；對(duì)照組100例用食醋、羌活、威靈仙，療程均為20天，對(duì)臨床療效、觀察指標(biāo)、實(shí)驗(yàn)室指標(biāo)進(jìn)行綜合評(píng)估。結(jié)果 治療組對(duì)風(fēng)濕、類風(fēng)濕、強(qiáng)直性脊柱炎、頸肩腰腿痛、寒濕阻絡(luò)證、寒熱錯(cuò)雜證、痰瘀阻絡(luò)證總有效率分別為98.89%，94.00%，96.15%，94.05%，98.22%，94.84%，95.52%；對(duì)照組分別為46.67%，20.00%，13.33%，45.00%，41.46%，10.53%，47.62%，顯示中藥汽療儀辨證施藥?kù)F化透皮法對(duì)四病三證的總有效率均超過(guò)90%，對(duì)照組總有效率均未能達(dá)到50%，兩組病證分別相比較，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01或P＜0.001）；治療組在改善臨床癥狀、體征和實(shí)驗(yàn)室指標(biāo)等方面的療效肯定（P＜0.05或P＜0.01），研究過(guò)程中未發(fā)現(xiàn)嚴(yán)重的不良反應(yīng)。結(jié)論 中藥汽療儀辨病辯證用藥?kù)F化透皮法是治療以寒濕阻絡(luò)證、寒熱錯(cuò)雜證、痰瘀阻絡(luò)證為主的風(fēng)濕、類風(fēng)濕、強(qiáng)直性脊柱炎、頸肩腰腿痛等病證有肯定療效的一種新方法且較安全。
【關(guān)鍵詞】 痹證/中藥療法；皮膚吸收；中藥離子透入
Transdermal Chinese medicine vapouring in treatment of rheumatoid diseases
ZHU Ben-wen，LENG Wen-fei.TCM Hospital of Dianjiang，Chongqing 408300，China
［Abstract］ Objective To research the therapeutic effect and safety of nebulizer transdermal drug by vapour therapy in dialectical treating on beriberoid disease，rheumatoid，ankylosing spondylitic，pains on neck-shoulder-waist-leg，which were caused by retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis.Methods Three hundred and seventy-six cases were randomly divided into two groups.Two hundred and seventy-six cases were treated with Bifukang Balneum Ⅰ，Ⅱ，Ⅲ as the study group，while 100 cases were treated with vinegar and Chinese clematis root as the control group，with a treatment course of 20 days for both groups.Therapeutic effect，observation index and laboratory index were compositively evaluated.Results The total effective rates for beriberoid disease，rheumatoid，ankylosing spondylitic dialectical，pains on neck-shoulder-waist-leg，retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis in the study group were 98.89%，94.00%，96.15%，94.05%，98.22%，94.84%，95.52%，while the control group were 46.67%，20.00%，13.33%，45.00%，41.46%，10.53%，47.62%.The total effective rate of the study group was more than 90% while that of the control group was less than 50%.There was great difference in two groups（P＜0.01 or P＜0.001）。The therapeutic effect of the study group on improving clinical symptom，physical sign and laboratory index is confirmed（P＜0.05 or P＜0.01）and without obvious side effect.Conclusion The nebuliser transdermal drug by vapour therapy meter in dialectical treating on beriberoid disease，rheumatoid，ankylosing spondylitic，pains on neck-shoulder-waist-leg，which were caused by retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis has preferable therapeutic effect and it‘s a new，safe method.
［Key words］ arthromyodynia/traditional Chinese medicine therapeutics；cutaneous absorption，traditional Chinese medicine iontophoresis
2004年2月～2005年12月墊江縣中醫(yī)院采用HH-QL型華亨牌中藥汽療儀辨病辨證分別選用自擬的痹復(fù)康Ⅰ、Ⅱ、Ⅲ號(hào)浴劑，霧化透皮法外治痹?。?］，包括風(fēng)寒濕性關(guān)節(jié)痛（風(fēng)關(guān)痛）、類風(fēng)濕性關(guān)節(jié)炎（類關(guān)炎）、強(qiáng)直性脊柱炎（強(qiáng)脊炎）、頸肩腰腿痛等376例，分為治療組276例、對(duì)照組100例進(jìn)行研究，現(xiàn)報(bào)告如下。
1 資料與方法
1.1 一般資料 276例患者均符合中國(guó)中西醫(yī)結(jié)合學(xué)會(huì)風(fēng)濕病專委會(huì)制定的診斷標(biāo)準(zhǔn)，并參照衛(wèi)生部中醫(yī)治療痹病臨床研究指導(dǎo)原則［2］，結(jié)合臨床常見(jiàn)的3個(gè)證型辨證施藥治療，依就診順序隨機(jī)按3∶1比例分為治療組和對(duì)照組。治療組276例，其中男124例，女152例；年齡18～69歲，平均（43.44±4.82）歲；病程平均4年6個(gè)月；病種：風(fēng)濕關(guān)節(jié)痛90例，類風(fēng)濕50例，強(qiáng)脊炎52例，頸肩腰腿痛84例；辨證分型：寒濕阻絡(luò)證112例，寒熱錯(cuò)雜證97例，痰瘀阻絡(luò)型67例。對(duì)照組100例，其中男44例，女56例；年齡18～59歲，平均年齡（42.14±3.34）歲；病程平均3～9年；病種：風(fēng)濕關(guān)節(jié)痛30例，類風(fēng)濕20例，強(qiáng)脊炎30例，頸肩腰腿痛20例；分型：寒濕阻絡(luò)證40例，寒熱錯(cuò)雜證38例，痰瘀阻絡(luò)證22例。治療組276例治療前均經(jīng)過(guò)其他方法治療無(wú)效而接受本療法。
1.2 方法
1.2.1 儀器 HH-QL型中藥汽療儀：生產(chǎn)廠家：江蘇無(wú)錫華亨實(shí)業(yè)集團(tuán)有限公司（蘇藥械準(zhǔn)字2001第2260349號(hào)，專利號(hào)：ZL97327954964.8和98218369.0）。
1.2.2 藥物組成 治療組根據(jù)臨床證型選用自擬的痹復(fù)康Ⅰ號(hào)浴劑（川烏、草烏、威靈仙、獨(dú)活、桂枝、秦艽、黃芪、當(dāng)歸、骨碎補(bǔ)、乳香、食醋，每袋300 g，適用于寒濕阻絡(luò)證）；痹復(fù)康Ⅱ號(hào)浴劑（忍冬藤、桑枝、防己、苦參、豨薟草、川烏、雷公藤、馬錢(qián)子、接骨木、桂枝、白芍、食醋，每袋320 g，適用于寒熱錯(cuò)雜證）；痹復(fù)康Ⅲ號(hào)浴劑（天南星、白芥子、半夏、接骨木、丹參、當(dāng)歸、黃芪、馬錢(qián)子、乳香、續(xù)斷、食醋，每袋330 g，適用于痰瘀阻絡(luò)證）。對(duì)照組方藥為：食醋、羌活、威靈仙，每袋100 g，用于治療三個(gè)證型。
1.2.3 使用方法 治療組按辨證分型選用痹復(fù)康Ⅰ、Ⅱ、Ⅲ號(hào)浴劑，將藥物置放于中藥汽療儀藥物霧化器中并加適量水，關(guān)閉器蓋；對(duì)照組不按證型用藥，全部配用食醋、羌活、威靈仙。按電源啟動(dòng)鍵，使藥物達(dá)到沸點(diǎn)，產(chǎn)生含藥?kù)F化汽體，使治療艙內(nèi)溫度達(dá)到40 ℃，囑患者進(jìn)入霧化艙，頭部暴露于治療艙外，關(guān)閉艙門(mén)，按體位調(diào)節(jié)鍵使患者達(dá)到舒適的體位。溫度一般控制在40 ℃～45 ℃，時(shí)間每次20～30 min，每日1次，連續(xù)治療5次休息2天，20天為1個(gè)療程。對(duì)照組使用方法相同。
1.2.4 統(tǒng)計(jì)學(xué)方法 療效比較用Ridit分析，計(jì)數(shù)資料比較用χ2檢驗(yàn)，計(jì)量資料比較用配對(duì)t檢驗(yàn)。
【關(guān)鍵詞】 痹證/中藥療法；皮膚吸收；中藥離子透入
Transdermal Chinese medicine vapouring in treatment of rheumatoid diseases
ZHU Ben-wen，LENG Wen-fei.TCM Hospital of Dianjiang，Chongqing 408300，China
［Abstract］ Objective To research the therapeutic effect and safety of nebulizer transdermal drug by vapour therapy in dialectical treating on beriberoid disease，rheumatoid，ankylosing spondylitic，pains on neck-shoulder-waist-leg，which were caused by retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis.Methods Three hundred and seventy-six cases were randomly divided into two groups.Two hundred and seventy-six cases were treated with Bifukang Balneum Ⅰ，Ⅱ，Ⅲ as the study group，while 100 cases were treated with vinegar and Chinese clematis root as the control group，with a treatment course of 20 days for both groups.Therapeutic effect，observation index and laboratory index were compositively evaluated.Results The total effective rates for beriberoid disease，rheumatoid，ankylosing spondylitic dialectical，pains on neck-shoulder-waist-leg，retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis in the study group were 98.89%，94.00%，96.15%，94.05%，98.22%，94.84%，95.52%，while the control group were 46.67%，20.00%，13.33%，45.00%，41.46%，10.53%，47.62%.The total effective rate of the study group was more than 90% while that of the control group was less than 50%.There was great difference in two groups（P＜0.01 or P＜0.001）。The therapeutic effect of the study group on improving clinical symptom，physical sign and laboratory index is confirmed（P＜0.05 or P＜0.01）and without obvious side effect.Conclusion The nebuliser transdermal drug by vapour therapy meter in dialectical treating on beriberoid disease，rheumatoid，ankylosing spondylitic，pains on neck-shoulder-waist-leg，which were caused by retention of cold-damp in the collaterals，cold-heat complicated syndrome，obstruction of collaterals cold hygrosis has preferable therapeutic effect and it‘s a new，safe method.
［Key words］ arthromyodynia/traditional Chinese medicine therapeutics；cutaneous absorption，traditional Chinese medicine iontophoresis
2004年2月～2005年12月墊江縣中醫(yī)院采用HH-QL型華亨牌中藥汽療儀辨病辨證分別選用自擬的痹復(fù)康Ⅰ、Ⅱ、Ⅲ號(hào)浴劑，霧化透皮法外治痹?。?］，包括風(fēng)寒濕性關(guān)節(jié)痛（風(fēng)關(guān)痛）、類風(fēng)濕性關(guān)節(jié)炎（類關(guān)炎）、強(qiáng)直性脊柱炎（強(qiáng)脊炎）、頸肩腰腿痛等376例，分為治療組276例、對(duì)照組100例進(jìn)行研究，現(xiàn)報(bào)告如下。
1 資料與方法
1.1 一般資料 276例患者均符合中國(guó)中西醫(yī)結(jié)合學(xué)會(huì)風(fēng)濕病專委會(huì)制定的診斷標(biāo)準(zhǔn)，并參照衛(wèi)生部中醫(yī)治療痹病臨床研究指導(dǎo)原則［2］，結(jié)合臨床常見(jiàn)的3個(gè)證型辨證施藥治療，依就診順序隨機(jī)按3∶1比例分為治療組和對(duì)照組。治療組276例，其中男124例，女152例；年齡18～69歲，平均（43.44±4.82）歲；病程平均4年6個(gè)月；病種：風(fēng)濕關(guān)節(jié)痛90例，類風(fēng)濕50例，強(qiáng)脊炎52例，頸肩腰腿痛84例；辨證分型：寒濕阻絡(luò)證112例，寒熱錯(cuò)雜證97例，痰瘀阻絡(luò)型67例。對(duì)照組100例，其中男44例，女56例；年齡18～59歲，平均年齡（42.14±3.34）歲；病程平均3～9年；病種：風(fēng)濕關(guān)節(jié)痛30例，類風(fēng)濕20例，強(qiáng)脊炎30例，頸肩腰腿痛20例；分型：寒濕阻絡(luò)證40例，寒熱錯(cuò)雜證38例，痰瘀阻絡(luò)證22例。治療組276例治療前均經(jīng)過(guò)其他方法治療無(wú)效而接受本療法。
1.2 方法
1.2.1 儀器 HH-QL型中藥汽療儀：生產(chǎn)廠家：江蘇無(wú)錫華亨實(shí)業(yè)集團(tuán)有限公司（蘇藥械準(zhǔn)字2001第2260349號(hào)，專利號(hào)：ZL97327954964.8和98218369.0）。
1.2.2 藥物組成 治療組根據(jù)臨床證型選用自擬的痹復(fù)康Ⅰ號(hào)浴劑（川烏、草烏、威靈仙、獨(dú)活、桂枝、秦艽、黃芪、當(dāng)歸、骨碎補(bǔ)、乳香、食醋，每袋300 g，適用于寒濕阻絡(luò)證）；痹復(fù)康Ⅱ號(hào)浴劑（忍冬藤、桑枝、防己、苦參、豨薟草、川烏、雷公藤、馬錢(qián)子、接骨木、桂枝、白芍、食醋，每袋320 g，適用于寒熱錯(cuò)雜證）；痹復(fù)康Ⅲ號(hào)浴劑（天南星、白芥子、半夏、接骨木、丹參、當(dāng)歸、黃芪、馬錢(qián)子、乳香、續(xù)斷、食醋，每袋330 g，適用于痰瘀阻絡(luò)證）。對(duì)照組方藥為：食醋、羌活、威靈仙，每袋100 g，用于治療三個(gè)證型。
1.2.3 使用方法 治療組按辨證分型選用痹復(fù)康Ⅰ、Ⅱ、Ⅲ號(hào)浴劑，將藥物置放于中藥汽療儀藥物霧化器中并加適量水，關(guān)閉器蓋；對(duì)照組不按證型用藥，全部配用食醋、羌活、威靈仙。按電源啟動(dòng)鍵，使藥物達(dá)到沸點(diǎn)，產(chǎn)生含藥?kù)F化汽體，使治療艙內(nèi)溫度達(dá)到40 ℃，囑患者進(jìn)入霧化艙，頭部暴露于治療艙外，關(guān)閉艙門(mén)，按體位調(diào)節(jié)鍵使患者達(dá)到舒適的體位。溫度一般控制在40 ℃～45 ℃，時(shí)間每次20～30 min，每日1次，連續(xù)治療5次休息2天，20天為1個(gè)療程。對(duì)照組使用方法相同。
1.2.4 統(tǒng)計(jì)學(xué)方法 療效比較用Ridit分析，計(jì)數(shù)資料比較用χ2檢驗(yàn)，計(jì)量資料比較用配對(duì)t檢驗(yàn)。