颈源性头痛中医外治机制研究进展  

Research Progress on Mechanism of Cervicogenic Headache Treated by TCM External Therapy

作　　者：张红[1] 赵焕军 宗晨旭 王浩然 张永臣[1,3] 贾红玲[4] ZHANG Hong;ZHAO Huanjun;ZONG Chenxu;WANG Haoran;ZHANG Yongchen;JIA Hongling(School of Acupuncture and Massage,Shandong University of Traditional Chinese Medicine,Jinan Shandong China 250355;The Second Hospital of Shandong University,Ji′nan Shandong China 250033;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji′nan Shandong China 250014;The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji′nan Shandong China 250001)

机构地区：[1]山东中医药大学,山东济南250355 [2]山东大学第二医院,山东济南250033 [3]山东中医药大学附属医院,山东济南250014 [4]山东中医药大学第二附属医院,山东济南250001

出　　处：《中医学报》2022年第7期1425-1431,共7页Acta Chinese Medicine

基　　金：山东省自然科学基金项目(ZR2019MH079)。

摘　　要：中医外治法治疗颈源性头痛(cervicogenic headache syndrome,CEH)机制主要为:减轻对颅外痛觉感受组织结构的机械压迫刺激;抑制疼痛信号的产生及在中枢的会聚和传导;调控炎性因子以减轻炎性反应;调节脑血管、血液动力学,改善脑血管功能紊乱;调节血液流变学,改善血浆黏度增高产生的不良反应;调节血管内皮因子,维持血管正常的舒缩功能,促进内皮修复;维持神经-内分泌系统的稳定,增强镇痛效应;提高脑功能区对疼痛的调控能力。中医外治法通过多个靶点作用于CEH,临床疗效显著。但目前研究仍存在一些不足,如缺乏规范化的操作标准;未严格遵循随机、对照、双盲、重复的临床试验原则;缺乏统一的疗效评判标准;未对临床试验进行远期跟踪回访;未深挖相关指标背后的作用机理;未重视经穴特异性对实验研究、临床研究的影响;缺乏对调控机制的整体宏观把握;缺乏中枢神经系统、信号通路、基因蛋白组学等方面的机制研究。因此,今后临床研究的重点为规范中医外治法的临床操作,开展大规模、高质量的临床随机对照试验,统一临床疗效评判标准;实验研究方面应加强中枢神经系统、信号通路等方面的实验研究,对不同的机制作用靶点进行有效串联。此外,亦应重视病理生理学、病因学研究,以提高患者生活质量与远期临床疗效,为临床治疗提供强力支撑。The main mechanisms of external therapy of traditional Chinese medicine in the treatment of cervicogenic headache syndrome(CEH)are as follows:reducing the mechanical pressure stimulation on the extracranial nociceptive tissue structure;inhibiting the generation of pain signals and their convergence and conduction in the center;regulating inflammation It regulates cerebrovascular and hemodynamics,improves cerebrovascular dysfunction,regulates blood rheology,improves adverse reactions caused by increased plasma viscosity,regulates vascular endothelial factor,maintains normal vasomotor function,Promote endothelial repair;maintain the stability of the neuro-endocrine system,enhance the analgesic effect;improve the ability of brain functional areas to regulate pain.External therapy of traditional Chinese medicine acts on CEH through multiple targets,and the clinical curative effect is remarkable.However,there are still some deficiencies in the current research,such as lack of standardized operating standards;failure to strictly follow the principles of randomized,controlled,double-blind,and repeated clinical trials;lack of uniform evaluation criteria for efficacy;no long-term follow-up of clinical trials;Exploration of the mechanism behind the relevant indicators;not paying attention to the influence of acupoint specificity on experimental research and clinical research;lack of overall macroscopic grasp of the regulatory mechanism;lack of mechanism research on the central nervous system,signaling pathways,genomics and proteomics,etc.Therefore,in the future,the focus of clinical research is to standardize the clinical operation of external treatment of traditional Chinese medicine,carry out large-scale,high-quality clinical randomized controlled trials,and unify the evaluation criteria for clinical efficacy;in terms of experimental research,experiments in the central nervous system and signaling pathways should be strengthened Research to effectively connect targets of different mechanisms.In addition,attention should

关 键 词：颈源性头痛 中医外治法 机制研究 针刺 推拿 针刀 

分 类 号：R274.9[医药卫生—中西医结合]