头痛针灸病证谱研究现状及问题分析——兼论头痛针灸优势病种  

Research Status and Problem Analysis on Acupuncture and Moxibustion Syndrome Spectrum of Headache&Suitable Kinds of Headache in Using Acupuncture and Moxibustion

作　　者：陈宇航 李晶 蒋亚楠 周文珠 王悦[1] 侯腾[2] 王琳[2] 范刚启[2] CHEN Yuhang;LI Jing;JIANG Yanan;ZHOU Wenzhu;WANG Yue;HOU Teng;WANG Lin;FAN Gangqi(Nanjing University of Chinese Medicine,Nanjing Jiangsu China 210023;Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing Jiangsu China 210001)

机构地区：[1]南京中医药大学,江苏南京210023 [2]南京中医药大学附属南京中医院,江苏南京210001

出　　处：《中医学报》2023年第5期1011-1020,共10页Acta Chinese Medicine

基　　金：南京市医学科技发展重点项目(ZKX18036)。

摘　　要：以第3版国际头痛疾患分类为轴,以循证针灸等级为主,基于头痛一级、亚型诊断,分析针灸疗效,对头痛针灸病谱及证谱现状进行总结,获得结论:(1)既往认为头痛类疾病是具有国际影响的针灸优势病种,但随着第3版国际头痛疾患分类的普及和应用,这一结论的外延及内涵就显得很模糊,限制了临床的深入及精准治疗;(2)初步判断偏头痛、紧张型头痛、颈源性头痛、三叉神经痛、枕神经痛等为头痛针灸优势病种;(3)丛集性头痛和缘于轻度头部外伤、缺血性卒中、非创伤性蛛网膜下腔出血、脑脊液压力减低、高血压、低氧血症和/或高碳酸血症的头痛,为针灸可能有效的头痛优势病种;(4)其他多数头痛及亚型,因研究空白,无法判断针灸疗效;(5)头痛证型与针灸疗效的关系研究薄弱,关于头痛针灸证谱(何证有效,何证效差,何证无效)缺乏系统研究,无确切结论。头痛针灸临床必须回答基于头痛亚型诊断的针灸疗效问题,建议采取头痛分病论治+辨证施针+系统研究之模式,“升级”现有证据,丰富头痛针灸病证谱的内涵,以利针灸精准治疗。This article focuses on the International Classification of Headache Disorders,3rd Edition(ICHD-Ⅲ)and evidence-based level of acupuncture to analyze the efficacy of acupuncture for different types and subtypes of headache disorders and summarize the research status of acupuncture disease and syndrome spectrum of headache as follows:(1)In previous research,headache is considered as highly suitable disease for acupuncture with international influence.However,with the popularization and application of ICHD-Ⅲ,the extension and connotation of this conclusion are very vague,which limits the clinical depth and treatment precision.(2)Migraine,tension-type headache,cervicogenic headache,trigeminal neuralgia,occipital neuralgia,etc.are considered as highly suitable diseases for acupuncture.(3)Cluster headache,headache attributed to mild traumatic injury to the head,ischaemic stroke,non-traumatic subarachnoid haemorrhage,low cerebrospinal fluid pressure,arterial hypertension and hypoxia and/or hypercapnia,etc.are considered as relatively suitable diseases for acupuncture.(4)For most other types and subtypes of headache disorders,the efficacy of acupuncture cannot be judged due to the lack of relevant research.(5)Researches on the relationship between the syndrome of headache disorders and the efficacy of acupuncture are insufficient.There is neither systematic research nor accurate conclusion for acupuncture syndrome spectrum of headache(for which syndrome the efficacy is good,poor or ineffective).This paper argues that headache acupuncture clinical work must solve the problem of acupuncture efficacy for different subtypes of headache disorders.Further,it is recommended to adopt the mode integrating acupuncture based on disease differentiation,acupuncture based on syndrome differentiation and systematic research to"upgrade"the current evidence and enrich the connotation of acupuncture disease and syndrome spectrum of headache,so as to facilitate the precise treatment of acupuncture.

关 键 词：头痛 针灸疗法 国际头痛疾患分类 针灸病谱 针灸证谱 针灸优势病种 

分 类 号：R246.6[医药卫生—针灸推拿学]