近五年针刺治疗紧张型头痛作用机制研究概述  

Overview of research on action mechanism of acupuncture in treatment of tension headache in recent five years

作　　者：刘佳伟 张爽[1] 邹伟[1] LIU Jiawei;ZHANG Shuang;ZOU Wei(Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学第一临床医学院,哈尔滨150040

出　　处：《环球中医药》2024年第1期150-156,共7页Global Traditional Chinese Medicine

基　　金：黑龙江省中医药管理局省级名中医专家传承工作室(20190529)。

摘　　要：紧张型头痛(tension-type headache,TTH)是临床上最常见的原发性头痛,现代医学缺乏行之有效的治疗手段,而中医针刺在TTH的治疗上疗效明显。本文通过归纳总结近年来针刺治疗TTH机制的相关研究发现针刺的治疗作用主要是基于神经系统和体液系统实现的,神经调节可以通过抑制痛觉信号传导、抑制背根反射、离子通道功能异常导致的外周敏化、抑制中枢敏化、抑制胶质细胞活化、调节神经递质和激活中枢镇痛机制等多种途径实现的,体液调节则从抑制趋化因子和炎症因子介导的炎症反应展开。除头痛以外,TTH患者还受到焦虑抑郁和颅周触痛的困扰,这些症状会诱发或者加重患者头痛,针刺可以通过改善患者的肌筋膜状态和精神心理状态而进一步缓解患者的头痛症状。笔者还发现除运用不同穴位组合治疗外,火针、电针和浮针等众多特殊针刺方法也被运用于TTH的治疗中,不同的针刺方法可以通过不同的作用机制发挥其治疗作用。这提示在临床实践中要根据患者的实际情况具体问题具体分析,选择适当的针刺方法才能取得事半功倍的效果。Tension-type headache(TTH)is the most common primary headache in clinic.Modern medicine suffers from lack of effective treatment,while Chinese acupuncture has obvious efficacy in the treatment of TTH.In this paper,we summarized the relevant studies on the mechanism of acupuncture treatment of TTH in recent years and found that the therapeutic effect of acupuncture was mainly achieved based on the nervous system and humoral system.Neuroregulation could be achieved by inhibiting pain signal transduction,inhibiting dorsal root reflex,peripheral sensitization caused by abnormal ion channel function,inhibiting central sensitization,inhibiting glial cell activation,regulating neurotransmitters and activating central analgesic mechanism.Humoral regulation starts from the inhibition of chemokines and inflammatory factor-mediated inflammatory reactions.In addition to headache,TTH patients are also plagued by anxiety,depression and pericranial tenderness,which can induce or aggravate headache in patients.Acupuncture can further alleviate the headache symptoms in patients by improving their myofascial state and mental and psychological state.The author also found that in addition to the combination treatment with different acupoints,many special acupuncture methods such as fire needle,electroacupuncture and floating needle were also used in the treatment of TTH,and different acupuncture methods could exert their therapeutic effects through different action mechanisms.This suggests that in clinical practice,appropriate acupuncture methods should be selected based on the specific analysis of specific problems in patients’actual conditions to obtain better therapeutic effects.

关 键 词：针刺 头痛 紧张型头痛 颅周筋膜紧张 精神心理状态 神经调节 体液调节 肌筋膜调节 

分 类 号：R245[医药卫生—针灸推拿学]