基于“寒者热之”理论运用内热针联合温通刮痧治疗寒湿痹阻型膝骨关节炎的临床观察

Clinical Observation of Treating Knee Osteoarthritis of Cold-Damp Obstruction Type with Internal Heat Needle Combined with Warm and Unblocking Scraping Based on the Theory of “Treating Cold with Heat”

摘要: 目的：探究基于“寒者热之”理论指导下，运用内热针联合温通刮痧两种中医外治治疗寒湿痹阻型膝骨关节炎(KOA)的临床疗效。方法：选取2021年1月~2024年12月期间广西壮族自治区南溪山医院中医科门诊及病房的100例KOA患者，按照随机信封法分为观察组和对照组各50例，对照组予普通针刺合常规刮痧治疗，观察组在对照组的基础上予以具有温热效应的内热针法合温通刮痧治疗，4周后评估平均临床疗效(包括关节疼痛VAS评分、关节症状指标、膝关节WOMAC评分和中医症候量化评分、临床疗效和安全性评价)。结果：干预治疗后，观察组患者的VAS评分、关节症状指标、WOMAC评分、中医症候量化评分和临床疗效均优于对照组(P < 0.05)；两组均未发生不良事件，安全性好。结论：在“寒者热之”理论的指导下，运用具有温热作用的内热针联合温通刮痧治疗KOA可改善KOA患者的膝关节功能，有效减轻临床症状，在临床推广应用价值较高。

Abstract: Objective: To explore the clinical efficacy of two traditional Chinese medicine external treatments, Nei Ren Zhen (internal heat needle) combined with Wentong gua sha (warm and unblocking scraping), guided by the theory of “treating cold with heat”, in the treatment of knee osteoarthritis (KOA) of the type characterized by obstruction due to cold-dampness. Methods: A total of 100 KOA patients from the Department of Traditional Chinese Medicine outpatient clinic and wards of Nanxishan Hospital of Guangxi Zhuang Autonomous Region, between January 2021 and December 2024, were selected. They were randomly divided into an observation group and a control group, each consisting of 50 cases. The control group received conventional acupuncture combined with routine gua sha treatment. The observation group received, on top of the control group’s treatment, Nei Ren Zhen (with warming effect) combined with Wentong gua sha. After 4 weeks of intervention, the average clinical efficacy was evaluated, including joint pain VAS scores, joint symptom indicators, WOMAC scores for the knee joint, TCM syndrome quantification scores, clinical efficacy, and safety evaluation. Results: After the intervention, the VAS scores, joint symptom indicators, WOMAC scores, TCM syndrome quantification scores, and clinical efficacy of patients in the observation group were superior to those in the control group (P < 0.05). No adverse events occurred in either group, indicating good safety. Conclusion: Under the guidance of the “treating cold with heat” theory, using Nei Ren Zhen with warming effects combined with Wentong gua sha to treat KOA can improve knee joint function in KOA patients, effectively alleviate clinical symptoms, and thus has high value for clinical promotion and application.