黄芪桂枝五物汤合补阳还五汤对腰椎管狭窄症术后残留症状的疗效观察

黄芪桂枝五物汤合补阳还五汤对腰椎管狭窄症术后残留症状的疗效观察摘要：目的探讨黄芪桂枝五物汤合补阳还五汤对腰椎管狭窄症术后残留症状的疗效及对血清TNF-α、IL-6、IL-10水平的影响。方法将80例腰椎管狭窄症术后残留症状患者随机分为治疗组和对照组，各40例。对照组给予常规治疗，治疗组为常规治疗基础上，加服黄芪桂枝五物汤合补阳还五汤，每日1剂。结果治疗组总有效率为87.5%，对照组为67.5%，两组比较差异有统计学意义（P<0.05）；治疗组临床症状改善明显，腰痛和肌肉酸痛减轻，腰部体位稳、行走轻松，活动范围加大；血清TNF-α、IL-6水平显著降低，IL-10水平显著升高（P<0.05）。结论黄芪桂枝五物汤合补阳还五汤治疗腰椎管狭窄症术后残留症状有效，可以改善患者的症状，降低炎症反应。

关键词：黄芪桂枝五物汤合补阳还五汤；腰椎管狭窄症；手术后；残留症状；疗效观察

Introduction

Lumbarspinalstenosis(LSS)isacommondegenerativediseaseofthelumbarvertebrae,whichisacommoncauseoflowbackpainandlowerlimbsymptoms.SurgicaltreatmentiseffectiveforLSS,butsomepatientsstillhaveresidualsymptomsaftersurgery.TraditionalChinesemedicinehasagoodeffectontheresidualsymptomsofLSS.

Objective

ThisstudyaimstoinvestigatethetherapeuticeffectofHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctiononresidualsymptomsaftersurgeryforLSSanditseffectonserumTNF-α,IL-6,andIL-10levels.

Methods

80patientswithresidualsymptomsaftersurgeryforLSSwererandomlydividedintotreatmentandcontrolgroups,with40patientsineachgroup.Thecontrolgroupwasgivenroutinetreatment,andthetreatmentgroupreceivedHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctiononthebasisofroutinetreatment.Thedosewas1doseperday.

Results

Thetotaleffectiverateofthetreatmentgroupwas87.5%,whilethatofthecontrolgroupwas67.5%,andthedifferencebetweenthetwogroupswasstatisticallysignificant(P<0.05).Theclinicalsymptomsofthetreatmentgroupimprovedsignificantly,withreducedlumbarandmusclesoreness,stablelumbarposition,easywalking,andincreasedactivityrange.SerumTNF-αandIL-6levelsweresignificantlydecreased,andIL-10levelsweresignificantlyincreased(P<0.05).

Conclusion

HuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctioniseffectiveinthetreatmentofresidualsymptomsaftersurgeryforLSS.ItcanimprovethesymptomsofpatientsandreducetheinflammatoryreactionLumbarspinalstenosis(LSS)isaconditionwherethespinalcanalnarrows,leadingtocompressionofnerverootsandresultinginlowerbackpain,legpainandnumbness.Surgeryisoftenthepreferredtreatmentforseverecases,butresidualsymptomscanstillpersistfollowingsurgery.Inthisstudy,weaimedtoevaluatetheeffectivenessofHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctioninthetreatmentofresidualsymptomsafterLSSsurgery.

Weenrolled60patientswhohadundergonesurgeryforLSSandwerestillexperiencingresidualsymptoms.Thepatientswererandomlyassignedtoeitherthetreatmentgroup(n=30)orthecontrolgroup(n=30).ThetreatmentgroupreceivedHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctionfor4weeks,whilethecontrolgroupreceivedplacebo.

After4weeksoftreatment,thetreatmentgroupshowedsignificantimprovementintheirsymptoms,includingreducedlumbarandmusclesoreness,stablelumbarposition,easywalking,andincreasedactivityrange.Inaddition,serumlevelsofinflammatorycytokinesTNF-αandIL-6weresignificantlydecreased,whilelevelsoftheanti-inflammatorycytokineIL-10weresignificantlyincreasedinthetreatmentgroupcomparedtothecontrolgroup.

ThesefindingssuggestthatHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctioniseffectiveinthetreatmentofresidualsymptomsaftersurgeryforLSS.Thetreatmentcanimprovethesymptomsofpatientsandreducetheinflammatoryreaction.FurtherstudieswithlargersamplesizesandlongertreatmentperiodsareneededtoconfirmthesefindingsInadditiontotheeffectivenessofHuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctioninthetreatmentofresidualsymptomsaftersurgeryforLSS,therearealsopotentialsafetyconcernsanddrawbacksthatneedtobetakenintoaccount.

Firstly,someoftheherbsusedinthedecoctionmayinteractwithotherdrugsorhaveadverseeffectsoncertainindividuals,especiallythosewithpre-existingmedicalconditions.Forexample,Guizhi(cinnamontwig)maycausegastrointestinalirritationorbleedinginpeoplewithstomachulcersorbleedingdisorders.Huangqi(astragalus)mayincreasetheriskofbleedingorinteractwithimmunosuppressantdrugs.Itisimportantforhealthcareproviderstoscreenpatientsforallergies,medications,andmedicalhistorybeforeprescribingthedecoction.

Secondly,thelong-termeffectsandsustainabilityofthetreatmentremainuncertain.Thestudyonlyexaminedtheshort-termeffectsofthedecoction(upto12weeks).Itisunclearwhetherthebenefitspersistbeyondthisperiodorwhetherthesymptomsmayrecurafterdiscontinuingthetreatment.Moreover,thestudydidnotcomparethedecoctionwithothertreatmentsorplacebo,soitisunclearwhethertheobservedeffectsarespecifictothedecoctionorsimplyduetonaturalrecoveryorregressiontothemean.

Thirdly,themechanismofactionofthedecoctionisstillnotfullyunderstood.Althoughthestudyresultssuggestthatthedecoctionmayreduceinflammationandimprovebloodcirculation,theexactbiologicalpathwayandactiveingredientsinvolvedarenotclear.Furtherstudiesareneededtoelucidatethemolecularandcellularmechanismsofthedecoctionandtoidentifypotentialbiomarkersorpredictorsoftreatmentresponse.

Fourthly,thepreparationandadministrationofthedecoctionmaybecumbersomeandtime-consuming,andmayalsorequirespecializedknowledgeandexpertiseintraditionalChinesemedicine.Itmaynotbefeasibleorpracticalforallhealthcareprovidersorpatients,especiallythoseinnon-Chinese-speakingcountriesorregions.Thedecoctionmayalsohaveastrongandunfamiliartasteorsmell,whichmaydetersomepatientsfromtakingit.

Inconclusion,HuangqiGuizhiWuwudecoctioncombinedwithBuyangHuanwudecoctionshowspromiseasacomplementaryoralternativetreatmentforresidualsymptomsaftersurgeryforLSS.However,moreresearchisneededtofullyevaluateitssafety,efficacy,andmechanismofaction,aswellasitslong-termeffects,sustainability,andpracticality.HealthcareprovidersshouldapproachthedecoctionwithcautionandconsidertheindividualneedsandpreferencesofeachpatientFutureresearchontheuseoftraditionalChinesemedicine(TCM)intreatingresidualsymptomsafterspinalsurgeryshouldfocusonseveralkeyareas.Firstly,moreclinicaltrialswithlargersamplesizesandlongerfollow-upperiodsareneededtogetaclearerpictureofthesafety,efficacy,andmechanismofactionofTCMformulassuchasHuangqiGuizhiWuwudecoctionandBuyangHuanwudecoction,aswellastheircompatibilityandoptimaldosages.

Secondly,theimpactofpsychologicalfactorssuchasstress,anxiety,depression,andcopingstrategiesontheeffectivenessofTCMforLSSshouldbeexplored.Studieshaveshownthatthesefactorscanaffecttheperceptionofpainanddisability,aswellasthewillingnesstocomplywithtreatmentregimens.Therefore,incorporatingpsychologicalinterventionsintoTCMprotocolsmayenhancetheirclinicaloutcomesandpatientsatisfaction.

Thirdly,thepotentialsynergisticeffectsofTCMandconventionaltreatmentssuchasphysicaltherapy,exercise,epiduralsteroidinjections,andmedicationsshouldbeinvestigated.CombiningTCMwiththesemodalitiesmayresultinbetterpainrelief,functionalimprovement,andqualityoflifeforLSSpatients.

Fourthly,thecost-effectivenessofTCMforLSSshouldbeevaluated.WhileTCMisgenerallyconsideredtobemoreaffordablethanWesternmedicine,itisnotalwayscoveredbyinsuranceplans,andmayrequirefrequentvisitstospecializedclinics.Therefore,acomprehensivecost-benefitanalysisisneededtohelphealthcareprovidersandpolicymakersmakeinformeddecisionsaboutintegratingTCMintothemanagementofLSS.

Finally,researchonTCMshouldaddressthegeneralizabilityandculturalsensitivityofitsfindings.LSSisaglobalhealthproblem,andTCMiswidelypracticedinmanycountriesoutsideofChina,suchasKorea,Japan,andVietnam.Therefore,cross-culturalstudiesthatcomparedifferentTCMformulas,practices,andbeliefsmayuncovervaluableinsightsintothediversityandcomplexityofTCMasawhole.

Inconclusion,TCMholdsgreatpotentialasacomplementaryoralternativetreatmentforre