[Cervical spondylosis of nerve root type with qi stagnation and blood stasis treated with warming needle with different lengths of moxa stick: a randomized controlled trial].

To compare the clinical efficacy on cervical spondylosis of nerve root type with qi stagnation and blood stasis treated with warming needle with different lengths of moxa stick.Six hundred patients with cervical spondylosis of nerve root type with qi stagnation and blood stasis were randomly divided into 4 groups: a 4 cm length group (150 cases, 5 cases dropped off, 2 cases suspended), a 3 cm length group (150 cases, 6 cases dropped off, 2 cases suspended), a 2 cm length group (150 cases, 6 cases dropped off), and a routine acupuncture group (150 cases, 6 cases dropped off). Warming needle with moxa stick in the length of 4 cm, 3 cm and 2 cm was delivered in the 4 cm length group, the 3 cm length group and the 2 cm length group, respectively. In the routine acupuncture group, simple acupuncture was applied. The acupoints selected in the above groups included Dazhui (GV 14) and bilateral Jiaji (EX-B 2) of C5 and C7, Fengchi (GB 20), Jianzhen (SI 9), Quchi (LI 11), Zhongzhu (TE 3), etc. In each group, the intervention was delivered once daily and 5 times a week. One course of intervention was composed of 2 weeks and 2 courses were required. The TCM syndrome score, the score of clinical assessment scale for cervical spondylosis (CASCS), the score of the brachial plexus traction test of the affected upper limb, F wave occurrence rate and conduction velocity of the ulnar nerve, the median nerve and the radial nerve of the affected upper limb were compared before and after treatment in the patients of each group. The levels of serum inflammatory factors, i.e. interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α) and hypersensitive C-reactive protein (hs-CRP), were measured before and after treatment in the patients of each group. The clinical cfficacy was evaluated in the 4 groups.After treatment, the results of TCM syndrome evaluation, i.e. the scores of neck pain, activity limitation and upper limb numbness and pain, as well as the total scores; and the scores of brachial plexus traction test were reduced when compared with those before treatment in each group (P<0.01, P<0.05). The scores of subjective symptoms and adaptability, and the total scores of CASCS were elevated in comparison with those before treatment in each group (P<0.01, P<0.05). In the 4 cm length group, compared with the other 3 groups, the scores of neck pain and activity limitation for TCM syndrome evaluation, and its total score were lower (P<0.05, P<0.01); and the scores of subjective symptoms and adaptability, and the total score of CASCS were higher (P<0.05, P<0.01). The score of the brachial plexus traction test in the 4 cm length group was lower than that of the routine acupuncture group (P<0.05). After treatment, F wave occurrence rates and conduction velocity of median nerve and radial nerve were increased when compared with those before treatment in each group (P<0.05, P<0.01). F wave occurrence rate and conduction velocity of the radial nerve in the 4 cm length group were higher than those of the other 3 groups (P<0.05), and those of the median nerve were higher when compared with the routine acupuncture group (P<0.05). After treatment, the levels of serum IL-1β, IL-6 and TNF-α were all reduced when compared with those before treatment in each group (P<0.01, P<0.05); the level of serum IL-6 in the 4 cm length group was lower than those of the other 3 groups and serum level of TNF-α was lower compared with that in the routine acupuncture group (P<0.05). The total effective rate of the 4 cm length group was 78.3% (112/143), which was higher when compared with the 3 cm length group (67.6%, 96/142), the 2 cm length group (65.3%, 94/144) and the routine acupuncture group (53.5%, 77/144), respectively (P<0.05).Warming needle with moxa stick of 4 cm in length effectively relieves the clinical symptoms of cervical spondylosis of nerve root type with qi stagnation and blood stasis, improves the nerve function of the upper limbs, and reduces the inflammatory responses caused by nerve compression. The clinical efficacy of this therapy with moxa stick of 4 cm in length is superior to the warming needle with moxa sticks of 3 cm and 2 cm, as well as the routine acupuncture.目的：比较不同长度艾段温针灸治疗神经根型颈椎病气滞血瘀证临床疗效。方法：将600例神经根型颈椎病气滞血瘀证患者随机分为4组：4 cm组（150例，脱落5例、中止2例）、3 cm组（150例，脱落6例、中止2例）、2 cm组（150例，脱落6例）和常规针刺组（150例，脱落6例）。4 cm组采用4 cm艾段温针灸治疗，3 cm组采用3 cm艾段温针灸治疗，2 cm组采用2 cm艾段温针灸治疗，常规针刺组仅予针刺治疗，取穴均为大椎及双侧夹脊穴（C5、C7）、风池、肩贞、曲池、中渚等，每天1次，每周治疗5次，两周为一疗程，共治疗2个疗程。分别于治疗前后比较各组患者中医证候评分、临床症状评价量表（CASCS）评分、患侧臂丛神经牵拉试验评分及患侧上肢神经（尺神经、正中神经和桡神经）F波出现率和传导速度，测定各组患者治疗前后血清炎性因子[白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子α（TNF-α）和超敏C反应蛋白（hs-CRP）]含量，并评定各组临床疗效。结果：治疗后，各组患者中医证候评分中颈部疼痛、活动受限、上肢麻痛评分及总分，臂丛神经牵拉试验评分均较治疗前降低（P<0.01，P<0.05）；CASCS评分中主观症状、适应能力评分及总分均较治疗前升高（P<0.01，P<0.05）。治疗后，4 cm组中医证候评分中颈部疼痛、活动受限评分及总分低于其他3组（P<0.05，P<0.01），CASCS评分中主观症状、适应能力评分及总分高于其他3组（P<0.05，P<0.01），臂丛神经牵拉试验评分低于常规针刺组（P<0.05）。治疗后，各组患者正中神经、桡神经F波出现率及传导速度均较治疗前升高（P<0.05，P<0.01），4 cm组桡神经F波出现率及传导速度高于其他3组、正中神经F波出现率及传导速度高于常规针刺组（P<0.05）。治疗后，各组患者血清IL-1β、IL-6、TNF-α含量均较治疗前降低（P<0.01，P<0.05），4 cm组IL-6含量低于其他3组、TNF-α含量低于常规针刺组（P<0.05）。4 cm组总有效率为78.3%（112/143），高于3 cm组（67.6%，96/142）、2 cm组（65.3%，94/144）和常规针刺组（53.5%，77/144，P<0.05）。结论：4 cm长度艾段温针灸可有效改善神经根型颈椎病气滞血瘀证的临床症状，提升上肢神经功能，减轻神经压迫造成的炎性反应，临床疗效优于3 cm、2 cm长度艾段温针灸和常规针刺。.