| Objective:Combined with clinical treatment needs,using the evidence-based medicine and clinical epidemiological evaluation of literature quality principles and methods of comprehensive retrieval of acupuncture treatment of lumbago back nearly three years of clinical research literature,and the methodological quality of the literature of all evaluation,emphasis on relying on the Meridian Theory,the Meridians Theory,the Fascia Theory treatment back evaluating and analyzing the clinical curative effect of lumbago back for the curative effect of acupuncture treatment of low back pain so far do have reliable evidence.It provides scientific basis and research methods for the evaluation and research of clinical efficacy of acupuncture and moxibustion.Secondly,combined with the specific international medical environment,the regular components in individual clinical efficacy cases were further summarized to provide new methods for painless acupuncture and moxibustion treatment and acupuncture and moxibustion for low back pain.Materials and methods:1.The literature studied the randomized controlled trials(RCT)of acupuncture and moxibustion for the treatment of lower back pain in domestic databases(CNKI,wanfang,weipu,CBM)in recent three years by using electronic and manual methods,the subject headings of"Lumbago","low back pain"and"prolapse of lumbar intervertebral disc"are matched with"acupuncture","acupuncture and moxibustion","electroacupuncture","acupuncture method","head acupuncture","ear acupuncture"(key words)and"random"(abstract).The retrieval time was from January 1,2015 to December 30,2017.Two evaluators independently used EndNote literature management software to screen the retrieved literature.If disagreement arises,the third evaluator is consulted,according to the principles of evidence-based medicine and method into the research literature,the literature evaluation,to determine the type and grades of literature,and the use of Revman5.3 software to analyze into literature.Effect model:Fixed or random effect model is selected according to the results of heterogeneity test,If P>0.1 andI~2?50%,heterogeneity is acceptable.Fixed effect model is used;if P<0.1 and I~2?50%,heterogeneity is not acceptable.Random effect model is used to analyze the causes of heterogeneity.Effect scale indicators:Selection according to data type,if the data is Two-Category Data,Odds ratio(OR)is used;if the data is continuous data,standard Mean Difference(SMD)is used and both calculate 95%confidence interval(CI),and If P<0.05,there is statistical difference.If more than 8 papers were included,funnel maps were drawn to observe whether there were publication bias and other bias.2.Clinical research 60 patients who met the diagnostic criteria,inclusion criteria and exclusion criteria were selected and enrolled in the clinical study after signing the informed consent.The patients were divided into the observation group and the control group by random number method,and age,course of disease,VAS score before treatment and other data of the patients in the two groups were tested.Determine comparability.The patients in the observation group were treated twice a week for 50 minutes,a total of five weeks is a course of treatment;The needle is EACU stainless steel filiform needle with specification of 0.22x25cm;Acupuncture method is implemented in three steps,and painless needle insertion method is used.In the first stage,the acupoints of Chengshan,Xuanshu,Yaoyangguan,Shenshu,Qihaishu,Dachangshu,Guanyuanshu and Baliao were selected;Needling in proper order and swinging hand-mainpulating of needle were all based on soft feeling without needling.The second stage is based on the patient's specific pain location and diagnosis situation,living acupuncture acupoint and 3-5 corresponding acupoints selected locally,2-3 lumbar Jiaji acupoints were supplemented,putting up and down acupoints along the vertical spine muscles on both sides of the spine,the acupoints are those with hard knot,stripe change or tenderness,shake the needle repeatedly until there is a feeling of softness in the part,then retain the needle for 30 minutes,and D6805-2 Electro-Acupuncture Therapeutic Instrument supplemented during needle retention,dilatational wave,5HZ,the intensity should be slight muscle tremor at the needle site,which patients can tolerate.In the third stage,patients get up and do stretching exercise for 3-5 minutes to feel the curative effect.Then dorsal decubitus,select Zhongwan,Guanyuan,Tianshu,straight puncture 1 cun,lifting and interpolation method for about 1 minute without retaining the needle.The patients in the control group were treated twice a week for 30 minutes,a total of five weeks is a course of treatment;The needle is EACU stainless steel filiform needle with specification of 0.22x25cm,and painless needle insertion method is used,routine acupuncture therapy combined with TDP acuacupoint irradiation therapy,in the second stage of acuacupoint selection and treatment group,TDP irradiation was mainly localized lesions,the irradiation time was 20 minutes,and Red halo is the degree.Visual analogue scale(VAS)and comprehensive lumbar vertebral disease score(JOA)were used as the main detection indicators.Visual analogue scale(VAS)and lumbar vertebral disease comprehensive score(JOA score)were used as the main indicators to evaluate the improvement of symptoms by observing the changes of parameters before and after treatment in each group.The reduction rate[(pre-treatment pain scale score-post-treatment pain scale score)/pre-treatment pain scale score]and the return visit reduction rate[(pre-treatment pain scale score)]Scale Score-Pain Scale Score at Return Visit)/Pain Scale Score before Treatment]We can evaluate the therapeutic effect of the two treatment methods and observe the adverse reactions between groups to evaluate the safety of the two methods.In the observation of clinical cases,the single variable(factor)was analyzed by variance analysis,the multiple linear regression(stepwise regression)was used for multivariate analysis,and the Q-test for comparing the mean of multiple samples was used for comparison between groups.All data were processed by SPSS11.0 software using SNK method.The measurement data of the test results are described by means of standard deviation(`x±s).The measurement data of normal distribution are tested by t-test,the difference between before and after and between groups is compared by chi-square test and t-test,and the rank sum test of measurement data and grade data of non-normal distribution is carried out with a=0.05 or 0.01(two sides)as the test level.Results:1.A total of 16 RCT literatures were selected after being screened,including 1666 patients with low back pain.Meta analysis results:12 items reported total effective rate,OR=4.81,95%CI[3.23,7.61],Z=7.73,P<0.00001;3 items reported excellent rate,OR=2.95,95%CI[1.43,6.11],P<0.005;13 items reported VAS score,VAS score of acupuncture group was lower than that of non-acupuncture control group.SM of the first group,D=-0.56,95%CI[-0.88,-0.24],Z=3.48,P<0.00001,SMD=-2.60,95%CI[-2.84,-2.36],Z=20.88,P<0.00001,SMD=-1.59,95%CI[-1.94,-1.24],Z=8.93,P<0.00001 in the second group;There were 3 reports of JOA score,SMD=1.53,95%CI[1.12,1.94],P<0.00001;ODI score in acupuncture group was lower than that in non-acupuncture group,95%CI was[-1.44,-0.65],Z=5.22,P<0.00001;3 reports of recurrence rate,OR=0.23,95%CI was[0.11,Z=3.49],and the recurrence rate in acupuncture group was lower than that in non-acupuncture control group.81,P<0.0001.2.Before treatment,the general data(age,sex,course of disease),VAS score and JOA score of the two groups were statistically processed,and the P values were 0.6.6,0.277 and0.790 respectively,which were all>0.05.The baseline data between the two groups were consistent and comparable;after acupuncture,the VAS score and JOA score of the two groups were statistically processed,P<0.05;the total effective rate of the observation group was 96.67%,and the total effective rate of the control group was 86.67,P<0.01.Three months after treatment,the total effective rate was 93.33%in the observation group and 76.67%in the control group,P>0.05;there was no significant difference in adverse reactions between the two groups,P>0.05.Conclusion:1.Meta-analysis of RCT literature of acupuncture and moxibustion in recent three years shows that acupuncture and moxibustion therapy is effective in treating low back pain.2.Acupuncture and moxibustion therapy generally has insufficient design of RCT and insufficient sample data.There is still a need for improvement in allocation concealment and the use of blind methods,and the quality of clinical reports is not high.3.Acupuncture and moxibustion therapy has a better effect on relieving pain in the treatment of low back pain and other diseases.4.The short-term and long-term efficacy of this method in the treatment of non-specific low back pain are better.5.This therapy fully embodies the concept of wholism of traditional Chinese medicine theory.This method is safe,painless and easy to be accepted by patients in clinical operation. |
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