Evaluation Of Clinical Efficacy Of The Prescription Of Fine Adjustment Points Based On Anatomy With Warming Needle Moxibustion On Cervical Headache

Objective:To analyze the possible anatomical causes of cervical headache and the anatomical location of the pain trigger points by dissecting the Shallow and deep structure of cadavers napex and the needle path of the "four nape points"(Tianzhu, Fengchi, Wangu, Tianyou), to form a new prescription of fine-turning points on cervical headache based on the relationship between the needle path of the four points and the anatomical location of the pain trigger points, and to validate the clinical efficacy of the new prescription combining with warming needle moxibustion on cervical headache through clinical randomized controlled trials.Methods:(1) Determine the treatment plan of fine-turning points:After dyeing, the point path is dissected by the method of regional anatomy. As the occipital tuberosity is the origin; the horizontal projection of superior nuchal line is abscissa, and the posterior median line is ordinate, the two-dimension rectangular coordinate system is built to measure and make a quantitative analysis of the relationship between the "four nape points" and the horizontal projection of the main nerves,muscle enthesis, bony landmarks and possible pain trigger points, and to make a qualitative analysis of the spatial relationship. According to that, the "four nape points" is fine-turned to determine the body surface location of the point and the direction of the needle.(2) The validation of Clinical efficacy:Under the random and contrast research method,127patients with cervical headache were divided randomly into four groups:routine points with acupuncture group (A),31patients; fine-turning points with acupuncture group (B),33patients; routine points with warming needle moxibustion group(C),30patients; fine-turning points with warming needle moxibustion group (D),33patients. Group A is treated by acupuncture at "four nape points" matching "Hegu","Taichong" and "Zulinqi"; group B is treated by acupuncture at the fine-turning points of "four nape points" matching "Hegu","Taichong" and "Zulinqi"; with the same treatment as group A, group C is also treated by warming needle moxibustion at the points of "Tianzhu","Fengchi","Wangu"; with the same treatment as group B, group D is also treated by warming needle moxibustion at the fine-turning points of "Tianzhu ","Fengchi","Wangu ". Each group once2days,3times a week, is treated for4weeks and followed1month after the treatment. Before treatment, the first2weeks during treatment, after treatment and1month after treatment, each group is recorded and evaluated the following items:NRS score, duration and frequency of headache, cervical ROM score, and neck symptom score. Finally, based on the curative effect valuation standard, the efficacy, compliance and safety are evaluated and analyzed by REDIT after treatment and follow-up.Results:The "four nape points" can be fine-tuned to the following stimulating points:(1) Tianzhu I point, is located parallel to skull base level and0.6cun lateral to the posterior midline with perpendicular insertion.(2) Tianzhu II point, is located parallel to Tianzhu and0.5cun lateral to the posterior midline with perpendicular insertion.(3)Tianzhu III point, is located0.6cun below Tianzhu and1.3cun lateral to the posterior midline with perpendicular insertion, or right on Tianzhu with oblique insertion.(4) Fengchi I point, is located in the depression between the upper portion of m. stemocleidomastoid and m. trapezius and parallel to skull base level and2.25cun lateral to the posterior midline with oblique insertion from the skull base to the bottom of nose tip.(5) Wangu I point, is located0.7cun above Wangu and inferior to the junction of mastoid posterior root and skull base with perpendicular insertion along the bone surface.(6)Tianyou I point, is located0.7cun below Tianyou and posterior to the m. sternocleidomastoid with the same manipulation and needling path as Tianyou. Clinical studies show that fine-turning points with warming needle moxibustion group is better than other three groups in NRS score, neck symptom score after treatment and follow-up(p<0.05). With the total effective rate93.94%at the end of treatment and the total effective rate87.88%during the follow-up, fine-turning points with warming needle moxibustion group is better than other three groups in short and long term efficacy(p<0.05). For the short and long term efficacy, routine points with warming needle moxibustion group is better than routine points with acupuncture group(p<0.05), while there is no significant difference between routine points with warming needle moxibustion group and fine-turning points with acupuncture group(p>0.05). For the short term efficacy, fine-turning points with acupuncture group is better than routine points with acupuncture group(p<0.05), while there is no significant difference for the long term efficacy(p>0.05).Conclusion:The prescription of fine-turning points based on anatomy with warming needle moxibustion has significant improvement in headache symptoms and neck symptoms of cervical headache, and is better than routine points with acupuncture, warming needle moxibustion and fine-turning points with acupuncture on short and long term efficacy, and has the advantage of a higher effective rate and cure rate, and a good compliance and safety.