Integrated Optimization Of TCM Appropriate Technology For Lumbar Disc Herniation In Primary Medical Institutions And Clinical Observation Of Its Application Effect

Objective:(1)to form an integrated and optimized treatment method for lumbar disc herniation in grass-roots medical institutions with appropriate Chinese medicine technologies;(2)To observe the clinical efficacy of integrated and optimized treatment methods of traditional Chinese medicine for lumbar disc herniation in primary medical institutions.Methods:(1)Adopt literature research method and modified Delphi method to carry out the study on the integrated and optimized treatment method of appropriate TCM techniques for lumbar disc herniation in primary medical institutions.(1)Literature research part: Search the CNKI,CBM,WF,VIP four Chinese databases before December31,2019,according to the inclusion and exclusion criteria of the literature,the clinical treatment of lumbar disc herniation common traditional Chinese medicine treatment technology for statistical analysis.(2)Modified Delphi method research part: According to the results of literature research,the commonly used TCM treatment techniques for lumbar disc herniation were made into expert consultation forms,and the modified Delphi method was applied to send the consultation forms to the experts engaged in the clinical work of TCM treatment of lumbar disc herniation.Each expert scored each TCM technology in three dimensions :grassroots suitability,curative effect satisfaction and patient acceptance.The expert questionnaire opinions were recovered,and the expert scoring results were statistically analyzed.The face-to-face expert consensus seminar was convened,and finally the integrated optimization method of TCM suitable technology for lumbar disc herniation in primary health institutions was formed.(2)Adopt multi-center,randomized controlled clinical research methods to carry out the clinical study of integrated optimized treatment of lumbar disc herniation with appropriate TCM techniques in primary medical institutions for the treatment of lumbar disc herniation.A total of 180 patients with lumbar disc herniation from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine(provincial tertiary care hospital),Fengling North Community Health Service Center in Nanning and Hengzhou Hospital of Traditional Chinese Medicine(county-level secondary care hospital)were randomly divided into observation group and control group,with 90 cases in each group.The observation group was treated with integrated optimization of appropriate technology of traditional Chinese medicine,and the control group was treated with conventional western medicine.Both groups took 8 days as a course of treatment,with 2 days of rest between courses,for a total of 3 courses of treatment.The visual analogue scale/score(VAS)and Japanese Orthopaedic Society(JOA)scores of low back and leg pain after each courseof treatment and the clinical efficacy of the two groups were observed,and the observation results were statistically analyzed.Results: The following results were obtained after completion of the above 2parts of the study.(1)Method integration optimization part:(1)Literature research results:Lumbar disc herniation TCM therapy methods are diverse,in descending order of frequency of occurrence: filiform needle acupuncture therapy,massage therapy,oral Chinese herbal decoction therapy,traditional Chinese medicine ironing therapy,moxibustion therapy,electroacupuncture therapy,oral Chinese patent medicine therapy,cupping therapy,traction therapy,floating needle therapy,bloodletting therapy,small needle knife therapy,traditional Chinese medicine ointment therapy,traditional Chinese medicine fumigation therapy,scraping therapy,acupoint catgut embedding therapy,acupoint application therapy,internal heat acupuncture therapy and hot needle therapy.(2)Research results of the modified Delphi method: consensus on the issue can be reached through a round of expert questionnaires and an expert face-to-face consensus seminar.Questionnaire score results: The first five techniques of weighted comprehensive rank were ironing of Chinese medicine,electroacupuncture/acupuncture,massage,cupping and moxibustion,among which the weighted scores of the first four three dimensions were≥7points.Experts face-to-face consensus discussion meeting formed the grass-roots medical and health institutions lumbar disc herniation suitable technology integration method : bed rest on the basis of acupuncture,cupping and traditional Chinese medicine ironing combined application of three methods.(2)Partial results of clinical study: A total of 173 patients were finally included in the data analysis,including 86 patients in the observation group and 87 patients in the control group.(1)There was significant difference in clinical efficacy between the two groups(P<0.05).The observation group(86 cases)was superior to the control group(87 cases).However,the clinical efficacy of each observation group in the three clinical study sites was compared,and the results revealed that the difference was not statistically significant(P >0.05).(2)VAS score results of lumbago and leg pain: The VAS score of lumbago and leg pain in the observation group after treatment[2(0.75,2.00)] was reduced compared with that before treatment [5(4.00,6.00)],and the difference had statistical significance(P < 0.05).The VAS score of lumbago and leg pain in the control group after treatment [2(1.00,3.00)] was also reduced compared with that before treatment [6(4.00,6.00)],and the difference had statistical significance.However,after treatment,the VAS score of low back and leg pain in the observation group [2(0.75,2.00)]was lower than that in the control group [2(1.00,3.00)],and the difference between the two groups was statistically significant(P<0.05).(3)Results of JOA score: The JOA score of the observation group after treatment [22(20.00,24.00)] was higher than that before treatment [7(7.75,15.00)],and the difference had statistical significance(P<0.05).The JOA score of the control group after treatment [19(17.00,21.00)] was also higher than that before treatment [11(7.00,14.00)],and the difference was also statistically significant(P<0.05).However,the JOA scores of the two groups after treatment were higher in the observation group [22(20.00,24.00)] than in the control group[19(17.00,21.00)],and the difference was significant(P<0.05).Conclusions:(1)Acupuncture,cupping and traditional Chinese medicine ironing are integrated and optimized methods of appropriate Chinese medicine techniques for treating lumbar disc herniation in primary medical institutions.(2)The comprehensive therapy of acupuncture,cupping and traditional Chinese medicine ironing is superior to the conventional western medicine drug therapy in clinical efficacy and improvement of related symptoms and signs.(3)The comprehensive therapy of acupuncture,cupping and ironing with traditional Chinese medicine can effectively relieve the pain symptoms of lumbar disc herniation and improve lumbar function,and it is suitable for primary medical institutions,so it is worthy of popularization and application in primary medical institutions.