CN103083451B - Traditional Chinese medical ointment for treating shoulder-hand syndrome as well as preparation method thereof - Google Patents
Traditional Chinese medical ointment for treating shoulder-hand syndrome as well as preparation method thereof Download PDFInfo
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Abstract
The invention relates to a traditional Chinese medical ointment for treating shoulder-hand syndrome as well as a preparation method thereof. The problem of medicines for treating shoulder-hand syndrome can be effectively solved. The traditional Chinese medical ointment shoulder-hand syndrome is prepared from the following raw materials by weight: 5-15g of Angelica sinensis, 5-15g of Ligusticum wallichii, 12-20g of root of common peony, 7-15g of monkshood, 5-18g of radix aconiti carmichaeli, 7-20g of cassia twig, 6-18g of pepper, 5-12g of radix sileris, 5-18g of the root of red-rooted salvia, 8-18g of radix angelicae pubescentis, 6-18g of notopterygium root, 5-15g of cynanchum paniculatum, 1-3g of asarum and 90-110g of emulsifiable paste matrix. With the adoption of the supercritical extraction technology and combination of conventional pasting therapy and modern preparation technology, the traditional Chinese medical ointment for treating shoulder-hand syndrome provided by the invention is green, low-carbon and environmental-friendly. Kangmo paste which is a novel transdermal drug delivery preparation is prepared to bring good news to massive patients suffering from shoulder-hand syndrome. The preparation is remarkable in curative effect and convenient to use, and does not cause pains to the patients, so that the traditional Chinese medical ointment for treating shoulder-hand syndrome is an innovation of medicines for treating shoulder-hand syndrome.
Description
Technical field
The present invention relates to medicine, particularly a kind of Chinese medicinal ointment for the treatment of shoulder-hand syndrome and preparation method thereof (claim again health rub cream and preparation method thereof).
Background technology
Shoulder-hand syndrome (shoulder-hand syndrome, SHS), claims again apoplexy back reflection sympathetic dystrophy syndrome (reflex sympathetic dystrophy, RSD), is the common complication of hemiparalysis after apoplexy patient.Nineteen forty-seven, first Stejnbroker report, its incidence rate is between 12.5%～74.1%.SHS is everlasting and occurs for after apoplexy 1-3 month, but also has early to 3 days, late person's to 6 month report.Clinical manifestation is that suffering limb shoulder hands pain, erubescence swelling, Pi Wen rise, FF is limited, have a strong impact on the recovery of patient's upper extremity exercise function, and because pain have directly affected patient's rehabilitation.As will not be suitably treated, by the permanent deformity that causes shoulder and hands, refers to.Therefore, the early diagnosis of hemiplegic patient shoulder-hand syndrome and rehabilitation are the keys in apoplexy therapeutic process.Modern medicine mainly contains the Therapeutic Method of shoulder-hand syndrome: Drug therapy, naturopathy, acupuncture and moxibustion treatment, massage, drug injection therapy, closed treating, stellate ganglion block, functional training etc.Western medicine is still confined to oral analgesic, nonsteroidal antiinflammatory drug etc., though alleviated patient's slight illness, it may be limited its application by cognitive side effect, by extensive patients, is not accepted.And physiotherapy, acupuncture and moxibustion treatment, acupoint therapy, block therapy functional training have just been alleviated the temporary transient slight illness of patient to a certain extent, therapeutic process patient's compliance is also poor, also not accepted by Most patients of therapeutic equipments costliness, some treatment has certain danger, stellate ganglion block is the therapeutic scheme of selecting in the situation that rehabilitation can not be alleviated, along with the improvement of rehabilitation technique, the needs that this operation gets involved have been reduced.Paste massage is very distinctive a kind of external treatment during Chinese conventional massage is learned, refer to when body surface is implemented massage manipulation, first coat the unguentum made from Chinese medicine, revolve again and use various massage manipulations, it both can prevent the breakage of patient's skin surface, be beneficial to again using of various maneuvers, can also improve the effect for the treatment of, maneuver and medicine are brought out the best in each other simultaneously.A maneuver of massage by rubbing the affected part with ointment for treating arthralgia and skin disease agent belongs to transdermal delivery system (TDDS), has without " first pass effect " and the gastrointestinal of liver and destroys, and content of dispersion is many, and the feature that dosage is few has reduced drug toxicity and side effect.Also there is the blood drug level that can remain stable, lasting, improve curative effect, the features such as convenient drug administration, and there is the percutaneous absorption of medicine and the double treatment characteristic of meridian point effect.Paste massage is all very popular in each period of China, especially Shanxi Tang and Song Dynasty time, and extensively using a maneuver of massage by rubbing the affected part with ointment for treating arthralgia and skin disease ruling by law to treat disease is a distinguishing feature in massage history, many physicians of China had deep research to it.Though the existing medicine that has various treatment shoulder-hand syndromes, for various reasons, and not fully up to expectations.Through retrieving effective external used medicine of combination with massaging manipulation shoulder-hand syndrome how so far there are no, be publicly reported.
Summary of the invention
For above-mentioned situation, for overcoming the defect of prior art, the present invention's object is exactly that combination with massaging maneuver provides a kind of Chinese medicinal ointment for the treatment of shoulder-hand syndrome and preparation method thereof, can effectively solve the medicine for treatment problem of shoulder-hand syndrome.
The technical scheme that the present invention solves is, the shoulder-hand syndrome traditional Chinese medical science is thought, because QI and blood is not lived, meridians are obstructed and cause hands edema pain and shoulder arthralgia, and make hands function limitation, its Therapeutic Principle should be blood circulation promoting and blood stasis dispelling, easypro network stimulates the menstrual flow, reducing swelling and alleviating pain, accordingly, the present invention adopts the material medicine of following weighing scale to make: Radix Angelicae Sinensis 5-15g, Rhizoma Chuanxiong 5-15g, Radix Paeoniae Rubra 12-20g, Radix Aconiti 7-15g, Radix Aconiti Lateralis Preparata 5-18g, Ramulus Cinnamomi 7-20g, Pericarpium Zanthoxyli 6-18g, Radix Saposhnikoviae 5-12g, Radix Salviae Miltiorrhizae 5-18g, Radix Angelicae Pubescentis 8-18g, Rhizoma Et Radix Notopterygii 6-18g, Radix Cynanchi Paniculati 5-15g, Herba Asari 1-3g and emulsifiable paste matrix 90-110g, preparation method is:
(1) preparation of emulsifiable paste matrix: emulsifiable paste matrix comprises water emulsifiable paste matrix, oil phase emulsifiable paste matrix two parts, and oil phase emulsifiable paste matrix accounts for 47.6% of emulsifiable paste matrix weight, and water emulsifiable paste matrix accounts for 52.4% of emulsifiable paste matrix weight, wherein:
The preparation of water emulsifiable paste matrix: triethanolamine 2ml, glycerol 13g, distilled water 50ml are placed in to beaker, and heating in water bath is dissolved into water emulsifiable paste matrix, in 65 ℃ of insulations, standby;
The preparation of oil phase emulsifiable paste matrix: stearic acid 16g, glyceryl monostearate 5g, Oleum Ricini 30g, azone 4.8g, propylene glycol 3.1g, ethyl hydroxybenzoate 0.1g are placed in to beaker, and heating in water bath is melt into oil phase emulsifiable paste matrix, in 65 ℃ of insulations, standby;
(2) preparation of medicine: Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari are adopted to supercritical fluid extraction, at pressure 25MPa, temperature 50 C, extraction 1.5h, obtain supercritical extract, standby;
The medicinal residues of supercritical extract are mixed with Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata, Radix Salviae Miltiorrhizae, the ethanol that the mass concentration that adds Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari, Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata and 10 times of weight of Radix Salviae Miltiorrhizae is 80%, reflux, extract, 3 times, each 1h, merge alcohol extract, decompression recycling ethanol, is concentrated into the alcohol-extracted extract of 60 ℃ of relative density 1.3-1.4, standby;
(3) synthetic Chinese medicinal ointment: supercritical extract prepared by step (2) adds in oil phase emulsifiable paste matrix, and adds Borneolum Syntheticum 0.3g, and mix homogeneously, in 65 ℃ of insulations, is made oil phase medicine, standby;
Alcohol-extracted extract prepared by step (2) adds in water emulsifiable paste matrix, in 65 ℃ of insulations, makes water medicine, standby;
By oil phase medicine and water medicament mixed, stir and be chilled to room temperature (18-25 ℃), obtain Chinese medicinal ointment of the present invention.
The present invention adopts supercritical extraction technique, traditional paste massage is combined with modern preparation technique, green low-carbon environment-friendly, prepare Novel percutaneous preparation-health cream that rubs, for vast patients with shoulder-hand syndrome brings glad tidings, said preparation has evident in efficacy, sufferer no pain, easy to use, be the innovation on treatment shoulder-hand syndrome medicine.
The specific embodiment
Below in conjunction with embodiment, the specific embodiment of the present invention is elaborated.
Embodiment 1
The present invention is in concrete enforcement, material medicine by following weighing scale is made: Radix Angelicae Sinensis 10g, Rhizoma Chuanxiong 12g, Radix Paeoniae Rubra 15g, Radix Aconiti 10g, Radix Aconiti Lateralis Preparata 12g, Ramulus Cinnamomi 10g, Pericarpium Zanthoxyli 15g, Radix Saposhnikoviae 9g, Radix Salviae Miltiorrhizae 10g, Radix Angelicae Pubescentis 12g, Rhizoma Et Radix Notopterygii 12g, Radix Cynanchi Paniculati 9g, Herba Asari 3g and emulsifiable paste matrix 100g, and preparation method is:
(1) preparation of emulsifiable paste matrix: emulsifiable paste matrix comprises water emulsifiable paste matrix, oil phase emulsifiable paste matrix two parts, and oil phase emulsifiable paste matrix accounts for 47.6% of emulsifiable paste matrix weight, and water emulsifiable paste matrix accounts for 52.4% of emulsifiable paste matrix weight, wherein:
The preparation of water emulsifiable paste matrix: triethanolamine 2ml, glycerol 13g, distilled water 50ml are placed in to beaker, and heating in water bath is dissolved into water emulsifiable paste matrix, in 65 ℃ of insulations, standby;
The preparation of oil phase emulsifiable paste matrix: stearic acid 16g, glyceryl monostearate 5g, Oleum Ricini 30g, azone 4.8g, propylene glycol 3.1g, ethyl hydroxybenzoate 0.1g are placed in to beaker, and heating in water bath is melt into oil phase emulsifiable paste matrix, in 65 ℃ of insulations, standby;
(2) preparation of medicine: Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari are adopted to supercritical fluid extraction, at pressure 25MPa, temperature 50 C, extraction 1.5h, obtain supercritical extract, standby;
The medicinal residues of supercritical extract are mixed with Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata, Radix Salviae Miltiorrhizae, the ethanol that the mass concentration that adds Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari, Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata and 10 times of weight of Radix Salviae Miltiorrhizae is 80%, reflux, extract, 3 times, each 1h, merge alcohol extract, decompression recycling ethanol, is concentrated into the alcohol-extracted extract of 60 ℃ of relative density 1.3-1.4, standby;
(3) synthetic Chinese medicinal ointment: supercritical extract prepared by step (2) adds in oil phase emulsifiable paste matrix, and adds Borneolum Syntheticum 0.3g, and mix homogeneously, in 65 ℃ of insulations, is made oil phase medicine, standby;
Alcohol-extracted extract prepared by step (2) adds in water emulsifiable paste matrix, in 65 ℃ of insulations, makes water medicine, standby;
By oil phase medicine and water medicament mixed, stir and be chilled to room temperature (18-25 ℃), obtain Chinese medicinal ointment of the present invention.
Embodiment 2
The present invention also can be made by the material medicine of following weighing scale: Radix Angelicae Sinensis 5g, Rhizoma Chuanxiong 5g, Radix Paeoniae Rubra 12g, Radix Aconiti 7g, Radix Aconiti Lateralis Preparata 5g, Ramulus Cinnamomi 7g, Pericarpium Zanthoxyli 6g, Radix Saposhnikoviae 5g, Radix Salviae Miltiorrhizae 5g, Radix Angelicae Pubescentis 8g, Rhizoma Et Radix Notopterygii 6g, Radix Cynanchi Paniculati 5g, Herba Asari 1g and emulsifiable paste matrix 90g, preparation method is with embodiment 1.
Embodiment 3
The present invention is in concrete enforcement, also can be made by the material medicine of following weighing scale: Radix Angelicae Sinensis 15g, Rhizoma Chuanxiong 15g, Radix Paeoniae Rubra 20g, Radix Aconiti 15g, Radix Aconiti Lateralis Preparata 18g, Ramulus Cinnamomi 20g, Pericarpium Zanthoxyli 18g, Radix Saposhnikoviae 12g, Radix Salviae Miltiorrhizae 18g, Radix Angelicae Pubescentis 18g, Rhizoma Et Radix Notopterygii 18g, Radix Cynanchi Paniculati 15g, Herba Asari 3g and emulsifiable paste matrix 110g, preparation method is with embodiment 1.
Embodiment 4
The present invention also can made by the material medicine of following weighing scale: Radix Angelicae Sinensis 6-9g, Rhizoma Chuanxiong 6-11g, Radix Paeoniae Rubra 13-14g, Radix Aconiti 8-9g, Radix Aconiti Lateralis Preparata 6-11g, Ramulus Cinnamomi 8-9g, Pericarpium Zanthoxyli 7-14g, Radix Saposhnikoviae 6-8g, Radix Salviae Miltiorrhizae 6-9g, Radix Angelicae Pubescentis 9-11g, Rhizoma Et Radix Notopterygii 7-11g, Radix Cynanchi Paniculati 6-8g, Herba Asari 1-2g and emulsifiable paste matrix 90-100g, preparation method is with embodiment 1.
Embodiment 5
The present invention also can be made by the material medicine of following weighing scale: Radix Angelicae Sinensis 11-14g, Rhizoma Chuanxiong 13-14g, Radix Paeoniae Rubra 16-19g, Radix Aconiti 11-14g, Radix Aconiti Lateralis Preparata 13-17g, Ramulus Cinnamomi 11-19g, Pericarpium Zanthoxyli 16-17g, Radix Saposhnikoviae 10-11g, Radix Salviae Miltiorrhizae 11-17g, Radix Angelicae Pubescentis 13-17g, Rhizoma Et Radix Notopterygii 13-17g, Radix Cynanchi Paniculati 10-14g, Herba Asari 2-3g and emulsifiable paste matrix 100-110g, preparation method is with embodiment 1.
Effective combination of said medicine, supports mutually, has blood circulation promoting and blood stasis dispelling, an effect of stimulate the menstrual flow easypro network, reducing swelling and alleviating pain, combines with massage manipulation, is effective to treat shoulder-hand syndrome, and has obtained good technique effect through clinical experiment, and relevant clinical data is as follows:
1 clinical data
1.1 select the standard of case to observe case totally 60 examples, and single-blind randomized is divided into 2 groups for the treatment of group, matched groups, every group of each 30 examples.Male 21 examples in treatment group, female's 9 examples, 45～75 years old age, average 60.6 years old, the course of disease 15 days～6 months, average 2 months.Patients with Cerebral Infarction 26 examples, patients with cerebral hemorrhage 4 examples, accompanied with hypertension 16 examples, diabetes 9 examples, hyperlipemia 9 examples, coronary heart disease 4 examples; Male 20 examples in matched group, female's 10 examples; 46～74 years old age, average 61.5 years old, the course of disease 12 days～6 months, average 2 months.Patients with Cerebral Infarction 25 examples, patients with cerebral hemorrhage 5 examples; Accompanied with hypertension 20 examples, diabetes 8 examples, hyperlipemia 5 examples, coronary heart disease 5 examples; Two groups at sex, age, the course of disease, coincident with severity degree of condition and accompanying diseases etc. relatively, and no significant difference (P>0.05), has comparability.
1.2 diagnostic criteria cerebrovascular disease diagnosis standards: the diagnostic criteria of working out with reference to < < China cerebrovascular guideline of prevention and treatment > >.Shoulder-hand syndrome diagnostic criteria: according to shoulder-hand syndrome diagnostic criteria in the rehabilitation evaluation of < < apoplexy and treatment > >.Patient has cerebrovascular disease; One-sided shoulder pain in hand, erubescence, Pi Wen rise; Hand swelling, FF is limited; The local evidence without wound, infection, also without the evidence of peripheral angiopathy.Standard by stages: I phase: shoulder pain, limitation of activity, homonymy wrist, finger swelling, occur that the vasomotions such as rubescent, Pi Wen risings sexually revise, and points to be more and stretch position, limited during flexing, causes severe pain, time remaining 3～6 months during passive flexing; The II phase: shoulder, the spontaneous pain of hands or the swelling of hands alleviate or disappears, sick side skin of hand, the obvious atrophy of muscle, x-ray is suffered from as seen hands osteoporosis sample and is changed, and time average continues 3～6 months; The III phase: skin, the amyotrophy of hands increase the weight of day by day, point complete contracture.
Inclusive criteria: the convalescent period of cerebrovascular disease; Meet shoulder-hand syndrome diagnostic criteria and I phase, II phase standard by stages; Every vital sign patient stably after apoplexy; 40～75 years old age; Informed consent person.
Exclusion standard: the caused shoulder-hand syndrome such as the cerebral tumor, cerebral trauma; Be associated with the serious illness of the systems such as other hearts, brain, liver, kidney, hemopoietic.
2 therapeutic schemes
2.1 matched groups give base therapy, and employing suitable limb position is put, rehabilitation training.1. suitable limb position is put and is comprised the position that keeps correct, and the carpal joint appropriateness back of the body is stretched position, and finger stretches and abduction.2. Rehabilitation exercise protocol in patients: patient adopts passive exercise (passively to carry out shoulder joint and other joint passive exercises of upper limb, each 10min, every day 2 times), (patient utilizes healthy side hand to help hemiplegia side upper limb to carry out anteflexion, the interior receipts of shoulder joint, abduction in auxiliary active exercise, the motions such as elbow joint flexing, each 10min, every day 2 times), active exercise (carrying each 5min, every day 2 times in both sides shoulders resistance).Treat altogether 4 weeks.
2.2 treatment groups coordinate Chinese medicinal ointment of the present invention (health rub cream) massage suffering limb on matched group basis, using method: take the appropriate outer suffering limb that is coated with of Chinese medicinal ointment of the present invention (health rub cream) by special messenger, use the massage suffering limbs such as palm-rubbing technique, grasping manipulation, pushing manipulation, each 20 minutes, every day 1 time.Treat altogether 4 weeks.
observation index and statistical method
3.1 observation index
3.1.1 health giving quality index
3.1.1.1 0 point of shoulder arthralgia evaluation: painless; 1 point: slight pain, or feels pain while only applying other factors; 2 points: uncomfortable pain, but still can stand, work and rest are not had a significant effect; 3 points: poverty-stricken pain, can affect and have a rest and work; 4 points: serious pain, endurable, has a strong impact on and has a rest and work; 5 points: violent pain, be impatient at, even can not have a rest and work, need to coordinate analgesic or additive method treatment.
3.1.1.2 range of motion is measured 0 point: freely, respectively in different directions passive activity shoulder joint, range of activity is normal, without pain in activity; 1 point: gentle activity is limited, range of activity exceedes the pain that occurs of normal range of joint motion at 1/2 o'clock; 2 points: activity is obviously limited, range of activity is less than the pain that occurs of normal range of joint motion at 1/2 o'clock; 3 points: completely stiff, pain when only having several years mobility or touching.
3.1.1.3 the assessment of function of upper limb integrated motion is according to the Fugl-Meyer upper extremity exercise function score of Fugl-Meyer rating method record treatment Patients Before And After.
3.1.2 the general health check-up project of safety indexes (body temperature, blood pressure, breathing, pulse), hematuria stool routine, darling renal function inspection, patient skin comfort level etc., to begin a project all before medication and clinical research finishes rear each inspection once, observe at any time untoward reaction.
3.2 statistical method total datas are all through SPSS10.0 software processes, and measurement data adopts mean ± standard deviation, and (x ± s) represent, measurement data adopts t check, enumeration data employing χ
2check, ranked data are checked with Ridit.
criterion of therapeutical effect and therapeutic outcome
4.1 criterions of therapeutical effect: evaluation of clinical curative effect is with reference to < < traditional Chinese medical science disease Standardization of diagnosis and curative effect > >;
Cure: shoulder joint is without obvious pain, and the back of the hand swelling alleviates, sign is improved, and lab testing takes a turn for the better, carpal joint and point each joint without obvious limitation of activity;
Take a turn for the better: shoulder arthralgia alleviates, the back of the hand swelling is alleviated, and has slight carpal joint or finger movement limited;
Do not heal: shoulder arthralgia is without significant change, and the back of the hand swelling is not improved, and finger movement is range limited.
The comparison of 4.2 liang of group patient curative effects, in Table 1.
Table 1 liang group patient curative effect comparison
| Group | Cure | Take a turn for the better | Do not heal | Total effective rate |
| Treatment group (30) | 17 | 10 | 3 | 90.00% |
| Matched group (30) | 10 | 12 | 8 | 73.33% |
As seen from Table 1, in the routine patient for the treatment of group 30, cure 17 examples, effective 10 examples, invalid 3 examples, total effective rate is 90.00%; In the routine patient of matched group 30, cure 10 examples, effective 12 examples, invalid 8 examples, total effective rate is 73.33%.Through Ridit check, U=2.01, P=0.04, P<0.05, two groups of total effects comparing difference statistical significances.
4.3 liang of group patient shoulder arthralgias, mobility and Fugl-Meyer scorings are compared, in Table 2
Table 2 liang group patient shoulder arthralgia, mobility and Fugl-Meyer scoring comparison (point, x ± s)
Note: compared with before the treatment of this group, * P < 0.05; * P < 0.01;
Compared with after treatment of control group, △ P < 0.01.
As seen from Table 2, shoulder arthralgia, range of motion and Fugl-Meyer scoring (the P < 0.05 that all has clear improvement before treatment after two groups of treatments; P < 0.01); After treatment, treatment group shoulder arthralgia, range of motion and Fugl-Meyer scoring have statistical significance (P < 0.01) with matched group comparing difference.
4.3 safety indexes are observed two groups of front and back of this clinical observation treatment general health check-up project of patient, the inspection of hematuria stool routine, cardiac inspection etc. and are had no significant change.Viewing duration, two groups there is not serious adverse events during this clinical observation.All patients massage position and are showed no skin abnormality change and special discomfort, through t, check, before and after two groups of treatments, hepatic and renal function and routine blood test index of correlation be all without significant difference, and P>0.05 all has no significant effect hepatic and renal function and hemogram during pointing out two groups of medications.
5 discuss
5.1 shoulder-hand syndrome (shoulder-hand syndrome, SHS), claim again apoplexy back reflection sympathetic dystrophy syndrome (reflex sympathetic dystrophy, RSD), are the common complication of hemiparalysis after apoplexy patient.Nineteen forty-seven, first Stejnbroker report, its incidence rate is between 12.5%～74.1%.SHS is everlasting and occurs for after apoplexy 1-3 month, but also has early to 3 days, late person's to 6 month report.Clinical manifestation is that suffering limb shoulder hands pain, erubescence swelling, Pi Wen rise, FF is limited, have a strong impact on the recovery of patient's upper extremity exercise function, and because pain have directly affected patient's rehabilitation.As will not be suitably treated, by the permanent deformity that causes shoulder and hands, refers to.From the feature of generation and the development of shoulder-hand syndrome, pain and edema be its in early stage sign, be also that treatment may effectively indicate.
Modern medicine mainly contains the Therapeutic Method of shoulder-hand syndrome: Drug therapy, naturopathy, acupuncture and moxibustion treatment, massage, drug injection therapy, closed treating, stellate ganglion block, functional training etc.Western medicine is still confined to oral analgesic, nonsteroidal antiinflammatory drug etc., though alleviated patient's slight illness, it may be limited its application by cognitive side effect, by extensive patients, is not accepted.And physiotherapy, acupuncture and moxibustion treatment, acupoint therapy, block therapy functional training have just been alleviated the temporary transient slight illness of patient to a certain extent, therapeutic process patient's compliance is also poor, also not accepted by Most patients of therapeutic equipments costliness, some treatment has certain danger, stellate ganglion block is the therapeutic scheme of selecting in the situation that rehabilitation can not be alleviated, along with the improvement of rehabilitation technique, the needs that this operation gets involved have been reduced.
5.2 etiology and pathogenesis and the rule for the treatment of
In motherland's medical science without shoulder-hand syndrome name of disease, according to its clinical manifestation, surely belong to " arthromyodynia " category of Chinese medicine, on the basis of discussing at ancient Chinese medicine doctor, the author is in conjunction with clinical experience, think that primary disease shows as limbs pain, hyperesthesia, hand diffusivity pitting edema, shoulder joint limitation of activity in early days more, its pathogenesis is mainly that qi depression to blood stasis, water wetly stop gathering, the wet stasis of blood is tied mutually, impatency passages through which vital energy circulates, wind, cold, wet pathogen numbness resistance muscle joint, stagnation of QI and blood may bring about pain; Pathogen usually intruding into collateral in protracted disease, podomere deficiency of the vessel is stagnant, therefore treatment should be with expelling wind and cold, warming YANG to induce diutesis, eliminating blood stasis and smoothing collaterals is main.
5.3 health rub cream Fang Yi analyze and feature
5.3.1 side's justice is analyzed health and is rubbed cream by ingredients such as Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Salviae Miltiorrhizae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asaris.Radix Aconiti Lateralis, Radix Aconiti energy warming the meridian, cold expelling, dredging collateral, damp eliminating, pain relieving in side; Pericarpium Zanthoxyli, the Herba Asari antalgic of invigorating blood circulation; Radix Angelicae Sinensis, Radix Paeoniae Rubra, kind the enriching blood of Radix Salviae Miltiorrhizae are invigorated blood circulation, Rhizoma Chuanxiong blood-activating and qi-promoting, wind-expelling pain-stopping; Radix Saposhnikoviae, Radix Angelicae Pubescentis, notopterygium wind dispelling victory wet; Ramulus Cinnamomi, Radix Cynanchi Paniculati qualcomm meridian, by phlegm-damp.Full side plays expelling wind and cold, warming YANG to induce diutesis, the merit of eliminating blood stasis and smoothing collaterals altogether.
All medicines are made the health cream that rubs according to certain technique above, and a maneuver of massage by rubbing the affected part with ointment for treating arthralgia and skin disease agent belongs to transdermal delivery system (TDDS), have without " first pass effect " and the gastrointestinal of liver and destroy, and content of dispersion is many, and dosage is few, reduces drug toxicity and side effect.Maintain stable, lasting blood drug level, improve curative effect, the features such as convenient drug administration, and there is the percutaneous absorption of medicine and the double treatment characteristic of meridian point effect.Said preparation has evident in efficacy, sufferer no pain, the advantage such as easy to use.The agent of this maneuver of massage by rubbing the affected part with ointment for treating arthralgia and skin disease has the unique advantage of percutaneous dosing, for the medicine of flesh table, gets all thick medicines of abnormal smells from the patient more, and in addition priming is led group medicine, the capable stagnant through sick institute of relieving accumulation of pathogens.Not only can penetrate the effects such as skin produces antiinflammatory, pain relieving, blood circulation promoting and blood stasis dispelling, the network that stimulates the menstrual flow away, deep, the expelling wind and cold of having one's ideas straightened out; And act on the medicine irritation teleneuron of body surface, and by reflection, blood vessel dilating, promotes local blood circulation.Improve surrounding tissue nutrition, reach detumescence, antiinflammatory and analgesic object.
Paste massage is very distinctive a kind of external treatment during Chinese conventional massage is learned, refer to when body surface is implemented massage manipulation, coat the unguentum made from Chinese medicine, revolve again and use various massage manipulations, it both can prevent the breakage of patient's skin surface, be beneficial to again using of various maneuvers, can also improve the effect for the treatment of, maneuver and medicine are brought out the best in each other simultaneously.Ben Kangmo cream in affected limb, is got excited signal to stimulate brain respective regions by the warm stimulation that puts on skin to cerebral cortex transmission through doctor's massage, promotes awakening and the recovery of function of nervous system.Also make local blood capillary fully expand simultaneously, accelerating penetrating of medicine makes medicinal liquid directly act on diseased region, drug effect is played one's part to the full, effectively reduce neural irritability, thereby can alleviate rapidly limbs pain, improvement and relieve muscle spasms, thereby improve the objects such as range of motion reaches expelling wind and removing dampness, invigorates blood circulation, eliminating stasis to stop pain, promoting the flow of QI in the collateral by warming the meridian, detumescence.
5.4 clinical efficacy
In the routine patient for the treatment of group 30, cure 17 examples, effective 10 examples, invalid 3 examples, total effective rate is 90.00%; In the routine patient of matched group 30, cure 10 examples, effective 12 examples, invalid 8 examples, total effective rate is 73.33%.Through Ridit check, U=2.01, P=0.04, P<0.05, two groups of total effects comparing difference statistical significances.
Shoulder arthralgia, range of motion and Fugl-Meyer scoring (the P < 0.05 that all has clear improvement before treatment after two groups of treatments; P < 0.01); After treatment, treatment group shoulder arthralgia, range of motion and Fugl-Meyer scoring have statistical significance (P < 0.01) with matched group comparing difference.
conclusion
By the clinical research of shoulder-hand syndrome after above treatment apoplexy, draw to draw a conclusion:
1. wind, cold, wet pathogen numbness resistance muscle joint, qi depression to blood stasis impatency passages through which vital energy circulates is main pathogenesis numb after apoplexy.Expelling wind and cold, warming YANG to induce diutesis, eliminating blood stasis and smoothing collaterals is the base therapy method of shoulder-hand syndrome after apoplexy.The health shoulder-hand syndrome that rubs after cream treatment apoplexy is evident in efficacy.
2. after apoplexy, after the treatment of the primary symptom of patients with shoulder-hand syndrome, all obviously improve, can obviously improve curative effect.
3. after the shoulder arthralgia of patients with shoulder-hand syndrome after apoplexy, range of motion and Fugl-Meyer scoring treatment, all obviously improve, the health cream that rubs can obviously improve curative effect.
4. the health cream that rubs is remarkable to the effect of apoplexy back porch hand syndrome patient treatment, and this medicine can effectively be treated pain symptom after apoplexy, has improved patient's quality of life, has shortened patient and has returned the social time.
5. liang group all has no significant effect hepatic and renal function, blood, urine, excrement etc. during treating.Patient massages skin also without special discomfort.
Visible, the present invention's (health rub cream) more can significantly improve the clinical symptoms of shoulder-hand syndrome than simple Primary Care, and does not have side effect, and patient compliance is good.
Claims (6)
1. treat the Chinese medicinal ointment of shoulder-hand syndrome for one kind, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 5-15g, Rhizoma Chuanxiong 5-15g, Radix Paeoniae Rubra 12-20g, Radix Aconiti 7-15g, Radix Aconiti Lateralis Preparata 5-18g, Ramulus Cinnamomi 7-20g, Pericarpium Zanthoxyli 6-18g, Radix Saposhnikoviae 5-12g, Radix Salviae Miltiorrhizae 5-18g, Radix Angelicae Pubescentis 8-18g, Rhizoma Et Radix Notopterygii 6-18g, Radix Cynanchi Paniculati 5-15g, Herba Asari 1-3g, 90-110g makes with emulsifiable paste matrix, and its preparation is:
(1) preparation of emulsifiable paste matrix: emulsifiable paste matrix comprises water emulsifiable paste matrix, oil phase emulsifiable paste matrix two parts, and oil phase emulsifiable paste matrix accounts for 47.6% of emulsifiable paste matrix weight, and water emulsifiable paste matrix accounts for 52.4% of emulsifiable paste matrix weight, wherein:
The preparation of water emulsifiable paste matrix: triethanolamine 2ml, glycerol 13g, distilled water 50ml are placed in to beaker, and heating in water bath is dissolved into water emulsifiable paste matrix, in 65 ℃ of insulations, standby;
The preparation of oil phase emulsifiable paste matrix: stearic acid 16g, glyceryl monostearate 5g, Oleum Ricini 30g, azone 4.8g, propylene glycol 3.1g, ethyl hydroxybenzoate 0.1g are placed in to beaker, and heating in water bath is melt into oil phase emulsifiable paste matrix, in 65 ℃ of insulations, standby;
(2) preparation of medicine: Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari are adopted to supercritical fluid extraction, at pressure 25MPa, temperature 50 C, extraction 1.5h, obtain supercritical extract, standby;
The medicinal residues of supercritical extract are mixed with Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata, Radix Salviae Miltiorrhizae, the ethanol that the mass concentration that adds Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari, Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata and 10 times of weight of Radix Salviae Miltiorrhizae is 80%, reflux, extract, 3 times, each 1h, merge alcohol extract, decompression recycling ethanol, is concentrated into the alcohol-extracted extract of 60 ℃ of relative density 1.3-1.4, standby;
(3) synthetic Chinese medicinal ointment: supercritical extract prepared by step (2) adds in oil phase emulsifiable paste matrix, and adds Borneolum Syntheticum 0.3g, and mix homogeneously, in 65 ℃ of insulations, is made oil phase medicine, standby;
Alcohol-extracted extract prepared by step (2) adds in water emulsifiable paste matrix, in 65 ℃ of insulations, makes water medicine, standby;
By oil phase medicine and water medicament mixed, stir and be chilled to room temperature.
2. the Chinese medicinal ointment for the treatment of shoulder-hand syndrome according to claim 1, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 10g, Rhizoma Chuanxiong 12g, Radix Paeoniae Rubra 15g, Radix Aconiti 10g, Radix Aconiti Lateralis Preparata 12g, Ramulus Cinnamomi 10g, Pericarpium Zanthoxyli 15g, Radix Saposhnikoviae 9g, Radix Salviae Miltiorrhizae 10g, Radix Angelicae Pubescentis 12g, Rhizoma Et Radix Notopterygii 12g, Radix Cynanchi Paniculati 9g, Herba Asari 3g, 100g makes with emulsifiable paste matrix, and its preparation is:
(1) preparation of emulsifiable paste matrix: emulsifiable paste matrix comprises water emulsifiable paste matrix, oil phase emulsifiable paste matrix two parts, and oil phase emulsifiable paste matrix accounts for 47.6% of emulsifiable paste matrix weight, and water emulsifiable paste matrix accounts for 52.4% of emulsifiable paste matrix weight, wherein:
The preparation of water emulsifiable paste matrix: triethanolamine 2ml, glycerol 13g, distilled water 50ml are placed in to beaker, and heating in water bath is dissolved into water emulsifiable paste matrix, in 65 ℃ of insulations, standby;
The preparation of oil phase emulsifiable paste matrix: stearic acid 16g, glyceryl monostearate 5g, Oleum Ricini 30g, azone 4.8g, propylene glycol 3.1g, ethyl hydroxybenzoate 0.1g are placed in to beaker, and heating in water bath is melt into oil phase emulsifiable paste matrix, in 65 ℃ of insulations, standby;
(2) preparation of medicine: Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari are adopted to supercritical fluid extraction, at pressure 25MPa, temperature 50 C, extraction 1.5h, obtain supercritical extract, standby;
The medicinal residues of supercritical extract are mixed with Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata, Radix Salviae Miltiorrhizae, the ethanol that the mass concentration that adds Radix Angelicae Sinensis, Rhizoma Chuanxiong, Ramulus Cinnamomi, Pericarpium Zanthoxyli, Radix Saposhnikoviae, Radix Angelicae Pubescentis, Rhizoma Et Radix Notopterygii, Radix Cynanchi Paniculati, Herba Asari, Radix Paeoniae Rubra, Radix Aconiti, Radix Aconiti Lateralis Preparata and 10 times of weight of Radix Salviae Miltiorrhizae is 80%, reflux, extract, 3 times, each 1h, merge alcohol extract, decompression recycling ethanol, is concentrated into the alcohol-extracted extract of 60 ℃ of relative density 1.3-1.4, standby;
(3) synthetic Chinese medicinal ointment: supercritical extract prepared by step (2) adds in oil phase emulsifiable paste matrix, and adds Borneolum Syntheticum 0.3g, and mix homogeneously, in 65 ℃ of insulations, is made oil phase medicine, standby;
Alcohol-extracted extract prepared by step (2) adds in water emulsifiable paste matrix, in 65 ℃ of insulations, makes water medicine, standby;
By oil phase medicine and water medicament mixed, stir and be chilled to room temperature.
3. the Chinese medicinal ointment for the treatment of shoulder-hand syndrome according to claim 1, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 5g, Rhizoma Chuanxiong 5g, Radix Paeoniae Rubra 12g, Radix Aconiti 7g, Radix Aconiti Lateralis Preparata 5g, Ramulus Cinnamomi 7g, Pericarpium Zanthoxyli 6g, Radix Saposhnikoviae 5g, Radix Salviae Miltiorrhizae 5g, Radix Angelicae Pubescentis 8g, Rhizoma Et Radix Notopterygii 6g, Radix Cynanchi Paniculati 5g, Herba Asari 1g, 90g makes with emulsifiable paste matrix, and preparation is with claim 1.
4. the Chinese medicinal ointment for the treatment of shoulder-hand syndrome according to claim 1, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 15g, Rhizoma Chuanxiong 15g, Radix Paeoniae Rubra 20g, Radix Aconiti 15g, Radix Aconiti Lateralis Preparata 18g, Ramulus Cinnamomi 20g, Pericarpium Zanthoxyli 18g, Radix Saposhnikoviae 12g, Radix Salviae Miltiorrhizae 18g, Radix Angelicae Pubescentis 18g, Rhizoma Et Radix Notopterygii 18g, Radix Cynanchi Paniculati 15g, Herba Asari 3g, 110g makes with emulsifiable paste matrix, and preparation is with claim 1.
5. the Chinese medicinal ointment for the treatment of shoulder-hand syndrome according to claim 1, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 6-9g, Rhizoma Chuanxiong 6-11g, Radix Paeoniae Rubra 13-14g, Radix Aconiti 8-9g, Radix Aconiti Lateralis Preparata 6-11g, Ramulus Cinnamomi 8-9g, Pericarpium Zanthoxyli 7-14g, Radix Saposhnikoviae 6-8g, Radix Salviae Miltiorrhizae 6-9g, Radix Angelicae Pubescentis 9-11g, Rhizoma Et Radix Notopterygii 7-11g, Radix Cynanchi Paniculati 6-8g, Herba Asari 1-2g, 90-100g makes with emulsifiable paste matrix, and preparation is with claim 1.
6. the Chinese medicinal ointment for the treatment of shoulder-hand syndrome according to claim 1, it is characterized in that, by the material medicine of following weighing scale: Radix Angelicae Sinensis 11-14g, Rhizoma Chuanxiong 13-14g, Radix Paeoniae Rubra 16-19g, Radix Aconiti 11-14g, Radix Aconiti Lateralis Preparata 13-17g, Ramulus Cinnamomi 11-19g, Pericarpium Zanthoxyli 16-17g, Radix Saposhnikoviae 10-11g, Radix Salviae Miltiorrhizae 11-17g, Radix Angelicae Pubescentis 13-17g, Rhizoma Et Radix Notopterygii 13-17g, Radix Cynanchi Paniculati 10-14g, Herba Asari 2-3g, 100-110g makes with emulsifiable paste matrix, and preparation is with claim 1.
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| CN103705748B (en) * | 2014-01-02 | 2015-09-09 | 张建雷 | A kind of medicament for the treatment of shoulder-hand syndrome |
| CN104398828A (en) * | 2014-01-02 | 2015-03-11 | 王芳 | Medicament for treating shoulder-hand syndrome |
| CN104274555B (en) * | 2014-10-31 | 2017-01-18 | 河南中医学院 | Traditional Chinese medicine composition for treating rheumatism, ointment and preparation method of traditional Chinese medicine composition |
| CN104998001A (en) * | 2015-07-04 | 2015-10-28 | 孙艳玲 | Traditional Chinese medicine composition for adjunctive treatment of stage I shoulder-hand syndrome |
| CN109602827A (en) * | 2018-12-28 | 2019-04-12 | 北京梅林科技有限公司 | A kind of Chinese medicine composition and its preparation method and application |
| CN114191468A (en) * | 2022-01-21 | 2022-03-18 | 北京市怀柔区中医医院 | Arthralgia removing prescription and application thereof in treating shoulder-hand syndrome after stroke |
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