【摘要】 目的：观察桃红四物汤合五苓散加减联合中医整骨手法治疗气滞血瘀型急性期神经根型颈椎病（ACSR）的临床疗效。方法：选取2024年1—12月在绍兴市上虞区中医医院骨伤科康复门诊治疗的70例气滞血瘀型ACSR患者，按随机数字表法分成对照组与治疗组各35例。对照组给予中医整骨手法治疗，治疗组在此基础上加用桃红四物汤合五苓散加减治疗，2组均治疗3周。观察2组治疗前及治疗3周后中医证候积分、McGill疼痛问卷[疼痛分级指数（PRI）、视觉模拟评分法（VAS）、现有疼痛强度（PPI）]评分、颈椎功能障碍指数（NDI）评分、血液流变学指标（全血高切黏度、全血低切黏度、血细胞比容）及炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)]水平的变化，评估2组的临床疗效，观察治疗期间患者不良反应的发生情况。结果：治疗3周后，治疗组总有效率高于对照组（P<0.05）。2组颈部活动障碍、颈肩疼痛、颈部压痛、上肢麻木积分均较治疗前降低（P<0.05），治疗组上述4项中医证候积分均低于对照组（P<0.05）。2组PPI、PRI、VAS、NDI评分均较治疗前降低（P<0.05），治疗组上述4项评分均低于对照组（P<0.05）。2组全血高切黏度、全血低切黏度、血细胞比容值及血清TNF-α、IL-6、IL-1β水平均较治疗前降低（P<0.05），治疗组上述6项指标均低于对照组（P<0.05）。治疗期间，2组均未发生明显不良反应。结论：桃红四物汤合五苓散加减联合中医整骨手法治疗气滞血瘀型ACSR疗效确切，可有效改善患者的颈椎功能、缓解疼痛，且安全性良好，其作用机制可能与改善血液流变学，促进局部微循环，以及减轻炎症反应有关。更多还原

【Abstract】 Objective:To observe the clinical effect of modified Taohong Siwu Decoction plus Wuling Powder combined with traditional Chinese medicine(TCM) bone-setting manipulation in the treatment of acute cervical spondylotic radiculopathy(ACSR) of qi stagnation and blood stasis type. Methods:A total of 70 patients with ACSR of qi stagnation and blood stasis type,treated in the rehabilitation outpatient clinic of the Department of Orthopedics and Traumatology, Shaoxing Shangyu Hospital of Traditional Chinese Medicine, from January to December 2024, were selected. They were randomly divided into a control group and a treatment group using the random number table method,with 35 cases in each group. The control group received TCM bone-setting manipulation, while the treatment group additionally received modified Taohong Siwu Decoction plus Wuling Powder. Both groups were treated for three weeks. Changes in TCM syndrome scores, scores of the McGill Pain Questionnaire [Pain Rating Index(PRI), Visual Analogue Scale(VAS), Present Pain Intensity(PPI)], Neck Disability Index(NDI) scores, hemorheological indices(whole blood high-shear viscosity,whole blood low-shear viscosity,hematocrit),and levels of inflammatory factors [tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6)] were observed before and after three weeks of treatment. The clinical efficacy of the two groups was evaluated, and the incidence of adverse reactions during treatment was observed. Results:After three weeks of treatment, the total effective rate in the treatment group was higher than that in the control group(P<0.05). Scores for neck movement disorder, neckshoulder pain, neck tenderness, and upper limb numbness decreased in both groups compared with those before treatment(P<0.05),and these four TCM syndrome scores in the treatment group were lower than those in the control group(P<0.05). The scores of PPI, PRI, VAS, and NDI decreased in both groups compared with those before treatment(P<0.05), and these four scores in the treatment group were lower than those in the control group(P<0.05). The values of whole blood high-shear viscosity,whole blood low-shear viscosity,hematocrit,and serum levels of TNF-α,IL-6,and IL-1β decreased in both groups compared with those before treatment(P<0.05),and these six indices/levels in the treatment group were lower than those in the control group(P<0.05). No significant adverse reactions occurred during the treatment period.Conclusion:Modified Taohong Siwu Decoction plus Wuling Powder combined with TCM bone-setting manipulation is effective in treating ACSR of qi stagnation and blood stasis type. It can effectively improve cervical function and relieve pain,and it demonstrates favorable safety. Its mechanism of action may be related to improving hemorheology,promoting local microcirculation,and reducing inflammation.更多还原