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Article(id=1322922752319037618, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.020, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793338962869, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338962869, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338962869, creator=13701087609, updateTime=1793338962869, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=88, endPage=91, ext={EN=ArticleExt(id=1322922752570695859, articleId=1322922752319037618, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Changes of Bradykinin and Interleukin-1β in Patients with Chronic Frozen Shoulder Treated with Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）Assisting Tuina Therapy, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effect of Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）assisting Tuina therapy for chronic frozen shoulder on the changes of bradykinin（BK）and interleukin-1β（IL-1β）in patients.

Methods

One hundred patients with chronic frozen shoulder admitted to the Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from May 2022 to April 2023 were selected，and were divided into the Tuina group and the Modified Shentong Zhuyu Decoction group by the randomized numerical method. The Tuina group was treated with Tuina therapy，and the Modified Shentong Zhuyu Decoction group was treated with Modified Shentong Zhuyu Decoction on the basis of Tuina therapy，and the clinical effects of the two groups were analyzed.

Results

The total effective rate was 96.00%（clinical cure rate 28.00% +significant effect rate 42.00% +effective rate 26.00%）in the Modified Shentong Zhuyu Decoction group was higher than that（84.00%）（clinical cure rate 18.00%+significant effect rate 36.00%+effective rate 30.00%）in the Tuina group，with a significant difference（P<0.05）. Before treatment，there was no difference in bradykinin（BK），5-hydroxytryptamine（5-HT）or inflammatory factors between the Tuina group and the Modified Shentong Zhuyu Decoction group（P>0.05）. The levels of BK，interleukin-18（IL-18），5-HT，IL-1β，interleukin-32（IL-32）and granulocyte-macrophage colony-stimulating factor（GM-CSF）were lower in the Tuina and Modified Shentong Zhuyu Decoction groups compared with those before treatment（P<0.05），and they were lower in the Modified Shentong Zhuyu Decoction group compared with those in the Tuina group（P<0.05）. Before treatment，there was no difference between the McGill Pain Questionnaire score and American Shoulder and Elbow Surgeons'Score（ASES）in the Tuina group and the Modified Shentong Zhuyu Decoction group（P>0.05）. McGill scores were lower in the Tuina and Modified Shentong Zhuyu Decoction groups than those before treatment（P<0.05），and lower in the Modified Shentong Zhuyu Decoction group than those in the Tuina group（P<0.05）. ASESscores were lower（P<0.05）in the Tuina and Modified Shentong Zhuyu Decoction groups than those before treatment，and the score in the Modified Shentong Zhuyu Decoction group higher（P<0.05）than that in the Tuina group.

Conclusion

Modified Shentong Zhuyu Decoction assisting Tuina therapy for chronic frozen shoulder can reduce the expressions of BK，5-HT and Inflammatory Factors and improve the daily living ability.

, authors=Jun YU, Wenjun KUI, Chunchun XUE, Zhen GU, Lei XIE, Aiping HUANG, Shuyi KONG, Kaiqiang WANG, authorsList=Jun YU, Wenjun KUI, Chunchun XUE, Zhen GU, Lei XIE, Aiping HUANG, Shuyi KONG, Kaiqiang WANG, authorCompany=null, correspAuthors=Kaiqiang WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322922753787044028, articleId=1322922752319037618, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对缓激肽、白细胞介素-1β变化的研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

研究身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对患者缓激肽（Bradykinin，BK）、白细胞介素-1β（Interleukin-1β，IL-1β）的变化影响。

方法

选取2022年5月—2023年4月上海中医药大学附属市中医医院收治的100例慢性肩周炎患者，以随机数字法分为推拿组和身痛逐瘀汤组。推拿组给予推拿疗法治疗，身痛逐瘀汤组在推拿疗法基础上给予身痛逐瘀汤加味治疗，分析两组的临床效果。

结果

身痛逐瘀汤组总有效率96.00%（48/50）高于推拿组84.00%（42/50），差异有统计学意义（P<0.05）。治疗前，推拿组和身痛逐瘀汤组BK、5-羟色胺（5-Hydroxytryptamine，5-HT）、炎症因子比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组BK、白细胞介素-18（Interleukin-18，IL-18）、5-HT、IL-1β、白细胞介素-32（Interleukin-32，IL-32）、粒细胞-巨噬细胞集落刺激因子（Granulocyte macrophage colony stimulating factor，GM-CSF）较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。治疗前，推拿组和身痛逐瘀汤组McGill疼痛问卷评分、美国肩肘外科医师评分（ASES）评分比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组McGill评分较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。推拿组和身痛逐瘀汤组美国肩肘外科医师评分（American Shoulder and Elbow Surgeons’Form，ASES）较前降低（P<0.05），身痛逐瘀汤组较推拿组更高（P<0.05）。

结论

身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎可降低BK、5-HT及炎症因子的表达，提高生活能力。

, authors=虞隽, 蒉文筠, 薛纯纯, 谷桢, 谢磊, 黄爱苹, 孔舒祎, 王开强, authorsList=虞隽, 蒉文筠, 薛纯纯, 谷桢, 谢磊, 黄爱苹, 孔舒祎, 王开强, authorCompany=null, correspAuthors=王开强, authorNote=

虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

, correspAuthorsNote=
王开强（1967-），男，山东滨州人，主任医师，博士，研究方向：中西医结合防治慢性疼痛的基础与临床。E-mail：。
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虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

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虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

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组别例数临床治愈显效有效无效总有效
推拿组509（18.00）18（36.00）15（30.00）8（16.00）42（84.00）
身痛逐瘀汤组5014（28.00）21（42.00）13（26.00）2（4.00）48（96.00）
χ2值4.000
P值0.046
), ArticleFig(id=1322922760883806451, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=CN, label=表1, caption=

两组慢性肩周炎患者疗效比较

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组别例数临床治愈显效有效无效总有效
推拿组509（18.00）18（36.00）15（30.00）8（16.00）42（84.00）
身痛逐瘀汤组5014（28.00）21（42.00）13（26.00）2（4.00）48（96.00）
χ2值4.000
P值0.046
), ArticleFig(id=1322922760955109620, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数BK/（pg/mL）5-HT/（μg/L）
治疗前治疗后治疗前治疗后
推拿组5022.85±4.0211.52±3.23*22.36±3.8917.45±2.56*
身痛逐瘀汤组5022.91±3.957.85±1.86*22.27±4.0213.54±2.12*
t值0.0756.9620.1148.318
P值0.4700.0000.4550.000
), ArticleFig(id=1322922761038995701, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=CN, label=表2, caption=

两组慢性肩周炎患者BK、5-HT水平比较（±s）

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组别例数BK/（pg/mL）5-HT/（μg/L）
治疗前治疗后治疗前治疗后
推拿组5022.85±4.0211.52±3.23*22.36±3.8917.45±2.56*
身痛逐瘀汤组5022.91±3.957.85±1.86*22.27±4.0213.54±2.12*
t值0.0756.9620.1148.318
P值0.4700.0000.4550.000
), ArticleFig(id=1322922761110298870, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IL-18/（pg/mL）IL-32/（pg/mL）IL-1 β/（ng/L）GM-CSF/（μg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
推拿组5062.58±8.4150.23±6.94*108.56±38.4774.15±24.76*91.58±10.1474.12±8.41*1.52±0.470.57±0.18*
身痛逐瘀汤组5062.43±9.2343.12±5.48*110.14±35.9460.23±18.89*90.86±11.4768.23±6.47*1.55±0.450.48±0.12*
t值0.0855.6850.2123.1610.3333.9250.3262.942
P值0.4660.0000.4160.0010.3700.0000.3730.002
), ArticleFig(id=1322922761202573559, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=CN, label=表3, caption=

两组慢性肩周炎患者炎症因子水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IL-18/（pg/mL）IL-32/（pg/mL）IL-1 β/（ng/L）GM-CSF/（μg/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
推拿组5062.58±8.4150.23±6.94*108.56±38.4774.15±24.76*91.58±10.1474.12±8.41*1.52±0.470.57±0.18*
身痛逐瘀汤组5062.43±9.2343.12±5.48*110.14±35.9460.23±18.89*90.86±11.4768.23±6.47*1.55±0.450.48±0.12*
t值0.0855.6850.2123.1610.3333.9250.3262.942
P值0.4660.0000.4160.0010.3700.0000.3730.002
), ArticleFig(id=1322922761294848248, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数McGill评分ASES评分
治疗前治疗后治疗前治疗后
推拿组5034.85±4.8912.20±2.54*13.56±2.5119.85±3.29*
身痛逐瘀汤组5034.92±5.028.47±2.41*13.52±2.5823.78±4.17*
t值0.0717.5330.0795.232
P值0.4720.0000.4690.000
), ArticleFig(id=1322922761382928633, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922752319037618, language=CN, label=表4, caption=

两组慢性肩周炎患者McGill评分、ASES评分比较（±s）

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组别例数McGill评分ASES评分
治疗前治疗后治疗前治疗后
推拿组5034.85±4.8912.20±2.54*13.56±2.5119.85±3.29*
身痛逐瘀汤组5034.92±5.028.47±2.41*13.52±2.5823.78±4.17*
t值0.0717.5330.0795.232
P值0.4720.0000.4690.000
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身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对缓激肽、白细胞介素-1β变化的研究
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虞隽 , 蒉文筠 , 薛纯纯 , 谷桢 , 谢磊 , 黄爱苹 , 孔舒祎 , 王开强
中华中医药学刊 | 国家项目点击 2025,43(2): 88-91
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中华中医药学刊 |国家项目点击 2025 , 43 (2) : 88 -91
身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对缓激肽、白细胞介素-1β变化的研究
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虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

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虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

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虞隽, 蒉文筠, 薛纯纯, 谷桢, 谢磊, 黄爱苹, 孔舒祎, 王开强
作者信息
  • 上海中医药大学附属市中医医院，上海 200071
通讯作者:
王开强（1967-），男，山东滨州人，主任医师，博士，研究方向：中西医结合防治慢性疼痛的基础与临床。E-mail：。
作者简介:

虞隽（1977-），男，浙江鄞县人，主治医师，硕士，研究方向：中西医结合防治慢性疼痛。

Changes of Bradykinin and Interleukin-1β in Patients with Chronic Frozen Shoulder Treated with Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）Assisting Tuina Therapy
Jun YU, Wenjun KUI, Chunchun XUE, Zhen GU, Lei XIE, Aiping HUANG, Shuyi KONG, Kaiqiang WANG
Affiliations
  • Shanghai Municipal Hospital of Traditional Chinese Medicine，Shanghai University of Traditional Chinese Medicine，Shanghai 200071，China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.020
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摘要
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目的

研究身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对患者缓激肽（Bradykinin，BK）、白细胞介素-1β（Interleukin-1β，IL-1β）的变化影响。

方法

选取2022年5月—2023年4月上海中医药大学附属市中医医院收治的100例慢性肩周炎患者，以随机数字法分为推拿组和身痛逐瘀汤组。推拿组给予推拿疗法治疗，身痛逐瘀汤组在推拿疗法基础上给予身痛逐瘀汤加味治疗，分析两组的临床效果。

结果

身痛逐瘀汤组总有效率96.00%（48/50）高于推拿组84.00%（42/50），差异有统计学意义（P<0.05）。治疗前，推拿组和身痛逐瘀汤组BK、5-羟色胺（5-Hydroxytryptamine，5-HT）、炎症因子比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组BK、白细胞介素-18（Interleukin-18，IL-18）、5-HT、IL-1β、白细胞介素-32（Interleukin-32，IL-32）、粒细胞-巨噬细胞集落刺激因子（Granulocyte macrophage colony stimulating factor，GM-CSF）较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。治疗前，推拿组和身痛逐瘀汤组McGill疼痛问卷评分、美国肩肘外科医师评分（ASES）评分比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组McGill评分较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。推拿组和身痛逐瘀汤组美国肩肘外科医师评分（American Shoulder and Elbow Surgeons’Form，ASES）较前降低（P<0.05），身痛逐瘀汤组较推拿组更高（P<0.05）。

结论

身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎可降低BK、5-HT及炎症因子的表达，提高生活能力。

身痛逐瘀汤加味  /  推拿疗法  /  慢性肩周炎  /  缓激肽  /  炎症因子
Objective

To study the effect of Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）assisting Tuina therapy for chronic frozen shoulder on the changes of bradykinin（BK）and interleukin-1β（IL-1β）in patients.

Methods

One hundred patients with chronic frozen shoulder admitted to the Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from May 2022 to April 2023 were selected，and were divided into the Tuina group and the Modified Shentong Zhuyu Decoction group by the randomized numerical method. The Tuina group was treated with Tuina therapy，and the Modified Shentong Zhuyu Decoction group was treated with Modified Shentong Zhuyu Decoction on the basis of Tuina therapy，and the clinical effects of the two groups were analyzed.

Results

The total effective rate was 96.00%（clinical cure rate 28.00% +significant effect rate 42.00% +effective rate 26.00%）in the Modified Shentong Zhuyu Decoction group was higher than that（84.00%）（clinical cure rate 18.00%+significant effect rate 36.00%+effective rate 30.00%）in the Tuina group，with a significant difference（P<0.05）. Before treatment，there was no difference in bradykinin（BK），5-hydroxytryptamine（5-HT）or inflammatory factors between the Tuina group and the Modified Shentong Zhuyu Decoction group（P>0.05）. The levels of BK，interleukin-18（IL-18），5-HT，IL-1β，interleukin-32（IL-32）and granulocyte-macrophage colony-stimulating factor（GM-CSF）were lower in the Tuina and Modified Shentong Zhuyu Decoction groups compared with those before treatment（P<0.05），and they were lower in the Modified Shentong Zhuyu Decoction group compared with those in the Tuina group（P<0.05）. Before treatment，there was no difference between the McGill Pain Questionnaire score and American Shoulder and Elbow Surgeons'Score（ASES）in the Tuina group and the Modified Shentong Zhuyu Decoction group（P>0.05）. McGill scores were lower in the Tuina and Modified Shentong Zhuyu Decoction groups than those before treatment（P<0.05），and lower in the Modified Shentong Zhuyu Decoction group than those in the Tuina group（P<0.05）. ASESscores were lower（P<0.05）in the Tuina and Modified Shentong Zhuyu Decoction groups than those before treatment，and the score in the Modified Shentong Zhuyu Decoction group higher（P<0.05）than that in the Tuina group.

Conclusion

Modified Shentong Zhuyu Decoction assisting Tuina therapy for chronic frozen shoulder can reduce the expressions of BK，5-HT and Inflammatory Factors and improve the daily living ability.

Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）  /  Tuina therapy  /  chronic periarthritis of shoulder  /  bradykinin  /  inflammatory factor
虞隽, 蒉文筠, 薛纯纯, 谷桢, 谢磊, 黄爱苹, 孔舒祎, 王开强. 身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎疗效及对缓激肽、白细胞介素-1β变化的研究. 中华中医药学刊, 2025 , 43 (2) : 88 -91 . DOI: 10.13193/j.issn.1673-7717.2025.02.020
Jun YU, Wenjun KUI, Chunchun XUE, Zhen GU, Lei XIE, Aiping HUANG, Shuyi KONG, Kaiqiang WANG. Changes of Bradykinin and Interleukin-1β in Patients with Chronic Frozen Shoulder Treated with Modified Shentong Zhuyu Decoction（身痛逐瘀汤加味）Assisting Tuina Therapy[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 88 -91 . DOI: 10.13193/j.issn.1673-7717.2025.02.020
正文
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慢性肩周炎又称“五十肩”，好发于40～60岁的中老年人群，患者肩关节周围肌肉、肌腱、关节囊、滑囊等发生慢性非特异性炎症反应，可引起颈肩痛、活动障碍等症状，进而影响患者的生活质量[1]。现代医学治疗慢性肩周炎尚无特效方法，多以抗炎镇痛药物、运动康复、理疗、手法松解等为主，可在一定程度上缓解症状。药物治疗易引起一定的不良反应，增加患者额外的痛苦。推拿手法可使局部痉挛的肌肉松弛，改善血液循环，缓解水肿，在慢性肩周炎的治疗中应用较多[2]。
中医学理论将慢性肩周炎归纳于“痹证”“肩凝”等范畴，探究其理为外感风寒湿邪、创伤或慢性劳损等引起的寒凝筋脉，气血瘀滞，以致筋失所养，筋脉拘急，不通则痛。加之年老之人素体虚弱，气血不足，不能荣养筋脉，不荣则痛[3]。身痛逐瘀汤方出自《医林改错》，功擅活血祛瘀、祛风除湿，对痹症有瘀血者效果尤佳[4]。本研究分析了身痛逐瘀汤加味辅以推拿疗法治疗慢性肩周炎对患者缓激肽（Bradykinin，BK）、白细胞介素-1β（Interleukin-1β，IL-1β）变化的影响。
1　资料与方法
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1.1　一般资料
本研究选取上海中医药大学附属市中医医院2022年5月—2023年4月间收治的100例慢性肩周炎患者作为对象研究，以随机数字法分为两组。纳入标准：（1）西医符合《肩关节周围炎》[5]诊疗标准中标准；（2）中医符合《中医骨伤科常见病诊疗指南》[6]血瘀气滞证标准：肩部肿胀，疼痛拒按，呈夜间加重，舌质淡有瘀斑，舌苔白或薄黄，脉弦或细涩；（3）年龄40～65岁；（4）视觉疼痛评分（Visual analogue scale，VAS）≥4分；（5）患者及家属签署知情同意书。排除标准：（1）伴严重心、脑、肝、肾及造血系统疾病者；（2）由其他原因引起肩部疼痛者，如肩袖损伤、肩关节结核、胆囊炎等；（3）伴肩关节其他类型疾病；（4）伴有癌症或严重精神疾病；（5）孕期、备孕或妊娠期；（6）过敏体质。推拿组50例，男28例，女22例；年龄40～65（56.09±9.77）岁；病程6～12（9.74±1.45）个月。身痛逐瘀汤组50例，男27例，女23例；年龄40～65（55.87±10.14）岁；病程6～12（9.82±1.36）个月。组间一般资料比较，差异无统计学意义（P>0.05）。本研究经上海中医药大学附属市中医医院医学伦理委员会审核通过。
1.2　方法
推拿组给予推拿疗法治疗，患者取坐位，医者立于患者身后，以拇指重揉肩髃、肩井、肩贞及肩三俞及阿是穴时长约15 min。以揉捻法、按摩患侧肩胛部及上臂时长约15 min。被动上举、外展、外旋及内收等患肢时长约10 min。推拿治疗1次/d。
身痛逐瘀汤组给予身痛逐瘀汤加味辅助推拿疗法治疗，身痛逐瘀汤加味方用：杜仲15 g，补骨脂15 g，桑寄生15 g，川芎10 g，桃仁10 g，红花10 g，秦艽10 g，地龙10 g，当归10 g，羌活10 g，木香10 g，牛膝10 g，没药6 g，五灵脂6 g，香附6 g，甘草6 g。制药方法：水煎取汁400 mL。用药剂量：上药1剂/d，分早晚温服。用药疗程：两组患者均连续治疗4周。
1.3　检测方法
于治疗前、治疗4周后采集患者晨起空腹时静脉血5 mL后分离血清检测各细胞水平。检测方法：采用酶联免疫吸附法试剂盒（南京建成生物工程研究所）检测缓激肽（Bradykinin，BK）、5-羟色胺（5-Hydroxytryptamine，5-HT）、白细胞介素-18（Interleukin-18，IL-18）、白细胞介素-32（Interleukin-32，IL-32）、IL-1β、粒细胞-巨噬细胞集落刺激因子（Granulocyte macrophage colony stimulating factor，GMCSF）水平。检测仪器：酶标仪（美国Hyperion公司，型号：MRⅢ型）。
1.4　观察指标
疗效标准[7]：（1）临床治愈：连续4周的治疗，无疼痛，肩关节正常活动，肌力正常；（2）显效：连续4周的治疗，疼痛显著减轻，肩关节活动范围和肌力显著改善；（3）有效：连续4周的治疗，疼痛有所好转，肩关节活动范围和肌力有所改善；（4）无效：疼痛、肌力等均无改善。
主观疼痛程度采用McGill评分评价，包括疼痛分级指数（0～45分）、视觉疼痛评分（0～10分）及现在疼痛状况（0～5分），分数越高，疼痛越厉害。
采用美国肩肘外科医师评分（American Shoulder and Elbow Surgeons’Form，ASES），10项内容，从轻至重分别记3～0分，分数越高，生活能力越好。
1.5　统计学方法
应用SPSS23.0对本研究得到的各种数据进行分析，涉及到的BK、5-HT及GM-CSF等计量方面的指标采用（）描述，行t检验，涉及的性别或疗效等计数方面的指标采用百分比表示，行χ2检验，P<0.05则差异有统计学意义。
2　结果
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2.1　疗效比较
身痛逐瘀汤组总有效率为96.00%，推拿组为84.00%，差异有统计学意义（P<0.05）。见表1。
2.2　BK、5-HT水平比较
治疗前，推拿组和身痛逐瘀汤组BK、5-HT比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组BK、5-HT较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。见表2。
2.3　炎症因子水平比较
治疗前，推拿组和身痛逐瘀汤组炎症因子比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组IL-18、IL-32、IL-1β、GM-CSF较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。见表3。
2.4　McGill评分、ASES评分比较
治疗前，推拿组和身痛逐瘀汤组McGill评分、ASES评分比较，差异无统计学意义（P>0.05）。推拿组和身痛逐瘀汤组McGill评分较前降低（P<0.05），身痛逐瘀汤组较推拿组更低（P<0.05）。推拿组和身痛逐瘀汤组ASES评分较前降低（P<0.05），身痛逐瘀汤组较推拿组更高（P<0.05）。见表4。
3　讨论
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慢性肩周炎是以肩部活动受限、强直、周围组织退变引起的关节炎症，其发病原因复杂，已有的研究认为可能与制动、退行性病变、内分泌异常、受凉、受潮、心理因素等有关[8]。目前临床对于肩周炎的治疗以手术治疗和非手术治疗为主，推拿、药物疗法、运动疗法、针灸、封闭疗法等均为非手术治疗方法[9]。推拿手法具有操作简便、效果确切、价格低廉等优势。肩髃可疏散风湿、通利关节；肩井可活血通络、行气化瘀；肩贞可通经活络、化瘀止痛；肩三俞包括肩中俞、肩外俞、肩内俞，可疏通经络、活血止痛；阿是穴无固定位置，以痛点为主。以肩为中心进行取穴推拿，具有舒筋通络、活血止痛、通利关节之功效[10]。
中医学理论认为，慢性肩周炎与素体虚弱、劳作过度、外感风、寒、湿邪有关，劳倦内伤损及筋脉，使气滞血瘀；中老年人气血不足，肝肾精亏，腠理空虚，使筋骨失荣；肩部感受外邪，阻痹气血等均可引起肩部经络阻滞不通，治则以补益肝肾、活血通络为法[11]。身痛逐瘀汤是中医活血逐瘀之古方，方中以杜仲、补骨脂、桑寄生共为君药，主在补益肝肾、强筋健骨。川芎、当归、没药、桃仁、红花为臣药，辅助以活血祛瘀、消肿止痛。佐以牛膝、五灵脂行血舒络且通痹止痛；秦艽、羌活祛风除湿且通经活络；香附、木香行气活血且通经止痛；地龙力专善走，周行全身，以行药力。甘草为使，缓急止痛、调和药性。上述诸药合用，共奏补益肝肾、活血通络之功效[12-13]。
本研究中采用身痛逐瘀汤加味联合推拿疗法治疗者总有效率更高，治疗后ASES评分高于单用推拿治疗者，McGill评分低于单用推拿治疗者。这一结果提示，身痛逐瘀汤加味联合推拿治疗慢性肩周炎具有更好的临床疗效，可促进疼痛消失、肩关节活动和肌力恢复正常。这是由于推拿手法可松解局部粘连的软组织，促进血液循环和局部营养、代谢，加速炎性渗出物吸收，推拿过程中产生的热力还可放松紧张的肌肉，提高患者的痛阈值而减轻疼痛[14]。身痛逐瘀汤加味方中杜仲、补骨脂、桑寄生、牛膝等补肾类中药可调节机体免疫功能，抑制过度炎症反应；川芎、当归、没药、桃仁、红花、五灵脂等活血化瘀类中药可改善局部微循环、抗血小板聚集、抗炎、抗氧化、镇痛[15]；秦艽、羌活、香附、木香可抗血小板聚集、抗血栓形成、改善微循环和抗炎；地龙具有抗凝血、抗血栓、抗炎、镇痛、耐缺氧、免疫调节等药理作用；甘草具有类似糖皮质激素样作用[16-17]。推拿与中药联合应用，可通过不同的作用途径发挥协同增效的作用。
BK可引起血管扩张、通透性增加，加重炎性渗出和肿胀程度[18-20]。5-HT是一种内源性炎性介质和致痛物质，在发生组织损伤时大量释放，可加重损伤部位组织炎症反应，促使伤害性感受器磷酸化而降低痛阈值，从而诱发疼痛[21-22]。IL-1β、IL-18、IL-32可诱导免疫细胞产生多种炎性细胞因子，参与组织炎性损伤和细胞凋亡过程[23-25]。GM-CSF是由损伤的内皮细胞释放的一种多肽类激素样造血生长因子，是炎症反应的敏感标志物[26-27]。本研究中采用身痛逐瘀汤加味联合推拿治疗者治疗后血清BK、5-HT、IL-18、IL-32、IL-1β、GM-CSF水平更低。这一结果提示，身痛逐瘀汤加味联合推拿治疗慢性肩周炎有助于减轻患者炎症反应，降低致痛因子表达。
综上所述，身痛逐瘀汤加味联合推拿治疗慢性肩周炎可减轻机体炎症反应，降低致痛因子的表达水平而减轻疼痛，提高生活能力。
基金
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  • 国家自然科学基金项目(81804122)
  • 上海市科技计划项目(20Y21903100)
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doi: 10.13193/j.issn.1673-7717.2025.02.020
  • 首发时间：2026-10-30
  • 出版时间：2025-02-10
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国家自然科学基金项目(81804122)
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    上海中医药大学附属市中医医院，上海 200071

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王开强（1967-），男，山东滨州人，主任医师，博士，研究方向：中西医结合防治慢性疼痛的基础与临床。E-mail：。
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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