针刀治疗顽固性呃逆32例疗效观察和机制探讨

Observation and mechanism of acupotomology in treating 32 cases of intractable hiccup

目的:针刀松解顽固性呃逆患者的脊柱带区有关病变的软组织,消除粘连、挛缩、瘢痕、堵塞等病理因素,使受牵拉卡压的迷走神经、膈神经、交感神经的生理功能得以恢复;观察其治疗效果并探讨其机制。中医杂症之呃有因于气逆,有因于寒,有因于热,有因于食滞,有因于气滞,实者多气疾火郁,虚者脾肾阳虚与胃阴不足;虽然病在胸膈,却病及心、肝、脾、胃、肾等诸脏腑;而病变软组织对支配上述脏腑的神经(迷走神经、膈神经、交感神经)的牵拉卡压是脏腑功能失调的根本因素。选择32例适宜针刀治疗的呃逆患者,针刀松解其神经易牵拉卡压的部位,观察、统计、随访。具体方法:①针刀松解双侧茎突前缘(翳风,迷走神经易牵拉卡压部位),②针刀松解双侧颈3、4、5横突后结节(扶突、天鼎,膈神经易牵拉卡压部位),③针刀松解胸1～12棘突间韧带及双侧椎间孔外口(督脉和华佗夹脊穴,交感神经易牵拉卡压部位),④针刀松解腰1、2、3横突尖及双侧椎间孔外口。根据病情轻重选取松解部位,每周1～2次,4周为1个疗程,1～3疗程评定效果。结果:一疗程治愈27例,随访一年无复发占84.4%,显效2例占6.3%,有效1例占3%,无效2例占6.3%。结论:针刀治疗,效果显著,说明,病变软组织对支配脏腑的神经的牵拉卡压是脏腑功能失调的根本因素,是呃逆的基本病因。这一机制是比较科学的,这种治疗方法值得推广。

Objective: By relieving the soft tissue in the spinal band of patients with intractable hiccup, acupotomer can eliminate the pathological factors such as adhesion, contracture, scar and blockage, so as to restore the physiological functions of the vagus nerve, phrenic nerve and sympathetic nerve under the tension and compression. To observe its therapeutic effect and explore its mechanism. The miscellaneous symptoms of TCM, hiccup, are caused by qi inversion, cold, heat, food stagnation and qi stagnation. Although the disease is in chest septum, and heart, liver, spleen, stomach, kidney and other viscera are affected;And the traction of the affected soft tissue is related to the nerve (vagus nerve, phrenic nerve, sympathetic nerve) and innervates above viscera is the fundamental factor of the dysfunction of viscera. Thirty-two cases of hiccup patients who were suitable for acupotomology were selected, and acupotomology was used to release the part where the nerve was easy to pull and hold pressure, for observation, statistics and follow-up. Methods: Acupotomer was applied to release:(1) Bilateral anterior margin of stem process (pannus, vagal nerve tractive compression site);(2) Bilateral cervical nodules 3, 4, and 5 transverse posterior nodules (ataxon, tianding, phrenic nerve easily pulled and jammed);(3) Thoracic 1-12 interspinous ligaments and external openings of bilateral intervertebral foramen;(4) Lumbar 1, 2, 3 transverse apical and bilateral intervertebral foramen. The release site was selected according to the severity of the disease, with 1-2 times per week, 1 course of treatment was for 4 weeks and the effect was evaluated after 1-3 courses. Results: 27 cases were cured in one course of treatment, and 84.4% of them were free of recurrence in one year of follow-up, with obvious effect (6.3%) in 2 cases, effective (3%) in 1 case and ineffective (6.3%) in 2 cases. Conclusions: Acupotomology had a remarkable effect, indicating that the traction of the affected soft tissue to the nerves that controlled zang-fu was the fundamental factor of the dysfunction of zang-fu and the basic cause of hiccup. The mechanism was relatively scientific, and the treatment was worth spreading.