范炳华教授“症因相关”论治膝痹及应用举隅

FAN Binghua’s Experience in Treatment of Knee Paralysis

[目的]介绍范炳华教授"症因相关"思想在膝痹推拿治疗上的应用,初步阐述如何建立症因相关思维。[方法]通过跟诊范炳华教授,收集资料并进行总结归纳,从资料收集、相关性分析和具体手法实施三个方面阐述症因相关理论在膝痹治疗上的应用,同时列举病案进行分析。[结果]范炳华教授诊治膝痹患者时要求问诊全面,强调触诊的重要性,重视负重情况下的影像学检查,同时建议对膝痹患者的步态进行分析。范教授认为,症因相关思维应建立在熟悉相关部位的解剖及生物力学的前提下,手法使用上要求施术者注意手法作用点、作用力大小、作用力方向三要素,同时结合相关特效手法如关节杠杆扳法、推髌法等。所举验案中,范教授结合患者症状、既往生活史、触诊结果,分析出患者膝痹致病原因可能为股神经卡压,辨因论治,对股神经进行针对性手法治疗,取得显著疗效。[结论]范炳华教授"症因相关"治疗膝痹,要求医者全面收集患者信息,分析病因,建立症状和病因的逻辑分析,根据不同病因,采用不同手法。此临床思路可有效提高临床治疗膝痹的疗效。

[Objective]To introduce the application of Professor FAN Binghua’s thoughts of"correlation between symptoms and causes"in massage treatment of knee paralysis,and preliminarily expound how to establish the thoughts "correlation between symptoms and causes"in clinic. [Methods]Through following Professor FAN Binghua’s clinic works,collecting and summarizing the data,the application of the theory of"correlation between symptoms and causes"was described from following aspects: Information collection,correlation analysis between symptoms and causes and the implementation of specific methods in the treatment of knee paralysis. One case was presented as proof. [Results]As to how to collect the patient ’s information,Professor FAN Binghua pays much attention to the inquiry of patient,the technique of palpation,and imaging examination on loading of the affected knee,and the gait analysis. As for building the correlation between symptoms and causes,a comprehensive understanding of the anatomy and biomechanics of the knee should be laid in the first place. As to the technique of Tuina,Professor FAN Binghua emphasizes the manipulation point,the size of force,direction of the force and combined with the special manipulation such as joint lever pulling manipulation,patella pushing manipulation. In this case,through analysis of the patient’s symptoms,past history and the result of palpation,Professor FAN Binghua analyzed that the cause of knee paralysis might be femoral nerve compression,and selected the appropriate Tuina methods to release the femoral nerve according to the analysis,which achieved good curative effect. [Conclusion]Professor FAN Binghua’s treatment of knee paralysis with "correlation between symptoms and causes"requires doctors to collect patients’ information comprehensively,analyze the causes,establish logical analysis of symptoms and causes,and adopt different methods according to different causes. The clinical thoughts can effectively improve the clinical treatment of knee paralysis.