课程思政视域下“中医学”融入中医药文化的教学探讨

中医学是中国传统文化的重要组成部分,中医药文化中蕴含着丰富的思政教育元素。本文分析了中医学课程思政融入中医药文化的必要性及两者融合的意义,提出加强师资队伍建设、深化教学改革、健全考核评价机制等路径,全面推进学科发展与课程思政建设相结合,达到两者的协同发展。

针刺足三里得气对脑功能活动影响的系统评价

目的:评价针刺足三里后得气状态相较于静息状态激活的脑区。方法:检索国内外10个医学文献数据库以及5个临床试验注册平台,系统收集以fMRI为观察指标,比较针刺足三里后得气状态相较于静息状态的不同脑活动临床试验文献。采用SDM软件进行体素Meta分析。结果:最终纳入10篇文献,共185名受试者。均值分析的结果显示,针刺足三里后有5个脑区的活动较静息状态更为活跃,包括右额下回、眶部、右中值扣带/扣带旁回、右缘上回以及右脑桥。结论:初步认为,针刺足三里后得气状态相较于静息状态有更多更强烈的脑区激活,且针刺足三里得气后激活的脑部区域与足三里的主治功能有一定关联。

不同时机电针对寒湿凝滞证原发性痛经镇痛效应的影响

目的探讨不同时机电针对寒湿凝滞证原发性痛经(PD)镇痛效应的影响。方法选取2018年12月至2020年12月首都医科大学电力教学医院门诊纳入的72例寒湿凝滞证PD患者为研究对象,采用随机数字表法将其分为经前组和经期组,各36例。两组均取三阴交、地机和悬钟,电针30 min,连续治疗3个月经周期,随访2个月经周期。采用疼痛视觉模拟评分法(VAS)和伴随症状严重程度评分(RSS-COX2)评价临床症状。结果整体分析发现:组间比较及交互作用的VAS评分比较,差异均无统计学意义(P>0.05);时间点VAS评分比较,差异有统计学意义(P<0.05)。第1~5周期的VAS评分与治疗前比较均降低,第2~5周期VAS评分与第1周期比较均降低,第3~5周期VAS评分较第2周期降低,第4~5周期的VAS评分较第3周期降低,第5周期VAS评分较第4周期降低,差异有统计学意义(P<0.05)。整体分析:组间比较、时间点比较及交互作用RSS-COX2评分差异均有统计学意义(P<0.05)。组内比较:第1~5周期RSS-COX2评分较治疗前降低,第2~5周期RSS-COX2评分较第1周期降低,第3~5周期的RSS-COX2评分较第2周期降低,第4~5周期RSS-COX2评分较第3周期降低,第5周期RSS-COX2较第4周期降低,差异均有统计学意义(P<0.05)。组间比较:从第2~5周期,经期组RSS-COX2评分高于经前组(P<0.05)。结论经前及经期电针对寒湿凝滞证PD均能显著缓解疼痛及伴随症状,经前治疗改善伴随症状优于经期。

针刺改善结直肠癌腹膜转移患者营养不良的临床研究

目的观察针刺改善结直肠癌腹膜转移患者营养不良的疗效。方法将84例结直肠癌腹膜转移伴营养不良患者,随机分为治疗组(n=42)和对照组(n=42),治疗组采取针刺联合常规营养治疗,对照组采取常规营养治疗,分析治疗6周前后主观整体评估量表评分、摄食改善率、体质量指数、前白蛋白和白蛋白变化,观察针刺改善营养不良的疗效。结果经治疗6周后,2组主观整体评估量表评分均较治疗前明显下降,摄食改善率、体质量指数、前白蛋白、白蛋白均有升高(P<0.05),且治疗组疗效优于对照组(P<0.05)。结论针刺有助于改善结直肠癌腹膜转移患者的营养不良。

近10年基于fMRI的得气研究概况

目的:总结以功能性磁共振成像(fMRI)技术研究针刺得气的中枢机制领域的研究内容,探讨已有的研究成果和取得的经验教训。方法:检索2007年1月至2016年12月中国期刊全文数据库(CNKI)、Pub Med数据库有关fMRI得气研究的文献,对纳入的文献从研究内容和研究方法(试验设计、受试者纳入、穴位选取以及得气评价方法)上进行分析。结果:最终纳入18篇以fMRI技术研究得气中枢机制的文献。根据纳入文献的研究内容,大体可分为2个不同方向的得气中枢机制研究:得气研究以及得气感研究。得气研究多为比较得气与否在脑功能活动上的差异,以总结得气的中枢响应模式;得气感研究则是将得气状态下不同得气感及得气感强度在中枢反应上的特点进行比较,来归纳不同得气感成分及强度对脑功能活动的影响。近10年该类研究数量总体呈增长趋势,试验设计较为多样,以随机对照试验及配对试验设计较多。研究的受试对象以健康人为主,研究的穴位以单穴居多,研究的主要穴位有足三里、外关、合谷等。得气评价方法以采用视觉模拟量表(visual analogue scale,VAS)评分为主。研究内容主要分为得气与否及不同得气感对脑功能活动影响的研究。当前研究可证实得气与否及不同得气程度具有显著不同的脑功能活动,且不同腧穴得气有其特异性激活。得气感程度与脑区激活程度呈正相关。刺痛感不属于得气感成分。结论:当前的得气fMRI研究的数量及质量有待提升,研究内容相对单一,研究方法仍处于探索阶段。当前得气fMRI研究得到的结果多为得气反应于中枢层面的现象,而亟需通过这些现象总结出得气与中枢效应的本质联系,揭示得气的作用机制。得气对脑功能活动的特异性影响仍需要通过进一步的临床研究进行验证。

Influence of the quickness and duration of De Qi on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern

OBJECTIVE: To investigate the influence of the quickness and duration of De Qi(or Qi arrival) on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern.METHODS: Sixty-eight patients were randomly assigned to the De Qi group(deep needling with thick needles and manipulation, n = 17) or the non-De Qi group(shallow needling with thin needles and no manipulation, n = 51). Both groups underwent needling at Sanyinjiao(SP 6) for 30 min.The visual analogue scale was used to measure the degree of menstrual pain, and the Acupuncture De Qi Clinical Assessment Scale was used to assess De Qi. Only data from patients who experienced actual De Qi were included in the analysis.RESULTS: Thirty-nine patients experienced actual De Qi. Patients who experienced actual De Qi in the De Qi group(n = 14) felt De Qi more rapidly(P =0.028) and for a longer duration(P = 0.04) than patients who experienced actual De Qi in the non-De Qi group(n = 25). Both groups showed a reduction in the visual analogue scale score for pain after treatment. The analgesic effect did not significantly differ between the two groups. The occurrence time of De Qi showed a significant negative correlation with pain reduction at 20 and 30 min after needle removal(P < 0.05). There was no correlation between the duration of De Qi and the therapeutic effect.CONCLUSION: In primary dysmenorrhea patients with a cold and dampness stagnation pattern,quicker onset of De Qi when needling Sanyinjiao(SP 6) achieves a better analgesic outcome. However, a longer duration of De Qi does not affect the degree of analgesia. Compared with minimal acupuncture, active acupuncture stimulation achieves a more rapid onset and longer duration of De Qi.

Applications of pain-related evoked potentials and short-latency somatosensory evoked potentials in acupuncture research:a narrative review

OBJECTIVE:To review and discuss the Chinese and English literature on the use of pain-related evoked potentials(PREP) and short-latency somatosensory EP(SLSEP) in acupuncture research.METHODS:China National Knowledge Infrastructure Database and MEDLINE were searched for the following key words:acupuncture and PREP or SLSEP.RESULTS:Thirty-seven articles were included in the review.Researchers usually use PREPs to study the analgesic effect of acupuncture,observe influential factors,or for mechanistic exploration.In the SLSEP studies,researchers focused on response characteristics of acupuncture,acupoint specificity,and influential factors of the treatment.There were some problems with the study design and conclusions.CONCLUSION:Researchers could use PREP and SLSEP to objectively validate the effects of acupuncture and explore its mechanisms using nerve electrophysiology.Further studies can benefit from observing more acupoints' effects using PREPs or SLSEPs and investigating the placebo effect of acupuncture.

A review of the methods used for subjective evaluation of De Qi

De Qi refers to a series of sensations experienced when acupuncture is performed at acupoints. De Qi comprises needling sensations felt by the patient, and the sensations perceived by the acupuncturist. Classical Traditional Chinese Medicine theory states that De Qi is closely related to curative effect.In modern studies, the main index that researchers have used to evaluate De Qi was the needling sensation reported by the patient. Between 1 st Aug and 31 st Oct 2014, we conducted an electronic database search of all fields in Chinese and English to select literature assessing acupuncture needle sensations. We then reviewed the methods used within these studies to evaluate De Qi. The methods included simple evaluation, and the use of a De Qi scale/questionnaire. The simple evaluation, a qualitative evaluation, was judged by typical sensations felt by the patient after needling at acupoints, such as soreness, numbness, fullness, and heaviness.This method was easy and practicable, and had been adopted widely by Chinese researchers. In contrast, the De Qi scale/questionnaire, a quantitative evaluation, had multiple compiling methods available for evaluating the intensity of De Qi. The standardization and objectification of the De Qi scale/questionnaire effectively improved the quality of studies on De Qi, thereby these scales/questionnaires have been acknowledged and applied by most researchers. The present review analyzed and compared the scales/questionnaires used to evaluate De Qi; furthermore, we provided suggestions for the development and improvement of these questionnaires through integration with classical De Qi theory.

Immediate analgesic effect of needling acupoints(bilateral De Qi vs unilateral De Qi)on primary dysmenorrhea:a multi-center,randomized,controlled trail

OBJECTIVE: To analyze the effect of needling acupoints(bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea(PD) patients participating in multi-center, randomized,controlled trail.METHODS: De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side(unilateral)or both sides(bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale(VAS).RESULTS: In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint,and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group.There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group(P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao(SP 6)and Xuanzhong(GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group(P < 0.05).CONCLUSION: Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the pa-tients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.