曾斌芳教授“辛苦开郁法”治疗咽痹经验

曾斌芳教授临证治疗咽痹以少阴客邪上泛、风邪犯肺客咽、脾虚湿浊痹阻、实火循经夹咽4种证型统之。甘草汤主少阴客热咽痛,桔梗汤主少阴寒热相搏咽痛;银翘散为辛凉之平剂,主风热犯肺客咽;理中汤合牡蛎泽泻散以通阳气、散水结,湿浊蕴阻之咽痹;清胃散专治实火牙痛,使以桔梗、半夏假道上行至咽,清热肃咽,取"辛开苦降"之义;黛蛤散主木火刑金之咽痹,佐以左金丸,使以桔梗循经上咽,调其所胜之气,太过者折之,取"木郁达之"之义。究其辨治用药谨防寒凉用事,避其郁遏之弊,始终不离"郁"字,其治以"辛苦开郁"为法。

新制上焦宣痹汤治疗小儿咽源性咳嗽200例

因咽部疾病(咽炎、扁桃体炎)导致的咳嗽称为咽源性咳嗽,此种咳嗽在儿科门诊咳嗽患儿中占很大比例,且多数患儿就诊前已经多种抗生素及中、西止咳化痰药物治疗,效果不理想.导师经多年临床实践,化裁古方,创新制上焦宣痹汤,治疗小儿咽源性咳嗽,临床常获效验,现报道如下.

利咽止咳汤辨治咽源性咳嗽(喉痹)

咽源性咳嗽(喉痹)乃外感风邪,留恋不去,客于咽喉;肝郁化火,肝火犯肺,或肺肾阴虚,虚火上扰,壅于咽喉所致。特点是咽喉发痒,痒则干咳,频频阵作,迁延难愈。病位在咽喉,宜利咽止咳,自拟利咽止咳汤:金银花24g,射干9g,薄荷6g,蝉蜕9g,麦冬12g,桔梗、木蝴蝶、玄参各9g,生甘草6g。凡外感表证已解,咽痒,久咳,无痰或少痰,排除其他疾病,均可选用;风热加菊花、桑叶、连翘、锦灯笼、牛子;过敏体质闻异味或遇凉风加重加荆芥、防风辛温发表、驱风散邪;咳嗽气逆喘憋加炙桑皮、炙百部;声音嘶哑加胖大海、凤凰衣;肺肾阴虚加沙参、知母、川贝等;肝胆郁热,肝火犯肺取黛蛤散合小柴胡汤加减;咽后壁淋巴滤泡增生加浙贝母、桃仁。附验案2则。

清咽除痹汤治疗急喉痹风热证的临床疗效

目的研究清咽除痹汤治疗急喉痹风热证的临床疗效。方法方便选取2017年1月—2018年12月该院就诊的急喉痹风热证患者200例,采用随机数字表法分为观察组和对照组,对照组采取常规方法治疗;观察组在常规治疗基础上,采用清咽除痹汤进行治疗。治疗10d后,统计分析患者治疗效果与白细胞改善情况。结果研究结果显示,对照组治疗有效率82%,观察组治疗有效率98%。观察组治疗效果明显好于对照组,其差异有统计学意义(χ^2=14.22;P<0.05);经过治疗后两组患者白细胞数量均有所降低,观察组患者白细胞改善情况明显好于对照组。差异有统计学意义(t=24.06;P<0.05)。结论清咽除痹汤能有效治疗急喉痹风热证,改善临床症状,且安全无毒副作用,具有一定的临床研究及推广价值。

利咽通痹汤治疗急性咽炎62例

利咽通痹汤治疗急性咽炎６２例Ｔｒｅａｔｍｅｎｔｆｏｒ６２ＣａｓｅｓｏｆＡｃｕｔｅＰｈａｒｙｎｇｉｔｉｓＷｉｔｈＬｉＹａｎＴｏｎｇＢｉＴａｎｇ陈谓尧（广西桂林石油医院桂林市５４１００４）关键词急性咽炎；利咽通痹汤；清热解毒药；托里排毒急性咽炎系...

清咽除痹汤治疗风热喉痹115例

目的:研究清咽除痹汤治疗风热喉痹的临床疗效。方法:115例风热喉痹采用清咽除痹汤(黄芩,射干,玄参,牛蒡子,浙贝母,赤芍,防风,荆芥,岗梅根,天花粉,桑白皮,板蓝根,白花蛇舌草,生甘草)治疗。结果:治愈98例(85.2%,98/115)、好转15例(13.0.%,15/115),未愈2例(1.7%,2/115),总有效率98.2%。结论:清咽除痹汤加减治疗风热喉痹疗效显著。

谢强“喉针”选用神门穴治疗喉痹经验浅析

谢强长期从事五官疾病的治疗,殚精竭虑40余年,学验颇丰,总结了大量关于治疗咽喉部等疾病的特色疗法,形成其独树一帜的经验思想。临床上大多咽喉部疾病因气候急剧变化,起居不慎,风邪侵袭和肺卫失固等原因所致,内服汤药和针灸在治疗上各有所长,其中在“喉针”中选取神门穴治疗喉痹已成为谢强教授的特色临床经验之一,遵循“从远至近、由下至上、下强上弱、补泻交替”的操作原则,可取得良好的临床疗效。

自拟利咽汤加减治疗咽源性咳嗽35例

咽源性咳嗽,中医称之为＂喉痹＂,发病特点主要为咽喉作痒或不适而引起的咳嗽,多数患者干咳少痰或咽部奇痒,遇冷空气或异味、粉尘刺激都可引发咳嗽,甚则呈阵发性连续急促咳嗽.西医对本病的治疗主要使用碘剂、维生素、抗生素、中枢镇咳药、抗过敏等治疗为主,疗程偏长,且久服副作用大,必要时使用激光、射频等外治法,疗效不确切.

射干古今方药历史应用考证

目的:对射干及其组方在不同历史时期临床应用进行梳理归纳,为现代射干及其组方临床应用提供指导,为射干药理作用及作用机制的研究提供更多的理论依据。方法:查阅春秋战国至明清时期的古籍文献、现代共10版中国药典及相关临床研究文献,了解射干临床应用的演变过程。结果:射干的应用在历代本草中均有记载,除用于治疗喉痹咽痛外,还用于治疗胸胁胀满、二便不利、女子月经不调及疮肿痈毒等。结论:射干及其组方主要用于治疗上呼吸道系统疾病,对其作用机制可进行深入研究。

CLINICAL RESEARCH ON TREATMENT OF DYSPHAGIA WITH NECK ACUPUNCTURE

Objective To observe the clinical therapeutic effects on dysphagia induced by pseudobulbar palsy chiefly treated with neck acupuncture and probe into the mechanism on the effects. Methods The 86 cases that had been diagnosed definitely were randomized into two groups, the treatment group and control group. The treatment group （acupuncture＋western medication） （44 cases） was treated with acupuncture on Fēngfǔ（风府 GV16）, Fēngchí （风池GB20）, Gòngxě（供血 Extra）, Yīmíng （翳明 EX-HN14）, Zhìqiāng （治呛 Extra）, Tūnyàn （吞咽 Extra）, Fāyīn （发音 Extra）, Liánquán （廉泉CV23）, etc., and the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. The control group （western medication） （42 cases） was treated with the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. Results The total effective rate was 97.73 % and 80.95 % in the treatment group and control group respectively, indicating very significant difference （P 〈 0.01 ）. Conclusion The therapeutic effects mainly with neck acupuncture are better on dysphagia induced by psudalbulbar palsy, which is superior to that with simple western medication and worth to be promoted. Concerning to the mechanism on the therapeutic results, it is viewed that acupuncture on neck points improves the excitability of cerebral neurocytes, resuscitates the reversible neurocytes or awakens the inhibited neurocytes.

Clinical Observations on Acupuncture Treatment of Post-Stroke Dysphagia

To seek a treatment that can improve the effect on dysphagia following post-stroke pseudobulbar palsy. Methods： Sixty patients were randomly allocated into observation and control groups, 30 cases each. The observation group was treated with Western drugs plus acupuncture at Tiantu （CV 22） and other three acupoints around Lianquan （CV 23） and the control group with simple Western drugs. Results： The effective rate was 86.7% in the observation group and 30.0% in the control group. Conclusion： Acupuncture can improve the curative effect of Western drugs on dysphagia following post-stroke pseudobulbar palsy.

Observation on mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in the convalescent stage

Objective： To observe the clinical effect of mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in convalescence stage. Methods： A total of 136 patients conforming to the inclusion criteria were randomized into three groups by the random number table, including group A of 46 cases, group B of 44 cases and group C of 46 cases. Patients in group A received swallowing disorder therapeutic apparatus treatment, patients in group B received mind-refreshing and orifice-opening needling method treatment, and patients in group C received mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus treatment. The treatment was given once a day for 10 d as a course, the whole treatment lasted for 4 courses. Therapeutic evaluation items including water-swallowing test （WST）, standardized swallowing assessment （SSA） and modified Barthel index （MBI） were measured before treatment, after treatment and at follow-up visit （2 months after treatment）. Results： After treatment, scores of WST and MBI in all three groups increased significantly （all P〈0.05）, while the SSA score dropped significantly （all P〈0.05）. After treatment and during follow-up visit period, score of WST in group C was significantly higher than that in group A and group B （both P〈0.05）, while the difference between group A and group B showed no statistical significance （P〉0.05）; the SSA score in group C was substantially lower than that in group A and group B （all P〈0.05）, the difference between group A and group B showed no statistical significance （P〉0.05）; the MBI scores in group B and group C were substantially higher than that in group A （all P〈0.05）, the difference between group B and group C showed no statistical significance （P〉0.05）. After treatment and during follow-up visit period, the differences in overall therapeutic effect between group A and group B showed no statistical significance （P〉0.05）, while the overall therapeutic effect in group C was substantially better than that in group A and group B （all P〈0.05）. Conclusion： Both mind-refreshing and orifice-opening needling method and swallowing disorder therapeutic apparatus can alleviate symptoms of deglutition disorder of stroke patients respectively, and the combination of two methods can improve the therapeutic effect.

Influence of acupoint-injection on TXB_2 and 6-keto-PGF_(1a) in patients with pseudobulbar palsy: a randomized controlled trial

Objective： To prove the feasibility and validity of Xing Nao Jing acupoint-injection （XNJ-AI） at Fengchi （GB 20） for pseudobulbar palsy caused by ischemic stroke （PBP-IS）. Methods： An assessor-blinded, two-parallel-group, randomized controlled trial was conducted, and the patients with PBP-IS were recruited and randomly divided into two groups. Patients in the control group received oral aspirin （100 mg per day for 2 weeks）. In addition to oral aspirin; patients in the treatment group received XNJ-AI at Fengchi （GB 20）, once a day, for two weeks. The primary outcome was assessed by the water-swallowing test （WST）. Thromboxane B2 （TXB2） and 6-keto-prostaglandin F1α （6-keto-PGF1α） in plasma were measured before and after the treatment. Results： In the treatment group, the percentage of swallowing function no less than grade 3 before and after the treatment was 32% and 88%, respectively; in the control group, it was 28% and 76% before and after the treatment, respectively; the difference after the treatment between the two groups was statistically significant （P〈0.05）. There were statistical differences between pre- and post-treatment levels of plasma TXB2 and 6-keto-PGF1α in the two groups （both P〈0.05）. After the treatment, there were significant differences in the levels of plasma TXB2 and 6-keto-PGF1α between the two groups （both P〈0.05）. Conclusion： XNJ-AI at Fengchi （GB 20） can improve the patients＇ swallowing function and balance the levels of TXB2 and 6-keto-PGF1α in plasma.

Therapeutic observation of Gao's nape acupuncture plus swallowing training for pharyngeal deglutition disorder after stroke

Objective: To observe the clinical efficacy of Gao's nape acupuncture plus swallowing training in treating pharyngeal deglutition disorder after stroke. Methods: One hundred patients with post-stroke pharyngeal deglutition disorder were randomized into a treatment group and a control group, with 50 cases in each group. The two groups both received routine neurological intervention. In addition, the treatment group was given Gao's nape acupuncture plus swallowing training, while the control group was intervened by swallowing training alone. After eight-week treatment, the two groups were observed in terms of the changes in repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), standardized swallowing assessment (SSA) and swallowing-related quality of life (SWAL-QOL). The clinical efficacies of the two groups were also compared. Results: After treatment, the RSST grading, and scores of MWST, SSA and SWAL-QOL changed significantly in both groups (P<0.05 or P<0.01). The RSST grading, and scores of MWSX SSA and SWAL-QOL in the treatment group were significantly different from those in the control group after treatment (P<0.05 or P<0.01). The total effective rate and markedly effective rate were respectively 100.0% and 72.3% in the treatment group, versus 97.9% and 34.0% in the control group. There was a significant differenee in the markedly effective rate between the two groups (P<0.01). The differenee in the clinical efficacy between the two groups was statistically significant (P<0.01). Con elusion: Gao's n ape acupu ncture plus swallowi ng training is an effective approach for post-stroke phary ngeal deglutiti on disorder. Its therapeutic efficacy is more significant than that of swallowing training alone.

Clinical observation on acupoint massage plus Vitalstim electrical stimulation for deglutition disorder after stroke

Objective:To observe the effect of acupoint massage plus Vitalstim electrical stimulation on deglutition function and surface electromyography(SEMG)of deglutition muscle groups.Methods:A total of 60 patients with deglutition disorder after stroke were selected and divided into an electrical stimulation group,a massage group and an integrated group according to the random number table method,with 20 cases in each group.Patients in these three groups were given the same routine rehabilitation training for deglutition.In addition,patients in the electrical stimulation group were given extra Vitalstim electrical stimulation,patients in the massage group were given extra acupoint massage on the head,face and neck,and patients in the integrated group were given extra acupoint massage plus Vitalstim electrical stimulation.Fujishima Ichiro food intake level scale(FILS)was scored before and after treatment.The swallowing duration and maximal amplitude of masseter muscle in SEMG were evaluated before and after treatment.Results:After treatment,the FILS score and the maximal amplitude of recruitment potential generated by muscular contraction of masseter muscle group in the three groups were higher than those before treatment(all P<0.05),and the swallowing duration of masseter muscle group was shortened compared with that in the same group before treatment(all P<0.05).After treatment,the FILS score in the integrated group was higher than that in the electrical stimulation group and the massage group(both P<0.05).The swallowing duration of masseter muscle group measured by SEMG was lower than that in the electrical stimulation group and the massage group(both P<0.05),while the maximal amplitude was higher than that of the electrical stimulation group and the massage group(P<0.05).After treatment,there were no significant differences in the FILS score,swallowing duration and maximal amplitude of masseter muscle group between the electrical stimulation group and the massage group(all P>0.05).Conclusion:Both acupoint massage and electrical stimulation can improve the deglutition function in patients with deglutition disorder after stroke,and improve the coordination and flexibility of masseter muscle.The integration of the two is more effective.

Efficacy evaluation of acupuncture plus rehabilitation training for post-stroke deglutition disorders of qi-deficiency blood stasis pattern

Objective:To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke deglutition disorders of qi-deficiency blood stasis pattern.Methods:Sixty-six patients with post-stroke deglutition disorders of qi-deficiency blood stasis patter were divided into an observation group and a rehabilitation group using the random number table method.The two groups both received conventional medications and supportive treatment for stroke.In addition,the observation group received acupuncture plus rehabilitation training while the rehabilitation group only received the same rehabilitation training.The interventions were conducted 3 times a week for a total of 4 weeks in both groups.They were evaluated using Kubota water swallowing test(KWST),Fujishima Ichiro food intake level scale(FILS)and symptoms score of traditional Chinese medicine(TCM)before and after treatment,and at the 1-month follow-up.The therapeutic efficacy was assessed at the 1-month follow-up.Results:The KWST grading and FILS result after treatment and at the follow-up were significantly different from those before treatment in both groups(all P<0.001);the results of these two items at the follow-up were not significantly different from those after treatment in the two groups(all P>0.05).There were significant differences in the KWST grading and FILS result between the two groups after treatment and at the follow-up(all P<0.05).The TCM symptoms score changed significantly after treatment and at the follow-up compared with that before treatment in both groups(all P<0.001).The TCM symptoms grading efficacy at the follow-up was significantly different from that after treatment in the observation group(P<0.05),while the difference was statistically insignificant in the rehabilitation group(P>0.05).The TCM symptoms grading efficacy in the observation group was significantly different from that in the rehabilitation group after treatment and at the follow-up(both P<0.05).Conclusion:Based on the conventional treatment for stroke,acupuncture plus rehabilitation training or use of rehabilitation training alone both can improve the clinical symptoms in post-stroke deglutition disorders of qi-deficiency blood stasis pattern,but acupuncture plus rehabilitation training can produce more significant efficacy and better long-term efficacy in improving TCM symptoms.

Characteristics of Mang Needle Therapy and Its Clinical Application

Mang needle （elongated needle, 芒针） is evolved from the long needle, one kind of nine needles in the ancient times, and is primarily characterized by its long needle-body and its arrival at the deep tissues of the body. However, because of the particularity of the physiology and anatomy of some diseases, direct deep puncturing can＇t reach the due tissues, thus the treatment results are affected. Based upon the deep puncturing of Mang needle and the physiology and anatomy of the human body, professor YANG Zhao-gang, a well-known acupuncturist, has made many improvements and innovations, in his long-term clinical practice, in the manipulations and indications of Mang needle, consequently to establish a series of unique puncturing techniques of Mang needle, which work excellently on some difficult and complicated diseases. This Mang needle therapy is introduced as follows.

Fire-needle therapy for deglutition disorders in post-stroke pseudobulbar palsy:a randomized controlled trial

Objective:To observe the clinical efficacy of fire-needle therapy in treating deglutition disorders due to pseudobulbar palsy in the remission stage of stroke.Methods:Sixty-two eligible subjects were divided into a fire-needle group and a rehabilitation group by a simple randomization method at a ratio of 1:1.The two groups received same basic intervention;in addition,the fire-needle group received fire-needle treatment,while the rehabilitation group received rehabilitation training.The two groups of subjects all received a 3-week treatment and were evaluated by the dysphagia severity rating scale (DSRS),modified Mann assessment of swallow ability (MMASA) and Kubota Toshio swallow test (KTST) before and after the intervention.The complications and adverse events occurred during the trial were recorded.The data were statistically analyzed.Results:At the third week,the DSRS,MMASA and KTST scores changed significantly compared with the baseline in both groups (P<0.05),and the changes in the fire-needle group were more significant than those in the rehabilitation group (P<0.05).The between-group comparison at the third week showed that the therapeutic efficacy in the fire-needle group was superior to that in the rehabilitation group (P<0.05).Conclusion:Fire-needle therapy can obviously change the DSRS,MMASA and KTST scores in pseudobulbar palsy in the remission stage of stroke,and significantly enhance the therapeutic efficacy of the treatment of deglutition disorders in this stage.

Therapeutic Observation on Acupoint Injection for Post-stroke Deglutition Disorder

Objective： To observe the clinical effect of acupoint injection in treating post-stroke deglutition disorder. Methods： Eighty patients with post-stroke deglutition disorder were randomized into a treatment group and a control group, 40 in each. The treatment group received acupoint injection in addition to routine Western medication, and the control group received the routine Western medication only. The treatment results in the two groups were compared and analyzed. Result： After treatment, the patients in the two groups had improvements in the scores of symptoms and signs. In comparison of water drinking test, the result in the treatment group was superior to that in the control group （P〈0.01）. Conclusion： Acupoint injection can achieve a satisfactory result in treating post-stroke deglutition disorder.