“针节术”理论探析及临床应用

目的通过对“四街”及“五乱”理论进行对应剖析,并举以相应的临床案例,探讨“针节术”在临床针刺治疗的有效性。方法针刺治疗时按照特定穴位的补泻需要施行迎随补泻和呼吸补泻,对穴位进行放血治疗时,持放血针点刺放血时辅以按摩挤压等手法将血放至不出。气在胸街用穴:在心取神门、大陵,在肺取鱼际、太溪;气在腹街用穴:取隐白、大都、厉兑、内庭,不下者针手足三里;气在头街用穴:取天柱、大杼,不效取通谷、束骨;气在胫街用穴:八邪点刺放血,取二间、三间、液门、中渚、内庭、陷谷、侠溪、足临泣。“针节术”中只有臂胫气街大络“结”在八邪,即八邪处是病根,故需三棱针点刺放血。观察治疗后临床效果。结果通过“针节术”治疗气乱于头、气乱于胸、气乱于腹、气乱于胫,可以有效减轻头昏、偏头痛、视物不明;胸闷少气、心慌烦躁;腹酸腹胀;四肢困重、疼痛等一系列“五乱”症状,临床治疗效果较好。结论“针节术”通过针刺特定穴位能够快速打通气血节点,祛瘀生新,疏通经络,促进气血循环,从而维持人体的动态平衡,其疗效较好且持久。

针刺蝶腭神经节治疗五官科疾病的临床研究进展

针刺蝶腭神经节疗法是由李新吾教授首创并应用于临床治疗鼻部疾病的特色外治疗法。当前,蝶腭神经节针刺疗法现已广泛应用于变应性鼻炎、干眼症、耳鸣、紧张性头痛、顽固性面瘫等头面五官科疾病的治疗,其操作简便、痛苦小、疗效显著,临床适应症不断扩大。文章对蝶腭神经节位置解剖、作用机制、针刺方法和临床应用现状进行综述,为蝶颚神经节的安全针刺入路及临床推广提供参考。

蝶腭神经节针刺术治疗动眼神经麻痹案1则

动眼神经麻痹可归于中医目系疾病,历代医家将其称为"上胞下垂"或"睑废"。该文介绍蝶腭神经节针刺术治疗动眼神经麻痹案1则,疗效突出。

针刺蝶腭神经节治疗不同年龄段过敏性鼻炎的临床观察

[目的]观察针刺蝶腭神经节治疗不同年龄段过敏性鼻炎患者的疗效差异、疗效特点。[方法]研究采用自身前后对照及组间对照观察方法,将60例患者分为青年组(6~29岁)、青中年组(30~39岁)、中老年组(40~70岁),每组各20例,均予蝶腭神经节针刺术,以鼻及鼻伴随症状评分和鼻黏膜炎症相关生活质量问卷评分、“鼻炎周记”总分为主要观察指标。[结果]各年龄组患者治疗结束及治疗后3个月鼻部症状总积分表(TNSS)、鼻伴随症状总分表(TNNSS)、鼻结膜炎生活质量问卷(RQLQ)总分、“鼻炎周记”总分均较治疗前显著改善(P<0.01),但以上指标在各组间差异并无统计学意义(P>0.05)。[结论]针刺蝶腭神经节能有效改善各年龄层过敏性鼻炎患者的鼻部症状和鼻伴随症状,且临床疗效不因年龄影响。

推拿配合刃针星状神经节触激术治疗颈源性头痛的临床观察

目的：研究推拿配合刃针星状神经节触激术治疗颈源性头痛的临床疗效。方法：56例颈源性头痛患者采取推拿配合刃针星状神经节触激术治疗，比较治疗前后疼痛视觉模拟评分及头痛情况。结果：治愈18例，好转30例，有效4例，无效4例，总有效率92．86％：治疗后VAS评分、每周疼痛次数及每次疼痛时间均显著低于治疗前（P〈0．01）。结论：推拿配合刃针星状神经节触激术治疗颈源性头痛能有效缓解疼痛，治疗效果显著，值得临床推广。

IMMUNOLOGICAL STUDY ON ACUPUNCTURE TREATMENT OF COLLAGEN-INDUCED ARTHRITIS IN CX43-KNOCK-OUT RATS

Objective To observe the therapeutic effect of acupuncture for collagen-induced arthritis （CIA） in Cx43 knock-out mice and its underlying immunological mechanism.Methods Heterozygote （Cx43^＋/-） mice （n=64） and wild-type （Cx43^＋/＋） mice （n=46） were used in the present study.CIA model was es- tablished by intracutaneous injection of bovine collagenⅡ（immunonization）.Acupuncture of Zúsānlǐ（足三里ST36） was carried out from the 4^th week on after the initial immunization,once a day for 3 weeks.Arthritis score and days of onset of CIA were recorded.Intracellular contents of Th subgroups of splenic lymphocytes were detected with flow cytometry.Results The incidence rate of CIA and arthritis score in Cx43^＋/- mice were significantly lower than those in Cx43^＋/＋ mice （P〈0.05）.In Cx43^＋/＋ mice,3 weeks after acupuncture treatment,the score of arthritis symptoms and signs in acupuncture group was significantly lower than that in model group （P〈0.01）,while in Cx43^＋/- mice,no significant difference was found between model group and acupuncture group in arthritis score （P〉0.05）.In comparison with control group,percentages of both Thl and Th2 and Th1/Th2 increased significantly in 0x43^＋/＋ CIA model group （P〈0.05）,while compared with model group,the percentage of Th1,Th2 and Th1/Th2 in acupuncture group decreased evidently （P〈0.05） or moderately,showing that acupuncture can effectively suppress arthritis-induced increase of Thl in Cx43^＋/＋ mice.In 0x43^＋/- mice,Th1 level and Th1/Th2 of CIA model group increased considerably in comparison with control group （P〈0.05）,while compared with model group,the Th1,Th2 and Th1/Th2 of acupuncture group had no significant changes （P〉0.05）,indicating that the effect of acupuncture in suppressing increase of Th1 percent and Th1/Th2 was eliminated.Conclusion Acupuncture of Zúsānlǐ（足三里ST 36） can effectively relieve CIA symptoms and signs and inhibit increase of splenic Th1 in Cx43^＋/＋ mice but has no any effect on CIA score,Th1,Th2 and Th1/Th2 in Cx43^＋/- mice.It shows the effect of acupuncture in improving CIA is closely related to Cx43 gene.

The effect of electroacupuncture preconditioning on cognitive impairments following knee replacement among elderly:A randomized controlled trial

Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.

Influence of acupotomy loosing on IL-6, IL-10 and TNF-α in synovial fluid of rheumatoid arthritis patients with elbow joint stiffness

Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis patients with elbow joint stiffness and investigate the anti-inflammatory mechanism of the acupotomy loosing.Methods： A total of 60 cases of rheumatoid arthritis（RA） patients with elbow joint stiffness were randomly assigned into the group receiving acupotomy loosing（group A）, group with electroacupuncture（group B） and the one undergoing medication treatment（group C） with 20 cases for each group. Based on the medication treatment, all patients underwent continuous oral administration with Methotrexate（MTX）, Leflunomide（LEF） and Bitongding capsules for 3 weeks. And no other treatments were given to group C. In addition to medications treatment, the electroacupuncture was performed in group B. The acupoints of Tianzhu（天柱 BL 10）,DAzhui（大椎 GV 14）; Fengchi（风池 GB 20）,Quchi（曲池 LI 11）,Quze（曲泽 PC 3）,Chize（尺泽 LU 5）, Shousanli（手三里 LI 10）, Xiaohai（小海 SI 8）, Shaohai（少海 HT 3）, Tianjing（天井 TE 10）,Qinglengyuan（清冷渊 TE 11） and Hegu（合谷 LI 4） in the affected side were selected. A pair of electrodes were connected to LI 11 and LI 10, and another pair of electrodes were connected to PC 3 and LU 5, and the continuous wave with frequency of 2 Hz was designed, the needle retention for 30 min was performed, and the acupuncture was performed for 6 times per week with 3 weeks for one course,and there was one course totally. Besides the medication treatment, group A underwent the acupotomy loosing therapy. The tender point in lateral elbow joint, etc. were taken as the treatment point, and 6-8 treatment points being taken for each time, and longitudinal dredging and transverse exfoliation were conducted for 2-3 times with the acupotomy. The treatment was given for one time per week with three weeks for one course, and there was one course totally. The changes of maximum angle of active extension position, maximum angle of active flexion position and range of motion were observed, and levels of IL-6, IL-10 and TNF-a in affected synovial fluid of elbow joint were tested before the treatment and 2 weeks after the treatment in the groups.Results： ① Compared with those before treatment, the maximum angle of active extension position were smaller, the maximum angle of active flexion position were larger and the range of motion were wider of the affected elbow joints of the patients in the 3 groups on the 2 weeks after the treatment.There were statistical significances for the differences（All P 0.05）. Two weeks after the treatment,as compared with those in group C, the affected elbow joint for patients in the group B and group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were statistical significances for the differences（All P 0.05）. Comparing with those in the group B, the affected elbow joint for patients in the group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were the statistical significances for the differences（All P 0.05）. ② Compared with those before treatment, the levels of TNF-a and IL-6 were lower and the level of IL-10 was higher of the 3 groups on the 2 weeks after the treatment. There were the statistical significances for the differences（All P 0.05）. For 2 weeks after the treatment, compared with those in the group C, group B and group A were lower in levels of TNF-α and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）. As compared with those in the group B, group A was lower in levels of TNF-a and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）.Conclusions： The combination of acupotomy loosing can improve the maximum angle of active extension position, maximum angle of active flexion position and range of motion in affected elbow joint for RA patients with elbow joint stiffness, whose efficacy was superior to single basic treatment and electroacupuncture combined with basic treatment. Meanwhile, the levels of proinflammatory cytokines,such as TNF-α and IL-6 can be decreased, and the level of anti-inflammatory cytokines, such as IL-10 can be increased, playing a role in regulating the imbalance between proinflammatory cytokines and anti-inflammatory cytokines in RA patients, which may be one of mechanisms regarding treating RA and improving the range of motion for stiff joints.