基于四关三通理论探讨颈关与情志的关系

“颈关”是山东中医药大学高树中教授“四关三通”理论的重要组成部分。“颈关”即颈项部,其作为头面与躯干衔接之处,汇聚脏腑经络气血,上输于头面,是人体的重要部位。临床发现,“颈关”与情志有着密切联系,在情志病的诊断与治疗方面发挥着一定作用。笔者分别从疏肝、理气、调神3个方面分析“颈关”与情志的关系,为临床情志病的治疗提供一定参考依据。

“颈关”快刺法临床应用

“颈关”理论为高树中教授首次提出,“颈关”即颈项部,“颈关”作为人体躯干最为狭窄之处,汇聚全身经络,运输脏腑精血上濡于脑,是人体起转折关联作用的重要关口。马玉侠教授基于“颈关”理论首创“颈关”快刺法,临床应用于颈椎病、肝郁病、脑病、神志病、情志病等疾病的治疗,具有通经络、调气血、解肝郁、畅情志、活脑络、醒脑神等作用,临床操作简便灵活、安全有效。文章围绕“颈关”理论,浅析“颈关”学术思想,介绍“颈关”快刺法的操作方法,并结合“颈关”理论及临床经验简述“颈关”快刺法的临床应用。

A preliminary study of neck-stomach syndrome

AIM: To determine the expression of c-Fos, caspase-3 and interleukin-1β (IL-1β) in the cervical cord and stomach of rats with cervical spondylosis, to analyze their relationship, and to offer an explanation of one possible cause for functional dyspepsia (FD) and irritable bowel syndrome (IBS) caused by cervical spondylosis. METHODS: The cervical spondylosis model in rats was established by destroying the stability of cervical posterior column. The cord segments C4-6 and gastric antrum were collected 3 mo and 5 mo after the operation. Rats with the sham operation were used as controls. The expressions of c-Fos, caspase-3 and IL-1β in the cervical cord and gastric antrum were determined by immunohistochemistry and/or Western blot. RESULTS: Immunohistochemical staining showed a few c-Fos, caspase-3 and IL-1β-positive cells in the cervical cord and antrum in the control. There was a significant increase in c-Fos, caspase-3 and IL-1β expression in model groups compared to the control groups at 3 mo and 5 mo after operation. More importantly, there was a significant (P < 0.05) increase in c-Fos, caspase-3 and IL-1β expression in the model group rats at 3 mo compared to those at 5 mo after the operation (c-Fos: 11.20 ± 2.26 vs 27.68 ± 4.36 in the cervical cord, 11.3 ± 2.3 vs 29.3 ± 4.6 in the gastric antrum; caspase-3: 33.83 ± 3.71 vs 36.32 ± 4.01 in the cervical cord, 13.23 ± 3.21 vs 26.32 ± 4.01 in the gastric antrum; IL-1β: 42.06 ± 2.95 vs 45.91 ± 3.98 in the cervical cord, 26.56 ± 2.65 vs 32.01 ± 2.98 in the gastric antrum). Western blotanalysis showed time-dependent changes of caspase-3 and IL-1β protein in the cervical cord and gastric antrum of rats with cervical spondylosis; there was no significant expression of caspase-3 and IL-1β protein in the control group at 3 mo and 5 mo after the sham operation, whereas there was a significant difference in caspase-3 and IL-1β protein levels between the model group rats followed up for 3 mo and those for 5 mo (P < 0.05). CONCLUSION: There is a significant association of c-Fos, caspase-3 and IL-1β expressions in the gastric antrum with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis.

Relationship between Cell Proliferation and Apoptosis in Cervical Carcinoma

Objective To study the relationship between cell proliferation and apoptosis in cervical carcinoma and its clinical significance. Methods The cell proliferation and apoptosis of cervical epithelial cells in archival formalin-fixed, paraffin-embedded tissue sections of normal cervix, cervical intraepithelial neoplasms (GIN) and cervical squamous carcinoma were tested by using immunohistochemistry assay and DNA nick end-labeling technigue. The proliferation index (PI) and apoptosis index (AI) were calculated and their correlation with clinical and pathological data was analyzed.Results PI was gradually increased, but the AI and AI/PI ratio decreased from normal cervical epithelium, GIN to cervical carcinoma. There was no significant relationship among cell proliferation, apoptosis, clinical stages and pathological grades. High AI was always associated with a poor prognosis of the patients.Conclusion Cell proliferation and apoptosis allow to distinguish among normal epithelium, GIN and cervical carcinoma and are useful for the assessment of the malignant potential of tumor tissues.

The Therapeutic Effects of Triple Puncture and Routine Body Needling for Cervical Spondylosis

The author has treated 216 cases of cervicalspondylosis with triple puncture and routine bodyneedling since 1996, and made a comparison of thetherapeutic effects between the two methods. Areport follows.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACPUNCTURE COMBINED WITH MASSAGE FOR CERVICAL SPONDYLOSIS OF VERTEBRAL ARTERIAL TYPE BY USING TRANCRANIAL DOPPLYER ULTRASONOGRAPHY

To observe the effect of acupuncture combined with massage on blood flow velocity of the vertebro-basilar artery in cervical spondylosis of vertebral arterial type （CSVAT） patients. Methods： In the present study, methods of evidence-based medicine, triple-centers, single-blindness, randomization and control were used. A total of 100 cases of CSVAT patients were randomized into acupuncture plus massage （acu-massage） group （n = 38）, acupuncture group （n = 32） and massage group （n = 30）. Acupoints used were Fengchi （风池, GB 20）, cervical Jiaji （颈夹脊 EX-B 2）, Baihui （百会 GV 20）, and the methods of massage used were kneading-rolling, adhesion-separating and acupoint-digital pressing, topical digital pressing and rubbing, traction-extending and mild palm-rubbing. The treatment was conducted once daily, with 7 sessions being a therapeutic course and continuously for 2 courses. Changes of peak velocity （Vp）, end-diastolic velocity （Vd）, mean velocity （Vm） of blood flow of the vertebral artery （VA） and basilar artery （BA）, etc were detected before and after the treatment by using transcranial Doppler （TCD） ultrasonography. Resuits： After the treatment, the abnormally low Vp of both VA and BA in acu-massage, acupuncture and massage groups, Vm of VA in acu-massage and acupuncture groups, Vm of BA in acu-massage and massage groups, and Vd of VA and BA in the 3 groups all increased significantly in comparison with their own pretreatment（ P 〈 0.05, 0.01）, and the therapeutic effects of acu-massage group in the 3 indexes were significantly superior to those of acupuncture group and/or massage group （P 〈0.05, 0.01 ）. The abnormally increased Vp of VA in acu-massage and acupuncture groups, Vm of VA in the 3 groups, and Vd of VA in acu-massage and massage groups decreased obviously after the treatment in comparison with their own pretreatment （P 〈 0.05, 0.01）, and the therapeutic effects of acu-massage group were significantly superior to those of acupuncture and/or massage group in the 3 indexes of VA （P〈0.05, 0.01）. In addition, the abnormally increased Vp, Vm and Vd of BA in the 3 groups showed a similar tendency. No significant differences between acupuncture and massage groups in 3 indexes （ P 〉0.05）. Conclusion： The therapeutic effects of acupuncture plus massage is significantly superior to those of simple acupuncture and simple massage therapies in improving abnormal blood dynamics of vertebral and basilar arteries in CSVAT patients.

CLINICAL OBSERVATION ON TREATMENT OF NERVE-ROOT TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE, TRACTION PLUS SELF-EXERCISE OF QIGONG

Purpose: To observe the therapeutic effect of acupuncture combined with traction and Qigong exercise for treatment of nerve root type cervical spondylosis. Methods: A total of 130 nerve root type cervical spondylosis patients were randomly divided into acupuncture + traction + Qigong exercise (ATQE) group (n=59), acupuncture + Qigong exercise (AQE) group (n=40) and traction + Qigong exercise (TQE) group (n=31). Main acupoints used were Fengchi (GB 20) and cervical Jiaji (EX B 2) on the affected side. Results: After one month’s treatment, in ATQE, AQE and TQE groups, 43 (72.88%), 18 (45.00%) and 12 (45.16%) had remarkable amelioration, 14 (23.72%), 14 (35.00%) and 10 (32.26%) were effective, and 2 (3.39%), 8 (20.00%) and 7 (22.58%) had no apparent changes with the total effective rates being 96.61%, 80.00% and 77.41% respectively. The therapeutic effect of ATQE group was significantly superior to that of AQE and TQE groups (P<0.01).

CLINICAL STUDY ON MANIPULATIVE TREATMENT OF DERANGEMENT OF THE ATLANTOAXIAL JOINT

The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.

The Establishment and Development of Finite Element Model of Human Cervical Vertebra and Its Application Example

The incidence rate of cervical spondylosis is high,and due to the complicacy of cervical vertebra structure,irregularity of shapes and non-uniformity of components,sometimes it’s difficult to achieve planned objectives by experiments in vitro through stress and strain analysis. Besides,the biomechanical factors are of vital significance in the cause of spinal disorders. In this paper the author makes a summary of the present modeling of human cervical vertebra and describes the major methods of establishing the finite element model of human cervical vertebra through several self-constructed models. With the advance of computer technology,the finite element methods have been rapidly developed in cervical vertebra biomechanical researches and have became a major approach for biomechanical researches to simulate more and more clinical conditions.

EXTRACAPSULAR SPREAD IN IPSILATERAL NECK METASTASIS:AN IMPORTANT PROGNOSTIC FACTOR IN LARYNGEAL CANCER

Objective To evaluate the impact of extracapsular spread （ECS） in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer. Methods The study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens. Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance. Reults We found pathological neck metastases in 80 patients. Among them, 26 cases （32. 5% ） had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N （pN） stages （pNl 3.7%, pN2a 25.0%, pN2b 50. 0%, and pN2c 55.6% ; P =0. 001）. ECS incidence also increased with number of positive nodes （1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66. 7% ; P 〈0. 001 ）. Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS （46.2% vs. 24. 1%, P=0.046; 34.6% vs. 7.4%, P =0.002）. The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS （23.1% vs. 57.4%, P =0. 013）. Conclution ECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.

Study of androgen and atherosclerosis in old-age male

Objective： To observe the difference of androgen and inflammatory cytokines level in atherosclerosis and analyse their relations. Method： Both carotid arteries and arteries of lower extremity were subjected to ultrasonic examination by Doppier＇s method. Those with much atheromatous plaque formation were ranged into case group, and those with normal result formed control group. Total, free testosterone and estradiol were assayed by radioimmunoassay. C reactive protein （CRP） was assayed by nepheloturbidity. Tumor necrosis factor-α（TNF-α）, lnterleukin-6 （IL-6）, lnterleukin-8 （IL-8）, lnterleukin-10 （IL-10）, Interleukin-18 （IL-18）, soluble intercellular adhesion molecule-1 （sICAM-1） and soluble vascular cell adhesion molecule-1 （sVCAM-1） were assayed by ELISA. The mean difference between two groups and the correlation between free testosterone and cytokines were analysed. Results： Free testosterone was （6.337±3.371） pg/L in case group and （11.375±4.733）pg/L in control group, P〈0.01. No differences were found in total testosterone and estradiol. CRP was （27.294±10.238）mg/L in case group and （12.843±6.318） mg/L in control group, P〈0.01. IL-6 was （41.700±31.385）pg/L in case group and （25.396±20.772）pg/L in control group, P〈0.05. IL-8 was （89.249±58.357）pg/L in case group and （67.873±31.227）pg/L in control group, P〈0.05. sICAM-1 was （470.491±134.078）pg/L in case group and （368.487±97.183）pg/L in control group, P〈0.01. sVCAM-1 was （537.808±213.172）pg/L in case group and （457.275±157.273）pg/L in control group, P〈0.05. There were no differences in TNF-α, IL-10 and IL-18. Correlation analysis showed that FT （free testosterone） had negative correlation with CRP, IL-6 and sICAM-1. Among them FT had well correlation with CRP, correlation index was -0.678. Conclusion： Free testosterone was in negative correlation with atherosclerosis in old-age male. Free testosterone may have the role of anti-atherosclerosis, and this effect was not achieved by its transformation to estradiol. Low tree testosterone level was followed by increased level of inflammatory cytokines. Low free testosterones coexist with inflammation and they both affect the process of atherosclerosis in old-age male.

《黄帝内经》“七次脉”穴的特点及应用浅析

对《黄帝内经》“七次脉”穴的释义、定位归经、主治病症进行归纳梳理,发现“七次脉”穴是“根溜注入”中的“上入穴”,与“离入出合”的“出合”部位相应,并包含气海、髓海的输注穴。提出“气阻于颈关,可取之七次脉”的新观点,以期为系统使用颈项部腧穴治疗颈肩疾病、头面五官疾病、情志疾患以及脏腑气机失调疾病提供新的思路。

基于“高氏三通”理论针灸治疗乳腺增生症23例

乳腺增生症是中年妇女常见的非炎性、非肿瘤性的良性增生性疾病,以单侧或双侧乳房疼痛伴乳房肿块为临床特点,与月经周期、情志变化明显相关。笔者基于"高氏三通"理论治疗乳腺增生症患者23例,现报道如下。1临床资料23例患者均来自2018年12月至2020年1月山东中医药大学附属医院针灸科及乳腺甲状腺外科门诊,年龄23~47岁,平均(33±4)岁。

Expression of recombinant adeno-associated virus in the brain of rats with a focal embolic stroke via carotid artery

OBJECTIVE: To study whether recombinant adeno-associated virus (rAAV) mediated foreign gene, LacZ, could pass the blood brain barrier by intra-carotid artery delivery and express in vivo in ischemic brain of the focal embolic stroke rats to investigate a possibility of delivering foreign gene through carotid artery to treat acute ischemic stroke. METHODS: The carotid artery territory in 41 rats was embolized with or without arterial-like fibrin rich clots to make a model of focal embolic stroke rat. rAAV containing LacZ gene (rAAV-LacZ) was constructed in 293 cells by calcium phosphate cotransfection. The rats were assigned to one of the following treatments: 1 control (without embolism) groups, including PBS treated (n = 6), pLacZ treated (n = 6 ) and rAAV-LacZ treated (n = 6): 2 embolic groups, including embolism + PBS (n =7),embolism + pLacZ (n = 8) and embolism + rAAV-LacZ (n = 8). Brains were cryosectioned and kappa-Gal stain was performed at 2, 4, and 8 weeks, respectively, after transfection, and then infarct volume was measured and the percentage of LacZ staining-positive cells was calculated. RESULTS: In all the control groups and embolism + PBS treated animal, no kappa-Gal staining-positive cells were found, but in embolism + pLacZ (n = 8) and embolism+rAAV-LacZ groups a lot of kappa-Gal staining-positive cells were found. The expression cells were in the tissues around the infarction. The gene expression persisted only nearly four weeks in embolic group with pLacZ. In the embolic group with rAAV-LacZ the expression was very stable during the experiment course (eight weeks) and the percentage of the expressed cells was significantly higher than that of its contralateral areas at the same time points, respectively. CONCLUSIONS: The plasmid vector and rAAV could enter the brain through the ischemia-damaged blood barrier and foreign gene can be expressed in brain. The positive gene expression is mainly in the peripheral areas of the infarction. rAAV as a permanent expression vector may ultimately be used for gene therapy of human ischemia cerebravascular diseases.

Therapeutic efficacy observation on bloodletting and cupping for cervical radiculopathy

Objective： To observe the efficacy and safety of bloodletting and cupping for cervical radiculopathy. Methods： The randomized controlled clinical trial was conducted in five centers. A total of 183 eligible subjects were randomly allocated into a bloodletting group （n=68）, an acupuncture group （n=56） and a combined group （n=59）. Patients in the bloodletting group were treated with bloodletting at Dazhui （GV 14） and Jianjing （GB 21） on the affected side, coupled with 5-10 min of cupping, 5 mL blood for each cup, 2-3 cups for one treatment. Patients in the acupuncture group were treated with needling cervical Jiaji （EX-B 2） points and Jianjing （GB 21） on the affected side. The needles were retained for 30 min. Patients in the combined group were treated with both methods. The treatment in all three groups were done once every three days, twice a week, 4 weeks for a course of treatment, for a total of 1-3 courses. Then the therapeutic efficacy was evaluated using scores of visual analogue scale （VAS）, neck disability index （NDL） and clinical assessment scale （CAS） before treatment and after 1, 2 and 3 courses of treatment. Results： The scores of VAS, NDI and CAS in all three groups were significantly decreased after 1, 2 and 3 courses of treatment （all P〈0.001）, and there were no inter-group statistical significances in comparing scores of VAS, NDI and CAS （all P〉0.05）. Conclusion： Bloodletting and cupping share the similar effect with acupuncture in pain relief and improvement of quality of life in patients with cervical radiculopathy.

Research Progress of Electroacupuncture Treatment on Cervical Spondylosis Radiculopathy in Recent Ten Years

Objective： To introduce electroacupuncture （EA） treatment on cervical spondylosis radiculopathy （CSR） at home and abroad in the prior ten years. Methods： EA, combined EA and other treatments for NCS are classified and analyzed. Results： The most commonly used acupoints are JiaJi （Ex-B2）, Fengchi （GB 20）, Waiguan （TE 5）, Quchi （LI 11）. EA is widely applied to treat CSR because of its definite therapeutic effects and safety. Conclusion： The validity of other evaluation indexes needs to be proved by more rigorously designed randomized controlled trials （RCT） with scientific methods.

Clinical observation on warm needling moxibustion plus acupoint sticking therapy for cervical radiculopathy

Objective: To observe the clinical effect of warm needling moxibustion plus acupoint sticking therapy for cervical radiculopathy. Methods: A total of 120 cases were allocated into an observation group, a warm needling group and an acupoint sticking group according to the random number table, with 40 cases in each group. Cases in the observation group received warm needling moxibustion plus acupoint sticking therapy;cases in the warm needling group received the same warm needling moxibustion in the observation group;cases in the acupoint sticking group received the same acupoint sticking therapy in the observation group. The scores of Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) were recorded before and after treatment. Results: The total effective rate was 95.0% in the observation group, versus 77.5% in the warm needling group and 75.0% in the acupoint sticking group (both P<0.05). Inter-group differences in JOA and VAS between the observation group and the other two groups were statistically significant (all P<0.05). Conclusion: Warm needling moxibustion plus acupoint sticking therapy is effective in treating cervical radiculopathy, and it can significantly alleviate pain and enhance clinical efficacy, and thus is worth clinical popularization.

Clinical Observation on Combined Moxibustion and Medication for Cervical Vertigo

Objective： To observe the clinical effect of combined moxibustion and Betahistine Hydrochloride for cervical vertigo. Methods： A total of 120 cervical vertigo cases were randomly allocated into an observation group and a control group, 60 cases in each group. The cases in the observation group were treated with combined moxibustion and Betahistine Hydrochloride, whereas the cases in the control group were treated with Betahistine Hydrochloride alone. Results： The intra-group comparison showed that the vertigo symptom and functional scores were significantly improved in both groups （P0.01）. After treatment, the vertigo symptom and functional scores in the observation group were significantly better than those in the control group （P0.01）. In addition, there were statistical significances in recovery and marked effect rates and total effective rates between the two groups （P0.05）. Conclusion： Combined moxibustion and Betahistine Hydrochloride works better for cervical vertigo than Betahistine Hydrochloride alone.

Clinical Observation on Treatment of Cervical Spondylotic Radiculopathy with Combined Electroacupuncture Tuina and Traction

Objective： To observe the clinical effect of combined electroacupuncture, tuina. and traction treating cervical spondylotic radiculopathy. Method： Depending on the orders of the patient＇s first visit, 120 cases were randomized into a treatment group （60 cases）, receiving electroacupuncture, tuina and traction treatment, and a control group （60 cases）, receiving electroacupuncture and tuina treatment. The treatment was done once a day, and 5 times constitute one course of treatment. A 2-day interval is set between the courses. The therapeutic effect was evaluated after 6 courses of treatment. Result： The total effective rate and recovery rate in the treatment group were 93.3% and 61.7%, respectively, whereas that of the control group were 78.3% and 31.7%, respectively, showing a significant statistical difference. Conclusion： Combined acupuncture, tuina and traction worked well for cervical spondylotic radiculopathy.

Observation on Efficacy of Acupoint Injection Combined with Traction for Cervical Radiculopathy

Objective： To observe the therapeutic effect of acupoint injection combined with traction for cervical radiculopathy. Methods： A hundred and twenty-two patients with cervical radiculopathy were randomly divided into 3 groups, including an observation group （42 cases）, an acupoint injection group （40 cases） and a traction group （40 cases）. The patients in the first group received acupoint injection combined traction therapy, while the ones in the second and the third group received acupoint injection and traction respectively. The differences of therapeutic effect were evaluated after the treatments. Results： The total effective rate of the observation group was 92.9%, while it was 72.5% in the acupoint injection group and 75.0% in the traction group. There were significant differences between the observation group and the other two groups respectively （P〈0.05） , but there was no statistic difference between the acupoint injection group and the traction group. Conclusion： Acupoint injection combined with traction treatment was more effective for the cervical radiculopathy than either acupoint injection or traction.