中医屈指推法的生物力学建模及分析

背景：推拿医学发展趋势是逐步摆脱单纯经验化的模式,走向客观化、精确化、量化和个体化,使推拿医师能控制手法的力量、时间、方向、频率等各项指标。目的：建立中医一指禅推法（屈指）的生物力学模型,探索在体情况下无0法无创检测的关节作用力的计算方法。方法：采用摄像技术,采集一指禅推法（屈指）的运动学数据,同时利用FZ-I型中医推拿手法测力分析仪采集作用力数据,依此建立手法的生物力学模型并计算各主要关节的作用力。结果与结论：建立了4杆件、5结点的中医一指禅推法（屈指）生物力学模型,计算得到了拇指指间关节、拇指掌指关节、腕关节和肘关节的作用力,分析了各关节在手法运动中的作用,与操作医师的实际感受一致。提示由中医一指禅推法（屈指）的生物力学模型可计算推拿过程中各关节的作用力,可为手法教学和研究提供一定的帮助。     

退阴补阳手法的临床应用

经过多年临床实践摸索出的一整套行之有效的推拿手法，再辅以中医传统的针炙、中药、推拿按摩，收到满意的效果。现汇报如下。１退阴手法 （１）患者仰卧位，医生站于患者右侧，先以右手拇指、食指、中指分别点左侧按天突、俞府、或中穴（即宣肺降气法），随即顺势沿任脉下拇指施一指禅推法由膻中而下至中脘、再至丹田（即心肾相交法），在下丹田用拇指内功震颤法点按；之后用手掌面或大鱼际（双手）分别推抹两胁肋（即疏肝理气法之一），顺时针摩腹２～３次（和胃通府法之一）。；再以右手拇指、食指、中指分别点按右侧或中、俞府、天突穴…     

推拿配合小针刀治疗肩周炎100例疗效观察

笔者从 1998年开始用推拿配合小针刀治疗肩周炎 100例，取得较满意的临床疗效。报道如下。 1资料与方法 100例患者中，女 60例，男 40例，年龄 27～ 70岁，病程最长 1年，最短 2个月。推拿手法： (1)一指禅推法及法：患者取坐势，运用一指禅推法及法于肩前部及上臂内侧。手法力求柔和有力、持久，以痛点为重点反复操作，配合患肢外展、外旋、上举、后弯等被动活动。 (2)弹拔法：体位同上，医者以拇指或中指腹在病人粘连部位沿肌纤维的垂直方向快速弹拔，动作要快速、柔和、有力、然后用掌揉法于肩周。 (3)摇肩法：体位同上，医者一手扶住病…     

关节松动术结合中医推拿手法治疗膝关节骨关节炎的临床研究

目的:探讨关节松动术结合中医推拿手法治疗膝关节骨关节炎的疗效。方法:对60例膝关节骨关节炎患者随机分成治疗组和对照组各30例。治疗组采用关节松动术结合中医推拿手法,对照组则只行关节松动术,隔天1次,15次1疗程,治疗前后按膝关节功能评定评分法进行评定。结果:治疗前2组患者膝关节功能评分比较差异无显著性(P>0.05);治疗后2组评分与治疗前比较均明显升高(P<0.001)。治疗组与对照组比较,膝关节功能改善更显著(P<0.005)。结论:应用关节松动术结合中医推拿手法治疗膝关节骨关节炎疗效显著。     

模拟腰部推拿手法建立“腰-盆-髋”有限元模型

背景:对局部椎体或整个脊柱进行推拿手法的有限元分析具有一定的局限性。目的:通过建立腰-盆-髋有限元模型对腰部推拿手法进行相关生物力学分析。方法:利用螺旋CT数据通过Mimics10.01建立具有高度几何相似性的腰椎、骨盆和股骨近端复合体骨骼的面模型,利用geomagic9精修模型,在hypermesh10.0中划分网格,添加椎间盘和主要韧带。并对有限元模型各部件进行材料属性赋值。利用有限元分析软件模拟腰椎推拿手法三工况加载,计算特征部位位移、最大应变及应力。结果与结论:有限元模型在三工况载荷下的特征部位应力、应变值基本能够反映腰-盆-髋特有的力学结构特性,模型的仿真性较好。在近似的几何外形下,据生物力学资料报道的材料赋值建模保证了有限元模型计算的正确性;模拟接近生理状况下的边界及载荷条件进行计算可以确保结果的准确性。     

手法治疗第三腰椎横突综合症

目的：观察中医推拿手法治疗第三腰椎横突综合症的疗效。方法：运用衮、按、揉、弹拨及一指禅推法，点压穴位进行治疗。结果：经1-3疗程治疗后，有效率98．33％。结论：运用中医手法治疗第三腰椎横突综合症确有较好疗效、治愈率高，疗效稳定。     

推拿为主治疗神经根型颈椎病

自１９９５～２０００年，采用以推拿为主，治疗神经根型颈椎病１０３例，取得良好效果。现报告如下。１对象与方法本组病例１０３例，男６６例、女３７例，年龄２３～６３岁，以３５～５０岁居多，占７２％，病程１周～４年。诊断标准：参照《中医骨伤科病证诊断疗效标准》。方法：手法推拿：１舒筋通络：首先在患者的颈项部、肩背部用揉、滚手法做３～５ｍｉｎ，然后用屈指推法屈指握拳，突出食、中二指近节指间关节，并以此为着力点，从风府→大椎两侧风池→大抒→肩峰端、以及背部上下往返操作使被推者的部位有酸胀温热的感觉而皮肤不发…     

骶髂关节紊乱特点和推拿干预研究

目的:回顾近年来国内外骶髂关节基础实验和骶髂关节紊乱的推拿临床研究,分析骶髂关节紊乱的特点和手法作用机制。资料来源:应用计算机检索Pubmed和OVID数据库1992-01/2006-04相关骶髂关节紊乱、生物力学研究和手法治疗的文献。检索词为“sacroiliacjoint,dysfunction,biomechanics,manipulation”并限定文献语言种类为English,同时计算机检索清华同方CNKI中国期刊全文数据库1992-01/2006-04相关骶髂紊乱的推拿临床治疗文献,检索词为“骶髂关节紊乱,生物力学,推拿”,并限定语言种类为中文;此外,在图书馆手工检索1993-01/2005-12出版的相关专著。资料选择:对资料进行初选,选取包含骶髂关节紊乱、生物力学研究和手法治疗的相关文献,开始查找摘要与全文。纳入标准:①骶髂关节紊乱和生物力学研究。②推拿手法治疗。排除标准:①骶髂关节骨折。②Meta分析、综述与重复的临床治疗文献。资料提炼:共收集了有关骶髂关节紊乱,生物力学实验和临床手法治疗的文献153篇,纳入27篇,其中1篇为研究性论著,1篇为诊疗常规,将文献进行综合评价。资料综合:骶髂关节紊乱是综合性因素,骶髂关节韧带劳损松弛是造成关节紊乱的内因,作用于骨盆的扭转外力是其外因。骶髂关节病变参与下腰痛的病理过程。推拿治疗是临床广泛采用的治疗方法。通过手法调整腰-盆-髋复合体、牵伸韧带及肌肉,可改善腰-骨盆的运动节律,恢复躯干腰臀部肌肉运动的协调性,提高其作功效率。结论:骶髂关节紊乱明确的临床诊断实验尚需作大样本的客观评价,调整失衡的骶髂关节,恢复骨盆的承载功能,配合针对性的骨盆稳定康复训练是推拿取得临床疗效的关键。     

模拟腰部推拿手法建立“腰-盆-髋”有限元模型

背景：对局部椎体或整个脊柱进行推拿手法的有限元分析具有一定的局限性。目的：通过建立＂腰-盆-髋＂有限元模型对腰部推拿手法进行相关生物力学分析。方法：利用螺旋CT数据通过Mimics10.01建立具有高度几何相似性的腰椎、骨盆和股骨近端复合体骨骼的面模型,利用geomagic9精修模型,在hypermesh10.0中划分网格,添加椎间盘和主要韧带。并对有限元模型各部件进行材料属性赋值。利用有限元分析软件模拟腰椎推拿手法三工况加载,计算特征部位位移、最大应变及应力。结果与结论：有限元模型在三工况载荷下的特征部位应力、应变值基本能够反映＂腰-盆-髋＂特有的力学结构特性,模型的仿真性较好。在近似的几何外形下,据生物力学资料报道的材料赋值建模保证了有限元模型计算的正确性;模拟接近生理状况下的边界及载荷条件进行计算可以确保结果的准确性。     

推拿结合关节松动术治疗肩周炎

目的:探讨推拿结合关节松动术治疗肩周炎的疗效.方法:60例肩周炎患者分为A、B 2组各30例,均采用超短波及中医推拿手法治疗,A组同时结合关节松动术治疗,隔天1次.结果:治疗20 d后,与治疗前比较2组病情程度评分均明显升高(P＜0.01),综合组优于对照组(P＜0.05).结论:推拿结合关节松动术综合治疗有助于提高肩周炎的临床疗效.     

有限元分析在中医正骨手法治疗腰椎疾病作用机制中的应用

背景:有限元分析方法探讨中医正骨手法治疗腰椎疾病过程中腰椎生物力学变化的特点及作用机制,将其转变为数字化结果显示,研究手段具有先进性,是数字化骨科研究的有效方法。目的:对有限元分析法研究中医正骨手法治疗腰椎疾病与损伤的作用机制进行总结。方法:应用计算机检索2000-01/2011-10PudMed、CNKI数据库、万方数据库、维普数据库及中华医学会数字期刊数据库及Google网络数据库中医正骨手法治疗腰椎疾病过程中腰椎生物力学变化特点及作用机制的相关文章,检索词"3-D finite element analysis mothed,lumbar disease,bonesetting massage manipulation"或"三维有限元分析法,腰椎疾病,正骨手法"。共检索到文献92篇,最终纳入符合标准的文献37篇。结果与结论:腰椎三维有限元模型的建立,能更好地模拟各种腰部手法的临床状态,可以得到与生物力学实验基本一致的结果,并且通过计算机图形图像技术将结果定性、定量、直观的显示出来。但是国内外目前对中医正骨手法作用机制及生物力学特性、临床量化和评价标准的有限元分析的相关研究较少,仍然不够深入。文章深入研究中医正骨手法治疗腰椎疾病与损伤的作用机制并进行数字化分析,为临床应用提供力学依据、量化及优化的理论与实验依据研究的新思路。     

眼部中药熏蒸、睑板按摩治疗睑板腺功能异常的临床观察

目的:观察和评价眼部中药熏蒸、睑板按摩治疗睑板腺功能异常(MGD)的临床疗效。方法:采取随机对照实验,将符合选取标准的患者58例(116眼)分为实验组30例(60眼)和对照组28例(56眼)。以裂隙灯显微镜检查睑板腺体、按摩睑板腺有无异常分泌物自腺口溢出、泪膜破裂时间(BUT)、主诉症状是否改善或消失为观察指标。实验组采用眼部中药熏蒸、睑板按摩治疗,隔日1次,10次为1个疗程;对照组每日点新泪然4次,持续用药20d。结果:实验组治疗后所有主诉症状消失;对照组中眼红、眼部烧灼感、异物感、干涩感、刺激感、痒、视疲劳症状有改善,但需要持续每日按时用药。实验组和对照组BUT均可得到改善,且实验组改善程度明显优于对照组,差异有统计学意义。结论:眼部中药熏蒸、睑板按摩治疗可有效治疗MGD,改善眼表条件及症状。     

运用穴位按摩护理习惯性便秘病人的临床观察

目的 :探索解除习惯性便秘的自然疗法。方法 :根据中医学理论 ,自创一套穴位按摩法 ,对 5 0例习惯性便秘者进行穴位按摩护理 ,按摩前后进行临床症状观察 ,肠鸣音检测 ,并进行了 3个月的随访。结果 :按摩护理后便秘症状改善总有效率为90 .5 % ,肠鸣音按摩前平均每分钟 4次 ,按摩后平均每分钟为 12次。随访显示按摩时间越长 ,各项症状改善越佳 ,效果越稳定 ,无复发现象。结论 :穴位按摩护理法具有较好的通便功效 ,简便易学 ,易于推广     

Hospital based massage therapy specific competencies

As massage therapy experiences a resurgence of use for hospitalized patients, it is appropriate to consider the competencies needed by practitioners to practice safely and effectively in the inpatient setting. Hospitals differ vastly from other massage practice locations such as private offices, spas, and sports clubs. The variety of conditions encountered in an acute care setting require the knowledge and ability to adapt massage protocols appropriately. The Academic Collaborative for Integrative Health (ACIH) created the Hospital Based Massage Therapy (HBMT) Task Force to determine if there is a need for HBMT specific competencies and then, if needed, to develop peer reviewed competencies that hospital staff, massage therapy educators, and massage therapists all may find useful.The members of the task force identified massage therapists who worked in hospitals generally, as well as in hospitals known to have HBMT programs. A spreadsheet was created listing the individuals and a survey was distributed to those on the spreadsheet. These individuals were also asked to identify others who might be interested in participating in the project. The purpose of the survey was to assess various elements of HBMT programs such as educational/experience requirements, employment model, orientation, and supervision. 32 out of 37 hospitals (87%) completed the survey. The Task Force considered the high response rate and the extent to which respondents provided in-depth answers to the open-ended questions as evidence of the need for specific competencies for safe and effective massage therapy for hospitalized patients.In addition to the survey, the task force used a Delphi technique to engage survey participants and other experts in the field to shape the initial draft of the competencies. As these competencies are shared with hospitals, massage therapists, and massage educators, the Task Force members expect that additional development of the competencies will take place as various groups implement them.     

ROLLER MASSAGER IMPROVES RANGE OF MOTION OF PLANTAR FLEXOR MUSCLES WITHOUT SUBSEQUENT DECREASES IN FORCE PARAMETERS

Background:

Limited dorsiflexion range of motion (ROM) has been linked to lower limb injuries. Improving limited ankle ROM may decrease injury rates. Static stretching (SS) is ubiquitously used to improve ROM but can lead to decreases in force and power if performed prior to the activity. Thus, alternatives to improve ROM without performance decrements are needed.

Objectives/Purpose:

To compare the effects of SS and self massage (SM) with a roller massage of the calf muscles on ankle ROM, maximal voluntary contraction (MVC) force F100 (force produced in the first 100 ms of the MVC), electromyography (EMG of soleus and tibialis anterior) characteristics of the plantar flexors, and a single limb balance test.

Methods:

Fourteen recreationally trained subjects were tested on two separate occasions in a randomized cross‐over design. After a warm up, subjects were assessed for passive dorsiflexion ROM, MVC, and a single‐limb balance test with eyes closed. The same three measurements were repeated after 10 minutes (min) of rest and prior to the interventions. Following the pre‐test, participants randomly performed either SS or SM for 3 sets of 30 seconds (s) with 10s of rest between each set. At one and 10 min post‐interventions the participants repeated the three measurements, for a third and fourth cycle of testing.

Results:

Roller massage increased and SS decreased maximal force output during the post‐test measurements, with a significant difference occurring between the two interventions at 10 min post‐test (p < 0.05, ES = 1.23, 8.2% difference). Both roller massage (p < 0.05, ES = 0.26, ~4%) and SS (p < 0.05, ES = 0.27, ~5.2%) increased ROM immediately and 10 min after the interventions. No significant effects were found for balance or EMG measures.

Conclusions:

Both interventions improved ankle ROM, but only the self‐massage with a roller massager led to small improvements in MVC force relative to SS at 10 min post‐intervention. These results highlight the effectiveness of a roller massager relative to SS. These results could affect the type of warm‐up prior to activities that depend on high force and sufficient ankle ROM.

Level of Evidence:

2c     

Quantitative application of transverse friction massage and its neurological effects on flexor carpi radialis

The purpose of the study was to determine the effects of transverse friction massage (TFM) on flexor carpi radialis (FCR) motoneuron (MN) pool excitability.Twenty-eight healthy subjects were randomly assigned into massage and control groups. Pre- vs post-TFM H-reflex data were collected. Controls received a rest period instead of massage. Massage dose was standardized by a novel electronic method which recorded the massage rate, momentary pressure and total cumulative pressure (energy). Two-way ANOVA of H/M ratios derived from maximal amplitudes of Hoffman reflexes (Hmax) and motor responses (Mmax) was used to analyze neurological effects and group differences.Analysis of pressure/time curve data showed: mean massage rate was 0.501 ± 0.005 Hz; mean duration of massage sessions was 184.6 ± 26.4 s; mean peak pressure was 4.990 ± 1.006 psi. Hmax/Mmax ratios declined from 14.3% to 10.3% for massage (P < 0.01) but showed no change for controls (P > 0.05).In conclusion a novel quantitative approach to the study of massage has been demonstrated while testing the effects of TFM on FCR MN pool excitability. TFM appears to reduce MN pool excitability. The novel method of quantifying massage permits more rigorous testing of client-centered massage in future research.     

中药外敷配合手法按摩对产后乳汁分泌及护理的分析

目的：探讨中药外敷配合手法按摩对产后乳汁分泌及护理的临床效果。方法：从我院众多治疗患者中,选取2018年01月-2019年12月收治的90例初产产妇,采用数表随机法平均分成对照组和研究组,各45例,对照组实施常规母乳喂养,研究组实施中药外敷配合手法按摩,将两组产妇产后的乳汁分泌情况进行比较,从而得出有效结论。结果：在首次泌乳时间更短、产后乳房胀痛发生率方面,研究组更具有明显优势,差异有统计意义(p<0.05);和对照组相比,研究组三天的乳汁分泌量明显更多,差异有统计意义(p<0.05);和对照组相比,研究组的护理满意度明显更高,数据间存在差异,差异有统计意义(p<0.05)。结论：中药外敷配合手法按摩对产后乳汁分泌有着显著效果,明显缩短了首次泌乳时间,降低了产后乳房胀痛发生率,增加了乳汁分泌量,促进了护患和谐相处,值得临床推广和应用。     

中医按摩对早产儿生长发育及高胆红素血症影响的研究

目的了解和证实中医按摩对早产儿生长发育和黄疸消退的促进作用。方法选取本院住院早产儿102例,随机分为实验组50例和对照组52例,实验组给予按摩,3次/d,15min/次,共15d或以上,对照组按常规护理但不进行按摩,2组同时测量身高、体重、大小便次数、摄入总量及黄疸指数。结果实验组生长发育及黄疸消退明显优于对照组,P<0.05。结论实验组对早产儿的生长发育和黄疸消退有良好的促进作用。     

中药足浴结合足底按摩对失眠症患者睡眠质量的影响

目的 评价中药足浴结合足底按摩对改善失眠症患者睡眠质量的效果.方法 选择84例失眠症患者,按是否愿意接受中药足浴按摩分为治疗组44例和对照组40例,对照组给予常规护理,治疗组在常规护理的基础上每晚睡前给予中药足浴及足部反射区按摩治疗.连续干预10 d后评价疗效,并采用匹兹堡睡眠质量指数量表(PSQI)评估患者睡眠质量.结果 治疗组疗效及睡眠质量显著优于对照组,治疗组患者治疗后睡眠较前明显改善.结论 中药足浴结合足底按摩能明显改善失眠症患者的睡眠质量.

Abstract：

Objective To evaluate the combination of foot bath using tradirional Chinese medicine and foot massage on sleep quality of patients with insomnia. Methods 84 cases of insomnia patients were divided into the treatment group(44 cases) and the control group(40 cases)according to their willingness whether to accept foot bath and foot massage or not. The control group received routine care, the treatment group was given foot bath using traditional Chinese medicine and foot reflex zone massage at bedtime on the basis of the routine care. The treatment effect were evaluated after 10 days of continuous intervention. Pittsburgh Sleep Quality Index Scale (PSQI)was used to assess sleep quality of patients. Results The treatment efficacy and quality of sleep of the treatment group was significantly better than the control group. After treatment, sleep condition in the treatment group significantly improved than before. ConduMons The combination of foot bath using traditional Chinese medicine and foot massage can improve sleep quality in patients with insomnia.