针刺头穴治疗中风手法的研究——小幅度快捻转与提插对比观察

头穴针刺治疗中风偏瘫,有着良好的疗效。关于头穴的选择,经多年临床实验及科学研究认为:以后从百会、前至神庭,两侧至曲鬓的菱形区内效果较好。关于针刺手法,多数以捻转为主,也有人提出用提插法、电针法、电动捻转、留针不捻转、旋磁法、头穴针刺按摩、穴位注射、梅花针及灸法等。因为提插与捻转是针刺手法中的基本手法,所以首先选择了提插与捻转。提插与捻转也有幅度与速度问题,为了便于观察,均采用     

针刺手法数据挖掘的关联规则与分类

目的探讨数据挖掘技术中的关联规则与分类规则在针刺手法测定中的应用。方法分别使用提插平补平泻、提插补法、提插泻法、捻转平补平泻、捻转补法、捻转泻法6种针刺手法,在ATP-II型针刺手法测定仪上进行总计200多次针刺手法操作,取得大量针刺手法参数。对测量参数整理后建立数据库;采用WEKA数据挖掘软件对其进行数据挖掘分析,主要采用关联规则中的Apriori关联规则和分类规则中的C4.5分类方法。结果 Apriori关联规则挖掘出的结果:提插手法与提插最大值、提插最小值存在一定关联并且捻转离散度最小;捻转手法的提插离散度最小并且捻转幅度较大。C4.5分类规则较好的区分了提插手法与捻转手法。对个别手法特点做出了正确的评估,提插平补平泻手法捻转离散度小,提插频率高;捻转手法的捻转离散度较高,提插频率低。结论应用数据挖掘技术在针刺手法参数的挖掘上具有可行性,也具有进一步研究的价值与应用前景。     

不同部位穴位与非穴位针刺提插捻转手法的实时检测

目的 应用微小力传感技术和生物力学原理,研制能实施针刺时测量提插力和捻转扭矩的医用传感针,针刺提插捻转手法进行实时检测.方法 选取20例健康志愿者,男、女各半,年龄20~30岁.选取临床较易得气、针感较好且便于提插捻转的足三里和腹部天枢两个穴位,单侧取穴,下肢非经非穴位为足三里穴与阳陵泉穴之间,足三里穴旁开1cm;腹部非经非穴位为天枢穴与大横穴之间中点.均垂直进针,穴位进针且在受试者出现酸麻胀等得气感后,行均匀提插手法,提插频率为2次/秒,保持提插的幅度和频率相同;行捻转手法时,捻转频率为2次/秒,捻转幅度为小于90°,保持捻转的幅度和频率相同.获得针体受力时连续有规律的十个周期波长的图像和数据.非穴位的提插手法及针体受力检测系统与穴位相同.结果 ①腹部和下肢同一部位穴位与非穴位针刺提插捻转手法后,医生的提插、捻转力比较差异无显著性（P＞0.05）.②下肢穴位足三里穴与腹部穴位天枢穴针刺提插捻转手法后,医生的提插、捻转力比较差异有显著性（P＜0.05）.结果 为针刺手法的定量化研究提供了科学的实验手段和依据.     

温通针法治疗脾虚湿阻型单纯性肥胖症临床观察

目的:观察温通针法治疗脾虚湿阻型单纯性肥胖症的临床疗效。方法:将脾虚湿阻型单纯性肥胖症患者120例随机分为捻转组、提插组和温通针法组,每组40例。捻转组给予捻转补法针刺手法治疗;提插组给予提插补法针刺手法治疗;温通针法组给予温通针刺手法治疗。观察3组临床疗效、血脂指标[总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)]水平及临床安全性。结果:总有效率捻转组为77.5%(31/40),温通针法组为87.5%(35/40),提插组为75.0%(30/40),温通针法组的疗效明显优于捻转组和提插组(P0.05)。治疗后3组TC、TG、HDL-C均较治疗前改善(P0.05),且温通针法组的改善程度优于提插组和捻转组(P0.05)。治疗过程中所有患者均未出现明显不良反应。结论:温通针法治疗脾虚湿阻型单纯性肥胖症疗效肯定、安全可靠。     

针刺手法对家兔穴区组织损伤的形态学观察

[目的]观察针刺治疗中3种基本操作手法(提插、捻转、提插捻转复合手法)对家兔穴区组织造成损伤形态计量学影响。[方法]36只家兔随机分入提插组,捻转组,提插捻转组和对照组,每组9只。对家兔足三里穴分别施3种操作手法,每日操作1次,行针时间1 min,共10次。计数穴区炎细胞数量;观察组织苏木精-伊红素(HE)染色和Masson染色后组织形态学变化。[结果]3组针刺组炎细胞数量差异无统计学意义,病理组织形态学结果显示提插组神经损伤最轻,捻转组和提插捻转组出现的神经损伤较重。[结论]在不影响针感的前提下,在有神经干分布的穴位上针刺操作时采用单一提插法,可以减轻对神经组织的损伤。     

子午捣臼

针刺手法名，出自《金针赋》。子午捣臼是一种捻转提插相结合的针刺手法。子午指左右捻转，捣臼指上下提插。得气后，先紧按慢提九次，再紧提慢按六次，同时结合左右捻转，反复施行。     

一种基于阵列式PVDF触觉传感器和机器学习的针刺手法识别系统

目前,对于针灸手法的学习评价,缺少针刺时施力大小、时长和方向等可以进行量化的物理参数。本文针对采集针刺过程中"捻转"和"提插"动作的触觉参数,设计了一种阵列式聚偏二氟乙烯膜(PVDF)触觉传感器;随后,给出了面向触觉信号的窗口分割方法,并提取窗口中的时域特征;最后,构建了一种基于模糊C均值聚类法(FCM)的针刺手法识别方法。通过实验证明该方法能够有效识别捻转补、捻转泻、提插补、提插泻四种基本针刺动作,有利于针刺手法的量化与传播。     

提插补泻血海穴对下肢胫前、胫后动脉血流变化的影响

目的:观察提插补泻血海穴对健康人下肢胫前、胫后动脉血流变化的影响。方法:对10名健康受试者右下肢血海穴分别进行提插补法、提插泻法、平补平泻手法以及单纯针刺及不针刺干预,应用B超监测针刺下右下肢胫前动脉、胫后动脉的血流变化。结果:提插补法、提插泻法分别与平补平泻法、单纯针刺、不针刺相比较,下肢胫前、胫后动脉最高最低流速增快(P0.01);提插补法与提插泻法相比较,下肢胫前、胫后动脉最高最低流速增快(P0.05);平补平泻法、单纯针刺、不针刺相比较,下肢胫前、胫后动脉最高最低流速无明显变化(P0.05)。结论:提插补泻手法操作血海穴可提高健康人下肢胫前、胫后动脉最高最低血流速度;提插补法与提插泻法相比较,血流速度改变无差异;平补平泻、单纯针刺及不针刺对血流速度改变无明显影响。     

不同针刺方法对中风患者手痉挛影响的对比研究

目的：观察内关穴不同针刺手法治疗中风患者手部痉挛的疗效。方法：将172例患者随机分为单纯针刺组（36例）、慢速捻针组（34例）、快速捻针组（30例）、单纯提插组（35例）和提插捻转组（37例）。均取内关穴，每天针刺2次，每次5分钟，并配合康复训练。以修订的Ashworth量表和Fugl—Meyer（FMA）手功能评分评定疗效。结果：手痉挛即刻有效率和治疗8周后有效率单纯针刺组分别为66．7％、55．6％，慢速捻针组为82．4％、85．3％，快速捻针组为96．7％、90．0％，单纯提插组为80．0％、82．9％，提插捻转组为94．6％、91．9％，快速捻针组与提插捻转组疗效优于其他3组（P〈0．01）。治疗后Ashworth量表分级和FMA评分提插捻转组、快速捻针组均优于其余3组（P〈0．05，P〈0．01），且提插捻针组和快速捻针组之间差异无显著性意义（P〉0．05）。结论：针刺内关穴有非常肯定的即刻效应，提插捻转手法与快速捻转手法对痉挛的抑制效果最佳。     

郭天保论烧山火透天凉手法在临床中的运用

从《医学入门》理论中探讨烧山火透天凉手法,对古人所云烧山火透天凉针刺手法加以论述,从临床实践中认为烧山火透天凉手法归纳起来不外乎“捻转提插”四个字,捻转的目的是为了诱导针感,提插的目的是为了施行补泻,而手法成功的关键是补必热,泻必凉.同时在临床运用中加以验证.     

手法对腰椎间盘突出症周围神经传导速度及H反射的影响

为观察手法对腰椎间盘突出症患者周围神经的传导速度及 H反射的电生理变化 ,对 31例患者行手法前后的电生理检查 ,测定周围神经传导速度 ( MCV、SCV)及 H反射值 ,并进行比较研究。结果显示 MCV、SCV及 H反射有显著性差异 ( P<0 .0 5 )。认为手法对腰椎间盘突出症所致的神经损伤有康复作用 ,推断手法对腰椎间盘突出症的作用机理为解除硬膜囊及神经根的压迫 ,消除软组织及神经根的炎性水肿及粘连 ,使椎间盘发生位移     

不同针刺手法对肾虚病人血管容积脉搏波的影响

<正> 根据针刺手法“补则针下热,泻则针下凉”临床效应,近代学者认为,这种“热”,“凉”效应与局部血管舒缩运动有密切关系。研究者们曾先后采用皮温、血管容积脉搏波、微循环技术、红外线成像等有关指标     

ZZ-手法模仿仪在针麻胃切除术中应用381例小结

<正> 我院从1964年开展针麻胃切除术临床研究以来,在重视针麻适应症、穴位处方、辅助用药、个体差异性和外科手术操作改进外,也很注重针刺方法的研究。起初,安圣承袭传统手法捻针进行针麻中穴位刺激。由于手术是一个较长时间的连续过程,这样就必须对穴位亦要连续不断地进行针刺,以保持继续“得气”,来克服手术创伤引起的疼痛和生理扰乱。这样就要花费很大的人力。为此,设想应用电麻仪代替人工针刺外,再     

THE MEASUREMENT OF DE-QI WITHIN AN ACUPUNCTURE CLINICAL TRIAL USING THREE DIFFERENT INSTRUMENTS

Background: De-qi is purported to be an indicator of the treatment efficacy or dose of acupuncture treatment.Several instruments have been developed to measure the level of De-qi.These include the Massachusetts General Hospital Acupuncture Sensation Scale(MASS) and Southampton Needle Sensation Questionnaire(SANSQ).In addition, some studies have used a simple Visual Analogue Scale(VAS).Despite their widespread use, scant research has been undertaken to evaluate whether there is a relationship among the three instruments.A study was therefore embedded within a clinical trial to determine whether statistically similar level of De-qi reported by participants on the three measurement occasions(session 1, session 5 and session 9) used the three different instruments.Methods: Three established instruments(MASS, SANSQ and VAS) that measure De-qi were administered in a clinical trial that was to assess the efficacy of acupuncture for lateral elbow pain(commonly known as tennis elbow).The needle manipulation was standardized and consisted of two periods of needle manipulation.Each period consisted of 2 min of deep needling using the technique of "wagging the dragons tail" at the sites of LI10 and LI11 at a frequency of 2 Hz.Following the administration of the acupuncture at the first, the fifth and the ninth sessions completed the three instruments.The evaluator administering the instruments was blind to the allocation of the participants.Results: The preliminary results concerning the consistency levels of De-qi among the three measurement periods will be presented and some of the issues of De-qi measurement within the context of the clinical trial will be discussed.     

THE EFFECT OF WARM ACUPUNCTURE ON RHEUMATOID ARTHRITIS OF 434 CASES

Clinical observation on 434 cases of rheumatoid arthritis shows that the warmingneedle method is markedly effective for rheumatoid arthritis (RA). It also helps to reveal the mecha-nism and function of acupuncture and moxibustion (AM) in curing diseases. Laboratory observationconfirms that the warming needle method can modulate the body's immunity function significantly. Inthe future, more attention should be paid to point selection and manipulation method so that the bestresult can be obtained.     

THE MECHANISM OF ACUPUNCTURE MANIPULATIONS BASED ON THE NEURAL ELECTRICAL SIGNALS

We know that different acupuncture manipulations produce different acupuncture effects.However, the mechanism is still unclear.The neural system has the function of encoding, which means different stimulation information is encoded in the neural signals and transported to the central neural system.We thought whether the mechanism is associated with the neural encoding or not.Action potentials(neural electrical signals) of peripheral afferent nerve, spinal dorsal horn neurons, and neurons in related brain nuclei evoked by different acupuncture manipulations, including lifting-thrusting manipulations and twirling manipulations with different frequency, were recorded in our study.These signals were analyzed with linear and nonlinear analysis methods.The results showed that: 1) The neural electrical signals evoked by acupuncture were chaotic, which means they are not random signals.2) The discharge frequency of the peripheral afferent nerve and the spinal dorsal horn neurons increased progressivelyfollowing with the increasing acupuncture manipulation frequency.But the discharge in the higher nervous center(the related brain neuronal nuclei) does not show the similar variation.This study indicates that the neural electrical signals evoked by different acupuncture manipulations are different to one another, and have an inner regularity.In the next work, the organ's effect will be observed combined with recording the neural electrical signals.The mechanism of the acupuncture manipulations will be further elucidated.     

针术与深部感受器放电反应的关系

在29只兔上观察到每类深部感受器均可对所用针术产生放电反应;针刺影响感受器的有效刺激点。说明针刺对感受器的有效刺激主要是针刺的压力、牵拉和振动等所产生的使感受器发生形变的应用作用。认为胀与胀痛,包括酸感为主的手针针感主要是兴奋了深痛感受装置。     

FACTORS THAT MAY CONTRIBUTE TO THE INSTANT ANALGESIC EFFECTS OF ACUPUNCTURE FOR PRIMARY DYSMENORRHEA IN CLINICAL RANDOMIZED TRIALS

Objective: There are a great many variables in acupuncture treatment(e.g., point selection, the number of points selected, Chinese medicine patterns, acupuncture manipulation, different intervention time of acupuncture, duration of needling, number and frequency of sessions and needling sensation), all of which need to be addressed in designing and reporting clinical trials.We aim to find the factors that may affect the instant analgesic effects of acupuncture on primary dysmenorrhea in randomized controlled trials(RCTs).Methods: We reviewed factors involved in RCTs in three systematic reviews about acupuncture for primary dysmenorrhea.Results: The overall findings of this literature review suggested that the durations of needling in most RCTs lasted for 20-40 min, and the number and frequency of sessions were likely to last for 5-7 d and continued for three sessions.However, those variables of stimulation including point selection, number of points used, Chinese medicine pattern, acupuncture manipulation and different intervention time of acupuncture were particularly diverse from each other in treatment for primary dysmenorrhea.Conclusion: Our findings reinforce the understanding of acupuncture as a complex intervention.To identify how each component contributes to the instant analgesic effect, well-designed trials comparing those interventions head to head would be a practical and realistic approach to establish optimally effective acupuncture for primary dysmenorrhea.Few rigorous studies have compared the relative efficacy of different acupuncture treatment components within their protocols.Conclusive agreement on those parameters supporting the optimal treatment for patients has not been achieved.Due to the poor quality of available evidence shown in current statues, controlled comparative studies looking at every relevant variable of treatment for primary dysmenorrhea ought to be paid more attention, which may help clinical trials to improve transparency and standardize treatment efficacy.     

THE INFLUENCE OF SKIN MICROCIRCULATION BLOOD PERFUSION AT ZUSANLI ACUPOINT BY STIMULATING WITH LIFT-THRUST REINFORCING AND REDUCING ACUPUNCTURE MANIPULATION METHODS ON HEALTHY ADULTS

Objective: Acupuncture manipulation is one of the key factors that affect the curative results of acupuncture in traditional Chinese medicine(TCM).It can be performed as lifting, thrusting or twirling with reinforcing or reducing strength.However, different manipulation methods can result in various changes at the acupuncture points.This study aimed to demonstrate the different influences of lift-thrust reinforcing and reducing on blood perfusion.Methods: The acupuncture manipulations of lift-thrust reinforcing and reducing were applied to the 15 healthy subjects at the Zusanli acupoint respectively and the changes of blood perfusion were monitored by Pericam Perfusion Speckle Imager(PSI).Results: The blood perfusion of Zusanli point was increased after acupuncture.There were different influences on the blood perfusion according to different acupuncture manipulations while reinforcing manipulation by lifting and thrusting is the most obvious.The reinforcing manipulation can make the blood perfusion kept at a higher level and this suggests that this increase may be caused by local vasodilators.Conclusion: Both of the manipulations of lift-thrust reinforcing and reducing increased blood perfusion at Zusanli acupoint while the increasing amount of blood perfusion in the reinforcing group is significantly higher than that in the reducing group.     

手术治疗大鼠实验性膝骨关节炎扫描电镜研究

为了从超微水平观察手法治疗大鼠膝骨关节炎的效果,采用结扎大鼠双侧股静脉造成下肢骨内高压的方法建立模型,术后４周起予以手法治疗,每３天１次,同时设立正常组。空白组及透明质酸钠阳性对照组。分别于手术后８、１６、２０周取材,取股骨外髁进行扫描电镜观察,结果发现除正常组外,其余各组病变均进行性加重,但手法组和透明质酸钠组病理改变较空白组轻。证实手法对防治膝骨关节炎确有疗效。