得气内涵的演变及其与气至、针感的关系

古今文献多以得气、气至与针感等概念来表述针刺感应,而对于三者含义的异同,有多种不同的认识。通过对相关文献的学习,分析了得气的内涵,及其与气至、针感的异同及关系。认为得气在不同历史时期有不同内涵,分广义和狭义。狭义得气是针灸治疗的前提,气至为广义得气,是治疗的最终目的;针感是针刺后机体的所有感觉。     

浅谈针气至

《灵枢经》提出针灸气至的概念，并说“气而有效”。后世医家对气于的理解不同，现代的说法大致可分为三种：一批局部针感，即针刺产生的局部酸、麻、胀感；二指气至病所；三指上述二者兼有。根据文献考证及临床实践验证，认为气至主要指气至病气，而气至病所又必须是在局部针感的基础上产生的。     

谈针感与得气的差异

针感是在现代针灸文献和著作中产生的新名词,是指当针入腧穴一定的深度或者施以一定的行针手法后,患者和医者分别感受到的针刺部位和刺手手指下各种主观感觉和自觉反应的概括.传统的观点认为针感与得气的意思相同,并将针感视为得气的主要表现形式和界定是否得气的重要指征,笔者认为不妥.试结合古今对得气、得气感、针感的研究和认识,来谈谈针感与得气的差异,并对针刺得气提出自己的见解.     

浅谈针灸气至

《灵枢经》提出针灸气至的概念，并说“气至而有效”，后世医家对气至的理解不同，现代的说法大致可分为三种：一指局部针感，即针刺产生的局部酸、麻、胀感；二指气至病所；三指上述二者兼有。根据文献考证及临床实践验证，认为气至主要指气至病所，而气至病所又必须是在局部针感的基础上产生的。（至病所疗效明显，局部针感疗效迟。由于体质（气血）不同，有些病人经气不易行走，因此施用各种手法，可促其达到气至病所。     

《内经》中有关得气、气至的初步探讨

自<内经>以后针灸界对得气和气至大多数已经形成以下的共识:①得气、气至为针刺行施补泻手法的前提,只有在得气的基础上再进行补泻,针刺才会有效.     

我对“针下气”的体会

介绍运用毫针如何凭手感辨别“针下气”，并探讨了所谓得气是指泻尽邪气是经气（谷气），术者与病家两种相依共同达到得气状态。     

从虚实辨证论“得气”与“气至”

“得气”与“气至”均为针刺过程中的特征性表现,“得气”以医者针下气感与患者酸麻胀痛之感为主,但这种气感并非一定提示“气至而有效”,还须先辨“气”之邪正;“气至”除上述感觉外兼有脉象或表浅症状的改善。针刺的临床疗效通过进入“气至”的境界而实现,而“气至”的前提往往是“得气”。在不同辨证下,“得气”与“气至”的关系也发生了一些变化。从实证、虚证、虚实夹杂证等方面,论述“得气”与“气至”的特点及关系,可为临床医生辨病辨证及判断针刺疗效提供一些思路。     

谈“针刺得气”与“气至病所”和针灸临床

谈“针刺得气”与“气至病所”和针灸临床高俊雄，赵万标（北京针灸骨伤学院北京１０００１５）关键词：《灵枢》；针刺得气；气至病所《灵枢·九针十二原》曰：“刺之要，气至而有效”。《灵枢·刺节真邪》曰：“用针之类，在于调气”。《金针赋》着重指出：“气速效速，...     

客观针感与肌电关系的研究

以毫针针刺12只家兔“足三里”穴,用8导仪描记针刺穴位、同经穴位、同侧及对侧有关穴位的肌电活动。结果表明:麻醉家兔在针刺穴位得气、出现客观针感时,穴区肌电多呈单位型或肌束型,干扰型肌电较少见。捻转补泻手法可分别引起上行或下行同经穴区肌电活动。提示肌肉行为可能是得气的生物学基础之一,肌肉活动可能与客观针感形成及循经感传密切相关。而同侧对抗肌及对侧对称肌穴区的相应肌电活动,可能与脊髓或更高级运动中枢协调的特定穴区针刺相应的防卫反应有关。     

曲意之气:针刺究竟补泻了什么

补泻刺法源于《黄帝内经》,在后世得到了丰富的发展,这于统编《针灸学》教材及术语规范等文本中有所体现。但过于繁复多样的补泻刺法实不利于其要义的传达与运用。梳理现代对补泻的定义与分类,提出解决这一问题的必要性;通过对《黄帝内经》中针刺补泻载述的研究,提出补泻刺法的本义实为顺势思维的质朴体现;而其愈渐玄化的原因,在于对"气"的理解失当。在解读经文的过程中,应特别注意对古代思想与语言特点的把握,辨析其中观念论述与经验记述两类内容,避免混淆理解与运用的谬误。     

火针配合体针围刺治疗局限性神经性皮炎疗效观察

[目的] 观察火针配合体针围刺治疗局限性神经性皮炎的临床疗效。[方法] 按随机数字表法将76 例患者随机分为两组,其中治疗组40 例,采用火针配合体针围刺治疗;对照组36 例,采用醋酸去炎松尿素软膏外用治疗,2 周后进行疗效评价。[结果] 治疗组总有效率为95.0%,对照组总有效率为83.3%;两组有效病例随访半年,治疗组复发率为5.3%,对照组为23.3%;两组主要症状、体征,即瘙痒及皮损改善程度评分比较,差异有统计学意义（P<0.01）。[结论] 火针配合体针围刺治疗局限性神经性皮炎疗效确切,取穴简便,无毒副作用,复发率低,值得临床推广。     

针刺得气对寒凝证类痛经模型大鼠效应指标的作用

目的观察针刺三阴交穴"得气"与"未得气"状态对寒凝证类痛经模型大鼠子宫收缩、微循环及扭体反应的影响。方法将96只动情间期雌性SD大鼠随机分为盐水对照组(对照组)、寒凝证类痛经模型组(模型组)、得气组与未得气组,每组24只。采用全身冷冻加雌二醇注射方法制备类痛经大鼠模型。得气组与未得气组造模成功后对大鼠双侧三阴交穴进行针灸刺激,观察大鼠子宫张力不同时间段变化、微循环多时间窗变化及扭体反应。结果与对照组相比,模型组子宫活动度显著增加。得气组的子宫收缩波个数及子宫活动度比模型组显著减少。模型组与未得气组的子宫微血管、毛细血管管径比对照组明显收缩;与模型组相比,得气组在各时间段微血管均扩张,毛细血管管径在针刺后40、50、60 min明显扩张(P0.05)。与模型组相比,得气组扭体潜伏期明显延长、扭体次数减少、扭体评分降低(P0.01)。结论针刺三阴交穴得气能缓解痛经模型大鼠子宫收缩,改善子宫微循环障碍,并具有一定的后续效应。     

Discussion on the Arrival of Qi and Its Relationship with Reinforcing and Reducing Manipulations in Acupuncture Therapy

With the concept of arrival of qi as the starting point, this paper deals with the content of qi as regard to arrival of qi, its continuity, as well as the relationship between arrival of qi and Qizhi. The relationship between arrival of qi and reinforcing and reducing manipulations in acupuncture therapy is somewhat self-contradictory according to those theory written on the textbook, which defines the arrival of qi something like needle in acupoint. The genuine premise and foundation of reinforcing and reducing manipulations in acupuncture therapy is supposed to be perception of healthy or evil qi beneath needles.     

Evidence and Expert Opinions:Drying Needling versus Acupuncture (Ⅱ)——The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016

In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding (1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using "fascia" hypothesis) in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain (dry needling promoters redefined it as "myofascial pain"). Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture's local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients' safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.     

Immediate effect of Fu’s subcutaneous needling for low back pain

The traditional Chinese acupuncture has been reported to alleviate pain and is widely accepted as a complement therapy for pain relief in the world.1In 1996, a novel acupuncture strategy, Fu＇s subcutaneous needling （FSN）, was developed from the traditional Chinese acupuncture, but quite different from it.2 In FSN, needles are penetrated and swayed in the subcutaneous layer, but not the muscular layer. The choosing of its insertion points doesn＇t obey the principles of traditional Chinese medicine. To date, FSN has been widely used by clinicians in China for its good job in pain management though the systemic and rigorous studies are still lack.     

"五心针"治疗脑卒中78例临床观察

目的观察"五心针"对脑卒中的疗效.方法将78例脑卒中病人随机分为2组,治疗组在常规治疗的基础上加用"五心针",对照组仅用常规取穴治疗.治疗30 d后,比较两组病人的疗效.结果与结论两组病人的恢复情况无显著性差异,但"五心针"对于风火上扰清窍、痰湿蒙塞心神和痰热内闭心窍等证型的疗效显著,对于出血性脑卒中的疗效也高过缺血性脑卒中,对于左侧脑部损伤的疗效高于右侧损伤.     

腕踝针配合温针灸治疗肩关节周围炎40例临床观察

目的观察腕踝针配合温针灸治疗肩关节周围炎的临床疗效。方法将80例肩关节周围炎患者随机分为治疗组和对照组,每组40例,治疗组采用腕踝针配合温针灸治疗,对照组采用单纯温针灸治疗,每日治疗1次,2周为1个疗程,1个疗程后观察2组治疗前后肩关节功能、活动度评分及临床疗效。结果治疗组与对照组均能明显改善患者的肩关节功能及活动度（P〈0.01）,但治疗组改善程度较对照组更为显著（P〈0.05）。治疗组总有效率为97.5%,对照组为85.0%,2组比较差异有统计意义（P〈0.05）。结论腕踝针配合温针灸是治疗肩关节周围炎较佳的治疗方法,其疗效优于单纯温针灸治疗。