脐针联合体针治疗广泛性焦虑症验案一则

<正>脐针是基于易学理论、中医基础理论、全息理论、时间医学理论四大理论体系之上的一种新型针刺技术。通过在脐部实施针术,以达到阴平阳秘、治病防病的目的。我科在临床上广泛应用脐针疗法,取得明显疗效,现辑录验案一则如下。1病历摘要患者女,15岁,高三学生,主诉焦虑、紧张1年多,入睡困难3个月。患者两年前因学习压力逐渐增大开始出现焦虑、紧张,有不能放松感,烦躁易怒,偶有心情低落;胸闷心悸,皮肤麻木。3个月前患者开始出现入睡困难,入睡时间3～4 h,严重时彻夜不眠（平     

天轨悬吊减重联合核心肌群训练对脑卒中患者平衡和步行功能的影响

<正>目前我国脑卒中患病人数位居世界第一位,并且其发病率仍呈显著上升趋势^[1,2]。平衡和步行功能障碍是常见的脑卒中后遗症之一,调查显示脑卒中后平衡障碍的发病率最高可达83%,满足日常生活行走速度和耐力的脑卒中患者的比例不到10%^[3,4]。减重步行训练是近年来逐渐兴起的一种下肢训练方法,已在康复领域中广泛应用,并被证实对脑卒中患者肢体功能恢复具有一定疗效^[5]。本次研究旨在观察天轨悬吊减重联合核心肌群训练对脑卒中患者平衡和步行功能的影响。现报道如下。     

Effects of electroacupuncture on cochlear morphology and expression of aquaporins in rats with AVP-induced endolymphatic hydrops

Objective: The objective of this study was to investigate the effects of EA on EH and the regulation of AQP2 and AQP7 protein expression in rats.Methods: Twenty-four rats were allocated randomly to four groups of blank group, EH group,EH+tolvaptan group and EH + EA group(n = 6 per group). EH rat model was established by intraperitoneally injection of arginine vasopressin(AVP). EA was administered at acupoints "Baihui(百会 GV 20)"and "Tinggong(听宫 SI 19)". Rats in the EH + tolvaptan group and EH+ EA group were treated with tolvaptan and EA, respectively, after EH establishment. Hematoxylin-eosin staining was used to measure the cochlear hydrops degree, and then the ratio of scala media(SM) area to SM + scala vestibuli(SV) area(R value) was calculated. Immunohistochemical method was used to observe AQP2/AQP7 protein expression in the rat cochlear lateral wall after treatment.Results: ①There was no endolymphatic hydrops in the blank group. Reissner' s membrane was extended markedly and bulged into SV in cochleae of the EH group and endolymphatic hydrops was noted. Statistical analysis revealed that R value in the EH group showed a significant increase compared with that in the blank group(0.42 ± 0.02 vs. 0.31 ± 0.05, P=0.000). The distension of Reissner's membrane was less obvious in the EH + tolvaptan group and EH + EA group when compared with the EH group. R value in the EH + tolvaptan group and the EH + EA group was significantly less than that in EH group(0.32±0.04 vs. 0.42 ± 0.02, =0.001;0.35 ± 0.05 vs. 0.42 ± 0.02, P=0.012). The degree of the hydrops in the EH + EA group was not different from that in the EH + tolvaptan group(0.35 ± 0.05 vs. 0.32 ±0.04,P= 1.000). ②The AQP2 protein expression in the rat cochlear lateral wall of EH group was significantly increased when compared with the blank group(12.74 ± 5.18 vs. 5.92 ± 1.52, P = 0.014). The AQP2 protein expression in the rat cochlear lateral wall of EH + tolvaptan group and EH + EA group were all lower than that of the EH group(6.52 ± 2.73 vs. 12.74 ± 5.18. P = 0.029;6.95 ± 3.10 vs. 12.74 ± 5.18, P = 0.047).The AQP2 protein expression in the rat cochlear lateral wall of EH + EA group was not different from that in the EH + tolvaptan group(6.95 ± 3.10 vs. 6.52 ± 2.73, P= 1.000).③The AQP7 protein expression in the rat cochlear lateral wall of EH group was significantly increased when compared with the blank group(30.32 ± 6.39 vs 16.64 ± 3.21, P=0.000). The AQP7 protein expression in the rat cochlear lateral wall of EH + tolvaptan group and EH + EA group were all lower than that of the EH group(18.32 ± 2.45 vs.30.32 ± 6.39, P= 0.001;19.54 ± 4.61 vs. 30.32 ± 6.39, P= 0.003). The AQP7 protein expression in the rat cochlear lateral wall of EH + EA group was not different from that in the EH + tolvaptan group(19.54 ±4.61 vs. 18.32 ± 2.45, P= 1.000).Conclusions: These results indicate that repeated EA stimulation exerted the same effects as tolvaptan application on AQPs levels and subsequent aquaretic effects. And dehydrating effect of EA on the inner ear might be associated with its down-regulation of both AQP2 and AQP7 protein expression, thereby provide a potential molecular mechanism involved in the treatment of Meniere's disease by EA.     

推拿联合耳穴压豆辅助治疗膝骨关节炎效果观察

目的 观察推拿联合耳穴压豆辅助治疗膝骨关节炎的效果。方法 选取浙江中医药大学附属杭州市中医院2021年1月至2022年6月收治的膝骨关节炎患者96例,随机分为观察组与对照组各48例。对照组给予塞来昔布胶囊口服,观察组在对照组基础上加用推拿联合耳穴压豆治疗,两组均连续治疗4周。比较两组治疗前后中医证候评分,视觉模拟评分法（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、健康调查简表（SF-36）评分及疗效。结果 观察组治疗总有效率（95.8%,46/48）明显高于对照组（77.1%,37/48）,治疗后中医证候、VAS、WOMAC评分低于对照组,SF-36评分高于对照组,差异均有统计学意义（P <0.01）。结论 推拿联合耳穴压豆辅助治疗膝骨关节炎,能有效缓解症状,减轻疼痛,改善关节功能,从而提高患者生活质量。     

悬吊辅助下不同强度核心肌群强化训练对脑卒中患者平衡和步行功能的影响

目的 观察悬吊辅助下不同强度核心肌群强化训练对脑卒中患者平衡和步行功能的影响。 方法 选取脑卒中患者68例,随机分为核心1组和核心2组,每组34例。2组患者均给予内科治疗和常规康复训练45 min,核心1组进行悬吊辅助下核心肌群强化训练15 min,核心2组进行悬吊辅助下核心肌群强化训练30 min。每日1次,每周5 d,共训练4周。分别于治疗前和治疗4周（治疗后）,采用Berg平衡量表(BBS)评分、Holden功能性步行量表(FAC)分级、步幅、步速和患侧步长对2组患者的平衡和步行功能进行评估。 结果 治疗后,核心1组和核心2组的BBS评分、FAC分级、步幅、步速和患侧步长均显著优于治疗前,差异均有统计学意义（P＜0.05）,且核心2组效果优于核心1组（P＜0.05）。 结论 悬吊辅助下核心肌群强化训练可有效改善脑卒中患者的平衡和步行功能,且30 min的训练强度效果优于15 min的训练。     

中医＂和＂的诊疗思想及其在脾胃病中的临床意义

中医以和为本,注重机体阴阳调和。中医＂和＂的思想理论的形成对脾胃病临床处方用药有重要的现实意义。通过对古代文献和现代研究的梳理,在历代医家的临床经验基础上,结合个人的临床体会,对中医＂和＂的思想理论体系的形成演变进行了归纳,并对和法和＂和＂的思想理论在脾胃病临床中的应用进行了阐述。认为和法不仅仅局限于和解少阳,还包括其它和解调和之法和多种调和之法有机配合使用。＂和＂的思想理论体系对中医临床的意义不仅仅局限于和的方法,更多的是理论思想的指导和遣药组方的思路。     

温针灸结合悬吊训练对肩袖损伤患者肌腱弹性和肩关节功能的影响及其相关性分析

目的 以弹性超声成像为评估手段,观察温针灸结合悬吊训练对肩袖损伤后肌腱弹性和肩关节功能的影响以及两者变化的相关性。 方法 将符合纳入条件的60例肩袖损伤患者随机分为治疗组和对照组,每组30例,均行关节松动康复训练治疗,每周训练3次（周一、三、五）,每次20 min,共治疗6周。在此基础上,对照组给予单纯温针灸治疗,治疗组加行温针灸和悬吊训练治疗,每周3次（周一、三、五）,每次30～40 min（艾条燃尽为止）,6周为1个疗程。分别于治疗前和6周治疗结束后（治疗后）,采用目测类比法（VAS）评分、肩关节各方主动活动度（SAROM）、杨氏模量（E）值评估2组患者的肩关节疼痛程度、肩关节的活动功能及肩袖肌腱弹性,并判定肌腱弹性及肩关节功能,分析两者间变化相关性。 结果 2组患者治疗后的VAS 评分和 E值较组内治疗前明显下降（P＜0.05）,其外展 SAROM 较组内治疗前显著增加（P＜0.05）;治疗后,治疗组的VAS评分、外展 SAROM和E值均明显优对照组（P＜0.05）。相关性分析显示,VAS与外展SAROM成负相关变化（治疗组r2=0.306,P＜0.05;对照组r2=0.178,P＜0.05）,而E值与VAS及外展SAROM均无线性相关关系,其中治疗组E值与VAS值的r2=7.723E-5,（P＞0.05）;E值与外展SAROM值的r2=0.004（P＞0.05）;对照组E值与VAS值的r2=0.025（P＞0.05）,E值与外展SAROM值的r2=8.363E-5（P＞0.05）。 结论 温热针灸结合悬吊训练疗法可有效改善肩袖损伤患者肩关节功能和肌腱弹性,患者肩袖疼痛改善程度与肩关节活动度呈线性相关,但肩袖疼痛改善程度与肌腱弹性的变化无相关。     

针灸治疗四边孔综合征1例

<正>四边孔位于肱骨内侧与肩胛骨外缘之间，是由小圆肌、大圆肌、肱三头肌长头肌腱及肱骨外科颈内侧组成的四边形孔隙，其中有腋神经及旋肱后动脉穿行。四边孔综合征即二者在四边孔处受压导致的一系列临床症状，主要表现为四边孔压痛，伴肩臂外侧感觉障碍、三角肌功能受限等。该病临床少见，因症状缺乏特异性，常与颈椎病、肩袖损伤、臂丛神经损伤等混淆。