椎动脉型颈椎病推拿前后颅脑多普勒变化的临床研究

目的:对椎动脉型颈椎病治疗前后推拿手法进行颅脑多普勒(TCD)的临床对比研究。方法:选取本病100例为治疗组,并与颈复康冲剂组、脑电仪治疗组进行疗效比较。分别对以上各组治疗后总疗效、症状体征改善情况及椎动脉系、颈动脉系等即刻、一疗程后的收缩峰(Vs)、舒张末(Vd)、平均血流速度(Vm)及血管搏动指数(Pi)变化进行了系统的临床观察研究。结果:治疗组总有效率为97%,对照1组(颈复康冲剂组)86%,对照2组(脑电仪治疗组)82%,三组疗效差异显著,P<0.05。症状体征疗效,治疗组与对照组亦有显著差异,P<0.05;治疗组与对照1、2组治疗前后即刻、一疗程后的Vs、Vd、Vm、Pi变化差异显著,P<0.01～0.001。结论:推拿手法治疗椎动脉型颈椎病疗效明显优于对照组,临床效果确实。     

推拿法引发人骨骼肌细胞生物学效应的机制探讨

目的：探索推拿法力学作用引发人骨骼肌细胞生物学效应的机制。方法：采用细胞培养技术,建立人骨骼肌细胞损伤模型后,将正常细胞和损伤细胞各自分为空白对照组、推拿法组、推拿法＋维拉帕米组、静态压力组和静态压力＋维拉帕米组。分别对各组细胞进行推拿法样刺激或静压刺激,持续时间10 min。其后对各组细胞的超氧化物歧化酶（SOD）活力、丙二醛（MDA）含量、肌酸激酶（CK）活力进行检测。结果：推拿法可以提高人骨骼肌细胞内SOD活力,降低细胞内MDA含量以及细胞上清中的CK活力;在加入钙离子拮抗剂———维拉帕米后,各项指标的变化均受到明显的影响。结论：推拿法的力学作用主要通过影响人骨骼肌细胞中钙离子的信号通路,从而激发损伤细胞修复的生物学效应。     

Therapeutic observation of warm needling plus tuina for senile functional constipation

Objective： To observe the clinical efficacy of warm needling plus tuina in treating senile functional constipation. Methods： Ninety elderly patients with functional constipation were randomized into two groups. Forty-six patients in the treatment group were intervened by warm needling plus tuina; the other forty-four patients in the control group were intervened by San Huang tablet. Results： In the treatment group, 19 patients were cured, 24 cases showed improvement, 3 cases failed, and the total effective rate was 93.5%; in the control group, 16 patients were cured, 18 cases showed improvement, 10 cases failed, and the total effective rate was 77.3%. There was a significant difference in comparing the therapeutic efficacy（P〈0.05）, and the therapeutic efficacy of the treatment group was higher than that of the control group. Conclusion： Warm needling plus tuina can produce a higher therapeutic efficacy than taking San Huang tablet in treating senile functional constipation.     

Clinical analysis of acupuncture combined with tuina in treating cervical vertigo

Objective： To investigate the clinical efficacy of acupuncture combined with tuina in treating patients with cervical vertigo. Methods： According to the principle of randomization, 258 cases with cervical vertigo who met the inclusion criteria for the study were randomly divided into an observation group and a control group, with 129 cases in each. The patients in the observation group received acupuncture combined with tuina therapy, while those in the control group were just treated by the same acupuncture therapy as in the observation group. After 10-day continuous treatments, the clinical efficacies of the two groups were analyzed and compared. Results： The total effective rate of the observation group was 100%, versus 86.0% of the control group, and the difference was significant（P〈0.05）. After treatment, cervical range of motion（ROM） scores in both groups were statistically significantly different from those before treatment（all P〈0.05）; in addition, there was a statistically significant difference in inter-group comparison of ROM score（P〈0.05）. Conclusion： Compared with simple acupuncture treatment, acupuncture combined with tuina therapy has a better effect in improving the ROM of cervical vertigo patients, with higher clinical efficacy.     

Therapeutic Efficacy Observation on Combining Foot Bath and Massage with Auricular Point Sticking for Community Senile Insomnia简

Objective： To observe the therapeutic efficacy of combining foot bath and massage with auricular point sticking for community senile insomnia. Methods： A total of 210 cases treated in our community health center were randomized into an observation group and a control group by their visit sequence numbers, 105 cases in each group. Cases in the observation group were treated with foot bath and massage plus auricular point sticking, whereas cases in the control group were treated with auricular point sticking alone. After four courses of treatment, the therapeutic efficacies were evaluated. In addition, the sleep quality was also assessed using the Pittsburgh sleep quality index（PSQI）. Results： The total effective rate in the observation group was 95.2%, versus 68.6% in the control group, showing a statistical significance（P〈0.05）. Conclusion： Combining foot bath and massage with auricular point sticking could obtain better effect for community senile insomnia than auricular point sticking alone.     

Clinical Study on Treatment of Cervical Spondylotic Radiculopathy by Electroacupuncture plus Tuina简

Objective： To observe the clinical effects of electroacupuncture（EA） plus tuina for cervical spondylotic radiculopathy. Methods： One hundred and twenty cases with cervical spondylotic radiculopathy were divided randomly by the digital table into the observation group and control group. The patients in an observation group were treated by EA plus tuina techniques. The patients in the control group were treated by simple tuina techniques. Results： The total effective rate was 91.7% in the observation group and 78.3% in the control group. The effective rates in the two groups were statistically different（P〈0.05）. Conclusion： EA plus tuina therapy is better than simple tuina therapy in the treatment of cervical spondylotic radiculopathy.     

推拿治疗慢性腰肌劳损临床随机对照研究

目的评价推拿治疗慢性腰肌劳损的临床疗效。方法将110例慢性腰肌劳损患者按照1∶1比例随机分为治疗组和对照组,每组55例。治疗组接受为期4周的推拿治疗,对照组接受为期4周的规范健康教育。分别于治疗前、治疗后、治疗结束后1个月评价疼痛VAS评分和中文版改良ODI指数。结果共有99例患者完成整个研究。与本组治疗前比较,治疗后两组VAS评分、ODI在不同访视点均显著降低(P0.001);治疗后及治疗结束后1个月时,治疗组VAS评分、ODI下降幅度均大于对照组(P0.001)。结论推拿能够缓解慢性腰肌劳损患者的腰痛症状,改善腰部功能活动,且疗效优于健康教育。     

针刺推拿治疗肝阳上亢型头风临床研究

目的:观察针刺配合推拿治疗肝阳上亢型头风的疗效。方法:115例符合肝阳上亢型头风诊断的患者采用随机对照方法进行观察。治疗组58例给予针刺百会、风池、率谷、合谷、太冲、行间、肝俞、阿是穴,配合推拿手法治疗;对照组57例口服盐酸氟桂利嗪胶囊治疗。两组疗程均为4周,主要观察指标包括头痛程度、频率和持续时间,以及其他伴随症状和体征。结果:治疗组总有效率为91.4%,对照组为71.9%,组间差异有统计学意义(P<0.05),治疗后治疗组头痛程度、频率和持续时间的改善明显优于对照组,其他伴随症状和体征如头部压痛、急躁易怒、失眠多梦、口苦咽干的改善明显优于对照组(P<0.05)。结论:针刺配合推拿治疗肝阳上亢型头风能有效改善患者头痛程度、频率和持续时间,以及伴随症状和体征。     

五步复位法治疗腰椎间盘突出症临床观察

[目的]观察五步复位法治疗腰椎间盘突出症的临床疗效。[方法]将2018年4月至2019年6月于浙江中医药大学附属第三医院住院的符合标准的124例腰椎间盘突出症患者按随机数字表法分为两组,五步复位法组63例采用五步复位法治疗,传统推拿法组61例采用传统推拿法治疗,两组患者均隔日治疗1次,每周3次,1周为1个疗程。治疗2个疗程及随访1年后观察临床疗效,并比较两组患者治疗前后疼痛视觉模拟评分(visual analogue scale,VAS)及改良腰椎功能障碍指数(Oswestry disability index,ODI)。[结果]治疗后五步复位法组总有效率为90.5%,传统推拿法组总有效率为86.9%,组间比较差异有统计学意义(P0.05);1年后随访五步复位法组总有效率为87.3%,传统推拿法组总有效率为73.8%,组间比较差异有统计学意义(P0.05)。两组患者治疗后及1年后随访VAS评分、ODI均较治疗前降低,差异有统计学意义(P0.01)。组间比较,治疗后五步复位法组VAS评分、ODI均较传统推拿法组降低,差异有统计学意义(P0.01);1年后随访时五步复位法组VAS评分同传统推拿法组差异无统计学意义(P0.05),ODI低于传统推拿法组,差异有统计学意义(P0.05)。[结论]五步复位法治疗腰椎间盘突出症可明显缓解疼痛、改善患者腰椎功能,且具有可操作性强、疗效显著等特点,值得临床推广应用。     

基于生物力学探讨侧卧定点踩跷法治疗极外侧型腰椎间盘突出症的临床思考

由于极外侧型腰椎间盘突出症疼痛剧烈,突出组织接近椎间孔等问题,传统推拿手法往往难达到好的疗效。笔者从中西医对该病发病过程的生物力学改变的认识,侧卧定点踩跷法的操作技巧及生物力学、神经效应等角度出发,对极外侧型腰椎间盘突出症的手法治疗思路及相关临床应用进行思考。