Resisting method of acupuncture at movement-painful points for treating the refractory cases of frozen shoulder during adhesion period: A randomized controlled study: 动痛穴阻力针法治疗粘连期难治性肩凝症的随机对照观察

ObjectiveTo objectively evaluate the clinical effect of resisting method of acupuncture at movement-painful points on treating the refractory cases of frozen shoulder during adhesion period, and to compare with that of the conventional acupuncture method.MethodsAccording to the random grouping principle, 90 patients with frozen shoulder during adhesion period were divided into “resisting method acupuncture group, general acupuncture group, and physiotherapy group”, 30 patients in each. In the resisting method acupuncture group, the resisting method of needling was applied at the “movement-painful points”, and during acupuncture the patient was asked to do shoulder movements. In the general acupuncture group, the conventional needling method of acupuncture was applied at the conventional three shoulder-acupoints. In the physiotherapy group, the patients were treated with shock wave at the affected shoulder. All groups were treated once a day, 5 times a week, a total of 2 weeks as a course of treatment. After one course of treatment, the clinical effect of the three groups was evaluated. The shoulder pain and shoulder function scale (Constant-Murley), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and infrared thermal imaging temperature change score were observed.ResultsAfter treatment, the shoulder pain was relieved and movement improved in all three groups, whilst the cured and remarkably effective rate of the resisting method acupuncture group was 96.7% (29/30), better than those of the general acupuncture group 86.2% (25/29) and the physiotherapy group 73.3% (22/30), with a statistically significant difference (P<0.05); the VAS score of the resisting method acupuncture group was significantly lower than those of the other two groups (P<0.05), the Constant-Murley score and the ASES score were significantly lower than those of the other two groups (all P<0.05), and the infrared thermal imaging temperature change score was significantly improved in comparing with those of the other two groups, with a statistically significant difference (both P<0.05).ConclusionThe resisting method of needling has an obvious analgesic effect and is able to restore the joint movement function in the treatment of refractory frozen shoulder during adhesion period.     

A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder

The integration of traditional Chinese and Western medicine and their clinical effects have been widely evaluated. Many studies have shown that using a combination of these two remedies has resulted in better outcomes than using only one of them. Acupuncture is a traditional Chinese medical technique, which plays an important role in enforcing pain control, prevention and functional improvement. In 1979, the World Health Organization (WHO) journal introduced acupuncture as a remedy for 43 diseases, including frozen shoulder. This study aims to assess the therapeutic outcomes of combining acupuncture and physical therapy to treat frozen shoulder, and hopes to establish an evidence-based study of the integration of acupuncture and western medicine in the future. A total of 75 frozen shoulder patients treated in a medical center were recruited for the study between January 2002 and December 2002. The average age of these patients was 54.8 years. The average duration of the condition was 25.8 weeks before treatment. Of the 75 patients, 30 were treated by physical therapy, 30 by acupuncture and 15 by both remedies. Before the treatment began, all patients were evaluated by assessing static pain scale, motion pain scale, active and passive ROM (range of motion) and quality of life scale sheet SF-36 (Short Form-36). The outcome was evaluated by follow-up assessments conducted at the 2nd week and 4th week of treatment sessions. All patients showed improvement in quality of life (Short Form-36). Pain was controlled better by acupuncture while ROM improved following physical therapy. However, patients treated by both methods had the best outcome. The integration of acupuncture and physical therapy to treat frozen shoulder leads to a better outcome than using only one method. The author suggests that an evidence-based foundation of the integration of Chinese and Western medicine should be established in the future, to encourage the integration of Chinese and Western medicine.     

针灸点穴配合体疗治疗腰痛症

目的：探讨针灸综合疗法对腰痛症治疗次数与疗效的关系。方法：以针灸配合点穴及体疗的综合疗法治疗34例腰痛患者，并采用目测疼痛分数法(Visual Ana1ogue Scale)作疗效评定。结果：接受l或2次治疗的病例，疼痛减缓27．7％；接受3一10次治疗的病例，疼痛减缓63．8％。结论：针灸综合疗法对腰痛症有较快的止痛效果，但要取得稳定且较高的疗效，宜治疗10次左右。     

针刺肩痛穴治疗肩周炎适宜在农村推广

从肩部发病因素,肩外因素论述针刺肩痛穴治疗肩周炎适宜在农村推广。指出:此项既有利于提高针刺肩痛穴治疗肩周炎的疗效、更有利于广大群众就医。     

Exploration of the therapeutic effect and clinical outcomes of acupuncture at pain-sensitive points to treat chronic nonspecific low back pain: Application of the acupoint sensitization theory 基于穴位敏化理论探讨针刺痛敏点对慢性非特异性腰痛患者的临床疗效

Objectives To investigate the clinical and therapeutic effects of acupuncture at the pain-sensitive points of patients with chronic nonspecific low back pain and optimize the acupuncture treatment for chronic nonspecific low back pain.Methods Using the FDK 20 pressure algometer, the pain-sensitive points were probed in 30 patients with chronic nonspecific low back pain. The top 5 points that elicited the most painful reaction were selected and stimulated with an even-needling technique after deqi. The needles were retained for 30 min. TDP irradiation was concurrently administered. The treatment was administered once daily on weekdays (Monday to Friday) and discontinued for 2 days during the weekend (Saturday and Sunday). The treatment lasted for 2 consecutive weeks. The changes in the range of motion (ROM) of the lumbar vertebrae, visual analogous scale (VAS) score, and the Oswestry disability index (ODI) score of the lumbar vertebrae were assessed before treatment and after 5 and 10 treatment sessions.Results Compared with the data before treatment, the spinal ROM increased after 5 and 10 treatment sessions in the patients with chronic nonspecific low back pain.The ROM after 10 treatment sessions was remarkably wider than that after 5 treatments, with statistical significance (all P < 0.05). Compared with that before treatment, the immediate VAS score showed statistically significant reduction after 5 treatment sessions (P < 0.05). Moreover, compared with the score after 5 treatment sessions, the immediate VAS score reduced after 10 treatment sessions, but without any statistical significance. After 5 and 10 treatment sessions, the ODI score was reduced in the patients and it was significantly different from that before treatment (both P < 0.05).Conclusion Acupuncture at the pain-sensitive points alleviates pain and improves lumbar vertebral function in patients with chronic nonspecific low back pain. Thus, further research is needed to confirm whether acupuncture can be a better intervention for chronic nonspecific low back pain.     

肩周炎三种不同治疗方案的临床观察

目的:探讨肩周炎三种不同治疗方案的临床效果。方法:选择肩周炎患者99例,随机分成三组,每组33例,对照组采用普通针刺、电针、拨罐、TDP照射治疗;康复锻炼组除对照组治疗外,每日早、中、晚根据肩周炎康复保健操锻炼3次;针刀治疗组除对照组治疗外,每周行1次小针刀治疗。结果:根据最常用的视觉模拟评分法(VAS),计算三组患者治疗后第7天及第14天肩关节外展、上举、内、外旋时的平均疼痛程度。结果治疗后第7天,对照组、康复锻炼组、针刀治疗组分值分别为6.06、5.13、4.61;治疗后第14天,分值分别为5.12、3.08、2.78。康复锻炼组、针刀治疗组与对照组比较,差异有显著性(P0.01);针刀治疗组第7天与康复锻炼组比较,差异有显著性(P0.01),第14天比较差异不显著(P0.05)。结论:康复锻炼和小针刀治疗与对照组比较均能降低肩周炎的疼痛的程度,康复锻炼随治疗时间增加能与小针刀疗效相当,提示康复锻炼在肩周炎治疗中起良好的促进作用。     

Randomized Trial of Trigger Point Acupuncture Treatment for Chronic Shoulder Pain: A Preliminary Study

There is evidence for the efficacy of acupuncture treatment for chronic shoulder pain, but it remains unclear which acupuncture modes are most effective. We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42–65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle. Outcome measures were pain intensity (visual analogue scale, VAS) and shoulder function (Constant–Murley Score: CMS). After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly (p < 0.001). Shoulder function also increased significantly between pretreatment and 5 weeks after TrP (p < 0.001). A comparison using the area under the outcome curves demonstrated a significant difference between groups (p = 0.024). Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.     

眼针配合刺络放血拔罐治疗肩周炎临床观察

目的 观察眼针配合刺络放血拔罐治疗肩周炎的临床疗效.方法 将200例肩周炎患者随机分为试验组与对照组.试验组患者采用眼针配合刺络放血拔罐治疗,对照组患者采用传统体针针刺治疗,2组均采取隔日治疗方式,2周为一个疗程,持续治疗2个疗程.对所有患者治疗前后进行肩部疼痛评分及关节功能评分,观察临床疗效.结果 试验组肩部疼痛缓解...     

不同针灸疗法留针60min治疗肩关节周围炎疗效比较

目的:观察并比较不同针灸疗法留针60min治疗肩关节周围炎的疗效,方法:将预纳入患者进行完全随机分组分为毫针组、电针组(频率选用2/100Hz)、温针灸组(每壮艾绒重3g)等3组进行治疗,分别测定治疗前和治疗后肩部疼痛指数和肩关节活动度评分,隔日1次,5次1疗程,观察并比较各组的疗效。结果:3种疗法治疗肩周炎均有一定的疗效,与治疗前比较有非常显著差异(P0.01)。其中,在3组中温针灸组总有效率达95.65%较电针组和毫针组整体疗效好,差异有非常显著意义(P0.01),且在缓解疼痛和改善肩关节活动度上效果显著(P0.05)。     

针刺肩痛穴治疗肩周炎31例临床观察

[目的]通过卫生适宜技术中医项目—针刺肩痛穴治疗肩周炎的推广,针刺治疗31例,进行疗效分析和总结。[方法]31例,取穴中平穴和中渚穴,配合手法,治疗肩周炎。[结果]治愈27例,占87%;显效3例,占9.7%;有效1例,占3.2%;无效0例,总有效率100%。[结论]通过临床应用观察,针刺肩痛穴治疗肩周炎疗效显著。     

马惠昇采用毫火针齐刺经筋法辨证治疗肩周炎思路

肩关节周围炎中医属痹症范畴,根据其发病特点及临床症状又称“五十肩”“冻结肩”“肩凝症”,临床西医常采用口服非甾体抗炎药、关节镜、局部封闭术等治疗,中医常规采用毫针针刺十二经穴联合推拿及理疗等保守治疗。马惠昇老师经过长期的临床观察及阅读古籍,认为肩周炎的病位在经筋,病机以外感风寒湿邪、体虚筋脉失养、外力创伤等以致经筋痹阻,不通则痛为主。毫火针齐刺经筋联合中药口服治疗可以更好地温阳散寒,激发人体阳气,活血通筋,迅速消除或改善“不通则痛”的症状,且疗程较短,价格低廉,易为患者所接受。故临床上常采用“温通经筋”法治疗肩周炎,疗效显著。现结合临床病案将马惠昇老师治疗肩周炎的思路进行介绍。     

Treatment of low back pain with acupuncture.

Twenty patients with low back pain were selected for treatment with acupuncture. Four standard acupuncture loci and a standard regime were used. The results were analyzed after a follow-up of 12 months. Initially, 16 patients responded favorably to the treatment while 4 did not respond at all. The degree of cure was not uniform. Instead they varied from complete cure in 4 to varying degrees of alleviation of pain in the rest. Recurrence or acute exacerbation of symptoms occurred in 13 of the 20 patients. Acupuncture was given to 11 of these patients and the results of treatment similated the initial course of acupuncture.     

针灸治疗肩周炎临床研究证据图

梳理和总结针灸治疗肩周炎的临床研究证据。计算机检索PubMed、EMbase、Cochrane系统评价数据库(CDSR)、Cochrane对照试验注册数据库(CENTRAL)、中国期刊全文数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普资讯中文期刊服务平台(VIP)和中国生物医学文献数据库(Sino Med)中针灸治疗肩周炎文献,检索时限为建库至2021年5月31日。采用AMSTAR-2评价纳入系统评价的方法学质量,并以证据图的形式总结针灸治疗肩周炎临床研究证据现况。共纳入原始研究文献266篇,系统评价文献6篇。目前小样本随机对照试验居多,干预措施以温针灸、毫针、针刀和电针等单一针灸疗法为主,临床有效率、肩关节疼痛评分、肩关节功能评分和生活质量评分是现有临床研究关注较多的结局指标。大多数研究结果显示了针灸作为肩周炎辅助治疗措施的优势,在疾病复发率以及安全性方面的临床证据较少。此外,针灸治疗肩周炎相关研究的证据质量也有待提高。     

针灸按摩推拿配合中药汤剂治疗68例肩周炎的临床观察

目的：探讨针灸按摩推拿结合中药汤剂治疗肩周炎的临床疗效。方法：选择110例确诊为肩周炎的患者,遵循随机数字表格法分成两组,每组55例,其中观察组予以针灸按摩推拿结合中药汤剂治疗,对照组单纯予以针灸治疗,两组治疗时间为1次/d,疗程为4周,疗程结束后观察两组患者的愈显率,肩关节活动改善情况以及视觉模拟量表（VAS）评分变化。结果：治疗后,观察组患者愈显率为92.7%,对照组患者愈显率为87.3%,与治疗前比较,两组患者的肩关节活动程度以及视觉模拟量表（VAS）评分均得到改善,但观察组改善更为明显,差异经统计学处理有显著意义（均P〈0.05）。结论：应用针灸按摩推拿结合中药汤剂治疗肩周炎,疗效更为显著,肩关节活动功能与疼痛评分均改善显著,建议推广及广泛应用。     

针灸治疗肩周炎的系统评价

目的：系统评价针刺治疗肩周炎的有效性及安全性。方法：以针刺、电针、针灸和肩周炎、肩凝症、冻结肩等为主题词,检索Cochrane骨关节病组,Cochrane临床试验资料库,Cochrane补充医学资料库,Cochrane图书馆中心数据库,MEDLINE,EMBASE等英文数据库和中国生物光盘数据库（CBM）等中文数据库。手工检索20种中医杂志及有关学术会议论文汇编。鉴定的相关文章附录的参考文献作为补充检索。结果：6个针刺及电针治疗肩周炎的随机对照试验符合纳入标准,均为较高质量研究。所纳入的人员数量从34人到257人,共668人。整体功能CMS／CSA评分汇总OR3．49（95％CI-2．64 to 9．63）,疼痛VAS评分汇总OR-1．24（95％CI-3．50 to 1．01）,肩关节活动范围ROM评分OR35．70（95％CI 22．91 to 48．49）,肩关节功能4活动MELLE评分OR4．30（95％CI2．32 to 7．98）。结论：目前有限的纳入研究显示针刺治疗肩周炎安全,对改善整体功能、疼痛、肩关节活动范围、肩关节功能活动较对照组有效,尚需更多高质量的研究以使证据强度更高。对针刺治疗肩周炎的其他评价指标的有效性尚需要更多的研究证实。     

温和灸激痛点治疗肩背部肌筋膜疼痛综合征:随机对照研究

目的:比较温和灸与针刺激痛点治疗肩背部肌筋膜疼痛综合征(MPS)的疗效差异,为肩背部MPS的治疗提供参考。方法:60例肩背部MPS患者随机分为温和灸组和针刺组,每组30例,两组均选取疼痛部位的激痛点进行治疗。温和灸组采用温和灸疗法,每次艾灸因人而异,20~100min不等,以患者出现透热感为度;针刺组采用毫针与皮肤呈45°角斜刺入并贯穿激痛点结节,每次留针30min。两组每日均治疗1次,10次为一疗程,治疗1个疗程后,采用国际公认的简化麦吉尔疼痛量表(McGill)作为观察指标,以治疗前后疼痛分级指数(PRI)、视觉模拟评分(VAS)和现时疼痛强度(PPI)的变化来评价疗效。结果:温和灸组愈显率80.0%(24/30),优于针刺组愈显率40.0%(12/30,P0.001)。治疗后两组PRI、VAS、PPI评分较治疗前均降低(均P0.001);两组治疗后PRI、VAS、PPI评分比较,差异均无统计学意义(均P0.05)。结论:温和灸激痛点与针刺激痛点对肩背部MPS均具有良好的治疗效果,但温和灸治愈显效更为明显,且操作简便,易于推广。     

三种外治法治疗肩凝症90例临床观察

目的 观察3种外治法对肩凝症的临床症状、体征改善作用,同时评价其安全性.方法 将90例肩凝症患者随机分为手法组、针刺组和扶他林组各30例,在相同功能锻炼的情况下,分别给予手法治疗、针刺治疗和扶他林外敷治疗,疗程均为14天.分别对肩周静止痛、活动痛、压痛、肩关节活动范围,在治疗前、治疗后7天、治疗后14天时进行评分,同时观察其安全性.结果 治疗后7天各组疗效比较,手法组有效率明显高于针刺组(P＜0.01),而与扶他林组比较差异无统计学意义(P＞0.05).治疗后14天,手法组和扶他林组痊愈率和显效率明显高于针刺组(P＜0.01),手法组和扶他林组比较差异无统计学意义(P＞0.05);手法组总有效率高于其余两组(P＜0.05).治疗后7天、14天,各组肩部静止痛、肩部活动痛、肩部压痛、肩关节活动范围评分均显著下降(P＜0.01).治疗后14天,针刺组与手法组肩周压痛评分差异比较有统计学意义(P＜0.05),手法组和扶他林组比较差异无统计学意义(P＞0.05);其他指标分值比较无统计学意义(P＞0.05).3组均无不良反应发生.结论 手法、针刺、扶他林外敷治疗肩凝症均安全可靠.其中手法对改善肩凝症肩周压痛作用明显高于针刺治疗.     

The effects of Park sham needles: a pilot study

BACKGROUND: When performing clinical trials involving acupuncture, it can be difficult to choose a placebo control. OBJECTIVE: To validate the Park sham needle for use as a double-blind control intervention.DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: Two different methods were employed. First, a researcher blinded to needle type administered the Park sham or a real needle, chosen at random, on the arms of 16 healthy volunteers. The researcher and the volunteers independently recorded which needle type they thought had been applied at each acupuncture point. Second, 19 patients with shoulder impingement syndrome were randomly assigned to receive acupuncture applied with the real needle or the Park sham needle, once a week for 6 weeks alongside a course of physiotherapy. At the end of the 6 sessions the patients recorded which needle type they thought was being used. The results were analyzed with a Fisher's exact test. This study was carried out in the Outpatient Department of Physiotherapy in Charing Cross Hospital, London, UK, on healthy volunteers and patients with shoulder impingement pain. The age range was 23 to 54 and 22 to 74 years respectively.RESULTS: Of the healthy volunteers, there was no difference(P=0.23) between the number of needles that were correctly(n=43) or incorrectly identified(n=53). All patients thought that they had received the real needles. The researcher correctly identified all needles that were applied. CONCLUSION: The researcher delivering the acupuncture recognized the needle type. However, both healthy and patient volunteers were blind to the needle type. This demonstrates that the Park sham needle is an effective single-blind control. It should be noted that the number of patients recruited was small and the study was underpowered to detect an effect of treatment.     

针灸与针刀治疗肩关节周围炎疗效比较的系统评价

目的:系统评价针灸与针刀治疗肩关节周围炎的疗效和安全性差异。方法:计算机检索中国生物医学文献数据库CBM(1978年—2010年)、中国知网CNKI(1979年—2010年)、维普数据库VIP(1989年—2010年)、PubMed(1966年—2010年)和Cochrane Library(2010年第4期),辅以手工检索相关期刊,纳入针灸与针刀比较治疗肩周炎的随机对照试验。由2名评价者按照Cochrane系统评价员手册4.2.8的要求独立提取资料并交叉核对,采用RevMan5.1软件进行Meta分析。结果:共纳入6个随机对照试验,包括570例患者,仅有1篇高质量文献。Meta分析结果:针刀组治疗肩周炎总有效率明显高于针灸组,OR=7.70,95%CI[2.58,22.99],Z=3.66,P0.01;针刀组治疗肩周炎痊愈率明显高于针灸组,OR=5.39,95%CI[3.48,8.32],Z=7.58,P0.01。结论:针刀治疗肩周炎疗效优于针灸。但本研究纳入试验数有限且文献质量较低,需设计更严格的随机对照试验来进一步验证上述结论。     

臂丛麻醉下针刀、手法松解治疗肩关节周围炎的临床观察

目的:观察臂丛麻醉下针刀、手法松解治疗肩关节周围炎的临床疗效。方法:将72例肩周炎患者随机分为两组,治疗组36例采用臂丛麻醉下针刀联合手法松解治疗,对照组36例采用针灸及推拿治疗,观察两组的镇痛效果、肩关节活动度改善情况及综合疗效。结果:①肩关节疼痛程度:两组治疗后VAS评分均较治疗前降低(治疗组:t=42.730,P=0.000;对照组:t=30.156,P=0.000);但治疗后治疗组VAS评分的降低程度较对照组明显(t=8.475,P=0.000)。②肩关节活动度:两组治疗后肩关节Mallet评分均较治疗前降低(治疗组:t=22.254,P=0.000;对照组:t=19.486,P=0.000);但治疗后治疗组肩关节Mallet评分的降低程度较对照组明显(t=4.841,P=0.000)。③综合疗效:两组综合疗效比较,治疗组优于对照组(Z=-2.075,P=0.038)。结论:臂丛麻醉下针刀、手法松解治疗肩关节周围炎疗效显著,值得临床推广。