近十年来留针的研究概况

通过对古代医家及近10多年来有关针刺留针的文献进行整理,从留针时间长短与针刺疗效关系进行总结归纳,认为留针是针刺过程中一个较重要环节,能否建立客观可行性的留针时间标准是针灸发展的方向之一。     

留针时间的探讨

通过对从《内经》到目前临床及实验研究有关留针时间的探讨,发现留针是针刺治疗的重要环节,留针时间的长短对针刺疗效是有影响的。但是,从古至今关于具体的留针时间仍然存在不一致性,这就需要更加细致和大量的科研工作,以寻求留针时间的内在规律性,用以指导临床。就目前而言,应以病情为主,进行辨证分析,从而选择适宜的留针时间以取得满意的治疗效果。     

针刺十七椎穴不同留针时间治疗原发性痛经的镇痛效果研究

目的:观察针刺十七椎穴不同留针时间治疗原发性痛经的镇痛效果,为确定最佳留针时间提供临床依据。方法:将符合纳入标准的90例原发性痛经患者,随机分为留针20 min组、留针30 min组和空白对照组,每组各30例。针刺组单刺十七椎穴,于月经第1天疼痛发作时针刺1次;空白对照组不予针刺治疗。应用视觉模拟评分法(VAS)和Mc Gill简化量表(SF-MPQ)观察各组治疗前后疼痛随时间变化情况,并进行比较。结果:针刺组镇痛效果从针刺10 min时开始显现,镇痛效果随留针时间的延长而增强;留针30 min组的镇痛效果显著优于留针20 min组(P0.01);两针刺组均能明显改善SF-MPQ中各项指标的评分,留针30 min组显著优于留针20 min组(P0.01)。结论:针刺十七椎穴对原发性痛经有明显的镇痛效果,留针30 min的镇痛效果优于留针20 min。     

留针时间与疗效探讨

时间针灸疗法在我国有悠久的历史。“子午流注”,“灵龟八法”就是古代“时间医学”的重要组成部分。随着“生物时钟”学说的兴起,“时间治疗学”的研究被推向了一个新的高潮.时间针灸疗法重点论述针刺时机与临床疗效的关系,但对于针刺后留针时间之长短与临床疗效的关系尚末论及。笔者认为,在针灸治疗疾病过程中,留针是一个重要环节.《素问·针解篇》云:“刺实须其虚者,留针阴     

针刺留针时间探讨

目前,在针灸临床中,很多人以留针20～30分钟为常规,更有甚者,不问疾病的阴阳、表里、寒热、虚实及针刺的得气与否,统统留针20～30分钟。根据《内经》对针刺留针时间的有关论述及临床体会,我认为是不太妥当的。现将留针时间之愚见分述于下:     

针刺留针与否对大鼠脑缺血再灌注后白细胞浸润的影响

目的:研究针刺留针与否对局灶性脑缺血再灌注大鼠脑组织中白细胞浸润及神经组织缺血程度的影响。方法:40只SD大鼠,随机分为正常组、假手术组、模型组、针刺留针组及针刺不留针组。针刺留针组在造模后2 h、24 h针刺三阴交、内关、人中,留针30 min;针刺不留针组针刺时间、穴位与针刺留针组相同,针刺后即起针。造模48 h后,取脑固定后行HE染色,比较各组大鼠浸润白细胞计数和神经组织缺血程度。结果:针刺留针组与针刺不留针组浸润白细胞数均低于模型组,差异有统计学意义(P<0.05);神经组织缺血程度较模型组轻,差异无统计学意义(P>0.05)。针刺留针组与针刺不留针组脑组织中浸润白细胞数及神经组织缺血程度比较差异无统计学意义(P>0.05)。结论:针刺能明显减少脑缺血坏死周边区的白细胞浸润,减轻神经细胞缺血程度。     

针刺留针与否对脑缺血再灌注大鼠IL-6表达的影响

目的:通过测定局灶性脑缺血再灌注大鼠血清白介素-6(IL-6)的含量,研究针刺留针与否对早期脑缺血再灌注大鼠脑的保护差异。方法:40只SD大鼠随机分为正常组、假手术组、大脑中动脉阻塞(MCAO)再灌注组、针刺留针及不留针组。针刺留针组在造模后2 h、24 h固定,针刺三阴交、内关、人中,留针30 min,针刺不留针组针刺时间、穴位均同针刺留针组,针刺后即起针而不留针。造模48 h后,测定各组大鼠血清中IL-6的含量。结果:针刺能升高脑缺血再灌注大鼠血清中IL-6的含量。早期针刺后留针与否对缺血再灌注大鼠血清中IL-6水平影响差异无统计学意义(P>0.05)。结论:针刺能升高大鼠脑缺血再灌注后血清中IL-6含量,对缺血组织起到抗损伤、促修复的作用;在缺血再灌注早期,针刺后留针与不留针可能对脑的保护作用并无差异。     

针刺疗效与留针及针刺间隔时间关系的研究进展

时间因素是影响针刺疗效的众多因素之一,随着针灸学的发展,关于针刺时间因素与疗效关系的研究越来越受到重视。文章通过搜集近年来研究针刺时效关系的相关文献,主要从留针时间与针刺间隔时间两个方面对针灸时效关系进行综述,研究发现留针时间和针刺间隔时间对针刺疗效有一定影响,同时提出了目前研究所存在的问题及展望,以期提升针灸临床疗效,促进针灸学的传承与发展。     

针刺留针时间探究

通过对《内经》、临床、实验研究的探讨,分析归纳针刺留针时间的依据,认为留针时间长短与针刺疗效之间具有相关性。传统理论和实验研究提示留针时间一般以20～30min为宜,但临床还应以中病即止,即得气为准,根据疾病情况,在辨证施治的原则下灵活运用。     

缺血性脑卒中择时针刺探讨

针刺治疗时机是影响缺血性脑卒中疗效的重要因素。影响针刺治疗脑卒中疗效的时间因素包括早期择时针刺、不同时辰针刺和留针时间3个方面,今后应对这些时间因素进行优选,以提高针刺治疗缺血性脑卒中的疗效。     

阿德福韦酯联合抗纤方治疗对慢性乙型肝炎患者血清肝纤维化指标的影响

目的探讨阿德福韦酯联合抗纤方治疗对慢性乙型肝炎患者血清纤维化指标影响。方法选择100例慢性乙型肝炎患者,随机分为两组,对照组50例应用阿德福韦酯治疗;治疗组50例在对照组治疗基础上加用抗纤方。两组均予以一般保肝及对症治疗,疗程均为6个月。观察两组总有效率、肝功能变化,检测并比较两组治疗前后血清透明质酸(HA)、Ⅲ型前胶原(ⅢPC)、Ⅳ型胶原(ⅣC)、层粘蛋白(LN)的含量。结果治疗组总有效率为94.0%,明显高于对照组的78.0%(P<0.05)。治疗后两组的TBIL、ALT、AST值均较治疗前显著改善(P<0.01),其中治疗组TBIL、AST值的改善程度显著好于对照组(P<0.01)。治疗后两组的HA、LN、Ⅳ-C、ⅢPC值均较治疗前显著改善(P<0.01),治疗组的改善程度显著好于对照组(P<0.01)。结论阿德福韦酯联合抗纤方治疗能更好的改善患者临床症状,更有利于肝功能的恢复,更好地抑制肝脏的炎症反应,改善肝脏微循环,控制肝纤维化,改善肝脏病理组织。     

Clinical study on reversing hepatic fibrosis with Handan Ganle () capsule) capsule

Objective: To observe the therapeutic effect on hepatic fibrosis of chronic hepatitis B by Chinese medicine—Handan Ganle capsule (HDGLC).Methods: A total of 104 patients with chronic hepatitis B has been treated by HDGLC for 6 months, liver fibrosis indexes and the serum biochemical indexes were detected before treatment, during the curative period and by the end of treatment. Hepatic biopsy was performed before or after the treatment.Results: The improvement rate of clinical symptoms was 79.0% - 90.6%, and the recovery rate of ALT was 72.6 %, serum fibrosis indexes such as HA, type IV collagen and LN were significantly decreased along with the extending course of disease (P < 0.05). The pathohistological score of liver was decreased from 7.82 ± 6.22 before treatment to 5.16 ± 3.75 after treatment (P < 0.05) and the score of hepatic fibrosis was decreased from 7.49 ± 5.45 before treatment to 5.16 ± 4.26 after treatment (P < 0.05).Conclusion: HDGLC has remarkable therapeutic and reversing effect on chronic hepatitis B induced hepatic fibrosis. Supported by the Key Project of the “9th Five Year Plan” of Science Commission of Guizhou Province     

Clinical observation of the effect of Xuesaitong soft capsule on post-hepatitis fibrosis

Objective: To study the effect of Xuesaitong soft capsule (XST) on liver fibrosis criteria in patients with post-hepatitis fibrosis.Methods: Sixty-four patients with such fibrosis were randomly divided into the treated group and control group. They were treated with XST and Dahuang Zhechong pill for 3 months respectively. Their liver fibrosis criteria were examined before and after treatment.Results: The levels of serum procollagen III, hyaluronic acid, collagen IV, laminin in the two groups were significantly lower (P<0. 01) than those before treatment. The differences between the two groups were insignificant (P>0.05).Conclusion: XST could recover liver dysfunction and had anti-liver fibrosis function.     

Clinical Pathologic Study on Effect of Qianggan Capsule (强肝胶囊) in Treating Patients of Chronic Hepatitis B with Liver Cirrhosis

Objective: To explore the clinical therapeutic effect of Qianggan Capsule (QGC) in treating chronic hepatitis B with liver fibrosis from the pathological aspect. Methods: Sixty-three patients of chronic hepatitis B with liver fibrosis were randomly divided into the treated group (n=45) and the control group (n=18). Both groups were treated with general liver protective drugs, such as Glucurone and vitamins B complex for 6 months. To the treated group, QGC was used additionally. The levels of serum alanine transaminase and liver fibrosis indexes including hyaluronic acid (HA), collagen type Ⅳ (C-Ⅳ) and laminin (LN) as well as the pathological examination of liver biopsy were observed before and after treatment. Results: The liver cirrhosis indexes, HA, C-Ⅳ and LN, were improved significantly in the treated group after treatment, P<0.05. The liver function improvement rate in the treated group and the control group was 90.3% and 66.7% respectively, comparison of the two groups showed insignificant difference, P>0.05. Pathological examination showed that the effective rate of treatment on liver inflammatory necrosis activity grade in the treated group was 57.8% and that on liver fibrosis stage was 75.6%, which were significantly improved as compared with those before treatment (P<0.05 and P<0.01), while in the control group, no significant improvement was found after treatment (P>0.05). Conclusion: QGC has marked effects in reversing liver fibrosis and alleviating hepatic inflammatory necrosis in patients of chronic hepatitis B with liver fibrosis, and could lower the serum liver fibrosis related indexes effectively.     

还原型谷胱甘肽联合前列腺素E_1治疗慢性乙肝效果观察

目的　探讨治疗慢性乙型肝炎 (CHB)及抗肝纤维化的有效方法。方法　采用还原型谷胱甘肽 (GSH)联合前列腺素E1(PGE1)静脉滴注治疗CHB患者 112例 (治疗组 ) ,并与单用PGE1治疗 98例 (对照组 )进行比较 ,观察两组治疗前后血清Ⅲ型前胶原 (PCⅢ )、透明质酸 (HA)、层粘连蛋白 (LN)、Ⅳ型胶原 (Ⅳ -C)及肝功能 (ALT、AST、TBil)等指标变化情况。结果　治疗组临床疗效及肝功能改善明显优于对照组 (P均 <0 .0 1) ,而血清肝纤维化指标变化两组比较差异无显著性 (P >0 .0 5 )。结论　GSH和PGE1联合治疗CHB有较好的疗效 ,PGE1具有较好的抗肝纤维化作用 ,而GSH对肝纤维化的作用不突出。     

清热利湿法在慢性乙型肝炎中的治疗作用

目的:观察清热利湿法在慢性乙型肝炎中的治疗作用,并进一步了解慢性乙型肝炎的辨证特点.方法:采取随机、对照的办法选取病例,以转氨酶水平、体液免疫、住院时间为观察指标作统计学处理.结果:两组病人治疗后在转氨酶、体液免疫水平上于第3、4周有差异,对住院时间有影响.结论:清热利湿法在慢性乙型肝炎的治疗中有意义,尤其能够降低体液免疫反应,对肝炎的活动有作用.     

Effects of Da Ding Feng Zhu Decoction in 30 Cases of Liver Fibrosis

To study the clinical effects of Da Ding Feng Zhu (大定风珠) Decoction on liver fibrosis. 56 patients withliver fibrosis due to chronic hepatitis B were randomly divided into a treatment group (30 cases treatedwith Da Ding Feng Zhu Decoction) and a control group (26 cases treated with colchicine). The serumlevels of hyaluronic acid (HA), procollagen Ⅲ (PC-Ⅲ), Ⅳ collagen (Ⅳ-C) and Laminin (LN) of thepatients were determined, compared and analyzed before treatment and after 3-month treatment in the twogroups. The results showed that in the treatment group, the levels of HA, PC-Ⅲ, Ⅳ-C and LN after3-month treatment were significantly lowered as compared to that before treatment (P＜0.01). In thecontrol group, only the HA level was obviously lowered (P＜0.05). There was an significant difference(P＜0.05) in PC-Ⅲ and Ⅳ-C and a very significant difference (P＜0.01) in HA after treatment between thetwo groups. It is therefore concluded that Da Ding Feng Zhu Decoction can lower serum indexes of liverfibrosis.     

恩替卡韦联合复方牛胎肝提取物片抗纤维化疗效观察

目的:观察恩替卡韦和复方牛胎肝提取物片联合应用治疗慢性乙型肝炎肝纤维化的临床疗效。方法:将80例慢性乙肝肝纤维化患者随机分为两组,治疗组和对照组。治疗组用恩替卡韦和复方牛胎肝提取物片治疗,对照组只用恩替卡韦治疗,疗程均为8个月。比较其治疗前后两组肝功能、HBV-DNA及肝纤维化指标(HA、LN、PCIII、CIV)变化情况。结果:治疗后两组肝功能、HBV-DNA、肝纤维化指标较治疗前均明显下降,治疗组肝纤维化指标下降与对照组相比有显著性差异(P<0.05)。结论:恩替卡韦联合复方牛胎肝提取物片可以明显改善慢性乙型肝炎肝纤维化指标。     

肾衰方对脾肾气虚湿浊型慢性肾衰竭患者血清钙磷及肾纤维化指标的影响

目的探讨肾衰方对脾肾气虚湿浊型慢性肾衰竭患者血清钙、磷及肾纤维化指标的影响。方法选取自2015年1月-2016年12月我院住院治疗的慢性肾功能衰竭患者78例,随机分为对照组39例和治疗组39例,对照组采用西医常规治疗;治疗组在对照组基础上采用肾衰方加减治疗,2组共持续4周为1疗程。治疗前后采肘静脉血,测定肾功能、肾纤维化及血清钙、磷、甲状旁腺素等指标,同时对比2组临床疗效。结果治疗后与对照组比,治疗组治疗后血清Scr、BUN、Cys C较低,Ccr较高,治疗后血钙、血磷、PTH水平改善明显(P0.05);对照组有效率69.23%低于治疗组有效率84.62%(P0.05)。结论肾衰方对脾肾气虚湿浊型慢性肾衰竭患者,能够调节血清钙、磷水平,延缓肾纤维化。     

血必净注射液治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者的疗效观察

目的 探讨血必净注射液对慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者的临床疗效。方法 将58例AECOPD合并呼吸衰竭患者随机分为治疗组31例和对照组27例,对照组给予西医常规治疗,治疗组在此基础上加用血必净注射液50 mL,2次/d,静脉滴注,疗程7 d。观察2组血气分析、血清降钙素原（PCT）浓度变化及脱机成功率、脱机时间。结果 治疗组血气、PCT改善情况明显优于对照组（P＜0.01）,脱机时间明显短于对照组（P＜0.05）,脱机成功率明显高于对照组（P＜0.01）。结论 在传统的西医疗法基础上加用血必净注射液可使AECOPD合并呼吸衰竭患者血清PCT水平快速显著下降,具有良好的治疗作用。PCT浓度与AECOPD的严重程度成正相关性,可以比较客观地评价其治疗效果和预后。