针刺奇穴结合辨证选穴治疗脑卒中后便秘

目的观察针刺奇穴结合辨证选穴治疗脑卒中后便秘患者的临床疗效。方法将脑卒中后便秘患者74例随机分为观察组和对照组各37例。观察组采用针刺治疗,每日1次,连续治疗10 d;对照组采用乳果糖口服溶液治疗,每日25 mL,早餐时一次口服,连续服用10 d。比较2组患者首次排便时间(首次治疗结束后至首次排便所需要的时间)、便秘评分(治疗后、随访时)及不良反应发生率。结果观察组的总有效率为 89.19%,优于对照组的75.68%(P<0.05);观察组的首次排便时间为(28.56±14.13)h,优于对照组的(45.07±23.28)h(P<0.05);观察组治疗后与随访时的便秘评分为(3.68±2.35)分和(5.13±1.65)分,优于对照组的(5.08±1.62)分和(7.22±1.97)分(均P<0.05);2组患者均未出现明显的不良反应。结论针刺奇穴结合辨证选穴能较好改善脑卒中后便秘患者的临床症状,与口服乳果糖口服溶液比较,具有见效快、疗效优、效果持续时间长的优势。     

固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变的疗效及对SOD、MDA、hs-CRP水平影响

目的:探讨固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变的疗效及对SOD、MDA和hs-CRP水平的影响。方法:选取我院收治的气虚血瘀型糖尿病周围神经病变患者60例,采用简单随机化原则分为两组,各30例。对照组给予八脉交会穴针刺治疗,治疗组在对照组基础上给予固本通络电针法治疗,对比治疗后的临床疗效、VAS评分、TCSS评分、神经传导速度及SOD、MDA和hs-CRP水平。结果:经过治疗后,治疗组总有效率高于对照组(P<0.05);两组患者VAS评分和TCSS评分较治疗前均明显降低(P<0.05),且治疗组降低较多(P<0.05);两组患者MCV和SSCV较治疗前均显著升高(P<0.05),且治疗组升高较多(P<0.05);两组患者MDA、hs-CRP水平较治疗前显著降低,SOD水平显著升高(P<0.05),且治疗组改善程度较大(P<0.05)。结论:采用固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变具有较好的治疗效果,能改善SOD、MDA和hs-CRP水平,安全性较高,值得在临床上推广应用。     

基于数据挖掘探析然谷主治优势病症和配伍规律

目的:探析然谷主治优势病症及配伍规律。方法:以1949年10月为时间分割点进行文献检索。1949年10月前的文献主要通过《中华医典》(第五版)、《中国近代中医药期刊汇编》检索,1949年10月后的文献从中国知网、万方数据库、维普期刊资源数据库、中国生物医学文献数据库、Pub Med、Web of Science中检索,根据纳入、排除标准筛选文献,建立SQL Server数据库,利用Gephi软件构建复杂网络模型,SPSS Modeler进行关联规则分析。结果:1949年10月前,然谷单穴、配伍主治优势病症分别为26种、28种,最优势病症为脐风和胸痹,常配伍太溪、肾俞、涌泉、行间、足三里;1949年10月后,然谷单穴、配伍主治优势病症分别为2种、12种,最优势病症为跟痛症,常配伍太溪、三阴交、关元、足三里、太冲、涌泉。结论:在主治病症方面,然谷古今均以治疗局部病症、本经病症及相关脏腑病症为主,1949年10月后主治病症减少,种类明显细化并有所侧重,突出表现在妇科、泌尿生殖科及疼痛科;在优势腧穴配伍方面,体现了本经配穴、表里经配穴和荥输配穴等方法,多配伍特定穴如五输穴、原穴和背俞穴,1949年10月后增加了募穴和交会穴。     

苦杏仁与甜杏仁的鉴别研究

杏仁有甜杏仁和苦杏仁之分,两者来源相近,功效类似,但甜杏仁较苦杏仁药力缓和,苦杏仁偏降气止咳,而甜杏仁偏于润肺止咳,故二者不可混淆使用。本文从来源、性状、功效、成分几个方面进行对比,总结二者的异同点,为杏仁的合理应用提供依据。     

返魂草药材的鉴别研究现状

目的：返魂草为我国长白山地区的一种特色药材资源,为保证其质量,为该药材的鉴定提供理论依据。方法查阅总结文献资料,对返魂草药材的鉴别进行综述。结果为返魂草药材提供了来源鉴定、性状鉴定、显微鉴定、理化鉴定方法。结论阐述了返魂草药材的鉴定研究现状。     

Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb

BackgroundPatients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases.AimsTo evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers’ tenderness and allodynia are associated with CRPS.MethodsA case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test.ResultsThe prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ² = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ² = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ² = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls.ConclusionThere is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.     

A critical overview of the current myofascial pain literature – November 2018

This is the first issue of this review column since the passing of Dr. Leon Chaitow. We would like to take a brief moment to acknowledge how much his mentorship, friendship, and confidence have meant to us. Leon was a force in osteopathic and naturopathic medicine and his influence reaches to all corners of the musculoskeletal realm crossing over many disciplines through his lectures, workshops, and of course, his many books, editorials, and articles. In the foreword to one of his books, Jan Dommerholt wrote that “Leon Chaitow […] continued the work of Travell and Simons, but also of many others, whose contributions he has skillfully woven into an intricate tapestry of clinical pearls, practical tips, and solid evidence-informed research.” Dr. Chaitow was a synthesizer, who always considered what different clinicians and researchers could possibly contribute to a better understanding of pain and dysfunction and provide real solutions to real problems. Even when he would not necessarily agree with all suggested remedies, he maintained an open mind and was able to take a step back and consider the bigger picture. For example, Leon was not a big fan of dry needling, yet, he valued the importance of this approach and encouraged the inclusion of dry needling papers in this review article and in his journal. The Journal of Bodywork and Movement Therapies became his baby and, considering the growth of the journal, there is no question that Leon's intense focus and efforts are appreciated by many around the globe. We wish to extend our condolences to Leon's wife Alkmini and daughter Sasha. He will surely be missed, but we can find peace in knowing that his legacy will stay with us forever.In this issue, we have included several basic myofascial pain research articles. As usual, dry needling (DN) studies and case reports are the most commonly referenced papers, but we also included neuroscience and electromyography studies, sleep studies, interrater reliability studies, and case reports of adverse events.     

Near-linear response of mean monsoon strength to a broad range of radiative forcings

Theoretical models have been used to argue that seasonal mean monsoons will shift abruptly and discontinuously from wet to dry stable states as their radiative forcings pass a critical threshold, sometimes referred to as a “tipping point.” Further support for a strongly nonlinear response of monsoons to radiative forcings is found in the seasonal onset of the South Asian summer monsoon, which is abrupt compared with the annual cycle of insolation. Here it is shown that the seasonal mean strength of monsoons instead exhibits a nearly linear dependence on a wide range of radiative forcings. First, a previous theory that predicted a discontinuous, threshold response is shown to omit a dominant stabilizing term in the equations of motion; a corrected theory predicts a continuous and nearly linear response of seasonal mean monsoon strength to forcings. A comprehensive global climate model is then used to show that the seasonal mean South Asian monsoon exhibits a near-linear dependence on a wide range of isolated greenhouse gas, aerosol, and surface albedo forcings. This model reproduces the observed abrupt seasonal onset of the South Asian monsoon but produces a near-linear response of the mean monsoon by changing the duration of the summer circulation and the latitude of that circulation’s ascent branch. Thus, neither a physically correct theoretical model nor a comprehensive climate model support the idea that seasonal mean monsoons will undergo abrupt, nonlinear shifts in response to changes in greenhouse gas concentrations, aerosol emissions, or land surface albedo.Monsoons deliver water to billions of people, so catastrophe would likely result if a gradual and small change in a forcing produced a comparatively abrupt and large change in monsoon strength. Previous studies (1, 2) used theoretical models to argue that monsoons will undergo exactly this sort of abrupt transition if anthropogenic or natural forcings exceed a critical threshold, which they referred to as a “tipping point” (3). Changes in land use or atmospheric aerosols sufficient to increase local top-of-atmosphere albedo to 0.5 have been predicted to cause a shift in the Indian summer monsoon from its current wet state to a dry state (1). The idea that anthropogenic climate forcings might produce an abrupt shutdown of some monsoons has become prominent (3, 4), even though some argue that this is unlikely to occur in the next century (5).Paleoclimate records contain abundant evidence for abrupt changes in various measures of monsoon strength (6, 7). However, such records typically measure variations at a particular location and so may not distinguish between a nonlinear response of the entire monsoon and a more gradual, linear shift of a spatial pattern with sharp horizontal gradients. It is also unclear whether mechanisms that govern monsoon changes on orbital to geological time scales are relevant for the response to anthropogenic forcings. However, even if proxy records of past monsoons are ambiguous, the modern seasonal cycle contains evidence for the abrupt response of monsoons to a radiative forcing: South Asian summer monsoon onset occurs more rapidly than can be explained by a linear response to the annual cycle of insolation (8, 9). Although the cause of this nonlinear seasonal evolution is the subject of active research (10, 11), it seems plausible that the same mechanism might produce an abrupt response of the seasonal mean monsoon to an imposed seasonal mean forcing.These results motivate our examination of how monsoon strength scales with a range of forcings. In particular, we use a simple energetic theory and an ensemble of global climate model (GCM) integrations to determine whether the summer mean strength of tropical monsoons will change discontinuously in response to a large range of radiative forcings.