PBL教学法在《针灸学》中的应用效果循证评价

目的:评估PBL教学法在《针灸学》教学中的应用前景,为改进《针灸学》教学提供有效循证依据。方法:系统全面检索当前相关临床研究文献,按照循证医学五级分类标准,对于能够评价标准的证据,从高到低选用,采用Epidata 2建立评价表数据库。采用统一编制的"文献质量评价信息证据采集表",对近年来发表的《针灸学》教学中PBL教学法应用的临床研究文献进行质量评价。结果:9篇文献符合研究需要。缺少高质量A级文献证据,B级文献证据4篇,C级文献证据2篇,D文献级证据3篇。结论:PBL教学模式与传统教育模式比较有明显优越性,符合教学改革的新趋势。     

Study on the thermesthesia features of heat-sensitive acupoints in patients with knee osteoarthritis

Objective

To observe the thermesthesia thresholds of the heat-sensitive acupoints in patients with knee osteoarthritis (KOA), and to provide scientific evidence for acupoint selection based on acupoint sensitization.

Methods

Forty-six patients with KOA of swelling type were recruited. By using the quantitative thermesthesia testing, the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance at Xuehai (SP 10), Neixiyan (EX-LE 4) and Yinlingquan (SP 9) were detected. The subjects were then divided into heat-sensitive groups and non-heat-sensitive groups according to whether there was a phenomenon of heat-sensitive moxibustion sensation at each acupoint, to compare the thermesthesia thresholds between the two groups.

Results

The thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (38.21±2.03) °C (44.47±1.8,) °C and (48.59±0.74) °C in the heat-sensitive group of Xuehai (SP 10), versus (36.76±1.93) °C, (42.91±2.05) °C and (46.95±1.14) °C in the non-heat-sensitive group of Xuehai (SP 10); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.47±1.77) °C, (44.55±1.63) °C, and (47.48±0.47) °C in the heat-sensitive group of Neixiyan (EX-LE 4), versus (35.92±1.69) °C, (42.72±1.94) °C and (45.53±0.41) °C in the non-heat-sensitive group of Neixiyan (EX-LE 4); the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance were respectively (37.30±2.23) °C, (44.39±1.92) °C and (47.76±0.58) °C in the heat-sensitive group of Yinlingquan (SP 9), versus (36.06±1.86) °C, (42.63±1.88) °C and (45.91±0.72) °C in the non-heat-sensitive group of Yinlingquan (SP 9). The statistical analyses showed that the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of each heat-sensitive group (all the three acupoints) were significantly higher than those of each corresponding non-heat-sensitive group (P<0.01).

Conclusion

There were differences in the thermesthesia thresholds between heat-sensitized and non-heat-sensitized acupoints in patients with KOA of swelling type; and the thermal sensation threshold, thermal pain threshold, and threshold of thermal pain tolerance of the heat-sensitized points were significantly higher than those of the non-heat-sensitized ones.

     

血府逐瘀汤治疗美尼尔氏综合症60例疗效分析

血府逐瘀汤出自清代医家王清任的《医林改错》,用于治疗"胸中血府血瘀"所致诸证的活血祛瘀、行气止痛之常用方剂。美尼尔氏综合症是临床上的高发病,应用血府逐瘀汤治疗,疗效显著。     

论热敏灸探感定位是阿是之法的传承与发展

从腧穴的原始概念文献记载探讨阿是之法的内涵及其临床意义,阐明阿是之法的精髓是以患者对力的敏感为标准来定位腧穴。热敏灸疗法的临床应用,则说明热敏灸探感定位是以出现热敏灸感为标准来判定腧穴。两者虽均以患者感觉为标准,但热敏灸探感定位是从另一新的角度、采用新的方法来定位腧穴。认为热敏灸探感定位是阿是之法的传承与发展。     

基于CONSORT与TIDieR-Placebo评价安慰针刺治疗膝骨性关节炎随机对照试验文献的报告质量*

目的：评估针对膝骨性关节炎治疗中安慰针刺的随机对照试验（RCT）文献的质量,探讨安慰针刺临床试验设计的思路。方法：计算机检索中国期刊全文数据库（CNKI）、维普中文期刊全文数据数据库（VIP）、万方数据知识服务平台（WF）、中国生物医学文献数据库（SinoMed）、PubMed、Web of Science（WOS）及Embase数据库,收集使用单纯针刺与安慰针刺进行对比的针灸治疗膝骨性关节炎RCT研究,检索时限从建库至2022年12月31日。使用CONSORT与TIDieR-Placebo标准评估文献报告质量,并对结果进行分析讨论。结果：共纳入20篇文献。CONSORT评价结果显示报告率不高于10%的条目为条目3b、 6b、11b、12b、14b、17b、18。TIDieR-Placebo评价结果显示报告率不高于10%的条目为条目6、9、10、11、13。安慰针刺的方式主要为“假穴假刺”“假穴真刺”“假穴浅刺”“非治疗穴真刺”“治疗穴假刺”5种。结论：有关安慰针刺的临床试验尚不严谨,质量有待提高。为推动针灸领域临床研究的标准化,建议未来的研究应更加重视依据这些标准来规范化研究报告。