武连仲教授治疗坐骨神经痛经验

全国名中医天津中医药大学第一附属医院针灸科武连仲教授用多年的临床经验总结概括出针刺的理、法、方、穴、术，其创立的"通经止痛"针刺疗法在临床中疗效佳，武老在治疗坐骨神经痛时，取足太阳膀胱经和足少阳胆经具有走窜针感的经穴为主穴，其配伍精确，组方严密，手法独特，可供临床参考。本文将武老运用"痛经止痛"针刺法治疗坐骨神经痛的经验从"理、法、方、穴、术"方面做浅述。     

Protocol for the development of consensus-based clinical case reporting guideline extension: CARE for acupuncture

BackgroundHealth research reporting guidelines for case reports (CARE - CAse REport) published in 2013 and 2017 have become a generally accepted standard for publishing case reports. The CARE guidelines represent an architectural framework for writing an evidence-based case report that can be customized as need for a specialty (or disease) if needed. We aim to develop a CARE guideline extension for acupuncture following the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) and the 2010″Guidance for Developers of Health Research Reporting". We have established a group of international experts including; clinicians, researchers and methodologists. We performed a needs assessment based on a review of acupuncture case reports published in the indexed medical literature. The needs assessment will be followed by (1) a series of expert interviews to establish a draft, (2) a modified Delphi process, and (3) a consensus meeting. Following the consensus meeting we will pilot test the CARE draft before publishing the CARE extension for acupuncture.MethodsWe will develop the CARE extensions for acupuncture following recommendations of the EQUATOR Network and the 2010 "Guidance for Developers of Health Research Reporting". We will establish an international multidisciplinary group including clinical practitioners, acupuncturists, researchers of reporting guidelines on acupuncture, clinical epidemiologists and statisticians.We performed a needs assessment, reviewing published case reports using acupuncture as a therapeutic intervention from indexed medical journals (PubMed-PMC and Medline, Scopus, Embase, the Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Wan Fang database, Chinese BioMedicine database (CBM), China National Knowledge Infrastructure (CNKI), and VIP). In consultations with advisors we will develop a draft of potential items to be included in the CARE extension for acupuncture. Then we will conduct a modified Delphi process of at least three rounds, hold a face-to-face consensus meeting, pilot test and submit the CARE extension for acupuncture for publication.ConclusionThe development of a widely accepted CARE extension for acupuncture for case reports published in indexed medical journals. These guidelines will follow the EQUATOR Network recommendations and the 2010 "Guidance for Developers of Health Research Reporting".     

Observations on the efficacy of combined acupuncture and medicine in Treating 50 cases of pseudobulbar paralysis

目的：观察针药结合治疗假性延髓麻痹的疗效。方法：采用完全随机抽样法分为针刺组50例，对照组48例。针刺组在西医治疗的同时，应用针刺进行综合治疗；对照组单纯接受西医药物治疗。结果：针刺组有效率为92．0％，对照组为62．5％。两组疗效差异具有非常显著性意义（P〈0．01）。结论：针药结合治疗假性延髓麻痹效果明显优于单纯西药治疗。     

Dopaminergic transmission in the hypothalamic arcuate nucleus to produce acupuncture analgesia in correlation with the pituitary gland

Acupuncture analgesia (AA) caused by low frequency stimulation of the acupuncture point (AP) was abolished by hypophysectomy and adrenalectomy. Termination of the AA producing pathway from the AP to the pituitary gland was in the medial hypothalamic arcuate nucleus (M-HARN). The origin of the descending pain inhibitory system associated with AA was in the posterior HARN (P-HARN). AA in the hypophysectomized rats, and enhanced neuronal activity in the P-HARN that were abolished during acupuncture stimulation, were both restored by intraperitoneal microinjection of 0.5 mg/kg morphine or 0.1 micrograms beta-endorphin into the P-HARN during acupuncture stimulation. Of the analgesia produced by dopamine or beta-endorphin injected into the P-HARN, that caused by beta-endorphin disappeared after denervation of the M-HARN. The P-HARN neurons that responded to acupuncture stimulation also responded to iontophoretic dopamine, but not to iontophoretic morphine nor ultramicroinjected beta-endorphin. The transmission between the M-HARN and P-HARN may be dopaminergic, and beta-endorphin might presynaptically modulate this transmission. Reduction of sodium ions may have been the reason for abolition of AA after adrenalectomy.     

硬膜外麻醉用于老年病人经尿道前列腺汽化术的麻醉

目的　探讨老年病人经尿道前列腺汽化术 (TUVP)的麻醉方法。方法　 1 0 2例老年病人在连续硬膜外麻醉下行尿道前列腺汽化术 ,观察了麻醉手术效果、生命体征的变化、手术操作条件及术中术后的麻醉手术并发症的发生情况。结果　 1 0 2例病人均痊愈出院。麻醉效果优良率 94%。Bromage <2的例数占 84%。术中出现血压下降等麻醉手术并发症较少且都得到及时纠正。结论　低浓度局麻药硬膜外麻醉用于老年病人TUVP手术对病人干扰少、经济、安全实用 ,可以作为首选的麻醉方法     

Randomised trial of long term effect of acupuncture for shoulder pain

Guerra de Hoyos JA, Andres Martin Mdel C, Bassas y Baena de Leon E, Vigara Lopez M, Molina Lopez T, Verdugo Morilla FA, Gonzalez Moreno MJ. Pain. 2004 Dec;112(3): 289-98.The objective of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale – VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95 % CI 1.2–2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting. q2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.     

针刺推拿中药综合治疗颈性眩晕疗效观察

目的观察针刺推拿中药综合治疗颈性眩晕的疗效。方法设综合组80例、电针组42例、推拿组68例和中药组36例,进行疗效比较分析。结果综合组有效率为93.8%,电针组有效率为73.8%,推拿组有效率为86.8%,中药组有效率为69.4%,综合组有效率与其他几组比较差异均有统计学意义（P〈0.05）。结论采用电针、推拿、中药相结合的综合疗法治疗颈性眩晕集诸单一疗法之精华,避免单一疗法的局限性,可提高有效率。     

不同针刺深度对前列腺增生症大鼠重量指数的影响及形态学观察

目的与方法 采用深刺和浅刺对丙酸睾酮所致前列增生症（BPH）大鼠模型进行干预，研究其作用殊同。结果 针刺组前列腺，膀胱指数明显小于模型组；形态学观察，针刺组较模型组增生明显减轻，腺上皮呈单层柱状，腺体数目明显减少，间质充血，钙化明显减轻，结缔组织无增生，腺腔内分泌物减少。深刺组好于浅刺组。结论 深刺对实验性BPH大鼠的干预作用好于浅刺方法。     

蜂毒和风痛宁穴位注射治疗骨关节炎468例

目的　探索骨关节炎新的有效治疗途径。方法　运用纯中药制剂蜂毒注射液和风痛宁注射液穴位注射治疗本病 ,并与局封治疗作对照比较。结果　治疗组总有效率为 92 .5 2 % ,对照组为 77.0 0 % ,两组比较有显著差异 (P<0 .0 5 ) ,且两组副作用、复发时间均有显著差异 (P<0 .0 5 )。结论　蜂毒和风痛宁穴位注射治疗本病疗效优于局封治疗 ,且能减少副作用 ,延长复发时间。     

Densities in dependent lung regions during anaesthesia: atelectasis or fluid accumulation?

In previous studied with computed tomography (CT) prior to and during general anaesthesia, we found that densities developed in dependent parts of the lungs immediately after induction of anaesthesia in all examined patients. It was suggested that the densities were atelectases created by compression of lung tissue but an alternative explanation could be accumulation of extravascular fluid in the lung tissue and/or in the pleural space. In the present study the nature of the densities was analysed in further detail. Injections of contrast medium into the pleural space revealed that the densities were located in the lung tissue and not in the pleural space. By injecting contrast medium intravenously and repeating the CT scanning over a 2-min period the passage of contrast through the major vessels and the lung densities could be studied. The transit time of the contrast medium was of the same magnitude in the densities and the major lung vessels. This indicates that there were no regions with an increased amount of extravascular fluid to delay the contrast passage. These findings oppose the idea of fluid accumulation as the cause of the densities, while atelectasis remains the most plausible explanation.