经筋疗法治疗腰背肌筋膜炎的临床观察
|
摘要
背景
腰背肌筋膜炎是一种常见的腰部疾病,腰背肌筋膜炎是指腰部一侧或两侧或正中等处发生疼痛之症,既是多种疾病的一个症状,又可作为独立的疾病,可见于现代医学所称之肾病、风湿病、类风湿病、腰背肌筋膜炎脊椎及外伤、妇科等疾病。主要症状为腰或腰骶部疼痛,反复发作,疼痛可随气候变化或劳累程度而变化,时轻时重,缠绵不愈。腰部可有广泛压痛,脊椎活动多无异常。急性发作时,各种症状均明显加重,并可有肌肉痉挛,脊椎侧弯和功能活动受限。腰背肌筋膜炎是临床上常见的病证,发病率很高,是许多腰背痛患者常见的共有症状。据统计,成人曾100%患过腰痛,由于生活节奏的加快,社会的竞争激烈,人体组织对长期、反复、持续的生活性压迫、打击,摩擦姿势的不正等应力的反应,使组织肥大和增生,以作代偿,累积迁延而成慢性腰肌劳损,急性损伤未经及时正确的治疗,也可迁延成慢性损伤,病变部位出现组织充血、水肿、增生变化,肉芽组织形成以及粘连等病理性改变,本病多发生于青壮年,曾有过劳、损伤和腰部外伤的病史。该病临床治疗较为困难,尚无特效疗法,腰背肌筋膜炎种为慢性病变,长期以来,影响患者的正常生活,工作,带来了很多麻烦,有些患者四处求医,反复发作,痛苦不堪,甚至心理蒙上一层阴影。
腰背肌筋膜炎是一种迁延难愈,需要长期坚持治疗的一种疾病。临床上治疗腰背肌筋膜炎的方法很多,但是,没有哪一种是治疗效果是绝对的。这就要求我们不断寻找新的治疗方法,以期针对腰背肌筋膜炎的治疗能有新的突破。我们在多年的临床实践中发现,经筋疗法治疗腰背肌筋膜炎效果突出,拟对其临床效果进行研究,以供临床医生选择参考。
经筋医学,有悠久历史,在古典《内经》中早有记载。是我国传统医学宝库中的一朵奇葩。但在慢长的历史发展过程中,经筋医学的发展曾停滞不前,但经验之技术实体深在民间,经筋作为人体重要的、庞大的实体器官；在生理、病理、诊断和治疗上,都具有独特的重要作用和深在意义。在临床上,尤其在现代意义下被认为久医不愈的痛症、痹症、杂症等；具有独到的、及有意想不到的治疗好效果。这是传统医疗经验能得以传承到今天的重要价值和作用所在。
本研究是观察经筋疗法治疗腰背肌筋膜炎的治疗效果,并与传统手法治疗比较,为经筋疗法的进一步推广,提供临床证据；为腰背肌筋膜炎的治疗,提供一种有效的治疗手段。
目的
探讨经筋疗法治疗腰背肌筋膜炎的临床疗效,供临床医生参考,以期为腰背肌筋膜炎的治疗提供新的方法。
方法
1.研究对象
120例腰背肌筋膜炎的患者,来自南方医院针灸科、南方医院康复科、骨伤科、香港中华经筋医学院。
(1)诊断标准：根据卫生部制订的《中华人民共和国中医药行业标准·中医骨伤科病证诊断标准》[4]来制定诊断标准。
①可有外伤后治疗不当、劳损或外感风寒等病史；
②腰背部酸痛、肌肉僵硬发板、有沉重感,疼痛常与天气变化有关,阴雨天及劳累后可使症状加重；
③腰背部有固定压痛点或压痛较为广泛,背部肌肉僵硬,沿竖脊肌走行方向常可触到条索状的改变,背部功能活动大多正常,X线检查无阳性体征。
(2)纳入标准：
①符合腰背肌筋膜炎上述诊断标准者；
②年龄在20—75岁之间者；
③病程在3周以上者；
④能够按计划坚持治疗并完成者；
(3)排除标准：
①与上述诊断标准及纳入标准不符合者；
②合并有严重心、肝、肾、脑血管及造血系统等原发性疾病者,及影响本研究的其他疾病(如：糖尿病、骨结核、骨肿瘤、严重骨质疏松症、周围神经病变、精神病患者；)；
③具有盲,聋,哑等残疾的患者；
④怀疑或确认有酒精、药物等滥用史者；
⑤妊娠或哺乳期妇女、症状严重的更年期综合征者；
⑥严重体虚者；
⑦不愿配合试验的人,不签署知情同意书者；
⑧同时应用其他疗法者。
(4)剔除和脱落标准：
①病例受试者的依从性差,发生严重不良事件,发生并发症或特殊生理变化不宜继续接受试验者；
②未达到1/2疗程者。
(5)中止试验标准：试验过程中病情恶化,出现严重的并发症,或出现严重的不良反应,均应中止试验,已超过1/2疗程者,计入疗效统计；因不良反应中止试验者,计入不良反应病例统计。
2.研究设计
采用随机对照试验方法,将合格受试者以1：1的比例分配至经筋疗法组及传统针刺组,每组均为60例。
3.随机化方法
病例分组采用简单随机的方法。具体的随机化分配方法由临床研究人员通过操作SAS(统计分析系统)软件得出随机数字,并制成随机分配卡片,加信封密封,信封序号与卡片序号相同。合格病例进入试验时,按其进入的先后次序,拆开号码相同的信封,按信封内卡片规定的分组进行治疗。
4.治疗方法
(1)经筋疗法组：
经筋疗法：第一步：足太阳经筋疗法：患者取俯卧位,医者采用肘关节之尖(鹰嘴)、钝(肱骨内髁)、硬(前臂尺骨面)、软(前臂内侧面)4个部位顺着足太阳经筋线从足到头方向进行全线按、揉、点、推、弹拔等松筋理筋,重点推按足跟筋结、踹外筋结(腓肠肌)、胭内筋结(胭绳肌)、大腿后筋结(股二头肌)、臀部筋结(臀大肌)、髀后筋结(髂肋肌)、华佗夹脊筋结(骶棘肌,腰三横突点,腰4、5或腰5骶1之间的棘突旁)等筋结病灶点,使足太阳经筋全线松解为佳。第二步：足少阳经筋疗法：患者取侧卧位,双膝间垫一小枕,医者用肘部尖、钝、硬、软4个部位顺着足少阳经筋从足到头方向进行全线松筋理筋,重点松解足次趾筋结(蹲长伸肌)、腓侧筋结(腓骨长肌、腓神经)、膝外筋结(股四头外侧肌)、伏兔筋结(二半膜肌、缝匠肌)、髀上筋结(髂筋束、阔筋膜张肌)、尻筋结(梨状肌)等筋结病灶点；配合侧板复位法。左右各1次。第三步：足阳明经筋疗法：患者取仰卧位,医者用肘部及拇指指腹顺着足阳明经筋从足到头方向全线松筋理筋。重点松解足背筋结(中三趾)、髀内筋结(股四头内侧肌)、气冲筋结(腹股沟股神经、股动脉点)、腹后筋结(腰大肌)等病灶点,点按股动脉时以有热气向下肢冲击为佳。一次治疗约30分钟。
(2)传统手法组：
传统手法：①患者俯卧位或侧卧位,医者站其旁,双手掌或单手掌反复揉腰骶部和两臀部数遍。②双拇指或肘尖,按揉腰骶部5条线(督脉和足太阳经一、二侧线,督脉以按压椎间隙为主)3-5遍；点按肾俞、志室、腰阳关、大肠俞、腰眼、八髎、阿是穴。③拇指或肘尖按揉理顺臀上皮神经路线和梨状肌投影处的酸痛点,反复施术3-5遍；点按环跳、秩边穴。④拿揉下肢后侧3-5遍。⑤肘尖按揉理顺大腿后侧足太阳经路线；重点按揉承扶、殷门、委中、承山、昆仑、涌泉。一次治疗约30分钟。
两组患者接受治疗后嘱病人保暖,避免劳累,每日治疗1次,连续治疗6次为1疗程,共2个疗程(2周)。每1疗程结束后,休息1天。
5.观察指标
(1)疼痛——简化McGill量表
治疗前后疼痛综合评定：采用国际公认的描述与测量疼痛的简化McGill量表进行测评。量表分为三部分：①疼痛分级指数(PRI)：含11个感觉性词与4个情绪性词,程度分为无、轻、中、重四级,分别以0、1、2、3分表示,可计算出PRI感觉分、情绪分和总分；②目测类比定级法(VAS)：为一条10cmm长的直线,两端分别代表无痛和剧痛,患者在其中画线以表示疼痛程度；③现有疼痛强度(PPI)：分无痛、轻度不适、不适、难受、可怕的疼痛、极为痛苦6级,分别以0、1、2、3、4、5分表示。
(2)功能评价
①功能障碍调查表(Roland-Morris):这些问题包括腰背痛患者的行走、站立、弯腰、工作、卧床、睡眠、穿衣、只常生活自理能力等方面,每个问题的分值为1分,回答“是”得1分,回答“否”得0分,各问题在分值上无权重之分,将回答“是”的各问题分值累加即为最后实际得分,最低分为0分,最高分为24分,分值越高,表示功能障碍越严重。
②功能障碍指数(Oswestry Disability Index):量化功能障碍的问卷调查表,分值O-5分,Oswestry功能障碍指数问卷表(ODI)是由10个问题组成,包括疼痛的强度、生活自理、提物、步行、坐位、站立、干扰睡眠、性生活、社会生活、旅游等10个方面的情况,每个问题6个选项,每个问题的最高得分为5分,选择第一个选项得分为0分,依次选择最后一个选项得分为5分,假如有10个问题都做了问答,记分方法是：实际得分/50(最高可能得分)×100%,假如有一个问题没有回答,则记分方法是：实际得分/45(最高可能得分)×100%,如越高表明功能障碍越严重。
(3)总疗效评定
依据《中华人民共和国中医药行业标准病证诊断疗效标准ZY/T001.1.—94》[5]将治疗结果分为
①治愈：腰痛症状消失,腰部活动自如；
②好转：腰痛减轻,腰部活动功能基本恢复；
③未愈：症状未改善。
6.观察方法
(1)以2个治疗疗程为观察周期；
(2)临床症状、体征在治疗前和治疗后各记录一次。
7.数据处理
所有统计数据,采用SPSS13.0统计软件进行统计学处理。根据观察指针和数据不同,计量数据采用均数士标准差(X士S)表示,并进行正态性分布及方差齐性检验,组间均数比较用方差分析检验,组内均数比较用配对t检验,计数数据比较用卡方检验,检验水平。当P<0.05认为有统计意义。
结果
(1)病例中断与脱落情况
对120例腰背肌筋膜炎患者进行治疗观察,其中传统手法组60例,经筋疗法组60例,观察过程中无脱落、剔除。
(2)基线指标
两组患者的性别、年龄、病程比较,差异均无统计学意义(P>0.05),具有可比性。
(3) McGill量表比较
McGill-PRI比较
①两组治疗前PRI比较：传统手法组治疗前PRI(X±S)为10.57±3.397,经筋疗法组治疗前PRI(x±s)为9.70±2.431,经独立样本t检验,两组患者治疗前PRI比较差异无显著性(t=1.607,P=0.111,P>0.05)。
②两组治疗后PRI比较：传统手法组治疗后PRI(x±s)为4.43±1.095,经筋疗法组治疗后PRI(x±s)为2.63±1.221,经独立样本t检验,两组患者治疗后PRI比较有显著性差异(t=8.502,P=0.000,P<0.05)。
③两组治疗前后PRI比较：传统手法组治疗前PRI(x±s)为10.57±3.397,治疗后PRI(x±s)为4.43±1.095,经配对样本t检验,传统手法组治疗后PRI与治疗前比较有显著性差异(t=13.629,P=0.000,P<0.05)；经筋疗法组治疗前PRI(x±s)为9.70±2.431,治疗后PRI(x±s)为2.63±1.221,经配对样本t检验,经筋疗法组治疗后PRI与治疗前比较有显著性差异(t=22.107,P=0.000,P<0.05)。
McGill-VAS比较
①两组治疗前VAS比较：传统手法组治疗前VAS(x±s)为6.42±1.907,经筋疗法组治疗前VAS(x±s)为6.97±2.066,经独立样本t检验,两组患者治疗前VAS比较差异无显著性(t=-1.515,P=0.132,P>0.05)。
②两组治疗后VAS比较：传统手法组治疗后VAS(x±s)为2.47±.049,经筋疗法组治疗后VAS(X士S)为0.92±0.829,经独立样本t检验,两组患者治疗后VAS比较有显著性差异(t=8.978,P=0.000,P<0.05)。
③两组治疗前后VAS比较：传统手法组治疗前VAS(x±s)为6.42±1.907,治疗后VAS(X士S)为2.47±1.049,经配对样本t检验,传统手法组治疗后VAS与治疗前比较有显著性差异(t=14.793,P=0.000,P<0.05)；经筋疗法组治疗前VAS(x±s)为6.97±2.066,治疗后VAS(x±s)为0.92±0.829,经配对样本t检验,经筋疗法组治疗后VAS与治疗前比较有显著性差异(t=20.822,P=0.000,P<0.05)。
McGill-PPI比较
①两组治疗前PPI比较：传统手法组治疗前PPI(x±s)为4.15±1.459,经筋疗法组治疗前PPI(X士S)为4.10±1.602,经独立样本t检验,两组患者治疗前PPI比较差异无显著性(t=0.179,P=0.858,P>0.05)。
②两组治疗后PPI比较：传统手法组治疗后PPI(x±s)为2.40±1.108,经筋疗法组治疗后PPI(x±s)为0.95±0.769,经独立样本t检验,两组患者治疗后PPI比较有显著性差异(t=8.330,P=0.000,P<0.05)。
③两组治疗前后PPI比较：传统手法组治疗前PPI(x±s)为4.15±1.459,治疗后PPI(x±s)为2.40±1.108,经配对样本t检验,传统手法组治疗后PPI与治疗前比较有显著性差异(t=7.650,P=0.000,P<0.05)；经筋疗法组治疗前PPI(x±s)为4.10±1.602,治疗后PPI(x±s)为0.95±0.769,经配对样本t检验,经筋疗法组治疗后PPI与治疗前比较有显著性差异(t=13.069,P=0.000,P<0.05)。
(4)Roland-morris量表
①两组治疗前Roland-morris比较：传统手法组治疗前Roland-morris(x±s)为11.07±3.025,经筋疗法组治疗前Roland-morris(x±s)为11.72±4.005,经独立样本t检验,两组患者治疗前Roland-morris比较差异无显著性(t=-1.003,P=0.318,P>0.05)。
②两组治疗后Roland-morris比较：传统手法组治疗后Roland-morris(x±s)为7.12±2.092,经筋疗法组治疗后Roland-morris(x±s)为4.93±1.876,经独立样本t检验,两组患者治疗后Roland-morris比较有显著性差异(t=6.018,P=0.000,P<0.05)。
③两组治疗前后Roland-morris比较：传统手法组治疗前Roland-morris(x±s)为11.07±3.025,治疗后Roland-morris(x±s)为7.12±2.092,经配对样本t检验,传统手法组治疗后Roland-morris与治疗前比较有显著性差异(t=8.336,P=0.000,P<0.05)；经筋疗法组治疗前(X±S)为11.72±4.005,治疗后Roland-morris(x±s)为4.93±1.876,经配对样本t检验,经筋疗法组治疗后Roland-morris与治疗前比较有显著性差异(t=11.890,P=0.000,P<0.05)。
(5)ODI量表
①两组治疗前ODI比较：传统手法组治疗前ODI(x±s)为32.17±7.088,经筋疗法组治疗前ODI(x±s)为30.70±7.358,经独立样本t检验,两组患者治疗前ODI比较差异无显著性(t=1.112,P=0.268,P>0.05)。
②两组治疗后ODI比较：传统手法组治疗后ODI(x±s)为23.45±7.643,经筋疗法组治疗后ODI(X士S)为16.60±5.459,经独立样本t检验,两组患者治疗后ODI比较有显著性差异(t=5.649,P=0.000,P<0.05)。
③两组治疗前后ODI比较：传统手法组治疗前ODI(x±s)为32.17±7.088,治疗后ODI(x±s)为23.45±7.643,经配对样本t检验,传统手法组治疗后ODI与治疗前比较有显著性差异(t=6.214,P=0.000,P<0.05)；经筋疗法组治疗前(X士S)为30.70±7.358,治疗后ODI(x±s)为16.60±5.459,经配对样本t检验,经筋疗法组治疗后ODI与治疗前比较有显著性差异(t=11.035,P=0.000,P<0.05)。
(6)总疗效比较
传统手法组：治愈8,显效20,有效14,无效18,总有效率70.00%；经筋疗法组：治愈13,显效24,有效17,无效6,总有效率90.00%,经两独立样本秩和检验,Z值为-2.271,P值为0.023(P<0.05)。
结论
本研究初步表明,经筋疗法治疗腰背肌筋膜炎疗效确切,经2个疗程治疗后,对McGill量表积分、Roland-morris量表积分、ODI量表积分的改善较传统手法更为明显；而总疗效比较,经筋疗法组与明显优于传统手法组。
Background
Back muscle fasciitis is a common disease of the waist, back muscle fasciitis refers to one or both sides or waist pain of the disease occurred in the middle, etc., is both a symptom of many diseases, but also as an independent disease seen in modern medicine called kidney disease, rheumatism, rheumatoid arthritis, spine and back muscles fasciitis trauma, gynecological and other diseases. The main symptoms of lumbar or lumbosacral pain, recurrent pain or fatigue can vary the degree of climate change, and change, when light weight, lingering diseases. Waist can have a wide range of tenderness, no abnormal spine activities and more. Acute onset, symptoms were significantly increased, and there are muscle spasms, scoliosis and functional activity limitation. Back muscle fasciitis is a common clinical syndromes, a high incidence of back pain is a common promise total symptoms. According to statistics,100%of adults have suffered from back pain, due to the accelerated pace of life, the intense competition in the social, human tissue for long-term, repeated, sustained life of oppression against friction posture is not correct, such as stress reaction, tissue hypertrophy and hyperplasia, for compensation, accumulated from persistent chronic lumbar muscle strain, acute injury without timely and proper treatment, can also be persistent chronic injury, the lesion appeared tissue congestion, edema, proliferative changes, granulation tissue formation and pathological changes in adhesion, etc. the disease mostly occurs in young adults, there was fatigue, injury history and waist trauma. The disease clinical treatment more difficult, there is no effective therapy, chronic low back muscle fasciitis species changed a long time, affecting the normal life of the patient, working to bring a lot of trouble, some patients around the doctor, recurrent, painful unbearable, even psychological cast a shadow.
Back muscle fasciitis is a protraction, you need to adhere to a long-term disease treatment. Clinical method for the treatment of low back muscle fasciitis lot, but no single treatment effect is absolute. This requires that we continually look for new treatments in order for the treatment of low back muscle fasciitis have a new breakthrough. We found that in years of clinical practice, tendons therapy for back muscle fasciitis outstanding results, the clinical effect of the proposed research for clinicians Reference.
Tendons medicine has a long history, has long been documented in the classic " Nei Jing". Is the treasure house of traditional Chinese medicine in a wonderful work. But in the long slow process of historical development, economic development has stalled tendons medicine, but the experience of deep technical entities in the private sector, as important as human tendons, large solid organ; in physiology, pathology, diagnosis and treatment, have a unique and important role and deep in meaning. In clinical practice, especially in the modern sense was considered for a long time doctors unhealed pain, arthralgia, diseases, etc.; has a unique and unexpected therapeutic effect is good. This is the traditional medical experience can be passed on to today's great value and role of lies.
This study is to observe the tendons back muscle fasciitis therapy treatment, and compared with the traditional manual therapy, in order to further promote the tendons therapy, provide clinical evidence; fasciitis treatment for the lower back muscles, providing a effective treatment.
Purpose
To evaluate the clinical efficacy of therapy tendons back muscle fasciitis, a reference for clinicians in order to provide a new approach for the treatment of low back muscle fasciitis.
Method
1study Object
120cases of patients with low back muscle fasciitis, from acupuncture, Nanfang Hospital, Southern Hospital rehabilitation, orthopedic, Hong Kong Chinese Medicine tendons.
(1) Diagnostic criteria:According to the Ministry of Health developed "in the People's Republic of China pharmaceutical industry standards· Clinical Medicine Syndrome Diagnostic Criteria" to develop diagnostic criteria.
①may have post-traumatic improper treatment, such as fatigue or exogenous cold history;
②lower back pain, muscle stiffness hair plate, there is a heavy feeling, pain often associated with changes in the weather related, rainy days and after exertion can aggravate the symptoms;
③lower back has a fixed point tenderness or tenderness is more extensive, back muscle stiffness, walking along the row direction of the erector spinae often touched streak changes are mostly back to normal functional activities, X-ray examination no positive signs.
(2) the inclusion criteria:
①meet back muscle fasciitis above diagnostic criteria;
②between the ages of20-75years old;
③course of more than three weeks by;
④according to plan and adhere to treatment completers;
(3) Exclusion criteria:
①with the diagnostic criteria and those who do not meet the inclusion criteria;
②with severe heart, liver, kidney, brain and hematopoietic system of primary vascular diseases, and the impact of the study of other diseases (such as:diabetes, bone tuberculosis, bone tumor, severe osteoporosis, peripheral neuropathy,;) psychiatric patients;
③patients blind, deaf, dumb, etc. with disabilities;
④suspected or confirmed alcohol, drug abusers, such as history;
⑤pregnant or lactating women, the symptoms of severe menopausal syndrome;
⑥severely physically weak;
⑦reluctant to experiment with people who do not sign the informed consent form;
⑧while other treatments were applied.
(4) remove and falling standards:
①cases of poor compliance of subjects, serious adverse events, the occurrence of complications or special physiological changes should not continue to accept the experimenter;
②not reach1/2courses were.
(5) abort test criteria:disease progression during the test, serious complications, or serious adverse reactions should discontinue the test, more than1/2of treatment were included in the efficacy of statistics; trials were suspended due to adverse reactions included cases of adverse reactions statistics.
2. Study Design
A randomized controlled trial, subjects will be qualified in a1:1ratio allocated to the tendons and traditional acupuncture group therapy group,60cases in each group.
3. Randomization method
Cases grouped using simple random method. Specific methods of randomized clinical researchers by operating SAS (Statistical Analysis System) software random number drawn and made randomly assigned cards, plus envelopes sealed envelope the same serial number and card number. Eligible patients entered the study, according to their order of entry, open the same number of envelopes, the inner envelope card by grouping prescribed treatment.
4Treatment
(1) tendons therapy group:
Tendons therapy:The first step:full sun tendons therapy:the patient prone, the doctor uses the tip of the elbow (olecranon), blunt (humeral condyle), hard (forearm ulnar side), soft (forearm side) four positions along the line from full sun tendons direction across the board by foot to the head, rubbing, point, push, pull and other loose tendon playing tendon, heel tendon junction emphasis push, kick outside the tendon junction (gastrocnemius), the popliteal tendon junction (hamstring), thigh tendon junction (biceps femoris), hip tendon junction (gluteus maximus), the thigh tendon junction (iliac rib muscle), Jiaji tendon junction (Erector, waist three transverse points5or L5lumbar sacral spinous process between1) lesions, such as tendon junction point so full sun tendon release is better across the board. Step two:Foot Shaoyang tendons therapy:Patients lateral position, a small pillow between the knees pads, elbow healer sharp, blunt, hard, soft four sites along the foot Shaoyang tendons from the foot to the head direction across the board loose tendon tendon, focusing release enough times toe tendon junction (hallucis longus), fibular tendon junction (peroneus longus, peroneal nerve), outside knee tendon junction (shares four lateralis muscle), V rabbit muscle Results (b semimembranosus, sartorius), the thigh tendon junction (iliac muscle bundles, tensor fascia lata), Tajiri tendon junction (piriformis) lesions, such as tendon junction point; with side reset method. Around the1st. The third step:Meridian tendon therapy:the patient supine, healer along with elbow and thumb tendons Meridian direction from the foot to the head line of loose tendons tendon. Focus release dorsal tendon junction (in the three-toed), the thigh tendon junction (medial quadriceps muscle), air impact tendon junction (inguinal femoral nerve, femoral artery points), the abdominal muscle knot (psoas muscle) and other foci, click the stocks to have a better impact on the heat to the lower extremity arterial. Treatment time about30minutes.
(2) traditional methods Group:
Traditional methods:①patients prone or lateral position, healer stand beside it, double or single palm palm repeatedly rubbing lumbosacral and two buttocks several times.②dual thumb or tip of elbow, rubbing lumbosacral five lines (Du and full sun one, two lateral line, Du to press the intervertebral space-based)3to5times; Tap shen, chi room, waist Yang Guan, Dachangshu, loin, eight Liao, Ashi.③thumb or tip of elbow rubbing cutaneous nerve route rationalization and projection sore point at the piriformis, repeated treatments3-5times; tap the jump ring, rank edge points.④get rubbed the lower extremity of3to5times.⑤tip of elbow rubbing the back of the thigh full sun to rationalize routes; emphasis rubbing Cheng Fu, Yin door, Venezuela, Cheng Shan, Kunlun, springs. Treatment time about30minutes.
Two groups of patients were treated and instruct patient warm and avoid exertion, once daily treatment, continuous treatment six times for a course of two courses (two weeks). After the end of each course of treatment, rest one day
5. OUTCOME MEASURES
(1) Pain-simplify McGill Scale
Comprehensive assessment of pain before and after treatment:a description of the use of internationally recognized measure of simplification McGill Pain Scale for evaluation. Scale is divided into three parts:(1) pain rating index (PRI): contains11words and four sensory emotional words were divided into none, mild, moderate and severe four, respectively,0,1,2,3indicates, calculate the PRI sensory points, score points and emotions;(2) visual analogue scale (VAS):is a10cm long straight ends represent painless and pain, patients in whom draw lines to indicate the degree of pain;(3) the existing pain intensity (PPI):points painless, mild discomfort, discomfort, uncomfortable, terrible pain, very painful six, respectively,0,1,2,3,4,5, said.
(2) Evaluation Function
①dysfunction questionnaire (Roland-Morris):These problems include low back pain patients walking, standing, bending, work, bed, sleeping, dressing, often only living skills, etc., scores for each question1minute, answered "yes"1point, the answer is " no"0points, each question on the unweighted score points, will answer "yes" to each question is the last actual cumulative score score, the lowest score0points, the highest score of24points, the higher the score, the more severe dysfunction.
②Disability Index (Oswestry Disability Index):quantification dysfunction questionnaire, scores O～5minutes, Oswestry Disability Index Questionnaire (ODI) is composed of10questions, including pain intensity, self-care, to mention objects, walking, sitting, standing, sleep interference, sexual life, social life, travel and other10areas, six options for each question, the maximum score is5points for each question, choose the first option a score of0points, choose the last option a score of5points, if there are10quiz questions are done, the score is:the actual score/50(the highest possible score)×100%, if there is a question not answered, the scoring method is:Actual score/45(the highest possible score)×100%, as higher indicate more serious dysfunction.
(3) The total efficacy evaluation
Based on " the People's Republic of China pharmaceutical industry standards Syndrome Diagnostic efficacy of the standard ZY/T001.1.-94"[42] The results were divided into treatment
①cure:low back pain symptoms, waist freedom of movement;
②improved:back pain relief, lumbar activity function was restored;
③healed:symptoms do not improve.
6. Observation methods
(1) to two treatment regimens for the observation period;
(2) Clinical symptoms and signs after treatment and prior to each recording time.
7. Data processing
All statistical data using SPSS13.0statistical software for statistical analysis. According to observations of different pointers and data, measurement data using mean±standard deviation (x±s) said, and the distribution of normality and homogeneity of variance test between the two groups were compared using analysis of variance, the number of the groups were compared by paired t test, count data comparison using chi-square test, test level. P<0.05was considered statistically significant.
Result
(1) Case interrupt and shedding
120cases of patients with low back muscle fasciitis treatment observation group,60cases in which traditional practices, tendons therapy group,60patients were observed without shedding process, removed.
(2) baseline indicators
Two groups of patients'gender, age, duration, the difference was not statistically significant (P>0.05), comparable.
(3) McGill Comparison Scale
McGill-PRI comparison
①PRI compare two groups before treatment:traditional practices before treatment PRI (x±s) was10.57±3.397, tendons therapy group therapy before PRI (x±s) was9.70±2.431, by independent samples t-test, two groups of patients before treatment PRI was no significant difference (t=1.607, P=0.111, P>0.05).
②After treatment, PRI comparison:the traditional approach group after treatment PRI (x±s) was4.43±1.095, tendons therapy group after treatment PRI (x±s) was2.63±1.221, by independent samples t-test, two groups of patients after treatment PRI there was a significant difference (t=8.502, P=0.000, P<0.05).
③PRI compare before and after treatment in both groups:the traditional approach group before treatment PRI (x±s) was10.57±3.397, after treatment PRI (x±s) was4.43±1.095, by paired samples t-test, traditional practices PRI group after treatment and before treatment there was a significant difference (t=13.629, P=0.000, P<0.05); tendons therapy group therapy before PRI (x±s) was9.70±2.431, after treatment PRI (x±s) was2.63±1.221, by paired sample t-test, a relatively former PRI and treatment of muscle therapy group after treatment was significant difference (t=22.107, P=0.000, P<0.05).
McGill-VAS comparison
①two groups before treatment VAS comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, tendons therapy group before treatment VAS (x±s) was6.97±2.066, by independent samples t-test, two groups of patients before treatment VAS difference was not statistically significant (t=-1.515, P=0.132, P>0.05).
②After treatment, VAS comparison:the traditional approach group after treatment VAS (x±s) was2.47±1.049, tendons therapy group after treatment VAS (x±s)was0.92±0.829, by independent samples t-test, two groups of patients after treatment VAS there was a significant difference (t=8.978, P=0.000, P<0.05).
③VAS before and after treatment comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, after treatment VAS (x±s) was2.47±1.049, by paired samples t-test, traditional practices and treatment group after treatment VAS ago there was a significant difference (t=14.793, P=0.000, P<0.05); tendons therapy group before treatment VAS (x±s) was6.97±2.066, after treatment VAS (x±s) was0.92±0.829, by paired sample T-test, a relatively VAS before therapy and treatment after tendon significant difference between the treatment group (t=20.822, P=0.000, P<0.05).
McGill-PPI comparison
①two groups before treatment PPI comparison:the traditional approach group before treatment PPI (x±s) was4.15±1.459, tendons therapy group before treatment PPI (x±s) was4.10±1.602, by independent samples t-test, two groups of patients before treatment PPI difference was not statistically significant (t=0.179, P=0.858, P>0.05).
②After treatment, PPI comparison:the traditional approach group after treatment PPI (x±S) was2.40±1.108, tendons therapy group after treatment PPI (x±s) was0.95±0.769, by independent samples t-test, two groups of patients after treatment there was a significant difference (t=8.330, P=0.000, P<0.05) PPI.
③the two groups before and after treatment PPI comparison:traditional practices before treatment PPI (x±s) was4.15±1.459, after treatment PPI (x±s) was2.40±1.108, by paired samples t-test, traditional practices group before and after treatment with PPI therapy there was a significant difference (t=7.650, P=0.000, P <0.05); tendons therapy group before treatment PPI (x±s) was4.10±1.602, after treatment PPI (x±s) was0.95±0.769, by paired sample t-test, there are more treatment before and after PPI therapy group therapy tendons significant difference (t=13.069, P=0.000, P<0.05).
(4) Roland-morris Scale
①two groups before treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, tendons therapy group therapy before Roland-morris (x±s) was11.72±4.005, by independent samples t-test, two groups of patients before Roland-morris no significant difference (t=-1.003, P=0.318, P>0.05).
②After treatment, Roland-morris comparison:the traditional approach group after treatment Roland-morris (x±s) was7.12±2.092, tendons therapy group after treatment Roland-morris (x±s) was4.93±1.876, by independent samples t-test, more Roland-morris significant difference (t=6.018, P=0.000, P<0.05) after treatment, both groups of patients.
③before and after treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, after treatment, Roland-morris (x±s) was7.12±2.092, by paired samples t-test, traditional practices group there after treatment before Roland-morris and treatment of more significant difference (t=8.336, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was11.72±4.005, after treatment, Roland-morris (x±s) was4.93±1.876, by paired samples t-test, Roland-morris there was a significant difference (t=11.890tendons therapy group after treatment compared with before treatment, P=0.000, P<0.05).
(5) ODI Scale
①ODI compare two groups before treatment:traditional practices before treatment ODI (x±s) was32.17±7.088, tendons therapy group before treatment ODI (x±s) was30.70±7.358, by independent samples t-test, two groups of patients before treatment ODI difference was not statistically significant (t=1.112, P= 0.268, P>0.05).
②After treatment ODI comparison:the traditional approach group after treatment ODI (x±S) was23.45+7.643, tendons therapy group after treatment ODI (x±S) was16.60±5.459, by independent samples t-test, two groups of patients after treatment ODI there was a significant difference (t=5.649, P=0.000, P<0.05).
③ODI before and after treatment comparison:the traditional approach group before treatment ODI (x±s) was32.17±7.088, after treatment ODI (x±s) was23.45±7.643, by paired samples t-test, traditional practices and treatment after treatment before ODI there was a significant difference (t=6.214, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was30.70±7.358, after treatment ODI (±s) was16.60±5.459, by paired samples t testing, a relatively former ODI tendon therapy and treatment group after treatment was significant difference (t=11.035, P=0.000, P<0.05).
(6) Total comparative efficacy
Traditional methods Group:cure8,20markedly effective in14,18invalid, the total efficiency of70.00%; tendons treatment groups:13were cured,24markedly effective in17,6, the total efficiency of90.00%, after two independent samples rank and inspection, Zis-2.271, P value of0.023(P<0.05).
Conclusion
This preliminary study showed that the tendon back muscle fasciitis therapy efficacy, after two courses of treatment, for the McGill scale score, Roland-morris scale integration, improve ODI scale score is more obvious than the traditional approach; while comparing the total effect, tendons therapy group and the group was significantly better than traditional methods.
腰背肌筋膜炎是一种常见的腰部疾病,腰背肌筋膜炎是指腰部一侧或两侧或正中等处发生疼痛之症,既是多种疾病的一个症状,又可作为独立的疾病,可见于现代医学所称之肾病、风湿病、类风湿病、腰背肌筋膜炎脊椎及外伤、妇科等疾病。主要症状为腰或腰骶部疼痛,反复发作,疼痛可随气候变化或劳累程度而变化,时轻时重,缠绵不愈。腰部可有广泛压痛,脊椎活动多无异常。急性发作时,各种症状均明显加重,并可有肌肉痉挛,脊椎侧弯和功能活动受限。腰背肌筋膜炎是临床上常见的病证,发病率很高,是许多腰背痛患者常见的共有症状。据统计,成人曾100%患过腰痛,由于生活节奏的加快,社会的竞争激烈,人体组织对长期、反复、持续的生活性压迫、打击,摩擦姿势的不正等应力的反应,使组织肥大和增生,以作代偿,累积迁延而成慢性腰肌劳损,急性损伤未经及时正确的治疗,也可迁延成慢性损伤,病变部位出现组织充血、水肿、增生变化,肉芽组织形成以及粘连等病理性改变,本病多发生于青壮年,曾有过劳、损伤和腰部外伤的病史。该病临床治疗较为困难,尚无特效疗法,腰背肌筋膜炎种为慢性病变,长期以来,影响患者的正常生活,工作,带来了很多麻烦,有些患者四处求医,反复发作,痛苦不堪,甚至心理蒙上一层阴影。
腰背肌筋膜炎是一种迁延难愈,需要长期坚持治疗的一种疾病。临床上治疗腰背肌筋膜炎的方法很多,但是,没有哪一种是治疗效果是绝对的。这就要求我们不断寻找新的治疗方法,以期针对腰背肌筋膜炎的治疗能有新的突破。我们在多年的临床实践中发现,经筋疗法治疗腰背肌筋膜炎效果突出,拟对其临床效果进行研究,以供临床医生选择参考。
经筋医学,有悠久历史,在古典《内经》中早有记载。是我国传统医学宝库中的一朵奇葩。但在慢长的历史发展过程中,经筋医学的发展曾停滞不前,但经验之技术实体深在民间,经筋作为人体重要的、庞大的实体器官；在生理、病理、诊断和治疗上,都具有独特的重要作用和深在意义。在临床上,尤其在现代意义下被认为久医不愈的痛症、痹症、杂症等；具有独到的、及有意想不到的治疗好效果。这是传统医疗经验能得以传承到今天的重要价值和作用所在。
本研究是观察经筋疗法治疗腰背肌筋膜炎的治疗效果,并与传统手法治疗比较,为经筋疗法的进一步推广,提供临床证据；为腰背肌筋膜炎的治疗,提供一种有效的治疗手段。
目的
探讨经筋疗法治疗腰背肌筋膜炎的临床疗效,供临床医生参考,以期为腰背肌筋膜炎的治疗提供新的方法。
方法
1.研究对象
120例腰背肌筋膜炎的患者,来自南方医院针灸科、南方医院康复科、骨伤科、香港中华经筋医学院。
(1)诊断标准：根据卫生部制订的《中华人民共和国中医药行业标准·中医骨伤科病证诊断标准》[4]来制定诊断标准。
①可有外伤后治疗不当、劳损或外感风寒等病史；
②腰背部酸痛、肌肉僵硬发板、有沉重感,疼痛常与天气变化有关,阴雨天及劳累后可使症状加重；
③腰背部有固定压痛点或压痛较为广泛,背部肌肉僵硬,沿竖脊肌走行方向常可触到条索状的改变,背部功能活动大多正常,X线检查无阳性体征。
(2)纳入标准：
①符合腰背肌筋膜炎上述诊断标准者；
②年龄在20—75岁之间者；
③病程在3周以上者；
④能够按计划坚持治疗并完成者；
(3)排除标准：
①与上述诊断标准及纳入标准不符合者；
②合并有严重心、肝、肾、脑血管及造血系统等原发性疾病者,及影响本研究的其他疾病(如：糖尿病、骨结核、骨肿瘤、严重骨质疏松症、周围神经病变、精神病患者；)；
③具有盲,聋,哑等残疾的患者；
④怀疑或确认有酒精、药物等滥用史者；
⑤妊娠或哺乳期妇女、症状严重的更年期综合征者；
⑥严重体虚者；
⑦不愿配合试验的人,不签署知情同意书者；
⑧同时应用其他疗法者。
(4)剔除和脱落标准：
①病例受试者的依从性差,发生严重不良事件,发生并发症或特殊生理变化不宜继续接受试验者；
②未达到1/2疗程者。
(5)中止试验标准：试验过程中病情恶化,出现严重的并发症,或出现严重的不良反应,均应中止试验,已超过1/2疗程者,计入疗效统计；因不良反应中止试验者,计入不良反应病例统计。
2.研究设计
采用随机对照试验方法,将合格受试者以1：1的比例分配至经筋疗法组及传统针刺组,每组均为60例。
3.随机化方法
病例分组采用简单随机的方法。具体的随机化分配方法由临床研究人员通过操作SAS(统计分析系统)软件得出随机数字,并制成随机分配卡片,加信封密封,信封序号与卡片序号相同。合格病例进入试验时,按其进入的先后次序,拆开号码相同的信封,按信封内卡片规定的分组进行治疗。
4.治疗方法
(1)经筋疗法组：
经筋疗法：第一步：足太阳经筋疗法：患者取俯卧位,医者采用肘关节之尖(鹰嘴)、钝(肱骨内髁)、硬(前臂尺骨面)、软(前臂内侧面)4个部位顺着足太阳经筋线从足到头方向进行全线按、揉、点、推、弹拔等松筋理筋,重点推按足跟筋结、踹外筋结(腓肠肌)、胭内筋结(胭绳肌)、大腿后筋结(股二头肌)、臀部筋结(臀大肌)、髀后筋结(髂肋肌)、华佗夹脊筋结(骶棘肌,腰三横突点,腰4、5或腰5骶1之间的棘突旁)等筋结病灶点,使足太阳经筋全线松解为佳。第二步：足少阳经筋疗法：患者取侧卧位,双膝间垫一小枕,医者用肘部尖、钝、硬、软4个部位顺着足少阳经筋从足到头方向进行全线松筋理筋,重点松解足次趾筋结(蹲长伸肌)、腓侧筋结(腓骨长肌、腓神经)、膝外筋结(股四头外侧肌)、伏兔筋结(二半膜肌、缝匠肌)、髀上筋结(髂筋束、阔筋膜张肌)、尻筋结(梨状肌)等筋结病灶点；配合侧板复位法。左右各1次。第三步：足阳明经筋疗法：患者取仰卧位,医者用肘部及拇指指腹顺着足阳明经筋从足到头方向全线松筋理筋。重点松解足背筋结(中三趾)、髀内筋结(股四头内侧肌)、气冲筋结(腹股沟股神经、股动脉点)、腹后筋结(腰大肌)等病灶点,点按股动脉时以有热气向下肢冲击为佳。一次治疗约30分钟。
(2)传统手法组：
传统手法：①患者俯卧位或侧卧位,医者站其旁,双手掌或单手掌反复揉腰骶部和两臀部数遍。②双拇指或肘尖,按揉腰骶部5条线(督脉和足太阳经一、二侧线,督脉以按压椎间隙为主)3-5遍；点按肾俞、志室、腰阳关、大肠俞、腰眼、八髎、阿是穴。③拇指或肘尖按揉理顺臀上皮神经路线和梨状肌投影处的酸痛点,反复施术3-5遍；点按环跳、秩边穴。④拿揉下肢后侧3-5遍。⑤肘尖按揉理顺大腿后侧足太阳经路线；重点按揉承扶、殷门、委中、承山、昆仑、涌泉。一次治疗约30分钟。
两组患者接受治疗后嘱病人保暖,避免劳累,每日治疗1次,连续治疗6次为1疗程,共2个疗程(2周)。每1疗程结束后,休息1天。
5.观察指标
(1)疼痛——简化McGill量表
治疗前后疼痛综合评定：采用国际公认的描述与测量疼痛的简化McGill量表进行测评。量表分为三部分：①疼痛分级指数(PRI)：含11个感觉性词与4个情绪性词,程度分为无、轻、中、重四级,分别以0、1、2、3分表示,可计算出PRI感觉分、情绪分和总分；②目测类比定级法(VAS)：为一条10cmm长的直线,两端分别代表无痛和剧痛,患者在其中画线以表示疼痛程度；③现有疼痛强度(PPI)：分无痛、轻度不适、不适、难受、可怕的疼痛、极为痛苦6级,分别以0、1、2、3、4、5分表示。
(2)功能评价
①功能障碍调查表(Roland-Morris):这些问题包括腰背痛患者的行走、站立、弯腰、工作、卧床、睡眠、穿衣、只常生活自理能力等方面,每个问题的分值为1分,回答“是”得1分,回答“否”得0分,各问题在分值上无权重之分,将回答“是”的各问题分值累加即为最后实际得分,最低分为0分,最高分为24分,分值越高,表示功能障碍越严重。
②功能障碍指数(Oswestry Disability Index):量化功能障碍的问卷调查表,分值O-5分,Oswestry功能障碍指数问卷表(ODI)是由10个问题组成,包括疼痛的强度、生活自理、提物、步行、坐位、站立、干扰睡眠、性生活、社会生活、旅游等10个方面的情况,每个问题6个选项,每个问题的最高得分为5分,选择第一个选项得分为0分,依次选择最后一个选项得分为5分,假如有10个问题都做了问答,记分方法是：实际得分/50(最高可能得分)×100%,假如有一个问题没有回答,则记分方法是：实际得分/45(最高可能得分)×100%,如越高表明功能障碍越严重。
(3)总疗效评定
依据《中华人民共和国中医药行业标准病证诊断疗效标准ZY/T001.1.—94》[5]将治疗结果分为
①治愈：腰痛症状消失,腰部活动自如；
②好转：腰痛减轻,腰部活动功能基本恢复；
③未愈：症状未改善。
6.观察方法
(1)以2个治疗疗程为观察周期；
(2)临床症状、体征在治疗前和治疗后各记录一次。
7.数据处理
所有统计数据,采用SPSS13.0统计软件进行统计学处理。根据观察指针和数据不同,计量数据采用均数士标准差(X士S)表示,并进行正态性分布及方差齐性检验,组间均数比较用方差分析检验,组内均数比较用配对t检验,计数数据比较用卡方检验,检验水平。当P<0.05认为有统计意义。
结果
(1)病例中断与脱落情况
对120例腰背肌筋膜炎患者进行治疗观察,其中传统手法组60例,经筋疗法组60例,观察过程中无脱落、剔除。
(2)基线指标
两组患者的性别、年龄、病程比较,差异均无统计学意义(P>0.05),具有可比性。
(3) McGill量表比较
McGill-PRI比较
①两组治疗前PRI比较：传统手法组治疗前PRI(X±S)为10.57±3.397,经筋疗法组治疗前PRI(x±s)为9.70±2.431,经独立样本t检验,两组患者治疗前PRI比较差异无显著性(t=1.607,P=0.111,P>0.05)。
②两组治疗后PRI比较：传统手法组治疗后PRI(x±s)为4.43±1.095,经筋疗法组治疗后PRI(x±s)为2.63±1.221,经独立样本t检验,两组患者治疗后PRI比较有显著性差异(t=8.502,P=0.000,P<0.05)。
③两组治疗前后PRI比较：传统手法组治疗前PRI(x±s)为10.57±3.397,治疗后PRI(x±s)为4.43±1.095,经配对样本t检验,传统手法组治疗后PRI与治疗前比较有显著性差异(t=13.629,P=0.000,P<0.05)；经筋疗法组治疗前PRI(x±s)为9.70±2.431,治疗后PRI(x±s)为2.63±1.221,经配对样本t检验,经筋疗法组治疗后PRI与治疗前比较有显著性差异(t=22.107,P=0.000,P<0.05)。
McGill-VAS比较
①两组治疗前VAS比较：传统手法组治疗前VAS(x±s)为6.42±1.907,经筋疗法组治疗前VAS(x±s)为6.97±2.066,经独立样本t检验,两组患者治疗前VAS比较差异无显著性(t=-1.515,P=0.132,P>0.05)。
②两组治疗后VAS比较：传统手法组治疗后VAS(x±s)为2.47±.049,经筋疗法组治疗后VAS(X士S)为0.92±0.829,经独立样本t检验,两组患者治疗后VAS比较有显著性差异(t=8.978,P=0.000,P<0.05)。
③两组治疗前后VAS比较：传统手法组治疗前VAS(x±s)为6.42±1.907,治疗后VAS(X士S)为2.47±1.049,经配对样本t检验,传统手法组治疗后VAS与治疗前比较有显著性差异(t=14.793,P=0.000,P<0.05)；经筋疗法组治疗前VAS(x±s)为6.97±2.066,治疗后VAS(x±s)为0.92±0.829,经配对样本t检验,经筋疗法组治疗后VAS与治疗前比较有显著性差异(t=20.822,P=0.000,P<0.05)。
McGill-PPI比较
①两组治疗前PPI比较：传统手法组治疗前PPI(x±s)为4.15±1.459,经筋疗法组治疗前PPI(X士S)为4.10±1.602,经独立样本t检验,两组患者治疗前PPI比较差异无显著性(t=0.179,P=0.858,P>0.05)。
②两组治疗后PPI比较：传统手法组治疗后PPI(x±s)为2.40±1.108,经筋疗法组治疗后PPI(x±s)为0.95±0.769,经独立样本t检验,两组患者治疗后PPI比较有显著性差异(t=8.330,P=0.000,P<0.05)。
③两组治疗前后PPI比较：传统手法组治疗前PPI(x±s)为4.15±1.459,治疗后PPI(x±s)为2.40±1.108,经配对样本t检验,传统手法组治疗后PPI与治疗前比较有显著性差异(t=7.650,P=0.000,P<0.05)；经筋疗法组治疗前PPI(x±s)为4.10±1.602,治疗后PPI(x±s)为0.95±0.769,经配对样本t检验,经筋疗法组治疗后PPI与治疗前比较有显著性差异(t=13.069,P=0.000,P<0.05)。
(4)Roland-morris量表
①两组治疗前Roland-morris比较：传统手法组治疗前Roland-morris(x±s)为11.07±3.025,经筋疗法组治疗前Roland-morris(x±s)为11.72±4.005,经独立样本t检验,两组患者治疗前Roland-morris比较差异无显著性(t=-1.003,P=0.318,P>0.05)。
②两组治疗后Roland-morris比较：传统手法组治疗后Roland-morris(x±s)为7.12±2.092,经筋疗法组治疗后Roland-morris(x±s)为4.93±1.876,经独立样本t检验,两组患者治疗后Roland-morris比较有显著性差异(t=6.018,P=0.000,P<0.05)。
③两组治疗前后Roland-morris比较：传统手法组治疗前Roland-morris(x±s)为11.07±3.025,治疗后Roland-morris(x±s)为7.12±2.092,经配对样本t检验,传统手法组治疗后Roland-morris与治疗前比较有显著性差异(t=8.336,P=0.000,P<0.05)；经筋疗法组治疗前(X±S)为11.72±4.005,治疗后Roland-morris(x±s)为4.93±1.876,经配对样本t检验,经筋疗法组治疗后Roland-morris与治疗前比较有显著性差异(t=11.890,P=0.000,P<0.05)。
(5)ODI量表
①两组治疗前ODI比较：传统手法组治疗前ODI(x±s)为32.17±7.088,经筋疗法组治疗前ODI(x±s)为30.70±7.358,经独立样本t检验,两组患者治疗前ODI比较差异无显著性(t=1.112,P=0.268,P>0.05)。
②两组治疗后ODI比较：传统手法组治疗后ODI(x±s)为23.45±7.643,经筋疗法组治疗后ODI(X士S)为16.60±5.459,经独立样本t检验,两组患者治疗后ODI比较有显著性差异(t=5.649,P=0.000,P<0.05)。
③两组治疗前后ODI比较：传统手法组治疗前ODI(x±s)为32.17±7.088,治疗后ODI(x±s)为23.45±7.643,经配对样本t检验,传统手法组治疗后ODI与治疗前比较有显著性差异(t=6.214,P=0.000,P<0.05)；经筋疗法组治疗前(X士S)为30.70±7.358,治疗后ODI(x±s)为16.60±5.459,经配对样本t检验,经筋疗法组治疗后ODI与治疗前比较有显著性差异(t=11.035,P=0.000,P<0.05)。
(6)总疗效比较
传统手法组：治愈8,显效20,有效14,无效18,总有效率70.00%；经筋疗法组：治愈13,显效24,有效17,无效6,总有效率90.00%,经两独立样本秩和检验,Z值为-2.271,P值为0.023(P<0.05)。
结论
本研究初步表明,经筋疗法治疗腰背肌筋膜炎疗效确切,经2个疗程治疗后,对McGill量表积分、Roland-morris量表积分、ODI量表积分的改善较传统手法更为明显；而总疗效比较,经筋疗法组与明显优于传统手法组。
Background
Back muscle fasciitis is a common disease of the waist, back muscle fasciitis refers to one or both sides or waist pain of the disease occurred in the middle, etc., is both a symptom of many diseases, but also as an independent disease seen in modern medicine called kidney disease, rheumatism, rheumatoid arthritis, spine and back muscles fasciitis trauma, gynecological and other diseases. The main symptoms of lumbar or lumbosacral pain, recurrent pain or fatigue can vary the degree of climate change, and change, when light weight, lingering diseases. Waist can have a wide range of tenderness, no abnormal spine activities and more. Acute onset, symptoms were significantly increased, and there are muscle spasms, scoliosis and functional activity limitation. Back muscle fasciitis is a common clinical syndromes, a high incidence of back pain is a common promise total symptoms. According to statistics,100%of adults have suffered from back pain, due to the accelerated pace of life, the intense competition in the social, human tissue for long-term, repeated, sustained life of oppression against friction posture is not correct, such as stress reaction, tissue hypertrophy and hyperplasia, for compensation, accumulated from persistent chronic lumbar muscle strain, acute injury without timely and proper treatment, can also be persistent chronic injury, the lesion appeared tissue congestion, edema, proliferative changes, granulation tissue formation and pathological changes in adhesion, etc. the disease mostly occurs in young adults, there was fatigue, injury history and waist trauma. The disease clinical treatment more difficult, there is no effective therapy, chronic low back muscle fasciitis species changed a long time, affecting the normal life of the patient, working to bring a lot of trouble, some patients around the doctor, recurrent, painful unbearable, even psychological cast a shadow.
Back muscle fasciitis is a protraction, you need to adhere to a long-term disease treatment. Clinical method for the treatment of low back muscle fasciitis lot, but no single treatment effect is absolute. This requires that we continually look for new treatments in order for the treatment of low back muscle fasciitis have a new breakthrough. We found that in years of clinical practice, tendons therapy for back muscle fasciitis outstanding results, the clinical effect of the proposed research for clinicians Reference.
Tendons medicine has a long history, has long been documented in the classic " Nei Jing". Is the treasure house of traditional Chinese medicine in a wonderful work. But in the long slow process of historical development, economic development has stalled tendons medicine, but the experience of deep technical entities in the private sector, as important as human tendons, large solid organ; in physiology, pathology, diagnosis and treatment, have a unique and important role and deep in meaning. In clinical practice, especially in the modern sense was considered for a long time doctors unhealed pain, arthralgia, diseases, etc.; has a unique and unexpected therapeutic effect is good. This is the traditional medical experience can be passed on to today's great value and role of lies.
This study is to observe the tendons back muscle fasciitis therapy treatment, and compared with the traditional manual therapy, in order to further promote the tendons therapy, provide clinical evidence; fasciitis treatment for the lower back muscles, providing a effective treatment.
Purpose
To evaluate the clinical efficacy of therapy tendons back muscle fasciitis, a reference for clinicians in order to provide a new approach for the treatment of low back muscle fasciitis.
Method
1study Object
120cases of patients with low back muscle fasciitis, from acupuncture, Nanfang Hospital, Southern Hospital rehabilitation, orthopedic, Hong Kong Chinese Medicine tendons.
(1) Diagnostic criteria:According to the Ministry of Health developed "in the People's Republic of China pharmaceutical industry standards· Clinical Medicine Syndrome Diagnostic Criteria" to develop diagnostic criteria.
①may have post-traumatic improper treatment, such as fatigue or exogenous cold history;
②lower back pain, muscle stiffness hair plate, there is a heavy feeling, pain often associated with changes in the weather related, rainy days and after exertion can aggravate the symptoms;
③lower back has a fixed point tenderness or tenderness is more extensive, back muscle stiffness, walking along the row direction of the erector spinae often touched streak changes are mostly back to normal functional activities, X-ray examination no positive signs.
(2) the inclusion criteria:
①meet back muscle fasciitis above diagnostic criteria;
②between the ages of20-75years old;
③course of more than three weeks by;
④according to plan and adhere to treatment completers;
(3) Exclusion criteria:
①with the diagnostic criteria and those who do not meet the inclusion criteria;
②with severe heart, liver, kidney, brain and hematopoietic system of primary vascular diseases, and the impact of the study of other diseases (such as:diabetes, bone tuberculosis, bone tumor, severe osteoporosis, peripheral neuropathy,;) psychiatric patients;
③patients blind, deaf, dumb, etc. with disabilities;
④suspected or confirmed alcohol, drug abusers, such as history;
⑤pregnant or lactating women, the symptoms of severe menopausal syndrome;
⑥severely physically weak;
⑦reluctant to experiment with people who do not sign the informed consent form;
⑧while other treatments were applied.
(4) remove and falling standards:
①cases of poor compliance of subjects, serious adverse events, the occurrence of complications or special physiological changes should not continue to accept the experimenter;
②not reach1/2courses were.
(5) abort test criteria:disease progression during the test, serious complications, or serious adverse reactions should discontinue the test, more than1/2of treatment were included in the efficacy of statistics; trials were suspended due to adverse reactions included cases of adverse reactions statistics.
2. Study Design
A randomized controlled trial, subjects will be qualified in a1:1ratio allocated to the tendons and traditional acupuncture group therapy group,60cases in each group.
3. Randomization method
Cases grouped using simple random method. Specific methods of randomized clinical researchers by operating SAS (Statistical Analysis System) software random number drawn and made randomly assigned cards, plus envelopes sealed envelope the same serial number and card number. Eligible patients entered the study, according to their order of entry, open the same number of envelopes, the inner envelope card by grouping prescribed treatment.
4Treatment
(1) tendons therapy group:
Tendons therapy:The first step:full sun tendons therapy:the patient prone, the doctor uses the tip of the elbow (olecranon), blunt (humeral condyle), hard (forearm ulnar side), soft (forearm side) four positions along the line from full sun tendons direction across the board by foot to the head, rubbing, point, push, pull and other loose tendon playing tendon, heel tendon junction emphasis push, kick outside the tendon junction (gastrocnemius), the popliteal tendon junction (hamstring), thigh tendon junction (biceps femoris), hip tendon junction (gluteus maximus), the thigh tendon junction (iliac rib muscle), Jiaji tendon junction (Erector, waist three transverse points5or L5lumbar sacral spinous process between1) lesions, such as tendon junction point so full sun tendon release is better across the board. Step two:Foot Shaoyang tendons therapy:Patients lateral position, a small pillow between the knees pads, elbow healer sharp, blunt, hard, soft four sites along the foot Shaoyang tendons from the foot to the head direction across the board loose tendon tendon, focusing release enough times toe tendon junction (hallucis longus), fibular tendon junction (peroneus longus, peroneal nerve), outside knee tendon junction (shares four lateralis muscle), V rabbit muscle Results (b semimembranosus, sartorius), the thigh tendon junction (iliac muscle bundles, tensor fascia lata), Tajiri tendon junction (piriformis) lesions, such as tendon junction point; with side reset method. Around the1st. The third step:Meridian tendon therapy:the patient supine, healer along with elbow and thumb tendons Meridian direction from the foot to the head line of loose tendons tendon. Focus release dorsal tendon junction (in the three-toed), the thigh tendon junction (medial quadriceps muscle), air impact tendon junction (inguinal femoral nerve, femoral artery points), the abdominal muscle knot (psoas muscle) and other foci, click the stocks to have a better impact on the heat to the lower extremity arterial. Treatment time about30minutes.
(2) traditional methods Group:
Traditional methods:①patients prone or lateral position, healer stand beside it, double or single palm palm repeatedly rubbing lumbosacral and two buttocks several times.②dual thumb or tip of elbow, rubbing lumbosacral five lines (Du and full sun one, two lateral line, Du to press the intervertebral space-based)3to5times; Tap shen, chi room, waist Yang Guan, Dachangshu, loin, eight Liao, Ashi.③thumb or tip of elbow rubbing cutaneous nerve route rationalization and projection sore point at the piriformis, repeated treatments3-5times; tap the jump ring, rank edge points.④get rubbed the lower extremity of3to5times.⑤tip of elbow rubbing the back of the thigh full sun to rationalize routes; emphasis rubbing Cheng Fu, Yin door, Venezuela, Cheng Shan, Kunlun, springs. Treatment time about30minutes.
Two groups of patients were treated and instruct patient warm and avoid exertion, once daily treatment, continuous treatment six times for a course of two courses (two weeks). After the end of each course of treatment, rest one day
5. OUTCOME MEASURES
(1) Pain-simplify McGill Scale
Comprehensive assessment of pain before and after treatment:a description of the use of internationally recognized measure of simplification McGill Pain Scale for evaluation. Scale is divided into three parts:(1) pain rating index (PRI): contains11words and four sensory emotional words were divided into none, mild, moderate and severe four, respectively,0,1,2,3indicates, calculate the PRI sensory points, score points and emotions;(2) visual analogue scale (VAS):is a10cm long straight ends represent painless and pain, patients in whom draw lines to indicate the degree of pain;(3) the existing pain intensity (PPI):points painless, mild discomfort, discomfort, uncomfortable, terrible pain, very painful six, respectively,0,1,2,3,4,5, said.
(2) Evaluation Function
①dysfunction questionnaire (Roland-Morris):These problems include low back pain patients walking, standing, bending, work, bed, sleeping, dressing, often only living skills, etc., scores for each question1minute, answered "yes"1point, the answer is " no"0points, each question on the unweighted score points, will answer "yes" to each question is the last actual cumulative score score, the lowest score0points, the highest score of24points, the higher the score, the more severe dysfunction.
②Disability Index (Oswestry Disability Index):quantification dysfunction questionnaire, scores O～5minutes, Oswestry Disability Index Questionnaire (ODI) is composed of10questions, including pain intensity, self-care, to mention objects, walking, sitting, standing, sleep interference, sexual life, social life, travel and other10areas, six options for each question, the maximum score is5points for each question, choose the first option a score of0points, choose the last option a score of5points, if there are10quiz questions are done, the score is:the actual score/50(the highest possible score)×100%, if there is a question not answered, the scoring method is:Actual score/45(the highest possible score)×100%, as higher indicate more serious dysfunction.
(3) The total efficacy evaluation
Based on " the People's Republic of China pharmaceutical industry standards Syndrome Diagnostic efficacy of the standard ZY/T001.1.-94"[42] The results were divided into treatment
①cure:low back pain symptoms, waist freedom of movement;
②improved:back pain relief, lumbar activity function was restored;
③healed:symptoms do not improve.
6. Observation methods
(1) to two treatment regimens for the observation period;
(2) Clinical symptoms and signs after treatment and prior to each recording time.
7. Data processing
All statistical data using SPSS13.0statistical software for statistical analysis. According to observations of different pointers and data, measurement data using mean±standard deviation (x±s) said, and the distribution of normality and homogeneity of variance test between the two groups were compared using analysis of variance, the number of the groups were compared by paired t test, count data comparison using chi-square test, test level. P<0.05was considered statistically significant.
Result
(1) Case interrupt and shedding
120cases of patients with low back muscle fasciitis treatment observation group,60cases in which traditional practices, tendons therapy group,60patients were observed without shedding process, removed.
(2) baseline indicators
Two groups of patients'gender, age, duration, the difference was not statistically significant (P>0.05), comparable.
(3) McGill Comparison Scale
McGill-PRI comparison
①PRI compare two groups before treatment:traditional practices before treatment PRI (x±s) was10.57±3.397, tendons therapy group therapy before PRI (x±s) was9.70±2.431, by independent samples t-test, two groups of patients before treatment PRI was no significant difference (t=1.607, P=0.111, P>0.05).
②After treatment, PRI comparison:the traditional approach group after treatment PRI (x±s) was4.43±1.095, tendons therapy group after treatment PRI (x±s) was2.63±1.221, by independent samples t-test, two groups of patients after treatment PRI there was a significant difference (t=8.502, P=0.000, P<0.05).
③PRI compare before and after treatment in both groups:the traditional approach group before treatment PRI (x±s) was10.57±3.397, after treatment PRI (x±s) was4.43±1.095, by paired samples t-test, traditional practices PRI group after treatment and before treatment there was a significant difference (t=13.629, P=0.000, P<0.05); tendons therapy group therapy before PRI (x±s) was9.70±2.431, after treatment PRI (x±s) was2.63±1.221, by paired sample t-test, a relatively former PRI and treatment of muscle therapy group after treatment was significant difference (t=22.107, P=0.000, P<0.05).
McGill-VAS comparison
①two groups before treatment VAS comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, tendons therapy group before treatment VAS (x±s) was6.97±2.066, by independent samples t-test, two groups of patients before treatment VAS difference was not statistically significant (t=-1.515, P=0.132, P>0.05).
②After treatment, VAS comparison:the traditional approach group after treatment VAS (x±s) was2.47±1.049, tendons therapy group after treatment VAS (x±s)was0.92±0.829, by independent samples t-test, two groups of patients after treatment VAS there was a significant difference (t=8.978, P=0.000, P<0.05).
③VAS before and after treatment comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, after treatment VAS (x±s) was2.47±1.049, by paired samples t-test, traditional practices and treatment group after treatment VAS ago there was a significant difference (t=14.793, P=0.000, P<0.05); tendons therapy group before treatment VAS (x±s) was6.97±2.066, after treatment VAS (x±s) was0.92±0.829, by paired sample T-test, a relatively VAS before therapy and treatment after tendon significant difference between the treatment group (t=20.822, P=0.000, P<0.05).
McGill-PPI comparison
①two groups before treatment PPI comparison:the traditional approach group before treatment PPI (x±s) was4.15±1.459, tendons therapy group before treatment PPI (x±s) was4.10±1.602, by independent samples t-test, two groups of patients before treatment PPI difference was not statistically significant (t=0.179, P=0.858, P>0.05).
②After treatment, PPI comparison:the traditional approach group after treatment PPI (x±S) was2.40±1.108, tendons therapy group after treatment PPI (x±s) was0.95±0.769, by independent samples t-test, two groups of patients after treatment there was a significant difference (t=8.330, P=0.000, P<0.05) PPI.
③the two groups before and after treatment PPI comparison:traditional practices before treatment PPI (x±s) was4.15±1.459, after treatment PPI (x±s) was2.40±1.108, by paired samples t-test, traditional practices group before and after treatment with PPI therapy there was a significant difference (t=7.650, P=0.000, P <0.05); tendons therapy group before treatment PPI (x±s) was4.10±1.602, after treatment PPI (x±s) was0.95±0.769, by paired sample t-test, there are more treatment before and after PPI therapy group therapy tendons significant difference (t=13.069, P=0.000, P<0.05).
(4) Roland-morris Scale
①two groups before treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, tendons therapy group therapy before Roland-morris (x±s) was11.72±4.005, by independent samples t-test, two groups of patients before Roland-morris no significant difference (t=-1.003, P=0.318, P>0.05).
②After treatment, Roland-morris comparison:the traditional approach group after treatment Roland-morris (x±s) was7.12±2.092, tendons therapy group after treatment Roland-morris (x±s) was4.93±1.876, by independent samples t-test, more Roland-morris significant difference (t=6.018, P=0.000, P<0.05) after treatment, both groups of patients.
③before and after treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, after treatment, Roland-morris (x±s) was7.12±2.092, by paired samples t-test, traditional practices group there after treatment before Roland-morris and treatment of more significant difference (t=8.336, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was11.72±4.005, after treatment, Roland-morris (x±s) was4.93±1.876, by paired samples t-test, Roland-morris there was a significant difference (t=11.890tendons therapy group after treatment compared with before treatment, P=0.000, P<0.05).
(5) ODI Scale
①ODI compare two groups before treatment:traditional practices before treatment ODI (x±s) was32.17±7.088, tendons therapy group before treatment ODI (x±s) was30.70±7.358, by independent samples t-test, two groups of patients before treatment ODI difference was not statistically significant (t=1.112, P= 0.268, P>0.05).
②After treatment ODI comparison:the traditional approach group after treatment ODI (x±S) was23.45+7.643, tendons therapy group after treatment ODI (x±S) was16.60±5.459, by independent samples t-test, two groups of patients after treatment ODI there was a significant difference (t=5.649, P=0.000, P<0.05).
③ODI before and after treatment comparison:the traditional approach group before treatment ODI (x±s) was32.17±7.088, after treatment ODI (x±s) was23.45±7.643, by paired samples t-test, traditional practices and treatment after treatment before ODI there was a significant difference (t=6.214, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was30.70±7.358, after treatment ODI (±s) was16.60±5.459, by paired samples t testing, a relatively former ODI tendon therapy and treatment group after treatment was significant difference (t=11.035, P=0.000, P<0.05).
(6) Total comparative efficacy
Traditional methods Group:cure8,20markedly effective in14,18invalid, the total efficiency of70.00%; tendons treatment groups:13were cured,24markedly effective in17,6, the total efficiency of90.00%, after two independent samples rank and inspection, Zis-2.271, P value of0.023(P<0.05).
Conclusion
This preliminary study showed that the tendon back muscle fasciitis therapy efficacy, after two courses of treatment, for the McGill scale score, Roland-morris scale integration, improve ODI scale score is more obvious than the traditional approach; while comparing the total effect, tendons therapy group and the group was significantly better than traditional methods.
引文
[1]熊翊华,陈飞.中医综合治疗慢性腰肌劳损43例疗效观察[J].中国医学工程,2011(1).
[2]樊莉,徐振华,朱晓平.热敏灸治疗慢性腰肌劳损临床研究[J].江西中医学院学报,2007,19(5)：61-62.
[3]蒋斌.中医治疗慢性腰肌劳损83例临床观察附：慢性腰肌劳损研究进展[D].成都中医药大学,2009.
[4]国家中医药管理局.中华人民共和国中医药行业标准[M].1994.
[5]国家中医药管理局.中华人民共和国中医药行业标准病证诊断疗效标准[M].1994.
[6]沈红新.穴位注射配合中药外洗治疗腰背筋膜炎62例[J].实用中医药杂志,2000(11)：30.
[7]黄松,吴建华.银质针针灸配合牵引治疗腰椎间盘突出症[J].中医外治杂志,1996(02)：21.
[8]刘元梅,张英杰.药罐结合治疗腰背筋膜炎57例[J].四川中医,1995,13(11)：46.
[9]乔和平,石桂珍.针刺治疗腰肌筋膜炎45例[J].现代中西医结合杂志,1999,8(10)：1647.
[10]陈红燕,杨米雄,陈彩仙.三联疗法治疗腰臀肌筋膜炎[J].中医正骨,2010,22(11)：56,58.
[11]王爱华,韩立明.帆板运动员腰背肌筋膜炎的分析研究[J].现代预防医学,2006,33(10)：1983-1984.
[12]贺新武,王爱华.国家队激流回旋运动员腰背肌筋膜炎患病的相关因素[J].中国临床康复,2006,10(32)：38-40.
[13]丁永玺,王爱华.坐式排球运动与腰背肌筋膜炎的关系及其损伤预防[J].中国组织工程研究与临床康复,2007,11(52)：10524-10526.
[14]李运友.中药内服合走罐治疗腰背肌筋膜炎[J].中医外治杂志,2004,13(5)：44.
[15]曹健.身痛逐瘀汤加手法治疗项背肌筋膜炎56例[J].陕西中医学院学报,2001,24(6)：30.
[16]林振禄.身痛逐瘀汤加减治疗慢性腰肌劳损[J].湖北中医杂志,2001,23(1)：38.
[17]王旭,詹海夫.身痛逐瘀汤加减治疗慢性腰肌劳损60例临床观察[J].长春中医药大学学报,2006,22(2)：27.
[18]王敏,贺灵慧.益肾蠲痹丸治疗腰背肌筋膜炎[J].现代中西医结合杂志,2005,14(23)：3100.
[19]毕东敏,刘桂荣.益肾蠲痹丸治疗腰背肌筋膜炎62例[J].陕西中医,2004,25(9)：809-810.
[20]傅瑞阳,王娅玲,沈丽芳,等.中药熏洗防治腰背肌筋膜炎[J].浙江中医学院学报,2006,30(1)：43,45.
[21]李照禄,邹乃清,商立智.活血止痛散热敷治疗腰背肌肉筋膜炎40例[J].中医外治杂志,2003,12(3)：23.
[22]张玉镇.《内经》寒痹熨法治疗项背肌筋膜炎60例[J].中医药学刊,2005,23(12)：2267-2268.
[23]乔和平,石桂珍.针刺治疗腰肌筋膜炎45例[J].现代中西医结合杂志,1999,8(10)：1647.
[24]戚红亮.针刺推拿治疗颈肩肌筋膜炎30例[J].中国针灸,2001,21(8)：498.
[25]鲁翔鹏,张义,周杰.针刺配合蜡疗治疗腰背肌筋膜炎30例[J].中国中医急症,2013,22(12)：2117.
[26]张倩如,程建东.毫针散刺治疗慢性筋膜炎216例[J].中国针灸,1997(10)：619-620.
[27]崔正友.恢刺为主治疗腰肌筋膜炎46例[J].中国民间疗法,1997(01)：20-21.
[28]夏东斌,黄泳.浮针治疗腰背部肌筋膜炎[J].中国针灸,2001,21(3)：137.
[29]陈宏伟,姚杰良,唐永春.平刺滞针弹拨法治疗肩背腰部肌筋膜炎102例疗效观察[J].上海针灸杂志,2006,25(5)：26-27.
[30]吴洪英.68例电针加手法治疗腰背肌筋膜炎[J].中国实用医药,2007,2(21)：54.
[31]陈成.电针排刺配合闪罐治疗背肌筋膜炎60例[J].实用中医药杂志,2005,21(10)：618.
[32]杨春花.温针灸、TDP配合刺络拔罐治疗腰背肌筋膜炎32例[J].浙江中医杂志,2012,47(6)：445.
[33]王乐琴.刮痧与温针灸治疗背肌筋膜炎疗效观察[J].中国针灸,2006,26(7)：478-480.
[34]韩刚.刮痧与温针灸治疗背肌筋膜炎疗效观察[J].健康之路,2013,12(8)：415.
[35]李爱萍,毛银芳.温针加锋钩针合身痛逐瘀汤加减治疗背肌筋膜炎50例疗效观察[J].山西中医学院学报,2007,8(3)：39-40.
[36]王喜荣,孙娟.温针结合走罐治疗背肌筋膜炎30例疗效观察[J].实用中西医结合临床,2010,10(5)：25-27.
[37]张波,冉琼.小针刀结合温针治疗肩胛背部肌筋膜炎临床疗效比较[J].实用医院临床杂志,2008,5(3)：74-75.
[38]赵礼明.推拿加点穴治疗颈肩腰背肌筋膜炎的临床体会[J].按摩与导引,2006,22(3)：33.
[39]吕海泉.浅谈筋膜炎的按摩治疗[J].甘肃中医,2006,19(4)：31.
[40]孙华斌,肖向涌,高真国.揉按弹拔手法治疗背肌筋膜炎患者取坐位,先用揉、按手法放松颈背部,然后点按风池、肩井、天宗穴,每穴约30秒钟,接着对肩背部压痛点及痛性筋束结节进行按压和弹拔,手法由轻到重,约2～3分钟,最后以搓、揉手法结束.隔日1次,7次为一疗程.用揉按手法放松颈背部肌肉,点按风池、肩井、[J].中国临床医生,2001,29(5)：40.
[41]齐晓田.手法治疗筋膜炎30例[J].湖北中医杂志,1999,21(7)：305.
[42]杨连生,杨红霞.治疗腰肌筋膜炎169例临床体会[J].职业与健康,2003,19(11)：148-149.
[43]廖信祥,周一庆,黎展文,等.辩证推拿配合中药热敷治疗腰背肌筋膜炎150例[J].中国实用医药,2013,8(18)：254-255.
[44]李建恒.推拿配合超短波治疗举重运动员腰背肌筋膜炎25例[J].广西医学,2006,28(11)：1816-1817.
[45]崔述生,王力.推拿配合滑罐治疗腰背肌筋膜炎[J].中国中医药信息杂志,2006,13(7)：63.
[46]梁杰群.小针刀治疗腰背肌筋膜炎30例[J].广西中医药,2004,27(4)：40.
[47]王英姿,王栋.针刀治疗背肌筋膜炎120例[J].上海针灸杂志,2005,24(3)：24.
[48]张东云,宋海云.浮针结合针刀治疗腰背肌筋膜炎80例临床研究*[J].云南中医学院学报,2013(4)：61-63.
[49]赵利军.小针刀治疗背肌筋膜炎40例[J].中国民间疗法,2012,20(1)：21-22.
[50]韦小东.小针刀治疗背肌筋膜炎60例[J].广西中医药,2001,24(2)：27-28.
[51]张苏杰,吕发明.小针刀治疗项背部肌筋膜炎的临床研究[J].新疆中医药,2008,26(3)：45-47.
[52]聂荣华.刺络拔罐法治疗腰背肌筋膜炎50例[J].山西中医,1997(03)：31.
[53]许天兵.刺血加拔罐治疗腰筋膜炎68例[J].山西中医,1994(04)：51-52.
[54]许天兵,幼明.刺血加拔罐治疗腰筋膜炎68例[J].实用中医药杂志,1994(05)：48.
[55]刘元梅,张英杰.药罐结合治疗腰背筋膜炎57例[J].四川中医,1995(11)：46.
[56]陈志祥.电针排刺配合走罐治疗腰背肌筋膜炎疗效观察[J].上海针灸杂志,2011,30(8)：560-561.
[57]王锦.走罐配合艾灸治疗腰背肌筋膜炎30例疗效观察[J].现代临床医学,2005,31(4)：233-234.
[58]温萍,李旭方,刘满芬.针灸配合走罐治疗腰背肌筋膜炎65例报告[J].甘肃中医,2006,19(8)：37-38.
[59]杨路,赖新生,冯淑兰.扬刺配合走罐治疗腰背肌筋膜炎89例临床研究[J].实用医学杂志,2007,23(23)：3780-3781.
[60]孙媛媛.电针加走罐疗法治疗肩背肌筋膜炎60例[J].河北中医,2012,34(11)：1674-1675.
[61]梁树勇.经筋挑刺治疗腰背肌筋膜炎疗效观察[J].中国针灸,2008,28(8)：621-622.
[62]熊晓山.挑治法治疗项背肌筋膜炎[J].四川中医,1997(02)：50-51.
[63]张贵有.补中益气汤加味配合手法治疗项背肌筋膜炎86例小结[J].中国中医骨伤科,1998(02)：24-25.
[64]肖雷,张辉,张广麒.解凝汤配合推拿治疗颈背肌筋膜炎60例[J].中国中医药信息杂志,2004,11(8)：727.
[65]王奎.背肌筋膜炎综合治疗效果观察[J].颈腰痛杂志,2002,23(2)：158.
[66]苳友金.针药配合治疗肩背部肌筋膜炎40例[J].针灸临床杂志,1999(04)：11-12.
[67]陈玉玲,罗素珍.针罐四联疗法治疗颈肩部肌筋膜炎临床观察[J].针灸临床杂志,1999(06)：19-20.
[68]曲运生,吴旭文,李济民,等.按摩导引合腰痛膏214例外敷治疗腰肌筋膜炎[J].中医外治杂志,1996(06)：22-23.
[69]朱广圣.局部注射配合推拿治疗腰臀筋膜炎158例[J].山西中医,1996(02)：31.
[70]饶艳秋.隔姜灸治疗背肌筋膜炎46例疗效观察[J].中国针灸,1998(07)：55.
[71]褚福昶.燃火加热中药垫配合梅花针治疗颈肩肌筋膜炎462例[J].上海针灸杂志, 2010(08)：531.
[72]刘琦.超声波药物透入疗法治疗颈背肌筋膜痛的临床研究[J].中华物理医学与康复杂志,2008,30(3)：193-194.
[73]张维,于俊敏,韩广敬,等.双氯芬酸二乙胺乳胶剂超声波透入治疗原发性纤维肌痛综合征的初步疗效观察[J].实用疼痛学杂志,2011,07(4)：264-266.
[74]李晓宏,赵伟成,杨承祥.替扎尼定治疗肌筋膜疼痛综合征的临床观察[J].中国康复医学杂志,2008,23(5)：434-435.
[75]李义凯,穆伟华,王爱华.治疗肌筋膜痛的药物[J].颈腰痛杂志,2002,23(2)：170-171.
[76]Bendtsen L, Norregaard J, Jensen R, et al. Evidence of qualitatively altered nociception in patients with fibromyalgia[J]. Arthritis Rheum,1997,40(1):98-102.
[77]田家林,骆大富,蔡永丰.超短波并电脑中频治疗肌纤维织炎146例[J].华南国防医学杂志,2004,18(2)：44-45.
[78]秦玉革.《内经》经筋的实质是神经[J].中国针灸,2006,26(2)：147-150.
[79]王雨.十二经筋病候与针灸临床[J].中医杂志,1989,30(5)：20-21.
[80]薛立功.经筋理论的探讨与发挥[J].中国针灸,1997,17(11)：698-699.
[81]孙之镐孙树椿.中医筋伤学[M].1.北京：人民卫生出版社,2002.
[82]王军,董为人,姚大卫,等.从经络穴位到支持与储备系统——基于数字解剖学研究提出人体第十大功能系统假说[J].南方医科大学学报,2007,27(5)：573-579.
[83]原林,姚大卫,唐雷,等.针灸经穴的数字解剖学研究[J].解剖学报,2004,35(4)：337-343.
[84]吴金鹏.中医“经筋”及“膜原”实质的筋膜理论探讨明[J].北京中医,2007,26(5)：283-285.
[85]Kern U, Martin C, Scheicher S, et al. [Treatment of phantom pain with botulinum-toxin A. A pilot study][J]. Schmerz,2003,17(2):117-124.
[86]Waling K, Sundelin G, Ahlgren C, et al. Perceived pain before and after three exercise programs-a controlled clinical trial of women with work-related trapezius myalgia[J]. Pain,2000, 85(1-2):201-207.
[87]Myburgh C, Hartvigsen J, Aagaard P, et al. Skeletal muscle contractility, self-reported pain and tissue sensitivity in females with neck/shoulder pain and upper Trapezius myofascial trigger points-a randomized intervention study[J]. Chiropr Man Therap,2012,20(1):36.
[88]杨丽美.《内经》经筋理论的应用[J].宁夏医学院学报,2006,28(3)：262-263.
[89]胥荣东.缓解病痛的理筋手法[J].特别健康,2011(11)：17.
[90]李洪,李婕.黄敬伟壮医经筋疗法探微[J].中国民族医药杂志,2010,16(9)：20-22.
[91]王源灏,陈莺歌,雷奶善,等.脊柱相关疾病的经筋诊疗[J].中国民族民间医药,2013,22(2)：98-99.
[92]李春.中医大辞典：内科分册[M].北京：人民卫生出版社,1987：78-80.
[93]韦英才.浅释经筋与经脉的异同及其临床意义[J].广州中医药大学学报,2007,24(3)：247-249.
[94]沈志生.《内经》经筋理论的再认识[J].中国针灸,2006,26(9)：639-640.
[95]廉玉麟.经筋的特点及其在针灸临床中的意义[J].天津中医学院学报,1984(01)：40-42.
[96]梁树勇.经筋挑刺治疗腰背肌筋膜炎疗效观察[J].中国针灸,2008,28(8)：621-622.
[97]植昌嘉,黄大红,蔡灵波.热敏灸治疗腰背肌筋膜炎45例[J].按摩与康复医学(中旬刊),2012,03(3)：178-179.
[98]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志,2008,14(4)：312-314.
[99]王春雷,原林,王军,等.人体筋膜重建经线与经典经线走行路线对比[J].解剖学杂志,2007,30(3)：340-343.
[100]王春雷,卞静,原林,等.数字人体下肢筋膜重建经线与经络线形态学相似性的计算机化研究[J].解剖学报,2008,39(2)：219-222.
[101]原林,焦培峰,唐雷,等.中医经络理论的物质基础--结缔组织、筋膜和自体监控系统(筋膜学)[J].中国基础科学,2005,7(3)：44-47.
[102]姜雪梅,杨春,原林,等.ERK在大鼠浅筋膜中的表达及针刺后的改变特征[J].南方医科大学学报,2009,29(4)：623-626.
[103]姜雪梅,原林,张学全,等.针刺对大鼠局部筋膜和脊髓细胞外信号调节激酶1/2和P38丝裂酶原活化蛋白激酶信号通路的影响[J].中国康复医学杂志,2009,24(11)：973-976,插1.
[2]樊莉,徐振华,朱晓平.热敏灸治疗慢性腰肌劳损临床研究[J].江西中医学院学报,2007,19(5)：61-62.
[3]蒋斌.中医治疗慢性腰肌劳损83例临床观察附：慢性腰肌劳损研究进展[D].成都中医药大学,2009.
[4]国家中医药管理局.中华人民共和国中医药行业标准[M].1994.
[5]国家中医药管理局.中华人民共和国中医药行业标准病证诊断疗效标准[M].1994.
[6]沈红新.穴位注射配合中药外洗治疗腰背筋膜炎62例[J].实用中医药杂志,2000(11)：30.
[7]黄松,吴建华.银质针针灸配合牵引治疗腰椎间盘突出症[J].中医外治杂志,1996(02)：21.
[8]刘元梅,张英杰.药罐结合治疗腰背筋膜炎57例[J].四川中医,1995,13(11)：46.
[9]乔和平,石桂珍.针刺治疗腰肌筋膜炎45例[J].现代中西医结合杂志,1999,8(10)：1647.
[10]陈红燕,杨米雄,陈彩仙.三联疗法治疗腰臀肌筋膜炎[J].中医正骨,2010,22(11)：56,58.
[11]王爱华,韩立明.帆板运动员腰背肌筋膜炎的分析研究[J].现代预防医学,2006,33(10)：1983-1984.
[12]贺新武,王爱华.国家队激流回旋运动员腰背肌筋膜炎患病的相关因素[J].中国临床康复,2006,10(32)：38-40.
[13]丁永玺,王爱华.坐式排球运动与腰背肌筋膜炎的关系及其损伤预防[J].中国组织工程研究与临床康复,2007,11(52)：10524-10526.
[14]李运友.中药内服合走罐治疗腰背肌筋膜炎[J].中医外治杂志,2004,13(5)：44.
[15]曹健.身痛逐瘀汤加手法治疗项背肌筋膜炎56例[J].陕西中医学院学报,2001,24(6)：30.
[16]林振禄.身痛逐瘀汤加减治疗慢性腰肌劳损[J].湖北中医杂志,2001,23(1)：38.
[17]王旭,詹海夫.身痛逐瘀汤加减治疗慢性腰肌劳损60例临床观察[J].长春中医药大学学报,2006,22(2)：27.
[18]王敏,贺灵慧.益肾蠲痹丸治疗腰背肌筋膜炎[J].现代中西医结合杂志,2005,14(23)：3100.
[19]毕东敏,刘桂荣.益肾蠲痹丸治疗腰背肌筋膜炎62例[J].陕西中医,2004,25(9)：809-810.
[20]傅瑞阳,王娅玲,沈丽芳,等.中药熏洗防治腰背肌筋膜炎[J].浙江中医学院学报,2006,30(1)：43,45.
[21]李照禄,邹乃清,商立智.活血止痛散热敷治疗腰背肌肉筋膜炎40例[J].中医外治杂志,2003,12(3)：23.
[22]张玉镇.《内经》寒痹熨法治疗项背肌筋膜炎60例[J].中医药学刊,2005,23(12)：2267-2268.
[23]乔和平,石桂珍.针刺治疗腰肌筋膜炎45例[J].现代中西医结合杂志,1999,8(10)：1647.
[24]戚红亮.针刺推拿治疗颈肩肌筋膜炎30例[J].中国针灸,2001,21(8)：498.
[25]鲁翔鹏,张义,周杰.针刺配合蜡疗治疗腰背肌筋膜炎30例[J].中国中医急症,2013,22(12)：2117.
[26]张倩如,程建东.毫针散刺治疗慢性筋膜炎216例[J].中国针灸,1997(10)：619-620.
[27]崔正友.恢刺为主治疗腰肌筋膜炎46例[J].中国民间疗法,1997(01)：20-21.
[28]夏东斌,黄泳.浮针治疗腰背部肌筋膜炎[J].中国针灸,2001,21(3)：137.
[29]陈宏伟,姚杰良,唐永春.平刺滞针弹拨法治疗肩背腰部肌筋膜炎102例疗效观察[J].上海针灸杂志,2006,25(5)：26-27.
[30]吴洪英.68例电针加手法治疗腰背肌筋膜炎[J].中国实用医药,2007,2(21)：54.
[31]陈成.电针排刺配合闪罐治疗背肌筋膜炎60例[J].实用中医药杂志,2005,21(10)：618.
[32]杨春花.温针灸、TDP配合刺络拔罐治疗腰背肌筋膜炎32例[J].浙江中医杂志,2012,47(6)：445.
[33]王乐琴.刮痧与温针灸治疗背肌筋膜炎疗效观察[J].中国针灸,2006,26(7)：478-480.
[34]韩刚.刮痧与温针灸治疗背肌筋膜炎疗效观察[J].健康之路,2013,12(8)：415.
[35]李爱萍,毛银芳.温针加锋钩针合身痛逐瘀汤加减治疗背肌筋膜炎50例疗效观察[J].山西中医学院学报,2007,8(3)：39-40.
[36]王喜荣,孙娟.温针结合走罐治疗背肌筋膜炎30例疗效观察[J].实用中西医结合临床,2010,10(5)：25-27.
[37]张波,冉琼.小针刀结合温针治疗肩胛背部肌筋膜炎临床疗效比较[J].实用医院临床杂志,2008,5(3)：74-75.
[38]赵礼明.推拿加点穴治疗颈肩腰背肌筋膜炎的临床体会[J].按摩与导引,2006,22(3)：33.
[39]吕海泉.浅谈筋膜炎的按摩治疗[J].甘肃中医,2006,19(4)：31.
[40]孙华斌,肖向涌,高真国.揉按弹拔手法治疗背肌筋膜炎患者取坐位,先用揉、按手法放松颈背部,然后点按风池、肩井、天宗穴,每穴约30秒钟,接着对肩背部压痛点及痛性筋束结节进行按压和弹拔,手法由轻到重,约2～3分钟,最后以搓、揉手法结束.隔日1次,7次为一疗程.用揉按手法放松颈背部肌肉,点按风池、肩井、[J].中国临床医生,2001,29(5)：40.
[41]齐晓田.手法治疗筋膜炎30例[J].湖北中医杂志,1999,21(7)：305.
[42]杨连生,杨红霞.治疗腰肌筋膜炎169例临床体会[J].职业与健康,2003,19(11)：148-149.
[43]廖信祥,周一庆,黎展文,等.辩证推拿配合中药热敷治疗腰背肌筋膜炎150例[J].中国实用医药,2013,8(18)：254-255.
[44]李建恒.推拿配合超短波治疗举重运动员腰背肌筋膜炎25例[J].广西医学,2006,28(11)：1816-1817.
[45]崔述生,王力.推拿配合滑罐治疗腰背肌筋膜炎[J].中国中医药信息杂志,2006,13(7)：63.
[46]梁杰群.小针刀治疗腰背肌筋膜炎30例[J].广西中医药,2004,27(4)：40.
[47]王英姿,王栋.针刀治疗背肌筋膜炎120例[J].上海针灸杂志,2005,24(3)：24.
[48]张东云,宋海云.浮针结合针刀治疗腰背肌筋膜炎80例临床研究*[J].云南中医学院学报,2013(4)：61-63.
[49]赵利军.小针刀治疗背肌筋膜炎40例[J].中国民间疗法,2012,20(1)：21-22.
[50]韦小东.小针刀治疗背肌筋膜炎60例[J].广西中医药,2001,24(2)：27-28.
[51]张苏杰,吕发明.小针刀治疗项背部肌筋膜炎的临床研究[J].新疆中医药,2008,26(3)：45-47.
[52]聂荣华.刺络拔罐法治疗腰背肌筋膜炎50例[J].山西中医,1997(03)：31.
[53]许天兵.刺血加拔罐治疗腰筋膜炎68例[J].山西中医,1994(04)：51-52.
[54]许天兵,幼明.刺血加拔罐治疗腰筋膜炎68例[J].实用中医药杂志,1994(05)：48.
[55]刘元梅,张英杰.药罐结合治疗腰背筋膜炎57例[J].四川中医,1995(11)：46.
[56]陈志祥.电针排刺配合走罐治疗腰背肌筋膜炎疗效观察[J].上海针灸杂志,2011,30(8)：560-561.
[57]王锦.走罐配合艾灸治疗腰背肌筋膜炎30例疗效观察[J].现代临床医学,2005,31(4)：233-234.
[58]温萍,李旭方,刘满芬.针灸配合走罐治疗腰背肌筋膜炎65例报告[J].甘肃中医,2006,19(8)：37-38.
[59]杨路,赖新生,冯淑兰.扬刺配合走罐治疗腰背肌筋膜炎89例临床研究[J].实用医学杂志,2007,23(23)：3780-3781.
[60]孙媛媛.电针加走罐疗法治疗肩背肌筋膜炎60例[J].河北中医,2012,34(11)：1674-1675.
[61]梁树勇.经筋挑刺治疗腰背肌筋膜炎疗效观察[J].中国针灸,2008,28(8)：621-622.
[62]熊晓山.挑治法治疗项背肌筋膜炎[J].四川中医,1997(02)：50-51.
[63]张贵有.补中益气汤加味配合手法治疗项背肌筋膜炎86例小结[J].中国中医骨伤科,1998(02)：24-25.
[64]肖雷,张辉,张广麒.解凝汤配合推拿治疗颈背肌筋膜炎60例[J].中国中医药信息杂志,2004,11(8)：727.
[65]王奎.背肌筋膜炎综合治疗效果观察[J].颈腰痛杂志,2002,23(2)：158.
[66]苳友金.针药配合治疗肩背部肌筋膜炎40例[J].针灸临床杂志,1999(04)：11-12.
[67]陈玉玲,罗素珍.针罐四联疗法治疗颈肩部肌筋膜炎临床观察[J].针灸临床杂志,1999(06)：19-20.
[68]曲运生,吴旭文,李济民,等.按摩导引合腰痛膏214例外敷治疗腰肌筋膜炎[J].中医外治杂志,1996(06)：22-23.
[69]朱广圣.局部注射配合推拿治疗腰臀筋膜炎158例[J].山西中医,1996(02)：31.
[70]饶艳秋.隔姜灸治疗背肌筋膜炎46例疗效观察[J].中国针灸,1998(07)：55.
[71]褚福昶.燃火加热中药垫配合梅花针治疗颈肩肌筋膜炎462例[J].上海针灸杂志, 2010(08)：531.
[72]刘琦.超声波药物透入疗法治疗颈背肌筋膜痛的临床研究[J].中华物理医学与康复杂志,2008,30(3)：193-194.
[73]张维,于俊敏,韩广敬,等.双氯芬酸二乙胺乳胶剂超声波透入治疗原发性纤维肌痛综合征的初步疗效观察[J].实用疼痛学杂志,2011,07(4)：264-266.
[74]李晓宏,赵伟成,杨承祥.替扎尼定治疗肌筋膜疼痛综合征的临床观察[J].中国康复医学杂志,2008,23(5)：434-435.
[75]李义凯,穆伟华,王爱华.治疗肌筋膜痛的药物[J].颈腰痛杂志,2002,23(2)：170-171.
[76]Bendtsen L, Norregaard J, Jensen R, et al. Evidence of qualitatively altered nociception in patients with fibromyalgia[J]. Arthritis Rheum,1997,40(1):98-102.
[77]田家林,骆大富,蔡永丰.超短波并电脑中频治疗肌纤维织炎146例[J].华南国防医学杂志,2004,18(2)：44-45.
[78]秦玉革.《内经》经筋的实质是神经[J].中国针灸,2006,26(2)：147-150.
[79]王雨.十二经筋病候与针灸临床[J].中医杂志,1989,30(5)：20-21.
[80]薛立功.经筋理论的探讨与发挥[J].中国针灸,1997,17(11)：698-699.
[81]孙之镐孙树椿.中医筋伤学[M].1.北京：人民卫生出版社,2002.
[82]王军,董为人,姚大卫,等.从经络穴位到支持与储备系统——基于数字解剖学研究提出人体第十大功能系统假说[J].南方医科大学学报,2007,27(5)：573-579.
[83]原林,姚大卫,唐雷,等.针灸经穴的数字解剖学研究[J].解剖学报,2004,35(4)：337-343.
[84]吴金鹏.中医“经筋”及“膜原”实质的筋膜理论探讨明[J].北京中医,2007,26(5)：283-285.
[85]Kern U, Martin C, Scheicher S, et al. [Treatment of phantom pain with botulinum-toxin A. A pilot study][J]. Schmerz,2003,17(2):117-124.
[86]Waling K, Sundelin G, Ahlgren C, et al. Perceived pain before and after three exercise programs-a controlled clinical trial of women with work-related trapezius myalgia[J]. Pain,2000, 85(1-2):201-207.
[87]Myburgh C, Hartvigsen J, Aagaard P, et al. Skeletal muscle contractility, self-reported pain and tissue sensitivity in females with neck/shoulder pain and upper Trapezius myofascial trigger points-a randomized intervention study[J]. Chiropr Man Therap,2012,20(1):36.
[88]杨丽美.《内经》经筋理论的应用[J].宁夏医学院学报,2006,28(3)：262-263.
[89]胥荣东.缓解病痛的理筋手法[J].特别健康,2011(11)：17.
[90]李洪,李婕.黄敬伟壮医经筋疗法探微[J].中国民族医药杂志,2010,16(9)：20-22.
[91]王源灏,陈莺歌,雷奶善,等.脊柱相关疾病的经筋诊疗[J].中国民族民间医药,2013,22(2)：98-99.
[92]李春.中医大辞典：内科分册[M].北京：人民卫生出版社,1987：78-80.
[93]韦英才.浅释经筋与经脉的异同及其临床意义[J].广州中医药大学学报,2007,24(3)：247-249.
[94]沈志生.《内经》经筋理论的再认识[J].中国针灸,2006,26(9)：639-640.
[95]廉玉麟.经筋的特点及其在针灸临床中的意义[J].天津中医学院学报,1984(01)：40-42.
[96]梁树勇.经筋挑刺治疗腰背肌筋膜炎疗效观察[J].中国针灸,2008,28(8)：621-622.
[97]植昌嘉,黄大红,蔡灵波.热敏灸治疗腰背肌筋膜炎45例[J].按摩与康复医学(中旬刊),2012,03(3)：178-179.
[98]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志,2008,14(4)：312-314.
[99]王春雷,原林,王军,等.人体筋膜重建经线与经典经线走行路线对比[J].解剖学杂志,2007,30(3)：340-343.
[100]王春雷,卞静,原林,等.数字人体下肢筋膜重建经线与经络线形态学相似性的计算机化研究[J].解剖学报,2008,39(2)：219-222.
[101]原林,焦培峰,唐雷,等.中医经络理论的物质基础--结缔组织、筋膜和自体监控系统(筋膜学)[J].中国基础科学,2005,7(3)：44-47.
[102]姜雪梅,杨春,原林,等.ERK在大鼠浅筋膜中的表达及针刺后的改变特征[J].南方医科大学学报,2009,29(4)：623-626.
[103]姜雪梅,原林,张学全,等.针刺对大鼠局部筋膜和脊髓细胞外信号调节激酶1/2和P38丝裂酶原活化蛋白激酶信号通路的影响[J].中国康复医学杂志,2009,24(11)：973-976,插1.