庄礼兴教授颈肩穴结合桂枝汤治疗颈椎病经验总结
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摘要
[目的]总结庄礼兴教授针药结合治疗常见类型颈椎病的诊治思路及临床应用经验。[方法]通过临床跟师侍诊,收集、分析老师临床针药结合治疗颈椎病的相关病历,总结庄师运用颈肩穴结合桂枝汤诊治颈椎病的临床思路及经验,并举验案一则加以佐证。[结果]庄礼兴教授认为颈椎病病位主要在颈项,与督脉、足太阳膀胱经密切相关,因气血阴阳失衡导致经络痹阻,从而引发相应的临床症状。在"引阳和阴,调和气血,针药结合,直达病所"临床思维纲要下,重视温针灸百会、风池引阳和阴,通督调神,颈三针配合经验穴颈肩穴舒筋通络,随症配穴并配合桂枝汤辨证加减,直达病所治疗颈椎病,临床有着较佳的疗效。病案中患者辨病为项痹病,辨证为气虚血瘀,以温针灸百会、风池、颈三针、颈肩穴为针灸基础处方,结合桂枝汤加减治疗,共奏调和营卫、行气活血、散寒除痹之效,使诸症悉除。[结论]庄礼兴教授临床运用针灸基础方结合桂枝汤加减治疗颈型、神经根型、交感神经型等常见类型颈椎病,临床疗效好,可供临床借鉴。
[Objective]To summarize the clinical experience of Professor ZHUANG Lixing diagnosis and treatment in cervical spondylosis.[Methods] Through studying with Professor ZHUANG, collecting and analyzing the relevant medical records of the clinical treatment of cervical spondylosis, summarizing the clinical thoughts and experience of the diagnosis and treatment of cervical spondylosis by Professor ZHUANG and a classic case was cited as an evidence.[Results] Professor ZHUANG believes that the cervical spondylosis is mainly in the neck, and is closely related to the Du Meridian and Taiyang Bladder Meridian of Foot. Due to the imbalance of Qi and Yang, the meridian is blocked, which leads to the corresponding clinical symptoms. Under the clinical thinking outline, the combination of acupuncture and medicine, direct attention to the clinical thinking outline, pay attention to warm acupuncture and moxibustion, Fengchi inducing Yang to harmonize Yin, the governor adjusting the spirit, the cervical three needles cooperate with the experience of Jinjian points to stretch the muscles and tendons, choose acupuncture points with the disease and in combination with Guizhi decoction syndrome differentiation and subtraction, thus the direct treatment of cervical spondylosis has a better clinical effect. [Conclusion] Professor ZHUANG has unique curative effect in the clinical treatment of cervical spondylosis, and this outline could be used for clinical reference, which may benefit the treatment of common types of cervical spondylosis.
[Objective]To summarize the clinical experience of Professor ZHUANG Lixing diagnosis and treatment in cervical spondylosis.[Methods] Through studying with Professor ZHUANG, collecting and analyzing the relevant medical records of the clinical treatment of cervical spondylosis, summarizing the clinical thoughts and experience of the diagnosis and treatment of cervical spondylosis by Professor ZHUANG and a classic case was cited as an evidence.[Results] Professor ZHUANG believes that the cervical spondylosis is mainly in the neck, and is closely related to the Du Meridian and Taiyang Bladder Meridian of Foot. Due to the imbalance of Qi and Yang, the meridian is blocked, which leads to the corresponding clinical symptoms. Under the clinical thinking outline, the combination of acupuncture and medicine, direct attention to the clinical thinking outline, pay attention to warm acupuncture and moxibustion, Fengchi inducing Yang to harmonize Yin, the governor adjusting the spirit, the cervical three needles cooperate with the experience of Jinjian points to stretch the muscles and tendons, choose acupuncture points with the disease and in combination with Guizhi decoction syndrome differentiation and subtraction, thus the direct treatment of cervical spondylosis has a better clinical effect. [Conclusion] Professor ZHUANG has unique curative effect in the clinical treatment of cervical spondylosis, and this outline could be used for clinical reference, which may benefit the treatment of common types of cervical spondylosis.
引文
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[7]刘承珠.针刺加穴位注射治疗神经根型颈椎病颈肩臂痛的临床观察[D].北京:北京中医药大学,2010:5.
[8]严用和.济生方[M].上海:上海人民出版社,2005:53.
[9]卢志明,唐占英,叶秀兰,等.颈椎病的发病机理及传统手法治疗研究进展[J].中国中医骨伤科杂志,2011,19(1):61-64.
[10]张义,郭长青.颈肌改变与颈椎病关系的研究进展[J].现代中西医结合杂志,2012,21(18):2045-2047.
[11]曾恒,周红海.颈椎生物力学平衡变化的研究进展[J].中国中医骨伤科杂志,2008,16(2):62-63.
[12]方维,赵勇.颈椎病发病与软组织张力的相关性探讨[J].中国中医基础医学杂志,2017,23(1):100-102.
[13]袁晓军,郝喜书.针刺风池穴对脑血流的影响[J].中医杂志,1996,37(5):285-286.
[14]王爱成,李柏,赵永烈,等.风池穴的径路解剖与作用机理[J].中医研究,2010,23(1):70-72.
[15]袁青.靳三针法[M].北京:人民卫生出版社,2014:99-100.
[16]黄俊浩.针刺颈三针为主治疗神经根型颈椎病的临床研究[D].广州:广州中医药大学,2014:25-45.李婷,等:庄礼兴教授颈肩穴结合桂枝汤治疗颈椎病经验总结
[2]Disease and Injury Incidence and Prevalence Collaborators.Global,regional,and national incidence,prevalence,and years lived with disability for 310 diseases and injuries,1990-2015:A systematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1545-1602.
[3]Hurwitz EL,Randhawa K,Yu H,et al.The Global Spine Care Initiative:a summary of the global burden of low back and neck pain studies[J].Eur Spine J,2018,27(6):796-801.
[4]Wong JJ,Shearer HM,Mior S,et al.Are manual therapies,passive physical modalities,or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders?An update of the bone and joint decade task force on neck pain and its associated disorders by the optima collaboration[J].Spine J,2015(15):1234-1236.
[5]Wong JJ,Cote P,Ameis A,et al.Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders,whiplash-associated disorders,or non-specific low back pain?A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management(OPTIMa)Collaboration[J].Eur Spine J,2016,25(1):34-61.
[6]沈金鳌.杂病源流犀烛[M].上海:上海科学技术出版社,1994:459-462.
[7]刘承珠.针刺加穴位注射治疗神经根型颈椎病颈肩臂痛的临床观察[D].北京:北京中医药大学,2010:5.
[8]严用和.济生方[M].上海:上海人民出版社,2005:53.
[9]卢志明,唐占英,叶秀兰,等.颈椎病的发病机理及传统手法治疗研究进展[J].中国中医骨伤科杂志,2011,19(1):61-64.
[10]张义,郭长青.颈肌改变与颈椎病关系的研究进展[J].现代中西医结合杂志,2012,21(18):2045-2047.
[11]曾恒,周红海.颈椎生物力学平衡变化的研究进展[J].中国中医骨伤科杂志,2008,16(2):62-63.
[12]方维,赵勇.颈椎病发病与软组织张力的相关性探讨[J].中国中医基础医学杂志,2017,23(1):100-102.
[13]袁晓军,郝喜书.针刺风池穴对脑血流的影响[J].中医杂志,1996,37(5):285-286.
[14]王爱成,李柏,赵永烈,等.风池穴的径路解剖与作用机理[J].中医研究,2010,23(1):70-72.
[15]袁青.靳三针法[M].北京:人民卫生出版社,2014:99-100.
[16]黄俊浩.针刺颈三针为主治疗神经根型颈椎病的临床研究[D].广州:广州中医药大学,2014:25-45.李婷,等:庄礼兴教授颈肩穴结合桂枝汤治疗颈椎病经验总结