方剑乔教授辨治原发性颈部肌张力障碍的辨证思路
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摘要
初步总结方剑乔教授辨治原发性颈部肌张力障碍的临证经验。方教授在西医辨病、中医辨证的基础上,结合针灸经络辨证,构建出针灸临床"辨病、辨证、辨经"三维诊治体系,认为对于原发性颈部肌张力障碍的诊治,神经系统体格检查、中医辨证、经络辨证不可偏废其一,并指出原发性颈部肌张力障碍的关键病机在于气血闭阻,经筋失养,基于此提出了"祛外邪,调气血,通经筋"的治疗原则。方教授在治疗时,强调要兼顾肌张力异常疾病的发病部位和影响因素进行针灸,局部选穴以颈部异常运动所涉及的责任肌肉附近的穴位为主,选取经验效穴"新设"穴,远端取穴则根据三维诊治体系进行选穴,同时在受累肌肉的起止点或交汇处使用经皮穴位电刺激疗法,从而起到理气养血,舒经通络的作用。
Professor FANG Jianqiao's clinical experience in the treatment of primary cervical dystonia based on the syndrome differentiation of TCM was explored preliminarily. Based on the disease identification of western medicine and the syndrome differentiation of TCM, in combination with the differentiations of meridians and collaterals of acupuncture, Professor FANG proposes the three-dimensional system of diagnosis and treatment of acupuncture, named "disease differentiation, TCM syndrome differentiation and meridian differentiation". Regarding the diagnosis and treatment of primary cervical dystonia, the physical examination of nerve system, TCM syndrome differentiation and meridian differentiation are equally important. It is pointed out that the key pathogenesis of the disease is qi and blood obstruction and the malnutrition in the muscle regions of meridians. Hence, the treating principle is proposed as eliminating the exogenous pathogens, regulating qi and blood and unblocking the muscle regions of meridians. Professor FANG also stresses that the affected sites and the factors of dystonia should be considered in acupuncture treatment. The local points are mainly those adjacent to the responsible muscles with the motor disturbance in the neck region. "Xinshe" point(Extra) is taken as the empirical point. The distal points are selected in accordance with the three-dimensional system of diagnosis and treatment. At the same time, the percutaneous acupoint electric stimulation is applied to the starting and ending points or the conjunctive points of the affected muscles, acting on regulating qi, nourishing blood and promoting the circulation in meridians and collaterals.
Professor FANG Jianqiao's clinical experience in the treatment of primary cervical dystonia based on the syndrome differentiation of TCM was explored preliminarily. Based on the disease identification of western medicine and the syndrome differentiation of TCM, in combination with the differentiations of meridians and collaterals of acupuncture, Professor FANG proposes the three-dimensional system of diagnosis and treatment of acupuncture, named "disease differentiation, TCM syndrome differentiation and meridian differentiation". Regarding the diagnosis and treatment of primary cervical dystonia, the physical examination of nerve system, TCM syndrome differentiation and meridian differentiation are equally important. It is pointed out that the key pathogenesis of the disease is qi and blood obstruction and the malnutrition in the muscle regions of meridians. Hence, the treating principle is proposed as eliminating the exogenous pathogens, regulating qi and blood and unblocking the muscle regions of meridians. Professor FANG also stresses that the affected sites and the factors of dystonia should be considered in acupuncture treatment. The local points are mainly those adjacent to the responsible muscles with the motor disturbance in the neck region. "Xinshe" point(Extra) is taken as the empirical point. The distal points are selected in accordance with the three-dimensional system of diagnosis and treatment. At the same time, the percutaneous acupoint electric stimulation is applied to the starting and ending points or the conjunctive points of the affected muscles, acting on regulating qi, nourishing blood and promoting the circulation in meridians and collaterals.
引文
[1]Defazio G.The epidemiology of primary dystonia:current evidence and perspectives[J].Eur J Neurol,2010,17(1):9.
[2]Stacy M.Epidemiology,clinical presentation,and diagnosis of cervical dystonia[J].Neurol Clin,2008,26(1):23.
[3]Albanese A,Abbruzzese G,Dressler D,et al.Practical guidance for CD management involving treatment of botulinum toxin:a consensus statement[J].J Neurol,2015,262(10):2201.
[4]Albanese A,Bhatia K,Bressman SB,et al.Phenomenology and classification of dystonia:a consensus update[J].Mov Disord,2013,28(7):863.
[5]张媛,杨楠楠,严伟倩,等.肌张力障碍诊断与治疗研究进展[J].中国现代神经疾病杂志,2017,17(1):18.
[6]王林,王宁.肌张力障碍的研究现状及治疗进展[J].中国微侵袭神经外科杂志,2017,22(7):289.
[7]Mahajan A,Jankovic J,Marsh L,et al.Cervical dystonia and substance abuse[J].J Neurol,2018,66(7):1.
[8]Albanese A,Romito LM,Calandrella D.Therapeutic advances in dystonia[J].Mov Disord,2015,30(11):1547.
[9]王超,孙晶,陈利芳,等.方剑乔针刺治疗痉挛性斜颈验案[J].浙江中医杂志,2015,50(5):376.
[10]张环,罗曙光.原发性肌张力障碍相关基因的研究现状[J].临床神经病学杂志,2015,28(3):234.
[11]Ostrem JL,Racine CA,Glass GA,et al.Subthalamic nucleus deep brain stimulation in primary cervical dystonia[J].Neurology,2011,76(10):870.
[12]陈利芳,方剑乔,陈露妮,等.基于神经解剖学的现代针灸疗法治疗脑卒中的成果与启示[J].针刺研究,2014,39(2):164.
[13]王琳,万新华.颈部肌张力障碍的再认识[J].中国现代神经疾病杂志,2017,17(2):105.
[14]梁宜.方剑乔痛证针灸治疗精要[M].北京:中国中医药出版社,2017:71.
[15]孙文善,楚宁宁,封燕婷,等.超声引导下颈夹脊穴埋线层次与得气的初步研究[J].中国针灸,2015,35(9):931.
[16]孙晶,方剑乔,邵晓梅,等.方剑乔教授分期治疗三叉神经痛[J].中国针灸,2016,36(2):191.
[17]方剑乔,梁宜,汪存信,等.经皮穴位电刺激对力竭运动大鼠海马、中脑5-HT及代谢产物含量影响的机制[J].中国康复医学杂志,2009,24(3):193.
[2]Stacy M.Epidemiology,clinical presentation,and diagnosis of cervical dystonia[J].Neurol Clin,2008,26(1):23.
[3]Albanese A,Abbruzzese G,Dressler D,et al.Practical guidance for CD management involving treatment of botulinum toxin:a consensus statement[J].J Neurol,2015,262(10):2201.
[4]Albanese A,Bhatia K,Bressman SB,et al.Phenomenology and classification of dystonia:a consensus update[J].Mov Disord,2013,28(7):863.
[5]张媛,杨楠楠,严伟倩,等.肌张力障碍诊断与治疗研究进展[J].中国现代神经疾病杂志,2017,17(1):18.
[6]王林,王宁.肌张力障碍的研究现状及治疗进展[J].中国微侵袭神经外科杂志,2017,22(7):289.
[7]Mahajan A,Jankovic J,Marsh L,et al.Cervical dystonia and substance abuse[J].J Neurol,2018,66(7):1.
[8]Albanese A,Romito LM,Calandrella D.Therapeutic advances in dystonia[J].Mov Disord,2015,30(11):1547.
[9]王超,孙晶,陈利芳,等.方剑乔针刺治疗痉挛性斜颈验案[J].浙江中医杂志,2015,50(5):376.
[10]张环,罗曙光.原发性肌张力障碍相关基因的研究现状[J].临床神经病学杂志,2015,28(3):234.
[11]Ostrem JL,Racine CA,Glass GA,et al.Subthalamic nucleus deep brain stimulation in primary cervical dystonia[J].Neurology,2011,76(10):870.
[12]陈利芳,方剑乔,陈露妮,等.基于神经解剖学的现代针灸疗法治疗脑卒中的成果与启示[J].针刺研究,2014,39(2):164.
[13]王琳,万新华.颈部肌张力障碍的再认识[J].中国现代神经疾病杂志,2017,17(2):105.
[14]梁宜.方剑乔痛证针灸治疗精要[M].北京:中国中医药出版社,2017:71.
[15]孙文善,楚宁宁,封燕婷,等.超声引导下颈夹脊穴埋线层次与得气的初步研究[J].中国针灸,2015,35(9):931.
[16]孙晶,方剑乔,邵晓梅,等.方剑乔教授分期治疗三叉神经痛[J].中国针灸,2016,36(2):191.
[17]方剑乔,梁宜,汪存信,等.经皮穴位电刺激对力竭运动大鼠海马、中脑5-HT及代谢产物含量影响的机制[J].中国康复医学杂志,2009,24(3):193.