针刺治疗急性期偏头痛的穴位选择
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摘要
对偏头痛急性期针刺治疗的穴位研究进展,从传统取穴、现代取穴、综合取穴等角度作述评;对影响穴位选择的穴位归经、穴性、病症等7个因素进行分析;对穴位优选方案的要点问题进行探讨。认为偏头痛急性期针刺选穴存在相对特异性,这种特异性不仅体现在传统中医的经络特异性、穴位特异性,也可能存在基于现代医学理论的穴位相对特异性。分析了目前穴位选择研究的薄弱点、空白点,并从中医传统取穴、现代医学取穴及两者联合取穴方案3个方面提出针刺治疗急性期偏头痛优化思路和方法,以期促进穴位优化研究迈上新台阶。
The progress of acupoint research on acupuncture treatment for acute migraine was reviewed in terms of acupoint selection of traditional medicine, acupoint selection of modern medicine and comprehensive method. Seven factors of the acupoint selection were analyzed, such as meridian tropism, acupoint property and disorders. The key issues on the optimal acupoint selection scheme were explored. It was believed that the relevant specificity was displayed in the acupoint selection for acute migraine treated with acupuncture. The specificity of it was reflected not only on the meridians and acupoints in TCM, but also on the relevant specificity of acupoints in modern medicine theory. The shortages and the gaps in the current research situation of acupoint selection were analyzed. The optimized approaches to acupoint selection are proposed in the aspects of TCM, modern medicine and the integrated medicine so that a higher stage of the research on acupoint selection is anticipated.
The progress of acupoint research on acupuncture treatment for acute migraine was reviewed in terms of acupoint selection of traditional medicine, acupoint selection of modern medicine and comprehensive method. Seven factors of the acupoint selection were analyzed, such as meridian tropism, acupoint property and disorders. The key issues on the optimal acupoint selection scheme were explored. It was believed that the relevant specificity was displayed in the acupoint selection for acute migraine treated with acupuncture. The specificity of it was reflected not only on the meridians and acupoints in TCM, but also on the relevant specificity of acupoints in modern medicine theory. The shortages and the gaps in the current research situation of acupoint selection were analyzed. The optimized approaches to acupoint selection are proposed in the aspects of TCM, modern medicine and the integrated medicine so that a higher stage of the research on acupoint selection is anticipated.
引文
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[2]杨春艳,刘慧林,张圆,等.针刺治疗偏头痛急性期文献质量评价[J].中国循证医学杂志,2012,12(3):365-370.
[3]余晓璐,范刚启.针刺方向、角度、深度与偏头痛针刺疗效的关系[J].针灸临床杂志,2012,28(8):76-79.
[4]赵凌,任玉兰,梁繁荣.基于数据挖掘技术分析历代针灸治疗偏头痛的用穴特点[J].中国针灸,2009,29(6):467-472.
[5]王黎明,陈少宗.针刺治疗偏头痛取穴现状分析[J].山东中医药大学学报,2011,35(3):213-214.
[6]刘波,邱丽敏.针刺“头四关穴”治疗偏头痛的临床研究[J].辽宁中医杂志,2006,33(11):1484-1485.
[7]张舒雁,马泽云,金国利.邻点透刺加缠针震颤法治疗瘀血型偏头痛急性发作疗效观察[J].中华中医药学刊,2007,25(2):401-403.
[8]任玉兰,赵凌,陈勤,等.数据挖掘技术在经穴选用及其特异性研究中的应用[J].中医杂志,2010,51(1):47-51.
[9]贾春生,马小顺,石晶,等.电针丘墟穴治疗偏头痛的多中心随机对照临床研究[J].中医杂志,2007,48(9):814-817.
[10]王少松.王麟鹏教授分期分型针刺治疗偏头痛经验[J].中国针灸,2016,36(7):743-746.
[11]Melchart D,Thormaehlen J,Hager S,et al.Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks:a randomized controlled trial[J].J Intern Med,2003,253(2):181-188.
[12]王巧妹,王京京,胡静,等.偏头痛针刺即刻镇痛效应方案优选研究[J].中国针灸,2010,30(10):798-801.
[13]王京京,吴中朝,胡静,等.偏头痛发作期针刺镇痛方案优选研究[J].针刺研究,2013,38(3):234-240.
[14]Travell JG,Simons DG.Myofascial pain and dysfunction:the trigger point manual.Vol.2,The lower extremities[M].Baltimore:Williams&Wilkins,1999.
[15]Fernández-De-Las-Pe?as C,Cuadrado ML,Pareja JA.Myofascial trigger points,neck mobility and forward head posture in unilateral migraine[J].Cephalalgia,2006,26(9):1061-1070.
[16]Giamberardino MA,Tafuri E,Savini A,et al.Contribution of myofascial trigger points to migraine symptoms[J].J Pain,2007,8(11):869-878.
[17]Ashkenazi A,Young WB.The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine[J].Headache,2005,45:350-354.
[18]Ashkenazi A,Blumenfeld A,Napchan U,et al.Peripheral nerve blocks and trigger point injections in headache management-a systematic review and suggestions for future research[J].Headache,2010,50(6):943-952.
[19]赵凌,任玉兰,余毓如,等.基于数据挖掘技术分析古代针灸治疗偏头痛的经穴特点[J].中国中医基础医学杂志,2008,14(10):774-776.
[20]范刚启,赵杨,符仲华.针刺方向、角度、深度与针刺镇痛的关系[J].中国针灸,2010,30(11):965-968.
[21]郝传传,朱正萍,孙轩翔,等.颈源性头痛针刺治疗方案的初步优选[J].中医杂志,2014,55(6):478-481.
[22]牛家苑.偏头痛急性期不同神经分布区穴位的针刺镇痛效应[D].南京:南京中医药大学,2016.
[23]Saper JR,Dodick DW,Silberstein SD,et al.Occipital nerve stimulation for the treatment of intractable chronic,migraine headache:ONSTIM feasibility study[J].Cephalalgia,2011,31(3):271-285.
[24]Clark SW,Doucet GE,Venkatesan L,et al.Comparison of Neural Activation in Chronic Migraine Patients During Optimal and Suboptimal Occipital Nerve Stimulation:A PET Imaging Study[J].Neurosurgery,2015,22(1):1-12.
[25]Allais G,Romoli M,Rolando S,et al.Ear acupuncture in the treatment of migraine attacks:a randomized trial on the efficacy of appropriate versus inappropriate acupoints[J].Neurol Sci,2011,32(S1):S173-S175.
[26]焦玥,吴中朝,胡静,等.《循证针灸临床实践指南:偏头痛》2014更新版解读[J].中国针灸,2016,36(7):751-756.
[27]Melchart D.Acupuncture in patients with tension-type headache:randomised controlled trial[J].BMJ,2005,331(7513):376-382.
[28]Assefi NP,Sherman KJ,Jacobsen C,et al.A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia[J].Ann Internl Med,2005,143(1):10-19.
[29]Li Y,Liang F,Yang X,et al.Acupuncture for treating acute attacks of migraine:a randomized controlled trial[J].Headache,2009,49(6):805-816.
[30]Wang LP,Zhang XZ,Guo Jia,et al.Efficacy of acupuncture for acute migraine attack:a multicenter single blinded,randomized controlled trial[J].Pain Med,2012,13(5):623-630.
[31]张慧,胡幼平,吴佳,等.电针少阳经穴对急性偏头痛即时镇痛作用时效规律研究[J].中国针灸,2015,35(2):127-131.
[32]柳美善,李瑞.近5年国外SCI源期刊文献中针灸治疗头痛的研究方法与特点评价[J].中国针灸,2012,32(10):952-956.
[33]Sandberg M,Lundeberg T,Lindberg LG,et al.Effects of acupuncture on skin and muscle blood flow in healthy subjects[J].Eur J Appl Physiol,2003,90(1):114-119.
[34]Srbely JZ,Dickey JP,Lee D,et al.Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects[J].J Rehabil Med,2010,42(5):463-468.
[35]Barlas P,Ting SL,Chesterton LS,et al.Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers:a randomized,double-blind,placebo-controlled study[J].Pain,2006,122(1-2):81-89.
[36]朱兵.穴位的效应特征:广谱性和特异性[J].针刺研究,2016,41(5):388-388.
[37]Niu JY,Fan GQ.Specific effect of acupuncture on the neural pathway in the acute stage of migraine headache[J].World JAcup-Mox,2015,25(4):59-66.
[38]Janis J E,Dhanik A,Howard J H.Validation of the peripheral trigger point theory of migraine headaches:single-surgeon experience using botulinum toxin and surgical decompression[J].Plast Reconstr Surg,2011,128(1):123-131.
[39]Magis D,D’Ostilio K,Thibaut A,et al.Cerebral metabolism before and after external trigeminal nerve stimulation in episodic migraine[J].Cephalalgia,2017,37(9):881-891.
[40]Chou DE,Gross GJ,Casadei CH,et al.External Trigeminal Nerve Stimulation for the Acute Treatment of Migraine:Open-Label Trial on Safety and Efficacy[J].Neuromodulation,2017,20(7):678-683.
[41]徐卫东,刘乡.电针对三叉背角会聚神经元镇痛作用的广泛性和特异性的中枢机制研究[J].针刺研究,2000,25(4):248-253.
[42]Zhu B,Rong PJ,Li YQ,et al.Acupoints-stimulated effective regularity and its mechanisms[J].World J Acup-Mox,2009,19(1):6-10.
[43]Dorsher PT.Myofascial meridians as anatomical evidence of acupuncture channels[J].Med Acupunct,2009,21(2):91-97.
[44]Dorsher PT.Can classical acupuncture points and trigger points be compared in the treatment of pain disorders?Birch's analysis revisited[J].J Altern Complement Med,2008,14(4):353-359.
[2]杨春艳,刘慧林,张圆,等.针刺治疗偏头痛急性期文献质量评价[J].中国循证医学杂志,2012,12(3):365-370.
[3]余晓璐,范刚启.针刺方向、角度、深度与偏头痛针刺疗效的关系[J].针灸临床杂志,2012,28(8):76-79.
[4]赵凌,任玉兰,梁繁荣.基于数据挖掘技术分析历代针灸治疗偏头痛的用穴特点[J].中国针灸,2009,29(6):467-472.
[5]王黎明,陈少宗.针刺治疗偏头痛取穴现状分析[J].山东中医药大学学报,2011,35(3):213-214.
[6]刘波,邱丽敏.针刺“头四关穴”治疗偏头痛的临床研究[J].辽宁中医杂志,2006,33(11):1484-1485.
[7]张舒雁,马泽云,金国利.邻点透刺加缠针震颤法治疗瘀血型偏头痛急性发作疗效观察[J].中华中医药学刊,2007,25(2):401-403.
[8]任玉兰,赵凌,陈勤,等.数据挖掘技术在经穴选用及其特异性研究中的应用[J].中医杂志,2010,51(1):47-51.
[9]贾春生,马小顺,石晶,等.电针丘墟穴治疗偏头痛的多中心随机对照临床研究[J].中医杂志,2007,48(9):814-817.
[10]王少松.王麟鹏教授分期分型针刺治疗偏头痛经验[J].中国针灸,2016,36(7):743-746.
[11]Melchart D,Thormaehlen J,Hager S,et al.Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks:a randomized controlled trial[J].J Intern Med,2003,253(2):181-188.
[12]王巧妹,王京京,胡静,等.偏头痛针刺即刻镇痛效应方案优选研究[J].中国针灸,2010,30(10):798-801.
[13]王京京,吴中朝,胡静,等.偏头痛发作期针刺镇痛方案优选研究[J].针刺研究,2013,38(3):234-240.
[14]Travell JG,Simons DG.Myofascial pain and dysfunction:the trigger point manual.Vol.2,The lower extremities[M].Baltimore:Williams&Wilkins,1999.
[15]Fernández-De-Las-Pe?as C,Cuadrado ML,Pareja JA.Myofascial trigger points,neck mobility and forward head posture in unilateral migraine[J].Cephalalgia,2006,26(9):1061-1070.
[16]Giamberardino MA,Tafuri E,Savini A,et al.Contribution of myofascial trigger points to migraine symptoms[J].J Pain,2007,8(11):869-878.
[17]Ashkenazi A,Young WB.The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine[J].Headache,2005,45:350-354.
[18]Ashkenazi A,Blumenfeld A,Napchan U,et al.Peripheral nerve blocks and trigger point injections in headache management-a systematic review and suggestions for future research[J].Headache,2010,50(6):943-952.
[19]赵凌,任玉兰,余毓如,等.基于数据挖掘技术分析古代针灸治疗偏头痛的经穴特点[J].中国中医基础医学杂志,2008,14(10):774-776.
[20]范刚启,赵杨,符仲华.针刺方向、角度、深度与针刺镇痛的关系[J].中国针灸,2010,30(11):965-968.
[21]郝传传,朱正萍,孙轩翔,等.颈源性头痛针刺治疗方案的初步优选[J].中医杂志,2014,55(6):478-481.
[22]牛家苑.偏头痛急性期不同神经分布区穴位的针刺镇痛效应[D].南京:南京中医药大学,2016.
[23]Saper JR,Dodick DW,Silberstein SD,et al.Occipital nerve stimulation for the treatment of intractable chronic,migraine headache:ONSTIM feasibility study[J].Cephalalgia,2011,31(3):271-285.
[24]Clark SW,Doucet GE,Venkatesan L,et al.Comparison of Neural Activation in Chronic Migraine Patients During Optimal and Suboptimal Occipital Nerve Stimulation:A PET Imaging Study[J].Neurosurgery,2015,22(1):1-12.
[25]Allais G,Romoli M,Rolando S,et al.Ear acupuncture in the treatment of migraine attacks:a randomized trial on the efficacy of appropriate versus inappropriate acupoints[J].Neurol Sci,2011,32(S1):S173-S175.
[26]焦玥,吴中朝,胡静,等.《循证针灸临床实践指南:偏头痛》2014更新版解读[J].中国针灸,2016,36(7):751-756.
[27]Melchart D.Acupuncture in patients with tension-type headache:randomised controlled trial[J].BMJ,2005,331(7513):376-382.
[28]Assefi NP,Sherman KJ,Jacobsen C,et al.A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia[J].Ann Internl Med,2005,143(1):10-19.
[29]Li Y,Liang F,Yang X,et al.Acupuncture for treating acute attacks of migraine:a randomized controlled trial[J].Headache,2009,49(6):805-816.
[30]Wang LP,Zhang XZ,Guo Jia,et al.Efficacy of acupuncture for acute migraine attack:a multicenter single blinded,randomized controlled trial[J].Pain Med,2012,13(5):623-630.
[31]张慧,胡幼平,吴佳,等.电针少阳经穴对急性偏头痛即时镇痛作用时效规律研究[J].中国针灸,2015,35(2):127-131.
[32]柳美善,李瑞.近5年国外SCI源期刊文献中针灸治疗头痛的研究方法与特点评价[J].中国针灸,2012,32(10):952-956.
[33]Sandberg M,Lundeberg T,Lindberg LG,et al.Effects of acupuncture on skin and muscle blood flow in healthy subjects[J].Eur J Appl Physiol,2003,90(1):114-119.
[34]Srbely JZ,Dickey JP,Lee D,et al.Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects[J].J Rehabil Med,2010,42(5):463-468.
[35]Barlas P,Ting SL,Chesterton LS,et al.Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers:a randomized,double-blind,placebo-controlled study[J].Pain,2006,122(1-2):81-89.
[36]朱兵.穴位的效应特征:广谱性和特异性[J].针刺研究,2016,41(5):388-388.
[37]Niu JY,Fan GQ.Specific effect of acupuncture on the neural pathway in the acute stage of migraine headache[J].World JAcup-Mox,2015,25(4):59-66.
[38]Janis J E,Dhanik A,Howard J H.Validation of the peripheral trigger point theory of migraine headaches:single-surgeon experience using botulinum toxin and surgical decompression[J].Plast Reconstr Surg,2011,128(1):123-131.
[39]Magis D,D’Ostilio K,Thibaut A,et al.Cerebral metabolism before and after external trigeminal nerve stimulation in episodic migraine[J].Cephalalgia,2017,37(9):881-891.
[40]Chou DE,Gross GJ,Casadei CH,et al.External Trigeminal Nerve Stimulation for the Acute Treatment of Migraine:Open-Label Trial on Safety and Efficacy[J].Neuromodulation,2017,20(7):678-683.
[41]徐卫东,刘乡.电针对三叉背角会聚神经元镇痛作用的广泛性和特异性的中枢机制研究[J].针刺研究,2000,25(4):248-253.
[42]Zhu B,Rong PJ,Li YQ,et al.Acupoints-stimulated effective regularity and its mechanisms[J].World J Acup-Mox,2009,19(1):6-10.
[43]Dorsher PT.Myofascial meridians as anatomical evidence of acupuncture channels[J].Med Acupunct,2009,21(2):91-97.
[44]Dorsher PT.Can classical acupuncture points and trigger points be compared in the treatment of pain disorders?Birch's analysis revisited[J].J Altern Complement Med,2008,14(4):353-359.