以醒脑开窍针刺法为核心的视神经脊髓炎综合诊疗观
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摘要
本文旨在探讨针对视神经脊髓炎（NMO）以醒脑开窍针刺法（以下简称“醒法”）为核心的综合诊疗模式及其创新点。
通过对NMO发病、病因、病理、治疗、预后的认识，参阅针灸治疗脊髓炎、视神经炎、多发性硬化、脊髓损伤等疾病的治法及作用机制研究进展，结合以醒法为主分期诊治NMO的临床典型病例分析，得出以下结论：
1 醒法领会《内经》“主明则下安，主不明则十二官危，使道闭塞不通”的精神，认为本病总病机是“神不导气，髓损目暗”，汲取“凡刺之法，必先本于神”的精髓，确立了“调神导气，益髓明目”总则，分期辨证诊治，具有渊远流长的理论根基和标新立异的创新精神。
2 与传统针法相比，醒法治疗NMO具有四大优势，即病机认识的深刻性、选穴处方的独创性、施术操作的规范性和临床疗效的显著性。从“粗守形”上升到“上守神”的层次，以“调神”、“治神”为先，弥补了以甲基强的松龙等为代表的药物疗法的局限性、副作用和传统“治痿独取阳明”针法对肌痉挛疗效不佳的弊端。
3 醒法以传统腧穴刺法理论为依据，创造性提出雀啄刺为第三种基本针刺手法和直刺新观念，完善了捻转、提插补泻定义，手法操作符合量学规定，力求“轻、巧、快、弹、借”，多用快针、提插刺法寻找、激发酸、麻、重、胀、疼、凉、热、串、动、抽十针感。
The paper aims at discussing on synthetic model of diagnosis and treatment for neuromyelitis optica（NMO）with the “Arouse the Brain and Open the Orifice”Acupuncture Therapy (Xin Nao Kai Qiao Acupuncture Therapy, also called XNKQ Acupuncture Therapy for short as follows) as its focus and its innovations.
By realizing the onset、course、pathology、therapy and prognosis of NMO, we draw conclusions as follows after consulting the advances of therapeutic mechanisms and methods on myelitis、optic neuritis、multiple sclerosis、spinal cord injury etc, and combined with the typical case analysis of NMO diagnosed and treated mainly by XNKQ Acupuncture Therapy by stages:
1 XNKQ Acupuncture Therapy grasps the soul of Canon of medicine, that is "Be the monarch normal, the followers are safe; while the monarch be abnormal, the twelves followers are dangerous and the channels are obstructed", believes that the main pathological mechanism of NMO be "The vitality can't direct the qi which making the medulla injuried and the optical passage closed". Absorbing the spirit of "The acupuncture therapy must be based on the vitality", XNKQ Acupuncture Therapy also establishes the main rule of "regulating the vitality to direct the qi, replenishing the medulla and brightening the eyes". Its diagnosis and treatment are based on an overall analysis of signs and symptoms by stages with an old theoretical origin and an innovative inspirt.
2 Compared with traditional acupuncture therapy, XNKQ acupuncture therapy has four advantages, namely, pathological mechanism understood profoundly, points selected originally, manipulated normatively, clinical curative effect obviously. From the level of "The poor doctor treats the body only " up to the one of "The wise doctor treats the vitality", XNKQ Acupuncture Therapy treats and regulates the vitality at first, makes up for the limitations and side effects of medicine therapy represented by methylprednisolone and the defects of poor curative effect on myospasm with the traditional acupuncture therapy of “Selecting the Yang-ming Channel only for the flaccidity".
3 Based on the traditional theories of acupoints and acupuncture methods, XNKQ Acupuncture Therapy puts forword creatively that sparrow-pricking being the third basic manipulation technique and the new conception of perpendicular puncture, consummates the definitions of reinforcing and reducing method by twirling-rotating and lifting-thrusting the needle. XNKQ acupuncture technique manipulation accords with the standard of quantitative measurement, pursues the manipulation goals of “tender, skilful, quick, elastic and resorting”. It applys mainly with quick needle and lifting-thrusting puncture method to look for and stimulate ten kinds of needling sensation of sore, numb, heavy, distending, painful, cool, warm, radiating, springing and spasm.
通过对NMO发病、病因、病理、治疗、预后的认识，参阅针灸治疗脊髓炎、视神经炎、多发性硬化、脊髓损伤等疾病的治法及作用机制研究进展，结合以醒法为主分期诊治NMO的临床典型病例分析，得出以下结论：
1 醒法领会《内经》“主明则下安，主不明则十二官危，使道闭塞不通”的精神，认为本病总病机是“神不导气，髓损目暗”，汲取“凡刺之法，必先本于神”的精髓，确立了“调神导气，益髓明目”总则，分期辨证诊治，具有渊远流长的理论根基和标新立异的创新精神。
2 与传统针法相比，醒法治疗NMO具有四大优势，即病机认识的深刻性、选穴处方的独创性、施术操作的规范性和临床疗效的显著性。从“粗守形”上升到“上守神”的层次，以“调神”、“治神”为先，弥补了以甲基强的松龙等为代表的药物疗法的局限性、副作用和传统“治痿独取阳明”针法对肌痉挛疗效不佳的弊端。
3 醒法以传统腧穴刺法理论为依据，创造性提出雀啄刺为第三种基本针刺手法和直刺新观念，完善了捻转、提插补泻定义，手法操作符合量学规定，力求“轻、巧、快、弹、借”，多用快针、提插刺法寻找、激发酸、麻、重、胀、疼、凉、热、串、动、抽十针感。
The paper aims at discussing on synthetic model of diagnosis and treatment for neuromyelitis optica（NMO）with the “Arouse the Brain and Open the Orifice”Acupuncture Therapy (Xin Nao Kai Qiao Acupuncture Therapy, also called XNKQ Acupuncture Therapy for short as follows) as its focus and its innovations.
By realizing the onset、course、pathology、therapy and prognosis of NMO, we draw conclusions as follows after consulting the advances of therapeutic mechanisms and methods on myelitis、optic neuritis、multiple sclerosis、spinal cord injury etc, and combined with the typical case analysis of NMO diagnosed and treated mainly by XNKQ Acupuncture Therapy by stages:
1 XNKQ Acupuncture Therapy grasps the soul of Canon of medicine, that is "Be the monarch normal, the followers are safe; while the monarch be abnormal, the twelves followers are dangerous and the channels are obstructed", believes that the main pathological mechanism of NMO be "The vitality can't direct the qi which making the medulla injuried and the optical passage closed". Absorbing the spirit of "The acupuncture therapy must be based on the vitality", XNKQ Acupuncture Therapy also establishes the main rule of "regulating the vitality to direct the qi, replenishing the medulla and brightening the eyes". Its diagnosis and treatment are based on an overall analysis of signs and symptoms by stages with an old theoretical origin and an innovative inspirt.
2 Compared with traditional acupuncture therapy, XNKQ acupuncture therapy has four advantages, namely, pathological mechanism understood profoundly, points selected originally, manipulated normatively, clinical curative effect obviously. From the level of "The poor doctor treats the body only " up to the one of "The wise doctor treats the vitality", XNKQ Acupuncture Therapy treats and regulates the vitality at first, makes up for the limitations and side effects of medicine therapy represented by methylprednisolone and the defects of poor curative effect on myospasm with the traditional acupuncture therapy of “Selecting the Yang-ming Channel only for the flaccidity".
3 Based on the traditional theories of acupoints and acupuncture methods, XNKQ Acupuncture Therapy puts forword creatively that sparrow-pricking being the third basic manipulation technique and the new conception of perpendicular puncture, consummates the definitions of reinforcing and reducing method by twirling-rotating and lifting-thrusting the needle. XNKQ acupuncture technique manipulation accords with the standard of quantitative measurement, pursues the manipulation goals of “tender, skilful, quick, elastic and resorting”. It applys mainly with quick needle and lifting-thrusting puncture method to look for and stimulate ten kinds of needling sensation of sore, numb, heavy, distending, painful, cool, warm, radiating, springing and spasm.
引文
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