与针刀医学相关的软组织松解术研究
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摘要
研究目的:研究与针刀医学相关的各种软组织松解术,针对针刀医学的基础研究现状,探讨针刀治疗的理论依据。
     研究方法:分析经筋学说、传统针具、传统刺法,分析传统针灸学中的软组织松解术;分析现代治疗技术中的软组织松解术;对比传统针灸学和现代针灸学的不同并分析原因;根据针刀的松解作用,对国内外相关文献进行归纳分析并提出假说。
     研究结果:共分五部分。
     第一部分:针刀治疗的实质是经皮微创软组织松解术,传统针灸学中包含经皮微创软组织松解术。针刀治疗的主要适应症是运动系统慢性损伤,而运动系统慢性损伤类疾病与传统经筋学说中的经筋病基本相符;圆利针、毫针和长针等直径较粗的传统针具能形成较大的软组织切口,因此具有锐性软组织松解作用;火针、多针刺、多向刺能形成较大的软组织切口,撬拨刺法和单向捻转刺法能对软组织形成强烈的牵拉作用,因此这些传统刺法也有锐性或者钝性软组织松解作用。然而现代针具变细变软,难以发挥传统针具和刺法的软组织松解作用。因此建议设置针刀器械的国家标准。
     第二部分:现代治疗运动系统慢性损伤的非手术方法很多,这些方法中相当的一部分具有软组织松解作用。这些方法有针刀、刃针等带刃针疗法,圆利针、银质针、拨针等不带刃的粗针疗法,提线松解术以及各种按摩手法等,这些方法各有特色,但是它们的共同特点是都有软组织松解作用,故临床常相互配合使用。
     第三部分:长期以来人们认为针刀与手术的关系密不可分,虽然针刀医学与外科手术有所交叉,但是软组织松解术只是外科手术中的一个手术技巧,在外科手术中占的比例很低;宣蛰人把软组织松解术从手术技巧发展为一类单独的外科手术,但随后又提出了粗针多针刺的方法用以代替外科软组织松解术;针刀治疗对外科松解手术的有部分替代作用。
     第四部分:与传统针灸学相比,现代针灸学偏重毫针针刺,并且在针具、刺法、针刺作用认识等方面发生了明显转变。其原因之一是受到日本的影响,这种影响与清末民初时期的时代背景有关。现代针灸名家承淡安先生是传播这种影响的一个典型代表,这与承淡安先生的生平经历、社会影响力巨大和门人弟子众多有关。因为上述转变,现代针灸学研究在对针灸作用的认识上存在局限性,认为针刺作用是针刺调动起来的人体自我调节功能,不是针刺直接作用,具有良性、双向性、整体性、综合性、功能性、早期性的特点,穴位特异性是相对的。而针刀医学填补了现代针灸学留下的空白,认为针刀有直接作用,具有单向性、区域性、器质性、晚期性的特点,某些穴位可能存在“绝对”特异性。针刀医学应作为针灸学之外的独立学科。
     第五部分:针刀医学基础研究薄弱。经过文献分析发现针刀治疗作用包括松解、损毁和针刺效应,以松解为主;软组织的各种病理变化可导致其力学状态改变,能够通过对邻近的神经、血管、骨、关节等组织器官产生影响,参与多种疾病的发病过程;针刀治疗的作用靶点是异常的软组织力学状态对人体生理功能的影响,并非软组织病理变化;软组织力学状态改变可能与人体静息肌张力、筋膜的主动收缩能力、肌筋膜的刚度与年龄的相关性有关。并提出“结缔组织硬化”以及关节和脊柱的“再稳定过程”和“过稳状态”假说。
Objective: To probe the soft tissue dissolution related to acupotomology.To probe the theoretical foundation of acupotomology.
     Methods: Analyzing musculature theory, traditional needle and traditionalacupuncture technique. Analyzing the soft tissue dissolution in traditionalacupuncture. Contrasting the difference between traditional acupuncture andmodern acupuncture and analyze the reason. Based on the tissue dissolution effectof acupotomology, analyze the pertinent literature and put forward thehypothesis.
     Results: There are five parts.
     Part1: Substance of acupotomy is percutaneous minimally invasive softtissue dissolution which was contained by traditional acupuncture. The mainindication of acupotomy is motor system chronic trauma which is similar toJingjin disease; Some traditional thick needles which can make larger soft tissueincision can be used for sharp soft tissue dissolution; Some acupuncturetechnique which can make larger soft tissue incision, and other which can dragsoft tissue strongly can be used for sharp or blunt soft tissue dissolution.However, becoming thinner and thinner, softer and softer, modern needles cannot give play to soft tissue dissolution. Therefore the standard of acupotomeshould be established.
     Part2: Nowadays, there are many non-surgery methods treating motor systemchronic trauma, in which many methods can produce the effect of soft tissuedissolution. This kind of methods contains edged needle therapy, thick needlewith no edge, dissolution by pulling string and massage manipulation. All ofthe methods take on its own character but the common characteristic is containingsoft tissue dissolution effect, so these kind of methods are often used inconjunction.
     Part3: Although acupotomy is considered to be related to surgery for a longtime, soft tissue dissolution is only a surgical skill, which accounts for onlya very small proportion of surgery; Dr Xuan Zheren has developed the skill toan independent type of surgery, but later he developed multi-needles puncturewith thick needle to take the place of surgery soft tissue dissolution; Acupotomycan substitute some surgery dissolution.
     Part4: Compared with traditional acupuncture, modern acupuncture payattention to filiform needle and changes obviously in the performance of needles,acupuncture technique and cognition of acupuncture effect. The main reason isthat Chinese acupuncture has been influenced by Japanese acupuncture since theperiod of the Republic of China, which is related to the historical backgroundof that time, for example, the famous acupuncture specialist Cheng Da’nan playeda very important role. Because of changes, cognition of acupuncture effect bymodern acupuncture research is limited, considering acupuncture effect as bodyself-control function elicited by acupuncture but not direct effect, which isbenign, bidirectional, global, Comprehensive, functional and pristine. Andacupuncture specificity is considered to be relative. But acupotomology is anhelpful supplement for modern acupuncture research, considering acupuncture isof direct effect, which can be monodirectional, regional, organic, terminal.And some acupuncture point specificity may be absolute. Acupotomology shouldbe a independent academic subject, but not a branch of acupuncture.
     Part5: Fundamental research of acupotomology is insufficient. Below canbe concluded by searching literature. The effect of acupotomy containsdissolution, damage and acupuncture effect (usually recognized), in whichdissolution is the most important. Various kinds of pathological change canresult in change in soft tissue mechanical property. The soft tissue, whosemechanical property is changed, may participate the pathogenesis of many deseaseby influencing adjacent nerves, vessels, bones, joints. The target site ofacupotomy is the influence on human physiological function from abnormal softtissue mechanical property, but not the soft tisse pathological change. Thechange of soft tissue mechanical property may related to human resting muscle(myofascial) tone, active contraction of fascia, the relationship betweenmyofascial stiffness and age. The hypothesis “connective tissue sclerosis”and “re-stabilify” and “excessive stability state” of joint and spine areraised.
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