四川名老中医杨天鹏骨伤学术思想及治疗经验的总结（运用杨派推拿手法治疗椎动脉型颈椎病的临床观察）
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摘要
目的：1、在骨科临床中,中医骨伤科许多行之有效的治疗方法——筋伤的中医手法治疗、体功锻炼、中药内服与外敷等治疗方法或被忽略遗忘或未完全继承导致疗效差,鉴于此本文较完整的发掘出名老中医杨天鹏骨伤学术思想及治疗经验的精髓,并继承、提炼出杨派治疗筋伤、骨伤的独特治疗方法,以指导目前教学、科研、临床工作；2、详细总结杨派治疗筋伤的手法,以期更有利于学习、继承、掌握和发扬光大；3、研究杨派推拿手法治疗椎动脉型颈椎病的机制和疗效；4、数据库建设。
方法：1、通过调查研究、专家咨询、文献查阅与检索、整理分析总结原始资料,继而跟随杨派传人学习,并与杨派传人研讨,总结资料；2、回顾性研究：治疗组运用杨派推拿手法配合中药内服治疗椎动脉型颈椎病40例,对照组予以枕颌带牵引配合中药内服治疗椎动脉型颈椎病40例,观察两组的疗效。
结果：1、结合个人在整理过程中的体会,以图片的形式展示了医生练功和患者体功锻炼的自我保健方法；2、杨派中医骨伤学术思想及治疗经验内容丰富,杨派尤以手法治疗骨伤和筋伤为特色；3、杨派推拿手法治疗椎动脉型颈椎病能有效的改善患者的临床症状及体征(P<0.05),延缓病情发展,并且无明显不良反应。
结论：1、杨派中医骨伤学术思想是中医骨伤科的文化瑰宝,其治疗经验是中医骨科治疗中不可缺少的一部分,应予以继承和发扬光大；2、杨派推拿手法治疗椎动脉型颈椎病疗效肯定,并且无明显不良反应,值得推广。
Objective:1. In clinical orthopedics, since many effective treatment methods of the traditional Chinese medicine bone wound department--muscle wound's manuver treatment, the body merit exercise, the traditional Chinese medicine, Chinese medicine's external apply and other methods of treatment either are neglected or not inherited completely,so the curative effect is bad. In view of the fact, this article completely excavates the bone wound academic thought and the treatment experience's essence, inherits and refines unique treatment methods of the muscle wound and the bone wound from the famous traditional Chinese medicine doctor--Yang Tian-peng,then instructs the present teaching, the scientific research, the clinical; 2. This article summarizes Yangpai's manuver treated the muscle wound in detail, then it is more advantageous to study, inherit, grasp and carry forward by this way; 3. To study and observe the mechanism of the cervical spondylosis of vertebral artery type and the curative effect of Yangpai manuver; 4. database construction.
Methods:1. Through the investigating and researching, consulting professor, searching and consulting the literature, the reorganization analysis summarizes the firsthand information, subsequently follows Yangpai hereditary people to study manuver, and discuss with Yangpai hereditary people, then summarizes the materials; 2. Review research:Using Yangpai manuver and traditional Chinese medicine to treat 40 patients with cervical spondylosis of vertebral artery type (the treatment group) and controlled by 40 patients treated by resting the head on the jaw belt hauling with traditional Chinese medicine(B group), observes curative effects of two groups.
Results:1. By my personally opinion,that shows doctor's body merit exercise and patient's body merit exercise methods by the picture form in the reorganization experience process; 2. Yangpai Chinese medicine bone wound academic thought and treatment experience is full of meat, Yangpai take the manuver to treat bone wound and the muscle wound as a characteristic; 3. Yangpai manuver are effective to treat cervical spondylosis of vertebral artery type,improve patient's clinical symptoms and the symptom(P<0.05), delay the disease development, and have not obvious untoward effect.
Conclusions:1. Yangpai Chinese medicine bone wound academic thought and the treatment experience is an essential part in orthopedics treatment, should inherit and carry forward; 2. The treatment effect of Yangpai manuver to cervical spondylosis of vertebral artery type has excellent curative,and this method is safe and reliable,so the treatment of Yangpai manuver and traditional Chinese medicine to cervical spondylosis of vertebral artery type has great development perspective.
方法：1、通过调查研究、专家咨询、文献查阅与检索、整理分析总结原始资料,继而跟随杨派传人学习,并与杨派传人研讨,总结资料；2、回顾性研究：治疗组运用杨派推拿手法配合中药内服治疗椎动脉型颈椎病40例,对照组予以枕颌带牵引配合中药内服治疗椎动脉型颈椎病40例,观察两组的疗效。
结果：1、结合个人在整理过程中的体会,以图片的形式展示了医生练功和患者体功锻炼的自我保健方法；2、杨派中医骨伤学术思想及治疗经验内容丰富,杨派尤以手法治疗骨伤和筋伤为特色；3、杨派推拿手法治疗椎动脉型颈椎病能有效的改善患者的临床症状及体征(P<0.05),延缓病情发展,并且无明显不良反应。
结论：1、杨派中医骨伤学术思想是中医骨伤科的文化瑰宝,其治疗经验是中医骨科治疗中不可缺少的一部分,应予以继承和发扬光大；2、杨派推拿手法治疗椎动脉型颈椎病疗效肯定,并且无明显不良反应,值得推广。
Objective:1. In clinical orthopedics, since many effective treatment methods of the traditional Chinese medicine bone wound department--muscle wound's manuver treatment, the body merit exercise, the traditional Chinese medicine, Chinese medicine's external apply and other methods of treatment either are neglected or not inherited completely,so the curative effect is bad. In view of the fact, this article completely excavates the bone wound academic thought and the treatment experience's essence, inherits and refines unique treatment methods of the muscle wound and the bone wound from the famous traditional Chinese medicine doctor--Yang Tian-peng,then instructs the present teaching, the scientific research, the clinical; 2. This article summarizes Yangpai's manuver treated the muscle wound in detail, then it is more advantageous to study, inherit, grasp and carry forward by this way; 3. To study and observe the mechanism of the cervical spondylosis of vertebral artery type and the curative effect of Yangpai manuver; 4. database construction.
Methods:1. Through the investigating and researching, consulting professor, searching and consulting the literature, the reorganization analysis summarizes the firsthand information, subsequently follows Yangpai hereditary people to study manuver, and discuss with Yangpai hereditary people, then summarizes the materials; 2. Review research:Using Yangpai manuver and traditional Chinese medicine to treat 40 patients with cervical spondylosis of vertebral artery type (the treatment group) and controlled by 40 patients treated by resting the head on the jaw belt hauling with traditional Chinese medicine(B group), observes curative effects of two groups.
Results:1. By my personally opinion,that shows doctor's body merit exercise and patient's body merit exercise methods by the picture form in the reorganization experience process; 2. Yangpai Chinese medicine bone wound academic thought and treatment experience is full of meat, Yangpai take the manuver to treat bone wound and the muscle wound as a characteristic; 3. Yangpai manuver are effective to treat cervical spondylosis of vertebral artery type,improve patient's clinical symptoms and the symptom(P<0.05), delay the disease development, and have not obvious untoward effect.
Conclusions:1. Yangpai Chinese medicine bone wound academic thought and the treatment experience is an essential part in orthopedics treatment, should inherit and carry forward; 2. The treatment effect of Yangpai manuver to cervical spondylosis of vertebral artery type has excellent curative,and this method is safe and reliable,so the treatment of Yangpai manuver and traditional Chinese medicine to cervical spondylosis of vertebral artery type has great development perspective.
引文
[1]曾一林.骨伤科名家杨天鹏[J].四川中医.1996,14(7):1-3.
[2]杨天鹏.损伤内治三法的临床应用体会[J].中医骨伤.1991,4(4):3-5
[3]曾一林.天鹏理筋手法探讨[J].四川中医.1948,1(2):21-22
[4]张继祥,周太安等.杨天鹏理筋手法概述[J].中医骨伤.1994,7(4):15-61
[5]《杨天鹏骨伤科治验心法》(主编张继祥·山西科技出版社·1996)
[1]卫生部颁标准中药成方制剂第三册WS3—B—0650—91[S].1991.
[2]中医病证诊断疗效标准[S].南京大学出版社,1994.186.
[3]孙宇,陈琪福.第二届颈椎病专题会纪要[J].中医外科杂志,1993,31(8)：472-474.
[4]杨克勤.颈椎病[M].人民卫生出版杜,1995.85.
[5]潘之清.实用脊柱病学[M].山东科学技术出版杜,1996.30.
[6]杨克勤.脊柱疾患的临床研究[M].北京出版社,1994.526-527.
[7]倪文才.椎动脉型颈椎病的手法治疗和发病机理的研究[J].中华骨科杂志,1985.5(3)：144.
[8]杨克勤.对颈椎病的一些认识[J].中华骨科杂志,1982.2(1)：29.
[9]柏蕙英.颈椎FT与椎动脉的测量及观察[J].解剖学报,1983.14(9)：225.
[10]张清,孙树春.椎动脉型颈椎病发病机理的研究近况[J].中国中医骨伤杂志,1998,6(4)：59--62.
[11]李景限.颈椎横突孔及动脉的观察及其在椎动脉型颈椎病发病学上的意义[J].中国骨伤,1994,7(1)：34—37.
[12]单云言.颈椎间管壁骨质增生的观察及意义[J].中国临床解剖学杂志,1992,0(1)：21—22.
[13]陈仲强,张之虎,党耕町.颈性眩晕病例的椎动脉造影观察[J].中华骨科杂志,1991,11(2)：95—96.
[14]李义凯,张云昆,钟世镇,等.颈后伸对椎动脉流速影响的研究及意义[J].中国康复医学杂志,1998,13(3)：101—103.
[15]冯世庆.椎动脉外膜剥离术的基础和临床研究[J].中国脊柱脊髓杂志,1998,8(1)：6—9.
[16]倪文才,沈志祥,范明等.椎动脉型颈椎病的手法治疗和发病机理研究[J].中华骨科杂志,1993,31(8)：456.
[17]冯世庆,杨明杰,孔晓红等.椎动脉型颈椎病血浆内皮素变化[J].中华骨科杂志,1997,17(6)：387.
[18]Bagkaner MK. Evidence for the participation of vascular endothelium Originated humoral factor to cerebral vasospasm[J]. English Acta Neurochix Wien,1993,124-135.
[19]Willette Rb Cerebral microvascular effects of endothelin[J]. Circulation,1989,80(Suppl):563-566.
[20]汪军明.川芎嗪和推拿对椎动脉型颈椎病患者内皮素心钠素的影响[J].中国康复,2000,15(1)：3-4.
[21]Ebraheim NA, Lu J, Haman SP, et al. Anatomic basis of the anterior surgery on the cervical spine:relationgships between uncusautery-root complex and vertebral artery iniury[J]. Surg Radiol Anat,1998,20 (6):389.
[22]ChopardRP,de Miranda Neto MH, LucasGA,et al. The vertebral artery:its relationship with adjoining tissues in its course intra and inter tran-sverse procwsses in man[J]. Rev Paul Med,1992,110(6):245-250.
[23]程东滨,金大地,钟世镇.椎动脉V2段与周围结构关系的解剖学观察[J].颈腰痛杂志,2001,22(2)：98.
[24]武兴杰.成人尸体椎动脉造影及病理观察[J].中华放射学杂志,1991,2(5)：345.
[25]刘植珊.椎动脉减压术治疗椎动脉型颈椎病[J].中华外科杂志,1984,2(2)：711.
[26]余家阔,吴毅立,汪发青,等.实验性应力应变分布改变对颈椎组织结构的影响[J].中华外科杂志,1993,31(8)：456—457.
[27]冯世庆.椎动脉动脉法数字减影血管造影研究[J].西安医科大学学报,1997,8(2)：1.
[28]况曙鸣.钩椎关节的形态研究与骨原性颈椎病的关系[J].上海第一医科大学学报,1982,9(2)：326—327.
[29]张其江.桂枝加葛根汤加味治疗椎动脉型颈椎病160例[J].中国社区医药,2006,23(18)：43.
[2]杨天鹏.损伤内治三法的临床应用体会[J].中医骨伤.1991,4(4):3-5
[3]曾一林.天鹏理筋手法探讨[J].四川中医.1948,1(2):21-22
[4]张继祥,周太安等.杨天鹏理筋手法概述[J].中医骨伤.1994,7(4):15-61
[5]《杨天鹏骨伤科治验心法》(主编张继祥·山西科技出版社·1996)
[1]卫生部颁标准中药成方制剂第三册WS3—B—0650—91[S].1991.
[2]中医病证诊断疗效标准[S].南京大学出版社,1994.186.
[3]孙宇,陈琪福.第二届颈椎病专题会纪要[J].中医外科杂志,1993,31(8)：472-474.
[4]杨克勤.颈椎病[M].人民卫生出版杜,1995.85.
[5]潘之清.实用脊柱病学[M].山东科学技术出版杜,1996.30.
[6]杨克勤.脊柱疾患的临床研究[M].北京出版社,1994.526-527.
[7]倪文才.椎动脉型颈椎病的手法治疗和发病机理的研究[J].中华骨科杂志,1985.5(3)：144.
[8]杨克勤.对颈椎病的一些认识[J].中华骨科杂志,1982.2(1)：29.
[9]柏蕙英.颈椎FT与椎动脉的测量及观察[J].解剖学报,1983.14(9)：225.
[10]张清,孙树春.椎动脉型颈椎病发病机理的研究近况[J].中国中医骨伤杂志,1998,6(4)：59--62.
[11]李景限.颈椎横突孔及动脉的观察及其在椎动脉型颈椎病发病学上的意义[J].中国骨伤,1994,7(1)：34—37.
[12]单云言.颈椎间管壁骨质增生的观察及意义[J].中国临床解剖学杂志,1992,0(1)：21—22.
[13]陈仲强,张之虎,党耕町.颈性眩晕病例的椎动脉造影观察[J].中华骨科杂志,1991,11(2)：95—96.
[14]李义凯,张云昆,钟世镇,等.颈后伸对椎动脉流速影响的研究及意义[J].中国康复医学杂志,1998,13(3)：101—103.
[15]冯世庆.椎动脉外膜剥离术的基础和临床研究[J].中国脊柱脊髓杂志,1998,8(1)：6—9.
[16]倪文才,沈志祥,范明等.椎动脉型颈椎病的手法治疗和发病机理研究[J].中华骨科杂志,1993,31(8)：456.
[17]冯世庆,杨明杰,孔晓红等.椎动脉型颈椎病血浆内皮素变化[J].中华骨科杂志,1997,17(6)：387.
[18]Bagkaner MK. Evidence for the participation of vascular endothelium Originated humoral factor to cerebral vasospasm[J]. English Acta Neurochix Wien,1993,124-135.
[19]Willette Rb Cerebral microvascular effects of endothelin[J]. Circulation,1989,80(Suppl):563-566.
[20]汪军明.川芎嗪和推拿对椎动脉型颈椎病患者内皮素心钠素的影响[J].中国康复,2000,15(1)：3-4.
[21]Ebraheim NA, Lu J, Haman SP, et al. Anatomic basis of the anterior surgery on the cervical spine:relationgships between uncusautery-root complex and vertebral artery iniury[J]. Surg Radiol Anat,1998,20 (6):389.
[22]ChopardRP,de Miranda Neto MH, LucasGA,et al. The vertebral artery:its relationship with adjoining tissues in its course intra and inter tran-sverse procwsses in man[J]. Rev Paul Med,1992,110(6):245-250.
[23]程东滨,金大地,钟世镇.椎动脉V2段与周围结构关系的解剖学观察[J].颈腰痛杂志,2001,22(2)：98.
[24]武兴杰.成人尸体椎动脉造影及病理观察[J].中华放射学杂志,1991,2(5)：345.
[25]刘植珊.椎动脉减压术治疗椎动脉型颈椎病[J].中华外科杂志,1984,2(2)：711.
[26]余家阔,吴毅立,汪发青,等.实验性应力应变分布改变对颈椎组织结构的影响[J].中华外科杂志,1993,31(8)：456—457.
[27]冯世庆.椎动脉动脉法数字减影血管造影研究[J].西安医科大学学报,1997,8(2)：1.
[28]况曙鸣.钩椎关节的形态研究与骨原性颈椎病的关系[J].上海第一医科大学学报,1982,9(2)：326—327.
[29]张其江.桂枝加葛根汤加味治疗椎动脉型颈椎病160例[J].中国社区医药,2006,23(18)：43.