卒中后认知障碍是发生在卒中后出现的一系列认知功能减退的表现,是卒中后常见的并发症.通督醒神理论是基于督脉与脑的相关性所提出的通过针灸督脉上的穴位,使精血上充于脑,从而起到醒神开窍作用的一种理论方法.本文从督脉的循行和功能特点出发,阐释通督醒神理论指导针灸治疗卒中后认知障碍中的重要作用,以期为其指导治疗卒中后认知障碍提供理论支持.

《黄帝内经》以五脏为中心的整体观是祖国医学最鲜明的特点之一,它强调了人体各部并非孤立,而是有机联系的,并以此来指导临床治疗.在脐针治疗过程中,尤为重视"落脏".落脏,即在治疗过程中寻找疾病所属的系统,调理相关脏腑,以达到治病必求于本.《黄帝内经》中提出了经络病位模型,分别是皮-肉-脉-筋-骨,这一疾病模型为脐针"落脏"提供了思路.现就《黄帝内经》中经络病位观,浅谈脐针落脏方法.

目的:观察脐针治疗心肾不交型失眠症的临床疗效及安全性.方法:将84例失眠症患者随机分为脐针组、联合组与体针组各28例.脐针组采用单纯脐针、联合组采用体针联合脐针、体针组采用常规针刺,均隔1～2d治疗1次,每周3次,连续4周.比较3组患者治疗前后匹兹堡睡眠质量指数(PSQI)、焦虑(SAS)自评量表、抑郁(SDS)自评量表、失眠症中医证候量表评分及其疗效.结果:3组治疗两周和治疗4周在PSQI总评分、睡眠质量、入睡时间、日间功能障碍、SAS、SDS和中医证候方面,均较治疗前降低(P＜0.01).治疗两周后,脐针组与联合组入睡时间、睡眠时间、日间功能障碍和中医证候评分均低于体针组(P＜0.01).治疗4周后,联合组PSQI总评分、各项睡眠因子评分、SAS和中医证候评分均低于其余两组(P＜0.01).治疗后,脐针组、联合组和体针组总有效率分别为92.9％ (26/28)、96.4％(27/28)和78.6％ (22/28),差异有统计学意义(P＜0.01).治疗过程中均未出现不良反应.结论:3种干预措施均可有效改善患者整体睡眠情况、中医证候及焦虑、抑郁状态,且具有良好安全性.脐针与体针联合用齐针治疗可能在短期内改善入睡时间、睡眠时间、日间功能障碍及中医证候方面更具优势;体针联合脐针治疗可能在PSQI各睡眠因子评分及总分、焦虑状态和中医证候评分方面均更具优势.

OBJECTIVE:To compare the clinical effect of Tongdu Xingshen (promoting the governor vessel and regaining consciousness) acupuncture and moxibustion combined with cognitive training and the simple cognitive training for post-stroke mild cognitive impairment (PSMCI).METHODS:Eighty-four patients with PSMCI were randomly divided into an observation group and a control group, with 42 cases in each group (3 cases in the observation group and 2 cases in the control group dropped off). The observation group was treated by Tongdu Xingshen acupuncture and moxibustion combined with cognitive training, acupuncture was given at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), etc., and moxibustion was given at Shenting (GV 24) , Baihui (GV 20), Shendao (GV 11), Fengfu (GV 16) and Xinshu (BL 15). The control group was only given cognitive training. All the above treatment was given once a day, 5 times a week, for 4 consecutive weeks. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living (ADL) and stroke-specific quality of life (SS-QOL) were compared between the two groups before treatment, after treatment, 4 weeks and 12 weeks after treatment.RESULTS:After treatment, 4 weeks and 12 weeks after treatment, the MoCA, MMSE and SS-QOL scores of the two groups were all higher than those before treatment (P<0.05), and the ADL scores were lower than those before treatment (P<0.05). In the observation group, the MoCA and MMSE scores were higher than those of the control group after treatment, 4 weeks and 12 weeks after treatment (P<0.05), and the SS-QOL score was higher than that of the control group 12 weeks after treatment (P<0.05).CONCLUSION:Both Tongdu Xingshen acupuncture and moxibustion combined with cognitive training and simple cognitive training can improve cognitive function, daily living ability and quality of life in patients with PSMCI, and the combined therapy is superior to simple cognitive training in improving cognitive function and long-term quality of life in patients with PSMCI.

脐针疗法是通过针刺脐部调动人体先天经气,从而进行治疗的一种新的针刺方法.脐针治疗干眼症强调"因人治宜".临证以震、离、坤3个方位为主穴,但具体到每一个患者时,应结合其脐部望诊、触诊及整体辨证,并可根据其兼见症状进行随症加减.脐针治疗较少运用手法补泻,注重定位治疗、方位补泻,且强调进针顺序.精准定位与方位的补泻配伍是脐针治疗的关键点,用针一般要求少而精,讲究"下针必有方向,进针需含补泻".选定方位及进针顺序前可综合考虑主次症状、发病部位、脏腑辨证、五行生克制化、六十四卦象吉凶等,选择其中一个或综合多个全息进行选穴,依序针刺,或根据脐部某方位上的色变点,局部皮肤的褶皱、凹陷等异常点灵活定位进针,若能将多个全息同时应用于一组选穴中,临床疗效更佳.

普通的磁共振成像(magnetic resonance ima-ging,MRI)不能显示联动的功能图像,无法用来研究大脑的活动过程.功能磁共振成像(fMRI)的出现为获得脑功能的活动信息及早期诊断提供了技术支持.最常见的分析方法是基于血氧水平依赖(blood oxygenation level dependent,BOLD)的功能磁共振技术,脑内的神经元活动可影响相应脑区局部血流中氧合及脱氧血红蛋白的相对浓度,从而可反映出静息状态下神经元的功能活动[1].当大脑受到刺激或执行任务时引起的相关脑区功能变化也能通过BOLD技术做出准确且可靠的检测,因此大多数fM-RI研究使用BOLD变化值来观察受试者大脑的活动情况,被广泛应用于视、听、思、说等大脑活动的研究.因该技术客观化、可视化、可重复率高等特点,对于针刺机制的研究具有其独特优势.1998年Cho等[2]首次利用fMRI技术研究针刺引起的对应脑区功能的改变,随后麻省总医院的Hui教授等[3]提出针刺效应机制假说为大脑边缘系统负激活理论.近年来越来越多的中内外研究着眼于此,在SCI收录的关于针刺研究的文献70％以上与fMRI技术相关.

皮部位居人体最表,通过十二经脉与脏腑相沟通,具有"审内"与"御外"的作用.治皮之理、浅刺之法,其意皆在激发体表皮肤的卫阳之气,进而通过皮部—经络—脏腑这一信息传输通道,达到疏通经络、调节脏腑及平衡阴阳之目的 .因此,无论是未病先防,还是既病防变,都可从"皮"论治,使病邪由"皮"而解.时至今日,从"皮"论治已衍生出多种针法,如梅花针、浮针、皮内针等.

目的 观察头穴针灸法为主对卒中后轻度认知障碍(PSMCI)认知功能的影响.方法 将50例PSMCI患者按照随机数字表法分为2组,均予脑血管病基础治疗.对照组25例予认知康复训练治疗,治疗组25例在对照组治疗基础上加头穴针灸法为主治疗.2组均治疗4周,疗程结束后4、12周随访.比较2组治疗前后蒙特利尔认知评估量表(MoCA)评分、简易智能精神状态检查量表(MMSE)评分、日常生活活动能力(ADL)评分变化;评价2组治疗安全性.结果 2组治疗后、疗程结束后4周、疗程结束后12周MoCA评分、MMSE评分均较本组治疗前升高(P<0.05),2组治疗后、疗程结束后4周、疗程结束后12周MoCA评分、MMSE评分组内两两比较差异均有统计学意义(P<0.05),治疗组治疗后、疗程结束后4周、疗程结束后12周MoCA评分、MMSE评分均高于对照组同期(P<0.05).2组治疗后、疗程结束后4周、疗程结束后12周ADL评分均较本组治疗前降低(P<0.05),2组治疗后、疗程结束后4周、疗程结束后12周ADL评分组内两两比较差异均有统计学意义(P<0.05).2组治疗后、疗程结束后4周、疗程结束后12周ADL评分组间比较差异均无统计学意义(P>0.05).结论 头穴针灸法为主治疗PSMCI,可改善患者认知功能,提高日常生活能力.

目的 观察腹针与体针两种方式分期治疗原发性痛经的临床疗效差异.方法 选取2017年6月至2018年11月北京中医药大学东直门医院40例原发性痛经患者,按照随机数字表法分为腹针组和体针组,每组20例.两组均根据女性生理特点进行周期疗法,依月经期、经后期、经间期、经前期分期而治.两组分别自月经周期的第1天开始治疗,每期治疗2次,每次留针30 min,治疗16次为1个疗程,比较两组治疗效果.结果 腹针组与体针组治疗短期均有效.且随着治疗次数的增加,腹针组疗效优于体针组,差异有统计学意义(P<0.05).治疗后随访3月,两组治疗总有效率比较差异无统计学意义(P>0.05),但腹针组总显效率优于体针组(40％vs 10％,P<0.05).结论 腹针治疗原发性痛经有较好的疗效,值得临床推广.

该文介绍刘云霞教授运用腹针配合穴位注射治愈带状疱疹后遗神经痛1例.

目的 评价腹针针刺治疗中重度过敏性鼻炎的效果.方法 选取2017年1～7月于北京中医药大学东直门医院针灸科及耳鼻喉科就诊的过敏性鼻炎患者66例,按照随机数字表法分为两组,各33例.治疗组脱落2例,对照组脱落3例,最终治疗组31例,对照组30例.治疗组采用腹部针刺治疗,对照组采用布地奈德鼻喷剂治疗,疗程4周.比较两组的鼻部症状、鼻伴随症状及生活质量评分.结果 治疗2、4周后,两组鼻总症状评分(TNSS)和总非鼻症状评分(TNNSS)均较治疗前显著降低,且治疗组治疗4周后低于治疗2周(P＜0.01).治疗组治疗2周TNSS评分高于对照组(P＜0.01).治疗2、4周后,两组鼻结膜炎生活质量调查问卷各项评分均较治疗前显著降低(P＜0.01),其中,治疗组治疗4周睡眠评分低于对照组(P＜0.05).结论 腹针针刺可显著缓解患者鼻症状及鼻伴随症状,并能提高其生活质量,改善睡眠效果优于布地奈德鼻喷剂.

该文介绍腹针疗法治疗小儿消化不良验案1则.

This study aimed to evaluate the efficacy of electroacupuncture (EA) on Ciliao (BL 32) and Zhongliao (BL 33) acupoints at different depths for the treatment of benign prostatic hyperplasia (BPH) through a single-blind randomized controlled trial. All 120 patients diagnosed with BPH were randomly allocated to an experimental group (deep insertion group, DI group, n = 60) and control group (shallow insertion group, SI group, n = 60) 3 times a week for 4 weeks. The observed results included the International Prostate Symptom Score (IPSS), Quality of Life score (QOL), maximum urine flow rate (Qmax), and postvoid residual urine volume (PVR). After treatment, at both depths, the BPH symptoms of patients were improved by EA. There were significant differences between the IPSS, QOL, and the effective rate of the experimental group and the control group (P < 0.05). Although the observed PVR and Qmax were better than those before treatment, there was no statistical significance between two groups (P > 0.05). Thus, EA with deep insertion can effectively improve the patients' urinary symptoms and quality of life, and it will be suitable for clinical application.

目的:通过随机对照研究,观察不同深度电针次髎、中髎穴治疗良性前列腺增生(BPH)的临床疗效.方法:50例BPH患者随机分为试验组(进针60～75 mm)和对照组(进针25～40 mm),通过国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、膀胱残余尿(PVR)等评价疗效.结果:两组患者IPSS、QOL评分、PVR均较治疗前明显降低(P＜0.05),Qmax较治疗前提高但无统计学意义,试验组IPSS、QOL及总有效率明显优于对照组.结论:两组均能有效改善BPH症状,电针深刺次髎、中髎穴在改善排尿症状及生活质量方面优于常规针刺,适于临床推广应用.

腹针疗法[1]是薄智云教授发明的一种新的针刺方法. 该方法以阴阳五行学说、脏腑学说、经络学说为理论基础,以神阙布气假说为核心,通过针刺腹部穴位以激发经络之气、调整脏腑机能,从而达到治疗全身疾病的目的,具有"处方标准化,操作规范化,辨证条理化"的特点,适用于内伤性疾病或久病及里的疑难病、慢性病. 重症肌无力眼肌型是以上睑抬举无力、晨轻暮重为主要临床表现的内因性疾病. 刘云霞教授运用腹针疗法治疗重症肌无力眼肌型患者1例,取得较好疗效,现述如下.

Objective:To explore the effect of facial shallow needling combined with abdominal acupuncture treating acute facial neuritis. Methods:60 patients with facial neuritis of acute stage were randomly divided into the treatment group(n =30) and the control group(n =30). The treatment group was given abdominal acupuncture and shallow needling on affected side at acute stage; whereas, the control group was only given western medication without acupuncture at acute stage. Two groups were both given routine acupuncture at stationary phase and convalescent stage. Facial nerve function was assessed before and after the treatment in the two groups to compare the clinical efficacy. Results:The curative rate was higher in the treatment group with shorter treating days, compared to those in the control group(P ＜0. 05). The total efficiency of the treatment group was 96. 7％, which was significantly higher than 80. 0％ of the control group(P ＜0. 05). The score of facial nerve palsy degree was higher in the treatment group than that in the control group(P ＜0. 05). Conclusion:The therapy of facial shallow needling combined with abdominal acupuncture can obviously improve facial nerve function, improve the curative effect, and shorten the treatment course when treating acute facial neuritis.

1 临床资料 患者男性,41岁. 2017年12月19日因右上眼睑内肿胀3周前来就诊.现病史:患者3周前无明显诱因出现右上眼睑肿胀,异物感,无疼痛,当时未予治疗. 2周前因右上眼睑肿胀增大,视力下降、疲劳而就诊于某三甲医院,诊断为"霰粒肿".给予左氧氟沙星滴眼液、红霉素软膏外用对症治疗,效果不佳,后因右上眼睑肿胀增大如黄豆大小, 再次就诊于某三甲医院检查后提示肿胀增大压迫神经, 医院建议手术治疗, 患者因畏惧手术而寻求针灸治疗.

目的:评估腹针疗法对中重度过敏性鼻炎患者血清组胺与白三烯D4含量的影响及临床疗效.方法:选择符合标准的病例50例,随机分为治疗组和对照组,各25例.治疗组采用腹部针刺治疗4周,对照组采用布地奈德鼻喷雾剂治疗4周,观察两组治疗2周后、4周后生活质量评分问卷RQLQ,治疗4周后组胺与白三烯D4含量,根据评分与两组血清学检测前后对比进行疗效评定.结果:治疗后两组组胺、白三烯D4含量、RQLQ均较治疗前降低,有显著性差异(P＜0.01或P＜0.05);对照组组胺含量下降优于治疗组(P＜0.05),在白三烯D4含量下降中两组无明显差异性(P＞0.05),在RQLQ量表中关于睡眠症状的改善,治疗组优于对照组,有显著性差异(P＜0.01),但两组在其他项评分中无明显差异性((P＞0.05)).结论:腹针疗法能明显降低患者血清组胺与白三烯D4含量,且能显著提高患者的生存质量,尤其对于睡眠质量的改善效果尤佳.

Objective To discuss the efficacy of abdominal acupuncture on drug-dependent insomnia and establish the theoretical basis for it with clustering analysis. Methods 30 patients of drug-dependent insomnia were treated with abdominal acupuncture,and the pre- and post-treatment results of Pittsburgh Sleep Quality Index (PSQI ) and symptom self-evaluation scale (SCL-90 ) were compared. The data were processed with clustering statistics and dimension reduction analysis to discuss the theoretical foundation for the treatment. Results The pre-/post-differences of PSQI and SCL-90 scores were both statistically significant (P ＜ 0. 05) after four weeks of treatment,with post-treatment scores lowering than that of pre- ones. The items " somatization" on SCL-90 of 14 out of 26 patients turned from positive (pre-) to negative (post-) with T value reducing from 2. 56 to 1. 96. Conclution Somatic symptoms can be greatly improved by abdominal acupuncture after the treatment as the movement of qi and blood could be invigorated and adjusted and the meridian and collateral system could be smoothed.