整理《针灸大成》中关于风池穴的相关记载,总结其定位、刺灸法及临床应用规律.风池穴操作手法以针刺为主,施以不同的补泻手法,部分病证应用灸法.治疗的病症主要包括头面五官病症、颈项腰背部病症、精神神志病症、外感病、中风等.将《针灸大成》中风池穴的应用进行总结,能够为现代临床应用提供文献支持,拓宽现代临床的治疗思路.

目的 观察芎芷地龙汤联合局部电针刺激疗法治疗偏头痛的临床疗效.方法 选择74例偏头痛患者按照随机数表法分为观察组与对照组,各37例.对照组进行常规药物西比灵预防性治疗,观察组以芎芷地龙汤联合局部电针刺激疗法为主.比较2组临床疗效、疼痛情况及中医证候评分.结果 与对照组相比,观察组临床疗效优于对照组(P<0.05);治疗后观察组VAS评分低于对照组,疼痛持续时间短于对照组,疼痛发作频率低于对照组,观察组的各证候评分均低于对照组(P<0.05).结论 采用芎芷地龙汤联合局部电针刺激疗法治疗偏头痛疗效确切.

目的 观察电针深刺"腰突五穴"治疗腰椎间盘突出症的疗效和安全性.方法 采用前瞻性队列研究的方法,将187例腰椎间盘突出症患者根据其接受的治疗方式分为2组.对照组87例(后脱落8例)采用西医保守治疗,治疗组100例(后脱落4例)采用电针深刺"腰突五穴"治疗.2组均隔日治疗1次,6次为1个疗程,连续治疗2个疗程.比较2组治疗前及治疗6、12次疼痛视觉模拟评分(VAS),治疗6、12次镇痛率,治疗6、12次日本骨科协会(JOA)下腰痛评分改善率及分级情况,并统计患者满意度及不良事件发生率.结果 治疗6、12次2组疼痛VAS均较本组治疗前降低(P<0.05),且治疗6、12次治疗组均低于对照组同期(P<0.05).治疗6、12次治疗组镇痛率60％ ～89％、30％ ～59％、<30％均优于对照组同期(P<0.05).治疗6、12次治疗组JOA下腰痛评分改善率均高于对照组(P<0.05).治疗6、12次治疗组JOA下腰痛评分改善率60％ ～89％、25％ ～59％、<25％均优于对照组同期(P<0.05).2组不良事件发生率比较差异无统计学意义(P>0.05),治疗组患者满意度高于对照组(P<0.05).结论 电针深刺"腰突五穴"可缓解腰椎间盘突出症患者的腰痛程度,改善腰椎功能,疗效和患者满意度均优于西医常规治疗.

五脏辨证理论在癃闭的发生与发展过程中起着重要的作用.肾阳不足、肝失疏泄、脾运失司、心火炽盛、肺失肃降均可导致水道不行,小便点滴,发为癃闭.分析五脏辨证与癃闭的关系,从五脏辨治癃闭.膀肾表里,气化失司,水液不能下输,发为癃闭;治以温肾化气、通利膀胱,方选金匮肾气丸加减.肺失肃降,津液不布,水道不利,癃闭乃生;治以宣降肺气、布散津液,方选补肺汤加减.肝失疏泄,气机不畅,水液代谢失常,从而发为癃闭;治以调达肝气、疏通水道,方选一贯煎加减.脾运失司,水液失常,导致癃闭;治以健脾益胃、化湿利水,方选补中益气汤加减.心火炽盛,熏灼水液,水液不能趋下,从而发生癃闭;治以清心利水、泻小肠热,方选导赤散加减.临证结合症状,辨病与辨证相结合,配伍相应的专病专药,以提高中医药治疗癃闭的临床疗效.

灸法用于“治未病”历史由来已久,其发展经历了萌芽-发展-批判-总结的过程.春秋战国时期开始萌发灸法保健,到唐代明确提出,宋元时期是其主要发展时期,其发展既包括理论的深入也包括治法的完善.可以说宋元时期是灸法“治未病”发展的鼎盛时期,随后到了明代,由于灸法“治未病”的滥用开始出现质疑,并在质疑中总结.在演变过程中,积累了大量的经验,但资料分散不易研究.本文按历史发展顺序为脉络对灸法“治未病”的几部重要文献进行了梳理分析.

目的:探讨针灸推拿配合中药方剂治疗神经根型颈椎病的效果.方法:按照随机数字表法将120例神经根型颈椎病患者均分为观察组和对照组各60例,对照组患者接受针灸+推拿治疗,观察组患者在此基础上加用黄芪桂枝五物汤治疗,比较两组治疗效果.结果:观察组患者治疗总有效率明显高于对照组,随访6个月复发率明显低于对照组,差异有统计学意义(P＜0.05);观察组患者治疗后各项主要中医证候积分和视觉模拟评分(VAS)均明显低于对照组,差异有统计学意义(P＜0.05);观察组患者治疗后血清脂质过氧化物(LPO)、白细胞介素-1 β(IL-1β)水平均明显低于对照组,差异有统计学意义(P＜0.05);观察组患者治疗后各项生活质量评分均明显高于对照组,差异有统计学意义(P＜0.05).结论:针灸推拿配合中药方剂治疗神经根型颈椎病疗效显著,可有效改善患者症状体征,血清LPO、IL-1β水平和生活质量,值得临床推荐.

自20世纪50年代日本首次发现穴位表面皮肤具有低电阻特异性以来,穴位电阻特性研究就引起了国内外学者的广泛关注.穴位电阻特异性作为电学特性的一部分,是经穴反应特异性研究常用的客观指标.但笔者查阅文献发现,目前对于穴位电阻特异性的认识并不一致,涉及的疾病、穴位及临床治疗方法也较多,而且临床试验中采用的仪器也没有统一标准.因此笔者以“穴位电阻”为关键词,通过对中国期刊网全文数据库(CNKI)、万方数据库、维普数据库及英文数据库PubMed自2012-2017年关于穴位电阻特异性研究的相关期刊文献进行检索,获得文献40篇,剔除重复、非临床试验研究后,得出密切相关文献21篇.笔者对以上文献从经穴电阻特异性表现、应用疾病、涉及的穴位及测试仪器、结合的临床治疗方法等方面进行归纳总结,以便为今后相关研究提供理论支持.

目的:观察足太阳膀胱经、足少阳胆经特定穴、非特定穴、非经非穴皮肤电阻在腰椎间盘突出症患者中的表现,探寻哪些穴位可以特异性地反应腰椎间盘突出症.方法:本研究在北京中医药大学第三附属医院针灸科门诊进行,招募腰椎间盘突出症患者78例(膀胱经组38例和胆经组40例)、正常受试者36例.选取膀胱经的特定穴包括原穴京骨、郄穴金门、络穴飞扬、下合穴及合穴委中,胆经的特定穴包括原穴丘墟、络穴光明、郄穴外丘、下合穴及合穴阳陵泉,非特定穴包括膀胱经的秩边、胆经的风市,以及非经非穴,连续动态探测3组受试者的皮肤电阻30 min,以同名穴位电阻差值作为结局指标.结果:膀胱经组委中穴的左右两侧同名穴位电阻差值有显著性差异(P＜0.01),其他穴位无明显差异(P＞0.05).结论:初步推测膀胱经的下合穴及合穴委中可能是腰椎间盘突出症的1个反应点.

Objective:To explore the clinical application rules of special acupoints by studying the related literature in the past five years using randomized controlled trial(RCT).Methods:" The specific points" was regarded as the theme or keywords to retrieval the related literature published from January 2010 to December 2015 from China Journal Full-text Database (CNKI),Wan Fang and the VIP database.Results:Through computer retrieval of commonly used Chinese databases,1072 documents were obtained.After reading articles and manually excluding documents that did not meet the inclusion criteria,a total of 39 documents which met the requirements were included in the data mining scope,among them,21 kinds of diseases were involved,and the total frequency of occurrence of all diseases was 39 times,and the frequency of migraine was the highest.A total of 53 acupuncture acupoints were retrieved;According to the frequency of appearance,there were 241,of which 204 were specific points;The following appeared more than 10 times:Yanglingquan (SP 9),Zusanli (ST 36),,Waiguan (TE 5),Qiuxu (GB 40),Fengchi (GB 20) for 14 times.Among the 39 articles,if not counting the frequency of occurrence,there were 53 acupoints which once appeared,all the specific acupoints of other categories appeared except the meridian points of the five Shu points with the highest proportion of acupints.From the retrieved literature summary,application method of specific points from high to low in order were as follows:25 articles on acupuncture,6 articles on moxibustion,and 2 articles on electro-acupuncture,2 articles acupoint injection,,2 articles on catgut embedding,1 article on massage,and 1 on infrared radiation.According to the site distribution,among53 specific points,11 were in lower limbs;21 were in upper limbs;8 were in back and waist;7 were in head and neck,5 were in chest and abdomen,and 1 was in sacrococcygeal.Conclusion:Specific acupoints are mainly used to treat meridian disease and visceral disease;The clinical application of specific points are mainly distributed in the limbs,using specific acupoints in five Shu acupoints is of the highest rate;Acupuncture and moxibustion are mostly used in clinical practice.

腰椎间盘突出症在我国成年人中有8%~25%的患病率 [1] ,青年人患病率有快速增长趋势,多因运动量小、长期坐姿不良,或长期不运动、不接受紫外线照射而产生骨质疏松所致。病情严重时,腰痛剧烈甚至不能活动,并可伴有下肢麻痹、发凉、无力、间歇性跛行,甚至肌肉萎缩及神经功能障碍等,具有发病率高和反复发作、

针刺治疗下肢动脉硬化闭塞症从脏腑辨证归肾、脾两脏,本在肾,肾阳虚衰,标在脾,脾阳虚弱,运化水湿无力,久致痰湿瘀阻治病.为探讨针刺治疗下肢动脉硬化闭塞症取穴规律,笔者利用CNKI数据库,以针刺和下肢动脉硬化闭塞症为关键词,检索文献里有穴位记录的有效文献共18篇.将文献中的穴位按照辨证分型归纳总结,将本病的治疗方法大致分为温阳通络法、活血化瘀法、健脾利湿法三大类.温阳通络法取穴以任脉、足少阴肾经、足阳明胃经穴位为主;活血化瘀法以行气活血为原则,取穴以多气多血的足阳明胃经、主藏血之肝经,化生气血之脾经为主;健脾利湿法取穴方法多以足阳明胃经、足太阴脾经之健脾利湿的穴位为主.

目的：针刺时间间隔对脑白质疏松轻度认知障碍患者疗效的影响。方法：本研究的患者来源于2013年4月～2014年5月北京中医药大学第三附属医院，共入组患者30例，其中男14例，女16例，年龄阶段：50～80岁，教育程度：小学以上。知情同意书由患者签署并同意参加本研究后，按照随机分配方案并根据标准将患者纳入，然后各组进行治疗。针刺方法：取穴：百会、神庭、（以下均取双侧）血海、太溪、丰隆，采用平补平泻手法。神庭、百会穴采用电针，疏密波，血海、太溪、丰隆穴常规针刺，进针15～25mm，得气后采用平补平泻手法行1min，留针每次30min；分组：治疗1组：每周3次，周一、周三、周五各1次，连续5周共15次针刺为一个疗程。治疗2组：每周5次，周一到周五连续5天每日一次，周六周日休息两天，治疗3周，共15次针刺为一个疗程。治疗后进行MMSE量表、MoCA量表、ADL－R量表进行统计学比较。结果：本试验表明，在MMSE和MoCA评分表现上针刺2组治疗效果优于治疗1组（ P＜0．05），说明连续针刺2组每天1次具有针刺后续效应量，而隔日针刺1组的治疗效果则不为显著，且针刺疗法长时程连续针刺可以作为MCI的有效干预手段之一。

OBJECTIVE: To study the effect of acupuncture at Fengchi (GB 20) on the activation of myosin light chain kinase (MLCK) in the middle meningeal artery of migraine modeled rats.METHODS: Forty-four clean grade healthy female Sprague-Dawley (SD) rats were randomly divided into four groups: the control group, blank control group, Fengchi (GB 20) acupuncture group, and Fengchi (GB 20) prevention group. Neurogenic inflammation of these rats was induced by electrical stimulation. The y-P-32 infiltration method was then used to detect MLCK activation in the middle meningeal artery, and immunocytochemistry was applied to detect the structural protein expression of MLCK.RESULTS: The migraine model was successfully established in the rats. Compared with the control group, MLCK activation was significantly decreased in the blank control group (P<0.01).CONCLUSION: The activation of MLCK in the middle meningeal artery was increased by acupuncture at Fengchi (GB 20), indicating its effectiveness in preventing and curing on acute migraine attacks. (C) 2015 JTCM. All rights reserved.

目的：观察针刺风池穴对RAMP1和5－HT1B受体的作用，探讨风池穴对偏头痛CGRP和5－HT信号的可能影响。方法：采用免疫组化的方法，观察了针刺风池穴对偏头痛模型大鼠脑膜中动脉RAMP1和5－HT1B受体的影响。结果：电刺激大鼠硬脑膜可引起脑膜中动脉RAMP1增多、5－TH1B受体减少，无论是在造模前针刺风池穴还是在造模后针刺风池穴，RAMP1表达显著减少，而对5－TH1B受体并没有显著影响。结论：在偏头痛发作期，存在着CGRP作用的激活和5－TH作用的抑制，针刺风池穴显然能影响偏头痛发作过程中的血管反应，而其主要作用可能是通过CGRP途径实现的。

Objective:To assess the possible effects of acupuncture at GB 20 ( Fengchi) on the CGRP and 5-HT signal of hemicrania based on the influence of inserting GB 20 ( Fengchi) on RAMP1 and 5-HT1B recep-tors.Methods:We used immunohistochemical staining to observe the influence of inserting GB 20 (Fengchi) on RAMP1 and 5-HT1B receptors.Results:Electrical stimulation of rats’ dura could cause the increase of RAMP1 and the decrease of 5-TH1B receptors of middle meningeal arteries.The expression of RAMP1 was significantly <br> reduced when acupuncture at GB 20 ( Fengchi) both before and after the modeling, while there was no signifi-cant changes of the expression of 5-TH1B .Conclusion:On acute attack of hemicrania, there is activation of CGRP and inhabitation of 5-TH.Acupuncture at GB 20 (Fengchi) can influence the blood response during the attack of hemicrania, and probably act mainly through CGRP path.

Objective: To study the effect of acupture of Fengchi point on the expression of myosin light chain kinase( MLCK) in middle meningeal artery of migraine model rats. Methods: Evoked by electrical stimulation induced migraine animal models,detect the expression of the MLCK in middle meningeal artery. Results: The models of migraine rats were established successfully. Through statistical analysis of the blank control group being compared with the control group,MLCK expression decreased obviously( P 0. 01); Fengchi acupuncture group compared with Fengchi prevention group,there was no significant difference( P 0. 05),but Fengchi acupuncture group compared with the blank control group,Fengchi prevention group compared with the blank control group,there were all significant differences( P 0. 05). Conclusion: Possibly there is a relationship between acute attack of migraine and the decrease of MLCK of calcitonin gene related pepitde( CGRP) signal system,and the expression of MLCK by acupuncturing Fengchi point in the middle meningeal artery is increased,and it has the preventive and curative effect acute attack of migraine.

文献研究发现,脑白质疏松症（Leukoaraiosis,LA）的进展是随着时间的推移而发展的,并且脑白质病变性的发病进程快慢与发病早期的变化有着重要关系,可以对整个疾病的进展速度做出判断。MRI上以斑点状异常为主要表现的为慢速进展趋势,而斑点状区域逐渐融合为带状区域,说明白质变性速度开始加快,这种融合趋势在病变早期变化往往进展迅速。调查发现,脑白质病变量增加,每年可发现多达1/4的受试者有斑点状区域融合。脑白质疏松症进展程度与认知能力下降有关,但这种关联性是复杂的并且受其他病理因素影响如脑萎缩。针刺是一种有效的治疗认知障碍的方式,传统针刺研究对认知障碍有着良好地疗效,但针刺对认知障碍的疗效评估缺少可视客观化的标准。本文对缺血性脑白质变性进行文献综述,希望对针刺干预治疗LA和认知障碍疾病的临床疗效评估有所帮助。

Objective: To evaluate the effects of Sanyinjiao (SP6) with electroacupuncture on labour pain in women during the labour process.Methods: A total of 350 women in labour from three centres were randomly divided into the electroacupuncture group (acupuncture group), the sham electroacupuncture group (sham group) and the control group. Women in labour in the electroacupuncture group received the electroacupuncture on the point Sanyinjiao (SP6). The analgesic effect was self-rated by women in labour, using visual analogue scale (VAS). The duration and paralysis time of uterine contraction, uterine contraction regularity, degree of cervical extension, presentation of foetal descent, the condition of intra-partum haemorrhage and postpartum haemorrhage, labour manner, lochia, involution of uterus, milk secretion, neonate Apgar Score and neonate body height and weight were also measured. All data were analysed with Statistical Package for Social Sciences (SPSS) 12.0.Results: Labour pain scores from women in the acupuncture group were less than in the control group at needle retaining at 30 min, 2 and 4 h after needle withdrawal. Other evaluated indices did not show significant differences among the three groups. No adverse events were observed during the labour process.Conclusion: SP6 with electroacupuncture could be an effective way for decreasing labour pain. (C) 2010 Elsevier Ltd. All rights reserved.

Objective: To study the effect of acupuncture at Fengchi Point (GB20) on neurogenic inflammatory reaction in the middle meningeal artery of rats by immunofluorescence. Methods: 44 healthy female Sprague–Dawley (SD) rats were randomly divided into four groups: normal control group, model control group, acupuncture at Fengchi group and prevention group. Normal control group without any treatment, model control group was arranged to modle only, acupuncture at Fengchi group were treatment with acupuncture at Fengchi point 20 minutes and Fengchi prevention group were processed with manipulation 2 minutes and needle retention 20 minutes and then to model by electrical stimulation. Results: Immunofluorescence microscopy showed that a large number of green fluorescent colored CRLR immunoreactive particles at the middle meningeal artery of the model control group, with higher brightness deeper color and higher fluorescence intensity of CRLR immunoreactive particles compared with other groups; the acupuncture at Fengchi group and prevention group was difficult to distinguish by fluorescence intensity and color distribution with naked eyes. The acupuncture group and the wind pool to prevent the wind pool acupuncture group and the fluorescence intensity distribution of eye color was difficult to distinguish differences between the two stain intensity compared with the control group, fluorescence intensity was weak. But both stain intensity of the two groups were lighter, compared with the model control groups. Conclusion: The CRLR expression of the middle meningeal artery was significantly increased at neurogenic inflammatory reaction model rats, compared with normal rats. And treatment with acupuncturing at Fengchi point can inhibit the expression of CRLR.

本文参考近年来关于针灸治疗偏头痛的18篇文章,根据针灸治疗的不同方法分别从毫针治疗、透刺治疗、刺血治疗、电针治疗、刺压耳穴治疗和其他疗法等6方面对偏头痛的治疗进行总结,以便为治疗本病和临床研究提供有效的方法。