BACKGROUND:CNSLBP accounts for 85% of all LBP cases and impairs physical health, quality of life, and work productivity, posing a significant health and economic burden. Baduanjin (BDJ) exercises are traditional Chinese Qi Gong mind-body exercises that have been practiced for over 1,000 years. However, the standard BDJ protocol established by the State Sports General Administration does not stimulate core muscles, limiting the effectiveness of low back pain rehabilitation. Therefore, it is necessary to improve the original BDJ protocol. METHODS:This 24-week single-center, single-blind, parallel-group randomized control superiority trial will allocate 100 patients into two groups (control and intervention) at a 1:1 ratio. The patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The patients in the patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The intervention group will perform intervention. The primary outcomes will be Quebec back pain disability scale. Secondary outcomes will include visual analog scale pain scores, Surface electromyography. The assessments of the tests will be performed at four time points. Adverse events will be recorded faithfully during the study. DISCUSSION:This randomized control trial is the first to compare a standard BDJ protocol and an optimized protocol in patients with CNSLBP. This study can help guide rehabilitation programs. TRIAL REGISTRATION:Chinese Clinical Trial Registry, ChiCTR2200065618, Registered on 10 Nov. 2022. This protocol is the first version 1, which was approved on 26 Aug 2022.

IntroductionFew studies are about the relationship between anemia and obesity, and previous studies have only paid attention to BMI.Methods and ResultsWe first included body fat percentage (BF%) as an assessment indicator and divided it into quartiles, grouped participants into obesity and non-obesity used data from NHANES database. After adjustment for age, gender, ethnicity, education and family income, the level of soluble transferrin receptor (sTfR), and incidence of elevated CRP or HsCRP were progressively higher with increased BF%, whereas mean cell volume (MCV), natural logarithm (Ln) serum ferritin (SF), and Ln SF/sTfR were progressively reduced. Although a higher prevalence of anemia and lower hemoglobin was observed with increased BF%, but there was no statistical difference. Women in the highest BF% group demonstrated a significantly higher risk of iron deficiency compared to those in the lowest BF% group.DiscussionBF% should be given more attention, and women with high BF% should pay attention to iron deficiency.

The fenrou zhijian is defined as potential gap between different layers in the three-dimensional network structure formed by the twelve meridian tendons. Various pathological changes of the meridian tendons lead to the adhesion and closure of fenrou zhijian, causing abnormal mechanical conduction of the meridian tendon system, which in turn leads to painful bi syndrome of meridian tendons. As such, restarting the fenrou zhijian is the key to acupuncture treatment for painful bi syndrome of meridian tendons. Under the guidance of musculoskeletal ultrasound, the level and the angle of needle insertion of acupuncture at fenrou zhijian could be accurately controlled, the efficacy of acupuncture is improved.

跟师教育是中医住院医师规范化培训的重要组成部分.其与病房规范化培训工作的结合旨在保障规培生既能具备统一、标准的中医思想,又能形成个性化的中医思维模式.但是在实践过程中,指导老师和规培生对跟师教育的积极性不高,跟师教育流于形式.分析跟师教育政策不能被很好落实的原因,并尝试从灵活调整跟师时间、完善导师与学生之间的双向选择制度、以团队的形式完成跟师教育工作3 个方面提出建议,以期更好地落实中医住院医师规范化培训中的跟师教育工作.

经筋是经络体系的重要组成部分.本研究以完善经筋病理论、拓展经筋病治疗为目的,对经筋理论的形成年代和经筋实质进行探讨.笔者认为经筋理论的形成年代晚于《足臂十一脉灸经》《阴阳十一脉灸经》,略早于《灵枢·经脉》时期.经筋是古人对"筋膜及筋膜连缀起来的运动功能单位"的朴素认识.经筋病的各种症状,是应力在肌腱处的集中或过大的力学负荷在张力传导网络中薄弱部位的体现.在针刺治疗经筋病时,除可选取本经经筋上的疼痛部位或压痛点为穴位进针外,还可取痛点所在的肌肉两端肌腱为穴位.

目的:观察低频电针对2型糖尿病大鼠血糖和胰岛素抵抗的干预作用,并从调控骨骼肌胰岛素受体底物1(IRS-1)磷酸化的角度,对电针的干预效果进行解释.方法:以Purina#5008饲料喂养ZDF大鼠制备2型糖尿病动物模型,并以ZL大鼠为空白组.成模动物根据空腹血糖随机分为模型组和电针组.电针组以15 Hz、2 mA的连续波电针"后三里""三阴交""脾俞""胃脘下俞"穴组,留针20 min,每日1次,6次/周,6周进行干预;空白组及模型组不干预.于全部干预结束后检测大鼠空腹血糖、空腹胰岛素含量,计算胰岛素抵抗指数(HOMA-IR),判断电针对2型糖尿病大鼠胰岛素抵抗的干预作用;取大鼠骨骼肌以Western blot法检测磷酸化氨基末端激酶(p-JNK)水平及p-IRS-1 Ser307含量,探讨电针干预效果的机理.结果:低频电针可显著降低模型动物激增的空腹血糖和胰岛素抵抗指数,显著下调模型动物骨骼肌p-JNK thr183/tyr185磷酸化及p-IRS-1 Ser307蛋白表达.结论:低频电针可显著改善2型糖尿病大鼠高血糖及胰岛素抵抗状态,上述作用可能通过下调骨骼肌JNK活性、抑制骨骼肌IRS-1丝氨酸磷酸化实现.

《灵枢·经筋》的主治病症以痛症为主,在治疗上采用"燔针劫刺,以知为数,以痛为输".本研究以深入探讨经筋理论、拓展临床应用为目的,尝试以应力集中理论、软组织张力理论和无菌性炎症理论解释经筋痛症的成因,并配合不同的针刺方法.对因应力集中所致的肌腱附着处的疼痛,推荐以远端取穴的方式进行治疗;对因筋膜压应力增高导致的肿、痛,推荐以合谷刺进行针刺;对因筋膜拉应力增高导致的挛急、扭痛和牵涉痛,推荐以多针刺将针沿着结节、条索的边缘刺入进行治疗;对因无菌性炎症导致的疼痛,推荐以斜刺、浅刺的方式进行治疗.

BACKGROUND:Pulsed electromagnetic field (PEMF) therapy is widely used to treat myofascial pain syndrome (MPS). Damp-clearing and pain-reducing paste (DPP) comprises medical herbs and has been a traditional method of reducing myofascial pain in China for a long time, and it is usually administered with heating. However, the synergistic effect of PEMF therapy on heating-DPP in patients with MPS is unclear.AIM:To investigate the synergistic effect of PEMF therapy plus heating-DPP in lumbar MPS.METHODS:This double-blind, randomized, placebo-controlled trial was conducted on 120 patients with lumbar MPS who were randomly divided into an experimental group (EG, n = 60) and a control group (CG, n = 60). Patients in both groups were treated with heating-DPP combined with PEMF therapy; however, the electromagnetic function of the therapeutic apparatus used in the CG was disabled. Each treatment lasted for 20 min and was applied five times a week for two weeks. The short-form McGill Pain Questionnaire was applied at five time points: pretest, end of the first and second weeks of treatment, and end of the first and fourth week after completing treatment. Visual analog scale (VAS), present pain intensity index (PPI), and pain rating index (PRI; total, affective pain, and sensory pain scores) scores were then analyzed.RESULTS:Compared with the CG, the VAS, PPI and PRI scores (total, affective pain and sensory pain scores) in the EG were significantly lower after treatment and during follow-up.CONCLUSION:PEMF therapy combined with heating-DPP showed better efficacy than heating-DPP alone in reducing the overall intensity of pain and sensory and affective pain.

目的:观察低频电针"胃脘下俞"穴对2型糖尿病大鼠胰腺形态和分泌功能的调控作用,从保护胰岛B细胞、维持胰腺分泌功能的角度探讨电针干预2型糖尿病高血糖的机制.方法:选取雄性SD大鼠以高脂饲料喂养结合腹腔注射链脲佐菌素(STZ)制备2型糖尿病大鼠模型.成模动物根据空腹血糖随机分为模型组、电针组,并与空白组进行对照.电针组以强度2 mA、频率2 Hz的低频电针"胃脘下俞"穴,6次/周,4周进行干预.空白组和模型组不干预.于全部干预结束后检测大鼠空腹血糖、空腹胰岛素含量,计算胰岛素分泌指数(HOMA-B),判断电针对胰腺分泌功能的调控作用;取大鼠胰腺组织进行HE染色及Masson染色,观察电针对胰腺形态学的调控作用;取大鼠胰腺组织以Western blot法检测GLP-1受体含量,探讨电针干预效果的机理.结果:低频电针"胃脘下俞"可显著提高2型糖尿病模型大鼠显著降低的胰岛素分泌指数(P＜0.05),且能改善胰岛形态,上调模型大鼠显著下降的胰腺GLP-1受体表达.结论:低频电针"胃脘下俞"穴对2型糖尿病大鼠胰腺形态、功能具有正向调控作用,上述作用可能与电针对胰腺GLP-1受体的调控有关.

肠易激综合征是消化科常见的功能性疾病之一,具有病程长、反复发作等特点,且治疗成本较高,严重影响患者的生活质量.隔物灸疗法指用加工过的药物将艾草制品与施术腧穴部位的皮肤隔开,施以艾灸的方法.回顾近年来隔物灸治疗的临床报道,发现隔物灸对肠易激综合征具有一定的治疗效果,本文初步分析其可能的作用机制,以期为临床及相关研究提供参考.

隔物灸是失眠的可行治疗手段之一.现行多个版本的关于失眠的治疗指南均提倡:(1)在失眠的治疗过程中,应尽量避免短期失眠发展为长期失眠;(2)在失眠的治疗中首选包含中医药在内的非药物疗法.因此,研究隔物灸的起效机理对失眠的治疗具有重要意义.文章综述近年来隔物灸治疗失眠的临床报道,发现隔物灸,特别是督灸对失眠具有突出的治疗效果.大多数医家以姜蓉覆盖大椎至腰俞节段的督脉和膀胱经第一、第二侧线,再于姜蓉上点燃艾炷施灸,取得了很好的疗效.其机理可以从中医理论中调理阳气,调理心神的作用得到解释:按“阳气者,精则养神,柔则养筋”的说法,艾灸督脉可鼓动阳气,使神气得养,神养于心.也能从调节交感神经、副交感神经之间的兴奋、抑制平衡的西医学角度得到解释:即艾灸的温热刺激和药物的药效可借助脊髓侧角将刺激传入脊髓,抑制过度兴奋的交感神经,并兴奋以迷走神经为主的副交感神经,达到调理睡眠的作用.

Given that the biomechanical theory cannot well explain the therapeutic effect of fan-ashi point (a special site that may relieve pain by pressing), the skeletal muscle tension is adopted and it is attempted to interpret the mechanism of the curative effect and the effect onset of fan-ashi point. It is viewed that the longitudinal tension conduction and transverse tension conduction pathways of skeletal muscle are the material basis of the effect onset of fan-ashi point. Hence, acupuncture at fan-ashi point may alter the longitudinal or transverse tension conduction of skeletal muscle to relieve muscle and tendon pain.

目的 利用肌骨超声评价放散状冲击波治疗慢性跟腱炎对于消除水肿的效果,进而明确冲击波疗法的作用,做到客观评价.方法 选取在中国中医科学院西苑医院门诊就诊的慢性跟腱炎患者55例,将其随机分为对照组27例和治疗组28例,对照组给予常规放散状冲击波治疗,治疗组在给予常规放散状冲击波治疗的同时加入承山及委中穴的冲击波治疗;治疗前后均使用肌骨超声对局部水肿最明显的部位进行测量,后根据结果进行统计分析.结果 治疗组总有效率89.3％(25/28)高于对照组总有效率77.8％(21/27),2组间差异有统计学意义(P＜0.05);治疗后2组患者VAS评分较治疗前均有下降,且治疗组VAS评分下降较对照组更为明显,差异有显著统计学意义(P＜0.01);治疗后,水肿程度治疗组下降57.1％,对照组下降30.0％,治疗组较对照组下降更为明显,差异有统计学意义(P＜0.01);治疗后2组功能评定情况优于治疗前,且治疗组优于对照组,差异有统计学意义(P＜0.05).结论 加入局部穴位后,放散状冲击波治疗慢性跟腱炎比单纯运用冲击波治疗更加有效;肌骨超声可以客观检测慢性跟腱炎水肿程度,评价治疗情况,值得推广.

梳理八段锦的古文献记录,对八段锦的源流和演变进行阐述和探讨.八段锦的部分动作模式可以上溯至南北朝时期;其首次见于记载的是晋代葛洪的《神仙传》.八段锦在宋代有了较大的发展和扩大,出现了坐式和立式的分化.时人以坐式养心,立式修身.晚晴时期,八段锦以立式为主,形式与今日几近相同.其在民国时期分为南北两派,并在新中国成立后有了更好的继承和发扬.经分析认为,八段锦的动作并非天然如此;其在演变过程中,部分变化是受到了医学以外因素的影响,在练习时不必盲从、死守一些要求.

Objective. To explore the possible mechanism of electroacupuncture to improve insulin sensitivity in type 2 diabetes rats. Methods. Fourteen Zucker Diabetic Fatty (ZDF) rats were randomly divided into two groups: a model group and an electroacupuncture group, with 7 rats in each group. Seven Zucker Lean (ZL) rats served as a control group. All rats were fed with Purina #5008 for 4 weeks, and the electroacupuncture group received 4-week electroacupuncture intervention, while the control group and model group received no intervention. We measured fasting blood glucose (FBG) on the fourth weekend. After 4 weeks of intervention, the expression levels of insulin receptor substrate-1 (IRS-1) tyrosine phosphorylation, IRS-1 serine/threonine phosphorylation, and GLUT4 in quadriceps femoris muscles were detected by western Blot. Results. Compared with the model group, the electroacupuncture group had a lower level of fasting blood glucose, serum insulin level, and insulin resistance index ( P < 0.05 ). The electroacupuncture group had lower IRS-1 serine/threonine phosphorylation than the model group, with the difference showing statistical significance ( P < 0.05 ). Furthermore, the mean score (MS) of the control group showed the lowest phosphorylation expression, followed by the electroacupuncture group, while the model group had the highest level of phosphorylated protein expression. The level of IRS-1 tyrosine phosphorylation at Tyr895 sites was compared, and the result showed that there was no significant difference between the electroacupuncture group and the control group ( P > 0.05 ), and the electroacupuncture group had higher phosphorylation expression than the model group ( P < 0.05 ). Compared with the control group and the model group, the expression level of GLUT4 protein in the electroacupuncture group was significantly increased ( P < 0.05 ). Conclusion. Electroacupuncture has the effect to improve the insulin sensitivity of type 2 diabetic ZDF rats by reducing fasting blood glucose, insulin level, and insulin resistance index, effectively up regulating the expression of GLUT4 protein in quadriceps femoris muscle. The mechanism is related to the regulation of skeletal muscle IRS-1 serine/threonine and tyrosine phosphorylation levels.

"分肉之间"首载于《黄帝内经》.本研究梳理了《黄帝内经》中10余处涉及分肉之间的散在篇章,初步整理出了分肉之间理论:即按《黄帝内经》思想,分肉之间是卫气循行的通道,是外邪侵入人体的途径.古医家用分肉之间理论指导针灸对运动系统疾病进行治疗,其治疗有采用多针刺法、快针针刺不留针,且配合时间医学针刺的特点.针对《黄帝内经》中关于分肉之间所在层次表述不一的情况,本研究将分肉之间理论与西医筋膜理论结合,认为分肉之间是《黄帝内经》时期对筋膜的朴素认识.上述认识在现代针灸治疗肌筋膜痛中仍有很好的临床指导价值.

目的:观察电针对2型糖尿病ZDF大鼠血糖、PI3Kp85及GLUT4蛋白表达影响.方法:选取14只体质量140～160 g(2月龄)SPF级雄性ZDF(fa/fa)大鼠,随机分为模型组、电针组;另取7只同月龄SPF级雄性(fa/+)大鼠作为对照组.连续干预4周,测定各组空腹血糖.4周后Western blot检测骨骼肌的磷脂酰肌醇3激酶(PI3K)和葡萄糖转运蛋白4(GLUT4)蛋白表达水平.结果:干预后与对照组比较,模型组空腹血糖显著升高(P ＜0.01);与模型组比较,电针组空腹血糖显著下降(P ＜0.05).Western bolt检测,与对照组对比,模型组PI3K p85、GLUT4蛋白表达量显著下降(P ＜0.01);与模型组比较,电针组PI3Kp85、GLUT4蛋白表达显著升高(P＜0.01).结论:电针干预可改善ZDF大鼠空腹血糖及骨骼肌细胞的胰岛素抵抗(IR).其机制可能与PI3K-GLUT4信号传导途径有关.

目的:观察电针对2型糖尿病大鼠血清炎性因子TNF-α、IL-6、IL-1β、空腹血糖(FBG)、胰岛素抵抗水平及骨骼肌IRS-1 Ser307、GLUT4蛋白表达的影响,从而探讨电针足三里、三阴交、脾俞及胃脘下俞穴治疗2型糖尿病的可能机制.方法:以7只雄性ZL大鼠作为空白组,14只雄性ZDF大鼠随机分为2型糖尿病模型组和电针组(每组各7只).干预4周,每周末检测空腹血糖,4周后取血清,放免法检测TNF-α、IL-6、IL-1β及胰岛素,取骨骼肌进行Western Blot检测IRS-1 Ser307、GLUT4蛋白表达,并计算胰岛素抵抗相关指标.结果:电针组、模型组与空白组相比,TNF-α、IL-6、IL-1β水平均显著升高(P＜0.05);电针组与模型组相比,TNF-α、IL-6、IL-1β水平均明显下降,差异有统计学意义(P＜0.05);电针组、模型组与空白组相比,空腹血糖均显著升高(P＜0.05);电针组与模型组相比,空腹血糖水平下降,但差异无统计学意义(P＞0.05);电针组与空白组比较,骨骼肌IRS-1 Ser07、GLUT4蛋白表达有所提高,但差异无统计学意义(P＞0.05);电针组与模型组比较,骨骼肌IRS-1Ser307蛋白表达明显下降(P＜0.05),而GLUT4蛋白表达明显提高(P＜0.05);电针组、模型组与空白组相比,大鼠胰岛素抵抗指数水平明显提高(P＜0.05);电针组与模型组相比,血清胰岛素抵抗指数水平差异有统计学意义(P＜0.05).结论:电针可调节2型糖尿病大鼠血清炎性因子、IRS-1 Ser307、GLUT4蛋白表达,其可部分解释电针对IR以及2型糖尿病的作用机制及作用途径.

本研究探讨了五输穴按向心方向排列走行和《灵枢·经脉》所载的十二经脉按半向心、半离心方向走向之间的悖论.首先论述了古代医家对此的解释,并在此基础上提出:目前针对经脉全向心循行和半向心、半离心循行之间的悖论尚不存在一种完美的解释.因为两种经络循行体系各有独特的临床指导价值.两种循行体系都是传统中医思想的有效传承媒介,不宜整合兼并.针灸从业者应同时学习两种体系,以对传统针灸理论有更深入的认识.

八会穴理论首载于《难经·四十五难》.其中,髓会绝骨的定位在《黄帝内经》《难经》中并无明确定位.后世《针灸甲乙经》首次提出绝骨位于足外踝尖上3寸,该定位是绝骨定位的主流观点.但古今医家也提出了髓会肾俞说、髓会枕骨说、髓会阳辅说等不同观点.本研究阐述了关于绝骨定位的诸多观点的来由,并予以分析.