中风后肢体痉挛是中枢神经系统损害后出现的以肌张力增高及协调能力失常为主的异常运动模式,中医学将其归属于"经筋病"范畴.早期打破异常的痉挛模式,重塑正常的运动模式是其首要的治疗目标.恢刺法作为主治筋肉挛急的特异刺法,具有舒筋通络、调畅气血之功,能有效缓解肢体痉挛状态,体现出针刺的特异性.本文试浅探在经筋理论指导下应用恢刺法治疗中风后肢体痉挛,以期为临床抗痉挛实践方案制定提供新的思路.

老年性骨质疏松症（senile osteoporosis，SOP）多指发生于70岁以后的原发性骨质疏松症，其引起的疼痛、畸形及并发症显著影响患者的生活质量。目前常用的抗骨质疏松药物治疗多处于平台期，且药物不良反应也限制其长期应用，故需探讨治疗SOP的更优方案。研究证实针灸治疗SOP的疗效明确，本文将对近几年临床相关文献进行总结。从针刺、灸法、其他疗法及综合疗法四个方面进行阐述，以期系统运用针灸治疗SOP，减少药物的毒副作用，起到增效减毒的作用。

呃逆为膈肌异常不自主收缩而引起的以喉间呃声连连,无法自止为主要表现的一种病证,而顽固性呃逆,指发作频繁或持续48小时以上者,属中医学"呃逆"范畴.笔者通过穴位埋线与耳穴压豆结合治疗顽固性呃逆1例,收效显著,且安全无副作用,以供临床借鉴参考.

背俞穴是针灸学中的一类特定穴，经过世 代传习，其被广泛应用于治疗神经系统相关性疾 病，大量研究证明背俞穴的应用使得许多神经系 统疾病有良好的效果。本文从神经系统疾病引发 的功能障碍、并发症的治疗总结近五年背俞穴应 用于此类疾病的临床报道，以归纳探索背俞穴的 研究价值及研究前景。

OBJECTIVE:To compare the effect among ultrasound-guided electroacupuncture (EA) at suprahyoid muscle group, conventional acupuncture and conventional EA at suprahyoid muscle group on pharyngeal dysphagia after stroke, and to explore its biomechanical mechanism.METHODS:A total of 120 patients with pharyngeal dysphagia after stroke were randomly divided into an observation group, a control-1 group and a control-2 group, 40 cases in each group. The patients in the observation group were treated with ultrasound-guided EA at suprahyoid muscle group; the patients in the control-1 group were treated with EA at Lianquan (CV 23), Wangu (GB 12) and Fengchi (GB 20), etc.; the patients in the control-2 group were treated with EA at suprahyoid muscle group according to anatomical location. The EA in the three groups were discontinuous wave, with frequency of 5 Hz and current intensity of 1 mA. The EA was given for 30 minutes, once a day, 6 times were taken as a course of treatment, and 4 courses of treatment were provided. The video floroscopic swallowing study (VFSS) was performed before and after treatment. The Rosenbek penetration-aspiration scale (PAS) score, the forward and upward movement distance of hyoid bone and thyroid cartilage, Ichiro Fujima ingestion-swallowing function score were recorded in the three groups, and the incidences of subcutaneous hematoma were recorded after treatment.RESULTS:Compared before treatment, the PAS scores were reduced and the Ichiro Fujima ingestion-swallowing function scores were increased after treatment in the three groups (P<0.05); the PAS scores in the observation group were lower than those in the control-1 group and the control-2 group, and the Ichiro Fujima ingestion-swallowing function scores in the observation group were higher than those in the control-1 group and the control-2 group (P<0.05). After treatment, the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group and the control-2 group was increased (P<0.05), and the forward and upward movement distance of hyoid bone was increased in the control-1 group (P<0.05); the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group was longer than that in the control-1 group and the control-2 group (P<0.05). The incidence of subcutaneous hematoma in the observation group was 0% (0/40), which was lower than 20.0% (8/40) in the control-1 group and 47.5% (19/40) in the control-2 group (P<0.05).CONCLUSION:Ultrasound-guided EA at suprahyoid muscle group could improve the swallowing function in patients with pharyngeal dysphagia after stroke by increasing the motion of hyoid laryngeal complex. Its effect and safety are better than conventional acupuncture and conventional EA at suprahyoid muscle group.

目的:观察廉泉、天容可视化齐刺治疗环咽肌功能障碍(CD)所致吞咽困难的临床疗效,并基于弥散张量成像(DTI)技术从脑白质纤维束结构与密度的改变探讨其可能的作用机制.方法:选取168例CD所致吞咽困难患者,按随机数字表法分为观察组和对照组,每组84例.观察组给予廉泉、天容可视化齐刺治疗,并在每侧的夹廉泉及天容旁连接电针;对照组给予常规针刺治疗.2组均治疗4周.比较2组治疗前后吞咽造影检查(VFSS)评分、舌骨喉复合体动度及患侧脑区各向异性分数(FA),比较2组临床疗效.结果:治疗后,2组VFSS评分均较治疗前升高(P＜0.01),观察组VFSS评分高于对照组(P＜0.01).治疗后,2组舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移距离均较治疗前增大(P＜0.05);观察组舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移距离均大于对照组(P＜0.05).治疗后,2组患侧小脑下脚、小脑中脚、小脑上脚、大脑脚、脑桥束、皮质核束FA值均较治疗前增大(P＜0.05),观察组患侧脑区上述6项FA值均大于对照组(P＜0.05).观察组总有效率为97.6％,高于对照组的89.3％,差异有统计学意义(P＜0.05).结论:廉泉、天容可视化齐刺可改善CD所致吞咽困难患者的临床症状,其作用机制可能是相关脑区白质纤维束的结构及密度改变增强了其神经可塑性.

目的 观察电针预防性治疗偏头痛的临床疗效.方法 将2017年5月—2018年11月厦门市中医院针灸康复科门诊132例偏头痛患者随机分为电针组和药物组,电针组予针刺风池、率谷、头维、太阳,药物组予口服氟桂利嗪,分别治疗3个月,以每月偏头痛发作次数与基线比减少50％ 以上的患者比例及视觉模拟评分法(visual analogue scale,VAS)作为评价指标,在治疗第1、2、3、6个月观察两组预防性治疗偏头痛的临床疗效.结果 治疗1个月时,电针组有效率达69％,药物组为31％,在3个月时电针组有效率达82％,而药物组为57％,两组有效率比较有明显统计学差异(P<0.01);两组VAS评分均较治疗前明显下降(P<0.01),且两组治疗后比较有统计学差异(P<0.01).结论 电针预防性治疗偏头痛起效快、安全,总疗效优于氟桂利嗪.

OBJECTIVE:To investigate the effect of electrical stimulation with bilateral scalp acupuncture on time parameters in video fluoroscopic swallowing study and cortical excitability in patients with dysphagia after cortical stroke, as well as its possible mechanism of action. METHODS:A total of 84 patients with dysphagia after cortical stroke were randomly divided into control group with 41 patients and observation group with 43 patients. The patients in the control group were given acupuncture based on acupoint selection for pseudobulbar palsy, and in addition to the treatment in the control group, the patients in the observation group were given electrical stimulation of bilateral scalp acupuncture, with acupuncture and pulse acupuncture at the lower 2/5 of the bilateral anterior oblique parietotemporal lines[on the line connecting Qianshencong (EX-HN1) to Xuanli (GB6)] and the lower 2/5 of the bilateral posterior oblique parietotemporal lines [on the line connecting Baihui (GV20)and Qubin (GB7)], with a needle retaining time of 30 minutes, once a day and 6 times a week for 3 weeks. Before treatment and after 3 weeks of treatment, oral delay time (ODT), oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were compared between the two group; the Rosenbek Penetration-Aspiration Scale was used to evaluate penetration-aspiration and appro-ximate entropy (ApEn) of EEG nonlinear index. RESULTS:After treatment, both groups had significant reductions in ODT, OTT, PDT, PTT, and Rosenbek Penetration-Aspiration score and a significant increase in ApEn (P<0.05). Compared with the control group after treatment, the observation group had significant reductions in ODT and OTT (P<0.05) and significant increases in the ApEn values of bilateral central, parietal, and posterior temporal regions (P<0.05), while there were no significant differences in PDT, PTT, and Rosenbek Penetration-Aspiration score between the two groups (P>0.05). CONCLUSION:In addition to body acupuncture, electrical stimulation with bilateral scalp acupuncture can improve ODT and OTT in the treatment of patients with dysphagia after cortical stroke, which may be associated with the increased excitability of the swallowing cortex.

目的 观察生熟白芥子不同配比三伏灸协定处方对支气管哮喘的临床疗效及皮肤反应观察.方法 将93例支气管哮喘患者随机分为A组(生熟白芥子1∶1)、B组(生熟1∶2)、C组(熟白芥子),每组31例,最终完成研究共88例,A组28例,B组30例,C组30例.各组均取双侧定喘、肺俞、心俞、厥阴俞穴,于三伏天穴位贴敷,每伏贴敷1次,共3次.观察各组治疗后临床疗效、中医症候积分改变,ACT评分、FEV1、PEF、EOS及皮肤反应评分的变化.结果 治疗后,A组、B组、C组有效率分别为78.60％ (22/28)、96.67％ (29/30)、13.33％ (4/30),各组疗效比较差异有统计学意义(P＜0.05).治疗后,B组中医症候积分,支气管哮喘ACT评分,肺功能参数FEV1、PEF,血清EOS优于A组、C组(P＜0.05).治疗后,3组皮肤过敏反应评分依次降低,差异有统计学意义(P＜0.05).结论 生熟白芥子不同配比三伏灸协定处均能改善支气管哮喘的症状,但随生白芥子比例增加,皮肤反应逐渐加重,起泡比例增加,但并非皮肤反应越强疗效越显著.生、熟白芥子1∶2配比三伏灸协定处方能够改善支气管哮喘中医相关症状同时,对ACT评分、FEV1、PEF、EOS均有改善作用,且皮肤反应轻,起泡少,患者依从性好.

Objective:To observe the effect on treating PSD (posts stroke depression) by acupuncture and medicine. Methods:150 cases were randomly divided into medicine treated group, acupuncture treated group, acupuncture combined with medicine group, with single blind method to observe changes of HAMD, the limb function, ADL and serum NE and 5-HT levels before and after treatment. Results:Before and after treatment HAMD, the limb function, ADL and serum NE and 5-HT levels of the three groups were significantly improved, acupuncture combined with medicine group was better than medicine treated group and acupuncture treated group. Conclusion:Compared with medicine or acupuncture alone, acupuncture combined with medicine has the comprehensive advantages on treating PSD.

目的探讨子午流注择时针法对治疗中风后便秘的临床疗效。方法将中风后便秘的患者90例随机分为治疗组46例、对照组44例,分别采用子午流注择时针法(治疗组)和普通针法(对照组)进行治疗。结果治疗组短期和长期疗效均显著优于对照组(P<0.05、P<0.05)。结论子午流注择时针法可以调节经脉气血运行,增强大肠的通降能力,达到益气通便的治疗目的。

目的观察针药结合疗法对卒中后抑郁患者抑郁状态及肢体功能康复的影响。方法将150例卒中后抑郁患者随机分为药物治疗组、针刺治疗组与针药结合组,采用单盲的方法观察三组患者治疗前后HAMD及肢体功能评分的变化情况。结果三组患者治疗前后HAMD及肢体功能评分均有显著改善,其中针药结合组在治疗前后差值方面均显著优于其他两组。结论针药结合疗法对卒中后抑郁患者的抑郁状态及肢体功能的综合改善较单纯针刺或药物治疗均显示出了明显的优势。

目的观察针熨结合治疗神经根型颈椎病的疗效。方法将101例患者随机分成生物陶瓷烫熨加针刺组(针熨组),单纯毫针组和单纯生物陶瓷烫熨组,在疗效上进行观察。结果三组方法均有效,但经统计学分析显示针熨组的治疗疗效优于其他两组。结论针熨结合能明显改善神经根型颈椎病的症状。

鸡眼为局限性的表皮角质增生过度而形成的圆锥形角化性损害.发生此病是因局部机械性摩擦、压迫或由于局部畸形骨刺等所致.笔者以直接灸治疗巨型鸡眼(母鸡眼),疗效满意,现报道如下: