OBJECTIVES:To establish a predictive model of acupuncture treatment of insomnia and to create a profile of suitable populations for acupuncture schemes, so as to help improve clinical efficacy. METHODS:The data was sourced from a prospective clinical study on acupuncture treatment of insomnia by "Tongdu Tiaowei" acupoint prescription (Baihui [GV20], Yintang [EX-HN3], bilateral Shenmai [BL62] and bilateral Zhaohai [KI6]). Data from 113 insomnia patients were included in the analysis of the present study, with the reduction rate of the Pittsburgh Sleep Quality Index (PSQI) served as the overall clinical efficacy evaluation. First, the feature selection was performed using univariate logistic regression and Boruta algorithm, and the prediction accuracy of the three boosting algorithms - adaptive boosting, gradient boosting, and extreme gradient boosting (XGBoost) - was compared for selecting the best algorithm. The grid search and ten-fold cross-validation were used to optimize the hyperparameters of the best algorithm. The optimal dataset partitioning method was selected using stratified random partitioning, and the best cut-off value was determined based on the Youden index. The predictive model for the therapeutic efficacy was constructed and its performance was evaluated. Finally, SHAP (shapley additive explanation) analysis was used to visually interpret the model. RESULTS:The features included in the model were the proportion of stage N1 to total sleep duration, the proportion of stage N2 to total sleep duration, R latency from lights out, stage N2 latency from lights out, the awake time after sleep onset, PSQI sleep efficiency score, and the presence of an old tongue (a tongue picture of a dry, rough texture and an old body). XGBoost was identified as the best algorithm, with the optimal probability threshold of 0.76, a corresponding precision of 0.91, a recall of 0.91, a F1 score of 0.91, an accuracy of 0.91, and an area under curve (AUC) of 0.82. Patients who meet the following conditions are more likely to respond to "Tongdu Tiaowei" acuoint stimulation:the proportion of N1 phase was about 6%-70% of the total sleep duration, N2 phase latency was less than about 40 min from the time when the lights were off, the wakefulness time was less than about 75 min or 100-300 min after falling asleep, the R phase latency was more than about 75 min from the time when the lights were off. The N2 phase were about 20%-50% of the total sleep duration, PSQI sleep efficiency score was 2 or 3, and there was no appearance of "old tongue". CONCLUSIONS:The predictive model of the efficacy of acupuncture treatment for insomnia established using XGBoost, along with the preliminary profile of the suitable population constructed using SHAP, provides a reliable auxiliary decision-making tool for acupuncture treatment of insomnia.

总结陆瑾采用舌针结合体针治疗失眠伴焦虑状态的经验.陆瑾治疗失眠伴焦虑状态以调和营卫、颐养心神为原则,兼以平衡脏腑阴阳,运用管氏舌针联合体针疗法,从整体观念出发,辨证诊治,临证灵活加减处方,标本兼治,疗效显著.附验案2则加以阐释.

目的:观察常规针刺结合唇四针治疗特发性面神经麻痹的治疗效果.方法:80例随机分为治疗组和对照组各40例,两组均予以常规针刺,治疗组加用唇四针治疗,两组疗程均为8周.结果:治疗组总有效率高于对照组(P＜0.05).两组治疗后FNFI、H-B均较治疗前好转(P＜0.05),且治疗组均优于对照组(P＜0.05).治疗组面神经功能恢复率高于对照组(P＜0.05).结论:唇四针可有效改善特发性面神经麻痹患者口角歪斜症状.

目的 观察腹针结合针刺运动治疗颈源性耳鸣的临床疗效和安全性.方法 将2019 年4 月—2020 年12 月在南京中医药大学附属南京中医院治疗的 90 例颈源性耳鸣患者随机分为腹针结合针刺运动组、腹针组和体针组,每组30 例.腹针结合针刺运动组予以腹针结合针刺运动治疗,腹针组和体针组分别予以腹针和体针治疗,均每日1 次,每周5 次,连续治疗4 周.于治疗前、治疗4 周后及8 周随访时比较3 组患者耳鸣残疾度量化表评分、耳鸣功能指数、颈部伯恩茅斯问卷评分,于治疗前及治疗4 周后测定3 组患者纯音听阈,并评价3 组治疗4 周后临床疗效,记录不良事件发生情况.结果 最终纳入86 例,其中腹针结合针刺运动组29 例,腹针组28 例,体针组29 例.腹针结合针刺运动组治疗4 周后及8 周随访时耳鸣残疾度量化表评分、耳鸣功能指数、颈部伯恩茅斯问卷评分均明显低于同期腹针组及体针组(P均<0.05),腹针结合针刺运动组治疗4 周后纯音听阈值均明显低于同期腹针组及体针组(P均<0.05).治疗4 周后腹针结合针刺运动组总有效率为86.2%(25/29),腹针组总有效率为60.7%(17/28),体针组总有效率为58.6%(17/29),腹针结合针刺运动组总有效率明显高于腹针组及体针组(P均<0.05).3 组均无不良反应发生.结论 腹针结合针刺运动治疗颈源性耳鸣能有效改善患者耳鸣、听力及颈部不适症状,临床疗效优于单纯腹针及体针,且安全性好.

肛肠病是临床多发疾病,手术是肛肠病早期主要的有效治疗手段,但术后疼痛、水肿、尿潴留、便秘等并发症仍是较大难题.针刺疗法可通过穴位的循经感传使得"气至病所",达到疏通经络、运行气血、调和阴阳、补虚泻实的功效,在缓解疼痛、促进创面愈合、减轻尿潴留、改善便秘、缓解肛门坠胀、改善睡眠症状、缓解焦虑情绪等方面发挥了重要作用.但是,针刺治疗肛肠病尚存在取穴不统一、机制研究不足等问题,今后应结合中医针刺镇痛机理和真实世界医疗数据研究,进一步提高针刺研究的质量和水平.

早在《黄帝内经》就有使用针刺方法治疗眼病的记载,其后诸多医家基于经络、脏腑理论开创了耳针疗法.耳尖放血因其简便易行、安全有效,在临床上常用于治疗头面五官等部位疾病,尤其适用于眼病,又因其相较针刺眼部周围取穴更简易安全,故被广泛应用于临床.近年来国内外诸多医家对于耳针疗法有了进一步研究,拓展了耳尖放血治疗眼病的范畴.文章梳理近年来相关文献加以归纳,并提出目前存在的问题和可能的未来研究方向.

三叉神经痛是临床上常见的神经系统疾病.近年来针灸疗法因具有疗效显著、操作简单、安全性高等优点,逐渐成为三叉神经痛的主要治疗手段之一.本文介绍用浮针配合常规针刺疗法治疗顽固性三叉神经痛验案1则,探讨其治疗机制,以期为临床上治疗此病提供参考.

贝尔面瘫是病因不明的急性同侧面神经麻痹,多由于病毒感染、受寒等引起面神经水肿或脱髓鞘改变,以眼睑闭合不全(抬眉、闭眼困难、不能皱眉)、口角歪斜(骨腮漏气)为主要临床表现的一种疾病.恰当的治疗可有效减少后遗症状,而不恰当的治疗则可导致面肌痉挛,加重面瘫的并发症,如鳄鱼泪等.

笔者查阅近十年穴位贴敷治疗失眠症的相关文献,旨在明确穴位贴敷治疗失眠的机制及疗效,为临床推广提供理论依据.经过整理总结,发现穴位贴敷治疗失眠有一定的疗效,且优于目前临床用药,在此基础上配合针刺、耳穴压豆、汤药方剂的联合运用,可使效果更显著.本文兼从中医、西医两方面分别阐述穴位贴敷治疗失眠的机制,中医认为穴位贴敷通过药物与穴位之间的协同作用,起到调节脏腑功能甚至平衡整体的作用.西医认为透皮给药系统与穴位的特异性,是穴位贴敷治疗失眠的主要机制.

OBJECTIVE:To explore the bidirectional regulation of acupuncture based on a subgroup analysis of multicenter randomized controlled trial of acupuncture with Tiaoshen Jianpi for irritable bowel syndrome (IBS).METHODS:A total of 519 patients were included in the analysis, including 137 patients with constipation type irritable bowel syndrome (IBS-C) (92 cases in the acupuncture group and 45 cases in the polyethylene glycol [PEG] group), and 382 patients with diarrhea type irritable bowel syndrome (IBS-D) (252 cases in the acupuncture group and 130 cases in the pinaverium group). The patients in the acupuncture group were given acupuncture at Baihui (GV 20), Yintang (GV 29), Tianshu (ST 25), Shangjuxu (ST 37), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) once every other day, 3 times a week. The patients in the PEG group received polyethylene glycol 4000 powder orally, and the pinaverium group received pinaverium bromide tablets orally. All were treated for 6 weeks. The IBS symptom severity score (IBS-SSS) was assessed at baseline, treatment period (2, 4, 6 weeks of treatment) and 12 weeks of follow-up, and the IBS quality of life (IBS-QOL) score was evaluated at the baseline period, 6 weeks of treatment and 12 weeks of follow-up.RESULTS:The total IBS-SSS scores of the two groups of IBS-C patients at 2, 4, 6 weeks of treatment and follow-up of 12 weeks were lower than those in the baseline period (P<0.01). The total IBS-SSS score in the IBS-C acupuncture group was lower than that in the PEG group at 12 weeks of follow-up (P<0.05). The total IBS-SSS scores of the two groups of IBS-D patients at 2, 4, 6 weeks of treatment and 12 weeks of follow-up were lower than those in the baseline period (P<0.01). The total IBS-SSS scores in the IBS-D acupuncture group were lower than those in the pinaverium group at 2, 4, 6 weeks of treatment and 12 weeks of follow-up (P<0.05). The total IBS-QOL scores at 6 weeks of treatment and 12 weeks of follow-up were higher than those in the baseline period in both groups of patients with IBS-C (P<0.01). The total IBS-QOL scores at 6 weeks of treatment and 12 weeks of follow-up were higher than those in the baseline period in both groups in patients with IBS-D (P<0.01). The total IBS-QOL score in the IBS-D acupuncture group was higher than that in the pinaverium group at 18 weeks of follow-up (P<0.05).CONCLUSION:Acupuncture with Tiaoshen Jianpi can improve the clinical symptoms and quality of life of patients with IBS-C and IBS-D, which can regulate different functional states (constipation and diarrhea) of the same disease (irritable bowel syndrome), reflecting the bidirectional regulation of acupuncture.

目的观察舌针结合体针对围绝经期失眠患者症状及血清雌二醇（E2）、促卵泡生成素（FSH）、促黄体生成素（LH）水平的影响。 方法选取25例围绝经期失眠患者采用舌针结合体针治疗，操作时先取体针针刺穴位：百会、太阳、印堂、神门、内关等常规针刺，留针30 min，每隔10 min行针1次，然后取舌针穴位：心穴、肝穴、肾穴等，进针0.5~1 mm，进针后进行小幅度（ 结果治疗后患者PSQI各项因子成分评分及总评分、Kupperman总评分、血清FSH、LH水平均低于治疗前（P 结论舌针结合体针针刺治疗能明显改善围绝经期失眠患者的入睡困难、睡眠质量、日间功能、围绝经期症状，同时能使血清FSH、LH水平下降，血清E2水平升高。

OBJECTIVE To compare the curative effect on diarrhea-predominant irritable bowel syndrome (IBS-D) between acupuncture for regulating shen and strengthening spleen and pinaverium bromide, and explore the relevant mechanism of curative effect of acupuncture in view of polymorphism of 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR). METHODS A total of 231 patients with IBS-D were randomized into an acupuncture group (154 cases) and a western medication group (77 cases) at the ratio of 2 to 1. In the acupuncture group, acupuncture was applied to acupoint regimen for regulating shen and strengthening spleen, i.e. Baihui (GV 20), Yintang (GV 29), Tianshu (ST 25), Shangjuxu (ST 37) and Zusanli (ST 36), etc. The treatment was given once every 2 days, 3 times a week. In the western medication group, pinaverium bromide was prescribed for oral administration, 50 mg each time, 3 times daily. The duration of treatment was 6 weeks in each group. Separately, before treatment, after treatment and in 3-month follow-up, the IBS symptom severity scale (IBS-SSS) and IBS quality of life scale (IBS-QOL) scores were adopted in assessment. After treatment, the curative effect and safety were compared between the two groups. Before treatment, 5-HTTLPR genotypes were determined in the patients. RESULTS After treatment and in follow-up, the total scores of IBS-SSS in the patients of the two groups were all reduced as compared with those before treatment (P<0.01) and the scores in the acupuncture group were lower than those in the western medication group (P<0.01). After treatment and in follow-up, the total scores of IBS-QOL in the two groups were all increased as compared with those before treatment (P<0.01) and the score in the acupuncture group was higher than the western medication group in follow-up (P<0.01). The total effective rate was 79.2% (122/154) in the acupuncture group, higher than 58.4% (45/77) in the western medication group (P<0.01). There was no severe adverse reaction found in the two groups. The difference in the total score of IBS-SSS before and after treatment in the patients with LS and SS genotypes was greater than that in the patients with LL in the acupuncture group (P<0.01). The difference in the total score of ISB-SSS before and after treatment in the patients with SS genotype was greater than that in the patients with LL in the western medication group (P<0.01). The difference in the total score of IBS-SSS before and after treatment in the patients with LS and SS genotypes in the acupuncture group was greater than that in the patients with the same genotypes in the western medication group (P<0.01). CONCLUSION Acupuncture for regulating shen and strengthening spleen achieves the more curative effect on IBS-D as compared with pinaverium bromide. The acupuncture regimen effectively relieves the clinical symptoms and improves the quality of life in patients as well as presents a satisfactory long-term effect and safety. The clinical curative effect of acupuncture is correlated with 5-HTTLPR polymorphism, in which, the curative effect of acupuncture may be more effective in the patients with LS and SS genotypes.

天宗穴是手太阳小肠经腧穴,按其体表分布位于肩胛区,查阅大量文献发现,其主治特性与其解剖部位具有高度相关性.临床中由于患者治疗体位的差异性,天宗穴的体表位置可出现一定的偏移,因此为取得较好的临床疗效,需要考虑不同体位下天宗穴的具体定位,以及根据其经络归属、解剖位置剖析其主治规律.

该文介绍腹针结合浮针治疗颈源性耳鸣病案1则.

介绍陆瑾教授治疗面肌痉挛的经验.陆教授认为面肌痉挛的发病多基于正虚不固,外邪客络,使面部经络因气血不和、经筋功能失调,终致面部肌肉痉挛、抽搐,甚至萎缩、瘫痪.临证中重视面部望诊,取穴以局部腧穴为主,选取眼部相应穴位和肢体远端穴位,以舒筋通络、息风止搐为总纲,采用体针结合眼针治疗,临床效果颇佳.附验案1则加以佐证.

中医治疗围绝经期失眠的疗法主要有中药内服治疗、普通针刺疗法、特殊针刺疗法、综合疗法等.目前,存在的问题有:①部分临床研究缺乏大样本量、严谨科学的对照实验设计和循证医学依据.②临床研究中缺少描述不良反应、注意事项及处理方法等内容.③较少临床研究的针灸方案按照STRICT报告条目进行针刺细节的描述,针刺疗法的可操作性、透明性、可重复性不显著.④基础研究方面,中医治疗该病的临床作用机制和实验研究较少.今后,应扩大样本量,增加循证医学证据,按照STRCIT报告条目进行针刺细节的描述,开展对该病作用机制的相关研究等.

目的:比较微针针刺眼睑局部联合常规针刺与常规针刺治疗面瘫恢复期眼睑闭合不全的临床疗效.方法:将100例面瘫恢复期眼睑闭合不全患者随机分为观察组和对照组,每组50例.对照组采用常规针刺方法,穴取患侧攒竹、阳白、瞳子髎、四白等.观察组在对照组基础上加用眼睑局部微针针刺.两组均每日治疗1次,留针30 min,每周5次,治疗4周后评定疗效.结果:治疗后,观察组总有效率为94.0％(47/50),高于对照组的78.0％(39/50,P<0.05).结论:眼睑针联合常规针刺能促进面瘫恢复期眼睑闭合功能的恢复,疗效优于常规针刺.

OBJECTIVE:To evaluate the effect and safety of acupuncture for the treatment of irritable bowel syndrome (IBS) through comparisons with those of polyethylene glycol (PEG) 4000 and pinaverium bromide.PATIENTS AND METHODS:This multicenter randomized controlled trial was conducted at 7 hospitals in China and enrolled participants who met the Rome III diagnostic criteria for IBS between May 3, 2015, and June 29, 2018. Participants were first stratified into constipation-predominant or diarrhea-predominant IBS group. Participants in each group were randomly assigned in a 2:1 ratio to receive acupuncture (18 sessions) or PEG 4000 (20 g/d, for IBS-C)/pinaverium bromide (150 mg/d, for IBS-D) over a 6-week period, followed by a 12-week follow-up. The primary outcome was change in total IBS-Symptom Severity Score from baseline to week 6.RESULTS:Of 531 patients with IBS who were randomized, 519 (344 in the acupuncture group and 175 in the PEG 4000/ pinaverium bromide group) were included in the full analysis set. From baseline to 6 weeks, the total IBS-Symptom Severity Score decreased by 123.51 (95% CI, 116.61 to 130.42) in the acupuncture group and 94.73 (95% CI, 85.03 to 104.43) in the PEG 4000/pinaverium bromide group. The between-group difference was 28.78 (95% CI, 16.84 to 40.72; P<.001). No participant experienced severe adverse effects.CONCLUSION:Acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks.TRIAL REGISTRATION:Chinese Clinical Trials Register, ChiCTR-IOR-15006259.

患者,男,72岁,退休职工,于2017年7月10日初诊.主诉:双侧胁肋部、右侧头颞部疼痛反复1年余,加重1个月.现病史:患者于2002年发现右侧肾癌,行右肾切除术后,一般情况良好,1年前患者自觉牙齿颜色变深,全身多处疼痛,遂于南京市第一医院查核素骨显像示:多发骨代谢异常;考虑多发骨转移可能.患者拒绝行放化疗,长期口服曲马多缓解疼痛,疗效不显.2017年6月9日于南京市中医院体检时查MRI示:①右侧第7、9肋骨,左侧第8肋骨及右侧肩胛骨破坏,左侧第6肋骨前段骨破坏伴皮下软组织肿块;②肾癌切除术后改变;胆囊结石.癌胚抗原(CEA):19.04 ng/mL;肾功能:肌酐(Crea):142.0 μmol/L,尿酸(UA):453.0 μmol/L;心电图:完全性右束支传导阻滞.刻下症:双侧胁肋部、右侧头颞部及背部疼痛明显,疼痛视觉模拟量表(VAS)评分为8～9分,四肢活动不受限,精神差,纳少,二便调,夜间疼痛明显,影响睡眠;舌尖红、苔黄腻,脉弦数.

陆瑾教授临证尤重病机审查,认为耳鸣病因主要有情志内伤、年老体虚、起居失常和外感风邪.其病性分虚实两端:虚者为气、血、精不足,耳窍失养;实者为风、火、痰扰乱,清窍失宁.治疗以调理中焦、清肝、补肾为基本法则,运用腹针引气归元(中脘、下脘、气海、关元)调理中焦以升清降浊.按照神龟全息理论重用阴都穴疏调耳窍,结合常规针刺远近选穴、辨证取穴、随证加减选穴以清肝火、补肾健脾豁痰、疏散风邪,辅以耳穴压豆、鸣天鼓法敲打耳后穴位及疏导心理、畅达情志、调摄起居和饮食治疗各型耳鸣.