Objective:To provide the evidence for quantitative assessment of clinical diagnosis of myofascial pain syndrome (MPS) of trapezius muscle and the therapeutic effect of acupotomy, utilizing portable shear wave elastography (SWE). Methods:A total of 49 subjects (including 21 cases of unilateral trapezius MPS, 20 cases of bilateral trapezius MPS and 8 healthy subjects) were recruited, including 98 trapezius samples. According to whether pain occurred or not, they were divided into an observation group (61 samples) and a control group (37 samples). The cases in the observation group were subdivided into an observation subgroup 1 (14 samples) and an observation subgroup 2 (47 samples) based on whether acupotomy was received. In the observation subgroup 1, under ultrasound guidance, only 1 intervention with acupotomy was performed to release the deep and superficial fascia layers of the trapezius muscle. In the observation subgroup 2 and the control group, no treatment was delivered. Before treatment, the shear modulus (G-value) and the score of visual analogue scale (VAS) were compared between the observation group and the control group, and the receiver operating characteristic (ROC) curve was plotted to determine the optimal diagnostic threshold of trapezius MPS. The G-value and VAS score were compared before and after treatment in the observation subgroup 1, and the therapeutic effect of acupotomy was assessed. Results:The G-value and VAS score in the observation group were higher than those in the control group (P<0.05) before treatment. For the diagnosis of trapezius MPS, the optimal diagnostic threshold of G-value was 9.08 kPa, yielding a specificity of 83.78% and a sensitivity of 75.41%. In the observation subgroup 1, both G-value and VAS score decreased after treatment in comparison with those before treatment (P<0.05). Conclusion:Acupotomy may improve the elasticity of the trapezius muscle and obtain the immediate therapeutic effect on trapezius MPS in patients. The portable SWE holds the promise for the objective evaluation of clinical diagnosis and therapeutic effect on trapezius MPS.

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.

《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.

目的 探索基于机器学习的人工智能(Artificial Intelligence,AI)辅助诊疗系统在非特异性腰痛诊断中的应用效果.方法 使用Thought Technology Ltd生产的FlexComp Infiniti 10肌电仪采集受试者腰部左右两侧多裂肌、左右两侧最长肌和左右两侧腰髂肋肌的肌电信号,15名受试者均为确诊非特异性腰痛患者,一次采集流程包括屈曲放松运动五次,双足桥式运动、左足桥式运动、右足桥式运动和Biering Sorensen等长运动各一次.3名资深医师使用常规诊断方式对患者进行诊断,并以此为标准,对比评价AI辅助诊断系统获得的结果.结果 AI辅助诊疗系统对本文选取的15名非特异性腰痛患者的检出准确性达到100％,且对于肌肉募集能力、疲劳速度和静息速度的检测结果与医生常规诊断方式相比具有良好的一致性,平均诊断用时减少26.3 min,具有统计学意义(P<0.05).结论 初步验证表明,该AI辅助诊疗系统可对非特异性腰痛提供准确高效的辅助诊断及量化评估,为临床检测提供可靠帮助.

We developed a portable non-specific low back pain measurement system EasiLBP and evaluated its performance in collecting EMG signals:during the wearer's movement without the assistance of a doctor, the collection of EMG signals by portable devices met problems such as large noise interference, difficulty in accurately calibrating the start and end points of the action interval, and imbalanced samples for feature recognition, et al. To challenge these problems, we proposed a small group-based noise removal method, a dynamic dual-threshold automatic method for identifying the start and end points of the motion interval, and a sampling method to balance group samples, respectively. Portable device and a medical EMG acquisition equipment Thought Technology FlexComp Infiniti 10 were used to perform EMG measurements on 15 patients with non-specific low back pain and 15 normal people. Clinical experiments and statistical analysis show that the portable EMG acquisition system has significant differences in EMG signal characteristics between normal people and non-specific low back pain patients, and it has good measurement consistency and accuracy with the medical EMG acquisition equipment.

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.

"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.

OBJECTIVE To detect the core muscle group in the patients with myofascial pain syndromes(MPS) by using the surface electromyography; to detect the distribution of muscle fiber type by the analysis of the median frequency and the slope of the median frequency. METHODS From October 2017 to March 2018, there were 100 patients with the MPS, including 45 males and 55 females; the average age was 48.5 years old, ranging from 29 to 76 years old. There were 40 cases of left back pain and 60 cases of right back pain. The course of illness was more than 6 months. Another 40 healthy patients without pain in the waist were included in the control group, 20 males and 20 females; the average age was 47.3 years old, ranging from 29 to 76 years old. All the patients had different degrees of back pain and muscle stiffness, which were diagnosed as lumbar fasciitis by clinical and imaging examination. Surface electromyography was used to measure the characteristics of the lumbar core muscles (multifissions, iliocostal muscles, and longest muscle) of the three groups in the Biering-Sorensen testing, such as median frequency(MF) and absolute slope of median frequency (MFs). RESULTS The MF values of the multifidus muscle in the three groups were as follows:the left side of the non-pain group was 133.88±26.61, and the right side was 131.39±29.81; left side of lift side pain group 117.29±10.93, right side 133.70±17.81; in the right pain group, the left side was 131.36±17.37, and the right side was 118.28±13.57. The MF values of the iliocostal muscle in the three groups were:106.94±28.01 on the left side of the non-pain group, 114.68±18.96 on the right side; left side of lift side pain group 93.95±11.17, right side 107.60±27.86; in the right pain group, the left side was 105.93±15.52, and the right side was 97.27±19.27. The MF values of the longest muscle in the three groups were:109.24±26.20 on the left side of the non-pain group, 112.58±17.70 on the right side. Left side of left side pain group 95.58±10.83, right side 108.79±26.39; in the right pain group, the left side was 106.50±17.98, and the right side was 98.20±11.16. The MFs values of the multifidus muscle in the three groups were:0.221±0.109 on the left side of the non-pain group, and 0.259±0.169 on the right side; left side of left side pain group 0.318±0.184, right side 0.210±0.159; in the right pain group, the left side was 0.258±0.169, and the right side was 0.386±0.166. The MFs values of the iliocostal muscles in the three groups were:0.241±0.158 for the left side of the non-pain group, and 0.238±0.128 for the right side. Left side of left side pain group 0.330±0.208, right side 0.252±0.171; in the right side pain group, left side 0.249±0.150, right side 0.343± 0.144. The MFs values of the longest muscle of the three groups were:0.244±0.252 on the left side of the non-pain group, and 0.210±0.128 on the right side; left side of left side pain group 0.348±0.255, right side 0.241±0.224; in the right pain group, the left side was 0.239±0.155, and the right side was 0.334±0.233. There were no statistically significant differences in MF and MFs values of the left and right lumbar multifidus muscle, iliocostal muscle and longest muscle in the non-pain group(P>0.05). MF values of the pain side multifidus muscle, iliocostal muscle and longest muscle in the lumbago group were lower than those in the non-pain group(P<0.05). MFs values of the painful side multifidus muscle, iliocostal muscle and longest muscle in the low back pain group were higher than those in the non-pain group(P<0.05). CONCLUSIONS The muscle fatigue degree of the back muscle in the pain side of patients with MPs is decreased, and the muscle fiber type is dominated by II muscle fiber.

棘上韧带炎属于中医学“筋伤”范畴,其病位在经筋,肝肾不足,筋脉失养为其内因,慢性劳损、感受风寒、久卧湿地为其主要外因.气血运行不畅,筋脉失去濡养[1],故出现腰背痛等症状.中医常采用特殊针法[2]、火针[3]、针刀[4]等方式治疗,但因其有创且治疗过程疼痛剧烈,加之针刀、火针等治疗需要严格的消毒,无菌要求严格,患者接受度低.有学者提出冲击波作用于穴位可产生类似于针灸的效果[5],相关研究使用冲击波刺激穴位治疗髋关节疼痛[6]、失眠[7]和肱骨外上髁炎[8]等疾病,取得较好的疗效.

目的 基于中医经筋理论运用放散状冲击波治疗慢性跟腱炎,从而更好地对慢性跟腱炎进行治疗.方法 选取在我院门诊就诊的慢性跟腱炎患者63例,将其随机分为对照组32例和治疗组31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对足太阳经筋上定点的冲击波治疗.结果 治疗组有效率90.3％,对照组有效率71.9％,2组间差异性具有统计学意义(P＜0.05);治疗前后患者VAS比较,具有统计学意义(P＜0.01);而治疗组较对照组更为明显(P＜0.01);运动功能评定分级中治疗前后,差异有统计学意义(P＜0.01);治疗后治疗组功能评定比较更为明显(P＜0.05).结论 基于中医经筋理论运用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,值得推广.

目的:比较分期疗法与常规疗法治疗面神经炎的疗效.方法:190例面神经炎患者按1:1:1:1的比例随机分为4组,分期针刺组48例按急性期、静止期及恢复期采用不同的针刺方法;针刺对照组48例患者常规针刺治疗;分期中药组47例按急性期、静止期及恢复期在牵正散的基础上急性期患者加防风、羌活、桂枝、茯苓、黄芪及大青叶,静止期加黄芩、菊花、夏枯草、白芷、鸡血藤,恢复期加赤芍、当归、丹参,加减用药;中药对照组47例只服用牵正散.治疗6周后,比较4组患者的疗效及面神经功能积分.结果:治疗6周后,从临床疗效比较,总有效率4组间差异无显著性意义,而临床治愈率分期针刺组为83.3％,明显优于针刺对照组75％ (P ＜0.01),分期中药组治愈率为83％,优于中药对照组72.3％(P＜0.01),分期针刺组、分期中药组两组临床治愈率无统计学差异(P＞0.05).4组患者面神经语言功能、运动功能及综合功能评分与治疗前比较均有提高(P＜0.05),总积分分期针刺组＞针刺对照组(P＜0.05),分期中药组＞中药对照组(P＜0.05).结论:分期疗法能显著改善面神经炎患者的预后.

目的 观察面神经炎中医分型治疗效果.方法 95例面神经炎患者按1∶1的比例随机分为两组,治疗组48例,对照组47例.两组均按急性期、静止期及恢复期采用不同的针刺方法.同时,治疗组将患者分为风寒客络型、风热袭络型及瘀阻络脉型,在牵正散的基础上风寒客络型加防风、羌活、桂枝、黄芪;风热袭络型加黄芩、菊花、夏枯草;瘀阻络脉型加当归、赤芍、香附等中药治疗.对照组不分证型,只服用牵正散中药.治疗6周后,比较两组的疗效及面神经功能积分.结果 从临床疗效比较,治疗组临床治愈率为83.3％,明显优于对照组74.4％ (P＜0.01),而在总有效率方面,两组无统计学差异.治疗6周后,两组患者面神经运动功能、语言功能及综合功能均较前有所提高(P＜0.05),且与对照组相比,治疗组患者面神经运动功能、语言功能及综合功能有所提高(P＜0.05).结论 面神经炎中医分型治疗能显著改善预后.

Objective To observe the effect of moxibustion on the learning ability and memory of rat models of Alzheimer’s disease (AD) and the expression of amyloidβ protein (Aβ)-42, interleukin (IL)-1β, and IL-2, for unveiling the function and mechanism of moxibustion in treating AD.Method Forty-eight healthy male Sprague-Dawley rats were randomized into a sham-operation group, a model group, a Western medication group, and a moxibustion group, 12 rats in each group. The AD model rats were established by injection of Streptozotocin (STZ) into bilateral ventricles. From the 10th day after the operation, the moxibustion group started to receive moxibustion at Baihui (GV 20), Mingmen (GV 4), Changqiang (GV 1), and Guanyuan (CV 4); meanwhile, the Western medication group received Donepezil hydrochloride via intragastric administration. After 30-day treatment, the learning and memory ability was tested by using water maze, the hippocampal Aβ-42 was examined by immunohistochemical method, and the expression of hippocampal IL-1β and IL-2 was by double-antibody sandwich ELISA.Result Compared to the model group, moxibustion significantly down-regulated the levels of Aβ-42 (P<0.05) and IL-1β protein (P<0.05), up-regulated the level of IL-2 protein (P<0.05) in hippocampus, and markedly improved the learning and memory of AD rats (P<0.05).Conclusion Moxibustion can enhance the immunity and learning ability, which is plausibly related to the down-regulation of IL-1β, up-regulation of IL-2, and improvement of Aβ-42 in hippocampus.

OBJECTIVE:To observe the effect of acupuncture stimulation of bilateral "Hegu" (LI 4) and "Taichong" (LR 3, the so-called "Four Gate Points") on learning-memory ability, hippocampal interleukin-1 (IL-1) P and IL-2 and amyloid beta (Abeta) 42 levels in Alzheimer's disease (AD) rats,so as to reveal its underlying mechanism in improving AD.METHODS:Male SD rats were randomly divided into sham operation, model, medication and acupuncture groups (n = 12 rats in each group). The AD model was created by microinjection of streptozotocin (10 pL, 3 mg/kg) into the lateral ventricle (repeated the microinjection once two days later). Bilateral LR 3 and LI 4 were punctured with filiform needles and stimulated manually, once a day, 6 days a week for 4 weeks. The rats of the medication group were intragastric perfusion of Donepezil HOI (0.045 mg/kg), once a day for 4 weeks. The learning-memory ability was detected by Morris water maze swimming tests. The immunoactivity of hippocampal Abeta 42 was detected by immunohistochemistry, and the contents of IL-1 P and IL-2 in the hippocampus tissue were determined by ELISA.RESULTS:After modeling, the average escape latency of Morris water navigation task was significantly increased, and the target-platform crossing times of space probe trials were significantly reduced in the model group (P<0.05), suggesting a g-memory ability. After acupuncture intervention, the increased escape latency and the decreased target-platform crossing times were reversed, suggesting an improvement of the learning-memory. The hippocampal Abeta 42 immunoactivity and IL-1 beta content were significantly higher in the model group than in the sham operation group (P<0.05), but the hippocampal IL-2 content was markedly decreased in the model group (P<0. 05). Following the interventions, the increased Abeta 42 expression and IL-1 beta contents, and the decreased IL-2 contents in the hippocampus were also reversed in both the acupuncture and medication groups (P<0.05).CONCLUSION:Acupuncture may improve learning-memory ability in AD rats, which may be associated with its effects in reducing hippocampal Abeta13 42 expression and IL-1beta content and in up-regulating IL-2 level.

目的:探讨艾灸防治阿尔茨海默病(Alzheimer Disease,AD)的作用及其机制.方法:大鼠双侧脑室微量注射STZ造模,术后第10天艾灸组灸"关元""长强""命门""百会",同时西药对照组灌胃盐酸多奈哌齐,治疗30 d后用Moris水迷宫测各组大鼠学习记忆能力,再取材用ELISA法、免疫组织化学、Western blot等检测海马区GSK-3β活性及tau蛋白磷酸化位点(Ser396/Thr231)的含量和表达水平.结果:艾灸组与西药对照组较模型组平均游泳距离百分比上升;与假手术组比较,模型组大鼠海马CA1区椎体细胞形态结构异常,阳性染色深,而艾灸组与西药对照组较模型组形态结构完整,阳性染色浅;除假手术组外,GSK-3β活性及磷酸化tau蛋白Ser396、thr231位点相对表达量均升高,且西药对照组和艾灸组低于模型组.结论:艾灸可部分改善AD大鼠学习记忆,其可能通过抑制海马GSK-3β活性,降低p-tau S396、T231的磷酸化水平起到防治AD的作用,且作用效果与西药盐酸多奈哌齐相同.