带状疱疹后神经痛(postherpetic neuralgia,PHN)是最常见的一种神经病理性疼痛,也是带状疱疹(herpes zoster,HZ)最常见的并发症,其发病率为3.9～42.0/10万[1-2].临床表现以疼痛为主,常伴有睡眠障碍和焦虑抑郁等情感障碍,严重损害患者的生活质量[3],超过50％的顽固性PHN患者有自杀倾向[4].

Objective: To observe the effect of intradermal needle therapy on back-shu points of five zang organs in treating chronic fatigue syndrome (CFS) and provide evidence for the usage of unilateral back-shu point. Methods: Patients were randomly divided into bilateral back-shu point group, unilateral back-shu point group and non-acupoint group, remove shedding cases, each group remaining 30 patients. In bilateral back-shu point group, both sides of back-shu points of five zang organs were selected. In unilateral back-shu point group, only one side was selected, left or right alternately. The location where non-acupoint group inserted by intradermal needles were outward from the back-shu points, left or right alternately. Fatigue Scale-14 (FS-14) was used to evaluate the fatigue level and the scores' improvement of physical fatigue and mental fatigue revealed the therapeutic effect on body constituents and spirits of CFS patient. Results: After the 8-week intradermal needle therapy, the total effective rate was 83.33％ in the bilateral back-shu point group, which was 76.67％ in the unilateral back-shu point group and 50.00％ in the non-acupoint group. The curative effects of the two groups whose back-shu points of five zang organs were inserted by intradermal needles were better than the non-acupoint group(P<0.05). There was no significant difference in clinical efficacy between the bilateral back-shu point group and the unilateral back-shu point group (P>0.05). There were statistical differences in FS-14 questionnaires including total, physical and mental scores between before and after the treatment in both the two back-shu point groups(P<0.05). Only the scores of total and physical fatigue in decreased in non-acupoint group(P<0.05), which means it couldn't help to alleviate mental fatigue statistically(P>0.05). Conclusions: (1) The intradermal needle therapy on back-shu points of five zang organs for CFS has a satisfying clinical efficacy in curing tiredness. It can help to reduce both physical and mental fatigue for the patients. Hence, it can regulate both body constituents and spirits simultaneously. (2) Needling the unilateral acupoints can get similar clinical efficacy to the bilateral points. It reveals that we can cut cost by reducing the consumption of the amount of intradermal needles used on one side. (3) Both the groups of back-shu points get better clinical efficacy than the non-acupoint group dramatically. The reason of why the intradermal needle can treat CFS maybe that back-shu points of five zang organs can regulate the functions of five zang organs characteristically.

在中医文献中,"导气"一词最早见于《灵枢·五乱》:"五乱者,刺之有道乎……徐入徐出,谓之导气,补泻无形,谓之同精,是非有余不足也,乱气之相逆也."有学者[1]认为,针灸学之"导气"或移用于"道家或以导气养性"(《论衡·道虚》),与道家养生调息之徐徐呼吸的特性相似,是一种"徐入徐出",非补非泻,通过引导逆乱之气恢复如常以治疗"五乱"的针刺方法.笔者通过查阅近现代针灸名家的相关著述[2-3],发现"导气"或"导气法"一词的内涵已不限于治疗"五乱"的一种针刺方法,而是扩大为"调气"和"行气"并举的一类针刺操作方法.有医者[4-6]则将"导气法"与"行气法"等同,将其作为针刺调气的辅助手法以引导经气运行.与"徐入徐出"之导气针法的"调气"作用相比,引导经气运行之导气法可增强"气至针下"和"气至病所"的作用,进而提高针刺调气的效果.笔者不揣浅陋,试阐述对导气法理论及其针灸临床应用的思考,以期与同道共同探讨.

呃逆,相当于西医学中的膈肌痉挛[1],与膈肌结构和功能的异常改变密切相关,是膈肌间歇性不自主痉挛收缩,空气随之迅速进入呼吸道,声门短暂关闭,声带振动而发出短促响亮声音的一种疾病.呃逆持续时间超过48 h则称为顽固性呃逆[2].

背景 笔者所在课题组前期研究发现,基于"根结"理论辨经取穴针刺治疗无先兆偏头痛具有良好的临床疗效,但其脑内调节机制尚不明确.目的 探讨基于"根结"理论辨经取穴针刺治疗无先兆偏头痛患者的临床疗效及其调控脑区.方法 2019年10—12月,在北京中医药大学东直门医院门诊公开招募到无先兆偏头痛患者15例,均进行基于"根结"理论辨经取穴针刺治疗,3次/周,连续治疗4周.比较本组患者治疗前后头痛发作次数、视觉模拟评分法(VAS)评分、止痛药使用次数、偏头痛特异性生活质量问卷(MSQ)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分;采用静息态功能磁共振成像技术观察本组患者治疗前后脑区区域一致性(ReHo)值的变化.结果 本组患者治疗后偏头痛发作次数少于治疗前,VAS评分、SAS评分、SDS评分低于治疗前,MSQ的情感领域评分、功能限制领域评分、功能障碍领域评分高于治疗前(P<0.05).本组3例患者起针后足趾有针刺感,均未进行干预并于2～3 d自行消失,未影响试验进程.功能磁共振成像(fMRI)结果显示,与治疗前比较,本组患者治疗后左侧额上回及双侧前扣带回上的ReHo值减弱,差异有统计学意义〔体素个数409个,团块体积11043 mm3,MNI坐标(X=0,Y=31,Z=46),峰值t值为-5.897,经高斯随机场多重比较校正,P<0.05〕.结论 基于"根结"理论辨经取穴针刺治疗无先兆偏头痛患者的临床疗效确切,能有效降低偏头痛发作次数、缓解疼痛程度,提高患者生活质量,减轻患者焦虑、抑郁情绪;其可能通过调节额上回和前扣带回ReHo值,进而调节了痛觉处理及痛觉情绪反应.

卒中后抑郁属于脑器质性抑郁障碍,病位在心君脑府,“脑络受损、神失所主”是其基本病机,“肝失疏泄、肝气郁滞”贯穿卒中后抑郁始终,是其病机关键,故“调神”是其治疗的关键.针灸治疗卒中后抑郁选用的主穴使用频次排名前十位的分别是:百会39次,太冲30次,神庭29次,内关27次,神门25次,三阴交22次,四神聪20次,印堂18次,合谷17次,足三里13次.其中以“调神”为主的相关腧穴6个,分别为百会、神庭、内关、神门、四神聪、印堂,使用频次达158次,以“疏肝”为主的相关腧穴2个,太冲、合谷,使用频次47次.诸穴合用,行气血,和阴阳,疏经络,调脏腑,以达到治疗疾病、改善预后的作用.

目的:观察针刺腧穴痛觉敏感点治疗偏头痛的临床疗效.方法:将60例偏头痛患者随机分为痛敏穴组和非穴组,确定受测者头部、颈部、上肢、下肢相应腧穴,用圆形探棒寻找痛觉敏感点,痛敏穴组在敏感点处行针刺泻法操作,非穴组在敏感点外旁开5mm处浅刺2～3mm,不做补泻手法,均留针20min,每周治疗2次,12次为1个疗程,1个疗程后评价治疗结果.结果:痛敏穴组治疗后VAS评分显著下降(P＜0.05),各腧穴敏感点压痛阈值显著增高(P＜0.05),其中角孙穴的敏感点治疗后压痛阈值显著增高(P＜0.01);非穴组治疗后VAS评分较治疗前无显著性差异,各腧穴敏感点压痛阈值与治疗前相比无显著性差异.结论:针刺腧穴敏感点能明显提高皮肤压痛阈值,从而减轻患者对疼痛的敏感度,达到临床治疗偏头痛的目的.

目的:初步分析总结北京市周围性面瘫住院患者的病因,并将其与患者临床主要的兼症进行相关性分析,为周围性面瘫的预防和临床治疗提供一些有价值的参考依据.方法:本研究纳入符合标准的住院患者病历资料共165份,对其中信息进行采集并整理后录入到SPSS 19.0统计软件做出统计学分析,对所得结果进行描述性分析.结果:面瘫常见的病因包括外因和内因,外因中风寒者140例(84.9％),风热者25例(15.1％);内因中劳累者63例(38.2％),情绪波动者53例(32.1％),多伴有眼、耳部不适,如眼干、流泪、耳周疱疹、听觉过敏、听觉减退等;劳累兼情绪波动者35例(21.2％),多同时伴有舌、眼、耳部不适;无明显内因者14例(8.5％).结论:周围性面瘫有外因与内因之分,外因是引起本病的直接原因,内因是诱发本病的潜在因素,不同内因与不同主要兼症有明显的相关性.内、外因多共同作用于人体而发病.

The clinical study on acupuncture-moxibustion of traditional Chinese medicine has been attracting more and more global attention. With the development of medical pattern, we hold that, to prove the therapeutic efficacy, not only modern clinical research methods should be adopted, but a scientific and standard evaluation method in accord with the features of acupuncture-moxibustion also needs to be developed. We also believe that, in the clinic of acupuncture-moxibustion, disease differentiation treatment and syndrome differentiation treatment share an equal role, as they are relatively independent but mutually unified, together boosting the completion of treatment for a type a disease in a dynamic variation process.

To explore the relativity between heart-brain and post-stroke anxiety disorder by analyzing the pathogenesis of post-stroke anxiety disorder combined with the physiology and pathology of organs. The acupoint selection thought was explored by its selection rule according to literature. Post-stroke anxiety belongs to the brain organic anxiety disorder, whose basic pathogenesis is mind injury. The crucial cause is heart and brain disorder at the same time. Thus, Baihui (GV 20), Fengfu (GV 16) for brain and Xinshu (BL 15), Shenmen (HT 7) for heart can improve anxiety disorder according to the theories such as five organ, qijie (qi thoroughfare), sihai (four seas), meridian and collateral.

根据患者的症状及舌脉表现，笔者认为该例面瘫后焦虑患者病机为肾气不足、神志被扰，治疗时以补肾纳气，安神定志为原则，取足少阴肾经原穴太溪穴，行提插补法，导气上行至丹田，肾气充足，神安志定，则惊恐等诸多症状自除。

目的:观察足三阳经井穴点刺放血对硝酸甘油诱发偏头痛模型大鼠的影响.方法:随机将SD大鼠分成空白对照组、模型组、西药组、放血组,每组10只.西药组造模成功后立即给大鼠灌对乙酰氨基酚(必理通)10mg/kg,并固定在大鼠固定器30min;放血组造模成功后,立即将其固定在大鼠固定器上,双侧厉兑、足窍阴、至阴穴点刺放血,留针30min.造模成功后4h,从各组大鼠目内眦抽取静脉血约3mL检测血清一氧化氮(N0)和5-羟色胺(5-TH).结果:足三阳经井穴点刺放血和必理通灌胃在干预后半小时内均可改善SD偏头痛模型大鼠挠头、爬笼次数,但没有显著差异.干预1h后,足三阳经井穴点刺放血对偏头痛的止痛效果开始显著优于必理通灌胃(P＜0.05).足三阳经井穴点刺放血和口服必理通均可降低大鼠血清NO含量、增高血清5-TH含量.结论:足三阳经井穴点刺放血均可硝酸甘油诱发SD大鼠偏头痛有治疗作用,其可能的机制之一是降低血清NO含量,同时升高血清5-HT含量;证明足三阳经井穴与头部存在着紧密的联系,为完善经络学说和根结理论提供实验依据.

偏头痛是一种反复发作性头痛，它不仅因频繁和严重的头痛导致患者的学习与工作能力下降、生活质量降低，而且也与脑卒中、情感障碍等多种疾患相关。在针灸门诊中占有相当大的比例，绝大部分患者均可经针灸治疗使偏头痛得到缓解或治愈。文章通过整理针灸治疗偏头痛的文献报道，从脏腑辨证、三因辨证、气血津液辨证等方面进行归纳，并结合目前的临床研究，以“理论—临床—理论”的模式整理出针灸治疗偏头痛的论治思路。通过探讨研究，博采各家之所长，突出了中医、针灸辨证论治的特色，明确了针灸治疗的优势及广阔前景。

目的:观察局远配穴、近部选穴、远部选穴及选取非穴法对肩周炎疗临床疗效的影响.方法:根据随机对照的原则,将所有纳入肩周炎患者分为A组(局远配穴组)、B组(局部选穴组)、C组(远部选穴组)及D组(非穴组),分别予针刺治疗,同时配合患者活动肩部,先针远部腧穴,再针刺局部腧穴,留针20 min.结果:局远配穴、近部选穴、远部选穴及选取非穴法对肩周炎均有一定的治疗作用.局远配穴组疗效明显优于其他3组,P＜0.05;近部穴位组与远部选穴组疗效无明显差异,P＞0.05;非穴对照组较其他3组疗效差,P＜0.05.结论:局远配穴、近部选穴、远部选穴及非穴对肩周炎均有疗效,针刺局远配穴在缓解肩周炎患者肩部疼痛及改善肩关节功能活动度方面较单纯近针刺部选穴或远部选穴法有更好的疗效,且远期疗效稳定.

Acupuncture is playing an important role in ShangHan Lun, meridian theory is the foundation of six meridians theory, acupuncture such as needling, moxibustion and warm-needles are effective therapies in treating some exogenous febrile disease, among them, some therapeutic methods could be as adjunctive therapy, some could be taken as main therapy, therefore, acupuncture therapy could be thought as necessary complements for the pre-scription in treating exogenous febrile disease.

基本病机——不通则痛,不荣则痛 偏头疼属于中医学的"头风"范畴,自古相关研究甚多,古代文献中多称之为"偏头疼" "偏头风" "偏正头风" "偏正头疼" "脑风"等.其病因主要包括风、痰、湿、火、热、血虚、气虚、气血两虚等.其基本病理则不外乎2条:或因风火痰瘀等病因阻滞经络,导致经络不通,就是所谓的"不通则痛";或因气血不足,经络失养,就是"不荣则痛".不通则痛好理解,荣是古代的一种中医术语,就是荣养,常见于虚证,表现为隐隐作痛、空痛,其疼痛比较轻,但缠绵,持续时间较长.比如文字工作者用脑过度时会感到头部的隐隐作痛,或者年老肾虚后出现的头脑空痛.

过敏性疾病多属变态反应类疾病,是机体被致敏以后,再次与同一抗原接触时所产生的不同于平常或过高的免疫反应.根据不同的发病阶段,可分为速发型和迟发型两类,并以速发型过敏反应常见,包括皮肤、呼吸道、消化道过敏反应及过敏性休克等.祖国医学认为过敏性疾病主要由内因和外因两方面所致.外因多为外邪从口鼻腠理入侵,内因主要责之于脏腑功能失调.大量的临床研究报道已充分肯定了灸法对此类疾病的疗效.本文主要从作用机制、常用方法以及常用腧穴等方面对灸法治疗过敏性疾病作初步探讨.

Acupuncture Clinical Practice Guideline of Stroke Supranuclear Paralysis is the research result of a subproject of West Pacific Region program supported by WHO,Clinical Practice Guideline of Chinese Evidence-Based Medicine.Acupuncture has a good curative effect on stroke supranuclear paralysis and there is a lot of literature at ancient and modern time about acupoint selection and operation for treating this disease.It is a pioneering work to edit and write clinical practice guideline.The research group finally finished the guideline through questionnaire,group discussion,expert consultation,expert demonstration,and determination of some questions including disease choice,clinical problems,search and evaluation of literature and formation of recommendation proposal.The paper read and explained Acupuncture Clinical Practice Guideline of Stroke Supranuclear Paralysis from 4 aspects including background,difficult points and countermeasures,main content and characteristics.