郭剑华教授学术思想与临床经验总结及针刺颈段足太阳膀胱经为主治疗神经根型颈椎病60例临床观察

发布时间：2018-05-06 00:03

本文选题：神经根型颈椎病 + 输刺法　；参考：《成都中医药大学》2016年博士论文

【摘要】：背景流行病学调查显示：中国颈椎病患者的发病率约为3.8%-17.6%,且每年新增颈椎病患者大约1百万,随着社会的进步和人民生活水平的提高以及社会竞争的日益激烈,颈椎病有迅速增加和年轻化趋势,给患者的正常生活与工作带来极大的痛苦和不便,将成为21世纪发病率最高的疾病之一。其中神经根型颈椎病((Cervical Spondylotic Radiculopathy, CSR))占60%-70%,绝大多数神经根型颈椎病可经非手术治疗痊愈或缓解,因此采取更为安全、效佳、价廉、副作用小的治疗手段来医治此病显得非常重要。本人在跟师学习和自己临床实践中,继承导师郭剑华教授在“颈椎病综合治疗”思想及多年临床经验的基础上,希望能进一步提高传统中医综合疗法治疗神经根型颈椎病的疗效,进一步阐明中医治疗神经根型颈椎病的机理。目的追溯郭剑华教授治疗筋伤疾病的学术渊源,整理、归纳、总结郭剑华教授治疗筋伤疾病的学术思想和临床经验,重点总结郭剑华教授对正常颈椎生理,神经根型颈椎病中医病因病机,中医综合治疗的临床经验；总结从太阳经论治神经根型颈椎病的经验,验证输刺足太阳膀胱经治疗神经根型颈椎病的有效性。探索神经根型颈椎病颈部输刺法的安全性、有效性,期能进一步完善治疗神经根型颈椎病疗效可靠、标准统一、可操作性强、安全性高的中医疗法,以提供指导临床应用,进一步提高中医综合疗法的临床疗效。方法经验总结方面,通过跟师学习,结合自身临床实践,学习中医经典和针灸典籍,查阅相关医学文献,归纳总结郭剑华教授论治筋伤疾病的学术思想和经验总结。临床研究方面,2014年10月至2015年4月,重庆市中医骨科医院筋伤科门诊确诊的患者,根据纳入标准和排除标准,选取神经根型颈椎病患者60例,根据初次就诊次序,按随机数字表法分为治疗组A和对照组B共两组,每组各30例。治疗组A采用输刺法针刺主穴,根据MRI提示的颈椎间盘突出部位,选用病变对应节段和下一节段的足太阳膀胱经为主穴；患侧上肢取穴,C5：臂佈,C6：手三里,C7：合谷,C8：中渚(例如：C4/5椎间盘突出,主穴取C4和C5棘突下旁开1.3寸,上肢取C5：臂佈)。对照组B采用针刺颈部取夹脊穴(选用对应节段和下一节段的棘突下缘旁开0.5寸),根据症状表现所在经络,患侧上肢进行辨证循经取穴(输穴),手阳明经选用三间,手太阴经选用太渊,手太阳经选用阳溪,手少阴经选用神门,手少阳经选用中渚,手厥阴经选用大陵。采用临床症状、体征评分,疼痛程度评价使用标尺法,对患者进行治疗前和治疗后评分,比较两组治疗前后,症状体征情况,颈椎活动度,积分下降情况,比较两组的显效率。结果1.郭剑华教授学术思想渊源：主要来源于中医四大经典,历代古典针灸典籍,如《黄帝内经》、《金匮要略》、《伤寒论》、《温病条辨》、《针灸甲乙经》、《针灸大成》等,取法仲景伤寒,系统学习中医经典著作,吸收现代医学关于颈椎病的认识,借助现代医学检验和检查手段,在长期临床实践中,兼收并蓄,融会贯通,形成了自己独到的学术思想,认为神经根型颈椎病发病原因在于颈部失衡,病机关键在于太阳经气不舒。2.郭剑华教授治疗筋伤疾病主要学术观点：(1)融汇古今,以“和”为法,(2)中西结合,病证结合；(3)熟读经典,活用经方；(4)提出了“筋伤顽疾、病证结合、法当综合、防治并重”的原则；(5)针灸并用,针药并用,内外合用,医患协作。3.郭剑华教授治疗神经根型颈椎病经验：(1)各种致病因素皆可导致神经根型颈椎病,正气虚弱是疾病发生的内因,风寒湿邪侵袭,劳损,颈部姿势不良,外伤等各种因素都可以导致神经根型颈椎病的发生；(2)颈椎内在动态平衡被打破是神经根型颈椎病发病的关键,各种致病因素对颈部的长期侵袭,量变引起质变,最终导致颈椎动态失衡；(3)神经根型颈椎病的病机关键在于太阳经气不舒,寒湿,瘀血,痰湿,痰饮,瘀积,气滞,皆标也,皆为病理产物,各种病理产物最终导致太阳经气不舒而发病；(4)从太阳经论治是治疗神经根型颈椎病的重要方法；(5)神经根型颈椎病致病因素众多,病因病机复杂,易于复发,治疗方法当以综合治疗为主；(6)恢复颈椎的动态平衡,达到“阴平阳秘”的状态是颈椎病治疗的目标。4.临床研究结果(1)本研究治疗组A和对照组B,各完成30例；全部共完成60例。(2)两组患者性别构成情况,经x2检验,p值0.05,无统计学意义,故性别分布没有差异；两组患者年龄分布情况,经x2检验,p0.05,无统计学意义,说明年龄分布没有差异；两组患者病程情况,经x2检验,p0.05,无统计学意义,说明病程情况没有差异。(3)临床疗效的比较,治疗组和对照组的显效率分别为80%和56.7%,p0.05,两组比较具有显着性差异,说明治疗组比对照组对该病患者临床症状和体征的改善优于对照组。(4)两组治疗方法均能起效,均有较好的临床疗效。结论本研究结果显示,两组方案治疗神经根型颈椎病皆有良好的疗效,输刺颈段足太阳膀胱经为主治疗神经根型颈椎病疗优于针刺颈夹脊穴,输刺颈段足太阳膀胱经具有操作流程标准化,不分证型的特点,易于掌握,可重复性好,便于临床推广。颈段足太阳膀胱经可能蕴藏有重要针刺点,甚至可能存在穴位,值得进一探索和步研究。
[Abstract]:The background epidemiological survey shows that the incidence of cervical spondylosis in China is about 3.8%-17.6%, and the number of patients with cervical spondylosis is about 1 million. With the progress of the society and the improvement of the people's living standard and the increasingly fierce social competition, the cervical spondylosis is increasing rapidly and young, bringing the patient's normal life and work very well. Great pain and inconveniences will become one of the most prevalent diseases in twenty-first Century. Among them, the Cervical Spondylotic Radiculopathy (CSR) accounts for 60%-70%, and most of the cervical spondylotic radicular spondylopathy can be cured or relieved by non operative treatment. Therefore, it is a safer, better, inexpensive, and less side effect treatment to cure this On the basis of "comprehensive treatment of cervical spondylosis" and many years of clinical experience, I hope to further improve the therapeutic effect of traditional Chinese medicine on the treatment of cervical spondylosis of nerve root type, and further clarify the treatment of cervical spondylotic radicular spondylopathy by traditional Chinese medicine. Objective to trace the academic origin, collation and summary of Professor Guo Jianhua's treatment of tendon injury, summarize and summarize the academic thoughts and clinical experiences of Professor Guo Jianhua in the treatment of tendon injuries, and to summarize the clinical experience of Professor Guo Jianhua on the normal cervical vertebra physiology, the etiology and pathogenesis of cervical spondylosis of nerve root type, and the comprehensive treatment of traditional Chinese medicine. On the experience of treating the cervical spondylosis of the nerve root type, the validity of the treatment of the cervical spondylosis of the nerve root type is verified. The safety and effectiveness of the neck puncture method for the cervical spondylosis of the nerve root type can be explored to further improve the curative effect of the treatment of the cervical spondylosis of the nerve root type, with a unified standard, strong maneuverability and high safety. To guide clinical application and further improve the clinical curative effect of TCM Comprehensive therapy. Method experience summary, through learning with teachers, combining with their own clinical practice, learning traditional Chinese medicine and acupuncture books, consulting relevant medical literature, summarizing professor Guo Jianhua's academic thoughts and experience on the disease of treating tendon injury. Clinical research, 1 2014 From 0 to April 2015, 60 patients with cervical spondylosis of nerve root type were selected according to the inclusion criteria and exclusion criteria. According to the first visit order, there were two groups of A and B in the control group according to the order of first visit, and 30 cases in each group. The A in the treatment group was Acupuncturing the main point with the puncture method, according to MRI The prominent position of the cervical intervertebral disc was selected, and the foot sun bladder meridian of the segment and the next segment was selected as the main point; the affected upper limb was taken acupoint, C5: arm cloth, C6: hand three li, C7: Hegu, C8: Zhu Zhu (for example, C4/5 intervertebral disc herniation, 1.3 inches of the main acupoint with C4 and C5 under the spinous process, the upper limb C5: arm cloth). The control group B adopted pinpricker neck clip. B The ridge (0.5 inches by the lower edge of the spinous process in the corresponding segment and the next section), according to the symptoms and collaterals of the symptoms of the meridians, the upper limbs of the affected side are selected to take acupoints based on syndrome differentiation, and three of the hand Yang Ming meridian is selected, the hand Taiyin is chosen Taiyuan, the hand sun meridian is selected in Yangxi, the hand Shaoyin is selected to use the God gate, the hand Shaoyang is selected in the Zhu Zhu, and the hand Jue Yin selected Daling. Use the clinical symptoms, signs, the degree of pain evaluation using the scale method, the patients before and after the treatment score, before and after two groups of treatment, symptoms and signs, cervical activity, integral decline, compared the two groups of significant efficiency. Results 1. professor Guo Jianhua's academic origin: mainly from the four classics of traditional Chinese medicine, ancient ancient times Classics of classics of acupuncture and moxibustion, such as "Huangdi Neijing", "Golden Chamber", < typhoid theory >, "febrile disease", "acupuncture and Moxibustion", "acupuncture and Moxibustion", and so on, are taken to learn the classical works of traditional Chinese medicine, absorb modern medicine's understanding of cervical spondylosis, and use modern medical examination and inspection means, in the long-term clinical practice, take both savings, fusion through, shape, form, form, form, form, shape, shape, shape, form, form It has become his own academic thought that the cause of the cervical spondylosis of the nerve root is the imbalance of the neck. The key to the pathogenesis of the disease is that the sun is not good at.2. Guo Jianhua's main academic viewpoint in the treatment of tendons and injuries: (1) the combination of ancient and modern, "harmony", (2) the combination of Chinese and western, the combination of diseases and syndromes; (3) read classics, use the Scriptures, and (4) put forward " The principle of tendon injury and stubborn disease, combination of disease and syndrome, combination of law and prevention, and prevention and treatment of equal weight; (5) Professor Guo Jianhua's experience in treating cervical spondylosis of nerve root type: (1) all kinds of pathogenic factors can lead to cervical spondylosis of nerve root type: (1) all kinds of pathogenic factors can cause the cervical spondylosis of nerve root type, and the deficiency of Qi is the internal cause of the disease, the invasion of wind cold wet evil, strain, neck A variety of factors such as bad posture, trauma and other factors can lead to the occurrence of cervical spondylosis of the nerve root type; (2) the internal dynamic balance of the cervical spine is the key to the onset of cervical spondylosis of the nerve root type, the long-term invasion of the neck, the qualitative change caused by quantitative changes, and the final result of the imbalance of the cervical vertebra; (3) the key to the pathogenesis of the cervical spondylosis of the nerve root type is the key to the pathogenesis of the cervical spondylosis of the nerve root type. The sun is not comfortable, cold dampness, blood stasis, phlegm, phlegm, phlegm, stasis, qi stagnation, all are the pathological products, and all kinds of pathological products eventually lead to the disease of the sun. (4) the treatment of the sun meridian is an important method to treat the cervical spondylosis of the nerve root type; (5) the pathogenic factors of the cervical spondylosis of the nerve root type are numerous, the etiology and pathogenesis are complicated and easy to recur and cure. The treatment method should be based on comprehensive treatment; (6) to restore the dynamic balance of the cervical spine, to achieve the "Yin Ping Yang constipation" state is the objective.4. clinical study of the treatment of cervical spondylosis (1) the treatment group and the control group B, each completed 30 cases, complete 60 cases altogether. (2) two groups of patients with gender composition, x2 test, P value 0.05, so no statistical significance, so there is no statistical significance, so there is no statistical significance, so there is no statistical significance There was no difference in sex distribution; the age distribution of the two groups of patients, x2 test and P0.05, showed no statistical significance, indicating that there was no difference in age distribution; the course of disease in the two group, x2 test, P0.05, showed no statistical significance. (3) the comparison of clinical efficacy, the effective rate of the treatment group and the control group was 80% and 56.7%, respectively. P0.05, the two groups had significant differences, indicating that the treatment group was better than the control group in improving the clinical symptoms and signs of the disease. (4) the two groups were all effective and had good clinical effect. Conclusion the results of this study showed that the two groups had good curative effect on the cervical spondylotic cervical spondylosis. The treatment of cervical spondylosis of nerve root type with Yang bladder meridian is superior to that of acupuncture at the point of Cervical Jiaji. And step research.

【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.9;R249

【参考文献】