周志杰学术思想及“脑、腹四针”治疗小儿痉挛型脑瘫的临床研究

发布时间：2018-06-04 02:26

本文选题：周志杰 + 学术思想　；参考：《中国中医科学院》2016年博士论文

【摘要】：目的：学习周志杰主任的临床经验、针法特点及“四针疗法”,总结出周老的学术思想,并在此基础上进行继承和发扬。脑性瘫痪是由于脑部非进行性损伤所致的一组症候群,多发生在胎儿或婴幼儿时期。表现为持续存在的中枢性运动和姿势发育障碍、活动受限。随着医疗水平的进步,新生儿死亡率逐年下降,小儿脑瘫的患病率却有升高的趋势。婴幼儿期是运动发育最为迅速的时期,粗大运动发育被认为是其他发育的基础,理应作为脑瘫康复的重要环节进行研究。小儿脑瘫的临床研究绝大多数是来自个人的经验,总结名老中医运用针灸治疗脑瘫的经验和学术思想较少。目前的研究大多数没有应用科学的方法进行随机对照,且样本量低,可重复性差,因而只能在小范围内使用,影响对针灸疗效的客观判断。在本次研究中我应用周老的“脑、腹四针”治疗小儿痉挛型脑瘫,并进行科学的临床观察与统计分析,进一步验证导师学术思想及四针疗法,为治疗小儿脑瘫的提供新的、疗效可靠的方法和学术理论。方法：1理论研究一方面,全面回顾收集周志杰主任的论文、论著、课题研究及临床病例资料,并对上述资料进行总结。另一反面,通过平日研读经典、聆听周老教诲及跟师学习,观察、分析、理解、体会其运用针灸治疗疾病的辩证思路、选穴配伍和针刺手法特点,提炼出周老临床针灸治病的学术思想和常用“四针疗法”,并在独立临床中进行应用和体会。2临床研究选择西安市儿童医院神经康复科门诊及脑瘫诊疗中心的140例痉挛型脑瘫患儿为观察对象,随机分为对照组和治疗组,每组各70例。采用评价者盲法,由固定评估医师进行量表评价,其不了解患者的治疗方法。数据由专门统计人员统计,统计者不了解分组与评价情况。对照组单纯进行康复治疗,治疗组在康复训练的基础上配合“脑、腹四针”,两组均每日1次,每周5次,60次为1疗程。观察两组对GMFM-66、MAS评分的影响,采用尼莫地平法判定疗效。观察指标采用SPSS17.0统计软件进行数据的统计处理,观察两组间有无差异,总结、评价其疗效,并对治疗后安全性进行评价。结果：理论研究成果：本研究挖掘总结了周老的学术思想及其渊源、常用的“四针疗法”及擅长的针法特点,并在临床上具体应用体会。周老受“准绳堂”父辈们“注重整体、针灸药食并重”思想,以及《内经》、《难经》及其他相关各家的影响,形成了其“整体调治”的学术思想。1学术思想1.1注重整体,阴阳并调1.1.1左右并调：临证时对于一侧疾患,如偏瘫、面瘫等,周老多采用“左右并调”的方法来补虚泻实,达到左右阴阳平衡。1.1.2上下并调：包括上病下取和下病上取,体现了在整体观念的指导下的阴阳并调之法,通过人体脏腑、经络及气机的上下联系来达到阴阳平衡。1.1.3前后并调：周老认为,腹在前为阴,背在后为阳,故前后配穴即可阳病治阴、阴病治阳,达到阴阳并调之效。1.1.4内外并调：肢体内、外侧阴阳经脉失调就会出现肌力、肌张力及姿势异常。周老治疗时多采取补阳泻阴或补阴泻阳的方法平衡阴阳。1.1.5气血并调：气为阳,血为阴。气和血一阴一阳,相互依存、相互资生、相互为用。周老治疗气病或血病时,常气血同调,阴阳并治。1.2重问诊,识三因,辩病源。周老临床强调通过“四诊”来辨识三因,根据不同“时因、地因、人因”,从天象、地象、人象的角度全面了解人体的状况,做到有针对性地因时、因地、因人制宜,发挥中医的整体调治优势。1.3注重食疗,强调针、药、食并重,各显其效。平疴食疗为先,不愈针药并举：症状较轻时,周老常单独采用食疗进行调理：如不愈,再予以针灸药物。对于慢性、易复发疾病,周老采用食疗为主,配合针药来治疗；急性疾病,以针药为主,配合食疗。平素注重饮食调养,纠正脏腑之偏：周老强调,日常生活中应根据体质采用食物进行合理调养,预防疾病；患病时则依辨证,采用食、针、药治疗,体现了中医“治未病”的理念。1.4重视经络辨证,强调熟识穴性。周老认为,经络循行是针灸治疗的基础,经络辨证包括依病候辨证、依病位辨证。针灸治病的关键,一在辨证,二关取穴,三乎手法。如果辩证确凿,取穴精巧,手法纯熟,治病即能事半功倍。2周老的“四针疗法”包括：形神兼调,善用“脏四针”调五脏；注重“四海”理论,各以“四针”调虚实：如调髓海用“脑四针”,调水谷之海用“腹四针”,调气血取“焦四针”。3周老针法特点包括：飞针速刺,强调“气至病所”；崇尚指针,强调指力为先；擅用芒针,一针多穴祛痼疾；崇尚任督,针、灸、点穴并用。4周老的临床经验包括：巧识病因,治愈顽固性腹胀；左右并调,治疗顽固性面瘫；内外同调,治疗中风后足内翻；上下并调,治疗少阳头痛；前后并调,治疗原发性痛经；表里经并调,治疗胁痛;针食结合,治疗习惯性便秘。独立临证时,将周老学术思想及临床经验应用于临床,采用温针灸治疗新生儿臂丛神经损伤、采用“脑、腹四针”治疗小儿遗尿及抽动症。临床研究成果：论文在全面学习和传承导师的学术思想和经验基础上,观察导师的“脑、腹四针”治疗小儿痉挛型脑瘫的疗效,结果如下：1收集完整病例130份,治疗组和对照组各65例。两组患儿治疗前年龄、性别及MAS、 GMFM-66均无差异(P0.05),具有可比性。2两组患儿治疗后GMFM-66评分较治疗前均有提高(P0.05),治疗组提高的更为明显(P0.05),提示治疗组疗效优于对照组。3两组患儿治疗后MAS评分均较治疗前降低(P0.05),治疗组降低的更为明显(P0.05),提示治疗组疗效优于对照组。4两组MAS有效率对比,治疗组显效16例,有效41例,无效8例,总有效57例(87.69%)；对照组显效9例,有效39例,无效17例,总有效48例(73.84%)。两组在统计学上存在差异(P0.05),治疗组优于对照组。5两组尼莫地平有效率对比,治疗组显效29例,有效27例,无效9例,总有效56例(86.15%)；对照组显效11例,有效36例,无效18例,总有效47例(72.31%)。两组在统计学上存在差异(P0.05),治疗组优于对照组。6不同年龄段患儿尼莫地平有效率,6月-12月为85.71%,13月-36月为71.66%,有统计学差异(P0.05),说明低年龄段患儿有效率高于高年龄段；低年龄段MAS有效率82.85%,高年龄段为78.33%,无统计学差异(P0.05),说明高低年龄段MAS的有效率没有差异。结论：1对于小儿痉挛型脑瘫,采用“脑、腹四针”配合康复训练,可以降低肢体的肌张力、改善肢体痉挛状态,促进粗大运动功能的发育。2运用“脑、腹四针”可以明显提高临床治疗小儿痉挛型脑瘫的有效率。3年龄与小儿痉挛型脑瘫的康复疗效相关,年龄越小,进步越快；年龄越大,进步越慢。脑瘫患儿治疗后痉挛程度的改善与年龄未发现相关性。4小儿脑瘫病变责之脾肾二脏,治疗重在任督二脉。痉挛型脑瘫临床呈现的肢体拘急挛缩,多与“阴阳失调”有关。治疗上,以“通督扶阳益髓、调任健脾益肾”为法。针刺督脉可以调节人体阳脉之气,补脑益髓：针刺任脉可以调节人体阴脉之气,补脾益肾。针刺任督二脉,即可以协调全身阴阳经气的平衡,通过“扶缓抑急”,达到“舒筋缓拘”的目的,从而有效的降低肌张力,减轻肌肉的痉挛,改变异常姿势,提高运动功能,达到治疗痉挛型脑瘫的目的。
[Abstract]:Objective: to learn the clinical experience of director Zhou Zhijie, the characteristics of acupuncture and the "four needle therapy", and summarize the academic ideas of the old Zhou, and carry on and carry forward it on this basis. Cerebral palsy is a group of syndrome caused by non progressive brain damage, which occurs more in the fetus or infant. With the improvement of the medical level, the mortality rate of newborns decreased year by year, the incidence of cerebral palsy in children had a rising trend. Infant period was the most rapid development period. The development of gross motor development was considered as the basis of other development, and should be considered as an important part of cerebral palsy rehabilitation. Most of the clinical studies of cerebral palsy are from personal experience. The experience and academic ideas of acupuncture and moxibustion in the treatment of cerebral palsy by Acupuncture and moxibustion are few. Most of the current studies have not applied scientific methods for random control, with low sample size and poor repeatability, so they can only be used in a small range and affect the objective effect of acupuncture and moxibustion. In this study, I used Zhou old "brain, abdominal four needles" to treat children's spastic cerebral palsy, and carried out a scientific clinical observation and statistical analysis to further verify the academic thought of the tutor and four needle therapy to provide a new, reliable method and academic theory for the treatment of cerebral palsy in children. Method: 1 theoretical research, on the one hand, comprehensive and comprehensive. Review and collect the papers, treatises, research and clinical case data of director Zhou Zhijie, and summarize the above data. On the other hand, through reading the classics on weekdays, listening to the old teachings and learning from the teachers, observing, analyzing, understanding, and understanding the dialectical thought of the use of acupuncture and moxibustion for the treatment of diseases, the characteristics of the selection of acupoints and acupuncture techniques, and the extraction of the week The academic thought of the old clinical acupuncture and moxibustion treatment and the commonly used "four needle therapy", and in the independent clinical application and experience of the.2 clinical study of 140 children with spastic cerebral palsy in the neurologic rehabilitation clinic and cerebral palsy center of Xi'an children's Hospital, were randomly divided into the treatment group and the treatment group, 70 cases in each group. The blind method, which was evaluated by a fixed assessment physician, did not understand the treatment of the patients. The data were counted by the special statisticians. The statisticians did not understand the group and the evaluation. The control group was treated with the rehabilitation therapy alone. The treatment group was combined with the "brain and four needles" on the basis of rehabilitation training. The two groups were 1 times a day, 5 times a week, and 60 times the 1 course. Observe the effect of two groups on the score of GMFM-66 and MAS, use nimodipine method to determine the curative effect. The observation index uses SPSS17.0 statistical software for statistical processing, observe the difference between the two groups, sum up, evaluate the curative effect, and evaluate the safety after treatment. The thought and its origin, the commonly used "four needle therapy" and the characteristics of the needling method and practical experience in clinical practice. Zhou old people are subject to the idea of "focusing on the whole, the weight of acupuncture and Moxibustion", and the influence of "inner classics >" and other related families, forming the academic thought of "overall regulation",.1 academic thought 1.1 Pay attention to the whole, yin and Yang and adjust 1.1.1 and adjust: in the case of one side disease, such as hemiplegia, facial paralysis, and so on, Zhou Lao adopts the method of "left and right and adjustable" to make up the deficiency and diarrhea to achieve the balance of the.1.1.2 and the right and the right and the right and the right and down. The body viscera, meridian and the Qi and the Qi machine link up and down to achieve the balance of yin and Yang before and after.1.1.3 and adjust: Zhou old thought, the abdomen in the front for the Yin, back in the Yang, so front and back with the point can treat Yin, yin disease treatment Yang, to achieve Yin and Yang and adjust the effect of.1.1.4 internal and external adjustment: outside Yin and Yang Meridian imbalance will appear muscle strength, muscle tension and posture abnormality. In the treatment of the old week, we take the method of nourishing yang and reducing yin or nourishing yin and reducing yang to balance yin and Yang.1.1.5 Qi and blood and adjust: Qi is Yang, blood is Yin, Qi and blood is Yin and Yang, interdependence, mutual qualifications and mutual use. When Zhou old treatment of Qi disease or blood disease, Qi and blood are often the same, yin and Yang and treatment of.1.2, three cause, plea source. Zhou old clinical stress through "four" To identify three causes, according to the different "time cause, ground cause, human cause", from the angle of celestial image, earth image and human image, to understand the human body in an all-round way, so as to give full play to the overall adjustment advantage of traditional Chinese medicine (.1.3), pay attention to the acupuncture, medicine and food. When the form is lighter, Zhou Lao often uses dietotherapy to regulate: if it does not heal, then give acupuncture and moxibustion. For chronic, easy to relapse disease, Zhou Lao adopts dietotherapy, combined with acupuncture and medicine; acute diseases, mainly with acupuncture and dietotherapy. Using food to properly adjust, prevent disease, when sick, according to the syndrome differentiation, using food, needle and medicine treatment, it embodies the concept of "treating no disease" in traditional Chinese medicine.1.4, emphasizes the syndrome differentiation of meridians and collaterals, emphasizes the acquaintance of the acupoints. Syndrome differentiation, two points to take the point, three methods. If the dialectical solid, acupoint exquisite, skillful and skillful, the treatment of.2 weeks old "four needle therapy" includes: the form and the spirit, the "dirty four needles" adjust five dirty; pay attention to the "Four Seas" theory, each with "four needles" to adjust the reality: such as the "four needle" in the sea, the sea of water to the sea of "abdomen four" "Needle", Qi and blood to take "coke four needles".3 week old needle method features include: Flying needle speed pricking, emphasizing "Qi to the disease"; advocating the pointer, emphasizing the strength of the first; unauthorized use of awn needle, one needle to dispel chronic disease; advocating the governor, needle, moxibustion, point points and the old clinical experience of.4 weeks including: the etiology, cure obstinate abdominal distention; left and right adjustment, treatment stubbornness Solid facial paralysis; internal and external homology, treatment of post apoplectic foot varus, up and down and adjustment, treatment of Shaoyang headache, treatment of primary dysmenorrhea, treatment of primary dysmenorrhea, treatment of hypochondriac pain, combination of needle and food, treatment of habitual constipation. When independent syndrome, we should use Zhou Lao academic thought and clinical experience to treat the brachial plexus God with warm acupuncture and moxibustion After injury, the treatment of infantile enuresis and aspiration was treated with "brain and abdominal four needles". Clinical research results: on the basis of learning and inheriting the academic thought and experience of the tutor, the paper observed the therapeutic effect of the mentor's "brain and abdomen four needles" on children's spastic cerebral palsy. The results were as follows: 1 collected 130 complete cases, and 65 cases in the treatment group and the control group. The age, sex and MAS, GMFM-66 of the two groups were not different (P0.05), and the GMFM-66 scores in the group.2 two were higher than before the treatment (P0.05), and the treatment group improved more obviously (P0.05), suggesting that the curative effect of the treatment group was better than that of the control group of.3 two groups after treatment (P0.05), and the treatment group decreased. Lower and more obvious (P0.05), suggesting that the curative effect of the treatment group was better than the control group.4 two group MAS efficiency comparison, the treatment group showed 16 cases, effective 41 cases, invalid 8 cases, total effective 57 cases (87.69%); the control group showed 9 cases, effective 39 cases, 17 cases, total effective 48 cases (73.84%). The two group was statistically different (P0.05), the treatment group was better than the control group.5 two group. The effect of nimodipine was effective in 29 cases, effective 27 cases, invalid 9 cases, total effective 56 cases (86.15%), 11 cases in the control group, 36 effective, 18 invalid, total effective 47 (72.31%). The two group was statistically different (P0.05), the treatment group was better than the control group.6 of different age groups of nimodipine, June -12 month 85.71%, 13 The month -36 month was 71.66%, with statistical difference (P0.05), indicating that the effective rate of children in the low age group was higher than that of the high age group; the effective rate of MAS in the low age group was 82.85% and the high age group was 78.33%. There was no statistical difference (P0.05). It showed that there was no difference in the efficiency of MAS in the high and low age segments. Conclusion: 1 for children with spastic cerebral palsy, the "brain and abdomen four needles" are used in combination with Kang. Repeated training can reduce the muscle tension of the limbs, improve the spasticity of the limbs, and promote the development of the gross motor function. The use of "brain, abdomen four needles" can obviously improve the effect of the effective.3 age of the clinical treatment of spastic cerebral palsy in children with the rehabilitation effect of spastic cerebral palsy in children, the smaller the age, the faster the progress, the greater the age and the slower the progress of the.2. The improvement of the degree of spasticity in children with cerebral palsy was not associated with the correlation between the age of spasm and age..4 was responsible for the two organs of the spleen and kidney of the children with cerebral palsy. The treatment was in the two pulse of Ren Du. The clinical manifestation of spastic cerebral palsy was related to the "imbalance of yin and Yang". It can regulate the Qi of the human body Yin pulse and nourish the spleen and nourish the kidney. The acupuncture of the two pulse of the spleen and governor can coordinate the balance of the Qi and Yang of the whole body. Through the "help slow down and restrain the urgency", it can achieve the goal of "relaxing the tendons and retarding", thus effectively reducing muscle tension, reducing muscle spasms, changing abnormal postures and raising movement. Function, to achieve the purpose of treating spastic cerebral palsy.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R277.7

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