李鴻霞

?

列缺穴治療落枕療效觀察

李鴻霞

(華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬荊州醫(yī)院行署醫(yī)療站,湖北 434020)

觀察列缺穴單穴和配伍及落枕后患者就診的時(shí)間對(duì)治療效果的影響。將84例患者隨機(jī)分為單穴組與配伍組,按患者就診時(shí)間單穴組42例分為24 h內(nèi)21例,24 h外21例;配伍組42例,分為24 h內(nèi)21例與24 h外21例。單穴組運(yùn)用一側(cè)發(fā)病取對(duì)側(cè)列缺穴,雙側(cè)發(fā)病取兩側(cè)列缺穴;配伍組列缺穴加風(fēng)池、大杼、天柱、天窗、肩中俞。兩組均每天針刺1次,每次留針30 min。對(duì)發(fā)病后24 h內(nèi)和24 h外就診患者進(jìn)行治療1次、2次、3次的療效觀察。24 h內(nèi)就診患者兩組治療效果1次治愈率為單穴組95.2%,配伍組100%;24 h外就診者1次治愈率為單穴組28.6%,配伍組38.1%;3次治愈率單穴組76.2%,配伍組95.2%。列缺穴治療落枕療效與發(fā)病后就診時(shí)間及配伍有關(guān)。

落枕;穴,列缺;配穴法;就診時(shí)間

落枕或稱“失枕”,為臨床常見(jiàn)病、多發(fā)病,常是入睡前無(wú)任何征兆,清晨醒后感到頸項(xiàng)背部疼痛,活動(dòng)受限,表現(xiàn)為一側(cè)或兩側(cè)頸肩部疼痛,旋轉(zhuǎn)連身,僵硬疼痛。筆者采用單穴列缺和配伍近部穴治療落枕,并觀察治療效果與患者就診時(shí)間的關(guān)系,現(xiàn)報(bào)道如下。

1 臨床資料

1.1 一般資料

64例患者均為本站門診患者,隨機(jī)分為單穴組與配伍組。單穴組42例,其中男23例,女19例;年齡最大61歲,最小15歲,平均42歲;病程最長(zhǎng)3 d,最短4 h。配伍組42例,其中男17例,女25例;年齡最大56歲,最小17歲,平均45歲;病程最長(zhǎng)1 d,最短3 h。兩組性別、年齡、病程比較差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性。

1.2 診斷標(biāo)準(zhǔn)

參照國(guó)家中醫(yī)藥管理局1994頒布的《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》[1]中落枕的診斷標(biāo)準(zhǔn)。

1.3 排除標(biāo)準(zhǔn)

①頸椎骨折、腫瘤患者;②暈針患者;③不能配合完成治療和觀察者。

2 治療方法

2.1 單穴組

單取列缺穴,采用交叉取穴,單側(cè)發(fā)病取對(duì)側(cè),兩側(cè)發(fā)病取雙側(cè)?；颊呷∽?使用0.30 mm×50 mm無(wú)菌針灸針,穴位常規(guī)消毒后,向肘部斜刺0.3～0.5寸,采用強(qiáng)刺激捻轉(zhuǎn)手法,令針感逐漸沿手太陰經(jīng)向手肘肩頸方向傳導(dǎo)。然后邊捻轉(zhuǎn)邊讓患者做主動(dòng)轉(zhuǎn)頭頸運(yùn)動(dòng),頭頸部盡量向左右轉(zhuǎn)動(dòng),下頜朝左右肩平行方向靠近,轉(zhuǎn)動(dòng)動(dòng)作要緩慢,以患者能接受為度,留針30 min。其間約5～6 min行針1次,每次行針均要求患者做頸部左右旋轉(zhuǎn)運(yùn)動(dòng)。30 min后取出。每天針刺1次。

2.2 配伍組

取列缺、風(fēng)池、大杼、天柱、天窗、肩中俞,采用平補(bǔ)平瀉手法,使針感擴(kuò)散至頸肩周圍,留針30 min。其間5～6 min行針1次,30 min后取出其他腧穴針,留列缺穴做強(qiáng)刺激捻轉(zhuǎn),令針感向頸肩方向傳導(dǎo),同時(shí)讓患者做自主轉(zhuǎn)頭(如單穴組),約3～5 min后取針。每天針刺1次。

兩組均在治療1、2、3次后進(jìn)行療效觀察。

3 治療效果

3.1 療效標(biāo)準(zhǔn)

參照《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》[1]中相關(guān)標(biāo)準(zhǔn)。

痊愈 頭頸肩部活動(dòng)自如,無(wú)疼痛酸脹感,功能恢復(fù)正常。

顯效 頭頸肩部疼痛酸脹感明顯減輕,頭頸肩部功能活動(dòng)明顯改善。

有效 頭頸肩部疼痛酸脹感有所好轉(zhuǎn),頭頸肩部功能改善。

無(wú)效 治療前后癥狀體征無(wú)改善。

3.2 治療結(jié)果

由表1可知,發(fā)病后24 h內(nèi)就診的單穴組與配伍組一次治愈率分別為95.2%和100%,差異無(wú)統(tǒng)計(jì)學(xué)意義(＞0.05),結(jié)果表明兩組均有較好的療效,且兩組24 h內(nèi)治愈率均高于24 h外(＜0.01);發(fā)病后24 h以上治療1次治愈率單穴組28.6%,配伍組38.1%;2次治愈率單穴組42.9%,配伍組47.6%;3次治愈率單穴組76.2%,配伍組95.2%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(＜0.05)。

表1 各組不同就診時(shí)間臨床療效比較 [n(%)]

注:組內(nèi)與24 h外比較1)＜0.01;與配伍組比較2)＜0.05

4 討論

落枕的病因主要有兩個(gè)方面,一是肌肉扭傷,如夜間睡眠姿勢(shì)不良,頭頸長(zhǎng)時(shí)間處于過(guò)度偏轉(zhuǎn)的位置;或因睡眠時(shí)枕頭不合適,過(guò)高、過(guò)低或過(guò)硬,使頭頸處于過(guò)伸或過(guò)屈狀態(tài),均可引起頸部一側(cè)肌肉緊張,使頸椎小關(guān)節(jié)扭錯(cuò)[2],時(shí)間較長(zhǎng)即可發(fā)生靜力性損傷,使傷處肌筋強(qiáng)硬不和,氣血運(yùn)行不暢,局部疼痛不適,動(dòng)作明顯受限等。二是感受風(fēng)寒,如睡眠時(shí)受寒,盛夏貪涼,使頸背部氣血凝滯,經(jīng)絡(luò)痹阻,以致僵硬疼痛,動(dòng)作不利。中醫(yī)學(xué)認(rèn)為本病為風(fēng)寒侵襲項(xiàng)背,致局部經(jīng)絡(luò)氣血不通,不通則痛,患者24 h內(nèi)就診,病在淺表,雖頸肩部經(jīng)氣不暢但血瘀初步形成,故針刺單穴列缺可以達(dá)到通經(jīng)疏氣的功效。列缺穴為手太陰肺經(jīng)絡(luò)穴,又為八脈交會(huì)穴通任脈,“頭項(xiàng)尋列缺”,有疏通絡(luò)脈病變的功效[3]。列缺最早見(jiàn)于《靈樞·經(jīng)脈》,研究表明[4]針刺列缺可有效增寬椎動(dòng)脈的血管內(nèi)徑,提高收縮期血流峰值、每分血流量,從而改善椎動(dòng)脈的供血強(qiáng)度?，F(xiàn)代醫(yī)學(xué)證明[5],手部穴位含有豐富的神經(jīng)末梢,靈敏度強(qiáng),通過(guò)刺激釋放神經(jīng)遞質(zhì)可使大腦皮層抑制,降低大腦皮層對(duì)疼痛的感覺(jué),從而提高疼痛閾值,阻斷痛覺(jué)的惡性循環(huán),達(dá)到鎮(zhèn)痛的目的。發(fā)病24 h后,頸肩部瘀阻的經(jīng)氣漸漸運(yùn)行不暢而導(dǎo)致血行不暢,氣滯血瘀,痙攣的肌肉血循障礙,致使局部血運(yùn)不暢,代謝產(chǎn)物滯留,加上疼痛讓患者心情煩躁,對(duì)疼痛的耐受性降低,因而治療使用單穴療效較差,需配伍頸肩部穴位。通過(guò)針刺疏通氣血,調(diào)通經(jīng)脈,緩解局部肌肉緊張。風(fēng)池穴能疏風(fēng)祛寒,又是足少陽(yáng)膽經(jīng)循行經(jīng)過(guò)頸部的穴位,膽經(jīng)循行于人體的兩側(cè),落枕的疼痛部位正是其循行所過(guò),是局部取穴,為主治所及;大杼和天柱穴是足太陽(yáng)經(jīng)經(jīng)脈循行于頸部的穴位,頭不能前后俯仰者病在足太陽(yáng)膀胱經(jīng),故取之。頭不能左顧右盼者病在手太陽(yáng)小腸經(jīng),天窗和肩中俞穴為手太陽(yáng)經(jīng)經(jīng)脈循行于肩頸部的腧穴。多穴合用可更好、更快達(dá)到治療落枕的目的。

[1] 國(guó)家中醫(yī)藥管理局.中醫(yī)病證診斷療效標(biāo)準(zhǔn)[S].南京:南京大學(xué)出版社,1994:65.

[2] WU Yao-chi, ZHANG Jun-feng, WANG Chong-miao. Clinical Study of Tuina for Stiff Neck[J]. J Acupunct Tuina Sci, 2009,7(4):225- 227.

[3] 朱博暢,單永華.列缺照海治療咽喉疾病舉隅[J].上海針灸雜志, 2007,26(3):31.

[4] 張曉華,艾群.列缺穴對(duì)椎動(dòng)脈血流動(dòng)力學(xué)影響的研究[J].上海針灸雜志,2006,25(6):36-38.

[5] 邱伊白,吳耀持.后溪穴和落枕穴治療落枕的療效比較[J].上海針灸雜志,2000,19(2):36.

Clinical Observation on Treating Stiff Neck with Acupoint Lieque (LU 7)

-.

,,434020,

To observe the influence of single acupoint treatment and treatment with acupoint compatibility with acupoint Lieque (LU 7), and the visiting time on the therapeutic effect in treating stiff neck.Eighty-four patients were randomized into a single-point group and a compatibility group. According to their visiting time, of the 42 patients in the single-point group, 21 patients came before 24 h and the other 21 came after 21 h after the onset; of the 42 patients in the compatibility group, 21 patients came before 24 h and the other 21 came after 24 h after the onset. In the single-point group, Lieque (LU 7) on the opposite side was selected for treating the unilateral stiff neck and bilateral Lieque (LU 7) were selected for treating the bilateral ones. In the compatibility group, Lieque (LU 7), Fengchi (GB 20), Dazhu (BL 11), Tianzhu (BL 10), Tianchuang (SI 16), and Jianzhongshu (SI 15) were selected for treatment. Both groups received acupuncture treatment once a day, 30 min for each time. The therapeutic effect was evaluated in the patients coming before 24 h and after 24 h after onset respectively after a treatment, two treatments and 3 times of treatment.The recovery rate after a treatment in the patients coming before 24 h in the single-point group was 95.2%, versus 100% in the compatibility group. The recovery rate after a treatment in the patients coming after 24 h was 28.6% in the single-point group, versus 38.1% in the compatibility group. The recovery rate after 3 times of treatment was 76.2% in the single-point group, versus 95.2% in the compatibility group.The therapeutic effect of treating stiff neck with point Lieque (LU 7) is related to the visiting time and point compatibility.

Stiff neck; Point, Lieque (LU 7); Point combination; Visiting time

R246.2

A

10.3969/j.issn.1005-0957.2011.12.843

1005-0957(2011)12-0843-02

李鴻霞(1963 - ),女,副主任醫(yī)師

2011-08-20