本文選題：周志杰 + 學術(shù)思想�。� 參考：《中國中醫(yī)科學院》2016年博士論文

【摘要】：目的：學習周志杰主任的臨床經(jīng)驗、針法特點及“四針療法”,總結(jié)出周老的學術(shù)思想,并在此基礎(chǔ)上進行繼承和發(fā)揚。腦性癱瘓是由于腦部非進行性損傷所致的一組癥候群,多發(fā)生在胎兒或嬰幼兒時期。表現(xiàn)為持續(xù)存在的中樞性運動和姿勢發(fā)育障礙、活動受限。隨著醫(yī)療水平的進步,新生兒死亡率逐年下降,小兒腦癱的患病率卻有升高的趨勢。嬰幼兒期是運動發(fā)育最為迅速的時期,粗大運動發(fā)育被認為是其他發(fā)育的基礎(chǔ),理應(yīng)作為腦癱康復(fù)的重要環(huán)節(jié)進行研究。小兒腦癱的臨床研究絕大多數(shù)是來自個人的經(jīng)驗,總結(jié)名老中醫(yī)運用針灸治療腦癱的經(jīng)驗和學術(shù)思想較少。目前的研究大多數(shù)沒有應(yīng)用科學的方法進行隨機對照,且樣本量低,可重復(fù)性差,因而只能在小范圍內(nèi)使用,影響對針灸療效的客觀判斷。在本次研究中我應(yīng)用周老的“腦、腹四針”治療小兒痙攣型腦癱,并進行科學的臨床觀察與統(tǒng)計分析,進一步驗證導(dǎo)師學術(shù)思想及四針療法,為治療小兒腦癱的提供新的、療效可靠的方法和學術(shù)理論。方法：1理論研究一方面,全面回顧收集周志杰主任的論文、論著、課題研究及臨床病例資料,并對上述資料進行總結(jié)。另一反面,通過平日研讀經(jīng)典、聆聽周老教誨及跟師學習,觀察、分析、理解、體會其運用針灸治療疾病的辯證思路、選穴配伍和針刺手法特點,提煉出周老臨床針灸治病的學術(shù)思想和常用“四針療法”,并在獨立臨床中進行應(yīng)用和體會。2臨床研究選擇西安市兒童醫(yī)院神經(jīng)康復(fù)科門診及腦癱診療中心的140例痙攣型腦癱患兒為觀察對象,隨機分為對照組和治療組,每組各70例。采用評價者盲法,由固定評估醫(yī)師進行量表評價,其不了解患者的治療方法。數(shù)據(jù)由專門統(tǒng)計人員統(tǒng)計,統(tǒng)計者不了解分組與評價情況。對照組單純進行康復(fù)治療,治療組在康復(fù)訓(xùn)練的基礎(chǔ)上配合“腦、腹四針”,兩組均每日1次,每周5次,60次為1療程。觀察兩組對GMFM-66、MAS評分的影響,采用尼莫地平法判定療效。觀察指標采用SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)的統(tǒng)計處理,觀察兩組間有無差異,總結(jié)、評價其療效,并對治療后安全性進行評價。結(jié)果：理論研究成果：本研究挖掘總結(jié)了周老的學術(shù)思想及其淵源、常用的“四針療法”及擅長的針法特點,并在臨床上具體應(yīng)用體會。周老受“準繩堂”父輩們“注重整體、針灸藥食并重”思想,以及《內(nèi)經(jīng)》、《難經(jīng)》及其他相關(guān)各家的影響,形成了其“整體調(diào)治”的學術(shù)思想。1學術(shù)思想1.1注重整體,陰陽并調(diào)1.1.1左右并調(diào)：臨證時對于一側(cè)疾患,如偏癱、面癱等,周老多采用“左右并調(diào)”的方法來補虛瀉實,達到左右陰陽平衡。1.1.2上下并調(diào)：包括上病下取和下病上取,體現(xiàn)了在整體觀念的指導(dǎo)下的陰陽并調(diào)之法,通過人體臟腑、經(jīng)絡(luò)及氣機的上下聯(lián)系來達到陰陽平衡。1.1.3前后并調(diào)：周老認為,腹在前為陰,背在后為陽,故前后配穴即可陽病治陰、陰病治陽,達到陰陽并調(diào)之效。1.1.4內(nèi)外并調(diào)：肢體內(nèi)、外側(cè)陰陽經(jīng)脈失調(diào)就會出現(xiàn)肌力、肌張力及姿勢異常。周老治療時多采取補陽瀉陰或補陰瀉陽的方法平衡陰陽。1.1.5氣血并調(diào)：氣為陽,血為陰。氣和血一陰一陽,相互依存、相互資生、相互為用。周老治療氣病或血病時,常氣血同調(diào),陰陽并治。1.2重問診,識三因,辯病源。周老臨床強調(diào)通過“四診”來辨識三因,根據(jù)不同“時因、地因、人因”,從天象、地象、人象的角度全面了解人體的狀況,做到有針對性地因時、因地、因人制宜,發(fā)揮中醫(yī)的整體調(diào)治優(yōu)勢。1.3注重食療,強調(diào)針、藥、食并重,各顯其效。平疴食療為先,不愈針藥并舉：癥狀較輕時,周老常單獨采用食療進行調(diào)理：如不愈,再予以針灸藥物。對于慢性、易復(fù)發(fā)疾病,周老采用食療為主,配合針藥來治療；急性疾病,以針藥為主,配合食療。平素注重飲食調(diào)養(yǎng),糾正臟腑之偏：周老強調(diào),日常生活中應(yīng)根據(jù)體質(zhì)采用食物進行合理調(diào)養(yǎng),預(yù)防疾�。换疾r則依辨證,采用食、針、藥治療,體現(xiàn)了中醫(yī)“治未病”的理念。1.4重視經(jīng)絡(luò)辨證,強調(diào)熟識穴性。周老認為,經(jīng)絡(luò)循行是針灸治療的基礎(chǔ),經(jīng)絡(luò)辨證包括依病候辨證、依病位辨證。針灸治病的關(guān)鍵,一在辨證,二關(guān)取穴,三乎手法。如果辯證確鑿,取穴精巧,手法純熟,治病即能事半功倍。2周老的“四針療法”包括：形神兼調(diào),善用“臟四針”調(diào)五臟；注重“四�！崩碚�,各以“四針”調(diào)虛實：如調(diào)髓海用“腦四針”,調(diào)水谷之海用“腹四針”,調(diào)氣血取“焦四針”。3周老針法特點包括：飛針速刺,強調(diào)“氣至病所”；崇尚指針,強調(diào)指力為先；擅用芒針,一針多穴祛痼疾；崇尚任督,針、灸、點穴并用。4周老的臨床經(jīng)驗包括：巧識病因,治愈頑固性腹脹；左右并調(diào),治療頑固性面癱；內(nèi)外同調(diào),治療中風后足內(nèi)翻；上下并調(diào),治療少陽頭痛；前后并調(diào),治療原發(fā)性痛經(jīng)；表里經(jīng)并調(diào),治療脅痛;針食結(jié)合,治療習慣性便秘。獨立臨證時,將周老學術(shù)思想及臨床經(jīng)驗應(yīng)用于臨床,采用溫針灸治療新生兒臂叢神經(jīng)損傷、采用“腦、腹四針”治療小兒遺尿及抽動癥。臨床研究成果：論文在全面學習和傳承導(dǎo)師的學術(shù)思想和經(jīng)驗基礎(chǔ)上,觀察導(dǎo)師的“腦、腹四針”治療小兒痙攣型腦癱的療效,結(jié)果如下：1收集完整病例130份,治療組和對照組各65例。兩組患兒治療前年齡、性別及MAS、 GMFM-66均無差異(P0.05),具有可比性。2兩組患兒治療后GMFM-66評分較治療前均有提高(P0.05),治療組提高的更為明顯(P0.05),提示治療組療效優(yōu)于對照組。3兩組患兒治療后MAS評分均較治療前降低(P0.05),治療組降低的更為明顯(P0.05),提示治療組療效優(yōu)于對照組。4兩組MAS有效率對比,治療組顯效16例,有效41例,無效8例,總有效57例(87.69%)；對照組顯效9例,有效39例,無效17例,總有效48例(73.84%)。兩組在統(tǒng)計學上存在差異(P0.05),治療組優(yōu)于對照組。5兩組尼莫地平有效率對比,治療組顯效29例,有效27例,無效9例,總有效56例(86.15%)；對照組顯效11例,有效36例,無效18例,總有效47例(72.31%)。兩組在統(tǒng)計學上存在差異(P0.05),治療組優(yōu)于對照組。6不同年齡段患兒尼莫地平有效率,6月-12月為85.71%,13月-36月為71.66%,有統(tǒng)計學差異(P0.05),說明低年齡段患兒有效率高于高年齡段；低年齡段MAS有效率82.85%,高年齡段為78.33%,無統(tǒng)計學差異(P0.05),說明高低年齡段MAS的有效率沒有差異。結(jié)論：1對于小兒痙攣型腦癱,采用“腦、腹四針”配合康復(fù)訓(xùn)練,可以降低肢體的肌張力、改善肢體痙攣狀態(tài),促進粗大運動功能的發(fā)育。2運用“腦、腹四針”可以明顯提高臨床治療小兒痙攣型腦癱的有效率。3年齡與小兒痙攣型腦癱的康復(fù)療效相關(guān),年齡越小,進步越快；年齡越大,進步越慢。腦癱患兒治療后痙攣程度的改善與年齡未發(fā)現(xiàn)相關(guān)性。4小兒腦癱病變責之脾腎二臟,治療重在任督二脈。痙攣型腦癱臨床呈現(xiàn)的肢體拘急攣縮,多與“陰陽失調(diào)”有關(guān)。治療上,以“通督扶陽益髓、調(diào)任健脾益腎”為法。針刺督脈可以調(diào)節(jié)人體陽脈之氣,補腦益髓：針刺任脈可以調(diào)節(jié)人體陰脈之氣,補脾益腎。針刺任督二脈,即可以協(xié)調(diào)全身陰陽經(jīng)氣的平衡,通過“扶緩抑急”,達到“舒筋緩拘”的目的,從而有效的降低肌張力,減輕肌肉的痙攣,改變異常姿勢,提高運動功能,達到治療痙攣型腦癱的目的。
[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.
【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R277.7

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