针刺预防性治疗偏头痛穴位优选现状及思考
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摘要
从中医传统理论选穴、现代医学理论选穴、穴位相对特异性3个方面,对针刺预防性治疗偏头痛穴位优选现状进行总结。发现目前针刺预防性治疗偏头痛研究在初步形成穴位优选方案的同时,亦存在诸多研究空白,在穴位相对特异性研究方面存在争议。认为通过对影响选穴的疾病特点、针刺手法、针刺工具及其他因素等进行系统分析,进一步明确穴位相对特异性,综合中医传统理论选穴与现代医学理论选穴优势,可进一步实现针刺预防性治疗偏头痛穴位的优化,提高疗效。
To summarize the status quo of acupoint optimization for prophylactic treatment of migraine from acupoint selection based on traditional Chinese medicine theory, acupoints selection based on modern medical theory, and the relative specificity of acupoints. It is found that at present, there are many gaps in the research of preventive treatment of migraine, while the initial optimization scheme of acupoints is formed, and there is controversy in the relative specificity of acupoints. It is believed that through the systematic analysis of the disease characteristics of acupuncture, manipulation, acupuncture tools and other factors that affect the selection of acupoints, the relative specificity of acupoints can be further clarified, and the advantages of acupoint selection based on traditional Chinese medicine theory and modern medical theory can be further optimized for the preventive treatment of migraine and improve the curative effect.
To summarize the status quo of acupoint optimization for prophylactic treatment of migraine from acupoint selection based on traditional Chinese medicine theory, acupoints selection based on modern medical theory, and the relative specificity of acupoints. It is found that at present, there are many gaps in the research of preventive treatment of migraine, while the initial optimization scheme of acupoints is formed, and there is controversy in the relative specificity of acupoints. It is believed that through the systematic analysis of the disease characteristics of acupuncture, manipulation, acupuncture tools and other factors that affect the selection of acupoints, the relative specificity of acupoints can be further clarified, and the advantages of acupoint selection based on traditional Chinese medicine theory and modern medical theory can be further optimized for the preventive treatment of migraine and improve the curative effect.
引文
[1]Tfelt-Hansen PC.Evidence-based guideline update:pharmacologic treatment for episodic migraine prevention in adults:report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society[J].Neurology,2013,80(9):869-870.
[2]中华医学会疼痛学分会头面痛学组,中国医师协会神经内科医师分会疼痛和感觉障碍专委会.中国偏头痛防治指南[J].中国疼痛医学杂志,2016,22(10):721-727.
[3]蒲圣雄,谭戈,邓勇,等.针刺对比药物预防治疗偏头痛有效性及安全性的Meta分析[J].重庆医科大学学报,2017,42(10):1293-1298.
[4]高树中,杨骏.针灸治疗学[M].北京:中国中医药出版社,2016:35-38.
[5]焦玥,吴中朝,胡静,等.《循证针灸临床实践指南:偏头痛》2014更新版解读[J].中国针灸,2016,36(7):751-756.
[6]张琰,张路,李彬,等.针刺预防性治疗对无先兆偏头痛患者生存质量的影响[J].中国针灸,2009,29(6):431-435.
[7]赵凌,任玉兰,梁繁荣.基于数据挖掘技术分析历代针灸治疗偏头痛的用穴特点[J].中国针灸,2009,29(6):467-472.
[8]秦卓,程凯,孟欢,等.偏头痛患者侧头部痛点分布与少阳经的相关性研究[J].中国中医基础医学杂志,2015,21(8):994-995,1013.
[9]常小荣,林海波,刘密,等.针刺少阳经特定穴治疗偏头痛患者远期疗效的临床观察[J].中华中医药杂志,2013,28(4):1139-1141.
[10]沈燕,樊小农,王舒.从“神”论针刺预防性治疗偏头痛的思路探讨[J].中华中医药杂志,2015,30(4):1160-1163.
[11]王少松.王麟鹏教授分期分型针刺治疗偏头痛经验[J].中国针灸,2016,36(7):743-746.
[12]邓启龙,武欢,马朝阳,等.头穴透刺治疗偏头痛急性发作疗效观察[J].中国中医急症,2012,21(12):2005-2006.
[13]王麟鹏,刘慧林,季杰,等.针刺治疗缓解期无先兆偏头痛疗效观察[J].中国针灸,2005,25(10):679-681.
[14]刘波,邱丽敏.针刺“头四关穴”治疗偏头痛的临床研究[J].辽宁中医杂志,2006,33(11):1484-1485.
[15]袁野,文泳鉴,王悦,等.头针治疗无先兆性偏头痛的临床研究[J].上海针灸杂志,2016,35(1):14-17.
[16]薄智云.腹针疗法[M].北京:中国中医药出版社,2012:115.
[17]Le DoaréK,Akerman S,Holland PR,et al.Occipital afferent activation of second order neurons in the trigeminocervical complex in rat[J].Neurosci Lett,2006,403(1-2):73-77.
[18]Zhao LP,Liu L,Pei P,et al.Electroacupuncture at Fengchi(GB 20)inhibits calcitonin gene-related peptide expression in the trigeminovascular system of a rat model of migraine[J].Neural Regen Res,2017,12(5):804-811.
[19]Niu JY,Fan GQ.Specific effect of acupuncture on the neural pathway in the acute stage of migraine headache[J].World JAcupunct-Mox,2015,25(4):59-66.
[20]牛家苑.偏头痛急性期不同神经分布区穴位的针刺镇痛效应[D].南京:南京中医药大学,2016.
[21]Carreira RJ,Shyti R,Balluff B,et al.Large-scale mass spectrometry imaging investigation of consequences of cortical spreading depression in a transgenic mouse model of migraine[J].J Am Soc Mass Spectrom,2015,26(6):853-861.
[22]石宏,李江慧,吉长福,等.电针对偏头痛大鼠的皮层扩展性抑制以及对血浆降钙素基因相关肽、P物质含量的影响[J].针刺研究,2010,35(1):17-21.
[23]于明,周倩文,徐宇浩,等.针刺对CSD偏头痛大鼠内源性镇痛系统的影响[J].广西中医药,2018,41(2):62-65.
[24]Fernández-de-las-Pe?as C,Cuadrado ML,Pareja JA.Myofascial trigger points,neck mobility and forward head posture in unilateral migraine[J].Cephalalgia,2006,26(9):1061-1070.
[25]Chessman AW.Review:acupuncture reduces migraine frequency more than usual care,sham acupuncture,or prophylactic drugs[J].Ann Intern Med,2016,165(8):JC44.
[26]张茜,王志红,耿左军,等.无先兆偏头痛发作间期的静息态功能磁共振研究[J].脑与神经疾病杂志,2016,24(2):88-91.
[27]范凯威,任璐,张茜,等.有先兆偏头痛患者发作间期的静息态功能磁共振变化[J].脑与神经疾病杂志,2016,24(2):95-99.
[28]Aurora SK,Barrodale P,Chronicle EP,et al.Cortical inhibition is reduced in chronic and episodic migraine and demonstrates a spectrum of illness[J].Headache,2005,45(5):546-552.
[29]Kruit MC,Launer LJ,Overbosch J,et al.Iron accumulation in deep brain nuclei in migraine:a population-based magnetic resonance imaging study[J].Cephalalgia,2009,29(3):351-359.
[30]Li Z,Liu M,Lan L,et al.Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment[J].Sci Rep,2016,6(3):20298.
[31]戴明,靳淼,沈维娜.针刺治疗偏头痛患者疗效观察及对脑血流的影响[J].上海针灸杂志,2007,26(9):3-5.
[32]谢菊英,贺莉萍,王灵,等.针刺不同经脉腧穴治疗偏头痛的作用比较[J].针灸临床杂志,2009,25(2):13-14.
[33]李国艳,李霞,李淑琴,等.穴位特异性研究进展[J].上海针灸杂志,2016,35(4):383-387.
[34]Diener HC,Kronfeld K,Boewing G,et al.Efficacy of acupuncture for the prophylaxis of migraine:a multicentre randomised controlled clinical trial[J].Lancet Neurol,2006,5(4):310-316.
[35]Linde K,Streng A,Jürgens S,et al.Acupuncture for patients with migraine:a randomized controlled trial[J].JAMA,2005,293(17):2118-2125.
[36]Wang Y,Xue CC,Helme R,et al.Acupuncture for frequent migraine:a randomized,patient/assessor blinded,randomized controlled trial with one-year follow-up[J].Evid Based Complement Alternat Med,2015,2015:920353.
[37]Hou M,Xie JF,Kong XP,et al.Acupoint injection of onabotulinumtoxin A for migraines[J].Toxins(Basel),2015,7(11):4442-4454.
[38]Zhao L,Chen J,Li Y,et al.The Long-term effect of acupuncture for migraine prophylaxis:a randomized clinical trial[J].JAMAIntern Med,2017,177(4):508-515.
[39]Chen J,Zhao L,Zheng H,et al.Evaluating the prophylaxis and long-term effectiveness of acupuncture for migraine without aura:study protocol for a randomized controlled trial[J].Trials,2013,14(1):361.
[40]杭晓娟,范刚启,郝传传.对针刺治疗偏头痛临床研究的几点建议[J].甘肃中医,2010,23(1):36-39.
[41]余晓璐,范刚启.针刺方向、角度、深度与偏头痛针刺疗效的关系[J].针灸临床杂志,2012,28(8):76-79.
[42]刘岚青,寇任重,文亚,等.偏头痛针刺治疗方案时间因素选择的文献分析[J].中医杂志,2018,59(5):435-440.
[43]范刚启,王玲玲,王启才,等.神经系病针灸临床病谱和治疗方案的优选[J].中国针灸,2003,23(8):477-479.
[44]文亚,王丹,范刚启.针刺治疗急性期偏头痛的穴位选择[J].中国针灸,2018,38(11):1183-1188.
[45]寇任重,范刚启,刘岚青,等.基于多学科协作的头痛单元组建与运作分析[J].中国医院管理,2017,37(6):36-38.
[2]中华医学会疼痛学分会头面痛学组,中国医师协会神经内科医师分会疼痛和感觉障碍专委会.中国偏头痛防治指南[J].中国疼痛医学杂志,2016,22(10):721-727.
[3]蒲圣雄,谭戈,邓勇,等.针刺对比药物预防治疗偏头痛有效性及安全性的Meta分析[J].重庆医科大学学报,2017,42(10):1293-1298.
[4]高树中,杨骏.针灸治疗学[M].北京:中国中医药出版社,2016:35-38.
[5]焦玥,吴中朝,胡静,等.《循证针灸临床实践指南:偏头痛》2014更新版解读[J].中国针灸,2016,36(7):751-756.
[6]张琰,张路,李彬,等.针刺预防性治疗对无先兆偏头痛患者生存质量的影响[J].中国针灸,2009,29(6):431-435.
[7]赵凌,任玉兰,梁繁荣.基于数据挖掘技术分析历代针灸治疗偏头痛的用穴特点[J].中国针灸,2009,29(6):467-472.
[8]秦卓,程凯,孟欢,等.偏头痛患者侧头部痛点分布与少阳经的相关性研究[J].中国中医基础医学杂志,2015,21(8):994-995,1013.
[9]常小荣,林海波,刘密,等.针刺少阳经特定穴治疗偏头痛患者远期疗效的临床观察[J].中华中医药杂志,2013,28(4):1139-1141.
[10]沈燕,樊小农,王舒.从“神”论针刺预防性治疗偏头痛的思路探讨[J].中华中医药杂志,2015,30(4):1160-1163.
[11]王少松.王麟鹏教授分期分型针刺治疗偏头痛经验[J].中国针灸,2016,36(7):743-746.
[12]邓启龙,武欢,马朝阳,等.头穴透刺治疗偏头痛急性发作疗效观察[J].中国中医急症,2012,21(12):2005-2006.
[13]王麟鹏,刘慧林,季杰,等.针刺治疗缓解期无先兆偏头痛疗效观察[J].中国针灸,2005,25(10):679-681.
[14]刘波,邱丽敏.针刺“头四关穴”治疗偏头痛的临床研究[J].辽宁中医杂志,2006,33(11):1484-1485.
[15]袁野,文泳鉴,王悦,等.头针治疗无先兆性偏头痛的临床研究[J].上海针灸杂志,2016,35(1):14-17.
[16]薄智云.腹针疗法[M].北京:中国中医药出版社,2012:115.
[17]Le DoaréK,Akerman S,Holland PR,et al.Occipital afferent activation of second order neurons in the trigeminocervical complex in rat[J].Neurosci Lett,2006,403(1-2):73-77.
[18]Zhao LP,Liu L,Pei P,et al.Electroacupuncture at Fengchi(GB 20)inhibits calcitonin gene-related peptide expression in the trigeminovascular system of a rat model of migraine[J].Neural Regen Res,2017,12(5):804-811.
[19]Niu JY,Fan GQ.Specific effect of acupuncture on the neural pathway in the acute stage of migraine headache[J].World JAcupunct-Mox,2015,25(4):59-66.
[20]牛家苑.偏头痛急性期不同神经分布区穴位的针刺镇痛效应[D].南京:南京中医药大学,2016.
[21]Carreira RJ,Shyti R,Balluff B,et al.Large-scale mass spectrometry imaging investigation of consequences of cortical spreading depression in a transgenic mouse model of migraine[J].J Am Soc Mass Spectrom,2015,26(6):853-861.
[22]石宏,李江慧,吉长福,等.电针对偏头痛大鼠的皮层扩展性抑制以及对血浆降钙素基因相关肽、P物质含量的影响[J].针刺研究,2010,35(1):17-21.
[23]于明,周倩文,徐宇浩,等.针刺对CSD偏头痛大鼠内源性镇痛系统的影响[J].广西中医药,2018,41(2):62-65.
[24]Fernández-de-las-Pe?as C,Cuadrado ML,Pareja JA.Myofascial trigger points,neck mobility and forward head posture in unilateral migraine[J].Cephalalgia,2006,26(9):1061-1070.
[25]Chessman AW.Review:acupuncture reduces migraine frequency more than usual care,sham acupuncture,or prophylactic drugs[J].Ann Intern Med,2016,165(8):JC44.
[26]张茜,王志红,耿左军,等.无先兆偏头痛发作间期的静息态功能磁共振研究[J].脑与神经疾病杂志,2016,24(2):88-91.
[27]范凯威,任璐,张茜,等.有先兆偏头痛患者发作间期的静息态功能磁共振变化[J].脑与神经疾病杂志,2016,24(2):95-99.
[28]Aurora SK,Barrodale P,Chronicle EP,et al.Cortical inhibition is reduced in chronic and episodic migraine and demonstrates a spectrum of illness[J].Headache,2005,45(5):546-552.
[29]Kruit MC,Launer LJ,Overbosch J,et al.Iron accumulation in deep brain nuclei in migraine:a population-based magnetic resonance imaging study[J].Cephalalgia,2009,29(3):351-359.
[30]Li Z,Liu M,Lan L,et al.Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment[J].Sci Rep,2016,6(3):20298.
[31]戴明,靳淼,沈维娜.针刺治疗偏头痛患者疗效观察及对脑血流的影响[J].上海针灸杂志,2007,26(9):3-5.
[32]谢菊英,贺莉萍,王灵,等.针刺不同经脉腧穴治疗偏头痛的作用比较[J].针灸临床杂志,2009,25(2):13-14.
[33]李国艳,李霞,李淑琴,等.穴位特异性研究进展[J].上海针灸杂志,2016,35(4):383-387.
[34]Diener HC,Kronfeld K,Boewing G,et al.Efficacy of acupuncture for the prophylaxis of migraine:a multicentre randomised controlled clinical trial[J].Lancet Neurol,2006,5(4):310-316.
[35]Linde K,Streng A,Jürgens S,et al.Acupuncture for patients with migraine:a randomized controlled trial[J].JAMA,2005,293(17):2118-2125.
[36]Wang Y,Xue CC,Helme R,et al.Acupuncture for frequent migraine:a randomized,patient/assessor blinded,randomized controlled trial with one-year follow-up[J].Evid Based Complement Alternat Med,2015,2015:920353.
[37]Hou M,Xie JF,Kong XP,et al.Acupoint injection of onabotulinumtoxin A for migraines[J].Toxins(Basel),2015,7(11):4442-4454.
[38]Zhao L,Chen J,Li Y,et al.The Long-term effect of acupuncture for migraine prophylaxis:a randomized clinical trial[J].JAMAIntern Med,2017,177(4):508-515.
[39]Chen J,Zhao L,Zheng H,et al.Evaluating the prophylaxis and long-term effectiveness of acupuncture for migraine without aura:study protocol for a randomized controlled trial[J].Trials,2013,14(1):361.
[40]杭晓娟,范刚启,郝传传.对针刺治疗偏头痛临床研究的几点建议[J].甘肃中医,2010,23(1):36-39.
[41]余晓璐,范刚启.针刺方向、角度、深度与偏头痛针刺疗效的关系[J].针灸临床杂志,2012,28(8):76-79.
[42]刘岚青,寇任重,文亚,等.偏头痛针刺治疗方案时间因素选择的文献分析[J].中医杂志,2018,59(5):435-440.
[43]范刚启,王玲玲,王启才,等.神经系病针灸临床病谱和治疗方案的优选[J].中国针灸,2003,23(8):477-479.
[44]文亚,王丹,范刚启.针刺治疗急性期偏头痛的穴位选择[J].中国针灸,2018,38(11):1183-1188.
[45]寇任重,范刚启,刘岚青,等.基于多学科协作的头痛单元组建与运作分析[J].中国医院管理,2017,37(6):36-38.