Chapter 13 Bilingual Acupuncture and Moxibustion Case (67 cases)

 第十三章   针灸学双语医案选 (67 案 )

13.1 Cases of Department of Gynaecology (21cases)

第一节  妇科病案（21例）

妇科疾病的流行病学特点为发病率高、复发率高、临床表现多样化、症状复杂化。发病原因与年 龄、遗传、卫生、生育和心因性因素等密切相关。中医药疗法治疗妇科疾病应用广泛，疗效明确，有着 其他疗法无法比拟的优势。在中医学理论“冲为血海”“任主胞胎”“女子体阴用阳，以肝为本”和 “肾主生殖”等理论的指导下，调理冲任、疏肝理气和养血补血成为妇科疾病治疗的法则。我们根据临 床经验，形成了治疗多囊卵巢综合征（polycystic ovarian syndrome，PCOS）的针灸治疗方法，现介绍 如下：

中医临床分型：根据症状及舌脉，分为4个证型。

痰瘀内阻型：主要症状为形体肥胖，经量减少或月经稀发，甚至闭经，舌黯苔腻，脉沉涩；  阴虚内热型：主要表现为形体适中或略瘦，月经紊乱，经量时多时少，舌红苔薄黄，脉细数；

气血不足型：临床主要表现为形体适中或略胖，月经量少或正常，经色淡，易外感，舌淡，舌体胖 大或边有齿痕，苔白或腻，脉濡；

血虚肝郁型：主要表现为形体适中或略瘦，月经量减少，经色黯或似有血渣，情绪低落，舌淡红苔 薄白或黄，脉弦或弦数。

针灸治疗方法：

主穴选用子宫穴、三阴交、中极、水道；痰瘀内阻型加归来、丰隆、中脘；阴虚内热型加太溪、地 机；气血不足型加关元、足三里、太溪；血虚肝郁型加内关、太冲。

操作方法：患者取仰卧位，全身放松，常规消毒后，子宫穴、中极穴、归来穴、关元穴采用舒张进 针法迅速将针透入皮下，缓慢向下深入，当患者自觉有酸胀感或酸痛感时，再向下深入0.2寸左右，使酸 胀感或酸痛感明显，持针守气5秒钟左右，徐徐由深层提退至浅层，再从浅层徐徐插入至深层，在徐徐插 入的过程中，如患者感觉针感传至阴部，持针守气5秒钟左右，即可停止行针；如患者没有感觉针感传 至阴部，则再将针徐徐提退至浅层，再从浅层徐徐插入至深层，如此反复，至患者有明显针感传至阴部 后，持针守气5秒钟左右。以能引起局部肉眼可见肌肉跳动为佳。内关、太冲、太溪直刺0.5寸，中脘、地 机、足三里、丰隆、三阴交直刺1寸，行提插捻转，手法平补平泻，针感为局部有明显酸胀或麻感，针刺 得气后留针20分钟。

分时段针刺法：滤泡期（月经4～8天）子宫穴、中极穴采用温针灸，将长度约2cm艾条，插在针尾，

Billingual Acupuncture and Moxibustion

从近针根端点燃；排卵期（月经9～17天）子宫穴、水道穴采用电针，频率20Hz，疏密波，强度在感觉阈 和痛阈之间；黄体期（月经17天至月经来潮）子宫穴采用温针灸，将长度约2cm艾条，插在针尾，从近针 根端点燃；月经期根据月经量多少决定是否针刺，月经量多不予针刺，月经量少，给予毫针针刺，不加 用温针、电针等。

如促孕，可结合经络循按：患者取仰卧位，腹部放松，痰瘀内阻型沿任脉腹部循行、肾经腹部循 行、胃经腹部循行、脾经腹部循行，从下至上，依次进行循按；阴虚内热型、气血不足型、血虚肝郁型 沿足太阴下肢循行、足厥阴下肢循行、足少阴肾经下肢循行，从下至上，依次进行循按。每经循按3次， 在循按过程中，如遇有疼痛明显或其他感觉明显部位，略延长按压时间。阴虚内热型、气血不足型、血 虚肝郁型每周2～3次，10次1疗程，共治疗3个疗程。月经期间不停止治疗，在月经期间腹部循按时，力 度适当减轻，对于月经量多的患者，月经期间三阴交针感适当减轻。

13.1.1 不孕症

女性无避孕性生活至少12个月而未孕者；或曾有过妊娠，未避孕而又一年未再受孕者，称之为不孕 症。前者为原发性不孕，中医学称为“全不产”；后者为继发性不孕，中医学称为“断续”【1】。

近年来，随着生活节奏加快，工作压力增加，环境污染加剧，不孕症发病率不断增加，目前我国不 孕症发病率约为7%~10%【2】。

根据中医学理论，不孕症的病因是由于肾虚、肝郁、痰湿内阻、瘀滞胞宫等导致肾气不足，气血冲 任失调所致【3】 。根据现代医学理论，不孕症的病因是多因盆腔因素及排卵障碍所致，此外还有男性不育 因素和不明原因不孕。

目前现代医学对不孕症的治疗主要是根据不孕症发生的原因进行对症治疗，治疗方法主要包括针对 生殖道器质性病变进行治疗、针对排卵障碍进行诱发排卵治疗，以及辅助生殖治疗技术等。近年来， 针灸疗法在国内外被广泛应用于不孕症的治疗当中，并且取得了较好的疗效，引起了国内外学者的关注 和重视。国内外开展的多项研究表明，针灸具有促进排卵、调节性腺轴激素水平、提高受孕率等作 用。在临床应用当中，任脉是针灸治疗不孕症最常选用的腧穴，中极、关元、然谷、水道、三阴交、子 宫、阴廉、商丘、阴交、石门是最为常用的腧穴【4】 。针灸对神经内分泌功能失调导致的不孕症有较好的 疗效【5】，尤其对排卵障碍性不孕症的治疗有其特有的优势【6】。

［ 1 ］马宝璋．齐聪．中医妇科学［M ］．北京：中国中医药出版社，2012. ［2］谢幸，苟文丽．妇产科学［M ］．北京：人民卫生出版社，2013.

［3 ］谢幸，苟文丽．妇产科学［M ］．北京：人民卫生出版社，2013.

［4］兰蕾，刘迈兰，曾芳，等．针灸治疗不孕症的古代文献分析［J ］．辽宁中医杂志，2009（ 11 ）：1968-1969. ［5］杜元灏，董勤．针灸治疗学［M ］．北京：人民卫生出版社，2012.

［6］肖达，张群．针灸治疗不孕症的研究进展［J ］．上海针灸杂志，2015（ 1 ）：80-84.

（ 1 ）宫外孕术后不孕症案

林某，女，35岁，2003年5月23日初诊。

主诉：宫外孕 术后6年未孕。

现病史：8年前妊娠后2个月，因外力撞击腹部而发生流产。2年后再次妊娠，妊娠40余天后因剧烈腹 痛伴下腹流血就诊，诊断为宫外孕破裂出血，行左侧输卵管局部切除术。术后6年一直未孕，碘油造影示右侧输卵管通而不畅。月经周期30天，行经期5天，量少，色黯，伴有少量血块。饮食可，二便调，寐可。 舌、脉象：舌淡苔白微腻，脉沉。

诊断：中医诊断：断续（断绪）。证型：痰瘀内阻。 西医诊断：继发性不孕（输卵管因素）。

治则：化瘀通络，温经化痰。 针灸处方：

主穴：水道、三阴交、内关。 配穴：合谷、血海、丰隆。

刺灸法：针刺水道穴时使用提插泻法，得气务必以出现针下有明显的跳动感为度，而后水道穴使用 温针灸。余穴均用平补平泻手法。起针后水道穴拔罐，留罐10分钟。

辨证分析：患者曾怀孕，现不孕，属于中医学的“断续”“断绪”范畴。《医宗金鉴 ·妇科心法》 言：“不子之故伤冲任，不调带下经崩或因积血胞寒热痰，饮脂膜病子宫。”患者先因外力撞击腹部， 导致冲任不固，而出现流产；再因宫外孕手术损伤胞络，冲任失于调养，瘀血阻于胞脉，故出现月经量 少，色黯，有少量血块；舌淡苔白微腻，脉沉表明患者内有痰湿，八纲辨证为寒证、里证。因此患者为 冲任损伤，痰瘀内阻，导致气机闭塞，不能摄精成孕。《神农本草经》云：“谓主妇人多无子，因无子 者多系冲任瘀血，瘀血去自能有子也。”故治宜化瘀通络，温经化痰为主。而且患者因年纪渐长，长期 不孕，心情焦虑，故在治疗时应考虑酌加舒肝解郁之法。

取穴依据：全方组穴以化瘀通络为主。主穴选用水道、三阴交、内关。选穴方法为近部选穴、远部 选穴和辨证选穴相结合。其中水道穴通胞脉，三阴交穴化瘀活血，内关穴理气解郁。水道，位置在“大 巨下一寸”《循经考穴编》，为足阳明胃经腧穴，取穴方法为仰卧，脐下3寸，正中线旁开2寸。《千金 翼方》载：“妊胎不成，若堕胎腹痛，漏胞见赤，灸胞门五十壮，关元左边二寸是也，右边名子户，子 藏闭塞不受精，灸胞门五十壮；胞衣不出，或腹中积聚，皆针胞门入一寸，先补后泻；去关元左二寸， 子死腹中及难产，皆针胞门。”文中所言胞门、子户即指左右水道穴。水道穴其下正为女性内生殖器的 解剖位置，故水道为近部取穴，针感以局部跳动为主，以便更好地发挥其疏通局部经络气血作用，促进 输卵管的蠕动。配穴中合谷、血海增强化瘀活血的作用，丰隆祛痰湿。丰隆，胃经络穴，别走太阳，连 络脾胃二经，有健脾化湿除痰作用。

疗程、疗效：治疗1个疗程（每周3次，10次为1疗程）后，月经颜色转红，没有血块，共治疗5个疗 程。1年后妊娠，次年产1子。

心得：《灵枢 · 九针十二原》：“夫善用针，取其疾也，犹拔刺也，犹雪污也，犹解结也，犹决 闭也。疾虽久，犹可毕也。言不可治者，未得其术也。”患者经多方求医，中西药物服用多种，屡治不 效，为未得其术也。《圣济总录》：“妇人纯阴，女子以血为主，以气为用；在上为乳饮，在下为月 事。”本病案中确诊患者病在血脉尤为重要，《针灸大成》云：“然而疾在肠胃，非药饵不能以济；在 血脉，非针刺不能以及；在腠理，非熨芮不能以达，是针、灸、药者，医家之不可缺之者也。”故使用 针灸之治法为得其术也。同时在治疗中要遵循《灵枢 ·九针十二原》之“刺之要，气至而有效”。水道 穴的得气是取得疗效的关键。纵观本病案，正如《百症赋》中所言：“夫医乃人之司命，非志士莫为； 针乃理之渊微，须至人指教。先究其病源，后攻其穴道，随手见功，应针取效”。

Case 1 Sterility following operation on ectopic pregnancy

Female patient, aged 35 years.

Chief complaint

No child following operation of ectopic pregnancy.

History of present illness

Eight years ago, because of the accident, she experienced abortion after a pregnancy of 2 months. She had

Billingual Acupuncture and Moxibustion

been pregnant again 2 years later. When she had been pregnant for more than 40 days, she had lower abdominal pain and vaginal bleeding. Ultrasonic examination revealed evidence of ectopic pregnancy. She received operation on cutting left uterine tube. Post-operative 6 years, she has not been  pregnant.  Special  examination revealed evidence of obstruction of right fallopian tube. Menstruation was regular with decreasing amount of bleeding.

Tongue and pulse

The patient’s tongue was pale with white and greasy coating and her pulse was deep (chen).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease). Phlegm blended with blood stasis (syndrome differentiation).

WM diagnosis: Secondary sterility (uterine tube factor).

Principle of treatment

Resolving stasis and dredging collaterals. Warming meridians and resolving phlegm.

Prescription

Main points: Shuidao (ST 28),Sanyinjiao (SP 6),Neiguan( PC 6).

Additional points: Hegu (LI 4),Xuehai (SP 10),Fenglong (ST 40).

Manipulation

Applying filiform needles with reducing by twirling and rotating needle to Shuidao (ST 28). The patient has needle sensation such as distending around the abdomen. Applying warming needle moxibustion to Shuidao (ST 28). Uniform reinforcing and reducing manipulation is applied to the other points. Cupping is given on Shuidao (ST 28) for ten minutes after removing needles.

Differentiation of the syndrome or disease

The 35-year-old female patient presented with no child as her chief complaint. She experienced abortion and operation on cutting left uterine tube, and her menstruation was regular with scanty bleeding. These signs and symptoms are classified as “sterility” in Traditional Chinese Medicine. The Golden Mirror of Medicine says: “Sterility due to injury of Thoroughfare and Conception vessels, it is caused by retention of the blood stasis and phlegm of uterus.” According to eight-principle syndrome differentiation, it was cold and interior syndrome. She experienced abortion and operation of ectopic pregnancy, which injured Thoroughfare and Conception vessels. The patient had pale tongue with white and greasy coating and her pulse was deep (chen), indicating that the syndrome differentiation is phlegm retention due to Spleen deficiency and blood stasis due to collaterals’ injury.

Explanation of the points

Shuidao (ST 28) dredges collaterals. Sanyinjiao (SP 6) activates blood to resolve stasis. Neiguan (PC 6) regulates qi to relieve depression. Shuidao (ST 28), water passage, located 3 cun below the umbilicus 2 cun laterd to the midline, regulates qi of the lower abdomen, and is usually used ingynaecological complaint. The A Supplement to Invaluable Prescriptions says: “Applying moxibustion to Shuidao (ST 28) in sterility and threatened labour.” Female genitals organs is locatad inside the Shuidao (ST 28), it promotes the peristalsis of fallopian tube. Hegu (LI 4) and Xuehai (SP 10) enhance to activate blood to resolve stasis. Fenglong (ST 40) resolves phlegm.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for 5 courses, she was pregnant and produced a baby.

Experience

The Spiritual Pi Vot of Huangdi’s Canon of Medicine says: “If the acupuncturists knowhow to handle the needles, they can cure diseases, even the diseases have been for a long time; if the acupuncturists don’t master acupuncture technique, they can’t cure any diseases.”

（ 2 ）月经稀发不孕症案

何某，女，29岁，2003年4月13日初诊。 主诉：婚后6年未孕，2~6个月行经1次。

现病史：结婚6年未孕，配偶身体健康。14岁月经初潮，月经2~6个月行经1次，量中等，颜色红，行 经4~6天。行经期间无腹痛等不适感，行B超监测排卵，6个月监测到2个成熟卵泡。伴面色光白，畏寒肢 冷，手足不温。饮食可，大便调，小便次数多，寐可。

舌、脉象：舌淡苔薄白，脉弱。

诊断：中医诊断：全不产（无子）。证型：肾阳不足。 西医诊断：原发性不孕。

治则：温肾壮阳，调补冲任。 针灸处方：

主穴：关元、气海、太溪。 配穴：三阴交、公孙。

刺灸法：针刺关元穴时使用捻转补法，得气以患者自觉小腹有胀感或温热感或舒适感为度。关元、 气海穴使用温针灸。余穴均用平补平泻手法。

辨证分析：患者从未怀孕过，属中医学的“无子”（《山海经》）、“全不产”（《备急千金要 方》）范畴；月经数月一行，属于中医学的“月经不调”范畴。其月经失调与不孕有着内在的联系。 《妇科切要》云：“妇女无子，皆由月经不调。”《万病回春》又云：“妇人之道，始于求子，求子之 法，莫先调经。”故其治疗的关键应从调经入手。患者舌淡苔薄白，脉弱，八纲辨证为虚证、里证、寒 证。因肾阳不足，导致命门火衰，不能温煦脏腑，致奇恒之腑女子胞功能低下，卵子数月一排，月经数 月一行；阳气不足不能温通经脉，而出现面色光白，畏寒肢冷，手足不温，小便次数多等症。故在治疗上 应用补法、温法，通过补肾壮阳，调补冲任，使肾阳旺盛，血海充盈，月经正常，方可妊子。

取穴依据：全方以补肾壮阳为主。主穴选用关元、气海、太溪。其中关元穴为强壮要穴，可补益全 身之阳气而强壮肾阳；太溪为滋肾阴以壮肾阳，所谓“善益阳者常于阴中求阳”；气海穴补气以壮阳。 关元为小肠募穴、足三阴经与任脉的交会穴，位置在“脐下三寸”《灵枢 ·寒热病》，取穴方法为仰 卧，脐下3寸，腹正中线上。《类经图翼》：“此穴当人身上下四旁之中，故又名大中极，乃男子藏精， 女子蓄血之处”；《灵枢 ·寒热病》：“身有所伤血出多，及中风寒，若有所堕坠，四支懈惰不收，名曰 体惰。取其小腹脐下三结交。三结交者，阳明、太阳也，脐下三寸关元也”；《太平圣惠方》引岐伯言： “但是积冷虚乏病，皆宜灸之”；《玉龙赋》：“带脉关元多灸，肾败堪攻”。配穴取公孙、三阴交，其 中公孙为八脉交会穴之一，通于冲脉，可调理冲脉气血，冲脉被称为“十二经脉之海”，又被称为“血 海”，与女性的月经、生殖有着密切的关系；三阴交为治疗妇科疾病的要穴，可补益足三阴经的气血。

疗程、疗效：隔天1次，每周3次，10次1疗程。共治疗6个疗程，其间月经规律为35天左右一行，一 年后妊娠。

心得：《标幽赋》：“夫观九针之法，毫针最微，七星上应，众穴主持。”在针刺主穴关元、气海 时应如《灵枢 ·九针十二原》中所言：“持针之道，坚者为宝，正指直刺，无针左右，神在秋毫属意病者，审视血脉者，刺之无殆。”针刺方向应如 《类经 ·针刺类用针虚实补泻》：“正而不斜，则必中 其气穴，医之神见，在悉秋毫，必精必确。”在操作过程中要注重押手的作用，诚如《难经 ·第七十七 难》云：“知为针者，信其左，不知为针者，信其右，当刺之时，先以左手厌按所针荥俞之处，弹而努 之，爪而下之，其气之来，如动脉之状，顺针而刺之，得气因推而内之，是谓补；动而伸之，是谓泻。”

Case 2 Oligomenorrhea sterility

Female patient, aged 29 years.

Chief complaint

No child since marriage 6 years ago.

History of present illness

She had never been pregnant since she got married 6 years ago, and her spouse is in good health. Her  menstrual history was as follows: 14-year-old menarche, with the cycle of menstruation irregular from 2 months’ to 6 months’ interval, the amount of bleeding normal, the color of bleedling red, lasting up to 4-6 days. The 2  mature ovarian follicles were monitored in the last 6 months. The patient had pale complexion and intolerance of cold. Her feet and hands were not warm.

Tongue and pulse

The patient had pale tongue with white and thin coating; her pulse was weak (ruo).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), Kidneys-yang deficiency (syndrome differentiation).

WM diagnosis：Primary sterility.

Principle of treatment

Warming and invigorating Kidneys-yang. Regulating thoroughfare and conception vessels.

Prescription

Main points: Guanyuan (CV 4),Qihai (CV 6), Taixi (KI 3).

Additional points: Sanyinjiao (SP 6), Gongsun (SP 4).

Manipulation

Applying filiform needles with reinforcing by twirling and rotating needles to CV 4. Needle sensation was warm feeling or comfortable feeling in low abdomen. Applying warming needle moxibustion to CV 4 and CV 6. Applying filiform needles with uniform reinforcing and reducing method to the other points.

Differentiation of the syndrome or disease

The 29-year-old female patient presented with no child as her chief complaint. She had never been pregnant before, and her menstruation come with irregular 2-6 months’ interval. These signs and symptoms are classified as “sterility” and “irregular menstrual cycle” in Traditional Chinese Medicine. Her irregular menstrual cycle closely connected with sterility. The An Outline of Obstetrics and Gynecology says: “The women have borne no child,which is caused by irregular menses”, and the Invaluable Prescription says: “The ways to treat sterility, first should regulate menstruations.” So the key of the treatment should regulate menstruation. Her pale tongue with white and thin coating, and weak pulse, indicating deficiency and interior syndrome. Kidney yang deficiency failed to warm internal organs.

Explanation of the points

CV 4 is the gate of original qi and the front-mu point of the small intestine meridian and the crossing point of the Conception meridian and the foot three yin meridians. It is located 3 cun below the umbilicus, on the midline of body. CV 4 is one of the most powerful points to replenish qi and blood and strengthen the body and mind. It replenishes kidneys and original qi and is a very powerful point to strengthen the general level of energy and kidneys. KI 3 indirectly strengthens kidneys yang by nourishing kidneys’ yin. CV 6 replenishes the original qi. Taiping Royal Prescriptions: “Both deficient and cold syndrome, applying moxibustion to the point of CV 4” . SP 4 is one of the eight crossing point. It relates to Thoroughfare vessel. Thoroughfare vessel is called “sea of twelve meridians” and “sea of blood” and it is related to menstruation and reproduction. SP 6 is a major point to use in gynaecological complaints, as it regulates the uterus and menstruation.

Frequency and duration and treatment outcome

Once every other day, ten treatments constituted a course. During the treatments, her menstruations came with regular interval of 35 days. After treated for 6 courses, she was pregnant.

Experience

The Spiritual Pi vot of Huangdi’s Canon of Medicine says: “It is important to keep needles stand up when inserting needles.”

（ 3 ）支原体、衣原体感染不孕症案 杨某，女，30岁，2006年5月2初诊。 主诉：婚后4年未孕。

现病史：婚后4年未孕，配偶身体健康。检查显示支原体（+），衣原体（+）。月经规律，周期30 天，行经期5天，经色黯红，经量适中。排卵期白带略多，流出时伴少许痒的感觉。平素自觉体健，无明 显不适。饮食可，二便调，寐可。

舌、脉象：舌质红苔黄腻，脉浮滑。

诊断：中医诊断：全不产（无子）。证型：湿热内蕴。 西医诊断：原发性不孕。

治则：清热祛湿，养血助孕。 针灸处方：

主穴：阴陵泉、三阴交。

配穴：中极、天枢、行间。

刺灸法：针刺阴陵泉穴时使用捻转、迎随泻法，得气以出现局部酸胀感为度；中极穴深刺，以针感 下传至外阴部为佳。余穴均用平补平泻手法。起针后天枢穴拔罐，留罐10分钟。

辨证分析：患者从未怀孕过，属中医学的“无子”（《山海经》）、“全不产”（《备急千金要 方》）范畴。患者排卵期白带略多，流出时伴少许痒的感觉；支原体（+）、衣原体（+），表明体内 有湿邪。《妇人大全良方 ·产定方序》：“气血，人之神也，不可不谨为调护，然妇人以血为基本，血 气宣行，其神自清，所谓血室，不蓄则气和，血凝结则水火相刑。”患者内有湿邪，湿蕴虫生，虫于阴 中，日久腐伤血络，阻滞冲任，胞宫；虫于阴中，杀精阻精，致阴阳不能交合，导致不孕。患者舌质红 苔黄腻，八纲辨证为里证、热证。故治疗以清热利湿为主，《本草纲目》论月水：“女子，阴类也，以 血为主”。故在治疗时还应辅以养血的方法。

取穴依据：全方重在祛湿清热，并辅以养血之法。脾主运化水湿，《妇科精华》卷中引陆九芝言

Billingual Acupuncture and Moxibustion

曰：“妇人经带皆水也，人之不知经为水，故治之不得道”。故以足太阴脾经腧穴阴陵泉、三阴交为主 穴，以健脾除湿，又因“脾统血”，取三阴交还可养血。阴陵泉位置为“膝下内侧辅骨下陷者中，伸 足乃得之”（《针灸甲乙经》），取穴方法为胫骨内侧髁下缘凹陷处取之。《备急千金要方》云：“阴 陵泉、关元，主寒热不节，肾病不可俯仰……”；《针灸甲乙经》载：“阴陵泉主妇人阴中痛，少腹 坚急痛”；《千金翼方》：“水肿不得卧，灸阴陵泉百壮”；《外台秘要》：“阴陵泉主女子疝瘕”。 在针刺阴陵泉时根据《难经 ·七十二难》：“所谓迎随者，知荣卫之流行，经脉之往来也。随其逆顺而 取之，故曰迎随”。故针刺阴陵泉穴时针尖方向逆足太阴脾经的走行方向“从足走腹”，指向足大趾。 在针刺中极穴时根据《灵枢 ·始终》：“补须一方实，深取之，稀按其痏，以极出其邪气； 一方虚，浅 刺之，以养其脉，疾按其痏，无使邪气得入”。采用深刺，起针时，摇大其孔以泻其热，不按针孔以出 其邪气的方法。配穴中按经脉配穴法中的表里经配穴法取足阳明胃经的腧穴天枢，在增强祛湿作用的同 时，尚可起到局部近治作用；中极利水祛湿，疏通局部气血；行间泻热。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个月后，支原体（-）、衣原体（-），5个月后 妊娠。

心得：《灵枢 · 官能》：“用针之服，必有法则。”正如汪机言：“夫病变无穷，灸刺之法亦无 穷。或在上，下取之；或在下，上取之；或正取之，或直取之，审经与络，分血与气，病随经所在，穴 随经而取，庶得随机应变之理。”患者虽为不孕，病位在腹，但其证主要为湿热内蕴，故在治疗上以膝 关节以下腧穴为主。杨继洲曰：“变通随乎症，不随乎法。”在操作时要注重手法的运用，徐凤在《金 针赋》中将能调节控制针刺感应向一定方向扩散传布的针刺之法称为调气、运气，并将《针经指南》 中的针法发展为“爪而切之，下针之法；摇而退之，出针之法；动而进之，催针之法；循而按之，行 气之法；搓则去病；弹则补虚；肚腹盘旋，扪为穴闭；重沉豆许曰按；轻浮豆许曰提； ……”。在针刺 阴陵泉时尤当注意上述手法的应用。针刺中极时，按《针经指南》所言：“捻针，使气下行至病所，行 气”。操作时遵循《灵枢 ·邪客》：“持针之道，欲端以正，安以静，先知虚实，而行疾徐，左手执骨 右手循之，无与肉果，泻欲端以正，补必闭肤，辅针导气，邪得淫佚，真气得居”。

Case 3 Sterility due to mycoplasma and chlamydia infection

Female patient, aged 30 year-old.

Chief complaint

No child since marriage 4 years ago.

History of present illness

She had never been pregnant for 4 years since she got married, and her spouse is in good health. Leukorrhea  examination revealed the following: Mycoplasma (+), chlamydia (+). Menses came with a regular 30 days’ interval, and went by for 5 days with dark color bleeding. Leucorrhea sometimes became more, together with  vaginal itching.

Tongue and pulse

The patient had red tongue with a yellow and greasy coating, and her pulse was soft (ru).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), damp–heat accumulation (syndrome differentiation).

WM diagnosis：Primary sterility.

Principle of treatment

Clearing damp-heat and nourishing blood.

Prescription

Main points: Yinlingquan (SP 9),Sanyinjiao (SP 6).

Additional points: Zhongji (CV 3), Tianshu (ST 25),Xingjian (LR 2).

Manipulation

Reduce by twirling and rotating needle on the point of SP 9 until the patient has feeling of distension in low abdomen. Puncturing CV 3 deeply with the needle sensation reach to vulva. Apply filiform needles with uniform reinforcing and reducing method to the other points. Apply cupping to ST 25 for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 30-year-old female patient presented with no child as her chief complaint. The patient had never been pregnant before. It is classified as “sterility” in Traditional Chinese Medicine. Her vaginal discharge became more and with vaginal itching during the period of ovulation, indicating internal retention of dampness. A Complete Collection of Effective Prescription for Women says: “Qi and blood are the important materials of body. They should be replenished carefully, and blood is the basis of women” . The patient had red tongue with yellow and greasy coating, indicating it was heat and interior syndrome. So the treatment should aim at clearing damp-heat and nourishing blood.

Explanation of the points

The spleen controls the transportation and transportation of fluid and dampness, selecting the points of Spleen meridian as main points. Yinlingquan (SP 9) is located at the medial aspect of the lower leg; in the depression of the lower border of the medial condyle of the tibia. The ABC Classics of Acupuncture and Moxibustion says: “Selecting Yinlingquan (SP 9) to relieve pain in reproductive system.” The direction of pinprick should point to toe against the pathway of spleen meridian while needling it. Tianshu (ST 25) clears dampness. Zhongji (CV 3) resolves damp-heat and promotes qi transformation. Xingjian (LR 2) clearsheat.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for 3 months, leukorrhea examination revealed the following: Mycoplasma (-), chlamydia (-), the patient was pregnant at the end of the year.

Experience

Spiritual Pi vot of Huangdi’s Canon of Medicine says: “It’s necessary to obey its rules when applying needles.” Although she suffered from sterility for a long time and the problem was in pneumoperitoneum, because its syndrome differentiation was damp-heat, the main points were located under the knee.

（ 4 ）黄体功能不足不孕症案

罗某，女，30岁。2003年2月11初诊。 主诉：自然流产2次，2年未孕。

现病史：5年前因子宫内膜异位症行左侧卵巢巧克力囊肿剥离术，3年前妊娠42天出现流产先兆现 象，注射黄体酮10天，56天流产。后查LH为23，诊为黄体功能不足，接受3个月的激素治疗。2年前第2

Billingual Acupuncture and Moxibustion

次妊娠，43天时再次出现流产先兆，注射黄体酮15天，51天流产。平素月经规律，周期、经量、经色正 常，偶在行经期有下腹疼痛。喜温怕冷，面色苍白，精神萎靡，夜尿多，小便清长。饮食可，寐可。

舌、脉象：舌质黯舌体胖大边有齿痕苔白，脉濡。

诊断：中医诊断：断续（断绪）。证型：脾肾阳虚。 西医诊断：继发性不孕（黄体功能不足）。

治则：温肾壮阳，养血活血。 针灸处方：

主穴：命门、肾俞、复溜。

配穴：交信、然谷、三阴交。

刺灸法：针刺命门穴时使用捻转补法，得气以患者出现针感感传至腹部为佳，可为胀感、也可为温 热感或舒适感；肾俞穴使用温针灸，可灸2~3壮，以腹部有温热感为度。余穴均用平补平泻手法。起针后 肾俞穴拔罐，留罐10分钟。

辨证分析：患者曾怀孕，但屡次流产，现不孕，属于中医学的“断续”“断绪”“漏胎”范畴。患 者先因子宫内膜异位症行卵巢巧克力囊肿剥离术，损伤胞络，伤及肾气，致冲任不固，肾气亏虚，瘀血 内留。中医学认为：肾藏精，是人体生长发育的根本，受孕的根本在于肾气充盛。患者肾气亏虚，不能 使肾阳充盛，故出现胎屡坠现象。患者舌质黯，舌体胖大，边有齿痕，苔白，脉濡，表明脾肾同亏，瘀 湿共存。女子体阴用阳，以血为本，血的资生赖于脾，在补肾的同时需补脾。现代医学认为黄体不健包 括黄体期缺陷和黄体期缩短，以致分泌期子宫内膜发育不良，难以维持孕卵的种植和早期发育，出现不 孕、流产、月经紊乱的现象。故治疗应以温肾壮阳，养血助孕为主。

取穴依据：全方根据《类经图翼》所载：“胎屡坠，命门、肾俞、中极、交信、然谷，在十四椎 节下间”组方。以命门、肾俞为主穴，以交信、然谷为配穴。《灵枢 ·根结》：“必审五脏变化之病， 五脉之应，经络之实虚，皮之柔粗，而后取之也。”主穴中以命门、肾俞温肾壮阳；复溜，足少阴肾经 的经穴，属金，肾经属水，肾阴不足，补复溜，是虚则补其母的取法。《素问 ·长刺节论》：“迫藏刺 背，背俞也”，《难经 ·六十七难》：“阴病行阳， ……俞在阳”，患者病位在腹部，属阴，在治疗上 选取背部的腧穴（属阳）为主进行治疗。肾俞位置为在“第十四椎下，两旁各一寸五分”（《针灸甲乙 经》），取穴方法为俯卧，在第二腰椎棘突下，旁开1.5寸。《医宗金鉴》载：“下元诸虚，精冷无子”。

《素问 · 阴阳应象大论》：“阴病治阳”，命门位置在“第十四椎下”（《针灸甲乙经》），取穴方 法为俯卧，在第二腰椎棘突下凹陷处。配穴交信、然谷养血活血；三阴交补脾养血。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个月后，再次妊娠，9个月后产下1健康女 婴。心得：《灵枢 ·根结》：“用针之要，在于知调阴与阳，调阴与阳，精气乃光，合形与气，使神内 藏。”《灵枢 ·始终》：“阴盛而阳虚，先补其阳，后泻其阴而和之。阴虚而阳盛，先补其阴，后泻其 阳而和之。”患者本虚标实，病在阴而治于阳。《灵枢 ·始终》：“凡刺之道，气调而止，补阴泻阳， 音气益彰，耳目聪明，反此者，血气不行。”根据《标幽赋》：“取五穴用一穴必端，取三经用一经而 可正”，在治疗时尽量精选最少的腧穴，在针刺操作时应“目无外视，手如握虎；心无内慕，如待贵 人。左手重而多按，欲令气散，右手轻而徐入，不痛之因”。

Case 4  Sterility due to inadequate luteal function

Female patient, aged 30-year-old.

Chief complaint

No child following spontaneous abortion 2 years ago.

History of present illness

Five years ago, she had endometrial cyst surgery. Three years ago she experienced threatened labor after a pregnancy of 42 days, the lute hormone was injected for 10 days without avail, and she had miscarriage on the 56th day. Lab examination showed lute hormone 23. Lute hormone therapy was given to treat inadequate luteal function for 3 months. Two years ago, she had been pregnant again, and the same situation happened again: She experienced threatened labor after a pregnancy of 43 days,and had miscarriage on the 51th day. Her menstruation is regular and normal; sometimes she suffered from the period pain. The patient had pale complexion and mental fatigue, and preference for warming but aversion to cold.

Tongue and pulse

The patient had dark and large tongue with tooth mark, and with a white coat; her pulse was soft pulse (run).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), kidney yang deficiency (syndrome differentiation).

WM diagnosis: Secondary sterility.

Principle of treatment

Warming the kidney and strengthening yang. Nourishing and activating blood.

Prescription

Main points: Mingmen (GV 4), Shenshu (BL 23),Fuliu (KI 7).

Additional points: Jiaoxin (KI 8),Rangu (KI 2),Sanyinjiao (SP 6).

Manipulation

Reinforce by twirling and rotating needle on the point of Mingmen (GV 4) until the needle sensation (such as swelling, warm up feeling or comfortable feeling) spread to the abdominal, then use warming needle moxibustion on the Mingmen (GV 4) until the patient feels warm in bellys. Uniform reinforcing and reducing method on the other points. Cupping is given on Shenshu (BL 23) for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 30-year-old female patient presented with no child as her chief complaint. She had once been pregnant,  but had two miscarriages. These signs and symptoms are classified as “habitual abortion due to kidney-deficiency” in Traditional Chinese Medicine. Chinese medical theories state that kidneys store the essence of life, which is the  basis of the body. The state of the essence reflects the state of the kidneys. If essence is flourishing and abundant,  the kidneys are strong and there will be great vitality, sexual power and fertility. The patient had dark and large  tongue with tooth mark, and with a white coat, her pulse is soft pulse (run), indicating deficiency of spleen and  kidneys, and at the meantime existence of stasis and dampness inside body. So both reinforcing kidneys and  invigorating spleen were important.

Explanation of the points

Illustrated supplement to Classified Canon says: “Selecting Mingmen (GV 4), Shenshu (BL 23), Fuliu (KI 7), Jiaoxin (KI 8),Rangu (KI 2) and Sanyinjiao (SP 6) to treat habitual abortion. Mingmen (GV 4) is located under the fourteenth vertebra” . Mingmen (GV 4), gate of life, which tonifies and warms the fire of the gate of vitality. Shenshu (BL 23) is the back transporting point for the kidneys, which tonifies and nourishes the kidney-essence. Fuliu (KI 7) is the river point of kidneys meridian, which tonifies the kdney-yin. Plain Questions of Huangdi’s Canon of Medicine says: “Selecting back-shu to treat the organs’ diseases” . Jiaoxin (KI 8) and Rangu (KI 2)

Billingual Acupuncture and Moxibustion

nourish and activate the blood. Sanyinjiao (SP 6) invigorates spleen to nourish blood.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for 3 months, she was pregnant again, and produced one healthy baby girl 9 months later.

Experience

Spiritual Pi vot of Huangdi’s Canon of Medicine says: “Adjusting the balance of yin and yang is the principal of using needles.” The differentiation of symptoms was asthenia in origin and excess in superficiality; it’s the best way to use the acupuncture and moxibustion to regulate yin and yang.

（ 5 ）原发性不孕症案

古某，女，2005年6月12日初诊。 主诉：婚后6年未孕。

现病史：结婚6年，配偶健康。行各种检查，均为正常。11岁月经初潮，周期28天，行经期5天，经 量中等，经色红。行经期无明显不适。平素自觉体健，饮食可，二便调，大便时而微溏，寐可。

舌、脉象：舌淡胖苔白厚，脉沉。

诊断：中医诊断：全不产（无子）。证型：寒湿内生。 西医诊断：原发性不孕。

治则：补肾壮阳，散寒祛湿。 针灸处方：

主穴：关元、大赫、三角灸。 配穴：复溜、太溪、阴谷。

刺灸法：手法为平补平泻，针刺关元、大赫、三角灸时得气以出现腹部有胀感、温热感或舒适感为 度，而后三角灸使用温针灸。起针后大赫穴拔罐。

辨证分析：患者从未怀孕过，属于中医学的“无子”（《山海经》）、“全不产”（《备急千金要  方》）范畴。患者平素体健，月经规律，惟舌淡胖苔白厚，脉沉，按八纲辨证为阴证、里证、寒证。为寒  湿内生，阻遏阳气而致不孕。由于此患者的寒湿之邪为内生，故在治疗上根据“益肾之源，以消阴翳” 的原则，不能直接散寒祛湿，而应通过补肾壮阳来达到祛寒湿的作用。“肾主生殖，封藏之本，精之处  也”，“精者，生之本也”。卵子即肾所藏之“阴精”，“肾者主蛰，司开合”， 一方面，“阳者卫外  而为固也”，排卵前肾阳发挥主蛰、主闭藏之功能，使得肾藏精而不泻，肾精充盈，卵子发育成熟；另  一方面，阳主乎动。肾阳气化使肾在排卵期短暂开放，作为内在动力鼓动成熟卵子排出。许多研究表明  补肾对于性腺轴的各个环节均有一定的调节功能。故以补肾壮阳以散寒祛湿，调理冲任以助孕育。

取穴依据：全方根据“不盛不虚以经取之”的治疗原则组方，主穴取足少阴肾经腧穴大赫，任脉腧 穴关元，奇穴三角灸。关元温肾壮阳，培元固本；三角灸为经外奇穴，位置为“以患人两口角为一分， 作三折成三角，以一角按脐心，两角在脐下两旁尽处是穴”（《神应经》），能主治妇人不孕；大赫穴位置 为“在气穴下一寸”（《针灸甲乙经》），取穴方法为仰卧，脐下4寸，正中线旁开0.5寸，为冲脉、足少阴 之会，为局部选穴，通过调理冲脉、足少阴肾经经脉之气，以调整冲脉、肾的功能。配穴按照经脉配穴 法中的本经配穴法取足少阴肾经五输穴中的输穴（原穴）太溪、经穴复溜 、合穴阴谷，以期补肾壮阳而 散寒祛湿。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗半年后，妊娠，次年产下1子。

心得：《灵枢 ·始终》：“治病先刺其病所从生者也。”患者寒湿内生的根本原因为肾阳不足，故  针刺时以肾经腧穴为主，先取大赫。《灵枢 ·海论》：“夫十二经脉者，内属于脏腑，外络于肢节。”

通过针刺腧穴以调理经络气血，从而调整相关脏腑功能。由于患者没有明显症状，根据《灵枢 · 九针 十二原》“节之交，三百六十五会， ……，所言节者，神气之所游行出入也，非皮肉筋骨也。 ……，虚 实之要，九针最妙。补泻之时，以针为之。 ……，逆而夺之，恶得无虚？追而济之，恶得无实？迎之随 之，以意和之，针道毕矣”，采用平补平泻的手法。《素问 ·调经论》：“血气者，喜温而恶寒，寒则 泣而不流，温则消而去之”，在其三角灸穴进行温针灸治疗。

Case 5  Primary sterility

Female patient, aged 29 years.

Chief complaint

No child since her marriage 6 years ago.

History of present illness

She had never been pregnant. Her spouse is in good health. Eleven-year-old menarche, menstruation lasted up to 5 days every 28 days. Sometimes she had a feeling of cold and she had loose stool.

Tongue and pulse

The patient had pale and large tongue with white and thick coating; her pulse was deep.

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), generation of cold from interior (syndrome differentiation).

WM diagnosis: Primary sterility

Principle of treatment

Replenishing kidneys and strengthening kidney-yang, expelling cold and eliminating dampness.

Prescription

Main points: Guanyuan (CV 4),Dahe (KI 12), Sanjiaojiu (extra point). Additional points: Fuliu (KI 7), Taixi (KI 3), Yingu (KI 10).

Manipulation: Reinforcing and reducing method on the points Guanyuan (CV 4), Dahe (KI 12), Sanjiaojiu (extra point). After the patient gets the needle sensation, such as swelling, warm up or comfortable feeling in abdominal part, using warming needle moxibustion on the Sanjiaojiu (extra point). Cupping on the Dahe (KI 12) for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 29-year-old female patient presented with no child as her chief complaint. She had never been pregnant before. She usually had a feeling of cold and she had loose stool. These signs and symptoms are classified as “sterility” in Traditional Chinese Medicine. It is very difficult to confirm the reason of sterility. The patient had pale and large tongue with white and thick coating and her pulse was deep, indicating uterus-coldness infertility. It was cold and interior syndrome according to eight-principle syndrome differentiation. Chinese medicine academic theories state that replenishing kidney originality to eliminate cold and dampness. Many researches revealed that invigorating kidneys could regulate sexual gland function.

Explanation of the points

According to the treatment principle of “If the symptoms are neither excessive nor deficient, the method of uniform reinforcing and reducing is applied” . Guanyuan (CV 4) warms and invigorates kidney-yang. Dahe (KI 12) is the crossing point of the kidney meridian and the thoroughfare vessel, which regulates the function of the

Billingual Acupuncture and Moxibustion

thoroughfare vessel and the kidneys to promote reproduction. Sanjiaojiu (extra point) is the experiential point in sterility. Primary points Taixi (KI 3) and the mother point Fuliu (KI 7) of kidneys meridian tonify the kidneys. Sea point Yingu (KI 10) expels cold and eliminates dampness.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for half a year, she was pregnant, and produced a baby in the next year.

Experience

Spiritual Pi vot of Huangdi’s Canon of Medicine says: “Only the source where the diseases occurred was found,the disease could be cured.” It was generation of cold from interior due to insufficient kidney-yang.

（ 6 ）子宫内膜异位症不孕症案

韦某，女，23岁，2005年7月1日初诊。 主诉：行经腹痛5年，婚后3年未孕。

现病史：5年前无明确原因出现行经腹痛，疼痛出现于行经期后，伴左侧大腿内侧放射样疼痛，疼痛 约持续5天。热敷、服用止痛药无效。行B超检测，诊为子宫内膜异位症。结婚3年，配偶健康。月经周期 30天，行经期5天，经量适中，经色黯，有血块。食欲好，大便干，小便黄，梦多。

舌、脉象：舌质红苔黄，脉涩。

诊断：中医诊断：经行腹痛、断续（断绪）。证型：热瘀内阻。 西医诊断：痛经、子宫内膜异位症、原发性不孕。

治则：养血化瘀，清热通经。 针灸处方：

主穴：冲门、血海、地机。 配穴：曲池、太溪。

刺灸法：针刺冲门穴时宜缓慢进针，可采用“苍龟探穴”的刺法，得气以出现针下有明显的酸胀感 为度。余穴均用平补平泻手法。起针后冲门穴拔罐。

辨证分析：患者经后腹痛，婚后3年未孕，属于中医学的“经行腹痛”“不孕”范畴。经行腹痛的最 早记载见于《金匱要略 ·妇人杂病脉证并治》：“带下，经水不利，少腹满痛”。《丹溪心法 ·妇人》 指出：痛经有经行腹痛、经后作痛，宜分辨虚实。现代医学研究认为，子宫内膜异位症因异位的内膜周 期性脱落而无法通过正常的途径排出体外，常于病变区出现紫褐色斑点或小泡，最后发展成大小不等的 紫蓝色实质结节或包块，属于中医学的“癥瘕结聚”范畴。此病在临床上可导致不孕，在文献中有明确 的记载，如明 · 王肯堂《女科证治准绳》云：“血瘕之聚，令人腰腹不可以俯仰， ……，少腹里急苦 痛， ……，此病令人无子”。因机体正气虚弱，经期、产后摄生不慎，或过度劳累、外邪侵入，七情内 伤等，可导致脏腑功能失调，气血运行不畅，而成离经之血。离经之血流逸脉外，不循常道，散发瘀积 于胞宫、胞脉、胞络之中，瘀积日久，气血运行不畅，不通则痛。根据瘀积阻滞部位不同而表现出全身 各脏腑随经期而发各种常见或罕见的气滞、血瘀、寒凝等证候。患者经后腹痛，伴左侧大腿内侧放射样 疼痛，经色黯，有血块，脉涩，表明患者内有瘀血；大便干，小便黄，梦多，舌质红苔黄，表明瘀血有 化热的征象。又因女子体阴用阳，以血为本，而血得热则行，故在临床其治疗应以养血化瘀为主，清热 通经为辅。

取穴依据：全方根据患者因血瘕（子宫内膜异位症）而致经行腹痛（痛经）导致无子（不孕）而组 方配穴。主穴依据《百症赋》：“带下产崩，冲门、气冲宜审；痃癖兮，冲门、血海强”，而取冲门、 血海为主穴。又因患者经行腹痛放射至大腿内侧，根据《针灸大成》中对地机穴的主治的记载：“主腰痛不可俯仰，溏泄，腹胁胀，水肿腹坚，不嗜食，小便不利，精不足；女子癥瘕，按之如汤沃，股内至  膝”，取地机穴为主穴。冲门穴位置为“上去大横五寸，在府舍下横骨两端约纹中动脉”（《针灸甲乙  经》），取穴方法为仰卧，平耻骨联合上缘中点旁开3.5寸处取穴。《针灸甲乙经》载：“为足太阴、厥阴  之会”；治寒气腹满，癃，身热，腹中积聚疼痛，又主阴疝。血海穴位置在“膝髌上内廉白肉际二寸” （《铜人腧穴针灸图经》），取穴方法为屈膝，在髌骨内上缘上2寸，当股四头肌内侧头的隆起处。《针  灸甲乙经》载：“妇人漏下，若血闭不通，逆气胀，血海主之”；《针灸大成》云：“暴崩不止，血海  主之”；《类经图翼》曰：“血海主带下气逆腹胀”；《医学入门》：“此穴极治妇人血崩，血闭不  通”。地机穴位置在“膝下五寸”（《针灸甲乙经》），取穴方法为在阴陵泉下三寸，当阴陵泉与三阴交连  线取穴。《针灸甲乙经》载：“溏瘕，腹中痛，脏痹，地机主之”。配穴中以曲池清热，以三阴交  养血。

疗效：隔天1次，每周3次，10次1疗程。治疗3个月后，痛经消失，5个月后妊娠。心得：《素问 ·宝 命全形论》中所言：“凡刺之道，必先治神。 ……是谓冥冥，莫知其形，见其乌乌，见其稷稷，从见其 飞，不知其谁。”“苍龟探穴”为飞经走气四法中的一种，适用于经络气血壅滞之证，作为通经接气的 催气手法，以促使针感通过关节而达病所。《金针赋》：“苍龟探穴，如入土之象， 一退三进，钻剔四 方。”在冲门穴的具体操作方法为将针快速透入皮下，缓慢进至1.5寸，然后再慢慢退至皮下，更换针尖 方向，从前后左右刺入深层，最后将针留在得气感最佳的方向。《灵枢 ·始终》：“邪气来也紧而急， 谷气来也徐而和。”

Case 6  Sterility due to endometriosis

Female patient, aged 23 years.

Chief complaint

No child since marriage 3 years ago, together with period pain for 5 years.

History of present illness

Five years ago, she gradually had period pain at the end of the menstruations; the pain could reach the inside of leg. Hot compress and pain reliever were taken without avail. Ultrasonic examination revealed evidence of adenomyosis. She had regular menstruation with dark color bleeding.

Tongue and pulse

The patient had red tongue with yellow coating and her pulse was unsmooth (se).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), mixture of blood stasis and heat (syndrome differentiation).

WM diagnosis: Dysmenorrheal, endometriosis, primary sterility.

Principle of treatment

Clearing heat and resolving blood stasis, nourishing blood to regulate menses.

Prescription

Main points: Chongmen (SP 12),Xuehai (SP 10), Diji (SP 8).

Additional points: Taixi (KI 3),Quchi (LI 11).

Manipulation

The needles should be inserted slowly on the point of Chongmen (SP 12), and “the turtle explore point” method should be manipulated, until the patient got the needle sensation such as partial swelling. Uniform  reinforcing and reducing method on the other points. Cupping on the Chongmen (SP 12) for ten minutes after

Billingual Acupuncture and Moxibustion

removing the needles.

Differentiation of the syndrome or disease

The 23-year-old female patient presented with no child together with period pain as her chief complaint. These symptoms are classified as “Abdominal pain during menstruation” and “sterility” in Traditional Chinese Medicine. Dysmenorrheal due to endometriosis can cause sterility in clinic, Standards for Diagnosis and Treatment of Women’s says: “Abdominal blood masses make the low back move with difficulty, abdominal pain, uncomfortable and sterility.”

Explanation of the points

Prescription of 100 Diseases Endow says: “Selecting the points of Chongmen (SP  12) and Xuehai (SP 10) to treat abdominal mass” and Great Compendium of Acupuncture and Moxibustion says: “If the women had abdominal blood mass, they would feel pain could reach the leg when abdomen was pressed, Diji (SP 8) should be selected.” Chongmen (SP 12), rushing door, is the meeting point of spleen and liver, which removes obstruction from the channel. Xuehai (SP 10), sea of blood, eliminates stasis of blood, especially blood in the uterus. The ABC Classics of Acupuncture and Moxibustion says: “The women had metros taxis with blood and qi blocked, Xuehai (SP 10) should be selected.” Diji (SP 8), earth point and cleft point of spleen meridian, relieves pain and removes obstruction from the channel. Taixi (KI 3) nourishes yin and clearsheat. Quchi (LI 11) clearsheat.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for 3 months, she didn’t suffer from period pain, and was pregnant after 5 months.

Experience

The special manipulation method of "the turtle explore point" can promote the needle sensation to pass the joint to reach the diseased part.

（ 7 ）子宫肌瘤不孕症案

陈某，24岁，2002年10月15日初诊。 主诉：2年未孕，发现子宫肌瘤1年。

现病史：4年前患者妊娠2个月时，行人工流产。3年前再次妊娠，妊娠45天时，自然流产。流产后3 个月，再次妊娠，妊娠6个月发现胎儿胎心过缓，诊为心脏发育不良，于妊娠7个月时行引产术。术后出 现月经不调，经量增多，伴下腹隐痛，白带增多，色黄。白带分析及B超检测示：细菌性阴道炎，子宫前 壁1.5cm×2cm肌瘤。接受西药、中药治疗3个月，效不显。患者内心焦虑，寐差，饮食尚可，常觉腹胀、 腹部隐痛。

舌、脉象：舌红苔薄黄，脉弦。

诊断：中医诊断：断续（断绪）。证型：肝郁气滞，瘀血内阻。 西医诊断：细菌性阴道炎、子宫肌瘤、继发性不孕。

治则：消积散结，疏肝理气。 针灸处方：

主穴：内关、照海。

配穴：阴交、石门、太冲、行间。

刺灸法：针刺石门穴时应徐入徐出，得气不宜过强。余穴均用平补平泻手法。起针后肝俞、膈俞穴拔罐。

辨证分析：患者曾怀孕，现不孕，B超检测示子宫前壁1.5cm×2cm肌瘤，属于中医学“断续”“断 绪”“癥瘕”疾病范畴。患者人工流产1次，自然流产1次，引产1次，导致冲任受损，气血失调，瘀血 积聚，留而成瘕。《景岳全书 ·妇人规》曰：“瘀血留滞作瘕，唯人有之，其证或由经期，或由产后， 凡内伤生冷，或外受风寒，或愤怒伤肝，气逆而血留……总有血动之时，余血未净，而一有所逆，则留 滞积，而渐以成瘕模。”患者因流产、引产多次，血瘀在先；后因一直未孕，内心焦虑，肝气郁结，气 滞在后，导致气血失调，脏腑功能失常，冲任阻滞，而出现 “不通则痛”；瘀积日久，则形成有形“癥 瘕”，可见包块等；天癸、冲任、子宫功能失调，胞脉失养，不能摄精成孕，故见不孕。故治疗时应以 消积散结，疏肝理气为主。

取穴依据：全方主穴的选用依据《玉龙赋》：“取内关于照海，医腹疾之块”，取内关、照海为 主穴。内关，手厥阴心包经的络穴，八脉交会穴之一，通于阴维脉。心包主脉所生病，三焦为阳气之 父，包络为阴血之母，阴维维诸阴，故内关能治腹中气血凝结。照海，八脉交会穴之一，阴跷脉发起之 处，为足少阴肾经的腧穴。《傅青主女科 ·种子门》云：“盖胞胎居于心肾之间，且上属于心而下系于 肾， …… ，胞胎上系于心包，下系于命门，系心包者通于心，心者，阳也；系命门者，通于肾，肾者， 阴也。”故因胞胎与心肾相关，故取内关、照海，调整阴阳，消积散结而治不孕之疾。内关穴位置在 “掌后去腕二寸”（《针灸甲乙经》），取穴方法为腕横纹上2寸，当掌长肌腱和桡侧腕屈肌腱之间。《针 灸甲乙经》：“心澹澹而善惊恐，心悲，内关主之。”现代腧穴学研究，内关穴宽胸解郁效果佳，常用 于抑郁症的治疗。配穴的选择根据《百症赋》：“无子搜阴交、石关之乡”，阴交为任脉、冲脉、肾经 的交会穴，石门为肾经与冲脉的交会穴。阴交位置“在脐下一寸”（《针灸甲乙经》），为任脉、气冲之 会。

《外台秘要》：“任脉、冲脉、少阴之会。”可起到温补下焦，益精培元，调理冲任的作用。石门 穴位置在“脐下二寸”（《针灸甲乙经》），取穴方法为仰卧，脐下2寸，腹正中线上。《千金方》：“石 门、商丘，主少腹坚痛，下引阴中。”太冲、行间疏肝解郁清热。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个月后妊娠，同年底产下1子。心得：《素 问 ·气府论》云：腧穴乃“脉气所发”之处。因《针灸甲乙经》载石门穴为“女子禁

不可刺灸中央，不幸使人绝子”，所以在针刺石门穴时，应依据《灵枢 ·五乱》：“徐出徐入，谓 之导气”；“是非有余不足也，乱气之相逆也”。针感不宜过强，以达到《灵枢 ·邪客》中所言：“辅 针导气，邪得淫泆，真气得居”。

Case 7  Sterility due to uterine leiomyoma

Female patient, aged 24 years.

Chief complaint

No child for 2 years.

History of present illness

4 years ago, the patient had an operation of artificial abortion after a pregnancy of 2 months. 3 years ago, she experienced spontaneous abortion after a pregnancy of 45 days. After 3 months of spontaneous abortionshe was pregnant again. When she has been pregnant for 6 months, prenatal examination revealed evidence of fetal cardiatelia; she had to have induction of labor after a pregnancy of 7 months. Menstruation became irregular with heavy amount of bleeding and period pain following the operation, together with more vaginal discharge than before. Lab examination revealed evidence of bacteriogenicvaginitis. Ultrasonic detection revealed evidence of hysteromyoma. She had received treatments both of Chinese herband Western medicine for 3 months without avail. The patient felt anxious, with bad sleeping.

Billingual Acupuncture and Moxibustion

Tongue and pulse

The patient had red tongue with yellow and thin coating; her pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), liver qi stagnation and internal blockage of blood stasis (syndrome differentiation).

WM diagnosis: Secondary sterility; uterine leiomyoma; bacteriogenicvaginitis.

Principle of treatment

Removing accumulation and resolving masses, soothing liver and regulating qi.

Prescription

Main points: Neiguan (PC 6), Zhaohai (KI 6).

Additional points: Yinjiao (CV 7), Shimen (CV 5), Taichong (LR 3),Xingjian (LR 2).

Manipulation

While inserting needles into the point of Shimen (CV 5), the acupuncturist should insert and remove needles slowly and gently, and the patient feels weak needle sensation. Uniform reinforcing and reducing method on the other points. Cupping on the Ganshu (BL 18) and Geshu (BL17) for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 24-year-old female patient presented with no child as her chief complaint. The patient had complex problems. She experienced artificial abortion, spontaneous abortion and induced abortion. Lab examination revealed evidence of bacteriogenic vaginitis. Ultrasonic detection revealed evidence of hysteromyoma. These signs and symptoms are classified as “sterility” and “abdominal masses” in Traditional Chinese Medicine. She had experienced three abortions, which caused damage of thoroughfare and conception vessels, disharmony between/ of qi and blood, internal blockage of blood stasis, with the result of masses. Jingyue’s Complete  Work says: “Accumulations of blood stases gradually become masses, which happens to people attacked by wind and cold or anger injures liver during menstruation or after reproduction. ”

Explanation of the points

Prescription of the Jade Dragon Endow says: “Neiguan (PC 6) and Zhaohai (KI 6) are selected to treat the masses.” Neiguan (PC 6), inner gate, is the connecting point and one of the eight confluent points of yin linking vessel. It is related to liver, and indirectly connects with uterus, and is often used in abdominal masses and depression. Zhaohai (KI 6), shining sea, is the confluent point ofyang heel vessel, which assists the uterus function of reproduction. Fuqing-zhu’s Gynecology and Obstetric says: “Embryo in the uterus is related to pericardium and Mingmen. Pericardium connects heart which is yang, Mingmen connects kidneys which is yin. Selection of points of Neiguan (PC 6) and Zhaohai (KI 6) which can regulate yin and yang and cure the sterility.” Prescription of 100 Diseases says: “Selecting points of Yinjiao (CV 7) and Shimen (CV 5) to treat sterility.” Yinjiao (CV 7) is the crossing point of thoroughfare, conception vessel and kidney meridian. Shimen (CV 5) is the crossing point of thoroughfare vessel and kidney meridian, which toinfy the function of uterus. Taichong (LR 3) and Xingjian (LR 2) sooth liver and resolve depression and clear heat.

Frequency, duration and treatment outcome

Once every other day, ten treatments constituted a course. After treated with acupuncture for 3 months, she was pregnant and produced 1 healthy baby.

Experience

Pay more attention to manipulation on the point of Shimen (CV 5), because The ABC classics of acupuncture and moxibustion says: “Shimen (CV 5) is the woman forbidden point, or which can cause sterility.”

（ 8 ）子宫内膜过度生长不孕症案

魏某，女，32岁。2002年5月12日初诊。

主诉：3年未孕，伴月经量增多，月经周期不规律。

现病史：患者于20岁后曾先后4次行人工流产，人工流产的时机最早为妊娠42天，最迟为妊娠2个多 月。于3年前逐渐出现月经周期不规律，经期提前，经量增多，经色黯红，有大量膜样物质，行经期12天 左右，伴腹痛。于四川省宜宾市第一人民医院，经刮宫诊断为子宫内膜腺囊型增生过长，行西药治疗2年 余，刮宫治疗3次，效不显。现患者面色萎黄，时觉倦怠，欲睡，但睡不踏实，时会惊醒。饮食可，二便 正常。

舌、脉象：舌淡苔薄白，脉弱。

诊断：中医诊断：断续（断绪）。证型：气虚血瘀。

西医诊断：功能性子宫出血、继发性不孕（子宫因素）。

治则：补气去瘀，调理冲任。

针灸处方：

主穴：天枢、水泉。

配穴：足三里、行间、三阴交。

刺灸法：针刺天枢穴时使用捻转补法，得气以出现针下有明显的胀感为度，而后天枢、足三里穴使 用温针灸。余穴均用平补平泻手法。起针后肾俞穴拔罐。

辨证分析：患者曾怀孕，现不孕，并有月经量多，行经期长的症状，属于中医学的“断续”“断  绪”“月水过多”“经水过多”范畴。患者多次行人工流产术，直接损伤胞宫，并且将息失宜，致使冲  任二脉失调，血海充盈不足，气虚血瘀，以致瘀血内结，瘀阻胞络，久病则气血不足脏腑功能失调，而  形成本病。正如《医宗金鉴 ·妇科心法要诀》所言：“因宿血积于胞中，新血不能成孕，或因胞寒胞  热，不能摄精成孕，或因体盛痰多，脂膜壅塞胞中而不孕，皆当细审其因，按证调治，自能有子也。” 现代医学研究认为，本病属于功能失调性子宫出血，是由于调节生殖的神经内分泌机制失常引起的异常  子宫出血，其中85%病例为无排卵性功能性子宫出血，故常伴不孕。长期大量的出血常导致患者贫血。故  患者表现为面色萎黄，时觉倦怠，欲睡，但睡不踏实，时会惊醒。舌淡苔薄白，脉弱。因此治疗上应以  补气去瘀为主，调理冲任为辅。

取穴依据：主穴的选定依据《百症赋》：“月潮违限，天枢、水泉细详”而定。天枢为足阳明胃经 腧穴，为大肠募穴。《针灸大成》载天枢穴的主治为：“妇人女子癥瘕，血结成块，漏下赤白，月事不 时”；《标幽赋》：“虚损天枢而可取”；《针灸集成》：“癥瘕肠鸣，泄痢绕腹绞痛，天枢百壮，章 门、大肠俞、曲泉、曲池，对脐脊骨上三壮，灸宜先阳后阴”。由此可知补天枢穴，使用灸法，可治疗 虚损型经水过多之症。天枢穴位置在“去肓俞一寸五分，侠脐两旁各二寸陷者中”（《针灸甲乙经》），取 穴方法为仰卧，脐旁2寸。配穴中选用足三里以补气强壮；三阴交补血，《神应经》：“女人漏下不止， 太冲、三阴交”；行间依据《针灸大成》中对其主治的描述：“主妇人小腹肿，面尘脱色，经血过多不 止，崩中，小儿急惊风”；《医宗金鉴》：“治小儿急慢惊风，及妇人血蛊癥瘕，涂身肿、单腹胀等

Billingual Acupuncture and Moxibustion

证”；行间位置“在足大指间动脉陷者中”（《针灸甲乙经》），取穴方法为足一、二趾缝间，趾蹼缘的上 方纹头处。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个疗程，次年怀孕，后产下1子。心得：功能性 子宫出血多为血瘀致病，本病案中患者在血瘀的同时气虚表现明显。究其发病原因为

人工流产术多，致使气虚血瘀，其症为经量增多，经色黯红，有大量膜样物质。《类经 · 针刺 类 ·贵贱逆顺》：“貌虽不足，而神气病气皆有余。此外似虚而内则实，邪气胜也，当急泻之。”故在 治疗上应补气与化瘀并重，所以选取天枢穴作为主穴，并用灸法。

Case 8  Sterility due to endometrial hyperplasia

Female patient, aged 32 years.

Chief complaint

No child since marriage 3 years ago.

History of present illness

The patient had once received four artificial abortions before 10 years. Menstrual cycle gradually became irregular for the last 3 years. Bleeding became heavy and there were a great deal of shell membrane materials, sometimes menstruation advanced  10 days. Examination of dilatation and curettage revealed evidence of endometrial ceruminous gland capsule type hyperplasia. She took some western medicine for more than 2 years and received dilatation and curettage without avail. She had sallow complexion, sometimes felt languid and drowsiness.

Tongue and pulse

The patient had pale tongue with white and thin coating; her pulse was weak (ruo).

Diagnosis

TCM diagnosis: Sterility and profuse menstruation (diagnosis of disease), qi deficiency and blood stasis (syndrome differentiation).

WM diagnosis: Secondary sterility and functional uterine bleeding.

Principle of treatment

Replenishing qi to remove stasis, regulating thoroughfare and conception vessel.

Prescription

Main points: Tianshu (ST 25),Shuiquan (KI 5).

Additional points: Zusanli (ST 36),Xingjian (LR 2),Sanyinjiao (SP 6).

Manipulation

Reinforcing by twirling and rotating needles on the point of Tianshu (ST 25), and then using warming needle moxibustion on Tianshu (ST 25) and Zusanli (ST 36). Uniform reinforcing and reducing method on the other points. Cupping on the Shenshu (BL 23) for 10 minutes after removing the needles.

Differentiation of the syndrome or disease

The 32-year-old female patient presented with no child as her chief complaint. She had once been pregnant before, and received four artificial abortions. Her menstrual cycle became irregular and amount of bleeding was heavy. Examination of dilatation and curettage revealed evidence of endometrial ceruminous gland capsule type hyperplasia. These signs and symptoms are classified as “sterility” and “profuse menstruation” in Traditional 

Chinese Medicine. The patient had four artificial abortions, which directly injured uterus, and caused disharmony of thoroughfare and conception vessels. Golden Mirror of Medicine says: Because blood stasis stays in uterus, the new blood fails to nourish uterus to help pregnancy. It’s functional uterine bleeding in western medicine, because of enzyme regulation reproduction of neuroendocrine mechanism disorder which caused excrescent metrorrhagia, among them 85% cases without ovulation.

Explanation of the points

Prescription of 100 Diseases says: Selecting the points of Tianshu (ST 25) and Shuiquan (KI 5) to treat irregular menstruation. Tianshu (ST 25), heavenly pillar, is the front-mu point of large intestine meridian. It tonifies qi and blood, and is usually used ingynaecological complaints. Zusanli (ST 36) tonifies the qi and blood to strengthen the body. Sanyinjiao (SP 6) invigorates spleen to nourish the blood. According to Great Compendium of Acupuncture and Moxibustion and Golden Mirror of Medicine, select Xingjian (LR 2) to reduce the amount of bleeding and eliminate abdominal masses.

Frequency and duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 3 courses, she was pregnant and produced a baby in 2004.

Experience

Most of functional uterine bleeding is caused by blood stasis. The patient not only had blood stasis but also had obvious qi deficiency. So the treatment should aim at removing blood stasis and tonifyingqi. 

（ 9 ）输卵管不通不孕症案

梁某，女，25岁。2004年7月1日初诊。 主诉：婚后3年未孕。

现病史：结婚3年未孕，配偶身体健康。碘油造影示双侧输卵管积水、不通。月经周期规律，经量 适中，经色鲜红，有少许血块。经期无腹痛、腹胀现象。白带较多，色发黄，有异味。脾气急躁，饮食 可，小便黄，寐差。

舌、脉象：舌质红苔黄厚，脉弦。

诊断：中医诊断：断续（断绪）。证型：湿热内蕴。 西医诊断：原发性不孕。

治则：清热利湿，疏肝通络。 针灸处方：

主穴：商丘、中极、水道。

配穴：行间、太冲、阴陵泉、带脉。

刺灸法：针刺中极穴时应先让患者排空小便，针尖指向外阴部，得气以针感传至会阴部为佳。水道 穴用提插泻法，得气以出现针下有明显的跳动感为度，并接通电针。余穴均用平补平泻手法。起针后水 道穴拔罐。

辨证分析：患者从未孕育过，属于中医学“全不产”“无子”范畴。《医学源流论》说：“冲任皆 起于胞中，上循背里，为经脉之海。此皆血之所从生，而胎之所由系。”受孕和胎儿发育成形需要冲、 任二脉的调和畅达，带脉的约束有度，又赖肝肾精血的充盛滋养。患者平素脾气急躁，为肝失疏泄，致 使气机不畅，木郁克土，湿热内生，流注下焦，阻滞胞宫胞脉，气血运行不畅，胞脉闭塞，两精难以结

Billingual Acupuncture and Moxibustion

合，胎孕不能。患者白带较多，色黄，此为带脉失约而使精华不固所致，胞宫不得育养，不能摄精成 孕，皆难以受孕妊娠。现代医学认为，不孕原因中，女性因素占60%，其中以输卵管及卵巢因素占多数， 其中输卵管因素是不孕症最常见因素。患者舌质红，苔黄厚，脉弦。因此在治疗时应以清热祛湿为主， 疏肝通络为辅。

取穴依据：主穴选用商丘、中极、水道。中极穴位置在“在脐下四寸”（《针灸甲乙经》），取穴方 法为仰卧，腹中线上，脐下4寸。《针灸甲乙经》载中极为：“足三阴、任脉之会”，膀胱经的募穴，补 可起到健脾补肾，固摄冲任，泻能清热化湿，疏肝解郁。《针灸大成》：“绝子，商丘、中极”；《玉 龙赋》：“赤带、白带求中极之异同”。水道为局部治疗作用，可促进输卵管蠕动。配穴行间、太冲疏 肝理气清热，阴陵泉祛湿除滞，带脉利湿止带。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗6个月后，妊娠。

心得：《千金翼方》：“凡孔穴者，是经脉所行往来处，引气远入抽病也”。取中极穴时，应用迎 随补泻中的泻法，以针尖指向病所（阴部），以会阴部有针感为度。如《灵枢 ·邪气脏腑病形》所言： “刺此者，必中气穴，无中肉节，中气穴则针染于巷，中肉节则皮肤痛。”水道穴的得气也很重要，以 电针加强刺激作用，患者在治疗第一次后，当晚即从阴道有排出液体的表现，量较多，更换二次卫生 巾。第二次、第三次也有排出液体现象，但液体量逐渐减少，第四次就没有排出液体的表现。

Case 9 Sterility due to obstruction of fallopian tube

Female patient, aged 25 years.

Chief complaint

No child since marriage 3 years ago.

History of present illness

The patient had never been pregnant. Her spouse is in good health. Special examination revealed evidence of both hydrosalpinx and obstruction. Menstruation was normal, and leucorrhea was heavy with yellow color and bad odor.

Tongue and pulse

The patient had red tongue with yellow and thick coating; her pulse was wiry.

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), internal retention of damp-heat (syndrome differentiation).

WM diagnosis: Tubal sterility.

Principle of treatment:

Clearing damp-heat, soothing liver and dredging collaterals.

Prescription

Main points: Shangqiu (SP 5), Shuidao (ST 28),Zhongji (CV 3).

Additional points: Xingjian (LR 2), Taichong (LR 3), Yinlingquan (SP 9),Daimai (GB 26).

Manipulation

Let the patient empty urine before needling Zhongji (CV 3). Direction of point of needle pointed to vulva until the needle sensation spread to the perineum. Reducing by lifting and thrusting needles on Shuidao (ST 28) and using electricity needle. Uniform reinforcing and reducing method on the other points. Cupping on the Shuidao (ST 28) for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 25-year-old female patient presented with no child as her chief complaint. She had never been pregnant. It is classified as “sterility” in Traditional Chinese Medicine. Medicine Course of Development Theory says: “Thoroughfare and conception vessels start from uterus, go up through back, which are sea of meridians and sea of blood, which is related to fetus.” Pregnancy and the growth of fetus need the harmony of thoroughfare and conception vessels and normal function of belt vessel, also depend on enough of essence and blood of liver and kidneys. Failure of liver to maintain free movement qi, which caused the stagnation of qi, and generation and and retention of damp-heat in lower energizer, with the result of obstruction of uterus collaterals.

Explanation of the points

The ABC Classic of Acupuncture and Moxibustion says: “Zhongji (CV 3) is the crossing point of conception and three foot-yin-channel.” It’s also the front-mu point of bladder meridian. It tonifies the kidneys and spleen when applying reinforcing manipulation to Zhongji (CV 3); it clearsheat-damp and soothes liver to resolve depression when applying reducing manipulation to Zhongji (CV 3). Great Compendium of Acupuncture and Moxibustion says: “Selecting the points of Zhongji (CV 3) and Shangqiu (SP 5) to treat sterility.” Shuidao (ST 28) dredges the partial qi and blood to promote the movement of the fallopian tube. Xingjian (LR 2) and Taichong (LR 3) sooth liver and regulate qi. Yinlingquan (SP 9) removes damp and dredges obstruction. Daimai (GB 26) dispels dampness to stop leucorrhea.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 6 months, she was pregnant.

Experience

Supplement to Invaluable Prescriptions says: “Points are the places where meridians pass by, which can cure the disease.” Selection of main points is very important in this case. After one treatment, she had gushes of watery vaginal discharge, and experienced the same discharge after the second and the third treatment.

（ 10 ）免疫性不孕症案

杨某，女，29岁，2006年2月3日初诊。 主诉：婚后6年未孕。

现病史：结婚6年，从未怀孕，夫妻生活和谐，配偶身体健康。实验室检测显示抗精子抗体阳性。11 岁月经初潮，12岁月经规律，月经周期31天左右，经量偏少，经色淡，经期5天。偶而有腹胀的感觉，与 月经周期无明显相关。时有外感，饮食可，小便清长，寐差，夜间起夜2~3次。

舌、脉象：舌淡苔白，脉细。

诊断：中医诊断：无子。证型：肾气亏虚。 西医诊断：原发性不孕。

治则：补气益肾，调补冲任。 针灸处方：

主穴：阴廉、太溪、大赫。

配穴：复溜、足三里、三阴交。

刺灸法：针刺阴廉穴时使用捻转补法，得气后做温针灸（艾条略长），以出现针下有明显的热感并

Billingual Acupuncture and Moxibustion

感传至阴部为度。足三里穴使用温针灸。余穴均用平补平泻手法。起针后肾俞穴拔罐。

辨证分析：患者从未孕育过，属于中医学的“全不产”“无子”范畴。患者主症为不孕，伴时有外 感，饮食可，偶而有腹胀，小便清长，寐差，夜间起夜2~3次诸症，为肾气亏虚的表现。中医学认为肾为 先天之本，藏精气，主生殖，为冲任之本，肾中精气的盛衰，主宰着人体的生长发育及生育功能的成熟 与衰退。《傅青主女科》谓：“妇人受妊，本于肾气旺也，肾旺是以摄精。”现代医学研究认为肾虚在 免疫性不孕（育）中占主导地位，免疫功能减退表现为肾阳虚，免疫功能异常增高表现为肾阴虚。此患 者体内存在抗精子抗体阳性，属于同种免疫，使精子与卵子不能结合或受精卵不能着床。肾气亏虚，脏 腑阴阳气血乖和，冲任胞宫功能失调，以致男精女“血”（卵）不能相搏而难以成孕。治疗时应以补益 肾气为主，调补冲任为辅。

取穴依据：主穴选用阴廉、太溪、大赫，起到补益肾气的作用。阴廉为足厥阴肝经腧穴，因“肝肾 同源”，《铜人腧穴针灸图经》载：“治妇人绝产，若未经生产者，可灸三壮即有子”。太溪、大赫同 为足少阴肾经腧穴，太溪为足少阴肾经输穴、原穴，大赫为冲脉、足少阴之会。《千金方》：“大赫、 然谷，治精溢，阴上缩。”阴廉位置“在羊矢下，去气冲二寸动脉中”（《针灸甲乙经》），取穴方法为在 气冲穴直下2寸，当内收长肌之外侧处。大赫位置“在气穴下一寸”（《针灸甲乙经》），取穴方法为脐下4 寸，腹正中线旁开0.5寸。配穴取复溜补肾，足三里益气，三阴交调理冲任。现代腧穴学研究认为足三里 具有明确的调整免疫功能的作用。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个月后，妊娠。心得：《灵枢 ·寿夭刚柔》： “治病先刺其病所从生者也。病先起于阴者，先治其阴而后治其阳，

病先起于阳者，先治其阳而后治其阴。”患者病起于肾气亏虚，故在治疗上，应考虑主要选取足 少阴肾经腧穴，在治疗时先益肾阳，后滋肾阴，以达到阴平阳秘的效果。取阴廉时应遵从《灵枢 · 五 邪》：“以手疾按之，快然乃刺之”的原则。

Case 10 Immune sterility

Female patient, aged 29 years.

Chief complaint

No child since marriage 6 years ago.

History of present illness

She had never been pregnant; her spouse is in good health. Lab examination revealed as follows: anti- spermatozoon antibody positive.  11-year-old menarche, her menstruation was normal. Sometimes she had abdominal distention but it had nothing to do with menstrual cycle. She had frequent attacks of common cold, with profuse and clear urine and bad sleeping.

Tongue and pulse

The patient had pale tongue with white coating and her pulse was thread (xi).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), deficiency of kidney-qi (syndrome differentiation).

WM diagnosis: Primary sterility.

Principle of treatment

Tonifying kidneys and replenishing qi, regulating and nourishing thoroughfare and conception vessels.

Prescription

Main points: Yinlian (LR 11), Taixi (KI 3),Dahe (KI 12).

Additional points: Fuliu (KI 7), Zusanli (ST 36),Sanyinjiao (SP 6).

Manipulation

Reinforcing by twirling and rotating needles on the point of Yinlian (LR 11), and then using warming needle moxibustion on Yinlian (LR 11) and Zusanli (ST 36). Uniform reinforcing and reducing method on the other points. Cupping on the Shenshu (BL 23) for ten minutes after removing the needles.

Differentiation of the syndrome or disease

The 29-year-old female patient presented with no child as her chief complaint. She had never been pregnant.

It is classified as “sterility” in Traditional Chinese Medicine. Chinese medical theories state that kidney is the foundation of inborn constitution, which stores essence of life and is in charge of reproduction. It’s also the foundation of the thoroughfare and conception vessels. Essence of Kidneys is in charge of the growth and the function of reproducing. Fuqing-zhu’s Gynecology and Obstetrics says: “Pregnancy is based on the enough qi of Kidneys.”

Explanation of the points

Yinlian (LR 11), Taixi (KI 3) and Dahe (KI 12) are selected to tonify kidney-qi. Yinlian (LR 11) is the point of the Liver meridian; liver and kidneys have the common source. Illustrated Manual of Acupoints on the Borne Figure says: “If the women have no child, applying moxibustion to Yinlian (LR 11). ” Taixi (KI 3) and Dahe (KI 12) are points of the kidney meridian, the former being the primary point and the later the crossing point of thoroughfare vessel and the kidney meridian. They tonify the kidney-qi to help pregnancy. Fuliu (KI 7) invigorates the kidneys. Zusanli (ST 36) benefits vital energy and regulates immunity. Sanyinjiao (SP 6) regulates the harmony of thoroughfare and conception vessels.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 3 months, she was pregnant.

Experience

Immune system is closely related to deficiency of kidneys. So the treatment should aim at tonifying kidneys.

（ 11 ）人工流产术后不孕症案

康某，女，31岁，2003年3月23日初诊。 主诉：人工流产术后4年未孕。

现病史：结婚6年，配偶身体健康。5年前妊娠2个月时，因工作繁忙不想要孩子，行人工流产，术后 未好好休息，之后一直未孕。碘油造影示，左侧输卵管不通，右侧输卵管通而不畅。月经周期规律，经 量偏多，经色黯，经期5天。白带量可，色黄。排卵期有腹痛、腹胀的感觉。饮食可，二便调，寐可。

舌、脉象：舌红苔薄黄，脉弦。

诊断：中医诊断：断续（断绪）。证型：气滞血瘀。 西医诊断：继发性不孕（输卵管因素）。

治则：化瘀通络，温经化痰。 针灸处方：

主穴：气海、水道、子宫穴。 配穴：行间、太冲、三阴交。

Billingual Acupuncture and Moxibustion

刺灸法：针刺气海时使用捻转泻法，使针感向下感传为佳；针刺水道穴、子宫穴使用提插泻法，得 气以出现针下有明显的跳动感为度。余穴均用平补平泻手法。起针时使用开阖补泻中的泻法。出针后水 道、子宫穴拔罐。

辨证分析：患者曾孕育，现不孕，属于中医学的“断续”“断绪”范畴。患者因妊娠2个月时行人工 流产，术后摄生不慎，复感外邪，入侵胞脉，致宿血停滞，内阻冲任，胞脉瘀阻，加之内因情绪不畅， 肝气郁结，气机不畅，日久成瘀，瘀久化热，瘀热互结，胞脉受阻，故出现排卵期腹胀、腹痛，经量偏 多，经色黯等气滞血瘀之症。其主要病机为经络气血运行不畅，“不通则痛”，其病位在胞脉，胞脉瘀 阻。现代医学研究认为胞脉即输卵管，人工流产后所致的输卵管不通，多由炎症所致，炎症引起输卵管阻 塞、蠕动能力减弱，从而导致不孕。《女科经纶 ·月经门》引戴元礼言曰：“经事来而腹痛，不来腹亦 痛，皆血之不调故也。欲调其血，先调其气。”故在治疗上以调气为主，因肝主疏泄，辅以疏肝活血。

取穴依据：方中主穴选用气海、水道、子宫穴，起到疏通局部经络气血的作用，针对性治疗胞脉瘀 阻不通。水道穴在病例1中已论述，在此不再做重复论述。子宫穴位置在“中极两旁各开三寸”（《针灸大 成》），取穴方法为仰卧，于耻骨联合上缘旁开3寸，再向上1寸。气海为任脉腧穴，为肓之原穴，擅长治疗 下焦气疾，位置“在脐下一寸五分”（《针灸甲乙经》），取穴方法为仰卧，腹正中线上，脐下1.5寸。

《胜玉歌》：“诸般气症从何治，气海针之灸之宜”；《针灸资生经》：“气海、石门，治崩中漏 下；气海、小肠俞，治带下”；《针灸大成》：“月经不调，气海、中极、带脉、肾俞、三阴交”。配 穴以行间、太冲疏肝理气，三阴交补血养血。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个疗程后，妊娠。

心得：《灵枢 ·官能》：“察其所痛，左右上下，知其寒温，何经所在。 ……泻必……摇大其孔， 气出乃疾；补必……气下而疾出之，推其皮，盖其外门，真气乃存。”因患者病位明确，在治疗时，定 穴、点穴显得尤为重要，也是取得疗效的关键。在针刺治疗时需先扪按其腧穴，《灵枢 ·刺节真邪》： “用针者，必先察其经络之实虚，切而循之，按而弹之，视其应动者，乃后取之而下之”。水道穴、子 宫穴需仔细扪按，常于医者指下有增厚的感觉，患者有疼痛或其他异常的感觉。出针时应摇大其孔出 邪气。

Case 11 Sterility following artificial abortion

Female patient, aged 31 years.

Chief complaint

No child following artificial abortion 4 years ago.

History of present illness

She received artificial abortion 4 years ago after a pregnancy of 2 months. Special examination revealed evidence of left fallopian tube impassability and right fallopian tube obstruction. Her menstruation was regular with heavy amount of bleeding and dark color. She always felt abdominal pain and distention during the period of ovulation.

Tongue and pulse

The patient had red tongue with yellow and thin coating; her pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), qi stagnation and the blood stasis (syndrome differentiation).

WM diagnosis: Secondary sterility.

Principle of treatment

Removing stagnation and dredging collaterals, warming vessels and resolving phlegm.

Prescription

Main points: Qihai (CV 6), Shuidao (ST 28),Zigongxue (EX-CA 1).

Additional points: Xingjian (LR 3), Taichong (LR 2),Sanyinjiao (SP 6).

Manipulation

Reinforcing by twirling and rotating needles on Qihai (CV 6). Reinforcing by lifting and thrusting needles on Shuidao (ST 28) and Zigongxue (EX-CA 1). Reducing by opening the punctured hole when removing the needles on the other points. Cupping on the Shuidao (ST 28) and Zigongxue (EX-CA 1).

Differentiation of the syndrome or disease

The 31-year-old female patient presented with no child as her chief complaint. She had once been pregnant. It is classified as “sterility” in Traditional Chinese Medicine. She took artificial abortion 4 years ago when she had been pregnant for 2 months, which injured uterus and caused internal blockage of blood stasis. Principal of Gynecology and Obstetric says: “Abdominal pain during the menstruation, which was caused by disharmony of the blood. The way of regulating blood is to regulate qi first.” So the treatments aim at regulating qi. Because liver regulates the free flow of qi, soothe liver and activate blood to regulate qi.

Explanation of the points

Selection of main points of Qihai (CV 6), Shuidao (ST 28) and Zigongxue (EX-CA 1) dredge partial qi and blood in fallopian tube impassability. Zigongxue (EX-CA 1) is located on the lower abdomen, 3 cun lateral to Zhongji (CV 3), which helps promote the movement of fallopian tube. Qihai (CV 6), sea of qi, tonifies qi and dispels qi stagnation in lower abdomen to relieve pain and distention. Xingjian (LR 3) and Taichong (LR 2) sooth liver and activate qi, Sanyinjiao (SP 6) replenishes blood.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 3 courses, she was pregnant.

Experience

For this case, it’s important to locate and palpate points, which is important to obtain curative effect. The acupuncturist needs to palpate carefully on the points of Shuidao (ST 28) and Zigongxue (EX-CA 1). He often feels thick sensation under the finger while the patient feelspain or has other uncomfortable feelings.

（ 12 ）霉菌性阴道炎不孕症案

张某，女，27岁，2005年1月12日初诊。

主诉：婚后3年未孕，伴白带多，外阴搔痒。

现病史：结婚3年，配偶身体健康。白带多，色时白时偏黄，时如浓鼻涕，时如豆腐渣，伴外阴搔 痒，白带流出时搔痒更剧。白带检测示霉菌感染。经内服西药，外用西药，病情时好时坏。月经周期规 律，经量偏少，经色红，有血块，经期3天。月经来临前，双乳胀痛。饮食佳，寐差，梦多，小便黄，大 便时干时溏。

舌、脉象：舌红苔黄微腻，脉滑数。

诊断：中医诊断：无子（全不产）。证型：湿热下注。 西医诊断：原发性不孕。

Billingual Acupuncture and Moxibustion

治则：清热利湿。 针灸处方：

主穴：阴陵泉、阴谷、外关。 配穴：足三里、合谷、血海。

刺灸法：针刺阴陵泉、阴谷穴时使用捻转、提插泻法，得气以出现针下有明显的酸胀感为度。余穴 均用平补平泻手法。

辨证分析：患者从未孕育过，伴带下，阴痒，属于中医学的“全不产”“无子”“阴痒”范畴。 中医学认为“本虚标实，脏虚虫动”而“脏虚者，主要责之于脾肾”。《医学心悟 ·妇人门 ·带下》记 载：“脾气壮旺，则饮食之精华生气血而不生带；脾气虚弱则五味之实秀，生带而不生气血。”患者由 房事不洁、秽浊之邪上犯或湿热内蕴，湿热瘀阻胞脉，久者致脾肾亏虚，湿邪久恋，湿热内蕴，虫蚀阴 中，致两精不能相搏而成孕。正如隋 ·巢元方《诸病源候论》中载：“妇人阴痒是虫蚀所为……，因脏 虚虫动，作食于阴，其虫作势，微则痒，重则乃痛。”患者白带分析，霉菌阳性，脉滑数。《金匱要 略》：“少阴脉滑数者，阴中即生疮，阴中蚀疮烂者，狼牙汤洗之”。《景岳全书 ·妇人规》：“妇人 阴痒，……多由湿热所化。”故在治疗上以清热利湿为主，可取足太阴脾经、足少阴肾经经穴为主。

取穴依据：全方以利湿清热为主。主穴取阴陵泉、阴谷、外关。阴陵泉、阴谷调整脾肾功能祛湿， 外关理气以祛湿。阴陵泉为足太阴脾经合穴，为祛湿要穴。《针灸甲乙经》：“阴陵泉主妇人阴中痛， 少腹坚急痛。”阴谷为足少阴肾经合穴，有补肾培元，调经利尿之功，现代临床常用于治疗泌尿生殖系 感染疾病。选用手少阳三焦经的络穴外关，以通调三焦之气机，以利水湿之行。配穴中足三里益气除 湿；血海穴在《类经图翼》中被称为百虫窠，以杀虫止痒；《医宗金鉴》：“血海治男子肾脏风，两腿 疮疡湿痛等症”，《类经图翼》：“血海主带下气逆腹胀”。

疗程、疗效：治疗期间嘱患者禁止同房，用小苏打水每日清洗外阴。治疗1个月，白带减少，外阴搔 痒消失。3个月后妊娠。

心得：霉菌性阴道炎又称为念珠菌阴道炎，据统计，约10%非孕妇女阴道中有此菌寄生，无明显症 状。故杀菌是一种治疗方案，扶助机体的正气以驱邪似乎更加符合本病的治疗。利湿清热理气的治则的 确立是本病治疗取得成功的关键。

Case 12 Sterility due to vaginal moniliasis

Female patient, aged 27 years.

Chief complaint

No child since marriage 3 years ago

History of present illness

She had never been pregnant since she got married 3 years ago. Her spouse is in good health. Vaginal discharge became profuse for a long time; it was yellow, thick and creasy, and she had sensation of itching. Lab examination showed infection of Monilia. After Internal and external Western medicine were given, the problem improved, but the trouble recurred frequently. Menstruation was regular with decreasing amount of bleeding. She had mammary distended pain pre-menstruation.

Tongue and pulse

The patient had red tongue with yellow and greasy coating, and her pulse was smooth (hua) and rapid (shuo).

Diagnosis

TCM diagnosis: Sterility (diagnosis of disease), downward attack of damp-heat (syndrome differentiation).

WM diagnosis: Vaginal moniliasis. Primary sterility.

Principle of treatment

Clearing heat and getting rid of dampness.

Prescription

Main points: Yinlingquan (SP 9), Yingu (KI 10),Ququan (LR 8).

Additional points: Zusanli (ST 36),Hegu (LI 4),Xuehai (SP 10).

Manipulation

Reducing by combination of twirling and rotating needle and lifting and thrusting needle on Yinlingquan (SP 9) and Yingu (KI 10). The patient had needle sensation such as obvious swelling. Uniform reinforcing and reducing method on the other points.

Differentiation of the syndrome or disease

The 27-year-old female patient presented with no child as her chief complaint. She had never been pregnant,  together with leukorrhagia and vaginal itching. These signs and symptoms are classified as “sterility” and “vaginal  itching” in Traditional Chinese Medicine. It is related to spleen and kidneys. It is excess symptom and the deficient  root causes. Enlightened Views on Medicine says: “If spleen qi is enough, food and refined essence produce qi  and blood; if spleen qi is insufficient, food and refined essence produce leukorrhagia replacing of qi and blood.” Jingyue’s Complete Works says: “Women suffered from vaginal itching, most of which were caused by damp-  heat.” So the treatment should aim at clearing heat and promoting dieresis.

Explanation of the points

Yinlingquan (SP 9), yin mound spring, is the sea point and the water point, which tonifies spleen and kidneys  to resolve dampness from the lower burner, and is often used in leukorrhagia caused by obstruction of dampness.  The ABC Classic of Acupuncture and Moxibustion says: “ Yinlingquan (SP 9) is used in women vaginal pain.” Yingu (KI 10), yin valley, is the sea point and water point; it expels dampness from the lower burner. Ququan (LR  8), spring and bend, is also the sea point and water point, and it eliminates dampness in the lower burner.  Zusanli  (ST 36) tonifies qi to remove dampness. Hegu (LI 4) clearsheat. Xuehai (SP 10) is called “home of hundreds of worms” in Illustrated Supplement to Classified Canon, and it eliminates vaginal itching.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. Sexual intercourse was forbidden during the first month, and let the patient wash vulva with soda water every day. After treated with acupuncture for  1 month, vaginal discharge became less and vaginal itching disappeared. She was pregnant 3 months later.

Experience

Vaginal moniliasis is also called colpomycosis. Some reaches revealed that there were about 10% of non- gravid females in whose vulva way this mold existed without any obvious symptom. For this case the principle of treatment is the key to get effective.

（ 13 ）宫寒不孕症案

李某，女，30岁。2005年7月10日初诊。 主诉：婚后7年未孕。

现病史：结婚7年，配偶身体健康。月经11岁来潮，周期32天，经量少，颜色淡，经下不畅，伴痛

Billingual Acupuncture and Moxibustion

经，得热痛减，得热后经下顺利，行经期5天。平素怕冷，手足凉，行经期更甚，自觉小腹似乎有一块冰 块，喜温，喜饮热饮。稍有饮食不慎，即腹泻。饮食尚可，小便清，大便微溏，寐可。

舌、脉象：舌淡苔白厚，脉紧。

诊断：中医诊断：无子（全不产）。证型：下焦虚寒。 西医诊断：原发性不孕。

治则：补肾填精，温肾暖宫。 针灸处方：

主穴：关元、归来。

配穴：太溪、交信、足三里。

刺灸法：关元穴以大艾炷灸之，三壮以上，以患者自觉小腹温热为度。足三里穴使用温针灸。余穴 均用平补平泻手法。起针后肾俞穴拔罐。

辨证分析：患者从未孕育，属于中医学的“全不产”“无子”范畴。患者症状较为典型，表现为 行经期自觉小腹似乎有一块冰块，喜温，喜饮热饮。《诸病源候论 ·子脏冷无子候》：“子脏冷无子 者，由将摄失宜，饮食不节，乘风取冷，或劳伤过度，致风冷之气，乘其经血，结于子脏，子脏冷故无 子。”患者月经每月略推后，经量少，颜色淡，经下不畅，伴痛经，得热痛减，得热后经下顺利，均表 明其子脏冷。《圣济总录》云：“妇女所以无子者，冲任不足，肾气寒也”，患者平素怕冷，手足凉， 行经期更甚，稍有饮食不慎，即腹泻，表明其肾阳不足。肾主藏精而通于冲任，为先天之本，肾内蕴真 阴真阳，皆天癸之物质基础，生殖之根本。肾精不足，冲任空虚，胞脉失养，摄精无源，不能成孕；精 血互生，经亏血少，月经迟来量少，难以成孕；精血缺乏，肾阳不足，不能温养胞脉，使宫寒而不孕， 故治疗以补肾填精，温肾暖宫为主。

取穴依据：全方以温肾壮阳为主。主穴选用关元、归来。关元为全身强壮要穴之一，尤擅长补益周 身之阳气。归来穴为足阳明胃经腧穴，位置“在水道下一寸”（《针灸逢源》）。《针灸大成》载归来 穴主治为：“主小腹奔豚，卵上入腹，引茎中痛，七疝，妇人血脏积冷。”配穴以足三里益气强壮，太 溪、交信益肾填精。

疗程、疗效：每日1次，每周5次，治疗2个月后，经色转红，痛经明显减轻，6个月后妊娠。心得： 子脏冷所致不孕在临床比较常见，本病案患者为一比较典型的案例。我们观察对于此类患者，关元穴直 接灸的方法比单纯针刺甚至是温针效果都好，以大艾炷直接置于关元穴上，点燃，至患者感到有痛的 感觉时，以棉花隔之，直至艾炷燃尽，期间可增加棉花。患者小腹内会有热感，壮数不限，以腹内热 为度。

Case 13  Uterus-coldness sterility

Female patient, aged 30 years.

Chief complaint

No child since marriage 7 years ago.

History of present illness

She never had been pregnant for 7 years since she got married. Her spouse is in good health. Eleven-year- old menarche, menstruation lasted up to 5 days every 32 days, scanty with thin color. She had period pain every month, which was worse by cold. She always felt her hands and feet cold, which was worse during menstruation. She felt a piece of ice-cube in her lower abdomen, and she wanted to have hot drinks. Frequently attacked by diarrhea if she paid no attention to food. 

Tongue and pulse

The patient had pale tongue with white and thick coating; her pulse was tense (jing).

Diagnosis

TCM diagnosis:  Sterility (diagnosis of disease) . Deficiency cold in lower energizer (syndrome differentiation).

WM diagnosis: Primary sterility.

Principle of treatment

Nourishing kidneys to replenish marrow. Warming kidneys and uterus.

Prescription

Main points: Guanyuan (CV 4), Guilai (ST 29).

Additional points: Zusanli (ST 36), Jiaoxin (KI 8), Taixi (KI 3).

Manipulation

Conducting moxibustion by putting more than three big moxa cones on Guanyuan (CV 4) until the patient felt warm in the abdomen, and using warming needle moxibustion on Zusanli (ST 36). Uniform reinforcing and reducing method on the other points. Cupping on Shenshu (BL 23) after removing the needles.

Differentiation of the syndrome or disease

The 35-year-old female patient presented with no child as her chief complaint. She experienced abortion and operation on cutting left uterine tube, and her menstruation was regular with scanty bleeding. These signs and symptoms are classified as “sterility” in Traditional Chinese Medicine. The patient had never been pregnant, which belongs to “sterility” in TCM. She always felt cold as if there were a piece of ice-cube in her lower abdomen during menstruation. Treatise on Causes and Symptoms of Disease says: “Uterus-coldness sterility is caused by coldness attacking the uterus.” General Medical Collection of Royal Benevolence says: “The reasons of sterility are deficiency of thoroughfare and conception vessels and the coldness of kidneys.” Kidneys store essence of life and communicate thoroughfare and conception vessels. They are is the foundation of in birth, and the root of reproduction. Insufficiency of essence and blood of kidneys failed to produce enough kidneys yang.

Explanation of the points

Guanyuan (CV 4), gate to original qi, is the front-mu point of small intestine meridian and the crossing point of conception vessel, spleen, liver and kidney meridian. It is one of the most powerful points to tonify qi and blood and strengthen the body and mind. Using direct moxibustion on Guanyuan (CV 4) to rescue the body yang. Great Compendium of Acupuncture and Moxibustion says: “Guilai (ST 29) is used in uterus-coldness.” Zusanli (ST 36) tonifiesthe body qi. Jiaoxin (KI 8) and Taixi (KI 3) tonify kidneys and replenish marrow.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 2 months, she didn’t have period pain, and was pregnant 6 months later.

Experience

Uterus-coldness sterility is popular in clinic. We found that direct moxibustion on GUANYUAN (CV4) was better than simple needles or warming needle moxibustion.

Billingual Acupuncture and Moxibustion 

13.1.2 绝经期综合征（menopause syndrome)

绝经期综合征是指妇女绝经前后出现性激素波动或减少所致的一系列躯体及精神心理症状［1］ 。 本病发病年龄多在45~55岁，临床症状以植物神经功能紊乱为主，伴有精神心理障碍的一些症状，如 月经紊乱，烘热汗出，烦躁易怒，失眠心悸等与绝经有关的症状。国内围绝经期综合征的发病率约为 60%～80%，且近年来该病有发病年龄提早、发病率上升的趋势［2］。

本病中医称为“绝经前后诸证”，肾衰天癸竭为其发病之基础，肾阴阳失衡为病机之关键［3］ 。目前 西医对本病主要采用激素替代疗法；中医则立足于整体治疗，对绝经期综合征的治疗有着丰富的理论和 临床实践经验。

研究表明针灸对本病有较好的疗效，临床治疗以任脉、足太阴经及背俞穴为主［4］，最常选用的腧穴 主要为三阴交、气海、中极、百会和关元［5］。同时，本病的治疗应注意配合心理疏导。

参考文献

［1 ］谢幸，苟文丽. 妇产科学［M］. 北京：人民卫生出版社，2013.

［2 ］程洁，李忠仁. 针灸治疗围绝经期综合征选穴规律的研究［J］．南京中医药大学学报，2010（ 1 ）：21-23.

［3 ］马宝璋. 齐聪. 中医妇科学［M］. 北京: 中国中医药出版社，2012.

［4 ］杜元灏，董勤. 针灸治疗学［M］. 北京：人民卫生出版社，2012.

［5］陈芷枫，张晓霞，赵芸芸，等. 运用数据挖掘研究历代针刺治疗围绝经期综合征的经穴运用规律［J］．世界中医药， 2015（4 ）：482-489.

 （ 1 ）围绝经期综合征案 患者，女，56岁。

主诉：阵发性潮热盗汗、紧张、焦虑1年。

现病史：近一年停经，潮热盗汗，睡眠差，紧张，易焦虑，每日潮热10~20次，夜间发作3~4次，严 重影响工作、生活。精神尚可，无明显疲劳感，食欲，二便正常。

舌、脉象：脉沉细弦，舌黯红。

诊断：中医诊断：绝经前后诸证。证型：肝肾阴虚，肝郁。 西医诊断：绝经期综合征。

治则：调补肝肾。 针灸处方：

主穴：太溪、三阴交、合谷、太冲。 配穴：百会、印堂、外关。

刺灸法：太溪、三阴交用补法，合谷、太冲用泻法，百会、印堂、外关用平补平泻的手法。 其他疗法：针刺耳穴：内分泌、卵巢、肝、肾、神门。

疗程、疗效：每周2次，一星期后潮热明显减少， 一星期只有3~4次潮热，睡眠明显改善。按同法继 续进行施治一周，各症状均消失。

心得：我们在临床上发现，针灸在治疗更年期综合征，甚至是在癌症术后服药，由于内分泌紊乱、 免疫功能低下、植物神经功能失调等，引起的潮热盗汗，烦燥，体重增加等临床症状，具有见效快， 无副作用的特点，常常有让医者、患者意想不到的效果。在国外，因时间、费用的缘故， 一般治疗为每 星期2次，往往临床为了提高疗效，常配合耳针共同治疗。耳针在调整内分泌功能上效果极佳。曾有患者 在癌症术后，因服用化疗药引起潮热，仅以耳针治疗就达到很好疗效。但在治疗时需注意患侧耳针慎用，因大多数患者在癌症术后服用化疗药时，机体免疫力都比较低下，操作不当，易在耳朵局部引起 感染。

Case 1  Menopause syndrome

Susan, female, 50 years old.

Chief complaint

With hot flash, stress, and anxious for a year.

Case history

No period for a year, with hot flash and night sweat, insomnia, stress, and anxious, hot flashes 10-20 times everyday and 3-4 times at night, which seriously affected her life and work.

Tongue and pulse

Dark and red tongue, deep thread wiry pulse.

Diagnosis

Liver-kidney yin deficiency, liver stagnation.

Principle of treatment

Regulating and replenishing liver and kidney.

Prescription

Selection of points: Taixi (KI 3),Sanyinjiao (SP 6),Hegu (LI 4), Taichong (LV 3), Baihui (GV 20), Yintang (EX-HN 3), Waiguan (TE 5)

Manipulation

Use reinforcing method on the points of Taixi (KI 3) and Sanyinjiao (SP 6), use reducing needle method on the points of Hegu (LI 4) and Taichong (LV 3), use uniform reinforcing and reducing needle method on the points of Baihui (GV 20), Yintang (EX-HN 3) and Waiguan (TE 5).

Selection of ear-point

Use uniform reinforcing and reducing needle method on the ear-point of endocrine, ovary, liver, kidney, Shenmen.

Time and course

twice a week.

Curative effect

The second treatment (after one week): The hot flashes obviously reduced, only attacked for 3-4 times in a week, sleeping better, the patient was satisfied with the acupuncture therapy.

The third treatment (after another one week): Menopause syndrome was controlled, and the patient asked acupuncture treatment for other problems.

Experience

In clinic, we realized acupuncture was very good for menopause syndrome, even for post-operative cancer with disorder endocrine, low immunity function, and vegetative nerve functional disturbance etc., which caused symptoms such as hot flashes, night sweat, twitchy, the body weight increase. The acupuncture got effect very fast,

Billingual Acupuncture and Moxibustion

withoutside effect, sometimes got other unexpected good effects even for doctors and patients.

Abroad, because of time and money, generally acupuncture therapy twice a week, in order to get curative effect, we often combine with ear acupuncture together. Ear-point is good to regulate endocrine function.

Once there was post-operative cancer patient suffered from hectic fever because of taking chemotherapy, only treated by ear acupuncture, and then attained very good curative effect.

But while treating, the acupuncturist needs to notice the pathologic change of ears. The ear acupuncture has to be used carefully, because most patients are in hypoimmunity situation at cancer post-operative and take chemotherapy medicine, if the acupuncturist doesn’t operate carefully, it is easy to cause infection at ear part (mainly on the side cancer happened).

（ 2 ）围绝经期综合征案

全某，女，56岁，2004年12月18日初诊。 主诉：月经紊乱4年，停经2年。

现病史：4年前出现月经紊乱，2年前停经，伴烘热汗出，潮热，失眠，焦虑，烦躁不安，记忆力明 显减退，头晕耳鸣，面浮足肿，腰背酸痛。来诊时见患者颧部潮红，面浮足肿，舌红少苔，脉细数。西 医诊断为围绝经期综合征，曾服过雌激素（尼尔雌醇）、更年安、维生素、中药等，不见明显效果，经 妇科医生介绍来诊。

舌、脉象：舌红少苔，细数。

诊断：中医诊断：绝经前后诸证。证型：肾阴虚。 西医诊断：绝经期综合。

治则：滋阴清火。 针灸处方：

主穴：百会、印堂、太阳、风池、内关、神门、三阴交、足三里。 配穴：太溪、关元。

刺灸法：先用直径0.32毫针针刺，针刺百会、印堂、太阳（双侧）、风池（双侧）、内关（双侧）、 神门（双侧）、三阴交（双侧）、足三里（双侧），配穴加太溪（双侧）。得气后于所针穴位分别接 6805电针仪，用连续波（频率5~6 Hz），电流强度以患者能耐受为度，得气感以周围上下传导为最佳。再 用灸法。艾灸以艾条点燃后放在灸盒内置于关元穴上30分钟，热度以热而不烫为宜。

其他疗法：磁珠耳压。以直径2mm的磁圆珠放在0.8cm×0.8cm的胶布上按压在耳穴的神门、肾、肝、 脾、心、脑、皮质下、内分泌、交感、卵巢，嘱患者自行按压磁珠所在穴位，每日不少于4次，每次每穴 按压30下，以耳部出现酸胀、痛感，耳廓发热发红为最好。

辨证分析：属于中医学的绝经前后诸证，证型为肾阴虚。舌红主邪热亢盛、热入营血或阴虚水涸、 虚火上炎。少苔多主阴虚。细数主阴虚。

取穴依据：我们采用针刺头部的百会、印堂、太阳、风池是为了调整机体的不和，从头部的诸阳 经穴开始，配合神门、内关调和心志（心为五脏六腑之大主）、安神解郁；针刺足三里、三阴交扶脾固 冲，保健强身；刺足少阴肾经的太溪穴以滋补肾气，平衡阴阳；艾灸关元以温暖、调理冲任。全方配伍 起到滋肾养肝、清心安神、益气养血、调理冲任、健脾和胃之功，使失去平衡的阴阳重新恢复，加上刺 激相关耳穴，使治疗作用持久，两者配合相得益彰，能收到显著疗效。

疗程、疗效：针灸治疗每次30~40分钟，每日1次，10次为1疗程；磁珠耳压，双侧耳穴交替贴按，隔 日换1次，5次为1疗程。采用上述方法治疗1个疗程后患者自觉症状明显减轻，情绪亦较前稳定。为巩固 疗效，嘱其隔日1次，再行10次治疗，经2个疗程的针灸耳压治疗后，患者上述症状体征完全消失，与生病前判若两人。半年后随访无复发。

心得：绝经期综合征临床表现为一系列躯体及精神心理症状，临床治疗中清心安神为其重要组成部 分，同时当配合心理疏导。

Case 2  Menopausal syndrome

Female patient, aged 56 years.

Chief complaint

Hectic fever with sweating of about 2 years.

Case history

The patient suffered from menses mess two years, and she had menopause 2 years ago. She had experienced hectic fever with sweating, insomnia, anxiety, dysphoria uneasy, poor memory, vertigo, tinnitus, edema in face and foot, low back soreness. Taking estrogenic hormone medication did not help.

Tongue and pulse

The patient had red tongue without coating, indicating deficiency  of yin, especially deficiency of kidney-yin. Her pulse was thready (xi) and rapid (shuo), indicating internal heat due to deficiency of yin.

Differentiation of the syndrome or disease

The 56-year-old female patient presented with hectic fever with sweating as her chief complaint. She suffered from hectic fever with sweating, insomnia, anxiety, dysphoria uneasy, poor memory, vertigo, tinnitus, edema in face and foot, low back soreness since she had been menopausal. These signs and symptoms are classified as “menopausal disease” in Traditional Chinese Medicine. Chinese medical academic theories state that it is caused by exhaustion of sex-stimulating essence and deficiency of kidney-qi.

Prescription

Point selection: Baihui (GV 20), Yintang (EX-HN 3), Taiyang (EX-HN 5), Fengchi (GB 20), Neiguan (PC 6), Shenmen (HT 7),Sanyinjiao (SP 6), Zusanli (ST 36), Taixi (KI 3), Guanyuan (CV 4).

Needles

Filiform needles and ear acupoints pressing.

Manipulation

Reinforcing needle technique.

Frequency and duration

Once a day for a course often days.

Explanation of the points

Baihui (GV 20), Yintang (EX-HN 3) and Taiyang (EX-HN 5) calm the mind. Fengchi (GB 20) and Neiguan(PC 6) deal with depression. Sanyinjiao (SP 6) and Zusanli (ST 36) regulate blood and qi. Taixi (KI 3) benefits kidney-yin. Guanyuan (CV 4) regulates the balance of yin and yang.

Treatment outcome

After 20 treatments, the symptoms disappeared. A follow-up telephone call 6 months later established that there had been no relapse of symptoms.

Billingual Acupuncture and Moxibustion

（ 3 ）围绝经期乳痛案

王某，女，51岁，2005年3月2日初诊。主诉：经乱1年，伴双侧乳房胀痛。

现病史：1年前出现月经周期紊乱，时而1月二至，时而3月一行，经量时多时少。偶有汗出，烦躁， 双乳胀痛明显，夜不能寐，不能戴胸罩，不能碰触乳房。乳腺摄片检测示，双乳外上限轻微乳腺囊性增 生。饮食可，大便不成形，时有一日二次，寐差。

舌、脉象：舌红苔薄黄，脉弦数。

诊断：中医诊断：乳栗（奶癖）。证型：肝肾亏虚，气滞血瘀。

西医诊断：乳房囊性增生病。 治则：益肾疏肝，理气化瘀。 针灸处方：

主穴：膻中、太冲、复溜。 配穴：肩井、少泽、乳根。

刺灸法：针刺膻中穴时使用迎随补泻中的补法，针尖指向头部；肩井穴采用平刺的方法，针尖指向 背部；乳根采用平刺的方法，针尖指向乳中。余穴均用平补平泻手法。起针后肝俞穴拔罐。

辨证分析：患者时值51岁，月经出现紊乱，以双乳胀痛为主要症状，属于中医学的“经断前后诸 症”“乳栗”“奶癖”范畴。《素问 ·上古天真论》：“女子七岁肾气盛，齿更发长；二七而天癸至， 任脉通，太冲脉盛，月事以时下，故有子……；七七任脉虚，太冲脉衰少，天癸竭，地道不通，故形坏 而无子也。”患者适逢围绝经期，任脉虚，太冲脉衰少，天癸渐竭，经络气血运行不畅。乳房为肝经循 行所过，《外科正宗》说：“忧郁伤肝，思虑伤脾，积想在心，所愿不得志者，致经络痞涩，聚结成 核”，肝经气血运行不畅，肝疏泄功能失调，经络阻塞而引发本病，所以患者出现双乳胀痛，不能碰 触。《外科医案汇编》：“乳中结核，虽云肝病，其本在肾。”表明本病其本在肾气渐虚，故患者出现 大便溏，时而一日两次，其标在肝失疏泄，故舌红苔薄黄，脉弦数，因此在治疗上应补肾疏肝并重。

《内经 ·举痛论》说：“百病生于气也，怒则气上，喜则气缓……思则气结。”表明本病与气机郁  结相关。《外科医案汇编》：“治乳症，不出一‘气’字定矣。 ……痰气凝结，为癖，为核，为痞。” 故在治疗上应注重理气。

取穴依据：方中主穴选用膻中、太冲、复溜。膻中理气，太冲疏肝，复溜补肾。膻中位置在“玉  堂下一寸六分，直两乳间陷者是”（《难经 · 三十一难》），取穴方法为在胸部两乳之中，为心包的  募穴，是脾经、三焦、小肠、任脉交会穴，八会穴之一，气之会穴，是调整胸部气机的要穴。《针灸  大成》：“乳痈，针乳痛处，膻中、大陵、委中、少泽、俞府”；《杨敬斋针灸全书》：“气疾痛，  膻中、巨阙便针”；《行针指要赋》：“或针气，膻中一穴分明记”；《难经 · 三十一难》：“上焦  者，在心下，下膈，在胃上口，主内而不出，其治在膻中”。太冲、复溜的选用依据《针灸甲乙经》：  “乳痛，太冲及复溜主之”。太冲穴位置在“足大指本节后二寸；或曰一寸五分陷者中”（《针灸甲乙  经》），取穴方法为足一、二跖骨结合部前方凹陷处。《铜人腧穴针灸图经》载：“胸胁支满，足寒大  便难，呕血，女子漏血不止，小儿卒疝，呕逆。”配穴选用肩井，《百症赋》：“肩井乳痈而极效。” 乳根位置在“乳下一寸六分陷者中”《针灸甲乙经》，为局部取穴，可疏通局部的气血。少泽为手太阳  小肠经的井穴，具有通乳的特殊治疗作用。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗6次后，疼痛明显减轻，3个疗程后疼痛消失。

心得：《灵枢 ·刺节真邪》：“用针之类，在于调气。”《灵枢 ·始终》：“凡刺之道，气调而 止。 ……凡刺之法，必察其形气。”对于乳房疾患的患者，调气尤为重要，因乳房为肝经循行所过，肝 主疏泄。本病案中患者因处于围绝经的特殊时期，故在治疗上，还应注重补肾。在临床中我们发现针灸 疗法对乳房疾患有着很好的疗效，往往治疗一、二次患者就有明显的感觉。

Case 3  Mastodynia in menopause period

Female patient, aged 51 years.

Chief complaint

Pain in breasts following irregular menstruation within last 1 year.

History of present illness

One year ago, the patient experienced menstrual cycle mess, sometimes twice a month, sometimes once every three months. At the mean time, she felt bad breastspain, and it became worse when she was sleeping. She also had sweat proptosis and dysphasia. Mammogram examination revealed evidence of cystic hyperplasia of breasts.

Tongue and pulse

The patient had red tongue with yellow and thin coating; her pulse was wiry (xuan) and rapid (shuo).

Diagnosis

TCM diagnosis ： Mastodynia (diagnosis of disease), deficiency of kidney and liver, qi stagnation and blood stasis (syndrome differentiation).

WM diagnosis: Cystic hyperplasia of breasts.

Principle of treatment

Benefitting kidneys and sooth liver. Activating qi to remove stasis.

Prescription

Main points: Taichong (LR 3),Fuliu (KI 7),Danzhong (CV 17).

Additional points: Jianjing (GB 21), Shaoze (SI 1),Rugen (ST 18).

Manipulation

Using directional reducing on Danzhong (CV 17), the tip of the needlepoints to the upper. Using horizontal insertion into Jianjing (GB 21), the tip of needlepoints to the back. Using horizontal insertion intoRugen (ST 18), the tip of needle points to Ruzhong (ST 17). Using uniform reinforcing and reducing method on the other points. Cupping on the Ganshu (BL 18) after removing the needles.

Differentiation of the syndrome or disease

The 51-year-old female patient presented with pain in breasts as her chief complaint. She experienced menstrual cycle mess; she felt bad breastspain together with sweat proptosis and dysphoria. Mammogram examination revealed evidence of cystic hyperplasia of breasts. These signs and symptoms are classified as “menopausal disease” in Traditional Chinese Medicine. Plain Questions of Huangdi’s Canon of Medicine says: “When women aged over 49 years gradually become deficient in thoroughfare vessel meridian-qi, their sex- stimulating essence quit and uterus vessel is blocked.” The liver meridian pathway passes the breasts. If liver fails to maintain free movement of qi, it will come to the result of breastspain. Collected Manual of External Diseases Cases says: Masses in breasts are caused by diseases of liver and kidneys.” The root of cystic hyperplasia is insufficiency of kidney-qi. So the treatment should aim at tonifying kidneys and soothing liver. Plain Questions of Huangdi’s Canon of Medicine says: “All kinds of diseases are caused by qi.”

Billingual Acupuncture and Moxibustion

Explanation of the points

Danzhong (CV 17), middle of chest, is the front-mu of the pericardium and gathering point of qi, also is  point of sea of qi; it dispels stagnation of qi to activate blood circulation. Great Compendium of Acupuncture and  Moxibustion says: “Tenderness is located in mammary and Danzhong (CV 17) is selected in breasts complaints.” The ABC Classics of Acupuncture and Moxibustion says: “Taichong (LR 3) and Fuliu (KI 7) are selected to relieve  breastspain.” Taichong (LR 3) soothes liver meridian-qi. Fuliu (KI 7) replenishes kidney-qi. Jianjing (GB 21) is  the experiential point in breasts disease. Rugen (ST 18) dredges the partial blood and qi to relieve pain. Shaoze (SI  1) is the well point of the small intestine meridian; it dredges obstruction of the collaterals in breasts.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 6 times, breast pain relieved and completely recovered after 3 courses.

Experience

Spiritual Pi vot of Huangdi’s Canon of Medicine says: “Regulating qi is the key to use needles.” It’s very important to regulate qi in breasts problems. The patient suffered from mastodynia in menopausal periods, and the treatment should aim at invigorating kidneys. We found acupuncture was one of the effective methods for breasts diseases: most patients could relieve after treated with acupuncture for 2-3 times.

（ 4 ）围绝经期心肌缺血案

毕某，53岁，2004年8月11日初诊。

主诉：心慌、胸痛3年，伴阵发性潮热汗出。

现病史：3年前绝经，在围绝经期间即出现心慌、胸痛，发作间期不等，短则1天发作1次，长则10天 发作1次，发作时间不定，以下午4时左右发作次数为多，每次持续时间从15分钟至2个小时不等，伴阵发 性潮热汗出，口服丹参滴丸可逐渐缓解。既往体健，无高血压、糖尿病史。24小时心电监测示，ST段压 低，T波低平、有倒置现象，诊为心肌缺血。动则外感，迁延不愈，怕冷，时有咳嗽，无痰。饮食可，情 绪焦虑，二便调，寐差。

舌、脉象：舌黯苔薄黄，脉细涩。

诊断：中医诊断：胸痛（胸痹）。证型：气虚血瘀。 西医诊断：心肌缺血。

治则：益气化瘀，宽胸理气。

主穴：内关、大陵、间使、曲泽。 配穴：合谷、复溜、足三里。

刺灸法：针刺内关穴时使用捻转泻法，得气以出现针感传至中指尖为度。余穴均用平补平泻手法。 起针后肺俞、肾俞穴拔罐。

辨证分析：患者胸痛3年，属于中医学“胸痛”“胸痹”“心痛”“真心痛”的范畴。患者适逢围 绝经期，任脉虚，太冲脉衰少，天癸竭，机体正处于一个新的阴阳平衡急需建立的时期，经络气血运行 不畅，脏腑功能低下。《诸病源候论 ·心痛候》：“心为诸脏主而藏神，其正经不可伤，伤之而痛为真 心痛。”明代《古今医鉴 ·心痛门》言：“或曰身受寒邪，口食冷物，因有郁热，素有顽痰，死血，或 因恼怒气郁……”其病机责之于“本虚标实”，因年过五旬，肾阳渐虚，心阳不足，心气虚，心气鼓动 血脉无力，致血瘀阻塞心之脉络，心脉闭塞而发。故出现胸痛，易外感且迁延不愈，舌黯苔薄黄，脉细 涩。《素问 ·痹论》曰：“胸痹者，脉不通”，说明心痛的病机在于经脉闭阻，不通则痛。

《金匮要略心典》：“胸痹不得卧，是肺气上而不下也。心痛彻背，是心气塞而不和也，其痹尤为 甚也。”故在治疗上应以益气化瘀为主。

取穴依据：方中主穴内关、大陵、间使、曲泽的选用，分别依据《针灸大成》：“心胸疼痛：  大陵、内关、曲泽”；《针灸甲乙经》：“心痛，善悲，厥逆，悬心如饥之状，心憺而惊，大陵间使  主之”；《备急千金要方》：“胸痹引背时寒，间使主之”而确定。内关穴位置在“掌后去腕二寸” （《针灸甲乙经》），取穴方法为在腕掌横纹上2寸，当掌长肌腱和桡侧腕屈肌腱之间。《八脉八穴症治  歌》述内关穴的功效有：“妇女胁疼心痛，结胸里急难当”；《拦江赋》：“胸中之病内关担”；《标  幽赋》：“胸腹满痛刺内关”；《四总穴歌》：“心胸内关应”。现代腧穴学研究认为，内关穴有纠正  心律，改善心肌缺血的功效。配穴合谷、复溜的选用是针对其阵发性潮热出汗的症状；足三里起补气益  气作用。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3个月，心慌、心痛发作5次，发作间期逐渐拉 长，发作时间缩短至5分钟，5个月后痊愈。

心得：《灵枢 ·九针十二原》：“右主推之，左持而御之。”针刺间使和内关穴时，应注意双手配 合，使气速至而效速。针刺内关时采用捻转泻法结合迎随补泻中的补法，针尖指向手心，以中指出现胀 痛或触电样感觉为度，多数患者在针刺内关后会感觉心情变得愉快。

Case 4 Myocardial ischemia in menopausal period

Female patient, aged 53 years.

Chief complaint

Palpitation, chest pain for 3 years, together with paroxysmal hectic fever and sweat.

History of present illness

The patient felt palpitation and chest pain since she was in menopause 3 years ago. It mainly occurred at about 4 o’clock afternoon, and lasted from fifteen minutes to 2 hours. She also experienced paroxysmal hectic fever and sweat. It was eased after she took the radix salvia miltiorrhizae drops of pill. Twenty-four-hour cardiac electricity monitor revealed evidence of myocardial ischemia. Frequent attacks of common cold.

Tongue and pulse

The patient had dark tongue with yellow and thin coating; her pulse was thread (xi) and unsmooth (se).

Diagnosis

TCM diagnosis: Qi obstruction of chest (diagnosis of disease), qi stagnation and blood stasis (syndrome differentiation).

WM diagnosis：Myocardial ischemia.

Principle of treatment

Benefiting qi to eliminate stasis, dredging vessel and activating qi.

Prescription

Main points: Jianshi (PC 6),Quze (PC 7),Neiguan(PC 5),Daling (PC 3)

Additional points: Hegu (LI 4),Fuliu (KI 7), Zusanli (ST 36).

Manipulation

Using reducing by twirling and rotating needles on Neiguan (PC 5), the patient got needle sensation reaching the middle finger. Using uniform reinforcing and reducing method on the other points. Cupping on Feishu (BL 13) and Shenshu (BL 18) after removing the needles.

Billingual Acupuncture and Moxibustion

Differentiation of the syndrome or disease

The 53-year-old female patient presented with palpitation and chest pain as her chief complaint. This is classified as “qi obstruction of chest ” and “ angina pectoris ” in Traditional Chinese medicine. The patient was in menopausal period, with conception vessel deficiency and insufficient thoroughfare meridian-qi, and sex- stimulating essence cessation, the body needed to establish the new yin and yang equilibrium. Treatise on Causes and Symptom of Disease says: “The heart presides the other organs and houses the mind. The meridian of heart can’t be injured. There is angina pectoris cardiac if it is injured.” It was deficiency root and excess symptom, following the age exceeding fifty years kidneys yang gradually became less than before, heart yang also became less than before. Deficiency of heart qi can’t promote blood circulate normally, with the result of stagnation of blood and qi of heart vessels and collaterals. Spiritual Pivot of Huangdi’s Canon of Medicine says: “qi obstruction of chest was caused by obstruction of vessels.” So the treatment should aim at benefiting qi to eliminate stasis.

Explanation of the points

Great Compendium of Acupuncture and Moxibustion says: “Quze (PC 7), Neiguan(PC 5) and Daling (PC 3) are selected in heart and chest pain.” The ABC Classic of Acupuncture and Moxibustion says: “Jianshi (PC 6) and Daling (PC 3) are selected in heart pain, sadness and palpitation.” Pericardium meridian is the outer guard of heart and the points of it usually are used in heart diseases. Neiguan(PC 5), inner gate, is the connecting point and opening point. It regulates qi and blood of heart to calm mind. Modern acupoints researches proved that Neiguan(PC 5) could rectify cardiac rhythm and improve the effect of cardiac muscle ischemia. Hegu (LI 4) and Fuliu (KI 7) are selected to relieve paroxysmal hectic fever and sweat. Zusanli (ST 36) invigorates qi.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 5 months, she recovered completely.

Experience

Spiritual Pi vot of Huangdi’s Canon of Medicine says: “Manipulating needles with right hand. Supporting needles and stimulating arrival of meridian qi with lefthand.” Applying filiform needles with reinforcing method to Neiguan (PC 5) until the patients felt needle sensation spread to the middle finger. Most patients could feel pleased after needling Neiguan (PC 5).

（ 5 ）围绝经期不寐案

冯某，女，49岁，2005年8月6日初诊。 主诉：绝经6个月，不寐1年。

现病史：2年前出现经乱，6个月前绝经。1年前出现夜不能寐，服用安定也只能入睡2个小时。伴烦 躁，阵发性潮热。体重下降，精神萎靡，记忆力下降，头晕，食欲差。

舌、脉象：舌红苔薄黄，脉细弦。

诊断：中医诊断：不寐（不得卧）。证型：心肾不交。 西医诊断：失眠。

治则：滋肾养心安神。 针灸处方：

主穴：神门、太溪、照海。 配穴：百会、阴郄、后溪。

刺灸法：针刺神门穴时使用浅刺法，针不必直立，可卧于皮肤上，针感以胀为主。余穴均用平补平 泻手法。起针后心俞穴拔罐。

辨证分析：患者夜不能寐1年，服用安眠类药物也只能睡3个小时，属于中医学的“不寐”“不得 卧”范畴。《张氏医通 ·不寐》：“不寐俱责之心肾不交，心不下交于肾，浊火乱其神明；肾不上交于 心，精气伏而不灵。”患者年过“七七”，《内经》所指的围绝经期，肾气已衰，肾精已虚，天癸已 绝，女子以阴血为本，肾虚血亏，冲任失充，经络失养则月经紊乱，进而绝经；阴虚阳亢，则五心烦 热，烘热汗出；肾水亏于下，不能上济心火，心阳独亢，则心悸失眠；久之心血不足，心神失养，则神 疲健忘。《景岳全书 ·不寐》：“无邪而不寐者，必营气之不足也。营主血，血虚则无以养心，心虚则 神不守舍，故或为惊惕，或为恐畏，或若有所系恋，或无因而偏多思妄，以致终夜不寐。及忽寐忽醒， 而为神魂不安等证。”患者出现烦躁，体重下降，精神萎靡，记忆力下降，头晕，食欲差等症，正如 《素问 ·疏五过论》所云：“不在脏腑，不变躯形，诊之而疑，不知病名。身体日减，气虚无精，病深 无气，洒洒然时惊。”故在治疗上应以滋肾阴清心火为主。

取穴依据：根据《灵枢 · 寿夭刚柔》：“病在阴之阴者，取阴之荥输”，方中主穴选用神门、太 溪和照海，其中神门为手少阴心经的输穴、原穴，太溪为足少阴肾经的输穴、原穴，手足少阴本为同名 经，同名经同气相求，同取其原穴，以调整心肾功能。照海穴为八脉交会穴之一，为阴跷脉与十二正经 相通的腧穴，因营气昼出于目而行于阳，夜入于踝而行于阴，故阴跷脉主司眼睑开合和睡眠，不寐可通 过调理阴跷脉而愈。同时照海又为足少阴肾经腧穴，与太溪可起到加强的治疗作用。神门穴位置“在掌 后兑骨之端陷者中”（《针灸甲乙经》），取穴方法为在尺侧腕屈肌腱的桡侧缘，腕横纹上取穴。百会 穴为督脉腧穴，督脉入络脑，脑为髓海，取百会以去其精神萎靡，记忆力下降，头晕等症。《丹溪心 法》：“心之所藏，在内者为血，发外者为汗，盖汗乃心之液。”由于患者阵发性潮热汗出，依据《百 症赋》：“阴郄、后溪治盗汗之多出。”阴郄为手少阴心经腧穴，后溪为手太阳小肠经腧穴，手少阴和 手太阳为表里经，因患者为一围绝经期的不寐，证型为心肾不交，取阴郄、后溪比取合谷、复溜更为 恰当。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗3次后可以不服用安定，入睡4个小时左右，治疗 10次后，诸症改善，睡眠7～8小时。

心得：《灵枢 ·终始》：“脉实者深刺之，以泄其气；脉虚者，浅刺之，使精气无得出，以养其 脉，独出其邪气。”患者脉细弦，浅刺其主穴神门，以泄其阳分邪气，清心火，在治疗过程中有很重要 的意义。

Case 5  Insomnia in menopause period

Female patient, aged 49 years.

Chief complaint

Insomnia for 1 year since climacteric.

History of present illness

The patient experienced menstrual cycle mess 2 years ago, and had been menopause before half a year. She had insomnia for 1 year. She depended on taking hypnotic to help fall asleep for 2 hours every night. She also suffered from dysphasia and paroxysmal hectic fever. She lost some weight, with mental fatigue, bad memory, dizziness and poor appetite.

Tongue and pulse

The patient had red tongue with yellow and thin coating; her pulse was thread (xi) and wiry (xuan).

Billingual Acupuncture and Moxibustion

Diagnosis

TCM diagnosis: Sleeplessness (diagnosis of disease), Incoordination between kidneys and heart (syndrome differentiation).

WM diagnosis: Insomnia.

Principle of treatment

Nourishing yin to strengthen kidneys, nourishing heart to tranquilize mind.

Prescription

Main points: Zhaohai (KI 6), Taixi (KI 3), Shenmen (HT 9).

Additional points: Yinxi (HT 6),Houxi (SI 3),Baihui (GV 2).

Manipulation

Using horizontal insertion for Shenmen (HT 9), untill the patient got distention for the needle sensation. Using uniform reinforcing and reducing method on the other points. Cupping on Xinshu (BL 15) after removing the needles.

Differentiation of the syndrome or disease

The 49-year-old female patient presented with insomnia as her chief complaint. This is classified as “sleeplessness” in Traditional Chinese Medicine. Zhang’s Treatise on General Medicine: “All sleeplessness is caused by disharmony of heart and kidneys.” Women take yin blood as origin，the patient with deficient kidneys and insufficient blood, thoroughfare and conception vessel deficiency. The treatment should aim at nourishing kidney-yin and clearing the fire of heart.

Explanation of the points

Spiritual Pi vot of Huangdi’s Canon of medicine: “Selecting the spring and stream points of the ying meridians in yin within yin diseases.” Shenmen (HT 9), mind door, is the stream point and the primary point; it calms the mind and nourishes heart-blood to relieve insomnia. Taixi (KI 3), greater stream, is the stream point and primary point. It tonifies essence and marrow to regulate uterus. Heart meridian and kidney meridian are channels with the same name. Zhaohai (KI 6), shining sea, is the opening point of yin heel vessel. Yin heel vessel is in charge of sleeping. It regulates yin heel vessel to relieve sleeplessness. Baihui (GV 2) nourishes marrow to relieve mental fatigue, bad memory and dizziness. Prescription of 100 diseases says: “ Yinxi (HT 6) and Houxi (SI 3) are selected in night sweating.” Because the patient’s syndrome differentiation was incoordination between the kidneys and heart, selection of Yinxi (HT 6) and Houxi (SI 3) was better than that of Hegu (LI 4) and Fuliu (KI 7).

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 3 times, she could sleep for 4 hours without hypnotic. Continuing to be treated for 6 times, her sleeping became normal.

Experience

Spiritual Pi vot of Huangdi’s Canon of medicine says: “The patients with excessive pulse should be punctured deeply to eliminate pathogenic qi; the patients with insufficient pulse should be punctured shallow to make essence qi keep inside of body nourish the vessel.” Using horizontal insertion on Shenmen (HT 9) to eliminate the pathogenic qi.

13.1.3 产后缺乳

产后哺乳期内，产妇乳汁甚少或全无，不够喂养婴儿者称为“缺乳”［1］ 。产后缺乳最易发生在产后 4~7天，近年来由于环境污染、精神因素的影响以及剖宫产率的增加，产后母乳不足有逐步上升趋势，占 53.9%［2］。

本症属西医学产后泌乳过少等病范畴。西医学认为产后乳少是因垂体功能低下或孕期胎盘功能不 全，造成促性激素、雌孕激素等分泌不足，阻碍乳腺发育，从而影响乳汁的分泌。中医认为产后多虚多 瘀，本病主要病机一为化源不足，二为瘀滞不行。治疗应以调理气血、通络下乳为原则辨证施治。目前 西医对于产后缺乳尚无针对性治疗方案，且药物治疗产后缺乳副作用大，很多药物均为哺乳期禁用和慎 用药物［3］。

针灸治疗产后缺乳疗效明显，临床治疗以任脉、足阳明及手太阳经穴为主［4］，腧穴中膻中、少 泽、足三里等穴使用频率较高［5］。

参考文献

［1 ］谢幸，苟文丽．妇产科学［M ］．北京：人民卫生出版社，2013.

［2］谢萍，乔峰妮，冯俭，等．产后缺乳相关因素分析［J］．中医药导报，2008（8 ）：78+81.

［3 ］张华，潘小芳．产后缺乳的中西医治疗研究进展［J ］．广西中医学院学报，2012（2 ）：78-79. ［4］杜元灏，董勤．针灸治疗学［M ］．北京：人民卫生出版社，2012.

［5］王娜，宋晓平．近十年针灸治疗产后缺乳的临床研究进展［J］．新疆中医药，2015（ 1 ）：53-55.

针灸治疗产后缺乳症案

赵某，女，48岁，经产妇，2001年2月24日初诊。 主诉：产后无乳3日。

现病史：足月单胎剖腹产，产后3日无乳。因患者坚持要求自行哺乳，不顾其丈夫反对，请求针灸治 疗。现患者面色无华，食欲不振，情绪易激动，胸闷作胀，恶露不多，色紫红，伴有血块。舌质淡紫边 红，舌苔薄白中腻，脉弦细。

舌、脉象：舌淡紫，脉细弦。

诊断：中医诊断：产后缺乳。证型：气血不足，痰郁气滞。 西医诊断：产后泌乳过少。

治则：补益气血，行气化痰。 针灸处方：

主穴：足三里、膻中、乳根、肩井。 配穴：内关。

刺灸法：患者取仰卧位，手心朝上，暴露胸廓和下肢，局部皮肤消毒后，四肢取穴采用左右 对应配穴法，即左内关配右足三里，右内关配左足三里，交替使用；胸廓区选用膻中、乳根。选用 0.25mm×40mm一次性不锈钢针灸针，先刺内关捻转补法，行针得气后，再刺足三里，中等刺激，最后用 0.30mm×50mm一次性不锈钢针灸针刺乳根穴，沿皮下向乳房方向进针深40mm左右，使针感向整个乳房 扩散。所有穴位留针30分钟，期间用无烟艾条温灸膻中穴，行雀啄灸法。起针后，再取双侧肩贞穴，平 补平泻，中等刺激，使针感向前胸放散后，即起针。

辨证分析：现代医学认为，在胎盘娩出子宫后，孕激素、雌激素水平突然下降，产妇开始泌乳。 生乳素是泌乳的基础，同时乳腺的发育、产妇的营养、健康状况及情绪均与泌乳有密切的关系。许多临

Billingual Acupuncture and Moxibustion

床实验和动物实验已经表明，针刺后血清脑垂体催乳素显著高于针刺前。中医学认为，产后缺乳的机理 不外乎两种，一为素体气虚血弱或产时失血，产后脾胃虚弱，乳汁生化无源，无乳可供排出；二是心情 抑郁，郁怒伤肝，气滞血瘀，乳络不通，有乳却不得下。此患者属于中医学中的脾气亏虚，气血生化无 源，伴肝郁血热，冲任血瘀气滞。舌淡紫主阳虚阴盛，气血运行不畅。

脉细主气血两虚、诸劳虚损、伤寒、痛甚及湿邪为病。弦主肝胆病、诸痛症、痰饮。

取穴依据：膻中是八会穴中的气会，具有调理气机、活血通乳的作用，为通乳要穴；因足阳明胃经 循行经过乳房，取足阳明胃经腧穴乳根，选用较粗针刺激，可清热开窍，疏通水液，两穴相配，相得益 彰；足三里为全身强壮要穴，又为胃经之合穴，脾胃为气血生化之源，后天之本，能培补气血，助乳汁 化生；内关为心包经络穴，别走手少阳三焦经，配之可理气和胃，宣通胸中之气；肩贞为手太阳小肠经 穴，针刺后针感向乳房周围扩散，激发气血运行，疏通乳络，促进排乳。艾灸不仅能行气活血，体现泻 的作用，还能温养脾胃，体现补的作用，使补泻有道，气血得养，乳汁畅行。采用左右对应配穴法，不 但可增强穴位的协同作用，更可减少穴位重复使用，预防穴位疲劳现象的发生。

疗程、疗效：上、下午各1次，7日为1疗程。按上述方法治疗后2日，患者即有明显双乳作胀，知饿 善饥；3日后有乳汁分泌；连续治疗6日后乳汁增多至500ml左右，恶露色红，行而通畅，血块消失。

心得：针灸治疗产后缺乳疗效明显，疏通乳络为治疗大法。临床治疗当辨清虚实，辨证施治。

Case Absence of lactation

Female patient, aged 48 years.

Chief complaint

No lactation after delivery for 3 days.

History of present illness

The patient received corporeal cesarean section 3 days ago. She had no lactation. She felt chest tight, pale complexion, poor appetite and anxiety.

Tongue and pulse

The patient had slight purple tongue with white and thin coating, the coating in the middle of tongue was greasy, indicating qi deficiency and blood stasis, disturbance of qi movement.

Her pulse was wiry (xuan) and thready (xi), indicating coexistence of deficiency and excess.

Differentiation of the syndrome or disease

The 48-year-old female patient presented with no lactation after delivery for 3 days as her chief complaint. This is classified as“insufficient lactation ”in Traditional Chinese Medicine. Chinese medical theories state that milk is transformed from qi and blood. If deficient of qi or the circulation in the meridians is stagnated, the lack of laction takes place.

Prescription

Point selection: Neiguan (PC 6), Zusanli (ST 36),Rugen (ST 18),Danzhong (CV 17),Jianjing (GB 21).

Needles

Filiform needles and moxibustion.

Manipulation

Reducing needle technique.

Frequency and duration

Twice a day for a course of seven days.

Explanation of the points

Danzhong (CV 17) is the gathering point for qi, which can regulate qi and dispel stagnation of qi in the chest to affect the breasts and be used in insufficient lactation. Rugen (ST 18) regulates stomach-qi in relation to the breast to regulate lactation in the nursing mother. Zusanli (ST 36) tonifies qi and blood to help lactation. Neiguan(PC 6) opens the chest. Jianjing (GB 21) is an experiential point to promote lactation in nursing mother. Applying moxibustion to Danzhong (CV 17) to promote warming-unblocking.

Manipulation

Alternatively take the left Neiguan (PC 6) and the right Zusanli (ST 36), the right Neiguan (PC 6) and the left Zusanli (ST 36). Choose to use a 0.25 mm ×40 mm needles, firstly conducte Neiguan (PC 6) point with reinforcing by twirling and rotating, then conducte Zusanli (ST 36) with uniform reducing and reinforcing, then choose 0.30 mm ×50 mm needles to conducteRugen (ST 18) with horizontal insertion and tip of needle upward, about 40mm depth. During stay needles, moxibustion with moxa-roll like a bird on the point of Danzhong (CV 17). After removing needles, conducte Jianjing (GB 21) with uniform reducing and reinforcing until the needle sensation spread to chest, then remove needle twice a day, 7 days for one course.

Treatment outcome

After two treatments, the symptoms improved. After 9 treatments, there was about 500 ml of milk every day.

13.1.4 闭经

凡女子年逾16周岁，月经尚未来潮，或月经周期已经建立后又中断6个月以上，或根据自身月经周期 计算停经3个周期以上者，称为闭经。前者为原发性闭经，约占5%；后者为继发性闭经，约占95%［1］。

中医学认为，导致闭经的主要原因主要是血枯和血滞，基本病机为胞脉空虚或胞脉闭阻，主要病位 在胞宫，与肝、脾、肾密切相关。治疗应以虚者补而充之，实者泻而通之为原则。西医学认为闭经是一 种症状，正常月经的建立和维持，有赖于下丘脑—垂体—卵巢轴的神经内分泌调节、靶器官子宫内膜对 性激素的周期性反应和下生殖道的通畅，其中任何一个环节发生障碍均可导致闭经［2］。

本病的治疗应首先明确是原发性还是继发性闭经，并排除生理性停经。目前，西医对本病主要采用 激素人工周期疗法。针灸对精神因素及功能性原因所致的闭经有较好疗效，临床以任脉及足太阴、足阳 明经穴为主［3］，常用的频次最高的腧穴是关元、三阴交、中极、气海［4］。

参考文献

［ 1 ］马宝璋，齐聪．中医妇科学［M ］．北京：中国中医药出版社，2012. ［2］谢幸，苟文丽．妇产科学［M ］．北京：人民卫生出版社，2013.

［3 ］杜元灏，董勤．针灸治疗学［M ］．北京：人民卫生出版社，2012.

［4］张鹏．针刺治疗产后尿潴留临床研究进展［J ］．中华针灸电子杂志，2015（2 ）：18-20.

病例

李某，女，42岁。2006年10月12日初诊。 主诉：闭经6个月。

现病史：因家中父亲亡故，月经中止，6个月未来。上次月经来潮时为4月11日，经量少，经色黯， 有血块，经期3天。11岁初潮，13岁月经规律，周期为30天左右，经色时黯时红，经量适中，经期5天。

Billingual Acupuncture and Moxibustion

18年前产有1子，夫妻生活和谐。无家族绝经提前史。确认无妊娠。伴烦躁，腰酸，口苦。寐差，二便 调，饮食可。

舌、脉象：舌红苔黄，脉沉弦。

诊断：中医诊断：经闭。证型：气滞血瘀。 西医诊断：闭经。

治则：疏肝理气，活血化瘀。 主穴：中极、合谷、三阴交。

配穴：太冲、行间、地机、内关。

刺灸法：针刺合谷穴时采用捻转补法，以左转为主，捻转角度小，频率慢；三阴交采用捻转泻法， 以右转为主，捻转角度大，频率快。余穴均用平补平泻手法。起针后肝俞、膈俞穴拔罐。

辨证分析：患者既往月经规律，因一时悲愤，6个月未来月经，属于中医学的“女子不月”“月 事不来”“血枯”“经水不通”等范畴。《校注妇人良方》：“……，积想在心，思虑过度，多致劳 损……，女子则月水先闭。”《素问 ·评热病论》曰：“月事不来者，胞脉闭也；胞脉者属心而络于胞 中。今气上迫肺，心气不得下通，故月事不来也”，肝肾同司下焦，肝主藏血，肾主藏精，精血互生， 有精血同源之称；肝主疏泄，肾司闭藏， 一开一合，一泄一藏，协调来维持月经正常。《万氏女科》： “忧愁思虑，恼怒怨恨，气郁血滞而经不行。”患者因突受刺激，致肝气郁结，气机不通，血滞不行， 而出现闭经。患者最后一次月经来潮时经量少，经色黯，有血块，表明有血瘀；患者现感烦躁，腰酸， 口苦，表明肝郁化火，肾阴出现不足。根据《内经》：“必伏其所主，而先其所因”的宗旨，调经不忘 调肝，治血不忘理气，补阳不忘阴中求阳，使气血和谐，阴阳协调。故在治疗上应以疏肝理气，活血化 瘀并重。

取穴依据：全方主穴的选用依据《针灸大成》：“月水断绝，中极、肾俞、合谷、三阴交”，因 肾俞取穴须俯卧位，故在拔罐中应用该穴。中极穴位置在“脐下四寸”（《针灸甲乙经》），取穴方法 为仰卧，腹正中线上，脐下4寸，是临床治疗泌尿生殖系统疾患的常用穴。合谷、三阴交配伍，可起到 活血化瘀的作用，尤其对女性妇科疾患，作用更加明显。《针灸大成》：“难产，合谷（补）、三阴交 （泻）、太冲”；《针灸集成》：“月经不通，合谷、阴交、血海、气冲”。配穴选用太冲、行间以疏 理肝气，调整肝的疏泄功能。内关穴现代研究认为其解郁效果好。地机为脾经郄穴，《百症赋》：“抑 又论妇人经事改常，自有地机、血海。”

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗5次，月经来潮。

心得：《类经 ·疾病类》：“隔者病发于暂，其证则成痛成实，通之则血行而愈，可攻也。枯者其 来也渐，冲任内竭，其证无形，必不可通也。”近年来，随着生活节奏的加快，工作压力加大，闭经患 者增多。在治疗闭经时，首先要根据患者闭经发生是突然的，还是逐渐发生的来判断其虚实。突然发生 的往往是实证，血瘀者多，可用通法；逐渐发生的往往虚证者多，万不可用通法，而应以补肾养血调理冲 任为主。本病案中的患者，月经因情绪突变而突然中止，故在治疗上以通法为主，因而取得较好的疗效。

Case  Menostasis

Female patient, aged 42 years.

Chief complaint

Absence of menstruation for 6 months.

History of present illness

Her menstruation stopped in the past 6 months following her father’s death. Last period was on April  11. Menstruation was regular prior to the last six months. She had a child of eighteen years old. No family advanced menopause history. She had dysphasia, low back acid and mouth bitter.

Tongue and pulse

The patient had red tongue with yellow coating and her pulse was deep (chen) and wiry (xuan).

Diagnosis

TCM diagnosis: Menostasis (diagnosis of disease), qi stagnation and blood stasis (syndrome differentiation).

WM diagnosis: Primary menostasis.

Principle of treatment

Soothing liver and activating qi. Activating blood to remove stasis.

Prescription

Main points: Sanyinjiao (SP 6),Zhongji (CV 3),Hegu (LI 4).

Additional points: Taichong (LR 3),Xingjian (LR 2), Diji (SP 8),Neiguan (PC 6).

Manipulation

Applying filiform needles with reinforcing by twirling and rotating needles to Hegu (LI 4), and with reducing by twirling and rotating needle to Sanyinjiao (SP 6). Uniform reinforcing and reducing method is applied to the other points. Cupping is given on Ganshu (BL 18) and Geshu (BL 17) after removing the needles.

Differentiation of the syndrome or disease

The 42-year-old female patient presented with absence of menstruation for 6 months as her chief complaint. This is classified as “absence of menstruation” in Traditional Chinese Medicine. Explanandum of Effective Prescription for Women says: “When women are extremely sad, the menstruation stop firstly.” Chinese medicine academic theories state that kidneys and liver take charge of the lower energizer, liver stores blood, kidneys store essence, blood and essence have a common source. Liver regulates free flow of qi, kidney is incharge of storage. Wan’s Gynecology and Obstetric says: “Worry, consider, angry and grudge, which cause qi stagnation and blood stasis, with the result of absence of menstruation.” Chinese medicine academic theories state regulating menses should regulate liver first, activating qi to treat blood disease, and replenishing yin to replenish yang. So the treatment should aim at soothing liver to activate qi and remove stasis.

Explanation of the points

Great Compendium of Acupuncture and Moxibustion says: “Sanyinjiao (SP 6), Zhongji (CV 3),Hegu (LI 4), Shenshu (BL 23) are selected to treat absence of menses.” Zhongji (CV 3) dredges partial blood and qi. Sanyinjiao (SP 6) and Hegu (LI 4) activate qi to eliminate the stasis. Taichong (LR 3)and Xingjian (LR 2) sooth liver and clear heat to help regulate the liver. Diji (SP 8) is the cleft point of spleen meridian, it regulates the menses.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 5 times, her menses came.

Experience

Classified Canon says: “Eliminating method is applied to remove stagnation.” In recent years along with increasing speed of living rhythm, and work pressure enlargement, people suffering from menostasis increase. If menostasis occurs gradually, it is deficient syndrome; if it occurs suddenly, it is excessive syndrome. Most excessive syndromes are caused by blood stagnation.

Billingual Acupuncture and Moxibustion

13.1.5 卵巢囊肿

卵巢囊肿是妇科常见良性肿瘤之一，多发于生育期妇女，是妇科常见病，多发病，发病率占生育期妇 女的15%［1］ 。临床症状多以月经量多、淋漓不尽、下腹部坠痛、不孕为特征。该病属中医学“癥瘕”范 畴。

目前本病的病因尚不明确。中医学认为该病是因正气不足，或外邪内侵，或内有七情、房室、饮食所 伤，导致脏腑功能失调，气机阻滞，从而形成瘀血、痰饮、湿浊，停聚于小腹，日积月累而成［2］。

卵巢囊肿的治疗当首辨善证、恶证。目前对于本病的治疗，现代医学常采用手术治疗。针灸对本病 有一定疗效，临床多针刺腹部卵巢区所在穴位配合辨证取穴［3-5］。

参考文献

［ 1 ］蒋婴，韩凤娟，王秀霞，等．卵巢囊肿的中医认识及治疗现状［J ］．辽宁中医药大学学报，2009（6 ）：80-82 . ［2 ］马宝璋．齐聪．中医妇科学［M ］．北京：中国中医药出版社，2012 .

［3 ］齐凤军，夏杨，刘建民．针灸结合中药治疗卵巢囊肿临床观察［J ］．湖北中医杂志，2010（5 ）：56-57 .

［4 ］郭蕊，韩凤娟，马宁，等．针刺结合超声介入治疗卵巢囊肿疗效观察［J ］．中国妇幼保健，2011（25）：3970- 3971 . ［5 ］彭尧书，钱旭，谢精华． 针刺结合微波治疗卵巢囊肿39例［J ］．光明中医，2012（ 10 ）：2049-2050 .

病例

熊某，女，37岁。2005年3月13日初诊。 主诉：小腹隐痛半个月，伴白带增多。

现病史：半月前月经结束后出现小腹隐痛，伴腰痛，得热痛减，白带增多，色白，质清，无异味， 不伴外阴瘙痒。B超示左侧卵巢可见一2 cm×2 cm大小的低回声区，诊为左侧卵巢囊肿。月经周期正常， 经色、经量无明显异常。饮食可，二便调，寐可，平素畏寒肢冷，近来常觉乏力，喜卧怕劳。

舌、脉象：舌淡边有齿痕苔白，脉细弦。

诊断：中医诊断：癥瘕（石瘕）。证型：肾阳不足。 西医诊断：卵巢囊肿。

治则：补肾壮阳，消癥散结。 主穴：中极、太溪、曲泉。

配穴：关元、气海、三阴交。

刺灸法：针刺中极穴时使用捻转泻法，针尖指向阴部，得气以出现小腹有胀痛感为度，如针感传至 阴中，则效更佳。而后中极、关元穴使用温针灸。余穴均用平补平泻手法。起针后水道穴拔罐。

辨证分析：患者年过35，主症为经后小腹隐痛，伴白带增多、腰痛，腹中有块，属于中医学中的 癥瘕范畴中的“石瘕”。《灵枢 ·水胀》：“石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶 血当泻不泻，血丑以留止，日以益大，状如怀子，月事不以时下。皆生于女子，可导而下。”杨上善： “可以针刺导而下之。”《诸病源候论 ·卷十九 ·癥瘕病诸候》：“癥瘕者，皆由寒温不调，饮食不 化，与脏气相搏结所生也。”《金匱要略 ·妇人杂病》：“妇人脏肿如瓜，阴中痛，引腰痛。”石瘕有 良性、恶性之分，正如华佗在《中藏经 ·积聚癥瘕》中所言：“积聚癥瘕杂虫者，皆五脏六腑，真气实 而邪气并，遂乃生焉。久之不除也，或聚或积，或癥，或瘕，或变，或蛊，有能害人者，有不能害人 者，有病缓者，有病速者，有疼者，有痒者，有生头足者，有如杯盘者，势类不同”。本病案中患者为 良性病变，因肾阳不足，无以温煦下焦，致六淫之邪内侵，脏腑功能失调，致使水湿内停于胞宫，蓄积 日久，则形成囊肿。表现为少腹隐痛，触之有块，伴有带下增多，腰痛。故在治疗上应补肾壮阳，消癥散结为主要治疗原则。

取穴依据：方中以中极、太溪、曲泉为主穴，依据《备急千金要方 ·针灸 ·腹胀病》：“中极， 主少腹积聚，坚如石，小腹满；通谷，主结积留饮癖囊，胸满饮食不消……”，“灸内踝后宛宛中”； 《针灸大成》载曲泉的主治：“女子血瘕，按之如汤浸股内，小腹肿，阴挺出，阴痒”。曲泉位置在 “膝内辅骨下，大筋上、小筋下陷者中，屈膝得之”（《针灸甲乙经》），取穴方法为屈膝，在膝关节 内侧横纹头上方，当胫骨内髁之后，于半膜肌、半腱肌止端之前上方取穴。根据《标幽赋》：“痹厥偏 枯，迎随俾经络接续；漏崩带下，温补使气血依归。静以久留，停针待之”，采用温针灸方法。配穴选 用气海、关元， 一方面起到温补肾阳的作用，另一方面起到局部治疗作用。三阴交为治疗妇科疾病的常 用穴，根据《灵枢》中对于石瘕的治疗原则“导而下之”，取三阴交利水清下的作用。

疗效：隔天1次，每周3次，10次为1疗程。治疗1个月后，腹痛消失，B超示左侧卵巢大小正常，无异 常发现。

心得：对于本例患者，中极穴、曲泉穴的针刺方法非常重要，患者有数次针感传至阴中，针刺曲泉 穴后有急于如厕的感觉，回家后阴道中即有排液现象，量较多，需用护垫。如此持续1周，排液现象即 消失。

Case  Ovary cyst

Female patient, aged 37 years.

Chief complaint

Dull pain in lower abdomen for half a month’s duration.

History of present illness

The patient felt dull pain in lower abdomen for the last fifteen days, together with more vaginal discharge than before, and she also felt painful in low back. Ultrasonic examination revealed evidence of ovary cyst (2 cm×2 cm). She felt tired recently.

Tongue and pulse

The patient had pale tongue with tooth mark and a white coat, her pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Abdominal mass (diagnosis of disease) . Deficiency of kidney-yang (syndrome differentiation).

WM diagnosis: Ovary cyst.

Principle of treatment

Invigorating kidneys to improve yang. Removing mass and dissipating nodulation.

Prescription

Main points: Zhongji (CV 3), Taixi (KI 3),Ququan (LR 8).

Additional points: Guanyuan (CV 6),Qihai (CV 6),Sanyinjiao (SP 6).

Manipulation

Using reducing by twirling and rotating needles on Zhongji (CV 3), direction of the point of needle: points to vulva. The patient had partial distended as the needle sensation. It’s better to spread needle sensation to vulva. Then using warming needle moxibustion on Zhongji (CV 3) and Guanyuan (CV 6). Using uniform reinforcing and reducing method on the other points. Cupping on Shuidao (ST 28) after removing the needles.

Billingual Acupuncture and Moxibustion

Differentiation of the syndrome or disease

The 37-year-old female patient presented with dull pain in lower abdomen for half a month’s duration as her chief complaint. She also felt painful in low back, with more vaginal discharge than before. Ultrasonic examination revealed evidence of ovary cyst (2 cm×2 cm). These signs and symptoms are classified as “abdominal mass” in Traditional Chinese Medicine. Chinese medical theories state that because deficient kidney-yang failed to warm lower energizer, then six exopathic factors attacked body, with the result of cyst. Applying filiform needles to dredge stagnation of qi and blood.

Explanation of the points

Invaluable Prescriptions for Emergencies says: “Zhongji (CV 3) is selected to treat abdominal masses.” Guanyuan (CV 6) and Qihai (CV 6) tonify kidney yang. Sanyinjiao (SP 6) is the experiential point in  gynaecological complaints.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for a month, abdominal pain disappeared. Ultrasonic examination showed left ovary was normal without cyst.

Experience

Manipulation is important while needling Zhongji (CV 3) and Ququan (LR 8).

13.2 Cases of Pediatric Department（4 cases）

第二节  儿科病案(4例)

针灸在儿科疾病的治疗当中也应用较为广泛，主要用于治疗免疫力差（易感冒等）、咳嗽、消化不 良、腹泻和脑瘫等。主要应用的治疗方法包括穴位敷贴、捏脊、耳穴贴压和毫针。由于小儿是稚阴稚阳 之体，经气充盛，易得气，针感强，而且难于长时间保持一个体位，故针刺小儿时，常常不留针。

13.2.1 遗尿

 遗尿是指3周岁以上的小儿睡中小便频繁自遗，醒后方觉的一种病症［1］ ，本病又称尿床。临床主要 表现为小儿在熟睡时不自主地排尿。

据统计，16%的 5 岁儿童、10%的7岁儿童和 5% 的11～12岁儿童患有不同程度夜遗尿，青春期和成 年早期仍有1%～3%受到夜遗尿困扰［2］。

中医认为本病为肾气不足，下元虚冷或病后体弱，脾肺气虚致三焦气化不利，肺、脾、肾三经之气 不固，膀胱失约而成。少数患儿因肝经湿热，疏泄失常，火热内迫，热迫膀胱，膀胱不藏而引起。

现代医学治疗小儿遗尿，最新公认的一线处理方法是去氨加压素和使用遗尿报警器，而针灸治疗遗 尿有较好的优势，其机理可能在于对大脑皮层及植物神经功能的调节［3］。

参考文献

［ 1 ］汪受传，虞坚尔．中医儿科学［M ］．北京：人中国中医药出版社，2012 ：208-212.

［2 ］Weaver A, Dobson P. Nocturnal Enuresis in Children［J ］．J FamHealth Care, 2007（ 17 ）：159-161. ［3 ］李丹丹，呼婧婧.针灸治疗小儿遗尿研究进展［J ］．河南中医，2014 ，34（3 ）：530-531.

案例

患者，女，15岁。

主诉：一直尿床，现每周尿床1~2次。

现病史：5岁前，一直使用尿不湿，5岁后，家人发现仍在夜间尿床，现在每星期尿床1~2次。入睡后 不易唤醒，伴手足易凉，余无其他不适。曾尝试过多种治疗方法，均无效。其母见网上说针灸可以治疗 遗尿，遂来求诊。查：体形微胖。

舌、脉象：舌淡胖边有齿纹，苔薄白，脉沉细弱。

诊断：中医诊断：遗尿。证型：脾肾两虚，气虚不固，膀胱失约。 西医诊断：尿失禁。

治则：健脾补肾，益气固本。 针灸处方：

主穴：关元、中极、百会、阴陵泉、太溪、三阴交、外关。

刺灸法：关元、中极、百会、阴陵泉、太溪、三阴交用补法，外关用平补平泻手法。 其他疗法：配以TDP照小腹30分钟。

辨证分析：中医学认为，遗尿的发生与肾阳虚，下元虚寒以及脾肺气虚，膀胱失约有关，若经久不 愈，可延及成年，严重影响患者的精神和日常生活。《幼幼集成 ·小便不利证治》云：“小便自出而不 禁者，谓之遗尿……此皆膀胱虚寒。”小便的正常排泄有赖于三焦和膀胱的气化功能，而三焦的气化又 与肺脾肾有关。

取穴依据：针灸治疗遗尿的治疗方法：采用针刺与TDP照射腹部结合的方法。取穴为关元、中极、百 会、阴陵泉、太溪、三阴交、外关。用关元、百会补气；阴陵泉，太溪与三阴交健脾益肾；中极，外关 调节三焦和膀胱的气化功能。并用神灯，使下元得温，膀胱有约，则尿止。

疗程、疗效：每周2次。从治疗开始，1个月未曾遗尿，遂减为每周1次针灸治疗，连续2周仍无遗尿， 再减至2周1次，2个月后改为每月1次针灸治疗，共治疗4个月，无遗尿，停止治疗。随访半年未复发。

心得：中医学认为，遗尿的发生与肾阳虚，下元虚寒以及脾肺气虚，膀胱失约有关，若经久不愈， 可延及成年，严重影响患者的精神和日常生活。《幼幼集成 ·小便不利证治》云：“小便自出而不禁 者，谓之遗尿……此皆膀胱虚寒。”小便的正常排泄有赖于三焦和膀胱的气化功能，而三焦的气化又与 肺脾肾有关。实验研究发现，针刺刺激可以调节交感神经和副交感神经对膀胱逼尿肌的作用，从而使膀 胱储尿和排尿功能得以调整。同时针灸对桥脑、中脑的排尿中枢放电频率也有较大的影响，对建立起排 尿控制有一定帮助。针灸治疗遗尿的治疗方法：采用针刺与TDP照射腹部结合的方法。取穴为关元、中 极、百会、阴陵泉、太溪、三阴交、外关。用关元、百会补气；阴陵泉，太溪与三阴交健脾益肾；中 极，外关调节三焦和膀胱的气化功能。并用神灯，使下元得温，膀胱有约，则尿止。

Case  Enuresis

Pat, female, 14 years old.

Main complaint

Had been wetting the bed, 1-2 times a week.

Billingual Acupuncture and Moxibustion

History of disease

She had used diaper before she was 5 years old. She always wet the bed at night since she stopped using diaper, which still happens 1-2 times a week now. It is not easy to wake her up when she was sleeping, usually with cold limbs. She had tried various treatment methods, nothing worked. Her mother learned from Internet that acupuncture could treat enuresis, so took her daughter to try acupuncture. The figure is fat.

Tongue and pulse

Pale tooth-marked tongue with thin and white coating and deep, thread and weak pulse,

Diagnosis

Deficiency of kidney and spleen.

Principle of treatment

Replenishing spleen and tonifying kidney, invigorating qi to consolidate urine.

Prescription

Selection of points: Guanyuan (CV 4), Zhongji (CV 3), Baihui (GV 20), Yinlingquan (SP 9), Taixi (KI 3), Sanyinjiao (SP 6), Waiguan (TE 5).

Manipulation

Use reinforcing needle method on the points of Guanyuan (CV 4), Zhongji (CV 3), Baihui (GV 20), Yinlingquan (SP 9), Taixi (KI 3), Sanyinjiao (SP 6); use uniform reinforcing and reducing needle method on the points of Waiguan (TE 5).

Other therapies

Heating on lower abdomen by TDP for 30 minutes.

Differentiation of the syndrome or disease

In TCM, enuresis is related to deficiency kidney-yang, deficiency cold in kidney, deficiency qi of spleen and lung and bladder losing to control qi. If it can not be cured for a long time, the disease could last till adults, seriously affect the patient’s quality of life.

Collected Works in Pediatrics: “Urine flows and can not be controlled，which is called enuresis... caused by deficiency cold in kidney.” The normal excretion of urinate depends on the function of qi transformation of triple energizer and bladder. The function of qi transformation of triple energizer relates to the function of lung, spleen and kidney.

Physiological research finds that the stimulation of needles can regulate sympathetic nerves and parasympathetic nerve’s action for detrusor of bladder, and making the function of bladder keeping urine and discharging urine normally. Acupuncture also can greatly affect the electric activity of the urination center in pons and mesencephalon in the meantime, help to produce urination reflex.

Explanation of the points

Guanyuan (CV 4), Zhongji (CV 3), Baihui (GV 20), Yinlingquan (SP 9), Taixi (KI 3), Sanyinjiao (SP 6), Waiguan(TE 5). Take Guanyuan (CV 4) to replenish qi. Take Baihui (GV 20) to increase qi. Take Yinlingquan (SP 9), Taixi (KI 3) and Sanyinjiao (SP 6) to invigorate spleen and tonify kidney. Take Zhongji (CV 3) and Waiguan (TE 5) to regulate qi transformation of triple energizer and bladder. Use TDP irradiation to warm the kidney.

Frequency, duration and treatment outcome

Twice a week. After acupuncture treatment, the patient had no enuresis for a month, hence treatment reduced to once a week; the patient had no enuresis for 2 weeks,then treatment reduced to once every 2 weeks; continue to treat for two months, treatment reduced to once a month. The patient got the acupuncture treatment for 4 months, had no more enuresis since. Follow-up survey half a year later, had no relapse.

13.2.2 小儿疫毒痢

疫毒痢又称疫痢、时疫痢，具有较强的传染性。常发于夏秋季节，以2～7岁儿童为多见。为痢疾证 候类型之一。可见于西医的中毒性菌痢，病原是痢疾杆菌、属于肠杆菌的志贺菌属，潜伏期多数为1~2 天，短者数小时，起病、发展快，高热可>40℃（少数不高）迅速发生呼吸衰竭、休克或昏迷，肠道症状 多不明显甚至无腹痛与腹泻，也有在发热、脓血便后2~3天始发展为中毒型［1］。

本病一年四季均可发生，夏秋季较常见，严重时引起暴发流行。

本病的病因病机是由于小儿肠胃虚弱，易受湿热疫毒侵袭。疫毒从口入，蕴伏肠胃，因其毒性剧 烈，故熏腐肠道化生脓血，又易迅速化火传变引起高热。

现代研究表明：针刺可以开窍醒神，调整肠胃功能。艾条温中散寒固本，使脾气降，胃气降，升 降得复，大肠功能得以调整，大便泄泻则止。并且，艾灸可改善机体免疫功能从而抵抗细菌、病毒的侵 犯，以达到预防和治疗某些传染性疾病的效果［2］。

参考文献

［ 1 ］沈晓明，王卫平．儿科学［M ］．北京：人民卫生出版社，2008：206-207.

［2 ］崔丽宽．针灸治疗小儿疫毒痢51例［J ］．河南中医学院学报，2009，24（ 141 ）：70-71.

案例

刘某，男，2岁，2002年1月16日就诊。 主诉：抽搐1日。

现病史：1天前因进食不洁食物而出现腹泻，夜间大便六七次，开始泻下为水样便，后泻下大便中见 脓血，半小时前，突然抽搐。体温38.5℃,脉搏120次/分，发育良好，营养欠佳，眼窝凹陷，口唇樱红而 干，全身皮肤黏膜干燥，弹性差。腹胀，肠鸣音亢进，肝脾不肿大，大便常规脓球强阳性。

针灸处方：

主穴：人中、百会、内关、中脘、天枢、足三里、神阙。

刺灸法：强刺激人中，大幅度的提插捻转至抽搐停止；内关、中脘、天枢、足三里，针用平补平泻 手法，留针15~20分钟。神阙、百会施以艾条温灸，在神阙穴处施以雀啄灸法，因小儿皮肤娇嫩，为防灼 伤皮肤，医者将中、食手指分开，放于穴位两侧，根据医者手指的感觉来测知患儿的受热程度，以随时 调节施灸的距离。灸至皮肤潮红为度。每天灸1~2次，在治疗期间乳食应定时定量，合理安排，注意 卫生。

辨证分析：疫毒痢主要是由于饮食染有疫毒的不洁之物，从口入腹，蕴伏肠胃，其次着凉、疲劳， 久病体弱则为其诱因。小儿脏腑娇嫩，肠胃脆弱，于夏秋之季，湿热内盛，秽邪疫毒入侵，聚于肠中， 若患儿正气尚盛则正邪相争，湿从热化，热盛化火，内窜营分，进迫厥阴、少阴，则可出现壮热、神 昏、抽风等邪实内闭之候；若患儿虚热正不胜邪或在闭厥的同时，又可伴见正气不支的虚脱症。

取穴依据：针刺人中，开窍醒神；取大肠募穴天枢，胃之合穴足三里，以调整肠胃功能；艾条温灸 百会益气升提；温灸神阙温中散寒固本，使脾阳得伸，运化有权，胃气得复，升降有序，水精四布则大

Billingual Acupuncture and Moxibustion

便实而泻止。现代研究已经证明，艾灸可改善机体免疫功能从而抵抗细菌、病毒的侵犯，达到预防和治 疗某些传染性疾病的作用，所以采用针灸疗法治疗小儿时疫之疾病（疫毒痢）是有一定的科学依据的。

疗程、疗效：急刺人中穴约2分钟后，抽搐停止。随后刺内关（双）、中脘、天枢（双）、足三里 （双）、曲池（双），平补平泻手法，留针15分钟。同时，用艾条温灸神阙半小时。因有脱水症状，配 以补液，纠正电解质紊乱。第二天患儿大便次数仅两次，大便镜检未见脓球，依前法又针灸两次，患儿 痊愈出院。

心得：痢疾一名，见于《济生方》，《内经》称“肠澼”。其病因常为湿热疫毒之气，交蒸于内， 蒸灼肠道，脉络受伤，气血凝滞，化为脓血；感于疫毒者，发病更为急重，热毒炽盛可蒙蔽清窍，动风 惊厥，甚至可出现外脱内闭之危候。针灸治疗疫毒痢，用人中以开窍醒脑，天枢则清热毒而通腑气，足 三里调脾胃而解阳明气分之热毒，曲池乃手阳明大肠经之合穴，泄肠热、凉营血，而灸神阙灸以益阴回 阳固脱，并配合西医的补液，纠正电解质紊乱，可以达到满意疗效。

Case  Pestilential dysentery

Male patient, aged 2 years.

Chief complaint

Diarrhoea for one day and convulsion for half an hour.

History of present illness

One day ago，the boy had diarrhea after eating unclean food. He moved bowels 6 and 7 times at night. It was watery to pus and blood stool. He experienced convulsion half an hour ago. The temperature was 38.5 ℃ , pulse rate was 120 per min and his lips were red and dry, skin mucous membrane were dry and of bad flexibility. Examination revealed evidence of pestilential dysentery.

Prescription

Point selection: Shuigou (GV 26), Tianshu (ST 25), Zusanli (ST 36), Shenque (CV 8), Baihui (GV 20), Neiguan (PC 6),Zhongwan (CV 12).

Needles

Filiform needles and moxibustion.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 2-year-old male patient presented with diarrhoea for one day and clonic convulsion for half an hour as his chief complaint. This is classified as“pestilential dysentery” in Traditional Chinese Medicine. Chinese medical theories state that pestilential dysentery is mainly caused by the unclean diet. Children’s internal organs are immature, and they’re easy to be attacked by pestilential pathogens. If yin is injured, it is with the result of convulsion.

Explanation of the points

Shuigou (GV 26) induces resuscitaton. Tianshu (ST 25) and Zusanli (ST 36) regulate the function of stomach and intestine. Applying moxibustion with moxa-roll to Shenque (CV 8), it warms and invigorates spleen yang. Apply moxibustion with moxa-roll to Baihui (GV 20) to elevate middle energizer qi. Modern researches have already proved that moxibustion improves body’s immunity function to resist bacteria and viruses, so it is often used to prevent or treat some communicable diseases.

Frequency, duration and treatment outcome

Once a day for a course of 3 days. After conducting manipulations on Shuigou (GV 26) about 2 minutes, the convulsion stopped. After 3 treatments, the boy completely recovered.

13.2.3 婴幼儿腹泻病

腹泻中医称为泄泻，是以大便次数增多，粪质稀薄或如水样为特征的一种小儿常见病，分为感染性 腹泻和非感染性腹泻两类，感染性腹泻多由病毒、细菌引起；非感染性腹泻常由饮食不当，肠道功能紊 乱引起。临床多有乳食不节，饮食不洁或感受时邪病史，以大便次数增多主症，常伴有恶心，呕吐，腹 痛，发热，口渴等症［1］。

小儿腹泻是儿科常见病，我国每年5岁以下儿童年患病率平均为每人每年2～2.5次，其中2岁以下占 75%，病原复杂［2］。

中医认为本病以感受外邪、伤于饮食、脾胃虚弱为多见，其主要病变在脾胃。因胃主受纳腐熟水 谷，脾主运化水湿和水谷精微，若脾胃受病，运化失职，则饮食入胃之后，水谷不化，精微不布，清浊 不分，合污而下，致成泄泻。现代研究表明：针灸可健脾养胃，和胃通肠，固涩肠道，有疏理胃肠气 机、益气固肠、补益脾胃之功效，治疗小儿腹泻效佳［3］ ；联合穴位推拿治疗小儿腹泻能较快地改善临 床症状［4］。

参考文献

［ 1 ］汪受传，虞坚尔．中医儿科学［M ］．北京：人中国中医药出版社，2012 ：123-129. ［2 ］梁连锦．小儿腹泻病的治疗进展［J ］．中外医学研究，2011 ，9（23）：155-157.

［3 ］陈淑荣，王志刚．针灸治疗婴幼儿腹泻临证对比观察［J ］．河北中医药学报，2012 ， 27（ 1 ）：38-39. ［4 ］肖哲．针灸联合穴位推拿治疗小儿腹泻疗效分析［J ］．中医中药，2013 ，20（8 ）：115-116.

案例

王某，女，7个月，2005年3月9日就诊。 主诉：腹泻1日。

现病史：患儿腹泻5天，每日7~10次，大便中混有消化不良食物，服用保赤丸、输液，未见好转。现 见患儿面色萎黄，精神不振，腹胀。

诊断：中医诊断：泄泻。证型：伤食泄。 西医诊断：腹泻。

针灸处方：

主穴：天枢（双）、足三里（双）、长强、神阙。

刺灸法：针刺天枢、足三里时，患儿取仰卧位，直刺0.5~1寸，行捻转提插手法不留针。针刺长强 穴，患儿俯卧位，针尖向上刺入1~1.5寸，行捻转手法，不留针。雀啄灸神阙穴10分钟，配合捏脊疗法， 捏到脾俞、胃俞、三焦俞、肾俞时重提捏10余次。治疗期间患儿禁吃甜食，减少乳食，多饮白开水。

辨证分析：小儿肝常有余，脾常不足，凡外感风寒、内伤饮食，皆可使脾胃受损，而出现腹泻。

取穴依据：天枢是大肠募穴，能调中和胃，理气健脾；足三里是胃经合穴，合治内腑，能健脾和 胃，化积导滞，理气消胀，二穴均属足阳明胃经，能调整胃肠功能；长强穴是督脉之络穴，督脉通于 肾，脾的运化功能赖于肾阳温煦，故刺长强穴能振奋脾肾功能；捏脊能调整脏腑功能；神阙穴属于任脉

Billingual Acupuncture and Moxibustion

腧穴，任督二脉同起胞宫，下出会阴，故灸神阙有温煦止泻之功。

疗程、疗效：治疗2次后，大便次数减少，又治疗1次，大便正常，痊愈。

心得：小儿由于“脾常不足”的生理特点，容易感受外邪，内伤乳食，或脾肾阳虚，均可导致脾胃 运化功能失调而发生泄泻，轻者治疗得当，预后良好。重者泄下过度，易见气阴两伤，甚至阴竭阳脱。 久泻迁延不愈者，则易转为疳证或出现慢惊风。针灸治疗上，足三里为足阳明胃经之合穴，补法健脾养 胃，泻法和胃通肠；天枢是大肠经之募穴，泻法可通肠导滞，补法可固涩肠道，灸神阙可温阳逐邪，配 合小儿捏脊能更好地调整脏腑阴阳，使该病治疗时间缩短。

Case  Diarrhoea

Female patient, aged 7 months.

Chief complaint

Diarrhoea for 5 days.

History of present illness

The patient had diarrhoea for 5 days, 7-8 times a day, and there were mixed dyspepsia food in bowels. Taking some medication did not help. She had sallow complexion and abdominal distention.

Prescription

Point selection: Tianshu (ST 25), Zusanli (ST 36),Changqiang (GV 1).

Needles

Filiform needles and moxibustion.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 7-month-old female patient presented with diarrhoea for 5 days as her chief complaint. This is classified as“diarrhoea”in Traditional Chinese Medicine. Chinese medical theories state that child’s Liver is often excessive, but the Spleen is often insufficient, so there are many factors which can cause diarrhoea.

Explanation of the points

Tianshu (ST 25) is the front-mu of the large intestine. It is used in all exess patterns of the stomach giving rise to abdominal problems. It is particularly indicated to stop diarrhoea and pain. Zusanli (ST 36) is the lower- sea point of stomach. It regulates the function of stomach and intestine. It is often used to help digest food. Changqiang (GV 1) is the connecting point of governor vessel. It is used in large intestine illness.

Frequency, duration and treatment outcome

Once a day for a course of 3 days. After 3 treatments, she completely recovered.

13.2.4 高热

小儿高热指腋温达到39.1～40℃,在临床上属于危重症范畴。可伴有烦躁不安、反复惊厥等症状。小 儿发热较为常见，也是小儿就诊率最高的原因之一，年龄越小的儿童，体温调节中枢发育越不完善，往 往发病就会出现高热［1］ 。发热诱因多为内伤和外感，小儿高热属于外感发热，其病因病机是小儿脏腑娇 嫩，形气未充，为稚阴稚阳之体，易受邪郁而发热。现代研究表明：针刺具有快速退热的作用，对经常 规治疗的急性扁桃体炎引发的高热不退的患儿具有较好的退热效果［2］。

参考文献

［ 1 ］孙微娜，沈林亚，王俊,等．中医治疗小儿发热的途径［J ］．中国疗养医学，2014，23（3 ）：279-280. ［2 ］刘东华，赵荣．针刺治疗小儿乳蛾高热34例［J ］．针灸临床杂志，2014 ，30（8）：14-15. 

案例

马某，女，4岁，2003年6月15日就诊。 主诉：发热两天。

现病史：发热两天，服用感康无效，高热持续不退，无汗，周身乏力，不思饮食。 舌脉象：舌红苔黄，脉数。

诊断：中医诊断：高热闭汗症。证型：外感风寒，郁而化热。 西医诊断：发热。

治则：清热发汗。 针灸处方：

主穴：孔最。

配穴：合谷、复溜。

刺灸法：针刺孔最、合谷、复溜，泻法，不留针。

辨证分析：此病属于中医学中的高热范畴。小儿为稚阴稚阳之体，外感风寒后易郁而化热，出现高 热症状。

取穴依据：孔最穴按腧穴名称解释，孔，通也；最，极也，第一的意思，为通之极，其功用最能开 瘀通窍。高热汗不出，是人体内外不通，用孔最为宜，效果好。孔最主热病汗不出，是肺经的郄穴，有 解表清热、调理肺气之功效。临床常用以治疗深重、急骤的病症。古人认为该穴为治热病汗不出之第一 要穴。配伍合谷、复溜，退烧疗效十分理想。

疗程、疗效：针刺2小时后，高热消退，第2天没再发烧。

心得：《针灸大成》中“热病汗不出，咳逆肘臂痛屈伸难，手不及头，指不握，吐血，失音，严重 头痛”和《备急千金要方》：“臂厥热痛，汗不出”等症状皆用孔最治疗，孔最为手太阴肺经郄穴，郄 穴用于治疗急症，特别是热病汗不出，配合合谷、复溜在本病例中取得较好效果。

Case  Fever

Female patient, aged 4 years.

Chief complaint

Fever of about 2 days ’ durarion.

History of present illness

The patient had fever for 2 days. Taking some medicine didn’t help. She had no sweat, and felt tired and had poor appetite.

Differentiation of the syndrome or disease

The 4-year-old female patient presented with fever as her chief complaint. This is classified as “fever” in Traditional Chinese Medicine. Chinese medical theories state that the exogenous pathogenic wind invades the body through the pores of skin, mouth and nose, leading to manifestation related to the lung meridian.

Prescription

Point selection: Kongzui (LU 6),Hegu (LI 4),Fuliu (KI 7).

Billingual Acupuncture and Moxibustion

Needles

Filiform needles.

Manipulation

Reducing needle technique without remaining needles.

Frequency and duration

Once a day.

Explanation of the points

The name of Kongzui (LU 6) means it is the most important point to comuniate with lung. When the patient had fever without sweat, it can inducediaphoresis to release the exterior. Kongzui (LU 6) is good at treating high fever without sweat.

Treatment outcome

After 1 treatment, she completely recovered.

13.3 Cases of Orthopedics Department (14 cases)

第三节  骨科病案(14例)

随着人类寿命的不断提高，全球已进入老龄化社会。目前骨与关节疾病的发病率急剧增加， 2002~2012年被我国定为“骨与关节10年”。骨与关节疾病的发生于衰老、遗传、种族和生活环境等因素 密切相关。由于骨与关节的主要作用就是对人体的支撑和活动，因此骨与关节疾患的临床主要表现为疼 痛和活动受限，甚至活动障碍。目前针灸疗法在颈肩腰腿痛的治疗当中被作为一种应用最广泛，疗效最 明显的治疗方法。针灸具有良好的止痛作用，在针灸学“痛则不通，通则不痛”及“燔针劫刺，以痛为 俞，以知为数”等理论的指导下，对骨与关节疾病的治疗原则主要是疏通经脉，调节经筋。具体治疗方 法就是，根据经络辨证，选用与病变部位密切相关的经脉及其经穴进行治疗；根据经筋的结聚起止，在 病变部位周围选用腧穴（包括阿是穴、压痛点），对经筋进行调整。现将我们在临床形成的治疗骨质疏 松症的整体调节针法以及治疗老年性脊柱侧凸的方法介绍如下：

1．治疗骨质疏松症的整体调节针法

（1）临床分型：根据OP发病的病因病机结合临床经验，在临床当中，将骨痿主要分为3个证型，肾 亏、脾虚和血瘀型。

肾亏型：主症为腰背酸痛反复发作，以腰部酸痛为主，遇劳加重，下肢酸软无力。舌脉象主要表现 为舌红或舌淡，尺脉沉。

脾虚型：主症为周身疼痛反复发作，以腰背酸痛为主，遇劳及阴雨天加重，小腿及手部会发生痉挛 现象。舌脉象表现为舌淡边有齿痕，脉濡。

血瘀型：主症为腰背酸痛反复发作，夜间疼痛为重，疼痛明显时可找到固定的痛点。舌脉象表现为 舌黯或舌有瘀斑、瘀点，脉涩。

（2）整体调节针法。

① 温针灸：主穴为大杼、肾俞、足三里；以肾虚为主的配命门、太溪、复溜，以脾虚为主的配阴陵 泉、三阴交、脾俞，以血瘀为主的配膈俞、三阴交。所有腧穴均采用指切进针法。膈俞、三阴交采用提 插和捻转泻法（即以上提和右转为主），其他腧穴采用提插和捻转补法（即以下插和左转为主），刺激

强度以患者得气为度。肾俞、足三里得气后进行温针灸，选用2厘米长的清艾条插于针柄，从靠近针根端 点燃。留针20分钟。

② 七星针：沿膀胱经背部第一侧线叩刺，血瘀型采用中刺激手法，以皮肤发红、个别部位有血点为 度，其余证型采用轻刺激手法，以皮肤潮红为度。

③ 走罐：先于叩刺的部位均匀涂搽凡士林，沿膀胱经第一侧线走罐，以患者能耐受的力度反复走行5 次为度。

④ 留罐：分别于大椎、肾俞及疼痛剧烈部位拔罐，留罐8～10分钟。

2．治疗老年性脊柱侧凸的方法

针刺方法：主穴取侧凸的顶点及顶点上下各1厘米处和阿是穴。配穴取肾俞、大肠俞、委中和昆仑。 伴椎间盘突出或椎间盘膨出的取中极、京门、背部压痛点正对腹部的点；伴腰椎骨质增生的取大椎、绝 骨；伴骨质疏松的取大杼、足三里、绝骨；舌淡胖、青紫或苔白腻的患者主穴针上加灸。

手法：起针后，让患者侧凸顶点向上侧卧，如侧凸顶点向左者取右侧卧位，医者以双手拇指按压在 侧凸顶点的椎体侧缘上，缓缓用力向下按压，以患者稍觉疼痛但可承受为度，按压3分钟后，缓慢松开。 如此反复3次。

13.3.1 颈椎病案

颈椎病又称“颈椎综合征”，是增生性颈椎炎、颈椎间盘脱出以及颈椎间关节、韧带等组织的退行 性改变刺激和压迫颈神经根、脊髓、椎动脉和颈部交感神经等而出现的一系列综合征候群。其部分症状 分别见于中医学的“项强”“颈筋急”“颈肩痛”“头痛”“眩晕”等病症中。好发于40～60岁中老年 人［1］。

西医学认为，本病是由于颈椎间盘慢性退变（髓核脱水、弹性降低、纤维环破裂等）、椎间隙变 窄、椎间孔相应缩小、椎体后缘唇样骨质增生等压迫和刺激颈脊髓、神经根及椎动脉而致。中医学认 为，本病因年老体衰、肝肾不足、筋骨失养，或久坐耗气、劳损筋肉，或感受外邪、客于经脉，或扭挫 损伤、气血瘀滞，经脉痹阻不通所致［1］。目前现代医学对颈椎病的治疗主要是根据颈椎病发生的原因进行对症治疗，治疗方法主要包括药物 治疗、磁疗、运动疗法、牵引治疗等。有研究表明：针灸对颈椎病有较好的的治疗作用，并能降低血液 黏度，改善局部微循环以促进炎症吸收，消除或减轻对病变颈椎附近的神经、血管的刺激而发挥作 用［2］ 。针刺夹脊穴可疏通督脉及太阳经脉，通经活络，行气活血，改善局部微循环，具有调节神经、 血管功能的作用。椎间隙狭窄者配合颈部牵引，可以加大各椎体间的间隙，缓解神经血管的压迫状态而 减轻症状。针刺也可以解除痉挛，消除炎症，减轻或解除神经根刺激症状；可以改善椎动脉型颈椎病患 者的椎基底动脉系统对脑部的血液供应，起到缓解症状，减轻晕厥等不适症状［3］ 。在临床应用当中，大 椎、天柱、后溪、颈椎夹脊等腧穴较为常用。

参考文献

［ 1 ］王启才，等．针灸治疗学［M ］．北京：中国中医药出版社，2003：209-210.

［2 ］岑玉文，杨顺益，庄礼兴．针灸治疗颈椎病的临床疗效观察及机理初探［J ］．颈腰痛杂志．2000 ，21（2 ）：104- 105.

［3 ］王玖忠．针灸治疗颈椎病疗效观察［J ］．当代医学．2011 ，17（36 ）：155-156.

（ 1 ）颈椎病致尺神经疼痛案

郎某，男，76岁。2006年4月5日初诊。

Billingual Acupuncture and Moxibustion

主诉：右肘关节阵发性抽搐性疼痛2周。

现病史：2周前无明显诱因出现右肘关节尺侧阵发性抽搐性疼痛，发作无先兆，患者自觉从肩胛下 开始，疼痛沿上臂后侧至右肘关节内侧，其中以右肘关节内侧疼痛最为剧烈，发作无定时，每次持续30 秒左右，一日发作几十次，疼痛发作时程度剧烈，伴右上肢不由自主的抽动，夜不能寐。服用止痛药无 效。肘关节X光片示，肘关节骨质正常。肘关节处皮色不红，皮温不高，无破损。颈椎X光片示，颈椎退 行性病变。查颈椎各向活动略受限，可于天宗穴、小海穴处触及较明显的压痛。纳差，二便调，微 恶寒。

舌、脉象：舌质黯舌体薄苔白，脉紧。

诊断：中医诊断：肩臂痛。证型：风寒外束，瘀血内阻。 西医诊断：颈椎病。

治则：疏风散寒，化瘀通络。 针灸处方：

主穴：颈夹脊、天宗、小海。 配穴：天井、少海、尺泽。

刺灸法：针刺小海穴时使用提插泻法，得气以出现针感传至前臂为度，而后天井、小海穴使用电 针。余穴均用平补平泻手法。起针后大椎穴、天宗穴拔罐。

辨证分析：患者以右肘关节阵发性抽搐性疼痛为主症，属于中医学“肩臂痛”范畴。因其发作时 患者自觉从肩胛下开始，疼痛沿上臂后侧至右肘关节内侧，其中以右肘关节内侧疼痛最为剧烈，并可于 天宗穴、小海穴处触及较明显的压痛，按经络辨证，可责之于手太阳小肠经证。《备急千金要方 · 四肢 第三》：“肩胛痛而寒至肘”，《灵枢 ·经脉》：“小肠手太阳之脉，起于小指之端，循手外侧上腕， 出踝中，直上循臂骨下廉，出肘内侧两骨之间，上循臑外后廉，出肩解，绕肩胛，交肩上， ……，是动 则病嗌痛颔肿，不可以顾，肩似拔，臑似折， ……，是主液所生病者， ……头颔肩臑肘臂外后廉痛”。 患者疼痛的路线基本符合手太阳小肠经的循行，病症与手太阳经证一致。因患者年过古稀，阳气渐虚， 五脏功能渐弱，心阳鼓动力量已不足，加之风寒外侵，故出现手太阳小肠经证，舌质黯舌体薄苔白，脉 紧，均支持以上辨证。在治疗上应以疏风散寒，化瘀通络为主。

取穴依据：全方以颈夹脊、天宗、小海为主穴。天宗、小海均为手太阳小肠经腧穴。小海为手太 阳小肠经合穴，位置在“肘内大骨外，去肘端五分陷者中，屈肘乃得之”（《针灸甲乙经》），取穴方 法为屈肘，当尺骨鹰嘴与肱骨内上髁之间取穴。《针灸甲乙经》：“小海主疟，背膂振寒”；《针灸大 成》：“小海治颔肿不可回顾，肩似拔，臑似折”。配穴取天井、少海和尺泽均为局部取穴。《玉龙 赋》：“尺泽理筋急之不用，腕骨疗手腕之难移。肩脊痛兮，五枢兼于背缝；肘挛痛兮，尺泽合于曲 池”。

疗效：每天1次，每周5次。治疗1次，疼痛明显缓解，发作次数减少，3次后疼痛消失。

心得：《灵枢 ·本神》：“是故用针者，察观病人之态，以知精神魂魄之存在得失之意。”患者为 一本虚标实之证，根据“急则治其标”的治疗原则，先用泻法止其痛。故针刺小海穴时应用提插泻法， 并用电针加强止痛作用。

Case 1  Ulnar nerve pain caused by cervical spondylosis

Male patient, aged 76 years.

Chief complaint

Paroxysmal pain together with muscular spasm in right elbow joint for last 2 weeks.

History of present illness

The patient felt paroxysmal pains and muscular spasms in right elbow joint for last 2 weeks. When it occurred, he felt the pain start from the inside of scapula, then decent to inside of right elbow joint, together with involuntary movement of right upper limb. It lasted up to 30s. He couldn’t sleep at night. He took some western medicine without avail. X-ray examination revealed evidence of cervical spondylosis. Physical examination showed cervical vertebra’s activities were slightly limited. There were obvious tenderness on Tianzong (SI 8) and Xiaohai (SI 11).

Tongue and pulse

The patient had dark and thin tongue with a white coat; his pulse was tense (jin).

Diagnosis

TCM diagnosis: Pain in shoulder and arm (diagnosis of disease), blood  stagnation and deficiency of both qi and blood (syndrome differentiation).

WM diagnosis: Cervical spondylosis.

Principle of treatment

Dispelling wind and dispersing cold. Removing stasis to dredge collaterals.

Prescription

Main points: Jingjiaji, Tianzong (SI 8),Xiaohai (SI 11).

Additional points: Tianjing (TE 10), Shaohai (HT 3), Chize (LU 5).

Manipulation

Using reinforcing by lifting and thrusting needle on Xiaohai (SI 11), the patient had needle sensation spreading to hand, then use electric needle on Xiaohai (SI 11) and Tianjing (TE 10). Use uniform reinforcing and reducing method on the other points. Cup on Dazhui (GV 14) and Tianzong (SI 8) after removing the needles.

Differentiation of the syndrome or disease

The 76-year-old male patient presented with paroxysmal pain together with muscular spasm in right elbow joint as his chief complaint. This is classified as “pain in the shoulder and arm” in Traditional Chinese Medicine. His pain was mainly located on the distribution of the small intestine meridian involved. Spiritual Pi vot of Huangdi’s Canon of Medicine says: “The small intestine meridian of Hand-Taiyang, starts at the ulnar side of the tip of the little finger. Following the ulnar side of the dorsum of the hand it reaches the wrist and ascends along the posterior aspect of the arm to the shoulder joint. Circling around the scapula, another branch goes up the arm and elbow and joints with the shoulder. The main symptoms of meridian disorder are as follows: sore throat, stiff neck, unbearable pain in the shoulder as if extracted, and severe pain of the upper arm as if fractured. ”

Explanation of the points

Main points were selected according to the pathway of the small intestine meridian. Great Compendium of Acupuncture and Moxibustion says: “Xiaohai (SI 11) is selected to treat neck pain.” Tianjing (TE 10), Shaohai (HT 3) and Chize (LU 5) promote circulation of partial qi and blood to relieve pain.

Frequency, duration and treatment outcome

Once a day, 10 treatments constituted a course. After treated with acupuncture for 13 times, he completely recovered.

Billingual Acupuncture and Moxibustion

Experience

It’s root deficiency and branch excess symptom, using reducing method firstly to relieve pain.

（ 2 ）颈椎病致头晕案

王某，男，38岁。2006年9月13日初诊。 主诉：阵发性头晕1周。

现病史：1周前因夜间睡眠姿势不当，引起颈项强痛，后经按摩，疼痛缓解。随即发现在仰头或转头 时出现眩晕，眩晕发作时大脑中一片空白，并伴内心恐慌。X光片示：右侧C4-5，C5-6椎间孔变小。查 颈椎各向活动受限，不敢向右侧转头，右侧臂丛神经牵拉试验（+），右侧椎旁肌肉僵硬，并有压痛。双 侧风池穴、风府穴明显压痛。记忆力减退，视物双眼易疲劳，腰酸，饮食可，二便调，寐可梦多。

舌、脉象：舌淡苔薄白，脉细弦。

诊断：中医诊断：眩晕。证型：肝肾不足。 西医诊断：颈椎病。

治则：补肾益肝，息风定眩。 针灸处方：

主穴：颈夹脊、风池、风府。 配穴：百会、列缺、太溪。

刺灸法：针刺风府、风池穴时，应注意针尖方向指向下颌，不可向内上方进针，进针后应缓慢向深 部刺入，仔细体验针下的感觉，并注意观察病人的表情，当针下有沉紧涩感，或患者有明显的胀感时， 即留针。余穴均用平补平泻手法。起针后大椎穴拔罐。

辨证分析：患者先因睡觉姿势不当出现颈项疼痛不适，后出现阵发性头晕，可因转头诱发，属于 中医学的“眩晕”范畴。《证治准绳 · 杂病》：“项强不可转移者，皆由肾虚不能生肝，肝虚无以养 筋，故机关不利。”《灵枢 ·五邪篇》：“邪在肾，则病骨痛阴痹……，肩背颈项痛，时眩。”《圣济 总录 ·卷十五 ·风癫》：“肩背拘急，头目昏痛，风府怯寒。”患者除眩晕外，还伴有记忆力减退，视 物双眼易疲劳，腰酸，梦多，表明患者为肝肾不足所导致清窍失养，故而出现眩晕。患者双侧风池穴、 风府穴明显压痛，按经络辨证，辨为督脉及足少阳经证。《难经 ·二十八难》：“督脉者，起于下极之 输，并于脊里，上至风府，入属于脑”；《难经 ·二十九难》：“督之为病，脊强而厥”。《灵枢 ·经 脉》：“肝足厥阴之脉，起于大指从毛之际， ……，连目系，上出额，与督脉会于巅”，肝与胆相表 里，《素问 ·至真要大论》：“诸风掉眩，皆属于肝”。故治疗上应以补肾益肝，息风定眩为主。

取穴依据：方中以颈夹脊、风府、风池为主穴，颈夹脊取其疏通局部气血，风府、风池取其息风止 眩作用。《针灸甲乙经》：“风府为督脉、阳维之会。”风府的位置“在项上，入发际一寸，大筋内宛 宛中”（《针灸甲乙经》），取穴方法为正坐，头微前倾，于后正中线上，后发际直上1寸。《行针指 要赋》：“或针风，先向风府、百会中。”《针灸甲乙经》：“头痛项急，目眩，鼻不得喘息，舌急难 言，刺风府。”《针灸甲乙经》载：“风池为足少阳、阳维之会。”《通玄指要赋》：“风伤项急，始 求于风府，头晕目眩，要觅于风池。”配穴取百会以填精益髓，太溪以补肾益肝，列缺为四总穴之一， 头项寻列缺。

疗程、疗效：每天1次，每周5次，10次为1疗程。治疗15次后，患者头晕基本消失，颈椎活动幅度 正常。

心得：《素问 · 宝命全形论》：“刺虚者须其实，刺实者须其虚，经气已至，慎守勿失，深浅在 志，远近若一，如临深渊，手如握虎，神无营于众物。”风池、风府为临床治疗眩晕的要穴，针刺时要 达到一定的深度，效果才好，故在针刺时必须做到“如临深渊，手如握虎，神无营于众物”，只要掌握 好进针的方向，一般成人毫针刺入小于或等于1.2同身寸，通常都是安全的。

Case 2  Vertigo caused by cervical spondylosis

Male patient, aged 38 years.

Chief complaint

Paroxysmal dizziness for last 1 week.

History of present illness

The patient felt neck stiff and pain for last one week after one time inappropriate sleeping posture at night; it was improved after receiving treatment of massage. Subsequently he felt vertigo while facing upward or turning his head. When it came on, he had a feeling that he would lose his consciousness together with heart dismay. The X-ray examination revealed evidence of cervical spondylosis. There was tenderness on Fengchi (GB 20) and Fengfu (GV 16).

Tongue and pulse

The patient had pale tongue with a white and thin coat; his pulse was thread (xi) and wiry (xuan).

Diagnosis

TCM diagnosis: Vertigo (diagnosis of disease). Deficiency both liver and kidneys (syndrome differentiation).

WM diagnosis: Cervical spondylosis.

Principle of treatment

Restoring kidneys and benefiting liver. Extinguishing wind to relieve dizziness.

Prescription

Main points: Jingjiaji, Fengchi (GB 20),Fengfu (GV 16).

Additional points: Baihui (GV 20), Taixi (KI 3),Lieque (LU 7).

Manipulation

Direction of the point of needles: points to mandible while needling Fengchi (GB 20) and Fengfu (GV 16). Use uniform reinforcing and reducing method on the other points. Cup on Dazhui (GV  14) after removing the needles.

Differentiation of the syndrome or disease

The 38-year-old male patient presented with paroxysmal dizziness as his chief complaint. The patient experienced neck stiff and pain. Subsequently he had dizziness. These symptoms are classified as“vertigo” in Traditional Chinese Medicine. Standards for Syndrome Differentiation and Treatment says: “The neck was too stiff to move. It was caused by deficient kidneys, failure to nourish liver, and then deficient liver failing to nourish sinews.” Apart from vertigo, he had bad memory. There was tenderness on Fengchi (GB 20) and Fengfu (GV 16). According to syndrome differentiation based on meridian theories, it’s on distribution of governor vessel with gall- bladder meridian involved. Classics of Difficult Problems says: “Governor Vessel originates from the uterus (or deep inside the lower abdomen in men) and goes to the perineum where it emerges. It then ascends on the midline all the way up back and neck to Fengfu (GV 16) from which it enters the brain.” Spiritual Pi vot of Huangdi’s Canon of Medicine says:“The liver meridian starts on the big toe and runs upwards on the dorsum of the foot and medial malleolus, connects eyes, and ascends forehead, goes to the top of the head to meet the governing vessel.”

Billingual Acupuncture and Moxibustion

Explanation of the points

Jingjiaji dredges partial stagnation of qi and blood. Fengchi (GB 20) and Fengfu (GV 16) extinguish wind to relieve dizziness. The ABC Classics of Acupuncture and Moxibustion says: “Fengfu (GV 16) is the meeting point of governing vessel and yang linking vessel. ” Fengchi (GB 20) is the crossing point of bladder meridian and yang linking vessel; it’s the very important point in neck stiff and dizziness. Baihui (GV 20) promotes resuscitation. Taixi (KI 3) benefits kidneys to nourish liver. Lieque (LU 7) relieves neck stiff.

Frequency, duration and treatment outcome

Once a day, 10 treatments constituted a course. After treated with acupuncture for  15 times, his dizziness disappeared; cervical activity amplitude recovered normal.

Experience

Fengchi (GB 20) and Fengfu (GV 16) are effective to vertigo in clinic; it is safe to puncture less or equal to

1.2 F-cun deep for common adults.

（ 3 ）颈椎病致上肢麻木案

李某，男，52岁，2005年11月2日初诊。 主诉：左上肢麻木4个月。

现病史：5年前自觉肩背疼痛不适，伏案工作时间长症状更为明显，休息后可缓解，反复落枕，按 摩后可缓解。4月前，出现左上肢麻木，尤以拇指和食指麻木明显。低头可缓解，仰头时可明显感觉麻木 从颈部一直走到手指，经甩手、捏按揉上肢麻木可缓解。X光片示：颈椎退行性改变。查颈椎各向活动 受限，左侧臂丛神经牵拉试验（+），椎旁肌肉僵硬，有压痛。手三里、合谷穴压痛明显。饮食可，二便 调，梦多。

舌、脉象：舌红苔薄黄，脉细。

诊断：中医诊断：痹证（肩臂痛）。证型：气虚血瘀。 西医诊断：颈椎病。

治则：益气活血，疏通经络。 针灸处方：

主穴：阿是穴（颈部）、尺泽、合谷。 配穴：少海、手三里、曲池。

刺灸法：颈部阿是穴针刺时使用捻转补法，得气以出现针下向上肢传导为度，合谷穴使用温针灸。 余穴均用平补平泻手法。起针后阿是穴拔罐。

辨证分析：患者肩背痛5年余，4月前出现左上肢麻木，属于中医学“痹证”中的“肩臂痛”范畴。 《中藏经》：“痹病或痛痒，或麻或急，或缓而不能收持，或举而不能舒张，或行立艰难。”痹证的 表现多种多样，患者属于以麻为主要临床表现。患者在颈项部有压痛，手三里穴、合谷穴压痛，同时 以左手拇指、食指麻木为主，按经络辨证，辨为手太阴、手阳明经证。《灵枢 · 经脉》：“肺手太阴 之脉，起于中焦， …… ，下肘中，循臂内上骨下廉，入寸口，上鱼，循鱼际，出大指之端。其支者， 从腕后，直出次指内廉，出其端。是主肺所生病者， ……，臑臂内前廉痛厥，掌中热。”《灵枢 · 经 脉》：“大肠手阳明之脉，起于大指次指之端，循指上廉，出合谷两骨之间，上入两筋之中，循臂上 廉，入肘外廉，上臑外前廉，上肩，出髃骨之前廉，上出于柱骨之会上，下入缺盆， ……，是主液所生 病者， ……，肩前臑痛，大指次指痛不用。”《通玄指要赋》：“圣人于是查麻与痛，分实与虚。实自 外而入也，虚自内而出欤。”《灵枢 ·始终》：“从腰以上者，手太阴阳明皆主之；从腰以下者，足太

阴阳明皆主之。”《标幽赋》：“大抵疼痛实泻，麻痒虚补。”故在治法上应以手太阴、手阳明经穴为 主，治则以益气活血，疏通经络为主。

取穴依据：方中以阿是穴、尺泽、合谷为主穴，取颈部阿是穴是根据患者在仰头时可从颈部一固定 位置出现一直传导至手指的麻感，以这一固定位置为阿是穴，起到直接的局部治疗作用。尺泽为手太阴 肺经的合穴，合谷为手阳明大肠经原穴，可起到疏通手太阴肺经、手阳明大肠经经气的作用。尺泽位置 “在肘中横纹上动脉”（《针灸甲乙经》），取穴方法为微屈肘，在肘横纹上，肱二头肌腱的桡侧缘。 配穴取少海、手三里、曲池，《席弘赋》：“曲池两手不如意，合谷下针宜仔细”；《圣玉歌》：“两 手痠痛难执物，曲池、合谷共肩髃”；《百症赋》：“且如两臂顽麻，少海就傍于三里”。

疗程、疗效：隔天1次，每周3次，10次为1疗程。治疗2个月后，症状消失，颈椎各向活动正常。

心得：《针灸大成 ·卷之四 · 经络迎随设为问答》：“经为正经，络为支络，血气不和，百病乃 生，但一经精气不足，便不和也。”患者因手太阴肺经、手阳明大肠经经络不通而出现手麻的症状，准 确的经脉辨证是取得疗效的关键。

Case 3  Numbness in left upper limb caused by cervical spondylosis

Male patient, aged 52 years.

Chief complaint

Numbness in left upper limb for last 4 months.

History of present illness

The patient experienced pain in shoulder and back for 5 years, increasing with long time work. He felt numbness in left upper limb for last 4 months. The X-ray examination revealed evidence of cervical spondylosis. There was tenderness on Shousanli (LI 10) and Hegu (LI 4).

Tongue and pulse

The patient had red tongue with a yellow and thin coat; his pulse was thread (xi).

Diagnosis

TCM diagnosis: Bi syndrome (diagnosis of disease) . Deficiency of qi and blood stasis (syndrome differentiation).

WM diagnosis: Cervical spondylosis.

Principle of treatment

Benefiting qi and activating blood. Dredging stagnation of meridians and collaterals.

Prescription

Main points: Ashi points, Chize (LU 5),Hegu (LI 4).

Additional points: Shousanli（LI 10 ）, Shaohai (HT 3),Quchi (LI 11).

Manipulation

Use reinforcing by twirling and rotating needle on Ashi points. The patient got needle sensation spreading to limbs. Use warming needle moxibustion on Ashi points and Hegu (LI 4). Use uniform reinforcing and reducing method on the other points. Cup on Ashi points after removing the needles.

Differentiation of the syndrome or disease

The 52-year-old female patient presented with numbness in left upper limb as his chief complaint. This is classified as “bi syndrome” in Traditional Chinese Medicine. The manifestations of bi syndrome are varied.

Billingual Acupuncture and Moxibustion

Tenderness was located around the neck as well as Shousanli (LI  10) and Hegu (LI 4). According to syndrome differentiation based on meridian theories, it’s on distribution of lung meridian with large intestine meridian involved. The Spiritual Pi vot of Huangdi’s Canon of Medicine says: “Lung meridian of Hand-Taiyin, originates from the middle energizer, … , descends along the medial aspect of the arm and reaches the styloid process of the radius, then goes to the thenar eminence and ends at the medial side of the tie of the thumb. A branch flows to the thenar eminence. Large intestine meridian of Hand-Yangming, starts from the toe of the index finger, and then runs along the radial side of the index finger and up the lateral-anterior aspect of the arm. Then reaches the shoulder at the point Jianyu (LI 15) and descends to connect with Dazhui (GV 14) and descends to the supraclavicular fosse to enter the lung. ” In clinic, generally pain indicates excessive syndrome, which should be treated by reducing; numbness and itching indicate deficient syndrome, which should be treated by reinforcing. So the treatment should aim at benefiting qi and activating blood, dredging stagnation of meridians and collaterals.

Explanation of the points

Cervical positive points were selected to treat his symptoms. The patient always felt the numbness started from the fixed point in neck to the fingers. The fixed point in neck was very important for treatment; it can dredge stagnation of qi and blood. Chize (LU 5) is the sea point; it promotes action of lung meridian-qi. Hegu (LI 4) is the primary point; it promotes action of large intestine meridian-qi. Shousanli (LI 10), Shaohai (HT 3) and Quchi (LI 11) are experiential points in clinic to relieve the limb numbness.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 2 months, he recovered completely.

Experience

The patient suffered from limb numbness caused by stagnation of lung meridian and large intestine meridian. It is important for acupuncture treatment to recognize distribution on meridians involved.

（ 4 ）颈椎病致肩背痛案

宋某，女，45岁。2006年2月5日初诊。 主诉：肩背痛反复发作5年，加重1周。

现病史：5年前因夜间睡觉姿势不当出现肩背痛，酸痛，持续不断，按摩叩击后可缓解，但旋即又 发。X光片示，颈椎退行性改变，颈椎曲度消失。经按摩理疗症状当时可缓解，但不久又发。1周前无 明显诱因出现疼痛加重，酸痛明显，疼痛面积增大，夜不能卧，随时需要按摩叩击。查：颈椎各向运动 可，颈夹脊肌、斜方肌、肩胛提肌僵硬，条索样改变，肌肉的起止点压痛明显。臂丛神经牵拉试验阴 性。双肩井穴、曲垣穴、风府穴、风池穴压痛。饮食可，二便调，寐差。

舌、脉象：舌红、苔黄、脉细数。

诊断：中医诊断：肩背痛。证型：痰瘀内阻。 西医诊断：颈椎病。

治则：化瘀通络，温经化痰。 针灸处方：

主穴：肩井、颈夹脊穴、曲垣。

配穴：风府、风池、阿是穴、巨骨、曲池、太溪。

刺灸法：针刺肩井穴时应平刺，针尖指向身体后部，使用捻转泻法，可采用恢刺法，即针刺入肩井 后，得气后不断更换针尖方向，但针体始终保持在斜方肌肌肉中，得气以出现局部明显的酸胀感为度。 余穴均用平补平泻手法。起针疼痛局部走罐。

辨证分析：患者以肩背部酸痛为主症，属于中医学中“痹证”中的“肩背痛”范畴。经按摩叩击后 可暂时缓解，舌红苔黄脉细数，因肾主骨，脾主肌肉，表明患者为肾阴不足，导致脾主升阳作用减弱， 出现经脉不荣而出现疼痛，经按摩叩击后局部气血流通稍好，症状稍减。患者疼痛部位主要集中在肩部 斜方肌走行之处，双肩井穴、曲垣穴、风府穴、风池穴压痛，按经络辨证为手足少阳经证。《灵枢 ·经 脉》：“三焦手少阳之脉，起于小指次指之端， … …，循臑外上肩，而交出足少阳之后， ……，是主气 所生病者， ……，耳后肩臑肘臂外皆痛……”《灵枢 ·经脉》：“胆足少阳之脉，起于目锐眦， … …， 下耳后，循行于手少阳之前，至肩上，却交出手少阳之后”，故治疗应以疏通手足少阳经为主。

取穴依据：方中取肩井、颈夹脊穴、曲垣穴为主穴。肩井为足少阳胆经腧穴，是胆、三焦、胃、阳 维四脉之会，能宣通肩背经络气血，为治疗肩背痛、臂不举的常用要穴。肩井穴位置“在肩上陷者中， 缺盆上，大骨前”（《针灸甲乙经》），取穴方法为，当大椎穴与肩峰连线的中点。《铜人腧穴针灸图 经》：“手、足少阳、阳维之会”。《玉龙赋》：“肩井除臂痛如拿。”曲垣穴为手太阳小肠经腧穴， 位置“在肩中央，曲胛陷者中，按之动脉应手”，取穴方法为在肩胛冈内上端凹陷处，约当臑俞与第二 胸椎棘突连线的中点。配穴取风府、风池、阿是穴、巨骨、外关、太溪。《素问 ·骨空论》：“大风， 颈项痛，刺风府，风府在上椎。 ……失枕在肩上横骨间，折使揄臂齐肘正，灸脊中。”《备急千金要 方》：“少泽、后溪、阳谷、完骨、昆仑、小海、攒竹，主项强急，痛不可以顾。”

疗程、疗效：隔天1次，每周3次，10次为1疗程。治疗1个月后，患者疼痛基本消失。

心得：《灵枢 ·官针》：“恢刺者，直刺傍之，举之，前后恢筋急，以治筋痹也。”这种刺法是专 门针对筋肉拘急痹痛的部位四周针刺。恢有恢复原来功能活动的意思。在肩井穴做恢刺的手法，要保证 针体始终在斜方肌肌肉内。

Case 4  Pain in shoulder and back caused by cervical spondylosis

Female patient, aged 45 years.

Chief complaint

Pain in shoulder and back off and on for last 5 years.

History of present illness

The patient had felt painful in shoulder and back off and on for last 5 years. She had received treatment of massage. The problem was improved, but the trouble recurred frequently. X-ray examination revealed evidence of cervical spondylosis. The symptoms became worse in the past 1 week. There was tenderness on the points of Jianjing (GB 21),Quyuan (SI 13),Fengfu (GV 16), and Fengchi (GB 20).

Tongue and pulse

The patient had red tongue with a yellow coat and her pulse was thread (xi) and rapid (shuo).

Diagnosis

TCM diagnosis: Pain in shoulders and back (diagnosis of disease), internal retention of phlegm and blood stasis (syndrome differentiation).

WM diagnosis ：Cervical spondylosis.

Principle of treatment

Removing stasis and dredging collaterals. Warming vessels and resolving phlegm.

Billingual Acupuncture and Moxibustion

Prescription

Main points: Jianjing (GB 21), Jingjiaji points, Quyuan (SI 13).

Additional points: Fengfu (GV 16),Fengchi (GB 20),Ashi point, Jugu (LI 16),Quchi (LI 11), Taixi (KI 3).

Manipulation

Apply filiform needles with manipulation of reducing by twirling and rotating the needle to Jianjing (GB 21). Direction of the point of needles: points to backward. Many-direction-needle is applied to Jianjing (GB 21). Uniform reinforcing and reducing manipulation is applied to the other points. Movable cupping is given on back after removing needles.

Differentiation of the syndrome or disease

The 45-year-old female patient presented with pain in shoulder and back off and on for last 5 years as her chief complaint. The symptoms became worse in the past  1 week. This is classified as “pain in shoulder and back” in Traditional Chinese Medicine. Traditional Chinese Medicine theories state that kidney controls bones and Spleen controls muscle. Tenderness was located on Jianjing (GB 21), Quyuan (SI 13), Fengfu (GV 16) and Fengchi (GB 20). According to syndrome differentiation based on meridian theories. The pain area is on distribution of gall-bladder meridian. Spiritual Pi vot of Huangdi’s Canon of Medicine says: “The triple energizer meridian starts at the tip of the ring finger. Running between the 4th and 5th metacarpal bones, it flows to the wrist and up the lateral aspect of the arm between the radius and ulna. It then reaches the shoulder joint and supraclavicular fosse from which it goes down to the chest to connect with the pericardium. The gall-bladder meridian starts at the outer canthus of the eye. It ascends the forehead and curves downwards to the region behind the ear; from here it runs down the neck to the supraclavicular fosse. Another branch from the outer canthus meets the triple energizer meridian in the infra-orbital.”

Explanation of the points

Jianjing (GB 21), shoulder well, it’s the meeting point of gall-bladder and triple energizer and yang linking vessel. It’s used to treat painful syndrome of the shoulders and neck. It relaxes the tendons and relieves stiffness. Quyuan (SI 13) is a particularly important local point in painful diseases. Fengfu (GV 16) and Fengchi (GB 20) dispel wind and dredge partial qi and blood. Ashi points relieve pain. Jugu (LI  16) dredges partial qi and blood. Quchi (LI 11) clearsheat. Taixi (KI 3) replenishes kidneys.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for a month, he recovered completely.

Experience

Many-direction-needle manipulation is effective to sinew disease.

（ 5 ）颈肩痛

患者，女，38岁，推拿师。

主诉：颈肩痛及头痛加重4天。

现病史：因职业关系，做推拿工作十余年，颈肩，上背部紧张，疼痛，痛引后头部，重则恶心，呕吐。月经来潮前症状尤为明显。近来颈肩痛及头痛加重4天。服用止痛片，收效甚微。查：C1-T9夹脊， 膀胱经穴广泛压痛（＋＋），肩井（＋＋＋），肩外腧（＋＋），天宗（＋＋）。

舌、脉象：舌黯，脉弦。

诊断：中医诊断：颈肩痛（经脉瘀阻）。 西医诊断：颈椎病。

治则：通经活络。 针灸处方：

主穴：颈夹脊、肩井、肩外俞。 配穴：风池、天宗。

刺灸法：针刺肩井穴时应平刺，针尖指向身体后部，使用捻转泻法，可采用恢刺法，即针刺入肩井 后，得气后不断更换针尖方向，但针体始终保持在斜方肌肌肉中，得气以出现局部明显的酸胀感为度。 颈部阿是穴针刺时使用捻转补法，得气以出现针下向上肢传导为度，余穴均用平补平泻手法。

辨证分析：颈项痛，病灶在颈项，以疼痛连肩、背而得名。在加拿大很多做计算机的人都有此职业 病，故又称”computer syndrome”。症状多为一侧或双侧颈肩肌肉紧张，疼痛，颈部旋转不利，重则可 引起紧张性头痛或肩臂疼痛，手指麻木，或疼痛下传至上背部。中医学认为颈肩痛的病变部位在经筋。 十二经筋是十二经脉之气输布于筋肉骨节的体系，是附属于十二经脉的筋肉系统。经筋具有约束骨骼， 屈伸关节，维持人体正常的运动功能的作用。经筋为病多表现为疼痛和活动不利。针灸疗法施治的直接 对象是人体的“筋肉系统”，当人体的“筋肉系统”受到损伤时，形成局部的病理性“筋结”病灶点， 导致局部的气血瘀滞，故治疗中找出“筋结”病灶点为关键的一步。“筋结”病灶处多有结节、瘀斑等 反应点。颈项侧部主要由手三阳和足三阳经循行所过，因此在临床上，沿着颈肩部，膀胱经，胆经，小 肠经认真寻找，都可以找到“筋结”病灶点。《灵枢 · 经筋》：“治在燔针劫刺，以知为数，以痛为 腧。”临床上对于疼痛明显的“筋结”病灶点可采用傍刺的方法。同时根据病人身体的虚实情况而施用 补泻手法，配合针后拔罐，祛瘀活血，可加强疗效。

如此施治，定位准确，直达病所，故疗效显著。另外，网球肘、高尔夫球肘、肩周炎等疾病也可以 按同法进行施治。

针灸治疗颈肩痛的治疗方法：采用针刺、拔罐、锻炼结合的方法进行治疗。首先于颈项两侧、手足 三阳经循行处寻找“筋结”病灶点，在针刺上述阿是穴的同时，加颈夹脊、肩井、肩外俞、风池、天宗 等穴。针后在疼痛明显处拔罐。并嘱咐患者注意坐立姿势，定时锻炼。

取穴依据：方中取颈夹脊穴、肩井、肩外俞为主穴。肩井为足少阳胆经腧穴，是胆、三焦、胃、阳 维四脉之会，能宣通肩背经络气血，为治疗肩背痛、臂不举的常用要穴。肩井穴位置“在肩上陷者中， 缺盆上，大骨前”（《针灸甲乙经》），取穴方法为，当大椎穴与肩峰连线的中点。《铜人腧穴针灸图 经》：“手、足少阳、阳维之会。”《玉龙赋》：“肩井除臂痛如拿。”肩外俞，出《针灸甲乙经》， 属手太阳小肠经，在背部，当第1胸椎棘突下，旁开3寸。另说：“大杼旁三寸”（《医学入门》）、 “平开大椎三寸”。主治肩背酸痛，颈项强急，落枕，肘臂冷痛等。配穴取风池、项部枕骨下，斜方肌 上部外缘与胸锁乳突肌上端后缘之间凹陷处，当风府与翳风之间，或颞骨乳突尖（下端）与第二颈椎棘 突之间连线的中点。《针灸甲乙经》：“在颞颥（脑空）后发际陷者中”；《外台秘要》：“夹项两 边”；《医学入门》：“耳后一寸半，横侠风府”；《针方六集》：“侠风府两傍各开二寸”；《循经 考穴编》：“平耳坠微上，大筋外发际陷中，与翳风相齐”。天宗，出《针灸甲乙经》，属手太阳小肠 经，定位：在肩胛区，肩胛冈中点与肩胛骨下角连线的上1/3与下2/3交点凹陷中。主治肩胛疼痛，胸肋支 满，颊颌肿痛，咳逆抱心，以及肩关节周围炎，乳腺炎等。

疗程、疗效：针灸治疗颈肩痛的治疗时间：每周2次，症状明显缓解后，改为每周1次，直至痊愈。 针刺后疼痛立止。持续8次治疗，症状90%消失。改为一星期1次，持续治疗3次后，痊愈。嘱其做拉伸锻

Billingual Acupuncture and Moxibustion

炼，保持肌肉的柔韧度和弹性。随访半年未复发。

心得：如此施治，定位准确，直达病所，故疗效显著。另外，网球肘、高尔夫球肘、肩周炎等疾病 也可以按同法进行施治。针灸治疗颈肩痛的治疗方法：采用针刺、拔罐、锻炼结合的方法进行治疗。首 先于颈项两侧、手足三阳经循行处寻找“筋结”病灶点，在针刺上述阿是穴的同时，加颈夹脊、肩井、 肩外俞、风池、天宗等穴。针后在疼痛明显处拔罐。并嘱咐患者注意坐立姿势，定时锻炼。

Case 5  Neck and shoulder pain

Ami, female, 38 years old, massotherapist.

History of present illness

Doing massage for more than 10 years as her occupation, strain and pain in shoulder and neck, which spread to back-head, sometimes companioned with nausea and vomitting. Her symptoms got worse before the menstruation. Pain in shoulder and neck, headache aggravated for 4 days recently. It did not work after taking medicine.

Physical examination

Dark tongue, wiry pulse.

Tenderness along the bladder meridian and the Jiaji points, tenderness Jianjing (GB 21) (+++), Jianwaishu (SI 14) (++), Tianzong (SI 11) (++).

Diagnosis

Blockage of the channels.

Principle of treatment

Openning the channels, regulating the circulation.

Prescription

Selection of points: Jingjiaji (extra points),Jianjing (GB 21), Jianwaishu (SI 14),Fengchi (GB 20), Tianzong (SI 11).

Manipulation

Use reducing needle method, retain needles 25 minutes, and use cupping.

First looking for “sinew node” around the neck along the pathways of hand-foot-three-yang meridians, selection of “sinew node” and Jingjiaji (extra points), Jianjing (GB 21), Jianwaishu (SI  14), Fengchi (GB 20), Tianzong (SI 11) etc. points. Cup on the obvious pain area after removing the needles. And tell the  patientshe should pay attention to her posture and exercise at fixed time.

Time of acupuncture treatment

Started twice a week. When the symptoms were under control, change to once a week, until the patient completely recovered.

Method of acupuncture treatment for neck and shoulder pain, in combination with the needles, cupping and exercise to treat.

Curative effect

The pain disappeared after the first treatment, but came back after working, continued to treat for 8 times, 90% of the symptom disappeared. Then once a week, completely recovered after continuing to treat 3 times. The patient was told to keep the muscle flexibility and retention by stretching exercises. Follow up survey for half a year, had no relapse.

Differentiation of the syndrome or disease

Pain in neck and shoulder, the focus lay in neck, and the pain spread to shoulder and back. Many people who use the computer a lot at work have this occupational disease in Canada, so this problem is called “computer syndrome” . The symptoms include musclestrain and pain in one side or both side of the shoulder. It is difficult to move the neck. The worse case could have symptoms like tension headache or bad pain in shoulders and arm, finger numbness, or the pain spread to upper back. The pain in neck and shoulder is caused by the disease of twelve muscle regions. Twelve muscle regions are the conduits which distribute the qi of the twelve regular meridians to the muscles, tendons and joints. They are external connecting regions of the twelve regular meridians, and mainly include sinews and muscles. The main function of the muscle regions are to connect with all the bones and control them to ease flexing and extending of the joints and normal motion of the body. Most pain diseases belong to the disease of twelve muscle regions. “Sinew node” will form when “sinew and muscle system” have problems. Hand-three-yang meridians and foot-three-yang meridians mainly pass the neck lateral part, so follow the meridians’ pathway to look for, usually find the “sinew node”. Based on the patient’s body condition, use two- needle method to insert the “sinew node”, and combine with the cupping to strengthen the effect.

Explanation of the points

Jianjing (GB 21), also named as shoulder well, is given priority to get, it is the point which Foot-Shaoyang gallbladder meridian acupoints, Yangwei, the Sanjiao (triple energizer), stomach meridian converging at. It can promotes  shoulder  meridian qi and blood, for  commonly used to treat shoulder  pain  and  periarthritis  of shoulder. Shoulders well hole location, Great Compendium of Acupuncture says: “Sank in the shoulder, be, big bone before”, midway between Dazhui (GV 14) and the acromion. Yu Long Fu: “Shoulder well is good at treating the arm pain.” Jianwaishu (SI 14), The ABC Classic of Acupuncture and Moxibustion says it belongs to the small intestine. In the back, 3 cun lateral to the lower border of the spinous process of the 1st thoracic vertebra. Another said: 3 cun besideDazhu (BL 11), 3 cun beside Dazhui (GV 14). Attending to treat shoulder ache, neck pain, neck stiffness, elbow, arm pain, etc. Match point to take Fengchi (GB 20), under which the occipital, upper trapezius muscle between outer edge and trailing edge of upper sternocleidomastoid cavity, between the midpoint of Fengfu GV 16 or DU 16 and Yifeng, or temporal bone mastoid tip (bottom) and the second cervical spine. The ABC Classic of Acupuncture and Moxibustion: In the depression down from the hairline. Introduction to Medicine: “An inch and a half after the ear, cross Fengfu.” Tianzong (SI 11), The ABC Classic of Acupuncture and Moxibustion says it belongs to the small intestine. Tianzong (SI 11), Location: On the scapula area, at the junction of the upper 1/3 and nether 2/3 line between the midpoint of mesoscapula and inferior angle of scapula, attending shoulder pain, chest and rib, buccal pain in the jaw, cough inverse heart, as well as around the shoulder joint inflammation, mastitis, etc.

Times and course

Twice a week, 8 times for 1 course.

Billingual Acupuncture and Moxibustion

Experience

Acupuncture directly works in “sinew and muscle system” of the human body. “Sinew node” will form when “sinew and muscle systems” have problems, which causes stagnation of partial qi and blood, so it is important to find the “sinew node” in treatment. “Sinew node”, such as nodosityandecchymosis, is the response or reaction point. Hand-three-yang meridians and foot-three-yang meridians mainly pass the neck lateral part, so follow the meridians’ pathway to look for, usually find the “sinew node” . In clinic, based on the patient’s body condition, use two-needle method to insert the “sinew node”, and combine with the cupping to strengthen the effect. Moreover, for tennis elbow, golf elbow, frozen shoulder etc, it can also use the same method to treat.

（ 6 ）颈肩痛案

患者，女，36岁，艺术家。初诊时间：2006年4月23日。 主诉：颈肩痛3周，伴手指麻木。

现病史：3周前，在工作后，出现颈肩疼痛，疼痛可放射到手指，拇指、食指有麻木感。低头时间或 工作时间过长时，症状加剧，活动后症状略有缓解。查：颈椎各向活动良好，斜方肌僵硬，有压痛点。

舌、脉象：舌红少苔，脉弦细。

诊断：中医诊断：颈肩痛（经脉瘀阻）。

西医诊断：颈椎病。 治则：通经活络。

针灸处方：

主穴：颈部阿是穴  曲垣、肩胛内侧阿是穴。 配穴：肾俞、三阴交。

刺灸法：颈部阿是穴针刺时使用捻转补法，得气以出现针下向上肢传导为度，余穴均用平补平泻手 法。起针疼痛局部走罐。

辨证分析：患者，女，36岁，以颈肩痛3周，伴手指麻木为主症，低头时间或工作时间过长时，症状 加剧，活动后症状略有缓解，属于中医学中的“颈肩痛”范畴。中医学理论认为，“邪气所凑，其气必 虚”，患者正当壮年，气血充盛，本不应出现这些症状。患者舌红少苔，脉弦细，表明患者肾气不足， 所以虽正当壮年，却出现退行性改变的症状。因此在治疗上，应以补肾活血为主，所以取肾俞强壮肾 气，三阴交活血补气，取局部阿是穴、曲垣疏通局部气血以止痛。

取穴依据：曲垣穴为手太阳小肠经腧穴，位置“在肩中央，曲胛陷者中，按之动脉应手”，取穴方 法为在肩胛冈内上端凹陷处，约当臑俞与第二胸椎棘突连线的中点。配穴为肾俞、三阴交。肾俞穴是足 太阳膀胱经的常用腧穴之一，位于第2腰椎棘突下，旁开1.5寸；三阴交，足太阴脾经穴位，位于小腿内侧 缘，踝关节上三寸。取肾俞强壮肾气，三阴交活血补气。

疗程、疗效：每周2次，痊愈为止。8次治疗后痊愈。

心得：《灵枢 ·本神》：“是故用针者，察观病人之态，以知精神魂魄之存在得失之意。”患者为 一本虚标实之证，根据“急则治其标”的治疗原则，先用泻法止其痛，并用电针加强止痛作用。电针穴 位以局部压痛点为主。

Case 6  Pain in the neck and shoulders

Female patient, aged 36 years, artist.

Chief complaint

Pain in the neck and shoulders for 3 weeks,and numbness in the fingers.

History of present illness

The patient first felt pain in her neck and shoulders after work 3 weeks before. The pain would sometimes spread to her fingers, with the thumb and index finger becoming numb. The symptoms became aggravated when the patient worked for a long time while looking down and eased when she did some exercise.

Physical examination

The cervical vertebra had normal movement. The trapezius muscle was stiff and tender.

Tongue and pulse

The patient’s tongue was red with a thin coating and her pulse was wiry and thready.

Prescription

Point selection: Quyuan (SI 13),Ashi points, Shenshu (BL 23),Sanyinjiao (SP 6).

Needles

Filiform needles.

Manipulation

Reinforcing needle technique.

Differentiation of the syndrome or disease and explanation of the points

This female patient aged 36 years presented with pain in her neck and shoulders with numbness in her fingers as the chief complaint, which is categorized as “neck and shoulder pain” in the Traditional Chinese Medicine. Chinese medical theories state that “pathogenic qi attacks the body when healthy qi is deficient” . As the patient is at a time of life when there is usually enough qi and blood, these symptoms would not normally be expected to appear. Therefore the treatment should focus on tonifying the kidneys and activating the blood. The points selected were Shenshu (BL 23) to tonify the kidneys,Sanyinjiao (SP 6) to activate the blood and replenish qi, Quyuan (SI 13) and Ashi points to drain and clear local qi and blood, thus relieving pain. Quyuan (SI 13) is the point which belongs to the small intestine ，its position “in the middle of the shoulder, medial depression of shoulder blade, touch to the arteriopalmus”, location: On the scapula, in the medial end of the suprascapular fossa, about midway between Naoshu (SI 10) and spinous process of the 2nd thoracic vertebra. Shenshu (BL 23),Sanyinjiao (SP 6) as additional points, BL 23 is a commonly used point which belongs to Foot-Taiyang meridian, 1.5 cun lateral to the lower border of the spinous process of the 2nd lumbar vertebra. SP 6，belongs to spleen meridian, location: 3 cun above the prominence of the medial malleolus, posterior to the medial crest of the tibia. Shenshu (BL 23) makes kidney stronger. Sanyinjiao (SP 6) invigorates the circulation.

Frequency and duration

Twice a week until completely recovered.

Treatment outcome

After 8 treatments, the patient recovered completely.

13.3.2 肩痛案

肩关节周围炎简称“肩周炎”，是指肩部酸重疼痛及肩关节活动受限、强直的临床综合征。属于中医学“肩痹”范畴。中医学根据其发病原因、临床表现和发病年龄等特点而有“肩漏风”“肩凝 风”“冻结肩”“五十肩”之称。女性发病率高于男性［1］。

本病的发生与慢性劳损有关，患者可有外伤史。主要病理系慢性退行性改变，多继发于肱二头肌腱 腱鞘炎、冈上肌腱炎或肩峰下滑囊炎。某些患者与感染性病灶或内分泌功能有关。中医学认为本病的病 变部位在肩部的经脉和经筋。五旬之人，正气不足。营卫渐虚，若局部感受风寒，或劳累闪挫，或习惯 偏侧而卧，筋脉受到长期压迫，遂致气血阻滞而成肩痹。肩痛日久，局部气血运行不畅，气血瘀滞，以 致患处肿胀粘连，最终关节僵直，肩臂不能举动［1］。

目前现代医学对肩痛的治疗主要是根据肩痛发生的原因进行对症治疗，治疗方法主要包括药物治 疗、理疗、局部封闭治疗等。针灸疗法治疗该病可根据病因及临床症状选择电针、温针灸、穴位注射等 均可取得一定疗效。在文献搜集研究中发现，治疗该病，多数医家采用温针灸疗法。温针灸是针刺和艾 灸相结合应用的一种治疗方法，针刺具有疏通经络，行气活血的作用，艾灸具有温通经络，祛湿除寒的 作用，正如《神灸经论》曰：“……取艾之辛香作炫，能通十二经，入三阴，理气血，逐寒湿，以治百 病，效如反掌”。温针灸除有针刺作用外，还可通过艾灸的温热作用使凝滞经脉得以温通舒畅。如《素 问 ·调经论篇》曰：“血气者，喜温而恶寒，寒则泣而不能流，温则消而去之。”［2］有研究表明［3］ ： 温针灸治疗肩关节周围炎疗效确切，在疾病的治疗过程中所施加的干预措施对疾病的改善有积极作用。 针灸治疗原则为：舒经活血、通络止痛。在临床应用当中，肩髃、肩中、肩髎、曲池等腧穴最为常用。

参考文献

［ 1 ］王启才，等．针灸治疗学［M ］．北京：中国中医药出版社，2003：211-212.

［2］杨瑞春．温针灸治疗肩关节周围炎的临床研究［J ］．辽宁中医药大学学报，2009 ，11（6 ）：181-182.

［3 ］权可，靳鹏超，权海霞，等．温针灸治疗肩关节周围炎随机对照临床研究文献 Meta 分析［J］．河南中医，2014 ，34 （ 11 ）.

案例

患者，男，70岁，初诊时间：2006年5月23日。 主诉：左肩痛3周余。

现病史：3周前无明显诱因出现左肩痛，夜间痛甚。疼痛发作时，起床活动，疼痛可缓解。口服止痛 药无效。查：左肩外形无改变，局部未见明显红、肿，肩关节活动受限，以上举和背伸受限明显，压痛 点主要位于肩峰下。

舌、脉象：舌红少苔，脉滑。

诊断：中医诊断：肩凝症（阴虚火旺）。 西医诊断：肩周炎。

治则：滋阴通络。 针灸处方：

主穴：肩髃、肩中、肩髎、曲池。 配穴：阿是穴。

刺灸法：肩髃向极泉透刺，可以产生强烈的针感，用于治疗肩关节屈伸不利等疾病，余穴均用平补 平泻手法。

辨证分析：患者，男，70岁，以左肩疼痛为主症，夜间疼痛明显，活动后疼痛可减轻，伴有活动受 限，属于中医学中的“漏肩风”“肩凝症”范畴。中医学理论认为，男子八八之后，气血渐衰，筋骨失 去强壮，经络气血运行渐趋于缓慢，容易出现疼痛、活动不利的症状。患者舌红少苔，脉滑，表明其证 型为阴虚内火旺盛。肩髃、肩中、肩髎为治疗肩部疾患的常用穴，因其穴位位于肩峰下，进针疼痛感较小，而且针感较强，容易为患者接受。曲池穴为手阳明大肠经的合穴，在本病案中起到清内火的作用。

取穴依据：方中取肩髃、肩中、肩髎、曲池为主穴。肩髃，出《针灸甲乙经》，属手阳明大肠经， 在肩部，当臂外展时，于肩峰前下方呈现凹陷处。主治肩臂痛，上肢麻痹或瘫痪，及肩关节周围炎等。 肩中穴肩峰穴直下二寸、肱骨上，即十四经肩髃穴下二寸半处。肩髎，在肩部，肩髃后方，当臂外展 时，于肩峰后下方呈现凹陷处，布有腋神经肌支和旋肱后动脉肌支。主治肩臂痛，上肢麻痹或瘫痪，及 肩关节周围炎等。曲池穴，手阳明大肠经的合穴，《金鉴》：主治中风，手挛筋急，痹风疟疾，先寒后 热等症。

配穴取局部阿是穴“以痛为腧”。

疗效：8次治疗后疼痛明显减轻，运动功能恢复 80％。电话随访半年未复发。心得：本病应把握针灸 治疗时机，病程越短效果越好。对组织产生粘连、肌肉萎缩者，应结合推拿

治疗，同时，自助锻炼和被动锻炼是配合针灸治疗、早日恢复肩关节功能不可缺少的环节。必须强 调适当进行肩部功能练习，每日做2~3次“爬墙”活动。

Case  Shoulder pain

Male patient, aged 70 years.

Chief complaint

Left shoulder pain for 3 weeks.

History of present illenss

The patient first felt pain in his left shoulder for no apparent reason 3 weeks ago, which became worse at night. It felt better if he got up to do some exercise while the pain was bad. Taking pain relief medication did not help.

Physical examination

The shape of the shoulder appeared normal with no obvious swelling. Movement of the shoulder joint was limited, especially while flexing and extending the shoulder. There was tenderness under the acromion.

Tongue and pulse

The patient’s tongue was red with a thin coat and his pulse was slippery (hua).

Therapeutic principle

Nourishing yin and dredging collaterals.

Prescription

Point selection: Jianyu (LI 15),Jianzhong (extra point),Jianliao (SJ 14),Quchi (LI 11).

Needles

Filiform needles.

Manipulation

Even needle technique.

Frequency and duration

Twice a week until completely recovered.

Differentiation of the syndrome or disease and explanation of the points

The 70-year-old male patient presented with left shoulder pain as his chief complaint. The pain was worse at night and would ease after movement of the shoulder, but there was also limited movement of the joint. These

Billingual Acupuncture and Moxibustion

signs and symptoms are classified as “frozen shoulder” in Traditional Chinese Medicine. Chinese medical theories state that men aged over 64 years gradually become deficient in blood and qi. Their bones and sinews are less strong than before and the circulation of qi and blood in the vessels becomes gradually slower. Symptoms of pain and limited movement commonly develop. The patient had a red tongue with a thin coat and his pulse was slippery (hua), indicating that the syndrome differentiation is heat caused by yin deficiency. The points Jianyu (LI 15),Jianzhong (extra point) and Jianliao (SJ  14) are often used to treat shoulder pain, because they are all located under the acromion. Inserting the needle caused a little pain, but patients often report feeling a strong needle sensation, which is not unpleasant. The point Quchi (LI 11) was selected because it is the he-sea point to clear heat.

Explanation of the points

Jianyu (LI 15), Jianzhong (extra point), Jianliao (SJ 14), Quchi (LI 11) are the main points. Jianyu (LI 15) belongs to Hand-Yangming meridian, location: When the arm is abducted parallel with the ground, it can be found in the depression just in front of the shoulder, attending shoulder and arm pain, upper limb paralysis and periarthritis of shoulder. Jianzhong (extra point),its location: 2.5 cun straight down from Jianyu (LI 15). Jianliao (SJ 14) belongs to Sanjiao meridian, according to The ABC Classic of Acupuncture  and Oxibustionacupuncture, location: In the shoulder, posterior to Jianyu (LI  15), in the depression which lies posterior and inferior to the lateral extremity of the acromion, attending shoulder and arm pain, upper limb paralysis  and periarthritis of shoulder. Its location have muscle branch of axillary nerve and brachial circumflex artery. Quchi (LI  11) belongs to Hand-Yangming as he-sea point according to Jinjian, attending stroke, hand  tendon cramps, wind, malaria, the first cold after the heat, etc. Ashi points are taken as additional points.

Treatment outcome

After 8 treatments the pain eased substantially and 80% of the shoulder’s function was regained. A follow-up telephone call 6 months later established that there had been no relapse of symptoms.

13.3.3 肘劳案

肘劳是以肘部疼痛、关节活动障碍为主症的疾病，俗称“网球肘”。属于中医学“伤筋”“痹证” 的范畴，相当于西医学的肱骨外上髁炎（或称“肱骨外上髁综合征”）。多因前臂旋转用力不当而引起  肱骨外上髁桡侧伸肌腱附着处劳损，是常见的肘部慢性损伤。多见于从事旋转前臂、屈伸肘关节和肘部  长期受震荡的劳动者，如网球运动员、打字员、木工、钳工、矿工等。中年人发病率较高，男女之比为  3∶1，右侧多于左侧［1］。

中医学认为劳累汗出、营卫不和、寒湿侵袭肘部经络，使气血阻滞不畅；长期从事旋前、伸腕等剧 烈活动，使经脉损伤、瘀血内停等均能导致肘部经气不通，不通则痛［1］。

目前现代医学对肘劳的治疗主要是根据肘劳发生的原因进行对症治疗，治疗方法主要包括局部封闭 治疗、理疗、营养神经药物局部肌肉注射等。针灸对该病的治疗原则为舒筋通络。

中医针灸治疗肱骨外上髁炎取得了较满意的临床疗效，弥补了现代医学应用激素及封闭疗法易复 发、副作用大等缺陷，发挥了中医学独特的优势与特色［2］ 。肱骨外上髁炎的治疗方法多种多样，但由 于有的治疗方法不够普及、有的操作繁琐、有的治疗内容说的不够仔细、且疗效标准不够统一，而像火 针、钩针、针刀等治疗时有一定痛苦，封闭疗法操作失当容易有副作用，因此很难评估哪种疗法最好， 疗效标准和疗效差异取决于穴位的选择。寻找一种简单易行、远期疗效确切、便于推广、无副作用的绿

色疗法，是未来的治疗趋势。综上所述，针灸综合疗法治疗网球肘具有疗效可靠、治疗方便、无副作用 等特点，值得临床深入研究推广［3］ 。在临床应用当中，局部压痛点、曲池、肘髎、手三里、合谷等腧穴 最为常用。

参考文献

［ 1 ］王启才，等．针灸治疗学［M ］．北京：中国中医药出版社，2003：213.

［2］于杰，孙忠人．针灸治疗肱骨外上骼炎的研究概况［J］．航空航天医学杂志，2013，24（ 11 ）：67.

［3 ］张向宇，牛博真，谢文智 ．针灸治疗肱骨外上髁炎的研究进展［J］．针灸临床杂志，2010，26（ 10 ）：79-80.

案例1

患者，女，55岁，初诊时间：2006年6月6日。

主诉：右肘疼痛2月余。

现病史：2月前无明显诱因出现右肘疼痛，端持物品时疼痛加重。经当地医院的物理治疗未见好转， 寻求针灸治疗。查：右肘关节无明显红肿，关节无变形，关节活动不受限。压痛点主要位于肱骨外上髁 附近。

舌、脉象：舌红苔薄白，脉细。

诊断：中医诊断：肘劳病（气血亏虚）。

西医诊断：肱骨外上髁炎。

针灸处方：

主穴：阿是穴、肘髎、曲池、手三里。

刺灸法：针刺肘髎穴时应平刺，沿肱骨前缘，进针1~0.5寸，局部酸胀，可向前臂放散。使用捻转泻 法，采用恢刺法，得气以出现局部明显的酸胀感为度。余穴均用平补平泻手法。

辨证分析：患者，女，55岁，以右肘疼痛为主症，端持物品时疼痛加重，不伴有关节活动受限， 属于中医学中的“肘劳”范畴。中医学理论认为，宗筋主束骨而利关节，当经筋出现病变时，会出现经 筋结聚部位的疼痛。患者舌红苔薄白，脉细，证型为气血亏虚型。患者疼痛部位主要位于肱骨外上髁附 近，表明其病位在手阳明大肠经，取穴应为阿是穴和手阳明经腧穴为主。

取穴依据：方中以阿是穴、肘髎、曲池、手三里为主穴。肘髎，属于手阳明大肠经，出自《针灸 甲乙经》。此腧穴在臂外侧，屈肘，曲池上方1寸（以取穴者自己拇指的指间关节的宽度为1寸），当肱 骨边缘处，有通经活络，舒筋利节的作用，主要治疗肘臂部疼痛、麻木、挛急等局部病症。《针灸甲乙 经》：“肩肘节酸重，臂痛不可屈伸。”《循经考穴编》：“肘节骨痛，拘挛麻木。”手三里，在前臂 背面桡侧，当阳溪与曲池连线上，肘横纹下2寸。

疗程、疗效：每周 1次，痊愈为止，6次治疗后疼痛消失。电话随访半年未复发。

心得：术者靠近患臂一侧取坐位，距离适度，便于操作为宜，确定痛点部位，并做出记号，局部常 规消毒，左手拇指或食指作指切压手，右手持已消毒的钩针，呈执笔式，针尖朝下，用速刺法将针进入 皮下组织后，进行提插法，“得气”后，不出针改行“一穴多向”刺，进行“钩拉”“弹拨”手法，随 即做“震颤”手法10次，嗣后再运用针头的光圆部分，对骨膜作轻柔的“按摩”手法，操作手法较重， 出针摇大其孔，以泻其实，操作完毕时，按进针方向倒退出针，然后用“创可贴”覆盖固定。

Case 1  Elbow disease

Female patient, aged 55 years.

Chief complaint

Right elbow pain for 2 months.

Billingual Acupuncture and Moxibustion

History of present illness

The patient first felt pain in her right elbow for no apparent reason 2 months ago. The pain became worse while carrying or holding objects. Physiotherapy at the local hospital was ineffective, so the patient sought treatment by acupuncture.

Physical examination

The right elbow joint had no obvious redness or swelling, no deformity or freely-moving articulation. The tenderness was mainly located around the lateral epicondyle of the humerus.

Tongue and pulse

The patient’s tongue was red with a thin white coat and her pulse was thready.

Prescription

Point selection: Ashi points, Zhouliao (LI 12),Quchi (LI 11), Shousanli (LI 10).

Needles

Electric needles.

Manipulation

Reducing needle technique.

Frequency and duration

Once a week until completely recovered.

Differentiation of the syndrome or disease and explanation of the points

The 55-year-old female patient presented with right elbow pain as her chief complaint. The pain was aggravated by carrying or holding objects, although articulation of the joint was unaffected. This is classified as “elbow disease” in Traditional Chinese Medicine. Traditional Chinese medical theories state that the sinews control the bones and help the joints to move. When there is disease in the sinews, there will be pain. The patient had a red tongue with a thin white coat and her pulse was thready, indicating that the syndrome differentiation is deficiency of qi and blood. The patient’s pain was mainly located around the lateral epicondyle of the humerus, locating the disease on the large intestine meridian of the Hand-Yangming. Therefore Ashi points and acupoints of the large intestine meridian were selected as the main points.

Explanation of the points

Zhouliao (LI  12), belongs to the Hand-Yangming, according to The ABC Classic of Acupuncture and Oxibustion. Its location: 1 cun above Quchi (LI 11) (take the width of the interphalangeal joint of the patient’s thumb as 1 F-cun), lateral to humerus edges; attending to elbow arm pain and numbness, according to The ABC Classic of Acupuncture and Moxibustion and Xunjing Xue Kao. Shousanli (LI  10) also means hand three mile, location: On the back of the forearm, radial side, on the line joining Yangxi (LI 5) and Quchi (LI 11), 2 cun below Quchi (LI 11).

Treatment outcome

After 6 treatments the pain disappeared. A follow-up telephone call 6 months later confirmed that there had been no relapse of symptoms.

Experience

It is very important that puncturing needle to many directions under the dermis to treat elbow disease.

案例2

患者，男，53岁，初诊时间：2006年6月19日。 主诉：双肘关节疼痛2年余。

现病史：2年前无明显诱因出现双肘关节疼痛，经当地医院检查排除风湿、痛风等疾病。经物理治 疗、封闭治疗，无效。现仍觉双肘关节疼痛，遇寒加重，得热痛减。查右肘关节无明显红肿，关节无变 形，关节活动不受限。双侧肘关节的压痛点主要位于肱骨外上髁附近。

舌、脉象：舌红苔白腻，脉弦紧。

诊断：中医诊断：肘劳病（气血亏虚）。

西医诊断：肱骨外上髁炎。

针灸处方：

主穴：阿是穴、肘髎、曲池、手三里。

刺灸法：针刺肘髎穴时应平刺，沿肱骨前缘，进针1~0.5寸，局部酸胀，可向前臂放散。使用捻转泻 法，采用恢刺法，得气以出现局部明显的酸胀感为度。余穴均用平补平泻手法。

辨证分析：中医学理论认为，宗筋主束骨而利关节，当经筋出现病变时，会出现经筋结聚部位的疼 痛。患者舌红苔薄白，脉细，证型为气血亏虚型。患者疼痛部位主要位于肱骨外上髁附近，表明其病位 在手阳明大肠经，取穴应为阿是穴和手阳明经腧穴为主。

取穴依据：方中以阿是穴、肘髎、曲池、手三里为主穴。肘髎，属于手阳明大肠经，出自《针灸 甲乙经》。此腧穴在臂外侧，屈肘，曲池上方1寸（以取穴者自己拇指的指间关节的宽度为1寸），当肱 骨边缘处，有通经活络，舒筋利节的作用，主要治疗肘臂部疼痛、麻木、挛急等局部病症。《针灸甲乙 经》：“肩肘节酸重，臂痛不可屈伸。”《循经考穴编》：“肘节骨痛，拘挛麻木。”手三里，在前臂 背面桡侧，当阳溪与曲池连线上，肘横纹下2寸。

疗程、疗效：每周2次，8次1疗程。2疗程后疼痛消失。

心得：针尖朝下，用速刺法将针进入皮下组织后，进行提插法，“得气”后，不出针改行“一穴多 向”刺，进行“钩拉”“弹拨”手法，随即做“震颤”手法10次，操作手法较重，出针摇大其孔，以泻 其实，操作完毕时，按进针方向倒退出针。

Case 2  Elbow disease

Male patient, aged 53 years.

Chief complaint

Bilateral elbow pain for 2 years.

History of present illness

The patient first felt pain in both elbows for no apparent reason 2 years ago. The local hospital had excluded diagnoses of rheumatism, gout etc. Physiotherapy was ineffective, and injections of pain relieving drugs were only partially successful. The patient still felt pain in both elbows, which was aggravated by cold and decreased by warmth.

Physical examination

The elbow joints had no obvious signs of redness or swelling. The joints were freely mobile. The tenderness

Billingual Acupuncture and Moxibustion

was mainly located around the lateral epicondyle of the humerus of both elbows.

Tongue and pulse

The patient’s tongue was red with a white greasy coat, and his pulse was wiry and tense.

Prescription

Point selection: Zhouliao (LI 12),Quchi (LI 11), Shousanli (LI 10),Ashi point.

Needles

Electric needles.

Manipulation

Reducing needle technique.

Frequency and duration

Twice a week for 4 weeks constituted a course of treatment.

Differentiation of the syndrome or disease and explanation of the points

Please refer to Case 1, “Elbow Disease ”.

Explanation of the points

Ashi point, Quchi (LI 11), Shousanli (LI 10) and Zhouliao (LI 12), are the main points. Zhouliao (LI 12) belongs to the Hand-Yangming, according to The ABC Classic of Acupuncture  and Oxibustion, location:  1 cun above Quchi (LI 11) (take the width of the interphalangeal joint of the patient’s thumb as  1 F-cun), lateral to humerus edges; attending to elbow arm pain and numbness, according to The ABC Classic of Acupuncture and Moxibustion and Xunjing Xue Kao. Shousanli (LI 10) also means hand three mile, location: on the back of the forearm, radial side, on the line joining Yangxi (LI 5) and Quchi (LI 11), 2 cun below Quchi (LI 11).

Treatment outcome

After 2 courses of treatment the pain disappeared.

Experience

It is very important that the needle punctures to many directions under the dermis to treat elbow disease.

13.3.4 腰痛案

腰痛又称“腰脊痛”，以自觉腰部疼痛为主症。腰痛的病因非常复杂，临床上常见于西医学的腰部 软组织损伤、肌肉风湿、腰椎病变、椎间盘病变及部分内脏病变等。［1］

中医学认为，腰痛主要与感受外邪、跌仆损伤和劳欲太过等因素有关。感受风寒，或坐卧湿地，或 长期从事较重的体力劳动，或腰部闪挫撞击伤未完全恢复，均可导致腰部经络气血阻滞，不通则痛。素 体禀赋不足，或年老精血亏衰，或房劳过度，损伤肾气，“腰为肾之府”，腰部脉络失于温煦、濡养， 可致腰痛、从经脉循行上看，主要归足太阳膀胱经、督脉、带脉和肾经（贯脊属肾）。故腰脊部经脉、 经筋、络脉的不通和失荣是腰痛的主要病机［1］。

目前现代医学对腰痛的治疗主要是根据腰痛发生的原因进行对症治疗，治疗方法主要包括药物治 疗、牵引治疗、手术治疗、运动疗法等。多项研究表明［2-4］ ：目前运用针灸疗法治疗由腰肌劳损、腰扭 伤、腰椎间盘突出症、腰椎间管狭窄症等所引起的腰痛病病均能取得良好的疗效。针刺能改善腰痛病所 引发的症状，治疗效果明显，腰痛病已经成为针灸疗法的优势病种。在临床应用当中，委中、腰阳关、 肾俞、大肠俞、局部阿是穴最为常用。

参考文献

［ 1 ］王启才，等．针灸治疗学［M ］．北京：中国中医药出版社，2003 ：60.

［2］刘伟．中西医结合治疗腰椎间盘突出急性腰痛 62 例临床分析［J］．按摩与康复医学，2011，2（32 ）：184. ［3 ］杨辉．腰痛的中医辩证及针灸治疗［J ］．中医临床研究，2011 ，3（20 ）：70-71.

［4］张治方．中医辨证配合针灸加拔罐治疗腰脊痛 90 例［J ］．实用医技杂志，2011 ，18（ 12 ）：1330-1331.

（ 1 ）急性腰扭伤案

邹某，女，46岁，2003年5月19日初诊。 主诉：腰部疼痛2天。

现病史：2天前因搬重物突感腰部疼痛，腰部活动受限，不能直立，夜间不能入睡。查：腰椎生理曲 度变直，双侧腰肌紧张，轻度压痛，拾物试验阳性，右下肢直腿抬高试验阳性。

舌、脉象：舌红苔黄，脉弦。

诊断：中医诊断：腰痛病（气滞血瘀）。 西医诊断：急性腰扭伤。

治则：行气活血。 针灸处方：

主穴：腰痛穴。

刺灸法：针刺手法采用上下提插法，达到要求针感时，即可出针。单侧腰痛为平刺手法，不提插， 对重症腰痛病人疼痛未完全控制，但在不发生晕针的情况下，可以留针。

辨证分析：诊断为急性腰扭伤。急性腰扭伤临床较为多见，多为暴力负重或姿势不良时扭转体位所 致。中医认为本病因气滞血瘀、经络不通所致。西医分析认为，急慢性损伤引起腰部肌肉、筋膜、韧带 等组织炎症反应、充血水肿、渗出和粘连等病理改变刺激压迫神经末梢，导致腰痛。

取穴依据：腰痛穴是位于手背部的经外奇穴。经外奇穴是指位于十二正经和奇经八脉之外的在临床 上具有某种特殊功能的反应点。腰痛穴具有治疗腰腿痛的作用。

腰痛穴在手背侧，位于第2、3掌骨及第4、5掌骨之间腕横纹与掌指关节的中点， 一手两穴。用2~2.5 寸28号毫针，每次针刺单手穴位，两手交替，进针时针尖向腕关节方向斜刺1~1.5寸。产生酸麻感后加用 电针，用G6805型电针治疗仪治疗，用疏密波，强度以患者能耐受为准，每天1次，每次30分钟，3次为1 个疗程，共治疗2个疗程。

疗程、疗效：针刺后患者即感腰部疼痛明显减轻，腰部活动明显好转，再巩固治疗2次，症状及体征 均消失。

心得：通过针刺腰痛穴能调节大脑皮层的兴奋性来提高痛阈，促进脊髓的再生和功能的恢复，调节 周围神经系统以利于炎性水肿的神经根的修复。同时在临床上应用电针治疗仪不仅可以节约人力资源， 而且使用疏密波能克服单一波形易产生人体适应性的特点。疏密波的作用较大，治疗时兴奋效应占优 势，能促进代谢和血液循环，改善组织营养，消除炎性水肿，从而缓解急性腰扭伤的临床症状，故在临 床应用上取得了较为满意的疗效。

Case 1  Lumbar sprain

Female patient, aged 46 years.

Chief complaint

Pain in low back of about 2 days’ duration.

Billingual Acupuncture and Moxibustion

History of present illness

2 days ago, when the patient carried heavey things, she suddenly felt bad pain in low back, and movement of waist was limited.

Tongue and pulse

The patient had red tongue with yellow coating, indicating retention of damp-heat. Her pulse was wiry (xuan), indicating painful syndrome.

Differentiation of the syndrome or disease

The 46-year-old female patient presented with pain in low back for about 2 days’ duration as her chief complaint. This is classified as “injury of tendons” in Traditional Chinese Medicine. Chinese medical theories state that due to ill posture of carrying heavey things, tendons and joints are injured, the circulation of qi and blood is stagnated in the local region and meridians and collaterals are obstructed.

Prescription

Point selection: Yaotongdian (EX-UE 7).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Frequency and duration

Once a day until the patient completely recovered.

Explanation of the points

Yaotongdian (EX-UE 7), location: On the dorsum of the hand, 2 points located between the second and third, the fourth and fifth metacarpal bones, at the midpoint between the transverse crease of the wrist and the metacarpopha-langeal joint. One hand has 2 points, and both hands include 4 points. Yaotongdian (EX-UE 7) is good at treating acute lumbar sprain.

Use 2-2.5 cun filiform needle, number 28, only single hand of the patient got treatment. Use the hands alternately, the tip of the needle was inserted obliquely towards the wrist when the needles were 1-1.5 cun. Produce needle sensation, then treat with type G6805 electric acupuncture apparatus. With the density wave, the strength would be subject to the patient’s toleration, 1 time a day, 30 minutes each time, 3 times for a period of treatment, 2 periods of treatment.

Treatment outcome

After 6 treatments, his symptoms completely disappeared.

（ 2 ）腰突致椎管狭窄案

郭某，30岁，2005年8月2日初诊。 主诉：间歇性跛行6个月。

现病史：腰酸3年余，遇劳则重。半年前骑摩托车摔伤，当时出现较剧烈的腰痛，行X光片检查示腰 椎骨结构正常。经贴膏药及休息后，腰痛逐渐减轻，仍余腰酸，但站立久后即出现左下肢疼痛无力，需下蹲后能缓解。逐渐发展为行走200米左右就出现左下肢疼痛难忍，需下蹲休息，方能继续前行。于云南 省盐津县医院行腰椎CT检查，诊为L5-S1向后突出，椎管狭窄。查：左侧直腿抬高试验（+），挺腹试验 （+），L5-S1椎旁有一固定压痛点，委中穴压痛，左下肢肌肉无明显萎缩。饮食可，二便调，寐可。

舌、脉象：舌红苔白，脉细弦。

诊断：中医诊断：腰腿痛。证型：肾虚血瘀。 西医诊断：腰椎间盘突出症（椎管狭窄）。

治则：补肾化瘀，疏筋通络。 针灸处方：

主穴：阿是穴、委中、昆仑。 配穴：阳陵泉、绝骨。

刺灸法：在第四腰椎至第二骶椎间寻找阿是穴，针刺阿是穴时使用提插泻法，得气以出现腰部有明 显的胀感为度，委中穴使用刺络拔罐放血法。余穴均用平补平泻手法。起针后阿是穴拔罐。

辨证分析：患者因职业为教师，长期站立，虽当而立之年，即有腰酸之症，又因闪挫，而出现 腰痛，腰痛稍缓解，就出现下肢疼痛，间歇性跛行，属于中医学中的“腰腿痛”范畴。《素问 · 脉解 篇》：“少阴所谓腰痛者，少阴者，肾也。十月万物阳气皆伤，故腰痛也。”《诸病源候论 · 腰痛 候》：“肾气不足……，劳伤则肾虚，虚则受于风冷，风冷与真气交争，故腰腿痛。”《备急千金要 方 ·卷十九 · 肾脏》：“腰背痛者，皆是肾气虚弱，卧冷湿当风所得也，不时速治，喜流入脚膝”。患 者素有腰酸，表明其肾气不足在先。《金匱翼 ·卷之六 ·瘀血腰痛》：“瘀血腰痛者，闪挫及强力举重 得之。盖腰者，一身之要，屈伸俯仰，无不为之。若一有损伤，则血脉凝塞，经络壅滞。令人卒痛不能 转侧。”《景岳全书 ·杂病谟 · 腰痛》：“行立不支，而卧息少可。”患者又因骑车闪挫，而出现瘀血 在后。患者的压痛点位于L5-S1之间，根据经脉辨证，其病变在足太阳膀胱经。因肾主骨，而足太阳膀胱 经的循行“从腰中，下夹脊，贯臀，入腘中。 ……夹脊内，过髀枢，循髀外后廉下合腘中……以下贯踹 内，出外踝之后……。是动则病……脊痛，腰似折，髀不可以曲，腘如结，踹如裂。 ……。是主筋所生 病者， ……，项、背、腰、尻、腘、踹、脚皆痛，小指不用”（《灵枢 ·经脉》）。因而出现足太明经 脉不通，不通则痛，而表现为间歇性跛行。根据《景岳全书 ·卷二十五 ·腰痛》：“跌仆伤而腰痛者， 此伤在筋骨。”故其治则确定为补肾化瘀，疏筋通络。

取穴依据：全方以阿是穴、委中、昆仑为主穴，依据《灵枢 · 经筋》：“治在燔针劫刺，以知为 数，以痛为输”。阿是穴在痛证的治疗中占有重要的地位。阿是之称始见于唐代《千金方》：“有阿是 之法，言人有病痛，即令捏其上，若里当其处，不问孔穴，即得便快成痛处，即云阿是，灸刺皆验， 故曰阿是穴也”。因腰腿痛大多责之于足太阳膀胱经经筋不通，故取足太阳膀胱经之合穴委中以通其 经筋，经穴昆仑以活血化瘀。委中穴位置在“腘中央约纹中动脉”（《针灸甲乙经》），取穴方法为 当腘窝横纹中央。《千金方》：“背连腰痛，委中、昆仑穴”；《针灸大成》：“足弱，委中、三里、 承山；血滞于下，刺委中，灸肾俞、昆仑；足腕痠：委中、昆仑；腰脊酸楚：委中、复溜”；《席弘 赋》：“委中专治腰间痛”“委中腰痛腿挛急，取得其经血自调”；《玉龙赋》：“人中、委中，除腰 脊痛闪之难制”；《素问 ·刺腰痛篇》：“衡络之脉，令人腰痛，不可以俯仰，仰则恐仆，得之举重伤 腰，横络绝，恶血归之，刺之在郄阳、筋之间，上郄数寸，横居为二痏出血”。故取委中穴刺络放血。 配穴取八会穴之筋会阳陵泉以疏筋，髓会绝骨以补肾通络。《天星秘诀》：“足缓难行先绝骨，次寻条 口及冲阳。”《标幽赋》：“悬钟、环跳，华佗刺躄足而立行。”

疗效：每天1次，每周5次，10次为1疗程。治疗一个半月，诸症消失，随访2年，未复发。

心得：《标幽赋》：“大抵取穴之法，必有分寸，先审自意，次观肉分；或伸屈而得之，或平直而 安定。在阳部筋骨之侧，陷下为真；在阴分郄腘之间，动脉相应。”在取委中穴时，因患者本来在委中 穴处即有明显的压痛，在定位和扪按腧穴时，委中穴以患肢屈曲时取穴为准，可触及动脉搏动，故刺络

Billingual Acupuncture and Moxibustion

放血时，不必拘泥于委中穴，而应以委中穴处明显充盈的“横络”为刺络放血点。正如《灵枢 ·刺节真 邪第七十五》：“一经上实下虚而不通者，此必有横络盛加于大经，令之不通，视而泻之，此所谓解结 也。”因其“横络”浮于体表，故点刺即可，不宜深刺。

Case 2  Vertebral canal narrow due to prolapse of lumbar intervertebral disc

Male patient, aged 30 years.

Chief complaint

Intermittent claudication for 6 months.

History of present illness

The patient had felt low back uncomfortable off and on in the recent 3 years, increasing when he was tired. He fell down when he rodea motorcycle half a year ago. He felt the violent lumbago. X-ray examination showed structure of the lumbar vertebra was normal. Lumbago improved after sticking plaster and having a rest, but subsequently he felt left lower limb pain and inertia. When he stood or walked for longtime, he had to squat down to relieve pain. He walked for 200 meters; it was too painful to walk. Computed tomography examination revealed evidence of vertebral canal narrow caused by disc between the fifth lumbar vertebrae and the first sacral vertebrae prolapse. Physical examination showed lasegue’s sign positive, tenderness was located between the fifth lumbar vertebrae and the first sacral vertebrae, as well as on Weizhong (BL 40).

Tongue and pulse

The patient had red tongue with a white coat and his pulse was thread (xi) and wiry (xuan).

Diagnosis

TCM diagnosis: Pain in waist and legs (diagnosis of disease). Deficiency of kidneys and blood stasis blocking collaterals (syndrome differentiation).

WM diagnosis: Prolapse of lumbar intervertebral disc (vertebral canal narrow).

Principle of treatment

Invigorating kidneys and removing stasis. Dredging vessels.

Prescription

Main points: Ashi points, Weizhong (BL 40), Kunlun (BL 60).

Additional points: Yanglingquan (GB 34),Xuanzhong (GB 39).

Manipulation

Using reinforcing by lifting and thrusting needle on Ashi points, the patient had partial distension feeling as needle sensation, then use blood-letting therapy on Weizhong (BL 40). Use uniform reinforcing and reducing method on the other points. Cup on Ashi points after removing the needles.

Differentiation of the syndrome or disease

The 30-year-old male patient presented with intermittent claudication for 6 months as his chief complaint. This is classified as “pain in waist and legs” in Traditional Chinese Medicine. Treatise on Causes and Symptoms of Disease says: “Pain in waist and legs is caused by deficiency of kidney-qi and overstrain.” The patient usually felt uncomfortable of low back, indicating deficient kidney-qi. He fell down when he rode the motorbicycle. Synopsis of Golden Chamber says: “Low back pain is caused by blood stasis. If low back is injured, the stasis stays in

vessels, with the result of stagnation of meridians and collaterals.” According to syndrome differentiation based on meridian theories. The pain area is on distribution of bladder meridian. Traditional Chinese medical theories state that kidneys control bone. Bladder meridian pathway passes the low back and the leg to the feet. So the treatment should aim at invigorating kidneys, removing stasis, and dredging vessels.

Explanation of the points

Spiritual Pivot of Huangdi’s Canon of Medicine says: “Taking tenderness as acupoint in painful diseases.” Name of Ashi points were firstly recorded in Invaluable Prescriptions for Emergency. Bladder meridian is  responsible for most waist and legspain in clinic. Weizhong (BL 40), location: At the midpoint of the transverse  crease of the popliteal fossa. “ Weizhong (BL 40) is selected to treat back and legs pain ”, Plain Questions of  Huangdi’s Canon of Medicine says: “Applying blood-letting method to Weizhong (BL 40) in back pain caused by  stagnation of bladder collaterals.” Kunlun (BL 60) is the river point; it relaxes sinews and removes obstructions  from channels. Yanglingquan (GB 34), the gathering point for sinews; it relaxes sinews to relieve pain. Xuanzhong  (GB 39), gathering point for marrow, benefits essence and nourishes the marrow to tonify kidneys.

Frequency, duration and treatment outcome

Once a day, 10 treatments constituted a course. After treated with acupuncture for one half a month, he could walk like before. Follow-up survey for 2 years.

Experience

Looking for the obvious small vein around the point of Weizhong (BL 40), and then conducting blood- letting therapy.

13.3.5 足跟痛案

足跟痛是急性或慢性损伤引起的足跟部疼痛。症状虽然简单，但病因复杂，且多缠绵难愈。 一般多 为从高处落下，强大暴力撞击足跟底部，或走路时足跟部被高低不平的路面或小石子顶挫致伤。因职业 关系长期站立于硬板地工作，扁平足，跑跳过多，足底跖筋膜、肌肉、韧带长期处于紧张状态，反复牵 拉跟骨附着处可引起足跟底痛。跳跃运动员踏跳过多，长跑运动员用前足掌蹬地过多，由于跖腱膜、屈 趾短肌、跖方肌以及跖长韧带等反复牵拉，日久也可发病［1］。

根据不同的损伤原因，可致跟底脂肪垫、滑液囊及骨膜挫伤，或跖腱膜、屈趾短肌等在跟骨结节前 方附着处的牵拉伤。损伤后，跖筋膜附着处可发生充血性渗出，脂肪垫充血、肿胀，滑囊慢性炎症，跟 骨骨膜增生，产生骨刺等改变。中医学认为，该病的形成是以肝肾亏虚、气血失和、筋脉失养为先决条 件，复因风、寒、湿邪侵袭及外伤、劳损等致使气血阻滞而成［1］。

目前现代医学对足跟痛的治疗主要是根据足跟痛发生的原因进行对症治疗，治疗方法主要包括药物 治疗、理疗、局部封闭治疗、矫正鞋垫治疗、跟骨砧孔减压术。针灸治疗该病方法多样，包括针刺、温 针灸法、电针、穴位注射、穴位贴敷、小针刀疗法等。有研究表明［2］ ：电针配合温针灸治疗足跟痛疗效 较好，能消除或改善临床症状，提高病人生活质量。本病的针灸治疗应遵循的原则是滋补肾阴，通经活 络，活血化瘀。在临床应用当中太溪、昆仑、照海、足跟部阿是穴等腧穴较为常用。

参考文献

［ 1 ］王启才，等．针灸治疗学［M ］．北京：中国中医药出版社，2003：219.

［2］林松青. 电针配合温针灸治疗足跟痛的临床观察［J ］．光明中医，2012，27（ 12 ）：2497-2498.

Billingual Acupuncture and Moxibustion

案例

患，男，53岁，初诊时间为2006年7月29日。 主诉：右跟腱疼痛2月余。

现病史：2月前，无明显诱因出现右足跟痛，行走时疼痛加剧。经当地医院的物理治疗，有所好转， 但现在仍时时感到疼痛，求助于针灸治疗。平素有腰酸，劳累后加重。查：足跟外形无明显异常，局部 无明显红肿，跟骨结节处压痛。

舌、脉象：舌红苔薄白，脉滑。

诊断：中医诊断：足跟痛（本虚标实）。 西医诊断：跟腱周围炎。

针灸处方：

主穴：肾俞、腰部阿是穴、委中、太溪、复溜、绝骨、昆仑。

刺灸法：在第四腰椎至第二骶椎间寻找阿是穴，针刺阿是穴时使用提插泻法，得气以出现腰部有明 显的胀感为度，委中穴使用刺络拔罐放血法。余穴均用平补平泻手法。起针后阿是穴拔罐，跟骨结节处 压痛刺络放血。

辨证分析：患者，女，53岁，主症为右足跟疼痛，行走加剧，主要疼痛点位于跟骨结节处，平素 伴腰酸，属于中医学中的“足跟痛”范畴。中医学理论认为，足少阴肾经的循行别入跟中，凡属于足跟 痛，与足少阴肾经相关。患者平素有腰酸，中医学理论认为腰为肾之府，故患者出现足跟痛，与足少阴 肾经相关。患者舌红苔薄白，脉滑，证型为实证。因此在治疗上，应以泻法为主，取足少阴肾经腧穴及 其表里经足太阳膀胱经为主。方中取肾俞是为了强壮肾气，太溪、复溜疏通肾经经气，委中、昆仑加强 疏通经络之气的作用。

取穴依据：方中取肾俞、腰部阿是穴、委中、太溪、复溜、绝骨、昆仑为主穴。肾俞穴是足太阳膀 胱经的常用腧穴之一，位于第2腰椎棘突下，旁开1.5寸，委中是腰背足太阳经两分支在腘窝的汇合点， “腰背委中求”，可疏调腰背部经脉之气血；腰为肾之府，肾俞可壮腰益肾；大肠俞、腰阳关、阿是穴 可疏通局部经脉、络脉及经筋之气血，通经止痛。《素问 ·刺腰痛》：“足太阳脉令人腰痛，引项脊尻 背如重状，刺其郄中。太阳正经出血， ……少阳令人腰痛，如以针刺其皮中，循循然不可以俯仰，不可 以顾，刺少阳成骨之端出血，成骨在膝外廉之骨独起者……足少阴令人腰痛，痛引脊内廉，刺少阴于内 棵上二痏。”《摘英集》：“寒湿腰痛，灸腰俞；闪着腰痛及本脏气虚，针气海。”《丹溪心法》： “腰痛，血滞于下，委中刺出血，仍灸肾俞、昆仑。”《席弘赋》：“气滞腰痛不能立，横骨、大都宜 救急。”《针灸大全》：“肾虚腰痛，举动艰难，取足临泣、肾俞、脊中、委中。”《标幽赋》：“悬 钟、环跳，华佗刺躄足而立行。”

疗程、疗效：每周1次，8次1疗程。治疗1疗程后疼痛消失。

心得：太溪穴向前上方斜刺，出现足底电麻为佳，留针30分，年老体弱者可用补法（手法宜轻）， 千万注意避免强刺激，得气或有电麻感即会有效，切记要避免损伤神经！大多数病人首次即有效，2到3 次症状消失，最严重一例，针刺针感不错，但针灸四五次后方才见效，十余次后症状消失。

Case  Heel pain

Female patient, aged 53 years.

Chief complaint

Pain in the tendon of the right heel for 2 months.

History of the present illness

2 months ago, the patient felt pain in the tendon of her right heel for no apparent reason, which worsened while running. Physiotherapy at her local hospital had relieved the pain temporarily, but the pain had now returned and the patient wanted to have treatment with acupuncture. She usually had low back pain and reported that the pain became worse after overwork.

Physical examination

The heel looked normal with no redness or swelling. There was tenderness in the calcaneal tuberosity.

Tongue and pulse

The patient’s tongue was red with a thin white coat and her pulse was slippery (hua).

Prescription

Point selection: Shenshu (BL 23), Ashi points,  Weizhong (BL 40), Taixi (KID 3), Fuliu (KID 7),Juegu (GB 39), Kunlun (BL 60).

Needles

Electric needles.

Manipulation

Reducing needle technique.

Frequency and duration

Treatment once a week for 8 weeks constituted one course of treatment.

Differentiation of the syndrome or disease

This 53-year-old female patient presented with a painful right heel as the chief complaint. The pain worsened while running, with tenderness in the calcaneal tuberosity. The patient usually felt discomfort in her lower back. These symptoms are categorized as “painful heel” in Traditional Chinese Medicine. Traditional Chinese medical academic theories state that the pathway of the kidney meridian of the Foot-Shaoyin passes through the heel, so the painful heel belongs to kidney meridian disease. The patient’s discomfort in her lower back also indicates problems with the kidneys, as Traditional Chinese Medicine academic theories state that the waist is the house of the kidney. The patient’s tongue was red with a thin white coat and her pulse was slippery (hua),which indicated that the syndrome differentiation was excessive. Therefore the treatment focused on clearing the stagnation on the kidney meridian. Acupoints were selected from the kidney and urinary bladder meridians. Shenshu (BL 23) was selected to tonify the kidneys. Taixi (KID 3) and Fuliu (KID 7) were selected to clear the kidney meridian. Weizhong (BL 40) and Kunlun (BL 60) were selected to strengthen the action of clearing the kidney meridian.

Explanation of the points

Shenshu (BL 23), Weizhong (BL 40), Taixi (KID 3), Fuliu (KID 7),Juegu (GB 39), Kunlun (BL 60) are the main points. Shenshu (BL 23), location: On the spine area, under the secondspinous process of lumbar vertebra, and 1.5 cun lateral to posterior midline; it can drain the lower back the qi of meridians; waist is the mansion of kidney. Weizhong (BL 40), location: At the midpoint of the transverse crease of the popliteal fossa. “ Weizhong (BL 40) is selected to treat back and legspain”, is the converging point of 2 branches of bladder meriaian. Taixi (KID 3),Fuliu (KID 7),Juegu (GB 39), Kunlun (BL 60) can also drain the qi of meridians to stop pain and dredge blood stagnation.

Treatment outcome

After one course of treatment, the pain disappeared.

Billingual Acupuncture and Moxibustion

Experience

Taixi (KID 3) is the key point to treat heel pain, but the practitioner should avoid deeper insertion to injure the nerve under this point.

13.3.6 痛风及高尿酸血症案

痛风是由多种原因引起的嘌呤代谢障碍所致血尿酸增高的一组慢性疾病［1］ 。临床表现为持续关节肿 痛、压痛、畸形及功能障碍。痛风多见于中年男性，女性仅占5%， 主要是绝经后女性，痛风发生有年轻 化趋势。通常血尿酸大于正常值为高尿酸血症，其中仅10%~20%发展为痛风。

痛风属于中医“痹症”等病症的范畴，而与痛风发病密切相关的过多的尿酸则属于“湿浊”的范 畴。痹症的发生与体质、气候、生活环境及饮食有关，感受风、寒、湿、热之气，合而为痹，或久病体 虚，内生痰浊湿热、瘀血、毒热等留滞经络、关节、肌肤、血脉、筋骨，痹阻肢体经络关节而成［2］ 。现 代医学将病因分为原发性和继发性两大类。原发性痛风多有遗传性，其原因主要是嘌呤代谢酶缺陷，次 黄嘌呤鸟嘌呤磷酸核糖转移酶（HGPRT）缺乏和磷酸核糖焦磷酸盐（PRPP）合成酶活性亢进。继发性痛 风与骨髓增生性疾病、恶性肿瘤、肾脏疾病、药物如噻嗪类利尿药、呋塞米、小剂量阿司匹林和烟酸 等有关。

现代研究表明用毫针、电针、针刀、三棱针、拔罐、灸法、蜂针以及放血等疗法治疗痛风效果显 著［2］ 。另外运用温针、穴位注射、梅花针叩刺、火针等方法均取得很好疗效［3］ 。针灸治疗本病使用频 率最高的是三阴交、足三里、阴陵泉、曲池、合谷、血海等穴，具有健运脾胃、化湿泻浊、泻热除瘀的 功效，同时配合肾经太溪以滋补肾阴［4］。

参考文献

［ 1 ］徐荣娟．内科学［M ］．北京：中国中医药出版社，2007.

［2］王明月 ．痛风性关节炎的针灸治疗进展［J ］．针灸临床杂志，2010，26（ 11 ）：69-70.

［3 ］崔关花，隽会英．浅述针灸治疗痛风［J ］．中国中医药，2014 ，12（24 ）：76-77.

［4 ］梁爽，黄凯裕，许岳亭，等．基于数据挖掘的针灸治疗急性痛风性关节炎临床选穴规律分析［J ］．中医研究， 2014 ，16（ 12 ）：2602-2604.

（ 1 ）痛风案

梁某，男，61岁，2006年2月14日初诊。

主诉：左踝关节疼痛反复发作2年，加重3天。

现病史：2年前夜间因踝关节剧烈疼痛痛醒。当时踝关节出现红肿，于第2日查血尿酸1005mmol，诊 为痛风性关节炎。后服用痛风利仙，踝关节疼痛红肿消失。此后随时因饮食不注意而发作。3天前因食 用豌豆，又出现踝关节的疼痛，因服用痛风利仙效果不明显，遂前来就诊。查左踝关节微肿，色红不明 显，疼痛昼轻夜重，疼痛发作时痛不可忍，疼痛性质为烧灼痛，左足不敢落地，压痛点位于内踝尖下， 踝关节的各向活动受限。饮食可，大便干，小便黄热，寐差。

舌、脉象：舌质黯苔黄，脉弦。

诊断：中医诊断：痛风（白虎病）。证型：湿瘀内阻。 西医诊断：痛风。

治则：化瘀利湿，疏通气血。

针灸处方：

主穴：商丘、三阴交。

配穴：照海、太溪、解溪。

刺灸法：针刺商丘穴时使用捻转泻法，得气以出现踝关节有明显的胀痛感为度，而后三阴交、商丘 穴接电针，波形为连续波，留针20分钟，强度以患者能耐受为度。余穴均用平补平泻手法。局部用TDP灯 照射。

辨证分析：患者以左踝关节疼痛肿大为主症，而且疼痛昼轻夜重，疼痛剧烈，属于中医学中的“痛 风”“白虎病”范畴。《徐大椿医书全集 ·杂病证治》：“痛风即《内经》痛痹也。因气血亏损，湿痰 浊血乘间流滞经络，或客四肢，或着肩、背、百节，走痛攻刺如风之善动”，其症见“骨节疼痛，走注 四肢，难以转侧，肢节或红，或肿，甚则遍体蔂块，或肿或夸包，或痛如掣，昼静夜剧”。《格致余 论 ·痛风论》：“彼痛风者，大率因血受热已自沸腾，其后或涉冷水，或立湿地，或扇取凉，或卧当 风，寒凉外搏，热血得搏，汗浊凝涩，所以作痛。夜则痛甚，行于阴也。”《外台秘要 ·卷十三》： “白虎病者，大都是风寒暑湿之毒，因虚所致，将摄失理，受此风邪，经脉结滞，血气不行。蓄于骨节 之间，或在四肢，肉色不变。其疾昼静而夜发，发即彻髓酸疼，乍歇，其病如虎之噬，故名白虎之病 也。”本病主要在于人体正气不足，脾肾功能失调，湿热痰瘀等病理产物聚于体内，留滞经络，复因饮 食劳倦，内外合邪，气血凝滞不通，湿浊流注关节，发为痛风。患者舌质黯苔黄表明体内有瘀有热，脉 弦主痛证。在治疗上根据《丹溪心法卷四痛风》：“肥人肢节痛，多是风湿与痰饮，流注经络而痛”的 说法，多采用祛湿化痰，疏通经络的治法。

取穴依据：方中主穴选用商丘、三阴交，主要是根据“脾主运化水湿”而定。《针灸甲乙经 · 阴  受病发痹第一》：“寒气在分肉间，痛上下，痹不仁，中渚主之”，提倡循经取穴或局部取穴。商丘、  三阴交均为足太阴脾经腧穴，且都位于踝关节周围。商丘位置在“足内踝下微前陷者中”（《针灸甲乙  经》），取穴方法为在内踝前下方凹陷处。《千金翼方》：“商丘主偏风痹，脚不履地，半身不遂”；  《胜玉歌》：“脚背疼时商丘刺”；《针灸甲乙经》：“三阴交主足下热痛，不能久坐，湿痹不能行；  惊不得眠”；《针灸大成》：“足踝以上病，灸三阴交，绝骨、昆仑”。配穴选用照海。照海为八脉交  会穴之一，为阴跷脉与十二正经相交腧穴，阴跷脉主司下肢运动，又位于内踝尖下，可起到疏通阴跷及  局部气血的作用；太溪为足少阴肾经原穴。《玉龙歌》：“太溪，昆仑，伸脉，最疗足肿之屯。”《丹  溪心法 ·卷四痛风》：“治法以辛热之剂，流散寒湿，开发腠理，其血得行，与气相和，其病自安。” 故在局部用TDP烤灯照射。

疗程、疗效：隔天1次，每周3次。治疗1次后，疼痛大减。后连续治疗6次，肿胀、疼痛消失。心 得：《素问 ·至真要大论篇第七十四》：“热因热用，寒因寒用；塞因塞用，通因通用，必伏其主，而 先其所因，其始则同，其终则异，可使破积，可使溃坚，可使气和，可使必已。”患者舌质黯苔黄，脉 弦，表面看起来是热证，但实际上并不是实热证，需用热法使腠理开发，气血得行。故对痛风患者使用 热法是取得疗效的关键。

Case 1  Gout

Male patient, aged 61 years.

Chief complaint

Pain in left ankle articulation for 2 years.

History of present illness

The patient experienced extremely pain in ankle articulation at night 2 years ago. The ankle articulation was swollen and redness. Lab examination revealed evidence of gouty arthritis. His symptoms disappeared after receiving Western Medicine treatment for several days, but it frequently recurred within the last 2 years. It became

Billingual Acupuncture and Moxibustion

worse in the past 3 days, and he took Western Medicine without avail. Physical examination showed left ankle articulation was slightly swollen. Movement of the ankle joint was limited; there was tenderness at the bottom of the medial malleolus point.

Tongue and pulse

The patient had dark tongue with yellow coating and his pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Bi syndrome (diagnosis of disease), stagnation both the stasis and dampness (syndrome differentiation).

WM diagnosis: Gout.

Principle of treatment

Resolving dampness and removing stasis. Dredging qi and blood.

Prescription

Main points: Shangqiu (SP 5),Sanyinjiao (SP 6).

Additional points: Zhaohai (KI 6), Taixi (KI 3),Jiexi (ST 41).

Manipulation

Using reinforcing by twirling and rotating needle on Shangqiu (SP 5), the patient had partial distension feeling as needle sensation. Use electric needles on Shangqiu (SP 5) and Sanyinjiao (SP 6) with continuous wave; stay needles for 20 minutes. Uniform reinforcing and reducing method was applied to the other points. Apply TDP light irradiation to the painful part.

Differentiation of the syndrome or disease

The 61-year-old male patient presented with pain in left ankle articulation for 2 years as his chief complaint. This is classified as “bi syndrome” in Traditional Chinese Medicine. Xudachun’s Medical Records says: “Gout is the same as the classic bi syndrome.” Chinese medical theories state that gout is mainly caused by damp-heat, phlegm and stasis accumulated in meridian due to deficiency of healthy qi and disharmony of spleen and kidneys.

Explanation of the points

According to The Spleen Controls Transportation and Transformation and the principal of treating bi syndrome,the main points were selected. Shangqiu (SP 5) and Sanyinjiao (SP 6) are the points of the spleen meridians and located surroundings of ankle articulation. Zhaohai (KI 6), is the opening point of yin heel vessel. Yin heel vessel controls the movement of the low limbs. Great Compendium of Acupuncture and Moxibustion says: “Selecting the points of Taixi (KI 3), Kunlun (BL 60) and Shenmai (BL 62) in feet diseases.” Jiexi (ST 41) clearsheat and relieves the ankle joint pain.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After one treatment, pain greatly relieved, then continuing to treat for 6 times, he recovered completely.

Experience

The patient had dark tongue with yellow coating and his pulse was wiry, indicating obstruction of blood. It’s important to promote blood circulation to remove stasis by using hot method in gouts.

（ 2 ）高尿酸血症

方某，男，43岁，2006年6月12日初诊。

主诉：双手拇指掌指关节酸楚不适6个月。

现病史：6月前进食海鲜并饮酒后，出现双手拇指掌指关节酸楚不适，因不伴有关节的红、肿、热、 痛，关节活动也不受影响，故当时未引起明显注意。后因症状持续不减，患者于昆明市第一人民医院检 查，血尿酸817mmol，诊为高尿酸血症。因患者不想服用西药降尿酸药物，自觉控制饮食，求治针灸。饮 食可，大便调，小便色黄，偶尔饮酒，寐可。

舌、脉象：舌红苔黄厚，脉滑。

诊断：中医诊断：着痹（著痹）。证型：湿热内盛。 西医诊断：高尿酸血症。

治则：祛湿清热，疏通气血。 针灸处方：

主穴：合谷、太冲、鱼际。 配穴：阴谷、曲池。

刺灸法：针刺鱼际穴时使用捻转泻法，得气以患者出现拇指掌指关节胀痛感为度。余穴均用平补平 泻手法。起针后，后背膀胱经第一侧线走罐。

辨证分析：患者主症为双手拇指掌指关节酸楚不适，以关节症状为主，属于中医学中的“痹证”范 畴，因患者症状固定于拇指的掌指关节，且舌红苔黄厚，脉滑，故属于痹证中的“着痹”“湿痹”“著 痹”。《景岳全书》：“痹者，闭也，以血气为邪气所闭，不得通行而病也。”《素问 · 痹论》： “风、寒、湿三气杂至，合而为痹也……，湿气盛者为着痹也”，“其留连筋骨间者，疼久，其不痛 不仁者，病久入深，荣卫之行涩，经络时疏，故不通，皮肤不营，故为不仁”。《医学原理》：“血虚 无以荣养筋骨，以至经隧凝滞，作麻木。”《诸病源候论》：“风湿痹病之状，或皮肤顽厚，或肌肉酸 痛。风寒湿三气杂至，合而为痹。其风湿气多而寒气少者，为风湿痹也。”《证治准绳 ·杂病着痹》： “麻者，气之虚也，真气弱不能流通填塞，经络四肢俱虚，故生麻木不仁。”患者正当壮年，食欲旺 盛，饮食不节，时而饮酒，湿热内生，聚于体内，留滞经络，致气血凝滞不通，关节筋骨失于濡养，故 而出现双手拇指掌指关节酸楚不适故治疗应以清热祛湿，疏通气血为主。

取穴依据：方中主穴选用合谷、太冲和曲池，其中合谷、太冲为开四关，二穴在手足的位置相对， 又同为手阳明大肠经、足厥阴肝经的原穴，相配伍可起到活血化瘀、疏通气血的作用。太冲为足厥阴肝 经输穴、原穴，输主体重节痛，其位置在“足大指本节后二寸；或曰一寸五分陷者中”（《针灸甲乙 经》），取穴方法为在足第一、二跖骨结合部之前凹陷中取穴。鱼际为循经取穴、局部取穴，因拇指为 手太阴肺经循行所过，取鱼际可起到有疏通经络，疏调局部气血的功效。配穴取阴谷，阴谷为足少阴肾 经的合穴，可起到利湿的作用；曲池为手阳明大肠经的合穴，为手太阴肺经的表里经，可起到清热利湿 的作用。

疗程、疗效：隔天1次，每周3次，10次1疗程。治疗10次后，患者双手拇指掌指关节症状消失，查血 尿酸605mmol，又治疗10次，血尿酸485mmol。

心得：《针灸大成》：“凡下针，若气不至，用指于所属部分，经络之路，上下左右循之，使气血 往来，上下均匀，针下自然气至。”在针刺鱼际穴时，如针感不能感传至拇指的掌指关节，应沿手太阴 肺经循行以向指尖方向为主进行循按，使针感传至病患处。

Billingual Acupuncture and Moxibustion

Case 2  Hyperuricemia

Male patient, aged 43 years.

Chief complaint

Mournful and unwell in metacarpophalangeal joints of thumbs for 6 months.

History of present illness

The patient felt mournful and unwell in metacarpophalangeal joints of thumbs for 6 months’ duration. He didn’t pay much attention to it at beginning, because the joint had no obvious redness or swelling, no deformity or freely-moving articulation. Lab examination revealed evidence of hyperuricemia.

Tongue and pulse

The patient had red tongue with yellow and thick coating, and his pulse was smooth (hua).

Diagnosis

TCM diagnosis: Damp arthralgia (diagnosis of disease) . Accumulation of damp-heat (syndrome differentiation).

WM diagnosis: Hyperuricemia.

Principle of treatment

Dispelling damp-heat. Dredging blood and qi.

Prescription

Main points: Hegu (LI 4), Taichong (LR 3), Yuji (LU 10).

Additional points: Quchi (LI 11), Yingu (KI 10).

Manipulation

Apply filiform needles with reducing by twirling and rotating needles to Yuji (LU 10). The patient had distended feeling as needle sensation. Uniform reinforcing and reducing method is applied to the other points. Moveable cupping is given on the first line on back of the Bladder meridian after removing the needles.

Differentiation of the syndrome or disease

The 43-year-old male patient presented with mournful and unwell in metacarpophalangeal joints of thumbs as his chief complaint. Lab examination revealed evidence of hyperuricemia. This is classified as “bi syndrome” in Traditional Chinese Medicine. The patient had red tongue with yellow and thick coating, and his pulse was smooth (hua), indicating damparthralgia. Treatise on Causes and Symptoms of Diseases says: “The clinical symptoms of rheumatism bi syndrome include unwell and thick in skin or muscle soreness.” So the treatment should aim at eliminating damp-heat and dredging blood and qi.

Explanation of the points

Selection of main points of Hegu (LI 4) and Taichong (LR 3), which is called “opening four gates” . Hegu (LI 4) and Taichong (LR 3) are primary points, and their locations on hands and feet are opposite; they activate qi to remove stasis and dredge blood and qi. Because the lung meridian pathway passes by the thumb, take Yuji (LU 10) to dredge the meridian-qi and clear heat. Quchi (LI 11) clearsheat. Yingu (KI 10) eliminates dampness.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for  1 course, he didn’t feel mournful and unwell in metacarpophalangeal joints of thumbs, but lab examination showed the uric acid 605 mmols. Then continue to treat for 1 course, and lab examination showed 485 mmols.

Experience

Great Compendium of Acupuncture and Moxibustion: “While needling without needle sensation，use fingers to massage along the pathway of meridians and collaterals.”

13.4 Cases of Neurology Department (18 cases)

第四节  神经内科病案(18例)

在关于经络实质的研究当中，神经学说占用重要的地位。临床上针刺时得气的反应也包括出现针尖 直接刺激到神经。近年来，脑控学说在经络研究的领域正受到越来越多的关注和重视。正是由于脑和神 经与经络有着密切的联系，针灸疗法在神经系统疾病中的应用一直非常广泛，而且有着其他疗法无法比 拟的优势，也取得了很好的临床疗效。神经系统疾病的确诊准确性一直是医学研究领域的难题。随着高 性能CT和MRI等影像学技术的不断发展，近年来神经系统疾病诊断的正确率正在不断提高。然而由于脑 的结构与功能的复杂性，目前人类对脑的认识仍存在很大的局限性，使得神经系统疾病成为临床诊疗的 疑难杂症。针灸疗法治疗神经系统疾病的主要方法有3个：第一，头针疗法，其对手法的要求较高；第 二，针尖直接刺激到相关神经，其对穴位选择和定位要求准确；第三，经络辨证，其对辨证的准确性要 求较高。

13.4.1 周围神经疾病案

周围神经是指嗅、视神经以外的脑神经和脊神经、自主神经及其神经节。周围神经疾病是指原发于 周围神经系统结构或者功能损害的疾病［1］ 。周围神经疾病常有运动障碍，包括运动神经刺激和麻痹症 状。其中刺激症状主要表现为肌束震颤、肌纤维颤搐、痛性痉挛等，运动神经麻痹症状表现为肌力减低 或丧失、肌萎缩等，也会有感觉缺失、感觉异常、疼痛、感觉性共济失调等感觉障碍，另外常伴有腱反 射减低或消失，自主神经受损常表现为无汗、竖毛障碍及直立性低血压等。

周围神经疾病病因复杂，可能与遗传、外伤、营养代谢、药物及中毒、血管炎、肿瘤或机械压迫等 原因相关，选择性地损伤周围神经的不同部位，导致相应的临床表现。在周围神经发病机制中轴索运输 系统意义重大。

目前现代医学对周围神经疾病的治疗首先是治疗原发病，其次是对症支持治疗（止痛药物、B族维生 素等），针灸、推拿、理疗是恢复期的重要措施，可预防肌肉挛缩和关节变形。

参考文献

［ 1 ］贾建平，陈生第 ．神经病学［M ］．北京：人民卫生出版社，2013.

（ 1 ）三叉神经痛

患者，女，38岁，幼儿园老师。 主诉：右侧面部疼痛4周。

现病史：4个星期前，晨起后，无明显诱因，突然出现右侧面部疼痛，吃饭、说话、刷牙都会诱发右 下颏及唇周的放电样疼痛。当地医院诊断为“三叉神经痛”，服用消炎止痛药，无效。仔细问诊后，患

Billingual Acupuncture and Moxibustion

者回忆在发病前1天，和同事因琐事吵架而生气。 舌、脉象：舌红，苔黄，脉弦。

诊断：中医诊断：面痛。证型：肝火上炎。 西医诊断：三叉神经痛。

治则：清肝降火，镇静安神。 针灸处方：

主穴：印堂、迎香、地仓、颊车、颧髎、耳门、翳风、内关、合谷、太冲。

刺灸法：印堂、迎香、地仓、颊车、颧髎、耳门、翳风、内关用平补平泻手法，合谷、太冲用 泻法。

辨证分析：神经痛是指由周围神经病变引起并放射至该神经支配范围内的疼痛。三叉神经痛属于中 医学中的面痛范畴，临床以眼、面颊部出现放射性、烧灼样、抽掣疼痛为主症的疾病。临床发病以女性 多见，以右侧面部发病为多。中医学认为，面部为诸阳之会，面痛的发病机理主要为风寒外邪袭于阳明 经脉，导致经络气血凝滞不通；或阳明火盛，循经上炎；或气血亏损，经络瘀滞不通，而出现疼痛。

取穴依据：针灸治疗三叉神经痛的治疗方法：以体针为主，取穴为疼痛局部取穴与整体辨证取穴相 结合。取穴为印堂、迎香、地仓、颊车、颧髎、耳门、翳风、内关、合谷、太冲。手法为补泻兼施。

疗程、疗效：每周2次，9次痊愈。

心得：针刺治疗时在局部取穴的基础上，应配合镇静安神和全身辨证取穴。治疗次数不可少于一星 期2次，否则，只是临时缓解，难以积累疗效，最终痊愈。

Case 1  Trigeminal neuralgia

Dionys, female, 38 years old, kindergarten teacher.

Main complain

Pain in right face for 4 weeks.

History of present illness

The patient felt pain in right face in the morning 4 weeks ago without obvious causes, eating, talking or brushing teeth would trigger the pain in right mandible and around the lip. It was diagnosed as a trigeminal neuralgia,and the patient took some painkiller, no effect.

After careful inquiry, the patient recalled that she had a dispute with a colleague the day before getting the problem.

Wiry Pulse, red tongue with yellow coating.

Diagnosis

TCM diagnosis: Up-flaming of liver fire (syndrome differentiation).

WM diagnosis: Trigeminal neuralgia.

Principle of treatment

Clearing liver and reducing fire, tranquilizing mind.

Prescription

Selection of points: Yintang (EX-HN 3), Yingxiang (LI 20),Dicang (ST 4), Jiache (ST 6), Quanliao (SI 18), Ermen (TE 21), Yifeng (TE 19),Neiguan (PC 6),Hegu (LI 4), Taichong (LR 3).

Manipulation

Use uniform reinforcing and reducing needle method on the points of Yintang (EX-HN 3), Yingxiang (LI 20) , Jiache (ST 6), Quanliao (SI 18), Ermen (TE 21), Yifeng (TE 19),Neiguan (PC 6); use reducing needle method on the points of Hegu (LI 4) and Taichong (LR 3).

Differentiation of the syndrome or disease

Neurodynia points to nerve pain caused by pathological changes from the surrounding innervated area.

Trigeminal neuralgia belongs to TCM facial pain, with such clinical symptoms as radiation, burn bright kind and convulsion pain in eyes and cheek. In clinic, most cases are females with the right side of the face. In TCM, the face is the yang meeting of the yang meridians, the facial pain caused by the wind-cold attacking Yangming meridians, which results in qi and blood stagnation in meridians and collaterals, or excessive fire in Yangming meridian going up to the face, or deficiency of qi and blood.

Taking pain relieverand anti-inflammatory drug to treat primary trigeminal neuralgia in Western Medicine, the side effect is strong and the effect is very limited. Acupuncture is better in treating pain disease.

Explanation of the points

Taking body needle as the main therapy, selection of points in combination with nearby points and remote points, Yintang (EX-HN 3), Yingxiang (LI 20), Yifeng (TE 19),Neiguan (PC 6),Hegu (LI 4), Taichong (LR 3).

Manipulation

Take reinforcing and reducing method as the main manipulation.

Frequency, duration and treatment outcome

Twice a week. Completely recovery after treated 9 times.

Personal experience in treating trigeminal neuralgia with acupuncture

Select nearby points, along with some points to tranquilize mind and some points based on the patient’s syndrome differentiation. Treatment schedule is no less than twice a week, otherwise it just relieves the pain temporarily, and it’s hard to accumulate curative effects to get complete recovery.

（ 2 ）坐骨神经痛  患者，男，74岁。

主诉：右侧坐骨神经痛1个月。

现病史：无明显诱因1个月前感右臀部疼痛，起先未加以注意，后症状逐渐加重，疼痛下行至右大腿 后部，小腿外侧。疼痛性质为抽紧样、持续性疼痛，与体位无明显关系。不伴有足趾疼痛麻木。当地医 生诊断为“坐骨神经痛”。经消炎药物，物理治疗无效。查：压痛点：环跳（＋＋），殷门（＋），委 中（＋－），阳陵泉（＋）。

舌、脉象：舌黯，脉沉。

诊断：中医诊断：腰腿痛。证型：寒凝经脉。 西医诊断：右侧坐骨神经痛。

治则：祛寒，活血通经。 针灸处方：

主穴：环跳、殷门、委中、阳陵泉、足三里、绝骨。

刺灸法：采用针刺、拔罐和TDP 照射结合的方法进行治疗。取穴为环跳、殷门、委中、阳陵泉、足 三里、绝骨，手法为泻法，配合疼痛局部的拔罐和TDP照射。

辨证分析：坐骨神经痛是指多种病因所致的沿坐骨神经通路（腰、臀、大腿后侧、小腿后外侧及足

Billingual Acupuncture and Moxibustion

外侧），以疼痛为主要症状的综合征，是各种原因引起坐骨神经受压而出现的炎性病变，属于中医学中 的腰腿痛。

取穴依据：早在《灵枢 ·经脉》中就记载了足太阳膀胱经证的病候为：“腰似折，髀不可以屈，腘 如结，踹如裂”。所以坐骨神经痛的病变主要在足太阳膀胱经。主要是由于风寒湿邪闭阻经络，外伤瘀 血内停经络，导致气血运行不畅，不通则痛。所以在临床治疗时也常取足太阳膀胱经的腧穴。

疗程、疗效：每周2次，症状大部分缓解后，改为每周针刺1次，直至痊愈。治疗1次后没有再约治 疗。1年后，他带着妻子来治颈肩痛。才知1次治疗后，他的坐骨神经痛完全消失，1年也没复发，觉得针 灸非常神奇，介绍给他的亲朋好友。

心得：我们在临床体会到，针灸对坐骨神经痛，尤其是非脊柱病变引起的坐骨神经痛（干性坐骨神 经痛），有非常好的疗效。我们有很多患者，多方尝试其他疗法（物理治疗，正骨等），均不效，最终 来尝试针灸治疗，而我们也没有辜负他们的期望，往往3~6次的治疗就可达到消除患者70%~100%的 症状。

Case 2  Sciatica

Steve, male, 74 years old.

Chief complaint

Suffered from right side sciatica for a month.

History of present illness

A month ago, the patient felt pain in right hip without obvious reason. At first he paid no attention to it. The symptom aggravated gradually: The pain spread to the right posterior thigh and lateral leg. Constant pain, no change with the posture and no pain and numbness in toes. Diagnosed as “sciatica” . It did not work after taking medicine and physiotherapy.

Tongue and pulse

Dark tongue, deep and tense pulse.

Diagnosis

TCM diagnosis: Cold accumulation in channels (syndrome differentiation).

WM diagnosis: Sciatica.

Principle of treatment

Dispelling cold, promoting the circulation in the channels.

Prescription

Selection of points: Huantiao (GB 30), Yinmen (BL 37),  Weizhong (BL 40), Yanglingquan (GB 34), Zusanli (ST 36),Juegu (GB 39).

Manipulation

In combination with the needles, cupping and TDP irradiation. Selection of  points Huantiao (GB 30), Yinmen (BL 37), Weizhong (BL 40), Yanglingquan (GB 34), Zusanli (ST 36),Juegu (GB 39), use reducing needle method and cupping on the pain part and partial TDP irradiation.

Differentiation of the syndrome or disease and Explanation of the points

The sciatica means various causes of disease with the result that following sciatic nerve thoroughfare (the waist, hip, thigh side, outside of leg and the lateral feet), take pain as the main symptom, which is inflammation of sciatic nerve due to various reasons causing sciatic nerve to be pressed. Belong to pain in waist and leg in TCM. Because the bladder meridians pass the back and leg, the sciatica is the disease of the bladder meridian. When the wind and cold, or dampness attacks body, it causes qi stagnation in meridians, or blood stasis obstructing channels, which results in pain. So we often select the points of bladder meridian in clinic. Clinical research finds that acupuncture has better effect than other options for sciatica, particularly those caused by nerve disease, not

by disc hernia. Most patients came to our clinic for acupuncture treatment after they tried many therapies, such as physiotherapy and chiropractor. We normally can reduce 70%-100% of their symptoms after 3-6 times of acupuncture treatment.

Frequency, duration and treatment outcome

Twice a week, then once a week after the pain greatly alleviated until completely recovered.

Curative effect

The patient stopped acupuncture treatment after the first-time treatment. After a year, he took his wife to get acupuncture treatment for her pain in neck and shoulder. He told the acupuncturist that his sciatica completely disappeared after that acupuncture treatment, and had not relapsed for a year. He felt the acupuncture was very miraculous and introduced acupuncture to his families and friends.

（ 3 ）细火针治疗坐骨神经痛案

于某，女，41岁，外来工人，2001 年 1 月 2 日初诊。 主诉：腰腿痛4年，近4天来加重。

现病史：腰腿痛4年，时轻时重，1 周前因受凉后复发，近 4天加重。现左侧臀部、大腿后部、小腿 的后外侧呈持续性胀痛难忍，夜间尤甚，屈腿、翻身均受影响，卧床不起。曾接受封闭等治疗无效，前 来就诊。查体：神清，痛苦貌，步履艰难，左侧直腿抬高 30 度，臀部正中、大腿后侧、小腿后外侧压痛 明显，局部无红肿。腰椎X光片无异常。

舌、脉象：舌淡苔白，脉弦紧。

诊断：中医诊断：腰腿痛。证型：寒凝经脉。 西医诊断：右侧坐骨神经痛。

治则：化瘀通络，温经化痰。 针灸处方：

主穴：阿是穴。

刺灸法：取细火针在阿是穴处进行治疗。

辩证分析：诊断为左侧坐骨神经痛。祖国医学认为，该病乃由风寒湿邪侵袭，以致经脉受阻，造成 气血瘀滞而引起“不通则痛”。

取穴依据：细火针针刺相应的有关部位，有疏通经络之功，使其“通而不痛”。其获效立竿见影， 令人满意。但在操作中，应注意在治疗时，要重点突出阿是穴针刺，其配穴可交替酌选有关的1～2个， 甚至弃之不用。阿是穴针刺后，该处的疼痛即相应消失，但有的在下次复诊时痛点又转移他处，此时应 随着转移的痛点进行针刺。

疗程、疗效：细火针治疗1次，针毕自觉疼痛大减，除小腿肚里略有不适外，诸症基本消失，可轻松 独步行走数米。2天后再次针刺1次，告愈。半年后随访无复发。

Billingual Acupuncture and Moxibustion

Case 3  Sciatica

Female patient, aged 41 years.

Chief complaint

Pain in low back and left low limb of about 4 years.

History of present illness

The patient experienced pain in low back and left low limb of about 4 years. It was worse in the past 4 days, especially at night. It was very difficult for her to bend leg or turn over.

Tongue and pulse

The patient had pale tongue with white coating, indicating cold syndrome.

Her pulse was wiry (xuan) and tense (jin), indicating inward attack of exogenous cold.

Diagnosis

TCM diagnosis: Cold accumulation in channels (syndrome differentiation).

WM diagnosis: Sciatica.

Prescription

Point selection: Ashi points.

Needles

Thin burning needle.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 41-year-old female patient presented with pain in low back and left low limb of about 4 years as her chief complaint. This is classified as “bi syndrome” in Traditional Chinese Medicine. Chinese medical theories state that it results from invasion of wind and cold. As a result, the qi circulation in the meridians is blocked due to pathogenic cold and damp, then leading to pain.

Explanation of the points

We applied thin burning needle to Ashi points, because the burning needle is very effective to cold syndrome.

Frequency, duration and treatment outcome

Once a day for a course of ten days. After 2 treatments, the patient completly recovered. A follow-up telephone call half a year later established that there had been no relapse of symptoms.

（ 4 ）上肢麻木案1

1 患者，女，33岁，初诊时间2006年5月18日初诊。 主诉：左手掌麻木，刺痛2月余。

现病史：2月前无明显原因，逐渐出现左手掌麻木、刺痛，以掌心为主。夜间麻木、疼痛加剧，持物 时，麻木加剧。按揉活动后症状减轻。经物理治疗，未见好转。查：左手手掌色泽无明显改变，痛觉过 敏，浅感觉有所减退。

舌、脉象：舌淡苔白，脉弦。

诊断：中医诊断：痹证。证型：气血不荣。

西医诊断：上肢麻木。

治则：疏筋通络。 针灸处方：

主穴：沿手厥阴心包经循经取穴，大陵、通里、内关、间使。 刺灸法：电针，泻法。

辨证分析：患者，女，33岁，以左手掌麻木、刺痛为主症，每当持物、到夜间时症状加重，按揉活 动后疼痛减轻，属于中医学“痹证”范畴。中医学理论认为，经络具有濡养经脉。运行气血的作用，如 果经络阻滞，则出现“不通则痛”的症状。患者舌淡苔白，脉弦，证型为气血不荣型。

取穴依据：因其主要症状在掌心，属于手厥阴心包经循行的部位，因此在治疗上沿手厥阴心包经循 经取穴。

疗程、疗效：6次治疗后症状消失。随访半年未复发。

Case 4  Upper limb numbness

Female patient, aged 33 years.

Chief complaint

Numbness of the lefthand and stabbing pain for 2 months.

History of present illness

The patient first felt numbness and pain in her lefthand for no apparent reason two months ago. She mainly felt the numbness and stabbing pain in the centre of her left palm. The symptoms became worse at night and while holding heavy things, but lessened after activity or massage. Physiotherapy was ineffective.

Physical examination

The colour of the left palm was normal. The patient had hyperalgesia and decreased sensitivity to touch.

Tongue and pulse

The patient’s tongue was pale with a white coat and her pulse was wiry.

Diagnosis

TCM diagnosis: Bi Syndrome (qi and blood failing to nourish the tendons).

WM  diagnosis: Upper limb numbness.

Prescription

Point selection: The pathway of the pericardium Hand-Jueyin channel was followed using Daling (PC 7), Neiguan (PC 6),Jianshi (PC 5),Ximen (PC 4).

Needles

Electric needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 33-year-old female patient presented with numbness and stabbing pain in her left palm as her chief complaint. The symptoms were aggravated by holding things at night, but eased after activity and massage, which is classified as “bi syndrome” in Traditional Chinese Medicine. Traditional Chinese medicial theories state that the meridians and collaterals nourish the vessels and carry qi and blood. If the meridians and collaterals stagnate, then

Billingual Acupuncture and Moxibustion

the symptoms of “blockage then pain” appear. The patient’s pale tongue with its white coat and her wiry pulse indicate that the syndrome differentiation was qi and blood failing to nourish the tendons.

Explanation of the points

As the symptoms of numbness and stabbing pain mainly lay in the palm of the hand, following the pathway of the pericardium meridian, the main points selected should focus on the acupoints of the pericardium meridian.

Frequency and duration

The patient was treated twice a week until completely recovered. The symptoms disappeared after six treatments.

（ 5 ）上肢麻木案 2

Mrs Deirdre Mcfarlane，54岁。初诊时间：2006年6月6日。 主诉：双手掌麻木，刺痛半年余。

现病史：半年前无明显原因逐渐出现双手掌麻木、刺痛，症状逐渐加重。持物、及夜间症状加重。 经当地医院物理治疗，无效。寻求针灸治疗。查双手掌色泽无明显改变，功能正常，浅感觉有所减退。

舌、脉象：舌红少苔，脉细。

诊断：中医诊断：痹证。证型：脉络痹阻。 西医诊断：上肢麻木。

治则：疏筋通络。 针灸处方：

主穴：沿手厥阴心包经循经取穴，大陵、通里、内关、间使。 刺灸法：电针，泻法。

辨证分析：患者，女，54岁，以双手掌麻木，刺痛为主症，持物、夜间时症状加重，属于中医学 “痹证”范畴。中医学理论认为，经络阻滞不能濡养经脉，运行气血，则出现“不通则痛”的症状。患 者舌红少苔，脉细，证型为脉络痹阻型。

取穴依据：因其主要症状在掌心，属于手厥阴心包经循行的部位，因此在治疗上沿手厥阴心包经循 经取穴。

疗程、疗效：每周2次，8次为1疗程。1个疗程后症状消失。

Case 5  Upper limb numbness

Female patient, aged 54 years.

Chief complaint

Numbness and stabbing pain in both hands for 6 months.

History of present illness

The patient felt numbness and stabbing pain in both hands for no apparent reason for half a year. The symptoms gradually worsened, especially when the patient held something at night. Physiotherapy at the local hospital was ineffective. The patient decided to try acupuncture therapy.

Tongue and pulse

The patient’s tongue was red with a thin coat, and her pulse was thready.

Diagnosis

TCM diagnosis: Bi Syndrome (qi and blood failing to nourish the tendons).

WM  diagnosis: Upper limb numbness.

Prescription

Point selection: The symptoms followed the pathway of the pericardium of Hand-Jueyin channel, therefore points were selected from the same channel: Daling (PC 7),Neiguan (PC 6),Jianshi (PC 5),Ximen (PC 4).

Needles

Electric needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease and explanation of the points

Please refer to Case 4, “Upper limb numbness” .

Frequency, duration and treatment outcome

Twice a week for 8 weeks constituted one course of treatment. After one course of treatment, the symptoms disappeared.

13.4.2 中枢神经系统病变

13.4.2.1  脑血管疾病案

脑血管疾病是指由各种原因导致的脑血管疾病的总称［1］ 。是发生在脑部血管，因颅内血液循环障 碍而造成脑组织损害的一组疾病，一般分为缺血性和出血性两类，包括脑出血、蛛网膜下腔出血、脑梗 塞、脑血栓、短暂性脑缺血发作等。中医“卒中”和“中风”都属于脑血管疾病，是以猝然昏倒，不省 人事，伴发口眼歪斜、语言不利、半身不遂或无昏倒而突然出现半身不遂为主要症状的一类疾病。

中医认为中风多是在内伤积损的基础上，又因外邪侵袭、饮酒饱食、情志不遂或劳逸失度等触发， 引起脏腑阴阳失调，血随气逆，肝阳暴涨，内风旋动，夹痰夹火，横窜筋脉，蒙蔽神窍引起［2］ 。西医认 为本病的根源是高血压、脑血管壁的粥样硬化，致使血管腔变狭窄或形成夹层动脉瘤，造成血管破裂或 堵塞，使脑血液循环障碍，形成部分脑组织缺血、水肿等病理改变，导致神经功能障碍。

针灸治疗中风疗效较满意，尤其对神经功能的康复有促进作用。张沛霖［3］通过实验研究表明针刺手 足少阳经穴可有效改善大脑前动脉、大脑中动脉的血流状态，有利于恢复基底节区的供血，改善神经功 能，减少病残率，临床疗效确切。

参考文献

［ 1 ］贾建平，陈生第 ．神经病学［M ］．北京：人民卫生出版社，2013. ［2］周仲瑛．中医内科学［M ］．北京：中国中医药出版社，2007.

［3 ］张建梅．张沛霖主任学术思想、临床经验总结及治疗急性基底节区脑梗塞临床研究［D ］．云南中医学院硕士论文， 2011.

（ 1 ）急性脑梗死案

彭某，男性，55岁，工程师，2005年2月8日入院。 主诉：右侧肢体活动不利3天。

现病史：2005年2月8日吃晚饭时，突感右侧肢体乏力、麻木。赴附近医院就诊，诊断为脑梗死， 经过门诊治疗观察，症状无改善，于2006年1月8日来院住院治疗。入院症见：神清，右上肢瘫痪，

Billingual Acupuncture and Moxibustion

不能活动，右下肢活动不利。跛行，伴右口角麻木。体温36.1度，呼吸19次/分，脉搏76次/分，血压 140/80mmHg。右上肢肌力0级，肌张力下降，腱反射减弱；右下肢肌力4级，肌张力正常，腱反射稍亢 进，霍夫曼氏征阳性，巴彬氏征弱阳性。CT检查示：左基底节区腔隙性梗死。在患者百会穴、右曲池穴 下1寸及右足三里穴处探及腧穴热敏化现象。

舌、脉象：舌质淡，苔薄白，脉细涩。

诊断：中医诊断：中风。证型：气虚血瘀，脉络阻滞。 西医诊断：急性脑梗死。

治则：益气活血，疏经通络。 针灸处方：

主穴：梁丘、足三里、曲池、百会。

刺灸法：用艾条悬灸百会穴时，患者感觉热流灌注颅内，继则向四周扩散，左侧脑部明显多于右 侧。灸感持续30分钟后，热流回缩至体表，施灸点处头皮有灼热感，遂结束该点施灸。灸右曲池穴下1寸 与右足三里穴处热敏化穴，两穴同时施灸。曲池穴下1寸处出现热流入里后沿手阳明经感传，先上行至肩 部，继返回下行至食指末端；足三里穴处热流向下传导至足背，与足阳明经感传路线基本吻合，施灸约 20分钟后，热感回缩至施灸点，施灸点出现体表灼热感，乃停灸，完成1次治疗。

辨证分析：西医诊断为急性脑梗死，属于中医学的“中风”范畴。患者为缺血性中风，其主要病机 为气血运行不畅，气虚血瘀，脉络阻滞。舌质淡主气血两虚、阳虚，白苔主表证、寒证。脉细主气血两 虚，诸劳虚损，伤寒、痛甚及湿邪为病；涩主伤津、血少、痰食内停、气滞血瘀。

取穴依据：近年临床研究发现，缺血性中风患者，常可在头部及患肢体表出现腧穴热敏化反应，艾 灸热敏化穴可激发灸性感传，气至病所，改善颅脑及患肢局部微循环，以改善临床症状。百会穴为诸阳 之会，艾灸此穴可鼓舞阳气，醒神开窍；梁丘、足三里、曲池均为阳明经腧穴，取阳明经热敏化穴作为 治疗点，乃取该经多气多血之义，以达益气活血、疏经通络之效。热敏化穴艾灸疗法是一项全新的针灸 治疗方法。该法操作简便，疗效显著，无副作用，值得进一步研究与推广。

疗程、疗效：第二天患者右上肢即可抬高及胸，下肢行走正常。继续按前法施灸，每天1次，共10 次。症状逐渐消失，10天后肢体活动正常，右上、下肢肌力5级，肌张力正常，腱反射正常，痊愈出院。

Case 1 Acute cerebral infarction

Male patient, aged 55 years.

Chief complaint

Right-sided hemiparesis of about 5 days’ duration.

History of present illness

2 days ago, while the patient was having dinner, he suddenly experienced numbness and weakness of his right limbs. His symptoms were improved after receiving treating in the local hospital for 3 days. Examination on admission: He was conscious, body temperature 36.1,breathe rate 19/minute, pulse rate 76/minute, blood pressure 140/80 mmHg. Neurological examination showed signs of right-sided facial paralysis of the central type. Right upper limb complete paralysis without activity, the right lower limb hemiparalysis with disadvantageous activity. The computed tomography revealed evidence of cerebral infarction.

Tongue and pulse

The patient had pale tongue with white coating, indicating deficiency qi with cold pathogenic inside body. His pulse was thready (xi) and unsmooth (se) indicating blood stasis due to deficiency qi.

Prescription

Point selection: Liangqiu (ST 34),Baihui (GV 20), Zusanli (ST 36),Quchi (LI 10).

Manipulation

Moxibustion with moxa roll.

Differentiation of the syndrome or disease

The 55-year-old male patient presented with right-sided hemiparesis as his chief complaint. This is classified as “stroke” in Traditional Chinese Medicine. Chinese medical theories state that stroke is related to interior wind, phlegm, stasis and fire. Because of the blood stasis due to deficiency qi, it failed to nourish meridians and collaters, with the result of palsy.

Explanation of the points

The recent years’ clinical researches discovered that some hot sensitive points were found in some patients with the ischemia stroke, if applying moxibustion to these points, which could stimulate the meridian-qi, and the patient could feel the hot feeling spread to diseases area, which could improve the microcirulation of brain and limbs. Baihui (GV 20) tonifies yang to promote the circulation of qi and blood. Liangqiu (ST 34), Zusanli (ST 36) and Quchi (LI 10) are the points of Yangming meridians.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After 20 treatments, the patient completly recovered.

（ 2 ）延髓背外侧综合征案

林某，男，53岁，农民，2003年6月23日住院。 主诉：左侧肢体麻木无力伴吞咽困难5天。

现病史：高血压病史多年，5天前因劳累，突发左侧肢体麻木无力，头晕。头部 MRI示：延髓左侧梗 死，小脑胼胝体膝部左侧梗死。血压180/120mmHg，心率95次/分，神清，头晕，吞咽困难，语声嘶哑。 双瞳孔不等大，右侧约为2.5mm，左侧为2mm，光反射存在，双眼球水平震颤，左眼睑下垂，左侧面部少 汗，咽反射减弱，左侧面部及右侧肢体痛温觉消失，左侧肢体肌力Ⅳ级，右侧肢体肌力Ⅴ级，左侧指鼻 试验阳性，左侧巴氏征阳性。喉科检查提示：左侧声带不全麻痹。

舌、脉象：舌黯，苔黄腻，脉弦滑。

诊断：中医诊断：中风。证型：痰瘀内阻。 西医诊断：脑梗死（延髓背外侧综合征）。 治则：醒脑开窍，疏通经络，利关通窍。

针灸处方：

主穴：内关、人中、三阴交、风池、翳风、完骨。

辅穴：廉泉、睛明、四白、阳白、攒竹、太阳、头皮针晕听区。

刺灸法：严格按照醒脑开窍针刺法要求规范操作。睛明穴常规消毒后，令其目睛下视，在目内眦 0.33cm处垂直进针1.65~3.3cm，捻转平补平泻手法，以眼球酸胀为度；四白穴直刺1.65cm，捻转平补平泻 手法，令局部酸胀为度；攒竹穴沿皮刺向鱼腰穴，捻转泻法，以酸胀为度；阳白沿皮刺向睛明穴，捻转 平补平泻法；太阳穴直刺1.65~3.3cm，捻转平补平泻手法，以酸胀为度；廉泉穴垂直进针3.3~4.9cm，捻转 平补平泻法，令局部酸胀为度；头皮针晕听区，在晕听区间隔1寸（同身寸）下针，斜刺至帽状腱膜，均 施小幅度高频率捻转补法，捻转频率为120次/分，施术3分钟，每日针刺2次。

辨证分析：诊断为脑梗死（延髓背外侧综合征），属于中医学“中风”范畴。治则为醒脑开窍，疏

Billingual Acupuncture and Moxibustion

通经络，利关通窍。缺血性延髓麻痹是脑卒中重要的并发症之一，进行性延髓麻痹为运动神经元疾病的 一个类型，主要累及后组颅神经，病变侵及脑桥和延髓运动神经核，出现构音不清、饮水呛咳、吞咽困 难等症。治疗关键应施以醒脑开窍、通关利窍、疏理经筋之法。舌黯多主瘀血内阻，黄腻苔多主湿热内 蕴。弦主肝胆病，诸痛症，痰饮；滑主痰饮、食滞、实热，亦是青壮年的常脉，妇人的孕脉。

取穴依据：取内关、人中调神导气，三阴交以滋补足三阴经；加之风池、翳风、完骨可改善椎—基 底动脉的血流供应，降低外周阻力，降低颈部软组织的紧张状态，从而改善脑干延髓的血液循环，恢复 脑干的传导和反射功能；廉泉、金津、玉液、咽部点刺具有利机关、熄风通窍之作用，配以口轮匝肌、 眼肌、颊肌的经筋透刺和排刺，疏理经筋，临床可收到理想效果。

疗程、疗效：7天后患者饮水咳呛、吞咽困难症状较前减轻，20天后左侧肢体无力较前减轻，头晕好 转，吞咽及肢体运动功能好转。

Case 2  Wallenberg syndrome

Male patient, aged 53 years.

Chief complaint

A left-sided hemiparesis and dysphagia of about 5 days ’ duration.

History of present illness

The patient had hypertention history for 5 years. He experienced numbness and weakness of his left limbs, together with dizziness and dysphagia 5 days ago. He had no loss of consciousness. Nuclear magenetic resonance imaging revealed evidence of cerebrovascular thrombosis. Neurological examination showed as follows: The sizes of pupils were not symmetrial; nystagmus; left-sided blepharoptosis; there was hemihyposthesia. Laryngoscopy showed evidence of left-sided semiparalysis of vocal cord.

Tongue and pulse

The patient’s tongue was dark with yellow and greasy coating and his pulse was wiry (xuan).

Prescription

Point selection

Main points: Neiguan (PC 6),Renzhong (GV 26),Sanyinjiao (SP 6), Wangu (GB 12),Fengchi (GB 20) and Yifeng(SJ 17)

Additional Points: Lianquan (CV 23), Jingming (BL 1), Sibai (ST 2), Yangbai (GB 14), Cuanzhu (BL 2), Taiyang (extra point),dizzry area (scalp acupuncture),Jinjing (extra point), Yuye (extra point).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 53-year-old male patient presented with a left-sided hemiparesis and dysphagia of about 5 days ’ duration as his chief complaint. The sizes of his pupils were not symmetrial; he had nystagmus, left-sided blepharoptosis and hemihypesthesia. These signs and symptoms are classified as “stroke” in Traditional Chinese Medicine. Chinese medical theories state that the pathological changes vary quickly like the wind, therefore it is also called “wind stroke” . It is usually caused by deficiency of the spleen-yang which leads to production of damp phlegm,and deficiency of liver-yin which leads to the excess of liver-yang. The patient’s tongue was dark with yellow and greasy coating and his pulse was wiry (xuan), indicating internal blockage of blood stasis and phlegm, transformation of liveryang into wind.

Explanation of the points

Renzhong (GV 26) is used to promote resuscitation. Neiguan (PC 6) clears the mind by its action on the brain and heart (to which the pericardium is related within the terminal yin) and moves blood and qi. Sanyinjiao (SP 6) nourishes blood andyin; it moves blood and eliminates stasis. Wangu (GB 12),Fengchi (GB 20) and Yifeng (SJ 17) are used to dredge the obstruction of blood and qi in head. Lianquan (CV 23) relieves dysphagia, Jingming (BL 1), Chuanzhu (BL 2), Yangbai (GB 14) and Sibai (ST 2) help to lift up eyelid and adjust size of pupil. Taiyang (extra point) clearsheat and supresses yang. Dizzry area (scalp acupuncture) helps to dredge obstruction of collaterals,Jinjing (extra point) and Yuye (extra point) move blood to relievedysphagia.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After 20 treatments, his symptoms improved. 13.4.2.2  其他病症

（ 1 ）脑外伤后遗症案

周某，男，36岁，工人。2003年9月12日入院。 主诉：四肢活动不利两月余。

现病史：两个月前自6楼坠落，急送至某医院，昏迷，呼吸不规则，心率100次/分钟，双瞳孔等大等 圆，光反射存在，双侧巴氏征阳性。头部核磁共振成像（MRI）示：重型颅脑损伤，原发性脑干损伤， 蛛网膜下腔出血。经气管插管、脱水、抗炎、止血、促醒等治疗，1个月后患者清醒，左侧肢体全瘫，右 侧肢体活动不利，时发癫痫。为进一步治疗，转入针灸特需病房。查体：神志清楚，表情淡漠，反应迟 钝，语言欠流利，时有烦躁，记忆力差，计算能力低下。左上肢全瘫，手无功能，肌力0级；左下肢平 移，肌力Ⅱ级；右上肢可活动，手握力尚可，肌力Ⅳ级；右下肢肌力Ⅲ级；双足内翻，肌张力高，生理 反射正常，左霍夫曼征阳性，其余病理反射未引出。小便偶有失禁，纳可，多寐。

舌、脉象：舌红，少苔，脉弦滑。

诊断：中医诊断：损伤出血性脑病。证型：瘀血阻络。

西医诊断：脑外伤后遗症案。 治则：醒脑开窍，疏通经络。 针灸处方：

主穴：内关、人中、三阴交、极泉、尺泽、委中、风池、完骨、天柱。 配穴：合谷、丘墟透照海，合谷针向三间。

刺灸法：治以醒脑开窍通络。配穴加合谷、丘墟透照海，合谷针向三间，提插泻法，使手指抽动为 度；丘墟透照海进针 8.75~9.9cm，施捻转泻法。

辨证分析：诊断为脑外伤后遗症，属于中医学中的损伤出血性脑病，证型为瘀血阻络。患者高楼坠 落，头部外伤，损及脑府，脑为神明之府，扰乱神明致神不导气，使道闭塞不通，经脉气血运行不畅， 症见语言、肢体、智力功能障碍。舌红主邪热亢盛、热入营血或阴虚水涸、虚火上炎。少苔多主阴虚。 弦主肝胆病，诸痛症，痰饮；滑主痰饮、食滞、实热，亦是青壮年的常脉，妇人的孕脉。

取穴依据：人中穴可开窍启闭，醒元神，调脏腑；内关穴可调整心脏功能，增加脑供氧，以达到 宁心、调血、安神的目的；三阴交穴为肝、脾、肾三经之交会穴，作为醒脑开窍之主穴，可以补足三阴 经、益脑髓、调气血、安神志。在治疗脑外伤方面，尤其应体现以醒脑开窍为主，疏通经络为辅的治疗

Billingual Acupuncture and Moxibustion

原则，以调元神、理气血、通经脉，兼而顾之，对本病起到关键治疗作用。

疗程、疗效：治疗1次后即显效，肢体功能每天均有所改善，7天后肢体运动功能明显恢复，左上 肢可抬至胸前，手指可屈伸，左下肢可直腿抬高30度。半个月后左上肢可抬至头，搀扶下缓慢行走，反 应较前灵活，记忆、计算、语言能力均有明显提高。1个月后可独立行走，好转出院。门诊继续针刺1个 月，生活能基本自理。1年后随访，一切正常。

Case 1  Post-traumatic brain syndrome

Male patient, aged 36 years.

Chief complaint

Palsy in limbs following serious cerebral injury for 2 months.

History of present illness

The patient fell down from the 6th floor 2 months ago. He had loss of consciousness. Nuclear magenetic resonance imaging revealed evidence of serious cerebral injury; brain stem injury; subrachnoid hemorrhage. His symptoms improved after receiving treatment in emergency of the hospital for more than 1 month. He had left- sided palsy and right-sided hemiparesis, together with serial epilepsy. He spoke with difficulty, slow in reaction, bad memory and calculation. Sometimes he was anxious.

Tongue and pulse

The patient’s tongue was red with a little coating and his pulse was wiry (xuan) and slippery (hua).

Prescription

Point selection: Neiguan (PC 6), Renzhong (GV 26), Sanyinjiao (SP 6), Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40), Wangu (GB 12),Fengchi (GB 20), Tianzhu (BL 10),Hegu (LI 4), Qiuxu (GB 40).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 36-year-old male patient presented with left-sided palsy and right-sided hemiparesis following serious cerebral injury as his chief complaint. This is classified as “palsy due to injury” in Traditional Chinese Medicine. Chinese medical theories state that headisregarded as the converging place of all the yang. The patient’s tongue was red with a little coating and his pulse was wiry (xuan) and slippery (hua), indicating blood stasis blocking collaterals and deficiency fire disturbance.

Explanation of the points

Renzhong (GV 26) is used to promote resuscitation. Neiguan (PC 6) calms the mind by its indirect action on the liver (to which the pericardium is related within the terminal yin) and moves blood and qi. Sanyinjiao (SP 6) nourishes blood andyin; it moves blood and eliminates stasis. Jiquan (HT 1), Chize (LU 5) and Hegu (LI 4) are used to treat palsy in arm. Wangu (GB 12),Fengchi (GB 20) and Tianzhu (BL 10) are used to dredge the obstruction of blood and qi in head. Weizhong (BL 40) and Qiuxu (GB 40) are use to treat palsy in leg.

Frequency, duration and treatment outcome

Once a day for a course often days. After seven treatments his symptoms improved. After fifteen treatments

he could walk with the help. After thirty treatments he could walk. Continue to be treated for thirty times, and he could live on himself. A follow-up telephone call one year later established that there had been no relapse of symptoms.

（ 2 ）一氧化碳中毒后遗症案

李某，女，75岁，2004年2月25日住院。 主诉：四肢拘挛1个月。

现病史：患者于2002年2月23日晚使用煤火不慎，次日清晨，家属发现其神昏，二便失禁，急送某 医院，诊为一氧化碳中毒。静脉滴注液体及高压氧治疗，经高压氧治疗10天后神志清楚，行动自如。停 止治疗后3天患者神志恍惚，四肢拘挛，继续给予高压氧治疗，病情不见好转，转入本院。查体：血压 130/80mmHg（1mmHg≈0.133kPa），心率80次/分钟，目睁，少意识，表情淡漠，失语，喉中有痰，查体 不合作，双瞳孔等大等圆，光反射存在，四肢拘挛，肌张力高，肌肉萎缩，无自主运动，肌力0级，腱反 射亢进，病理反射未引出。二便失禁，舌红少苔，脉沉细。2004年3月2日颅脑MRI示：双侧大脑半球脑白 质区弥漫性异常信号影，考虑一氧化碳中毒后改变。

舌、脉象：舌红少苔，脉沉细。

诊断：中医诊断：痉证。证型：毒邪内攻。 西医诊断：一氧化碳中毒。

治则：醒神开窍，熄风通络。 针灸处方：

主穴：内关、人中、三阴交、极泉、尺泽、委中、风池、完骨、天柱。 配穴：风府、合谷、太冲、百会、四神聪、阳陵泉、关元。

刺灸法：风府低头进针，针尖方向指向喉结，用提插泻法，得气以全身或一侧肢体抖动为度，得气 后立即出针。百会、四神聪向后斜刺，与头皮成60度，进针 1.65cm，施平补平泻法1分钟。合谷、太冲直 刺3.3cm，施捻转泻法1分钟。阳陵泉直刺6.6cm，施捻转泻法1分钟；关元直刺6.6cm，施呼吸补法，针感 向会阴部放射，施手法1分钟。在治疗过程中，曾出现肺感染、消化道出血、心力衰竭、低蛋白血症、电 解质紊乱等并发症，一一给予对症治疗。采用上述方法治疗，病情渐趋稳定。

辨证分析：诊断为一氧化碳中毒后遗症，属于中医学“痉证”范畴。证型为毒邪内攻。患者因毒邪 内攻，心窍被蒙，血脉瘀滞，经络受阻，毒热内蕴，耗气伤阴，肝失所养，阳亢生风，发为痉证。舌红 主邪热亢盛、热入营血或阴虚水涸、虚火上炎。少苔多主阴虚。沉主里症，细主气血两虚，诸劳虚损， 伤寒、痛甚及湿邪为病。

取穴依据：方中选内关、人中，有良好的醒神开窍作用，配以督脉与阳维脉的交会穴风府，起到 通脑窍，醒元神，利机关，通经络之效。百会、四神聪有协助主穴，增强醒元神的作用；合谷穴与太冲 穴，一阳一阴，一气一血，一上一下，名为“四关”，两者同用有调气血，和阴阳，平肝潜阳，清火泻 热之功；补关元，可强肾，助关，疏理开合，治疗二便失禁；用足三里、三阴交治疗气血亏耗，起到补 气血，滋肾阴，强后天，充元阴之功；极泉、尺泽、委中可疏理经脉，活血通络。以上治疗，随其转 归，辅穴迥然有别，疗效显著。

疗程、疗效：2个月后神志清醒，可回答简单问题，肢体运动功能好转，肌力Ⅱ~Ⅲ级。巩固治疗7 个月，四肢肌力恢复至Ⅳ级，可缓慢行走，反应较从前敏捷，应答切题，临床痊愈出院。2年后随访， 一 切正常。

Billingual Acupuncture and Moxibustion

Case 2  Sequela of carbon monoxide poisoning

Female patient, aged 75 years.

Chief complaint

Spasm in limbs following carbon monoxide poisoning for 1 month.

History of present illness

The patient had carbon monoxide poisoning. She had loss of consciousness. Nuclear magenetic resonance imaging revealed evidence of serious cerebral injury; brain stem injury; subrachnoid hemorrhage. Her symptoms improved after receiving treatment in local hospital for 10 days, but she had semi consciousness and spasm in limbs after treatment cessation 3 days later. Many treatments were given without avail.

Tongue and pulse

The patient’s tongue was red with a little coating and her pulse was deep (chen) and thready (xi).

Prescription

Point selection: Neiguan (PC6), Renzhong (GV 26), Sanyinjiao (SP 6), Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40), Wangu (GB 12), Fengchi (GB 20), Tianzhu (BL 10), Hegu (LI 4), Taichong (LR 3), Baihui (GV 20), Guanyuan (CV 4),Sishencong (extra points),Fengfu (GV 16), Yanglingquan (GB 34).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 75-year-old female patient presented with spasm in limbs following carbon monoxide poisoning for 1 month as her chief complaint. This is classified as “convulsion” in Traditional Chinese Medicine. Chinese medical theories state that convulsion is caused by toxin attacking Yingfen and Xuefen. The patient’s tongue was red with a little coating and her pulse was deep (chen) and thready (xi), indicating toxin attacking Yingfen and Xuefen, deficiency both qi andyin.

Explanation of the points

Hegu (LI 4) combinated with Taichong (LR 3), they expel interior wind and have specific action in calming spasm. Baihui (GV 20) eliminates interior wind and clears mind. Guanyuan (CV 4) tonifies yang to promote resuscitation. Sishencong (extra points) replenishes marrow. Fengfu (GV 16) eliminates interior wind to clear the mind and stimulate the brain.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After receiving acupuncture treatments for 2 months, her symptoms

improved, and she could answered simple questions, spasm disappeared. Continue to be treated for 7 months, and she recovered completely. A follow-up telephone call 2 years later established that there had been no relapse of symptoms.

13.4.3 嗜睡案

多寐指不分昼夜，时时欲睡，呼之即醒，醒后复睡的病症，亦称为“嗜睡”“多卧”“嗜眠”等， 西医的发作性嗜睡、神经官能症、某些精神病根据其临床症状可归属于本病辨证论治［1］。

中医多认为本病病机关键是湿、浊、痰、瘀困滞阳气，心阳不振；或阳虚气弱，心神失荣［1］ 。而西 医则认为嗜睡的原因多有睡眠剥夺、睡眠片段、原发性觉醒异常、其他（神经系统疾病、精神疾患、药 物所致）［2］。

西医治疗多以对症治疗为主。现代医家运用针灸疗法治疗各种原因引起的嗜睡症，其主穴多选用百 会、四神聪、心俞、神门、三阴交、内关、足三里等［3］ ，也有学者［4］ 运用石氏醒脑开窍法治疗嗜睡患 者，均取得了很好的疗效。针灸治疗效果明显，起到调神醒脑、调和阴阳的作用，使针灸治疗嗜睡症得 到更好的推广。

参考文献

［ 1 ］周仲瑛．中医内科学［M ］．北京：中国中医药出版社，2007 .

［2］黄颜．白天过度嗜睡病因和治疗［J ］．中国现代神经疾病杂志，2006 ，6（ 1 ）：25-29. ［3 ］朱玉 ．针灸治疗嗜睡案例学习心得［J ］．中国医药指南，2014 ，12（6 ）：175-176.

［4］张培东 ．石氏醒脑开窍针刺法治疗嗜睡 78 例［J ］．中医外治杂志，2006 ，15（4 ）：60-61. 

案例

郑某，女，52岁，2002年4月15日就诊。 主诉：嗜睡 6 个月。

现病史：嗜睡6个月，高血压病史9年。家属于6个月前发现患者睡眠时间明显延长，每日达12小时， 每次将其唤醒后不久又睡，精神不振，反应迟钝，多方求治，疗效不佳。查体：生理反射存在，病理反 射未引出。

舌、脉象：舌质红，苔白腻，脉滑。

诊断：中医诊断：多寐。证型：脾虚湿困证。

西医诊断：原发性睡眠增多症。 治则：交通阴阳，调神醒脑。

针灸处方：

主穴：内关、百会、四神聪、三阴交、风池、列缺、脾俞。 配穴：脾俞、足三里、丰隆。

刺灸法：取坐位或俯卧位（手腕和足踝部充分暴露），采用30号2寸毫针。常规消毒后，风池穴采用 指切进针法向对侧眼球方向斜刺1~1.5寸，施捻转补法1分钟；内关穴采用指切进针法（避开体表静脉）， 进针0.5~1寸，捻转手法平补平泻1分钟，令局部酸胀强烈，并向中指放射；三阴交直刺0.5~1寸，施捻转 法1分钟；四神聪穴针与头皮呈30度夹角进针，刺入1寸，小幅度快速捻针2分钟。

辨证分析：嗜睡是意识障碍的表现，现代医学多认为是由脑动脉硬化及颅内高压造成病理性倦睡。 中医认为，本病主要是脾虚湿困，清阳不展及肝肾亏虚，髓海不充而致。

取穴依据：取百会为主穴之一，展清阳而充髓海，使脑海得充，而精、气、神充沛；三阴交为三条 阴经的交会穴，补足阴精，阴中求阳；列缺为手太阴经络穴，又为四总穴之一；内关为手厥阴心包经的 络穴，八脉交会穴，通阴维脉；风池为足少阳与阳维经交会穴，均有良好的醒神及调节睡眠作用；四神 聪为经外奇穴，配伍以上穴位，更增强了醒神开窍之功。

Billingual Acupuncture and Moxibustion

疗程、疗效：每日1次，12日为1个疗程。治疗3次后即感精神好转，经2个疗程治疗，睡眠时间缩短 至8个小时，精神大有好转。随访1年无复发。心得：对多寐症的形成原因，《内经》中以为:“阳气盛则 瞋目，阴气盛则瞑目”，说明多寐系阳虚阴盛所致。因为阳主动，阴主静，阴盛故多寐，《内经》中所 谓“肠胃大而皮肤涩”所致之多寐，是由于中焦阳气不足，脾失健运，不能运化水谷而留于肠胃，致湿 邪内停所致。《脾胃论 ·卷上》中指出：“脾胃之虚，怠惰好卧。”《脾胃论 · 胃虚脏腑经络皆无所受 气而俱病论》：“食入则困倦，精神昏冒而欲睡者，脾亏虚也。”《丹溪心法 · 中湿》:“脾胃受湿，沉 困无力，怠情好卧。”故在针灸治疗中，多选取任督脉以调和阴阳及多气多血之阳明经以调和脾胃后天 之本为主。

Case  Lethargy

Female patient, aged 52 years.

Chief complaint

Lethargy in the last 6 months.

History of present illness

The patient had hypertension history for 9 years. 6 months ago, her family found she slept much more time than before, if they woke her up, after a while she would fall asleep again, together with mental fatigue and respond muff. The symptoms weren’t improved after receiving treatments.

Tongue and pulse

The patient had red tongue with white and greasy coating, indicating internal retention of phlegm-damp. Her pulse was slippery, indicating phlegm.

Prescription

Point selection: Baihui (GV 20), Sanyinjiao (SP 6), Neiguan(PC 6), Lieque (LU 7), Fengchi (GB 20), Sishencong (EX-HN 1),Pishu (BL 20), Zusanli (ST 36),Fenglong (ST 40).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 52-year-old female patient presented with lethargy as her chief complaint. This is classified as “lethargy”in Traditional Chinese Medicine. Chinese medical theories state that this is mainly caused by spleen deficiency with dampness retention, and lucid yang fails to ascend, with the result of insufficient sea of marrow.

Explanation of the points

Baihui (GV 20) tonifies yang to lift spirit. Sanyinjiao (SP 6) stimulates the three-foot-yin meridians. Neiguan (PC 6) strengthens the function of “heart control the spirit” . Lieque (LU 7) stimulates the descending and dispersing of lung-qi. Fengchi (GB 20) clears the brain. Sishencong (EX-HN  1) induces resuscitation. Pishu (BL 20), Zusanli (ST 36) and Fenglong (ST 40) invigorate spleen to dissolve phlegm.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After 3 treatments, the symptoms improved. After 20 treatments,

she recovered completely. A follow-up telephone call a year later established that there had been no relapse of symptoms.

13.4.4 癫证病

中医病名。癫病以精神抑郁，表情淡漠，沉默痴呆，语无伦次，静而多喜为特征。西医学的精神分 裂症、躁狂抑郁症，其临床表现与本病症类似，均可归属于此范围［1］。

近年来，由于生活节奏加快，生活和工作压力增加，使得经济文化水平偏低、地理位置偏僻及年龄 较大的人群患此类精神疾病的患病率不断增加。

中医认为，癫狂的发生与七情内伤、饮食失节、禀赋不足相关，损及心、脾、肝、胆、肾，导致脏 腑功能失调和阴阳失于平秘，进而产生气滞、痰结、郁火、瘀血等，蒙蔽心窍或心神被扰，神明逆乱而 引起神志异常［1］ 。现代医学对其发病机理尚不清楚，近来发现与脑内一些神经递质如儿茶酚胺、5-羟色 胺等多种物质代谢可能有关。

目前临床上多选用第二代抗精神病药物治疗，如氯氮平、奥氮平、利培酮等。且该类药物对于阳性 症状及阴性症状均有一定疗效［2］ 。现代医家运用针灸疗法治疗癫证大多也取得了较好的疗效。其主穴多 选用神门、丰隆、心俞、脾俞，并可配合耳针、电针、穴位注射等治疗［3］。

参考文献

［ 1 ］周仲瑛．中医内科学［M ］．北京：中国中医药出版社，2007 .

［2］潘宇翔 ．第二代抗精神病药的临床运用［C］．生物技术世界，2013 ：72 . ［3］王启才．针灸治疗学［M ］．北京：中国中医药出版社，2003 ：90 .

案例

伍某，男，45岁，2003年3月23日就诊。 主诉：精神抑郁两日。

现病史：因家庭琐事夫妻吵架，悲伤过度，哭泣两天两夜，不吃不喝，出现精神抑郁，表情淡漠， 语无伦次，喃喃自语，经多家医院检查，诊断为精神分裂证。服用中西药（药名不详）后，疗效不佳， 经人介绍求治于针灸疗法。

舌、脉象：舌苔白腻，脉弦滑。

诊断：中医诊断：癫证。证型：痰气郁结。 西医诊断：精神分裂症。

治则：涤痰开窍，养心安神。 针灸处方：

主穴：心俞、肝俞、脾俞、丰隆、神门。

刺灸法：上穴均用平补平泻法，留针15分钟。

辨证分析：属于中医学“癫证”范畴。患者因思虑悲伤过极，肝气被郁，脾失健运而生痰浊，痰浊 阻滞神明而致，正如《证治要诀 ·癫狂》所说：“癫狂由七情忧郁，遂生痰涎，迷塞心窍”，《丹溪心 法 ·癫狂篇》说：“癫属阴，狂属阳，大率多因痰结于心胸间”。故治以疏肝解郁，化痰开窍。

取穴依据：佐心俞、肝俞、脾俞均为背俞穴，共用可开心窍，疏肝郁运脾气；丰隆为足阳明胃经络 穴，神门为手少阴心经原穴，心主神志，丰隆配神门，为原络配穴法，以原络相配来化痰浊而宁心神。

疗程、疗效：每日1次，连用3天。

心得：经上述治疗后，患者情绪明显好转，可进饮食，对答切题，但睡眠较差，多梦，舌苔薄白，

Billingual Acupuncture and Moxibustion

脉弦。此为痰迷心窍，肝郁气滞所致，治以疏肝解郁，豁痰开窍，安神宁心。在原方基础上加内关穴， 内关为手厥阴心包经络穴，与阴维脉相通，可治胃、心、胸疾患，用之可加强镇静、豁痰、安神作用。 留针15分钟，予平补平泻法，连用1周。患者经1周治疗后，神志恢复正常，睡眠饮食尚可，仅体质较 弱。治以扶正固本，补益心脾，取八会穴之膈俞（血会）、膻中（气会）、中脘（腑会），穴位注射， 药液选用当归注射液2ml加黄芪注射液1ml，每穴0.15ml，每日1次，连用5日。患者经上述治疗后，体质恢 复良好，癫证消失。嘱其自我精神调养，避免情志刺激，以免复发。

Case  Schizophrenia

Male patient, aged 45 years.

Chief complaint

Psychic depression of about 2 days.

History of present illness

The patient quarrled with his wife 2 days ago. He cried and didn’t eat any food for 2 days. The family found him with psychic depression, apathetic expression and incoherent speech. Taking some medicine did not help.

Tongue and pulse

The patient’s tongue was pale with white and greasy coating; his pulse was wiry (xuan) and smooth (hua).

Prescription

Point selection: Xinshu (BL 15), Ganshu (BL 18),Pishu (BL 20), Shenmen (HT 7),Fenglong (ST 40).

Needles

Filiform needles.

Manipulation

Reducing needle technique.

Differentiation of the syndrome or disease

The 45-year-old male patient presented with psychic depression, apathetic expression and incoherent speech as his chief complaint. This is classified as “depressive psychosis” in Traditional Chinese Medicine. Chinese medical theories state that depression is caused by worry and emotional depression, which may damage the liver and spleen, then lead to dysfunction of the liver in maintaining the free flow of qi and spleen in transportation and transformation. As a result, the accumulated fluid due to impaired transportation, turns into phlegm, which goes upward to disturb the mind. The patient’s tongue was pale with white and greasy coating, his pulse was wiry (xuan) and smooth (hua), indicating phlegm misting heart.

Explanation of the points

Xinshu (BL 15) promotes the function of Heart to calm mind. Ganshu (BL 18) regulates the movement of qi. Piahu (BL 20) tonifiesspleen to remove phlegm. Shenmen (HT 7) promotes heart meridian qi. Fenglong (ST 40) removes the phlegm.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After 7 treatments, his symptoms disappeared.

13.4.5 重症肌无力（眼肌型）案

重症肌无力（MG）是一种由神经—肌肉接头处传递功能障碍所引起的自身免疫性疾病，临床主要表 现为部分或全身骨骼肌无力和易疲劳，活动后症状加重，经休息后症状减轻。中医称之为“痿证”，指 肢体筋脉迟缓，软弱无力，不能随意运动，或伴有肌肉萎缩的一种病症［1］。

眼肌型重症肌无力任何年龄均可起病，有报道称［2］其发病具有易变性、波动性、缓解—复发交替性 的特点。

中医病因有感受湿热毒邪、饮食毒物所伤、久病防劳、跌仆瘀阻，其病机之本为五脏受损，津精不 足，气血亏耗，筋脉失养，日久则发为本病。现代医学重症肌无力的发病原因分两大类， 一类是先天遗 传性，极少见，与自身免疫无关；第二类是自身免疫性疾病，最常见。

针灸在治疗眼肌型重症肌无力方面有独特的优势，有学者［3］ 以申脉、照海为主穴辨证治疗重症肌无 力（眼肌型）单眼总有效率为 100%，双眼总有效率80%；另有学者［4］ 取太阳、睛明、承泣、瞳子髎、 风池、眼睑下垂穴（经验穴，即下垂之眼睑）为主穴治疗该病，总有效率 92.9%；另外，针刺配合中药、 灸法、新斯的明等均可取得较好的疗效［5］。

参考文献

［ 1 ］周仲瑛．中医内科学［M ］．北京：中国中医药出版社，2007.

［2］马晓伟．眼肌型重症肌无力临床分析［J ］．中国现代神经疾病杂志，2011 ，11（ 1 ）：88-92.

［3 ］任晋玉．申脉、照海为主穴针刺治疗重症肌无力眼肌型 9 例［J］．江苏中医药，2014，46（6 ）：59. ［4］胡玉茹，蔡春沉. 针刺治疗眼睑下垂 28 例［J ］．上海针灸杂志，1999 ，18（5 ）：44.

［5］徐志凤．针灸治疗眼肌型重症肌无力临床进展［J ］．山东中医杂志，2008，27（ 12 ）：850-853.

案例

艾某，女，65岁，2006年5月8日初诊。 主诉：双上眼睑上抬无力3个月。

现病史：3月前无明显原因逐渐出现双上眼睑上抬无力，开始未加以注意。后症状逐渐加重，睁眼时 间长时上眼睑会逐渐下垂，需时时用外力帮助上眼睑上抬，否则视物自觉有障碍。于云南省第二人民医 院确诊为重症肌无力（眼肌型），予溴比斯的明口服。查：双上眼睑肌肉松弛、下坠，其他部位肌肉无 明显异常。困倦、乏力，寐多。饮食可，饮水无发呛，二便调。

舌、脉象：舌淡边有齿痕苔薄白，脉细。

诊断：中医诊断：肉痿。证型：气血虚弱。 西医诊断：重症肌无力（眼肌型）。

治则：补气养血，提气升阳。 针灸处方：

主穴：三阴交、攒竹、丝竹空。 配穴：百会、足三里、养老。

刺灸法：三阴交、足三里均采用温针灸法，以局部感到温热为度。余穴均用平补平泻手法。起针后 脾俞、肺俞穴拔罐。

辨证分析：患者双上眼睑上抬无力，目平视时上眼睑会不自主逐渐下垂，需时时用手指去支撑上 眼睑，否则视物困难，属于中医学中的“肉痿”范畴。《素问痿论》：“脾气热，则胃干而渴，肌肉不 仁，发为肉痿。”将病机归为脾，因脾主肌肉，清阳宜升。在《诸病源候论 · 睢目候》则将痿证进一步

Billingual Acupuncture and Moxibustion

细化，对于痿证发于眼部的描述尤为详尽，其具体描述如下：临床表现为“其皮缓纵，垂复于目，则不 能开”，病因为“血气虚则腠理开而受风，风客于睑肤之间，所以其皮缓纵，垂复于目”。

《太平圣惠方》首先提出五轮，后世逐渐发展完善为五轮学说，在五轮学说中，上、下眼睑为肉 轮，属脾。患者在除双眼睑上抬无力的主症外，还伴有困倦、乏力、寐多等症，而且舌淡边有齿痕苔薄 白，脉细，这些均表明其气血虚弱，尤其是脾气不足，其升阳力量不够。运用针灸疗法治疗痿证已有很 久的历史，也有较系统的治疗。《内经》中提到“痿”病，与重症肌无力颇为类似，并提出“因其所 在，补分肉间”（《灵枢 · 口问》）的针灸之法。故在治疗上应以补益脾气升阳为主。

取穴依据：方中主穴选用三阴交、攒竹、丝竹空。其中三阴交为足太阴脾经腧穴，根据《眼科 锦囊》：“上睑低垂，轻症者灸三阴交”，故取三阴交并用温针灸。攒竹穴位于眉头凹陷处，为足太 阳膀胱经气初起之处；丝竹空位于眉梢凹陷处，为手少阳三焦经的止穴，两穴分在眉头、眉尾，又分 别为起穴和止穴，可以疏散上焦风邪，疏通上眼睑局部气血。三阴交位置“在内踝上三寸，骨下陷者 中”（《针灸甲乙经》），为足太阴、厥阴、少阴之会。《千金方》载：“三阴交主劳淋，妇人下血泄 痢。”配穴中取人之巅的百会穴，取其升阳益气作用；取足太阴脾经的表里经足阳明胃经腧穴足三里补 脾益气；手太阳小肠经腧穴养老为治疗眼疾的经验穴，养老为小肠经郄穴，小肠经循于目眶下，《百 症赋》：“目觉硫硫，急取养老，天柱”。在脾俞、肺俞拔罐是根据《针灸甲乙经 · 热在五脏发痿第 四》：“治之各补其萦而通其俞，调其虚实，和其逆顺”，以及杨继洲认为痿病为多因素相并为患， 《针灸大成》：“有湿热，有痰，有无血而虚，有气弱，有瘀血。针中渚、环跳，灸三里、肺俞”。

疗程、疗效：每天1次，每周5次，10次1疗程。治疗6次后，患者眼睑上抬基本正常。

心得：《素问 ·至真要大论》：“谨察阴阳所在而调之，以平为期。”在治疗时取三阴交，温针灸 时应以局部温热为度。本病的治疗应以早期治疗为主，适度的针感是取得疗效的关键。

Case  Blepharoptosis in myasthenia gravis

Female patient, aged 65 years.

Chief complaint

Blepharoptosis for 3 months.

History of present illness

She gradually felt it difficult to lift up her eyelids within last 3 months. She didn’t pay much attention to it at the beginning, but it became worse recently. Her Eyelids would drop slowly to disturb insight while opening eyes for long time; she had to lift up eyelids by hands. Physical examination revealed evidence of blepharoptosis in myasthenia gravis. She felt weary, tired and sleepy.

Tongue and pulse

The patient had pale tongue with tooth mark, with white and thin coating, and her pulse was thread (xi).

Diagnosis

TCM diagnosis: Muscular atrophy-flaccidity (diagnosis of disease). Deficiency both qi and blood (syndrome differentiation).

WM diagnosis: Blepharoptosis in myasthenia gravis.

Principle of treatment

Invigorating qi and nourishing blood. Lifting qi and raising yang.

Prescription

Main points: Sanyinjiao (SP 6), Sizukong (TE 23), Cuanzhu (BL 2).

Additional points: Baihui (GV 20), Zusanli (ST 36), Yanglao (SI 6).

Manipulation

Using warming needle moxibustion on Sanyinjiao (SP 6) and Zusanli (ST 36), the patient had partial warming as the needle sensation. Use uniform reinforcing and reducing method on the other points. Cup on Pishu (BL 20) and Feishu (BL 13) after removing the needles.

Differentiation of the syndrome or disease

The 65-year-old female patient presented with blepharoptosis for 3 months as her chief complaint. This is  classified as “muscular atrophy-flaccidity” in Traditional Chinese Medicine. Plain Questions of Huangdi’s Canon  of Medicine says: “If there are problems of stomach and spleen, it will be result of muscular atrophy- flaccidity.” Chinese medical theories state that spleen nourishes muscles and sends clarity-yang upward. Blepharoptosis  in myasthenia gravis was recorded in detail in Treatise on Causes and Symptoms of Diseases. Taiping Sacred  Remedies was firstly named five-orbiculi, which gradually developed into five-orbiculi theory. The top and down  eyelids are muscular-orbiculi according to five-orbiculi theory, and they belong to spleen. The history has been  long to use acupuncture and moxibustion in muscular atrophy-flaccidity, and the therapy methods have developed  completely now.

Explanation of the points

Prescription Of the Ophthalmology says: “Applying moxibustion to Sanyinjiao (SP 6) in upper eyelids dropping.” Cuanzu (BL 2) is located in the hollow place of the front of eyebrow; it is the place where the bladder meridian-qi starts. Sizukong (TE 23) is located in the hollow place of the end of eyebrows; it dredges the partial qi and blood of eyelids. Baihui (GV 20) lifts qi and raises yang. Zusanli (ST 36) tonifies spleen-qi. Yanglao (SI 6) is the cleft point; it is the experiential point in eye diseases. Cupping is given on Pishu (BL 20) and Feishu (BL 13) to strengthen muscle according to Great Compendium of Acupuncture and Moxibustion.

Frequency, duration and treatment outcome

Once a day, after treated with acupuncture for 6 times, she recovered completely.

Experience

Conduct moxibustion on Sanyinjiao (SP 6) until the patient had warming feeling in low abdomen.

13.4.6 癔病

 癔病又称歇斯底里，其产生有明显的精神因素，如生活事件、内心冲突或强烈的情绪体验、暗示 或自我暗示等，无相应的器质性基础。其临床表现属中医“脏躁”“郁证”“奔豚气”“梅核气”“气 厥”“百合病”“失音”“暴聋”等范畴。其病因总以情志所伤、脏气郁结、气机紊乱、阴阳失调、心 失所主等［1］。

现代研究表明针刺治疗癔病有独特疗效，治疗时以醒脑开窍为原则，多采用醒脑开窍法［2］ 、粗针弹 拨法［3］、独取涌泉法［4］等等方法施以强刺激治疗。

参考文献

［ 1 ］鲍远程．现代中医神经病学［M ］．北京：人民卫生出版社，2003 .

［2］杨洸 ．醒脑开窍针刺法治疗癔病应用体会［J ］．中医临床研究，2013 ，5（ 15 ）：48-49 .

［3］张秀芬．粗针弹拨法治疗癔病 228 例疗效分析［J ］．世界中西医结合杂志，2011 ，6（ 12 ）：1061-1063 .

Billingual Acupuncture and Moxibustion

［4］巴艳东 ．针刺涌泉治疗癔病性失语［J ］．针灸临床杂志，2010，26（9 ）：35 .

（ 1 ）癔病性运动功能障碍案

李某，男，16岁，学生。2002年5月9日初诊。

主诉：头昏、不能行走2月余，阵发性抽搐、角弓反张1月余。

现病史：2002月3月5日晚，患者在被老师责骂、侮辱后，突然晕倒，送至宿舍后醒来，进食后睡 去。第2日下午出现头昏、双下肢活动不利，立即送至乡卫生院，以“感冒”收治，予静脉输注药物（具 体不详）。发病第5天，转院至县医院，以“头昏原因待查”收治，行血常规、心电图、脑电图、头颅 CT检查，无明显异常，给予安神药物治疗。发病第10天，出现阵发性抽搐、角弓反张，每次发作持续 10～20分钟。转院至昆明医学院第一附属医院，以“精神分裂症”收入院，给予常规安神药物治疗，症 状有所改善，偶尔能行走，每日19：00点则出现抽搐、角弓反张，持续15分钟。住院56天，医生建议出 院休养治疗。回家后症状又加重，不能站立，每日阵发性抽搐、角弓反张发作5～6次。发病第69日，经 人介绍来我处求诊。背入病房，精神萎靡，神情呆滞，面色苍白，形体瘦削，不愿言语，反应迟钝，四 肢肌张力正常，腱反射低下，四肢肌正常，纳差，二便正常。

舌、脉象：舌淡苔薄白，脉弦。

诊断：中医诊断：郁证（风痱）。证型：气机逆乱。 西医诊断：癔病性运动功能障碍。

治则：安神，定魄，理气。 针灸处方：

主穴：肝区（眼针）、三焦区（眼针）、百会。 配穴：足三里、三阴交、内关、太冲。

刺灸法：手法为平补平泻。针后医者用言语暗示患者已经好了，鼓励患者站立起来。患者犹豫了一 下，摇摇晃晃站起，医者牵其手，患者很配合，开始行走，起初步伐不协调，双下肢无力，慢慢走了10 余分钟后，逐渐步伐协调起来，嘱其父牵患者手继续行走了约1小时。让患者平躺于床，针刺足三里、三 阴交、内关、太冲，平补平泻，留针半小时。起针后，嘱患者自行走回住处。

辨证分析：患者年仅16岁，因受老师责骂、侮辱，而出现晕厥，随后发展为头昏、双下肢活动不 利，并伴有阵发性抽搐，属于中医学“郁证”“骨痿”“风痱”范畴。患者为农村孩子，地处偏僻之 处，平素胆小，做错事，受到老师的责骂侮辱后，又惊又恐又悲，《素问 ·举痛论》：“怒则气上， 喜则气缓，悲则气消，恐则气下，惊则气乱，思则气结……”，导致气乱、气下、气消，气乱致机体 气机逆乱，出现晕厥；气下致清阳不升，出现头晕；气消致气虚不足，出现双下肢无力，《灵枢 ·本神 篇》：“恐惧不解则伤精，精伤则骨酸萎厥”。由于当地的卫生医疗条件有限，没有及时对患者进行心 理疏导，以调节其气机的运行，反以“感冒”“头昏”等疾病进行治疗，导致其机体气机运行完全失 调，而出现阵发性抽搐。《锦囊秘录》：“脑为元神之府，主持五神，以调节脏腑、阴阳、四肢百骸之 用”，《刘子新论 ·清神第一》：“形者，身之器也；神者，心之宝也。故神静而心和，心和而形全， 神躁则心伤，心伤则形伤。将全其形，先在理神”，故其治疗应安神为先。又根据《灵枢 ·本神篇》： “并精出入者，谓之魄。”张景岳曰：“魄之为用，能动能作，痒痛由之觉也，定魄为辅。”还根据 《证治汇补 ·郁症章》：“郁病虽多，皆因气不周流，法当顺气为先，开提为次，至于降火化痰消积， 犹当分多少治之”，理气为本。

取穴依据：方中取肝区（眼针）、三焦区（眼针）、百会为主穴，起到安神理气的作用。百会为督 脉腧穴，因督脉“入络脑”，《灵枢 ·海论》：“……脑为髓之海，其输上在于其盖，下在风府”，这 里“其盖”所指就为百会穴，可起到回阳救逆，安神的作用；取眼针的肝区、三焦区，其依据为“肝主 疏泄”“三焦为气机运行的通道”，取其理气作用，在这里取眼针的原因还在于，因患者辗转求医多家

而不效，自觉病情严重，内心感觉一般疗法不会起效。眼针穴位位于眼睛周围，针刺眼区，让患者感觉 其治疗不是一般的治疗，而且眼区穴位针感较强，能有效地稳定患者的心神。之后配合言语暗示，让患 者行走，促使其气机正常运行。之后取内关、太冲解郁定魄，足三里、三阴交补气养血。

疗程、疗效：第2日患者在其父的陪同下走进诊室，诉症状基本消失，能够自主行走，无头昏，无阵 发性抽搐、角弓反张。治法同前，共针刺6次，诸症皆除。随访半年，无复发。

心得：《灵枢 ·本神》：“凡刺之法，先必本于神。血脉营气精神，此五藏之所藏也。”取眼针肝 区、三焦区，配合言语暗示，鼓励患者自行行走是促进其气机正常运行，解除其思想顾虑的关键步骤。

Case 1  Hysterical paralysis

Male patient, aged 16 years.

Chief complaint

Disability and dizziness for 2 months, paroxysmal convulsion and opisthotonus for more than 1 month.

History of present illness

The patient was suddenly faint after blamed and humiliated by the teacher 1 month ago; he woke up after sent to dormitory. Subsequently he felt dizziness and weakness in his lower limbs, and wasn’t able to walk. He experienced paroxysmal convulsion and opisthotonus 10 days later; it lasted up for 15 minutes. He was hospitalized in different hospitals, and he had received many treatments without avail. When he was ill for 69 days, the boy was carried by his father to our clinic. The boy had mental fatigue, stagnant facial expression and pale complexion, thin body, dull response and reaction, normal limbs and extremities iliacus tension, low tendon reflex.

Tongue and pulse

The patient had pale tongue with white and thin coating; his pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Depression (diagnosis of disease). Disturbance qi movement (syndrome differentiation).

WM diagnosis: Hysterical paralysis.

Principle of treatment

Tranquilizing mind. Regulating qi and inferior spirit.

Prescription

Main points: Liver area (eye acupuncture), triple energizer areas (eye acupuncture),Baihui (GV 20).

Additional points: Zusanli (ST 36),Sanyinjiao (SP 6),Neiguan (PC 6), Taichong (LR 3).

Manipulation

Apply filiform needles with manipulation of uniform reinforcing and reducing to Liver area (eye acupuncture), triple energizer area (eye acupuncture) and Baihui (GV 20) . After removing needles, the acupuncturist suggested he had recovered and encouraged him to stand up. The boy walked for an hour with the help of others. Then puncture Zusanli (ST 36), Sanyinjiao (SP 6), Neiguan(PC 6), Taichong (LR 3) and remain needles for half an hour. After treatment, the boy went back on foot.

Differentiation of the syndrome or disease

The  16-year-old patient presented with disability, paroxysmal convulsion and opisthotonus as chief complaint. It classified for “depression” in Traditional Chinese Medicine. Plain Questions of Huangdi’s Canon of

Billingual Acupuncture and Moxibustion

Medicine says: “When people were sad then qi eliminated, when people were fear then qi decreased, when people were surprised then qi disordered.” The boy was suddenly frightened and sad, which caused disturbance of qi movement. The boy was feared, which caused qi sinking. So the treatments should aim at tranquilizing mind and inferior spirit.

Explanation of the points

Baihui (GV 20) is selected according to governor vessel connects brain directly. Spiritual Pivot of Huangdi’s Canon of Medicine says: “The brain is the sea of marrow, upward point is Baihui (GV 20), and downward point is Fengfu (GV 16).” Liver area and triple energizer areas of eye acupuncture are selected to regulate qi movement. Eye acupuncture points are located around eyes with strong needle sensation. Neiguan (PC 6) and Taichong (LR 3) are selected to relieve depression and regulate inferior spirit. Zusanli (ST 36) and Sanyinjiao (SP 6) are selected to nourish qi and blood.

Frequency, duration and treatment outcome

Once every other day, 10 treatments constituted a course. After treated with acupuncture for 1 time, the boy could walk into the room with his father. Continuing to be treated for 6 times,he recovered completely. A follow- up telephone call 6 months later confirmed that there had been no relapse of symptoms.

Experience

Eye acupuncture is effective to depression.

（ 2 ）癔症性失语案

田某，女，19岁，学生。2003年6月12日初诊。主诉：不能说话、不能发声2月余。

现病史：2003月4月1日晨，患者在家做农活时不慎从3楼跌下，当时未出现昏迷。患者只觉得极度 恐慌，想喊叫却无法发声。在地上坐了30分钟后被家人发现，行走、活动无碍，只见嘴唇活动，却无法 出声。当即送宜宾市第一人民医院行头颅CT检查“未见异常”，以“失语待查”收入院，静脉给予药物 （具体不详）治疗。第8天因患者仍不能发声，患者经济条件困难而出院。后去一些私人诊所间断性服用 中药治疗未见疗效。期间患者逐渐出现不敢登高，不敢上楼梯，不敢独处一室。发病第73日，经人介 绍来我处求诊。步入病房，精神萎靡，面色苍白，形体瘦削，不能发声，靠文字进行交流，文字书写 流畅，思路清晰，对当时的情况记忆犹新。四肢肌张力正常，腱反射正常，四肢肌力正常，纳差，二 便正常。

舌、脉象：舌淡苔薄白，脉沉弦。

诊断：中医诊断：郁证（瘖）。证型：惊恐伤肾。

西医诊断：癔病性失语。 治则：醒神，调理气机。 针灸处方：

主穴：涌泉。

刺灸法：独取涌泉，强刺激，不留针。

辨证分析：患者因无意中失足从高处坠地，内心极度恐惧，当时即出现不能言语，属于中医学中的 “郁证”“瘖”范畴。《素问 ·大奇论》：“肝脉鹜暴，有所惊骇，脉不至若瘖。”《仁斋直指方》： “心为声音之主，肺为声音之门，肾为声音之根。”《金匮要略心典》：“肾伤于恐……，以肾肝同处 下焦，而其气并善上逆也。”《问斋医案》：“心肾素亏，七情不适，，卒加惊恐，惊则神伤，恐则精

却，神因精却以无依，精为神伤而不化，以故神摇于上，精消于下，阴阳不交。”患者因“恐伤肾”， “恐则气下”，导致窍闭神匿，而出现瘖的症状，故在治疗上应以肾经为主，取其醒神开窍的腧穴。同 时根据《丹溪治法心要 · 郁第十一》：“气血冲和，万病不生， 一有怫郁，诸病生焉。人身万病，皆生 于郁”，而用解郁之法。《脉经》：“郁脉多沉，在上见于寸，在中见于关……又郁脉或结或促……”

取穴依据：方中独取涌泉穴，以起到醒神，调理气机的作用。涌泉穴为足少阴肾经的起始穴，位置 在“足心陷者中，屈足卷指宛宛中”（《针灸甲乙经》），取穴方法为踡足时，在足心前三分之一的凹 陷中。《灵枢 ·经脉》：“肾足足少阴之脉，起于小指之下，邪走足心， …… 。其直者，从肾上贯肝、 膈，入肺中，循喉咙，夹舌本。”涌泉穴同时还是回阳九针穴之一，具有很强的醒神开窍作用。

疗程、疗效：针刺时患者即发出“呀呀”的声音。针后医者用言语暗示患者当天的事情已经完全 过去了，你已经好了，鼓励患者说话。患者犹豫了一下，张开嘴只发出“呀呀”的声音。医者让患者跟 着唱歌，医者唱简单的乐谱，患者跟着勉强能发出类似的音调，慢慢学唱了10分钟。医者嘱患者回家接 着练习。第2日患者已能将第1日的乐谱准确地唱出来，但仍不能说话。继用前法，针刺时患者发出“哎 呀”的声音。针后医者暗示患者可以唱歌了，在医者的领唱下，患者能跟随医者唱歌，但发音含糊。按 前法治疗了4次，患者可以自行说话。生活、学习如故。随访3个月，无复发。

心得：《灵枢 ·本神》：“恐惧者，神荡惮而不收。”患者表现为不能言语，起因为受惊吓，将其 病位确定在肾十分重要，是取得疗效的关键。不仅因恐伤肾，还因肾经的循行夹舌本。

Case 2  Hysterical mutism

Female patient, aged 19 years.

Chief complaint

Dumbness following accidents 2 months ago.

History of present illness

The patient suddenly had dumbness following the accident; she fell down from the 3rd floor when she did housework two months ago. She felt extremely scared, and wanted to ask help but couldn’t give out sound. She had sat on the ground for 30 minutes when the family found her. She lost the ability to speak. She had received many treatments, both Chinese Medicine and Western Medicine without avail. The patient had mind fatigue and pale complexion; the way of thinking was clear.

Tongue and pulse

The patient had pale tongue with a white coat and her pulse was wiry (xuan).

Diagnosis

TCM diagnosis: Depression (diagnosis of disease), fear injured the kidneys (syndrome differentiation).

WM diagnosis: Hysterical mutism.

Principle of treatment

Inducing resuscitation, regulating qi movement.

Prescription

Main points: Yongquan (KI 1).

Manipulation

Strong stimulation without remaining needles.

Differentiation of the syndrome or disease

The 19-year-old patient presented with numbness for 2 months as her chief complaint. This is classified as

Billingual Acupuncture and Moxibustion

“depression” in Traditional Chinese Medicine. Chinese medical theories state that heart is the predictor of voice, lungs the door of voice, kidneys the root of voice. Because of “fear injures kidney” and “while people are feared then qi sinks”, qi failed to go up to help pronounce.

Explanation of the points

Yongquan (KI 1), building spring, is the well point; it calms mind, restores consciousness and clears the brain. It is extremely effective in calming down, and is used in severe anxiety or mental illness such as hypomania. Kidney meridian pathway passes throat and connects with tongue.

Frequency, duration and treatment outcome

The patient gave out voice of “ahah” while the needles were applied with manipulation to Yongquan (KI 1). After removing the needle, the acupuncturist suggested all things were gone and encouraged her to talk. She hesitated a few seconds, then opened mouth to sent out the voice “ahah”, and she followed the acupuncturist to sing a song. She started to sing the simple musical songs. The acupuncturist told her to continue to practice singing songs at home. After treated with acupuncture for 4 times, she recovered completely. A follow-up telephone call 3 months later confirmed that there had been no relapse of symptoms.

Experience

The patient could not give out sound because of frighten. It is very important to identify kidneys, disorder, which is the key to obtain curative effect.

13.4.7 抑郁症案

抑郁症又称抑郁障碍，以显著而持久的心境低落为主要临床特征，是心境障碍的主要类型。中医称 之为“郁症”，以心情抑郁、情绪不宁、胸部满闷、胁肋胀满，或易怒易哭，或咽中如有异物哽塞为主 症的一类病证［1］。

近年来，随着生活压力不断增大，抑郁症的发生率呈逐年上升趋势，尤其是城市人群在面对巨大 的工作压力时因情绪不能得到及时舒缓和释放使得抑郁症的发生率明显上升。因此我们需正确认识抑郁 症，并运用有效的手段帮助患者走出抑郁症的困扰，进而提高他们的生活质量。

郁症的病因总属情志所伤，发病与肝的关系尤为密切，其次涉及心、脾。肝失疏泄、脾失健运、心 失所养、脏腑气血阴阳失调是郁症的主要病机［1］ 。目前，抑郁症的病因并不十分清楚，但可以肯定的是 抑郁症的发病与治疗存在复杂的脑机制，与神经内分泌关系十分密切［2］。

目前，针灸多采用针刺（以手足厥阴经俞穴为主）、耳针（心、枕、脑点、神门、内分泌）、电 针、穴位注射、穴位埋线等方法治疗该病［3］。

参考文献

［ 1 ］周仲瑛．中医内科学［M ］．北京：中国中医药出版社，2007 ：373-380.

［2］奚耕思．抑郁症发生机制研究进展［J ］．陕西师范大学学报（自然科学版），2011 ，39（6 ）：64-71. ［3］王启才．针灸治疗学［M ］．北京：中国中医药出版社，2003 ：95-96.

（ 1 ）紧张、焦虑、抑郁 患者，女，42岁。

主诉：反复心慌、焦虑半年。

现病史：诉半年前因母亲去世，心中悲伤过度，晚上难以入睡，于医院检查，医生建议服用安眠 药，但其拒绝服用。现症见神情抑郁，每晚入睡2~3小时，乏力，时感心慌、胸闷，尤遇紧张情况时常感 惊悸，焦虑。食欲尚可，二便正常。

舌、脉象：脉沉细，舌淡边有齿痕，苔薄白。 诊断：中医诊断：郁症。证型：心脾气虚证。 西医诊断：抑郁症。

治则：补气，调心，安神。 针灸处方：

取穴：百会、印堂、膻中、关元、内关、神门、三阴交、太冲。 耳穴：神门、交感、内分泌、心、肝。

刺灸法：百会、印堂、膻中、关元、内关、神门、三阴交用补法，太冲平补平泻。

辨证分析：患者处于中年时期，家中突发变故，肝气郁结不解，情怀不畅，肝失疏泄，则神情抑 郁、焦虑。忧思伤脾，思则气结，即可致气郁生痰，又可因生化无源，气血不足而成为心脾两虚之证， 故见乏力、心慌、胸闷等血不养心症状。

取穴依据：全方组穴以梳理气机、养心安神为主。以手、足厥阴经、任、督脉腧穴为主。其中内关 为心包经络穴，神门为心经原穴共奏宁心安神、宽胸解郁之效；膻中、肝之原穴太冲疏肝理气以解郁； 百会、三阴交调和阴阳。关元扶正固本。

疗程、疗效：每周2次。针刺治疗1次后，患者诉睡眠质量明显好转，夜间睡眠时间约为6个小时，连 续3天睡眠均好转。3个疗程后，诸症皆除。随访半年未复发。

心得：《灵枢 ·本神》：“心藏脉，脉舍神，心气虚则悲，实则笑不休。”《灵枢 ·邪气脏腑病 形》：“愁忧恐惧则伤心。”《素问 ·举痛论》：“余知百病生于气也，怒则气上，喜则气缓，悲则气 消，恐则气下……思则气结”“肺在志为忧，肝再志为怒……脾在志为思”。综上所述，在针灸治疗郁 症的过程中，多以调气、治心为其关键。

Case 1  Stress, anxiety and depression

Margaret, female, 46 years old, office worker.

History of present illness

Half a year following her mother’s death, the patient was too sorrowful to sleep, doctor suggested to take hypnotic, but the patient did not like to take hypnotic. Sleeping for 2-3 hours every night now, feeling tired, confused, short breath, chest distress. Particularly while driving, she often suddenly felt palpitation and anxiety. Having a good appetite, normal discharge.

Physical examination

Depresseel facial expression.

Pale and tooth-marked tongue with thin and white coating, deep and thread pulse.

Diagnosis

Deficiency of both heart and spleen (syndrome differentiation).

Principle of treatment

Replenishing qi, regulating heart, tranquilizing mind.

Prescription

Main points: Baihui (GV 20), Yintang (EX-HN 3), Guanyuan (CV 4), Neiguan (PC 6), Shenmen (HT 7), Sanyinjiao (SP 6), Taichong (LV 3).

Billingual Acupuncture and Moxibustion

Ear-points: Shenmen, sympathetic nerve, endocrine, heart and liver.

Use reinforcing needle method on the points of Baihui (GV 20), Yintang (EX-HN 3), Zhongwan (CV 12), Guanyuan (CV 4),Neiguan (PC 6), Shenmen (HT 7),Sanyinjiao (SP 6), and use uniform reinforcing and reducing needle method on the point of Taichong (LV 3).

Ear-points pressed by the seed of cowherb: Shenmen, sympathetic nerve, endocrine, heart and liver.

Frequency, duration and treatment outcome

Twice a week. The patient slept for 6 hours at night after the first treatment, and said she had never slept so well like this since her mother died. She kept on sleeping well for three nights. After treated 6 times, complete recovery. Half a year’s follow-up, having no relapse.

（ 2 ）失眠、抑郁案

患者，女，74岁，退休。初诊时间：2006年7月9日。 主诉：失眠、抑郁5年。

现病史：5年前无明显原因逐渐出现失眠、抑郁。入睡困难，睡眠深度浅，易惊醒，醒后很难再入 睡。情绪低落，时感生活没有乐趣，不愿与人相处，也不愿谈话，常一人独处。来诊时见神情萎靡，面 色无华，不愿与人交谈。

舌、脉象：舌淡苔白，脉细。

诊断：中医诊断：郁症。证型：心脾两虚证。 西医诊断：抑郁症。

治则：养心益脾。 针灸处方：

主穴：神门、内关、百会、三阴交。 刺灸法：各穴位均行补法。

辨证分析：患者年老，体质虚弱，饮食渐减，生化乏源，日久必气血不足，心神失养则眠差，心脾 失养故见神情萎靡，面色无华；情志失调，肝失调达，气失疏泄而致肝气郁结故见情绪低落郁郁寡欢。

取穴依据：全方组穴以梳理气机、调养心脾为主。选用神门、三阴交、内关、百会。其中内关为心 包经络穴，神门为心经原穴共奏宁心安神、宽胸解郁之效。百会为百脉之会，贯达全身，调节机体阴阳 平衡。三阴交为足三阴经交会穴起调补肝、脾、肾三经气血之功。

疗程、疗效：每周2次，连续8次为1个疗程。两个疗程后，患者诉睡眠质量明显好转，夜间入睡7~8 小时。

心得：《内经》认为郁症的发生与心的关系最为密切，其首要为调心安神，而现今中医吸收了郁症 为脑源性疾病的认识，在治疗上不仅治心，更是加入了以督脉头部俞穴来调理神气的治疗思路。

Case 2  Insomnia

Female patient, aged 74 years, retired.

Chief complaint

The patient had suffered from insomnia and depression for 5 years.

History of present illness

5 years ago, the patient gradually began to develop insomnia and depression. She had difficulty falling asleep, slept lightly and was easily startled awake. She found it difficult to fall asleep again after waking up. The patient suffered with depression, often feeling that life was boring. She did not feel like associating with others,

and mostly lived alone.

Physical examination

The patient felt fatigued, had a lustreless complexion and seldom felt like talking with others.

Tongue and pulse

The patient’s tongue was pale with a white coating and her pulse was thready.

Prescription

Point selection: Neiguan (PC 6), Shenmen (HT 7),Baihui (DU 20),Sanyinjiao (SP 6).

Needles

Filiform needles.

Manipulation

Reinforcing needle technique.

Differentiation of the syndrome or disease and explanation of the points

The 74-year-old female patient presented with insomnia and depression as the chief complaint, which are categorized as “insomnia” in Traditional Chinese Medicine. Traditional Chinese Medicine theories state that the heart controls mental activities, so insomnia is usually caused by heart problems. In clinic, we often use acupoints on the heart meridian to treat insomnia. Shenmen (HT 7) was selected to regulate the action of the heart to help sleep. Neiguan (PC 6) was selected to resolve the depression. Baihui (DU 20) was selected to calm the mind. Sanyinjiao (SP 6) was selected to tonify the spleen and the heart, to nourish the blood and to calm the mind.

Frequency, duration and treatment outcome

Treatment twice a week for 4 weeks constituted one course of treatment. After 2 courses of treatment, the patient could sleep for seven to 8 hours.

13.4.8 复视案

复视是指在正常视网膜对应的前提下， 一个物象落在分开过大的视网膜非对应点上，不能形成双眼 单视，而将一个物体看成两个。产生的原理是一只眼睛的影像落在黄斑部的小凹，而另一眼的影像不落 在小凹上。

复视的原因很多，中医认为多由脾胃气虚，脉络空虚，风邪侵袭，目系拘急所致，或肾阴亏虚，肝 风内动，或外伤，气血瘀滞，经脉弛缓所致［1］ ，西医认为是眼睛的外眼肌无力或麻痹所引起，而外眼肌 是由脑神经所控制，所以脑神经或大脑本身的疾病都可能引起复视。

针灸治疗复视多眼周邻近取穴，常用睛明、攒竹、太阳、丝竹空、瞳子髎、四白、球后等穴。西医 认为应找出眼疾病因，治疗眼疾，如：白内障摘除手术、治疗肌无力症及脑神经或脑部病变，也可借助 配戴眼镜来减轻症状。

参考文献

［ 1 ］王启才．针灸治疗学［M ］．北京：中国中医药出版社，2003.

案例

周某，女，44岁，2002年2月18日就诊。 主诉：突发双眼复视，视物模糊2个月。

Billingual Acupuncture and Moxibustion

现病史：患者以正前方及左、右斜下方复视较明显，视野变窄，伴有头晕，头痛。曾因视物模糊重 影10天住院治疗。查视力左眼0.1，右眼0.25。复视象：交叉复视，右眼物象在周边，物象最大分离在左 下方。眼底：右眼上斜肌不全麻痹，视网膜动脉硬化。血流变示：高黏血症，高脂血症。患2型糖尿病史 近8年，空腹血糖8.3mmol/L，餐后2小时10.2mmol/L。MRI示：双侧额叶皮层下，双侧基底节区及双侧半 卵圆中心多发腔隙性梗死。右侧上颌窦囊肿。曾接受维生素、ATP等药治疗，效果不明显。遂来中医门 诊治疗。

舌、脉象：舌红、苔黄腻，脉弦大。

诊断：中医诊断：风牵偏视。证型：风痰入络证。 西医诊断：右滑车神经受损，左动眼神经受损。

治则：疏散风邪、化痰通络。

针灸处方：

主穴：睛明、攒竹、太阳、丝竹空、瞳子髎。

配穴：四白、球后、上迎香、头维、上星、合谷、风池、丘墟、解溪、光明、公孙。

刺灸法：针刺睛明、攒竹穴时，针尖应向外下方浅刺；外直肌麻痹引起的复视，针刺太阳、瞳子、

丝竹空穴时，针尖应向内下方浅刺。双侧复视时可配合针刺印堂穴。在针灸治疗中应注意在针刺眼 眶穴位时，针具选择不宜过粗，需严格消毒，用1.5寸32号毫针进针0.5寸，留针30分钟。选取局部穴位睛 明、攒竹、太阳、丝竹空、瞳子，配合四白、球后、上迎香、头维、上星等穴位，根据病情和所累及眼 肌、神经的不同，每次选取4~5穴，交替使用。左右眼分别取左右局部穴位，并配合远端穴位合谷、风池 或丘墟、解溪、光明、公孙等穴。隔日治疗1次。

辨证分析：诊断为右滑车神经受损，左动眼神经受损，多发腔隙性梗死，右侧上颌窦囊肿，2型糖尿 病。复视是神经系统常见的症状，常常由于眼外肌麻痹引起，为麻痹性斜视的特征之一。此症不仅难治 而且常常是脑外伤或脑血管疾病的并发症。因此，临床上许多患者主诉头痛、头晕、视物重影、视力减 退等。舌红主邪热亢盛、热入营血或阴虚水涸、虚火上炎。少苔多主阴虚。黄苔主里证、热证，腻苔主 湿浊、痰湿、食积。弦主肝胆病，诸痛症，痰饮。单用药物治疗不易缓解，故采用针药并用治疗常收效 显著。

取穴依据：全方组穴以疏散风邪、化痰通络为主。主穴选用睛明、攒竹、太阳、丝竹空、瞳子髎， 为治疗眼病要穴，可疏通目络，调养气血。《秘传眼科龙木论》：“风牵歪偏外障，宜令火针出泪，又 针睛明穴。”患者右眼上斜肌不全麻痹，故配合四白、球后，上迎香，头维、上星，合谷、风池善于祛 风通络，光明为胆经络穴，专治目疾。

疗程、疗效：治疗3次后，患者自觉症状好转，无头晕及头痛。右下方视一为二现象已消失，仅正前 方及左斜下方明显。治疗7次后，正前方复视亦消失，眼疲劳感明显减轻，看报时间延长，左下方复视时 有反复，血糖已降至正常。后针刺以单侧（左眼）局部取穴为主，10次后，复视完全消失，病愈。

心得：针灸治疗斜视疗效肯定，眼周临近取穴效果较好。睛明穴在治疗眼疾方面占有重要地位。

Case  Diplopia

Female patient, aged 44 years.

Chief complaint

Suddenly blurred vision of about 2 months’ duration.

History of present illness

The patient suddenly had blurred vision and diplopia 2 months ago, together with headache and dizziness. Examination revealed evidence of hemi-ophthalmoplegia and retinopathy. Nuclear magenetic resonance imaging revealed evidence of cerebrovascular thrombosis. Taking some medicine did not help.

Tongue and pulse

The patient’s tongue was red with a little yellow coating and her pulse was wiry (xuan).

Diagnosis

Right trochlear nerve damage. Left oculomotor nerve damage.

Prescription

Point selection: Jingming (BL 1), Cuanzhu (BL 2), Taiyang (extra point), Sizhukong (TE 23), Tongziliao (GB 1).

Needles

Filiform needles.

Manipulation

Reinforcing needle technique.

Differentiation of the syndrome or disease

The 44-year-old female patient presented with blurred vision and diplopia as her chief complaint. This is classified as “blurred vision” in Traditional Chinese Medicine. Chinese medical theories state that the eyes are connected to the liver. It is the nourishment and moistering of liver-blood that gives the eyes the capacity to see. If liver-blood is deficient, there may be blurred vision. The patient’s tongue was red with a little yellow coating and her pulse was wiry (xuan), indicating deficiency of liver-yin.

Explanation of the points

Jingming (BL 1) is effective to ophthalmoplegia. Chuanzhu (BL 2), Tongziliao (GB 1), Taiyang (extra point) and Sizhukong (TE 23) move blood and qi to promote the function of eyes.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After ten treatments, her symptoms disappeared.

13.4.9 动眼神经麻痹案

动眼神经麻痹是指由于各区域的病变引起动眼神经及其支配组织功能丧失称为动眼神经麻痹。可出 现上眼睑下垂，眼球向内、向上及向下活动受限而出现外斜视和复视，并有调节和聚合反射消失等症。

中医认为引起动眼神经麻痹的原因是由于风邪侵袭，肝风内动或瘀血阻络致目系拘急或经脉弛缓所 致［1］ ，西医认为是先天发育异常或产伤所致，或因脑干病变、脑膜炎、脑炎、血管病变、肿瘤、脱髓鞘 疾病以及外伤等原因引起。

针灸治疗动眼神经麻痹多眼周邻近取穴，常用眼周的穴位如鱼腰、阳白、四白、丝竹空、攒竹、头 维等，配合远端取穴，益气补血，活血祛瘀，疏通局部经络，刺激眼周肌肉，提升其收缩力，促进眼肌 功能恢复。西医多采用手术治疗。

参考文献

［ 1 ］王启才．针灸治疗学［M ］．北京：中国中医药出版社，2003.

案例

朱某，男，69岁，农民，2002年11月12日入院。

Billingual Acupuncture and Moxibustion

主诉：右侧眼睑下垂2月余。

现病史：2002年11月12日患者买菜回家路上，不幸被车撞倒在地，神志不清达半小时，当时无开放 性外伤。头颅CT显示：小脑出血，经2个月治疗后病情基本稳定，但右眼睑下垂不能上抬，眼球活动受 限，视物模糊，诊断为动眼神经损伤。曾用血塞通、脑苷肌肽治疗，疗效不佳。于11月12日来我院住院 治疗，症见右眼睑下垂不能上抬，视物模糊，瞳孔等大，对光反射正常，眼球外斜，常流泪，无头痛头 昏。CT复查显示颅内未见出血征象。

舌、脉象：舌红少苔，脉细。

诊断：中医诊断：痿证。证型：瘀血阻络。 西医诊断：动眼神经麻痹（外伤型）。

治则：活血化瘀，益气通络。 针灸处方：

主穴：鱼腰、阳白、四白、丝竹空、攒竹、百会、头维。

配穴：合谷、足三里、三阴交、关元、气海、血海、申脉、照海。

刺灸法：先刺百会，针尖向前施迎随补法，观察眼睑运动变化，再针刺鱼腰透阳白，接下来依次针

刺丝竹空、攒竹、头维、四白，针尖均指向上，用泻法。其余穴用补法。针刺后在鱼腰、四白、攒 竹、丝竹空进行穴位注射弥可保，每穴1.25mL，隔日1次。

辨证分析：患者系外伤导致动眼神经损伤，为经络受损，瘀血阻络，经脉失养，筋肉失用所致。舌 红主邪热亢盛、热入营血或阴虚水涸，虚火上炎；少苔多主阴虚。脉细主气血两虚、诸劳虚损、伤寒、 痛甚及湿邪为病。

取穴依据：鱼腰、阳白、四白、丝竹空、攒竹、头维疏通局部经络，刺激眼周肌肉，提升其收缩 力，促进眼肌功能恢复。配合局部注射弥可保（神经营养剂）营养神经，延长针刺后效应。面为阳明之 乡，取手足阳明经合谷、四白，以疏通阳明经气血，濡润筋肉。远端取足三里、关元、气海，补益真 气，推动气血运行；三阴交、血海健运脾胃，补益气血；阴跷脉、阳跷脉交会于目内眦，司眼睑开合， 选取分别通于阴跷脉、阳跷脉的照海、申脉穴，可调整阴跷脉、阳跷脉的经气，发挥濡养眼目和司眼睑 开合的功效。诸穴同用，共奏益气补血、活血祛瘀之功，使经脉得通，筋肉得养。

疗程、疗效：经治疗35天，右眼睑与健侧基本对称，眼球无外斜，活动自如，视物清晰。

Case  Oculomotorius paralysis

Male patient, aged 69 years.

Chief complaint

Right-sided blepharoptosis remaining for 2 months.

History of present illness

2 months ago, the patient was knocked down by a car on the way home. He had loss of consciousness for half an hour. The head computed tomography revealed evidence of cerebellar hemorrhage. His symptoms improved after receiving treatment in local hospital for 2 months. He had right-sided blepharoptosis. Movement of the eyeball was limited, indicating  injury of the oculomotor nerve. Taking some medicine did not help.

Tongue and pulse

The patient had red tongue with a little coating, indicating deficiency of yin. His pulse was thready (xi), indicating deficency of spleen.

Prescription

Point selection: Baihui (GV 20), Yuyao (EX-HN 4) to Yangbai (GB 14), Sizhukong (TE 23), Cuanzhu (BL

2), Touwei (ST 8), Sibai (ST 2),Hegu (LI 4), Zusanli (ST 36),Sanyinjiao (SP 6), Guanyuan (CV 4), Qihai (CV 6), Xuehai (SP 10), Shenmai (BL 62), Zhaohai (KI 6).

Needles

Filiform needles and acupoints injection.

Manipulation

Even needle technique.

Differentiation of the syndrome or disease

The 69-year-old male patient presented with right-sided blepharoptosis remaining for 2 months as his chief complaint. This is classified as “artrophy-flaccidity syndrome” in Traditional Chinese Medicine. Chinese medical theories state that spleen controls muscle. His meridians and collaterals were directly injured by the car accident, with the result of blood stasis retention of meridians, failing to nourish muscle.

Explanation of the points

Selecting the local points of Yuyao (EX-HN 4) to Yangbai (GB 14), Sizhukong (TE 23), Cuanzhu (BL 2), Touwei (ST 8) and Sibai (ST 2) to dredge the channel obstruction to stimulate the muscle around the eyes. Acupoints injections nourish the nerve and prolong the function of acupunture. Zusanli (ST 36), Guanyuan (CV 4) and Qihai (CV 6) benefit qi. Sanyinjiao (SP 6) and Xuehai (SP 10) invigorate spleen to nourish blood. Because theyin heel vessel and yang heel vessel collect at the eye and take charge of eyelid opening and closing, selecting Shenmai (BL 62) and Zhaohai (KI 6) to help recover the eyelid movement. Baihui (GV 20) elevates qi to lift eyelid.

Frequency, duration and treatment outcome

Once a day for a course of 10 days. After 35 treatments, the patient completly recovered.

13.5 Cases of Dermatology Department (4 cases)

第五节  皮肤科病案（4例）

由于皮肤类疾病的主要临床表现为丘疹、水疱、瘙痒和增生等。因此针灸疗法在皮肤科疾病的治疗 当中应用也比较广泛。根据中医学理论“肺主皮毛”和“治风先治血，血行风自灭”等理论，皮肤类疾 病在运用针灸疗法治疗时主要采用的方法是扬刺（皮肤针）和凉血养血，主要采用的腧穴是手太阴肺经 和其表里经大肠经，以及一些具有清热、凉血养血功效的腧穴。主要治疗的病种包括带状疱疹、痤疮、 荨麻疹等。目前针刺美容正在受到越来越多的关注，在治疗时主要依据的理论是《素问 ·上古天真论》 中的“五七阳明脉衰，面始焦，发始堕；六七三阳脉衰于上，面皆焦，发始白”，选用阳明经腧穴和面 部腧穴，起到防止皮肤松弛下坠和除皱祛斑的作用。临床上治疗迟发性痤疮的方法介绍如下：

针灸方法：主穴为曲池、尺泽、合谷、三阴交。配穴上，根据证型，风热证大椎、肺俞点刺拔罐放 血；湿热证加阴陵泉，脾俞、大椎点刺拔罐放血；血瘀证加肝俞、膈俞点刺拔罐放血；冲任失调证加中 极，肾俞拔罐。根据临床症状，凡有脓疮、囊肿、结节、较大炎性丘疹，在皮损局部进行围刺。

中药：以清肺枇杷饮为主进行加减。桑白皮15克、黄芩12克、黄连9克、白芷15克、生甘草6克。根 据证型，风热证加金银花15克、连翘12克；湿热证加薏苡仁30克、苍术15克；血瘀证加川芎12克、丹参

Billingual Acupuncture and Moxibustion

15克；冲任失调证加益母草15克、当归12克。根据临床症状，凡有脓疮、囊肿、结节、较大炎性丘疹， 加夏枯草12克、紫草9克、金银花15克。

13.5.1 白塞氏综合征

白塞氏综合征又称白塞氏病，或眼—口—生殖器综合征，或狐惑病，或贝赫切综合征，为自身免疫 性疾病，是一种不仅侵犯眼、口及生殖器，而且可使全身多个系统受累的血管炎性疾病，只不过各系统 及器官病损发生的时间先后不同。

白塞氏综合征尽管发病率仅0.1％，但内科医师遇到白塞氏综合征机会还是较多的，且常常被误诊、 漏诊［1］ 。白塞氏综合征在中纬度地区的土耳其一带有较高的发病率［2］。

根据中医学理论，病因主要由湿热之邪积久，腐蒸气血蚀于人体幽隐部位而成。湿热侵袭，郁久 化火成毒。在临床不能单纯从三焦湿毒，心脾积热考虑，而要抓住口舌干燥，盗汗乏力，低热，知饥少 纳、干咳等一派阴虚内热和中气不足之病机。心、脾、肝、肾经均受邪。血热而内湿，湿热相合，热毒 下传肝经而生阴疮；入脾经而为肉疮；入心经而致舌糜；入肾经而致瞳神疾患。西医认为与以下几种因 素有关：感染，有报道说，本病与急、慢性病毒感染、细菌感染（如链球菌、结核杆菌感染），引起的 自体免疫异常有关；遗传因素，对表明人类遗传特征的物质HLA的研究发现，白塞病患者中HLA-B5阳 性检出率可达60%以上，HLA-B51的阳性检出率也很高；微量元素，患者病变组织多种微量元素含量 增高，如有机氯、有机磷和铜离子，也有人发现某些微量元素锌、硒缺乏，可能与本病有关；免疫异 常等。

目前现代医学对白塞氏综合征的治疗主要包括对症治疗、眼炎治疗、血管炎治疗。白塞氏综合征为 自身免疫性疾病，目前针灸用于治疗该病报道甚少。但针刺的作用机制之一是调节全身免疫系统达到治 疗和预防疾病的目的。所以针刺治疗白塞氏综合征理论上是可行的。

参考文献

［ 1 ］阳惠湘，彭重恩．临床病例讨论［J ］．湖南医科大学学报，1994 ，19（5 ）：455-456.

［2］杨宇洋，刘竞元，吴墨政，等．土耳其中医针灸发展概况［J ］．中国针灸，2014 ，34（6 ）：595-597.

案例

黄某，23岁，2005年10月9日初诊。 主诉：下肢红斑8年。

现病史：8年前夏季时无明显诱因出现下肢多处丘疹，色红，大小为2cm×3cm，开始未引起注意， 以为是蚊虫叮咬所致，瘙痒不明显。后丘疹逐渐发展为硬结，硬结逐渐发展为局部色素沉着，随着色素 沉着的逐渐消退，局部出现红斑，遇寒后红斑显现明显。8年中反复发作，现于臀部以下均可见红斑。曾 服用多种药物，不效。于华西医院行皮肤切片病理检测，诊为白塞氏综合征。 一般情况可，无反复性口 疮，无外阴溃疡，白带多，色黄，偶有外阴瘙痒。饮食可，二便调，寐可。

舌、脉象：舌淡苔白，脉沉。

诊断：中医诊断：狐惑（湿匿虫）。证型：湿热下注。 西医诊断：白塞氏病。

治则：疏通卫气，祛湿清热。 针灸处方：

主穴：至阴、涌泉。

配穴：合谷、血海、阴陵泉、风市。

刺灸法：取至阴、涌泉穴时使用1寸短针，刺入约0.1寸许，因二穴进针时较痛，故进针时速度应快。 针刺涌泉穴时，患者的下肢会不由自主回缩，脚掌屈曲。余穴均用平补平泻手法。起针后肾俞穴拔罐。

辨证分析：白塞氏综合征属于中医“狐惑病”范畴，“狐惑病”之名首载于《金匮安略 ·百合狐 惑阴阳毒病脉证治》。中医认为本病属于“寒疡”“阴疡”范畴，证属里、寒、虚。本病的主要病因病 机是，感受湿热毒邪火热，或瘀毒未尽与湿浊相合，或久居潮湿之地，湿毒侵犯肌肤蕴久化热所致。毒 热内蕴，结于脏腑，湿热毒邪循经上攻于口、眼，下注于外阴，损伤局部皮肤黏膜则发为溃疡；若湿热 困脾，脾失健运，则见腹胀、纳差或胃肠道溃疡；湿热伤及血脉则肢体皮肤出现红色结节，压痛明显； 湿热流于关节则见膝、踝、腕、关节肿痛。《金匱要略 ·百合狐惑阴阳毒病脉证治第三》：“狐惑之为 病，状如伤寒，默默欲眠，目不得闭，卧起不安。蚀于喉为惑，蚀于阴为狐，不欲饮食，恶闻食臭，其 面目乍赤、乍黑、乍白，蚀于上部则声嘎，甘草泻心汤主之。”《灵枢 ·本藏第四十七》：“卫气者， 所发温分肉，充皮肤，肥腠理，司开合者也……。卫气和则分肉解利，皮肤调柔，腠理细密矣。”《灵 枢 ·邪客第七十一》：“卫气者，出其悍气之摽疾，而先行四末分肉皮肤之间而不休者也。昼日行于 阳，夜行于阴，常从足少阴之分间，行于五脏六腑。”杨上善在注《素问 ·生气通天论》中“因于气为 肿”的“气”时，注解为“因邪气客于分肉之间，卫气壅遏不行，遂聚为肿”。故在治疗上应以疏通卫 气，祛湿清热为主。

取穴依据：因卫气“昼日行于阳，夜行于阴，常从足少阴之分间，行于五脏六腑”，故取足太阳膀 胱经的止穴（井穴）至阴，及足少阴肾经的起穴涌泉为主穴， 一方面可以起到加强作为表里经的膀胱经 和肾经的交接，一方面可以起到疏通卫气的作用。至阴穴位置“在足小指外侧，去爪甲如韭叶”（《针 灸甲乙经》），取穴方法为在足小趾外侧，距指甲角0.1寸许。涌泉穴位置为“在足心陷者中，屈足卷指 宛宛中”（《针灸甲乙经》），取穴方法为踡足时，在足心前1/3的凹陷中取穴。配穴取血海，依据“治 风先治血，血行风自灭”及《胜玉歌》中：“热疮臁内年年发，血海寻来可治之”；取风市亦为祛风； 取阴陵泉为祛湿；取合谷因肺主皮毛，肺与大肠相表里，故取合谷以清热治疗皮肤疾患。

疗程、疗效：每天1次，每周5次，10次1疗程。治疗2个月后，患者没有新发丘疹，红斑从臀部消 退，唯余小腿腓肠肌处稍存红斑。

心得：《金匮要略 ·百合 ·狐惑阴阳毒病征治》云：“狐惑之为病，状如伤寒，默默欲眠，目不得 闭，卧起不安，蚀于喉为惑，蚀阴为狐，不欲饮食。”隋代《诸痰源候论》谓：“……此皆由湿毒气所 为也。”清 ·魏念庭《金匮要略方论本义》曰：“狐惑者，阴虚血热之病也”“治虫者，治气标也；治 虚热者，治其本也”。

因患者病症只表现在皮肤上，故治疗本病，确立疏通卫气的治则非常重要。取至阴、涌泉作为主穴 是治疗取得疗效的关键，因针刺涌泉时疼痛较为明显，故应事先与病人沟通好。

Case  Bchcet’s syndrome

Female patient, aged 23 years.

Chief complaint

Erythematic in lower limb for 8 years.

History of present illness

8 years ago, she first got several papules in lower limb, the color of papules was red, the size was around 2 cm×3 cm, and without itching. She didn’t pay much attention to it at the beginning, but subsequently the symptoms became worse. Papule gradually evolved into the indurations, the indurations gradually evolved into the partial pigmentation, and following gradual regression of pigmentation, obvious erythematic anderythematic appeared by cold. They occurred again and again. There were several erythematic below the hip. She had received many treatments without avail. Examination of skin pathological section revealed evidence of Bchcet’s syndrome.

Billingual Acupuncture and Moxibustion

Tongue and pulse

The patient had pale tongue with white coating and her pulse was deep (chen).

Diagnosis

TCM diagnosis: The fox delude disease (diagnosis of disease). Downward attack of damp-heat (syndrome differentiation).

WM diagnosis: Bchcet’s syndrome.

Principle of treatment

Dredging defensive qi. Eliminating damp-heat.

Prescription

Main points: Zhiyin (BL 67), Yongquan (KI 1).

Additional points: Hegu (LI 4),Xuehai (SP 11), Yinlingquan (SP 10),Fengshi (GB 31).

Manipulation

Taking the size of 1 cun filiform needle to insert into Yongquan (KI 1) and Zhiyin (BL 67) with the depth of cun. Because the patient would feel pain while insertion of needles, speed of insertion should be quickly. Use uniform reinforcing and reducing method on the other points. Cup on Shenshu (BL 23) after removing the needles.

Differentiation of the syndrome or disease

The 23-year-old female patient presented witherythematic in lower limb for 8 years as her chief complaint.

She experienced abortion and operation on cutting left uterine tube, and her menstruation was regular with scanty bleeding. Bchcet’s syndrome is classified as “the fox delude disease” in Traditional Chinese Medicine. It was first recorded in Synopsis of Golden Chamber, and was caused by damp toxin. Spiritual Pivot of Huangdi’s Canon of Medicine says: “The defensive qi is able to warm muscle and nourish skin and striated layer. It circulates in yang in daytime but in yin at night. It often stars from the kidney meridian to circulate in five zang and six fu organs.” So the treatment should aim at dredging defensive qi and eliminating damp-heat.

Explanation of the points

The defensive qi starts from kidneys meridian and circulates in five zang and six fu organs, so the endpoint of the bladder meridian Zhiyin (BL 67) and the starting point of kidneys Yongquan (KI 1) were selected to dredge defensive qi. Xuehai (SP 11) and Fengshi (GB 31) are experiential points in skin diseases. Yinlingquan (SP 10) eliminates dampness. Hegu (LI 4) clears the lung-heat.

Frequency, duration and treatment outcome

Once a day, 10 treatments constituted a course. After treated with acupuncture for 2 months, the patient didn’t get new papuleanderythematic faded away from the hip, only remaining slightly erythematic in leg gastronomies.

Experience

The establishment of principle to dredge defensive qi is very important. It’s key to select Zhiyin (BL 67) and Yongquan (KI 1) as main points.

13.5.2 过敏

过敏是一种机体的变态反应，当过敏原接触到过敏体质的人群才会发生过敏，过敏原有花粉、粉 尘、异体蛋白、化学物质、紫外线等几百种。过敏根据种类和程度的不同，可出现不同的临床症状。其 中最常见的是皮肤过敏症状。

过敏的原因多种多样，近年来由此引起的人体皮肤过敏症发病率不断提高［1］ 。中医学多数医家认 为［2］过敏的主要病因病机是风寒之邪外袭，肺脾肾内虚。根据现代医学理论，内在因素就是本身具有过 敏体质，这在皮肤过敏的发病中起主导作用。及早彻底脱敏是治疗皮肤过敏，防止复发的关键。外在因 素也很多，包括饮食、吸入物、气候、接触过敏物因素等。其中海鲜、蛋白质、辛辣食品、酒、花粉、 尘螨、寒冷天气、接触化学物品、肥皂、洗涤剂等是皮肤过敏最常见的诱因。由于如此复杂的原因，使 得皮肤过敏因众多的发病原因和诱发因素交织在一起而反复发作。

目前，现代医学对过敏的治疗主要有脱敏疗法和采用抗过敏药物（如：抗组织胺药、过敏反应介质 阻滞剂、钙剂、免疫抑制剂等）。针灸治疗过敏引起的皮肤瘙痒症状已得到临床大量的证实。经过大量 的文献研究发现，针刺对皮肤过敏引起的瘙痒症的治疗效果明显。针灸止痒辨证取穴，通过对穴位的刺 激，激发机体良性的自我调整并调节全身机能，改善身体的内环境，达到“以外治内，扶正祛邪”的作 用，且疗效好、费用低、副作用小，在皮肤过敏引起的瘙痒症治疗方面具有现实意义和广阔前景。

参考文献

［ 1 ］石锋，崔文芳，王立军，等．高氮奥氏体不锈钢研究进展［J ］．上海金属，2006，20（5 ）：90-92.

［2］郑湘瑞．中医药调整特应性素质症状和免疫的研究．中华医学会心身医学分会第 12 届年会论文集［C ］，2006.

案例

艾利斯，女，60岁，2003年7月25日初诊。 主诉：小腿近踝处常年瘙痒20余年。

现病史：患者20年前无明显诱因出现腿近踝处瘙痒，每日晨起喷嚏连作，鼻塞眼痒，无咽痒。全身 皮肤易过敏。小腿近踝处常年瘙痒，皮肤抓痕明显，每年换季时症状加重。身体状况良好。

舌、脉象：舌淡苔薄白，边有齿痕。脉尺弱。

诊断：中医诊断：皮肤瘙痒症。证型：精血虚弱，风湿蕴阻。 西医诊断：皮肤过敏。

治则：养血益精，祛风除湿。 针灸处方：

主穴：百会、三阴交、太溪、足三里。

配穴：列缺、合谷、迎香、四白、风池。

刺灸法：主穴百会、三阴交、太溪、足三里用补法，配穴列缺、合谷、迎香、四白用泻法，配穴风 池用平补平泻法。

辨证分析：患者，女，60岁，主症为小腿近踝处常年瘙痒20余年，属于中医学中的“皮肤瘙痒症” 范畴。清代《外科证治全书痒风》记载：“痒风，遍身瘙痒，并无疮疥，搔之不止。”瘙痒发病之根本  在于风，皮肤气血不和是病理基础。实证由外感六淫、饮食所伤、瘀血内停所致，虚证多因年老体衰、  久病失养、精血亏虚而发，实证等反复不愈易发展为虚实夹杂。患者舌淡苔薄白，边有齿痕。脉尺弱。  属久病失养、精血亏虚虚实夹杂证，证型为精血虚弱，风湿蕴阻。

取穴依据：主穴选用百会、三阴交、太溪、足三里。配穴选列缺、合谷、迎香、四白、风池。百会

Billingual Acupuncture and Moxibustion

为督脉穴，肝脾肾同时交于三阴交，太溪为肾经腧穴，足三里为强壮要穴，四穴相配达养血益精之功， 治疗过敏本虚。选列缺、合谷、迎香、四白为配穴，共奏风湿蕴阻之实。

疗程、疗效：2次/周，10次1疗程。经针灸治疗10次后，喷嚏消失90%，眼内眦仍稍痒，双小腿的皮 肤瘙痒与抓痕完全消失。随访半年未复发。

心得：中医学称皮肤瘙痒病为“痒风”“诸痒”“风瘙痒”等。《医宗金鉴 ·外科心法要诀》中 “辨痒”云：“痒属风，亦各有因。”《诸病源候论》载“风瘙痒”病名，认为“风瘙痒者，是体虚受 风，风入肌理，血气相搏，而俱往来于皮肤之间，邪气微，不能冲击为痛，故但瘙痒也”。这与《内 经》“诸痒为虚”的理论相吻合。针刺风池、列缺、血海、足三里、三阴交等，能增强机体免疫能力， 抑制抗原抗体反应，阻止组胺和缓激肽等介质的释放。针刺治疗起到标本兼治的良好效果，且复发率 低，所以临床值得推广使用。

Case Allergy

Alice, female, 60 years old.

Chief complaint

Her allergic history is more than 20 years.

History of present illness

She sneezes frequently in the morning, her eyes itchy and nasal congestion. Her skin was easily allergic. The legs near ankle were often itching for many years. There were obvious scratch mark on her skin. Season change aggravated the symptoms. Her general health was good.

Tongue and pulse

Pale and tooth-marked tongue with thin and white coating, chi pulse was weak.

Diagnosis

TCM diagnosis: Itchy skin disease (diagnosis of disease), Jingxie weak, wind and dampness aggregates (syndrome differentiation).

WM diagnosis: Allergy.

Principle of treatment

Nourishing essence and blood, functions of dehumidification.

Prescription

Main points: Baihui (GV 20),Sanyinjiao (SP 6), Taixi (KI 3), Zusanli (ST 36).

Additional points: Lieque (LU 7),Hegu (LI 4), Yingxiang (LI 20), Sibai (ST 2),Fengchi (GB 20).

Manipulation

Use reinforcing methods on the main points, use reducing methods on the assistant points expect for Fengchi (GB 20), and use uniform reinforcing and reducing method on the point of Fengchi (GB 20). Retain 25 minutes.

Differentiation of the syndrome or disease

The 60-year-old female patient presented with the primary symptom of leg near the ankle perennial itch for more than 20 years. It belongs to the category of “itchy skin disease” in TCM. Qing Dynasty Surgical Treatment to Cure Itching Wind Book records: “Wind, itching, that all is not sore itch, scratch more.” The foundation of the itch disease is in the wind, the skin blood feud is the pathological basis. Empirical by exogenous, wounds, caused by blood stasis to diet, deficiency syndrome for elderly, along with long illness, Jingxie deficiency and hair, such

as empirical repeatedly is not easy for the development of factors. Patients have pale tongue moss thin white, the side with teeth marks. Chi pulse is weak. Weakness of vital essence and blood alongwith long illness or Jingxie deficiency. Aggregation of wind and dampness, as syndrome differentiation.

Explanation of the points

For main points it will choose Baihui (GV 20), Sanyinjiao (SP 6), Taixi (KI 3), Zusanli (ST 36). For additional points Lieque (LU 7), Hegu (LI 4), Yingxiang (LI 20), Sibai (ST 2), Fengchi (GB 20) are selected. Baihui is du meridian acupuncture point, liver and spleen kidney 3 meridians converge to Sanyinjiao ，Taixi belongs to kidney meridian acupoints. Combine with Zusanli for tonifying 4 points suitable for nourishing blood Yi Jing for root cause together with Lieque (LU 7),Hegu (LI 4), Yingxiang (LI 20), Sibai (ST 2),Fengchi (GB 20).

Frequency, duration and treatment outcome

Twice a week, 10 times for 1 course. After 10 acupuncture treatments, the sneeze frequency reduced 90%, inner canthus slightly itchy, the skin itching and scratch mark all disappeared. Follow-up survey for half a year, having no relapse.

13.5.3 湿疹

湿疹是比较常见的由多种内外因素引起的表皮及真皮浅层的炎症性皮肤病，属于一种变态反应性疾 病。常自觉、剧烈瘙痒，皮损多形性，对称分布，有渗出倾向，慢性病程，易反复发作。

英国一项调查研究表明湿疹占就诊患者的19%，新加坡国家医疗中心则报道湿疹病例达到了该中心 病例的34%［1］ 。国内湿疹发病率非常高，占皮肤科门诊病例的15%～30%［2］。

中医认为，湿疹病因病机较多，大抵由于禀赋不耐，饮食失节，或过食辛辣刺激荤腥动风之物， 脾胃受损，失其健运，湿热内生，又兼外受风邪，内外两邪相搏，风湿热邪浸淫肌肤所致。根据现代医 学理论，过敏有很多因素引起。遗传因素，某些类型的湿疹与遗传有密切的关系；环境因素，很多研究 证实环境因素是湿疹患病率增加的重要原因之一；感染因素，湿疹与微生物的感染也有一定关系，这些 微生物包括金黄色葡萄球菌等各种细菌与霉菌；饮食因素，有些食物中经常应用一些化学添加剂，如香 精、染料等，长期食用就容易引起变态反应，导致湿疹产生。除此之外，湿疹的产生尚可由忧虑、紧张 等神经精神因素及物理因素所引起。

目前现代医学对湿疹的治疗主要有一般疗法、全身疗法、局部治疗。针灸是我国传统医学中的瑰 宝，它不仅具有悠久的历史，在当今更以其独特的疗效受到世人瞩目。针刺的双向良性调整作用及对湿 疹的临床疗效已被古今医家的临床实践及诸多研究资料所证实。针刺疗法依其独特的优势，有望在湿疹 等态反应疾病的治疗中发挥重要作用。

参考文献

［ 1 ］欧阳恒，杨志波，向亚平．湿疹的诊断与治疗［M ］．北京：人民军医出版社，2004.

［2］娄方璐，刁庆春，刘毅，等．湿疹中医外治处方用药规律分析［J ］．陕西中医，2012 ，33（ 1 ）：97-100.

案例

患者，女，19岁，工人。初诊时间：2006年6月12日。 主诉：周身皮肤反复瘙痒、结痂1年。

现病史：1年前，无明显诱因逐渐出现手臂外侧皮肤瘙痒，抓挠后结痂。后逐渐蔓延至全身。未经系

Billingual Acupuncture and Moxibustion

统治疗，服用抗过敏药物，无效。查：颈项部、后背部分布有大小不等的皮损，皮损中渗出、结痂。 舌、脉象：舌红，苔白厚腻，脉濡。

诊断：中医诊断：皮肤瘙痒症。证型：湿邪内蕴。 西医诊断：湿疹。

治则：祛风除湿。 针灸处方：

主穴：曲池、合谷、足三里、三阴交。 刺灸法：均采用平补平泻法。

辨证分析：患者，女，19岁，主症为周身皮肤反复瘙痒、结痂1年，属于中医学中的“湿疹”范畴。 中医理论认为肺主皮毛，脾主运化水湿，当脾的功能出现障碍，水湿会停留在体内，而成为致病因素。 由于脾肺的功能紧密相关，当脾主运化水湿的功能失常时，由于肺为水之上源，导致肺的功能也失常， 一些人就会表现出皮肤的症状。患者舌红，苔白厚腻，脉濡，证型为湿邪内蕴型。

取穴依据：在治疗上宜健脾化湿，清热为主。取足阳明胃经合穴足三里，以益气化湿；取三阴交以 健脾除湿；取手阳明大肠经的合谷、曲池，以清热止痒。

疗程、疗效：每周2次。治疗期间嘱咐患者忌鱼腥、乳制品，8次治疗后痊愈。

心得：《医宗金鉴 ·外科心法》对湿疹做了细致描述：“血风疮证生遍身，粟形搔痒脂水浮，肝肺

脾经风湿热，久郁痉痒抓血津………，此证由肝脾二经湿热，外受风邪，袭于皮肤，郁于肺经，致遍身

生疮，形如粟米，搔痒无度，抓破时，津脂水浸淫成片，令人烦燥、口渴搔痒，日轻夜甚……若日久风 邪郁在肌肤，则耗血生火，搔痒倍增，夜不得寐，挠破津血，心烦，大便燥热，咽干不渴，此属火躁 血短。”

Case  Eczema

Female patient, aged 19 years, worker.

Chief complaint

Persistent itching of the skin all over the body for one year and scarring from scratching.

History of present illness

One year ago, the patient felt itching on the skin of her lateral arm for no apparent reason. After scratching, scabs would form. The itching and scabs gradually spread to the whole body. The patient took an anti-allergy drug, which was ineffective.

Tongue and pulse

The patient’s tongue was red with a white greasy coat and her pulse was soggy (ru).

Diagnosis

TCM diagnosis: Itchy skin disease (diagnosis of disease), the origin intrinsic of damp (syndrome differentiation).

WM diagnosis: Eczema.

Principle of treatment

Removing wind and dehumidification.

Prescription

Main points: Quchi (LI 11),Hegu (LI 4), Zusanli (ST 36),Sanyinjiao (SP 6).

Manipulation

Even needle technique.

Differentiation of the syndrome or disease

The 19-year-old female patient presented with itching and scratch marks on the skin all over her body as the chief complaint, which is categorized as “eczema” in Traditional Chinese Medicine. Chinese medical theories state that the lungs control the skin, and the spleen controls the transportation and transformation of fluids. If there were problems with the lungs or spleen, dampness would be produced and accumulate in the body, becoming a pathogenic factor causing disease. The spleen and lungs are functionally close, so if the spleen fails to control the transportation and transformation of fluids, the lungs, as the “upper source of water” in the body, cannot reduce the refined fluids from the spleen to a fine mist and spray, and skin disease results. The patient’s red tongue had a thick greasy coat and her pulse was soggy (ru), which indicated that the syndrome differentiation was internal retention of dampness.

Explanation of the points

The treatment focused on tonifying the spleen to dissipate dampness and clear heat. Zusanli (ST 36) was selected to replenish qi and dissipate dampness; Sanyinjiao (SP 6) to tonify the spleen to dissipate dampness; Quchi (LI 11) and Hegu (LI 4) to clear heat and stop the itching.

Frequency, duration and treatment outcome

Twice a week until symptoms disappeared. During the treatment period, the patient was advised not to eat seafood or dairy products. After 8 treatments the patient completely recovered.

13.5.4 面部美容

面部美容即采用护肤品或特殊方法保养面部皮肤，延缓衰老，使青春常在。如增白、除雀斑、去皱 纹等。

针灸被大量用于面部美容。针灸推拿和面部美容有着密切的联系［1］ 。中医认为衰老的内在机理是以 五脏虚衰为根本原因，虚、瘀、气滞、痰湿致肾虚气滞血瘀痰阻，精血不足为衰老的最基本病因病机。 根据现代医学理论，由于衰老，外界环境等的影响，面部出现皱纹，雀斑，色素沉着等。

目前，现代医学对抗衰老的方法主要包括实行健康的生活模式（例如饮食均衡，做适量的运动，充 足的睡眠，不吸烟，减少饮酒）。此外，服用抗衰老药物以及卡路里控制，也是抗衰老的主要策略。针 灸用于面部美容已经在临床广泛推广运用，针灸美容具有疗效持久可靠、安全简便易行、无化妆美容副 作用、美容健身同步进行等诸多优点。

经络不仅是气、血、精的运行通道，“行气血而营阴阳，濡筋骨，利关节也”，也是联络脏腑、 表里、四肢、五官九窍、筋骨皮肤的枢纽，“夫十二经脉者，内属于脏腑，外络于肢节”，经络将人体 紧密地连接成一个统一的整体。经络同时又和面部有着密切关系，“十二经脉，三百六十五络，其气血 皆上注于面”，且手三阳经、足阳明经和任督二脉皆循行于面。因此，颜面是内脏的窗口与镜子，面色 是脏腑气血的外部表象，“有诸内，必形诸外”，面色红润说明脏腑精气充足，经络顺畅，如有皮肤粗 糙、色泽晦暗甚至有色斑、松弛、皱纹、毛孔粗大等，均说明脏腑功能有异常。因此，面部美容以补养 脏腑，调理气血为主。

Billingual Acupuncture and Moxibustion

参考文献

［ 1 ］崔莉，赵鹏．针灸推拿与美容的关系浅析［J ］．河南中医，2006（4 ）：53-54.

［2］娄方璐，刁庆春，刘毅，等．湿疹中医外治处方用药规律分析［J ］．陕西中医，2012 ，33（ 1 ）：97-100.

案例