恢刺阿是穴为主治疗急性踝关节扭伤随机对照研究
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摘要
研究背景：
急性踝关节扭伤是临床常见的急性软组织损伤之一,主要因为剧烈运动、不当负重、意外跌倒、外在力量过度牵拉扭转等原因导致踝关节过度内、外翻所致,表现为踝关节肿胀疼痛,伤处皮肤见青紫色瘀斑,活动受限,一般无骨折脱臼及皮肉破损。有20%-40%的急性患者会迁延成慢性踝关节不稳。本病属于中医学伤筋范畴,也属于骨伤学的筋伤戳脚。中医学认为本病是因为突然暴力导致的损伤,故称为新伤。本病由外伤致局部血瘀气滞引起局部经络不通,筋肉经络随即受损,气血互阻,瘀阻脉络,引起疼痛、肿胀。针对这一病机,针灸是治疗疼痛性疾病的重要手段。
大量研究表明,针灸能有效治疗急性踝关节扭伤。《灵枢.九针十二原》云：“欲以微针通其经脉,调其血气,营其逆顺出入之会”。针灸治疗急性踝关节扭伤主要是通则不痛。主要是通过参与改变5-轻色胺、内胖肤、乙酞胆碱等中枢神经介质而产生镇痛的作用。从针灸经典理论出发,急性踝关节扭伤属于经筋病范畴,应当选用相应的经筋刺法。恢刺是《内经》十二刺法之一,《灵枢·官针》记载：“恢刺者,直刺傍之,举之前后,恢筋急,治筋痹也”。
恢刺正是治疗经筋病的重要方法之一。恢刺法属于《内经》具有代表性的经筋刺法。恢刺是针对筋肉拘急疼痛,即经筋病的刺法。恢刺法针感较为强烈,针刺刺激量较大,对应经筋点、线、面的循行分布特点,能较为明显的舒筋通络的功效。恢刺法还能疏调经气,畅通经脉气血,濡养经筋,舒缓局部的拘挛。可以概括为“通经络,调气血,荣经筋”。
研究目的：
通过比较恢刺阿是穴和常规针刺、RICE(休息制动、冰敷、加压包扎、抬高患肢)治疗急性踝关节扭伤的临床疗效差异,并对其机理进行初步探讨,以探讨最佳的针灸治疗急性踝关节扭伤的临床方案。本研究继承《灵枢·官针》的恢刺法思想,将经筋刺法有机运用到临床中,进一步观察恢刺法在急性踝关节扭伤这一常见病的应用价值。
研究方法：
纳入符合标准的90例急性踝关节扭伤患者,采用计算器产生随机序列,将受试者随机分为三组,每组30例。试验组A采用恢刺阿是穴为主的治疗方法,通过触摸、轻捏等手法,找出具有压痛的阿是穴,然后用2寸毫针,垂直进入穴位,再将针略微提起至皮下,不出针,将针体倾斜,沿肌腱纵轴方向将针插入穴位0.5-1寸；然后再将针提至皮下,不出针,微微换个角度再行插入,反复几次,然后左右提插捻转,扩大针孔,其余配穴常规操作,有悬钟、足三里、丘墟、昆仑、三阴交等。留针20min,留针期间TDP照射。对照组B采用常规针刺方法,根据杜元灏、石学敏主编的《中华针灸临床诊疗规范》的标准处方,即取阿是穴、申脉、丘墟、解溪、照海、昆仑、太溪。对照组C采用常规RICE处理方法,即休息制动、冰敷、加压包扎、抬高患肢。针灸均为1次／天,7天为1个疗程。分别在治疗前、治疗中、治疗后观察受试者的视觉模拟评分法(VAS)、踝关节扭伤症状积分(ASI),包括关节疼痛指数、关节障碍指数、关节肿胀、关节红热等情况。通过整理分析研究资料数据,对三种方法治疗急性踝关节扭伤进行科学、系统的疗效评价。
研究结果：
三组间受试者在性别、年龄、病程、病情分级、疾病分期VAS疼痛评分和踝关节症状积分(ASI)评分均无统计学意义(P＞0.05),因此说明组间基线资料具有可比性。
各组治疗后VAS评分与治疗前比较,均具有统计学意义(P＜0.01)；三组间治疗后VAS评分比较也具有统计学意义(P＜0.05),这说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善急性踝关节扭伤的疼痛方面具有优势。
各组治疗后ASI评分与治疗前比较,均具有统计学意义(P＜0.01)；三组间治疗后ASI评分比较也具有具有统计学意义(P＜0.05),这说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善急性踝关节扭伤的症状方面具有优势。
三组受试者治疗前、中、后关节疼痛指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)：每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中与治疗后比较都具有统计学意-义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节疼痛具有优势,而且在治疗第4天就已经显现。
三组受试者治疗前、中、后关节肿胀指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)；每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗后相比较都有统计学意义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节肿胀具有优势。
三组受试者治疗前、中、后关节红热指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)；各组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中与治疗后相比较均有统计学意义(P＜0.05),治疗中和治疗后恢刺法与常规针刺比较没有统计学意义(P＞0.05)。说明恢刺阿是穴为主与常规RICE比较在改善踝关节红热具有优势,与常规针刺比较疗效相当。
三组受试者治疗前、中、后关节压痛指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.05)；每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中和治疗后相比较均有统计学意义(P＜0.05),说明恢刺法阿是穴与常规RICE、常规针刺比较在改善踝关节压痛具有优势,而且在治疗第4天就已经显现。
三组受试者治疗前、中、后关节障碍指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.05)：每组治疗后和治疗前相比较,差异均具有统计学意义(P＜0.01)。三组间治疗中和治疗后相比较均有统计学意义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节障碍具有优势,而且在治疗第4天就已经显现。
不同分期的VAS评分比较,得出针灸介入时期不同对治疗前后症状评分变化值的影响不同(P＜0.05)。三组治疗前后症状评分变化值由大到小依次为：急性期>亚急性期>恢复期。说明针刺介入越早,治疗效果越好。
三组受试者治疗后整体疗效比较,恢刺阿是穴为主的临床疗效优于常规RICE、常规针刺(P＜0.05)。而且Ⅰ级损伤和Ⅱ级损伤的疗效分布在组间没有差异,说明病情分级没有影响组间的疗效差异(P＞0.05)。
研究结论：
本研究显示恢刺阿是穴治疗急性踝关节扭伤优于常规针刺、RICE治疗,特别对关节疼痛、关节压痛、关节功能障碍方面,恢刺阿是穴的疗效优势更快显现。可见,恢刺阿是穴治疗急性踝关节具有疗效肯定,优势明显,值得在临床上大力推广。
Background:
Acute ankle sprain is one of clinical common acute soft tissue injury, mainly because of intense exercise, improper weight, falling accident, outside forces excessive pull reverse. It causes ankle excessive internal and eversion. It is characterized by ankle swelling and pain. The wound skin becomes green purple bruises, and activity limitations. There is no fracture dislocation and skin damage.20%-40%of the patients with acute ankle sprain can grow into chronic ankle instability. The disease belongs to the category of TCM injury muscle, also belong to injured stamp foot and fractures of ribs. Since sudden violence leads to injury, TCM called it new injury. The disease is caused by trauma, and leads to local blood stasis and qi stagnation in local meridians impassability. Brawn meridian immediately damaged. Qi and blood are mutual resistance and cause pain and swelling. According to the pathogenesis, acupuncture and moxibustion is an important means of treatment of painful disease.
Numerous studies indicated that acupuncture and moxibustion was effective in the treatment of acute ankle sprains. Spirit pivot of Nine and twelve said: Through the meridians, micro needle adjusted its flesh and its inverse Qi in and out of the blood vessel". Acupuncture and moxibustion in the treatment of acute ankle sprains are mainly improve pain. Mainly through participation change within5-light tryptamine, fat skin and b choline phthalein central neurotransmitters such as analgesia action. From classic theory, acute ankle sprains belong to the category of the muscle disease, and should choose the corresponding the reinforcement method. Restore is one of the twelve thorn in Neijing method,"pivot, the officer needle" records:" Puncture, pierce bang, as before, restore muscle anxious, treatment of tendon Bi ". Lateral puncture is one of the important methods for the treatment of the muscle disease. Lateral puncture is a representative reinforcement method in Neijing. Lateral Puncture is arrested sharp pain for brawn, namely the sting method of muscle disease. Lateral puncture method are relatively strong. Stimulating amount is larger, corresponding to the reinforcement follow line of point, line and plane distribution characteristics. It can be more obvious and tendons. Lateral puncture method can regulate the menstrual function, smooth meridians qi and blood, moisten the muscle, relieve local twin. Its function can be summarized as "main and collateral channels, qi and blood, honor through reinforcement".
Objective
To compare the clinical curative effect of the lateral puncture, routine acupuncture, and RICE (rest, ice, compression bandage, raise the limb) in the treatment of acute ankle sprains, and to discuss its mechanism, in order to investigate the best acupuncture therapy in the treatment of acute ankle sprains. This study inherited the restore of the Pivot, and applied it to the clinical, restore thorn further observation method in the application value of the common diseases of acute ankle sprains.
Methods
90cases of patients with acute ankle sprains were included in the trial. The study used calculator to produce random sequence. The subjects were randomly divided into three groups. Each group were30cases. Experimental group A adopted lateral puncture.A-shi acupoint was the treatment of acupuncture point and is selected by touching, gently kneading, found out with tenderness, and then we used2inches filiform needle, and punctured vertically into acupuncture points, then lifted needle slightly to the skin,do not withdraw the needle, the needle body tilt, the longitudinal axis along the tendons insert needles into acupuncture points0.5-1inch; Couldn't then to subcutaneous needle, the needle, slightly change the Angle to insert again, again and again several times, and then inserted twisting around, enlarge the pin hole. The macthed acupoints contained Xuanzhong, Zusanli, Quxu, Kunlung, Sanyinjiao and etc. TDP irradiation was used during the retaining needle time,20min for retaining needle. Control group B used routine acupuncture method, according to Du Yuanhao, Shi Xuemin editor of "Chinese acupuncture clinical diagnosis and treatment norms" standard, that these were Ashi, Shenmai, Qiuxu, Jieqi, Zhaohai, Kunlun, Taixi. Control group C used conventional RICE processing method, that is, rest, ice, compressi on bandage, braking up limb. Acupuncture and moxibustion was used1time/day,7days for a course of treatment. Respectively before treatment, after treatment. The trial observed the subjects' visual analogue scale (VAS), ankle sprains symptom integral (ASI), including joint pain, joint disorders index, joint swelling, joint red, and so on and so forth. Research sorted out and analyzed data for curative effect evaluation, using the three methods for scientific treatment of acute ankle sprains,
Results
Subjects between the three groups in gender, age, course and grade of disease, disease stages VAS pain score and ankle symptoms integral (ASI) score had no statistical significance (P>0.05), so that the baseline data were comparable between groups.
Each group after treatment compared with before treatment, VAS score were statistically significant (P<0.01); VAS score after treatment compared between three groups are statistically significant.(P<0.05), suggesting that o restore sting method were compared with the conventional RICE, conventional acupuncture has the advantage in improving pain of acute ankle sprains.
Groups of ASI scores compared with before treatment, after treatment were statistically significant (P<0.01); ASI scores after treatment compared between three groups has statistically significant (P<0.05), suggesting that o restore sting method were compared with the conventional RICE, conventional acupuncture has the advantage in improving symptoms of acute ankle sprains. Three groups of patients before, during and after treatment of joint pain index comparison, compared with before treatment in each treatment, have statistically significant(P<0.01);Each group compared with before treatment, after treatment were statistically significant (P<0.01). Treatment and after treatment comparison between the three groups were statistically significant (P<0.05), suggesting o restore sting method were compared with the conventional RICE, conventional acupuncture has advantages in improving ankle pain, and has appeared in the treatment of4days.
Three groups of patients before, during and after treatment of joint swelling index comparison, compared with before treatment in each treatment, all statistically significant (P<0.01); Each group compared with before treatment, after treatment were statistically significant (P<0.01). Compared between three groups after treatment was statistically significant (P<0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle swelling.
Three groups of patients before, during and after treatment of joint red heat index comparison, compared with before treatment in each treatment, all statistically significant (P<0.01); Groups compared with before treatment, after treatment were statistically significant (P<0.01). Treatment and after treatment compared between three groups had statistical significance (P<0.05), after treatment and restore method compared with conventional acupuncture is not statistically significant (P>0.05). That restore o sting method were compared with conventional RICE, have an advantage in improving the ankle red-hot, compared with conventional acupuncture curative effect. Three groups of patients before, during and after treatment of joint tenderness index comparison, compared with before treatment in each treatment, all statistically significant (P<0.05); Each group compared with before treatment, after treatment were statistically significant (P<0.01). After treatment and compared between three groups had statistical significance (P <0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle joint tenderness has advantages, and has appeared in the treatment of4days. Three groups of patients before, during and after treatment
Three groups of patients before, during and after treatment of joint disturbance index comparison, compared with before treatment in each treatment, all statistically significant (P<0.05); In each group after treatment compared with before treatment, the differences were statistically significant (P<0.01). After treatment and compared between three groups had statistical significance (P<0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle dysfunction has advantages, and has appeared in the treatment of4days.
Different stages of VAS score comparison, concluded that different symptom scores before and after the treatment of acupuncture intervention period affect the value is different (P<0.05). Three groups of symptom scores before and after the treatment value changes from big to small in turn for:acute stage> subacute stage> recovery. Shows that acupuncture intervention the sooner, the better therapeutic effect.
Three groups of subjects after treatment the overall curative effect comparison, restore sting method the clinical curative effect of acupuncture point is better than that of conventional RICE, conventional acupuncture (P <0.05). And level-i trauma and II distribution in the effect of level of no difference between groups, suggests that condition classification did not influence the curative effect of the differences between groups (P>0.05).
Conelusions:
This study showed that the effect of lateral puncture Ashi is superior to conventional acupuncture in treatment of acute ankle sprains, RICE treatment, especially for joint pain, joint tenderness and joint dysfunction, restore the curative effect of acupuncture point advantage appeared faster. Lateral puncture has curative effect in the treatment of acute ankle, obvious advantages, and is worth promoting in clinic.
急性踝关节扭伤是临床常见的急性软组织损伤之一,主要因为剧烈运动、不当负重、意外跌倒、外在力量过度牵拉扭转等原因导致踝关节过度内、外翻所致,表现为踝关节肿胀疼痛,伤处皮肤见青紫色瘀斑,活动受限,一般无骨折脱臼及皮肉破损。有20%-40%的急性患者会迁延成慢性踝关节不稳。本病属于中医学伤筋范畴,也属于骨伤学的筋伤戳脚。中医学认为本病是因为突然暴力导致的损伤,故称为新伤。本病由外伤致局部血瘀气滞引起局部经络不通,筋肉经络随即受损,气血互阻,瘀阻脉络,引起疼痛、肿胀。针对这一病机,针灸是治疗疼痛性疾病的重要手段。
大量研究表明,针灸能有效治疗急性踝关节扭伤。《灵枢.九针十二原》云：“欲以微针通其经脉,调其血气,营其逆顺出入之会”。针灸治疗急性踝关节扭伤主要是通则不痛。主要是通过参与改变5-轻色胺、内胖肤、乙酞胆碱等中枢神经介质而产生镇痛的作用。从针灸经典理论出发,急性踝关节扭伤属于经筋病范畴,应当选用相应的经筋刺法。恢刺是《内经》十二刺法之一,《灵枢·官针》记载：“恢刺者,直刺傍之,举之前后,恢筋急,治筋痹也”。
恢刺正是治疗经筋病的重要方法之一。恢刺法属于《内经》具有代表性的经筋刺法。恢刺是针对筋肉拘急疼痛,即经筋病的刺法。恢刺法针感较为强烈,针刺刺激量较大,对应经筋点、线、面的循行分布特点,能较为明显的舒筋通络的功效。恢刺法还能疏调经气,畅通经脉气血,濡养经筋,舒缓局部的拘挛。可以概括为“通经络,调气血,荣经筋”。
研究目的：
通过比较恢刺阿是穴和常规针刺、RICE(休息制动、冰敷、加压包扎、抬高患肢)治疗急性踝关节扭伤的临床疗效差异,并对其机理进行初步探讨,以探讨最佳的针灸治疗急性踝关节扭伤的临床方案。本研究继承《灵枢·官针》的恢刺法思想,将经筋刺法有机运用到临床中,进一步观察恢刺法在急性踝关节扭伤这一常见病的应用价值。
研究方法：
纳入符合标准的90例急性踝关节扭伤患者,采用计算器产生随机序列,将受试者随机分为三组,每组30例。试验组A采用恢刺阿是穴为主的治疗方法,通过触摸、轻捏等手法,找出具有压痛的阿是穴,然后用2寸毫针,垂直进入穴位,再将针略微提起至皮下,不出针,将针体倾斜,沿肌腱纵轴方向将针插入穴位0.5-1寸；然后再将针提至皮下,不出针,微微换个角度再行插入,反复几次,然后左右提插捻转,扩大针孔,其余配穴常规操作,有悬钟、足三里、丘墟、昆仑、三阴交等。留针20min,留针期间TDP照射。对照组B采用常规针刺方法,根据杜元灏、石学敏主编的《中华针灸临床诊疗规范》的标准处方,即取阿是穴、申脉、丘墟、解溪、照海、昆仑、太溪。对照组C采用常规RICE处理方法,即休息制动、冰敷、加压包扎、抬高患肢。针灸均为1次／天,7天为1个疗程。分别在治疗前、治疗中、治疗后观察受试者的视觉模拟评分法(VAS)、踝关节扭伤症状积分(ASI),包括关节疼痛指数、关节障碍指数、关节肿胀、关节红热等情况。通过整理分析研究资料数据,对三种方法治疗急性踝关节扭伤进行科学、系统的疗效评价。
研究结果：
三组间受试者在性别、年龄、病程、病情分级、疾病分期VAS疼痛评分和踝关节症状积分(ASI)评分均无统计学意义(P＞0.05),因此说明组间基线资料具有可比性。
各组治疗后VAS评分与治疗前比较,均具有统计学意义(P＜0.01)；三组间治疗后VAS评分比较也具有统计学意义(P＜0.05),这说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善急性踝关节扭伤的疼痛方面具有优势。
各组治疗后ASI评分与治疗前比较,均具有统计学意义(P＜0.01)；三组间治疗后ASI评分比较也具有具有统计学意义(P＜0.05),这说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善急性踝关节扭伤的症状方面具有优势。
三组受试者治疗前、中、后关节疼痛指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)：每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中与治疗后比较都具有统计学意-义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节疼痛具有优势,而且在治疗第4天就已经显现。
三组受试者治疗前、中、后关节肿胀指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)；每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗后相比较都有统计学意义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节肿胀具有优势。
三组受试者治疗前、中、后关节红热指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.01)；各组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中与治疗后相比较均有统计学意义(P＜0.05),治疗中和治疗后恢刺法与常规针刺比较没有统计学意义(P＞0.05)。说明恢刺阿是穴为主与常规RICE比较在改善踝关节红热具有优势,与常规针刺比较疗效相当。
三组受试者治疗前、中、后关节压痛指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.05)；每组治疗后和治疗前相比较,都具有统计学意义(P＜0.01)。三组间治疗中和治疗后相比较均有统计学意义(P＜0.05),说明恢刺法阿是穴与常规RICE、常规针刺比较在改善踝关节压痛具有优势,而且在治疗第4天就已经显现。
三组受试者治疗前、中、后关节障碍指数比较,各组治疗中与治疗前比较,均具有统计学意义(P＜0.05)：每组治疗后和治疗前相比较,差异均具有统计学意义(P＜0.01)。三组间治疗中和治疗后相比较均有统计学意义(P＜0.05),说明恢刺阿是穴为主与常规RICE、常规针刺比较在改善踝关节障碍具有优势,而且在治疗第4天就已经显现。
不同分期的VAS评分比较,得出针灸介入时期不同对治疗前后症状评分变化值的影响不同(P＜0.05)。三组治疗前后症状评分变化值由大到小依次为：急性期>亚急性期>恢复期。说明针刺介入越早,治疗效果越好。
三组受试者治疗后整体疗效比较,恢刺阿是穴为主的临床疗效优于常规RICE、常规针刺(P＜0.05)。而且Ⅰ级损伤和Ⅱ级损伤的疗效分布在组间没有差异,说明病情分级没有影响组间的疗效差异(P＞0.05)。
研究结论：
本研究显示恢刺阿是穴治疗急性踝关节扭伤优于常规针刺、RICE治疗,特别对关节疼痛、关节压痛、关节功能障碍方面,恢刺阿是穴的疗效优势更快显现。可见,恢刺阿是穴治疗急性踝关节具有疗效肯定,优势明显,值得在临床上大力推广。
Background:
Acute ankle sprain is one of clinical common acute soft tissue injury, mainly because of intense exercise, improper weight, falling accident, outside forces excessive pull reverse. It causes ankle excessive internal and eversion. It is characterized by ankle swelling and pain. The wound skin becomes green purple bruises, and activity limitations. There is no fracture dislocation and skin damage.20%-40%of the patients with acute ankle sprain can grow into chronic ankle instability. The disease belongs to the category of TCM injury muscle, also belong to injured stamp foot and fractures of ribs. Since sudden violence leads to injury, TCM called it new injury. The disease is caused by trauma, and leads to local blood stasis and qi stagnation in local meridians impassability. Brawn meridian immediately damaged. Qi and blood are mutual resistance and cause pain and swelling. According to the pathogenesis, acupuncture and moxibustion is an important means of treatment of painful disease.
Numerous studies indicated that acupuncture and moxibustion was effective in the treatment of acute ankle sprains. Spirit pivot of Nine and twelve said: Through the meridians, micro needle adjusted its flesh and its inverse Qi in and out of the blood vessel". Acupuncture and moxibustion in the treatment of acute ankle sprains are mainly improve pain. Mainly through participation change within5-light tryptamine, fat skin and b choline phthalein central neurotransmitters such as analgesia action. From classic theory, acute ankle sprains belong to the category of the muscle disease, and should choose the corresponding the reinforcement method. Restore is one of the twelve thorn in Neijing method,"pivot, the officer needle" records:" Puncture, pierce bang, as before, restore muscle anxious, treatment of tendon Bi ". Lateral puncture is one of the important methods for the treatment of the muscle disease. Lateral puncture is a representative reinforcement method in Neijing. Lateral Puncture is arrested sharp pain for brawn, namely the sting method of muscle disease. Lateral puncture method are relatively strong. Stimulating amount is larger, corresponding to the reinforcement follow line of point, line and plane distribution characteristics. It can be more obvious and tendons. Lateral puncture method can regulate the menstrual function, smooth meridians qi and blood, moisten the muscle, relieve local twin. Its function can be summarized as "main and collateral channels, qi and blood, honor through reinforcement".
Objective
To compare the clinical curative effect of the lateral puncture, routine acupuncture, and RICE (rest, ice, compression bandage, raise the limb) in the treatment of acute ankle sprains, and to discuss its mechanism, in order to investigate the best acupuncture therapy in the treatment of acute ankle sprains. This study inherited the restore of the Pivot, and applied it to the clinical, restore thorn further observation method in the application value of the common diseases of acute ankle sprains.
Methods
90cases of patients with acute ankle sprains were included in the trial. The study used calculator to produce random sequence. The subjects were randomly divided into three groups. Each group were30cases. Experimental group A adopted lateral puncture.A-shi acupoint was the treatment of acupuncture point and is selected by touching, gently kneading, found out with tenderness, and then we used2inches filiform needle, and punctured vertically into acupuncture points, then lifted needle slightly to the skin,do not withdraw the needle, the needle body tilt, the longitudinal axis along the tendons insert needles into acupuncture points0.5-1inch; Couldn't then to subcutaneous needle, the needle, slightly change the Angle to insert again, again and again several times, and then inserted twisting around, enlarge the pin hole. The macthed acupoints contained Xuanzhong, Zusanli, Quxu, Kunlung, Sanyinjiao and etc. TDP irradiation was used during the retaining needle time,20min for retaining needle. Control group B used routine acupuncture method, according to Du Yuanhao, Shi Xuemin editor of "Chinese acupuncture clinical diagnosis and treatment norms" standard, that these were Ashi, Shenmai, Qiuxu, Jieqi, Zhaohai, Kunlun, Taixi. Control group C used conventional RICE processing method, that is, rest, ice, compressi on bandage, braking up limb. Acupuncture and moxibustion was used1time/day,7days for a course of treatment. Respectively before treatment, after treatment. The trial observed the subjects' visual analogue scale (VAS), ankle sprains symptom integral (ASI), including joint pain, joint disorders index, joint swelling, joint red, and so on and so forth. Research sorted out and analyzed data for curative effect evaluation, using the three methods for scientific treatment of acute ankle sprains,
Results
Subjects between the three groups in gender, age, course and grade of disease, disease stages VAS pain score and ankle symptoms integral (ASI) score had no statistical significance (P>0.05), so that the baseline data were comparable between groups.
Each group after treatment compared with before treatment, VAS score were statistically significant (P<0.01); VAS score after treatment compared between three groups are statistically significant.(P<0.05), suggesting that o restore sting method were compared with the conventional RICE, conventional acupuncture has the advantage in improving pain of acute ankle sprains.
Groups of ASI scores compared with before treatment, after treatment were statistically significant (P<0.01); ASI scores after treatment compared between three groups has statistically significant (P<0.05), suggesting that o restore sting method were compared with the conventional RICE, conventional acupuncture has the advantage in improving symptoms of acute ankle sprains. Three groups of patients before, during and after treatment of joint pain index comparison, compared with before treatment in each treatment, have statistically significant(P<0.01);Each group compared with before treatment, after treatment were statistically significant (P<0.01). Treatment and after treatment comparison between the three groups were statistically significant (P<0.05), suggesting o restore sting method were compared with the conventional RICE, conventional acupuncture has advantages in improving ankle pain, and has appeared in the treatment of4days.
Three groups of patients before, during and after treatment of joint swelling index comparison, compared with before treatment in each treatment, all statistically significant (P<0.01); Each group compared with before treatment, after treatment were statistically significant (P<0.01). Compared between three groups after treatment was statistically significant (P<0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle swelling.
Three groups of patients before, during and after treatment of joint red heat index comparison, compared with before treatment in each treatment, all statistically significant (P<0.01); Groups compared with before treatment, after treatment were statistically significant (P<0.01). Treatment and after treatment compared between three groups had statistical significance (P<0.05), after treatment and restore method compared with conventional acupuncture is not statistically significant (P>0.05). That restore o sting method were compared with conventional RICE, have an advantage in improving the ankle red-hot, compared with conventional acupuncture curative effect. Three groups of patients before, during and after treatment of joint tenderness index comparison, compared with before treatment in each treatment, all statistically significant (P<0.05); Each group compared with before treatment, after treatment were statistically significant (P<0.01). After treatment and compared between three groups had statistical significance (P <0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle joint tenderness has advantages, and has appeared in the treatment of4days. Three groups of patients before, during and after treatment
Three groups of patients before, during and after treatment of joint disturbance index comparison, compared with before treatment in each treatment, all statistically significant (P<0.05); In each group after treatment compared with before treatment, the differences were statistically significant (P<0.01). After treatment and compared between three groups had statistical significance (P<0.05), suggesting o restore sting method were compared with conventional RICE, conventional acupuncture in improving ankle dysfunction has advantages, and has appeared in the treatment of4days.
Different stages of VAS score comparison, concluded that different symptom scores before and after the treatment of acupuncture intervention period affect the value is different (P<0.05). Three groups of symptom scores before and after the treatment value changes from big to small in turn for:acute stage> subacute stage> recovery. Shows that acupuncture intervention the sooner, the better therapeutic effect.
Three groups of subjects after treatment the overall curative effect comparison, restore sting method the clinical curative effect of acupuncture point is better than that of conventional RICE, conventional acupuncture (P <0.05). And level-i trauma and II distribution in the effect of level of no difference between groups, suggests that condition classification did not influence the curative effect of the differences between groups (P>0.05).
Conelusions:
This study showed that the effect of lateral puncture Ashi is superior to conventional acupuncture in treatment of acute ankle sprains, RICE treatment, especially for joint pain, joint tenderness and joint dysfunction, restore the curative effect of acupuncture point advantage appeared faster. Lateral puncture has curative effect in the treatment of acute ankle, obvious advantages, and is worth promoting in clinic.
引文
[1]Fong DT, Hong Y, Chan LK, et al.A systematic review on ankle injury and ankle sprain in sports[J]. Sports Med,2007,37 (1):73-94.
[2]Tricia J, Hubbard, Craig R, Denegar, Does Cryotherapy Improve Outcomes With Soft Tissue Injury[J]. Journal of Athletic Training,2004,39(3):278-279.
[3]Koo ST, Lim KS, Chung K, et al. Electroacupuncture induced analgesia in a rat model of ankle sprain pain is mediated by spinal alpha adrenoceptors[J]. Pain,2008;135:11-19.
[4]Hee Young Kim, Sung Tae Koo, Jae Hyo Kim, et al. Electroacupuncture analgesia in rat ankle sprain pain model:neural mechanisms[J]. Neurological Research,2010;32:10-17.
[5]Norihiro Samoto, Kazuya Sugimoto, Takanori Takaoka, et al. Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography[J]. J Orthop Sci,2007(12):49-54.
[6]Pi jnenburg ACM, VanDijk CN, BossuyMM, etal. Treanment of ruptures of the lateral ankle ligaments:A meta-analysis. [J].J Bone Joint Surg(Am),2000,82:761-773.
[7]OzekiS, YasudaK, KanedaK, etal. Simultaneous strain measurement with determination of azero strain referenee for the media landlateral ligaments of the ankle. [J]. Footankleint,2002,23, (9):825-832
[8]汪学松,邱贵兴,翁习生等.踝关节内外侧韧带损伤的诊断和治疗[J].中国矫形外科杂志,2008,2,16,4：269-272.
[9]万里.踝关节创伤后手法治疗效果评估[J].中国临床康复.2005,11(9)：126-127
[10]吴在德等.外科学[M].第5版.北京：人民卫生出版社2002,148
[11]王正义.足踝外科学[M].北京：人民卫生出版社,2006：209
[12]王岩,卢世壁,译.坎贝尔骨科手术学第11版[M].北京：人民军医出版社,2009：1845
[13]王亦璁.骨与关节损伤[M].第4版.北京：人民卫生出版社,2007,1498-1499.
[14]田金玉.跺关节扭伤的解剖学原因探讨[J].卫生职业教育,2007,7：47-48.
[15]蒋协远.跺关节外侧副韧带急性断裂治疗的近代概念[J].创伤骨科学报,1992,1(3)：27
[16]袁建迪等.中医外治急性软组织损伤的临床研究进展[J].中医外治杂志,2008,2(17)：41-43
[17]李嘉祁.踝关节韧带损伤的康复[J].现代康复,1999：3(2)：211-212
[18]陆赈照.踝关节损伤与治疗学[M]上海,上海科学技术文献出版社,1988,124
[19]曲绵域,高云秋,浦钧宗,等.实用运动医学[M].北京：北京科学技术出版社,1996：782.
[20]国家中医药管理局.中医病证诊断疗效标准[M].南京：南京大学出版社,1994.198.
[21]徐进,田向坤.急性踝关节扭伤的处理和预防[J].武警医学,2006；7；17(7)：559.
[22]刘文志.踩关节扭伤的治疗体会[J].实用骨科杂志,2005.12；11(6)：550-551.
[23]孙文山.分期运用中药熏洗治疗跺关节扭挫伤[J].中医正骨,2003.1：15(1)：38-39.
[24]何新芳,肯海斌.针刺阳陵泉治疗外跺关节扭伤疗效观察[J],中国针灸,2006.8,26(8)：569
[25]于德淮.闭合性踩扭伤急性期的冷处理[J].现代康复,2000；6：4(6)：916
[26]孙树椿.中医筋伤学[M].北京：人民卫生出版社,1990：25-26
[27]张栋.针灸的原理和经络研究中红外热像技术的应[J].中国针灸,2004；24(1)：38-39
[28]詹曦菁.针刺足三里穴对鼠红细胞免疫功能影响的实验研究[J].武警医学,2001,12(5)：267-268.
[29]骆方.巨刺法治疗急性踝关节扭伤39例-附患侧同名穴针刺治疗32例对照[J].浙江中医杂志,2002,22(3)：115-116.
[30]杨继若.耳体对照治疗急性踝关节扭伤120例临床分析[J].甘肃医药,1996,9(3)：36.
[31]李以松,何淑琴,田从豁.局部、远端取穴治疗急性踝关节扭伤的临床观察[J].针灸临床杂志,2001,17(11)：19-20.
[32]吉健友.针刺跗骨窦治疗踝关节扭伤的临床观察[J].中国针灸,2004,24(10)：679-680.郑集诚.巨刺配以动气疗法治疗急性闭合性踝扭伤[D].广州,广州中医药大学博士学位论文.
[33]郑集诚.巨刺配以动气疗法治疗急性闭合性踝扭伤[D].广州,广州中医药大学博士学位论文.
[34]刘敏娟,赵大贵.水罐加微波治疗踝关节扭伤40例[J].上海针灸志,2003,22(12)：35-36.
[35]睢明河,王欢.散刺为主治疗急性外踝扭伤的临床观察[J].北京中医药大学学报(中医临床版),2003,10(2)：45-46
[36]赵延红.巨刺配合拔罐治疗踝关节扭伤78例[J].吉林中医药,2003,23(1)：36-37.
[37]曾小香,梁进娟.输穴刺络拔罐治疗急性踝关节扭伤临床观察[J].上海针灸杂志2006,25(3)：25-26[38]王梁超.耳穴贴压法治疗踝关节扭伤63例[J].陕西中医,2005,26(10)：1095-1096.
[39]何新芳,胥海斌.运用阳陵泉穴治疗外踝关节扭伤46例[J].江西中医药,2006,37卷(5)：42-43.
[40]杨建华,郭灵芝,熊健.针刺结合刺络拔罐治疗急性踝关节扭伤46例临床观察[J].中医药导报,2007,13(4)：29-30.
[41]郑全成,王磊.针刺肩髃髑穴治疗外踝关节扭伤疗效观察[J].海南医学院学报,2010,16(5)：600-601.
[42]吴红英.火针温针结合治疗急性踝关节扭伤40例疗效观察[J].高校保健医学研究与实践,2006,3(3)：30-31.
[43]刘红,彭华.小节穴结合刺络拔罐法治疗急性踝关节扭伤疗效观察[J].吉林医学,2012,33(16)：3430-3431.
[44]喻坚.二甲亚砜凝胶加针灸治疗踝关节扭伤疗效观察[J].海南大学学报自然科学版.1999.17(4)：374-376.
[45]张伟.针灸、理疗治疗踝关节扭伤疗效观察[J].中外医疗,2012,5(7)：113.
[46]洪东芹.针刺加中频治疗急性踝关节扭伤40例疗效观察[J].山西中医,2011,27(3)：30-31.
[47]葛晟,马勇.针刺配合活血利水法治疗踝关节扭伤80例[J].南京中医药大学学报(自然科学版),2000,16(4)：237-239.
[48]李骁.针刺治疗踝关节扭伤疗效观察[J].中国临床医生,2002,30(7)：46-47.
[49].段玲.针刺放血配合中药外敷治疗踝关节扭伤临床观察[J].湖北中医杂志,2007.29(8)：52-53.
[50]郝红梅,王旭.中药外敷配合针灸治疗踝关节扭伤63例临床观察[J].山西中医学院学报, 2006,7(4)：29-30
[51]陈秀玲,罗仁瀚,源援基.推拿加电针治疗急性踝关节扭挫伤56例疗效观察[J].按摩与导引,2006,22(8)：4-5.
[52]余晓慧.针灸推拿治疗踝关节扭伤的临床观察[J].中国中医骨伤科杂志,2007,15(2)：15-17.
[53]阮志强.针刺加推拿治疗急性踝关节扭伤338例对比观察[J].宁德师专学报(自然学版),1995,7(2)：63-65.
[54]卢其洋,申国祥.中西医结合治疗踝关节扭伤56例疗效观察[J].现代中西医结合杂志,2003,12(16)：1774-1775.
[55]焦辉,王宏.TDP照射下针炙治疗踝关节扭伤临床观察[J].武警医学院学报,2004,13(15)：399-400.
[56]陈玉华.“恢刺”、“关刺”治筋病[J].针刺研究,1993,13(3)：6-7.
[57]孟仕贵.恢刺加灸在颈肩部疾病中的应用[J].长春中医学院学报,2005,21(3)：23.
[58]夏筱方.恢刺加灸治疗梨状肌综合征73例[J].江苏中医,1994,15(5)：31-32.
[59]陆永辉.《灵枢》恢刺法治疗颈型颈椎病疗效观察[J].中国针灸,2013,33(1)：20-23.
[60]吴刚,李茵茵.恢刺加艾灸治疗膝关节侧副韧带炎临床观察[J].湖北中医杂志,2001,23(8)：44-45.
[61]朱晓红陈立钢.阿是穴恢刺法埋线治疗肩周炎临床护理45例[J].中国民族民间医药,2012.5(6)：32-34.
[62]杨军雄.恢刺合推拿治疗肩周炎30例临床观察[J].江苏中医药,2008,40(10)：80.
[63]王峥.恢刺治疗肩关节周围炎疗效观察[J].上海针灸杂志,2009,28(8)：471.
[64]赵勇刚.恢刺加刺络拔罐法治疗急性关节扭伤35例[J].中国针灸,1990,16(3)：23.
[65]陈朝明,张彩荣.粗银针恢刺治疗脊柱过敏症临床研究[J].河南中医学院学报,2008,23(3)：27-29
[66]刘靖,张淑杰,汤艳娟.合谷刺和恢刺法治疗网球肘72例[J].中国民间疗法,2008,6(3)：10.
[67]赵刚明,高效祥.恢刺法加艾灸治疗肱骨外上髁炎49例临床观察[J].针灸临床杂志,2003,19(12)：26-28
[68]奚向东,张鑫海.恢刺加灸与常规针刺治疗肚骨外上髁炎353例疗效分析[J].针灸临床杂志,1996,12(7、8)：34.
[69]杨正明.采用曲池恢刺法配合隔药饼灸治疗网球肘62例[J].江苏中医药,2006,27(3)：43.
[70]凌建维.恢刺法治疗肱二头肌长头腱腱鞘炎76例[J].中国针灸,2006,26(5)：334-335.
[71]严书荣,孙乐芹.恢刺、短刺配合按摩治疗老年性膝关节炎64例[J].中国社区医师,2005,7(18)：30.
[72]李雪梅.采用恢刺扬刺法治疗膝骨性关节炎96例[J].实用中医内科杂志,2007.21(1)：91.
[73]侯志,罗开民,杨琳,戚天臣.恢刺法治疗肱骨外科颈骨折术后肩关节活动功能障碍30例临床观察[J].河北中医,2012,34(3)：334-336.
[74]俞国瑛.恢刺法治疗腱鞘囊肿46例[J].中国针灸,1997,25(4)：40
[75]张淑杰,刘靖.恢刺法治疗慢性软组织损伤120例[J].中国民间疗法,2008,4(1)：23.
[76]刘海英,时国臣,李晓艳,刘长艳.恢刺法治疗缺血性中风后上肢痉挛性瘫临床观察[J].黑龙江中医药,2012,34(12)：36-37.
[77]何晓华.恢刺和关刺法治疗中风后上肢痉挛性瘫痪临床观察[J].上海中医药杂志2008,42(12)：45-46.
[78]高洁,欧阳八四.恢刺加电针对中风患者痉挛状态缓解的临床观察[J].湖南中医杂志,2007.23(7)：3-4
[79]余兆安,叶晓红,章薇.恢刺痉挛肌起止点治疗中风病痉挛瘫痪30例[J].湖南中医杂志,2012,28(4)：105-106.
[80]闫毓茜.经筋恢刺法治疗中风后上肢痉挛30例临床观察[J].四川中医,2012,30(9)：125-126.
[81]王洪峰,黎明全.头针加恢刺治疗中风痉挛性偏瘫36例[J].吉林中医药,2003,23(4)：22-23.
[82]吕忠礼,陈志强.恢刺压痛点治疗小儿落枕[J].中国针灸,2000,19(6)：23.
[83]周立武.恢刺治疗颈源性头痛临床观察[J].针刺研究,2007,32(1)：67-68.
[84]周立武.恢刺治疗髂腰韧带损伤70例[J].中国针灸,2009,29(7)：559-560.
[85]刘军,范庆花,徐鲁云.经筋恢刺法治疗颈肌筋膜疼痛综合征68例[J].中国中医急症,2011,20(11)：1864.
[86]倪瑞军.经筋恢刺法治疗颈肌筋膜疼痛综合征68例[J].中国中医急症,2011,20(11)：1864.
[87]丁丽玲.四针恢刺法治疗腰椎间盘突出症66例[J].云南中医中药杂志,2006.27(5)：26.
[88]项立敏,朱凤仙,杜丽娜.头皮针结合关刺、恢刺、毛刺治疗脑瘫32例[J],上海针灸杂志,1997.16(1)：11-12.
[89]杜元灏.石学敏.中华针灸诊疗规范[M],第1版,江苏科学技术出版社,2007.8
[90]刘玉秀,成琪,刘丽霞.2010版CONSORT声明：平行组随机试验报告的新指南[J].中国临床药理学与治疗学,Oct：15(10)：1189-1194
[91]Moher D. CONSORT:an evolving tool to help improve the quality of reports of randomized controlled trials. Consolidated Standards of Reporting Trials. JAMA.1998; 279(18):1489-1491
[92]Kjaergard LL, Villumsen J, Gluud C. Quality of randomised clinical trials affects estimates of intervention efficacy.7th. Cochrane Colloquium. Rome. Italy.1999
[93]Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA.1995:273(5):408-412
[94]石学敏.针灸学[M],第1版,中国中医药出版社,2002.8
[95]孙呈样.软组织伤治疗学[M].上海：上海中医学院出版社.1988,284-288
[2]Tricia J, Hubbard, Craig R, Denegar, Does Cryotherapy Improve Outcomes With Soft Tissue Injury[J]. Journal of Athletic Training,2004,39(3):278-279.
[3]Koo ST, Lim KS, Chung K, et al. Electroacupuncture induced analgesia in a rat model of ankle sprain pain is mediated by spinal alpha adrenoceptors[J]. Pain,2008;135:11-19.
[4]Hee Young Kim, Sung Tae Koo, Jae Hyo Kim, et al. Electroacupuncture analgesia in rat ankle sprain pain model:neural mechanisms[J]. Neurological Research,2010;32:10-17.
[5]Norihiro Samoto, Kazuya Sugimoto, Takanori Takaoka, et al. Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography[J]. J Orthop Sci,2007(12):49-54.
[6]Pi jnenburg ACM, VanDijk CN, BossuyMM, etal. Treanment of ruptures of the lateral ankle ligaments:A meta-analysis. [J].J Bone Joint Surg(Am),2000,82:761-773.
[7]OzekiS, YasudaK, KanedaK, etal. Simultaneous strain measurement with determination of azero strain referenee for the media landlateral ligaments of the ankle. [J]. Footankleint,2002,23, (9):825-832
[8]汪学松,邱贵兴,翁习生等.踝关节内外侧韧带损伤的诊断和治疗[J].中国矫形外科杂志,2008,2,16,4：269-272.
[9]万里.踝关节创伤后手法治疗效果评估[J].中国临床康复.2005,11(9)：126-127
[10]吴在德等.外科学[M].第5版.北京：人民卫生出版社2002,148
[11]王正义.足踝外科学[M].北京：人民卫生出版社,2006：209
[12]王岩,卢世壁,译.坎贝尔骨科手术学第11版[M].北京：人民军医出版社,2009：1845
[13]王亦璁.骨与关节损伤[M].第4版.北京：人民卫生出版社,2007,1498-1499.
[14]田金玉.跺关节扭伤的解剖学原因探讨[J].卫生职业教育,2007,7：47-48.
[15]蒋协远.跺关节外侧副韧带急性断裂治疗的近代概念[J].创伤骨科学报,1992,1(3)：27
[16]袁建迪等.中医外治急性软组织损伤的临床研究进展[J].中医外治杂志,2008,2(17)：41-43
[17]李嘉祁.踝关节韧带损伤的康复[J].现代康复,1999：3(2)：211-212
[18]陆赈照.踝关节损伤与治疗学[M]上海,上海科学技术文献出版社,1988,124
[19]曲绵域,高云秋,浦钧宗,等.实用运动医学[M].北京：北京科学技术出版社,1996：782.
[20]国家中医药管理局.中医病证诊断疗效标准[M].南京：南京大学出版社,1994.198.
[21]徐进,田向坤.急性踝关节扭伤的处理和预防[J].武警医学,2006；7；17(7)：559.
[22]刘文志.踩关节扭伤的治疗体会[J].实用骨科杂志,2005.12；11(6)：550-551.
[23]孙文山.分期运用中药熏洗治疗跺关节扭挫伤[J].中医正骨,2003.1：15(1)：38-39.
[24]何新芳,肯海斌.针刺阳陵泉治疗外跺关节扭伤疗效观察[J],中国针灸,2006.8,26(8)：569
[25]于德淮.闭合性踩扭伤急性期的冷处理[J].现代康复,2000；6：4(6)：916
[26]孙树椿.中医筋伤学[M].北京：人民卫生出版社,1990：25-26
[27]张栋.针灸的原理和经络研究中红外热像技术的应[J].中国针灸,2004；24(1)：38-39
[28]詹曦菁.针刺足三里穴对鼠红细胞免疫功能影响的实验研究[J].武警医学,2001,12(5)：267-268.
[29]骆方.巨刺法治疗急性踝关节扭伤39例-附患侧同名穴针刺治疗32例对照[J].浙江中医杂志,2002,22(3)：115-116.
[30]杨继若.耳体对照治疗急性踝关节扭伤120例临床分析[J].甘肃医药,1996,9(3)：36.
[31]李以松,何淑琴,田从豁.局部、远端取穴治疗急性踝关节扭伤的临床观察[J].针灸临床杂志,2001,17(11)：19-20.
[32]吉健友.针刺跗骨窦治疗踝关节扭伤的临床观察[J].中国针灸,2004,24(10)：679-680.郑集诚.巨刺配以动气疗法治疗急性闭合性踝扭伤[D].广州,广州中医药大学博士学位论文.
[33]郑集诚.巨刺配以动气疗法治疗急性闭合性踝扭伤[D].广州,广州中医药大学博士学位论文.
[34]刘敏娟,赵大贵.水罐加微波治疗踝关节扭伤40例[J].上海针灸志,2003,22(12)：35-36.
[35]睢明河,王欢.散刺为主治疗急性外踝扭伤的临床观察[J].北京中医药大学学报(中医临床版),2003,10(2)：45-46
[36]赵延红.巨刺配合拔罐治疗踝关节扭伤78例[J].吉林中医药,2003,23(1)：36-37.
[37]曾小香,梁进娟.输穴刺络拔罐治疗急性踝关节扭伤临床观察[J].上海针灸杂志2006,25(3)：25-26[38]王梁超.耳穴贴压法治疗踝关节扭伤63例[J].陕西中医,2005,26(10)：1095-1096.
[39]何新芳,胥海斌.运用阳陵泉穴治疗外踝关节扭伤46例[J].江西中医药,2006,37卷(5)：42-43.
[40]杨建华,郭灵芝,熊健.针刺结合刺络拔罐治疗急性踝关节扭伤46例临床观察[J].中医药导报,2007,13(4)：29-30.
[41]郑全成,王磊.针刺肩髃髑穴治疗外踝关节扭伤疗效观察[J].海南医学院学报,2010,16(5)：600-601.
[42]吴红英.火针温针结合治疗急性踝关节扭伤40例疗效观察[J].高校保健医学研究与实践,2006,3(3)：30-31.
[43]刘红,彭华.小节穴结合刺络拔罐法治疗急性踝关节扭伤疗效观察[J].吉林医学,2012,33(16)：3430-3431.
[44]喻坚.二甲亚砜凝胶加针灸治疗踝关节扭伤疗效观察[J].海南大学学报自然科学版.1999.17(4)：374-376.
[45]张伟.针灸、理疗治疗踝关节扭伤疗效观察[J].中外医疗,2012,5(7)：113.
[46]洪东芹.针刺加中频治疗急性踝关节扭伤40例疗效观察[J].山西中医,2011,27(3)：30-31.
[47]葛晟,马勇.针刺配合活血利水法治疗踝关节扭伤80例[J].南京中医药大学学报(自然科学版),2000,16(4)：237-239.
[48]李骁.针刺治疗踝关节扭伤疗效观察[J].中国临床医生,2002,30(7)：46-47.
[49].段玲.针刺放血配合中药外敷治疗踝关节扭伤临床观察[J].湖北中医杂志,2007.29(8)：52-53.
[50]郝红梅,王旭.中药外敷配合针灸治疗踝关节扭伤63例临床观察[J].山西中医学院学报, 2006,7(4)：29-30
[51]陈秀玲,罗仁瀚,源援基.推拿加电针治疗急性踝关节扭挫伤56例疗效观察[J].按摩与导引,2006,22(8)：4-5.
[52]余晓慧.针灸推拿治疗踝关节扭伤的临床观察[J].中国中医骨伤科杂志,2007,15(2)：15-17.
[53]阮志强.针刺加推拿治疗急性踝关节扭伤338例对比观察[J].宁德师专学报(自然学版),1995,7(2)：63-65.
[54]卢其洋,申国祥.中西医结合治疗踝关节扭伤56例疗效观察[J].现代中西医结合杂志,2003,12(16)：1774-1775.
[55]焦辉,王宏.TDP照射下针炙治疗踝关节扭伤临床观察[J].武警医学院学报,2004,13(15)：399-400.
[56]陈玉华.“恢刺”、“关刺”治筋病[J].针刺研究,1993,13(3)：6-7.
[57]孟仕贵.恢刺加灸在颈肩部疾病中的应用[J].长春中医学院学报,2005,21(3)：23.
[58]夏筱方.恢刺加灸治疗梨状肌综合征73例[J].江苏中医,1994,15(5)：31-32.
[59]陆永辉.《灵枢》恢刺法治疗颈型颈椎病疗效观察[J].中国针灸,2013,33(1)：20-23.
[60]吴刚,李茵茵.恢刺加艾灸治疗膝关节侧副韧带炎临床观察[J].湖北中医杂志,2001,23(8)：44-45.
[61]朱晓红陈立钢.阿是穴恢刺法埋线治疗肩周炎临床护理45例[J].中国民族民间医药,2012.5(6)：32-34.
[62]杨军雄.恢刺合推拿治疗肩周炎30例临床观察[J].江苏中医药,2008,40(10)：80.
[63]王峥.恢刺治疗肩关节周围炎疗效观察[J].上海针灸杂志,2009,28(8)：471.
[64]赵勇刚.恢刺加刺络拔罐法治疗急性关节扭伤35例[J].中国针灸,1990,16(3)：23.
[65]陈朝明,张彩荣.粗银针恢刺治疗脊柱过敏症临床研究[J].河南中医学院学报,2008,23(3)：27-29
[66]刘靖,张淑杰,汤艳娟.合谷刺和恢刺法治疗网球肘72例[J].中国民间疗法,2008,6(3)：10.
[67]赵刚明,高效祥.恢刺法加艾灸治疗肱骨外上髁炎49例临床观察[J].针灸临床杂志,2003,19(12)：26-28
[68]奚向东,张鑫海.恢刺加灸与常规针刺治疗肚骨外上髁炎353例疗效分析[J].针灸临床杂志,1996,12(7、8)：34.
[69]杨正明.采用曲池恢刺法配合隔药饼灸治疗网球肘62例[J].江苏中医药,2006,27(3)：43.
[70]凌建维.恢刺法治疗肱二头肌长头腱腱鞘炎76例[J].中国针灸,2006,26(5)：334-335.
[71]严书荣,孙乐芹.恢刺、短刺配合按摩治疗老年性膝关节炎64例[J].中国社区医师,2005,7(18)：30.
[72]李雪梅.采用恢刺扬刺法治疗膝骨性关节炎96例[J].实用中医内科杂志,2007.21(1)：91.
[73]侯志,罗开民,杨琳,戚天臣.恢刺法治疗肱骨外科颈骨折术后肩关节活动功能障碍30例临床观察[J].河北中医,2012,34(3)：334-336.
[74]俞国瑛.恢刺法治疗腱鞘囊肿46例[J].中国针灸,1997,25(4)：40
[75]张淑杰,刘靖.恢刺法治疗慢性软组织损伤120例[J].中国民间疗法,2008,4(1)：23.
[76]刘海英,时国臣,李晓艳,刘长艳.恢刺法治疗缺血性中风后上肢痉挛性瘫临床观察[J].黑龙江中医药,2012,34(12)：36-37.
[77]何晓华.恢刺和关刺法治疗中风后上肢痉挛性瘫痪临床观察[J].上海中医药杂志2008,42(12)：45-46.
[78]高洁,欧阳八四.恢刺加电针对中风患者痉挛状态缓解的临床观察[J].湖南中医杂志,2007.23(7)：3-4
[79]余兆安,叶晓红,章薇.恢刺痉挛肌起止点治疗中风病痉挛瘫痪30例[J].湖南中医杂志,2012,28(4)：105-106.
[80]闫毓茜.经筋恢刺法治疗中风后上肢痉挛30例临床观察[J].四川中医,2012,30(9)：125-126.
[81]王洪峰,黎明全.头针加恢刺治疗中风痉挛性偏瘫36例[J].吉林中医药,2003,23(4)：22-23.
[82]吕忠礼,陈志强.恢刺压痛点治疗小儿落枕[J].中国针灸,2000,19(6)：23.
[83]周立武.恢刺治疗颈源性头痛临床观察[J].针刺研究,2007,32(1)：67-68.
[84]周立武.恢刺治疗髂腰韧带损伤70例[J].中国针灸,2009,29(7)：559-560.
[85]刘军,范庆花,徐鲁云.经筋恢刺法治疗颈肌筋膜疼痛综合征68例[J].中国中医急症,2011,20(11)：1864.
[86]倪瑞军.经筋恢刺法治疗颈肌筋膜疼痛综合征68例[J].中国中医急症,2011,20(11)：1864.
[87]丁丽玲.四针恢刺法治疗腰椎间盘突出症66例[J].云南中医中药杂志,2006.27(5)：26.
[88]项立敏,朱凤仙,杜丽娜.头皮针结合关刺、恢刺、毛刺治疗脑瘫32例[J],上海针灸杂志,1997.16(1)：11-12.
[89]杜元灏.石学敏.中华针灸诊疗规范[M],第1版,江苏科学技术出版社,2007.8
[90]刘玉秀,成琪,刘丽霞.2010版CONSORT声明：平行组随机试验报告的新指南[J].中国临床药理学与治疗学,Oct：15(10)：1189-1194
[91]Moher D. CONSORT:an evolving tool to help improve the quality of reports of randomized controlled trials. Consolidated Standards of Reporting Trials. JAMA.1998; 279(18):1489-1491
[92]Kjaergard LL, Villumsen J, Gluud C. Quality of randomised clinical trials affects estimates of intervention efficacy.7th. Cochrane Colloquium. Rome. Italy.1999
[93]Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA.1995:273(5):408-412
[94]石学敏.针灸学[M],第1版,中国中医药出版社,2002.8
[95]孙呈样.软组织伤治疗学[M].上海：上海中医学院出版社.1988,284-288
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