张士杰学术思想与临床经验总结及针刺太溪穴、曲泉穴治疗KOA的临床研究

【作者】 李峥；

【导师】 张士杰；

【作者基本信息】 北京中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 张士杰老中医的学术思想的渊源最主要的是来自于《黄帝内经》。张老师长期钻研《黄帝内经》,从《素问·示从容论》：“览观杂学,及于比类”,悟入《黄帝内经》针刺理论。通过对《黄帝内经》及其他秦汉以及魏晋时期的文献的研究分析和比较,得出结论,《黄帝内经》的完整成书历经数千年,从其内容来看显然是古代医经家的著作,而非经方家的著作。《黄帝内经》中大量探讨的是针灸学的诊断问题与治疗方法,而不是方药。《黄帝内经》中仅有13个方子,并且非常简单,不过这并不是当时经方家组方水平低,例如“方书之祖”《伤寒杂病论》就是在《汤液经》等的基础上收集整理而来,只是古代经方家的著作大多亡佚罢了。《黄帝内经》中讲述有关针刺的理论非常完善,并且是与经方家的理论有所区别的。但是因为战乱《黄帝内经·灵枢》隐没数百年,北宋时才从海外重新流传回国。以至于《黄帝内经》针灸理论传承断代。后世许多针灸家只得借用经方派的脏腑辨证理论指导针灸临床。有鉴于此张老师提倡发掘弘扬古法针刺,也就是《黄帝内经》本身的针刺理论与方法。在本论文中首先论述了古法针刺的特点：1、重视援物比类的思想,分析病因病机以及选穴严格遵循《内经》的方式,而不同于经方家的辨证论治；2、注重针刺是的调气,强调气调则止,而不一味留针；3、重视治神。张老师运用古法针刺的最著名之处在于应用太溪穴单穴为主治疗了很多种疾病,其中不乏一些疑难病、罕见病,疗效十分肯定,所以针灸界有很多同仁称张老师为张太溪。在此论文中我尽可能地将我多年追随张老师学习的过程中看到的老师如何使用《内经》的思维方式分析病因病机、然后应用太溪穴来治疗的69种疾病的典型病例记述出来。这69种疾病包括包含了内、外、妇、儿等多学科的疾病。包括足少阴是动病、发作性睡眠、失眠、失聪、肠鸣音亢进二便难、神经官能症、唏、膈肌痉挛、奔豚病、梅核气、嗳气、郁证、癔病性失音、癔病性失明、癔病性强直、下肢萎软无力、寒战、多汗症、厌食症、腹胀、便秘、溏泄、遗尿、晕动症、晕厥、美尼尔综合征、厥逆、三叉神经痛、偏头痛、痛经、局部抽搐症、短暂脑缺血反复发作、椎基底动脉供血不足、假性延髓麻痹、脑瘫、颈项强直、手足徐动症、肝豆状核变性、痉挛性斜颈、面肌痉挛、怔忡、无脉症、大隐静脉炎、甲亢、石淋、骨性关节炎、痛风、肢端硬化型系统性硬皮病、湿疹、蔬菜日光性皮炎、黄褐斑、寻常性痤疮、抗精神病药物的推体外副反应、哮喘、支气管扩张、呕血、急性一氧化碳中毒(中度)、水合氯醛中毒、麻痹性斜视、舌咽神经痛、胸痹心痛、噎嗝、背肌筋膜炎、腱鞘囊肿、髌下脂肪垫损伤、股内收肌损伤、踝关节扭伤、丹毒等。如上所述,张老师针刺强调应用古法,最有特点的就是运用太溪一穴治疗了大量的杂病。当然张老师也把古法针刺应用到诸如腕骨、昆仑等穴治疗多种杂病的临床中。但是使用太溪一穴最有特点,也运用最广泛。受到论文篇幅及撰写时间所限,所以我的此篇继承论文就以总结老师运用太溪穴治疗各种杂病为主要内容。同时因为我本身在单位的工作科室是骨伤科,所以我非常注意学习老师应用古法针刺治疗骨伤科疾病。我观察到老师仅取太溪穴、曲泉穴两穴针刺治疗膝骨关节炎KOA效果很好。其理论依据是：膝关节骨性关节病在中医属于“痹症”的范畴,《素问·痹论》：“风寒湿三气杂至,合而为痹,其风气盛者为行痹,寒气胜者为痛痹,湿气胜者为着痹。”仿《灵枢·终始》：“屈而不伸者,其病在筋,伸而不屈者,其病在骨,在骨守骨,在筋守筋。”应用援物比类的思想,肝主筋而与肾同源,肾主骨而又坎中之阳,可温煦脾土,以祛湿散寒,故取肾之原穴太溪为主穴,辅以曲泉。曲泉,属足厥阴肝经,为肝经合穴,五行属木,古书云治膝胫痛。而且临床上膝骨关节炎患者病源丰富,病例容易收集。膝骨关节炎(KOA)是骨伤科最为常见疾病种类之一,膝骨关节炎为多发于中老年人群中的慢性、进行性骨关节疾病。随着全世界人口老龄化程度的加剧,膝骨性关节炎的发病率显著增高,该病严重伤害中老年人的生存质量。膝骨关节炎临床表现为膝关节乏力疼痛、登高困难,也可同时伴有膝部畸形、僵硬,也有可能诱发急性滑膜炎而出现膝关节红、肿、热、痛。现代医学一般认为膝骨关节炎是在生物学、力学因素的共同作用下,软骨下骨、软骨细胞、软骨基质三者之间合成分解代谢失衡所造成的后果。本论文科研部分主要为文献综述与临床研究两部分。第一部分文献综述分别探讨了现代西医学及中医学对膝骨关节炎的认识。对膝骨关节炎病因、病理、治疗情况等方面的现代西医研究现状进行了总结。同时对近年来中医药诊治膝骨关节炎的情况进行了回顾。第二部分临床研究。研究依据是张士杰老师将古法针刺应用到治疗膝骨关节病中,仅使用太溪穴、曲泉穴两个穴位就取得了很好的疗效。实验目的为了科学的评价古法针刺太溪穴、曲泉穴在治疗膝骨关节病中的作用,故设计了这个实验。临床方法是通过与西药常用药双氯芬酸钠治疗膝骨关节炎的疗效进行对比,观察古法针刺太溪穴、曲泉穴对膝骨关节炎患者的总体疗效。根据实验结果探讨膝骨关节炎的发病机理及古法针刺治疗的机理。研究中采用随机、对照的方法,以古法针刺太溪穴、曲泉穴治疗为实验组,口服西药双氯芬酸钠治疗作为对照组,每组48例。按照美国风湿学会1995年设立的标准纳入患者,共治疗膝骨关节炎患者96例。结果显示：(1)经过3周的治疗,古法针刺组和西药对照组均取得了一定的近期效果,与治疗前相比WOMAC分值均有显著改善,但两组的有效率比较无显著性差异。(2)疗效的优良程度与治疗方法有关,古法针刺组优良程度显著好于西药对照组。(3)两组患者治疗前后自身WOMAC指标分值比较有所下降,具有统计学意义,古法针刺组与西药对照组治疗后WOMAC指标分值比较无统计学差异。更多还原

【Abstract】 Doctor Zhang Shijie’s academic thought comes mainly from his study of《Yellow Emperor’s Inner Canon》independently. Doctor Zhang summaries the acupuncture theory from the chapter《Su Wen·Questions of Fundamental Nature/The Importance of Correct Diagnosis》:"read many other books beside medical and learned many other skills beside medical skills, so to understand the medical principle". Through studying the《Yellow Emperor’s Inner Canon》and many other books in the dynasties of Qin、Han、Wei、Jin, etc. Doctor Zhang concludes that "the book of《Yellow Emperor’s Inner Canon》costs thousands of years, the book obvious is the literature collection of ancient Chinese medical scholars, rather than the literature of ancient Chinese prescription scholars.《Yellow Emperor’s Inner Canon》focuses on the diagnosis and treatment of acupuncture, rather than herb prescription. So the book contains only thirteen prescriptions which are rather simply. It doesn’t stands for the low level of scholars of classical prescription at that time.The book《Treatise on Febrile and Miscellaneous Diseases》, the ancestor of the prescription books, is collected and sorted out on the base of《Tang Ye Jing》and other books. It’s a pity that most classical prescription books are lost. So the theory of《Yellow Emperor’s Inner Canon》about acupuncture is rather perfect, it has a special theoretical system relative to the system of classical prescription scholars.The《Yellow Emperor’s Inner Canon.Ling Shu》came back to China in the the Northern Song Dynasty after centuries of lost caused by the war. The acupuncture theory of《Yellow Emperor’s Inner Canon》was not carried on for these years. Later,many acupuncture scholars used classical prescription scholars’internal organs to discriminately guide the acupuncture. So Doctor Zhang encourages others to carry on the Chinese traditional methods of acupuncture which is the method of acupuncture of the《Yellow Emperor’s Inner Canon》’s period.The paper first discusses the characteristics of Chinese traditional methods of acupuncture:1. Emphasis on analogy follow the《Canon of Medicine》to analyze the pathogeny and to choose the acupuncture points, which is different from classical prescription scholars’discrimination methods. 2. Emphasis on the adjustment of the vital energy, it stops before going too far instead of long-time’s retaining of needles.3. Emphasis on heal the spirit.Second, Doctor Zhang’s greatest discovery is the acupuncture on Taixi point to cure many diseases, including some rare illness. The curative effect is positive. Because of this,he was named Zhang Taixi. In the paper, I will try my best to show Dr. Zhang’s appl ication of《Canon of Medicine》to analyze the pathogeny, and I will try my best to recall his sixtynine typical cases which is cured by acupuncture the Taixi point during my stady with him.The 69 typical cases include internal medicine、surgery、gynaecology、paediatrics, etc. The cases specially include nephropathy、gelincau syndrome、insomnia、deafness、borborygmus、neurosis、sob、diaphragmatic spasm、renal mass disease、globus hysteriocus、belching、depression syndrome、hysterical aphonia、hysterical tetania、general fatigue、chill、ephidrosis、apositia、abdominal distension、astriction、loose stool、enuresis、motion sickness、syncope、Meniere’s syndrome、cold limbs、douloureux tic、cephalagra、dysmenorrhea、tics、repeat outbreaks of temporal cerebral ischemia vertebro-basilar artery insufficiency、laughing sickness、cerebral palsy、neck rigidity、athetosis、amyostatic syndrome、intermittent torticollis、mimetic convulsion、palpitation、takayasu disease、great saphenous vein inflammation、hyperthyreosis、urolithic stranguria、osteoarthritis、gout systemic scleroderma featuring peripheral sclerosis、eczema、solar dermatitis induced by vegetables、chloasma、acne vulgaris、extrapyramidal side effect of antipsychotics、asthma、bronchiectasia、haematemesis、acute carbon monoxide poisoning、chloral hydrate toxicosis、paralytic strabismus、glossopharyngsal neuralgia、thoracic obstruction cardialgia、choke、dorsal muscles fasciitis、peritendinitis serosa、injury of infrapatellar fat pad、injury of adductor of femur、sprain of ankle、erysipelas, etc.Dr. Zhang stress to use Chinese traditional method, the most distinctive feather of the Chinese traditional method is to use the taixi point to cure many miscellaneous diseases. Of course, Doctor Zhang aslo extend the Chinese traditional method to other areas like carpal bones、Kunlun point, etc. The Taixin point is the most distinctive point which is most widely used. The paper includes sixtynine kinds of miscellaneous cases which is cured by Doctor ZhangAt the same time, I work in the department of orthopedics and traumatology, so I closely pay attention to Dr. Zhang’s special ways to cure the orthopedics and traumatology’s patients using the way of traditional method. I find that Doctor Zhang’s acupuncture of Taixi and Ququan points to cure KOA shows good effect. Its theory evidence is that acromyle arthritis belong to the arthromyodynia category in Chinese traditional medical science. The book《Plain questions·Bi-Syndrone》:"Convergence of Wind, Cold and Dampness Leading to Qi Stagnation. According to different major cause, arthralgia divides into three different subtypes, that’s to say, wind, dampness and cold." is copied from the book《(Linshu:Spiritual Pivot/Shizhong:Laws)》"Chronic dyskinesia results in muscle and bone dysfunction. Thus, a correct therapy is to deal with corresponding acupuncture points." follow the idea of analogy, liver controlling tendon while liver and kidney sharing the same origin. Kidney determines bone and is closely connected with archaeus, thus it helps to dispel wet and cold, so to choose the Taixi point---original point of kidney---to be the main acupoint, the Ququan to be the subsidiary. Ququan point belongs to Liver Channel of Foot-Jueyin. It is the liver meridian mutual acupoint, it attributes to the water in the the five elements. The ancient book stated it could cure the knee bone ache and shin bone ache. In the clinical situation, there are many KOA patients, the cases (of illness) are easy to collect. So I design and practice the research《To cure the KOA illness in the clinical trials uing the traditional acupuncture on Taixi and Ququan points》.The specific contents will be shown in the second part. Knee osteoarthritis (KOA) is one of the most common illnesses in the orthopedics and traumatology, KOA is a chronic progressive bone articulus illness mostly happening among the middle-aged and the old-aged patients. The tendence of world’s population aging is deepen, the incidence of KOA increases obviously, the illness seriously effect the quality of their daily lives. The KOA’s clinical manifestations are observed as knee joint pains and clamber difficulties which accompanies the symptoms of knee abnormality and stiff. Sometimes it can bring out red、swollen、fever、ache of the knee joint. Modern medical science general regards the KOA as the mutual effect of biology and mechanics, it regards KOA to be the unbalance result of the decomposition、metabolism of the articular cartilage、subchondral bone、cartilage cell and cartilage base material.The paper include two parts:the abstract part and the clinical research part.In the abstract part, the literature review investigates the understanding of KOA in the modern Western Medicine (WM) and in the Traditional Chinese Medicine (TCM) separately. This part concludes the present situation of pathogeny、pathology and treatment of KOA in the WM. It also reviews the treatment s of KOA in Chinese Medicine in recent yearsIn the clinical research part, the research introduces the treatments of KOA by Doctor Zhang Shijie following the traditional method of acupuncture. He tries acupuncture on the Taixi and Ququan points which acquires perfect curative effect. The aim of the test is to scientifically evaluate the effect of the acupuncture of the two points in the treatment of KOA, so we design the test. The clinical research often compare the effect of Chinese traditional method with the effect of taking western medicine-Diclofenac Sodium, the test designs to observe the general curative effect of acupuncture on the Taixi and Ququan points. It discusses the paroxysm mechanism of KOA and the principles of Chinese traditional method of acupuncture upon the test result. The research uses the stochastic and comparative ways, arranging two experimental groups. The patients of first group is treated by the Chinese traditional method of acupuncture, the patients of the contrast group take Diclofenac Sodium orally. Each group has 48 cases.According to the standard set by ACR in 1995, the test in all cures 96 cases of KOA. The results reveal that (1) after three weeks’treatment, the two measures all have some effects, the WOMAC marks all have obvious improvements, but the efficiencies are not different. (2)curative effects are related to different methods, the Chinese traditional way is better than the comparative Western Medicine group. (3) the WOMZC level decrease considerately, the result has statistics means. The WOMZC index have no obvious statistics differences between Chinese traditional method of acupuncture and the Western Medicine ways.更多还原