【作者】 雷红；

【导师】 黄光英；

【作者基本信息】 华中科技大学 ， 中西医结合， 2010， 博士

【摘要】 第一部分文献回顾及数据库建立目的：为了全面、集中的总结归纳古代医籍中“得气”的论述,为相关人员提供方便、可靠的搜索古代医籍“得气”相关资料平台。通过广泛阅读古代医籍,建立一个古籍中关于“得气”知识的数据库。方法：阅读所有与针灸相关的古代医籍31本；其中21本书籍中有涉及“得气”的描述,将书中与“得气”相关的论点及描述重点标记和理解；并作收集和归纳；再从不同角度,分类这些论点和描述,运用现代计算机数据库技术,将与得气相关的古代书籍信息作为一张表,针对医书作注释的一些古籍作为注释书籍的表,对于有注解的描述分类组织成一张关系表。关系表的实现主要是：对得气内容所做的标记分为26个方面,作为关系表的26个字段,组织成关系数据库。结果：建立一个书籍的主键自增,关系表中的自增主键和书籍主键作为关系表的主键,同时,书籍的主键作为关系表的外键,可以实现级联删除的作用,通过SQL语句,在关系数据库上对得气内容的不同方面进行布尔查询,从而实现对数据的模糊和组合查询,且管理员,可以对关系数据库表上的元组进行插入和删除操作的“古籍得气数据库”结论：古代医家非常重视针刺得气,他们关于“得气”的论述精辟而丰富；建立一个古籍“得气”数据库有助于相关人员查阅古籍,指导临床和研究。第二部分针刺“得气”对Bell’s麻痹临床疗效影响的研究目的：通过采用针刺“得气”对Bell’s面瘫临床疗效的研究,探讨针刺“得气”在治疗Bell’s面瘫中的重要意义,为古籍中“得气”重要性的论述提供依据。方法：将36例患者随机分为手法与非手法组。发病后1周内两组均不施行手法。1周后,手法组施行适当手法得气,非手法组,不施行手法。取针后,针灸师询问病人“得气”感受,记录患者的得气评分。患者取仰卧位,常规消毒后,面部穴位采用提捏进针法,针刺角度与面部呈45°斜角或垂直面部皮肤表面进针,其它部位穴位采用双手爪切进针法,垂直皮肤表面进针。手法组：进针后,面部穴位轻轻运用手法,使局部稍感酸胀或麻感,其它穴位施以提插捻转等手法,使患者得气,产生酸、麻、胀、痛、放射等针感,医者手下有沉、涩、滞、紧等感觉,每10分钟捻针一次,共留针30分钟。非手法组：进针后,不施行任何手法,直接留针30分钟。评价方法：结果的评价采用House-Brackmann (HB)面部神经功能评分系统,HBⅠ级为正常,级别越高,面神经功能损伤越严重,Ⅵ级为面神经功能完全受损；面部残疾指数的测定(FDIP),通过问卷评分,FDIP分值越低,面神经损伤越严重,100分为面神经功能恢复正常；Nottingham (NOTT)面部神经功能评分系统,该方法通过客观数据评价面神经功能,数值越大,面神经功能恢复越好,100%为痊愈。结果：发病第28天(D28)非手法组总有效率是94.12%,手法组总有效率100%,手法组治疗有效率明显高于非手法组(P<0.01)；采用HB分级评价：第D28非手法组和手法组分别与同组就诊第一天(D1)相比,病情程度均有显著减轻,(P<0.01)；且第D28手法组病情减轻程度均明显好于非手法组,(P<0.01)。采用F DIP评分：两组D28FDIP评分均明显高于同组D1(P<0.01)；且D28,手法组FDIP评分值较非手法组高,手法组疗效优于非手法组(P<0.05)。采用NOTT评分：D28两组NOTT评分分别高于同组D1(P<0.01)；且D28,手法组NOTT评分值较非手法组高,手法组疗效优于非手法组(P<0.05)。从治愈所用时间相比,手法组平均时间明显短于非手法组(P<0.01)。手法组医者和患者得气评分值均明显高于非手法组(P<0.01)。结论：1.针刺治疗Bell’s面瘫,施行手法组得气,可获明显针感,且疗效优于不施行手法组。2.针刺治疗Bell’s面瘫,施行手法得气,可以明显减少治疗时间,节约治疗费用。3.针刺治疗Bell’s面瘫效果明显。更多还原

【Abstract】 Part 1 literature review and database establishmentObjective:To establish a database of "Deqi" after reading many ancient medical books.To Provide an overall、concentrated、convenient and reliable search for correlated researchers.Methods:All ancient books related with acupuncture are read and those sentences about "Deqi" are picked out. We understand、collect、and sum up them, distinguish them from different direction. Using modern computer technique, we take the old medicine books that have something to do with DeQi as a table, take the books that comment on the medicine books as a table, classify the attributes of DeQi and orginize them as a relationship table. The implementation of the relationship table is to classify the 26 properties as the 26 attributes of the relationship table.results:We establish the "Deqi" database using the auto-increment primary key as the books’ primary key, and take the auto-increment primary key and books’ primary key as the primary key of the relationship table, which makes cascade delete practical and realizable. we use SQL statement to query the different aspects of the content related with DeQi, which could relize the Data’s Faintness and Combination Search. As a administrator, you can also do operation such as insert and delete tuples of the tables of the RDBMS.Conclusions:Ancient acupuncture specialists thought that acupuncture "Deqi" played an important rule in acupuncture clinic. They had a plentiful and penetrating discussion about "Deqi",It is important to establish a database of "Deqi" from ancient medical books. It is helpful to many researchers and doctors.Part 2 Clinical Reasearch of Acupuncture Deqi for Bell’s PalsyObjective:Evaluating the reliability of acupuncture Deqi for Bell’s palsy through clinical observation. Validating the necessity of Deqi explained in Chinese ancient medical books.Methods:36 subjects are divided randomly into two groups:manuduction group and non-manuduction group. Manuduction is absent during the first week in the two groups. All subjects in manuduction group obtain needling response through manuduction after one week. Manuduction doesnot been performed in non-muauduction group. Acupuncturist inquires qi sensation according to the design and records the date after finishing treatment.The patient lies in supine position, all acupoints are sterilized routinely. Insertion using 0.25 x 25-mm needles was performed on facial points with an angle of 45°or 90°and left hand bringing up the skin on the points. Insertion using 0.25 x 40-mm needles was performed on other points with an angle of 90 and nail-pressing method. Manuduction group:Qi response such as acid、tingling、radiation was elicited on the affected face by manually vibrating needles. Manuduction such as lifting、inserting、twirling with same frequency and strength is performed on other points. Manipulation was performed once every ten minutes to improve the patient’s qi sensation. Needles were inserted and retained for 30 minutes.Needles were inserted without obtaining Deqi and retained for 30 minutes.Evaluation methods:All subjects are evaluated with the House-Brackmann facial nerve grading system (HBS), the Nottingham facial nerve grading system, and the Facial Disability Indexes (FDIP). In the HBS, nerve function is graded from I to VI, or from normal to total facial paralysis respectively. In the Nottingham system, movement is measured at four points on the face and the sides are compared with movement on the abnormal side calculated as a percentage of that on the normal side. In the FDIP indexes,100 represents complete normalityResults:Effective rate is 100% and 94.12% in manuduction and Non-manuduction acupuncture groups On the 28th day respectively; The manuduction group has better clinical effect compared with Non-manuduction group (P<0.01)The grades of HB、NOTTINGHAM and PDIP on the 28th in manudution group are significantly higher than that in non-manuduction group respectively. According to HBS、Nott and FDIP, The manuduction group has better clinical effect compared with Non-manuduction group (P<0.01 or P< 0.05)The manuduction acupuncture group has significantly higher average grade of deqi (P<0.01) than that in non-manuduction.The manuduction acupuncture group has significantly shorter treatment time (P<0.01) than that in non-manuduction group. Conclusion:1.There is an evident effect for Bell’s palsy by acupuncture.2.The manuduction acupuncture group has significantly better treatment Outcome compared with non-manuduction group.3. It is obviously that manuduction for Bell’s palsy shorten course and time of treatment and reduce treatment costs.更多还原