中风偏瘫的导引康复文献研究

【作者】 邢若星；

【导师】 林殷；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2007， 硕士

【摘要】 偏瘫康复中占有重要地位的是运动疗法,导引是中国传统的运动疗法。偏瘫导引术在医籍中没有专论,而是散见于许多医书、道书和导引专著之中。目的:通过本论文的研究,整理历代记载导引在偏瘫康复中应用的文献资料,分析各种术式的机理和作用,探讨导引在偏瘫康复中的地位,展望未来的发展方向。方法:研究以文献学方法为主,结合逻辑学方法(包括分析、归纳、演绎等)和临床观察。首先,将文献研究范围分为古代和现代。古代文献分文、史、哲与医学两条线索。前者以《道藏》、《诸子全书》、《四库全书》、《二十六史》为纲,选取与偏瘫导引术相关书籍2本,后者以中医科学院编著《全国中医图书联合书目》为纲,选取相关书目10本,共12本。现代文献以CNKI为主,笔者剔除所选书籍中的重复和与课题相关度低的内容,选择了49种有关偏瘫康复的导引术式,结合现代康复理论加以分析,阐述其机理和作用,以及操作时的注意事项。最后,选取首都医科大学附属医院北京同仁医院康复中心为观察场所,在一定程度上结合临床实践,探讨了导引在现代应用的情况。在对所选导引术式分析研究的基础上,得出的结论是:1偏瘫导引术以肢体运动、行气和自我按摩为重要内容本文在第二部分共介绍49个导引术式,其中肢体运动18个,行气4个,自我按摩8个,肢体运动加行气15个,共计45个,占术式总数的92%。被动运动2个,器械1个,声音1个,共计4个,占术式总数的8%。表明肢体运动、行气和自我按摩是偏瘫导引术的重要内容。2功法选择以针对肢体功能的恢复和针对全身状态的调节为原则所有术式中,以动作的重点来看,重在恢复上肢功能的有12个,占总数25%,下肢有11个,占22%,同时有上肢和下肢有5个,占10%,躯干有3个,占6%,头部有2个,占4%,共计占全部的67%。调节全身的有16个,占33%。3在偏瘫导引术的发展过程中,从横向看,是以汇集医家以外其他诸家、尤其是道家功法为主,从纵向看,是以传承为主,兼有发挥医家导引取众家之长,以中医理论为指导,以祛病强身为目的,动静结合,注重实用。另一方面,自《诸病源候论》辑录众家导引法系统运用之后,后世多宗其法,同时也有医家和养生家结合自己实践,将其进行提炼,并总结推广,零金碎玉,弥足珍贵。4导引在偏瘫康复中的作用机理主要有促进偏瘫肢体功能的恢复和调节整体状态两个方面导引在偏瘫康复中的作用是通过局部和整体两方面来实现的。导引能舒痉除挛、促进正确运动模式的建立、防治合并症,还可以从整体调节机体状态,加快康复进程。在临床中,笔者观察了由导引术与操作性肌电生物反馈相结合而创立的神经训导康复治疗体系的应用,展望了导引在现代康复医学中的发展方向,认为导引与现代康复理念、技术与器械相结合,在努力降低偏瘫病人的残损程度,减轻其残弱状态,减少“复中”,提高其生存质量与生活自理能力,节省医疗费用等方面,有着非常广阔的发展前景。导引在康复中应用的文献资料和实践经验还有很多,相关的理论和方法亟待发掘和整理,以丰富现代康复医学理论与实践。更多还原

【Abstract】 Exercise therapy is very important in the rehabilitation of hemiplegia.Daoyin is the exercise therapy of traditional Chinese medicine.We can not find the special records about Daoyin’s applications in the rehabilitation of hemiplegia,which are scattered in medical collection,books fo Taoism and Daoyin monograph.Through the research of the thesis,we systematized the academic documents Based on the systematic collection and analysis on the previous academic documents about the applications of Daoyin in the rehabilitation of hemiplegia.At first,the range of the literature research was disparted into two parts,ancientry and modern times.In the ancientry research,two books were choosed in the Taoism monograph,and ten books were choosed in the medical monograph.In the modern literature research,we coordinated the information of CNKI.And then the content was eliminated which was repeated or has less correlation with the task.we choosed forty-nine maneuvers about the applications of Daoyin in the rehabilitation of hemiplegia.Combining the modern rehabilitation medicine,the mechanism,the function and the attention are expounded.To pay full attention to the organic connection between basic theory and clinical treatment,Beijing Tongren hospital was choosed to be the observe place.we discussed the complexion of Daoyin’application,and elicited the conclusion as following:1 The movement of limbs,Xingqi(Promoting and Conducting Qi)and self-massage are the important content of hemiplegia’s Daoyin maneuvers.In the first part of the tesis,forty-nine maneuvers were discussed,among them,maneuvers about the movement of limbs appeared eighteen times,Xingqi four times,shlf-masssage eight times,maneuvers which combined the movement of limbs and Xingqi fifteen times.This indicated that the movement of limbs,Xingqi(Promoting and Conducting Qi)and self-massage are the important content of hemiplegia’s Daoyin maneuvers.2 The choice of maneuvers regards recovering the function of limbs and regulating the postural of the whole body as the principles.In the forty-nine maneuvers,sixty-seven percent maneuvers is about the recovering the function of limbs.Thirty-three percent maneuvers is about the regulating the postural of the whole body.3 Viewed from the landscape,the maneuvers chosen influxed the maneuvers of other domains,especially Taoism.Viewed from the portrait,the maneuvers mostly inherit the methods recorded before and also has exertion.Viewed from the development of the history of traditional Chinese medicine,doctors through the ages all paid great attention to Daoyin and had great attainments in Daoyin as well.4 The function mechanism of Daoyin which is used in the rehabilitation of hemiplegia,has two sides,one is to promote the recover the function of limbs,the other is to regulate postural of the whole body.It is estimated that the application and research of Daoyin may bring large profits to human beings and play an important role in founding a new science of human body and life,enrich the theory and practice of modern rehabilitation medicine.更多还原