针药结合疗法的指导理论及其临床应用策略

代冉冉; 王欣君

doi:10.14148/j.issn.1672-0482.2023.0606

针药结合疗法的指导理论及其临床应用策略

doi: 10.14148/j.issn.1672-0482.2023.0606

代冉冉,
王欣君^,

南京中医药大学针灸推拿学院·养生康复学院, 江苏南京 210023

基金项目:

江苏省高等学校自然科学研究重大项目 20KJA360002

第四批江苏省中医临床优秀人才研修项目

详细信息

作者简介:
代冉冉，女，硕士研究生，E-mail：892664691@qq.com

通讯作者:
王欣君，男，教授，主要从事针刺操作技术及手法量学的研究，E-mail：nj_drwang@163.com

中图分类号: R246
计量
- 文章访问数: 175
- HTML全文浏览量: 31
- PDF下载量: 28
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-16
- 网络出版日期: 2023-07-15
- 发布日期: 2023-07-10

Guiding Theory and Clinical Application Strategy of Acupuncture-Moxibustion and Medicine Combination Therapy

DAI Ran-ran,
WANG Xin-jun^,

School of Acupuncture-Moxibustion and Massage, School of Health and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, China

摘要

摘要: 论述了针药结合疗法的历史及现状，认为针药结合疗法自古至今均有应用，但其直接指导理论一直未明确。通过分析历代针药结合疗法的相关文献，认为经络理论为其直接指导理论，提出针药结合疗法的临床应用策略首先要遵循早治防变、标本缓急、三因制宜的治疗原则，以病位病性特征、病情轻重缓急、疾病发展预期为出发点，根据病在脏腑、肢节、经络等不同情况，采用不同的临床策略，以实现增效和/或减毒的效应目标。并就针灸疗法和药物疗法在针药结合中的角色特征进行了分析。
- 针药结合 /
- 脏腑 /
- 经络 /
- 肢节 /
- 增效减毒 /
- 临床应用策略
Abstract: This article discusses the history and current situation of acupuncture-moxibustion and medicine combination therapy, and believes that the combination therapy has been applied since ancient times, but its direct guiding theory has not been clear. By analyzing the relevant literature in previous dynasties, it is believed that the meridian theory is its direct guiding theory. The clinical application strategy of acupuncture-moxibustion and medicine combination therapy should first follow the treatment principles of early treatment and prevention of changes, syndrome urgency, and adaptation to three conditions. Starting from the location and property characteristics of the disease, the severity of the condition, and the expectation of disease development, different clinical strategies should be adopted based on disease conditions, e.g., the location of the disease in the organs, limbs, or meridians, to achieve the goal of increasing efficacy and/or reducing toxicity. Finally, the role characteristics of acupuncture-moxibustion and medicine therapy in the combination of acupuncture-moxibustion and medicine were analyzed.
- combination of acupuncture-moxibustion and medicine /
- visceral organs /
- meridian /
- limb joints /
- increase efficiency and reduce toxicity /
- clinical application strategy

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参考文献(42)

[1]	黄帝内经[M]. 北京: 中华书局, 2010. The Yellow Emperor's Inner Classic[M]. Beijing: Zhonghua book company, 2010.
[2]	张仲景. 伤寒论[M]. 福州: 福建科学技术出版社, 2012. ZHANG ZJ. Treatise on Cold Damage [M]. Fuzhou: Fujian science and technology press, 2012.
[3]	李东垣. 脾胃论[M]. 北京: 中国中医药出版社, 2007: 39. LI DY. Treatise on the Spleen and Stomach[M]. Beijing: China traditional Chinese medicine press, 2007: 39.
[4]	薛己. 薛氏医案选[M]. 北京: 人民卫生出版社, 1983: 12. XUE J. Xue's Medical Case Selection[M]. Beijing: People's health publishing house, 1983: 12.
[5]	万全. 幼科发挥[M]. 北京: 人民卫生出版社, 1963: 45. WAN Q. Elaboration on Pediatrics[M]. Beijing: People's health publishing house, 1963: 45.
[6]	杨婷婷, 王若禹, 田岳凤. 针药结合的源流及其应用特点[J]. 中国民间疗法, 2022, 30(1): 1-3. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL202201001.htm YANG TT, WANG RY, TIAN YF. The origin and flow of acupuncture and drug combination and its application[J]. Chin Folk Ther, 2022, 30(1): 1-3. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL202201001.htm
[7]	王耀帅, 张建斌, 王玲玲, 等. 对针药结合研究现状与发展趋势的思考[J]. 中医杂志, 2012, 53(6): 473-475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201206011.htm WANG YS, ZHANG JB, WANG LL, et al. Reflections on the current status and development trends of the study on the combination of acupuncture and medicine[J]. J Chin Med, 2012, 53(6): 473-475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201206011.htm
[8]	徐斌. 针药结合, 内外同治[J]. 南京中医药大学学报, 2007, 23(4): 208-210. http://xb.njucm.edu.cn/article/id/20070478 XU B. Combination of acupuncture and medicine, internal and external treatment[J]. J Nanjing Univ Tradit Chin Med, 2007, 23(4): 208-210. http://xb.njucm.edu.cn/article/id/20070478
[9]	孙思邈. 备急千金要方[M]. 沈阳: 辽宁科学技术出版社, 1997: 451. SUN SM. Important Formulas Worth A Thousand Gold Pieces for Emergency[M]. Shenyang: Liaoning science and technology press, 1997: 451.
[10]	吴昆. 针方六集校释[M]. 北京: 中国医药科技出版社, 1991: 271. WU K. Acupuncture Principles in Six Volumes[M]. Beijing: China medical science and technology press, 1991: 271.
[11]	高武. 针灸聚英[M]. 北京: 中医古籍出版社, 1999: 1. GAO W. A Collection of Gems in Acupuncture and Moxibustion[M]. Beijing: Traditional Chinese medicine ancient books publishing house, 1999: 1.
[12]	杨继洲. 针灸大成[M]. 天津: 天津科学技术出版社, 2017: 85. YANG JZ. The Great Compendium of Acupuncture and Moxibustion[M]. Tianjin: Tianjin science and technology press, 2017: 85.
[13]	吴瑭. 吴鞠通医案[M]. 北京: 中国中医药出版社, 1998. WU T. Wu Ju-tong's Case Records[M]. Beijing: China traditional Chinese medicine press, 1998.
[14]	李学川. 针灸逢源[M]. 北京: 中国中医药出版社, 2019: 1. LI XC. The Source of Acupuncture and Moxibustion[M]. Beijing: China traditional Chinese medicine press, 2019: 1.
[15]	张建斌. 针药结合临床实践模式对中医药学术发展的启示[C]//世界针灸学会联合会, 世界卫生组织, 中国中医科学院, 北京市中医管理局. 世界针灸学会联合会成立20周年暨世界针灸学术大会论文摘要汇编, 2007: 2. ZHANG JB. Inspiration of clinical practice mode of combination of acupuncture and medicine on academic development of traditional Chinese medicine[C]//World Federation of acupuncture and moxibustion Societies, World health organization, Chinese academy of traditional Chinese medicine, Beijing municipal administration of traditional Chinese medicine abstract collection of papers on the 20th anniversary of the world federation of acupuncture and moxibustion societies and the world acupuncture and moxibustion academic conference, 2007: 2.
[16]	吴根诚, 李为民, 王彦青. 针刺镇痛临床和基础研究再思考[C]//全国针法灸法临床与科研学术研讨会暨脊柱病研究新进展论文汇编. 中国针灸学会针法灸法分会: 中国针灸学会, 2005: 3. WU GC, LI WM, WANG YQ. Rethinking on clinical and basic research of acupuncture analgesia[C]//National academic conference on clinical and scientific research of acupuncture and moxibustion and compilation of papers on new progress in spinal disease research. Acupuncture and Moxibustion Branch of Chinese Acupuncture and Moxibustion Society: Chinese acupuncture and moxibustion society, 2005: 3.
[17]	程海波, 徐斌. 针药结合学[M]. 北京: 中国中医药出版社, 2021: 11. CHENG HB, XU B. Combination of Acupuncture and Medicine[M]. Beijing: China traditional Chinese medicine press, 2021: 11.
[18]	宋国良, 赵秀萍. 针药结合治疗胆结石120例临床观察[J]. 中医药信息, 2005, 22(4): 70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN200504042.htm SONG GL, ZHAO XP. Clinical observation on 120 cases of cholelithiasis treated by acupuncture combined with medicine[J]. Inf Tradit Chin Med, 2005, 22(4): 70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXN200504042.htm
[19]	刘智, 彭赛, 周启. 不同电针频率在肺切除术患者针刺麻醉中的应用及对应激反应、免疫功能的影响[J]. 湖南中医药大学学报, 2020, 40(2): 209-213. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202002018.htm LIU Z, PENG S, ZHOU Q. Application of different electroacupuncture frequencies in the acupuncture anesthesia of patients undergoing pneumonectomy and its effects on stress response and immune function[J]. J Hunan Univ Chin Med, 2020, 40(2): 209-213. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202002018.htm
[20]	郁慧杰, 徐小琴, 许嵩翱, 等. 针药复合对心脏外科手术患者镇痛及镇静效果的影响[J]. 中国中西医结合杂志, 2016, 36(3): 289-293. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ201603007.htm YU HJ, XU XQ, XU SA, et al. Analgesic and sedative effect of acupuncture combined with medicine on patients undergoing cardiac surgery[J]. Chin J Integr Tradit West Med, 2016, 36(3): 289-293. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ201603007.htm
[21]	周一辰, 邵萍, 袁岚, 等. 针药复合麻醉在妇科宫腔镜手术中镇痛及镇静作用的临床研究[J]. 上海中医药杂志, 2020, 54(增1): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ2020S1002.htm ZHOU YC, SHAO P, YUAN L, et al. Clinical study of analgesic and sedative effects of combined acupuncture-drug anesthesia in gynecological hysteroscopy[J]. Shanghai J Tradit Chin Med, 2020, 54(Z1): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ2020S1002.htm
[22]	樊文朝, 马文, 赵创, 等. 不同频率电针在针药复合麻醉中对肺切除患者心功能的影响[J]. 上海针灸杂志, 2012, 31(9): 625-627. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ201209004.htm FAN WC, MA W, ZHAO C, et al. Effects of different frequencies of electroacupuncture on cardiac function during combined acupuncture and medicine anesthesia in pneumonectomy patients[J]. Shanghai J Acupunct Moxibust, 2012, 31(9): 625-627. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ201209004.htm
[23]	王庆国, 李宇航, 陈萌. 刘渡舟伤寒论讲稿[M]. 北京: 人民卫生出版社, 2008. WANG QG, LI YH, CHEN M. Liu Duzhou's Lecture on Treatise on Cold Damage[M]. Beijing: People's health publishing house, 2008.
[24]	吴尚先. 理瀹骈文[M]. 北京: 人民卫生出版社, 1984: 4. WU SX. Rhymed Discourse on External Remedies[M]. Beijing: People's medical publishing house, 1984: 4.
[25]	徐大椿. 医学源流论[M]. 北京: 中国中医药出版社, 2008: 48-49. XU DC. Treatise on the Origin and Development of Medicine[M]. Beijing: China traditional Chinese medicine press, 2008: 48-49.
[26]	陈幼楠. 《针灸技术操作规范第6部分穴位注射》的研制与研究[D]. 北京: 北京中医药大学, 2007. CHEN YN. Development and research of acupoint injection, part 6, acupuncture technical operation specification[D]. Beijing: Beijing University of Chinese Medicine, 2007.
[27]	FOUNTAS A, VAN UUM S, KARAVITAKI N. Opioid-induced endocrinopathies[J]. Lancet Diabetes Endocrinol, 2020, 8(1): 68-80.
[28]	曹小定. 针药结合优势互补: 发展中西医结合针刺研究的思考[C]//纪念承淡安先生诞辰一百周年暨国际针灸发展学术研讨会论文集, 1998: 93-94. CAO XD. Complementary advantages of combination of acupuncture and medicine: Thoughts on the development of acupuncture research in combination of traditional Chinese and western medicine [C]//Proceedings of the international academic conference on the development of acupuncture and moxibustion in commemoration of the 100th anniversary of Mr. Cheng Dan'an's Birth, 1998: 93-94.
[29]	俞裕天, 荣培晶, 唐纯志. 针药结合改善SSRIs类抗抑郁药起效延迟效应的探索[J]. 中华中医药杂志, 2017, 32(3): 1165-1168. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201703078.htm YU YT, RONG PJ, TANG CZ. Research of acupuncture combined with western medicine in the improvement of therapeutic delay of SSRIs[J]. China J Tradit Chin Med Pharm, 2017, 32(3): 1165-1168. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201703078.htm
[30]	王欣君. 针药结合抗抑郁快速起效的中枢5-HT受体机制及临床研究[D]. 南京: 南京中医药大学, 2009. WANG XJ. The rapid-onset of antidepressant of central 5-HT receptor mechanism and clinic study in acupuncture combining medicine[D]. Nanjing: Nanjing University of Chinese Medicine, 2009.
[31]	张瑶. 乌龙汤配合针刺治疗寒湿型腰椎间盘突出症的临床观察[D]. 广州: 广州中医药大学, 2016. ZHANG Y. Clinical observation of acupuncture plus medicine for lumbar disc herniation of cold-dampness type[D]. Guangzhou: Guangzhou University of Chinese Medicine, 2016.
[32]	闻人耆年. 备急灸法[M]. 北京: 中国中医药出版社, 2018: 20-22. WENREN QN. Moxibustion Techniques for Emergency[M]. Beijing: China traditional Chinese medicine press, 2018: 20-22.
[33]	王叶青. 温针灸结合中药治疗肩周炎的临床研究[D]. 广州: 广州中医药大学, 2010. WANG YQ. Clinical study on periarthritis treatment with warm needle combined with Chinese herbs[D]. Guangzhou: Guangzhou University of Chinese Medicine, 2010.
[34]	张志聪. 黄帝内经灵枢集注[M]. 北京: 中医古籍出版社, 2012: 340-341. ZHANG ZC. Collective Annotations of The Yellow Emperor's Inner Classic: The Spiritual Pivot[M]. Beijing: Traditional Chinese medicine ancient books publishing house, 2012: 340-341.
[35]	俞震. 古今医案按[M]. 北京: 中国中医药出版社, 1998: 1. YU Z. Comments on Ancient and Modern Case Records[M]. Beijing: China traditional Chinese medicine press, 1998: 1.
[36]	心禅僧. 一得集[M]. 上海: 上海科学技术出版社, 1986. XIN CS. Yi De Collection[M]. Shanghai: Shanghai scientific and technical press, 1986.
[37]	司马迁. 史记全本新注[M]. 武汉: 华中科技大学出版社, 2020. SIMA Q. New Notes on Records of the Historian[M]. Wuhan: Huazhong university of science and technology press, 2020.
[38]	卞镝, 田辉, 隋月皎, 等. 电针"内关"对缺血性心肌损伤大鼠钠离子通道相关蛋白的影响[J]. 中国针灸, 2016, 36(1): 64-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201601029.htm BIAN D, TIAN H, SUI YJ, et al. Effects of electroacupunctureat "Neiguan"(PC 6)on sodium channel-related proteins in rats with ischemic myocardial injury[J]. Chin Acupunct Moxibust, 2016, 36(1): 64-68. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201601029.htm
[39]	余芝, 庞婷婷, 贾新新, 等. 电针大鼠天枢穴抑制西沙必利促进胃运动效应的观察[J]. 世界中医药, 2020, 15(21): 3194-3198. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202021004.htm YU Z, PANG TT, JIA XX, et al. The influence of electroacupuncture at ST25 oncisapride induced gastric motility with different intensity[J]. World Chin Med, 2020, 15(21): 3194-3198. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202021004.htm
[40]	陈履埠, 陈恩平, 孙德芝, 等. 针刺足三里、内关穴联合兰索拉唑治疗功能性消化不良112例疗效观察[J]. 西部医学, 2012, 24(3): 545-546. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201203051.htm CHEN LD, CHEN EP, SUN DZ, et al. Clinical observation on 112 cases of functional dyspepsia treated by acupuncture on Zusanli and Neiguan with lansoprazole[J]. Med J West China, 2012, 24(3): 545-546. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201203051.htm
[41]	吴钢, 姜建伟, 曹小定. 静脉注射安定减弱家兔电针镇痛[J]. 上海医科大学学报, 1988(5): 396-397. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK198805018.htm WU G, JIANG JW, CAO XD. Intravenous injection of diazepam reduces electroacupuncture analgesia in rabbits[J]. J Shanghai Med Univ, 1988(5): 396-397. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK198805018.htm
[42]	张素云, 吴连方, 范玲, 等. 针药结合分娩镇痛的临床研究[J]. 中华围产医学杂志, 2003, 6(1): 6-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHWC200301001.htm ZHANG SY, WU LF, FAN L, et al. Clinical study on combination of acupuncture and medicine for labor analgesia [J]. Chin J Perinat Med, 2003, 6(1): 6-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHWC200301001.htm