中醫(yī)學(xué)教學(xué)課件：16 manipulation techniques

刺法灸法學(xué)

studyofacupunctureandmoxibustiontechnique

仁濟(jì)醫(yī)院中醫(yī)科

TCMDepartmentofRenjihospital針法acupuncturemanipulation體針、耳針、頭針、鼻針、眼針Bodyacupuncture,auricularacupuncture,scalpacupuncture,nasalacupuncture,eye-acupuncture梅花針、三棱針Percussopunctator,three-edgedneedle,電針、激光針、水針Electroacupuncture,laseracupuncture,acupointinjection火針、芒針Fireneedle,elongatedneedle腕踝針、穴位埋線、小針刀Wrist-AnkleAcupuncture,acupointcatgutembedding,acupotomy灸法moxibustionmanipulation直接灸、間接灸directcontactmoxibustion,indirectmoxibustion艾絨灸、艾條灸、艾柱灸、moxamoxibustion,moxibustionwithamoxastick,moxibustionwithamoxacone藥物灸、發(fā)泡灸、溫灸器灸drugmoxibustion,blistermoxibustion,thermalboxmoxibustion拔罐法cuppingtherapy陶罐、銅罐、竹罐、玻璃罐potterycups,coppercups,bamboocups,glasscups抽氣罐suctioncups走罐、閃罐、排罐movingcups,flashingcups,rowcups藥罐drugcups刺法灸法的起源theorigin

砭石（古代最原始的針刺與切割用具）stoneneedletheoriginalform骨針與竹針boneneedleandthebambooneedle九針nineneedle灸法（取暖→燙傷→治愈某些?。﹎oxibustionfromheatingtoburningandhealingsomedisease罐法（從角法開始）Cuppingtherapyfromhorncupping毫針的結(jié)構(gòu)毫針的結(jié)構(gòu)：thestructureofneedle針尖apex、針身body、針根root、針柄handle、針尾end長度length：0.5寸（15mm),1寸(25mm),1.5寸(40mm),2寸(50mm),2.5寸(65mm),3寸(75mm),4寸(100mm),5寸(125mm),6寸(150mm).直徑diameter：26(0.45mm),27(0.42mm),28(0.38mm),29(0.34mm),30(0.32mm),31(0.30mm),32(0.28mm),34(0.23mm).毫針的選擇choosetheproperneedle質(zhì)地(好壞之外,還有金銀不銹鋼之分)Materialofneedle:suchasgoldandsliver,mainlyarestainlesssteel光潔度smoothfinish針身挺直圓正富有彈性straightbodywithflexibility針尖尖中帶圓猶如松針，銳利適度，進(jìn)針阻力小propersharpnesslikepinewithslightlyfractionastheobstruction.針柄纏繞成花式，要粗大為好handleconvolved,thickandbig針柄尾部有橫向突出和平柄之分endwithtwotype:flatandprotuded針刺前準(zhǔn)備preparationbeforemanipulation做好診斷與解釋工作Diagnosisandtheexplainationtothepatient檢查選擇針具Check-upbeforetheneedleareused消毒Sterilization體位選擇Properbodyposition針具消毒與一次性用針Asepsisandthesingle-useneedle高溫高壓hightemperatureandhighpressureWYC自助毫針消毒器self-servicesterilizer一次性針灸針singleuseneedle針刺體位bodyposition仰臥位：頭面胸腹四肢supinepositionforheadandface,chestandbelly,limbs俯臥位：頭項(xiàng)背腰臀下肢后側(cè)pronepositionfortheheadandneck,backandwaist,posteriorofthelegs側(cè)臥位：體側(cè)lateralposition:lateralsidesuchashypochondrium仰靠坐位：頭面頸前胸部四肢supinepositionduringsitting:headandface,throat,chestandlimbs針刺體位俯伏坐位：頭項(xiàng)背部pronepositionduringsittingforheadandneck,back側(cè)伏坐位：頭側(cè)面頰耳前后lateralpositionduringsittingfortemporal,cheek,auralregion屈肘仰掌位：手三陰經(jīng)elbowflexionwithpalmupforhandyinmeridians屈肘俯掌位：手三陽經(jīng)elbowflexionwithpalmdownforhandyangmeridians屈肘側(cè)掌位：陰陽經(jīng)同取elbowflexionwithpalmsideforbothyangandyinmeridianonupperlimbs針刺的角度,方向,深度Angle,directionanddepthofmanipulation角度：angle直刺perpendicularly（90度）斜刺obliquely（45度）橫刺horizontally（沿皮刺15-25度）方向：direction循經(jīng)脈方向、病變部位或疼痛處alongsidethemeridian,leisonregion,triggerpoint深度depth:依據(jù)年齡、體質(zhì)、病情、時令、針刺部位而定accordingtotheage,consititution,stateofillness,seasonandtheareaformanipulation.針刺的基本手法basicmanipulation提插法：lifting-thrustingmethod一定深度tocertaindepth淺shallow——深profound插thrust

深profound——淺shallow提lift

針刺的基本手法捻轉(zhuǎn)法：twistingmethod一定深度tocertaindepth拇指和中、食指持針withthethumb,theindexfingerandthemiddlefinger一前一后，來回旋轉(zhuǎn)捻動rotatingbackandforth針刺的輔助手法supplementarymanipulation循法：以手于所刺腧穴的四周或沿經(jīng)脈的循行部位，進(jìn)行徐和的循按的方法行氣，催氣；宣散氣血Pressing:slightlykneadingandpressaroundtheacupointstopromotetheflowofQi刮柄法：拇指或食指指腹抵住針尾，拇指、食指或中指爪甲，由下而上刮動針柄的方法催氣Scrappng:scrapthehandleofneedlewithnailorthumbsastostrengthentheneedlesensation.彈柄法：以手指輕彈針柄，使針身產(chǎn)生輕微的震動，使經(jīng)氣速行Plucking:pluckthehandleofneedletomakethebodyofneedleshakeslightly,forstimulationinordertoobtainQi針刺的輔助手法搖柄法：手持針柄進(jìn)行搖動，如搖櫓之狀，用以出針瀉邪rotating:rotatetheneedletostrengthenthesensationandpurgationfortheevil震顫法：右手持針柄，用小幅度、快頻率的提插捻轉(zhuǎn)動作，使針身產(chǎn)生輕微的震顫，促使得氣或增強(qiáng)扶正祛邪的作用agitating:shakingtheneedlewithsmallamplitudeandhighfrequency,tostrengthentheQisensationortostrengthenthebodyresistanceforeliminatingpathogenicfactors關(guān)于得氣的概念WhatisDeqi?進(jìn)針后施以一定的行針手法，使針刺部位產(chǎn)生經(jīng)氣的感應(yīng)，這種針下的感應(yīng)，叫做“得氣”。它包括病人在針刺部位有酸脹重麻的感覺，有時還可出現(xiàn)不同程度的感傳現(xiàn)象；醫(yī)生持針的手上也會感覺針下有沉重緊澀的現(xiàn)象。Deqirefersthephenomenaafterthepunctureprogressofneedlewiththemanipulation.Thesensationsuchasaching,numbness,heavinessordistentionaroundtheacupointsiscausedbytheinteractionoftheQiinthemeridianandsometimesinduceperception,meanwhilethepractitionersaresuretofeeltheheavytension.針刺補(bǔ)瀉的原則和依據(jù)

theprincipleformanipulation原則：principle盛則瀉之，虛則補(bǔ)之，熱則疾之，寒則留之，陷下則灸之TreatingtheexcesswithreductionTreatingthedeficiencywithtonificationTreatingthehotwithpromptinterventionTreatingthecoldwithretaininginterventionTreatingthecollapseofQibymoxibustion依據(jù)：明辨經(jīng)絡(luò)、審察形神、辨別虛實(shí)。Outline:meridianassessment,evaluatethebodyandspirit,andidentifythesthniaandasthnia針刺補(bǔ)瀉手法徐疾補(bǔ)瀉法（徐進(jìn)疾出謂之補(bǔ)）RapidandslowininsertionandwithdrawlingReinforcingmeansslowlyinsertingandrapidlywithdrawling.提插補(bǔ)瀉法（重插輕提謂之補(bǔ)）Liftingandthrusting:Reinforcingmeansheavilyrapidlythrustingandgentlyslowlifting捻轉(zhuǎn)補(bǔ)瀉法（左轉(zhuǎn)捻針大指向前，食指向后轉(zhuǎn)謂之補(bǔ)）Twistingandrotatingofneedle:thumbforwardandindexfingerbackwardinsmallamplitudeasthereinforing呼吸補(bǔ)瀉法（呼進(jìn)吸出謂之補(bǔ)）Respiration:Reinforcingmeansinsertingneedlewhenexhalingandwithdrawlingwheninhaling開闔補(bǔ)瀉法（出針后速按針孔謂之補(bǔ)）AcupintsopenandcloseReinforcingmeansressingtheacupointsquicklyafterthewithdrawlingofneedle.迎隨補(bǔ)瀉法（順<隨>經(jīng)脈而刺謂之補(bǔ)）Directionalsupplementationanddrainingmethod:reinforcingmeansthedirectionofneedleisalongtowardsthedirectionofthemeridian.平補(bǔ)平瀉法（既補(bǔ)又瀉,不補(bǔ)不瀉）ModeratereinforcingandreducingmethodReinforcewiththereduction,orkeepbalanceofreinforcingandreducing.留針與出針留針：retention一般病癥，留針10-20分鐘10-20minasroutine慢性,頑固性,疼痛性,痙攣性病癥留針時間延長Longdurationforthechronic,intractable,painfulandspasticdiseases.期間可間歇性行針Manipulationduringtheintervalsfortheretention.若不得氣，可留針待氣RetentionforDeQiontheconditionofslowreactionofsensation出針：withdrawl出針應(yīng)檢查針數(shù)tocheckthenumberofneedle針刺異常情況及處理（暈針）faintngduringacupuncturetreatment【原因cause】體虛infirmityanddebility,緊張anxiety；疲勞fatigue,饑餓hunger；手法過強(qiáng)inpropermanipulationcausestrongsensation【現(xiàn)象phenomenon】頭暈?zāi)垦ertigo,面色蒼白paleface,身出冷汗coldsweating,心慌欲嘔nauseaandpalpitation,暈厥syncope【處理measurement】起針withdrawltheneedle,平臥liedown,放低頭部head-downposition；予以熱飲hotrefreshment；針刺合谷,人中,內(nèi)關(guān)needlingacupointssuchasLI4,GV26,PC6【預(yù)防prevention】觀察解釋observationandexplaination,合適體位suitableposition,手法適宜propermanipulation針刺異常情況及處理（滯針）stuckneedleduringacupuncturetreatment【原因cause】精神緊張anxiety；行針手法不當(dāng)inpropermanipulation；留針時間過長longretentionoftheneedle【現(xiàn)象phenomenon】針在體內(nèi)，行針困難，針下澀滯（提插捻轉(zhuǎn)出針）stickingfeelingduringmanipulation,hardtowithdrawltheneedle【處理measurement】放松肌肉relaxingthemusle；旁刺1,2針auxiliaryneedleintheregionnearby1-2cun；反向捻轉(zhuǎn),twistingtheneedleintoreverseddirection【預(yù)防prevention】解釋explaination；手法適宜propermanipulation；避免單向捻轉(zhuǎn)both-waytwistinginmanipulation針刺異常情況及處理（彎針）curvedneedleduringacupuncturetreatment【原因cause】手法不當(dāng)inpropermanipulation；體位移動shiftduringtreatment；外力碰撞collisionofexternalforce【現(xiàn)象phenomenon】針身彎曲curvedneedle，針柄傾斜leanhandle【處理measurement】恢復(fù)體位restorethecorrectposition；順勢拔針withdrawltheneedle【預(yù)防prevention】手法熟練propermanipulation；體位適當(dāng)properposition；保護(hù)針刺部位payattentiontotheregionduringtreatment針刺異常情況及處理（斷針）Brokenneedleduringacupuncturetreatment【原因cause】質(zhì)量欠佳poorqualityofneedle；肌肉收縮musclecontraction；手法過重inpropermanipulation【現(xiàn)象phenomenon】針身中斷，殘留體內(nèi)brokenneedleinthebody【處理measurement】鎮(zhèn)靜不動freezethepatient；手或鑷子拔針withdrawltheneedlebyhandortweezer；手術(shù)處理surgery【預(yù)防prevention】檢查針具checktheneedlebeforemanipulation；避免過強(qiáng)手法propermanipulation；不隨意移動體位correctpositionandholdon；不宜將針身全部刺入皮膚payattentiontothedepthoftheneedle；正確處理滯針、彎針correctmeasurementstothestuckneedleorcurvedneedle針刺異常情況及處理（血腫）Hematomaduringacupuncturetreatment【原因cause】質(zhì)量欠佳poorqualityoftheneedle；刺傷血管injuryofvessel【現(xiàn)象phenomenon】皮下出血引起腫痛，局部青紫bruisecausebybleeding【處理measurement】微量出血不必處理；反之冷敷止血，再熱敷或按揉Littlespotofbleedingjustpresswithcottonballasroutine,coldcompresstostopbleeding，thenhotcompresswithmassageafter.【預(yù)防prevention】檢查針具checktheneedlebeforemanipulation；避開血管keeptheneedleawayfromvessel針刺異常情況及處理（后遺感）Leaveoverfeelingoftheneedle【原因cause】針刺手法過重strongsensationinthetreatment【現(xiàn)象phenomenon】不適的酸脹痛inacceptableacheordistention【處理measurement】輕者不必處理；重者局部熱敷theslightisregular,thesevereneedsthehotcompress【預(yù)防prevention】手法熟練propermanipultion針刺異常情況及處理（刺傷內(nèi)臟）Injuryoftheorgans【原因cause】針刺角度和深度不當(dāng)inproperangleanddepthoftheneedle【現(xiàn)象phenomenon】氣胸pneunothorax，死亡death，內(nèi)臟出血bleedingoforgans【處理measurements】對癥處理emergencyforacutemeasurements【預(yù)防prevention】熟悉穴位解剖basicknowledgeofanatomicalstructure針刺注意事項(xiàng)thecautionofmanipulation過饑hunger、過飽satiation，酒醉drunk，大驚terror，勞累過度overworkandfatigue久病體虛chronicdiseasewithweakbody、大汗profusesweating、大血hemorrhoea皮膚感染skininfection、潰瘍ulcerandanabrosis、疤痕scar、腫瘤部位tumorregion孕婦pregentwoman灸法的概念Whatismoxibustion借灸火的熱力給人體以溫?zé)嵝源碳?，通過經(jīng)絡(luò)腧穴的作用，以達(dá)到防治疾病目的的一種方法。Moxibustionisatherapyusedtotreatandpreventdiseasebyapplyingtheburningmoxatostimulatethehumanbodywithheat.灸法的分類classificationofmoxibustion艾柱灸moxacone直接灸directcontractmoxibustion——疤痕灸scarring

無疤痕灸non-scaring間接灸indirectmoxibustion——隔姜灸withginger

隔蒜灸withgarlic

隔鹽灸onsalt

隔附子餅灸withaconiti艾條灸moxastick回旋灸circling雀啄灸pecking雷火灸thunder-firemoxibustion溫針灸warmingneedle溫筒灸moxaburnermoxibustion天灸naturalmoxibustionwithmedicinalherbs白芥子蒜泥毛茛艾灸的作用Efficacyofmoxibustion溫散寒邪，溫通經(jīng)絡(luò)Warmingandactivatingthemeridintoexpelthecoldevil活血逐痹，回陽固脫Invigoratingthebloodcirculationtodispeltheblockage,Recuperatingdepletedyangtotreatcollapsesyndrome消瘀散結(jié)，防病保健DispersingbloodstasisandresolvinglumpPreventionofdiseaseforhealthcare艾柱灸（疤痕灸）scarringmoxibustion【方法method】艾柱置于穴位上燃燒，愈后有疤痕【適應(yīng)范圍indication】頑固性疾病intractabledisease：哮喘asthma、肺癆tuberculosis、瘰疬scrofula【注意事項(xiàng)caution】顏面，血管，關(guān)節(jié)，皮膚薄弱處不宜face,vesselandjointarethecontraindication艾柱灸(無疤痕灸）nonscarringmoxibustion【方法method】艾柱置于穴位上燃燒1/2，2/3時，患者感到灼痛移除更新，無疤痕Moxaconeburntabout1/2or2/3,withburningsensation,thenremovetheconewithanewmoxapile【適應(yīng)范圍indication】一般虛寒性疾病normallyforthedeficiencyofyangandsyndromeofcold【注意事項(xiàng)caution】局部紅暈，不起泡為度reddishwithoutblister艾柱灸（間接灸）moxacone【方法method】艾柱置于媒介之上燃燒，待燃盡移除更新Moxaconeisburntontheintermediarytotallybeforeitextinguish.【適應(yīng)范圍indication】隔姜灸：因寒而致嘔吐、腹痛腹瀉、風(fēng)寒痹癥等；Vomitting,bellypain,diarrheaandarthritiscausedbycoldsyndromewithginger隔蒜灸：肺癆、瘰疬、腫瘍初期；Tuberculosisscrofulaulcerandanabrosisintheearlystatewithgarlic隔鹽灸：傷寒陰證，吐瀉并作，中風(fēng)脫證；Colddamagewithyinsyndrome,vomittinganddiarrhea,strokewithprostrainsyndromewithsalt隔附子餅灸：陽痿早泄等Impotenceandprematureejaculationwiththeacontini【注意事項(xiàng)caution】媒介的制作thechoicefortheintermediatry艾條灸moxastickmoxibustion溫和灸mildmoxibustion——慢性病chronicillness雀琢灸peckingmoxibustion——急性病acuteillness溫針灸warmingneedle針灸并用theintegrationofacupunctureandmoxibustion型如棗核shaoelikeanucleus松緊適宜propertightness適用于寒癥（實(shí)寒、虛寒）indicationforcoldsyndromebothoftheexcessandthedeficiency.灸法的注意事項(xiàng)Cautionforthemoxibustion以虛證、寒證、陰證為主。Indicationfordeficiencycoldandyinsyndrome陰虛陽亢或邪熱內(nèi)熾禁灸Yindeficiencyandyangexcesssyndromeaswellastheinnerevilheatsyndromeisthecontraindication實(shí)證、熱證及陰虛發(fā)熱者不宜Excessandheatsyndromeaswellastheyindeficiencysyndromeisnottheproperindicationformoxibustion顏面五官、陰部和大血管處禁直接灸Faceandthesenseorgans,

perineumandaortaistheregioninthecontraindication孕婦腹部及腰骶部不宜施灸Thepregnantwomanisnotpermittedtomoxibustionatthebellyandlumbosacralregion罐的種類、拔罐方法及注意事項(xiàng)罐有：竹罐、陶罐、銅罐、玻璃罐、抽氣罐、藥水罐。Cupmaterials:bamboopotterycoppergla