细银针在疼痛科的应用课件.ppt

1、我国使用金针、银针治疗伤病由来已久，相传是从古代“九针”中的鍉针和长针发展而成。Use of gold needle and silver needle for treatment of injuries was for a long time.They were developed from the blunt needle and long needle.长沙马王堆汉墓中，足臂十一脉灸经、阴阳十一脉灸经记载了各种疼痛、痉挛等症状，都是用灸法治疗的。”Foot eleven pulse moxibustion lection”and”Yingyang eleven pulse moxibus

2、tion lection”in Changsha Mawangdui Han Tomb recorded all kinds of pain,cramps and other symptoms,were treated with moxibustion therapy.黄帝内经中已多方面记载了各种痛症和脏腑疾病的针灸疗法。The silver needle therapy used as a variety of pain and viscera disease was also recorded from Huangdi Neijing”.1968年河北满城汉墓出土了西汉时期的金针（5根）、

3、银针（4根），说明当时金针银针治疗疾病已经相当普遍。Gold needle(5)and silver needle(4),unearthed from Hebei Mancheng Han tomb of Western Han Dynasty in 1968,indicated that the gold needle and silver needle in the treatment of disease were already commonplace.九针，针具名。为九种针具的总称。出自黄帝内经。即鑱针、员针、鍉针、锋针、铍针、员利针、毫针、长针和大针。灵枢官针：“九针之宜，各有所为

4、；长短大小，各有所施也，不得其用，病弗能移。”指出九针的形状、用途各异，据情选用，方可去病。The nine classical needles are those of different forms used in the ancient times,originating from“Huang Di Nei Jing”,as the shear needle,round-point needle,spoon needle,lance needle,stiletto needle,round-sharp needle,filiform needle,long needle and big

5、needle.l 此法始见于东汉时张仲景的伤寒论。Advocated by Zhang ZhongJing of Han Dynasty in his Shang Han Lun“.l 明代杨继洲的针灸大成，对此法叙述较详：“其法针穴上，以香白芷作圆饼，套针上，以艾灸之，多以取效此法行于山野贫贱之人，经络受风寒致病者，或有效，只是温针通气而已。”Yang Jizhou of the Ming Dynasty,“Zhen Jiu Da Cheng has been recorded.l 以后，历代都有沿用。此法至今仍在民间广为流传应用。Later,Warm Needling Treatment

6、had been used in the successive dynasties.This method became popular among the people.40年代，宁波陆银华老先生用家传长银针（纯银打造）治疗四肢关节软组织损伤，采取“循经取穴”和“以痛为腧”的针刺疗法，取得了比传统毫针较为满意的镇痛效应，在浙东地区颇有声誉。温针灸法，又称温针，是在毫针针刺得气留针后，于针尾捻裹艾绒,燃点加温以治疗疾病的一种方法。又称为针柄灸法。目的是使热力通过针身传入穴位内，以发挥治疗作用。临床适用于风寒湿痹、痿证等。n不锈钢针艾绒加热：由于不锈钢的导热系数低，为16.3 W/mk，而银的导

7、热系数达到429 W/mk，因此要使用不锈钢针加艾灸来实现使热力通过针身传入穴位内的目的，是不能达到的.Stainless needle moxa heating:thermal conductivity of stainless steel needle is 16.3 W/m.C,versus that of silver needle of 429 W/m.C.Accordingly,heat conduction can not be achieved through stainless needle into acupoints.n银质针艾绒加热：艾绒加热无法控制调整加热的温度，升降

8、变化快，波动大，加热不稳定.银质针过短，易烫伤皮肤；银质针过长，针尖的温度就低，导热效果就差;Silver needle moxa heating:moxa heating hardly controls and adjusts the heating temperature,bringing big heat-conducting instability.It is easy to burn skin if the silver needle is too short;the needle tip temperature will be too low if the silver needl

9、e is too long,heat conductivity effect is therefore unsatisfied.n艾绒加热污染环境，烟熏使医生和病人难以忍受，燃烧时易掉火芯伤人。Pollution or unpleasant environment brought by moxa heating and injured by flame of moxibustion.n不同留针长度不锈钢针艾绒加热的热量传导情况(室温30C)The heat conduction of acupuncture and moxibustion(room temperature at 30C)不锈钢

10、针的传导作用非常弱，虽然艾绒燃烧的绝对最高温度可达到350C左右，但既使离针尾仅4.0cm最高绝对温度还只有43.9C，而离针尾7.0cm的距离几乎温度不能被传至。With low thermal conductivity,although the absolute highest temperature of moxa combustion can reach 350 C,the temperature of needle point still can not achieve the target temperature.010204050012345678910 11 12 13 14

11、15 16 17 18 19 20时间Time(Min)温度Temperature(C)针灸4.0cm30针灸5.0cm针灸6.0cm针灸7.0cm85%的银质针灸针 银质针导热巡检仪高导热效率的银质针n提高银质针的含银量，由原来的75%，增加到85%n去掉圆顶针尾改为平顶针尾，与探头密切配合，去掉散热空间。改针柄由散热为加热n去掉针柄上的弹簧，使针身、针柄为一体，提高导热效率n严格加工工艺,保证产品质量。使导热率达到一致l 稳定可控高效的银质针导热巡检仪l 操作可控性强l 每路加热探头都能任意设定温度，独立控制温度,巡回显示每路探头实时加热温度l 在运行过程中可适时调整l 加热稳定性好，加热

12、温度上下波动小于4Cl 导热效率高l 加热升温快，2分钟达到温度设置值，4-5分钟能稳定在设置值上l 有效加热时间长且稳定l 安全可靠，操作简单l 完全按照国际安全标准设计制造的l 银质针和加热电流完全隔离，银质针上无微电流通过注册证号(Registration No)：沪食药监械(准)字2009第2271019号发明专利申请号(PA No.)：200510005305.2注册证号(Registration No.)：沪食药监械(准)字2008第2270040号发明专利申请号(PA No.)：200410091397.6在针刺的基础上，分别留针(皮肤至针尾)4.0cm，4.5cm，5.0cm，

13、分别使用银质针和银质针导热巡检仪加热和传统不修钢针艾绒加热20分钟，其间皮肤进针点温度变化。After acupuncture,needles lay outside(skin to the backshank)4.0cm,4.5cm,5.0cm,respectively using silver needle no heating,heating with Heat Conducting and Temperature Control Equipment,acupuncture and moxibustion for 20 minutes,record the temperature cha

14、nge of the needle point.目标温度Target temperature：432C l导热效率高，稳定性好High efficiency and good stability of heat conduction 银质针灸针导热疗法，是在银质针针刺治疗的基础上，通过针身向穴位导入所需的最佳温度，从而达到良好治疗效果的一种治疗方法。2007年经上海市科委高新技术成果转化服务中心审定，被认定为上海市67个高新技术成果转化项目之一 The Silver Needle Heat Conduction Treatment(SNHC Treatment)is an innovative

15、 acupuncture treatment with better efficacy by providing acupoints of the optimal temperatures through silver needles shaft.P=0.87P=0.36P=0.27P=0.27P=0.15P=0.03经过一个疗程五次的治疗,二组病人疼痛都有改善,治疗前后比较二组都有显著差异(P0.001)，二组间比较，前四次疼痛改善没有显著差异，只有第五次治疗有显著差异(P=0.03)，银检仪加热治疗组疼痛改善优于传统艾灸治疗组。n疼痛强度明显缓解 Significantly relieve

16、 pain有效率 effective rate(%)经过一个疗程五次治疗，二组病人的疼痛缓解率都有所提高，电子灸组经过治疗100%的病人疼痛得到缓解，艾灸组97.9%的病人疼痛得到缓解。After five times of treatment,pain relief rate of both groups are improved:the rate of SNHCT group reached 100%and the rate of moxibustion group reached 97.9%.n疼痛缓解率明显上升 Significantly increase the response r

17、ate of pain relief 不良事件发生数银检仪加热组艾灸加热组P 值*Adverse EventsHCTCWarm NeedlingP Value 总的不良事件数 Total Events10120.3024 红肿 Swelling45 起泡 Blistering01 出血 Bleeding66 SAE00*检验P值是采用chisq-test中的Fisher精确检验n不良事件发生情况 Adverse Events患者能够耐受的最高温度the maximum tolerant temperature 耐 受 温 度 Tolerance()病人能够耐受的最高温度47.331.99Max

18、imum tolerant temperature 性别 Gender男 Male47.503.09女 Female47.221.16年龄 Age20-40岁44.852.6240-60岁48.382.8260-80岁47.641.09 摘自：叶刚等.银质针电子加热留针长度与温度设定关系的临床研究.中国康复医学杂志,2008,23(1):70-7145C41C39C38C37C皮肤进针点94C70C66C59C54C47C44C41C39C38C38C43C40C39C38C皮肤进针点85C66C53C50C46C44C39C39C38C室温:25CRoom temperature银质针长:1

19、5cmLength of SN设置温度:150CSetup Temperature银质针导热近针部位温度银质针导热近针部位温度The Temperature of Near-Pin Position病人一病人一 Patient 1病人二病人二 Patient 2室温:26CRoom temperature银质针长:13cmLength of SN设置温度:115CSetup Temperature导热治疗在一定程度上弥补了传统艾灸在导热的控制和调整，治疗环境和易掉火星伤人等方面的不足;Overcome the weakness in heat conduction control,temper

20、ature adjustment,environmental protection and eliminate injury by flame of moxibustion;导热治疗通过银质针向穴位导入所需的最佳温度，且加热稳定，临床治疗效果确切;Provide acupuncture points the optimal temperature through the silver needles shaft,to achieve therapeutic efficacy;导热治疗发生的不良反应少,使用安全可靠；Less side-effects and safe to use;银检仪做到了

21、每路加热探头都能任意设定温度,独立控制温度,巡回显示每路探头的实时加热温度,在运行过程中也可适时调整,使用方便,操作简单。The heating detector of each channel could set the temperature discretionarily and adjust the temperature independently,circle checking the real-time heating temperature of each detector.It also could be adjusted during the operation proce

22、ss.Convenient and easy to manage.l 董生，41岁，因胸痛、胸闷3天而入院。Mr.Dong,41 years old,pectoralgia,chest distress 3 days,admission.胸背部温度偏低 SNHC Treatment l细银针治疗图片。Silver needle treatment.l治疗前后对比热图。Infrared thermography examination before and after treatmentl卢女士，40岁，因颈腰痛及全身不适1月而入院。Ms.Lu,40 years old,neck back pa

23、in and general malaise one month,admission.l 入院后给予细银针等治疗，5次后症状改善出院。Silver needle heat treatment for 5 times,symptom relieved,discharge.l杨生，男，64岁，腰痛半年。向左侧弯活动受限，无明显双下肢症状。Mr.Yang,64 years old,low back pain.The left side bend is limited,no obvious symptoms of lower limbs.l按红外热像诊断结果，我科予细银针等治疗。According t

24、o the infrared thermography examination,sliver needle heat treatment given,etc.胸背部温度均偏低l治疗后诉腰部疼痛明显缓解，腰部侧弯明显改善，同时胸前低温区也明显改善。以下是一天后及一周后红外热图。After treatment,the pain was relieved and the left side bend was improved obviously.The phenomenon of low temperature in the chest was obviously improved.The foll

25、owing is the infrared thermography after one day and one week.l赵某，男，59岁，腰痛伴右下肢放射痛10年，直腿抬高右40(+)左60(+)，腰部活动前屈背伸均有受限。Mr.Zhao,59 years old,backache and right lower limb radiating pain for 10 years,Straight leg raising:right 40(+),left 60(+),waist activity:anteflexion and dorsal extensor were limited.l经

26、细银针头、手共3针治疗后症状明显好转Sliver needle treatment,3 pins in head and hand,symptom relieved obviously.l治疗前患者右下肢明显比左下肢温度偏低，治疗后右下肢温度上升，基本与左侧持平。The temperature of right lower limb was significantly lower than left lower limb before treatment.After treatment the temperature of right lower limb was increased,Bila

27、teral temperature was balanced.治疗前：右下肢低温治疗后：双下肢温度相差不大治疗前和治疗后红外热图对比Comparison of infrared thermography before and after treatmentl朱生，男，22岁，腰痛伴左下肢放射痛7天来诊。Mr.Zhu,22 years old,backache and right lower limb radiating pain for 7 days.l经细银针5针针灸下肢治疗后，腰痛及左下肢放射痛缓解80%。Sliver needle treatment,5 pins in lower li

28、mb,80%of symptom relieved.治疗前：左下肢低温治疗后：双下肢温度相差不大l杨生，男，42岁，因左侧腰臀部疼痛2年来诊。Mr.Yang,42 years old,the left waist hip pain for 2 years.l经细银针5针针灸下肢治疗后，疼痛当场缓解80%，复查热图前后改善明显。Sliver needle treatment,5 pins in lower limb,80%of symptom relieved immediately.Comparison of infrared thermography before and after tre

29、atment,Symptoms improved significantly.治疗前：左下肢低温治疗后：双下肢温度相差不大l郭阿姨，70岁，因双膝痛20年，伴右肩痛及不能抬举1月。Ms Guo,70 years old,both knees pain for 20 years,Right shoulder pain and lifting limited for one month.l李阿姨，女，73岁，主诉：右侧肢体无力9月余。Ms Li,73 years old,Right limb weakness for 9 months.l患者于9月前无明显诱因出现右侧肢体乏力活动障碍，言语不清，在

30、外院诊断为“脑梗塞”。Right limb weakness,activity disorder,speech is not clear 9 months before,diagnosis as“Cerebral infarction”.l专科情况：右侧肢体明显萎缩，肢体感觉减退，右侧皮肤温度较左侧低，肌张力明显下降，右侧上肢肌力1+，右侧下肢肌力2-级。The right side of the limb was Atrophy,hypaesthesia,and the right side skin temperature was lower than the left side,the

31、muscle tone was significantly decreased,and the right upper limb muscle strength was 1+,and the right lower limb muscle strength was 2-.l经过2次的内热针治疗后，右侧肢体萎缩和肢体感觉减退好转，右侧皮肤温度与左侧一样，肌张力好转，右侧上肢肌力3-，右侧下肢肌力3+。可自行在学步支架下行走。After 2 times internal thermal needle treatment,Atrophy and hypaesthesia was improved.T

32、he right side skin temperature was as same as the left side,the muscle tone was significantly increased,the right upper limb muscle strength was 3-,and the right lower limb muscle strength was 3+.Can walk with the walker.l褚生，男，36岁，厨师，因将军肚伴腰痛10年而就诊Mr.Chu,36 years old,cook,central obesity with low bac

33、k pain for 10 years.l 银质针、细银针导热、内热针、经皮骨骼肌松解治疗、小针刀、刃针、微针刀、水针刀、埋线减肥、芒针、扶阳火疗、扶阳督脉灸、腹针、飞针、干针、湿针、龙氏正骨、苗氏拉伸、宣式按摩、平衡针、平衡火罐、无痛泄血、奇穴放血、扳机点注射法、枝川疗法、星状神经节阻滞术、臭氧疗法、肌筋膜微针刺激疗法等。Silver Needle,SNHC Treatment，Internal Thermal Treatment,Inner Heating Therapy,needle knife,Blade needle,etc.l 我们科常年培训银质针和内热针SNHC Treatment and needle Treatment trainingl 欢迎各位专家来我们医院指导！Welcome to our hospital!