推拿-p又称失枕

病因病理etiology1.劳损2.外伤3.感受风寒4.肾虚1.be

tired

,fatigue2.injury3.invasion

by

windand

cold4.kidney

deficiencyetiology■1、劳损睡眠时头部不良或垫枕过高，使肌肉、韧带受到较长时间不适当的牵拉而使软组织损伤，局部缺血缺氧，而出现疼痛和活动功能。caused

by

long-time

overstrain

of

the

muscle

groupin

the

neck

and

the

nuchalregion

(usually

one

sideonly

)

due

to

improperh

e

i

g

h

t

of

p

i

l

l

o

w

or

improper

posture

duringsleep病因病理■2、扭伤 当颈项过度前屈时突然旋转或复位，而致肌肉、关节扭错损伤；或关节突关节的间隙拉开，关节囊的滑膜层进入关节间隙，至滑膜嵌顿于关节之间。The

muscles

and

joints

beinjured

by

overturning

theneck.c

a

u

s

e

d

by

s

y

n

o

v

i

a

li

n

c

a

r

c

e

r

a

t

i

o

n

of

t

h

ecervical

vertebra

jointsdue

to

muscular

sprain

orsuddenturnof

the

head

.病因病理■3、感受风寒

露卧当风，项背受寒，风寒通过腠理，侵入经络，络而使肌肉紧张疼痛。caused

by

myospasmor

myofibrositis

due

toexposure

to

wind-coldness

.脉受阻，气血运行不畅，

• T

h

ew

i

n

d

–

c

o

l

dinvades

the

patient’smeridian

from

neckand

back,qi

and

bloodcan’t

move

very

well,then

the

muscles

arespasm.pathology■4、肾虚《证治准绳》：“久坐并失枕致不可转移者，皆由肾虚不能生肝，肝虚无以养筋，故机关不利”。Kidney

deficiencyK

i

d

n

e

y

w

a

t

e

r

can

’

t

p

r

o

d

u

c

e

liver

wood,

liverb

l

o

o

d c

a

n

’

tnourish

the

tendons.So

,the

joint

can’tmove

freely.剖胸锁乳突肌斜方肌提肩胛肌菱形肌斜方肌（trzius）起自上项线、枕外隆凸、项韧带、第七颈椎和全部胸椎的棘突，上部的肌束斜向外下方，中部的平行向外，下部的斜向外上方，止于锁骨的外1/3、肩峰和肩胛冈。作用：使肩胛骨向脊椎靠拢，上部肌束可上提肩胛骨，下部肌束可使肩胛骨下降；如果肩胛骨固定，一侧肌收缩使颈向同侧屈、脸转侧，两侧同时收缩可使头后仰。胸锁乳突肌Sternocleidomastoid起自

前面和锁骨的胸骨端，止于颞骨的乳突，作用：一侧肌收缩使头向同侧倾斜，脸转

侧；两侧收缩可使头后仰。提肩胛肌Levator

scapulae起自上4个颈椎的横突，止于肩胛骨的上角。作用：上提肩胛骨。如肩胛骨固定，可使颈向同侧屈曲。菱形肌Rhomboideus起自第6、7颈椎和第1～4胸椎的棘突，止于肩胛骨的内侧缘。作用：使肩胛骨向脊椎靠拢并略向上。临床表现

Manifestations1、疼痛

颈项和上背部疼痛1.pain

at

the

neckand

upper

backmanifestations提肩胛肌、菱形肌等。2、肌肉痉挛：斜

•

2.myospasm:方肌、胸锁乳突肌、•

Tr

zius,SternocleidomastoidJIJIN:Foot

taiFoot

shaojijinjijinmanifestations■3、畸形：往往固

•

3

.

deformity,

the定于略为偏歪的前屈位的特殊

。neck

is

a

obliqueand

flexion

forwardposition.manifestations■4、运动

：颈

•

4

.

d

i

s

a

b

i

l

i

t

y

o

f项伸屈旋转受限。

movement,

such

asFlexion

forwardExtensionLateral

flexionTurningmanifestations■5、伴有头痛、头胀、失眠、纳呆和情绪烦躁等症。•pany

with

headache,

fullness

of

head,

insomnia,

p

o

o

r

a

p

p

e

t

i

t

e

,restlessness,

etc.体征Signs1.肌肉痉挛2.压痛3.活动1.myospasm2.tender3

.

c

a

n

’

tfreelym

o

v

eX

film少数出现：椎体前缘骨质增生，脊椎生理弧度改变、序列不整、侧弯等。X片：一般无明显变化。•

Generally,

it

is

nochanges.A

fe

tient

willhave

hyperosteogenyv

e

r

t

e

b

r

a

e

,a

t t

h

e f

r

o

n

t o

ft

h

ephysiological

curvewill

disappear

,

or

turnto

scoliosis.辨证分型

differentiation■1、外伤型：因劳累、•1.injury

type扭伤所引起，发病急

•

Be

caused

by

tired骤，疼痛较重。

or

sprain,

onsetsuddenly,

the

painis

seriously.differentiation■2、风寒型：因风酸痛，局部肌肉僵硬，怕冷。2.Wind-coldtype寒或汗出当风引起，•

Wind

invades

aftersweating,

or

wind–

c

o

l

d

i

n

v

a

d

e

w

h

e

n

s

l

e

e

,soreness

and

pain,local

muscles

stiff,aversion

to

cold.differentiation■3

、肾虚型：平时体质虚弱，伴有头晕耳鸣，腰膝酸软等症。3.kidney

deficiency

:the

patient

is

weakusually,

has

suchs

y

n

d

r

o

m

e

s

a

sd

i

z

z

i

n

e

s

s

,tinnitus

,

sore

andweak

of

low

back

andknee

joints.鉴别Differentiation■史和肩部负重史。可摄颈椎张口位片证实。1、寰枢关节半脱位：•

1.atlas-axis

jointsemidislocationT

h

e

C

2

s

p

i

n

a

lprocess

is

deviated

.Take

a

open

mouthX

film

can

helpyour

diagnosis.Differentiation■2、颈椎病：反复落枕。2

.

c

e

r

v

i

c

a

lspodylopathy,The

patient

has

ahistory

of

repeatedstiff

neck.Principles of

treatment■治则：舒筋通络，活血止痛，理筋整复1.relax

the

tendon

a

n

d

d

r

e

d

g

e

t

h

e

collateral2.move

blood

andstop

painR

e

t

u

r

n

t

h

eligaments

and

crackthe

jointspoints■风府、肩中俞、肩外俞、秉风、肩井、天宗、缺盆等。压痛点：常分布在肩中俞、秉风、肩井及肩胛内上缘。取穴：患部及风池、•GB20,GB21,DU16,SI11,SI12,SI14,SI15ST12A

SHI

pointmanipulations■手法：一指禅推法、•Budda

finger,滚法、揉法、拿捏、•Rolling,点压、弹拨、摇、Kneading

,扳、拔伸、擦法等。•Gras,Digital

pressingPullingCrackScrubbingTuina

treatment操作

movements1.一指禅推颈段督脉、颈夹脊。2.按揉颈段督脉、颈夹脊。3.滚肩胛带、颈根部、颈夹脊1

.

B

u

d

d

a

f

i

n

g

e

rp

u

s

h

i

n

g

t

h

e

d

umeridian,jing

jiaji2

.

p

r

e

s

s

i

n

g

a

n

dkneading

du

meridian

,jing

jiaji3.rolling

jing

jiaji,

theroot

of

neck,

round

thescapula.movements4.按揉上述穴位，5.拿颈项部，6.弹拨肌肉痉挛处4

.

p

r

e

s

s

i

n

g

a

n

d

kneading

the

points

mentioned

above.5

.

g

r

a

s

t

h

e

neck(

GB

20

)

and

shoulder(GB21)6.plucking

the

areaof

myospasmmovements7.拔伸摇颈。8.颈椎扳法，整复错缝。9.擦颈部，7.Lifting

,

pulling,and

rotating

theneck8.crack

the

neckjoint9

.

scrubbing

the

neck

and

upper

backmovements10.摩肩，11.拍打肩背部12叩击肩背部。10

.

rubbing

bothshoulders11.patting

the

upperback

and

shoulder12

.

s

t

r

i

k

i

n

g

t

h

eupper

back.Other

treatmentsPuncuring

luozhen

point,

and

asking

thepatient

movesthe

neck

slowly.Moxa

Dazhui(DU14),

or

following

themeridian,such

as

from

BL10

to

BL11,

fromGB20

to

GB21,from