中医针灸之针刺补泻及意外情况的处理english

针刺补泻手法及意外情况的处理

蚌埠医学院第二附属医院陈莉秋主任医师教授研究生导师针刺补泻

ReinforcingandReducingMethods

凡是能鼓舞人体正气，使低下的功能恢复旺盛的叫补法

；凡是能疏泄病邪，使亢进的功能恢复正常的叫泻法。它们都是通过刺激腧穴，激发经气来调节脏腑功能，达到阴阳平衡的。针刺补泻效果的产生，主要取决于以下几个方面：

Themethodwhichisabletoinvigoratethebodyresistanceandtostrengthentheweakenedphysiologicalfunctioniscalledreinforcing,whiletheotheronewhichisabletoeliminatethepathologicalfunctionsofisknownasreducing.ThereinforcingandreducingfortheregulationofthefunctionsofZang-FuorgansandthebalanceofYinandYangareachievedbystimulatingthepointstoactivatetheQiofmeridians.Theeffectsofreinforcingorreducingmainlydependuponthefollowingfactors:⑴机体的机能状态

（TheFunctionedConditionsofthePatien）在不同的病理状态下，针刺可以产生不同的调节作用即补泻效果。如当机体处于虚脱状态时，针刺可以起到回阳固脱的作用，当机体处于热邪壅闭的情况下，针刺又起到泄热启闭的效果。针刺对机体的这种调节作用，与人体正气的盛衰有着密切的关系，如机体正气充盛，则经气易于激发，针刺的调节作用就显著；若正气不足，经气不易激发，则针刺的调节作用就较差。⑴TheFunctionedConditionsofthePatientUnderdifferentpathologicalconditions,acupuncturemayproducedifferentregulatingfunctions,eitherreinforcingorreducing.Ifanindividualisinacollapsecondition,acupuncturefunctionstorescueYangfromcollapse;whenanindividualisunderaconditionofinternalpathogenicheat,acupuncturefunctionstoexpeltheheat.Thisdualregulatingfunctioniscloselyrelatedtothedefensiveabilityofhumanbody.Ifitisvigorous,themeridianQiiseasytobeactivatedandtheregulatingfunctionisgood.Onthecontrary,ifitislowered,themeridianQiisdifficulttobeexcitedandtheregulatingfunctionispoor.⑵腧穴特征

(TherapeuticPropertiesofthePoints)不同的腧穴在功能上具有相对的特异性，有些腧穴适宜补虚，有些腧穴适宜泻实。如气海、关元、命门、足三里、膏肓俞等穴，具有强壮作用，多用于虚损病证；而少商、十宣等穴具有清热的作用，多用于实热病症。⑵TherapeuticPropertiesofthePointsAcupuncturepointshaverelativespecificityasfarasthetherapeuticpropertiesareconcerned,somepointstendtoreinforcethebodyresistance,suchasQi-hai(CV6),Guangyuan(CV4),Mingmen(GV4),Zusanli(ST36),Gaohuang(BL43)etc,whicharemainlyappliedfordeficiencysyndromes;andsomepointssuchasShaoshang(LU11)andShixuan(EX-UE11),whichhavethepropertyofclearingawayheatandpromotingtheresuscitationareemployedoftenforexcessiveheatsyndromes.⑶针刺手法

(NeedlingMethods)此法是捻转角度的大小和速度的快慢来区别补泻。针下得气后，捻转角度小，用力轻，频率慢，操作时间短者为补法。捻转角度大，用力重，频率快，操作时间长者为泻法。也有以左传时即拇指向前的角度大，用力重者为补；右转时即食指向前的角度大，用力重者为泻

①捻转补泻：(ReinforcingorReducingbyTwirlingandRotatingtheNeedle)⑶NeedlingMethods

①ReinforcingorReducingbyTwirlingandRotatingtheNeedleThereinforcingandreducingofthiskindcanbedifferentiatedbytheamplitudeandspeedused.WhentheneedleisinsertedtoacertaindepthandtheQiarrives,rotatingtheneedlegentlyandslowlywithsmallamplitudeforrelativelyashortperiodiscalledreinforcing,onthecontrary,rotatingtheneedlerapidlyandheavilywithlargeamplitudeforrelativelyalongperiodisknownasthereducing.Itisalsoconsideredthatrotatingtheneedlewiththethumbforwardforcefullyinlargeamplitudeisreinforcing,whilerotatingtheneedlewiththeindexfingerforwardforcefullyinlargeamplitudeisreducing.②提插补泻

(ReinforcingandReducingbyLiftingandThrustingtheNeedle)此法是以提插时用力轻重和速度快慢来区分补泻。针刺得气后，提时用力较轻，速度较慢，而插时用力较重，速度较快为补法；提时用力较重，速度较快，而插时用力较轻，速度较慢为泻法。②ReinforcingandReducingbyLiftingandThrustingtheNeedleInthismethod,thereinforcingandreducingcanbedifferentiatedbytheforceandspeedused.Aftertheneedleisinsertedtoagivendepthandtheneedlingsensationappears,thereinforcingisobtainedbyliftingtheneedlegentlyandslowly,whilethrustingtheneedleheavilyandrapidly.Thereducingisachievedbyliftingtheneedleforcefullyandrapidlywhilethrustingtheneedlegentlyandslowly.③徐疾补泻

(TheReinforcingandReducingAchievedbyRapidandslowInsertionandwith-drawaloftheNeedle)此法是以进针、退针过程的快慢来区分补泻。行补法时，进针要慢，逐步进针达到一定的深度，出针要快，迅速提至皮下，稍停片刻出针；行泻法时，进针要快，一次就插到所需的深度，出针要慢，逐步分层退出。TheReinforcingandReducingAchievedbyRapidandslowInsertionandwithdrawaloftheNeedle

Thissortofreinforcingandreducingmethodisdistinguishedbythespeedofinsertionandwithdrawaloftheneedle.Duringmanipulations,thereinforcingmethodisconductedbyinsertingtheneedletoagivendepthslowlyandliftingitrapidlyjustbeneaththeskin,andamomentlaterwithdrawit.Thereducingisperformedbyinsertingtheneedlerapidlytothegivendepthinonestepandwithdrawingitslowlyinafewsteps.④开合补泻

(TheReinforcingandReducingAchievedbyKeepingtheHoleOpenorClose)此法是以出针时是否按闭针孔来区分补泻。补法时，出针较快，出针后立即按闭针孔，意在使真气留存；行泻法时，出针时右手持针摇大针孔，一面摇一面推出，出针后不闭针孔。④TheReinforcingandReducingAchievedbyKeepingtheHoleOpenorCloseOnwithdrawingoftheneedle,pressingtheneedlingholequicklytocloseitandpreventthevitalQifromescapingiscalledreinforcingshakingtheneedletoenlargetheholewhilewithdrawingit,andkeepingtheholeopenisknownasreducing.⑤迎随补泻

(TheReinforcingandReducingAchievedbytheDirectiontheNeedleTipPointingto)此法是以经脉循行的顺逆来定补泻。行补法，将针尖顺经而刺；行泻法时，针尖要逆经而刺。⑤TheReinforcingandReducingAchievedbytheDirectiontheNeedleTipPointingtoTheneedletippointinginthedirectionofthemeridianisknownasreinforcing,andtheneedletippointingagainstthemeridiandirectionisconsideredasreducing.⑥呼吸补泻

(TheReinforcingandReducingAchievedbyMeansofRespiration)与病人呼气时进针，吸气时出针为补法，吸气是进针，呼气时出针为泻法。⑥TheReinforcingandReducingAchievedByMeansofRespirationInthemethod,thereinforcingisachievedbyinsertingtheneedlewhenthepatientbreathesinandwithdrawingtheneedlewhenthepatientbreathesout.Thereducingisachievedinanoppositeway.⑦平补平泻

(EvenReinforcingandReducingMovement)进针得气后均匀地提插，捻转后即可出针。⑦EvenReinforcingandReducingMovementWhentheneedleisinsertedintothepointandtheneedlingsensationappears,lift,thrustandrotatetheneedleevenly,thenwithdrawtheneedle.留针与出针

RetainingandWithdrawingtheNeedle⑴留针（Retaining）留针是指将针刺入腧穴行针施术后，将针留置穴内。留针的目的是为了加强针感和便于继续行针施术。留针与否和留针时间的长短，主要依病情而定。一般病症，针下得气后留针15-20分钟；但对某些慢性顽固性疼痛，痉挛性病症，可适当延长留针时间，有的病症留针可达数小时之久，在留针过程中作间歇行针，以增强疗效。对针感较差患者，留针还可以起到候气的作用。⑴RetainingRetainingmeanstokeeptheneedleinplaceafteritisinsertedtoagivendepthbelowtheskinandmanipulated.Thepurposeofitistoprolongtheneedlingsensationandforfurthermanipulation.Pathologicalconditionsdecidetheretaininganditsduration.Ingeneral,theneedleisretainedforfifteentotwentyminutesafterthearrivalofQi.Butforsomechronic,intractable,painfulandspasticcases,thetimeofretainingtheneedlemaybeappropriatelyprolonged.Forsomediseases,thedurationmaybeaslongasseveralhours.Meanwhile,manipulationsmaybegivenatintervalsinordertostrengthenthetherapeuticeffects.Forpatientswithadullneedlingsensation,retainingtheneedleservesasamethodtowaitQitocome.

⑵出针（Withdrawing）出针时先以左手拇、食两指按住针孔周围皮肤，右手持针轻微捻转并慢慢将针提至皮下，然后将针起出，并用消毒棉球轻揉针孔，以防出血。最后检查针数，以防遗漏。⑵WithdrawingOnwithdrawingtheneedle,presstheskinaroundthepointwiththethumbandindexfingerofthepressinghand,rotatetheneedlegentlyandliftitslowlytothesubcutaneouslevel,thenwithdrawitquicklyandpressthepuncturedpointwithasterilizedcottonballforawhiletopreventbleeding.Besurenottoleaveanyneedleonthebody.针刺意外情况

的处理

ManagementofPossibleAccidents一、晕针（Fainting）原因：由于患者精神紧张、体质虚弱、疲劳、饥饿，或因体位不适，或医者操作不当，手法过重等因素造成。Cause:Thisisoftenduetonervousnessdelicateconstitution,hunger,fatigue,improperpositionormanipulation,suchastooforcefulmanipulation.

现象：患者在针刺过程，突然感觉心慌、头晕目眩，或恶心欲吐，出冷汗，面色苍白，脉象微弱；严重者出现肢体厥冷，血压下降，二便失禁，不省人事等。Manifestations:DuringAcupuncturetreatment,theremayappearpalpitation,dizziness,vertigo,nausea,coldsweating,pallorandweakpulse.Inseverecases,theremaybecoldextremities,dropofbloodpressure,incontinenceofurineandstool,andlossofconsciousness.

处理：立即停止针刺，将已经针刺的毫针取出，令患者平卧，头部稍低，注意保暖。轻者静卧片刻，喝点温开水或热水,即可恢复。重者以指掐或针刺人中、合谷、内关、足三里等穴，如仍不缓解时，可配合其他急救措施。

Management:Stopneedlingimmediatelyandwithdrawalltheneedle,thenhelpthepatienttoliedown,andoffersomewarmorhotwatertothepatient.Thesymptomswilldisappearafterashotrest.Inseverscases,presshardwiththefinger-nailorneedleRenzhong(GV.26),Hegu(LI4),Neiguan(PC.6)andZusanli(ST.36).Generally,thepatientwillrecover,butifnot,otheremergencymeasuresshouldbetaken.

预防：对于初次接受针灸治疗和精神紧张者，应先做好解释工作，消除顾虑，手法不宜过重，尽量采取卧位，少留针或留针时间不宜过长；对于过度疲劳、饥饿者不宜针刺；医者在针刺过程中，发现患者面色苍白，出汗或诉说头晕等晕针先兆时，应及时采取处理措施。

Prevention:Forpatientsbeingtreatedbyacupunctureforthefirsttime,orthoseofsensitiveindividuals,abriefaccountofneedlingshouldbegiventothempriortothetreatmenttorelievetheirnervousness,andsupinepostureisadopted.Themanipulationshouldnotbetooforceful.Needlesarenotretainedforlongtime.Duringthetreatment,ifthereappearsomeprodromalsymptomssuchaspallor,sweatingordizziness,managementshouldbetakenpromptly.二、滞针（Stuckneedle）：原因：患者精神紧张，针刺入后，局部肌肉强烈收缩；或行针时向同一方向连续捻转，而致肌纤维缠绕针身；或因针身刺入肌腱；或针刺后体位改变，都可引起滞针。

Cause:Thismayresultfromnervousness,strongspasmofthelocalmuscleaftertheinsertionoftheneedle,twirlingtheneedlewithtoolargeamplitudeorinonedirectiononlycausingmusclefiberstobind,orfromachangeofthepositionofthepatientaftertheinsertionoftheneedles.

现象：进针后针下异常紧涩，出现提插、捻转及出针困难。Manifestations:Aftertheneedleisinserted,itisfounddifficultorimpossibletorotate,liftandthrusttheneedles.

处理：嘱患者消除紧张情绪，使局部肌肉放松，因单向捻转而致者，则须反向捻转。如属肌肉一时性紧张，可留针一段时间，然后再行捻转出针，也可轻轻按揉针刺周围的皮肤肌肉，或在附近部位加刺一针，以宣散气血，缓解痉挛，因体位改变者，应恢复体位后随之将针取出。

Management:Askthepatienttorelax.Iftheneedleisstuckduetoexcessiverotationinonedirection,theconditionwillreleasewhentheneedleistwirledintheoppositedirection.Ifstuckneedleiscausedbytemporarymusclespasm,leavetheneedleinplaceforawhile,thenwithdrawitbyrotating,orbyinsertinganotherneedlenearbytodispersetheQiandblood,andtorelievethespasm.Ifthestuckneedleiscausedbythechangingofthepositionofthepatient,theoriginalpostureshouldberesumedandthenwithdrawtheneedle.

预防：对精神紧张者，下做好解释工作，消除紧张心理。行针时不可用力过猛，避免单向捻针及将针刺入肌腱，留针过程中不宜随意改变体位。Prevention:Nervouspatientsshouldbeencouragedtorelaxtheirtension.Manipulationshouldnotbetooforceful.Avoidpuncturingthemusculartendonduringinsertion.Twirlingtheneedleinonlyonedirectionshallnotbeallowed.Duringretentionoftheneedles,thepostureofthepatientshouldremainunchanged.

三、弯针（Bentneedle）原因：医者手法不熟练，进针时用力过猛，或针下碰到坚硬组织；或留针时患者体位移动；针柄受到外物的压迫和碰撞，以及滞针没有及时处理。Cause:Thismayarisefromunskillfulmanipulationortooforcefulmanipulation,ortheneedlestrikingonthehardtissue,orasuddenchangeofthepatient'sposture,orthehandleofneedlebeingtouchedorpressedbysomething,orfromanimpropermanagementofthestuckneedle.

现象：针身弯曲，针柄改变了进针时刺入的方向，提插、捻转及出针均感困难，患者感觉疼痛。

Manifestations:Itisdifficulttolift,thrust,rotateandwithdrawtheneedle,andthepatientfeelspainful.

处理：发现弯针后，不可再行提插、捻转等手法。应顺势慢慢退出；如因患者体位改变所致，应使患者慢慢恢复体位，使局部肌肉放松后，再将针慢慢退出，切记强行拔针，以免将针断入体位。Management:Whentheneedleisbent,lifting,thrustingandrotatingshallbenolongerconducted.Theneedlemayberemovedslowlyandwithdrawnbyfollowingthecourseofbent.Ifthebentneedleiscausedbythechangeofthepatient'sposture,helphimtoresumetheoriginal,relaxthelocalmuscleandremovetheneedle.Nevertrytowithdrawtheneedlewithforcesoastobreaktheneedleinsidethebody.

预防：医者进针手法要熟练，指力要均匀轻巧；针刺前应选择舒适的体位，留针期间不能随意变动体位。Prevention:Skillfulinsertionandevenmanipulationarerequired.Priortotreatment,thepatientshouldhaveacomfortableposition.Duringtheretentionoftheneedle,apatientisnotallowedtochangethepositionashepleases.

四、断针（Brokenneedle）原因：针具质量欠佳，针根或针身有剥蚀损坏；行针时手法过重，肌肉强烈收缩；或患者体位改变，滞针和弯针现象未能及时正确处理等，均可造成断针。Cause:Thismayresultfromthepoorqualityoftheneedleorerodedbaseoftheneedle,fromtoostrongmusclespasm,orasuddenmovementofthepatientwhentheneedleisinplace,orfromwithdrawingastuckneedle.

现象：针身折断，或部分针身尚露于皮肤之外，或针身残端全部没入皮肤之下。Manifestations:Theneedlebodyisbrokenduringmanipulationandthebrokenpartisbelowtheskinsurfaceoralittlebitoutoftheskinsurface.

处理（Management）：嘱患者不要紧张、乱动，以防断针继续向肌肉深层陷入，如残断部分针身尚露于体外，可立即用手指或镊子取出；如残断与皮肤相平，可按压针孔两旁，使断针暴露于体外，用镊子取出；如断针完全深入皮下或肌肉时，应在x线下定位，手术取出。

Management:Whenithappens,thepatientshouldbetoldtokeepcalmtopreventthebrokenneedlefromgoingdeeperintothebody.Ifthebrokenpartprotrudesfromtheskin,removeitwithforcepsorfingers.Ifthebrokenpartisatthesameleveloftheskin,pressthetissuearoundthesiteuntilthebrokenendisexposed,thenremoveitwithforceps.Ifitiscompletelyundertheskin,surgeryshouldberesortedwiththehelpofx-