推拿实训教学的改革与创新

推拿学是一门实践性很强的学科,推拿教学不仅要重视理论学习,更要加强体能训练和强化手法技能,如何在有限的教学时间内,尽可能地提高学生的实践能力是教师必须考虑的问题.关键字:推拿学;实训;教学改革

Objective: To observe the efficacy of tuina manipulations for fibromyalgia syndrome (FMS).
Methods:Sixty eligible FMS patients were randomized into two groups, 30 in each group. Patients in the observation group were intervened by tuina manipulations to the corresponding segment of the spine based on the detection of disorders of the spine-related bones and tendons;patients in the control group were directed to practice functional exercises. Before and after intervention, the fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS) were adopted for evaluation.
Results:After intervention, the FIQ and VAS scores dropped significantly in both groups (all P<0.05), and there were significant differences between the two groups (both P<0.05). The total effective rate was 86.7%in the observation group versus 63.3% in the control group, and the difference was statistically significant (P<0.05).
Conclusion:Spinal tuina manipulations are effective and safe in treating FMS, for significantly promoting the quality of life of the FMS patients.

Objective:To observe the clinical efficacy of tuina plus ultrasonic therapy in treating infantile muscular torticollis.
Methods:Seventy kids with muscular torticollis were intervened by tuina plus ultrasonic therapy, and the efficacy was evaluated after 8-month treatment.
Results: After 8-month treatment, 41 subjects were cured, accounting for 58.6%, 27 were improved, occupying 38.6%, 2 failed, occupying 2.8%, and the total effective rate was 97.2%.
Conclusion: Tuina plus ultrasonic therapy can produce a significant efficacy in treating infantile muscular torticollis, without adverse effects.

Objective: To observe the effect of acupoint massage in relieving pain after ureteroscopic holmium laser lithotripsy.
Methods: Ninety-two patients undergone ureteroscopic holmium laser lithotripsy were enrolled and randomized into a treatment group and a control group, 46 in each group. Patients in the control group were given regular nursing care, while patients in the treatment group were intervened by acupoint massage in addition to the regular nursing care. The pain was evaluated by visual analogue scale (VAS) at 6 h, 12 h, and 24 h after operation, and compared between the two groups.
Results:There was no significant difference in comparing the VAS score at 6 h after operation between the two groups (P>0.05). The VAS scores in the treatment group at 12 h and 24 h after operation were significantly lower than those in the control group (both P<0.05). Fewer patients in the treatment group used analgesics compared with those in the control group.
Conclusion: Acupoint massage can effectively relieve the pain after ureteroscopic holmium laser lithotripsy, reduce the use of analgesics, and promote the recovery.

Objective: To observe the clinical effects of acupoint injection therapy plus massage on primary dysmenorrhea (PD).
Methods: Ninety patients with PD were randomly divided into a treatment group or a control group, 45 cases in each group. The treatment group was treated by injection of Vitamin K3into Sanyinjiao (SP 6) plus massage on Diji (SP 8). The control group was treated by oral administration of Ibuprofen sustained-release capsule. Before and after the treatment, visual analogue scale (VAS) was adopted to assess pain degree of the patients. The therapeutic effects were observed after continuous treatment of three cycles of menstruation.
Results: After treatment, VAS scores were obviously decreased in both groups and the differences were statistically significant (allP<0.05). The difference in VAS score after treatment was more significantin the treatment group than that in the control group (P<0.01). The total effective rate was significantl higher in the treatment group than that in the control group (P<0.05).
Conclusion: Acupoint injection therapy plus massage for PD is effective and better than simple oral administration of Ibuprofen sustained-release capsule.

Objective: To observe the clinical effect of tuina combined with auricular point sticking on cervical radiculopathy and evaluate in health economics.
Methods: Using randomized single-blind controlled clinical design, a total of72 cases with cervical radiculopathy were randomly allocated into an observation group or a control group by the ratio of 1:1, 36 in each group. Cases in the observation group were treated with tuina combined with auricular point sticking, whereas cases in the control group were treated with tuina alone. Then the clinical effects in the two groups were observed and the cost of health economics was evaluated.
Results: The drop-out, recovery, improvement and failure cases, recovery rate and total effective rate in the observation group were 1, 15, 20, 0, 42.9% and 100% respectively, versus 2, 6, 23, 5, 17.6% and 85.3% in the control group, showing significant differences in recovery rate and total effective rate (P<0.05). As for health economics, the cost-effect in the observation group was better than that in the control group.
Conclusion: Compared with tuina alone, tuina combined with auricular point sticking can obtain better effect and lower cost in health economics for cervical radiculopathy.

Objective: To observe theclinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation.
Methods: A total of 60eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment.
Results: The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference (P<0.05). The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference (P<0.01). The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference (P<0.01).
Conclusion: Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.

Objective: To observe the clinical effects of comprehensive treatmenton cutaneous region for low back pain.
Methods: One hundred and twenty outpatients with low back pain who met the diagnostic criteria were randomly divided into a cutaneous region group or a medication group, 60 cases in each group. The cases in the cutaneous region group were treated by Nie-pinching up the skin of the lumbosacral region, cupping and acupuncture. Those in the medication group were treated by oral administration of Celecoxib capsule. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the therapeutic effects.
Results: After treatment, the VAS scores of both groups were different from those before treatment, showing statistical significances (allP<0.01). The D-valuse of VAS scores of both groups were different from those before treatment, showing statistical significances (allP<0.01). The D-value of OID scores in the cutaneous region group was significantly different from that in the medication group(P<0.01). After treatment, the total effective rate was 91.7% in the cutaneous region group versus 76.7% in the medication group, there was a significant difference in comparing the clinical effect (P<0.01).
Conclusion: Both comprehensive treatment on the cutaneous region and Celecoxib capsule can obviously relieve low back pain. But comprehensive treatment on the cutaneous region is better than Celecoxib capsule in the therapeutic effects.

Objective:To observe the effect of Chinese herbal fumigation combined with three-step tuina manipulation on concentration of endothelin (ET) and calcitonin gene-related peptide (CGRP) and vertigo in patients with vertebral artery cervical spondylosis (VACS).
Methods:A total of 120 eligible cases were randomly allocated into an observation group and a control group, 60 in each group. Cases in the observation group were treated with Chinese herbal fumigation combined with three-step tuina manipulation, whereas cases in the control group were treated with oral Flunarizine Hydrochloride Capsules.
Results: After treatment, vertigo in both groups was alleviated; there were intra-group significant differences in ET decrease and CGRP increase (P<0.01, P<0.05);and there were also inter-group significant differences (both P<0.05).
Conclusion: Chinese herbal fumigation combined with three-step tuina manipulation can regulate the levels of ET and CGRP and improve vertigo in patients with VACS. Its therapeutic efficacy is superior to oral Flunarizine Hydrochloride Capsules.

Objective:To observe the clinical efficacy of Chinese herbal fumigation plus beating with mulberry stick in treating heel pain.
Methods: Sixty patients with heel pain were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by Chinese herbal fumigation plus beating with mulberry stick, and the control group was by orally taking Diclofenac Sodium Sustained Release Tablets plus external use of She Xiang Zhen Tong Gao (Moschus Analgesic Plaster). After one treatment course, the visual analogue scale (VAS) was used to observe the change of pain, and the clinical efficacies were also evaluated.
Results: After intervention, the improvement of VAS score in the treatment group was more significant than that in the control group (P<0.01). The total effective rate of the treatment group was significantly higher than that of the control group (P<0.01).
Conclusion:Chinese herbal fumigation plus beating with mulberry stick can produce a higher clinical efficacy than orally taking Diclofenac Sodium Sustained Release Tablets in treating heel pain.

In addition to conventional palpation method, examination on vertebral range of motion (ROM) and mobility can help to determine a pathological displacement and thus provide solid basis for spinal tuina manipulation.

Objective: To observe the therapeutic efficacy of fire-needle therapy plus tuina in treating primary knee osteoarthritis (KOA) in the elderly.
Methods: Twenty-three patients with KOA were intervened by pricking with fire-needle therapy plus tuina, and evaluated by using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) before and after intervention.
Results: After intervention, the total score, scores of pain, rigidity, and activities of daily living of WOMAC dropped significantly (P<0.05).
Conclusion: Pricking with fire needle plus tuina can produce a significant therapeutic efficacy in treating KOA in the elderly, thus worth application in clinic.

BACKGROUND:Subjective discomforts in a preclinical range are often due to imbalanced autonomic nervous system activity, which is a focus of craniosacral therapy. OBJECTIVE:The aim of this work was to determine any changes in heart rate variability (HRV) in a study on craniosacral therapy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This is a quasi-experimental (controlled) study with cross-over design. In a private practice, measurements were performed on 31 patients with subjective discomforts before and after a control and an intervention period. HRV was determined using a device that requires a measuring time of 140 s and electrode contact only with the ifngertips. Main PRIMARY OUTCOME MEASURES: HRV change under the inlfuence of a deifned one-time intervention (test intervention) with craniosacral therapy versus control (deifned rest period). RESULTS:Standard deviation of all RR-intervals (ms) and total power of RR-interval variability in the frequency range (ms2) were together interpreted as an indicator of test subjects’ autonomic nervous activity and as a measure of their ability to cope with demands on their health. Neither of these parameters increased during the control period (P>0.05), whereas during the test intervention period there was an increase in both (P<0.05, P<0.01). Nevertheless, interactions between treatment and the increase were statistically not signiifcant (P>0.05). No changes were observed in the low frequency/high frequency ratio (sympathetic-vagal balance) in the course of the control or the test intervention period (P>0.05). CONCLUSION: Craniosacral treatment had a favourable effect on autonomic nervous activity. This in itself is an interesting result, but further research will be needed to distinguish speciifc effects of craniosacral therapy technique from less speciifc therapist-client interaction effects.