腰痛是临床常见症候之一，可由多种不同原因引起。Lumbag

12009/5/251腰痛的诊断与治疗DiagnosisandTreatmentofLumbago东华东华东华东华三院三院三院三院东华东东华东东华东东华东院院院院────香港理工大香港理工大香港理工大香港理工大学学学学中中中中医药临医药临医药临医药临床研究服床研究服床研究服床研究服务务务务中心中心中心中心TungWahEasternHospital–TheHongKongPolytechnicUniversityChineseMedicineClinicResearchandServicesCenter中国中医科学院针灸研究所中国中医科学院针灸研究所中国中医科学院针灸研究所中国中医科学院针灸研究所InstituteofAcupunctureandMoxibustionChinaAcademyofChineseMedicalSciences胡金生2009/5/252腰痛是临床常见症候之一，可由多种不同原因引起。Lumbagoisoneofcommonlyseendiseasesinclinic,andcanbecausedbydifferentfactors.•中医学认为：腰痛与肾虚、感受寒湿以及外伤有关。TraditionalChinesemedicinebelieves:lumbagorelateswithkidneydeficiency;invasionoflumbarregionbycoldanddampness;traumaticinjury.22009/5/253腰痛的分类Classificationoflumbago•腰痛可以分为：•腰部软组织病变，如肌肉、韧带、筋膜等的急慢性损伤；•腰部关节炎，如创伤性关节炎、增生性关节炎、强直性关节炎等；•椎间盘病变，如腰椎间盘突出症。•Lumbagocanbecausedby:•Diseasesofsofttissuesoflumbarregion:suchasacuteorchronicinjuriesofmuscle,ligament,tendonetc.•Lumbararthritis:suchastraumaticarthritis,hypertrophicarthritis,ankylosingarthritisetc.•Diseasesoflumbardiscs:protrusionoflumbardiscs.2009/5/254针灸治疗：以行气止痛，通经活络为主。AcupunctureTreatmentToregulateqiforstoppingpain,topromotemeridians.•基本处方：•肾俞、大肠俞、腰阳关、委中。•Primaryprescription:•BL23,BL25,GV3,BL4032009/5/255加减Modification:•肾虚者，可配用命门、太溪；•寒湿者，加用灸法；•外伤者，配用局部阿是穴、人中、腰痛穴，针用泻法，或于委中穴三棱针点刺出血。•Kidneydeficiency:GV4,KI3;•Invasionofcoldanddampness:Addingmoxibustion;•Traumaticinjury:locala-shipoints,GV26,YaoTongXue,orbleedingbythreeedgedneedleonBL40.2009/5/256临床应用Clinicalapplication•软组织损伤者，可于损伤局部阿是穴，针用单刺或围刺法，慢性损伤者，可配用灸法；•腰部关节病变者，可根据病变所累及的关节，选用相应水平的督脉及膀胱经俞穴；•腰间盘病变者，在病变椎体旁和上下各一个椎体旁选用相应的华佗夹脊穴，针灸并用。•Injuryofsofttissue:toprefera-shipointpuncturedbysingleneedleorsurroundingneedles;addmoxibustionforchronicinjury;•Lumbardiseases:toapplyGVpointsandBLpointsthataresamelevelwithdiseasedregionorjoints;•Diseasesoflumbardiscs:touserelativeHuaTuoJiaJipointthataresamelevel,onevertebraeaboveandonedownwithdiseasedvertebrae.42009/5/257诊断与治疗Diagnosisandtreatment临床上有的患者，其腰痛部位在腰骶部，对此可选用膀胱经的上髎、次髎穴；•Whenpatientscomplainpainonlumbar-sacralregion,wewillneedleBL31andBL32.2009/5/25852009/5/259诊断与治疗Diagnosisandtreatment有的患者，为骶髂关节病变，选其骶髂关节处的阿是穴作为针刺点；Whenlumbagoiscausedbydiseasesofsacroiliacjoint,wewillneedlea-shipointslocatedonsacroiliacregion.2009/5/251062009/5/2511诊断与治疗Diagnosisandtreatment有患者的腰痛，在臀上部位，是臀上皮神经损伤，临床上应注意选用损伤部位的治疗，可选用臀上部位作为针刺点。Whenpatientfeelslumbagoonsuperiorglutealregioncausedbyinjuryofnervicluniumsuperiores,wewillprefertoneedlepointsonsuperiorglutealregion.2009/5/251272009/5/2513小小小小结结结结•腰痛是一种常见又较复杂的病证，临床应根据辨证结合辨病，诊断明确，根据不同类型的腰痛，分别采用不同的治疗方法，才能做到有的放矢。•Lumbagoiscommonlyseenandcomplicateddisease.Clinically,weshouldcombinesyndromedifferentiationwithsymptomobservation,thenapplydifferentpointsandmethodsaccordingtodifferenttypesoflumbago.2009/5/2514Thankyou!谢谢!