Chinese Medicine Paper II
Treatment of acute soft tissue injury with moxibustion
Report of 113 cases
Since 1987, we have treated 187 cases of acute soft tissue injury with moxibustion using “Zhou’s All-power Moxibustion Pen” invented by the moxibustion expert Dr. Meisheng Zhou and using conventional local closed control in western medicine, proving that the curative effect of moxibustion is satisfactory for acute soft tissue injury. The results are summarized below.
Clinical data
本组共187例，其中男117例，女70例;年龄最小11岁，最大78岁，以20~50岁者为多见; 病程均在3天以内，以6小时内为多。肘部损伤12例，腕部损伤14例，腰部损伤76例，膝部损伤16例，踝部损伤69例，以腰、踝部损伤多见。本组病例全部选择闭合性损伤，并以软组织损伤为限，主要是急性肌肉扭伤，不包括急性韧带挫伤、韧带断裂和各类骨折、骨裂，并剔除急性椎间盘突出。主要临床表现为局部疼痛，放射至邻近部位，肿胀、乏力，功能减退或消失，活动受限，损伤之关节不能作全幅活动，被动拉伸。做最大静力收缩和重复损伤机转时，疼痛均显著加重，多可在一条或数条肌肉处查到固定压痛点，肌肉损伤能摸到紧张性痉挛。其中灸疗组113例，局封组74例。
There were 187 cases in this group, including 117 males and 70 females. The youngest was 11 years old and the oldest was 78 years old, and the patients aged from 20 to 50 years old were more common. The course of the disease was within three days, most of which was within six hours. There were 12 cases of elbow injury, 14 cases of wrist injury, 76 cases of waist injury, 16 cases of knee injury and 69 cases of ankle injury, among which the waist and ankle injuries were more common. All cases in this group chose closed injury, which was limited to soft tissue injury, mainly acute muscle sprain, excluding acute ligament contusion, ligament rupture, and all kinds of fractures and fractures, and excluding acute disc herniation. The main clinical manifestations include local pain, radiation to adjacent parts, swelling, weakness, hypofunction or disappearance, limited motion, inability to make full motion of the damaged joint, and passive stretching. When the maximum static contraction and repeated injury machine rotation are performed, the pain is significantly aggravated, and more fixed tenderness points can be found in one or more muscles, and tonic spasm can be felt due to muscle injury. There were 113 cases in the moxibustion group and 74 cases in the local sealing group.
Therapeutic method
1. 灸疗组 取穴原则为在损伤部位上下、周围循经选穴，局部损伤部位，从背部寻找阳性压痛点。三者均是本病选穴的思路。肘部损伤取手三里、曲池、肘髎、尺泽。腕部损伤取阳溪、阳池、阳谷、外关、大陵、支沟、太渊。腰部损伤取肾俞、委中、昆仑、腰阳关、秩边、殷门、命门。膝部损伤取阳陵泉、阴陵泉、足三里、梁丘、血海、承山、委中、膝眼、犊鼻、曲泉、梁门。踝部损伤取昆仑、太溪、申脉、解溪、悬钟、丘墟、中封。同时加用局部损伤部位和背部阳性压痛点。将点灸笔点燃后，右手食指和拇指挟持药笔下1/3端，左手将备好的药纸平铺覆盖在穴位上，用点灸笔隔药纸对准所选穴位雀啄样点灼4~5下即可，避免将药纸燃穿，防止造成烫伤，灸后患者自觉局部不痛或仅有蚊咬样微痛，局部皮肤无改变，或微红润。灸量以轻重适中为佳，重则易烫伤皮肤起水泡，手法过轻则达不到治疗目的。灸后局部穴位可搽薄荷油，以防发疱。若不慎而烫伤发疱，可用绿药膏外搽或自制蟾皮油膏搽拭 (蟾皮 6g, 冰片 6g，麻油250g，将蟾皮、冰片研粉浸人麻油中，7天后可用)，每日数次，3~5日后可愈，不留疤痕。每日点灸2次，3日为1个疗程。
1, The principle of acupoint selection in the moxibustion group was to select acupoints above, below and around the injury site along the meridians, and to find positive tenderness points from the back of the local injury site. All these are the ideas of acupoint selection for this disease. For elbow injury, the acupoints of Zusanli (ST 36), Quchi (LI 11), Quliao (LI 14) and Chize (CV 12) were selected. The wrist injuries were recorded from Yangxi (GB 34), Yangchi (GB 34), Yanggu (GB 34), Waiguan (GB 26), Daling (GB 39), Zhigou (GB 34) and Taiyuan (GB 39). Shenshu (BL 23), Weizhong (BL 40), Kunlun (BL 60), Yaoyangguan (GB 34), Zhibian (GB 26), Yinmen (BL 21) and Mingmen (BL 21) were selected for the lumbar injury. For knee injury, Yanglingquan, Yinlingquan, Zusanli, Liang Qiu, Xuehai, Chengshan, Weizhong, Xiyan, Dubi, Ququan and Liangmen were selected. The ankle injuries were taken from Kunlun, Taixi, Shenmai, Jiexi, Xuanzhong, Qiuxu and Zhongfeng. Meanwhile, positive tenderness points at local injury site and back were added. After the moxibustion pen is ignited, the index finger and the thumb of the right hand grip the 1/3 end of the medicinal pen, the left hand flatly covers the prepared medicinal paper on the acupoints, and the medicinal paper partition of the moxibustion pen is used for aiming at the sparrow-pecking point burning at the selected acupoints for 4-5 times, so that the medicinal paper is prevented from being burnt through, and the scald is prevented; and after moxibustion, the patient feels no local pain or only slight pain like mosquito bites, and the local skin is unchanged or slightly ruddy. The optimal quantity of moxibustion is moderate in severity, which is apt to cause burns and blisters on the skin if it is severe, or therapeutic purpose can not be achieved if the manipulation is too mild. Peppermint oil can be applied to local acupoints after moxibustion to prevent blistering. For burns and blisters caused by carelessness, the green ointment could be applied externally or the self-made toad skin ointment could be applied for wiping (6g of toad skin, 6g of borneol and 250g of sesame oil; the toad skin and the borneol were ground into powder and immersed in the sesame oil for 7 days; the powder could be used); the ointment could be applied for several times a day and cured after 3–5 days without leaving scars. Moxibustion was performed twice a day, and 3 days constituted a course of treatment.
2. 局封组 取1%利多卡因2~10ml加地塞米松5~10mg，据不同损伤部位及年龄大小酌量注射治疗。如腕部损伤一般注射2~4ml，而腰部损伤则可注射5~10ml。其要点是必须使药液注射到肌肉于骨骼附着点内，腰部则将其注人骶棘肌肌腹中，而不可仅注人皮下疏松组织中。
2. In the local sealing group, 2–10 mL of 1% lidocaine plus 5–10 mg of dexamethasone were injected, appropriately according to the injury site and age. For example, 2–4 mL can be injected for wrist injury and 5–10 mL for waist injury. The main point is that the liquid medicine must be injected into the muscles at the attachment points of bones, and into the muscular belly of human sacrospinous muscle at the waist, instead of only into the subcutaneous loose tissues.
治疗结果
两组疗效比较，统计学处理 x平方 = 16.68，P < 0.01, 点灸组疗效明显优于局部封闭组。
Treatment results
The curative effects were compared between the two groups. The statistical treatment showed that the x-square was 16.68, P < 0.01. The curative effect of the moxibustion group was significantly better than that of the local sealing group.
体会
急性软组织损伤是临床多发病，尤以腰踝部损伤多见，西医较优良方法常是局部封闭疗法，以促进瘀血吸收，肿胀消退，并阻断局部恶性刺激的反射弧，增进无菌性炎症的消退以达到止痛和恢复功能。实践证明，点灸疗法在对穴位进行温热刺激后，能使损伤之肌肉组织在发生节律性强烈收缩后转为松弛，能改善患处的微循环，提高新陈代谢，使气机通畅，血脉调和，经络通达，加速渗出物的吸收，从而使本疗法具有解痉消炎，消肿止痛，尽快恢复受伤部位功能的作用。
Experiences and insights
Acute soft tissue injury is a frequently-occurring disease in clinic, especially in the waist and ankle. The local blocking therapy is often adopted by the better western medicine to promote the absorption of blood stasis and the regression of swelling, block the reflex arc of local malignant stimulation, and promote the regression of aseptic inflammation to achieve the purpose of pain relief and recovery. It has been proved in practice that after warm stimulation, the damaged muscle tissues can be converted into relaxation after rhythmic and strong contraction, thereby improving the microcirculation and metabolism of the affected part, enabling the qi movement to be smooth, the blood vessels to be harmonious, the meridians to be accessible, and the absorption of exudate to be accelerated. As a result, the moxibustion therapy has the effects of relieving spasm and inflammation, relieving swelling and pain, and recovering the function of the injured part as soon as possible.
Date of Receipt: June 09, 1998
Author’s affiliation: 241000 Wuhu, Second Affiliated Hospital of Southern Anhui Medical College (Zhen, Li Yang); Wuhu Changhang Hospital (Li Mingjie) Original edition of Shanghai Journal of Acupuncture and Moxibustion (Vol. 18, No.1, 1999) (clinical report)
收稿日期 1998-06-09 齐丽珍发稿
作者单位: 241000 芜湖，皖南医学院附属第二医院(李杨缜); 芜湖长航医院 (李名杰)
原载《上海针灸杂志》1999年2月第18卷第1期（临床报道）
