Korostyshevskiy Vladislav
Private practice, Brooklyn, NY, USA.
Med Acupunct. 2020 Oct 1;32(5):320-324. doi: 10.1089/acu.2020.1429. Epub 2020 Oct 19.
Much of the world's population suffers from knee pain. Treatment options are too extreme (surgery), have side-effects (drugs), or take too long (physical therapy). Research has shown that acupuncture can provide modest relief of knee pain. This article presents ways to improve the effectiveness of acupuncture for treating knee pain. Using 3 composite "cases," the author offers specific modifications to acupuncture treatments-particularly palpatory techniques-that produce more-successful relief of patients' knee pain. Analyzing 3 composites of multiple similar typical cases, the author compares what made the treatments more successful than would be statistically anticipated. Women, older than, 50 had knee osteoarthritis (OA), periodic pain, more at night and during weather changes. Men and women, in their 40s and early 50s, had mild knee arthritis, and were given injections to relieve pain that was mild-to-moderate and worse at night. Men between their late 20s and early 40s, experienced knee pain 1-4 times per week, with some patients reporting knee buckling after some activities. Palpation of these patients' knees revealed the causes of their knee pain-spasms, adhesions, and/or fibrosis-and the patients were treated with individually selected points based on results of the Four Examinations. Most obtained relief lasting from 4 months to 2 years. Mainstream acupuncture treatments rarely involve using the Four Examinations of Traditional Chinese Medicine. Instead, these treatments involve common point selections for addressing knee pain or more-advanced approaches, such as Five Elements or pattern diagnosis, often disregarding such basic but essential diagnostic techniques as visual inspection and particularly palpation. According to the Four Examinations, OA is not often the cause of knee pain; instead, adhesions and fibrosis of the soft tissues around the knee joint cause nerve entrapments, and knee pain is referred from those sources. While muscle fibrosis is well-known to cause pain, it is rarely addressed in detail in acupuncture literature. If palpation of the soft tissues around the knee joint evokes a patient's pain-thus, locating the nerve entrapment in each specific case precisely-this allows the clinician to insert acupuncture needles into the soft-tissue fibrosis. This needling could improve the clinical outcomes of acupuncture treatment of knee pain significantly, providing shorter- as well as longer-term relief.
世界上许多人都饱受膝盖疼痛之苦。治疗选择要么过于极端（手术），要么有副作用（药物），要么耗时过长（物理治疗）。研究表明，针灸可以适度缓解膝盖疼痛。本文介绍了提高针灸治疗膝盖疼痛有效性的方法。作者通过3个综合“病例”，对针灸治疗方法——特别是触诊技术——提出了具体的改进建议，这些改进能更成功地缓解患者的膝盖疼痛。通过分析3组多个类似典型病例的综合情况，作者比较了使治疗比统计学预期更成功的因素。50岁以上的女性患有膝关节骨关节炎（OA），有周期性疼痛，在夜间和天气变化时疼痛更明显。40多岁和50岁出头的男性和女性患有轻度膝关节炎，接受注射以缓解轻至中度且夜间更严重的疼痛。28岁末至40岁初的男性每周经历1 - 4次膝盖疼痛，一些患者报告在某些活动后膝盖会屈曲。对这些患者的膝盖进行触诊揭示了他们膝盖疼痛的原因——痉挛、粘连和/或纤维化——并根据四诊结果为患者选取特定的穴位进行治疗。大多数患者获得了持续4个月至2年的缓解。主流针灸治疗很少涉及运用中医四诊。相反，这些治疗涉及针对膝盖疼痛的常见穴位选择或更高级的方法，如五行或证型诊断，常常忽视诸如望诊尤其是触诊等基本但重要的诊断技术。根据四诊，OA并不常是膝盖疼痛的原因；相反，膝关节周围软组织的粘连和纤维化会导致神经受压，膝盖疼痛由此而来。虽然肌肉纤维化众所周知会引起疼痛，但在针灸文献中很少详细提及。如果对膝关节周围软组织的触诊引发患者疼痛——从而在每个具体病例中精确确定神经受压位置——这能让临床医生将针灸针插入软组织纤维化部位。这种针刺可以显著改善针灸治疗膝盖疼痛的临床效果，提供短期和长期的缓解。
