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浮针治疗一例茎突切除术后颈部周围疼痛 Ms. Prange 图一 问:昨晚治疗之后，感觉如何? 答: 昨晚感觉棒极了! 我做了一些颈肩的轻度伸展，取出来留管。 今天早上起来，觉得休息的很好，竟不需要闹铃，自己就醒了！这太罕见了，我真高兴!今天，我仍然觉得很好，我的下颌关节松快了，打哈欠也不疼了，咽东西也容易多了!非常感谢你的帮助，下周再约。 2020年1月28日二诊：此次主诉为左侧前臂局部压痛，左侧肩背部疼痛不适一周。 检查：左侧前臂按压痛（疼痛指数2-3），抬肩动作可加重左肩痛（疼痛指数4），左侧颈部痛（疼痛程度7），当头向右旋时疼痛加重，出现抽搐感。左侧肱桡肌（++），指伸肌（++++），胸锁乳突肌（+++），头夹肌（++++）斜角肌（+++）斜方肌上束（+++）冈下肌（+++）。浮针针对上述肌肉扫散、再灌注，治疗后所有酸痛症状消失。相关动作不再诱发或者加重疼痛。嘱患者注意正确体位和劳逸结合。（见视频） 视频翻译：这是我第二次看丽荣医生，我从前不敢打哈欠，不能适度的张嘴，不敢左右转头， 不敢抬头，她一开始给我治疗，这些问题马上就修正了，我不知道她是如何做到的， 她是个魔术师。 患者有后颈部疼痛10年病史，确诊为茎突综合征（Styloid process syndrome）。茎突综合征是因茎突过长或其方位、形态异常刺激邻近血管神经而引起的咽部异物感、咽痛或反射性耳痛、头颈部痛和涎腺增多等症状的总称。吞咽时加重。有时可有耳鸣、流涎、失眠等神经衰弱的表现当颈动脉受到压迫或摩擦时，疼痛可从一侧下颌角向上放射到头颈部或面部。。患病这10年之间，患者为避免诱发、加重疼痛，势必对其头颈肩的体位姿势加以调整，长此以往，必然导致相关肌肉，肌肉链出现劳损。茎突切除术之前，因茎突过长刺激而产生的疼痛占优势（疼痛指数7-9），掩盖了其他肌肉损伤的疼痛。术后，这种优势疼痛有效缓解之后，其他患肌的问题表达出来。 回顾治疗经过，可以看到，患者并没有遵医嘱在短时间内完成1个疗程3次的治疗。第二次治疗和第一次间隔了2周的时间，而且两次治疗的方向已经发生了偏移。第一次是以不能张口，打哈欠下颌部疼痛为主诉，第二次主要是要解决前臂，肩膀的疼痛不适。虽然我们知道疼痛消除并不意味着临床治愈，但患者多是“好了伤疤忘了疼“，第一次治疗过后，不但很好的解决了患者的痛点，而且患者的睡眠质量也提升了，这也验证了浮针关于患肌--失眠的相关理论。第二次治疗过程中，触诊时指下患肌条索，结节明显，我从3 个不同部位针对患肌进针，针刚刚进到患肌临近位置，并没有进行任何的扫散，更不要说灌注了，当时再次检查，条索结节已经消失，要求患者重复可以诱发疼痛的姿势动作，疼痛消失，这也证明没有患肌，肌肉的功能受限也跟着消失。所以在浮针治疗中，熟悉肌肉的解剖，生理功能，常见病理损伤及活动受限类型，以及相关肌肉的之间的关系（协同，拮抗），推测出嫌疑患肌，加上临床仔细的触诊，找到患肌，做针对性治疗，进一步验证，对于提高浮针的临床疗效非常重要。 A case of pain around the neck after Styloidectomy treated with Fu’s Subcutaneous Needling (FSN) Ms. Prange Female, 28 years old, student The patient had posterior neck pain for 10 years and underwent bilateral styloid process in October 2019. Postoperative neck pain was relieved, but pain and numbness around side neck, shoulder and mandible appeared. After several massage and chiropractor treatments, the effect was not obvious. Then acupuncture treatment was considered. First visit on January 7, 2020 : The patient described that the neck pain was significantly reduced compared with before surgery, but complained the mandible occlusal disorder, molars and submandibular numbness, restricted mouth opening, pain when yawning, and both sides of the neck pain near the mastoid of the temporal bone, sore shoulders, most symptoms showing on the left side. Examination: right-turn neck, rotate-neck to right and head-up are all limited. Left brachioradialis (++++), extensor digitorum(+++) biceps brachii (++), sternocleidomastoid muscle (+++), scalene(+++) trapezius Upper bundle (+++), splenius capitis (++++), splenius cervicis (+++). The needles are inserted subcutaneously from the radial side of the forearm, the upper shoulder, and behind the earmastoid. FSN treatment for the above tightened muscles with reperfusion approaches. After treatment, the pain is significantly reduced, the mouth opening is increased, and the yawn pain disappears. The tension of each affected muscle was significantly reduced. We recommend that patient should let the affected muscles have enough time to recover. Do not over use. It is recommended for the best effect that patients should complete 3 courses of treatment in a short period of time. On the second day, the patient's e-mail feedback showed that the symptoms almost disappeared (see Figure 1), and the following treatment was not consolidated in accordance with the doctor's instructions.（see figure 1） Second visit on January 28, 2020: The main complaint was local tenderness in the left forearm, left shoulder and back pain for a week. Examination: left forearm compression pain (pain level 2-3), shoulder lift can aggravate left shoulder pain (pain level 4), left neck pain (pain level 7), pain worsens when head turns to the right, and twitching occurs. Left brachioradialis muscle (++), extensor digitorum (++++), sternocleidomastoid (+++), splenius capitis (++++), splenius cervicis (+++), scalene (+++), trapezius upper bundle (+++) and infraspinatus (+++). FSN treatment for the above tightened muscles with reperfusion approaches. All the sore symptoms disappeared after treatment. Relevant actions and movement no longer induce or aggravate pain. Recommend patients to correct posture and enough rest. (See video) The patient had a 10-year history of posterior neck pain and was diagnosed with Styloid process syndrome. Styloid process syndrome is a general term when it causes clinical symptoms as neck and cervicofacial pain. It is supposed that this symptoms and signs are due to the compression of the Styloid process on some neural and vascular structures, symptoms such as pharyngeal foreign body sensation, reflex earaches and otalgia may occur in patients with this. Aggravated when swallowed. Sometimes there are signs of neurasthenia such as tinnitus, salivation, and insomnia. When the carotid artery is compressed or rubbed, pain can radiate upward from the angle of one mandible to the head and neck or face. During the 10 years of illness, in order to avoid inducing and aggravating pain, the patient will inevitably adjust the posture of her head, neck, and shoulders. In the long run, the related muscles and muscle chains will inevitably be strained. Prior to the styloid process, the pain due to the long stimulation of the styloid process was dominant (pain index 7-9), which masked the pain of other muscle injuries. After this effective pain relief, other muscle problems were expressed. Reviewing the treatment process, it can be seen that the patient did not complete a course of treatment 3 times in a short time in accordance with the doctor's order. The second treatment was separated by two weeks from the first treatment, and the patient’s main complains of the two visits had shifted. In first her complaint was inability to open mouth and yawning jaw pain, and the second was to deal with pain and discomfort in the forearm and shoulder. Although we know that the elimination of pain does not mean a clinical cure, but patients are mostly 'well scars forget the pain'. After the first treatment, not only the pain are well solved, also the sleep quality of the patients is also improved. This also validates FSN theories on muscle issue related with insomnia. During the second treatment, the affected muscle was obvious during palpation, it shows as the nodules and strips. Right after inserted the needle from three different locations for the affected muscle, not even to mention reperfusion, at the time of the re-palpation, the nodule and strips had disappeared, and the patient was asked to repeat the postures and movements that could induce pain, and the pain did not show up. This also proved at that moment the affected muscle was cured and its dysfunction also disappeared. Therefore, in order to maximum the effect of FSN treatment , acupuncturist should be knowledgeable with the muscle anatomy, physiological functions, common pathological injuries and restricted movement types, also the relationship (synergy, antagonism) between related muscles. It help to scope the suspected muscles. Plus careful palpation, determining the affected muscles, and doing targeted treatment, further verification, all these steps are very important to improve the clinical efficacy of FSN. 徐丽荣 美国注册针灸师 Lirong Xu LAc Xu’s Acupuncture 15654 western Ave, Omaha, NE 68118, USA |
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