Includes bibliographical references and index.

Includes bibliographical references and index.

Includes bibliographical references and index.

Includes bibliographical references and index.

Includes bibliographical references and index.

Includes bibliographical references and index.

背景：肱骨外上髁炎（ Lateral epicondylitis, LP ），又名網球肘、肘勞等，是一種以肘外側疼痛、肘關節功能下降為主要臨床表現的運動系統疾病。溫針被廣泛運用於肱骨外上髁炎的臨床治療，但目前未有專門的文獻研究與系統評價，其臨床研究的開展情況、療效與安全性尚不明確。 目的：(1）運用計量分析的方法，分析總結溫針治療肱骨外上棵炎臨床研究的開展情況、使用規律與理論依據﹔（ 2 ）運用系統評價的方法，評估當前臨床隨機對照試驗(Randomized Controlled Trial, RCT)的開展質量，評估溫針治療肱骨外上髁炎的療效與安全性。方法：系統檢索中國知網、Pubmed 等12 個電子數據庫，將符合計量分析納入標準的文獻進行統計與分析。同時，對符合系統評價納入標準的RCT使用PEDro 、Cochrane 偏倚風險評估工具與STRICTA 進行質量評價，並根據干預措施的不同以分組的形式對溫針治療肱骨外上髁炎進行療效與安全性評價。結果：計量分析共納人文獻81 篇，結果顯示： (1) 《中醫病證診斷療效標準》為臨床試驗中最主要的診斷與療效標準（ n＝48，59.25% ﹔ n=68, 83. 95% ）﹔（ 2 ）臨床試驗中溫針與其它乾預措施聯合的比例為92.59%(n=75 ），且聯合特殊針刺方法較為普遍( n=34, 41. 98% ）﹔ (3 ）溫針取穴頻數前6 的穴位為：阿是穴（ n=61, 34.27% ）、曲池（ n=37, 20. 79% ）、手三里（ n=27, 15 . 17% ）、外關（ n=ll, 6.18%) 、肘膠(n＝10, 5.62% ）、合谷（n=lO, 5.62% ）,穴位歸經以手三陽經為主。系統評價共納入文獻12 篇，計患者1177 例，主要結果顯示：(1 ）根據PEDro 量表3 篇RCT被評估為「良好」, 偏倚風險評估結果，顯示所有RCT 至少含有1 項高風險或不詳風險﹔（ 2) 2 篇RCT顯示溫針療效優於普通針刺，合併治癒率RR=3 .84, 95%CI﹝ 1.85, 7.96](P = 0.0003 ），合併總有效率RR=l.29, 95%CI ﹝ 1.10, 1. 52] ( P=O. 002 ），均有統計學差異﹔ (3) 2 篇RCT顯示溫針療效優於電針，合併治癒率RR=l. 47, 95%CI [1.18, 1.84 ﹞, P=0.0008 ，合併總有效率RR=l.06, 95%CI [1. 00, 1.3]，p = 0.03 ，均有統計學差異﹔（ 4 ）溫針優於其他替代療法，包括推拿、封閉、TDP 照射﹔（ 5) 1 篇RCT報告不良事件，包括暈針、出針後出血。結論：(1 ）溫針治療肱骨外上髁炎具有豐富的中醫理論基礎﹔（ 2 ）阿是穴、手三里、外關、曲池、合谷、肘膠是臨床上溫針治療肱骨外上髁炎的優選穴位，並主要從手三陽經論治﹔（ 3 ）溫針治療肱骨外上髁炎優於其他替代療法，包括普通針刺、電針、TDP照射、推拿與穴位注射，但證據等級較低。由於不良事件報告過少，暫無法就溫針的安全性得到確切結論。確切的結論尚需更多高質量的RCT以求證，建議將來開展設計科學的大樣本、多中心RCT。關鍵字：肱骨外上髁炎，網球肘，溫針，系統評價

中風後抑鬱症（ Post-strok Depression, PSD ）的發生率，在中風後患者中佔有較大比例，嚴重影響患者的康復。國外研究結果顯示中風後抑鬱症的發病率為28%-56%而國內臨床相關文獻提示中風後抑鬱的患病率大致為20% - 50%。臨床中存在有許多繼發於中風的抑鬱患者，診療未受到關注的現狀。而一些接受治療的病人，也因長期口服抗抑鬱藥導致副作用愈發突出。與此同時，針灸治療抑鬱的臨床優勢已經得到國內外醫學界的重視與肯定。本文著重以近10 年來針灸治療中風後抑鬱症的文獻為主進行研究，總結關於該病因病機及有特色針灸療法的最新研究進展，歸納選穴處方的規律特點，進而在已有研究基礎上融人自己的見解，對於PSD 這種身心疾病的治療提出相關值得探討的問題與對今後研究的展望。新近的國內外研究提示，在針灸治療中風後抑鬱領域目前主要有毫針針刺和特種針法，並結合電針、配合藥物以及心理健康教育等方法，可以促進中風後患者抑鬱情緒的調整，且一定程度上也加強其他肢體功能以及神經功能的康復。同時針刺在治療的臨床研究方面也已取得較大進展，部分實驗已設立自身前後對照研究及其他藥物或針刺對照比較觀察，在診斷及評定療效標準時使用了量表及統計分析，增強了療效的可信度及可比性。一些課題也已進入實驗室研究，從神經遞質、神經內分泌方面探求針刺治療PSD 的機制，並取得一定的進展。本研究得出今後應該加強隨機大樣本對照的前瞻性設計實驗的結論，認為中風後抑鬱症的臨床分型、穴位配伍、針刺手法、刺激量大小以及療效評價等方面，均將成為針灸治療本病的繼續研究之探索方向。

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, at Technikon Natal, 1999. / The purpose of this investigation was to compare the relative effect of spinal manipulation as opposed to acupuncture treatment in order to determine a more effective approach in the treatment of chronic sinusitis. It was hypothesized that chiropractic treatment and acupuncture treatment would both be effective in the treatment of chronic sinusitis. However, it was proposed that the chiropractic treatment would be more effective than acupuncture treatment / M

O stress pode ser definido como uma reação complexa, necessária e benéfica ao organismo, porém quando permanece por um período prolongado cria-se um desequilíbrio no funcionamento global orgânico, enfraquecendo o sistema imunológico e deixando o indivíduo exposto a infecções e doenças oportunistas. Diversos tratamentos são propostos para o controle do stress dentre eles está à acupuntura, uma técnica milenar que consiste na inserção de agulhas em pontos específicos da pele. O eletroencefalograma (EEG) é um instrumento de registro gráfico das variações do potencial de membrana dos neurônios corticais, seu registro e sua interpretação é um processo rotineiro de diagnóstico neurológico e neste caso foi utilizado para verificar se existe alguma alteração no espectro de frequência do EEG imediatamente após a aplicação da acupuntura. Foram selecionados 38 sujeitos randomizados em grupo controle (n= 13), grupo acupuntura (n=13) e grupo eletroacupuntura (n=12). Antes das intervenções os sujeitos foram submetidos ao Inventário de Sintomas de Stress para adultos de Lipp (ISSL), a escala visual analógica (EVA) de stress, mensurados frequência cardíaca (FC) e pressão arterial (PA). As intervenções ocorreram durante vinte minutos e vinte minutos antes e depois das intervenções foram realizados os registros de EEG. Após o término do EEG os sujeitos novamente responderam ao EVA e foram mensurados FC e PA. Para análise dos dados foram utilizados ANOVA, correlação, BOOTSTRAP e teste t-student. Não foram encontradas diferenças significativas em relação ao espectro de frequência do EEG e a EVA antes e depois das intervenções, houve uma diminuição significante da FC após as intervenções. Não houve alteração da PA durante todo o processo. A acupuntura e a eletroacupuntura não apresentaram efeitos imediatos significativos após sua realização no espectro de frequência do EEG, embora tenha apresentado uma tendência a alterações. Não houve relação do espectro do EEG e os quesitos questionário de Lipp e EVA / Stress can be defined as a complex, necessary and beneficial response by the body, but when it remains for a prolonged period creates an imbalance in the overall organ function, by weakening the immune system, leaving exposed the individual opportunistic infections and diseases. Several treatments are proposed for the control of stress among them is acupuncture, an ancient technique that involves inserting fine needles into specific points on the skin. The electroencephalogram (EEG) is a tool of graphic record of the variations of the membrane potential of cortical neurons registration and its interpretation is a routine process of neurological diagnosis and this case was used to verify if there is any change in the frequency spectrum of the EEG immediately after application of acupuncture. 38 subjects randomized into control group (n = 13), acupuncture group (n = 13) and electroacupuncture group (n = 12) were selected. Before the intervention the subjects were submitted to the Inventory of Stress Symptoms for adults Lipp (ISSL), a visual analog scale (VAS) of stress, measured heart rate (HR) and blood pressure (BP). The interventions occurred for twenty minutes and twenty minutes before and after interventions EEG records were performed. After the end of the EEG subjects again responded to the EVA and HR and BP were measured. For data analysis, ANOVA, correlation, BOOTSTRAP and student t test were used. No significant differences were found in relation to the frequency of the EEG spectrum and VAS before and after the interventions, there was a significant decrease in HR after the interventions. There was no change in BP during the entire process. Acupuncture and electroacupuncture showed no significant immediate effect after its completion in the EEG frequency spectrum, although it had a tendency to change. There was no relation of the EEG spectrum and the questions questionnaire Lipp and EVA