疼痛患者就诊指南
Patients’ Guide to Treatment of Pain
（原载：全国软组织疼痛研究会.《软组织外科开拓者》.1987年3月）
在当今的世界上，头、颈、背、肩、臂、腰、骶、臀、腿疼痛，可算是世界各国中最为常见和多发的疾病之一了。据美国哈佛大学卫生学院估计，美国全年有七千万人患有背痛，这些人为治疗背痛所付出的费用以及因不能工作所造成的损失约价值七千亿美元。在中国，有学者作过调查，发现“五口之家，常有一腰痛。”据此，作一保守的估计：患有腰痛的在我国约不下一亿人。
由于头、颈、背、肩、臂、腰、骶、臀、腿痛的患者在各国人群中的比重是那样大，它对人体的危害：轻则疼痛难熬，重则可丧失劳动能力和生活自理能力。因此，它与癌症、冠心病等疾病一样，被列为世界性的重大研究课题。目前，美国、苏联、日本、法国、西得等国都在积极推进这一研究工作。
近四分之一世纪以来，我国医学界以全国软组织疼痛研究会理事长、上海市静安区中心医院骨科主任医师、软组织外科研究室主任宣蛰人为代表，依据大量临床事实，经过潜心研究，提出人体头、颈、背、肩、臂、腰、骶、臀、腿痛主要是软组织病变引起。所谓软组织是人体的筋膜、骨骼肌、韧带、关节囊、骨膜、脂肪结缔组织等等。它是人体生命活动中不可缺少的重要组成部分。它在人体中的分布不但是面最广------从头到脚，人体各部位各个层次都有软组织；而且它在人体中的比重也最大--------从头到脚，人体除了骨骼、脏器、心血管等之外，就全成了软组织的天下。另外它与人体各器官、各系统的关系也最为密切，最为复杂，犹如水乳交融，难分难解。宣蛰人医师在长达四分之一世纪的临床实践中，经过细心观察和研究，发现当软组织生病之后，不仅会出现疼痛，而且会并发头痛、眩晕、胸闷、胸痛、腹胀、腹泻、大小便失禁、痛经等等五十余种类似内科、神经科、腹部外科、泌尿外科、妇科、眼耳鼻喉科等疾病中的一些相似症状。宣蛰人指出椎管内、外软组织无菌性炎症病变是引起头、颈、背、肩、臂、腰、骶、臀、腿疼痛及其它并发症的重要原因，他创用了独特的宣氏松解方法治疗这类病，并治好了这类病。、
在现代医学中，人体各器官差不多都作为专科，被分门别类地进行研究。但是，唯独人体软组织却没有被进行专门研究。宣蛰人医师创立了以软组织系统病变引起各种征象的疾病为研究对象，以软组织松解等外科手术或非外科手术方法为治疗手段的软组织外科新学说，从而填补了医学空白，为人类征服疼痛作出了重大贡献。
现在，我国已分别总结出整套的西医、中医和中西医结合比较完善而有效的治疗和预防人体头、颈、背、肩、臂、腰、骶、臀、腿痛的方法。其中，尤以宣蛰人医师根据他二十五年来所创立的躯干和四肢各部位的软组织松解手术所发掘出来的压痛点，结合祖国医学“以痛为腧”的理论和传统治疗手段而采取的压痛点强刺激推拿和压痛点银质针针刺，方法最为简便安全，收效最为迅速稳固。近四年来，宣蛰人医师应用上述方法治疗上万例头、颈、背、肩、臂、腰、骶、臀、腿痛病人，有效率达到百分之九十，多数病人常在一次性治疗后即收立竿见影之效。
那么，哪些病痛最适合于上述方法治疗呢？又有哪些病痛最适合于非手术方法治疗？现简介如下：
一、下列病痛适合用压痛点强刺激推拿治疗或银质针针刺治疗：
1、 头痛（枕部痛、头顶痛、偏头痛、太阳穴痛、前额痛、眉间痛、枕颈痛、全头痛）；
2、 眼眶痛或眼球痛；
3、 无因可查的或拔牙无效的牙根痛；
4、 咽喉干痛和吞咽障碍、咽喉异物感；
5、 面颊痛或三叉神经痛；
6、 美尼尔氏综合症；
7、 胸震荡后遗症；
8、 颈肩肌筋膜炎或颈肩纤维织炎；
9、 颈型颈椎病；
10、椎动脉型颈椎病；
11、神经根型颈椎病；
12、交感神经型颈椎病；
13、背痛、前胸痛、背胸痛或假性冠心病；
14、胸壁痛或肋间神经痛；
15、肩关节周围炎或冻结肩；
16、肩胛骨喙突痛；
17、臂神经痛；
18、肱骨外上髁炎或肱骨内上髁炎；
19、腕关节痛或腕管综合症；
20、手背痛、手掌痛或手指痛；
21、颈椎、胸椎或腰椎后关节错位痛；
22、颈椎、胸椎或腰椎后关节滑膜嵌顿痛；
23、增生性脊柱炎；
24、腰痛、腰骶痛、腰臀痛、骶尾骨痛；、
25、腰腹痛或剖腹探查阴性的严重腹痛；
26、臀肌筋膜炎或臀纤维织炎；
27、臀上皮神经症候群；
28、梨状肌综合症；
29、下腹痛、腹股沟痛或大腿根部痛；
30、生殖器痛（女性阴蒂痛、阴唇痛、尿道口痛、阴道痛或性交痛；男性阴囊痛、阴茎根部痛或龟头痛）；
31、男女性尿频尿急症或女性用力性尿失禁；
32、月经痛；
33、妇女分娩后遗耻骨分离症引起的疼痛；
34、典型性坐骨神经痛；
35、腰椎间盘切除术或腰椎管减压术无效的或后期复发的腰腿痛；
36、膝内方痛、足踝外方痛或足踝前方痛；
37、腘窝痛；
38、半月板切除术后遗膝痛；
39、髌骨（或股骨髁）软骨软化症或髌骨末端病；
40、小腿后方痛或跟腱痛；
41、足踝内方痛、足踝外方痛或足踝前方痛；
42、跟骨痛或跟骨骨刺痛；
43、前足痛或足趾痛；
44、更年期综合症引起的疼痛；
45、先天性骨骼畸形引起的疼痛；
46、脊神经根炎等等。
二、下列病痛适合用软组织松解手术治疗：
1、 对上述各类病变特别是严重的顽固性病例，经多种非手术疗法医治无效者；
2、 髋关节骨关节病引起的腰腿痛；
3、 成人股骨头缺血性坏死包括股骨头骨折愈合后好发的股骨头缺血性坏死等引起的腰腿痛。
4、 人工股骨头或人工髋关节置换术治疗无效的腰腿痛；
5、 各类髋部骨性手术治疗无效的腰腿痛；
6、 腰椎滑脱症引起的腰腿痛；
7、 跟骨骨折畸形愈合后遗的足踝痛；
8、 痉挛性平蹠足痛；
9、 阵挛性斜颈；
10、经暗示疗法无效的癔症性瘫痪等等。
Ⅰ. Patients’ Guide to Treatment of Pain
Pain in the head, neck, back, shoulder, upper limb, waist, sacrum, buttock and lower limb is one of the most common diseases in the world today . The Harvard University School of Public Health estimates that many as seventy million people in the U.S. suffer from the illness each year . It costs almost seven billion dollars for the treatment and loss of work. In China , some surveys show that “almost one in a family five suffers from lumbago”. Therefore , it is a conservative estimation that not less than one hundred million people suffer from lumbago in China.
The proportion of sufferers of pain in those regions is large and the harmful effects of the disease is great . Those who suffer mildly complain of acute and unbearable pain and those who suffer heavily eventually lose their ability to work and perform daily functions . No wonder it is listed as an important research project as cancer and coronary heart disease in the world today . At present ,much research work is being undertaken in the field in the United States, USSR, Japan , France and Federal Republic of Germany .
For almost a quarter of a Century , Dr . Xuan Zheren ,Chairman of All China Society of Research on Pain of Soft-Tissues , Prof . of the Orthopedic Surgical Department and Chief of Research Section of Soft-Tissues Surgery of Shanghai Jing-an District Central Hospital, has accumulated large amounts of clinical materials and made intensive studies on this problem .He puts forward that pain in the head, neck ,back , shoulder, upper limb, waist, sacrum , buttock and lower limb of the human body is induced primarily by the lesions in the soft tissues .The so-called soft tissue comprises fascia, skeletal muscles, ligaments, bursa, periosteum and adipose connective tissues . They are the integral and vital part of human activities, not only because soft tissues occupy most part of surface areas——from head to foot——of our body , but because there are soft tissues in every part and layer of our body . They occupy the largest percentage in the human body——from head to foot , except skeleton, visceral organs and cardio-vascular system . Furthermore , there are more intimate and more complex relations between other organs in the human body . After a quarter of a century of clinical practice and intensive observations and research , Prof . Xuan Zheren has found that once sickness is involved in the soft tissue it may not only induce pain but may also complicate headache , dizziness , oppressive feeling of the chest and chest pain, intestinal distension, diarrhea, incontinence of urination and defacation or dysmenorrhea , etc. that is , about some fifty kinds of symptoms as diseases of internal medicine , neurological, surgical abdominal, urological, gynecological as well as symptoms from oculo-oto-naso-laryngological disorders . Prof . Xuan Zheren points out that aseptic inflammatory process of either intra or extra vertebral canal lesion are the main factors which induce pain of the head , neck , back , shoulder , upper limb , waist , sacrum , buttock and lower limb , and other complications as well . He has established the unique method of Xuan’s treatments to cure such diseases .
In modern medical science ,organs of the human body are specialized as specialities and studied each of them separately . Aiming at the symptoms induced by lesions of the soft-tissue system as his research topic , Prof. Xuan has established his new theory of soft-tissue surgery by application of soft-tissue dissolution in either surgical or non-surgical way ,thus filling a blank in medical science and making a great contribution in the conquest of pain of mankind .
Now ,China has made separate and systematic conclusions in the treatment and preventive measures of the pain of the head , neck , back , shoulder , upper limb , waist , sacrum , buttock and lower limb by applications of both Traditional Chinese Medicine and Western medicine in relatively complete and effective ways . Amongst these , one must emphasize that Prof. Xuan Zheren , in accordance with the tenderness point discovered from the soft-tissue operations he has performed, has established his theory of soft-tissue surgery after twenty-five years of clinical practice . With the combination of the theory of “taking aim at pain” of the traditional Chinese medicine as a therapeutic measure by the application of naprapathy as a strong stimulation on the tenderness point and puncture on the tenderness point by using silver acupuncture needles , one would get more effective and safe results . During the last four years , Prof. Xuan Zheren has treated over the thousand cases of pain in the head , neck , back , shoulder , upper limb , waist , sacrum , buttock and lower limb, with satisfactory results as high as 90% of the cases . Most of them were cured in just after one treatment .
As to which of these patients are indicated to the above——mentioned therapy and which of those indicated to surgical intervention ? Please read the following brief account：
Ⅰ. The indication of strong stimulation naprapathy on the tenderness point or puncture by silver needle acupuncture therapy :
1. Headache (occipital headache ,vertex pain , migraine , temporal headache , frontal headache , pain of glabella ,occipital-cervical pain and pain of the entire head );
2. Orbital pain or ocular bulb pain ;
3. Phantom odontalgia or pain of unknown origin ;
4. Laryngo-pharynagalgia and dysphagia , sensations of foreign bodies in pharynx and larynx ;
5. Trigeminal neuralgia and geniculate neuralgia ;
6. Meniere’s Syndrome ;
7. Sequela after concussion of brain ;
8. Myofascitis of neck and shoulder girdle or fibrositis of the neck and shoulder girdle ;
9. Cervical type of cervical spine syndrome ;
10 .Vertebral arterial type of cervical spine syndrome;
11. Neural root type of cervical spine syndrome ;
12. Sympathetic nerve type of cervical spine syndrome ;
13. Back pain ,anterior chest wall pain or pseudo-coronary heart disease ;
14. Pain of the chest wall or inter-costal neuralgia ;
15. Fibrositis of the shoulder or frozen shoulder ;
16. Pain of the acromion of the scapula ;
17. Brachial Neuralgia ;
18. Epicondylitis lateralis and medialis of humerus ;
19. Pain of the wrist or carpal tunnel syndrome ;
20. Pain of dorsum manus , pain of the palm or pain of the phalanx ;
21. Pain from the dislocation of articular processes articulations and impaction of the synovial membrane of the cervical , thoracic and lumbar vertebra ;
22. Pain induced by impaction of synovial membrane of the articular processes articulation of cervical , thoracic or lumbar spine ;
23. Hypertrophic spondylitis ;
24. Waist sore , lumbo-sacrum pain , lumbo-gluteal pain , sacro-coccygeal pain or coccygeal pain ;
25. Lumbo-abdominal pain or severe abdominal pain with negative findings in exploratory laporatomy ;
26. Fasciitis or fibrositis of the gluteal muscles ;
27. Syndrome of nn.clunium superiores ;
28. Piriform muscle syndrome ;
29. Pain of the lower abdomen , pain of the inguinal region or pain of the proximal end of the thigh ;
30. Pain of the external genitalia (Pain of clitoris , pain of the vulva , pain in the urethral orifice , pain in the vagina or pain during coitus in female ; pain in the vagina or pain during coitus in female ;pain of the scrotum , pain of the root of penis or glans penis ;
31. Frequency and urgency in urination in male and female or incontinence during exertions ;
32. Dysmenorrhea ;
33. Pain of separation of os pubis complicated after childbirth ;
34. Classic ischialgia ;
35. Unsuccessful or recurred cases after disc resection of lumbar iner-vertebral disc protrusion or after decompress operation of the lumbar vertebral canal ;
36. Pain in the medical , lateral or anterior part of the knee ;
37. Pain in the popliteal fossa ;
38. Pain of the knee after meniscectomy ;
39. Chondromalacia of patella (or condyle of femur ) ;
40. Pain in the posterior part of leg or pain of the Achilles tendon ;
41. Pain of the medial , lateral or anterior part of the ankle ;
42. Pain of the os calcis or pain of the spur of os calcis ;
43. Pain of the anterior part of the foot or pain of the toe ;
44. Pain caused by congenital malformation of the skeleton ;
45. Pain cause by climacteric syndrome ;
46. Radicular neuritis .
Ⅱ. Indications to patients which are suitable for surgical dissolution of the soft-tissues :
1. Those stubborn cases which fail to various nonsurgical treatments ;
2. Pain of lumbodynia induced by osteoarthropathy of the hip joint ;
3. Aseptic necrosis of the head of femur in adults including lumbodynia induced after healed fracture of femur neck complicates aseptic necrosis of femoral head ;
4. Lumbodynia caused by unsuccessful cases after artificial femoral head or artificial hip joint replacement ;
5. Lumbodynia by unsuccessful cases after various bone surgery of the hip ;
6. Lumbodynia induced by spondylolisthesis ;
7. Pain of the ankle and foot after mal-union of the fracture of the os calcis ;
8. Pain of pes planus spastica ;
9. Spastic torticolis ;
10. Unsuccessful cause of hysteric paralysis after suggestion-therapy .
出处：宣蛰人医学网 发布日期：2007/7/3 15:22:08 浏览次数：3409 