常海燕^[1]

[摘要]目的：比较新九针圆利针与普通芒针治疗梨状肌综合征的疗效差异，并探讨其作用机制。 方法:将8 0例患者随机分为新九针圆利针组（圆利针组）和芒针治疗组（芒针组），每组4 0例。圆 利针组采用新九针圆利针（0. 6 0mmX12 5 mm)在“梨状肌三穴”实施齐刺治疗，芒针组以普通规 格芒针（0. 32mmX125mm)在“梨状肌三穴”实施齐刺治疗，两组均予常规针刺委中、阳陵泉。每 周3次，2周为一疗程。1个疗程后评价临床疗效，并于治疗前后测定两组患者痛阈值。结果：圆 利针组总有效率为92.5%(37/40)，优于芒针组的77.5% (31/40，尸<0.05)。两组治疗后痛阈值 较治疗前均显著提高（均P<0. 01)圆利针组痛阈值增量明显大于芒针组(T<0. 01)。结论：新九 针圆利针治疗梨状肌综合征疗效确切，优于普通芒针，与其能有效提高局部组织痛阈值有关。

[关键词]梨状肌综合征；针刺疗法；新九针，圆利针；芒针；齐刺

Observation on therapeutic effect of round-sharp needle of new nine-needle and elongated needle for piriformis syndrome with triple puncture method

CHANG Hai Yan   jiancaoping district, Taiyuan City, Shanxi Province   changhaiyanClinic

Method，while the elongated needle group was treated with elongated needle of ordinaryspecifications (0. 32 mm X 125 mm) at three points in piriformis with triple puncture method. Besides，the two groups were also treated with routine acupuncture at Weizhong (BL 40) and Yanglingquan (GB 34)，3 times every week，2 weeks as one course of treatment.After one course of treatment，the clinical effect was evaluated and the pain threshold values were measured before and after treatment in the two groups. Results The total effective rate in the round-sharpneedle group was 92.5% (37/40)，which was superior to 77.5% (31/40) in the elongated needle group (P<0. 05). Compared before  treatment，the pain threshold values after treatment in two groups were improved significantly (both P<0. 01).

The increment of pain threshold value in the round-sharp needle group was higher than that in the elongated needlegroup (P<0. 01). Conclusion Round-sharp needle of new nin^needle is effective in treatment of piriformis syndrome and is better than ordinary elongated needle，which is related to that it can effectively increase pain threshold  value of the local tissue.

KEY WORDS piriformis syndrome； acupuncture therapy； new nine-needle，round-sharp needle； elongated needle； triple puncture

       新九针圆利针是山西省针灸研究所原所长师怀堂教授(1922—2012)创立的“新九针”中的一种针具，从早期师氏圆利针针身直径（.5 mm)改良后，又新增直径0．60 mm 规格。2009 年7 月至2011 年12 月笔者采用新九针圆利针齐刺法治疗梨 状肌综合征， 并与芒针治疗做对照， 现报告如下。

1临床资料

1.1 一般资料

       80 例梨状肌综合征患者均来自湖北中医药大学附属国医堂医院 针灸科 门诊，按就诊 顺序采用随机数字表法分为新九针圆 利针治疗组（圆利针组）和普通芒针治 疗组（芒针组）每组40例。圆利针组男28例，女12例；年龄22〜54岁，平 均（33 士 7)岁；病程7天〜4个月，平 均（412±231）天；病情轻度5 例 ，中度 12 例 ，重 度 23 例 。 芒 针 组 男29例，女11例；年龄18〜61岁，平均 (34±10)岁；病程5天〜5个月，平均 （43．6±21．5 ) 天；轻 度 4 例 ， 中 度11 例， 重度25 例。两组患者性别、年 龄、病程及病情程度等一般资料比较，差异无统计学意义（均P>0. 05)，具有可比性。

1.2 诊断依据

      根据《中医骨伤科学》［2］梨状肌综合征诊断要点：①臀痛和下肢沿坐骨神经分布区放射 性疼痛，多由间接外力及慢性劳损、感受风寒侵袭引起；②梨状肌肌腹有压痛，可触及 条索状隆 起的肌束或痉挛的肌肉，有钝厚感 ，或 者肌腹呈弥漫性 肿胀，肌束变硬、 坚 韧，弹性减低，臀肌可有轻度萎缩，沿坐骨神经有压痛；③直腿抬高在60°以内疼痛明显，超过 60°后疼痛 减轻， 梨状肌紧张试验阳性。

1. 3排除标准

      ①腰椎间盘突出症、椎管狭窄症、 臀上 皮 神 经 损 伤 引 起 的 腰 腿 痛 者； ②患处局部感染者；③不能耐受针刺 治疗或晕针者。

2治疗方法

2 1 圆利针组

取穴：患 侧 梨 状 肌 三 穴、 委 中、 阳 陵泉。梨状肌三穴定位方法：患者侧 卧位，患 侧在 上，患 髋关节前屈 45°。 依据梨状肌体表投影(如图1 所示)，髂嵴上缘（B)与尾骨尖（C)连线的中 点（D)至股骨大转子尖（A)的连线相 当于梨状肌肌腹中线（AD)，取AD中 点（E。）及内外各1. 5寸（E1、E2)，E。、 E1、E2即为梨状肌三穴。操作：各穴 位常规消毒后，先用0. 60 mm X 125 mm新九针圆利针直刺患侧梨状

肌三穴60〜80 mm，使针感向膝部、小腿外侧或足底放射，再用 0.32mmX40mm毫针依次刺患侧委中、阳陵泉，以得气为度。 每10分钟行针1次，留针20min出针。每周3次，共治疗2周。

图1梨状肌三穴定位示意图

       注：八点为股骨大转子尖，B点为骼嵴上缘，C点为尾骨尖，D点为BC连 线中点，E0点为AD连线中点，E1E2为E0内外各1.5寸。

2.2 芒针组

       除梨状肌三穴针具使用0. 32mmX125mm芒针针刺外，其 余治疗取穴、针刺方法、疗程均同圆利针组。

3疗效观察 3. 1观察指标

       痛阈值测定：采用SANLING EP601C痛阈测定仪（华东师范 大学科教仪器厂生产）于治疗前及治疗结束后各进行一次痛阈值 测定，两组患者测定均在患侧梨状肌E1、E2穴进行。观察记录两 组治疗过程中不良反应和病例脱落情况。

3.2疗效评价标准

      依据国家中医药管理局制定的《中医病证诊断疗效标准》3， 在末次治疗后对两组治疗效果进行评价。痊愈：疼痛完全消失，行走活动自如，梨状肌牵拉试验阴性，局部无压痛；显效：疼痛基本消 失，行走活动无障碍，局部有轻微压痛；有效：疼痛有减轻，但行走 活动仍有轻度障碍，梨状肌牵拉试验阳性，局部有压痛；无效：台疗 后疼痛无减轻，各种症状仍存在。

3.3 统计学处理

      采用SPSS12.0统计分析软件进行处理，计量资料以均数士 标准差表示，采用f检验，计数资料率的比较采用f检验， P<0. 05为差异有统计学意义。

3.4治疗结果

        由表1可见，圆利针组治愈和显效例数均高于芒针组，总有效 率达92. 5%，明显高于芒针组的77. 5%(f = 10. 613，尸<0.05)，

(2)两组患者治疗前后痛阈值变化比较（见表2) 表2两组梨状肌综合征患者治疗前后痛阈值比较 （x±5，mA) 

注：与同组治疗前比较，npco. 01与芒针组比较，2)_P<0. 01。

      由表2可见，治疗前两组痛阈值比较差异无统 计学意义（p>0. 05)，组间具有可比性；治疗后两组 痛阈值均较治疗前增加（均P<0. 01);两组治疗 1个疗程后的痛阈值比较差异有统计学意义(T< 0.01)两组治疗后痛阈值增量比较差异有统计学意 义(T<0. 01)，圆利针组痛阈值增量明显大于芒针组。 提示新圆利针对患者痛阈值改善优于普通芒针。

不良反应和病例脱落情况

        两组患者均无不良反应和病例脱落，显示两种 治疗具有良好的安全性，患者对两种治疗具有良好 的依从性。

4讨论

      梨状肌综合征临床表现为臀腿痛及活动障碍， 本病产生多因梨状肌解剖变异或外伤、劳损、受凉等 因素导致梨状肌肿胀渗出、粘连和挛缩，卡压坐骨神 经所致[4]。早在《黄帝内经》时代就己对关节疼痛及 活动障碍的治疗积累了丰富的临床经验，如《灵枢• 官针》曰：齐刺者，直入一，傍入二，以治寒气小深 者，或曰三刺，治痹气小深者也”。梨状肌综合征在 中医学属“痹症”“筋出槽”范畴，痹症总因“风寒湿三 气杂至合而为痹也”（《素问•痹论》），当以散寒止 痛、活血舒筋为治则。梨状肌位于臀部深层，故以针 刺齐刺之法治其“痹气小深者”。本病臀部疼痛多沿 下肢后外侧，故治疗取膀胱经之委中、胆经之阳陵 泉。临床采用齐刺法为主治疗梨状肌综合征己多见 报道[5—8]，但笔者临床中体会，采用普通毫针（包括芒 针）针刺效果往往欠理想。笔者跟随山西省针灸研 究所祁越主任学习使用新九针圆利针治疗梨状肌综 合征常获良效。与古圆利针“末端尖锐、中部略膨 大，针身反细小”不同，新九针圆利针针尖部分与毫 针相同，为尖而圆的松针形，但针体较普通芒针稍粗 (见图2)，用于深刺人体一定部位而产生治疗作用， 主治一些顽固性腰腿痛（如骨痹、筋痹等）”[9]。临床 实践表明，新九针圆利针针对骨伤疾病尤擅长治疗 梨状肌综合征、腰3横突综合征等疾病[1]。为探索 新九针圆利针治疗本病的优势和有关机制，故开展本次研究。

       本项研究结果表明，新九针圆利针治疗梨状肌 综合征总有效率达92. 5%，明显高于普通芒针治疗 效果（P<0. 05)。治疗前两组痛阈值比较无明显差 异(T>0. 05)，两组治疗2周后圆利针组痛阈值增 量明显大于芒针组（P<0. 01)。提示新九针圆利针 治疗梨状肌综合征疗效确切，优于普通芒针，与其能 有效提高局部组织痛阈值有关。

       临床上大多数医生治疗梨状肌综合征常以“阿 是穴”为要，盖以针刺直达病所是其关键，但实践表 明，采用普通毫针从体表确定的阿是穴处下针，经常 是针寻不准病所，也就达不到预期针感和疗效。仔 细分析可能与梨状肌位置深、从臀部表层压痛点处 进针与实际病损组织存在偏差有关。笔者采用新九 针圆利针针刺“梨状肌三穴”，是根据现代解剖学基 础知识在实践中总结而来，能避免体表穴与实际病 损表里不一问题；另外，也能避免普通毫针针体柔 软，从外操作不易掌握针刺方向问题。本项研究证 实，虽然取穴和针具长度相同，但新九针圆利针对梨 状肌综合征治疗效果要优于普通芒针，可能与其能 更加有效地松解局部粘连、提高梨状肌筋膜内外组 织血液通透性、促进微循环、提高组织痛阈值有关。 临床上也有采用粗针治疗梨状肌综合征获得较好效 果的报道[10—11]，这与笔者的研究不谋而合，具有异 曲同工之妙。至于新九针圆利针治疗本病的其他作 用机制还需今后进一步研究、探讨。

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[1] 尹凌云，姜跃斌.粗针齐刺罐治疗梨状肌综合征46例 疗效观察[J].针灸临床杂志，2003，19(7) :42.

Comparative observation on the effect of new nine-needle circular needling and pointed needling in the treatment of piriformis syndrome

Chang Haiyan[1]

Chang Haiyan Clinic, jiancaoping district, Taiyuan City, Shanxi Province

Observation on therapeutic effect of round-sharp needle of new nine-needle and elongated needle for piriformis syndrome with triple puncture method

CHANG Hai Yan   jiancaoping district, Taiyuan City, Shanxi Province   changhaiyanClinic

Method，while the elongated needle group was treated with elongated needle of ordinaryspecifications (0. 32 mm X 125 mm) at three points in piriformis with triple puncture method. Besides，the two groups were also treated with routine acupuncture at Weizhong (BL 40) and Yanglingquan (GB 34)，3 times every week，2 weeks as one course of treatment.After one course of treatment，the clinical effect was evaluated and the pain threshold values were measured before and after treatment in the two groups. Results The total effective rate in the round-sharpneedle group was 92.

5% (37/40)，which was superior to 77.5% (31/40) in the elongated needle group (P<0. 05). Compared before  treatment，the pain threshold values after treatment in two groups were improved significantly (both P<0. 01).

The increment of pain threshold value in the round-sharp needle group was higher than that in the elongated needlegroup (P<0. 01). Conclusion Round-sharp needle of new nin^needle is effective in treatment of piriformis syndrome and is better than ordinary elongated needle，which is related to that it can effectively increase pain threshold  value of the local tissue.

KEY WORDS piriformis syndrome； acupuncture therapy； new nine-needle，round-sharp needle； elongated needle； triple puncture

[1]Correspondent author: Chang Haiyan ( 1978 - ), male, attending physician research direction: acupuncture combined with medicine for the treatment of waist and leg pain

The new nine-needle round needle is one of the " new nine needles" created by Professor Shi Huaitang ( 1922 - 2012 ), former director of Shanxi Institute of Acupuncture and Moxibustion. After the improvement of the early Shi's round needle body diameter (. 5 mm ), a new diameter of 0.60 mm was added. From July 2009 to December 2011, the author used the new nine-needle round and sharp needling method in the treatment of piriform muscle syndrome, and compared it with that of the long-needle treatment. Now the report is as follows.

1 Clinical data

1.1 General information

Eighty patients with piriformis syndrome were all from the department of acupuncture and moxibustion in the hospital affiliated to Hubei university of traditional Chinese medicine. they were randomly divided into the new nine - needle round - needle treatment group ( round - needle group ) and the ordinary one - needle treatment group ( round - needle group ) with 40 cases in each group. There were 28 males and 12 females in the round needle group. The age is 2254 years old, and the average age is 33 and 7 years old. The course of disease was 7 days and 4 months, with an average of ( 412 231 ) days. The disease was mild in 5 cases, moderate in 12 cases and severe in 23 cases. There were 29 males and 11 females in mans acupuncture group. The age was 1861 years, with an average of ( 34 10 ) years. The course of disease was 5 days and 5 months, with an average of ( 43.6 21.5 ) days. There were 4 cases of mild degree, 11 cases of moderate degree and 25 cases of severe degree. There was no significant difference between the two groups in general data such as gender, age, course of disease and degree of illness ( all p > 0.05 ), which was comparable.

1.2 Diagnostic Basis

According to the diagnostic points of piriformis syndrome in Chinese medicine bone injury science [ 2 ], ① buttock pain and radiation pain of lower limbs along the sciatic nerve distribution area are mostly caused by indirect external force, chronic strain and cold invasion. ( 2 ) The piriformis muscle has tenderness in the abdomen, can touch the muscle bundle or spastic muscle with cord-like growth, has a dull and thick feeling, or has diffuse swelling in the abdomen, the muscle bundle is hard, firm and tough, the elasticity is reduced, the gluteal muscle can have slight atrophy and tenderness along the sciatic nerve; ③ The pain was obvious when the straight leg was raised within 60 degrees, and relieved after it was over 60 degrees. The piriformis tension test was positive.

1.3 Exclusion Criteria

( 1 ) lumbar intervertebral disc protrusion, spinal canal stenosis and pain in the waist and legs caused by injury of the upper skin of the buttock; ② Locally infected persons; ③ Those who cannot tolerate acupuncture treatment or motion sickness.

Methods of treatment

2 1 round needle group

Point selection: Three points of pear-shaped muscle on the affected side, Wei Zhong and Yang Ling Quan. Location method of piriformis three points: the patient's side lies in the supine position, the affected side lies on the upper side, and the affected hip joint bends forward 45 degrees. According to the projection of the piriformis surface ( as shown in fig. 1 ), the line from the middle point ( d ) of the line between the superior iliac crest ( b ) and the caudal bone tip ( c ) to the greater trochanter tip ( a ) of the femur corresponds to the piriformis belly line ( ad ), and the middle point ( e ) of the ad is taken. ) and 1. 5 inches inside and outside ( E1, E2 ) and E respectively. E1 and E2 are the three points of piriformis. Operation: After regular disinfection of each acupoint, the affected pear shape was first stabbed with a new 9 - needle circular needle of 0. 60 mm x 125 mm.

The third point of the muscle 6080 mm makes the needle feel radiating to the knee, the outside of the lower leg or the sole of the foot, and then uses a 0.32 mm x 40 mm filiform needle to stab the affected side committee and Yanglingquan in order to gain qi. Once every 10 minutes, keep the needle for 20min and take out the needle. Three times a week for 2 weeks.

Fig. 1 schematic diagram of the location of piriformis three points

Note: At eight o'clock, the femoral trochanter tip, B point is the upper edge of the iliac crest, C point is the caudal bone tip, D point is the midpoint of BC connecting line, E0 point is the midpoint of AD connecting line, E1E2 is 1.5 inches inside and outside E0.

2.2 Munger Needle Group

Except that the piriformis three-point needle was used with 0. 32 mmx 125 mm long needle, the other treatment points, acupuncture methods and treatment courses were the same as those of the round needle group.

3 observation of curative effect 3.1 observation index

Pain threshold measurement: Sanling EP 601 C pain threshold measurement instrument ( manufactured by Science and Education Instrument Factory of East China Normal University ) was used to measure the pain threshold before treatment and after treatment. Both groups of patients were measured at points E1 and E2 of piriformis muscle on the affected side. Observed and recorded the adverse reactions and cases falling off during the treatment of the two groups.

3.2 Evaluation Criteria of Curative Effect

According to state administration of traditional chinese medicine's " Criteria for Diagnosis and Curative Effect of TCM Syndrome" 3, the therapeutic effects of the two groups were evaluated after the last treatment. Healing: Pain completely disappeared, walking freely, piriformis traction test negative, local tenderness free; Remarkable effect: pain is basically eliminated, walking activities are barrier - free, and local tenderness is slight. Effective: The pain was relieved, but there were still slight obstacles in walking, the piriformis traction test was positive, and local tenderness was found. Ineffective: The pain did not abate after the treatment, and various symptoms still existed.

3.3 Statistical Processing

SPSS 12.0 statistical analysis software was used to process the data. The measurement data were expressed as standard deviation of the mean value, and F test was used to compare the data rate, P < 0.05 was statistically significant.

3.4 Treatment Results

( 1 ) Comparison of clinical efficacy between the two groups ( see Table 1 )

Table 1 Comparison of Curative Effects of Two Groups of Patients with piriformis Syndrome ( % )

组别 例数 痊愈 显效 有效 无效 总有效

圆利针组 40 23(7. 5) 9(22.5) 5(12 5) 3(7 5) 37(2. 5)1)

芒针组 40 12(30. 0) 6(15.0) 13(32 5) 9 (22 5 ) 31(77 5)

Note: compared with the long needle group, 1 ) p < 0.05.

From table 1, it can be seen that the number of cured and markedly effective cases in the round needle group is higher than that in the long needle group, with the total effective rate reaching 92. 5 %, significantly higher than 77. 5 % in the long needle group ( f = 10. 613, corpse < 0.05 ).

( 2 ) Comparison of pain threshold changes between the two groups before and after treatment ( see Table 2 ) Table 2 Two groups of patients with piriformis syndrome before and after treatment

Pain threshold comparison ( x 5, ma )

组别 例数 治疗前 治疗后 痛阈值增量

圆利针组 40 0. 78±0. 24 1. 61±0. 321)2) 0. 83±0. 452)

芒针组 40 0. 74±0. 22 1. 29±0. 151 0. 55±0. 34

It can be seen from table 2 that there is no statistical significance in the comparison of pain threshold between the two groups before treatment ( p > 0.05 ), and there is comparability between the two groups. After treatment, the pain threshold of both groups increased compared with that before treatment ( all p < 0.01 ). The difference of pain threshold between the two groups after one course of treatment was statistically significant ( t < 0.01 ). the difference of pain threshold increment between the two groups after treatment was statistically significant ( t < 0.01 ), and the pain threshold increment in the round needle group was significantly larger than that in the long needle group. It is suggested that Xinyuanli is better than ordinary needle in improving the pain threshold of patients.

Adverse reactions and cases falling off

The two groups of patients had no adverse reactions and cases dropped off, indicating that the two treatments had good safety and patients had good compliance with the two treatments.

4 discussion

The clinical manifestation of piriformis syndrome is pain in buttocks and legs and movement disorder. The disease is mainly caused by piriformis swelling, exudation, adhesion and contracture due to anatomical variation of piriformis or trauma, strain, cold and other factors, as well as compression of sciatic nerve [ 4 ]. As early as the Yellow Emperor's Canon of Internal Medicine, he has accumulated rich clinical experience in the treatment of joint pain and movement disorders, such as " Lingshu Guanzhen" saying: " If you stab all the way into one place, you can enter two places to treat those who are cold and deep, or three pricks, you can also treat those who are arthralgia and weak and deep". In traditional Chinese medicine, piriformis syndrome belongs to the category of " arthralgia syndrome" and " muscle breaking out of the channel". arthralgia syndrome is always arthralgia due to " the combination of wind, cold and dampness with three qi" ( Su Wen Bi Lun ) and should be treated with dispelling cold and relieving pain, promoting blood circulation and relaxing muscles. The piriformis muscle is located deep in the buttocks, so the rule of law is " bi qi is small and deep" by needling. The pain in the buttocks of this disease is mostly along the posterior and lateral sides of the lower limbs. Therefore, it is necessary to treat Yanglingquan, the center of bladder meridian and the center of gallbladder meridian. It has been reported that the treatment of piriformis syndrome mainly adopts the method of needling together in clinic [ 5 - 8 ], but the author's clinical experience shows that the effect of using ordinary filiform needles ( including awn needles ) is often not ideal. The author followed the director of Shanxi Institute of Acupuncture and Moxibustion Qiyue to learn how to treat piriformis syndrome with a new nine-needle round needle. Unlike the old round needle, which has a sharp end, a slightly swollen middle part and a tiny needle body, the new nine-needle round needle has the same needle tip as a millineedle and is in the shape of a pointed and round needle, but the needle body is slightly thicker than the ordinary long needle ( see fig. 2 ) and is used to deeply stab a certain part of the human body to produce a therapeutic effect, mainly treating some intractable lumbocrural pain ( such as osteoarthralgia, tendon arthralgia, etc. ) [ 9 ]. Clinical practice shows that the new nine-needle round needle is especially good at treating diseases such as piriformis syndrome and lumbar 3 transverse process syndrome. In order to explore the advantages and related mechanisms of new nine-needle circular needling in the treatment of this disease, this study was carried out.

图2新九针圆利针与普通芒针比较

The results of this study showed that the total effective rate of the new nine-needle round needle in the treatment of piriformis syndrome was 92. 5 %, which was significantly higher than that of the ordinary needle ( p < 0.05 ). There was no significant difference in pain threshold between the two groups before treatment ( t > 0.05 ), and the increase of pain threshold in the round and sharp needle group was significantly greater than that in the long needle group after 2 weeks of treatment ( p < 0.01 ). It is suggested that the new nine-needle round needle has a definite curative effect on piriformis syndrome, which is superior to the ordinary long needle and is related to its ability to effectively raise the local tissue pain threshold.

In clinical practice, most doctors often treat piriformis syndrome with " Ashi" as their main point, and covering it with acupuncture directly to the disease site is the key. However, practice shows that using ordinary filiform needles to place needles at Ashi, which is determined on the body surface, often fails to identify the disease site, thus failing to reach the desired needle feeling and curative effect. The fine analysis of the young may be related to the deep position of piriformis muscle, the deviation between the needle inserted from the tenderness point on the surface of buttocks and the actual lesion tissue. The author uses the new nine-needle round needle to needle " the three points of piriformis" according to the basic knowledge of modern anatomy in practice, which can avoid the problem of exterior and interior disharmony between body surface points and actual diseases. In addition, the problem that the needle body of a common filiform needle is soft and soft and the needle direction is not easy to grasp from outside operation can also be avoided. This study shows that although the length of acupoints and needles is the same, the treatment effect of new nine needles round is better than that of ordinary long needles in treating piriformis syndrome, which may be related to its more effective release of local adhesion, improvement of blood permeability inside and outside the piriformis fascia, promotion of microcirculation, and improvement of tissue pain threshold. There are also reports that the treatment of piriformis syndrome with thick needles has achieved good results [ 10 - 11 ], which coincides with the author's research and has the same effect. As for the other mechanisms of the new nine-needle round needle therapy for this disease, further research and discussion are needed in the future.

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