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頸椎病手法整復治療探析
王海光
(澳州悉尼大學草本研究教育中心主席)
頸椎病又稱頸椎綜合征,它是由于慢性勞損、外傷或老年性脊椎退行性變導致頸椎間盆退變,以及繼發性骨質增生刺激或壓迫鄰近組織,致使頸段血管、頸神經根、脊髓、交感神經等繼發性損害而引起的一組臨床症候群。本病雖屬于以退行性變為主的疾患,但與多種因素有關。由于其解剖特點擔負著頭部的頻繁活動,又是上肢、肩背部、頸部的負重、運動的中軸支柱,全身神經沿頸椎管內上行下達地傳導,顱腦的血氧供應由頸動脈、椎動脈輸送,頸交感神經支配顱腦、五官、上肢的血管、腺體分泌、心律調節等。所以,頸部手法直接與上述器官或功能有關,選用手法治療必須緊慎,切勿在頸椎病中泛用手法,以避免不必要的醫療事故發生。為了說明頸椎病手法選擇的必要性和重要性,結合本人在澳大利亞進行巡迴教授與臨証的經驗,特作如下論述,供同道參考。
1 頸椎的解剖特點
正常人的頸部有7個頸椎、6個椎間盆、枕環關節、環樞關節、鈎椎關節和後關節、8對頸神經和部份第一胸神經。
1.1 頸1(寰椎)、頸2(框椎)、頸7(隆椎)的結構特殊,與普通頸椎有所差異故稱「特殊頸椎」。頸椎與顱骨連接主要為寰枕關節、寰樞關節。頸部旋轉運動雖有各關節參與,但活動量的一半由頸1-2完成。
1.2 頸部椎間盆只有6個,躭骨與頸1、頸1與頸2的椎間無椎間盆和椎間孔,故第1、2對頸神經根得不到椎間孔的保護,易受外傷。因無椎間孔,故頸1-2無椎間孔壓迫症狀。
1.3 普通頸椎(頸3-7)之間有椎間盆、椎間孔。若椎間盆萎縮退變、椎間隙變窄、暴力使頭頸突然扭轉等,可引起椎體滑脫、椎間孔變窄,從而產生神經根壓迫症狀。
1.4 頸椎正常活動度:前屈35-45゜;後仰35-45゜;左、右側彎40-45゜;左、右旋轉60-80゜。
2 頸椎病好發部位與生物力學的關係
2.1 頸椎在仰伸狀態下X光片顯示:頸2與頸7後緣的垂直力線,交叉於頸4-5間隙,說明此部位承受之壓力與扭曲最大。
2.2 頸椎前屈狀態下X光片顯示:頸2與頸7後緣的垂直力線,交叉於頸5-6間隙線。說明長期低頭工作者,此處最易受損、形成骨贅、退變等。
2.3 臨床統計學說明:病變(勞損、骨刺)以頸5-6(第6頸神經通過)最多;其次為頸4-5(第5頸神經通過)、頸6-7(第7頸神通過)。
3 神經根在不同部位受壓的臨床病象
3.1 頸4-5 (第5頸神經):疼痛自頸向前胸、上臂外側放射,三角肌區與上臂外側麻痹,肱二頭肌、肱橈肌膫反射消失或減退。。
3.2 頸5-6 (第6頸神經):疼痛自頸向前胸、肩胛、上臂、前臂外側放射。拇指、食指麻木,肱二頭肌反射消失與減退。
3.3 頸6-7 (第7頸神經):疼痛自頸向前胸、肩胛、前臂、腕的背側放射。食指、中指麻木,肱三頭肌反射消失或減弱。
3.4 頸7-胸1 (第8頸神經):疼痛自頸向前胸、肩胛、上臂、前臂內側放射。小指、無名指麻木,中指偶及麻木,肱三頭肌反射減弱或消失。
4 頸椎病手法治療探析
筆者在澳洲對頸椎病的探研30餘載。從漫長的臨床研究中總結出針對疾病的不同特點,靈活選用兩種常用而有效的手法,現分述如下。
4.1 脊柱(定點)旋轉復位法:此為中國中醫科學院馮天有醫生,從民間手法中整理創立的手法,被當年周恩來總理稱之為「新醫正骨法」。其特點是患者坐位,可單人或雙人操作,以被動旋板患者頸椎,使棘突恢復至正中軸線。臨証中以頸椎後關節突錯位療效最佳;鈎突錯位的復位手法療效較弱。
4.2 臥位整脊手法:這是廣州陸軍總醫院龍層花醫生所創,病人臥位,對頸椎不同的關節錯位採取不同的手法,具有頸肩部肌肉鬆弛,手法輕巧,病人易接受的優點。本法針對環樞關節錯位、頸1、頸2後關節錯位,選取仰頭搖正法;針對頸2-7後關節錯位,選取低頭搖正法;針對頸2-7鈎突關節錯位,選用側頭搖正法。
手法整復臨証體會:手法是整復調節頸椎的內在平衡,使之回復到正常的解剖狀態。但是,手法復位未對脊椎的外平衡給予調整。所以,筆者主張在頸椎手法整復前,應給予「頜枕牽引」,使頸肩軟組織牽拉放鬆,調節頸椎的外平衡。構成頸椎外平衡的軟組織有:頸前、後縱韌帶,棘間韌帶,橫突間韌帶,黃韌帶,棘上韌帶,環齒韌帶,齒狀韌帶,關節滑膜,斜角肌等。這些軟組織牽附於椎體、橫突、棘突、椎板、後關節突、硬膜上面,構成了椎體前後、左右各方向的平衡力,使脊椎維持於一個生理狀態。因頸椎病是一個慢性病,各軟組織積累性勞損,長時間後彈性減弱,力量不對稱,造成了生理曲度、椎體順列的改變,引起椎體錯位,甚至脫位。頜枕牽引通過長期有規律的對頸部各軟組織向同一方向牽拉,使之達到平衡,再結合手法整復,進一步調整頸椎的內、外平衡,使移位的椎體穩定於正常狀態。總之,應重視頸部牽引與手法復位相結合,才能達到調整頸椎的內外平衡,加上日常生活中注意頭頸部姿勢,則頸椎病可避免復發。
5 手法治療的禁忌証
頸椎是人體諸組織中結構最為巧妙的部位之一,由於其解剖位置和生理功能的特殊性,任何粗暴的動作(重手法推拿),盡管較為罕見,均有可能使患者突然出現神經症狀,甚至完全癱瘓,亦可立即死亡。所以,任何手法的選擇,均應符合頸椎的生理解剖學基礎。。為了提高療效,避免事故發生,應嚴格遵循以下手法治療禁忌証。
5.1 診斷不明,難以除外椎管內腫瘤等病變者:應重視中醫的四診,尤以詳細查詢病史,若兩側肢體對稱、進行性痙攣性癱瘓,且感覺缺失,病變節段神經根痛等痰瘀實証者,應警惕!
5.2 椎管發育性狹窄或頸椎畸形者。(常規X光片診斷)
5.3 以脊椎受壓症狀為主者:骨源性頸椎病(中央型)的骨刺位於椎體後方中部,使脊髓前方及其血管受壓,引起運動障礙為主的一系列症狀。此類型最怕屈頸動作,可使症狀加重,若突然前屈,輕者可使下肢呈觸電感;重者則損傷脊髓前動脈和四肢癱瘓。
5.4 頸椎椎管有破壞性病變者(創傷、癌症等)。
5.5 椎動脈型頸椎病,有典型椎動脈缺血症狀者:其發作與頸旋轉、側彎有關,X光片顯示鈎突明顯增生者,切勿應用手法突然轉頸及側彎,防止與避免頭頸部受傷。若反覆發作影響工作者,以手術為宜。
5.6 椎動脈—神經根型,此型多因鈎椎關節病變範圍廣泛,脊神經根與椎動脈兩者同時受累,且多較嚴重。
5.7 伴有頸椎骨折、脫位或其他損傷者。
5.8 後縱韌帶鈣化者:過去認為日本人特有的韌帶骨化,中國人也非少見,本人在臨証中,也發現香港有此類病例。因後縱韌帶鈣化,可造成椎管狹窄,易傷及脊髓。
5.9 全身或咽、喉、頸、枕有急、慢性炎症者。大量臨床病例表明,當咽喉及頸部有急性或慢性感染時,甚易透發頸椎病,使病情加重。尤以 兒童絕大多數自發性頸1、2脫位者,每與咽喉及頸部炎症誘發有關(因炎症破壞了局部完整與穩定性)。
參考文獻:
[1] 魏征. 頸椎綜合征.脊椎病因治療學. 商務印書館出版. 1987:158-175
[2] 李恩. 頸椎綜合征. 中國中西醫結合臨床全書. 中國古籍出版社. 2003:1971-1973
[3] 趙定麟等. 脊椎頸段的解剖與生物力學特點. 頸椎病. 上海科技文獻出版社.1988:1-43
[4] 謝永立. 頸椎病治療方法探究. 中醫雜誌. 增刊. 2004:112-113
游南發北京中醫傷科整脊 註冊中醫
Yau, Nam Fat
Registered Chinese Medicine Practitioner
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游南發好唔好?
四十餘年臨床骨傷經驗
傳承發展國家級專家手法
中醫研究院 骨傷科研究所專科醫生
北京中醫中藥大學畢業
佢既師傅 馮天有
https://www.facebook.com/yaunamfat/
馮天有醫師
馮天有(1942年2月—2020年9月16日),天津人,中國新醫正骨專家。空軍總醫院副院長,全軍中西醫結合正骨治療中心主任,中央保健委員會會診專家。
1966年畢業於第四軍醫大學。歷任空軍第一高等技術專科學校、第十三航校航空軍醫,空軍總醫院外科副主任、副院長兼新醫正骨科主任、主任醫師。1975年創造了治療腰椎間盤突出症新方法「椎體旋轉復位」,擔任全國中西醫結合治療骨關節損傷學習班主任。1993年被授予空軍專業技術少將軍銜。2001年12月被空軍聘為首席專家。2020年9月16日23時44分在北京逝世。
馮天有 人物 新醫正骨療法創始人
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Jagad Guru Siddhaswarupananda Paramahamsa
Impersonalism is a very dangerous philosophy for it proposes the absurd idea that we are all God. It is presently being taught in schools, universities and colleges all over the world. Some of its adherents are teaching it more subtly and do not speak out directly about becoming God. Rather, they disguise it in various ways like self-improvement, success-oriented seminars, "Christianity" and movements that aim to cultivate the "hidden powers of man." Yet, people succumb to the foolishness of this idea. Life Force Series, then, takes a stand and aims to educate people of the stupidity of impersonalism. We hope that with this understanding, people may recognize such a philosophy even in its disguised forms to be foolish and absurd. We therefore present this in-depth interview with JAGAD GURU Siddhaswarupananda Paramahamsa, world renowned philosopher and teacher of the Science of Identity.
The game is not to know God; the game is to be God. 1Werner Erhard, the founder of est, has a similar teaching:
You're god in your universe. You caused it. You pre- tended not to cause it so you could play in it, and you can remember you caused it any time you want to. 2Swami Muktananda puts it this way:
Meditate on your SelfMaharishi Yogi, Vivekananda, and a host of other prominent swamis and theologians, as well as countless numbers of religion professors and yoga teachers, are also directly teaching the "I am God" philosophy.
Honor your Self
Worship your Self
Understand your Self
God dwells within you as you. 3
The impersonalist philosophy is so degraded that it has taken the insignificant living entity to be the Lord, the Supreme Truth, thus covering the glory and the Supremacy of the Absolute Truth with monism. -- Chaitanya Charitamrita, Adi-lila, Vol. 2,7:120To say that God is forced to transmigrate into the bodies of worms, maggots, flies, dogs and hogs, birds and humans denies His power and intelligence.
. . . the highest consciousness becomes bound by . . . limitations; its primal powers of omniscience, omnipotence, perfection, everlastingness and all-pervasiveness are experienced in a reduced condition. Although omniscient, He knows only a few things; though omnipotent, He feels helpless and acts effectively only in a small sphere. The Master of perfect bliss, He is ensnared in pleasure and pain, attachment and aversion. The Eternal Being cries aloud from fear of death, regarding Himself as mortal. Pervading all space and form, He grieves because He is tied to a particular place and a particular form. 4So, according to the impersonalist philosophers, God becomes bound up on the wheel of birth and death, and this is all due to His having forgotten that He is God. According to this theory, God needs to meditate and struggle against material nature to remember who He is. So we have "God" watching His diet, doing breathing exercises, bouncing up and down on His bottom to try to wake up the kundalini, and trying in so many ways to remember His identity.
I am God . . . I am God . . . How did I forget? I am God . . . damn mosquito! . . . It's just me, I haven't forgotten. I am God, I am God . . . Why am I having to struggle?This is the impersonalists' philosophy. Muktananda says:
God forgets His own true nature and looks for God. God worships God. God meditates on God, and God is trying to find God. 5He's saying that God forgot. Now, that's just brilliant! "God forgot who He was and now He has to meditate to remember." Only a fool could make such a statement. The fact is, God does not need to meditate to remember His identity. God knows who He is, always has and always will. There is no question of amnesia for the Supreme Lord. God never forgets His identity, or anything else for that matter. In fact, it is described in the ancient Vedic scripture, Srimad Bhagavatam, that Mayadevi, the personification of ignorance and illusion, is afraid to show her face before the Lord.
It is only the One that becomes many. There is only the One in the many. Behind the differences lies the undifferentiated. The undifferentiated manifests differences. It is only the nondual becoming dual that revels unceasingly. 6In other words, the impersonalist theory holds that God has become the world and all souls or living beings. Impersonalists sometimes explain that God is like a piece of paper tearing itself up into many pieces. Thus God becomes fragmented and scattered everywhere. He divides Himself and appears as the many. And, like a piece of paper that is torn and scattered about, the original and unseparated whole no longer exists other than in that separated condition as the world and all living beings.
Brahma satyam jagan mithya. ["This world is false; only Brahman is real."]QUESTION: What is your idea? Isn't God impersonal? Isn't that the Absolute Truth?
I am the basis of the impersonal Brahman.-Bhagavad-gita 14:27So the personal form of God is not material, but is sat-chit-ananda-- full of eternity, knowledge and bliss. The impersonal Brahman (which the impersonalists consider Supreme) is simply the rays or effulgence emanating from the Supreme Person. This is described in the Brahma Samhita:
I serve the Supreme Personality of Godhead, Govinda, the primeval Lord, whose transcendental bodily effulgence is known as the impersonal Brahman (which is unlimited, unfathomed, and all-pervasive).The impersonalist knows that all material forms spring from the formless Brahman--and this is a fact--but that formless Brahman is springing from the Supreme Person.
-Brahma Samhita 5:14
The Absolute Truth is so perfect that although innumerable energies emanate from Him and manifest creations which appear to be different from Him, He nevertheless maintains His personality. He never deteriorates under any circumstances. 7QUESTION: So, if we are emanations or energies of God, then we're actually eternally individuals?
Assuming physical bodies, He appears as separate entities. 8The impersonalist idea is that we appear to be individuals because we have on physical bodies. Without the physical bodies there would be no individuality.
One who sees the Supersoul accompanying the individual soul in all bodies, and who understands that neither the soul nor the Supersoul is ever destroyed, actually sees.Also, Krishna states:
- Bhagavad-gita 13:28
Never was there a time when I did not exist, nor you, nor all these kings; nor in the future shall any of us cease to exist.The individuality of the soul and the Supreme Soul is clearly documented in this verse. Krishna could have said, "I am you and I am them and I have always existed and always will," but He didn't. He made a clear distinction between Himself, Arjuna and the kings by pointing to each as being eternal.
- Bhagavad-gita 2:12
Whenever and wherever there is a decline in religious practice, O descendant of Bharat, and a predominant rise of irreligion--at that time I descend Myself.Guru actually means the descent of the representative of the Supreme Personality. But since the impersonalists say that each of us is God descended, "avatar" or "guru" has no meaning. To them guru or avatar is nothing special. According to their theory, we are all avatars, even the soul in the body of a dog or rat.
- Bhagavad-gita 4: 7
The truth is that the highest Lord, pure consciousness, lives in absolute freedom . . . He can do whatever He likes. If an emperor wants to enact the role of an ordinary constable, he puts aside his pomp and majesty, his elephants and horses, and plays a commoner for a while. In exactly the same way, the supreme Lord, who is of the nature of consciousness, sheds His undifferentiated state and accepts differences. 9Muktananda goes on to explain how the Emperor, God, then gets subjected to the most terrible misery, sometimes taking on the bodies of hogs, sometimes dogs, sometimes humans, sometimes maggots, etc. That is the flaw in this philosophy.
We're all here in eternal time and space . . . We're just doing lila rasa, the divine dance. We're dancing and dancing and dancing, dance after dance, in one body, in another body. 10QUESTION: And after God divides Himself into many, He forgets the Oneness that He can enjoy?
If you come back into form from having merged with God, you are in the world though not of it. You play the cosmic sport. You fill the forms though there is no one home, it is just more lila, the dance of God. 11So, the impersonalist admittedly descends to "enjoy" the names and forms of the world. This is lust. After going so high to the outer circumference of God's Kingdom, still they are attracted to enjoy pastimes in the material world. When they come down, they again get polluted by karmic reaction due to their sinful activities. After again becoming polluted, they want to again "merge" and become "nothing."
You're in the void. Then the Buddha nature sees there are many beings whose veils are very thin and you can come back and teach them through your being. That's the boddhisattva role. 12Most impersonalists say they descended out of compassion, but compassion is based on individuality, and impersonalists deny individuality. But to say that they descended out of compassion for others means that they are admitting the existence of others. The impersonalist says he was enjoying perfect bliss in the Brahmajyoti but that he has come down to help suffering humanity. He thinks, "I was enlightened and in a blissful condition, but out of compassion I descended to help others."
You're in the void. Then the Buddha nature sees there are many beings whose veils are very thin and you can come back and teach them through your being That's the boddhisattva role.Firstly, when someone is merged in the Brahman effulgence or void, there is absolutely no awareness of one's self as an individual. Nor is there any awareness of others as being separate from one's self. That is why the condition is called void. Buddhists describe the void like this:
'Nirvana'--'the state of a fire blown out'. When a fire is blown out, nothing remains to be seen. 13It is absolutely impossible to be "merged" into the Brahman and simultaneously be conscious of the existence ]of others--what to speak of feeling compassion for them. The statement that when one is "in the void," he sees many beings who are suffering, is not based on reality. There is no such experience.
We're just doing lila rasa, the divine dance. We're dancing and dancing and dancing. dance after dance, in one body, in another body. And we're all here. We're all staying right here. 14Or, as Swami Vivekananda puts it:
It is all really in sport . . . If you are poor, enjoy that as fun; if you are rich, enjoy the fun of being rich; if dangers come, it is also good fun; if happiness comes, there is more good fun. The world is just a playground, and we are having good fun, having a game . . . It is only when you forget that it is all play . . . that misery and sorrows come. But as soon as you give up the serious idea of reality . . . and know it to be but a stage on which we are playing . . . at once misery ceases for you. 15These people sound like complete mental cases. Just try to understand that Vivekananda said this in the middle of Calcutta, the most poverty-stricken, suffering city in the world. The question is this: if a person is God and he is having "good fun" in this world--if this is his pleasurable pastime--why does he come back to get himself out of it?
DISCIPLE: Why have you come, O Guru?These people are fools covered by maya
GURU: I have come out of compassion for others.
DISCIPLE: For others?
GURU: Well, of course there are no others, but I have come to help them. They do not really exist, but I could not bear to see them suffering.
DISCIPLE: You're so heavy, Guru. Perhaps one day I will understand.
GURU: Don't worry. Be happy.
The experiencer and the experience have merged and you have become God; and the concept of God is long gone. 16QUESTION: And atheism leads to materialism?
"It is all really in sport . . . If you are poor, enjoy that as fun; if you are rich, enjoy the fun of being rich; if dangers come, it is also good fun; if happiness comes, there is more good fun. The world is just a playground, and we are having good fun, having a game."
- so says Swami Vivekananda
Meditate on your Self, honor and worship your Self. Kneel to your Self, because the supreme reality, the highest truth, lives within you as you. 17The ordinary materialist usually discriminates between correct or incorrect, acceptable or unacceptable ways to get sense gratification. The Super Materialist, however, has no such "hang-ups." Whatever feels good, do it! It's all the same. No limits of good or bad, right or wrong. After all, you are "God."
You are the laws of the universe. 18There is no question of having to act in such a way that God is pleased. After all, since you are God, whatever is pleasing to you is pleasing to God. Whatever you (God) wants to do is what God (you) wants you to do.
What you are doing is what God wants you to do. 19Since you are "God," doing "God's will" is no problem at all. Your will is God's will.
Bagawan Das, clearly a young man of extremes, ate one [pizza] and then went upstairs in the company of a female admirer, coming back a half hour later for another of each. 20Ram Dass' other friend and teacher, the popular Tibetan Buddhist, Trung Pau Rimpoche, is also described in Rolling Stone as "one who sleeps with his female devotees, appears drunk in public and plays ego deflating games with his closest associates." 21
The "I" who uses the senses and organs of action is none other than the Supreme Lord who has limited Himself for His own sport or amazement. 22By this philosophy, we can conclude that to try to restrain the senses so that you are not "enjoying" is based on the illusion that you are the enjoyer when, in reality, it's simply God enjoying via the bodily senses.
When we eat, Shiva [God] is eating. When we hear, Shiva is hearing. 23This is how Muktananda puts it.
Sometimes people get the notion the purpose of est is to make you better. It is not. I happen to think that you are perfect exactly the way you are. 24(Of course, if he thinks like this, one may ask, why does he teach his course? ) If all individuals are already perfect, this means that society is also perfect, no changes are needed, social improvement is unnecessary. If we are all God (perfect), then this is the Kingdom of God, this is heaven. It is just a matter of "realizing it."
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