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理论啊理论:《医行天下》 随记

楼主:wannian 时间:2015-05-02 12:38:23 点击:718 回复:14
脱水模式给他打赏只看楼主 阅读设置
  美国医生Andrew Taylor Still(1828-1917)在创立整骨医学,osteopathy,之前,曾经是科班医生。后来,历经儿子乃至养子重病,就医不效而故,奋而另辟蹊径,走上替代医学之路。萧先生书中的脊柱椎间关节手复疗法及其理论广义推衍,并没有出离S氏医学。100多年了,为什么整骨疗法长盛不衰?它一定有疗效。盛而不能转正?理论不备的缘故。
  如果理论解决好了,萧先生医学所谓拉筋疗法的疗效机制,也就不难俘获了。老S他还是有些道道的。为了解决这些千百年的难题,从S氏开始,不失为好点。
  待续
楼主wannian 时间:2015-05-02 14:00:40
  资料准备,自维基:
  Osteopathic manipulative treatment (OMT in the U.S. or simply "osteopathic treatment" elsewhere) is the therapeutic application of manually guided forces by a practitioner, intended to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.[19] Somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures and their related vascular, lymphatic and neural elements. Acute somatic dysfunction is an immediate or short-term impairment or altered function of related components of the somatic (body) framework. It is characterized in early stages by vasodilation, oedema, tenderness, pain, and tissue contraction. It is diagnosed by history and palpatory assessment of tenderness, asymmetry of motion and relative position, restriction of motion and tissue texture change.[19] Chronic somatic dysfunction is the impairment or altered function of related components of the somatic (body framework) system. It may be characterized by tenderness, itching, fibrosis, paresthesias, and tissue contraction.[19]
作者 :春江沐雨 时间:2015-05-03 07:11:18
  ding
楼主wannian 时间:2015-05-03 21:49:29
  xiexie!
  进一步的资料准备:
  The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still, MD, DO. Still was a physician and surgeon,[9][10] Kansas state and territorial legislator,[11] a free state leader,[12] and one of the founders of Baker University,[13] who lived near Baldwin City, Kansas at the time of the American Civil War. In Baldwin, he developed the practice of osteopathy.[14]

  Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions."[15] Still founded the American School of Osteopathy (now A.T. Still University of the Health Sciences) in Kirksville, Missouri, for the teaching of osteopathy on 10 May 1892. While the state of Missouri granted the right to award the MD degree,[16] he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.[17] In 1898 the American Institute of Osteopathy started the Journal of Osteopathy and by that time four states recognized osteopathy as a profession.[18]
楼主wannian 时间:2015-05-03 22:05:34
  从以上材料可以看出,老S的实践是治骨以及全身;理论是小骨关节----例如椎间关节移动错位乃至炎症反映整个机体功能紊乱。小骨关节的炎症病变可以表现为触痛点,这个现象既提供了诊断点,也提供了治疗点。
  小骨关节病变能够映照机体其它部位病变,其机制是组织微循环,其血管淋巴乃至神经因素整体相关。
  在这里,要特别注意的是实践经验。老S为什么要处心积虑建设理论,实在是他一定心爱整骨治疗的临床效果。临床上有成就了,得陇望蜀,他才需要总结经验,提升理论。有了好的理论,实践才会更加得心应手。
  老S的创立门户之路,也值得《医行天下》的作者萧先生效仿。
楼主wannian 时间:2015-05-04 12:59:10
  为了深入分析老S的理论得失以其对萧先生拉筋疗法的交集,看看老人家提到的筋膜,myofascial,作一些资料准备(简明起见,仅取维基):

  筋膜是贯穿身体的一层致密结缔组织,它包绕着肌肉、肌群、血管、神经。[1]筋膜分好几层,分别叫浅筋膜、深筋膜、内脏筋膜,它们延绵不断贯穿身体上下。[2]

  筋膜是致密结缔组织,其内含紧密规则排列的胶原纤维,胶原纤维的方向是顺着拉力的方向,所以,筋膜具有很强的单向抗拉性能。[1]

  A fascia (/?f???/, /?f??i?/; plural fasciae /?f???.i/; adjective or fascial; from Latin: "band") is connective tissue fibers, primarily collagen, that form sheets or bands beneath the skin to attach, stabilize, enclose, and separate muscles and other internal organs.[1] Fasciae are classified according to their distinct layers, their functions and their anatomical location: superficial fascia, deep (or muscle) fascia, and visceral (or parietal) fascia.

  Like ligaments, aponeuroses, and tendons, fasciae are dense regular connective tissues, containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull. Fasciae are consequently flexible structures able to resist great unidirectional tension forces until the wavy pattern of fibers has been straightened out by the pulling force. These collagen fibers are produced by the fibroblasts located within the fascia.[1]

  Fasciae are similar to ligaments and tendons as they have collagen as their major component. They differ in their location and function: ligaments join one bone to another bone, tendons join muscle to bone and fasciae surround muscles or other structures.

楼主wannian 时间:2015-05-04 20:25:57
  对于S氏乃至当今颇具规模的整骨医学,筋膜是纲领。所以,仔细看看筋膜的定义,很有必要。筋膜是以胶原蛋白为主要成分的,连接固定肌肉骨骼的结缔结构。筋膜,显然包括着萧先生的筋。拉筋,显然是在指拉筋膜。
  能够深入体察的筋膜的结构,这是100年前老S非常来了不起的成就。今天,整骨医学似乎也未能超越这一规范。那么,从现代医学的角度,筋膜说的局限何在?
  1,就结缔组织而言,筋膜组织的细胞成分稀少,几乎可以忽略不计。所以,筋膜的胶原蛋白,应有其细胞来源。这个来源,应为内皮组织,这是相邻组织。
  2,同理,筋膜组织的如老S所谓血液神经支持,除了肌肉,只能来自皮下组织。这就是所谓支持组织。
  皮下组织对于筋膜的支持如此重要,可整骨医学对于人体展开如篮球场般广大的皮下组织几如无视,这是多么大的失误!
  3整骨医学在体察血液循环和神经成分的调节作用时,也没有“发现”某些组织主动转输组织液体的能力----完全别出血管淋巴循环和神经的动作能力。之所以说“也没有发现”,因为目前全部的医学对此都欠缺研究。
楼主wannian 时间:2015-05-04 20:33:01
  纠正:人体展开如篮球场般广大的皮下组织----
  应为:人体内展开如篮球场般广大的粘膜组织,从而内皮组织......
楼主wannian 时间:2015-05-06 21:52:19
  初步结论:任何其疗效机制尚不完全明了的替代医学如整骨医疗,针灸,按摩,刮痧,拔罐,乃至拉筋疗法,其有效点都在于粘膜组织尤其是皮下粘膜组织的液体状态,其疗效来自液体调节----粘膜组织液体调节有三大要点:

  1,可以双向调节,液多或液少双向调节;
  2, 可以作为支持组织影响筋膜等结缔组织;
  3,具有整体效应。
  而解释粘膜组织液调的整体效应机制是难中之难。
楼主wannian 时间:2015-05-07 13:18:16
  粘膜是一种特殊的内皮组织,(在某些部位也处于“外”皮的位置上)。同筋膜主要由胶原蛋白构成不同,粘膜的构成蛋白复杂得多,既有皮肤组织的纤维蛋白,还有大量分泌出的粘蛋白。粘膜的细胞分布丰富,其成纤维细胞是胶原蛋白的生产细胞。粘膜组织从蛋白分泌到液体转运的方面支持着筋膜组织。
楼主wannian 时间:2015-05-09 14:21:07
  粘膜的英文描述不见了。原来管理的手还在。))
  那末,资料准备中的转运蛋白,殃及池鱼地也不见了。在粘膜组织和皮下组织中的细胞,其膜电位的变动,具有整体传递效力。例如心肌细胞膜电位的动作电位,可以在机体远离心脏处记录(心电图肢体导联)。这种传递效应其实才是解释膜治疗和皮治疗的疗效机制关键。
楼主wannian 时间:2015-05-09 14:28:41
  再重复一遍,很多替代疗法,其实质都是膜治疗和皮治疗。所谓骨治疗或筋治疗都是表象,还有中国古代医学所谓经络穴位理论,都是对粘膜皮肤疗法的早期认识。
  类似于转运离子,膜和皮的组织细胞还可以转运液体。细胞转运液体的机制是解释膜治疗和皮治疗的关键。这种转运的主体是细胞内和膜上的相应蛋白质共同联动的工作。
楼主wannian 时间:2015-05-11 12:36:49
  从拉筋疗法,扯到美国起源的整骨医学,二者颇有共同。理论缺陷,我经过研究,认为二者都有忽视粘膜组织和内皮(皮下)组织的问题。而整骨医学,提到组织液体时,没有认识到筋膜组织的液调来自粘膜组织和皮下组织的支持,乃至细胞水平的组织液调,这是时代局限。整骨医学在理论上,比萧先生强。就理论,我再往深里整,有离开帖义太远之嫌,要另帖展开。
作者 :孤城之觞老 时间:2017-04-13 11:19:47
  问题的关健在于,现在大家都不信医院的医生了,他们开的药只为了自已的收入,哪还管治不治得好你的病啊,大家只能去找其他办法了

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