林晉賢 1 林于娟 2 陳志道 3 前言 85 (futile medical care) (complementary and alternative medicine, CAM) 60-70% [1] 針灸的簡介 1 亞東紀念醫院家庭醫學科住院醫師 2 中國醫藥大學附設醫院中醫部住院醫師 3 亞東紀念醫院家庭醫學科主任醫師 Acupuncture, Hospice, Palliative Care, pain control [2] (1) (2) 233
針灸作用機轉 (endogenous opioid peptides) 1950 A- C (diffuse noxious inhibitory controls, DNIC) [3] 安寧與針灸適應症 (palliative care) (WHO) [4] 2000 [5] (CPR) Do not resuscitate (DNR) total pain [6] 1996 (WHO) 64 安寧一般治療 ( ) 2012 (WHO) (three-step analgesic ladder) (dose by the clock) 針灸處置效果 ( ) systematic review meta-analysis [7-10] 234
(1) 疼痛 meta-analysis (onset time) [7] GRADE RCT metaanalysis (ST36) (PC6) (LI4) (Ashi) (BL) (SP6) (GB34) (Ex-B2) (2) 疲倦 meta-analysis [8] (routine care) meta-analysis (QLQ-C30) [9] [10] metaanalysis (ST36) (SP6) (KI3) (LI4) (SP9) (3) 腸胃道症狀 meta-analysis [10] meta-analysis (ST-36) 討論 結語 systematic review meta-analysis RCT 235
表一相關穴位取穴與位置 背俞穴 (BL) 足太陽膀胱經共計 12 穴穴位取穴針刺深度肺俞 BL13 T3 下, 兩旁距脊各 1.5 寸 厥陰俞 BL14 T4 下, 兩旁距脊各 1.5 寸 心俞 BL15 T5 下, 兩旁距脊各 1.5 寸 肝俞 BL18 T9 下, 兩旁距脊各 1.5 寸 膽俞 BL19 T10 下, 兩旁距脊各 1.5 寸 斜刺, 入五分 脾俞 BL20 T11 下, 兩旁距脊各 1.5 寸 胃俞 BL21 T12 下, 兩旁距脊各 1.5 寸 三焦俞 BL22 L1 下, 兩旁距脊各 1.5 寸 腎俞 BL23 L2 下, 兩旁距脊各 1.5 寸 大腸俞 BL25 小腸俞 BL27 膀胱俞 BL28 L4 下, 兩旁距脊各 1.5 寸 S1 下, 兩旁距脊各 1.5 寸 S2 下, 兩旁距脊各 1.5 寸 直刺, 入一寸至一寸半 合谷 (LI4) 手陽明大腸經 三陰交 (SP6) 足太陰脾經 太谿 (KI3) 足少陰腎經 取穴 手掌橈側第一掌骨之中點處 針刺深度 進針五分 取穴 足內踝上三寸, 脛骨後緣凹陷中 針刺深度 直刺, 針入五至八分 取穴 足內踝後五分, 跟骨上動脈應手陷中 針刺深度 斜刺, 針入五分 足三里 (ST36) 足陽明胃經 陰陵泉 (SP9) 足太陰脾經 內關 (PC6) 手厥陰心包經 取穴 小腿前外側, 犢鼻下三寸, 脛骨外一寸餘, 兩筋分肉間 針刺深度 直刺, 針刺五分至一寸半 取穴 小腿內側進膝處, 膝下脛骨內緣凹陷中 針刺深度 直刺, 針入五分至一寸半 取穴 手掌後, 腕上二寸, 兩筋間 針刺深度 直刺, 針入五分 236
陽陵泉 (GB34) 足少陽膽經 取穴 小腿外側, 膝下一寸, 脛骨之後, 腓骨之前凹陷中 針刺深度 直刺, 針入五分至一寸半 其他 1. 華陀夾脊 (Ex-B2) 取穴 T1 至 L5 棘突兩旁, 距脊正中線五分, 一側 17 穴, 左右共 34 穴 針刺深度 頸胸部 : 斜刺或橫刺五分腰部 : 直刺五分至一寸 2. 阿是穴 (Ashi) 取穴 非穴位, 為局部治療部位, 壓痛點是確定阿是穴主要依據, 但並非一定是阿是穴 資料來源 : 參考資料 2 11 參考資料 1. Dorfman J: The Role of Complementary and Alternative Medicine in End-of-Life Care. Psychiatric 2012; 42: 150-5. 2. : 2009 1-47 3. Kawakita K, Okada K: Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders? BioPsychoSocial Medicine 2014; 8: 4. 4. Loring B, Bouësseau MC, Varghese C et al: Planning and implementing palliative care services: A guide for programme managers World Health Organization, 2016: 5. 5. 2014 4 6. Romeo MJ, Parton B, Russo RA, Hays LS, Conboy L: Acupuncture to Treat the Symptoms of Patients in a Palliative Care Setting. Explore 2015; 11: 357-62. 7. Hu C, Zhang H, Wu W, Yu W, Li Y, Bai J et al: Acupuncture for Pain Management in Cancer: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine 2016. 8. Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC: Effects of Acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy on Symptom Management and Quality of Life for Cancer Patients: A Meta-Analysis J Pain Symptom Manage. 2016; 51: 728-47. 9. He XR, Wang Q, Li PP: Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2013; 14: 3067-74. 10. Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H et al: Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016; 95: e2901. 11. Shigeru O, Wang X, Huang L, Shuichi K, Shoji S et al: WHO standard acupuncture point locations. WPRO Nonserial Publication 2009. 237