針灸配合呼吸法治療肩頸疼痛之臨床思路探討

ON THE COMBINED CLINIC THERAPY OF ACUPUNCTURE AND BREATHING PATTERN AIMED AT NECK AND SHOULDER PAIN

肩頸疼痛是針灸科臨床常遇見的症狀之一，其臨床的主要表現為兩側肩頸部僵硬，常合併酸、痛、脹或麻感，甚至放射至背部肩胛區、頭頸面部及手臂，症狀斷續惱人。目前常見針灸治療方法包括經筋、脊神經根、臂叢神經根和局部療法等，但治療後仍容易反覆發作而造成患者日常生活和工作的阻礙，並對社會的醫療支出造成負擔。由於肩頸疼痛經常合併胸悶、短氣等呼吸不暢的症狀，且斜角肌、胸鎖乳突肌等呼吸肌肉僵硬疼痛，因此筆者推論其原因可能在於不正確的呼吸型態對呼吸輔助肌造成過度負擔而引發肩頸疼痛。在臨床上以針灸調整呼吸氣機及治療受損之呼吸肌肉為主要治療模式，不但呼吸不暢、胸悶等呼吸方面症狀獲得緩解，亦可達到治療肩頸疼痛的效果。再配合衛教，正確的教導協調式呼吸法，提醒患者時時刻刻保持良好的呼吸狀態，更可減少復發的機會。本文提出治療肩頸疼痛的另一思路，由呼吸的角度切入，維持呼吸舒暢及衛教正確的呼吸方式可以達到標本同治的雙重效果。Neck/shoulder pain is one of the most common complaints among patients of acupuncture clinic. Those patients suffer from neck & shoulder stiffness, feeling sore, pained, swelling or numbing on the mentioned body parts. Moreover, such painful feeling even spread to scapula, head, and arms. The most common views of treatments used in acupuncture were channel sinew, spinal nerve root, brachial plexus root and local therapy. However, such treatments did not stop the recurrence of neck/shoulder pain which may disturb patients' daily life and work by revisiting doctors repeatedly. The patients’ revisits to hospital also increase the burden of the national medical expense. As such neck/shoulder stiffness often comes along with respiration problems (like chest distress, shortness of breath) and with sore stiff respiratory muscles (scalene muscle and Sternocleidomastoid muscle), the author assumes that the cause of stiff neck/shoulder may be the incorrect breathing pattern which overly presses the respiratory muscles in the neck/shoulder area. According to this hypothesis, we try to treat and adjust patients' breathing condition by acupuncture, and we find that the patients were relieved from chest distress and short of breathing, and afterward their neck/shoulder pain is alleviated. In the same time, if we instruct patients with the correct coordinated way of exhaling / inhaling , and remind them to keep good breathing pattern all the time, the recurrence of the neck/shoulder pain is greatly reduced. Via breathing pattern, we believe that it could provide us another therapy to treat the patients with neck/shoulder pain: helping patients breathe smoothly and instructing them with correct coordinated respiration can keep them away from such neck/shoulder pain for good.