颞下颌关节紊乱症(TMD)的针灸阶段化治疗

Staged Acupuncture Treatment for Temporomandibular Joint Disorders

摘要: 颞下颌关节紊乱病(TMD)是一组影响口腔和面部功能的疾病，根据不同病理特征分为功能紊乱阶段、结构紊乱阶段和器质性破坏阶段，其针灸治疗呈阶段化，早期以“通络止痛”为主，取穴下关、颊车、合谷等，留针20~30分钟，每周2~3次，4周见效；中期出现关节盘移位，需联合手法推拿或物理治疗，强化远端配穴，改善关节活动；晚期器质性破坏，针灸仅辅助止痛。治疗需动态评估，个体化调整，推荐中西医结合的综合方案，并注意禁忌症。

Abstract: Temporomandibular joint disorder (TMD) is a group of diseases that affect the oral and facial functions. According to different pathological features, it is divided into functional disorder stage, structural disorder stage and organic destruction stage. The acupuncture treatment for TMD is staged. In the early stage, the treatment focuses on “unblocking the meridians and relieving pain”, with acupoints such as Xiaguan, Jiache and Hegu selected. The needles are retained for 20 to 30 minutes, and the treatment is given 2 to 3 times a week, with effects seen in 4 weeks. In the middle stage, when the articular disc is displaced, it needs to combine manipulation or physical therapy, and distant acupoints are strengthened to improve joint movement. In the last stage of organic destruction, acupuncture is only used as an auxiliary for pain relief. The treatment should be dynamically evaluated and adjusted according to individual conditions. A comprehensive treatment plan combining traditional Chinese and Western medicine is recommended, and contraindications should be noted.