搜索
醒脑开窍针刺法的临床应用及基础研究ClinicalApplicationandResearchonXNKQAcupuncture石学敏教授ShiXueminProf.全国针灸临床研究中心天津中医学院第一附属医院TheNationalAcupunctureClinicalResearchCenterofChinaNo.1TeachingHospitalofTianjinUniversityofTraditionalChineseMedicine2013年底，新院区将竣工并投入使用。Attheendof2013，thenewhospitalcompoundwillbecompletedandinoperation.中风病是危害人类健康的四大主病之一，发病率在我国居首位，其死亡率高、后遗症多，给家庭和社会带来了巨大的负担。Strokeisoneoffourmaindiseasesthatendangershumanhealth.ItsmorbidityliesinthefirstplaceinChinaanditsmortalityisveryhigh.Itisaccompaniedbymanycomplications,andhasbroughtaheavyburdentoboththesocietyandfamilies.近些年来，全国各医疗及科研部门，对中风病的诊断、治疗及机理开展了多方面、多层次的研究，使得中风病的诊断与治疗水平日趋提高，发病和治疗机理的研究已达到了分子水平和基因水平。Inrecentyears,manymedicalinstitutesandhospitalsalloverthecountryhaveperformedresearchonthediagnosis,treatmentandmechanismofstrokeinvariousaspects.Thishasraiseditsstandardofdiagnosisandtherapyrapidly.Researchonitspathogenesisandtherapeuticmechanismhavealreadybeenreachedmolecularandgenelevels.自1972年，我提出醒脑开窍针刺法以来，我们对于中风的诊断、治疗、机理探讨开展了系统的临床研究和深入的基础研究，临床治疗患者达200万人次，形成了一套以针灸治疗为中心的中风诊疗体系。Since1972whenIhadproposedthetreatmentprincipleof“XingNaoKaiQiao”(XNKQ,awakeningbrainandopeningorifices),thisacupuncturemethodhasbeenwidelyappliedtomorethantwomillionpatientswithstroke.Inaddition,aseriesofin-deptsystematicresearchinthemechanism,diagnosisandtreatmentofstrokehavebeencarried,formingasystemthatmainlyusesacupunctureforstroketreatment.醒脑开窍针刺法“醒脑开窍”法是针对中风病的基本病机为瘀血、肝风、痰浊等病理因素蒙蔽脑窍致“窍闭神匿，神不导气”而提出的治疗法则和针刺方法。XNKQACUPUNCTURETHERAPY“XNKQ”acupuncturetherapywasformulatedonthefundamentalpathogenesisofstrokewhichisduetoobstructionofbrainorificesandhidingofvitalityresultingfromupwardinvasionofbloodstasis,liverwindandphlegm.在选穴上以阴经和督脉穴为主，并强调针刺手法量学规范，有别于传统的取穴和针刺方法。ThepointsonYinmeridiansandDumeridianareselectedmainlyandstandardquantitativemanipulationsareapplied,whicharequitedifferentfromtraditionalpointselectionandacupuncturemanipulationsintreatmentofstroke.临床研究部分CLINICALRESEARCH一般资料GeneralData中风病住院患者9005例：男性6029人；女性2976人，年龄最小19岁，最大87岁。病种：脑出血3077例；脑梗死5928例，合并缺血性球麻痹者521例。9005strokeinpatients:male6029;female2976,theyoungest19years,theoldest87years.Categories:3077caseswithcerebralhemorrhage,5928caseswithcerebralinfarction;521caseswithstrokewithcomplicationofischemicbulbarparalysis.病程：最短2小时，最长2年。首次发病6765例，两次以上发病者2240例。Courseofdisease：theshortest2hours,thelongest2years.Firsttimeonset6765cases,morethantwotimeonset2240cases.治疗方法Treatment1.处方主穴：内关(手厥阴心包经)人中(督脉)三阴交(足太阴脾经)1.PointPrescriptionMainpoints:Neiguan(PC6,PericardiumMeridianofHand-Jueyin)Renzhong(DU26,DUMeridian)Sanyinjiao(SP6,SpleenMeridianofFoot-Taiyin)辅穴：极泉(手少阴心经)委中(足太阳膀胱经)尺泽(手太阴肺经)Supplementarypoints：Jiquan(HT1,HeartMeridianofHand-Shaoyin)Weizhong(BL40,BladderMeridianofFoot-Taiyang)Chize(LU5,LungMeridianofHand-Taiyin)位于腕横纹中点直上2寸，两筋间，直刺0.5~1.0寸，采用提插捻转结合泻法。内关穴采用作用力方向的捻转泻法，即左侧逆时针捻转用力自然退回；右侧顺时针捻转用力自然退回。配合提插，双侧同时操作，施手法1分钟。内关PC62cunabovethecreaseofthewrist,betweenthetendons.PuncturebilateralNeiguan(PC6)perpendicularlyfor0.5-1cun,usingcombinativereducingmethod(lifting-thrustingandtwirling-rotating)for1minute.补法（左侧顺时针；右侧逆时针）泻法（左侧逆时针；右侧顺时针）右R左L左L右R于鼻唇沟上1/3处，向鼻中隔方向斜刺0.3~0.5寸，采用重雀啄手法。针体刺入穴位后，将针体向一个方向捻转360°，使肌纤维缠绕在针体上，再施雀啄手法，以流泪或眼球湿润为度。人中DU26Thejunctionofupper1/3andmiddle1/3ofthenasolabialfold.PunctureRenzhong(DU26)obliquelyupwardstothenasalseptumfor0.3-0.5cunwithheavybird-peckingmethoduntilthepatient’seyeballsaremoistenedortearsflow.三阴交Sanyinjiao(SP6)沿胫骨内侧缘与皮肤呈45度角斜刺，进针1~1.5，用提插补法，使患侧下肢抽动3次为度ThirdlypunctureSanyinjiao(SP6)obliquelyfor1-1.5cun,attheangleof45degreeswiththeskinsurfacealongtheposteriorborderofthemedialaspectofthetibia,withreinforcingmethodofliftingandthrustingtheneedletomaketheaffectedlowlimbhaveticforthreetimes.极泉，部分古籍记载极泉穴为禁针穴，究其原由有以下几点：极泉穴部位腋毛茂密，不易消毒；极泉穴部位的汗腺丰盛，细菌容易滋生；极泉穴部位组织疏松，对穴位部位中的血管缺少压迫，容易出现皮下血肿。SomeancientbookssaidthatHT1isaforbiddenareaandthereasonsareasfollows:firstisthedenseaxillaryhairwhichisdifficulttodisinfect;secondisthatitisrichinsweatglandwherebacteriabreedseasily;thirdisthetissueisloose,andlackinginvascularcompression,thereforepronetosubcutaneoushematoma.根据极泉穴的解剖特点，醒脑开窍针刺法将其延经下移1~2寸，避开腋毛，在肌肉丰厚的位置取穴。直刺1~1.5寸，施用提插泻法，以上肢抽动3次为度。极泉HT1SelectJiquan(HT1)pointat1cunbelowtheoriginallocationalongtheheartmeridiantoavoidthearmpithair.Punctureperpendicularlyfor1-1.5cunwithreducingmethodofliftingandthrustingtheneedletomaketheaffectedupperlimbjerkforthreetimes.取穴应屈肘为内角120º，术者用手托住患肢腕关节，直刺0.5~0.8寸，用提插泻法，针感从肘关节传到手指或手动外旋，以手外旋抽动3次为度。尺泽LU5PerpendicularlypunctureChize(LU5)for1cunwhiletheforearmbendstoformanangleof120degrees.Performreducingmanipulationofliftinganduntiltheaffectedarmandfingerstwitchforthreetimes.仰卧位抬起患侧下肢取穴，术者用左手握住患肢踝关节，以术者肘部顶住患肢膝关节，刺入穴位后，针尖向外15º，进针1~1.5寸，用提插泻法：以下肢抽动3次为度。委中BL40SelectWeizhong(BL40)pointwiththepatientinsupinepositionandthelowerlimblifted.Punctureperpendicularlyfor0.5-1cun,withreducingmethodofliftingandthrustingtomakethelowerlimbjerkfor3times.中风病其他并发症的治疗TreatmentofComplications中风病根据颅脑损伤的不同部位和原发病灶，可并发诸多不同临床表现的并发症及合并症。我们根据不同的并发症、合并症设立了相应的配穴治疗，通过大量临床适应症研究均收到非常理想的临床疗效。Accordingtotheaffectedareaofthebrainandprimarylesiono