针药结合治疗缺血性中风病

1针药结合治疗缺血性中风病的系统研究ThesystemresearchofAcupunctureandherbstotreatischemicstroke石学敏SHIXuemin天津中医药大学第一附属医院TheFirstTeachingHospitalofTianjinUniversityofTraditionalChineseMedicine中风病的治疗难点Theproblemoftreatingapoplexy如何减轻血管神经单元的损害、促进重构神经组织、重建脑组织循环是神经功能恢复的根本。中风病治疗的难点及突破点，聚焦在神经与血管的新生。Howtoreducethedamageofneurovascularunit,promotereconstructionnervetissueandreconstructionbraincirculationisneurologicalrecovery.Thetreatmentofstroke,focusonproblemsandbreakthroughofnewbloodvesselsandnerves.目前，治疗中风病最有效的方法是卒中单元，但是现代医学意义上的卒中单元需要较高的软硬件配备，无法于现有医疗资源基础上推广应用。所以，如何利用有效的中医手段构建符合中国特色的“中风单元”是今后重要的研究方向。Currently,thetreatmentofstrokearethemosteffectivewaystostroke,butmodernmedicalunitonthesignificanceofthesoftwareandhardwareunitneedshigherstrokewithexistingmedicalresources,notinbasedonapplication.Therefore,howtoeffectivelyusethetraditionalmethodtosetupChinesecharacteristicstrokeunitisanimportantresearchdirectioninfuture.针刺和有效中药制剂是我国治疗中风病的重要手段，也是构建“中风单元”的主要因素。由“醒脑开窍针刺法”、“丹芪偏瘫胶囊”相结合为关键内核的“石氏中风单元”，在临床上取得了显著疗效，并被国家列为重大科技推广项目。AcupunctureandherbsareeffectivetreatmentinChinaandanimportantfactorofstrokeunit.“Shi’sstrokeunit“whichbemadeof“XNKQ”acupuncturetherapyandDanqihemiplegiacapsule,getgreatclinicaleffect,andhasachievedremarkablelistedbythestatescienceandtechnologymajorpromotionprojects“醒脑开窍”针法简介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。ThepointsonYinmeridiansandDumeridianaremainlyselectedandstandardquantitativemanipulationsareappliedemphatically,whicharequitedifferentfromtraditionalpointselectionandacupuncturemanipulationsintreatmentofapoplexy.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,thePericardiumMeridianofHand-Juejin)Renzhong(DU26,theDUMeridian)Sanjinjiao(SP6,theSpleenMeridianofFoot-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,theHeartMeridianofHand-shaoyin)Weizhong(BL40,theBladderMeridianofFoot-Taiyang)Chize(LU5,theLungMeridianofHand-Taiyin)配穴：吞咽障碍加风池、翳风、完骨；手指握固加合谷；语言不利加上廉泉，金津、玉液放血；足内翻加丘墟透照海。PointModification：Fordifficultyofswallowing,Fengchi(GB20),Yifeng(SJ17)andWangu(GB12)areadded.Forfailingtoextendfingerswithstiffness,Hegu(LI4)isadded.Forslurredspeech,Shanglianquan(EX-HN)isadded,andJinjin(EX-HN12)andYuye(EX-HN13)areusedwithblood-lettingmethod.Forstrephenopodia,penetratingmethodfromQiuxu(GB40)toZhaohai(KI6)isused.2.操作方法Manipulation内关Neiguan(PC6)直刺0.5~1寸，采用捻转提插结合泻法，施手法1分钟；FirstpuncturebilateralNeiguan(PC6)perpendicularlyfor0.5-1cun,usingcombinativereducingmethodoflifting-thrustingandtwirling-rotatingtheneedlefor1minute;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人中Renzhong(DU26)SecondlypunctureRenzhong(DU26)obliquelyupwardstothenasalseptumfor0.3-0.5cunwithheavybird-peckingmethoduntilthepatient’seyeballsaremoistenedortearsflowdown.向鼻中隔方向斜刺0.3~0.5寸，用重雀啄法，至眼球湿润或流泪为度；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Jiquan(HT1)原穴沿经下移1寸，避开腋毛，直刺1~1.5寸，用提插泻法，以患侧上肢抽动3次为度。SelectJiquan(HT1)pointat1cunbelowtheoriginallocationalongtheheartmeridiantokeepawayfromthearmpithair,punctureperpendicularlyfor1-1.5cunwithreducingmethodofliftingandthrustingtheneedletomaketheaffectedupperlimbhaveticforthreetimes.尺泽Chize(LU5)屈肘成120度角，直刺1寸，用提插泻法，使患者前臂、手指抽动3次为度。PerpendicularlypunctureChize(LU5)for1cundepthwhiletheforearmbendstoformanangleof120degreeswithreducingmanipulationofliftingandthrustingtheneedleuntiltheaffectedarmandfingershaveticforthreetimes.委中Weizhong(BL40)仰卧直腿抬高取穴，直刺0.5~1寸，施提插泻法，使患侧下肢抽动3次为度。SelectWeizhong(BL40)pointwiththesupinepositionandthelowerlimblifted,punctureperpendicularlyfor0.5-1cun,withreducingmethodofliftingandthrustingtomakethelowerlimbhaveticfor3times.风池、完骨、翳风Fengchi(GB20)Wangu(GB12)Yifeng(SJ17)针向结喉，进针2~2.5寸采用小幅度高频率捻转补法，每穴施手法1分钟；PunctureFengchi(GB20),Wangu(GB12)andYifeng(SJ17)inthedirectionofthelaryngealprotuberancefor2-2.5cun,withreinforcingmanipulationoftwirlingandrotatingtheneedleinhighfrequencyandsmallamplitudefor1minutetoeachacupoint.合谷针向三间穴Hegu(LI4)toSanjian(LI3)进针1~1.5寸，采用提插泻法，使患者第二手指抽动或五指自然伸展为度；PunctureHegu(LI4)1-1.5cunindepthwiththeneedletiptowardSanjian(LI3),withreducingmethodofliftingandthrustingtomakethepatient’ssecondfingerorfivefingersextendedfreely.上廉泉Shanglianquan(EX-HN)针向舌根1.5~2寸，用提插泻法；PunctureShanglianquan(EX-HN)for1.5-2cun,withtheneedletiptowardstherootofthetongueandreducingmethodofliftingandthrustingtheneedle.金津、玉液Jinjin(EX-HN12)Yuye(EX-HN13)用三棱针点刺放血，出血1~2毫升；PrickJinjin(EX-HN12)andYuye(EX-HN13)withthethree-edgedneedletocausebleedingfor1-2ml.丘墟透向照海穴Qiuxu(GB40)toZhaohai(KI6)约1.5~2寸，局部酸胀为度。PunctureQiuxu(GB40)1.5-2cunindepthwiththeneedletiptowardZhaohai(KI6),untilsorenessanddistensionoccurredlocally.中风病其他并发症的治疗TreatmentofComplications(1)便秘：针外水道、外归来、丰隆。Constipation:PunctureWaishuidao(EX-CA),Waiguilai(EX-CA)andFenglong(ST40)(2)呼衰：针刺双侧气舍RespiratoryFailure:PuncturebilateralQishe(ST11)(3)尿失禁、尿潴留：针中极、曲骨、关元、局部施灸、按摩或热敷Inco