脑卒中后吞咽障碍的针灸康复思路探析

针刺治疗结合康复训练对促进脑卒中后吞咽障碍患者吞咽功能的恢复、改善生命质量具有重要意义。中医辨证辨经相结合，吞咽功能及时筛查与系统评估相结合，整体察病，对脑卒中后吞咽障碍患者的全面评估及康复治疗有重要的指导意义。可根据吞咽分期五期模式分期论治：认知期阴阳失调，窍闭神匿，治神为本，取之督脉；口腔准备期和口腔期清窍失养，气血阻滞，取之阳明；咽期脉络闭阻，气机不通，辨证取穴；食管期邪实渐去，精血耗伤，故以补为用，取之阳明；辅以康复运动疗法，针灸与康复并举。

Thinking of Acupuncture and Rehabilitation for Post- stroke Dysphagia

Acupuncture combined with rehabilitation training is of great significance in promoting the recovery of swallowing function and improving the quality of life in patients with post- stroke dysphagia. The combination of traditional Chinese medicine (TCM) syndrome differentiation and meridian differentiation, timely screening of swallowing function and systematic evaluation, and overall observation of disease have important guiding significance for the comprehensive evaluation and rehabilitation treatment of patients with post- stroke dysphagia. Treatment can be performed according to the five stages of dysphagia: in the cognitive stage, there are imbalance between Yin and Yang, blockage of orifices, and disappearance of spirit, and treatment should focus on the spirit and select the governor meridian; in the oral preparation stage and the oral stage, there are Yang- orifices failing to be nourished and Qi- blood stagnation, and treatment should select the Yangming meridians; in the pharyngeal stage, there are stagnation in collaterals and obstruction of Qi- movement, and acupoint selection should be performed based on syndrome differentiation; in the esophageal stage, there are gradual disappearance of pathogens and consumption and damage of essence and blood, and treatment should focus on tonification and select the Yangming meridians. Rehabilitation exercise therapy can also be used to achieve the combination of acupuncture and rehabilitation.