"醒脑开窍"针刺法治疗不同证型脑卒中的效果比较

背景:“醒脑开窍”针刺法是针对脑卒中“窍闭神匿,神不导气”的病机创立的以阴经穴为主,辅以规范的手法量化标准的,能有效治疗脑卒中的一套系统针法。目的:观察“醒脑开窍”针刺法对不同证型脑卒中患者血脂及血黏度的影响。设计:对比观察。单位:天津中医学院第一附属医院针灸研究所和特需针灸病房。对象:选择2001-01/12天津中医学院第一附属医院特需针灸病房住院脑卒中患者750例,男466例,女284例,平均年龄(64±12)岁,病程2h～3年。均对治疗方案知情同意。方法:①参考高等医学院校教材《中医内科学》(第5版)确立辨证分型:中经络者688例,中脏腑者47例。②选用苏州生产的“华佗牌”毫针(长1.0～1.5寸,直径0.32～0.38mm)施以“醒脑开窍”针刺法。先刺双侧内关,直刺0.5～1.0寸,采用捻转提插结合泻法,施手法1min;继刺人中,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;再刺三阴交,沿胫骨内侧缘与皮肤呈45°角斜刺,进针1.0～1.5寸,用提插补法,使患侧下肢抽动3次为度;委中,直刺0.5～1.0寸,施提插泻法,使患侧下肢抽动3次为度。极泉,原穴沿经下移1寸,避开腋毛,直刺1.0～1.5寸,用提插泻法,以患侧上肢抽动3次为度;尺泽,屈肘成120°角,直刺1寸,用提插泻法,以患侧上肢抽动3次为度。2次/d,7d为1个疗程。③平均治疗4个疗程后,采用血流变测定仪测定全血黏度(正常值:低切为6.50～9.25mPa·s,中切为4.35～5.45mPa·s,高切为3.65～4.40mPa·s)。采用血脂测定仪测定总胆固醇(正常值:3.38～6.5mmol/L)和三酰甘油(正常值:0.56～1.47mmol/L)水平。主要观察指标:“醒脑开窍”针刺法对不同证型脑卒中患者血脂及血黏度的影响。结果:完成全血黏度和血脂检测的患者分别为690和721例。中脏腑证全血黏度正常的脑卒中患者所占比例明显低中经络证(10.3%,15.4%,P<0.01),总胆固醇、三酰甘油正常者比例明显高于中经络证(80.5%,91.5%;64.1%,71.3%,P<0.01)。结论:中经络证脑卒中患者血脂水平较中脏腑证者更为异常,全血黏度则优于中脏腑证者。

Effect of xingnao kaiqiao acupuncture method on stroke of different syndrome types

BACKGROUND: Xingnao kaiqiao acupuncture is a series of systematic acupuncture methods with yin channels in domination, assisted by specified standards of quantity manipulation, which was founded according to the pathogenesis of stroke, and it is effective in treating stroke.OBJECTIVE: To observe the effects of xingnao kaiqiao acupuncture on blood lipids and blood viscosity in stroke patients of different syndrome types.DESIGN: A comparative observation.SETTINGS: Institute of Acupuncture and Moxibustion, and Special Care Ward of Acupuncture, the First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine.PARTICIPANTS: Totally 750 stroke inpatients (466 males and 284 females) were selected from the Special Care Ward of Acupuncture, the First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine between January and December in 2001, the average age was (64±12) years,the disease course ranged from 2 hours to 3 years. All the patients were informed and agree with the therapeutic program.METHODS: ① The traditional Chinese medicine (TCM) syndrome differentiations of stroke were in reference to the fifth edition of Traditional Chinese Medicine and Internal Medicine. There were 688 cases of stroke of meridian and collateral type and 47 cases of stroke attacking zang-fu organs type. ② Huatuo filiform needles produced by Suzhou [1.0-1.5 cun in length, 0.32-0.38 mm in diameter (No. 30-28)] were used in the xingnao kaiqiao acupuncture. Firstly, the acupoints of bilateral Neiguan were acupunctured perpendicularly for about 0.5-1.0 cun, the reducing manipulation by twirling as well as lifting and thrusting the needle was performed for 1 minute; Secondly, the needle was inserted at Renzhong towards nasal septum for about 0.3-0.5 cun, the manipulation of heavy bird-peck needling was used till the eyeballs were wet or tears fell down; Then Sanyinjiao was acupunctured, the needle was inserted along the medial border of tibia at an angle of 45° with skin for about 1.0-1.5 cun, the reinforcing manipulation by lifting and thrusting the needle was performed till the ipsilateral lower limb had three tics; The acupoint of Weizhong was selected by lying and lifting the leg, the needle was inserted perpendicularly for 0.5-1.0 cun, and the reducing manipulation by lifting and thrusting was applied till the ipsilateral lower limb had three tics; The acupoint of Jiquan was acupunctured at 1 cun below the source point along the channel in avoidance of axillary hairs, the needle was inserted perpendicularly for 1.0-1.5 cun, and the reducing manipulation by lifting and thrusting was applied till the ipsilateral upper limb had three tics; The elbow was flexed to 120° for acupuncture at Chize, the needle was inserted perpendicularly for 1.0 cun, the reducing manipulation by lifting and thrusting was applied till the ipsilateral upper limb had three tics. Twice a day for 7 days as a course. ③ After four courses averagely, the whole blood viscosities were detected with the hemorrheologic detector, and the normal ranges for lowshear, middle-shear and high-shear of whole blood viscosities were 6.50-9.25, 4.35-5.45 and 3.65-4.40 mpa ·s respectively. The levels of total cholesterol and triglyceride were detected with blood lipid detector, and the normal ranges were 3.38-6.5 mmol/L and 0.56-0.147 mmol/L.MAIN OUTCOME MEASURES: The effects of xingnao kaiqiao acupuncture on the blood lipids and blood viscosity in stroke patients of different syndrome types were observed.RESULTS: Totally 690 and 721 cases finished the detections of whole blood viscosities and blood lipids respectively. There were obviously fewer cases with normal whole blood viscosities in the patients with stroke of meridian and collateral than in those with stroke attacking zang-fu organs (10.3%, 15.4%, P ＜ 0.01), but markedly more cases with higher total cholesterol and triglyceride than in those with stroke attacking zang-fu organs (80.5%, 91.5%; 64.1%, 71.3%; P ＜ 0.01).CONCLUSION: The levels of blood lipids in the patients with stroke of meridian and collateral are more abnormal than in those with stroke attacking zang-fu organs, but their blood viscosities are better than in those with stroke attacking zang-fu organs.