针灸在脑血管病治疗和康复中应用.pptx

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1、脑血管疾病由于各种脑部血管病变所引起 的脑功能缺损的一组疾病的总称。脑卒 中，又称中风或脑血管意外，是一组 突然起病，以局造性神经功能缺失 为共同特征的急性脑血管疾病Cerebrovascular disease is a genaral name which including a group of diseases with brain function defects which caused by various Lesions in brain vascular.Stroke,also known as cerebral vascular accident,is another na

2、me of acute Cerebrovascular disease with a common feature of neurological deficit.第1页/共78页 脑卒中是一类严重威胁人类健康和寿命的常见病和多发病,具有发病率高,死亡率高,致残率高,复发率高及并发症多的特点。是目前人类疾病三大死亡原因之一 Stroke which occurs commonly and frequently is a serious threat to human health and longevity,with features of high incidence,high mortal

3、ity,high disability rate,high recurrence rate and multiple complications第2页/共78页流行病学流行病学-EpidemiologyGlobal pidemic第3页/共78页mortality of strokeWith the widespread application of CT and MRI(magnetic resonance imaging technology)and improvement of treatment level,the mortality of stroke has decreasedCT

4、Treatment levelMRI随着CT和核磁共振成像技术的广泛应用及治疗水平的提高,脑卒中的死亡率有所下降第4页/共78页Disability rate 50%-80%slurred speechmuscle atrophyhemiplegia存活者中50%一80%留下不同程度的致残性后遗症，如:偏瘫,言语不清、智力障碍、肌肉萎缩、关节活动受限等,大部分患者丧失劳动能力，生活不能自理，给本人、家庭、社会带来压力和负担still 50%to 80%of the survivors have different degrees of disabling sequelae,such as:he

5、miplegia,slurred speech,intellectual impairment,muscle atrophy,joint mobility and so on.Most patients lose work ability,cannot live by themselves,and serious pressure and burden for themselves,their families and social第5页/共78页 促进脑血管 侧枝循环的建立 promote the establishment of cerebral collateral circulatio

6、n 扩张血管dilate blood vessel上下运动神经元的功能恢复improve the function recovery of motor neuron改善脑及肢体微循环improve the microcirculation of brain and limbs增加病损组织血氧供应 increase the oxygen supply for lesion tissue激活神经细胞activate neural cells提高新陈代谢improve the metabolism第6页/共78页基本病机-瘀血、肝风、痰浊等病理因素蒙蔽脑窍而致“窍闭神匿，神不导气”“XNKQ”acu

7、puncture therapy has been formulated on basis of our new knowledge on pathogenesis of stroke which is mainly due to obstruction of brain orifices and hiding of vitality resulting from upward invasion of blood stasis,liver wind and phlegm.第7页/共78页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。The points on

8、Yin meridians and Du meridian are mainly selected and standard quantitative manipulations are applied emphatically,which are quite different from traditional point selection and acupuncture manipulations in treatment of apoplexy.第8页/共78页1995年年 以以“醒脑开窍针刺法治疗中风的临床及实验研醒脑开窍针刺法治疗中风的临床及实验研究究”为题的科学研究获国家科技进步

9、三等奖为题的科学研究获国家科技进步三等奖the research project named“Clinical and Experimental Research on Apoplexy Treated with XNKQ”won the“Third Class Award for Science and Technology Progress of China”1999年年 被国家中管局列为十大医药科技推广项目之一被国家中管局列为十大医药科技推广项目之一it became one of the ten important promoting wider applications of med

10、icine scientific accomplishments in National Chinese Medicine Administration Bureau2000年年 荣获天津市科技兴市突出贡献奖荣获天津市科技兴市突出贡献奖won the“Award for Science and Technology promoting Tianjin”第9页/共78页此外，在针灸教学和针灸科研成果推广应用方面分别获得国家教学成果一等奖和科技成果推广二等奖.In addition,in the aspects of acupuncture teaching and promoting wider

11、 application of scientific accomplishments in acupuncture science we have respectively won the first and the second national prizes.第10页/共78页所建立的方法和技术被收入全国高等中医院校规划教材以及美国考试委员会指定教材。This methods and technologies are included into the teaching material of National Colleges and universities of traditiona

12、l Chinese Medicine and the Specified materials of U.S.Board of Examiners 第11页/共78页其研究水平在中医针灸研究领域处于领先地位，具有重要的学术价值，并取得十分显著的社会效益The researches of“XNKQ”therapy are Advanced in the field of acupuncture research,has important academic value,and achieve very significant social benefits 第12页/共78页“醒脑开窍针刺法”在中

13、风不同时期的应用 XNKQ ACUPUNCTURE THERAPY ApplicationIn Different Stage of Stroke第13页/共78页醒脑开窍针刺法醒脑开窍针刺法XNKQ ACUPUNCTURE THERAPY第14页/共78页醒脑开窍针刺法之所以有效的重要原因是其有严格的组方原则，并强调针刺手法量学规范。临床上应用主穴是最为重要的，起到醒神开窍、通调元神的主要功效。One of the important reasons for which Xingnao Kaiqiao acupuncture therapy is effective is that the

14、acupuncture have a strict set of principles,and standard quantitative manipulations are applied emphatically.The main points with effect of refreshing and regulating the soul are very important in the clinical application.第15页/共78页醒脑开窍针刺法主穴分为两个组方，主穴之方主要应用于中风急性期，主穴之方更多用于中风恢复期和后遗症期。The main points of

15、Xingnao Kaiqiao acupuncture therapy method is divided into two groups,the main points I are mainly used in the acute phase of stroke,and the main points II more for stroke recovery and sequelae period.第16页/共78页1双侧内关-bilateralNeiguan手厥阴心包经PC 6,the Pericardium Meridian of Hand-Juejin2人中-Renzhong督脉DU 2

16、6,the DU Meridian3患侧三阴交-Sanyinjiao足太阴脾经SP 6,the Spleen Meridian of Foot-Taiyin主 穴Mainpoints 针刺处方-Point Prescription第17页/共78页First puncture bilateral Neiguan(PC 6)perpendicularly for 0.5-1 cun,using combinative reducing method of lifting-thrusting and twirling-rotating the needle for 1 minute先刺双刺内关穴，

17、直刺0.51寸，采用捻转提插结合泻法，施手法1分钟内 关Neiguan(PC 6)操作方法-Manipulation主穴第18页/共78页Secondly puncture Renzhong(DU 26)obliquely upwards to the nasal septum for 0.3-0.5 cun with heavy bird-pecking method until the patients eyeballs are moistened or tears flow down.继刺人中，向鼻中隔方向斜刺0.30.5寸，用重雀啄法，至眼球湿润或流泪为度人 中Renzhong(DU

18、26操作方法-Manipulation主穴第19页/共78页Thirdly puncture Sanyinjiao(SP 6)obliquely for 1-1.5 cun,at the angle of 45 degrees with the skin surface along the posterior border of the medial aspect of the tibia,with reinforcing method of lifting and thrusting the needle to make the affected low limb have tic for

19、three times再刺沿胫骨内侧缘与皮肤呈45度角斜刺，进针11.5，用提插补法，使患侧下肢抽动3次为度三 阴 交Sanyinjiao(SP 6)操作方法-Manipulation主穴第20页/共78页3双侧内关-bilateralNeiguan手厥阴心包经PC 6,the Pericardium Meridian of Hand-Juejin 2上星透百会Shangxing to Baihu督脉DU 23,DU 20,the DU Meridian4患侧三阴交-Sanyinjiao足太阴脾经SP 6,the Spleen Meridian of Foot-Taiyin主 穴Mainpoi

20、nts 针刺处方-Point Prescription1印堂-Yintang经外奇穴EX-HN 3第21页/共78页First puncture Yintang(EX-HN3)obliquely upwards to the nasal root for 0.3-0.5 cun with light bird-pecking method until the patients eyeballs are moistened or tears flow down.先刺印堂，向鼻根部斜0.30.5寸，用轻雀啄法，至眼球湿润或流泪为度印 堂Yintang(EX-HN3)操作方法-Manipulatio

21、n主穴第22页/共78页Secondly puncture flatly from Shangxing(DU 23)to Baihui(DU 20)using needle of 3 cun with reinforcing anipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute 继刺上星，选3寸毫针沿皮平刺透向百会，采用小幅度高频率捻转补法，施手法1分钟上 星Shangxing (DU 23)操作方法-Manipulation主穴第23页/共78页操作

22、手法同主穴之方 The manipulation is same as Mainpoints 三 阴 交Sanyinjiao(SP 6)操作方法-Manipulation主穴内 关Neiguan(PC 6)第24页/共78页“醒脑开窍针刺法”适用于中风先兆、中风急性期（包括出血及梗死）、稳定期、后遗症期，并对脑卒中的多种合并症，如吞咽障碍、失语、失明等也具有很好的疗效。Xingnao Kaiqiao acupuncture therapy is applicable to the aura of stroke,stroke acute period(including hemorrhage a

23、nd infarction),stable period,sequelae,and also has good curative effect for multiple comorbidities of stroke,such as dysphagia,aphasia and blindness.适用范围-Scope of application第25页/共78页中风急性期-病程在2周内Acute period-in 2 weeks中风先兆-一过性Aura of stroke-transient中风病的分期中风后遗症期-发病半年之后Sequelae period-Six months late

24、r中风恢复期-发病2周至半年 Stable period-between 2 weeks to 6 months全国中风病的诊断和疗效评定标准1986年Stages of strokeNational standard of diagnosis and evaluation for stroke1986year第26页/共78页中风先兆的治疗 The Treatment In Aura Phase of Stroke第27页/共78页中风先兆即短暂性脑缺血发作，也称一过性脑缺血发作。它是脑梗死的前兆，及时治疗TIA是预防缺血性卒中的重要措施。Aura of stroke，which is tr

25、ansient ischemic attack（TIA）,also known as a transient ischemic attack.It is the precursor of cerebral infarction,and timely treatment of TIA is an important measure for the prevention of ischemic stroke.第28页/共78页针刺处方 主穴：内关、人中、印堂、上星透百会、风池 辅穴：上肢麻木无力加极泉、尺泽 下肢麻木无力加委中、三阴交 Mainpoints Supplementary points

26、Neiguan、Renzhon、Yintang、Shangxing、Baihui、Fengchiweakness and numbness of Upper limb:Jiquan、Chize are addedweakness and numbness of limb:Wenzhong、Sanyinjiao are added第29页/共78页内关-Neiguan手厥阴心包经PC 6,the Pericardium Meridian of Hand-Juejin印堂-Yintang经外奇穴EX-HN3人中-Renzhong风池-Fengchi针刺处方-Point Prescription督脉

27、DU 26,the DU Meridian 上星透百会Shangxing to Baihu督脉DU 23,DU 20,the DU Meridian主 穴Mainpoints足少阳胆经GB 20,Gallbladder Meridian of Food-shaoyang第30页/共78页极 泉-Jiquan手少阴心经HT 1,the Heart Meridian of Hand-shaoyin尺 泽-Chize手太阴肺经LU 5,the Lung Meridian of Hand-Taiyin辅 穴Supplementary points委中-Weizhong足太阳膀胱经BL 40,the B

28、ladder Meridian of Foot-Taiyang针刺处方-Point Prescription患侧三阴交-Sanyinjiao足太阴脾经SP 6,the Spleen Meridian of Foot-Taiyin第31页/共78页风 池-足少阳胆经刺向对侧眼角方向，入1寸，施小幅度高频率捻转补法1分钟Puncture Fengchi(GB 20)in the direction of canthus on the other side for 1cun，with reinforcing manipulation of twirling and rotating the need

29、le in high frequency and small amplitude for 1 minute to each acupoint.Fengchi(GB20)操作方法-Manipulation第32页/共78页其余穴位操作方法同前介绍The Manipulation of other points is same as before.操作方法-Manipulation第33页/共78页 中风急性期的治疗 The Treatment In Acute Phase of Stroke第34页/共78页1双侧内关-bilateralNeiguan手厥阴心包经PC 6,the Pericar

30、dium Meridian of Hand-Juejin2人中-Renzhong督脉DU 26,the DU Meridian3患侧三阴交-Sanyinjiao足太阴脾经SP 6,the Spleen Meridian of Foot-Taiyin主 穴Mainpoints 针刺处方-Point Prescription第35页/共78页极 泉-Jiquan手少阴心经HT 1,the Heart Meridian of Hand-shaoyin尺 泽-Chize手太阴肺经LU 5,the Lung Meridian of Hand-Taiyin辅 穴Supplementary points委中

31、-Weizhong足太阳膀胱经BL 40,the Bladder Meridian of Foot-Taiyang针刺处方-Point Prescription第36页/共78页操作方法同前介绍The Manipulation of these points is same as before.操作方法-Manipulation第37页/共78页中风急性期常见并发症的治疗中风急性期常见并发症的治疗 The Treatment of Common Complications During The Acute Phase of Stroke第38页/共78页3.吞咽障碍difficulty of

32、swallowing加风池、翳风、完骨Fengchi(GB 20),Yifeng(SJ 17)and Wangu(GB 12)are added4.语言不利 slurred speech加上廉泉，金津、玉液放血Shanglianquan(EX-HN)is added,and Jinjin(EX-HN 12)and Yuye(EX-HN13)are used with blood-letting method配穴 Point Modifi-cation1椎基底动脉供血不足insufficienc of Vertebrobasilar加凤池、完谷、天柱Fengchi(GB 20),Wangu(GB

33、 12)and Tianzhu(BL 10)are added 2.高血压 Hypertension加人迎、曲池、合谷、足三里、太冲Renying(GB 20),Quchi(GB 12),Hegu(BL 10),Zusanli(),Taichong are added 5 呼吸衰竭Respiratory Failure加凤池、完谷、天柱Fengchi(GB 20),Wangu(GB 12)and Tianzhu(BL 10)are added第39页/共78页配 穴Point Modification加丰隆、左侧水道、归来、左侧外水道、归来Shuidao(ST40),Guilai(ST29)W

34、aishuidao(EX-CA),Waiguilai(EX-CA)and Fenglong(ST 40)6.便秘Constipation7.小便失控Urine out of control加关元、中极、曲骨Zhongji(RN3),Qugu(RN 2),Guanyuan(RN4).8.共济失调Ataxia 9.复视Double Vision 风府、哑门、颈椎夹脊穴Fengfu(DU 16),Yamen(DU 15)and cervical Jiaji points(EX-B2).凤池、天柱、晴明、球后 Fengchi(GB20),Tianzhu(BL 10),Jingming(BL 1)and

35、 Qiuhou(EX-HN7)第40页/共78页椎-基底动脉系统是颅脑供血的一部分，负责颅内1/3的血供，是脑卒中病人侧枝循环建立的重要组成部分。Vertebral-basilar artery is a part of Brain blood supply,and responsible 1/3 blood supply for brain.It is an important part of stroke patients collateral circulation1.改善椎基底动脉供血-Improve the Vertebrobasilar第41页/共78页配 穴-PointModif

36、ition风池完骨天柱Fengchi(GB 20)Wangu(GB 12)Tianzhu(BL 10)操作方法-ManipulationPuncture Fengchi(GB 20)in the direction of canthus on the other side for 1-1.5 cun,Wangu(GB 12)and Yifeng(SJ 17)are punctured directory，all of the points with reinforcing manipulation of twirling and rotating the needle in high freq

37、uency and small amplitude for 1 minute to each acupoint.双侧凤池向对侧眼角直刺1-1.5寸，双侧完谷、天柱直刺1-1.5寸，均采用小幅度高频率捻转补法，每穴施手法1分钟，留针30min操作方法-Manipulation第42页/共78页2.高血压高血压-Hypertension高血压是脑卒中最多见的合并症之一，持续的高血压直接影响脑卒中的疾病转归，也是脑卒中再次发病的重要危险因素之一。有效的调整和控制血压是治疗和预防脑卒中的重要手段。Hypertension is the most common complication of strok

38、e,sustained hypertension directly influence the prognosis of stroke,and is also one of the most important risk factors of strokes recurrence.Effective adjustment and control of blood pressure is an important mean of treatment and prevention of cerebral apoplexy.第43页/共78页人迎-Renying足阳明胃经 Stomach Merid

39、ian of Foot-Yangming合谷-Hegu(LI 4)足三里-Zusanli太冲-Taiconng针刺处方-Point Prescription 曲池-Quchi足厥阴肝经LR 3，Liver Meridian of Foot-Jueyin手阳明大肠经 LI 11,Large intestine Meridian of Hand-Yangming足阳明胃经ST 36,Stomach Meridian of Foot-Yangming手阳明大肠经 LI 4，Large intestineMeridian of Hand-Yangming第44页/共78页人迎，直刺11.5寸，见针体随

40、动脉搏动而摆动，施用小幅度高频率捻转补法1分钟Puncture Renying()for 1-1.5cun,then you can see the needle swing with the arterial pulse,and with reinforcing manipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute 操作方法-Manipulation第45页/共78页合谷、太冲，均直刺0.81寸，施用捻转泻法1分钟；Puncture Hegu(LI

41、 4),Taichong(LR 3)for 0.8-1cun with reducing manipulation of twirling and rotating the needle for 1 minute 曲池、足三里，直刺1寸，施用小幅度高频率捻转补法1分钟 Puncture Quchi(LI 11),Zusanli(ST 36)for 1cun with reinforcing manipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute操作方法

42、-Manipulation第46页/共78页吞咽困难至今为止仍是现代医学无法积极治疗的疑难病症，消极的支持疗法不能保证患者的生活质量。醒脑开窍针刺法及其配穴的应用有非常理想的治疗效果Dysphagia is still a difficult case to treat effectively for modern medicine by far,negative support therapy can not guarantee the quality of patients life.Xingnao Kaiqiao acupuncture and the application of ac

43、upoint matching have very ideal therapeutic effect.3.吞咽障碍-difficulty of swallowing第47页/共78页 操作方法-Manipulation 配 穴风池完骨翳风Fengchi(GB 20)Wangu(GB 12)Yifeng(SJ 17)Puncture Fengchi(GB 20),Wangu(GB 12)and Yifeng(SJ 17)in the direction of the laryngeal protuberance for 2-2.5 cun,with reinforcing manipulatio

44、n of twirling and rotating the needle in high frequency and small amplitude for 1 minute to each acupoint.均针向结喉，进针22.5寸采用小幅度高频率捻转补法，每穴施手法1分钟，留针30min操作方法-Manipulation第48页/共78页语言恢复除了语言矫正和训练之外，针刺治疗起到了非常重要的作用。Speech correction and training is the main method for the recovery of slued speech therapy,but

45、the acupuncture treatment aslo play a very important role4.语言不利-slurred speech第49页/共78页Shanglianquan(EX-HN)Puncture Shanglianquan(EX-HN)for 1.5-2 cun,with the needle tip towards the root of the tongue and reducing method of lifting and thrusting the needle.Jinjin(EX-HN12)Yuye(EX-HN13)Prick Jinjin(EX

46、-HN12)and Yuye(EX-HN13)with the three-edged needle to cause bleeding for 1-2ml.上廉泉针向舌根1.52寸，用提插泻法slurred speech语言不利 金津、玉液用三棱针点刺放血，出血12毫升操作方法-Manipulation第50页/共78页5.呼 衰-Respiratory Failure 针刺双侧气舍Puncture bilateral Qishe(ST 11)人迎穴直下，锁骨上缘，在胸锁乳突肌的胸骨头与锁骨头之间 第51页/共78页在脑卒中急性期内，便秘可引起腹压的增高，进而影响血压及脑压的调整，影响脑血管

47、病的康复。In the acute phase of stroke,constipation can cause increases of abdominal pressure,and effect the adjustment of blood pressure and cerebral pressure,and the rehabilitation of cerebrovascular disease.6.便 秘-Constipation 第52页/共78页针外水道、外归来、丰隆Puncture Waishuidao(EX-CA),Waiguilai(EX-CA)and Fenglong(

48、ST 40)当脐中下寸，距前正中线3寸 当脐中下3寸，距前正中线3寸 外踝尖上8寸，条口穴外1寸，胫骨前嵴外2横指处 Waishuidao(EX-CA)Waiguilai(EX-CA)Fenglong(ST 40)操作方法-Manipulation第53页/共78页脑卒中患者随着脑功能的蜕变，或部分小便控制中枢（旁中央小叶）的损害，常出现小便失控，老年患者多见。包括尿失禁和尿潴留。With the evolution of brain function,or the damage of the control central of urination(next to the central l

49、obule),stroke patients,especially elderly patients,can not control their urine7.尿失禁、尿潴留 Incontinence of Urine,Retention of Urine 第54页/共78页针中极、曲骨、关元、局部施灸、按摩或热敷Puncture Zhongji(RN 3),Qugu(RN 2),Guanyuan(RN4).Moxibustion is applied on the local area,while massage and hot compress are applicable too.腹下部

50、耻骨联合上缘上方凹陷处 下腹部，前正中线上，当脐中下4寸 Guanyuan(RN4)下腹部，前正中线上，当脐中下3寸 Qugu(RN2)Zhongji(RN 3)操作方法-Manipulation第55页/共78页8.共济失调-Ataxia 针风府、哑门、颈椎夹脊穴Puncture Fengfu(DU 16),Yamen(DU 15)and cervical Jiaji points(EX-B2).后正中线上，入后发际1寸后正中线上，入后发际0.5寸风府Fengfu(DU 16)哑门Yamen(DU 15)cervical Jiaji points(EX-B2).第56页/共78页9.复视-D