讲稿-“通关利窍”针刺法治疗脑干梗死吞咽障碍的临床研究培训 医学ppt课件

“通关利窍通关利窍”针刺法治疗针刺法治疗脑干梗死吞咽障碍的临床研究脑干梗死吞咽障碍的临床研究1“通关利窍”针刺法治疗1研究背景研究背景BackgroundDysphagia is a common complication of cerebrovascular diseases，the rate of dysphagia due to stroke is 51-73%.It could bring about complications like aspiration pneumonia,insufficient intake of fluids and nutrients,asphyxia,hence affecting the patients quality of life。It is an important cause of death amongst stroke patients.1of46吞咽障碍吞咽障碍为脑血管疾病常为脑血管疾病常见并发症，见并发症，脑卒中急性期发生脑卒中急性期发生率为率为51-73%51-73%，可引发吸入性肺可引发吸入性肺炎、水分营养物质摄入障碍、炎、水分营养物质摄入障碍、窒息等并发症，严重影响患者窒息等并发症，严重影响患者生存质量，生存质量，是导致中风病患者是导致中风病患者死亡的重要原因之一死亡的重要原因之一。2研究背景Background1of46吞咽障碍为脑血管疾病常2005年年中国脑血管病防治指南中国脑血管病防治指南 2005 China Cerebrovascular Diseases Guidelines吞吞咽咽障障碍碍可可分分为为真真球球麻麻痹痹、假假球球麻麻痹痹，其其中中真真球球麻麻痹痹主主要要为为延延髓髓疑疑核核损损伤伤，假假球球麻麻痹痹是是由由双双侧侧皮皮质质或或皮皮质质脑脑干干束束损损伤伤造造成成，两两者者统称为吞咽统称为吞咽困难困难。DysphagiaDysphagia can be categorized into bulbar paralysis and pseudobulbar paralysis.Bulbar paralysis is due to lesions at the nucleus ambiguous of the medulla oblongata,while pseudobulbar paralysis is either due to lesions at the corticobulbar tracts or on both the cortical tracts.They were termed both conditions“dysphagia”.2of4632005年 2005 China Cerebrovascul真球麻痹真球麻痹Vs假球麻痹假球麻痹Bulbar Paralysis Vs Pseudobulbar Paralysis临临床床上上鉴鉴别别真真/假假球球麻麻痹痹多多以以疑疑核核定定位位，疑疑核核及及疑疑核核以以下下的的部部位位病病损损即即下下运运动动神神经经元元病病损损为为真真球球麻麻痹痹，疑疑核核以以上上部部位位病病损损为为假假球球麻麻痹痹。临临床床中中由由于于影影像像学学对对于于疑疑核核定定位位尚尚存存在在困困难难，无无法法清清晰晰看看到到疑疑核核受受损损情情况况，因因此此将将延延髓髓部部位位存存在在病病损损的的患患者归入真球麻痹。者归入真球麻痹。Clinically,lesions at and below the nucleus that is lower motor neuron are referred to bulbar paralysis,while lesions above the nucleus are known as pseudobulbar paralysis.In radiography,the location of the nucleus remains unclear，therefore we broadened the scope,and classified lesions in the medulla oblongata under bulbar paralysis as well.3of464真球麻痹Vs假球麻痹Bulbar Paralysis Vs 大脑的供血系统大脑的供血系统Blood Supply of Brain4of465大脑的供血系统4of465研究背景研究背景 Background5of46现代医学对于吞咽障碍的现代医学对于吞咽障碍的治疗多以留置胃管技术改治疗多以留置胃管技术改善患者营养摄入，吞咽障善患者营养摄入，吞咽障碍已成为严重的医疗和社碍已成为严重的医疗和社会问题。会问题。Modern medicine may attempt to improve nutrient intake via the insertion of the feeding tube,but dysphagia remains a severe medical and social problem.6研究背景 Background5of46现代医学对于吞咽障碍病案病案举隅举隅A Medical Record马某 男 49岁 美国人主因“四肢瘫痪伴失语、吞咽障碍16个月”于2011年8月26日入院。患者于2008年和2010年两次患脑干梗死，予气管切开置管、胃壁造瘘及保守治疗，经治病情平稳，为进一步治疗收入我院。Martin Acierno,Male,49 years,American.The patient was admitted to hospital on 26 August 2011 due to quadriplegia,aphasia and dysphagia.He suffered from brainstem infarction in 2008 and 2010,and underwent tracheal intubation,gastric intubation and other conservative treatment.His condition stabilized,hence was admitted to our hospital for further treatment.6of467病案举隅A Medical Record马某 男 49入院时入院时At Admission7of46神情，精神弱，被动体位，神情，精神弱，被动体位，构音不能，面部无表情，通构音不能，面部无表情，通过眼球移动表达是和否，吞过眼球移动表达是和否，吞咽障碍，气切处置管，持续咽障碍，气切处置管，持续吸氧，痰涎壅盛，每日吸痰吸氧，痰涎壅盛，每日吸痰16次，胃壁造瘘，尿管通畅，次，胃壁造瘘，尿管通畅，二便失禁。二便失禁。His mental state was poor,was in a passive position,suffered from aphasia and could only communicate using eyeball movement.His head could move slightly,but could not open his mouth.He had dysphasia,tracheal intubation,required long term oxygen inspiration,had excessive saliva,phlegm suctioning 16 times daily,gastric intubation,had clear urinary tube,urine and motion incontinence.8入院时At Admission7of46神情，精神弱，被动体入院时入院时At Admission8of46查体：查体：四肢肌力四肢肌力0级，肌张力增高。级，肌张力增高。双侧巴氏征双侧巴氏征（+）诊断：诊断：脑干梗死脑干梗死 闭锁综合征闭锁综合征 高血压病高血压病3级级 肺感染肺感染泌尿系感染泌尿系感染 胃壁造瘘术后胃壁造瘘术后 气管切开术后气管切开术后 Physical examination:Level of muscle strength 0,increased muscle spasticity,bilateral Babinski sign(+).Diagnosis:Cerebral Infarction,Locked-In Syndrome,Hypertension(Level 3),tracheal intubation,gastric intubation,urinary infection,lung infection.9入院时At Admission8of469治疗治疗TreatmentTreatment:“Tong Guan Li Qiao”acupuncture therapy,twice daily。“通关利窍通关利窍”针刺法治疗针刺法治疗 每天治疗两次每天治疗两次10治疗TreatmentTreatment:“通关利窍”针刺病情变化病情变化Condition ChangesThe urine tube was removed on the SECOND day of admission.After one month,his facial expressions improved.His swallowing improved,and could ingest 10 ml of semi fluid diet.Oxygen inspiration was reduced from 24 h to 12h and phlegm suctioning was reduced to once every 2-3 hours.Perspiration improved,and he could sleep better,but still had incontinence.10 of46入院后入院后第第2天天拔掉尿管；拔掉尿管；住院住院1个月后个月后面部表情基本面部表情基本正常，可口入正常，可口入10ml半流质饮半流质饮食，吸氧时间由食，吸氧时间由24小时减为小时减为12小时，吸痰次数减少为小时，吸痰次数减少为23小时一次。小时一次。11病情变化Condition ChangesThe urine治疗结果治疗结果ResultsAfter three monthsAfter three months,his spirits and body constitution improved.He did not require oxygen inspiration,and had better facial expressions.His swallowing ability improved further,and could ingest 100 100 mlml of semi fluids.He was admitted for a total of 178 days,after which he was discharged.11 of住院住院3个月后个月后，患者体质增强，无需吸氧，患者体质增强，无需吸氧，面部表情恢复正常，可发出面部表情恢复正常，可发出低微声音，每天可口入低微声音，每天可口入100ml100ml半流质饮食。共住院治疗半流质饮食。共住院治疗178天，出院时可发出低微声音，天，出院时可发出低微声音，口入半流质饮食可满足日常口入半流质饮食可满足日常能量需要。能量需要。46of12治疗结果ResultsAfter three months,病案病案举隅举隅A Medical Record患者杜某某，男，55岁，主因“右侧肢体活动不遂伴失语、吞咽困难18天”住院。The patient,Mr.Du,male,55 years was admitted to hospital due to disability on his right,difficulty in speaking and swallowing for 18 days.12 of4613病案举隅A Medical Record12of4613入院时入院时At Admission13 of46入院时语言謇涩，持续右侧肢体不遂，右上肢肌力0级，右下肢肌力2级，饮水咳呛、吞咽困难，纳食自胃管注入。During admission,his speech was slurred,had continuous disability on his right,muscle strength on the right arm was level 0,right leg was level 2,experienced coughing when drinking water,difficulty in swallowing,and had insertion of feeding tube.14入院时At Admission13of46入院时语言謇涩，持治疗治疗Treatment针刺治疗针刺治疗针刺治疗针刺治疗 （2 2次次次次/日）日）日）日）上午上午“通关利窍通关利窍”针刺治疗：针刺治疗：针刺内关、人中、三阴交、针刺内关、人中、三阴交、风池、完骨、翳风，咽后壁风池、完骨、翳风，咽后壁点刺，舌面点刺点刺，舌面点刺下午下午后颅凹排刺后颅凹排刺Acupuncture Threpy:In the morning“Tong Guan Li Qiao”acupuncture therapy,inclusive of Nei Guan(PC6),Ren Zhong(DU26),San Yin Jiao(SP6),Feng Chi(GB20),Wan Gu(GB12),Yi Feng(SJ17),pricking of the posterior pharyngeal wall and tongueIn the afternoonLined acupuncture treatment on the back of his head.15治疗Treatment针刺治疗（2次/日）Acupunct治疗结果治疗结果ResultsAfter 2 weeks of treatment,the patient was able to ingest lotus root paste,milk,could drink small sips of water using a straw,and could speak clearer than before.After the 23rd day,the patient could drink water without coughing,and could intake as much as 3000 ml of water.He was able to satisfy his daily energy requirement,therefore removed his feeding tube the next day.His dysphagia was considered clinically cured 15 of46治疗2 周后周后，患者可口入半流质饮食，构音较前清晰；治疗第第23天天，患者可饮水，不呛，口入量达3000ml，满足日常能量需要，吞咽障碍临床痊愈。16治疗结果Results15of46治疗2 周后，患者可口入半17How is that possible?如何治疗的？17我们以通关利窍、滋补三阴为原则，严格规范取穴、针刺手法量学，治疗吞咽障碍临床疗效显著 Using the principles of“Tong Guan Li Qiao”acupuncture therapy and nourishing the three yin,we standardized the prescription of acupuncture points,manipulation and quantification.Satisfactory clinical results were achieve.18采用“通关利窍”针刺法 我们以通关利窍、滋补三阴为原则，严 内关内关NNei ei GGuanuan,PC6,PC6人中人中RRen en Z Zhonghong,DU26,DU26三阴交三阴交S San an YYin in J Jiaoiao,SP6,SP6风池风池F Feng eng CChihi,GB20,GB20完骨完骨WWan an GGu u,GB12,GB12翳风翳风YYifengifeng,SJ17,SJ17咽后壁点刺咽后壁点刺Prick the posterior Prick the posterior pharyngeal wallpharyngeal wall针刺主穴针刺主穴The Main Points19 内关人中三阴交风池完骨翳风咽后壁点刺针刺主穴19操作方法操作方法 Manipulation内内 关关Neiguan(PC 6)直刺直刺0.50.51 1寸，采用提插捻转泻法，施手法寸，采用提插捻转泻法，施手法1 1分钟；分钟；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;19 of2420操作方法 Manipulation内 关 直刺0.51寸补法补法补法补法（左侧顺时针；右侧逆时针）（左侧顺时针；右侧逆时针）（左侧顺时针；右侧逆时针）（左侧顺时针；右侧逆时针）（左侧顺时针；右侧逆时针）（左侧顺时针；右侧逆时针）泻法泻法泻法泻法（左侧逆时针；右侧顺时针）（左侧逆时针；右侧顺时针）（左侧逆时针；右侧顺时针）（左侧逆时针；右侧顺时针）（左侧逆时针；右侧顺时针）（左侧逆时针；右侧顺时针）右右右右左左左左左左左左右右右右21补法（左侧顺时针；右侧逆时针）泻法（左侧逆时针；右侧顺时针）人人 中中Renzhong(DU 26)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.向鼻中隔方向斜刺向鼻中隔方向斜刺0.30.30.50.5寸，行雀啄手法，寸，行雀啄手法，至眼球湿润或流泪为度；至眼球湿润或流泪为度；20 of4622人 中Secondly puncture Renzhon三三 阴阴 交交Sanyinjiao(SP 6)沿胫骨内侧缘与皮肤呈沿胫骨内侧缘与皮肤呈4545度角斜刺，进针度角斜刺，进针1 11.51.5，用提，用提插补法，使患侧下肢抽动插补法，使患侧下肢抽动3 3次为度次为度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 three times.23三 阴 交沿胫骨内侧缘与皮肤呈45度角斜刺，进针11.5，2424风池、完骨、翳风风池、完骨、翳风Fengchi(GB 20)Wangu(GB 12)Yifeng(SJ 17)针向结喉，进针针向结喉，进针1.51.52 2寸，施小幅度、高频率捻转补法寸，施小幅度、高频率捻转补法1 1分钟，以咽喉麻胀为宜；分钟，以咽喉麻胀为宜；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 manipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute to each acupoint.22 of4625风池、完骨、翳风针向结喉，进针1.52寸，施小幅度、高频率咽后壁点刺咽后壁点刺prick at pharynx posterior wall 令患者张口，用压舌板压住舌体，清楚暴露咽后壁，令患者张口，用压舌板压住舌体，清楚暴露咽后壁，用用0.3075mm长针点刺双侧咽后壁，每天一次长针点刺双侧咽后壁，每天一次The patient was told to open his mouth,and his tongue was pressed downusing a spatula to fully expose the posterior pharyngeal wall.Use 0.3075 mm needle to prick both sides of the posterior pharyngeal wall once daily.23 of4626咽后壁点刺令患者张口，用压舌板压住舌体，清楚暴露咽后壁，23取穴方义取穴方义Explanation24 of46123人中人中RenzhongRenzhong三阴交三阴交SanYinJiaoSanYinJiao内关内关NeiGuanNeiGuanl内关穴为八脉交会穴之一，通于阴维脉，属手厥阴心包经 之络穴，有养心安神、疏通气血之功。Calm the mind,improve the circulation of qi and blood.l人中为督脉与手足阳明经之会穴，督脉起于胞中，上行人脑达巅，故泻人中可调督脉，开窍启闭可健脑宁神。针刺可刺激穴周的面神经、三叉神经分支，激活了三叉神经-脑血管系统，可达到兴奋脑神经元，改善脑血流的作用。l Regulate the Du meridian,open orifices,nourish the brain and calm the mind.l足三阴之经脉或挟舌本，或络于舌本，或连舌本，散舌下;补其三阴可达补益肝肾，健脾利湿之功。lNourish the kidneys,liver,spleen and clear dampness.27取穴方义Explanation24of46123人中三阴交内取穴方义取穴方义Explanation25 of46123风池、完骨、翳风风池、完骨、翳风FengChiFengChi，WanWanGuandYiFengGuandYiFeng咽咽咽咽后壁点刺后壁点刺PrickthePricktheposteriorposteriorpharyngealpharyngealwallwall风池风池FengChiFengChil风池穴乃治风要穴，为足少阳与阴维之会，归属胆经，可条达阳经之气，潜阳熄风，活血化瘀，清头利窍。lCalm wind,suppress yang,improve blood circulation and clear the head.l风池、完骨、翳风穴共为少阳之脉，具有通利枢纽之功，三穴合用可达养脑髓、通脑窍、利机关的作用。l Three points together can nourish the brain matter,open brain orifices,and regulate qi.l配合咽后壁点刺局部取穴，诸穴合用可调神导气、平衡阴 阳，通关利窍的作用。lAll points together may regulate qi and the mind,balance yin and yang,and unblock any obstruction.28取穴方义Explanation25of46123风池、完骨、研究方案研究方案 Research programs我我们们以以临临床床实实践践为为基基础础，以以醒醒脑脑开开窍窍为为原原则则，在在取取穴穴、配方、针刺手法及其量学方面做了严格规范，临床疗效显著配方、针刺手法及其量学方面做了严格规范，临床疗效显著。临床资料临床资料 Clinical Data26 of46疗效评定疗效评定 Assessment of Results治疗结果治疗结果 Results of Treatment治疗方法治疗方法 Treatment Method29研究方案 Research programs我们 临床资料临床资料Clinic Date27 of46排除标准排除标准 诊断及纳入标准诊断及纳入标准一般资料一般资料General DataGeneral DataExclusion Exclusion CriteriaCriteriaDiagnosis and Inclusion Criteria30 临床资料27of46General DataExclusi 一般资料一般资料General Date28 of46Diagram脑干梗死吞咽障碍患者脑干梗死吞咽障碍患者64例例64 post brainstem infarction dysphagiapatients were screened年龄平均年龄平均63.869.49岁岁average age of the patients was 63.869.49 years病程平均病程平均23.8920.71天天average course of disease was23.8920.71 days 31 一般资料General Date28of46Diagram诊断及纳入标准诊断及纳入标准Diagnosis and Inclusion Criteria29 of4632诊断及纳入标准Diagnosis and Inclusion 排除标准排除标准 30 of46DiagramExclusion Criteria Other diseases that might cause dysphagia;Poor consciousness,psychological problems and have difficulty complying with the doctor;Suffers from other primary diseases like liver,kidney and endocrine disorders 运动神经元性疾病导致的吞咽障碍；运动神经元性疾病导致的吞咽障碍；神志不清，有精神症状不能配合治疗者；神志不清，有精神症状不能配合治疗者；合并有肝肾、造血系统、内分泌系统等严重原合并有肝肾、造血系统、内分泌系统等严重原 发病及精神疾患者；发病及精神疾患者；33 排除标准 30of46DiagramExclusion C 治疗方法治疗方法Treatment Method2of6 治疗周期均为治疗周期均为28天天采用采用“通关利窍通关利窍”针刺法针刺法Perform the“Tong Guan Li Qiao”acupuncture therapy.The course of treatment was 28 days.34 治疗方法2of6 治疗周期均为28天采用“通关利窍”Per 疗效评定疗效评定Assessment of Results32 of46评定吞咽功能评定吞咽功能 assess the patients swallowing ability洼田饮水试验洼田饮水试验 Kubota water test藤岛一郎吞咽疗效评价标准藤岛一郎吞咽疗效评价标准 Fujishima Ichiro rating scale标准吞咽功能评价量表（标准吞咽功能评价量表（SSA）Standard Swallowing AssessmentBarthelBarthel生活指数生活指数Barthel Index评价生活质量评价生活质量assess standard of living35 疗效评定32of46评定吞咽功能洼田饮水试验Barthel治疗结果治疗结果 Results of Treatment采用洼田饮水试验进行疗效比较，治疗前后评分具有显著性差异，说明通关利窍针刺法在改善吞咽功能方面效果显著。ComparisonofResultsforBulbarParalysis/BrainstemInfarction/CombinedInfarction，thereweresignificantdifferencesbetweenthescoresofKubotawatertestbeforeandaftertreatment.Thisshowsthat“TongGuanLiQiao”acupuncturetherapyiseffectiveinimprovingswallowingability.33 of4636治疗结果 Results of Treatment采用洼田洼田饮水试验洼田饮水试验Kubota water test34 of46Diagram延髓梗死患者治疗前洼田饮水评分较高、病情较重，但治疗前后评分改善程度明显，表现出了更好的疗效趋势。Comparisonamongthegroupsshowedthatinbrainsteminfarctionpatients,theKubotaWaterTestresultswerehigher,andtheirconditionweremoreseriousbeforetreatment,butaftertreatment,theyshowedabettertrendinrecovery.37洼田饮水试验Kubota water test34of46D洼田饮水试验洼田饮水试验Kubota water test35 of46Diagram结合患者影像学结果进行分析，延髓梗塞组病变部位在延髓，导致舌咽神经、舌下神经缺血缺氧，导致吞咽障碍的发生，通过针刺可有效地改善脑循环，快速建立代偿机制，取得临床疗效。Withreferencetotheirradiographicreports,thelesionsofthesepatientsareatthemedullaoblongata,henceoftenpressagainsttheglossopharyngealnerveandhypoglossalnerve,causingdysphagia.Acupuncturecaneffectivelyimprovethebraincirculation,swiftlysetupcompensatorymechanismsandachieveclinicalresults.38洼田饮水试验Kubota water test35of46D治疗结果治疗结果 Results of treatment36 of46采用藤岛一郎试验进行疗效采用藤岛一郎试验进行疗效比较，治疗前后评分具有显著比较，治疗前后评分具有显著性差异，说明通关利窍针刺法性差异，说明通关利窍针刺法在改善吞咽功能方面效果显著。在改善吞咽功能方面效果显著。Comparison of Results for Bulbar Paralysis/Brainstem Infarction/Combined Infarction，there were significant differences between the scores of Fujishima Ichiro rating before and after treatment.This shows that“Tong Guan Li Qiao”acupuncture therapy is effective in improving swallowing ability.39治疗结果 Results of treatment36of治疗结果治疗结果 Results of Treatment37 of46采用吞咽功能评价量表（采用吞咽功能评价量表（SSA）进行）进行疗效比较，治疗前后评分具有显著性差疗效比较，治疗前后评分具有显著性差异，有效的改善了患者异，有效的改善了患者吞咽功能吞咽功能吞咽功能吞咽功能，加，加速了患者生活能力的恢复，有助于提高速了患者生活能力的恢复，有助于提高患者生活质量。患者生活质量。Comparison of Results for Bulbar Paralysis/Brainstem Infarction/Combined Infarction，there were significant differences between the SSA scores before and after treatment.This therapy can effectively improve the swallowing ability of patients,and hasten the recovery of their standard of living.40治疗结果 Results of Treatment37of治疗结果治疗结果 Results of Treatment38 of46采用采用Barthel生活指数进行疗效比较，生活指数进行疗效比较，治疗前后评分具有显著性差异，有治疗前后评分具有显著性差异，有效的改善了患者效的改善了患者吞咽功能吞咽功能吞咽功能吞咽功能，加速了，加速了患者生活能力的恢复，有助于提高患者生活能力的恢复，有助于提高患者生活质量。患者生活质量。Comparison of Results for Bulbar Paralysis/Brainstem Infarction/Combined Infarction，there were significant differences between the Barthel scores scores before and after treatment.This therapy can effectively improve the swallowing ability of patients,and hasten the recovery of their standard of living.41治疗结果 Results of Treatment38of 疗效判定标准疗效判定标准Assessment of Results39 of46治愈治愈显效显效有效有效无效无效42 疗效判定标准39of46治愈显效有效无效42治疗结果治疗结果 Results of Treatment40 of4643治疗结果 Results of Treatment40of治疗结果治疗结果 Results of Treatment41 of46l本试验本研究治疗延髓梗死患者总有效率95.86%，64例患者治疗后，吞咽功能及生活质量均得到显著提高，提示本针法治疗脑卒中后延髓麻痹吞咽障碍疗效显著。lThe total efficacy rate of treating dysphagia after medulla oblongata infarction was 95.86%,the 64 patients showed marked improvement in their swallowing ability and quality of life,showing that this acupuncture method is effective in treating dysphagia caused by post stroke bulbar paralysis.44治疗结果 Results of Treatment41of治疗结果治疗结果 Results of Treatment42 of46l This study has shown that the efficacy rate forcombined infarction was lowest with poor prognosis l本疗法对单纯真球麻痹疗效显著l真球麻痹并发其他多部位梗死的患者治疗有效率相对较低。l Our treatment for pseudobulbar paralysis is effective45治疗结果 Results of Treatment42of数据分析数据分析Data Analyze43 of46吞咽困难复发率低，患者很少有舌吞咽困难复发率低，患者很少有舌肌震颤、舌肌萎缩症状。肌震颤、舌肌萎缩症状。Raising the difficultly of building collateral circulation,thus the prognosis was the poorest.有效改善脑卒中后吞咽障碍患者有效改善脑卒中后吞咽障碍患者 吞咽功能及血氧饱和度水平吞咽功能及血氧饱和度水平 Improve post stroke dysphagia and blood oxygen saturation levels.随访随访临床临床研究研究46数据分析Data Analyze43of46吞咽困难复发率低44 of46 显著改善中风性假性延髓麻痹患显著改善中风性假性延髓麻痹患者的血循环、血流变学、脑血流图和者的血循环、血流变学、脑血流图和颅底动脉血流状况，增加脑血流量，颅底动脉血流状况，增加脑血流量，改善病损脑组织的血氧供应，促进中改善病损脑组织的血氧供应，促进中枢神经功能的恢复枢神经功能的恢复实验实验观察观察 This acupuncture therapy can significantly improve blood circulation,blood rheology,rheoencephalogram,hence promoting cranial blood supply,the recovery of central nervous system,thus promoting the recovery of this condition.The recovery of the function of neural tissue is related to the cranial blood circulation.laboratory researchData Analyze数据分析数据分析19991999年第年第8 8期于中国针灸发表期于中国针灸发表“针刺治疗假性延髓麻痹针刺治疗假性延髓麻痹325325例临床和机理研究例临床和机理研究”4744of46 显著改善中风性假性延髓麻痹患者的血循环、结论结论Conclusion45 of46“通关利窍通关利窍”针刺法治疗脑干梗死针刺法治疗脑干梗死吞咽障碍疗效明显，可有效改善患吞咽障碍疗效明显，可有效改善患者生活质量。者生活质量。“Tong Guan Li Qiao”acupuncture treatment for dysphagia due to brainstem stroke has received satisfactory results,and can improve the patients quality of life.48结论Conclusion45of46“通关利窍”针刺法治疗机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血管的再生。研究针刺手段促进损伤后脑循环重建及神经细胞再生管的再生。研究针刺手段促进损伤后脑循环重建及神经细胞再生管的再生。研究针刺手段促进损伤后脑循环重建及神经细胞再生管的再生。研究针刺手段促进损伤后脑循环重建及神经细胞再生的作用，从形态学、生物化学、中枢神经机制、分子生物学等方的作用，从形态学、生物化学、中枢神经机制、分子生物学等方的作用，从形态学、生物化学、中枢神经机制、分子生物学等方的作用，从形态学、生物化学、中枢神经机制、分子生物学等方面开展了二十余项基础实验。面开展了二十余项基础实验。面开展了二十余项基础实验。面开展了二十余项基础实验。Defines the mechanism research and treatment of apoplexy,focusing on nerve and breakthrough of blood vessels.Research methods to promote the head injury acupuncture and nerve cells regeneration cycle,from the morphology,biochemistry,molecular biology,central nervous mechanism for more than twenty experiments.针刺治疗缺血性中风病的机理研究针刺治疗缺血性中风病的机理研究The mechanism research of Acupuncture treatment ischemic stroke49机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血管的再生形态学研究，证明针刺可促进侧枝循环建立形态学研究，证明针刺可促进侧枝循环建立Morphology research that acupuncture can promote collateral circulation梗塞半球梗塞半球脑表面缺血区脑表面缺血区Cerebral infarction hemisphere surface ischemia阻断大脑中动脉后，大脑表面缺血区所见：阻断大脑中动脉后，大脑表面缺血区所见：Block after middle cerebral artery surface area,the brain ischemia缺血后缺血后自身代偿情况自身代偿情况After compensatory.Their ischemia针刺干预情况针刺干预情况Acupuncture intervention醒脑开窍针刺法对缺血区脑组织的改善醒脑开窍针刺法对缺血区脑组织的改善“XNKQ”can improve the brain ischemia area50形态学研究，证明针刺可促进侧枝循环建立梗塞半球阻断大脑中动脉针刺前：神经细胞溶解、破坏针刺3h后：线粒体轻度肿胀针刺 6h后：线粒体肿胀减轻针刺12h后：线粒体完整，出现微管微丝针刺24h后：神经细胞基本正常针刺保护细胞形态、减轻神经元损伤、针刺保护细胞形态、减轻神经元损伤、12h内促进微管微丝等细胞的内促进微管微丝等细胞的“骨骨架架”的再生与修复的再生与修复Acupuncture protect cells form,reduce damage,promote neurons 12h microtubules microfilament cells skeleton renewable and repair醒脑开窍针刺法对病变神经元结构的修复醒脑开窍针刺法对病变神经元结构的修复Acupuncture to repair pathological neuron structure51针刺前：针刺24h后：针刺保护细胞形态、减轻神经元损伤、12醒脑开窍针法对脑梗死患者脑葡萄糖代谢的影响醒脑开窍针法对脑梗死患者脑葡萄糖代谢的影响Acupuncture in patients with cerebral infarction of the brain glucose metabolism 醒脑开窍针刺法可以：醒脑开窍针刺法可以：促进病灶周围功能重组促进病灶周围功能重组 Promote surrounding function restructuring激活运动功能区域激活运动功能区域 Activation function area促使正常脑区的代偿促使正常脑区的代偿 To decompensation the normal brain areas改善与记忆、认知、语言功能和情绪等相关区域的代谢。改善与记忆、认知、语言功能和情绪等相关区域的代谢。Improve memory,cognition,emotion and language functions related areas of metabolism52醒脑开窍针法对脑梗死患者脑葡萄糖代谢的影响 国家科技部、中医药管理局科技成果推广项目国家科技部、中医药管理局科技成果推广项目 National science and technology department,administration of traditional Chinese medicine science promotion project已推广到全国和世界已推广到全国和世界6060多个国家和地区，形成了辐射全球的技术平台多个国家和地区，形成了辐射全球的技术平台 Has extended to the world in more than 60 countries and regions of the world,formed the radiation technology platform以以以以“醒脑开窍醒脑开窍醒脑开窍醒脑开窍”针法、丹芪偏瘫胶囊为组合的针药结合治疗缺血性中风针法、丹芪偏瘫胶囊为组合的针药结合治疗缺血性中风针法、丹芪偏瘫胶囊为组合的针药结合治疗缺血性中风针法、丹芪偏瘫胶囊为组合的针药结合治疗缺血性中风病取得了巨大的成果病取得了巨大的成果病取得了巨大的成果病取得了巨大的成果“XNKQ”acupuncture therapy and Danqi hemiplegia capsule,treatment of ischemic apoplexy made great achievements53国家科技部、中医药管理局科技成果推广项目以“醒脑开窍”针法、收治数百名外籍中风患者，取得了显著的临床疗效，形成一批标志性的成果，被国外媒体广为宣传。患脑干（桥脑）出血患脑干（桥脑）出血4 4年年经针刺治疗后痊愈，正常工作经针刺治疗后痊愈，正常工作将自身治疗经过写成书籍将自身治疗经过写成书籍走出黑暗走出黑暗 （Out of the DARKNESSOut of the DARKNESS ）在美国出版引起轰动。在美国出版引起轰动。患者：患者：患者：患者：RuthRuthRuthRuth职业：护士职业：护士职业：护士职业：护士国籍：美国国籍：美国国籍：美国国籍：美国54 收治数百名外籍中风患者，取得了显著的临床疗效，形成一一个关乎希望、勇气和整个家庭奔向中风康复的非凡旅程一个关乎希望、勇气和整个家庭奔向中风康复的非凡旅程摘自摘自“9000 Needls”网站网站患者：患者：患者：患者：DevenDevenDevenDeven 职业：健美教练职业：健美教练职业：健美教练职业：健美教练国籍：美国国籍：美国国籍：美国国籍：美国患大面积脑梗死