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針藥結合治療缺血性中風病的 系統研究

2010/11 年度「傑出學人系列」講座 Distinguished Scholar Lecture Series 2010/11. 針藥結合治療缺血性中風病的 系統研究. The S ystem R esearch of Acupuncture and H erbs to T reat I schemic S troke. 石學敏 SHI Xuemin 中國工程院院士 天津中醫藥大學第一附屬醫院榮譽院長 Academician, Chinese Academy of Engineering

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針藥結合治療缺血性中風病的 系統研究

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  1. 2010/11年度「傑出學人系列」講座 Distinguished Scholar Lecture Series 2010/11 針藥結合治療缺血性中風病的系統研究 The System Research of Acupuncture and Herbsto Treat Ischemic Stroke 石學敏 SHI Xuemin 中國工程院院士 天津中醫藥大學第一附屬醫院榮譽院長 Academician, Chinese Academy of Engineering Honorary President, The First Teaching Hospital of Tianjin Universityof Traditional Chinese Medicine

  2. 中風病的治療難點The problem of treating apoplexy 如何減輕血管神經單元的損害、促進重構神經組織、重建腦組織迴圈是神經功能恢復的根本。中風病治療的難點及突破點，聚焦在神經與血管的新生。 How to reduce the damage of neurovascular unit, promote reconstruction nerve tissue and reconstruction brain circulation is neurological recovery. The treatment of stroke, focus on problems and breakthrough of new blood vessels and nerves.

  3. 目前，治療中風病最有效的方法是卒中單元，但是現代醫學意義上的卒中單元需要較高的軟硬體配備，無法於現有醫療資源基礎上推廣應用。所以，如何利用有效的中醫手段構建符合中國特色的“中風單元”是今後重要的研究方向。目前，治療中風病最有效的方法是卒中單元，但是現代醫學意義上的卒中單元需要較高的軟硬體配備，無法於現有醫療資源基礎上推廣應用。所以，如何利用有效的中醫手段構建符合中國特色的“中風單元”是今後重要的研究方向。 Currently, the treatment of stroke are the most effective ways to stroke, but modern medical unit on the significance of the software and hardware unit needs higher stroke with existing medical resources, not in based on application. Therefore, how to effectively use the traditional method to set up Chinese characteristic "stroke unit" is an important research direction in future.

  4. 針刺和有效中藥製劑是我國治療中風病的重要手段，也是構建“中風單元”的主要因素。由“醒腦開竅針刺法”、“丹芪偏癱膠囊”相結合為關鍵內核的“石氏中風單元”，在臨床上取得了顯著療效，並被國家列為重大科技推廣專案。針刺和有效中藥製劑是我國治療中風病的重要手段，也是構建“中風單元”的主要因素。由“醒腦開竅針刺法”、“丹芪偏癱膠囊”相結合為關鍵內核的“石氏中風單元”，在臨床上取得了顯著療效，並被國家列為重大科技推廣專案。 Acupuncture and herbs are effective treatment in China and an important factor of "stroke unit". “Shi’s stroke unit” which be made of “XNKQ”acupuncture therapy and Danqi hemiplegia capsule, get great clinical effect, and has achieved remarkable listed by the state science and technology major promotion projects.

  5. “醒腦開竅”針法 簡介

  6. 在選穴上以陰經和督脈穴為主，並強調針刺手法量學規範，有別於傳統的取穴和針刺方法。 The points on 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.

  7. 治療 方 法Treatment

  8. 1.處 方 主穴：內關(手厥陰心包經) 人中(督脈) 三陰交(足太陰脾經) 1. Point Prescription Mainpoints: Neiguan(PC 6,the Pericardium Meridian of Hand-Juejin) Renzhong(DU 26,the DU Meridian) Sanjinjiao(SP 6,the Spleen Meridian of Foot-Taiyin)

  9. 輔穴：極泉(手少陰心經) 委中(足太陽膀胱經) 尺澤(手太陰肺經) Supplementary points： Jiquan(HT 1,the Heart Meridian of Hand-shaoyin) Weizhong(BL 40,the Bladder Meridian of Foot-Taiyang) Chize(LU 5, the Lung Meridian of Hand-Taiyin))

  10. 配穴：吞咽障礙加風池、翳風、完骨；手指握固加合穀；語言不利加上廉泉，金津、玉液放血；足內翻加丘墟透照海。配穴：吞咽障礙加風池、翳風、完骨；手指握固加合穀；語言不利加上廉泉，金津、玉液放血；足內翻加丘墟透照海。 Point Modification: For difficulty of swallowing, Fengchi(GB 20),Yifeng(SJ 17) and Wangu(GB 12) are added. For failing to extend fingers with stiffness, Hegu (LI 4) is added. For slurred speech, Shanglianquan(EX-HN) is added, and Jinjin(EX-HN 12) and Yuye(EX-HN13) are used with blood-letting method. For strephenopodia, penetrating method from Qiuxu(GB 40) to Zhaohai(KI 6) is used.

  11. 2.操作方法 Manipulation 内關 Neiguan (PC 6) 直刺0.5-1寸，採用撚轉提插結合瀉法，施手法1分鐘； 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;

  12. 補法（左側順時針；右側逆時針） 右 R 左 L 右 R 左 L 瀉法（左側逆時針；右側順時針）

  13. 人 中 Renzhong (DU 26) 向鼻中隔方向斜刺0.3-0.5寸，用重雀啄法，至眼球濕潤或流淚為度； Secondly puncture Renzhong(DU 26) obliquely upwards to the nasal septum for 0.3-0.5 cun with heavy bird-pecking method until the patient’s eyeballs are moistened or tears flow down.

  14. 三 陰 交 Sanyinjiao (SP 6) 沿脛骨內側緣與皮膚呈45度角斜刺，進針1~1.5，用提插補法，使患側下肢抽動3次為度 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.

  15. 三 陰 交 Sanyinjiao (SP 6) 沿脛骨內側緣與皮膚呈45度角斜刺，進針1~1.5，用提插補法，使患側下肢抽動3次為度 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.

  16. 極 泉 Jiquan (HT 1) 原穴沿經下移1寸，避開腋毛，直刺1-1.5寸， 用提插瀉法，以患側上肢抽動3次為度。 Select Jiquan(HT 1) point at 1 cun below the original location along the heart meridian to keep away from the armpit hair,puncture perpendicularly for 1-1.5 cun with reducing method of lifting and thrusting the needle to make the affected upper limb have tic for three times.

  17. 尺澤 Chize (LU 5) 屈肘成120度角，直刺1寸，用提插瀉法， 使患者前臂、手指抽動3次為度。 Perpendicularly puncture Chize(LU 5) for 1 cun depth while the forearm bends to form an angle of 120 degrees with reducing manipulation of lifting and thrusting the needle until the affected arm and fingers have tic for three times.

  18. 委 中 Weizhong (BL 40) 仰臥直腿抬高取穴，直刺0.5-1寸，施提插瀉法，使患側下肢抽動3次為度。 Select Weizhong(BL 40) point with the supine position and the lower limb lifted, puncture perpendicularly for 0.5-1 cun, with reducing method of lifting and thrusting to make the lower limb have tic for 3 times.

  19. 風池、完骨、翳風 Fengchi(GB 20) Wangu(GB 12) Yifeng(SJ 17) 針向結喉，進針2-2.5寸採用小幅度高頻率撚轉補法， 每穴施手法1分鐘； 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.

  20. 合谷針向三間穴 Hegu(LI 4) to Sanjian(LI 3) 進針1-1.5寸，採用提插瀉法，使患者第二手指 抽動或五指自然伸展為度； Puncture Hegu(LI 4) 1-1.5 cun in depth with the needle tip toward Sanjian(LI 3), with reducing method of lifting and thrusting to make the patient’s second finger or five fingers extended freely.

  21. 上廉泉 Shanglianquan (EX-HN) 針向舌根1.5-2寸，用提插瀉法； 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.

  22. 金津、玉液 Jinjin(EX-HN12) Yuye(EX-HN13) 用三棱針點刺放血，出血1-2毫升； Prick Jinjin(EX-HN12) and Yuye(EX-HN13) with the three-edged needle to cause bleeding for 1-2ml.

  23. 丘墟透向照海穴 Qiuxu(GB 40) to Zhaohai(KI 6) 約1.5-2寸，局部酸脹為度。 Puncture Qiuxu (GB 40) 1.5-2 cun in depth with the needle tip toward Zhaohai(KI 6),until soreness and distension occurred locally.

  24. 中風病其他併發症的治療 Treatment of Complications

  25. 便秘：針外水道、外歸來、豐隆 Constipation: Puncture Waishuidao(EX-CA), Waiguilai(EX-CA) and Fenglong(ST 40)

  26. (2)呼衰：針刺雙側氣舍 Respiratory Failure:Puncture bilateral Qishe(ST 11)

  27. (3)尿失禁、尿潴留：針中極、曲骨、 關元、局部施灸、按摩或熱敷 Incontinence of Urine, Retention of Urine: Puncture Zhongji(RN 3),Qugu(RN 4), Sanyinjiao (SP 6), Yinlingquan(SP 9). Moxibustion is applied on the local area, while massage and hot compress are applicable too.

  28. (4)共濟失調：針風府、啞門、頸椎夾脊穴 Ataxia:Puncture Fengfu(DU 16),Yamen(DU 15) and cervical Jiaji points(EX-B2).

  29. 頸 椎 夾 脊 穴 Cervical Jiaji Points(EX-B2)

  30. (5)複視：針天柱、晴明、球後 Double Vision:Puncture Fengchi(GB 20), Tianzhu(BL 10), Jingming(BL 1) and Qiuhou(EX-HN7)

  31. (6)癲癇：針大陵、鳩尾 Epilepsy: Puncture Daling(PC 7), Jiuwei(RN 15)

  32. (7)肩周炎：針肩髃、肩髎、肩內陵、 肩貞、肩中俞、肩外俞，痛點刺絡拔罐 Periarthritis of Shoulder: Puncture Jianneiling(EX-UE), Jianliao(SJ 14), Jianzhen(SI 9), Jianzhongshu(SI 15), Jianwaishu (SI 14).Apply blood letting and cupping method to the local pain point.

  33. (8)血管性痴呆：針百會、四神聰、 四白、太沖 Vascular Dementia:Puncture Baihui (DU 20), Sishencong(EX-HN1), Sibai(ST 2) and Taichong(LR 3).

  34. 太沖 Taichong(LR 3)

  35. (9)睡眠倒錯：針上星、神門 Paradoxic Sleep: Puncture Shangxing (DU 23), Shenmen(HT 7).

  36. “醒腦開竅”針法 最新研究進展

  37. 在30餘年的臨床實踐中，逐步形成了針刺治療缺血性中風病及其併發症的診療規範和評價體系。近年來更是引入先進的研究方法和手段，對其療效進行了綜合系統的評價，獲得了高級別的臨床證據，並結合現代科學技術，系統地闡明了針刺治療缺血性中風病的科學內涵及療效機理。在30餘年的臨床實踐中，逐步形成了針刺治療缺血性中風病及其併發症的診療規範和評價體系。近年來更是引入先進的研究方法和手段，對其療效進行了綜合系統的評價，獲得了高級別的臨床證據，並結合現代科學技術，系統地闡明了針刺治療缺血性中風病的科學內涵及療效機理。 In more than 30 years of clinical practice, gradually formed the acupuncture treatment of ischemic apoplexy and the treatment of complication norms and evaluation system. In recent years is introduced advanced research methods and its effect on the comprehensive evaluation system, advanced clinical evidence, and combined with the modern science and technology, systematically expounds the acupuncture treatment of ischemic stroke mechanism of scientific connotation and curative effect.

  38. 針刺可明顯改善各期中風患者神經功能缺損程度Acupuncture can obviously improve the neurologic deficits in stroke patients SSS CSS 臨床研究嚴格按照循證醫學原則進行RCT試驗證明： Clinical studies in strict accordance with the principle of evidence-based medicine RCT experiments prove： NIHSS 39

  39. 針刺可改善各期中風患者日常生活能力，急性期的改善尤其明顯Acupuncture may improve the stroke patients in daily life, especially in the acute phase of improvement BI BI改变量

  40. 6個月隨訪證實，針刺可改善各期中風患者神經功能缺損及日常生活能力的作用6 months follow-up, acupuncture can improve the stroke patients neurologic deficits and daily life 神經功能缺損（SSS） 日常生活能力（SS-QOL） 41

  41. 針刺可降低各期中風患者殘障程度 Acupuncture may reduce the degree of disability in stroke patients 牛津殘障評分（OHS） 76% 63% 66% 33% 40% 40% 后遗症期 恢复期 急性期

  42. 終點指標： End index： 針刺可降低缺血性中風病患者的復發率和死亡率Acupuncture may reduce the recurrence of patients with ischemic stroke mortality 復 發 率 6.7% 15.9% 28.8% 2.2% 4.3% 3.3% 死 亡 率 2.2% 1.1% 1.7% 0 1.1% 0.86% 急性期 後遺症期 恢復期

  43. 安全性評價： Safety evaluation: • 不良反應：未出現嚴重不良反應 Adverse reaction: did not appear serious adverse reactions • 極少數出現輕微不良反應，主要有皮下出血，血腫，疼痛。 A mild adverse reactions, subcutaneous bleeding, hematoma, pain

  44. 本研究獲得了天津市科技進步一等獎 The research of the Tianjin science and technology progress prize

  45. 針刺治療缺血性中風病的機理研究Themechanism research of Acupuncture treatment ischemic stroke 機理研究緊扣中風病的治療難點及突破點，聚焦在神經與血管的再生。研究針刺手段促進損傷後腦迴圈重建及神經細胞再生的作用，從形態學、生物化學、中樞神經機制、分子生物學等方面開展了二十餘項基礎實驗。 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.

  46. 醒腦開竅針刺法對缺血區腦組織的改善 “XNKQ” can improve the brain ischemia area 47 形態學研究，證明針刺可促進側枝迴圈建立 Morphology research that acupuncture can promote collateral circulation 阻斷大腦中動脈後，大腦表面缺血區所見： Block after middle cerebral artery surface area, the brain ischemia 梗塞半球 腦表面缺血區 Cerebral infarction hemisphere surface ischemia 缺血後 自身代償情況 After compensatory. Their ischemia 針刺干預情況 Acupuncture intervention

  47. 醒腦開竅針刺法對病變神經元結構的修復 Acupuncture to repair pathological neuron structure 針刺保護細胞形態、減輕神經元損傷、12h內促進微管微絲等細胞的“骨架”的再生與修復 Acupuncture protect cells form, reduce damage, promote neurons 12h microtubules microfilament cells "skeleton" renewable and repair 針刺3h後： 線粒體輕度腫脹 針刺前： 神經細胞溶解、破壞 針刺 6h後： 線粒體腫脹減輕 針刺12h後： 線粒體完整，出現微管微絲 針刺24h後： 神經細胞基本正常

  48. 醒腦開竅針法對腦梗死患者腦葡萄糖代謝的影響醒腦開竅針法對腦梗死患者腦葡萄糖代謝的影響 Acupuncture in patients with cerebral infarction of the brain glucose metabolism 49 • 醒腦開竅針刺法可以： • 促進病灶周圍功能重組 Promote surrounding function restructuring • 啟動運動功能區域 Activation function area • 促使正常腦區的代償 To decompensation the normal brain areas • 改善與記憶、認知、語言功能和情緒等相關區域的代謝 • Improve memory, cognition, emotion and language functions related areas of metabolism

  49. 丹芪偏癱膠囊 治療中風病的最新成果

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