课件：针灸在脑血管病治疗和康复中的应用.ppt

,针灸在脑血管病 治疗和康复中的应用,The Application of Acupuncture In Cerebrovascular Disease,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 name of acute Cerebrovascular disease with a common feature of neurological deficit.,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 mortality, high disability rate, high recurrence rate and multiple complications,流行病学-Epidemiology,Global pidemic,mortality of stroke,With the widespread application of CT and MRI(magnetic resonance imaging technology) and improvement of treatment level, the mortality of stroke has decreased,CT,Treatment level,MRI,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,Disability rate 50% -80%,slurred speech,muscle atrophy,hemiplegia,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: hemiplegia, 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,促进脑血管 侧枝循环的建立 promote the establishment of cerebral collateral circulation,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,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” acupuncture 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.,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 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.,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 application of scientific accomplishments in acupuncture science we have respectively won the first and the second national prizes.,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 traditional Chinese Medicine and the Specified materials of U.S. Board of Examiners,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,“醒脑开窍针刺法” 在中风不同时期的应用 XNKQ ACUPUNCTURE THERAPY Application In Different Stage of Stroke,醒脑开窍针刺法,XNKQ ACUPUNCTURE THERAPY,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 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.,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 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.,1双侧内关-bilateralNeiguan,手厥阴心包经 PC 6,the Pericardium Meridian of Hand-Juejin,2人中-Renzhong,督脉 DU 26,the DU Meridian,3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,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，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,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 26,操作方法 -Manipulation,主穴,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,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,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 Meridian,4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,1印堂-Yintang,经外奇穴 EX-HN 3,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 -Manipulation,主穴,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,操作手法同主穴之方 The manipulation is same as Mainpoints ,三 阴 交 Sanyinjiao (SP 6),操作方法 -Manipulation,主穴,内 关 Neiguan (PC 6),“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 and 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,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 later,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 stroke,National standard of diagnosis and evaluation for stroke1986year,中风先兆的治疗 The Treatment In Aura Phase of Stroke,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 transient 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.,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,Neiguan、Renzhon、Yintang、 Shangxing、Baihui、Fengchi,weakness and numbness of Upper limb: Jiquan、Chize are added,weakness and numbness of limb: Wenzhong、Sanyinjiao are added,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 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,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 Bladder 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,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 needle in high frequency and small amplitude for 1 minute to each acupoint.,Fengchi(GB20),操作方法 -Manipulation,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,中风急性期的治疗 The Treatment In Acute Phase of Stroke,1双侧内关-bilateralNeiguan,手厥阴心包经 PC 6,the Pericardium Meridian of Hand-Juejin,2人中-Renzhong,督脉 DU 26,the DU Meridian,3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,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 Bladder Meridian of Foot-Taiyang,针刺处方-Point Prescription,操作方法同前介绍 The Manipulation of these points is same as before.,操作方法 -Manipulation,中风急性期常见并发症的治疗 The Treatment of Common Complications During The Acute Phase of Stroke,3.吞咽障碍 difficulty of swallowing,加风池、翳风、完骨 Fengchi(GB 20),Yifeng(SJ 17) and Wangu(GB 12) are added,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,1椎基底动脉供血不足 insufficienc of Vertebrobasilar,加凤池、完谷、天柱 Fengchi(GB 20),Wangu(GB 12) and Tianzhu(BL 10)are added,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,配 穴 Point Modification,加丰隆、左侧水道、归来、左侧外水道、归来 Shuidao(ST40), Guilai(ST29) Waishuidao(EX-CA), Waiguilai(EX-CA) and Fenglong(ST 40),7.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 Qiuhou(EX-HN7),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 circulation,1.改善椎基底动脉供血-Improve the Vertebrobasilar,操作方法 -Manipulation,2.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 stroke, 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.,人迎-Renying,足阳明胃经 Stomach Meridian 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,人迎，直刺11.5寸，见针体随动脉搏动而摆动，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,合谷、太冲，均直刺0.81寸，施用捻转泻法1分钟； Puncture Hegu(LI 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 -Manipulation,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 acupoint matching have very ideal therapeutic effect.,3.吞咽障碍-difficulty of swallowing,操作方法-Manipulation,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.,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,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 the acupuncture treatment aslo play a very important role,4.语言不利-slurred speech,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- 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,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,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,针外水道、外归来、丰隆 Puncture Waishuidao(EX-CA), Waiguilai(EX-CA) and Fenglong(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,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 lobule) , stroke patients, especially elderly patients ,can not control their urine,7.尿失禁、尿潴留 Incontinence of Urine, Retention of Urine,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,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).,9.复视-Double Vision,针凤池、天柱、晴明、球后 Puncture Fengchi(GB 20), Tianzhu(BL 10), Jingming(BL 1) and Qiuhou(EX-HN7),目内眦上方凹陷处 大约向内上0.1寸,当眶下缘外1/4与内3/4交界处,Fengchi(GB 20),后发际正中旁开约2厘米,Jingming(BL 1),Qiuhou(EX-HN7),中风恢复期及后遗症期 常见并发症的治疗,The treatment of common complications during the stable and sequelae phase of stroke,2.足内翻 strephenopodia,加丘墟透照海 penetrating method from Qiuxu(GB 40) to Zhaohai(KI 6) is used,加合谷、上八邪 Hegu (LI 4) ，Shangbaxie(EX-UE9)are added,3.肩周炎 Frozen shoulder,加肩髃、肩髎、肩贞、肩中俞、肩外俞 痛点阿是穴刺络拔罐 Jianneiling(EX-UE), Jianliao(SJ 14), Jianzhen(SI 9), Jianzhongshu(SI 15), Jianwaishu (SI 14).,4.血管性痴呆 Vascular dementia,加百会、四神聪 、四白、太冲 Baihui (DU 20), Sishencong(EX-HN1), Sibai(ST 2) and Taichong(LR 3).,加大陵、鸠尾 Puncture Daling(PC 7), Jiuwei(RN 15),6.睡眠倒 Paradoxic Sleep,加上星、神门 Puncture Shangxing (DU 23), Shenmen(HT 7),脑卒中后遗症的患者多由于上肢屈肌张力增高出现手指握固，严重影响患者的生活自理 In stroke sequelae period, for the flexor hypertonia of upper limb, solid finger grip which seriously affecting patients self-care is existed in many patients.,1.手指握固 - stiff fingers,操作方法-Manipulation,配 穴,合谷针向三间穴,Hegu(LI 4) toward Sanjian(LI 3),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 patients second finger or five fingers extended freely,进针11.5寸，采用提插泻法，使患者第二手指抽动或五指自然伸展为度,上八邪,Shangbaxie (EX-UE 9),合谷针向三间穴,Hegu(LI 4) toward Sanjian(LI 3),上八邪,Shangbaxie (EX-UE 9),操作方法 -Manipulation,丘墟透向照海穴,Qiuxu(GB 40) to Zhaohai(KI 6),约1.52寸，局部酸胀为度。,Puncture Qiuxu (GB 40) 1.5-2 cun in depth with the needle tip toward Zhaohai(KI 6),until soreness and distension occurred locally.,2.足内翻-strephenopodia,3.肩周炎-Periarthritis of Shoulder,针肩髃、肩髎、肩贞、肩中俞、 肩外俞，痛点刺络拔罐 Puncture Jianyue(LI 15), Jianliao(SJ 14), Jianzhen(SI 9), Jianzhongshu(SI 15), Jianwaishu (SI 14).Apply blood letting and cupping method to the local pain point.,Jianwai shu (SI 14),Jianzhongshu(SI 15),Jianyue (LI 15),Jianliao(SJ 14),Jianzhen(SI 9),4.血管性痴呆-Vascular Dementia,针百会、四神聪、四白、太冲 Puncture Baihui (DU 20), Sishencong(EX-HN), Sibai(ST 2) and Taichong(LR 3).,前正中线，入前发际5寸,两目正视，瞳孔直下眶下孔中,在足背侧，当第1跖骨间隙的后方凹陷处,Baihui (DU 20),Taichong(LR 3),Sibai(ST 2),针刺治疗症状性癫痫有较好的控制作用，有助于减少或停止抗癫痫药物应用 Acupuncture treatment has a better control effect for symptomatic epilepsy and contribute to reduce or stop the application of anti-epileptic drugs,5.癫 痫-Epilepsy,癫 痫-Epilepsy,针大陵、鸠尾 Pu