Who knows acupuncture cerebral infarction Chinese medicine

Overview

Acute cerebral infarction is one of the acute ischemic cerebrovascular diseases, and this section discusses the acupuncture treatment of atherosclerotic thrombotic cerebral infarction. This disease is seen in middle-aged people and above, most of them have a history of high blood too, diabetes mellitus, coronary heart disease or hyperlipidemia. It develops mostly during quiet rest, and a part of patients find symptoms in the early morning after waking up from sleep. Its onset is slower than that of cerebral hemorrhage, and often reaches its peak in minutes, hours, half a day, or even 1 to 2 days. There may be headache on the sick side, but rarely severe pain and vomiting. The patient's consciousness remains clear while hemiparesis, aphasia and other symptoms are more obvious.

The effective rate of acupuncture therapy in treating the acute stage of atherosclerotic cerebral infarction is about 90%, and the efficacy is definite. A large number of practices have shown that this disease can be treated by applying acupuncture alone, and it is further found that the efficacy of acupuncture is better in the infarction of anterior cerebral artery and middle cerebral artery, and worse in the thrombosis of vertebral basilar artery [1]. In addition, the effect of acupuncture is better in surface infarcts of the brain than in deep infarcts. A comparative observation of acupuncture and niacin treatment has been made in patients with acute ischemic cerebrovascular disease, and no significant difference in efficacy was observed between the two groups [2]. The work in the last two decades has confirmed that acupuncture has a definite protective and repairing effect on ischemic brain tissues in terms of pathomorphology, and has multiple regulatory mechanisms for ischemic injury, thus preventing the occurrence and development of ischemia and accelerating the repair of brain tissues. Regarding the early involvement of acupuncture in acute cerebral infarction, it is currently not only advocated in the acute phase (within 24 or 48 hours of onset), but also recommended that acupuncture be intervened in the ultra-early phase (3 or 6 hours). Although further evaluation, screening, and selection of specific protocols for this intervention are needed, there is considerable evidence that the earlier acupuncture is involved in treatment, the more pronounced the protection against ischemic brain injury, including increasing cerebral blood flow, improving cerebral electrical activity and oxygen metabolism, decreasing cerebral edema, facilitating softening and dissolution of clots, decreasing infarct size, inhibiting apoptosis, and improving endothelial cell metabolism caused by acute cerebrovascular occlusion. ATPase metabolism and by regulating the content of cAMP and cGMP and their ratio, it improves the blood supply of brain tissue in the infarcted area.

In recent years, the clinical data on the use of acupuncture for acute cerebral infarction have been increasing, and the acupuncture points and treatments are very rich. However, there is still a lack of rigorous large-sample, multi-center, comparative control between different methods, which reduces the value of clinical guidance to a certain extent. It is necessary to strengthen this aspect of work.

Aetiology

Dialectic typing

Treatment

(1) Body acupuncture (one of them)

1. Acquisition of acupoints

Principal acupoints: Neiguan, ShuiGou.

Complementary points: extreme spring, commission, Sanyinjiao, shakuzawa; pseudo-bulbar palsy plus wind pool, cataract.

2. Treatment

The main point is taken first, and according to the severity and prominence of the disease and the manifestation of symptoms, the supporting points are added.

The treatment method first prick double Neiguan, straight prick 1 inch to 1.5 inches, Shi Tizhi insertion combined with twisting laxative method, running the needle for 1 minute, re-prick Shuigou, to the nasal septum under the diagonal piercing 5 minutes, with the sparrow pecking (tremor) method of laxative to the extent that the tears or wet eyeballs; prick Sanyinjiao, the tip of the needle to the back diagonal piercing, and the skin at an angle of 45 degrees, 1 inch to 1.5 inches, Tizhi insertion tonic, to the extent that the patient's lower limbs jerking 3 times. Extreme spring, straight stabbing needle 1 inch to 1.5 inches, lifting and inserting diarrhea, to the extent that the upper limb twitches 3 times in a row, shakuzawa is the same as extreme spring. Zhizhong, lying on the back and lifting the leg to take the point, 1 inch to 1.5 inches into the needle, using the method of lifting and inserting the diarrhea, to the extent that the lower limb twitches 3 times. Needle Fengchi, needle tip toward the throat, 1.0 inch to 2.0 inches into the needle. Adopt rapid twisting technique and run the needle for half a minute. Needle cataract, same as Fengchi. Needle Hegu, with the needle tip directed obliquely toward Sanma, the lower edge of the second metacarpal bone, using the lifting and inserting diarrhea method. One to two times a day, 10 times for a course of treatment.

3. Therapeutic efficacy

This method is known as the method of waking up the brain and opening up the mind, treating 617 cases of patients with acute cerebral infarction and sequelae stage, according to the above criteria for evaluating the efficacy of cerebral hemorrhage in the stable stage, the clinical cure rate was 59.3%, and the total effective rate was 99.4%, among which, 399 cases in the period of onset of 1 day to 10 days were cured clinically, and 253 cases were cured (63.41%), and the total effective rate reached 99.3%. Through the electrophysiological measurements before and after acupuncture, it was proved that this method has the effect of sedation, hypotension, antispasmodic and awakening [3].

(2) Body acupuncture (bis)

1. Acupuncture points

Principal points: Baihui, Shenting, Daxi, Quchi, Hands Sanli, Hegu, Ashigaru, Yanglingquan, Blood Sea, Yongquan.

Complementary points: dysphagia plus Lianquan, speech disorders plus tongue root.

2. Treatment

Take 4 to 5 main points each time, after deep stabbing and getting qi, Baihui, Shenting, Daxi, Ashigaru, and Handsanli apply twisting and tonifying method, Quchi, and Sea of Blood use twisting and diarrhea, and the rest of the points use lifting and inserting plus twisting and tonifying and diarrhea method. The upper point was operated for 2 minutes, and the needle was left for 30 minutes, with an interval of 5 minutes to 10 minutes to perform the needle once. Can also be connected to the G6805 electroacupuncture instrument, with sparse and dense wave, frequency of 5Hz ~ 10Hz, intensity to the extent that the patient can tolerate. According to the symptoms of discretionary addition of matching points, the upper Lianquan to the root of the tongue in the direction of a deep stabbing 2 inches, after the gas does not leave the needle. Needle 1 ~ 2 times a day, 5 days ~ 7 days for a course of treatment, treatment interval 1 day.

3. Efficacy

The effective rate of treating 199 patients with acute cerebral infarction by this method was 92.31-98.3% [2, 4, 5, 16].

(C) Body acupuncture (ter)

1. Acupuncture points

Principal points: the upper star through the Baihui, Yintang.

Complementary points: Fengchi, Wanjiao, Tianzhu.

2. Treatment

Acute stage of the upper points are used, after the improvement of the disease, discretionary additional points. Yintang point, with 28 1-inch needle along the skin stabbing 0.5 ~ 0.8 inches, first twisting method, twisting amplitude of 360 °, and then bird pecking, continued for 1 minute. Then use No. 28 to No. 30 millimeters needle to penetrate from Shangxing to Baihui, penetrate 2 inches to 3 inches along the skin (segmental penetration method can be adopted), twisting maneuver with small amplitude and high frequency, and continue to run the needle for 1 minute to 5 minutes. Fengchi was needled toward the opposite eyeball, pierced 1 inch to 1.5 inches, and the twisting and tonic method was used for 1 minute. Leave the needle in place for 30 minutes, during which time the needle was transported 3 times respectively. Needle once a day.

This method must be carried out in conjunction with conventional Western medicine therapy.

3. Efficacy

The above method **** treatment of 500 cases of acute cerebrovascular disease patients (including cerebral infarction and cerebral hemorrhage), all in the acute stage of treatment, the results of the apparent effect of 200 cases, effective 125 cases, ineffective 88 cases, 87 cases of death, the total effective rate of 85%. Among them, 228 cases with impaired consciousness, 141 cases survived; 53 cases of deep coma, 10 cases of successful resuscitation [6].

(D) Head acupuncture (one)

1. Acupuncture points

Main points: motor area, sensory area, foot transport sensory area.

Complementary points: shoulder, quchi, waiguan, huanjiao, foot Sanli, taichong.

2. Treatment method

The main point with the head needle method: each time to choose 2 to 3 areas, all needles paralyzed limb of the opposite side of the acupuncture point area (foot transport sense of the area can be used bilaterally). In the selected stimulation area, separate the patient's hair, after routine disinfection, the use of No. 28 2.5 inches to 3 inches long millimetre needle along the scalp diagonal stabbing, according to a certain direction of stabbing to the length of the area should be. With a frequency of 240 ~ 260 times per minute continued twisting the needle for 3 minutes ~ 5 minutes, preferably so that the affected limbs appear numbness and heat, swelling or sweating, leaving the needle for 15 minutes ~ 20 minutes, and then twisting the needle in the middle. It can also be stimulated by pulsed electric stimulation, connected to the G6805 electroacupuncture instrument, with sparse and dense wave, energized for 30 minutes. Head acupuncture 1 ~ 2 times a day, 5 ~ 7 times for a course of treatment. The interval between courses of treatment 1 day ~ 2 days.

Complementary points can be used acupoint injection method, each time to take 2 points, each point injection of 0.5 liters of medicine. The drug is Thromboxane (specification 70mg/2ml). 2 times a day, the course of treatment as above.

3. Therapeutic efficacy

Applying this method to treat patients with acute cerebral infarction 1507 cases, the effective rate is 93.9% to 98.5%. Between the head and body acupuncture, therapeutic efficacy there is no difference? Some people think that there is no difference, and some people suggest that the effect of body acupuncture is better than that of head acupuncture, but most people advocate that the combination of the two, the efficacy is better [7-10].

(E) Head acupuncture (bis)

1. Acupuncture points

The main points: (1) Baihui → Quzhu (Sun); (2) Qianping → Hangxian.

2. Treatment

Any group. For the first group, take a 28-gauge 2-inch needle, from Baihui perpendicularly stabbing into the capitellar tendon under the skin at a 15-degree angle, quickly stabbing along the skin to the curved temples point, into the needle 1.5 inches. Or from Baihui point to the solar plexus line, for the head point penetration point needling area. After routine disinfection with 75% alcohol, with a 28-gauge 2.0-inch millimetre needle along the stimulation zone in three segments of a circular pick up three needles, hands clamped at a 15-degree angle with the scalp in the direction of the direction of stabbing the capitellum under the tendon membrane to a depth of about 1.5 inches. Continuous twisting was required for 3 minutes, with a twisting rate of 200 times/minute or more, with a 5-minute break in between, and then the starting needle was repeated 2 more times. The twisting amplitude was about 180 degrees forward and backward for each direction. For the second group of points, with a 28-gauge 2.5-inch needle, 3 needles were stabbed along the skin in sections from the top to the bottom, and each needle was about 2 inches deep. After the needle into the large rapid twisting, frequency 200 times / min, for 2 minutes to 3 minutes, every rest 5 minutes to 10 minutes and then twist 1 time, 3 times in a row after the start of the needle, 1 time a day, 15 times for a course of treatment.

3. Therapeutic efficacy

After the clinical study of various index observation method, this method can not only improve the motor function of patients with acute cerebral infarction, but also can make the circulating endothelial cell lipid peroxidation content decrease and reduce platelet aggregation, indicating that this method has a selective adjusting effect on the organism [11]. Observed from 40 patients, 35 minutes after the start of the needle, the muscle strength of the upper and lower muscle groups of the patients was significantly enhanced compared with that before the needle (P<0.01) [12]. Observed from 100 cases, its total effective rate was 98.6%-100% [13, 17].

(IV) Eye acupuncture

1. Acupuncture points

Main points: upper and lower jiao.

2. Treatment

The main points are all taken, with the affected side as the main point, and can be combined with the healthy side according to the situation. First, use the eye-pointing stick or three-pronged needle handle in the range of the periorbital region of the eye, gently press the point area, to appear sore, numbness, distension, heaviness, or heat, coolness, and a sense of comfort as the stimulation point. When needling, press the eyeball with the left finger to make the orbital skin taut, hold a No. 32 5-point millimetre needle in the right hand and gently stab it, stabbing straight or horizontally along the skin within the boundaries of the meridian area without using manipulation. According to the symptom, follow the order of the distribution of the eye acupuncture meridian points into the needle for tonic, and vice versa for diarrhea, leave the needle for 5 minutes to 15 minutes, once a day.

3. Efficacy

This method is limited to patients with acute cerebral infarction who are clear, with no deformation of muscles and limbs, and with muscle strength of 0 to 3 degrees. ***Treatment of 453 cases, the total effective rate is around 97% (cure rate 23.1%) [14, 15].

(E) Fire acupuncture

1. Acupuncture points

Main points: Baihui, Shakuzawa, and Zhenzhong.

2. Treatment

Fire needle puncture Baihui, shakuzawa, commission at the floating point of the blood, needle once a day, 10 times a course of treatment, every other day for the second course of treatment. At the same time supplemented with defibrinase 5U added to 250ml saline intravenous drip, once a day, **** 3 days.

3. Efficacy

***Treatment of acute cerebral infarction 66 cases, 36 cases were cured, 17 cases were effective, 9 cases were effective, 4 cases were ineffective, and the total effective rate was 93.9% [18].

(F) Acupuncture point injection

1.Acupuncture point

Main point: Baihui.

2. Treatment

Liquid: sterilized water for injection.

Select the Baihui point, strictly sterilized, the acupoint injection. Each injection of 2ml of water for injection, after injection with a sterilized cotton ball pressure for about 1 minute, every other day. 15 times for a course of treatment. At the same time, static point pulse 500ml plus Chuanxiongzine 160mg ~ 200mg, once a day, 30 days a course of treatment.

3. Efficacy

***Treatment of acute cerebral infarction 84 cases, 42 cases of basic healing, 9 cases of significant progress, 24 cases of progress, no change 9 cases. The effective rate was 89.3% [19].

(VII) Other measures

1. The general treatment in the acute stage is more or less the same as that of cerebral hemorrhage. Special attention should be paid to control blood pressure and blood sugar. Lowering body temperature can reduce the volume of experimental cerebral infarction, so this is also an important measure.

2. For those who are not well treated with acupuncture, cerebral vasodilators and intravenous infusion of low molecular dextrose anhydride can be given appropriately, and traditional Chinese medicines that activate blood circulation and remove blood stasis can also be used, such as Danshen injection.

3, as early as possible to start functional exercise. From passive activities to active sports and even a variety of functional exercises.

Selected Ancient Cases/Masterpiece Cases

Li ××, female, 55 years old, farmer from Jiulong Commune, Jintang County, Sichuan Province. first diagnosed on July 8, 1972

Complaint: Suddenly fell down, unconscious for half a day.

History: the patient's physical abundance, with many years of dizziness and hypertension history, sometimes in recent years, numbness of the fingers. On the morning of the day of consultation, small labor, inadvertently fell to the ground, phlegm sound, the left side of the limbs are not benevolent not to use, mouth and nose skewed, language is not conducive to, in the evening of July 8 in the Department of Acupuncture and Moxibustion treatment.

Examination: slightly reddish color, thick mouth drinking, pale red tongue, thin white moss, smooth pulse, blood pressure 21.3/13.3kPa (160/100mmHg).

Diagnosis: Stroke (cerebral thrombosis), Yang closed type.

Treatment: opening and closing the orifices, calming the liver and extinguishing wind, and activating the channels.

Access points: four groups: (1) Shui Gou, Twelve Wells, Feng Long, Tai Chong through Chung Quan, He Gu through Laogong; (2) Shoulder, Quchi, Waiguan, Foot Sanli, Di Cang through Che Che, Lian Quan, Zyongsiao, He Gu, Feng Fu; (3) Yang Ling Quan, Kun Lun, Nei Ting, Huan Qiao, Ying Xiang through Sibai, Pupil's Bowls, Cheng Siao, Mute Gate; (4) Hand Sanli, Feng Long, He Gu, Tong Li, Xie Xi, Jie Bone, Corresponding Clamping Spine Points, Feng Shi.

Treatment: millipercentrifuge method. When a sudden attack occurs, take the prescription of group (1) to open the orifices and extinguish the wind, and to relieve the urgency of divine dizziness. When the patient is awake, leaving limb paralysis, crooked mouth and eyes and other meridian pathologies, the other three groups of prescriptions are used. Once a day, each time 1 group, exchange rotation. Bilateral acupuncture points, flat tonic and flat diarrhea. 7 to 10 times for 1 course of treatment, rest 3 days to 5 days, and then continue treatment.

The treatment is accompanied by massage and functional exercises. The patient, after treatment for 3 months, blood pressure is normal, throw away the crutches, without assistance, step by themselves, life can basically take care of themselves.

(Yang Jiebin medical case)