【作者】 劳沛良；

【导师】 原林；

【作者基本信息】 南方医科大学 ， 中西医结合， 2011， 博士

【摘要】 背景：中风是临床上一种常见病、多发病。几千年来,中医药在中风的预防和治疗上发挥了重要作用,对降低病死率、减轻致残率都有突出贡献。针灸是中医学重要组成部分,作为有效的非药物治疗手段,因其具有疗效确切、便于操作、副作用小、安全等特点,所以,在现代医学飞速发展的今天,针灸仍然有着旺盛的生命力。历代中医方书汗牛充栋,关于中风防治方面有大量的有效经验.中风属心脑血管疾病,是危害人类的第一杀手,远高于癌症。中医称本病为”卒中”、”中风”。是由于阴阳失调,气血逆乱,上犯于脑,所引起。以突然昏仆,不醒人事,半身不遂,口眼歪斜；或不经昏仆,仅以半身不遂,口眼歪斜,言语不利,偏身麻木为主要表现的一种病症。西医称为脑血管病,是脑部血液循环障碍引起的急性脑功能损伤的一组疾病。临床特点为起病急骤,迅速出现神经功能缺失症状。存活者存在不同程度地丧失劳动能力,重度致残者可达40%以上,脑卒中也是脑血管性痴呆的主要原因。我国乃脑卒中的高发国家之一,发病率与日本接近,高于西方国家。中风后遗症分为出血性和缺血性两大类。出血性主要包括脑出血和蛛网膜下腔出血,缺血性包括短暂性脑缺血发作、脑血栓形成与脑栓塞。中风后遗症患者在急性期过后,应进行康复治疗。泗滨砭石可明显改善局部微循环,加快血流速度,疏通经络,故笔者把泗滨砭石疗法应用于中风后遗症的治疗,并取得了满意的疗效。中医学,在中华文明上下传承过程中,担负举足轻重的作用,在国人防病治病特别是科技不发达时代的预防保健过程中不可或缺,是被实践证实了的历代中医文人志士的经验总结。不仅在中国,在欧美发达国家,随科技的发展、文化交流的加速和人民对绿色治疗手段的要求,中医理论指导下开展的治疗手段广泛作为补充或替代治疗而开展。传统中医学核心之一的经络学说及针灸实践,吸引大量国内外广大学者对它进行深入研究。回顾针灸经络研究史,我国投入大量资金和人力物力进行多学科综合性研究和攀登,历经五十多年研究高峰时期,设立“八五”和“九五”的经络研究攀登计划,进行临床、实验、机理等多方面的研究,证实了经络客观存在性、循经感传性、经穴-脏腑相关性,进一步发现经穴具有跨体节传导性、循经双向传递性、高温发光性、低阻高导性、钙离子富集性等特征。综观几十年经络探秘,各种假说纷至沓来,争议不断,难以趋同。最大的裂谷莫过于“功能”与“结构”、“整体”与“局部”之间的矛盾。经络研究逐渐形成神经生理学派-神经传导学说、生物物理学派-生物场学说、生理生化学派-体液循环学说,但众多学说各执一词,只从单个侧面或角度证实经络的存在但未曾囊括全部。从原林教授提出人体结构的结缔组织“筋膜支架,,和H.MLangevin提出全身疏松结缔组织在人体构成“片状网络支架”和“信号网络’”的观点后,研究人员逐渐认识到此结构在人体的重要性。原林教授课题组在承担国家863计划“数字化虚拟中国人的数据集构建与海量数据库系统”项目的过程中,通过对人体结缔组织构成的筋膜支架进行标记和计算机三维重建后,可得出筋膜在人体内从浅入深由5种结构构成：真皮致密结缔组织；皮下疏松结缔组织；肌肉表面疏松结缔组织；肌间隔和肌间隙结缔组织；内脏器官门、被膜和内部间隔结缔组织。并通过研究国标人体14条经络361个穴位的进针部位和手法,发现穴位针刺部位均位于筋膜的不同层次,而位于肌间隔和肌间隙结缔组织者最多,其次是真皮致密结缔组织层和皮下疏松结缔组织层,位于肌肉表面疏松结缔组织(深筋膜)和内脏器官门、被膜和内部间隔结缔组织最少。原林教授通过对发育生物学的探究,提出：中胚层间充质分化成多个器官系统后,所剩下的部分构成遍布全身的“筋膜支架”。该支架以细胞为主体,建构了遍布全身相互沟通的空间“信息网络”,该系统在神经、体液、免疫的参与下为其他功能细胞的再生提供细胞储备和支持,同时检测和调控机体内环境的变化,也即“支持与储备系统”新观点。该课题组在实验中也利用超声、CT、MRI等医学影像手段和我国数字人海量数据集认为：在针刺的过程中,通过提插、捻转等操作,可带动亦或牵动周边较大范围的结缔组织。一般当针灸针尖到达外肌膜时出现“得气”现象,而针尖到达肌肉时其“得气”减弱,若针尖停留在外肌膜上再增加刺激,“得气”感又会增强；中医学认为人体存在经穴也有阿是穴,经穴主要循经分布而阿是穴没有固定位置,由此提出全身的结缔组织支架可能是针灸经络的解剖学物质基础；穴位是在结缔组织支架上在针刺进行提插和捻转时能产生较强生物学信息的部位；穴位与非穴位仅是信息量的差异而没有质的区别；从广义的角度来讲,全身各个部位均是穴位,原因在于几乎所有人体的组织器官之间的间隙均有结缔组织存在。古代记载的穴位是人体结缔组织聚集处,刺激这些部位后,可通过自身的神经调节、体液调节等发挥疗效。我们从发育生物学入手,探索个体胚胎发育的过程,模式化分析筋膜结缔组织的生物进化。通过对人体结缔组织支架--经络进行发育生物学和生物进化起源的逐本溯源,我们发现在个体发育的过程中由中胚层间充质分化成多个器官系统后所遗留的部分形成遍布全身的结缔组织筋膜支架；在生物进化的过程中,单胚层生物的细胞外基质与二胚层生物的中胶层、三胚层生物的间充质及人体非特异性结缔组织为同源结构。人体的非特异性结缔组织支架为已分化组织细胞提供支持和支撑作用,并为这些功能组织细胞的修复、再生提供细胞储备及生存的环境。人体由遍布全身的结缔组织支架所构成的支持与储备系统和被该支架所支持和包绕的各种功能细胞所构成的功能系统所构成。支持与储备系统为功能系统的各种细胞提供稳定的机体内环境,并为功能系统各种细胞的更新、修复提供源源不断的细胞供应,同时对其功能和更新修复进行调控。对支持与储备系统(筋膜支架)自身机制的研究和该系统与功能系统(各种功能细胞)相互作用的研究领域称之为筋膜学。目的：中风病具有高死亡率、高复发率及高致残率等特点,其后遗症表现为不同程度的偏瘫,语言障碍和智力减退。在中风后遗症的治疗中,改善患者肢体功能,提高患者的生活质量,成为我们努力的目标。本研究随机对照试验,观察泗滨砭石优化方案在临床治疗中风后遗症的疗效与优势。研究泗滨砭石优化疗法治疗中风后遗症的疗效并探讨作用机理。方法：采用随机对照研究方法,自广州南方医院选择60例病例,就诊前均经西医明确诊断,西医诊断标准参照1995年中华医学会第四次全国脑血管病学术会议修订的《各类脑血管疾病诊断要点》,中医症候诊断参照1996年国家中医药管理局脑病急症科研协作组起草制订的《中风病诊断疗效评定标准》。按简单随机分组方法,分治疗组与对照组,两组取穴均参照32篇文献中,26篇选取体针作为主要治疗方法,其中包括十四经选穴、醒脑开窍针法及其他方法,在临床上多采用体针、头针、靳三针结合治疗本病。分别设立泗滨砭石优化方案组、单纯按摩组。将泗滨砭石优化方案和单纯疗法比较。两组均使用基本的对症治疗药物,如降压药、降脂药、降糖药等,前四天根据病情可给予甘露醇静滴,随后给予丹参针6m1静滴12天,后12天给予胞二磷胆碱针0.25g静滴。并记录合并用药的名称,剂量,使用时间。试验组与对照组的病例数相等。参照1996年制定的《中风病诊断与疗效评定标准》及日常生活能力量表(Activity of Daily Living Scale ADL)Barthel指数(BI)记分法、《脑卒中患者临床神经功能缺损程度评分标准》制定量表,治疗前后分别填写,临床试验结束后分别进行评分,汇总资料,进行统计分析。结果：治疗组30例,基本痊愈6例,显著进步15例,进步8例,无变化1例。对照组30,基本痊愈3例,显著进步6例,进步11例,无变化10例。两组总有效率Z=-3.244,P=0.001。两组差异有统计学意义；在提高日常生活能力方面,治疗组效果显著(Z=-2.91,P=0.004)；两组治疗均能改善病人的神经功能缺损症状,而治疗组的疗效显著(Z=-3.024,P=0.002)。结论：泗滨砭石优化疗法治疗中风后遗症疗效肯定,是治疗中风后遗症的有效治疗手段。泗滨砭石疗法可以改善微循环,加快血流速度,疏通经络,从而增强肌力,恢复肢体运动,故对脑血栓后遗症有显著疗效。泗滨砭石石疗法具有副作用小、疗效快、便于操作、患者易于接受,故应在临床推广应用。更多还原

【Abstract】 Back groundStroke is a clinically kind of common disease, frequently-occurring disease. For thousands of years, Chinese medicine on the prevention and treatment in stroke play an important role of mortality, ease morbidity have outstanding contribution. Acupuncture is an important part in traditional Chinese medicine, as effective non-drug treatment, due to its efficacy precise and easy operation, small, safety features side effects, so, the rapid development of modern medicine, acupuncture today still has strong vitality. In TCM books recorded about stroke prevention and plenty of effective treatment experience.Stroke is a kind of heart head blood-vessel, is harmful to human as the first killer more than the cancer. Chinese medicine named the disease as "stroke" and "stroke". Due to the imbalance of Yin and Yang, qi and xue committed to the inverse disorderly to brain. With a faint servant and unconscious, half-paralyzed, mouth eye skewed; Or not only by the faint servants, with half-paralyzed, mouth and eye skewed, words adverse, partial body numb as the main manifestation of a disease. Modern medicine called cerebral vascular accident (C.V.A.), is the brain blood circulation barrier acute cerebral function caused by a group of diseases. Damage Clinical characteristics, is characterized by rapid appear neurologic deficits symptoms. Survivors there exists different degree to lose labor ability, severely disabled person can reach to 40%, and stroke is the main cause of cerebral sex dementia. Hemorrhagic mainly include cerebral hemorrhage and subarachnoid hemorrhage, ischemic including transient ischemic attack, cerebral thrombosis and cerebral embolism. Apoplexy Sequela patients after acute period in, should undertake rehabilitation therapy. Sibin Bian-stone can obviously improve local micro-circulation, accelerate the blood flow velocity, channels, so the author put Sibin Bian-stone Needling therapy the treatment of Stroke Sequela, application and satisfactory curative effect.Chinese medicine for thousands of Chinese culture as a crystallization of Chinese civilization in the process of upper and lower transmission plays an important role in Chinese science and technology to prevent and cure diseases, especially of the time developed an indispensable process of preventive health care, are confirmed in practice scholars of the ancient Chinese medicine experience lofty ideals, for which won the admiration of the public. In recent years, with the development of technology, cultural exchanges and people to accelerate the treatment of Green’s request, in theory under the guidance of traditional Chinese medicine treatments not only in the Chinese residential area but also in Europe and the United States developed regions such as the United Kingdom, Germany, France, Belgium, the Netherlands, the United States, Canada extensively as a supplement or alternative treatment which is carried out. In recent years, with the development of technology, cultural exchanges and people to accelerate the treatment of Green’s request, treatments under the guidance of traditional Chinese medicine are carried out not only in the Chinese residential area but also in Europe and the United States developed regions such as the United Kingdom, Germany, France, Belgium, the Netherlands, the United States, Canada extensively as a supplement or alternative treatment. As the one of core of traditional Chinese medicine, the meridian theory, or the needle, moxibustion practice under the guidance of the meridian theory attract vast numbers of scholars to study it. Recalling the history of acupuncture meridians study, there has two climax periods in abroad from fifties to sixties of twentieth century and from the end of the twentieth century to now. Japan (Ryukyu countries) and Korea (Korea country) exchange culture with ancient china closely, but the "Golden Wind Han," Case stop the enthusiasm and led to the climax to End. Because of economy, technology, talented scholars, the United States far away in the western hemisphere had paid much attention to Acupuncture and Meridian Research and now they have a number of research papers published in SCI and had raised several hypothesis. As Chinese, we have the duty to clarify the mechanism of acupuncture and meridians. Therefore, our country has invested substantial funds and a large number of scholars to study it, and has established "eight-five" and "nine-five" meridian climb research projects. Clinical, laboratory research confirmed the objective existence of meridians, and further found that Meridian has a cross-section of conductive body through by a two-way transmission, and low resistance, high conductivity, high temperature luminescence, and calcium ion concentration of characteristics of the population. Summed up decades researching, there had difficulties to unify the various theories. The biggest rift existed between "functional" and "structure", "overall" and "partial". Since the HM Langevin proposed the standpoint of loose connective tissue in the human body constitutes a "flaky network support" and "signal network", the researchers come to realize the importance of structure in our bodies. It is worth mentioning that the Professor Yuan Lin Research Group think that fascia in the human body from the shallow into the deep structure has five kinds of components:1, dermal dense connective tissue; 2, subcutaneous loose connective tissue; 3, muscle surface of loose connective tissue; 4, muscle and muscle clearance interval connective tissue; 5, door internal organs, connective tissue envelope and internal partitions.Group by studying the human body 14 GB 361 meridian acupuncture points needling sites and methods and found that parts of the body acupuncture points are located at different levels of the fascia, which is located in muscle connective tissue gap spacing and muscle up, followed by dense dermal connective tissue layer and the subcutaneous loose connective tissue layer, a small number of loose connective tissue at the muscle surface (deep fascia) and the internal organs door, envelope and internal partitions of connective tissue. By combination the above-mentioned studies and the developmental biology, Professor Yuan Lin research group pointed out:in multi-cellular organisms, mesenchyme is derived from jelly-like Extra-cellular Fluid (ECF) and further differentiates into many cell types, tissues, even organs. In higher creatures like human beings, mesenchyme gives rise to all the fascia tissue throughout the body. The fascia form support the framework of connective tissues to growth of cells of all except for framework the central nerve system, can be regarded as one functional organs and therefore this of the essential elements of the internal environment for all kinds of living cells. Functionally, the connective tissue framework not only provides a soft support of the body but also maintains the systemic balance by regulating the neural reflexes, neuroendocrine activity, neuroimmunity, and by repairing the cell and tissue injuries. Therefore, they put forward a hypothesis that an auto-surveillance system may exist in the human body, which differs essentially from the nine established functional systems. The auto-surveillance system has two main functions. One is to regulate the functional state (metabolic activity and excitation), such as neural reflex regulation and neuroendocrine regulation. The other is to regulate the state of life activity (cell division, growth and apoptosis), including cell division and growth regulation through the sympathetic nerves and cell apoptosis regulation through lymphocyte-mediated immunity. In human, the auto-surveillance system is composed of the connective tissue network which monitors and regulates living and functional conditions of tissue cells. The group’s study by using ultrasound, CT, MRI and other medical imaging tools consider:In the course of acupuncture,by interpolation or twist, you can drive or affect a large scope of the connective tissue; When the acupuncture needle generally arrive outside the sarcolemma, a sense "de qi" occurs, when the needle arrival the muscles, the sense "de qi" weaken, if the needle stays on outer sarcolemma to increase the excitement, this sense will enhance; By using CT images, we have built strip structure which run along the meridian. But group also acknowledged the existence of inconsistent line structure. Contrast to the record in Chinese medicine books:group think that:records related to acupuncture points:Systemic connective tissue scaffold may be the material basis of the meridian; the acupuncture point is the site which can generate strong biological information in the connective tissue scaffold; the difference between acupuncture point and non-acupuncture point is only the amount of information and not the t qualitative difference. From a broad perspective, all parts of the body are acupuncture points, because connective tissue exist almost all the body’s tissue gap.On the other hand, acupuncture points were located mainly at certain connective tissue sites, such as the muscular septa of limbs, sensory nerve endings, internal organs with rich sensory nerve distribution, and mesenteries of viscera. Basing on the results of our research and the literature on meridians and acupuncture points, as well as their diversities and clinical applications, we have put forward the following opinions:The basis of the meridian is the connective tissue framework. Manipulation on connective tissue sites of the body can generate strong biological information, such as sensory information, stretch and injury stimuli of the local tissue. ’Acupuncture points’ and ’Non- acupuncture points’ of the whole body can generate different amount of biological information but without qualitative difference. In other words, acupuncture points are located everywhere of the body. There is a multileveled anatomical relevance between acupuncture points and disease sites in local structures, spinal cord segments, nerve pathways and central nerve distributions. The mechanism of acupuncture is to mechanically stimulate connective tissues to generate biological effects, which regulates the body functions and life activities.According to the current research in Traditional Chinese Medicine (TCM), meridians and acupuncture points have commonly been related to connective tissues. When using Tomography and Visualized Human Techniques to mark connective tissue sites of the cadaver and to create the three-dimensional reconstruction, we found that the traditional meridians and acupuncture points closely matched to our reconstruction. Furthermore, when marking all the connective tissues in the body, a complete body-shaped framework appeared. Therefore, we draw the conclusion that the connective tissue framework is the anatomical basis of the meridian.To explore a theoretical support of our opinions, we looked back into developmental biology, the developmental process of an individual embryo, and the biological evolution of fascia connective tissue. We find that the connective tissue framework is derived from the leftover of the mesenchyme after it differentiates into variable organ systems. The extracellular matrix of a single germ layer organism, the mesogloea of a two germ layer organism, the mesenchyme of a three germ layer organism, and the non-specific connective tissue of the human are all homologous structures. The non-specific connective tissue framework in the human body provides cell storage and maintains the stability of internal environment by cell proliferation and differentiation, cell repair and regeneration. Therefore, we proposed a new anatomical approach to the human body from a dynamic view, which is the two-system theory. In this theory, the human body can be classified into two systems. One is the supporting-storing system consisting of undifferentiated non-specific connective tissues. The other one is the functional system consisting of various differentiated functional cells. Basing on this theory, we further propose a research area, Fasciaology.The human body is composed of the supporting-storing system formed by connective tissue framework and the functional system which consists of various functional cells surrounded by the framework. The supporting-storing system supplies various cells to renew and repair aging cells in the functional system to sustain a stable internal environment. The study on the mechanism of supporting-storing system, which is also called fascial framework, and its interaction with the functional system, which refers to various functional cells, is called Fasciaology.ObjectiveStroke is our common disease. The disease is characterized by multiple complications, high morbidity, re-current strong performance in varying degrees of paralysis, language barriers and mental deterioration. The treatment of Stroke Sequela can improve physical function of patients and improve the quality of life of patients and become the focus of our efforts. Through this program of research is to illustrate the optimal acupuncture treatment for stroke after-effects in clinical efficacy and superiority.To observe the elinieal effect of applying Sibin Bian-stone needling therapy in treating post-stroke patients of the deficient and blood stasis syndrome. MethodSixty post-stroke patients from Southern Hospital Guangzhou were chosen to participate in the study. Their diagnostic requirements were met according to the Forth National SymPosium of Cardio-vascular Disease Diagnostic Standards held in 1995 and the Chinese Medical diagnostic standards of stroke. The Patients were randomly divided into treatment and control groups. The patients were both treated with the same set of acupoints, but the treatment group used the Sibin Bian-stone Needling method, while the control group used massage. Both groups were using the basic symptomatic therapy, such as antihypertensive drugs, lipid-lowering drugs, hypoglycemic agents, etc., the first four days may be granted under the condition of mannitol infusion, and then give Salvia needle for 12 days to 12 days after citicoline choline needle. Experimental group and control group equal to the number of cases. The patients’progress was observed according to the criteria set in 1996 for stroke diagnostic standards and using the Barthel’s Activity of Daily Living scale (ADL), and neurological function assessment. The data were collected and analyzed statistically.Results30 patients treated, the basic cure 6,15 cases of significant progress, progress in 8 cases, no change in 1 case, the total effective rate was 96.7%.Control group of 30 are recovered in 3 cases,6 cases of significant progress, progress in 11 cases, remained unchanged in 10 cases, the total effective rate 66.7%.The total effective rate Z=-3.244,P<0.05. However, with respect to the degree of improvement in clinical symptoms, the treatment group was more significant than the control group(p<0.05).The patients in the treatment group had a better ADL Score(Z=-3.244, P=0.001), and a very significant improvement in their neurological function (Z=-2.91, P=0.004)than the control group after treatment. The difference between the two groups was significant(Z=-3.024, P=0.002). ConclusionSibin Bian-stone needle treatment is effective for Stroke Sequela, and also is an effective treatment for Stroke treatment complications.更多还原