【作者】 区智坚；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 背景：中风包括现代医学的脑出血,蛛网膜下腔出血,动脉血管瘤破裂及脑梗塞等脑血管疾病。由于本病所造成的大脑器质性病变,除在临床上出现一系列神经系统体征外,尚可发生发音、构音等语言障碍,称之为中风失语。语言障碍亦即失语症(aphasia)是脑损害导致的语言交流能力障碍,包括各种语言符号(口语、文字、手语)等表达或理解能力受损或丧失。患者意识清醒,无精神障碍或严重认知障碍,无视觉听觉缺损和口、咽喉、舌等发音器官肌肉瘫痪及共济失调,却听不懂别人或自己讲的话,也不能表达,不理解或写不出病前会读、会写的字句等。实是“有口难言”,正如俗语所言“哑吧吃黄连,有苦自己知”,未能畅所欲言,真苦不堪言。中风后语言障碍的病机在于人的语言与五脏六腑的生理功能有着密切关系。若脏腑功能正常,气血调和,阴平阳秘,则意识清明,思维敏锐,语言流利。但是语言与心、脑、肾的关系最为密切。心主神志而开窍于舌,手少阴之别系舌本,脑为元神之府,脑髓充盈则语言正常,肾藏精,足少阴之经脉系于舌本。因此,心、脑、肾等脏腑生理功能正常,则发音、构音等语言功能亦正常,若肾精亏损,津液不能上承,或痰瘀互结,蒙蔽心窍,舌窍失灵,或血郁于脑,神失所主,均能导致语言功能障碍,轻者语言不利,重者失音不语。靳瑞教授所创的“靳三针”之舌三针临床疗效显著,其舌Ⅰ针为廉泉,又名舌本,为任脉脉气所发,该穴的深部正当舌体根部,与舌体的运动有密切关系。舌Ⅱ针和舌Ⅲ针分别称为左、右旁廉泉。针刺舌三针,不但加强了舌体根部刺激,而且有取合谷刺的含义,正如《灵枢.官针》“合谷刺者,左右鸡足,针于分肉之间,以取肌痹,此脾之应也”。舌体根部是心包经、脾经任脉所经过之处,取舌三针行合谷刺,加强了针刺的强度,促使语言功能恢复。目的：通过随机、对照、单盲的临床研究,运用舌三针治疗中风后运动性失语,对患者的临床疗效、语言障碍程度、语言能力评分的疗效指标进行观察评价,综合判定舌三针治疗的临床疗效。以期对此作出客观科学的评价,并为多种疗法配合使用治疗运动性失语提供新的思路和理论依据。方法：按随机、对照、单盲的基本原则,将符合纳入标准的门诊中风后运动性失语患者60例按随机数字表随机平均分成2组：针刺组及对照组,针刺组采用舌三针治疗、对照组采用常规中风后针法。分别于治疗前后对患者临床疗效、语言功能评分,然后进行统计学分析。为进一步详细研究不同时期的中风后运动性失语患者的疗效,舌三针组及对照组内均分为3个小组,每组内根据患者中风后到就诊时之时间划分为三小组：第1小组----中风后30天至60天(各有8例)；第2小组----中风后60天至90天(各有9例)；第3小组----中风后90天至120天(各有13例)。(1)第一组(舌三针组)：采用舌三针疗法治疗。取穴：舌Ⅰ针、舌Ⅱ针、舌Ⅲ针；针具：天协牌28号0.35×25mm,0.35×40mm,0.35×50mm一次性使用的不锈钢针,苏州天协针灸医疗器械有限公司；操作方法：患者取仰卧位,医者用75%的酒精棉球将局部进行常规消毒后。取穴采用先左后右,先上后下的原则,术者双手持28号0.35×50mm的不锈钢针毫针,单手快速进入,针尖向舌根方向呈45°-60°斜刺入0.8-1寸,在得气的基础上,行提插捻转手法20s,使患者舌根有酸麻胀痛感并发出声音者佳,留针30min,每10min捻转1次,每次捻转20s,行平补平泻手法,出针后鼓励患者尽量大声说话。另配取四神针,颞三针,智三针；上肢配取外关、后溪、合谷；下肢配取足三里、申脉、太冲。针刺头皮针时,选用0.35×25mm毫针,常规75%乙醇局部消毒,采取沿皮平刺,针刺深度为0.8-1寸,以患者得气为度,留针30min,每10min捻转1次,行平补平泻。针刺肢体穴位时,选用0.35×50mm毫针,常规75%乙醇局部消毒,采取直刺,针刺深度为25-35mm,提插捻转,以患者得气为度,留针30min,每10min捻转1次,行平补平泻。(2)第二组(对照组)：采用常规中风后针法。①取穴：四神针,颞三针,智三针；上肢配取外关、后溪、合谷；下肢配取足三里、申脉、太冲。②针具：天协牌28号0.35×25mm,0.35×40mm,0.35×50mm一次性使用的不锈钢针,苏州天协针炙医疗器械有限公司；③操作方法：患者取仰卧位,医者用75%的酒精棉球将局部进行常规消毒后。取穴采用先左后右,先上后下的原则,针刺头皮针时,选用0.35×25mm毫针,常规75%乙醇局部消毒,采取沿皮平刺,针刺深度为0.8-1寸,以患者得气为度,留针30min,每10min捻转1次,行平补平泻。针刺肢体穴位时,选用0.35×50mm毫针,常规75%乙醇局部消毒,采取直刺,针刺深度为25-35mm提插捻转,以患者得气为度,留针30min,每10min捻转1次,行平补平泻。以上各组均嘱患者日常生活注意保暖、避风寒,适当营养饮食,调情志。以上各组每周治疗两次,十次为一疗程,共治疗3疗程后进行第一次评定各组临床疗效、作语言改善程度、语言功能评分。再治疗3疗程后进行第二次评定各组临床疗效、进行语言改善程度、语言功能评分。结果：1.针刺组的疗效优于对照组(P<0.05),2.治疗前,语言功能程度两秩和检检比较(P>0.05),差异无显著性意义,雨组病例之间(包括3个小组)均具有可比性。治疗后语言改善程度、语言功能评分针刺组、对照组比较有显著性差异(P<0.05)。结论：中风后运动性失语患者以半身不遂、言语蹇涩、发音不清、咬字不正、说话含糊,甚或发单音亦有困难,语速很慢,甚至完全说不出,很难用准确的语言表达自己的意思。舌三针能逐步改善症状,临床疗效明显优于常规针刺法。在治疗三个月后语言表达有进步,可勉强将一些内心感觉及对周围事物的触觉清楚用口语慢慢讲出来。在治疗六个月后,患者在舌三针治疗下已见说话流畅度加强,咬字及构音清晰,应对及反应明显进步,对自己的感受及感觉表达已可流畅发挥。两组比较WAB评分结果说明舌三针组比对照组更优越。更多还原

【Abstract】 BackgroundStroke can occur when an aneurysm (a blood-filled pouch that ballons out from an artery) ruptures, flooding the surrounding tissue with blood which is named as hemorrhagic stroke. There are two kinds of hemorrhagic stroke which includes a blood vessel reptures, disrupting blood flow to part of the brain name Subarachnoid Hemorrhage and Intracerebral Homorrhage which occurs when a blood vessel bleeds into the tissue deep within the brain. This type of hemorrhage is responsible for more than ten per-cent of all strokes. Chronically high blood pressure or aging blood vessels are the main cause of this type of stroke. Clinically, a stroke can affect a person’s ability to speak. Symptoms are typically related to the specific areas such as Broca’s, Wernicke’s and other areas. Aphasia leaves patients with little ability to form comprehensible language, or to understand written or spoken language. They are left unable to read or write.Aphasia is a disorder stemming from damage to the language portion of the brain, usually the left side. It is a communication disorder that interferes with the ability to process, understand or speak language. There are varying degree of Aphasia from mild to severe. Prognosis for Aphasia is much greater for younger people.In applying the etiology of Traditional Chinese Medicine philosophy to interpret the after-stroke aphasia, the theory of five yin organs and six yang organs must have to be closely-related together. The ability to speak has the tightest relationship with our heart, brain and kidney. Our heart dominates our mind of thinking, controls the blood vessels, stores the spirit and is reflected in our tongue. Kidney contains the (Jin) minute-essence of our body that can transform into many essential elements for other organs in the form of Qi and blood. The brain is the home of spirit. Any traumatic injury, like stroke, causes kidney, heart and brain malfunctioning and the disability of speech (Aphasia).Jinsanzhen (the Jin’s three-needle technique) in particular, the3-Tongue point has been proved to have prominent clinical effect in curing Aphasia. This technique was firstly established by Professor Jin Rui.ObjectivesUnder the clinical research conducted in Hong Kong (HKSAR) based on statistical randomized dummy control group methodology, together with the application of3-Tongue Points techniques in curing Aphasia of the after-stroke patients, assessment of improvement is determined through observing the clinical effect, the impairment of listening and speaking of languages and the ability of language usage throughout the whole course of research. With the scientific and objective point of view of research work, and also in combination of multi and integrated method of treatment, a brand new concept of thinking and theory is expecting to be derived from this treatment research analysis.MethodsAccording to the randomized dummy control group method in clinical practices research, sixty selected patients are divided into two groups by numbers assigned by random numbers of computer, one is3-Tongue point group applying the Jinsanzhen acupuncture technique, another group is normal acupuncture technique as contrast. Each group is further subdivided into3subgroups, viz.:Group1(for period from30to60days after stroke); Group2(for period from60to90days after stroke); Group3(for period from90to120days after stroke). A complete treatment course was three-months period, two treatment courses (i. e.total six months) were applied. After completion of each individual treatment course, assessment and evaluation was employed for statistical analysis.Both groups of patients are reminded to preserve body warmth, avoid windy and cold weather condition and have a balanced and nutritious diet.Results1.The effect of Jinsanzhen group is obviously better than the contrast group (p<0.01). 2. Before treatment, both groups, including all3subgroups, using the rank-sum test (p>0.05) there didn’t have any statistical significant difference. After completion of the treatment courses, Jinsanzhen group was obviously has significant statistical difference in the improvement and functionality of their speech of language (p<0.01).ConelusionsAccupuncture in curing after-stroke aphasia have great significance in the improvement and prognosis in clinical performance. This provide new and sound methodology of thinking and theoretical evidence for different ways of treatment in coping with aphasia of after-stroke patients.3-Tongue Points of Jin’s3-Needle Techniques in treating aphasia is obviously advantageous.更多还原