【作者】 林润煜；

【导师】 李忠仁；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 中风偏瘫是由急性脑血管病所引起的脑损害症状,是目前致死率,致残率最高的疾病之一。针刺治疗中风有肯定的疗效且为首选的疗法。“大接经法”是中医运用在脑卒中偏瘫治疗上的特殊手法,因操作简便,作用迅速,对中风偏瘫的治疗有极佳效果,深入研究其机理与应用,对临床具有重要的指导意义。有关中风的认识,历代医家各抒己见,形成了中医传统学派各自独具的观点风格。在历经了不断发展的过程后,使其日臻完善。此中既有外因,也有内因,但以内因为主。在内因中,既有火、气、痰、湿的作用,也有风、虚、瘀的存在,更有心、肝、肾三脏阴阳失调这一根本因素存在,这对理解中风的本质和进行临床治疗具有指导意义。近代依古籍理论及中风病的发病特点创用了“大接经法”治疗中风明显取得疗效,所谓大接经,“大”指大周天,“接经”指接通经脉,即是使大周天的经脉全部接通,方法是针刺十二井穴,以沟通十二经脉的气血,改善全身气血运行,振奋周身气机,使大经脉的阴阳气血得以正常交接而从根本上解除中风病人脑内的致病原因。其特点是选用十二井穴为主,它是对脑部疾病的一种直接治疗方法,如使用得当,效果甚为理想,治疗更为彻底。本研究以脑卒中风痰瘀血痹阻脉络型病人为对象,经检查有肢体偏瘫,舌质红、边有瘀点,脉沉实之表现。针刺十二井穴能明显地降低患者血黏度、红细胞压积及红细胞聚集指数,改善血液循环,以活血通络,增加脑组织供血,有利脑神经功能恢;同时发现其改善血液流变学的作用明显优于常规疗法。“大接经法”是通过消除中风机体的自由基、LPO调节机体内的花生四烯酸系统平衡,提高PGI₂及PGI₂/TXA₂的比值,抑制中风患者体内已存在的血小板聚集,降低血液黏滞性,减少血管痉挛,能防止其活性物质的释放,从而避免血管的收缩和血栓形成,对缺血性中风的治疗有良好的作用。透过本研究实验设计,探讨“大接经法”治疗脑卒中风痰瘀血痹阻脉络型病人的临床疗效。本研究将急性缺血性中风患者60例为研究对象,随机分为治疗组（大接经法）与对照组（传统刺法）,各30例,比较两组治疗前后的血液流变学差异和临床疗效比较,并采用Barthel指数分级法来评定患者日常生活活动能力（ADL）。并用CT脑灌注成像技术（multislice CT perfusion,imaging,MSCTPI）来探测缺血性脑卒中急性脑梗死在大接经法治疗前后脑血流动力学指标的变化。两组治疗后血液流变学变化比较,全血黏度有显着性差异（P＜0.05,P＜0.01）,血小板聚集有明显差异（P＜0.05）。研究表明,治疗组优于对照组,治疗组的痊愈率为76.67%,而对照组的痊愈率为36.7%,两组比较有显着性差异（P＜0.01）。两组治疗后Barthel指数评分都有所提高,疗组评分提高幅度更大,两组比较有显着差异（p＜0.01）。经配对t检验治疗前后数值CBF、CBV均较治疗前增加,而TP较治疗前缩短,有显着性差异（p＜0.01）。本研究对指导临床选用最佳针灸治疗脑卒中偏瘫方案有极其重要的借鉴作用。也为今后进一步的机理探讨奠定了基础。更多还原

【Abstract】 Wind stroke (Apoplexy) is a symptom of the cerebral lesion caused by acute cerebrovascular disease. Acupuncture has had good results and is one of the best choices in treatment. In traditional Chinese medica science," The Treatment of Acupuncture by the Big-Circle on Dredging the Meridians of Bodies "is a special technique that is performed on the firstaid of Apoplexy and the treatment of its sequlae. Because the technique is easy to apply and works swiftly, it brings admirable results on the first aid of Apoplexy andthe treatment of its sequlae. Further research on the mechanism and the applications of the technique is important to the clinical cases.Through this study, we explored the change of the Hemorheology with "The Wind-Phlegm and Blood Stasis Obstruct the Meridian"according to" The Treatment of Acupuncture by the Big-Circle on Dredging the Meridians of Bodies "and traditional acupuncture treatment. 60 patients suffering cerebral infarction were randomly divided into treatment group (30 cases receiving acupuncture treatment of" The Treatment of Acupuncture by the Big-Circle on Dredging the Meridians of Bodies " method’) and control group (30 cases receiving acupuncture treatment of Tradition method’). Then observe two groups capability of activities of daily living (using Barthel index scale). The result of the clinical research of The Treatment of Acupuncture by the Big-Circle on Dredging the Meridians of Bodies "group compare to the comparison group, we found the Hemorheology index had to reveal the different level in treatment group ( P<0.05, P<0.01 ) . The test of the PLT-MA value was significantl in treatment group ( P<0.05 ) .The study shows that the results in the former group with a recovery rateof 76.67% is better than the latter group with a recovery rate of 36.7%,P<0.01 . Comparing with Barthel index scale of two groups, the former group with Barthel index scale of post-treatment are better than the latter group. The difference was significant. (p<0.01) . This research showed " The Treatment of Acupuncture by the Big-Circle on Dredging the Meridians of Bodies "for Apoplexy working into curative effect on patients .This research provided a good guidance to select the best acupuncture methods for Apoplexy, as well as establishing a foundation for further research on the mechanism of acupuncture in treating Apoplexy.更多还原