【作者】 林凤英；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2010， 博士

【摘要】 目的因周围性面瘫针刺治疗得到国内外较一致认同,但针刺与物理治疗疗法对照研究,遂尚没有大样本临床对照研究。本研究旨在提交针刺治疗周围性面瘫的疗效,以及观察对照以康复学手段之一：物理治疗对照,以针刺规范化及临床应用提供科学及临床依据。方法将临床诊断为周围性面瘫的病患者76例,随机分为针刺组(试验组)、对照组(物理治疗组),针刺组(试验组)40例、对照组(物理治疗组)36例,作为研究对象,针刺组(试验组)操作以常规针刺；对照组(物理治疗组)操作以西医物理治疗。两组均选用相同穴位,取手阳明大肠经合谷穴、迎香穴、足阳明胃经四白穴、颊车穴、地仓穴、足太阳膀胱经攒竹穴、足少阳胆经阳白、足少阴肾经太溪穴、任脉承浆穴、督脉水沟穴、及经外其穴太阳穴。针刺组(试验组)用75%酒精消毒,据《灵枢·经筋》中云：“虚则补之”为原则,采用补法针刺方法及华佗牌针灸钢针1.5寸,针尖抵于腧位皮肤,运用指力以拇食指捻动针柄,拇指后退瞬即将针尖刺入,使之得气,连接上海G6805-1电针仪,采用疏密波,刺激作用较强,连接3个上述穴位,电量以患者感到耐受为度,面部肌肉微见跳动为宜。对照组(物理治疗组)采用Nihon Medix 1/f Yuragi SSP TherapyTM-550,无痛针灸医疗仪器。两组每次治疗30分钟,每星期治疗5天,10次为1疗程,共治疗1个疗程,疗程结束后观察分析结果。结果按医学统计学处理,两组病患者发病性别、年龄、病程、分型、患病轻重度均无显着性意义(P>0.05)具有可比性,治疗前后积分则为P<0.01,针刺组优于对照组。治疗结果发现,以常规针灸治疗周围性面瘫病症的治疗组总有效率为92.5%,对照组总有效率为75%,采用SPSS.V11.0统计软件分析,得出P<0.05,说明两组患者临床疗效比较,针刺组优于对照组。讨论祖国医学认为此病是由于正气不足,络脉空虚,卫外不固,风寒邪气乘虚入中,经脉痹阻,气血运行不畅,邪风中脉络,使面部经筋失于濡养,肌肉弛缓不收所致；或平素素体阳盛,或因风热邪气侵扰,影响气血运行,筋脉肌肉弛纵不收；或病延日久,邪气郁久成瘀,或炼津为痰,痰瘀阻滞,络道不利,使病患更为严重；或耗伤气血,病情由实转虚,阴血不足则血虚生风,气血两虚则不能上荣于面。《灵枢.经筋》载：“颊筋有寒则急引颊移口,有热则筋弛缓不能收,故僻。”“足少阳之筋,....出太阳之前,循耳后,上额角,交巅上,下走颔,上结于頄；支者,结于目为外维。....从左之右,右目不开,上过右角,并蹻脉而行,左络于右。”“足阳明之筋,....上颈,上挟口,合于頄,下结于鼻,上合于太阳。太阳为目上网,阳明为目下网；其支者,从颊结于耳前。其病....,卒口僻,急者目不合,热则筋纵,目不开。颊筋有寒,则急引颊移口；有热则筋弛纵缓,不胜收故僻。”因此,寒邪引致为外风侵扰,导致周围性面瘫。《诸病源候论》中云：“风邪入于足阳明,手太阳之经,遇寒则筋急引颊,故使口喎僻,言语不正,而目不能平视”“夜卧,....风入耳中,喜令口喎”。“医部全录”云：“凡半身不遂者,必口眼喎斜,亦有无半身不遂而口眼喎斜者,....多属阳明经病。”明确指出无半身不遂而单见口眼喎斜者,为阳明经受病之喎僻。从经脉循行及经筋的分布,本病多位于手阳明、足少阳、足阳明之经脉及经筋。面神经麻痹早期及时治疗是痊愈的关键,病程愈短则疗效愈快,内治外治的方法兼用疗效更佳。本病初期,即病后1～2周,应宣散风寒或风热之邪,行气活血,化痰通络,疏调面部经络之气,促进气血循环,调节面部经络气血的失衡状态,此期疗效较佳。中期即病后3～8周,应以活血化瘀,舒筋通络,调补气血,使面部气血畅通,濡养肌肉血脉。后遗症期,少数病人经数月治疗病情仍未有好转,患侧面肌可由弛缓状态转至拘挛状态。此期宜补益气血,滋养阴液,濡润筋脉,柔肝熄风,但于这个阶段治疗却有一定难度。西医学认为周围性面瘫是因面神经自桥脑部出髓后至茎乳孔,是一条弯曲颇长的管腔,遇到冷风侵袭或感染时,内组织便会出现急性水肿、缺血,髓鞘或轴突出现不同程度的变化,面神经受压,从而失去生理功能；或面神经本身的炎症所引至的周围性面神经损伤,称为面神经麻痹,又称贝尔麻痹。面神经受损程度取决于茎乳孔内急性炎症水肿的程度及持续时间。水肿时间愈长,病患程度愈重；面神经受压时间愈长,面神经愈难以恢复。面神经麻痹常发生于青壮年,男性为多,多于受凉吹风后急性发病,常于清晨洗脸,漱口时发现口角歪斜,临床表现主要是患侧,面部表情肌麻痹,例如眼睑闭合不全、口角向健侧歪斜等。本病起始时可见耳后疼痛,于数小时或1～2日内症状达至高峰,表现为一侧面部表情肌瘫痪,漱口时水从患侧口角溢出,进食时食物滞于病侧颊齿之间,有碍于说话。检查：患侧表情肌运动障碍,额纹消失,不能皱额,蹷眉,眼裂扩大,眼睑闭合不全,易于流泪,鼻唇沟变浅,口角下堕,露齿时口角歪向健侧,鼓气或吹口哨时会漏气,角膜反射、眼及口轮匝肌反射均减退。发病1～2周后开始恢复,1～3月内约4／5以上的病者症状可完全恢复；若半年以上仍未恢复,则完全康复的痊愈率不大,病者因恢复不完全或面神经再生紊乱,出现面肌挛缩、痉挛或连带运动。西医治疗本病,一般采用理疗、体疗及激素。针灸治疗用于治疗各种疾病已有很久的历史,其临床疗效于许多临床运用中得以证实,运用常规针灸治疗法治疗周围性面瘫,已取得良好的临床疗效,本研究治疗结果发现,以常规针灸治疗周围性面瘫病症的总有效率为92.5%,对照组总有效率为75%,采用SPSS.V11.0统计软件分析,得出P<0.05,说明值得进一步探讨和研究。更多还原

【Abstract】 ObjectiveThe acupuncture treatment of peripheral facial paralysis is confirmed by internal and worldwide for the time being, but it is lack of bulky samples of the research between the treatment of acupuncture and therapy. The coming study is just carried out the result of the treatment of peripheral facial paralysis, observing one of the method of therapy contrast group, using the method of routine acupuncture and practical to apply scientific and practical evidence.MethodsSeventy-six patients who suffered from peripheral facial paralysis, divided into two groups which is acupuncture group (testing group) and comparison group (therapy group), the acupuncture group (testing group) cured forty patients, the comparison group (therapy group) cured thirty-six patients as well, as the analysis targets. The acupuncture group (testing group) adopted the routine method to cure, the comparison group (therapy group) used the western method of therapy to cure. Two groups adopted the same acu-points. Hegu, Yingxiang of Large Intestine Meridian of Hand-Yangming, Sibai, Geche Diceng of Stomach Meridian of Foot-Yangming, Zhanzhu of Bladder Meridian of Foot-Taiyang, Yangbai of Gallbladder Meridian of Foot-Shaoyang, Taixi of Kidney Meridian of Foot-Shaoyin, Chengzheng of Ren Meridian, Shuigou of Du Meridian and Taiyang of the Qi-point of Meridain Outside. The acupuncture group(testing group), used 75% alcohol for hygiene. Using the method of reinforcing of the points and 1.5inch of Hwato acupuncture needle, used thumb to twist acupuncture needle, then inserted into acu-point quickly, wait it sound, connected with the G6805-1 Shanghai electricity machine, used the wave of’shu-mi’, much strong stimulate, linked with three acu-points, the electricity volume made patients feel comfort, the muscle of the patients’face tension a little bit. The comparison group (therapy group) adopted Nihon Medix 1/f Yuragi SSP Therapy TM-550, the machine of painfulless acupuncture. Two groups took thirty minutes for each treatment, five days per week, one cycle treatment took ten times. Results will be observed after one cycle treatment.ResultsAccording to the statistic of medical, there is no difference between the sex, age, the interval of the illness, kind of illness and the severe level of ilness suffered of two groups patients (P>0.05), so it should be comparable, before and after treatment (P＜0.01), it showed that the acupuncture group is much sounded than the constrast group. It has been found that the percentage of the final sound result of the method of routine acupuncture (testing group) is 92.5%. The percentage of the final sound result of the comparison group (therapy group) is 75%. After analysis by SPSS.V11.0 statistic software analysis pakage, P＜0.05, it shows that the results of acupuncture group is much better than therapy group.ConclusionChinese Medical thinks it is because deficient of qi, so the illness of peripheral facial paralysis arised, collaterals and meridians are empty, the whole body is not strengthen, cold evil wind invade, meridians emiplegia and banned, qi and blood may not go smoothly, evil wind invades meridians and collaterals, makes the nerves of the face lose the nutrient, muscles go not tight; or it may be routine the propersity of yang of the whole body, or it may be the evil warm wind invade, affects the moving of qi and blood, makes the muscles go not smoothly; or it may be patients have been ill for a long time, the evil qi becomes stasis, or it may becomes phlegm, stasis and phlegm ban the collaterals, makes the illness much more severe; or it may be exhausted of qi and blood, the illness becomes worse from sufficient, deficient of the blood of yin, so wind creates, both qi and blood deficient, it may not nourish upward to the face.<Lin Su. Jing Gen> says, "if there was cold wind flow around the nerve of the cheek, made the cheek move acutely irregular; if there was warm wind flow, then the nerve of the cheek would be loose, so the illness of facial paralysis will be arised." "The nerve of the meridian of the Foot of Shao Yang,......before she moves out of Tai Yang, she moves around the rear of the ears, she goes upward to the corner of forehead, reaches the vertex of the head, goes downward to the cheek, then goes upward; her branch stations at the corner of eyes.......From left to right, the eye of the right is not open, then goes upward to the right corner, accompanies with Qiao Mai to move, the left collateral stations at the right." "The nerve of the Foot of Yang Ming,......moves upward to the neck, then goes to the mouth, stations at the cheek, goes downward to the nose, encounters with Tai Yang. The meridian of Tai Yang is the upper ridge of the eyes, the meridian of Yang Ming is the lower ridge of the eyes; her branches go to the cheek and station at the front of the ears. The illness......, the illness of facial paralysis arised, the eyes may not be closed acutely, the nerve looses when encounters heat, the eyes may not open. When there is cold wind around the cheek, the cheek may acutely move irregular." Therefore the invasion of cold evil wind will led to the illness of peripheral facial paralysis.<Zhu Bing Yuan Hou Lun> says, "Wind evil blows in the meridian of Foot Yang Ming, the meridian of Shao Tai Yang, the meridian goes to the cheek irregular when encounters cold evil wind, so the illness of facial paralysis will be arised, speak wordings not as usual, and the sight will not function as usual as well." "Sleeping at night,......wind blows into the ears, makes paralysis arised. <Yi Bu Chuen Lu> says, facial paralysis must be arised, but there are cases no facial paralysis arised. When there is facial paralysis arised, it states that the meridian of Yang Ming is sick. It says if there was no paraplegia, but facial paralysis was seen, it states the facial paralysis of the meridian of Yang Ming. From the route of the meridians and the distribution of the nerves. The illness always arised in the meridian of Shao Yang Ming, the meridian of Foot Shao Yang, and the meridian of Yang Ming., treatment of the illness of peripheral facial paralysis, the shorter period of the illness, the recovery of the illness is much faster, the internal and external treatment methods used is much better. At the early of the illness,1 to 2 weeks after the illness arised, it may be cleared off the evil of cold and warm wind, regulated qi and activated blood circulation, eliminated phlegm, dredged the collaterals, makes the nerves of the face of the side of sickness creating exciting, enhances the tissue of the muscle becoming tight, healing inflammation and edema speedy, regulated the qi of the meridians of the face, proposed the circulation of qi and blood, adjusted the imbalance status of the meridians, and qi and blood of the face, to reach the result of going smooth of the meridians, the result will be sounded good. The period of intermediate, that means 3 to 8 weeks after the illness arised, the treatment methods may be activated blood circulation and eliminated static, relaxed tendons and dredged the collaterals, nourished qi and blood, made the blood and qi go smooth of the face, nourished the muscles and meridians. Within the period of side-effect, rare patients still not go better after the treatment of serval months, the sickness side of the face may go the status of tight from loosing, at that time, the treatment method may be streghtened qi and blood, nourished the fluid of Yin, regulated the meridians, comforted the liver to inhibite the endogenous wind, but at this status, the treatment may be much difficult. Western medical thinks the illness of peripheral facial paralysis is due to the nerves of the face come from pons out of marrow to stylomastoid, it is a bend and long tube, when encounters the invasion of cold wind, edema, lack of blood of the internal organsation will be arised, myelinization will perform irregularly at different level, the nerve of the face will be suppressed, lost the function of physiology, or the synapsis of the facial nerve will arise the wound of peripheral facial nerve, it is called peripheral facial paralysis. The level of the wound of the facial nerve is decided by the level of inside of stylomastoid acute inflammation edema and long lasting of time. The long lasting of time of edema is much longer, the illness is much servere; the time of the suppression of facial nerve is much longer, the facial nerve is much more difficult to recovery. The illness of peripheral facial paralysis is always arised at youth and middle age, male arise much more, usually suffer from after blowing by cold wind, the illness arsied acutely during morning wake-up time, facial paralysis is found, the muscle of the illness side of the face paralysis, for example:eyes browses may not close completely, the angle of the mouth go oblique to the healthy side of the face. At the early of the sickness, the rear of the ears wil be felt painful, the peak time will be taken serval hours or 1-2 days, the symptom is that one side of the facial muscle went pouring out of water from the corner of the sickness side of the mouth; during eating, the food will leave within the teeth; speaking is not very fluent. By checking, the muscle of the sickness side of the face is restricted; veins of the forehead disappeared, can not wrinkle, knit the brows, the crack of eyes enlarge, eyes browses may not close completely, easy to cry, phitrum becomes shallow, the corner of the mouth trends downward and paralysis to the healthy side trends downward and paralysis to the healthy side during smiling; when blowing with bellow or blowing whistle, it may be punctured; corneas reflect; the reflection of the muscle of eyes and mouth decline. The sickness start to recover after the illness arised 1-2 weeks, 4/5 patients will get totally recover within 1-3 months; If it still not recover after six months, then the percentage of totally recovery is not sounded. It is because not totally recovery or it may be the facial nerve go into a mess again, so the facial muscle become contracture, convulsion or relative movement. Doctors heal this illness, usually adopt physiotherapy, exercise and hormone as well. It is a long time of the treatment of acupuncture method has been used for any illness, many practice has been proved. The treatment of routine acupuncture method of the illness of peripheral facial paralysis is sounded good. From this study, the percentage of the final sound result of the method of routine acupuncture is 92.5%. The percentage of the final sound result of the comparison group (therapy group) is 75%. After analysis by SPSS.V11.0 statistic analysis software pakage, P<0.05, so it shows that the result of the treatment of the routine acupuncture sound much better, it took lesser time and patients recovered much faster, so it worths to go on to practice and observe.更多还原