论补肝肾调脾胃在面肌痉挛治疗中的重要作用

Important Role of Spleen and Stomach in Treatment of Hemifacial Spasm

面肌痉挛是常发生于中老年人的一种疾病,且女性多见。最初发病时,多为眼轮匝肌抽搐,逐渐缓慢地扩散至一侧面部的其他面肌。入睡后抽搐停止,两侧面肌均有抽搐者非常少见。少数患者在病程的晚期可伴有患侧面肌轻度瘫痪。本病是一种缓慢进展的疾患,如不给予治疗,一般不会自然好转,病情严重者眼轮匝肌重度痉挛,使眼不能睁开,严重影响病人的心身健康,降低生活质量。在西医学上,本病病因不明,推测是某种压迫使面神经传导发生病理性干扰所致。面肌痉挛属中医学"面风","眼睑目闰动"等范畴。中医学认为该病多因肝肾亏虚,阴血不足,筋脉失养,而致肝风内动,或脾胃素虚,运化失司,生化乏源,筋脉失养,血虚不能上荣于面,气血亏虚,面部经筋失养,或风寒诸邪入侵,久留经络,血不荣筋,致经络收引抽搐,使面部经络气血、阴阳失调所致。脾胃与"肝""风"有着极为紧密的联系,肝主疏泄、脾主运化,若肝脏疏泄功能失职,或暗耗肝肾之阴,或横侮脾土,致肝用偏亢、肝风上扰;肝脾经络不通,肌肤失养,风性善动,在肢体则表现为筋惕肉瞤,在眼、面部则筋急抽搐、脾轮振跳。所以在治疗面肌痉挛时,必须重视调理脾胃。针刺治疗通常采用远近配合取穴、辨证取穴的方法,近取局部眼周、口周穴位可以舒筋活络,改善局部气血的运行,远取又可疏通经气,调气活血,但是经研究发现,如果配合补脾健脾之穴位与针刺手法,往往会取得更好的疗效,共同达到息风止痉的目的。因本病多为脾胃虚弱,脾虚肝旺所致。所以应用具有补脾胃作用的中药治疗本病时,往往也会取得较好疗效。如缓肝理脾汤,方中党参、白术、山药、炙甘草功在补脾益胃固本,与方中其他药去合用,可以达到温运脾阳,扶土抑木的目的,治疗本病疗效显著。归脾汤加减治疗面肌痉挛的也有很好疗效。《内经》云:"治病必求于本"。尤其在治疗面肌痉挛这种易复发、易迁延难愈的病症上,我们应审视其真正的病因,在缓解其抽动的同时,扶正固本。脾胃与"肝"及"风"所系疾病密切相关,在治疗面肌痉挛上,调理脾胃的方法应予以高度重视。

Facial spasm is a disease that occurs frequently in middle and old age,and commonly in women.In the first episode,many of the eye muscles twitch,slowly spreading to the other facial muscles of the side.After falling asleep,the convulsions stop,and both sides of the facial muscles are very rare.A small number of patients may have mild paralysis of the lateral muscles in the terminal stage of the disease.This disease progresses slowly.If not treated,it is can not recover spontaneously.The serious condition would cause orbicularis oculi muscle cramping,making the eye cannot open,seriously affecting the patients’psychosomatic health and lowering the quality of life.In western medicine,the cause of the disease is unknown,and it is speculated that some kind of compression causes the pathological interference of the facial nerve conduction.Facial spasm belongs to traditional Chinese medicine"wind","eyelid movement",etc.TCM holds that this disease is due to liver and kidney deficiency,Yin-blood insufficiency and tendons and meridians failing to be nourished,which can lead to liver wind,or spleen deficiency and failing to transport so that the Qi and blood can not be generated which causes the tendons and meridians failing to be nourished.Because of blood deficiency,the facial tendons and meridians can not be nourished or attacked by wind and cold evils which stay in the meridians for a long time,finally leading to convulsion.Spleen and stomach are closely linked with liver and wind.If the liver can not work normally,the liver wind would disturb the upper.If the spleen and liver meridians are obstructed,the muscles and skins would lose of nourishing and then cause hemifacial spasm.As a result,we must pay attention to the spleen and stomach when treating the disease.Acupuncture treatment usually adopts the methods of distance and local acupoints,syndrome differentiation.The local acupoints are around the eyes and mouth which can relax the muscles and stimulate blood circulation.The distance acupoints can dredge meridiansQi.But the study has found that if the coordinates of tonifying spleenacupuncture technique and acupoints tend to get better curative effect.Because the disease is mostly due to the spleen and stomach deficiency,the application of Chinese medicine with the effect of strengthening the spleen and stomach can also obtain better curative effect.Neijing said:"The treatment principle is to treat the root cause."Especially in the treatment of hemifacial spasm which is an easy to relapse and refractory disease,we should examine its real root causes.The spleen and stomach are closely related to the disease and the method of regulating the spleen and stomach should be taken seriously in the treatment of facial spasm.