石学敏院士治疗中风后吞咽障碍思路浅析

Brief Analysis of Academician Shi Xuemin′s Thoughts in Treating Post-Stroke Dysphagia

中风病的基本病机为“窍闭神匿,神不导气”,中风后吞咽障碍的病机为“窍闭神匿,神不导气,关窍闭阻”。临证应以醒脑、调神、滋阴、利窍为原则的“通关利窍”针刺法治疗。“通关利窍”针刺法在“醒脑开窍”针刺法的基础上创立而成,专用于中风后吞咽障碍,主穴为双侧内关、人中、患侧三阴交、双侧风池、双侧完骨、双侧翳风,咽后壁点刺。针刺内关、人中、三阴交以治“神”;针刺风池、完骨、翳风,咽后壁点刺以治“窍”。诸穴合用,可显著改善患者椎-基底动脉及颈内动脉的血液供应,改善受损脑组织的血氧供应,促进病灶区侧支循环的建立,促进吞咽相关神经功能的修复,使吞咽障碍得到恢复。

The basic pathogenesis of stroke is classified as"closed orifice and hidden spirit,the spirit not guiding Qi".The pathogenesis of dysphagia after stroke is"closed orifice and hidden spirit,the spirit not guiding Qi as well as orifice being obstructed".In clinical treatment the method of"Tong Guan Li Qiao"acupuncture,which is based on the principle of refreshing the brain,regulating the mind,nourishing the Yin,and relieving the orifices,should be used.The"Tong Guan Li Qiao"acupuncture method was founded on the basis of the"Xing Nao Kai Qiao"acupuncture method,which is specially used for post-stroke dysphagia.The main acupoints used are Neiguan on both sides,Renzhong,Sanyinjiao on the affected side,Fengchi on both sides,Wangu on both sides,Yinfeng on both sides,and fast insertion on the posterior wall of the pharynx.Acupuncture at Neiguan,Renzhong,and Sanyinjiao to treat"spirit".Acupuncture at the points of Fengchi,Wangu,Yinfeng,and the posterior wall of the pharynx to treat"orifice".The combination of various points can significantly improve the blood supply of the vertebral-basilar artery and the internal carotid artery,improve the blood oxygen supply of the damaged brain tissue,promote the establishment of collateral circulation in the lesion area,and promote the repair of swallowing-related nerve function,so that swallowing disorders can be recovered.