浅议百会至骨法治疗短暂性脑缺血发作的理论基础及作用机制

Theoretical basis and action mechanism “Touching-bone” acupuncture at Baihui acupoint on transient ischemic attack

短暂性脑缺血发作(Transient Ischemic Attack,TIA)是急性脑卒中的常见表现,可因每次发作受累的血管和部位有所不同而临床表现多变,亦可因每次发作缺血部位基本相同而临床表现相似或刻板。TIA会导致卒中的风险增加,可作为更严重和致残性卒中的警示。现代医学以溶栓、双重抗血小板聚集、强化降脂、抗凝、扩容、血管介入等手段干预治疗,但在3个月内仍有较高的卒中风险。中医学认为本病以本虚邪实为根本病机,发病与中风机制相一致:主要是由于正气虚弱,肝风内动,造成心、肝、脾、肾脏腑阴阳失调,再加上五志过极,饮食不节,房劳过度,或外邪侵袭等诱因,致气血运行受阻,肌肤筋脉失于濡养,或者阴亏于下,肝阳暴涨,阳化风动,血随气逆,上冲于脑,蒙蔽清窍致猝然昏仆、半身不遂诸症而发病,数分钟即可好转。中医治疗有针刺及相关特色针法(至骨针法、醒脑开窍针法等)、中药汤剂口服等,目前临床常用的治疗方法为针刺,而选取百会穴治疗属对症选穴。至骨针法作为新针刺方法,以刺激骨膜及松解深筋膜为手法特色,对百会穴进行至骨操作,可多系统、多层次、多维度作用于颅内缺血血管,改善组织内供血,有即刻起效、长期维持的效果。文章将从至骨针法选穴、操作、针效3个方面探析百会穴至骨针刺治疗TIA的可能机制,以期为临床工作者提供更多治疗思路。

Transient ischemic attack(TIA),a common manifestation of acute stroke,can vary depending on the vessel and site of each attack.It can also occur because the site of ischemia is basically the same in each attack,and the clinical manifestations are similar or stereotypical.TIA is associated with an increased risk of stroke and may as a warning for more severe and disabling strokes.Modern medicine uses thrombolysis,double anti-blood small class aggregation,intensive lipid-lowering,anticoagulation,dilatancy,vascular intervention and other means of intervention,but there is still a high risk of stroke within 3 months.TCM believes that this disease is based on the deficiency and evil,which is the basic pathogenesis,and the pathogenesis is consistent with the mechanism of stroke:it is mainly due to the weakness of vital Qi(气),liver wind internal movement,resulting in the imbalance of Yin(阴)and Yang(阳)in the heart,liver,spleen and kidney,coupled with the excessive five emotions,improper diet,excessive sex life,or the invasion of external evils and other incentives,it can result in the obstruction of Qi and blood,the deficiency of skin,tendons and veins,or Yin deficiency in the lower,liver Yang inflation,wind movement,blood and Qi reversed and rushed to the brain,deluded orifices,which causes stroke,hemiplegia and other diseases,and the disease can be relieved in a few minutes.TCM treatment includes acupuncture and related characteristic acupuncture methods[“Touching-bone”acupuncture,Xingnao Kaiqiao(醒脑开窍)acupuncture,etc.],TCM decoction oral administration,etc.At present,the commonly used clinical treatment method is acupuncture,and the selection of Baihui acupoint(DU20)treatment is symptomatic.As a new acupuncture method,“Touching-bone”acupuncture is characterized by stimulating the periosteum and loosening the deep fascia.The operation of“Touching-bone”acupuncture at Baihui acupoint can act on the intracranial ischemic blood vessels in a multi-system,multi-level and multi-dimensional manner,improve the blood supply in the tissue,and have immediate effects and long-term maintenance.This paper will explore the possible action mechanism of“Touching-bone”acupuncture at Baihui acupoint on TIA from three aspects of acupoint selection,operation and acupuncture effect,so as to provide more therapeutic ideas for clinical workers.