针药并用分期论治周围性面瘫体悟

Understanding of stage treatment of peripheral facial paralysis by acupuncture and medicine

周围性面瘫相当于西医学中的面神经炎,为神经内科的常见病,主要临床表现为口眼喎斜,眼睑闭合不全或不能闭合,不能完成鼓腮、露齿、吹气、皱眉等动作,伴或不伴一侧面部额纹消失,部分患者起病前几天可有同侧耳后、乳突区轻微疼痛。发病年龄主要集中在20~40岁,男性患病率高于女性,大部分为单侧发病,双侧同时发病者极少,以冬春季、夏季发病率较高。由于病变部位主要在面部,影响患者美观及日常生活,使患者心理负担较重,常伴有焦虑情绪。在治疗方面,激素类药物疗效显著,可减少炎症反应,减轻面神经水肿,但同时不良反应亦较多,使患者在治疗过程中顾虑重重。针灸在治疗面瘫方面历史悠久,配合中药口服,预后良好,无明显不良反应。关于本病要防治结合,将“治未病”的思想贯穿始终,不但治已病,更要防复发,这对其治疗及预后具有重要意义。临证时当全面分析病情。在急性期,及时应用营养神经、糖皮质激素、B族维生素、扩血管等药物治疗,辅以中药、针灸治疗。在恢复期及后遗症期,针药并用,辅助机体恢复正气,调节免疫状态,促进面部肌肉恢复。文章结合作者临证经验,介绍了从急性期、恢复期、后遗症期3期辨治,针药并用的心得体会,疗效满意,进行总结归纳,以供同道参合。

Peripheral facial paralysis is equivalent to facial neuritis in Western medicine,and is a common disease in the department of neurology.The main clinical manifestations are oblique mouth and eye,incomplete closure of eyelids or inability to close,unable to complete the movements such as bulging gills,showing teeth,blowing and frowning,with or without the disappearance of the wrinkles on the forehead in one side of facial.Some patients may have slight pain in ipsilateral ear and mastoid area a few days before onset.The age of onset was mainly from 20 to 40 years old,and males have a higher prevalence than females,most of them were unilateral,and very few patients had bilateral diseases at the same time.The incidence was higher in winter,spring and summer.As the lesion is mainly in the face,affecting the beauty and daily life of patients,so that the psychological burden of patients is heavy,often accompanied by anxiety.In terms of treatment,hormone drugs are effective,which can reduce inflammatory reaction and facial nerve edema,but at the same time,there are many adverse reactions,which make patients worry a lot in the process of treatment.Acupuncture has a long history in the treatment of facial paralysis.With oral administration of TCM medicine,the prognosis is good,and there is no obvious adverse reaction.The author believes that the treatment of this disease should be combined with prevention and treatment,and the idea of preventive treatment of disease should be carried through all the time,not only to treat the disease,but also to prevent recurrence,which is of great significance to its treatment and prognosis.A comprehensive analysis of the disease should be made during the clinical period.In the acute stage,nerve nutrition drugs,glucocorticoids,B vitamins,vasodilator drugs and so on are used timely to treat the disease,supplemented by TCM medicine and acupuncture.In the recovery period and sequela period,acupuncture and TCM medicine are used to restore vital Qi( 气),regulate immunity and promote the recovery of facial muscles.Combined with clinical experience,the author differentiates and treats the disease from acute stage,convalescent stage and sequela stage,and the curative effect is satisfactory.Then,it is summarized as follows for reference.