基于祛风化痰针刺法探讨卒中后遗症期构音障碍治疗思路

Treatment Idea of Dysarthria in Stroke Sequelae Period Based on the Dispelling Wind and Resolving Phlegm Acupuncture Method

目前临床治疗卒中后构音障碍,多以针灸结合言语康复为主。依据中医学理论,此病病机总属风痰扰窍,故治疗以祛风化痰、通络利咽为原则。吴清明确立“祛风化痰”针刺法,选取风池、完骨、廉泉及丰隆为主穴,配合针法刺激,以改善病灶部位的微循环障碍,促进受损构音组织的功能恢复,临床治疗脑卒中急性期构音障碍取得较好疗效,但对肌肉组织僵硬挛缩、纤维化的后遗症期患者的治疗作用欠佳,而针刀疗法治疗痉挛硬化的软组织病变具有肯定优势。基于临床治疗现状,结合此病的病因病机,笔者提出运用“祛风化痰”针刺法以“调神”,并结合解剖学,选取构音肌群起止点以“调形”,形与神共调,以期为临床治疗卒中后构音障碍带来一种新的思路与策略。

As one of the common sequelae after stroke,dysarthria after stroke is mostly caused by dysarthria-related muscle movement abnormalities.The main clinical manifestations are abnormal pronunciation and intonation,reduced speech clarity and fluency,etc.At present,the clinical treatment of this disease is mainly based on acupuncture combined with speech rehabilitation,and a variety of physical factors are combined.According to the theory of traditional Chinese medicine,this disease is based on qi deficiency of viscera,phlegm and blood stasis blocking collaterals as the standard,and the pathogenesis is always wind phlegm disturbing the orifices.Therefore,the clinical treatment idea is based on the principle of dispelling wind and resolving phlegm,dredging collaterals and relieving pharynx.Professor Wu Qingming and his team have summarized many years of clinical experience to establish the acupuncture method of dispelling wind and resolving phlegm,and selected Fengchi(GB20),Wangu(GB12),Lianquan(RN23)and Fenglong(ST40)as the main points,combined with acupuncture stimulation,to improve the microcirculation disturbance at the lesion site and promote the functional recovery of damaged articulation tissue.In the clinical treatment of acute dysarthria of stroke,good curative effect has been achieved.However,in practice,it has been found that patients with sequelae of long course of disease have stiff and contracture muscle tissue,even fibrosis,and acupuncture treatment has poor effect.Acupotomy therapy has a positive advantage in treating soft tissue lesions of spasm and sclerosis,which can not only restore the blood supply of articulation muscle group immediately.It can also relieve the compression of the surrounding nerve by the diseased tissue.Based on the current situation of clinical treatment,combined with the etiology and pathogenesis of this disease,the author proposes to use the acupuncture method of expelling wind and resolving phlegm to regulate the spirit,and combined with anatomy,select the starting and ending points of the articulation muscle group to regulate the shape,shape and spirit,and cooperate with speech function rehabilitation training,in order to bring a new idea and strategy for the clinical treatment of dysarthria after stroke.