针灸治疗吞咽障碍的历史源流

Historical Source Analysis of Treating Dysphagia by Acupuncture

吞咽障碍是脑卒中的常见并发症之一,严重影响患者的生活质量,甚至危及生命。针灸治疗吞咽障碍历史悠久,对其病因的认识从脏腑及其归属经络的内因扩展到与风、痰、火等外邪夹杂,病机由'脾脉微急''肾虚'逐渐发展到'风痰上扰、肾气亏虚、精血亏耗、血虚风动、肝阳化风、心经火热、脾肾积热'。病位也从单一的脾、肾、心等发展到肝胆、肝肾、心肾、心脾、脾胃、肺胃等多个脏腑。选穴规律从单独的局部选穴逐渐演变为穴位组合,再到循经、辨证选穴。针灸方法也从点刺出血逐渐多样化、综合化。针灸治疗吞咽障碍疗效已得到证实,探索针灸治疗吞咽障碍的源流及其机制,因人制宜,辨证施治,旨在更好指导临床。

Dysphagia is a common complication of stroke,delivering a great threat to the life quality of patients,even to their lives.Acupuncture has been used for a long history to treat dysphagia.The understanding of etiology of dysphagia extends from internal cause including viscera and bowels and its affiliated meridians to complex cause combining internal cause and external pathogen like wind,phlegm and fire.The pathogenesis of dysphagia gradually extends from'spleen-pulse slight rapid and kidney deficiency'to'wind-phlegm harassing upward,kidney qi deficiency,deficiency of essence and blood,blood deficiency engendering wind,liver yang transforming into wind,hyperactive heart-meridian fire and heat accumulating in spleen-kidney'.The disease location of dysphagia develops from single organ(spleen,kidney and heart)to multiple organs like liver-gall bladder,liver-kidney,heart-kidney,heart-spleen,spleen-stomach and lung-stomach.The rule of selecting acupuncture acupoints changes from singleness and local to combination,and then to selecting acupoints in accordance with the channel and syndrome.Acupuncture methods also changed gradually from pricking bloodletting to diversification and comprehensiveness.The curative effect of acupuncture on dysphagia has been verified.Further research on the etiology and mechanism of dysphagia will benefit individual treatment and syndrome differentiation,providing a better clinically guidance.