吞针后勒颈自杀法医学分析1例

1案例资料1.1简要案情及现场勘验包某,女,43岁,某日被发现死于家中床上。尸体呈仰卧位,头及肩背部枕于两只枕头上,颈部紧勒一棕色牛皮带,搭扣位于右项部,皮带自左向右扭曲折叠后穿过搭扣并向左颈部反折,顺时针扭曲沿腋前线下行握于左手,穿出左手部分长30cm,双上肢自然屈曲于胸腹前。赤足,足内侧弓及其上方有点状血迹,足底有泥。头部南侧枕头边缘及床头、床边有血迹,床头边垃圾篓内见红色血液约4m L,

CLINICAL RESEARCH ON TREATMENT OF DYSPHAGIA WITH NECK ACUPUNCTURE

Objective To observe the clinical therapeutic effects on dysphagia induced by pseudobulbar palsy chiefly treated with neck acupuncture and probe into the mechanism on the effects. Methods The 86 cases that had been diagnosed definitely were randomized into two groups, the treatment group and control group. The treatment group （acupuncture＋western medication） （44 cases） was treated with acupuncture on Fēngfǔ（风府 GV16）, Fēngchí （风池GB20）, Gòngxě（供血 Extra）, Yīmíng （翳明 EX-HN14）, Zhìqiāng （治呛 Extra）, Tūnyàn （吞咽 Extra）, Fāyīn （发音 Extra）, Liánquán （廉泉CV23）, etc., and the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. The control group （western medication） （42 cases） was treated with the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. Results The total effective rate was 97.73 % and 80.95 % in the treatment group and control group respectively, indicating very significant difference （P 〈 0.01 ）. Conclusion The therapeutic effects mainly with neck acupuncture are better on dysphagia induced by psudalbulbar palsy, which is superior to that with simple western medication and worth to be promoted. Concerning to the mechanism on the therapeutic results, it is viewed that acupuncture on neck points improves the excitability of cerebral neurocytes, resuscitates the reversible neurocytes or awakens the inhibited neurocytes.

A case report of acupuncture of dysphagia caused by herpes zoster virus infection

Herpes zoster is a common clinical disease.In this paper,we retrospectively analyzed a case of dysphagia caused by herpes zoster virus infection.Treated with deep Yang stitch(acupoint selection:lofty bone,ridge spring and side ridge spring)and electroacupuncture in lofty bone and ridge spring as assistant therapy for 21 days,the patient was found that swallowing function recovered and no recurrence one year later.It shows that the method of deep Yang stitch has certain clinical curative effect on"Qiao disease".

“Tong Guan Li Qiao” Acupuncture Therapy on Post-Stroke Dysphagia

The differences between the“Tong Guan Li Qiao”acupuncture therapy and the conventional and current other acupuncture methods for poststroke dysphagia are as follows:first,it adheres to the basic idea of "Xing Nao Kai Qiao"acupuncture therapy in selecting and combining acupoints,centers on the brain,and combines the dysphagia symptoms of the mouth,tongue,and throat-related orifices with the root cause of"brain";second,thereare strictand standard requirements intheacupuncture operation,that is,manipulation quantification.In addition to standardized twirling,lifting,and thrusting,the techniques of deep needling on the acupoints in the neck region,blood-letting puncturing at the posterior wallof the pharynx,and theneedling sensation of"like a fishbone getting stuck in the throat"are all unique.

内镜取出38枚缝针一例

患者,女,87岁,因患双下肢脉管炎疼痛难忍,自杀性吞入缝针1把,2 h后来院急诊,胸腹X片示上腹部见多枚针样金属影.胃镜检查见咽部被扎数枚缝针,有活动性渗血;食管未见异物及出血;胃体、胃底内见数十枚金属缝针,大多呈纵向排列位于黏膜皱襞内(见图1),胃及十二指肠黏膜未见明显异常.

Treatment of 85 patients with dysphagia after stroke with deep needling at local glossopharyngeum

Objective To observe the clinical efficacy of deep needling at local glossopharyngeum in treatment of dysphagia after stroke. Methods Deep needling at local glossopharyngeum was applied in 85 patients with dysphagia after stroke. Firstly, quick prick was conducted on lingual surface（mainly at the side of paralysis lingualis）, Jīnjīn（金津 EX-HN 12） and Yùyè（玉液 EX-HN 13） under the tongue; secondly, filiform needle with the length of 75 mm was used to perform quick prick at posterior wall of pharynx at the affected side about three or four times, and then the needle was removed rapidly. Filiform needle with the length of 75 mm was inserted perpendicularly at Liánquán（廉泉 CV 23） towards root of tongue; after deqi, the needle was pushed towards root of tongue in the depth of 60–70 mm, and the needle was retained for 30 min. Meanwhile, the patient was asked to swallow, and the feeling of abnormal deglutition without pain was considered as most appropriate. During needle retention, twirling for reinforcement was applied for two times. The manipulation was conducted once daily, and six days was considered as one course of treatment. Between two courses, one day was free of treatment; and there were four courses in total. Kubota＇s drinking water test evaluation scale was applied to assess the efficacy after the treatment for two weeks and four weeks. Results The score of Kubota＇s drinking water test at the early stage of treatment was 5.08 ± 2.28, the score of evaluation of treatment with deep needling at local glossopharyngeum after treatment for two weeks was 4.56 ± 2.32, and the total effective rate was 89.4%; the score of evaluation after treatment for four weeks was 2.80 ± 2.12, and the total effective rate was 95.3%. Compare before the treatment, the score of Kubota＇s drinking water test was reduced after treatment for two and four weeks（P〈0.05, P〈0.01）. Conclusion Deep needling at local glossopharyngeum in treatment of dysphagia after stroke has good effect.

Therapeutic efficacy of swallowing neuromuscular electrical stimulation combined with acupuncture for post-stroke dysphagia

Objective To seek a better therapy for treating post-stroke dysphagia. Methods Patients with stroke and swallowing disorders were randomly divided into ordinary acupuncture group （group A, 58 cases） and swallowing neuromuscular electrical stimulation combined with acupuncture group （group B, 62 cases）. Two-group patients were given the same basic internal medical treatment. In addition, group A was given normal acupuncture treatment with the choice of local points： Junjin （金津 EX-HN 12）, Yuye（玉液 EX-HN 23）, Fengchi （风池 GB 20）, Yifeng （翳风 TE 17）, Lianquan （廉泉 CV 23）, Wangu （完骨 GB 12）. Group B was given swallowing neuromuscular electrical stimulation combined with acupuncture： GB 20, Fengfu （风夜 GV 16）, TE 17, Yiming （翳明 EX-HN 14）, Yamen （哑门 GV 15）, Tianrong（天容 SI 17）, Tianchuang （天窗 SI 16）, CV 23, the uniform reinforcing-reducing manipulation was used; EX- HN 12, EX-HN 13, the piercing and blood-letting method （1-2 mL blood） was used; at the same time, the swallowing neuromuscular electrical stimulation therapy device was used to electrically stimulate the nerves and muscles in the throat and neck at specific output pulse current （50-100 Hz）. Treatment was made twice a day, 30 minutes each time. Two weeks after the treatment, the patients were assessed in symptoms improvement and clinical efficacy. Results The total effective rate in group B was 91.4% and 75.8% in group A; in the total efficiency comparison in both groups, χ^2=5.232, P〈0.05. The difference in improvement of symptoms with post-stroke dysphagia treated with above mentioned combination treatment was statistically significant between both groups （P〈0.05）. Conclusion The above mentioned swallowing neuromuscular electrical stimulation combined with acupuncture treatment has a better clinical effect when compared with ordinary acupuncture.

Treatment of 40 Cases of Post-apoplectic Dysphagia by Acupuncture plus Rehabilitation Exercise

Objective： To investigate the efficacy of acupuncture plus rehabilitation exercise in treating post-apoplectic dysphagia. Methods： The patients were randomly allocated into treatment and control groups. The treatment group was treated by acupuncturing points Fengchi（GB 20）, Tianzhu（BL 10）, Tongli（HT 5） and Lianquan（CV 23） plus rehabilitation exercises and the control group only by rehabilitation exercise. Results： The total effective rate was 95.0% in the treatment group and 71.9% in the control group. There was a significant difference between the two groups （P〈0.01）. Conclusion： Acupuncture plus rehabilitation exercise can improve the curative effect on postapoplectic dysphagia.

Clinical Observations on Acupuncture Treatment of Post-Stroke Dysphagia

To seek a treatment that can improve the effect on dysphagia following post-stroke pseudobulbar palsy. Methods： Sixty patients were randomly allocated into observation and control groups, 30 cases each. The observation group was treated with Western drugs plus acupuncture at Tiantu （CV 22） and other three acupoints around Lianquan （CV 23） and the control group with simple Western drugs. Results： The effective rate was 86.7% in the observation group and 30.0% in the control group. Conclusion： Acupuncture can improve the curative effect of Western drugs on dysphagia following post-stroke pseudobulbar palsy.

Survey on acupuncture treatment of neurogenic dysphagia and analysis of regularity of acupoint selection

Objective： To understand the general situation of clinical study on acupuncture for neurogenic dysphagia and the regularity of acupoint selection by literature analysis. Methods： By searching the relevant Chinese and English literature on acupuncture treatment of neurogenic dysphagia from 2999 to 2014 in China National Knowledge Infrastructure （CNKI）, Wanfang Database and Ovid Gateway, the data of the recruited literature, including average age of the patients, acupoint selection, course, therapeutic effects and follow-up information, were input into the data table of Microsoft Excel 2010. Results： Totally, 51 articles were input, involving 4 606 patients. The average course of acupuncture treatment for neurogenic dysphagia was 24.8 d. The average retaining time of the needles was 26.2 min. The average total effective rate was 91.2%. Lianquan （CV 23）, Fengchi （GB 20）, Fengfu （GV 16） and Yifeng （TE 17） were the most commonly used acupoints from the regular meridians, accounting for 63.4% of the totally-used acupoints. Jinjin （EX-HN 12） and Yuye （EX-HN 13） were the most commonly used acupoints from the extraordinary meridians, accounting for 45.9% of the totally-used extraordinary acupoints. The frequently-used meridians in turns were the Conception Vessel, Gallbladder Meridian of Foot Shaoyang and Stomach Meridian of Foot Yangming, accounting for 63.3% of the involved meridians. Conclusion： The therapeutic effect of acupuncture treatment for neurogenic dysphagia was satisfactory. The acupoints were Lianquan （CV 23）, Fengchi （GB 20） and Fengfu （GV 26） in predominance, and they were mostly selected from the Conception Vessel, Gallbladder Meridian and Stomach Meridian those are in close relationship with the throat and neck.

Therapeutic effects of acupuncture for neurogenic dysphagia-a randomized controlled trial

OBJECTIVE:To evaluate the therapeutic effects and long-term efficacy of acupuncture for neurogenic dysphagia.METHODS:Subjects with neurogenic dysphagia undergoing routine swallowing management were randomized to receive either 20 sessions of true acupuncture(experimental group) or sham acupuncture(control group 1) for approximately one and a half months.A third group(control group 2) comprised of non-randomized subjects with neurogenic dysphagia who received routine care were recruited from separate wards.The outcomes were assessed by the Royal Brisbane Hospital Outcome Measure for Swallowing(RBHOMS),as well as by the consistencies of ingested food and fluid.RESULTS:A total of 87 subjects(experimental group,n= 20;control group 1,n=19;control group 2,n=48) were recruited into the trial.The average RBHOMS score showed a greater improvement in the experimental group and in control group 1 than in control group 2.The average levels of foodand fluid consistencies displayed greater improvement in the experimental group than in the two control groups.CONCLUSIONS:This study demonstrates that acupuncture may have therapeutic effects and long-term efficacy for neurogenic dysphagia.However,due to an insufficient sample size and the lack of follow-up for control group 2,multi-centre trials employing a larger sample size may be required to draw concrete conclusions.

Acupuncture for Chronic Dysphagic Stroke Evaluated by Fiberoptic Endoscopic Evaluation of Swallowing: A Case Report

Objective： To describe the effect of acupuncture with a new acupoint prescription in treating dysphagia from a chronic stroke patient by fiberoptic endoscopic evaluation of swallowing （FEES）. Methods： A case of chronic dysphagic stroke patient was treated by acupuncture with 5 established acupoints, and assessed by FEES before and after 4-week treatments. Results： There is improvement in swallowing and speech function after acupuncture treatment. Conclusion： There is evidence showing that new acupuncture points maybe beneficial for dysphagic stroke patients.

Therapeutic Observation on Acupoint Injection for Post-stroke Deglutition Disorder

Objective： To observe the clinical effect of acupoint injection in treating post-stroke deglutition disorder. Methods： Eighty patients with post-stroke deglutition disorder were randomized into a treatment group and a control group, 40 in each. The treatment group received acupoint injection in addition to routine Western medication, and the control group received the routine Western medication only. The treatment results in the two groups were compared and analyzed. Result： After treatment, the patients in the two groups had improvements in the scores of symptoms and signs. In comparison of water drinking test, the result in the treatment group was superior to that in the control group （P〈0.01）. Conclusion： Acupoint injection can achieve a satisfactory result in treating post-stroke deglutition disorder.

Influence of Acupuncture on Remodeling of Swallowing Functions for Patients with Pseudobulbar Palsy after Cerebral Infarction

Objective： To explore the interfering effect of acupuncture treatment in remodeling the swallowing functions for the patients with pseudobulbar palsy after cerebral infarction. Methods： Seventy-two cases with pseudobulbar palsy after cerebral infarction were randomly allocated into an observation group and a control group, 36 cases in each group. The treatment neurological therapies, once a day, with one day rest group was treated with acupuncture based upon routine after continuous treatment for six days, and therapeutic effects were assessed after six courses of the treatments. The control group was treated with routine neurological therapies, with the therapeutic effects observed after the treatment for 42 d. Results： The total effective rate was 80.6% in the observation group and 58.3% in the control group, with statistical significance in comparison of difference between the two groups （P〈0.05）, and with statistical significance in comparison of the score of deglutition disorder between the observation group and control group （P〈0.01）. Conclusion： Nape acupuncture can obviously improve the clinical symptoms and signs for the patients with pseudobulbar palsy, with affirmative therapeutic effects, and is worthy of popularization.

Characteristics of Mang Needle Therapy and Its Clinical Application

Mang needle （elongated needle, 芒针） is evolved from the long needle, one kind of nine needles in the ancient times, and is primarily characterized by its long needle-body and its arrival at the deep tissues of the body. However, because of the particularity of the physiology and anatomy of some diseases, direct deep puncturing can＇t reach the due tissues, thus the treatment results are affected. Based upon the deep puncturing of Mang needle and the physiology and anatomy of the human body, professor YANG Zhao-gang, a well-known acupuncturist, has made many improvements and innovations, in his long-term clinical practice, in the manipulations and indications of Mang needle, consequently to establish a series of unique puncturing techniques of Mang needle, which work excellently on some difficult and complicated diseases. This Mang needle therapy is introduced as follows.