A COMPARATIVE STUDY ON THE TREATMENT OF VASCULAR DEMENTIA BY PUNCTURING BAIHUI (GV20), SHUIGOU (GV26) AND SHENMEN (HT7)

Objective: To observe the relative specialty of the therapeutic effect of acupuncture of Baihui (百会 GV 20), Shuigou (水沟 GV 26) a nd Shenmen (神门 HT 7) in the treatment of vascular dementia (VD) patients. Methods: F ifty VD patients were randomly divided into routine treatment group (control gro up), Baihui (GV 20) group (GV 20 group), Shuigou (GV 26) group (GV 26 gr oup), Shenmen (HT 7) group (HT 7 group) a nd GV 20+GV 26+HT 7 group (joint treatment group), with 10 cases in ea ch group. In control group, acupoints used were Jianyu (肩NFDA1 LI 15), Quchi (曲池 L I 11), Waiguan (外关 TE 5), etc. (which were also used in the other four groups) on the paralyzed side. The treatment was conducted once a day except weekends, 20 session s all together. Clinical Dementia Rating Scale (CDR), Mini-Mental State Examin at ion (MMSE) test, Blessed Dementia Rating Scale (BDR) and Clinical Neurological D eficit Rating (CNDR) were used to assess the patients’ intelligence state befor e and after acupuncture treatment. Results: After acupuncture tr eatment, the VD patients’ intelligence in all the five groups was improved at different degrees . Additional acupuncture of each of GV 20, GV 26 and HT 7 had a remarkable e ffec t in improving the VD patients’ fluid intelligence, and could obviously promote their abilities of temporal orientation, spatial orientation and figure drawing ; and additional joint acupuncture of the three acupoints could improve their co gnitive and non-cognitive functions, such as reducing the severity of dementia , raising the temporal orientation, spatial orientation, calculation, short-term m emory and figure drawing abilities, and improving their activities of daily livi ng and personality. Besides, acupuncture of GV 20 could improve the abilities of calculation and short term memory, and correct the personality change of VD pat ients, while acupuncture of GV 26 could improve the abilities of naming and sh or t-term memory. Conclusion: Acupuncture of GV 20, GV 26 and HT 7 all had a certai n therapeutic effect in improving VD; the therapeutic effects of acupuncture of GV 20 and GV 26 were better than that of acupuncture of HT 7; and the effica cy of the three points used in combination was the best.

近十年人中穴(GV26)临床应用概述

目的了解近十年间人中穴在临床应用中的现状与价值。方法通过搜索近十年中国知网(CNKI)、万方(Wangfang)、维普(VIP)三大国内数据库进行文献检索,将含有“人中穴”或“水沟穴”文献进行纳入,通过导入文献管理软件进行手工筛选分类。结果人中穴主要应用在神经系统疾病,集中在脑梗死及其后遗症、急性腰扭伤、面瘫、促醒、呃逆、抑郁等疾病。结论近十年人中穴应用范围较为集中,优势病较为明显,其相关作用的部分机理已经被有效证实,但是其适应病种和手法量学仍然有进一步的拓展价值和研究潜力。

A Comparative Study on the Acupoints of Specialty of Baihui, Shuigou and Shenmen in Treating Vascular Dementia

Objective： To study the relative specialty of the acupoints of Baihui （DU20）, Shuigou （DU26） and Shenmen （HTT） in treating vascular dementia （VD）. Methods： Fifty patients suffering from VD were divided into 5 groups randomly and treated by conventional acupuncture for hemiplegia, or conventional acupuncture plus needling in DU20, DU26, HT7 respectively or simultaneously. Clinical symptoms were observed, and the scales such as Hasegawa＇s dementia scale-recension （HDS-R）, activities of daily living （ADL） and functional activities questionnaire （FAQ） were used for assessment before and after acupuncture treatment. The scores were processed statistically. Results： DU20 and HT7 could improve the abilities of memory, orientation, reaction and reduce adamancy and trance. Bedsides, DU 20 was helpful in improving the abilities of understanding, calculating and social adapting. While DU26 is helpful in treating retardation, failure in daily activities, trance and poor memory. The combination of the 3 acupoints could improve the intelligence and social adapting ability of VD patients. Conclusion： DU20, DU26 and HT7 had its own effect in treating VD, but the effect of three points used in combination was the best.

Effects of different frequencies of electro-acupuncture at Shuigou(GV 26) on recovery of motor function in rats with focal cerebra ischemic injury

OBJECTIVE:To investigate the effects of different frequencies of electro-acupuncture at Shuigou(GV 26) on the latent period and wave amplitude of motor evoked potentials(MEPs) in rats with focal cerebral infarction.METHODS:Fifty healthy male Wistar rats were randomly divided into five groups:controls,model,2 Hz Shuigou,50 Hz Shuigou and 100 Hz Shuigou.There were 10 rats in each group.Using a modification of a technique for middle cerebral artery occlusion,focal cerebral ischemic injury was induced in all rats except those in the control group.The rats in the control group received no treatment.After behavioral deficit had been evaluated using the Zausinger 6-point neurological function score,therats in the Shuigou groups underwent acupuncture and continuous wave stimulation at a frequency of 2 Hz,50 Hz or 100 Hz(intensity 1 mA) for 10 min twice daily for 3 days.The control and model groups underwent no intervention.Zausinger 6-point neurological function score and MEPs were measured 72 h after the start of treatment.RESULTS:The neurological function scores of the three Shuigou groups were significantly higher than those of the model group(P<0.05).There was no significant difference between sides in the latency and amplitude of MEPs in the model group(P> 0.05).The latency on the affected side in the model group was significantly longer than that in the control group(P<0.05) and the amplitude on affected side was significantly reduced(P<0.01).After 3 days of electro-acupuncture,the latency on the affected side in the 2 Hz Shuigou group was significantly shortened(P<0.05) and the amplitude was significantly increased(P<0.05) compared with the model group.CONCLUSION:Low frequency electro-acupuncture at Shuigou(GV 26) can promote recovery of motor function after focal cerebral ischemic injury in rats.

Comparative Study on the Effect of Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） on Cognition of Patients with Vascular Dementia

Objective： To study the relative specificity of Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） in improving the cognitive function of patients with vascular dementia （VD）. Method： Fifty VD cases were randomized into 5 groups, which were treated with routine points, routine points plus Baihui （GV 20）, routine points plus Shuigou （GV 26）, routine points plus Shenmen （HT 7）, and routine points plus the above-mentioned three points together respectively. The scale of elderly cognitive function （SECF） was measured before and after the treatment for statistical management. Results： The total score of SECF was markedly increased after Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） were added to the routine points, more specifically, with addition of Baihui （GV 20）, the patients with VD got increased scores in such aspects as orientation, instant memory, long-term anamnesis, animal names, cancellation and calculation, and classification and analogy; with addition of Shuigou （GV 26）, the patients with VD got increased scores in such aspects as orientation, cancellation and calculation, and classification and analogy; with addition of Shenmen （HT 7）, the patients with VD got increased scores in such aspects as digital scope, animal names, and classification and analogy. Conclusion： Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） could improve the cognitive function of patients with VD, and the combination of the three points got the best result despite their respective specificity.

电针“水沟”与“井穴”对全脑缺血大鼠脑组织钙调素活性影响的对比研究

目的 :观察电针“水沟”与“井穴”对全脑缺血大鼠脑细胞内活性钙调素 (CaM )含量的影响。方法 :采用大鼠全脑缺血再灌注模型 ,用磷酸二脂酶法测定电针后正常对照组、模型对照组、电针“水沟”穴组、电针“井穴”组、假手术对照组脑组织活性CaM的含量。结果 :脑缺血后脑组织活性CaM含量明显升高 ,电针刺激“水沟”和“井穴”均可使大鼠缺血区脑组织活性CaM含量明显降低 ,两组无显著性差异。结论 :电针“水沟”与“井穴”均能明显降低活性CaM的含量 。

“水沟”穴最佳刺激参数的筛选研究

目的:了解针刺参数对针效的影响,探讨"醒脑开窍"针刺法中水沟穴最佳刺激参数。方法:复制大鼠大脑中动脉缺血模型(MCAO),以针刺频率的慢、中、快(1、2、3次/秒)和针刺时间的短、中、长(5 s、60 s、180 s)的两因素三水平针刺参数搭配组合9种针刺方法刺激"水沟"穴,以脑血流量为效应指标,通过正交试验、析因分析、单因素方差分析,综合分析不同针刺手法作用于"水沟"穴对MCAO大鼠脑血流量的影响。结果:针刺效应受针刺频率、时间以及它们两者的交互作用影响,其中,针刺时间影响作用最大。尽可能长时间地应用最快频率针刺,可取得最佳针刺效应。结论:"醒脑开窍"针刺法中"水沟"穴的操作是快频率、足够长时间的针刺(雀啄手法以眼球湿润为度),可取得最佳效应。此法是"水沟"穴最佳刺激参数。

电针水沟穴抗轻、中度休克：多中心随机对照研究

目的:探讨电针水沟穴抗轻、中度休克的作用。方法:采用3中心分层随机对照研究方法,将276例患者随机分为针药组(138例)、西药组(138例)。西药组仅给予西医常规治疗,针药组在给予西医常规治疗的同时,电针水沟穴,观察治疗6小时后的疗效。结果:针药组可即刻升高血压,升压起效时间早于西药组(P<0.001)。针药组显效率为52.9%,高于西药组的18.1%(P<0.001)。结论:在西药基础上电针水沟穴治疗轻、中度休克疗效优于单纯西药。

Electroacupuncture improves neurovascular unit reconstruction by promoting collateral circulation and angiogenesis

Acupuncture at Shuigou（GV26） shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacupuncture at GV26（15 Hz and 1 m A, continuous wave [biphasic pulses], for 5 minutes）. Electroacupuncture effectively promoted regional cerebral blood flow on the infarct and non-infarct sides, increased infarct lesions, lectin, and number of blood vessels, upregulated von Willebrand factor and cell proliferation marker Ki67 expression, and diminished neurological severity score. These findings confirm that electroacupuncture at GV26 promotes establishment of collateral circulation and angiogenesis, and improves neurological function.

醒脑开窍针法中水沟穴作用探讨

目的 :探讨水沟穴在醒脑开窍针法中的作用。方法 :根据文献及现代医学机理 ,对针刺水沟穴在中风急性期和恢复期、后遗症期的作用进行分析。结果 :中风急症期可醒脑神、开清窍 ,中风恢复期、后遗症期以调神作用为主 ,其作用机制 ,在于针刺刺激了穴周的面神经、三叉神经分支 ,激活了三叉神经—脑血管系统 ,一方面兴奋脑神经元 ,另一方面 ,改善了脑血流。其刺激的量化标志就是流泪。

电针“水沟”对脑梗死大鼠脑动脉血管平滑肌中Ca^(2﹢)-ATP酶及钠钙交换体表达的影响

目的观察电针“水沟”穴对脑梗死大鼠脑动脉血管平滑肌Ca^(2﹢)-ATP酶及钠钙交换体表达变化的动态调节规律。方法130只雄性Wistar大鼠随机分为空白组、模型组、电针组、假手术组,后3组在造模后又分为3 h、6 h、12 h、24 h 4个时相组,每组10只。采用线栓法复制大鼠大脑中动脉阻塞(middle cerebral artery occlusion,MCAO)模型,假手术组除不插入线栓外,其余操作同模型组。电针组在造模后即刻针刺“水沟”穴,电针刺激20 min。应用激光多普勒血流仪检测梗死侧血流量的变化,然后各组动物均按时相处死,分别分离和剪取梗死侧的大脑前动脉、中动脉和后动脉各8 mm。应用Western blot法检测血管中Ca^(2﹢)-ATP酶的相对表达量;应用RT-qPCR法检测血管中钠钙交换体1(sodium calcium exchanger 1,NCX1)及钠钙交换体3(sodium calcium exchanger 3,NCX3)mRNA的相对表达量。结果大鼠脑梗死后24 h内,与假手术组比较,模型组和电针组各时项血流量均明显下降(P<0.01);电针组大鼠在3 h、6 h、12 h时脑血流量高于模型组(P<0.05)。与空白组和假手术组比较,模型组3 h时Ca^(2﹢)-ATP酶下调(P<0.05),各时项NCX1及NCX3 mRNA表达量下调(P<0.05);与模型组比较,电针组3 h时项Ca^(2﹢)-ATP酶表达量的表达水平上调(P<0.05),3 h、6 h时项NCX1 mRNA的表达水平上调(P<0.05),3 h时项NCX3 mRNA表达水平上调(P<0.05)。结论电针干预能增加脑梗死及其周边区域血供,明显抑制脑动脉血管平滑肌上Ca^(2﹢)-ATP酶表达量及NCX1和NCX3 mRNA表达的下调,从而达到减轻脑动脉血管平滑肌内Ca^(2﹢)超载,进而维持细胞内外Na^(﹢)、Ca^(2﹢)稳态,这对于抑制缺血后血管平滑肌痉挛,保持血管功能和状态的正常,从而增加脑梗死区周围血流灌注具有重要作用,但电针的干预具有一定的时效性。

百会、水沟、神门治疗血管性痴呆的比较研究

目的比较百会、水沟、神门治疗血管性痴呆(VD)的相对特异性。方法50例血管性痴呆患者,随机分为5组,A组治以常规穴位针刺,在A组基础上B组加用百会、C组加用水沟,D组加用神门,E组加用百会、水沟和神门3穴。治疗前后均观察临床症状的变化,并运用修订长谷川痴呆量表、日常生活活动量表、社会功能活动调查等量表进行测评,评分结果进行统计学处理。结果百会、神门能够改善VD患者记忆、定向、反应、固执、恍惚等方面的症状,百会长于帮助患者理解、计算、适应社会;水沟则偏重于针对VD患者喜睡嗜卧、反应迟钝、神思恍惚、记忆等症状的改善;百会、水沟、神门3穴联合运用,对于VD患者的智力水平、社会适应能力有着较为全面的改善。结论百会、水沟、神门3穴在改善VD患者临床症状和智力水平方面各有其相对特异性,3穴联合运用疗效最佳。

百会、水沟、神门影响血管性痴呆患者认知功能的比较研究

目的:探讨百会、水沟、神门改善血管性痴呆(VD)患者认知功能的相对特异性。方法:50例VD患者,随机分为5组,分别施以针对偏瘫的常规穴位针刺,常规穴位加用百会穴,加用水沟穴,加用神门穴,加用百会、水沟和神门穴。治疗前后运用老年认知功能量表(SECF)进行测评,评分结果纳入统计学处理。结果:常规穴位加用百会、水沟、神门等穴位治疗后,SECF总分有显著提高;加用百会穴治疗后,VD患者的定向、瞬间记忆、长回忆、动物名、划销和计算、分类与类同等方面评分有明显提高;加用水沟穴治疗后,VD患者的定向、划销和计算、分类与类同等方面评分有明显提高;加用神门穴治疗后,VD患者的数字广度、动物名、分类与类同等方面评分有明显提高。结论:百会、水沟、神门能够改善VD患者认知功能,三穴虽然分别有各自的相对特异性,但联合运用效果最佳。

针刺水沟穴抑制MCAO大鼠海马区神经细胞坏死的作用研究

目的:对比针刺水沟穴与水沟旁非穴对MCAO大鼠海马区坏死神经元作用。方法:将72只健康雄性Wistar大鼠按照随机数字表分为正常组、假手术组、模型对照组、非针刺组、水沟旁组、水沟组6组,每组12只。模型对照组、水沟旁组、水沟组参照Zea-Longa线栓法复制大鼠大脑中动脉缺血模型(MCAO)。水沟旁组、水沟组以频率180次/min、持续5s进行针刺干预。观察大鼠神经行为学,血流量,脑梗死面积比率,以及海马区神经细胞坏死率。结果:水沟组分别与非针刺组和水沟旁组比较差异都具有显著差异性P<0.05,而增加血流量方面水沟组也明显优于水沟旁组P<0.01。水沟旁组与非针刺组无显著性差异(P>0.05)。结论:针刺水沟穴抑制MACO大鼠神经细胞坏死,增加血流量从而降低梗死面积,而水沟旁无此作用.

针刺与药物结合治疗小儿热性惊厥临床观察

目的:探寻治疗小儿热性惊厥的有效疗法。方法:将70例热性惊厥患儿随机分成两组,针药组(36例)采用针刺醒脑开窍法以水沟穴为主,配合鲁米那肌肉注射、安定静脉推注;药物组(34例)单纯采用肌肉注射鲁米那、安定静脉推注。观察两组疗效、止惊起效时间及复发率。结果:针药组总有效率为86.1%,优于药物组的79.4%;在止惊起效时间上,针药组明显短于药物组(P<0.01),且针药组复发率低于药物组(P<0.05)。结论:针刺配合肌肉注射鲁米那、静脉推注安定治疗热性惊厥是一种快速、有效、安全的方法。

基于光镜观察的水沟穴治疗脑梗塞的参数优化研究

目的根据灰色系统理论，从病理形态学角度筛选“醒脑开窍”针刺法的主穴之一“水沟”穴治疗脑梗塞的最佳参数（频率、时间）。方法将72只SD大鼠随机分为12组，分别为正常纽、假手术组、模型未干预组及模型干预组（包括：参数1～参数9，共9组）。模型组均复制一侧大脑中动脉缺血模型，分别以9种参数针刺模型干预组的“水沟”穴．2次／d．连续治疗3d后，取皮层、海马及纹状体3个区域的脑组织，光镜下分别计数神经细胞、微血管、炎性细胞、阳性细胞及噬神经现象，并对统计数据进行灰色关联分析，从而筛选“水沟”穴治疗脑梗塞的最佳针刺参数。结果各针刺参数的灰色关联度排序为：参数6〉参数2〉参数5〉参数8〉参数9〉参数3〉参数4〉参数1〉参数7。结论病理形态学研究提示，参数6（即针刺频率：3）k／s；针刺时间：5s）为手针刺”水沟”穴治疗脑梗塞的最佳拳数。

针刺对心肺复苏家兔脑组织Na^+-K^+-ATP酶的影响

目的研究针刺水沟穴、内关穴对心肺复苏家兔脑组织的保护作用。方法采用家兔窒息型心脏骤停-心肺复苏(CA-CPR)模型,设立针刺复苏组、常规复苏组及假手术组。于自主循环恢复120 min快速开颅、取左侧脑组织分离ATP酶活性(ATP酶活性的检测采用定磷法)。结果与假手术复苏组比较,针刺复苏组和常规复苏组脑组织Na+-K+-ATPase活性均见下降,但是针刺复苏组(1.68±0.50 mol·Pi/mgpro·th-1)高于常规复苏组(1.44±0.32 mol·Pi/mgpro·th-1),差异有统计学意义(P<0.05)。结论针刺能在常规复苏方法基础上提高脑组织的Na+-K+-ATPase活性,从而起到保护心肺复苏家兔脑组织的作用。

针刺治疗中风后手指过屈疗效及对患者中医症候积分与关节功能相关指标的影响

目的:观察针刺治疗中风后手指过屈的疗效及对患者中医症候积分与关节功能相关指标的影响。方法:将60例中风后手指过屈患者随机分为针刺治疗组(30例)和巴氯芬治疗组(30例),治疗30d后,观察两组患者治疗效果,治疗前后中医证候积分、手指痉挛程度、神经功能缺损评分(NISS)、中医侯症积分和掌指关节活动度变化情况及检测两组患者治疗前后cAMP、cGMP、IP3、DAG水平。结果:针刺组患者治疗总有效率(86.67%)显著高于巴氯芬组(56.67%)(P<0.05),针刺组患者在治疗15d和30d后手指痉挛改善程度和掌指关节活动度显著优于巴氯芬组(P<0.05);治疗后针刺治疗组患者NISS评分和中医证候积分较巴氯芬药物组改善更明显,差异具有统计学意义(P<0.05)。与巴氯芬药物组比较,治疗后针刺组患者cAMP含量显著增加,而cGMP、IP3和DAG含量明显降低,差异具有统计学意义(P<0.05)。结论:针刺治疗中风后手指过屈有显著改善作用,能够提高cAMP水平和降低cGMP、IP_3、DAG水平,介导Ca^(2+)超载,降低肌肉张力,促进手指关节功能恢复。

素髎、水沟穴主治机理新释

目的:对素髎、水沟穴的主治机理进行新的阐释。方法:以中医的藏象学说为中心,结合西医解剖学对素、水沟穴的主治机理进行分析。结果:不仅提出五官与五脏之间有相互对应(外形的“复制”)的关系,而且运用这一理论解释了素、水沟穴以及周围(鼻尖、鼻中沟)某些奇穴具有相同主治作用的理由。结论:该思路对发现新的针灸治疗点及确定针刺的角度、方向具有指导意义。

针刺人中穴治疗急性腰扭伤的临床试验研究

目的:针刺人中穴治疗急性腰扭伤,为腧穴主治提供临床依据。方法:对患者240例,按照随机方案选择患者。针刺人中穴(治疗组120例)、针刺委中穴(对照组120例),并对其疗效进行分析。结果:试验组:总有效率95.83%;对照组:总有效率86.67%;两组总疗效比较有统计学意义,试验组好于对照组(P<0.05)。结论:针刺治疗急性腰扭伤效果明显,取穴人中疗效优于委中。