卒中后认知功能障碍多发生于"阴气自半"的中老年人,临床表现多样,证候兼夹多变,病机复杂.临证多从复法立论治疗,通过复合立法、组方配伍,使其相互为用,形成新的功用,以增强疗效.卒中后认知功能障碍核心病机归结为肾精不足、髓海空虚、痰瘀阻窍.临证审证求机,复法合方,采用补肾填精、化痰祛瘀通窍复法治疗.

目的:观察周围性面神经麻痹急性期应用疏风散邪方联合针灸的治疗效果.方法:将80例周围性面神经麻痹急性期随机分为对照组40例和治疗组40例,两组患者在西医对症治疗的基础上,对照组给予针刺治疗,治疗组给予中药联合针刺治疗.治疗2周后,观察两组临床疗效和面神经功能评分.结果:两组疗效比较,治疗组优于对照组(P＜0.05).两组治疗前后面神经功能总评分比较差异有统计学意义(P＜0.05).结论:疏风牵正汤联合针灸治疗周围性面神经麻痹急性期临床疗效明确,可以促进面神经的早期恢复,利于患者康复,值得推广应用.

目的 观察复方通络饮治疗脑梗死急性期患者的临床疗效及可能机制.方法 158例脑梗死急性期患者随机分为治疗组86例和对照组72例.对照组采用西医基础治疗,治疗组在西医基础治疗同时加用复方通络饮,每日1剂,两组共治疗28天.治疗前和治疗14、28时进行美国国立卫生研究院卒中量表评分(NIHSS)、日常生活活动能力评分(BI指数),检测血清血管内皮生长因子(VEGF)、血管生成素1(Ang-1)、碱性成纤维细胞生长因子(bFGF)含量.结果 与本组治疗前比较,两组患者治疗14、28天时NIHSS评分下降,BI指数升高,且在治疗14、28天时治疗组NIHSS评分低于对照组,BI指数高于对照组(P ＜0.05或P＜0.01).治疗组治疗14、28天时血清VEGF、Ang-1含量高于本组治疗前及对照组治疗后同时间点,血清bFGF含量低于本组治疗前及对照组治疗后同时间点(P＜0.05或P＜0.01).结论 复方通络饮可改善脑梗死急性期患者神经功能,提高日常生活活动能力,可能与调节血管生长相关因子表达有关.

目的:观察通脑活络针刺法联合凉血通瘀方治疗急性脑出血的临床疗效.方法:将69例患者按随机数字表法分为治疗组35例和对照组34例,治疗组在对照组内科常规治疗基础上采用通脑活络针刺法联合凉血通瘀方治疗,疗程均为14d,评价2组美国国立卫生研究院卒中量表(NIHSS评分)、日常生活活动能力评分(ADL评分)、脑出血量和综合疗效.结果:2组治疗后NIHSS评分、ADL评分均有改善,治疗组改善更明显;治疗组治疗后脑出血量低于对照组,治疗组总有效率91.4％,高于对照组82.4％.结论:在内科常规治疗基础上,联合使用通脑活络针刺法和凉血通瘀方治疗急性脑出血可明显提高临床疗效,且未见不良反应.

近年来,笔者运用电针结合康复手法治疗中风后肩痛30例,并与单纯采用康复手法治疗的30例作对照,取得较好疗效,现报告如下。1临床资料1.1一般资料2006年12月～2010年5月南京中医药大学第三附属医院脑病中心和江苏省人民医院康复科门诊、住院患者64例,随机分为治疗组、对照组。临床观察中脱落4例,最终有完整资料者60例。治疗组30例:男25例,女5例;年龄38～75岁,平均年龄（61.63±11.13）岁;平均病程（1.57±0.88）月;脑出

Objective To evaluate the effect of Tongnao Huoluo Acupuncture(THA) therapy on acute cerebral infarction(ACI).Methods Adopting the improved micro embolus method to manufacture SD rats middle cerebral artery embolism mode.264 ACI SD rats were randomly divided into 5 groups:≤1.5h group(n=72);1.5～2h group(n=72);2～3h group(n=72),ischemia group(n=24);and sham operation group(n=24).The first 3 groups were respectively treated with THA,thrombolysis with urokinase(TU) and body acupuncture.Therapeutic effect was evaluated by HE staining,TUNEL staining and TTC staining at 24h,and 72h time point.Results In 2h period,compared with TU,numbers of TUNEL-positive staining cells and the percentage of infarction volume in rats brain of THA were insignificantly different at 24h,and 72h time point(P0.05),In this period,the above index of THA and TU were remarkably different from ischemia group and body acupuncture group(P0.05).In 2～3h period the therapeutic effect of THA showed remarkable difference from TU,Ischemia group and body acupuncture group(P0.01).Therapeutic effect of THA showed great difference in these 3 periods(P0.05).Conclusion THA therapy shows favorable effects in decreasing the percentage of apoptosis cells and infarction volome in rats with acute cerebral infarctioninfarction.Therapeutic effect of THA is closely related with time window.

迄今为止时间窗内应用(r-tPA)溶栓治疗急性缺血性卒中是唯一有效的手段,是世界医学领域公认的金标准,也是治疗急性脑梗死的热门话题之一,为了在中医方法上时间窗内治疗急性脑梗死,拟创立了通脑活络针刺法,临床观察显示了较好的疗效.此法显示了中医创新特色,提升了中医治疗急性脑梗死的水平,填补了此项医学的空白,值得更进一步的深入探讨研究,使之更加完善和提高这项技术的水平.

OBJECTIVE:To compare the therapeutic effect difference between electroacupuncture combined with rehabilitation techniques and simple rehabilitation techniques for treatment of the shoulder subluxation after stroke.METHODS:Sixty cases of shoulder subluxation patients were divided into an acupuncture combined with rehabilitation group (30 cases) and a rehabilitation group (30 cases). The acupuncture combined with rehabilitation group was treated with electroacupuncture at Jianyu (LI 15), Jianliao (TE 14) and Jianzhen (SI 9) etc. combined with rehabilitation treatment, the rehabilitation group was treated with rehabilitation only. The therapeutic effects were evaluated and the pain score of the shoulder joint, passive range of motion of shoulder joint, the muscle strength of middle group of the deltoid and the function grade of the upper limbs motion of the two groups were evaluated before and after treatment.RESULTS:The acupuncture combined with rehabilitation group was superior to that of the rehabilitation group in pain score of the shoulder joint, passive range of motion of shoulder joint, the muscle strength of middle group of the deltoid and the function grade of the upper limbs motion with significant differences between the two groups (all P<0.05); the total effective rate of 93. 3% in the acupuncture combined with rehabilitation group was superior to that of 73.3% in the rehabilitation group (P<0.05).CONCLUSION:The therapy of electroacupuncture combined with rehabilitation techniques can act a good regulating role on muscle strength and the muscular tension of shoulder joint and the muscles around the scapula through many steps, and can effectively improve the shoulder subluxation.

Objective To compare the curative effects between Tongnaohuoluo acupuncture therapy and the conventional therapy on acute cerebral infarction(ACI),and the best therapeutic time window of Tongnaohuoluo acupuncture therapy on ACI.Methods By the methods of multi-centered,randomized and controlled,145 ACI patients(acupuncture therapy group) according course were divided into 6 h sub-group,6-48 h sub-group and 48 h sub-group.Based on conventional treatment,Tongnaohuoluo acupuncture therapy was given once daily for 14 d.The score of National Institute of Health stroke scale(NIHSS),Barthel index(BI) pre and post treatment were evaluated.Ninety d after treatment,the curative effects were assessed and compared with other 125 ACI patients who only taken conventional therapy(conventional therapy group).Results After treatment,the total effective rates in each acupuncture therapy sub-group(96.4%,90.9%,80.4%)were significant higher than those in each conventional therapy sub-group(86.7%,75.0%,58.3%)(all P0.01);and in acupuncture therapy group,which in6 h sub-group was significantly higher than 6-48 h and 48 h sub-groups(P0.05-0.01).Compared with each conventional sub-group,NIHSS scores in the each acupuncture sub-group was significantly lower and BI was significantly higher(P0.05-0.01);and in acupuncture therapy group,which in 6 h sub-group were superior to 6-48 h and 48 h sub-groups(P0.05-0.01).Conclusions Tongnaohuoluo acupuncture therapy for ACI has remarkable efficacious.The best time of this therapy is within 6 h after ACI onset.

ACA双侧闭塞并发多发性脑梗塞是一种较少见的脑血管疾病,发病时可产生双侧下肢感觉及运动障碍甚至瘫痪,其发病危险因素包括烟酒嗜好、高血压病、糖尿病、冠心病、高脂血症、风心病、房颤等。对大脑前动脉双侧闭塞合并脑梗塞1例进行病案分析,并总结治疗经验。

Recent literature of acupuncture treatment and rehabilitation of post-stroke dysphagia were analysed. Acupuncture combined with rehabilitation is the best treatment of dysphagia following post-stroke pseudobulbar,which paly an important role in reducing disability and improving the quality of life for patients with dysphagia.

AIM: To investigate the effect of pattern of stroke unit on the early treatment of acupuncture of patients with severe stroke in intensive care unit (ICU).METHODS: Stroke ICU was open in Nanjing Hospital of Traditional Chinese Medicine in December 1999. During routine treatment,acupuncture treatment was intervened early by selecting various acupoints according to its main symptoms and complications.RESULTS: Early acupuncture can improve cerebral oxygen metabolism,increase cerebral blood stream and increase of blood glucose support, protect central neuron, decrease apoptosis of cerebral neuron, treat ischemic and hemorrhagic stroke and process hicough, swallowing disorder, limb paralysis,speech disorder, urine disordcer and other complications after stroke.CONCLUSION: Early acupuncture and combination of TCM and western are advantageous for early rehabilitation.

肩关节半脱位是中风病人常见并发症,早期的针刺与康复治疗以预防和纠正半脱位对患者上肢功能的恢复具有重要意义,文章着重回顾并分析了近20年来针灸结合康复手法治疗本病的文献资料,认为目前临床对本病的治疗以电针结合康复手法最为广泛,但临床研究性报道较少,观察指标难以准确反映针刺治疗肩半脱位的作用机理。有必要深入研究并以简便可行的康复评定方法进一步筛选出更为有效的治疗方案以促进该项技术在临床治疗中的运用推广。

Ninety-six cases of prolapse of lumbar intervertebral disc of posterior protrusion type were divided randomly into observation group including 50 cases and control group including 46 cases. Patients in observation group were treated with combined use of acupuncture, traction and Tuina, and patients in control group were only treated with acupuncture. After treatment, the significant difference was found between the observation group and control group in therapeutic affect. The comprehensive therapy is definitely effective and simple in the treatment of prolapse of lumbar intervertebral disc of posterior protrusion type, which has guiding significance to the clinical practice.

归纳针刺与康复治疗中风后吞咽困难的多种方法,以提高治疗效果,通过整理近期中风后吞咽困难针刺与康复的治疗方法和效果的文献,认为针刺与康复结合治疗法是目前卒中后假性球麻痹治疗的最佳方案,对减少病人致残率、提高生存质量和回归家庭社会具有较好的作用.

目的:观察头针结合腹针治疗缺血性脑卒中的疗效.方法:治疗组60例采用头针结合腹针,对照组40例采用常规针刺.以神经功能缺损程度评分标准(CSS量表)和Barthel指数评价神经功能恢复状况.结果:治疗4周后2组总有效率比较有显著性差异(P<0.05),治疗6周后2组总有效率比较有非常显著性差异(P<0.01).2组在治疗6周后的神经功能缺损积分的变化及Barthel指数评分的变化相比差异均存在非常显著性意义(P<0.01).结论:头针结合腹针治疗缺血性脑卒中疗效较常规针刺显著.

在脑血管疾病的重症患者中极易导致肢体运动功能障碍,出现肩关节半脱位的异常模式状态,尤以肥胖、体虚、年老、瘦弱者为多见,直接影响着患侧上肢的功能恢复,近几年笔者采用了针刺与康复手法中西医结合的治疗方法,并设对照组观察,现报告于下.

慢性便秘属祖国医学"气秘""虚秘"等范畴,许多原因都可以引起便秘.本篇所论是重症中风患者病后因长期卧床,肠蠕动功能减弱,以腹部胀满、排便次数减少或便时困难、过分用力、粪便过硬等为其主要症状,属于结肠无力型神经系统病变的患者.

Objective:To observe the effect of acupu ncture and rehabilitation integrated traditional and Western medicine in post st roke pseudobulbar palsy patients who have difficulty in swollow.Method:71cases i n the treated group underwent acupuncture and rehabilitation methods to cure fal se palsy.34cases as control group,were treated with medicine only.Result:By the end of the course,the effective rate was91.5%in the combine treated group,in the control group the effective rate was38.2%.Conclusion:The effect of the combine treated group were much better than the control group.The difference is very sig nificant(P0.01)?

本文阐述了在脑卒中单元治疗模式中,针刺应当早期介入中风重症监护病房(intensive care unit,ICU)中的必要性.其根据是针刺治疗能够保护脑细胞,调节脑部供血,治疗缺血性和出血性等脑血管病,并能及时处理卒中并发症和合并症.认为这样有利于针灸传统医学的发展创新.