​ ABSTRACT Background: Polyendocrine metabolic ovarian syndrome (PMOS) affects 5%–18% of reproductive-age women worldwide. Autonomic nervous system dysfunction—sympathetic overactivity with reduced vagal tone—is increasingly recognized as a key pathogenic driver. Although acupuncture is widely used for PMOS in China, high-level evidence is inconclusive, partly because most trials rely on traditional abdominal/lower-limb points with little neuroanatomical rationale. Drawing on the Huangdi Neijing's "Qi Street" theory and evidence that ovarian sympathetic innervation arises from T9–T10 spinal segments while vagal pathways modulate hypothalamic function, we developed a "targeted autonomic electroacupuncture" strategy. Objective: To evaluate this novel regimen (vagal auricular/cervical stimulation plus T9–T10 sympathetic modulation) against conventional electroacupuncture. Methods: This two-center, randomized, assessor-blinded, parallel-controlled superiority trial will enroll 72 PMOS patients with infertility (aged 20–40 years), allocated 1:1 to experimental or control groups. Both receive 36 sessions over 12 weeks. Co-primary outcomes are ovulation rate and heart rate variability (HF power and LF/HF ratio). Secondary outcomes include hormones, metabolic parameters, inflammatory cytokines, menstrual patterns, clinical scores, psychological scales, and Patient Global Assessment. Exploratory outcomes include resting pupil diameter and fMRI in a subsample. Analyses use ANCOVA and chi-square tests on intention-to-treat (α=0.05, 80% power). Ethics and dissemination: Approved by the lead ethics committee on 20 March 2026 (approval no. 2026-02-05). All participants provide written consent. Results will be reported regardless of direction. Trial registration: ITMCTR2026001081.

Hyperemesis gravidarum (HG), an extreme form of nausea and vomiting during pregnancy (NVP), significantly impairs the quality of life of affected individuals. This review examines the multifactorial etiology of the HG and evaluates the efficacy of non-traditional therapeutic approaches, namely, vagus nerve stimulation (VNS) and electroacupuncture. By synthesizing a comprehensive body of literature, we highlight the neurophysiological mechanisms underlying these therapies and propose a novel model for the HG management. The model focuses on vagus nerve modulation through targeted stimulation at the auricular and cervical points, suggesting a promising avenue for effective and safe treatment strategies against the NVP/HG.

Infertility remains a global challenge, with female factors accounting for the majority of cases. Endometrial receptivity (ER), the ability of the endometrium to accept and support embryo implantation, is a critical determinant of successful conception. Traditional Chinese medicine, specifically acupuncture, has been widely adopted as an adjunct therapy for enhancing ER and improving reproductive outcomes in infertile women. This literature review explores the efficacy and underlying mechanisms of acupuncture in promoting ER by focusing on key areas, including improvements in endometrial morphology, increasing uterine blood flow, adjustment to hormone levels, regulation of molecular markers, modulating endometrial immune-inflammatory microenvironment, and probably activating the somatosensory-autonomic reflex pathway. Although promising, existing studies on acupuncture and ER often face limitations in sample size and methodological rigor, highlighting the need for larger, high-quality randomized controlled trials (RCT). Furthermore, the safety profile of acupuncture in infertility treatment is favorable, with few reported adverse effects. These findings suggest that acupuncture could be a viable complementary therapy for improving pregnancy outcomes in women with compromised ER, although further research is essential to establish definitive protocols and mechanisms.

Abstract Aim: To investigate the prevalence and predictors for anxiety and depression in Chinese women with polycystic ovary syndrome (PCOS) undergoing infertility treatment. Materials and Methods: This study was a secondary analysis of a randomized controlled clinical trial in which a total of 1,000 women with PCOS undergoing infertility treatment recruited from 27 hospitals across mainland China were enrolled. Anthropometric, endocrine, and metabolic parameters were measured at the baseline visit. Anxiety and depression state were evaluated according to the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Mann–Whitney test and logistic regression were used to identify predictors for anxiety and depression. Results: A total of 19.86% of the women had anxiety, and the prevalence of mild, moderate, and severe anxiety were 16.45%, 2.91% and 0.50%, respectively. A total of 24.58% of the women had depression, and the prevalence of mild, moderate, and severe depression were 18.96%, 5.52% and 0.10%, respectively. The multivariate logistic regression results showed that age, acne score, and number of induced abortions were independent predictors for anxiety. In terms of depression, its related factors included age, hypertension, and duration of infertility. Conclusions: It seems that anxiety and depression among women with PCOS in our country were not as high as in Western countries. The dominating predictors for anxiety in PCOS were age, acne score, and number of induced abortions, and the major predictors for depression were age, hypertension, and duration of infertility. These predictors explored in this study may promote the development of individualized interventions for psychological disorders in such patients.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age. The etiology of PCOS is multifactorial, and current treatments for PCOS are far from satisfactory. Recently, an imbalanced autonomic nervous system (ANS) with sympathetic hyperactivity and reduced parasympathetic nerve activity (vagal tone) has aroused increasing attention in the pathogenesis of PCOS. In this paper, we review an innovative therapy for the treatment of PCOS and related co-morbidities by targeting parasympathetic modulation based on non-invasive transcutaneous auricular vagal nerve stimulation (ta-VNS). In this work, we present the role of the ANS in the development of PCOS and describe a large number of experimental and clinical reports that support the favorable effects of VNS/ta-VNS in treating a variety of symptoms, including obesity, insulin resistance, type 2 diabetes mellitus, inflammation, microbiome dysregulation, cardiovascular disease, and depression, all of which are also commonly present in PCOS patients. We propose a model focusing on ta-VNS that may treat PCOS by (1) regulating energy metabolism via bidirectional vagal signaling; (2) reversing insulin resistance via its antidiabetic effect; (3) activating anti-inflammatory pathways; (4) restoring homeostasis of the microbiota-gut-brain axis; (5) restoring the sympatho-vagal balance to improve CVD outcomes; (6) and modulating mental disorders. ta-VNS is a safe clinical procedure and it might be a promising new treatment approach for PCOS, or at least a supplementary treatment for current therapeutics.

Objective: To observe the clinical therapeutic effect of electroacupuncture on postpartum sexual dysfunction associated with urinary incontinence. Methods: The prospective case-series study was adopted. A total of 36 patients with postpartum sexual dysfunction associated with urinary incontinence were included consecutively. Electroacupuncture was applied to Shenshu (BL23), Huiyang (BL35), Pangguangshu (BL28), Shiqizhui (EX-B8), Ciliao (BL32), Zhongliao (BL33), Qihai (CV6), Guanyuan (CV4), Zhongji (CV3), Qugu (CV2), Shuidao (ST28), Zigong (EX-CA1), Zusanli (ST36) and Sanyinjiao (SP6), once daily, 6 times a week. The treatment for 2 weeks was as one phase and it should be completed in one menstrual cycle. For the cases without menstrual cycle recovery, the treatment should be given for any two weeks in one menstrual cycle and for those with menstrual cycle recovery, the treatment should avoid the menstrual period. Totally, the treatment lasted for 3 menstrual cycles. Before and after treatment, the scores of postpartum female sexual dysfunction diagnostic scale (PFSDDS), sexual intercourse pain assessment scale (SIPAS) and pelvic floor muscle strength test (PFMST), as well as the results of urodynamic examination (UE) were observed before and after treatment in the patients. Results: After treatment, the scores of PFSDDS, SIPAS and PFMST were all increased as compared with those before treatment separately, presenting the statistical significance (all P < 0.05). Regarding UE, after treatment, the maximum bladder capacity, detrusor pressure at maximum flow, maximum flow rate and maximal urethral closure pressure were increased and postvoiding residual urine volume was reduced obviously as compared with the values before treatment, respectively, indicating the statistical differences (all P < 0.05). Conclusion: Electroacupuncture has the significant effect on postpartum sexual dysfunction associated with urinary incontinence. (C) 2022 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

Abstract Purpose: Serum phosphorus is reported to be associated with insulin resistance (IR) and testosterone in many populations. However, studies exploring the role of serum phosphorus in polycystic ovary syndrome (PCOS) patients are rare. Thus, we aimed to investigate the associations of serum phosphorus concentrations with IR and hyperandrogenemia (HA) in women with PCOS.Methods: This was a secondary analysis of a multicenter and large-sample clinical trial including 1000 PCOS subjects diagnosed by the modified Rotterdam criteria. A total of 508 normal-weight PCOS patients with available serum phosphorus data were enrolled in the present study. Serum phosphorus, metabolic indices, and total testosterone (TT) concentration were measured. IR status was defined by a homeostasis model assessment of insulin resistance (HOMA‐IR) ≥ 2.69, and HA status was defined as a TT level ≥ 1.67 nmol/L. Multivariable linear regression and logistic regression models were used to evaluate the associations of serum phosphorus with IR and HA.Results: Multiple linear regression analysis showed that the serum phosphorus concentration was inversely correlated with fasting plasma glucose (FPG), fasting insulin (FIN), HOMA‐IR, and TT (P trend < 0.05 for all) after adjusting for confounding factors. Logistic regression showed that the serum phosphorus concentration was negatively correlated with IR and HA status. The multivariable-adjusted odds ratios with 95% confidence intervals for IR and HA status for the lowest vs. the highest quartiles of serum phosphorus were 2.26 (1.17-4.35, P trend = 0.009) and 2.58 (1.48–4.51, P trend = 0.002), respectively. Conclusion: Our results demonstrated that lower serum phosphorus concentrations were associated with higher risk of IR and worsened HA in normal-weight women with PCOS.

Aim To evaluate the association between the apolipoprotein B/A1 ratio (ApoB/ApoA1) and metabolic and endocrine parameters in women with polycystic ovary syndrome (PCOS). Methods This study was a secondary analysis of the Acupuncture and Clomiphene for Chinese Women with Polycystic Ovary Syndrome trial (PCOSAct), and 957 subjects with available ApoB and ApoA1 measurements were included. Tests for linear trends and linear regression were used to assess the relation between the ApoB/ApoA1 ratio and metabolic and endocrine parameters. Logistic regression was used to estimate the association between the ratio and risk of metabolic syndrome (MetS) and insulin resistance (IR). The receiver operating characteristics (ROC) curve was used to determine the predictive value of the ApoB/ApoA1 ratio for MetS and IR. Results The results showed that the ApoB/ApoA1 ratio was positively associated with waist circumference, systolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, fasting plasma glucose, fasting insulin, homeostatic model assessment-insulin resistance, high free testosterone, high free androgen index, alanine transferase, aspartate transferase, and higher prevalence of MetS and IR, but was negatively correlated with high-density lipoprotein and sex hormone-binding globulin after adjusting for age and body mass index. Logistic regression showed that compared with the ApoB/ApoA1 ratio in first quartile, those in the fourth quartile demonstrated a higher risk of MetS (OR: 24.48, 95%CI: 8.54–70.15, P trend <0.001) and IR (OR: 1.78, 95%CI: 1.10–2.87, P trend <0.05) after adjusting for confounding factors. ROC curve results showed that the AUC MetS was 0.84 (95%CI: 0.81–0.86) and had 86.8% sensitivity and 70.3% specificity with a threshold value of 0.64, and the AUC IR was 0.68 (95%CI: 0.64–0.71) and had 74.3% sensitivity and 58.2% specificity with a threshold value of 0.56. Conclusions Increased ApoB/ApoA1 ratio was associated with worse MetS components, IR, and elevated androgen hormones and liver enzymes. The ratio might be a useful tool to screen for MetS and IR in PCOS patients.

Objective: to observe the clinical effect of electroacupuncture on postpartum urinary retention (PPUR) through a randomized controlled study. Methods: seventy-two PPUR puerperae who met the inclusion criteria were divided into the observation group (electroacupuncture at Ciliao (BL32) and Zhongliao (BL33) group) and the control group (sham acupuncture group) according to the random number table method, with 36 cases in each. Urine catheters were retained. After 3 days of treatment, the therapeutic effect of PPUR was compared between the two groups. Results: in the observation group, the first urination time was significantly earlier than that in the control group, the first urination volume was significantly more than that in the control group, the bladder residual urine volume was significantly less than that in the control group, and the urinary infection was significantly less than that in the control group, the differences were statistically significant (all P < 0.001). Compared with the control group, there were statistically significant differences in catheter removal, independent urination, cured cases, effective cases, ineffective cases, and total effective cases in the observation group (all P < 0.05). Conclusion: the therapeutic value of electroacupuncture at BL32 and BL33 for primiparae with PPUR is significantly obvious. This therapy is worthy of clinical promotion. (C) 2021 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

Objective: To evaluate the clinical effect of electroacupuncture treatment for chloasma in young and middle-aged women. Methods: Sixty young and middle-aged female patients with chloasma were divided into treatment group (n = 30) and control group (n = 30) according to random number table. In the treatment group, the electroacupuncture was applied to the facial acupoints and "Vagus" in the cavity of concha in the ear. The selection of facial acupoints was relating to the running course of facial nerve trunk: Yifeng (TE17), Shangguan (GB3)-Sizhukong (TE 23) (Temporal branch), Xiaguan (ST7)-Sibai (ST2) (Zygomatic branch), Qianzheng (Extra)-Quanliao (SI18) (Zygomatic branch), Jiache (ST6) -Jiachengjiang (Extra) (Buccal branch), Hegu (LI4). Electro-stimulation was adopted at "Vagus" in the cavity of concha in the ear(two distribution points of the vagus in the cavity of concha of each ear). The control group received conventional acupuncture (surrounding method of needling at the Ashi points in the facial lesion area and 15 acupoints which were selected in the highest frequency in the conventional acupuncture treatment). After 8 weeks of treatment, the clinical effects were compared. The total score of facial skin lesion, score of skin lesion color, score of lesion area, and effective rate of treatment for chloasma were used to evaluate the clinical effect of the two groups before and after treatment. Results: After treatment, the effective rate of the treatment group was 95.00%, that of the control group was 67.50%. The effect of the treatment group was better than that of the control group, and the difference was statistically significant (chi(2) = 9.928, P = 0.002). Before treatment, there was no difference in the area score, color score, and total score of skin lesions between the two groups (P>0.05). After treatment, the area score, color score, and total score of skin lesions in the treatment group were (1.05 +/- 0.64), (1.05 +/- 0.64), and (2.10 +/- 0.98) points respectively, while those in the control group were (1.38 +/- 0.63), (1.28 +/- 0.75), and (2.65 +/- 1.19) points respectively. The area score, color score, and total score of skin lesions in the treatment group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusion: electroacupuncture is more effective than conventional acupuncture in treating chloasma in young and middle-aged women. (C) 2021 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

目的 探索基于问题的教学模式(PBL)联合基于案例的教学模式(CBL)教学法在针灸科住院医师规范化培训(规培)中的教学效果.方法 144名规培学员随机分为试验组和对照组,每组72名.试验组采用PBL联合CBL教学法,对照组采用基于讲授式的教学模式(LBL)教学法.规培结束后,对两组规培学员进行出科成绩考核及问卷调查两种方式评价教学效果.结果 试验组考核成绩优于对照组,差异有统计学意义(P<0.05).问卷调查结果 显示,试验组满意率为75.0％,对照组满意率为41.7％,差异有统计学意义(P<0.05);试验组对带教老师质量评价反馈的分数高于对照组,差异有统计学意义(P<0.05);试验组在激发学习兴趣、提高自学能力、提高沟通和协作能力、培养临床思维、提高临床实践能力、提高分析和解决问题的能力方面均优于对照组,差异有统计学意义(P<0.05).结论 PBL联合CBL教学法在针灸科规培中取得良好效果,是胜任于提高中医类规培学员在针灸科规培的临床综合能力的教学模式探索.

A female patient with vaginal pain induced by multiple sclerosis was treated by acupuncture. Her chief complaint: pricking vaginal pain during intercourse for 1 year. Electroacupuncture was applied to Shenshu (BL23), Huiyang (BL35), Ciliao (BL32) and Zhongliao (BL33) on lumbosacral region. The disperse wave was adopted firstly, followed by the dense wave in stimulation. The stimulation intensity was determined by the patient's tolerance. The needles were retained for 50 min totally. After 2-month treatment, the sexual function of the patient was recovered to be normal. The sexual activity was normal in 1-year follow-up and vaginal pain was not recurred. (C) 2020 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

目的 研究桔梗皂苷-D对宫颈癌Hela细胞凋亡的诱导作用及其机制.方法 将体外培养的Hela细胞系随机分为4组,对照组常规培养,桔梗皂苷-D低、中、高剂量组(7,14,28μmol/L)分别加入相应浓度桔梗皂苷-D进行培养.各组细胞培养24 h后,收集细胞用于后续检测.采用CCK8法检测细胞活力,采用流式细胞仪检测细胞周期及细胞凋亡比率,采用TUNEL染色法观察细胞核的形态变化,采用RT-PCR法检测细胞内Bax、P53、Caspase-3、Bcl-2、Hippo信号通路关键因子(MST、LATS、YAP、TAZ、C-myc、β-Catenin)mRNA表达水平,采用Western blot法检测细胞内Bax、P53、Caspase-3、Bcl-2、Hippo信号通路关键因子蛋白表达水平.结果 与对照组比较,各组桔梗皂苷-D细胞活力随桔梗皂苷-D浓度增高而显著下降(P均<0.05).与对照组比较,桔梗皂苷-D各组G1期细胞比例显著增高(P均<0.05),且G1期细胞占比随桔梗皂苷-D浓度增高而逐渐增高,桔梗皂苷-D中、高剂量组G2期及S期Hela细胞占比显著降低(P均<0.05).与对照组比较,桔梗皂苷-D各组TUNEL染色阳性细胞核的比率和早期凋亡细胞比例均显著增高(P均<0.05),且随桔梗皂苷-D浓度增高而逐渐增高.与对照组比较,桔梗皂苷-D各组Bax、P53、Caspase-3、Bcl-2的mRNA和蛋白表达水平随桔梗皂苷-D浓度增高而逐渐升高(P均<0.05),YAP、TAZ、C-myc、β-Cate-nin的mRNA和蛋白表达水平随桔梗皂苷-D浓度增高而逐渐降低(P均<0.05).结论 桔梗皂苷-D能显著抑制Hela细胞增殖,促进其凋亡,其机制可能是通过激活Hippo信号通路,下调该通路下游YAP、TAZ的过度表达,上调促凋亡因子Bax、P53、Caspase-3表达,从而使Hela细胞发生G1期阻滞,促进Hela细胞凋亡.

Non-invasive transcutaneous auricular vagus nerve stimulation (ta-VNS) is established on the basis of auricular acupuncture and the principle of vagus nerve stimulation (VNS). The results of the comparative study of 4 indications of VNS show that ta-VNS achieves almost the equivalent effect as VNS. Moreover, the ta-VNS is advantageous at safety, economy and portability. Regarding the clinical prevention and treatment of polycystic ovary syndrome (PCOS), it is still controversial for the effect of acupuncture and moxibustion therapy including auricular acupuncture. Moreover, it is the difficulty for the principle of acupoint selection and the treatment mechanism of this therapy to be in line with modern medicine. As neuroendocrine disease, PCOS and the ovary, its target organ are all associated with the vagus nerve. It is a new idea to introduce the ta-VNS in treatment of PCOS by regulating the reproductive and endocrinal disturbance of PCOS in terms of vagus nerve and improving the acupuncture and moxibustion therapy, such as the auricular acupuncture. In the paper, the potential mechanism of the ta-VNS in treatment of PCOS is presented: 1)the ta-VNS treats PCOS by improving insulin resistance; 2)the ta-VNS relieves PCOS-induced psychological disorders through the treatment of depression; 3)the ta-VNS is applicable in treatment of PCOS complications, such as hypertension and diabetes.

患者,男,58岁,于2017年9月1日就诊.主诉:肝脏肿瘤切除术后呃逆21 d.现病史:2017年8月于哈尔滨医科大学附属肿瘤医院诊断为“肝右叶顶部(Ⅶ、Ⅷ段)肝细胞癌”,行肿瘤部分切除术,肝实质离断采用超声刀锐性切除结合钳夹法,肝门阻断采用肝蒂阻断法(Pringle手法).术前无呃逆症状,术后持续出现呃逆,予盐酸氯丙嗪、盐酸甲氧氯普胺、巴氯芬片等联合治疗3d,呃逆未见好转,既往无腹膜炎病史、无慢性呃逆病史.

患者,女,31 岁.就诊日期:2017 年 2 月 13 日.主诉:下腹坠痛伴性交痛 1 年,加重 3 个月.现病史:1 年前出现下腹坠痛,性交时疼痛明显,性欲下降,3 个月前上述症状明显加重,月经量、白带增多.已婚,既往月经规律,否认慢性病史及手术史.至哈尔滨医科大学附属医院妇科就诊,妇科检查:子宫前屈位,大小正常,稍有压痛,活动度可,双附件无异常;腹腔镜检查示:子宫前屈位,表面呈黄棕色淤血斑及浆膜下水肿,子宫静脉充盈曲张、卵巢静脉怒张呈静脉瘤样,阔韧带静脉增粗、曲张;诊断为盆腔淤血综合征.

妊娠剧吐是早孕期一种危及母婴健康的顽固性呕吐,近年来发病呈上升趋势.西医学多采用对症支持疗法,但不能较快改善患者症状,且易引发诸多并发症.中医药治疗妊娠剧吐历史悠久,除口服中药制剂外,针灸治疗妊娠剧吐也积累了大量经验.笔者将针灸治疗妊娠剧吐的应用现状做一综述,并指出目前针灸治疗存在的问题,探讨日后的发展方向,以期为临床妇产科医师及学者提供参考.

针灸作为中医特色疗法之一,近年来在治疗妊娠剧吐方面积累了大量临床经验,具有独特优势.笔者查阅文献,将近几年针灸治疗妊娠剧吐的应用现状作一综述,主要有毫针刺法、灸法、耳穴压豆、穴位贴敷、穴位注射、综合治疗及其他疗法等.并总结了目前针灸治疗妊娠剧吐临床研究中存在的一些问题,如循证医学证据级别低、安全性报道不足、随访较少、未进行分类论治、缺乏横向比较、针刺干预心理认识不够、机制研究不深等,以期为医师临床实践及学者研究提供参考.

患者,男,61岁.就诊日期:2017年3月5日.主诉:视物成双、行走不稳伴排尿障碍10d.现病史:10天前在北京时出现视物成双、行走不稳,同时出现排尿困难,至北京某三甲医院神经内科就诊并住院治疗.患者自述1 7天前在海南三亚旅游时因淋雨后出现“上呼吸道感染”,以咳嗽、咽痛、发热(达39℃)为主.既往健康,无家族及遗传病史.患者自带上述医院住院病历示:入院查体:双眼外展运动不能,四肢肌力正常,四肢腱反射消失,双侧指鼻试验、跟-膝-胫试验欠稳准;头颅MRI未见明显异常;腰穿脑脊液示:外观淡红色、微浑,潘氏试验(卅),蛋白650 mg/L,白细胞10×106/L,红细胞10×106/L,葡萄糖4.1 mmol/L,氯化物130 mmol/L;血抗G01 b抗体强阳性;以“Miller-Fisher综合征”收入院,予丙种球蛋白20 g/d,静脉滴注5d,予留置导尿管对症治疗及营养神经(甲钴胺,500μg/d)和改善微循环(前列地尔,5 μg/d)治疗10d后,患者共济失调明显改善,眼球活动障碍无改善,四肢腱反射(+),出院.为求中医针灸治疗,遂来高维滨教授名老中医工作室就诊.

患者,女,22岁.就诊日期:2017年7月18日.主诉:四肢麻木、无力并进行性加重3周,排尿困难2周.现病史:于3周前在国外时无明显诱因出现一过性黑蒙、意识丧失伴跌倒,数分钟后自行恢复,无抽搐,此后自觉行走时双足麻木无力,病情进行性加重,麻木逐渐进展至双侧小腿,2周前出现站立不能伴跌倒数次,双上肢活动不利,双手和胸部麻木,同时出现排尿困难,立即回国,至北京某三甲医院急诊科就诊,予留置导尿管治疗.既往体健,5年前独自留学美国,生活不规律,近1年间断吸食笑气(N2O),聚会时将笑气(8 g/罐)充进气球吸食(2～3罐/次、1～2次/月),近1个月因无聊而吸食10余次;否认毒物接触史和吸毒史;无其他不良史;否认家族史及遗传病史.怀疑N2O致神经中毒而转入此院神经内科,行实验室检查:红细胞计数2.90×1012/L,血红蛋白97 g/L,余正常;腰穿检查:脑脊液检查正常,血液和尿液毒物检测重金属正常;头颅MRI示:大脑皮质轻度萎缩;脊椎MRI示:C2～C3平面髓内可疑长T2信号;肌电图(EMG)示:双侧胫神经、正中神经和尺神经神经源性损害.以"中毒性脊髓病(脊髓亚急性联合变性)、周围神经病、共济失调"入院,予鼠神经生长因子18 μg/d肌内注射、甲钴胺500 μg/d静脉注射、氯硝西泮0.50 mg/d 口服,连续治疗2周,患者病情未加重也未见明显好转.为求中医针灸治疗,遂来我校高维滨教授名老中医工作室就诊,查体:神志清楚,吟诗样语言,精神差、易激惹,对答切题,计算力、记忆力减退;双上肢肌力4级,双下肢近端肌力3级、远端2级,四肢肌张力降低;快复轮替试验动作笨拙,双侧指鼻试验欠稳准,跟-膝-胫试验不能完成;T4平面以下痛温觉略减退,四肢"手套-袜套"样痛觉过敏,深感觉障碍;上肢深反射均减弱,下肢跟、膝腱反射未引出,双侧巴宾斯基(Babinski)征(+ ),舌质红、苔薄白,脉细弱弦;我院门诊(2017年7月18日)复查颈椎MRI(3.0T)示:颈髓后索倒"V"形长T2信号;查脑电图:呈现边缘状态;免疫学检测、肿瘤标志物筛查正常.中医诊断:痿证;癃闭.西医诊断:中毒性脊髓亚急性联合变性病;周围神经病;共济失调.采用针灸和中药治疗:(1 )针灸取穴:电项针取风池、供血穴(风池下1.5寸);尿潴留对症治疗取电针肾俞、会阳穴;头穴取双侧足运感区、大脑运动区、大脑感觉区、情感区、舞蹈震颤区、平衡区、视区.操作:局部皮肤常规消毒后,选用0.30 mm×40 mm 毫针(会阳穴选用 0.30 mm×60 mm毫针)常规针刺,先坐位针刺:头穴,针尖与头皮呈15°～30°角快速刺入头皮下或肌层10～20 mm,留针30 min;风池、供血穴直刺20～30 mm,使用KWD-808 Ⅱ型电针仪,将每根导线的正极接风池穴,负极接同侧供血穴,通过调节电针仪输出功率,以出现颈部肌肉做轻微运动、患者可耐受幅度偏大为佳,每次30 min.然后侧卧位针刺:电针肾俞、会阳穴,肾俞直刺20～30 mm,会阳直刺30～40 mm (肌肉丰厚,应深刺),使用KWD-808Ⅱ型电针仪,将每根导线的正极接肾俞穴,负极接同侧会阳穴,每次30 min.针刺每天1次.(2)中药治则:益气养血,方剂:黄芪30g、当归20g、女贞子20g、醋龟甲20g、白芍15g,每日1剂,水煎服;嘱患者每天自服大枣10枚.治疗5 d后拔导尿管,语言流利、记忆力和计算力好转;治疗14 d后能站立行走,双下肢肌力4+级,双上肢肌力正常,共济失调明显改善,麻木减轻;继续治疗7 d,四肢肌力正常,肌张力正常,症状完全消失,停止针灸治疗,继续服汤药7剂.1个月后随访,患者已正常上学.