醒脑开窍”针刺法的临床应用课件文档资料.ppt

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1、“醒脑开窍”针法简介Introduction of XNKQ Acupuncture,“醒脑开窍”针法是石学敏院士1972年针对中风病的基本病机，即瘀血、肝风、痰浊等病理因素蒙蔽脑窍导致“窍闭神匿，神不导气”而提出的治疗法则和针刺方法。XNKQ Acupuncture is raised by Shi Xue-MIN Academician in 1972.It aimed at the basic pathogenesis,such as blood stasis,liver wind,phlegm which lead to orifices closed,consciousness lo

2、st and Qi-disorder.,在选穴上以阴经和督脉穴为主，并强调针刺手法量学规范，有别于传统的取穴和针刺方法。The points on Yin meridians and Du meridian are mainly selected and standard quantitative manipulations are applied emphatically,which are quite different from traditional point selection and acupuncture manipulations in treatment of stroke

3、.,治 疗 方 法 Treatment,1.处 方 主穴：内关(手厥阴心包经)人中(督脉)三阴交(足太阴脾经)1.Point PrescriptionMainpoints:Neiguan(PC 6,the Pericardium Meridian of Hand-Juejin)Renzhong(DU 26,the DU Meridian)Sanjinjiao(SP 6,the Spleen Meridian of Foot-Taiyin),辅穴：极泉(手少阴心经)委中(足太阳膀胱经)尺泽(手太阴肺经)Supplementary points：Jiquan(HT 1,the Heart Meri

4、dian of Hand-shaoyin)Weizhong(BL 40,the Bladder Meridian of Foot-Taiyang)Chize(LU 5,the Lung Meridian of Hand-Taiyin),配穴：吞咽障碍加风池、翳风、完骨；手指握固加合谷；语言不利加上廉泉，金津、玉液放血；足内翻加丘墟透照海。Point Modification：For difficulty of swallowing,Fengchi(GB 20),Yifeng(SJ 17)and Wangu(GB 12)are added.For failing to extend finger

5、s with stiffness,Hegu(LI 4)is added.For slurred speech,Shanglianquan(EX-HN)is added,and Jinjin(EX-HN 12)and Yuye(EX-HN13)are used with blood-letting method.For strephenopodia,penetrating method from Qiuxu(GB 40)to Zhaohai(KI 6)is used.,2.操作方法 Manipulation,内 关Neiguan(PC 6),直刺0.51寸，采用捻转提插结合泻法，施手法1分钟；,

6、First puncture bilateral Neiguan(PC 6)perpendicularly for 0.5-1 cun,using combinative reducing method of lifting-thrusting and twirling-rotating the needle for 1 minute;,人 中Renzhong(DU 26),Secondly puncture Renzhong(DU 26)obliquely upwards to the nasal septum for 0.3-0.5 cun with heavy bird-pecking

7、method until the patients eyeballs are moistened or tears flow down.,向鼻中隔方向斜刺0.30.5寸，用重雀啄法，至眼球湿润或流泪为度；,三 阴 交Sanyinjiao(SP 6),沿胫骨内侧缘与皮肤呈45度角斜刺，进针11.5，用提插补法，使患侧下肢抽动3次为度Thirdly puncture Sanyinjiao(SP 6)obliquely for 1-1.5 cun,at the angle of 45 degrees with the skin surface along the posterior border o

8、f the medial aspect of the tibia,with reinforcing method of lifting and thrusting the needle to make the affected low limb have tic for three times.,极 泉Jiquan(HT 1),原穴沿经下移1寸，避开腋毛，直刺11.5寸，用提插泻法，以患侧上肢抽动3次为度。,Select Jiquan(HT 1)point at 1 cun below the original location along the heart meridian to keep

9、 away from the armpit hair,puncture perpendicularly for 1-1.5 cun with reducing method of lifting and thrusting the needle to make the affected upper limb have tic for three times.,尺 泽Chize(LU 5),屈肘成120度角，直刺1寸，用提插泻法，使患者前臂、手指抽动3次为度。,Perpendicularly puncture Chize(LU 5)for 1 cun depth while the forear

10、m bends to form an angle of 120 degrees with reducing manipulation of lifting and thrusting the needle until the affected arm and fingers have tic for three times.,委 中Weizhong(BL 40),仰卧直腿抬高取穴，直刺0.51寸，施提插泻法，使患侧下肢抽动3次为度。,Select Weizhong(BL 40)point with the supine position and the lower limb lifted,pu

11、ncture perpendicularly for 0.5-1 cun,with reducing method of lifting and thrusting to make the lower limb have tic for 3 times.,风池、完骨、翳风Fengchi(GB 20)Wangu(GB 12)Yifeng(SJ 17),针向结喉，进针22.5寸采用小幅度高频率捻转补法，每穴施手法1分钟；,Puncture Fengchi(GB 20),Wangu(GB 12)and Yifeng(SJ 17)in the direction of the laryngeal pr

12、otuberance for 2-2.5 cun,with reinforcing manipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute to each acupoint.,合谷针向三间穴Hegu(LI 4)toSanjian(LI 3),进针11.5寸，采用提插泻法，使患者第二手指抽动或五指自然伸展为度；,Puncture Hegu(LI 4)1-1.5 cun in depth with the needle tip toward Sanjian

13、(LI 3),with reducing method of lifting and thrusting to make the patients second finger or five fingers extended freely.,上廉泉Shanglianquan(EX-HN),针向舌根1.52寸，用提插泻法；,Puncture Shanglianquan(EX-HN)for 1.5-2 cun,with the needle tip towards the root of the tongue and reducing method of lifting and thrusting

14、 the needle.,金津、玉液Jinjin(EX-HN12)Yuye(EX-HN13),用三棱针点刺放血，出血12毫升；,Prick Jinjin(EX-HN12)and Yuye(EX-HN13)with the three-edged needle to cause bleeding for 1-2ml.,丘墟透向照海穴Qiuxu(GB 40)toZhaohai(KI 6),约1.52寸，局部酸胀为度。,Puncture Qiuxu(GB 40)1.5-2 cun in depth with the needle tip toward Zhaohai(KI 6),until sore

15、ness and distension occurred locally.,醒脑开窍针刺法适宜病症THE Suitable Diseases Of XNKQ Acupuncture,1.中风病及其并发症的治疗 Treatment of Stroke and Complications2.神志、精神疾患的治疗 Treatment of consciousness and mental disorders3.厥闭脱证的治疗 Treatment of prostration syndrome with fainting and closure 4.痛症的治疗 Treatment of pain5.各

16、种脑病的治疗 Treatment of encephalopathy6.各种疑难杂症的治疗 Treatment of Difficult Miscellaneous Diseases,1.中风病及其并发症的治疗Treatment of Stroke and Complications,中风病的治疗难点The Problems of Treating Apoplexy,如何减轻血管神经单元的损害、促进重构神经组织、重建脑组织循环是神经功能恢复的根本。中风病治疗的难点及突破点，聚焦在神经与血管的新生。How to reduce the damage of neurovascular unit,pr

17、omote reconstruction of nerve tissue and brain circulation is important for neurological recovery.The treatment of stroke is focus on the regeneration of blood vessels and nerves.,目前，治疗中风病最有效的方法是卒中单元，但是现代医学意义上的卒中单元需要较高的软硬件配备，无法于现有医疗资源基础上推广应用。所以，如何利用有效的中医手段构建符合中国特色的“中风单元”是今后重要的研究方向。Currently,the stro

18、ke unit are the most effective ways to stroke,but modern medical unit requires advanced software and hardware which does not meet the available medical resource.Therefore,how to effectively use the traditional method to set up Chinese characteristic stroke unit is an important research direction in

19、the future.,针刺是我国治疗中风病的重要手段，也是构建“中风单元”的主要因素。“醒脑开窍”针刺法在临床上取得了显著疗效，并被国家列为重大科技推广项目。Acupuncture are effective treatment in China and important factors of stroke unit.“XNKQ acupuncture”get great clinical effect,and has achieved remarkable listed by the state science and technology major promotion project

20、s.,(1)椎-基底动脉供血不足：针风池、完骨、天柱、颈椎夹脊穴,vertebro-basilar artery insufficiency:Puncture Fengchi(GB 20),Wangu(GB 12),Tianzhu(BL10),Cervical Jiaji Points(EX-B2).,(2)吞咽障碍：针风池、完骨、翳风、咽后壁点刺,Dysphgia:Puncture Fengchi(GB 20),Wangu(GB 12),Yifeng(SJ 17),Prick Posterior Pharyngeal.,风池、完骨、翳风三穴均向喉结方向斜刺，进针22.5寸，施用小幅度；高频率

21、捻转补法，即捻转幅度小于 90；捻转频率为120160转/分钟，行手法1分钟。要求双手操作同时捻转，留针2030分钟。,风池、完骨、翳风,(3)语言謇涩：针上廉泉、金津、玉液,Inhibited Speech:Puncture Shanglianquan(EX-HN),Jinjin(EX-HN12),Yuye(EX-HN13).,颈 椎 夹 脊 穴,Cervical Jiaji Points(EX-B2),颈椎夹脊穴于颈椎正中线旁开0.5寸，平棘突直刺0.81寸，每对穴施捻转补法30秒。均留针20分钟。,(5)复视：针天柱、晴明、球后,Double Vision:Puncture Fengch

22、i(GB 20),Tianzhu(BL 10),Jingming(BL 1)and Qiuhou(EX-HN7),（6）便秘：针外水道、外归来、丰隆。,Constipation:Puncture Waishuidao(EX-CA),Waiguilai(EX-CA)and Fenglong(ST 40),(7)肩周炎：针肩髃、肩髎、肩内陵、肩贞、肩中俞、肩外俞，痛点刺络拔罐,Periarthritis of Shoulder:Puncture Jianneiling(EX-UE),Jianliao(SJ 14),Jianzhen(SI 9),Jianzhongshu(SI 15),Jianwai

23、shu(SI 14).Apply blood letting and cupping method to the local pain point.,(8)尿失禁、尿潴留：针中极、曲骨、关元、局部施灸、按摩或热敷,Incontinence of Urine,Retention of Urine:Puncture Zhongji(RN 3),Qugu(RN 4),Sanyinjiao(SP 6),Yinlingquan(SP 9).Moxibustion is applied on the local area,while massage and hot compress are applica

24、ble too.,(9)手指握固：针合谷、上八邪,Fingers grip solid:Puncture Hegu(LI 4),Shangbaxie(EX-UE9).,合谷,合谷向三间穴方向（既第二指掌关节基底部）透刺 11.5寸，施用提插泻法，以握固的手指自然伸展或食指不自主抽动 3 次为度；再取1.5寸毫针1支，仍在合谷穴位置针刺向第一指掌关节基底部透刺，进针11.5寸，施用提插泻法，以拇指不自主抽动3次为度，合谷穴两针均留针30分钟以上。,上八邪,上八邪分别在23、34、45指掌关节上1寸，向指掌关节基底部斜刺，进针11.5寸，施用提插泻法，以各手指分别不自主抽动3次为度，留针30分钟以

25、上。,(10)足内翻：丘墟透照海,Strephenopodia:Puncture Qiuxu(GB 40)to Zhaohai(KI 6),自丘墟穴进针向照海部位透刺，透刺应缓慢前进，从踝关节的诸骨缝隙间逐渐透过，进针为22.5寸，以照海穴部位见针尖蠕动即可，施用作用力方向的捻转泻法，即左侧逆时针；右侧顺时针捻转用力，针体自然退回，行手法30秒钟，手法结束后，将针体提出11.5寸，留针30分钟。,(11)血管性痴呆：针百会、四神聪、四白、太冲,Vascular Dementia:Puncture Baihui(DU 20),Sishencong(EX-HN1),Sibai(ST 2)and T

26、aichong(LR 3).,太 冲,Taichong(LR 3),(12)睡眠倒错：针上星、神门,Paradoxic Sleep:Puncture Shangxing(DU 23),Shenmen(HT 7).,(13)高血压：针人迎、曲池、足三里、合谷、太冲,Hypertension:Puncture Renying(ST 9),Quchi(LI 11),Zusanli(ST36),Hegu(LI 4),Taichong(LR 3),直刺11.5寸，见针体随动脉搏动而摆动，施用捻转补法第二定义1分钟；留针30分钟,人迎,直刺1寸，施用捻转补法1分钟，留针30分钟,曲池,足三里,均直刺0.8

27、1寸，施用捻转泻法1分钟，留针30分钟,合谷,太冲,(14)呃逆：针人中、内关,Hiccup:Puncture Renzhong(DU 26),Neiguan(PC 6),典型病例-呃逆 王某,男,56岁,2010年9月9日初诊。主诉:频繁呃逆1周。病史:2010年9月1日因与家里人发生口角,情志不畅,出现头晕头痛,口角右侧歪斜,右半身不遂,于附近医院诊为脑梗死。1周前突发呃逆,经系统对症治疗,病情有所缓解后出院。患者遗留右侧肢体活动不利,呃逆频发。现证:呃逆频发,呃声有力,已影响进食,右侧肢体活动不利,胸胁胀闷不舒,纳呆,寐差,二便调。舌红苔黄,脉弦滑。,诊断：脑梗死、中枢性呃逆。治法：醒脑

28、开窍,降逆和胃。处方:人中、内关、三阴交、天突、劳宫、膻中、中脘、足三里、百会、四神聪、风池、丰隆。操作:患者取仰卧位,天突用泻法,持续行针13 min,患者自觉胀感为佳;人中施雀啄法,行针以患者眼睛湿润为佳。内关直刺05寸,施捻转提插法,使针感沿前腕向手放射;三阴交沿胫骨内缘与皮肤呈45角进针05寸,施提插补法,使患肢抽动3次,针感为电击感向下放散，下肢抽动三次为度。百会、四神聪、足三里毫针补法;余穴可用毫针平补平泻法。以上穴位留针30 min,留针期间隔10 min行针1次。上述穴位每日针刺1次,7次为1个疗程。经此法治疗3次,患者呃逆次数减少,可正常进食;胁肋胀闷不舒及纳呆消失,睡眠亦有

29、所好转。连续治疗3个疗程,患者呃逆消失,寐安,右侧肢体活动亦较前好转。随访半年,未见复发。,2.神志、精神疾患的治疗Treatment of consciousness and mental disorders,癔病、郁症究其病机，气机郁闭、神窍失宣，情迷志乱是为关键。运用“醒脑开窍”针法开窍启闭、宣发神气、调神定志，可以直达病所，使心神复明，动则精神饱满，静则志定神宁。醒法的变通作用，对诸如神经衰弱、癔病以及强迫症、抑郁症、焦虑症等各种神经、精神疾患，主治广泛，疗效确切。Depression and stagnation of Qi,dysfunction of the mind and e

30、motional upset,what are the key points of the pathogenesis of hysteria and melancholia.To induce resuscitation,release shen-qi,modulate the function of shen and calm the mind,we use Xing Nao Kai Qiao”acupuncture method,which is target therapy,as well as could rebound the pure brightness of heart-spi

31、rit.XNKQ acupuncture can treat diseases such as neurasthenia,hysteria,compulsion,depressive disorder and anxiety disorder etc.,典型病例-癔病性瘫痪 岳,女,54岁,于2001年1月22日以“四肢不能活动1个月为主诉”入院。入院时患者神清,情绪低落,声音低怯,畏惧感,只能平卧,四肢不能抬举。患者在家中拒绝治疗,且曾有轻生之举。查体:患者神志清楚,瞳孔正常,四肢无自主运动,肌张力、肌容量均正常,双下肢感觉混乱,生理反射存在,病理反射未引出。头部MRI检查未见异常,颈、腰椎

32、MRI示骨质退行性改变,舌红少津,脉细弦。诊断为癔病性瘫痪。治以醒脑开窍,疏络强筋,选内关、人中,三阴交为主穴,辅以极泉、委中、环跳等穴,并鼓励其树立战胜疾病的信心,第一次治疗后患者双上肢可抬离床面约50度,双下肢抬离床面约30度,治疗3天,患者即可下地行走约500米,1周后患者拾级、上下床均可自行完成,情绪稳定。,3.厥闭脱证的治疗Treatment of prostration syndrome with fainting and closure,“阴平阳秘、精神乃治；阴阳离决，精气乃绝”，阴阳失和，神气逆乱而生闭厥。此时当急行醒脑开窍之法,以奏苏厥救逆之效。“life activitie

33、s being normally maintained when both yin and yang in equilibrium;exhaustion of vital essence when dissociation of yin and yang”.When it becomes prostration syndrome with fainting and closure,for the sake of imbalance between yin and yang and upset of vital spirit,we should use XNKQ acupunture metho

34、d as soon as possible to revive the yang for resuscitation.,“醒脑开窍”法可调节阴阳和脏腑功能，调整心经气血，开启心窍之闭，宣发心神之气；人中穴，疏通督脉之阳，醒精明脑腑之神，共奏启闭、醒神、苏厥之效。因而，现代临床各种原因所致的休克、虚脱，以及中暑、癫痫等，应用本法急救多能起死回生。XNKQ acupunture method can be used to modulate the function of yin-yang and zang-fu-organs,regulate the qi and blood of the Hea

35、rt meridian,unlock the closure of heart-orifice,disperse qi of heart-spirit.Ren zhong point(DU26)could regulate the yang of DU meridian,promote the spirit of the brain.They together contribute to the effect of unlocking the closure,promoting resuscitation and recuperating life.Consequently,using XNK

36、Q acupunture method could retrieve the life back in morden clinical situations such as shock,atrophy,sunstroke and epilepsy and so on due to various causes.,典型病例-厥证 张某,男性,16岁。因突然昏倒,不省人事90min而来诊。患者平素学习成绩较好,但日前因考试成绩不理想,情志不舒,今晨突然昏倒。诊见呼之不应,口噤拳握,四肢厥冷,苔薄白,脉沉弦。血压120/78mmHg,既往无癫痫病史。中医诊断为气厥之实证。急施以醒脑开窍法,患者仰卧位

37、,针刺人中、双合谷、双内关、双涌泉。取泻法,于10min患者手脚开始自行活动,神志逐渐清醒。,4.痛症的治疗 Treatment of pain,坐骨神经痛三叉神经痛脊髓内血管瘤术后疼痛(病例)SciaticaProsopalgiaPostoperative pain after angioma of spinal cord,疼痛病机在于各种原因引起的经脉气血运行不畅，而经脉气血的流行又与心和神关系密切。神能导气，气畅则道通，“通则不痛”。故治以调神法，“制其神，令气易行”，能收“以意通经”而达到镇痛之效。,运用醒神之法止痛，范围广泛，无论感冒及内伤头痛；痹症关节疼痛，肌肉疼痛；兼或胃痉挛、胆

38、道梗阻、泌尿系结石甚至心绞痛等各种内脏绞痛，还是三叉神经痛、臂丛神经痛、坐骨神经痛、带状疱疹等各种神经痛，以及急性扭伤、跌打肿痛等施用本法，在常规治疗不满意时使用此法可缓急止痛，立竿见影。,典型病例-急性腰扭伤 冯某,女 56 岁,退休,初诊 2007 年 1 月 20 日。晨起腰部疼痛,活动不能,被家人抬入医院,腰 CT 示腰椎间盘突出,建议立即手术,患者及家人要求保守治疗。先刺双侧内关,直刺0.51寸,采用捻转提插结合泻法,施手法1min;继刺人中,向鼻中隔方向斜刺0.30.5寸,用重雀啄法,至眼球湿润或流泪为度;随即令患者下床轻轻活动腰部,反复做扭转屈伸下蹲等活动5min,中间行针2次。

39、取针后,患者的腰部疼痛都有不同程度的缓解。患者俯卧,取双侧肾俞、气海俞、大肠俞、关元俞,各穴位得气后施以平补平泻手法,使局部产生酸麻胀重的针感。委中,直刺0.51寸,以患者下肢出现放射传导感为度。飞扬,采用常规刺法,大幅度捻转1min,留针30min,每日1次,连针 3 次,痛疼缓解,汗少寐安,配体针治疗 1 月痊愈,。,5.各种脑病的治疗Treatment of encephalopathy,小儿脑性瘫痪 Pediatric cerebral palsy 老年性舞蹈病 Chronic progressive nonhereditary chorea 烟雾病 Moyamoya disease

40、进行性延髓麻痹 Progressive bulbar palsy 脑外伤 Cerebral trauma CO中毒（病例）CO Poisoning,典型病例-CO中毒 王某,男,18 岁,初诊 2002 年 5 月 10 日。CO 中毒,深昏迷间歇性惊厥,两颧、口唇樱红,做人工呼吸无效,病情继续恶化,诊断 CO 中毒(重度)。取水沟穴进针 1.5 寸后不断提插捻转,留针 2 分钟行针一次,惊厥次数减少,停止行针留针,病人神志逐渐恢复,能识人,整个过程 30 分钟,随后送病房进一步治疗,2 周后恢复健康,无任何后遗症。,6.各种疑难杂症的治疗Treatment of Difficult Misc

41、ellaneous Diseases,术后尿潴留 Retention of Urine after operation 颈性眩晕 Cervical Vertigo发作性睡病 Narcolepsy美尼尔氏综合症 Menieres syndrome突发性耳聋 Sudden deafness顽固性呃逆 Hiccup失嗅症 Anosmia放射性口干症 Radiotherapy-induced XerostomiaMerge综合征 Meiges syndrome,典型病例-神经性耳聋 李,男,6岁。患儿在1992年9月13日在同小朋友做游戏时,有人贴在其右耳边悄声说话,竟然丝毫不能听见。家人发现后,即带

42、至医院检查,右耳鼓膜正常,但电测听检查右耳听力损失100分贝,诊断为:右耳神经性全聋。针刺取内关、人中。先刺双侧内关穴,直刺11.5寸,采用提插捻转相结合的泻法,施术1分钟;继刺人中,斜向上刺入0.5寸左右,用雀啄手法,至流泪或眼球周围充满泪水为度。留针5分钟后,即出针。取翳风、听会、中渚、侠溪穴宣统耳络。翳风穴斜向内上方刺入11.5寸,频频捻动针柄,使耳内沉胀,如有风行;听会穴斜向内耳道1.0寸左右,且方向为斜向下,捻转针柄使针感放散至内耳。侠溪、中渚均顺骨间斜向上方刺入1寸,左右捻转针体,促使针感上传。留针30分钟,中间每10分钟行针1次。依法施针1次,行针时患儿即能听到叫喊声。连续针刺三

43、次,右耳听力基本恢复,与左侧相比无明显异常。医院电测听复查,右耳听力恢复65分贝。后又继续针刺2次以巩固疗效。,许多疾病千变万化、错综复杂，或病因难寻、或辨证难确、或久治不愈，但探本求源，多责之于心（神），心主任万物，神主机变，故用醒法，调神醒脑，开窍启闭，使神转志移，气复神使，气血调和，机体恢复正常。,展望(Outlook)醒脑开窍针法具有广泛的适应范围和卓著的临床疗效。我们将加强对脑腑、脑神功能的中医理论探讨；继续拓展醒法在临床上的应用范围；对现代医学尚无公认治疗方法而醒法确有疗效的脑病：如帕金森氏病、痴呆、小儿脑瘫、多动症、CO中毒、发作性睡病、脑外伤后遗症等病症加强其针刺机理探讨。,谢 谢Thanks,