284中风病针灸早介入为好

大医精诚 - 2012年12月15日 - 258 浏览

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在谈到中风病(脑血管病)的治疗前,先废话两句中医立法。我是支持中医立法的,中医从业人员在语言上的确要过关,不只是法律上的语言要求,更是中医师能否和现代医学交流沟通的需要,能否得到更多不了解中医的人的理解的需要。当然,中医本身发展的规律和培训,需要按照中医本身的理论和实践框架来做。比如,医药就不宜象西医那样分家!

讲到中风病,如果在现代医学治疗的同时,及时的针灸介入,那病死率和致残率会大大下降,越早越好。现在不是,很多是到了缓解期,甚至后遗症期了才想到中医针灸来收拾。中风病有几类,一是中风先兆或小中风。短时间出现语言、肢体运动和感觉功能障碍。一般几秒到24小时内恢复;二是,中风中经络,没有意识障碍,主要是语言、肢体运动和感觉障碍。急性期主要是3型,肝阳暴亢、痰瘀痹阻和痰热腑实;缓解期主要是风痰瘀阻络、气虚血瘀和阴虚风动型。三是,中风中脏腑,有意识障碍,分为闭、脱两证。闭证主要有痰火闭窍和痰湿蒙窍,脱证是元气败脱、心神散乱。针灸和中药结合治疗最好。

针法:1,中风先兆,要降气化痰、平肝潜阳。针风池、太冲、阳陵泉、丰隆、足三里。皆双侧。本身针法是起到预防作用,因为这个病态可以自行恢复。

2,中脏腑,出现昏迷了。闭证要启闭开窍,针:人中、劳宫、十二井或十宣穴。有时可加百会。脱证则要回阳固脱。重灸神阙、气海、关元。

3,中经络:急性期,醒脑开窍,清热祛风。针百会、风府、风池、大陵、行间、丰隆。除不对称的穴位外,都针双侧。

恢复期,针百会、舌下、极泉、曲池、环跳、绝骨和足三里。肢体软瘫的,多选患侧的极泉、肩髃、曲池、合谷、八邪、环跳、阳陵泉、绝骨和解溪。肢体硬瘫的,则选双侧的,极泉、曲池、尺泽、大陵、天井、环跳、曲泉、三阴交和绝骨。

中药治疗中风昏迷方面有一定经验。朱进忠教授的经验可借鉴。他分成几个证型。

1,阳明实热,痰蒙心窍。昏迷伴牙关紧闭、抽搐、面红气粗、二便不通(但未到腑实,腹诊可鉴),身热,舌红,苔黄干,脉弦滑数,关脉明显。用白虎承气汤合安宫牛黄丸。石膏30-120克,知母9-15克,郁金12克,大黄9-12克,芒硝6-9克(冲)。安宫1日2次,1次1丸。

2,气营两燔,阳明腑实。昏迷伴发热,便秘,舌质红绛,苔黄燥,脉沉而滑数。犀角地黄汤加减:全蝎(代犀角)10克,生地15克,白芍15克,丹皮12克,元参30克,大黄9克,芒硝3-9克(冲),郁金9克。喉中痰声辘辘,竹沥汁和生姜汁冲安宫两丸。可以看出,这两型通腑方面差不多少,只是清宫和清阳明热的不同。

3,肝阳上亢,痰蒙心窍证:昏迷伴面红赤、苔白或黄白,脉弦大,寸脉明显,甚至上到大鱼际处。镇肝熄风汤合安宫牛黄丸。

4,风痰阻络,痰蒙心窍证,昏迷伴痰声辘辘,苔白或黄白,没有热象,显静,脉沉滑数。星蝎二陈汤。钩藤,地龙,全蝎,郁金,茯苓,南星,半夏,橘红,连翘,竹沥(冲),生姜汁(冲)。

5,阳气欲脱证:昏迷伴目闭口张,手撒遗尿,汗出肢冷,脉散或沉微欲绝。参附汤。

6,下元虚衰,虚阳上浮,痰浊蒙窍:昏迷伴面赤如妆,足冷,脉虚大而无根。注意,同样是阳虚,但此时重点是元阳不潜,有离绝之危险。地黄饮子加减。

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