【作者】 陈建男；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2008， 硕士

【摘要】 难治性面瘫是由多发性的周围性面瘫经多种方法治疗效差迁延而致,是临床较为难治的一种病症,一般认为是因面神经损害较重而导致面瘫迁延难愈者(发病三个月以上)。面瘫患者,患侧面部运动功能丧失,不可扬眉与上提口角,严重者可形成角膜白斑,甚至失明,饮食时口角流涎等,给患者生理上带来不便。本研究从临床观察的角度,客观评价针刺加隔姜灸治疗难治性面瘫的临床疗效。以期更好地推广应用于临床。方法:60例难治性面瘫的患者,分为治疗组(针刺加隔姜灸组)30例进行针刺加隔姜灸进行治疗;对照组(针刺组)30例,常规针刺,将两组进行临床研究。临床观察指标为:面神经功能评价计分表。研究对象:两组患者60例来源为广州中医药大学第一附属医院针灸门诊部。治疗方法:1.治疗组(针刺加隔姜灸组)①取穴及配穴:牵正、翳风、迎香、地仓、颊车、阳白、鱼腰、四白、颧髎、合谷。(方义:本方以地仓穴为手足阳明、任脉、阳桥脉之会;颊车穴为足阳明脉气之所发,再以四白、颧髎同用,以疏导面颊部经气:阳白穴为足少阳、手足阳明、阳维脉之会可疏调额部经气)。以上除合谷取健侧,余穴均取患侧。其中采用透刺法有阳白透鱼腰、迎香透地仓、地仓透颊车。临证加减:不能皱眉者加攒竹;鼻唇沟平坦者加上迎香;颏唇沟歪斜者加承浆;味觉消失、舌麻者加廉泉;迎风流泪、目赤者配睛明;人中沟歪斜者配水沟;恶风寒者配风池。②基础操作:选用直径0.35mm毫针,牵正、翳风、合谷均为垂直进针,阳白穴用提捏进针法透刺到鱼腰穴,迎香朝地仓方向斜刺,地仓朝颊车方向斜刺。针睛明穴时,嘱患者闭目,医者左手轻推眼球向外侧固定,右手缓慢进针,紧靠眶缘直刺0.5～1寸。不捻转,不提插。水沟穴朝巨髎穴方向直刺;针风池穴时,针尖朝鼻尖方面斜刺,每穴(除睛明外)进针后提插捻转手法直到得气,即患者局部有酸麻胀感,留针30分钟。③出针后,将鲜生姜切成厚约0.3厘米的薄片,置在所选取的穴位上,上以适量大小的艾炷点燃施灸。也有些病人因鲜生姜刺激,刚灸即感觉到灼痛感,这时可将姜片提起,得灼痛感消失再重新放下再灸。若一段时间后,病患诉灼热难耐,可将姜片向上提起,下衬一些干棉花或软纸,以灸至肌肤内感觉温热,局部皮肤潮红湿润为度。且医者应常掀起姜片查看,以防因病患者感觉迟钝造成起泡。一般每次施灸5～10壮,一姜片一炷。2.对照组(针刺组)①取穴及配穴:同治疗组;②基础操作:同治疗组。结果:1.治疗前两组各项指标比较无显着性差异(P＞0.05)。表明两组样本来自同一总体,具有可比性。2.治疗后两组各项指标比较具有显着性差异(P＜0.01)。3.两组治疗前后组内各项指标比较具有显着性差异(P＜0.01)。结论:本次临床研究显示:采用针刺循经取穴与辨证取穴加隔姜灸治疗难治性面瘫,临床疗效与单纯应用针刺治疗有显着性差异。采用针刺循经取穴与辨证取穴加隔姜灸治疗难治性面瘫为临床上切实可行的治疗方法。更多还原

【Abstract】 [Objective]Refractory multiple facial paralysis from the peripheral facial paralysis as a number of ways a result of persistent poor treatment effect is of a more intractable diseases, generally considered to be heavier because of the facial nerve damage caused by prolonged refractory facial paralysis(Incidence for more than three months).Patients with facial paralysis,loss of motor function in the face side,and Yang-Mei can not be mentioned on the mouth,can create serious corneal leukoplakia,and even blindness,restaurants drooling at the mouth,to patients with physical inconvenience.the research evaluate objectively clinical curative effect from clinical direction of observation on the refractory facial muscle paralysis,in order to preferably spread and apply in clinical treatment.[Methods]60cases of were divided into 2 groups,acupuncyure and ginger moxibustion therapy group(group A)and control group(group B).The evaluation of clinical observation was the Index of facial nerve function.The 60 cases of facial muscle paralysis ptients come from the first clinic of the NO.1 affilated hospital of GuangZhou TCM university. Method of treatment:The point selection of two groups was based on main point combine with the affected channel and selection of point according to the differentiation of symptoms and signs.Main point:qianzhen,dicang,jiache,yangbai,sibai,quanliao,yifeng, yuyao,and hegu.Meanwhile,Control group was treated by acupuncyure and ginger moxibustion,30 days was one period of treatment,treat for 3 periods at all.[Results]1.Each item of index of two groups had no manifest difference before treatment, possess comparability(P＞0.05),It showed that two sample were the same ensemble,can make the synchronic research;2.Each item of index of two groups have a significant difference between the two groups after treatment.(P＜0.01);3.there was a significant difference in each groups between before and after treatment(P＜0.01);[Conclusion]This clinical research indicated that The Acupuncture and ginger moxibustion is a practicable method to treat the refractory facial muscle paralysis in clinical treatment.and it is better than use the acupuncyure only.and maybe can preferably spread and apply in clinical treatment.更多还原