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中 风 讲授人 刘自力教授
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第五节 中 风 一、定义：又名卒中、偏枯，以猝 然昏仆、不省人事，伴口角歪斜、 语言不利、半身不遂或不经昏仆仅 以口喎、半身不遂为临床主症的疾 病, 因起病急骤，症见多端，变化迅 速与自然界之风善行数变特性相似 而名中风。
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Wind Stroke Wind stroke,also known as stroke or apoplexy(n,an illness caused by a problem in your brain which can damage your ability to move,feel,or think,stroke),is a disease chiefly manifested( to appear or to become easy to see) as a sudden collapse(to suddenly fall down or become unconscious because you are ill) and loss of consciousness (n,the condition of being awake and able to understand what is happening around you)accompanied by deviation(n, a noticeable difference from what is expected or acceptable 偏离越轨，偏差误差） of the mouth,slurred （ slur,v to speak unclearly without separating your words or sounds correctly)speech,and hemiplegia 偏瘫半身不遂,or directly as a deviation of the mouth and hemiplegia without sudden collapse. This disease has a high incidence and death rate and is often followed by sequelae 后遗症. It is a severely life – threatening disease and with a decreases such as cerebral infarction 梗死,cerebral hemorrhage 出血,cerebral embolism （ something such as a hard mass of blood or a small amount of air that blocks a tube carring blood through the body) and subarachnoid 蛛网膜下的 hemorrhage.
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Bilingual words Apoplexy n,an illness caused by a problem in your brain which can damage your ability to move,feel,or think,stroke manifest v. to appear or to become easy to see Collapse n.to suddenly fall down or become unconscious because you are ill
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Bilingual words consciousness n,the condition of being awake and able to understand what is happening around you Deviation n, a noticeable difference from what is expected or acceptable 偏离越轨，偏 差误差 slur,v to speak unclearly without separating your words or sounds correctly
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Bilingual words hemiplegia 偏瘫半身不遂 sequelae 后遗症 cerebral infarction 脑梗死 cerebral hemorrhage 脑出血 cerebral embolism （ something such as a hard mass of blood or a small amount of air that blocks a tube carring blood through the body) 脑栓塞 subarachnoid hemorrhage 蛛网膜下出血
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二、西医范畴 脑血管病（按病因分短暂性脑缺 血发作、脑梗塞、颅内出血、高 血压脑病、颅内动脉瘤、颅内血 管畸形、脑动脉炎、脑动脉盗血 综合征、颅内异常血管网病、颅 内静脉炎及脑静脉血栓、脑动脉 硬化症；按病称进展分短暂性脑 缺血发作、可逆性脑缺血发作、 进展性中风、完全性中风）
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三、病因病机 风 (wind)- 房室不节劳累太过肾阴不 足 肝阳偏亢 (liver yang rising) → 肝肾阴 虚，肝风内动 火 (fire) — 忧思恼怒，心火暴亢 痰 (Phlem) — 嗜肥甘厚腻 → 痰热内盛 阴阳之气离决 → 脱证 (closed Syndrome) ； 气血阻（瘀）滞 (qi and blood stasis) → 经络失常 风阳暴升与 痰火相夹， 气血逆乱， 并走于上， 蒙蔽清窍 ( 脑 府 ) → 闭证 窍闭神匿， 神不导气
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Causes( etiology) and pathogenesis of the disease 中文名称：病机 英文名称： pathogenesis 发病机制 定义： 疾病发生、发展、变化的机理，包括病性、病位、 病势、脏腑气血虚实变化及其预后等。 etiology n the cause of a disease or the scientific study of this. 病因
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四、辨证及鉴别要点 diferentiation ： （一）辩证分型 1 、中风先兆：有眩晕、心悸、肢麻，手足乏力， 舌强等先兆症状
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2 、中经络 (Meridians and collaterals Affected) ： 半身不遂，肌肤不仁，舌强言謇（ jian ，口吃， 言辞不顺利）口角歪斜，脉弦滑 → 病在经络， 未及脏腑。
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3 、中脏腑 (Viscera Affected) ：症见突然 昏仆或神志昏昧 ( 渐进性 ) ，并见半身不 遂，舌强失语，口角歪斜等症。
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阴阳之气离决 → 脱症； 窍闭神匿，神不导气 → 闭症 （ 1 ）闭证 (closed Syndrome) ：实证为气火冲逆、血 菀于上，肝风煽张、痰浊壅盛。 症见神志昏昧，牙关紧闭，两手紧握，面赤气粗，喉 中痰鸣，二便不通，脉弦滑而数。 （ 2 ）脱证 (Collapse syndrome) ：虚证为真气衰微、元 阳暴脱，症见目合口张，手撒、遗溺、鼻鼾息微，四 肢逆冷，脉象细弱等，如见汗出如油，两颧淡红，脉 微欲绝或浮大无限 → 真阳外越。
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（二）辨证鉴别要点： 有无神志改变 (consciousness change or not ) ，为中经络中脏腑之鉴别要点 中经络：病位浅病情轻，多无神志改变 中脏腑：病位深病情重，有神志改变
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Bilingual words Consciousness:n.an alert cognitive state in which you are aware of youself and your situation.
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( 三 ) 中经络分型 肝阳暴亢 风痰阻络 阴虚风动 痰热腑实 气虚血瘀 肝阴虚阳 亢型
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( 三 ) diferentiation of Meridian and collaterals affected syndrome Mainly can be divided into 3 types: Liver yin deficiency and yang excess Phlegm heat and constipation Qi deficiency and blood stasis
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（ 1 ）闭证（实证）治法： 醒脑开窍，手厥阴经及督脉为主，毫针 刺用泻法或点刺出血 处方：内关、水沟、百会、十二井、合 谷、太冲、丰隆 方义：平肝熄风、清火豁痰、开窍启闭
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（ 1 ） Tyreatment of closed Syndrome(excess) Back the consciousness and open orifices,pericardium channel and du vessel Formula:Neiguan(PC6),Renzhong(GV26), Baihui(GV20),the 12 jing-well points,Hegu(LI4),Taichong(LR3),Fenglo ng(ST40) explanation
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（ 2 ）脱症（虚证）治法： 取任督脉经穴为主，用大艾柱灸之 处方：内关、 水沟、关元、气海、神阙 方义：回阳固脱
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（ 2 ） Tyreatment of Collapse syndrome(deficiency) Mainly use moxibustion as following points of Ren and du channel for yang - returning: Formula:Neiguan(PC6),Renzhong(GV26) Guanyuan(CV4),Qihai(CV6),Shenque(CV 8)
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2 、中经络 （现代醒脑开窍法：内关、水沟、三阴 交为主穴，极泉、尺泽、委中为辅穴）， 配穴见 p67 页
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Treatment of Meridian and collaterals affected syndrome Main Points: Neiguan(PC6),Renzhong(GV26), Sanyinjiao(SP6) Supplement points:Jiquan(HT1),Chize(LU5),Weizhon g(BL40)
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二头针法二头针法 Scalp acupucture 顶颞前斜线
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二头针法二头针法 双侧交替使用以下各线，可用电针 顶颞前斜线 顶颞后斜线 顶旁一线 顶旁二线 枕下旁线 透穴刺法 ( 脑空透风池、玉枕透天柱、脑 户透风府、风池透风池 ) 治疗中风后遗症 疗效显著，安全性好， 。 (1) 中风患者，如脑出血急性期，有昏 迷血压过高时，不宜用头针治疗，须待血 压和病情稳定后方可做头针治疗。（ 2 ） 头针治疗急性缺血性脑中风（脑血栓）效 果较好, 宜及早进行头针治疗（ 3 ）凡有高 热急性炎症和心力衰竭时，一般慎用头针 治疗 (4) 对于血压高或血压不稳者，注意 选穴及手法的轻重，补泻适宜, 防止针刺 引起血压突然升高发生意外。
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按语 中风后遗症采用针灸、理疗、药物、功能锻炼、心理 疗法综合治疗比单一疗法疗效较高。 通过临床观察发现针刺上、下肢阴经穴位 ( 患侧上肢取 极泉、少海、灵道，患侧下肢取箕门、曲泉、膝关、 中封 ) 后再加以电针疗法对降低中风偏瘫患者的肢体肌 张力有一定疗效，有利于偏瘫肢体的康复。 以头针为主配合体针疗效较单一体针好，取瘫肢对侧 头部运动区、感觉区、足运感区，并配合体针透刺治 疗中风偏瘫者 384 例；对照组 120 例采用常规穴位针 刺治疗。结果观察组总有效率为 74.0% ，对照组总有 效率为 49.0% ，
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