孙远征教授针刺治疗原发性面肌痉挛经验撷要_李凯庆.pdf

浙江中医药大学学报2023年2月第47卷第2期JOURNAL OF ZHEJIANG CHINESE MEDICAL UNIVERSITY VOL.47NO.2 Feb.2023国医传承孙远征教授针刺治疗原发性面肌痉挛经验撷要李凯庆1于天洋2夏雪1孙远征21.黑龙江中医药大学哈尔滨1500402.黑龙江中医药大学附属第二医院摘要：目的总结孙远征教授针刺治疗原发性面肌痉挛的临床经验。方法通过临床跟师学习，从孙师对本病的认识及治疗特色等方面进行阐述，分析孙师对本病的辨治思路，并通过病案举例加以验证。结果孙师认为，本病实质为正虚风动，与情志因素关系密切，风为导致痉挛发病最主要的致病因素，情志不调为导致疾病加重的诱发因素，将其分为内风、外风两种致病模式。孙师认为本病病位在面部经筋，与面部经气受损有关，经络之气不通，局部气血流通不畅，故发为本病。孙师治疗本病有以下特色，重视“调神”，神安形止；基于“缪刺”，调衡阴阳；揿针留置，长效止痉；明辨经络，辨证遣针，以此四法针刺辨治原发性面肌痉挛。文中所附一例原发性面肌痉挛病案，观其舌苔脉象及症状表现，辨为面风，阴虚风动型，治以疏肝养阴、熄风止痉，以调神法、缪刺法、揿针法、远取法联合治疗，收效甚佳，随访半年未复发。结论孙师临床辨治原发性面肌痉挛，以形神关系为基础，以明辨经络、定病经、辨证遣针为原则，治疗时调神、缪刺、揿针、远取相结合，体现了针刺治疗的优势所在，拓宽了该病的诊治思路，值得学习和推广。关键词：原发性面肌痉挛；调神法；缪刺法；揿针法；名医经验；孙远征中图分类号：R245文献标志码：A文章编号：1005-5509（2023）02-0167-04DOI:10.16466/j.issn1005-5509.2023.02.010Professor SUN Yuanzhengs Experience in Acupuncture Treatment of Primary Hemifacial Spasm LI Kaiqing1，YU Tianyang2，XIA Xue1，et al1.Heilongjiang University of Chinese Medicine，Harbin(150040)，China；2.The Second Affiliated Hospital ofHeilongjiang University of Chinese MedicineAbstract:ObjectiveTo summarize Professor SUN Yuanzhengs clinical experience in acupuncture treatment of primary hemifacialspasm.MethodsThrough clinical study with teachers，Professor SUNs understanding of the disease and treatment characteristics wereexpounded，and the ideas on differentiation and treatment of the disease were analyzed and verified by example of medical record.ResultsProfessor SUN believes that the essence of the disease is that Qi deficiency leads to wind movement，which is closely related toemotional factors.Wind is the main pathogenic factor leading to spasm，and emotional disorder is the inducing factor leading to theaggravation of the disease，which can be divided into two pathogenic modes：internal wind and external wind.Professor SUN believesthat the disease is located in the facial meridian tendons，which is related to the damage of facial meridian Qi，the Qi of meridians isblocked，and the local Qi and blood circulation is not smooth，so it is suffered from the disease.Professor SUN has the followingcharacteristics in the treatment of this disease，paying attention to“regulating mind”and the mind is at rest and the form is motionless；based on“Miao acupuncture”，regulating Yin and Yang；indwelling acupuncture with long-term effect to stop spasm；distinguishingmeridians and collateral，acupuncture according to syndrome differentiation.In the case of primary hemifacial spasm，the pulse andsymptoms of tongue coating were identified as the type of facial wind and Yin deficiency，which was treated by soothing the liver andnourishing Yin，extinguishing wind and stopping spasm，and also treated with mind-regulating method，Miao acupuncture method，press-needle method and distant method.The effect was very good，and there was no recurrence after follow-up for half a year.ConclusionProfessor SUNs clinical diagnosis and treatment of primary hemifacial spasm is based on the relationship between form andspirit，according to the principle of distinguishing channels and collateral，clarifying disease meridians，acupuncture according tosyndrome differentiation.It reflects the advantages of acupuncture treatment，broadens the diagnosis and treatment of the disease，and isworth learning and popularizing.Key words：primary hemifacial spasm；mind-regulating method；Miao acupuncture method；press-needle method；famous doctors ex-perience；SUN Yuanzheng基金项目：国家中医药管理局全国名老中医药专家传承工作室建设项目（国中医药人教发201420号）Fund project：National Famous Traditional Chinese Medicine Expert Inheritance Studio Construction Project of the StateAdministration of Traditional Chinese Medicine(G.TCM.R.J.F.201420)通信作者：孙远征，E-mail：167浙江中医药大学学报2023年2月第47卷第2期原 发 性 面 肌 痉 挛（primary hemifacial spasm，PHFS）又称面肌抽搐，是指在面神经分布区内出现的肌肉不自主的阵发性跳动抽搐，可由精神紧张、疲劳及面部自主活动等因素诱发或加剧，发作时患者自身无法控制，静止状态下也可出现，休息时可缓解1。本病多发于中老年，女性多于男性，随着时代的进步，生活压力增大，本病有年轻化的趋势2。PHFS发病时症状明显，虽不危及生命，但会对患者的心理健康产生不良影响，给其日常生活带来诸多不便，易引发焦虑、烦躁甚至抑郁等不良情绪，而此种情绪亦会加重病情，导致疾病难以痊愈。PHFS发病机制尚不明确，现代医学普遍认为本病的发生与面神经通路受到机械刺激、责任血管受压等因素有关3。针对PHFS，现代医学首选肉毒毒素A局部注射，但疗效持久性差，反复应用还可能引起面部僵硬4。药物治疗则以抗癫痫药、镇静药为主，虽短期疗效显著，但无法根治，长期应用剂量逐渐累积，易诱发药物性肝、肾损害5。手术治疗的疗效虽较上述诸法持久，但对机体创伤较大，危险性高，且术后易复发，容易出现面神经麻痹、听力障碍等并发症6。中医学以整体观念、辨证论治为基本特点，在辨治疾病时，强调辨病与辨证相结合，以司外揣内、见微知著、以常衡变、因发知受为诊断疾病的基本原理，采取内服之中药、外敷之膏药、补泻之针刺、穴位之埋针等方法治疗，其中针灸疗法源远流长，流传至今，治疗作用广泛，疗效确切。研究发现，针刺治疗PHFS具有操作简便、不良反应少、疗效稳定等优点7。孙远征教授为第五批全国名老中医药专家学术经验继承工作指导教师，从事针灸临床、科研、教学工作40余年，临床经验丰富，对本病有着独到的见解，形成了独具特色的治疗方法。笔者有幸跟师学习，受益良多，特撰此文，以供临床借鉴。1孙师对本病的认识PHFS为现代医学病名，古籍中鲜有记载，中医将本病归属于“瘛疭”“面风”等范畴。张氏医通 瘛疭云：“瘛者，筋脉拘急也，疭者，筋脉驰纵也，俗谓之抽。”8依据上文可知，筋脉受邪，拘急驰纵，发于颜面，其症状与PHFS相似。孙师认为，本病的病因常与情志内伤及气血不足有关，基本病机为外邪阻滞或内风扰动，筋脉拘急。PHFS的发作不规律，时发时止，这与风邪的致病特点相应，因此孙师认为，风为导致本病最重要的致病因素，并将其分为内风阴动、外风阳动两种致病模式。内风表现为虚风内动，主要包括血虚动风及阴虚动风，血虚不能养筋，筋脉挛急，故见肌肉瞤动；阴液不足，筋脉失濡，虚风内动则筋脉拘挛不伸，属“阴动”范畴。外风表现为风邪侵袭，风邪善行数变，易袭阳位，颜面部位于人体上部，而眼睑又处于颜面部的上位，故痉挛发病多从眼睑开始，逐渐向下发展，属“阳动”范畴。PHFS发病后患者多情志不遂，神动则形不安，形动则神不宁，二者循环不已，促进疾病进展。因此，孙师认为本病以内外风为标，神不安为本，中医学提倡“形神一体观”，故强调针刺调神，以调神为治疗本病的根本原则。内风发生乃为五脏元气不充，施治内风所致的PHFS，调神为调和五脏气血阴阳；外风为风邪直接侵袭颜面部，治疗外风所致的PHFS，调神为调节面部阴阳平衡。另外，孙师重视经络辨证，远端取穴与缪刺结合，根据病位选择远端穴位，体现循经远取的诊疗思路。2治疗特色2.1重