| Objective:The present study was conducted from the Awakening and Tongue legislation,to compare and observe the difference in the efficacy of moxa stick warm acupuncture and traditional moxa segment warm acupuncture in the treatment of hand dysfunction in stroke disease,and to investigate the correlation between the sensory transmission stimulated by moxa stick warm acupuncture and the efficacy,in order to provide new ideas for the clinical practice of acupuncture in the treatment of this disease.Method:1.Case selection and enrollment method: The 60 patients with hand dysfunction in stroke disease selected for this study were all from the Jiangxi Provincial Hospital of Traditional Chinese Medicine.In this study,a parallel-controlled,randomized grouping design was used to divide the enrolled cases into the moxa stick warm acupuncture method group(referred to as the test group)and the traditional moxa segment warm acupuncture method group(referred to as the control group),with30 cases each.2.Treatment methods:2.1 Test group: moxibustion with warm acupuncture was the main treatment.Main points: Shuigou,Baihui,parieto-temporal anterior oblique line(middle 2/5 segments),Neiguan,Dazhui,Jingjiaji(C4-C7),Jianyu,Jianliao,Binao,Quchi,Shousanli,Waiguan,Houxi,Hegu,Bazi.Matching points: Lower limb disorder with Huanjiao,Zusanli,Yanglingquan,Yinlingquan,Taichong and Fengshui.Additional points are added according to the type of evidence and symptom group: Wind-phlegm stasis with Fenglong and Yinlingquan;Phlegm-heat and internal organs with Nei Ting and Feng Long;qi deficiency and blood stasis with Qihai and Xuehai;yin deficiency and wind movement with Taixi and Fengchi;phlegm and dampness with mengshen,Fenglong and tai Chong;add Yamen and Lianquan for those with unfavorable speech or aphasia;for people with mental retardation,add the Dazhong and the Shenmen;with strabismus and diplopia,add Cuanzhu,Sizhukong,and Chengqi;for facial paralysis,add Dicang,Xiaguan and Jiache;with constipation with Tianshu and Zhigou;with urinary incontinence,urinary retention with Zhongji and Guanyuan.Operation method: The above points were taken bilaterally on the Jingjiaji,and the rest were taken on the affected side and needled with0.3×40 mm milli-needles.The patient was placed in a lateral position(the healthy side facing down),and the twisting and tonic method was applied to Dazhui and Houxi for about 1 minute respectively after the acupuncture was obtained,while the rest of the acupuncture points were operated by conventional acupuncture,following the application of moxibustion(moxa fire close to the needle handle)at Dazhui and Houxi points,the patient should feel the warm sensation along the needle body into the deeper layers of the acupuncture points or stimulate other sensory transmissions,and remove the moxa ash once every 3-5 minutes to prevent the ash from falling off and burning the skin.The needles are left in place for 30 minutes,once a day.2.2 Control group: treated mainly with moxibustion and warm acupuncture.Main and matching points: same as the test group.Operation method: The above points were taken bilaterally on the Jingjiaji,and the rest were taken on the affected side and needled with0.3×40 mm milli-needles.The patient was placed in a lateral position(the healthy side facing down),and the twisting and tonic method was applied to Dazhui and Houxi for about 1 minute respectively after the acupuncture was obtained,while the rest of the acupuncture points were operated by conventional acupuncture,following the application of moxibustion at Dazhi and Houxi with a moxa needle(a 2-cm-long moxa needle is placed on the handle of the needle to apply moxibustion,and the ashes are removed after burning,2 strokes of moxibustion can be applied to each point each time,based on the amount of moxa burning in 30 minutes,and the needle is removed after applying moxibustion.(To avoid burning the skin and clothing when applying moxa,cut a 4cm square cardboard pad for acupuncture points).The needles are left in place for 30 minutes,once daily.Course of treatment: Treatment 6 times a week,every Sunday off,4weeks of continuous treatment for a course of treatment,after 2 courses of treatment to assess the effectiveness of treatment.Basic treatment: Different underlying diseases such as hypertension,diabetes mellitus and hyperlipidemia were treated accordingly in both groups.3.Observed indicators3.1 Evaluation of hemiplegic hand movement,coordination and sensory function: Modified Lindmark scale was used.3.2 Hemiplegic hand motor function rating: Brunnstrom hand function rating scale was used.3.3 Hand muscle spasticity assessment: Modified Ashworth spasticity(MAS)assessment scale was used.3.4 Assessment of the ability to perform daily living: the Modified Barthel Index(MBI)scale was used.3.5 Comprehensive TCM efficacy assessment: using the diagnostic criteria scale for stroke disease categories.3.6 Sensory transmission phenomena.4.Statistical methods.All data collected in this study were statistically analyzed using SPSS25.0 software.Among them,categorical data were tested by chi-square test;t-test was used when the measurement data conformed to normal distribution,otherwise,rank sum test was used;correlation analysis of two variables,Spearman correlation analysis was used: and the correlation coefficient r > 0 indicated that the two variables were positively correlated;conversely,r<0 indicated that the two variables were negatively correlated,and the closer the absolute value of r was to 1,the stronger the correlation was.Results:1.Baseline comparison: The age,gender,disease duration,Western medical disease type,Chinese medical evidence type and main observation indexes(Modified Lindmark Scale,Brunnstrom Hand Function Rating Scale,MAS Rating Scale,MBI Rating Scale,Diagnostic Criteria Scale for Stroke Disease Category)of the two groups(P>0.05)indicated that the baseline data of the two groups were comparable.2.Comparison of modified Lindmark scores: the Lindmark scores of both groups improved significantly after treatment compared with those before treatment(P < 0.05),indicating that hemiplegic hand movements,coordination,and sensory functions improved in both groups.;the scores of the test group were higher than those of the control group after treatment(P<0.05),indicating that the effect of treatment in the test group was better than that of the control group.3.Comparison of Brunnstrom’s hand function assessment: both groups showed significant improvement in hand motor function after treatment compared with that before treatment(P<0.05);the improvement of hand motor function in the test group was better than that in the control group after treatment(P<0.05).4.Comparison of MAS assessment: the degree of hand spasm in both groups was significantly relieved after treatment compared with that before treatment(P<0.05);the degree of hand spasm relief in the test group was better than that in the control group after treatment(P< 0.05).5.Comparison of MBI scores: The MBI scores of patients in both groups improved significantly after treatment compared with those before treatment(P < 0.05),indicating that patients in both groups have improved self-care and are better able to live;the scores of the test group were higher than those of the control group after treatment(P<0.05),indicating that the effect of treatment in the test group was better than that of the control group.6.Comparison of comprehensive efficacy of Chinese medicine: The diagnostic standard score of stroke disease was selected as the clinical efficacy assessment standard.3 cases in the experimental group were cured,16 cases were apparently effective,7 cases were effective,and 4 cases were invalid,with an effective rate of 86.7%;1 case in the control group was cured,10 cases were apparently effective,12 cases were effective,and 7 cases were invalid,with an effective rate of 76.7%.When comparing the comprehensive efficacy of the two groups,the total effective rate of the test group was higher than that of the control group(P<0.05).It is suggested that moxa stick warm acupuncture and moxa segment warm acupuncture can improve the overall symptoms of stroke disease better,and the efficacy of moxa stick warm acupuncture is better than that of moxa segment warm acupuncture.7.Comparison of sensitization rate:During the treatment,there were 24 people with sensitization in the test group,including 5 people with full sensitization,19 people with partial sensitization,and 6 people without sensitization,with a sensitization rate of 80.0%;in the control group,there were 17 people with sensitization,including 2 people with full sensitization,15 people with partial sensitization,and 13 people without sensitization,with a sensitization rate of 56.7%,and the rate of sensitization in the two groups was compared at(P<0.05),suggesting that both the moxa stick warm acupuncture method and the the rate of sensitization in the two groups was 56.7%(P<0.05),suggesting that both moxibustion and moxibustion can stimulate sensitization,but the moxibustion method is more likely to stimulate sensitization.8.Correlation study between efficacy and sensitization:By spearman correlation analysis:The correlation coefficient between the efficacy and sensitization of both groups was 0.81 and 0.68,respectively,indicating that the correlation between the efficacy and sensitization of the two groups was positive and strong.Conclusion:1.from the legislation of awakening and clearing the divine energy,both moxa strip warm acupuncture and moxa segment warm acupuncture have better efficacy in treating hand dysfunction in stroke disease,and the efficacy of moxa strip warm acupuncture is significantly better than that of moxa segment warm acupuncture.2.Compared with moxibustion,moxa stick acupuncture is more likely to promote the operation of meridian qi and stimulate the sensory transmission phenomenon;and the appearance of the sensory transmission phenomenon can promote the normalization of the operation of the Shenqi,so as to restore the motor-sensory function of the brain marrow and the coordination of the hand.3.In the treatment of hand dysfunction in stroke disease with moxa stick warm acupuncture,there is a positive correlation between the sensory transmission phenomenon stimulated by moxa stick warm acupuncture and the improvement of hand dysfunction. |
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