| According to the data from the World Health Organization, the morbidi ty of stroke in China was increasing at the rate of8.7%every year, whic h was twice compared with that of America. The number of patient in strok e in our country now is about7million, which is almost the gross popula tion of Hongkong at the beginning of2010.So, from these number, we know that stroke is a common disease. With improvement of the diagnosis and th e level of emergency treatment, the mortality rate has dropped dramatical ly, however the morbidity is significantly increased. In China, about80%of patients left over from the different degrees of physical dysfunction, among which, the incidence of hemiplegia was the highest, about90%of p atients with limb spasticity occurs within3post burn weeks, The quality of life was seriously affect. Spasm refers to muscle or muscle group int ermittent or persistent involuntary contraction, performance increased mu scle tone muscles, abnormal coordination particular model.The mechanism of spastic hemiplegia was not yet entirely clear. It is generally believed that the spasm caused by increased spinal reflex activity in the upper motor neuron injury, abnormal muscle tone is characterized by speed-dependent stretch reflex enhanced, due to motion control disorders; its core is abnormal stretch reflex hyperactivity. Post-stroke central movement suppression system disorders, a motor neurons and Y motor nerve cell mutual restraint, interaction imbalance, caused y movement neurons dominant, the central movement to inhibit system weakened, resulting in low-level center of the originalrelease, resulting in the motion loop enhance the excitability of the affected limb increased muscle tone, was spasticity. Clinical practice, upper limb flexors and lower limb extensors increased muscle tone, forms the so-called Wernicke-Mann position. In other words, the post-stroke hemiplegic limb spasticity of spinal cord excitability increase is caused by enhanced activity of α-γ loop.Limb spasticity seriously impeded the completion of activities of limb function, so that how to break the pattern and to promote the limb separation movement has become an important key to the treatment of stroke hemiplegia spasm as soon as possible. The stroke hemiplegia spasm comes about three weeks after the onset of spasms usually lasts about three months, mostly due to wrong treatment or loss of governance spasticity permanently fixed, it directly affects the improvement of stroke hemiplegia rehabilitation effects. Therefore, the search effectively alleviate the treatment of hemiplegia spasticity become an important issue for the medical profession. Hemiplegia spasticity clinical treatment more difficulty, is still lack of a better therapeutic means, and how to reduce spasm is still the main content and problems of rehabilitation medical research.Summary of recent post-stroke spastic hemiplegia treatment research, from which can be seen in Western and Chinese medicine have certain understanding. There are more treatment, and the efficacy of various treatments is sure. But western medicine has adverse reactions, such as limb weakness, drowsiness, gastrointestinal reactions, psychosis (mental depression) and occasional liver and kidney dysfunction, and the long-term efficacy needs to be further investigated. Surgical treatment is difficult, technically demanding, high cost, and is not easy to promote. The use of Physical therapy, such as functional electrical stimulation, due to the lack of basic research demonstration, coupled with the small-scale research or non-randomized controlled, this therapy is still difficult to make a convincing scientific conclusions.In recent years, with China’s development of rehabilitation medicine, acupuncture treatment of spastic hemiplegia after stroke shows unique advantages, this therapy carried out a large number of clinical observation and research in clinical medicine workers at home and abroad and certainly thethe clinical efficacy of the therapy. But the presence of clinical reports assessment standards are not uniform, there is no specification of the cases included in the discharge standard, some are not randomized controlled defects, and often only highlighted the acupoints, spasm side acupoints, the antagonistic side acupoints, spasm antagonistic side at the same timeacupoints, while ignoring the difference between acupuncture manipulation applications.Jin needle therapy as an important academic content of the Lingnan school of acupuncture is widely used in clinical practice. As early as the early1980s, Professor Rui Jin founded Jin needle therapy in the treatment of post-stroke hemiplegia, aphasia, pseudobulbar palsy and other aspects, and has been carrying out a number of clinical studies; the treatment of the disease has accumulated a wealth of experience. For limb muscle atrophy, joint contractures and deformation of a series of clinical symptoms caused by spastic hemiplegia after a stroke and clinical difficult point mentor Professor Li Xing Zhuang further improved Jin-pin theory, summed up the twin needle, and the applyclinical, and clinical observation proved have got good effect.On the basis of past clinical experience accumulated, this study further investigated the possible mechanism of action, and thus to find the effective ways to improve the quality of life of stroke patients with spastic hemiplegia.1. Objectives1.1The mechanism of spastic hemiplegia after stroke was unclear, the lack of targeted drug therapy, surgical treatment is difficult, so that it is not easy to be popularized, the use of physical therapy is lack of basic research demonstration, so that make it a clear that the efficacy Jin acupuncture treatment of hemiplegia by the spastic in the after a stroke as well as the impact on the patients’comprehensive functionality by the controlled study.1.2Preliminary explores the mechanism of Jin-pin the spastic hemiplegia role in the treatment of stroke.1.3Improve the temporal three-pin, twin three-pin the spastic hemiplegia solution in the treatment of stroke, to discuss its promotional value.2. Methods2.1Literature ResearchLiterature section focus on reviewing the mechanism of spastic hemiplegia after stroke in recent years, were described in terms of pathology, physiology, molecular biology, pharmacology; From medical theory of yin and yang, viscera theory to make analysis. And it carried out a detailed review of the mechanism of acupuncture treatment for stroke spastic hemiplegia.2.2Clinical Research 100patients was divided into Jin three-needle group, rehabilitation and combined groups, met the inclusion criteria of post-stroke patients with spastic hemiplegia, All patients on the basis of drug therapy with reference to cerebrovascular disease prevention and treatment guidelines (Ministry of Health, Department of Disease Control, Chinese Medical Association Academy of Neurology,2005), to control blood pressure, blood sugar, regulate blood fat, prevent platelet aggregation, and give symptomatic treatment, prevention of complications, nutritional support, and so on.Jin three-needle group using temporal acupuncture combined with twin three-pin main point in the treatment, rehabilitation therapy rehabilitation group, the combined group Jin three-pin joint rehabilitation training, the14-day course of treatment, before treatment,7days,14days, functional comprehensive assessment (FCA) respectively, for patients with clinical neurological deficit score (NDS), limbs simplify the Fugl-Meyer score (FMA), assessment the clinical spasms index (CS1). Follow-up at the end of treatment after3months and assess these scale.3Results3.1Literature results show that after a stroke the spastic hemiplegia mechanism is not yet clear, acupuncture is increasingly shows unique advantages, this therapy carried out a large number of clinical observation and research in clinical medicine workers at home and abroad in recent years, Jin pin the therapy gradually become one of the hot spots.3.2General informationPatients enrolled in the research on the aspects of the average age, the average duration and gender composition difference was not statistically significant, prompt baseline data consistent with good comparability. Before treatment, FCA, NDS, FMA, CSI rated by comparison has no significant difference in scale score.3.3The results of FCAFrom the study results we know that, the difference among three groups was statistically significant (P=0.013), which meant that three treatment had within-group difference. The changing trend was different at different stage on the aspect of FCA score, which showed that the score of Combined Group was higher than that of Jin three-needle group and rehabilitation group(P respectively0.034,0.004). However, the score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which meant that the scores between two groups was nearly the same.3.4The results of NDSFrom the study results we know that, the difference among three groups was statistically significant (P=0.007), which meant that three treatment had within-group difference. The changing trend was different at different stage on the aspect of NDS score, which showed that the score of Combined Group was lower than that of Jin three-needle group and rehabilitation group (P respectively0.012,0.003). However, the score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which meant that the scores between two groups was nearly the same.3.5The results of FMAFrom the study results we know that, the difference among three groups was statistically significant (P=0.000), which meant that three treatment had within-group difference. The changing trend was different at different stage on the aspect of FMA score, which showed that the score of Combined Group was lower than that of Jin three-needle group and rehabilitation group(P respectively0.003,0.000). However, the score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which meant that the scores between two groups was almost the same.3.6The results of CSIFrom the study results we know that, the difference among three groups was statistically significant (P=0.001), which meant that three treatment had within-group difference. The changing trend was different at different stage on the aspect of NDS score, which showed that the score of Combined Group was lower than that of Jin three-needle group and rehabilitation group(P respectively0.000,0.005). However, the score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which meant that the scores between two groups was almost the same.3.7The follow-up results of the planned the research programThat some patients did not continue the original treatment plan after the end of treatment, or to return home, or living in a nursing home, some patients regularly out-patient referral. The total number of cases is30, Jin-pin group of12people,10people in the rehabilitation group and the combined group of8people. We can see from the follow-up results that the three groups had statistical difference on the aspect of FCA score(P=0.034), which meant that the follow-up result had within-group difference. The follow-up FCA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.044,0.012), which indicated that the long-term FCA score was better than that of the other groups. However, the follow-up score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which indicated that the follow-up scores between two groups was almost the same.Meanwhile, the three groups had significant statistical significance on the aspect of NDS score (P=0.034), which meant that the follow-up result had within-group difference. The follow-up NDS score of combined group was lower than that of Jin three-needle group and rehabilitation group (P respectively0.044,0.012), which indicated that the long-term NDS score was better than that of the other groups. However, the follow-up NDS score of Jin three-needle group had no statistical difference compared with that of rehabilitation group(P>0.05), which indicated that the follow-up NDS scores between two groups was almost the same.The three groups had significant statistical significance on the aspect of FMA score(P=0.000), which meant that the follow-up result had within-group difference. The follow-up FMA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.005,0.000), which indicated that the long-term FMA score was better than that of the other groups. However, the follow-up FMA score of Jin three-needle group had statistical difference compared with that of rehabilitation group(P=0.000), which indicated that the follow-up FMA scores of Jin three-needle group was better than that of rehabilitation group.The three groups had significant statistical significance on the aspect of CSI score (P=0.002), which meant that the follow-up result had within-group difference. The follow-up FMA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.001,0.010), which indicated that the long-term CSI score was better than that of the other groups. However, the follow-up CSI score of Jin three-needle group had no statistical difference compared with that of rehabilitation group(P>0.05), which indicated that the follow-up CSI scores between two groups was almost the same.3.8The unplanned follow-up research resultsAfter the end of treatment, some patients continued to outpatient or hospital treatment, all patients were in accordance with the treatment options in the hospital during the execution. There are a total of22cases, including5in Jin three-needle group,7in the rehabilitation group, and the combined group of10people.We can see from the follow-up results that the three groups had statistical difference on the aspect of FCA score (P=0.000), which meant that the follow-up result had within-group difference. The follow-up FCA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.000,0.001), which indicated that the long-term FCA score was better than that of the other groups. However, the follow-up score of Jin three-needle group had no statistical difference compared with that of rehabilitation group (P>0.05), which indicated that the follow-up scores between two groups was almost the same.Meanwhile, the three groups had significant statistical significance on the aspect of NDS score(P=0.030), which meant that the follow-up result had within-group difference. The follow-up NDS score of combined group was lower than that of Jin three-needle group and rehabilitation group (P respectively0.047,0.016), which indicated that the long-term NDS score was better than that of the other groups. However, the follow-up NDS score of Jin three-needle group had no statistical difference compared with that of rehabilitation group(P>0.05), which indicated that the follow-up NDS scores between two groups was almost the same.The three groups had significant statistical significance on the aspect of FMA score(P=0.000), which meant that the follow-up result had within-group difference. The follow-up FMA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.042,0.000), which indicated that the long-term FMA score was better than that of the other groups. However, the follow-up FMA score of Jin three-needle group had statistical difference compared with that of rehabilitation group(P=0.007), which indicated that the follow-up FMA scores of Jin three-needle group was better than that of rehabilitation group.The three groups had significant statistical significance on the aspect of CSI score (P=0.040), which meant that the follow-up result had within-group difference. The follow-up FMA score of combined group was higher than that of Jin three-needle group and rehabilitation group (P respectively0.044,0.026), which indicated that the long-term CSI score was better than that of the other groups. However, the follow-up CSI score of Jin three-needle group had no statistical difference compared with that of rehabilitation group(P>0.05), which indicated that the follow-up CSI scores between two groups was almost the same.4Conclusions4.1Temporal three-pin with twin three-pin could effectively relieve the spastic hemiplegia state of post-stroke patients.Studies had shown that Jin three-needle (temporal three-pin with twin three-pin) could relieve spastic hemiplegia state of post-stroke patients, in FCA, NDS, FMA scale scores, limb function in the three groups of patients after14days of treatment were all improved; effect showed in the7days after treatment relative to the rehabilitation group, Jin three-needle group, and the combined group, the role of acupuncture can not be ignored. Acupuncture role in improving motor function had been widely confirmed, especially in early onset of stroke while rehabilitation is slightly insufficient in this aspect.4.2The popularization of Jin three-needle therapy was conducive to the development of rehabilitation medicine.Results from this study, the Jin three-needle group could effectively alleviate limb spasticity after stroke, reduced dysfunction, after the end of treatment follow-up results could be seen Jin three-needle treatment in favor dysfunction and spasm the degree of further ease. Jin three-needle therapy has the acupoints flexible, and acupoints streamlined. Meanwhile, in the treatment regimen, in principle, three-pin main and TCM acupoints; card with points to improve and supplement the various types of three-pin prescription, to enhance the therapeutic effect. Three-pin with points to be prioritized, as stated in the Chinese medicine prescription Jun, Chen Zuo, so; treatment program reflected the points and the syndromes suitable acupuncture prescription rare model.Based on the above characteristics, to popularize Jin three needle therapy in the community hospitals and grass-roots hospitals will be conducive to the development of rehabilitation in these hospitals. And this therapy also solved the problem that these hospitals relied too much on equipment and personnel. Jin three-needle therapy was for a wide range, but also conducive to acupuncture the popularity.4.3The mechanism lied likely in coordination and balance agonist with antagonistic muscles and tension muscle as well as improvement on the effect of rehabilitation training.Coordination and balance agonist with antagonistic muscles and tension muscle, promote common motion is converted to the separatist movement is the focus of treatment of spastic hemiplegia, the acupoints and practices twin30-pin It is based on this theory. The main points in hand twin needle to the pole spring, Chize, the customs, the use of lift and thrust twist and twirl, strong stimulation to suppress the upper limb adductor muscle tension; foot twin three-pin groin, Yin LingQuan, Sanyinjiao main points, groin, yinlingquan point, put plug Twist flat reinforcing-reducing techniques Sanyinjiao lift and thrust twist and twirl muscles balance inside and outside, can make strong muscle tonebe suppressed, and helps to relieve muscle.In addition to relieve spasticity, has a role in promoting similar or better than the facilitatory effect of acupuncture on rehabilitation training, and can improve the awareness of patients receiving rehabilitation treatment. This may be temporal acupuncture combined with twin three-pin the spastic hemiplegia role in the treatment of stroke mechanism.5. The innovation of study5.1It fully reflects the whole concept of Jin three-needle therapyJin needle treatment of post-stroke hemiplegia clinical programs focus on the wholel concept, focus on head local points acupoints along meridians, a different three-pin therapy applied to flaccid paralysis and spastic paralysis post-stroke hemiplegia,; for spasticthe hemiplegia symptoms complexity, the use of three-pin ankle, open three-pin and other acupoints symptomatic treatment; different symptoms associated with hemiplegia after stroke, three-pin port, treatment of sublingual needles and other points with the disease. The entire treatment program reflects the acupoints of Jin three-needle therapy flexible and acupoints streamlined.5.2Evaluation criteria more comprehensive, standardized and objectiveThis project uses the current prevailing functional comprehensive assessment (FCA), clinical neurological deficit score (NDS), limbs simplified Fugl-Meyer score (FMA), the clinical spasms Index (CSI) assessment, Jin three-needle treatment of strokespastic hemiplegia evaluation criteria are more comprehensive, standardized and objective. The study has played a good role model in acupuncture cl inical standardization, standardization research.5.3Follow-up studies on long-term efficacy of acupuncture and rehabilitation contrast, analysis of the importance and necessity of early and continuing rehabilitation. |
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