| Purpose:To clarify the meridian sinew theory is the theoretical basis of fire needle therapy for spastic hemiplegia after stroke based on the basic theory of traditional Chinese medicine.To observe the clinical effect of fire needle therapy on the increased muscle tone after stroke.To evaluate the effects of fire needle therapy guided by meridian sinew theory combined with conventional acupuncture and the effects of conventional acupuncture on the clinical spasm index,muscle tension,comprehensive function and limb motor function of patients with increased muscle tone after stroke,and to compare the efficacy of the two treatment schemes.Simultaneously,apply surface electromyography to detect sEMG signal of muscles on affected and healthy sides before and after treatment,select integral electromyogram(IEMG)and median frequency(MF)as indicators,inquire into the mechanism of fire needle therapy guided by meridian sinew theory on the increased muscle tone after stroke by means of surface myoelectricity,in order to provide a scientific theoretical and practical basis for the further promotion of the use of fire needle.Material and method: The first paper:Under the guidance of traditional Chinese medicine theory,through the literature research on meridian sinew disease,stroke,restraint,meridian sinew theory and fire needle therapy in ancient books of traditional Chinese medicine,and combined with a large number of modern clinical observation and mechanism research of spastic paralysis after stroke,it is proved that meridian sinew theory is the theoretical support of fire needle therapy for spastic paralysis after stroke.The second paper:Materials and Methods: According to the principle of randomized and controlled scientific research and design,and according to the criteria of disease diagnosis and test inclusion,80 patients with increased muscle tone after stroke who were hospitalized in the Department of Encephalopathy Rehabilitation Department of Rehabilitation Center of Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from March 2017 to January 2019 were randomly divided into two groups: The experimental group(fire needle + conventional acupuncture)and the control group(conventional acupuncture).There are 40 cases in each group.Both groups were given individualized routine drug treatment for cerebrovascular diseases in neurology department to regulate blood pressure,control blood sugar,regulate blood lipids,provide symptomatic treatment and prevent complications,supplemented by necessary neurotropic support.Meanwhile,cooperate with the "one-to-one" mode of routine rehabilitation training according to the specific conditions of patients.The control group was treated with simple conventional acupuncture and the following acupoints were selected.Acupoints in upper limbs: Jianyu acupoint,Quchi acupoint,Chize acupoint,Waiguan acupoint,Hegu acupoint,Baxie acupoint.Acupoints in lower limbs: Huantiao acupoint,Weizhong acupoint,Yanglingquan acupoint,Sanyinjiao acupoint and Kunlun acupoint.Acupuncture once a day from Monday to Friday,five times a week,except at weekends,continuously for three weeks.The experimental group was treated with fire needle combined with conventional acupuncture under the guidance of meridian sinew theory.Acupoints on the upper limbs were selected to find tendon nodes or tenderness points in the area of Sanyang meridian sinew of hand(mainly on both sides of the tendons of triceps brachii and extensor digitorum communis).Acupoints on the legs were selected to find tendon nodes or tenderness points in the area of Sanyang meridian sinew of foot(mainly on both sides of semitendinosus,semimembranosus and medial head of quadriceps femoris).Acupoints for foot spasm were selected in the area of the meridian and tendons of Sanyang meridian sinew of foot(mainly on both sides of the long peroneal muscle,the short peroneal muscle and the extensor digitorum longus tendon).On the basis of weekly conventional acupuncture treatment from Monday to Friday,the patients were treated with fire needle on every Monday,Wednesday and Friday.The experiment was completed 21 days later.All patients were assessed before treatment(day 1),during treatment(day 11)and after treatment(day 21)by CSI Score Scale of Clinical Spasm Index,Standard Scale for Diagnosis and Therapeutic Evaluation of Stroke,Modified Ashworth Spasm Scale(MAS)Score Scale and Fugl-Meyer(FMA)scale,and the data were processed statistically.Observe the curative effect of patients before and after treatment.The third paper:The clinical materials,case selection,grouping methods and treatment methods are the same as those in the second paper.Use surface electromyography to detect the sEMG signals of the affected and healthy muscles before and after treatment,observe and statistically analysis the changes of integrated electromyography(IEMG)and median frequency(MF)indices,in order to observe the curative effect of the patients before and after treatment.Results: 1.Theoretical research results 1.1 The meridian sinew theory is the basic theory of treating meridian sinew disease.1.2 Spastic paralysis after stroke is equivalent to "tendon disease" in traditional Chinese medicine,and is the manifestation of tendon injury.The causes include the disorder of yin and Yang in the viscera and body,deficiency of Qi and blood stasis,blockage of meridians and collaterals by wind phlegm,obstruction of blood vessels by phlegm and blood stasis,etc.The pathogenesis is deficiency of liver and kidney,and the tendons and veins cannot be nourished.The location of the disease is in the tendons,the syndrome belongs to deficiency in nature and excess in superficiality.Deficiency in nature includes deficiency of liver and kidney,and deficiency of Yin,Yang,Qi and blood.Excess in superficiality includes the blockage of collaterals caused by wind,fire,phlegm and blood stasis.1.3 The meridian sinew theory can guide many kinds of meridian sinew acupuncture methods,including the clinical treatment of fire needle therapy.1.4 With the theoretical support of traditional medicine and the basis of modern clinical research,meridian sinew theory is the guiding theory of fire needle therapy for spastic hemiplegia after stroke.2.Scale evaluation results 2.1 Before treatment,there were no significant differences in general clinical data,CSI score of clinical spasm index,standard score of stroke diagnosis and efficacy evaluation,and improved Ashworth Spasm Scale score between the two groups(P > 0.05).2.2 On the 11 th day after treatment,the CSI score of clinical spasm index in the experimental group was lower than that before treatment(P < 0.01),and was the same as the control group(P > 0.05);the diagnostic standard scores of stroke in both groups were lower(P < 0.01),and the Fugl-Meyer scale scores in both groups were higher(P < 0.01).2.3 After 11 days of treatment,the CSI score of the experimental group was lower than that of the control group(P < 0.01).The diagnostic criteria,curative effect evaluation,modified Ashworth Spasm Scale score and Fugl-Meyer Scale score of the two groups were similar(P > 0.05).2.4 After treatment(on the 21 st day),the CSI scores of the two groups were lower than those before treatment(P < 0.01),the diagnostic criteria scores of apoplexy in both groups were lower than those before treatment(P < 0.01),the curative effect evaluation of apoplexy in the two groups was significantly higher than that on the 11 th day of treatment(P < 0.01),and the score of Fugl-Meyer scale in both groups was higher than that before treatment(P < 0.01).2.5 Comparing two groups after treatment(on the 21 st day),the CSI score and the diagnostic criteria score of stroke in the experimental group were lower than those in the control group(P < 0.05).The therapeutic criteria score of stroke in the experimental group was higher than that in the control group(P < 0.01).The efficiency of the improved Ashworth Spasm Scale in the experimental group was higher than that in the control group(P < 0.05).The Fugl-Meyer Scale score in the experimental group was higher than that in the control group(P < 0.05).3.Clinical observation results 3.1 Fire needle therapy for foot varus: the total effective rate of the experimental group was 93.33%,and that of the control group was 47.06%.Statistical test showed that the difference was significant(P < 0.05).3.2 Fire needle therapy for myositis ossificans: 3 of the 4 patients in the treatment group had a significant reduction in the area of the mass,while 1 patient had no significant change in the size and size of the mass.The hardness of palpation improved from harder texture to slightly elastic.In the control group,there were no significant changes in the size and hardness of the legs mass.4.Test results of surface electromyography 4.1Before treatment,there was no significant difference in IEMG and MF values of biceps brachii and rectus femoris muscles between the two groups(P > 0.05).There was no significant difference in IEMG and MF values of biceps brachii and rectus femoris between the two groups(P > 0.05).4.2 After treatment,the IEMG values of biceps brachii and rectus femoris in the affected side of the experimental group were higher than those before treatment,with statistical significance(P < 0.01);the IEMG values of biceps brachii and rectus femoris in the control group were higher than those before treatment,with statistical significance(P < 0.01).The mean values of MF of biceps brachii and rectus femoris in the experimental group were lower than those before treatment,and the difference was statistically significant(P < 0.01);the mean values of MF of biceps brachii and rectus femoris in the control group were lower than those before treatment,and the difference was statistically significant(P < 0.01).4.3 Comparing two groups after treatment,the IEMG value of biceps brachii in the experimental group was higher than that of the control group with statistical significance(P < 0.05);and the IEMG value of rectus femoris in the experimental group was higher than that of the control group with statistical significance(P < 0.01).The MF values of biceps brachii and rectus femoris in the experimental group were higher than those in the control group with statistical significance(P < 0.01).Conclusion: 1.Meridian sinew theory is the theoretical basis of fire needle therapy for spastic hemiplegia after stroke.Fire needle therapy guided by meridian tendon theory is effective in treating spastic hemiplegia after stroke.2.Fire needle therapy is superior to conventional acupuncture therapy in improving muscle tension,alleviating spastic state and restoring limb movement for patients with spastic paralysis after stroke,and it has a faster effect than conventional acupuncture therapy in alleviating spasm.3.Fire needle therapy,selecting acupoints according to meridian-tendon theory,has a significant effect on foot varus after stroke,which is superior to conventional acupuncture therapy.4.The effect of fire needle therapy is better than that of conventional acupuncture therapy in improving the recruitment ability of motor units of the affected limb.5.In terms of relieving muscle fatigue of the patients with spastic paralysis after stroke,the effect of fire acupuncture therapy is better than that of conventional acupuncture therapy. |
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