Chinese Medicine Times : Keeping You Informed

Chinese Medicine Times : Keeping You Informed

Shi Xue-Min and Xing Nao Kai Qiao Legacy

by Jing Liu and Kun Liu. Translated by Eric Brand

What is Xing Nao Kai Qiao?

According to the World Health Organization, stroke is the third leading cause of death in most countries of the world, surpassed only by heart disease and cancer. By the year 2030, it is expected to be the leading cause of death. In the United States, each year 750,000 individuals suffer a stroke and 150,000 people die from stroke. Each year in China, 5-6 million people suffer from stroke and approximately 1.5 million people die from stroke. Stroke affects three times as many women as breast cancer, and it is an important cause of prolonged disability. Survivors of strokes are often unable to return to work. The economic, social and psychological costs of stroke are enormous. In the U.S., each ischemic stroke costs an average of $140,000.

The "Xing Nao Kai Qiao” (XNKQ) method was created by Dr. Shi Xue-min in 1972, illustrating a new approach to the treatment and rehabilitation of stroke patients. As a result of nearly 40 years of working with stroke patients, the "XNKQ” method has developed into a diagnostic and treatment system. (历经三十余年的临床与基础研究,已经形成以"醒脑开窍针刺法为主的中风病综合诊疗体系).

The theoretical TCM basis of the "Xing Nao Kai Qiao” method was based on "spirit-arousing” and "spirit-regulating.” Dr. Shi Xue-min put forward a new conception of the etiology and pathogenesis of stroke, based on a deep understanding the theory of "spirit” in TCM combined with the anatomy and physiology of the brain in biomedicine. Dr. Shi posited that fire, phlegm, blood (stasis), and deficiency carried upwards by wind (internal wind) disturbed the lucid orifices and spirit, leading to closure of the orifices and concealment of the spirit, which in turn caused the spirit to fail to guide the Qi, thus stroke occurred. The XNKQ acupuncture method for treating apoplexy/stroke explained the main pathological keys to etiology, pathogenesis, disease location, and manifestations, and created scientific standards of points selection and acupuncture manipulation. A large amount of clinical practice has confirmed that the treatment method is effective, easy, convenient and practical with a strong scientific standard. The XNKQ method is based on activating and regulating the spirit, restoring qi and spirit, regulating yin-yang and qi-blood, calming, dredging the meridians and supplementing the marrow.

中风病传统针刺治疗原则是急性期"平肝潜阳、镇肝息风;稳定期及后遗症为"疏通经络。取穴方面多沿用"风取三阳"治痿独取阳明的理论,以取阳经穴为主。通过大量的临床对比研究和基础实验证实:传统针刺法治疗中风病确实对稳定病情,改善肢体功能有一定的疗效。但是,在改善脑循环、保护脑细胞、改变脑功能等方面作用则不明显。石学敏院士设立的"醒脑开窍针刺法则以阴经穴为主;以督脉穴为主,以"醒脑开窍、滋补肝肾为主;"疏通经络为辅。

The principles of traditional acupuncture treatment in stroke patients include "calming liver-yang and smoothing liver wind” in the acute period. "Smoothing meridians” is the main principle in stable cases and the sequela period. The points chosen were based on the theories of "using three yang meridians to treat wind” and "using Yang-Ming meridians to treat apoplexy.” A comparison of clinical effects and research shows that the traditional acupuncture treatment for stroke patients has a definite effect in stabilizing the disease and improving physical function. However, to improve cerebral circulation and protect the brain cells, the changes in brain function are not obvious. Dr. Shi’s XNKQ mainly uses Yin meridians and the Du meridian to activate the brain and open the orifices and nourish the liver and kidney; smoothing the meridians is supplementary.

醒脑开窍的四大要素

"醒脑开窍针刺法配伍腧穴的操作进行量学规范

石学敏院士将"醒脑开窍针刺法配伍腧穴操作进行量学规范。为此,开展了大量临床研究和基础实验逐一确定了腧穴位置、进针深度、针刺方向、施术手法、施术时间、针刺效应及针刺最佳间隔时间等。使"醒脑开窍针刺法日趋规范化、剂量化、科学化。

The theory of quantitative acupuncture manipulation put forward first by Dr. Shi Xue-min determines a new definition and quantitative manipulation for reinforcing and reducing methods of needle manipulation. Particular attention is given to twirling and rotating, including 4 important factors. The direction of applied force is an important factor in determining reinforcing vs. reducing technique. The reinforcing or reducing nature of twirling and rotating is directly related to the applied force, the best duration of reinforcing or reducing manipulation based on twirling and rotating the needle is 1-3 minutes for each point. Finally, the best interval between two sessions of acupuncture is 3-6 hours, allowing acupuncture therapy to be more reproducible, standardized, and controlled.

Additionally, Dr. Shi Xue-min investigated the most commonly used methods of manipulation for reinforcing and reducing in terms of frequency, range, and direction of applied force. His research on quantification of reinforcing and reducing manipulation techniques resulted in two significant definitions: 1) The twelve channels are positioned with the Ren and Du channels in the center; in regard to the right or left direction of needle rotation, directing the rotation towards the heart is reinforcing and directing the rotation away from the heart is reducing. 2) Rotating the needles within a narrow range with light force is reinforcing; the force is light and the range of rotation is narrow but the frequency is high, the needles are rotated under 90 degrees and the frequency of rotation reaches 120 times per minute. By contrast, a wide angle of rotation, increased force, and relatively less frequent rotation is reducing; the angle of rotation is greater than 180 degrees and the frequency is approximately 50-60 times per minute.

此外,石学敏院士对最常用的捻转补泻手法,根据捻转的频率、幅度、作用力方向提出了量化的补泻定义及操作规范,确定的捻转补泻两大定义为:十二经脉以任督二脉为中心,左右捻转时作用力的方向,向心为补,离心为泻;捻转幅度小用力轻为补,即捻转时施行小幅度高频率捻转,幅度小于90°,频率大于120/分,捻转幅度大用力重为泻,即捻转时施行大幅度低频率捻转,幅度大于180°,频率在50~60/分。

The manipulation and composition of the XNKQ needling method

One of the main reasons for the efficacy of the XNKQ method lies in its strict application of principles, in particular its special specifications in terms of manipulation technique. The principle points in clinical use are the most important because they free and regulate the spirit; this emphasis is one of the most important differences between the XNKQ method and traditional acupuncture.

The principle points of the XNKQ method include Du 26, P 6, Sp 6, Lu 5, Ht 1, and UB 40. Du 26 is a point that was highly regarded historically for emergency situations; it can directly excite and activate the restrained state of the brain cells. It has a special characteristic of increasing the circulation of the carotid artery, which helps the dynamics of blood circulation and improves cerebral circulation. Thus, the use of this point with sparrow pecking stimulation can open the orifices, arouse the original spirit, and regulate the bowels and viscera. P 6 is the luo point of the pericardium channel, it can benefit stroke patients by improving cardiac output and oxygen supply while calming the heart, regulating the blood, and quieting the spirit. Sp 6 supplements the three yin channels, boosts marrow, regulates qi and blood, and quiets the spirit. Ht 1, Lu 5 and UB 40 can dredge the channels, move qi and blood, and improve the function of the limbs. Within these points, Du 26 is the chief, P 6 and Sp 6 are ministers, and Ht 1, Lu 5, and UB 40 are assistants and couriers; together they regulate and brighten the original spirit, balance yin and yang, regulate qi and blood, and free the channels. One treatment course constitutes ten days of twice daily treatments; 3-5 treatment courses are used continuously.

Needle Manipulation Techniques Used in XNKQ

The efficacy of XNKQ is closely related to its strict attention to techniques of needle manipulation. One of the key differences between XNKQ and traditional acupuncture methods is the importance placed upon principle points that arouse the spirit and open the orifices in order to achieve the essential effect of regulating and freeing the original spirit.

"醒脑开窍针刺法的主穴为人中、内关、三阴交、极泉、尺泽、委中。人中作为醒脑急救之要穴为历代医家所推崇,针之可直接兴奋上行激活系统,解除脑细胞的抑制状态,可特异性地增加颈动脉血流,纠正血液动力学紊乱,改善脑循环,故采用雀啄法泻人中可开窍启闭,醒元神,调脏腑。

The principle points used in XNKQ are DU-26 (ren2 zhong1), PC‑6 (nei4 guan1), SP‑6 (san1 yin1 jiao1), HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1). Ancient doctors greatly valued DU-26 (ren2 zhong1) as an important point to arouse the brain in emergency situations; it has an excitatory effect on the nervous system and it has an idiosyncratic effect of increasing blood flow in the carotid artery while improving cerebral circulation. Using sparrow pecking technique to drain DU-26 (ren2 zhong1) opens the orifices, arouses the original spirit, and regulates the bowels and viscera.

PC‑6 (nei4 guan1) is the luo-connecting point of the pericardium channel; it is traditionally said to quiet the heart, regulate the blood, and calm the spirit, and it improves the cardiac output of stroke patients and improves the supply of oxygen to the brain. SP‑6 (san1 yin1 jiao1) supplements the three yin channels of the leg and boosts marrow while regulating qi and blood and calming the spirit. HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1) smooth the channels and network vessels while moving qi and blood to improve movement of the limbs.

DU-26 (ren2 zhong1) is regarded as the sovereign point in the prescription, while PC‑6 (nei4 guan1) and SP‑6 (san1 yin1 jiao1) are ministers. HT‑1 (ji2 quan2), LU‑5 (chi3 ze2), and BL‑40 (wei3 zhong1) are assistants and couriers. This combination regulates the original spirit and brings out brightness. It creates yin-yang balance and rectifies qi and blood to harmonize the thoroughfare (chong) vessel. By freeing the channels, it promotes uninhibited movement. Treatment is given twice per day for 10 days per treatment course, and 3-5 continuous courses of treatment are recommended.

The XNKQ method of needling has a clear effect in stroke patients, with pronounced positive effects in multiple systems. Prof. Shi Xue-Min has studied its clinical effects for over 30 years in numerous systems involving many different disciplines of treatment, prevention, and rehabilitation. He has contributed standards of integration and management for the diagnosis and treatment of stroke, which has been called a unique "chapter on the treatment methods of Master Shi.” It has been shown to reduce mortality and enhance rehabilitation in stroke patients, and is widely regarded as an excellent method of treatment.

Another key aspect of the XNKQ method is the emphasis on manipulation techniques for the principle points. Each point has clear specifications on direction, depth, and hand techniques, which have been assessed with numerous scientific studies. Thus, the needling method is based on established science and standards that enhance clinical results.

After Dr. Shi published his work with the XNKQ needling method, a clinical system of stroke diagnosis and treatment was developed. Altogether, over two million stroke patients have been treated with this system of acupuncture therapy. In recent years, 9005 patients with stroke at various different stages were assessed based on strict, harmonized diagnostic standards and treated principally with the XNKQ method. Based on their specific condition, patients utilized drug therapies including medication for hypertension, infections, and other concerns based on internationally accepted standards of care. Marked results were seen in 95-98% of patients with a variety of different stages and conditions, including acute stages, hemorrhagic stroke, and recovery stages.

Over the past forty years, Dr. Shi Xue-Min’s humble yet highly innovative work has truly entered the history books.

醒脑开窍针法的另一个重要组成部分即对配方组穴从进针方向、深度、以及采用的手法和刺激量均作出了明确的规定,并通过了科学实验的验证。这样使该针法的操作趋于科学化、规范化,为提高临床疗效奠定了坚实的基础。

"醒脑开窍针刺法治疗中风病临床疗效显著;对人体多系统均有良性导向作用。石学敏院士经过三十多年的临床归纳,将多系统、多学科诊疗、预防、康复方法有机地结合管理,综合、程序化用于中风病的诊疗中,形成了——"石氏中风单元疗法。更进一步降低了中风病死亡率;提高中风病康复率,为中风病的治疗开辟了更好的治疗途径。

"醒脑开窍针刺法的组成与操作

醒脑开窍针刺法之所以有效的重要原因之一,是其有严格的组方原则,尤其在操作上有着特殊的规定。临床上应用中主穴是最为重要的,起到醒神开窍;通调元神的主要功效,也是醒脑开窍针刺法区别于传统针刺法的核心之一.

"醒脑开窍针刺法的主穴为人中、内关、三阴交、极泉、尺泽、委中。人中作为醒脑急救之要穴为历代医家所推崇,针之可直接兴奋上行激活系统,解除脑细胞的抑制状态,可特异性地增加颈动脉血流,纠正血液动力学紊乱,改善脑循环,故采用雀啄法泻人中可开窍启闭,醒元神,调脏腑。内关穴为心包经之络穴,可改善中风患者的左右心输出量,改善脑血氧供应,具有宁心调血安神之效。三阴交可补三阴,益脑髓,调气血,安神志。极泉、尺泽、委中可疏通经络,运行气血,改善肢体运动功能。其中,人中为君,内关、三阴交为臣,极泉、尺泽、委中为佐使,以调元神,使之达明;顺阴阳,使之平衡,理气血使之冲和;通经脉,使之畅达。治疗疗程:每日针2次,10天为1疗程,持续治疗3~5个疗程。

"醒脑开窍针刺法治疗中风病临床疗效显著;对人体多系统均有良性导向作用。石学敏院士经过三十多年的临床归纳,将多系统、多学科诊疗、预防、康复方法有机地结合管理,综合、程序化用于中风病的诊疗中,形成了——"石氏中风单元疗法。更进一步降低了中风病死亡率;提高中风病康复率,为中风病的治疗开辟了更好的治疗途径。

醒脑开窍针法的另一个重要组成部分即对配方组穴从进针方向、深度、以及采用的手法和刺激量均作出了明确的规定,并通过了科学实验的验证。这样使该针法的操作趋于科学化、规范化,为提高临床疗效奠定了坚实的基础。

石学敏院士自提出了醒脑开窍针法之后,对中风病的诊断及治疗开展了系统的临床研究,共诊治患者达200万人次,形成了一套以针灸治疗为中心的中风诊疗体系。近年来,应用严格的、统一的诊断标准对临床9005例各期中风患者采用以"醒脑开窍针法治疗为主,根据病情需要,辅以降颅压、抗感染、降血压的西药进行治疗,采用国际公认的爱丁堡斯堪的纳维亚疗效评定标准对疗效进行评价,其中脑出血3077例,脑梗死5928例,总有效率达98%以上,中风急性期患者4728例,总有效率95.44%,后遗症期773例,总有效率98.84%,经回顾性研究,其疗效明显优于中药、西药、及其他针刺法。

石学敏院士从医的四十年是创新的四十年,是无愧的四十年,他的业绩将载入史册,他无愧于中国工程院针灸院士。

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