TCM Acupuncture and Massage

Chapter 61 Nervous system diseases (3)
([-]) Treatment

1. The treatment principle of facial neuritis in modern medicine is to improve local blood circulation, reduce facial nerve edema, relieve nerve compression, and promote functional recovery.

(1) At present, it is mostly advocated to use a course of corticosteroid hormone therapy as early as possible in the acute stage. Dexamethasone 10-15mg/d can be used for 7-10 days; or prednisone, the initial dose is 1mg/(kg·d), and the Take orally orally in 2 times, for 5 consecutive days, and then gradually reduce the dose within 7 to 10 days.If it is caused by herpes zoster infection, the corresponding antiviral drugs can be taken orally.

(2) Vitamin B drugs can promote the recovery of nerve myelin sheath, vitamin B100mg, vitamin B12500ug, both 1 time / d intramuscular injection.

(3) Champagne can improve local blood circulation by reducing muscle tension. It should be gradually increased from a small dose, and can be gradually increased to 30-40 mg/d, orally 3 times a day.However, individual patients cannot tolerate its side effects, such as nausea, vomiting and drowsiness.

(4) Physiotherapy In the acute stage, ultrashort-wave diathermy, infrared radiation or local hot compress near the stem-mammary foramen can help improve local blood circulation and eliminate nerve edema.In the recovery period, iodine ion penetration therapy, acupuncture or electroacupuncture can be done.

(5) Rehabilitation treatment As long as the affected side muscles can move, self-function training should be started as soon as possible. You can frown, raise your forehead, close your eyes, show your teeth, puff your cheeks, and whistle in front of the mirror, several times a day for a few minutes each time , and supplemented by facial muscle massage.

(6) Surgical therapy For those who have not recovered after 2 years of illness, facial nerve-accessory nerve, facial nerve-hypoglossal nerve or facial nerve-phrenic nerve anastomosis can be considered, but the curative effect is still uncertain, and it should only be tried in severe cases.Patients with severe facial paralysis may undergo cosmetic surgery.

(7) Prevention of eye complications. The cornea is exposed for a long time due to the inability to close the eyes or blink, and is prone to infection. Goggles, eye drops and eye ointment can be used for protection.

2. Acupuncture and moxibustion treatment Acupuncture and moxibustion has a very definite curative effect on peripheral facial paralysis. In the case of timely intervention, it can significantly relieve symptoms and shorten the course of the disease.Generally, patients can recover in about a month, younger patients can be shorter, and elderly patients can be slightly longer.If early stage does not carry out timely and correct processing to primary disease, can develop into obsolete facial paralysis.At this time, treatment is relatively difficult, and multiple treatment methods can be combined for treatment. The course of the disease usually takes three months or even longer.The following are common acupuncture treatments for facial paralysis:
(1) Acupuncture treatment: For the selection of acupoints, see the content of acupoint massage below.In the acute stage (within two weeks of onset), acupuncture should be performed daily, and once every other day after the symptoms gradually relieve after two weeks.

(2) Electroacupuncture: 2 to 3 pairs of acupoints on the lesion face can be selected and connected to an electroacupuncture machine for treatment.However, it is generally not recommended to use it in the early stage (within two weeks after the onset), because neurodegeneration may occur, which is not conducive to the recovery of facial nerve function, and it can be used as appropriate after two weeks.

(3) Local irradiation with magic lamp (TDP): Generally, this treatment is carried out at the same time as acupuncture treatment until the skin flushes, which can enhance local blood circulation.

(4) Auricular acupuncture therapy: Acupuncture or pressing pills can be performed on cheeks, liver and gallbladder, stomach, eyes, mouth, endocrine and other points.

(5) Skin acupuncture: use skin needles to puncture the side of the diseased side, with the local reddish as the degree.1 time per day or every other day.

(6) Ginger-separated moxibustion: Make moxa cones into conical moxa cones, place them on the side of the lesion, and place a 2-3 mm thick and perforated ginger slice in the middle, and ignite them for moxibustion.Moxibustion until the skin is reddish without blistering.Daily or every other day.

(7) Massage treatment: After acupuncture treatment, it can be operated locally with gentle manipulation.

During acupuncture and moxibustion treatment, avoid local exposure to cold and wind. If necessary, wear a mask and goggles for protection, and actively prevent eye infections.During the treatment period, it can also be combined with traditional Chinese medicine treatment.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
Main acupoints: Yifeng, Fengchi, Hegu, Taichong, Dicang, and Jacar.Matching acupoints according to the symptoms: when the nasolabial fold becomes shallow, add Yingxiang and Renzhong;

2. Positioning
Yifeng—behind the earlobe, the depression between the mastoid process and the angle of the mandible.

Fengchi - the nape, under the occipital bone, the depression between the sternocleidomastoid muscle and the upper end of the trapezius muscle.

Hegu—the back of the hand, at the midpoint of the radial border of the second metacarpal bone.

Taichong—on the dorsal side of the foot, in the depression behind the space between the 1st and 2nd metatarsal bones.

Dicang—Look straight ahead, pupils go straight down, level with the corner of the mouth.

Cheekcar—cheek, about one transverse finger (middle finger) above the front and upper part of the mandibular angle, where the masseter muscle bulges when chewing, and presses the depression.

Yingxiang - next to the midpoint of the outer edge of the alar nose, in the nasolabial fold.

Human center - face, at the intersection of the upper 1/3 and middle 1/3 of the human center groove.

Chengjiang—the face, the central depression of the chin-labial groove.

Clamp Chengjiang-face, open 1 inch on the left and right side of Chengjiang acupoint.

Sibai—directly below the pupil, in the depression of the infraorbital foramen.

The sun—the midpoint between the tip of the brow and the outer canthus of the eyes, in the depression one inch backward.

Yangbai - Pupils go straight up, 1 cun above the eyebrows.

Yintang - the forehead, the midpoint of the two brows.

([-]) Self-massage

During the operation, both sides are operated at the same time, but the lesion side is the main one.The specific method is as follows:
1. Wipe the face Use the ribbed surface of the thumbs of both hands to wipe upwards from Yintang to the upper star, then wipe from the center of the forehead to the sides of the head according to the upper, middle and lower parts, then wipe along the upper eye socket, lower eye socket, and eyeball to the sun, along the Apply Yingxiang on the side of the nose, and apply on the center and Chengjiang along the upper and lower lips.Operate for 5-10 minutes.

2. Finger kneading Use the ribbed surface of your fingers to rub the Yintang, Jingming, Yuyao, Yangbai, Taiyang, Sibai, Xiaguan, Jache, Yingxiang, Renying, Dicang, Chengjiang and other points on the head and face, locally There is a feeling of soreness and swelling, and each point is 1 minute.

3. Massage the face Use the index, middle and ring fingers to massage the forehead and left and right cheeks respectively.Operate for 5-10 minutes.

4. Finger tapping Use both hands and four fingers to gently tap the forehead, temples on both sides, and cheeks.

Senile dementia

An overview of the disease

([-]) Relevant knowledge

Dementia is currently divided into four types: senile dementia, vascular dementia, mixed dementia and other dementias.Alzheimer's disease (Alzheimer AD) is a chronic brain degenerative disease.The clinical manifestations are progressive far and near memory impairment, decline in analysis and judgment, emotional changes, behavioral disturbances, and even confusion, and finally died of pneumonia or urinary tract infection.Its etiology is still unknown, and the onset is often gradual, and the onset can be in the early stage of old age, but the incidence rate is higher in old age.The type with onset before the age of 4 often has a family history of dementia, and the disease progresses faster. The onset of the disease after the age of 65 progresses slowly, with memory impairment as the main feature. AD can last for 65 years, early or mild for 20 years, mid-term or moderate for 9 years, and aggravated for 5 years, bringing a heavy burden and pain to individuals, families, and spirits.AD is the fourth leading cause of death after heart disease, tumor and stroke in western countries.So far, there is no effective anti-dementia drug treatment, which is mainly a nursing care problem in clinical practice.

([-]) Etiology and pathogenesis

1. The etiology is unknown, but it is mainly believed to be related to the following factors.

(1) Genetic factors: AD has family clustering, and 40% of patients have a positive family history.

(2) Environmental factors: including aluminum accumulation, viral infection, immune system dysfunction, neurotransmitters, normal aging, estrogen effects and other factors.

In conclusion, among all the etiologies of AD, age and genetic factors are relatively clear.

2. The important changes in the brain of pathological AD patients are general atrophy of the brain, especially in areas related to cognitive ability such as the hippocampus and the corresponding cortex, enlarged ventricles, widened brain sulci, significantly reduced nerve cells, and extensive degeneration of ganglion cells.

([-]) Clinical manifestations

There are more women with this disease than men (about 1.5-2.1).Most of the onsets are slow, and it is difficult to determine the period of the disease. When the dementia is obvious and the doctor is sought, it is often more than 1 to 2 and a half years after the onset.

1. Mental decline At the beginning, it is often the accelerated deterioration of aging. In a short period of time, slow thinking, stickiness and rigidity appear, and self-centeredness is worse, emotions are difficult to control, concentration is not concentrated, and things are sloppy.Within a few years, malignant amnesia appeared, which developed from occasional forgetting to frequent forgetting, from forgetting recent events to distant events, and from forgetting the details of the event to involving the event itself.Immediate recall is severely impaired, and what happened hours or even minutes ago cannot be recalled, resulting in a shortened temporal memory.In the end, it can be so serious that even its name, date of birth and family members are completely forgotten, as if living in childhood, and it is often accompanied by a decrease in computing power.At the same time as memory loss, disorientation may occur.For example, after going out, they do not know the route home; after going to the toilet, they cannot find the hospital bed they are sleeping in, etc.Difficulty associating, impaired comprehension, and poor judgment.At first, it manifests as unplanned and creative work, and then even the familiar work cannot be completed.In severe cases, they can't even understand other people's speech. If they are asked to take off their clothes, they will open their mouths, and if they are asked to stretch out their hands, they will stand still for a long time.

2. Behavior change Behaviors are naive and clumsy at first, often perform ineffective labor, and there may be aimless labor later.For example, rummaging through boxes and cabinets, misplacing things, being busy, not knowing what to do; loving to hide waste, treating it as treasure, afraid of being stolen; not paying attention to personal hygiene habits, not washing dirty clothes, not rinsing in the morning, sometimes appearing unreasonable and hindering public order conduct that affects law and order.There are also movements that are gradually decreasing, sitting in a corner, dumbstruck.In the late stage, they are unable to move, are bedridden, have incontinence of feces and bowels, have no ability to deal with life, and are in a vegetative state.According to statistics, 60% generally died within 6 months after admission, and 80% died within 18 months after admission. The main cause of death was secondary infection.

3. Affective disorder At the beginning, the emotion may be naive, or childishly euphoric and irritable.In the later stage, the expression is dull and the emotion is dull.

4. Focal symptoms may occasionally appear during the course of the disease.In the event of aphasia, apraxia, agnosia, and miscalculation, all cognitive abilities may eventually be lost.

5. Appearance changes. The appearance of senile dementia patients is aging, and they often appear old-fashioned, with white hair, teeth falling out of the mouth, and senile rings in the cornea.Pupils are occasionally blunted in response to light.Sensory organ dysfunction, slow physiological reflexes, body bending, unsteady walking, staggering gait, weight loss, muscle disuse atrophy, involuntary shaking of the head, slurred speech, salivation, finger tremor and difficulty in writing, etc.

6. Most of the laboratory tests showed no obvious changes.EEG showed abnormalities.Cerebral blood flow diagram shows that the local cerebral blood flow in the cerebral cortex decreases, and the cerebral oxygen metabolism rate decreases. CT scan or MRI often show varying degrees of ventriculomegaly and cortical atrophy, widening of the brain sulci.

(End of this chapter)