运用调神开窍法治疗卒中后呃逆重症探析

An Analysis of the Application of the Method of Regulating the Spirit and Opening the Orifices in Treating Severe Post-Stroke Hiccups

摘要: 卒中后顽固性呃逆(PSH)伴格拉斯哥昏迷量表(GCS) ≤ 8分重度意识障碍是脑卒中常见并发症，现代医学药物副作用突出，传统中医针灸多聚焦轻度意识障碍者，难及“窍闭神匿，神不导气”核心病机。本文基于《灵枢》“治神”理论及石学敏院士学术思想，构建以翳风为主穴、攒竹等为配穴的“调神开窍”针刺方案，简化为实、虚、中性3类辨证倾向，主穴操作不变，仅微调配穴补泻适配急救场景。临床案例(GCS 7分患者)显示，治疗后30分钟内止呃，连续6日无复发，且无药物相关副作用。结果表明，该方案精准契合核心病机，验证了中医急救辨证施治的有效性，为此类病症提供新诊疗思路。

Abstract: Post-stroke Intractable hiccups (PSH) accompanied by severe consciousness impairment (Glasgow Coma Scale ≤ 8) represent a common complication of stroke. Modern medical treatments often carry significant side effects, while traditional Chinese acupuncture primarily targets patients with mild consciousness impairment, failing to address the core pathogenesis of “obstructed orifices, concealed spirit, and spirit failing to guide qi”. This paper develops an acupuncture protocol for “regulating spirit and opening orifices” based on the “Treating the Spirit” theory from the Lingshu and the academic insights of Academician Shi Xuemin. It employs Yifeng (TE17) as the primary point and Zanzhu (BL2), among others, as auxiliary points. The protocol simplifies diagnosis into three patterns—excess, deficiency, and neutral—while maintaining the primary point unchanged. Only the auxiliary points are slightly adjusted for tonification or dispersion to suit emergency scenarios. A clinical case (GCS 7 patient) demonstrated cessation of hiccups within 30 minutes post-treatment, with no recurrence over six consecutive days and no drug-related side effects. These results confirm the protocol’s precise alignment with the core pathogenesis, validating the efficacy of TCM emergency diagnosis and treatment based on syndrome differentiation, and offering a novel therapeutic approach for such conditions.