针药结合治疗中风后吐弄舌案

A Case Report of Post-Stroke Tongue Protrusion Treated with Combined Acupuncture and Herbal Medicine

摘要: 目的：探讨针药结合治疗中风后吐弄舌这一罕见难治症状的临床思路与疗效。方法：报告1例69岁男性脑梗死后吐弄舌患者，采用针刺(醒脑开窍法结合引气归元针法)与内服中药(导赤散合泻黄散加减)相结合方案，并随证调整。结果：治疗5天后，患者舌体外伸由3.5 cm缩短至2 cm，吐弄频率由90次/分降至45次/分，伴随症状改善；治疗14天后，舌体未见外伸，吐弄基本消失，随访1周未复发。结论：本案表明，以“清心脾之热、调畅气机”为法，采用针药结合并遵循“随证治之”原则，能有效改善中风后吐弄舌，为此类症状的临床处理提供了可资借鉴的个体化治疗范本。

Abstract: Objective: To explore the clinical rationale and therapeutic efficacy of combined acupuncture and herbal medicine in the management of post-stroke tongue protrusion, a rare and refractory symptom. Methods: We report the case of a 69-year-old man who developed tongue protrusion after cerebral infarction. The patient was treated with a combined regimen of acupuncture, consisting of the Xingnao Kaiqiao method and the Yinqi Guiyuan technique, together with orally administered herbal medicine based on modified Daochi Powder and Xiehuang Powder. The treatment protocol was adjusted according to symptom evolution. Results: After 5 days of treatment, the protrusion length of the tongue decreased from 3.5 cm to 2.0 cm, and the frequency of tongue protrusion was reduced from 90 to 45 times per minute, accompanied by improvement in associated symptoms. After 14 days of treatment, no tongue protrusion was observed, the abnormal tongue movements had basically resolved, and no recurrence was noted during 1 week of follow-up. Conclusion: This case suggests that a combined acupuncture and herbal medicine approach, based on clearing heat from the heart and spleen and regulating qi movement, and applied according to dynamic syndrome differentiation, may effectively alleviate post-stroke tongue protrusion. It may provide an individualized therapeutic reference for the clinical management of this condition.