针灸干预中风先兆期的临床研究现状与进展

Clinical Research Status and Progress of Acupuncture Intervention in the Prodromal Stage of Stroke

摘要: 中风是具有高发病率、高致残率、高死亡率的重大脑血管疾病，其中风先兆期(短暂性脑缺血发作)是阻断病情进展、预防完全性卒中的关键窗口期。针灸以中医“治未病”为指导，以调气血、通经络为核心，在中风先兆干预中优势突出。本文系统梳理近十余年临床研究发现，针灸干预以通督调神、程氏通督开窍、电项针等针法为主，常用百会、风池、大椎、风府等督脉及头颈部穴位，可采用针刺单用或联合中药、西药、推拿、穴位贴敷等方式。研究证实，针灸能够改善脑血流动力学、调节脂代谢、抑制血小板聚集、减轻炎症反应、保护血管内皮与神经功能，有效缓解眩晕、肢体麻木等先兆症状，降低中风发生率与复发率，部分疗效优于单纯西药。目前研究仍存在样本量偏小、操作不统一、机制阐释不足等问题。未来应立足临床实际，制定统一的针灸操作规范与疗效评价标准，开展大样本、多中心、长期随访的高质量临床研究；结合现代技术深入揭示针灸干预的具体作用靶点与机制；推动针灸纳入中风先兆临床路径，构建基层可推广的防治模式，切实提升针灸在中风先兆期“既病防变”中的应用价值。

Abstract: Stroke is a major cerebrovascular disease with high incidence, high disability rate, and high mortality rate. The prodromal stage of stroke (transient ischemic attack) is a critical window for blocking disease progression and preventing complete stroke. Guided by the traditional Chinese medicine concept of “treating disease before it occurs” and focusing on regulating qi and blood and unblocking meridians, acupuncture has shown prominent advantages in intervening in stroke prodromes. This paper systematically reviews clinical research over the past decade and finds that acupuncture interventions mainly include the Cheng’s method of unblocking the Du meridian and opening orifices, and electro-acupuncture techniques. Commonly used acupoints include Baihui, Fengchi, Dazhui, and Fengfu, which belong to the Du meridian and head and neck regions. Acupuncture can be applied alone or combined with Chinese medicine, Western medicine, tuina massage, or acupoint plasters. Studies have confirmed that acupuncture can improve cerebral hemodynamics, regulate lipid metabolism, inhibit platelet aggregation, reduce inflammatory responses, and protect vascular endothelium and nerve function. It effectively alleviates prodromal symptoms such as dizziness and limb numbness and reduces the incidence and recurrence of stroke, with some effects superior to Western medicine alone. Currently, there are still issues such as small sample sizes, inconsistent operations, and insufficient mechanism explanations. In the future, clinical practice should serve as the basis for developing standardized acupuncture operation protocols and efficacy evaluation criteria, conducting high-quality clinical studies with large samples, multiple centers, and long-term follow-up; using modern technology to deeply explore the specific targets and mechanisms of acupuncture intervention; promoting the inclusion of acupuncture in clinical pathways for stroke prodromes; and constructing grassroots prevention and treatment models that can be widely applied to truly enhance the application value of acupuncture in “preventing disease progression once it has occurred” during the stroke prodromal stage.