Can Acupuncture Really benefit Stroke?

Transcription

1 Can Acupuncture Really benefit Stroke? 朱氏头皮针介绍与中风治疗应用的讨论 朱明清 Ming Qing Zhu 蕭慕如 Moyee Siu 1 Strokes statistics 中风的统计 795,000 per year in USA; 50,000 in Canada 1 per 45 sec, 1 die every 4 min in USA 15 million per year worldwide 4 th leading cause of death (150,000/yr) 1 st leading cause of neurologic disability 2/3 occur > age 65 but younger age 25% has 2nd stroke within 5 years Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 2 2 每年新中风病例 stroke prevalence per year 800, , , , ,000 Vancouver population 50, ,000 USA 1 stroke every 45 sec 1 die Canada every 4 min 1 stroke every 10 min, 315,000 living with stroke 3

2 Disability Scale 伤残程度 0. No symptoms at all 完全 无症状 1. No significant disability despite symptoms; able to carry out all usual duties and activities. 有症状, 但不影响正常 生活 2. Slight disability:unable to carry out all previous activities but able to look after own affairs without assistance. 轻微残障, 能 生活 自理 3. Moderate disability:requiring some help, but able to walk without assistance. 中度残障, 需要帮助, 但能 自 己 行 走 4. Moderately severe disability:unable to walk without assistance, and unable to attend to own bodily needs without assistance. 略重残障, 行 走及 身体需求均须有帮助 5. Severe disability:bedridden, incontinent, and requiring constant nursing care and attention. 严重残障, 卧床, 大 小便失禁, 需要时刻护理 6. Dead 死亡 (about 20%) Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 4 4 Strokes statistics 中风的统计 Stroke cost Americans 63 billion dollars in medical costs for stroke in 2007 Stroke cost Canadians 3.6 billions in medical costs and disability The overall cost is obviously greater this dollar amount Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 5 5 In a study on ischemic stroke survivors aged 65 or more, the following disabilities were observed 6 months after stroke: 50% had some hemiparesis. 30% were unable to walk without some assistance. 26% were dependent in activities of daily living. 19% had aphasia. 26% were institutionalized in a nursing home. Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 6 6

3 Western Treatments for Stroke 1. Thrombolytic agent tpa (within 4.5 hours) tissue plasminogen activator dissolve clot for acute ischemic stroke only (88%) risks include death, bleeding a small window Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 7 7 How good is tpa? Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 8 8 Western Treatments for Stroke 1. Thrombolytic agent tpa (within 4.5 hours) 2. Endovascular intervention (within 8 hours) Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc. 9 9

4 Routine care for stroke 1-7 days in hospital 1-2 weeks in rehab facility 3 or more weeks of outpatient rehab program Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc Acupuncture Treatments for Stroke Copyrights (c) Zhu's Neuro-Acupuncture Center, Inc 研究结论 : 传统中医体针对中风后运动康复没有价值 12

5 針灸對中風的康復沒有幫助 路透社報導 : 南韓研究結論 美國廣播電視新聞 : 針灸無益於中風

6 朱氏頭皮針病例 ( 一 ) 朱氏頭皮針病例 ( 二 ) ZSA Benefits cerebellar stroke instantly 朱氏头皮针治疗小脑梗死 立竿见影 18

7 Watch more videos on Youtube Channel moyee Does acupuncture really benefit stroke recovery? 针灸对中风康复有价值吗 20 灵枢 九针十二原 言不可治者, 未得其术也 Spiritual Axis Chapter 1: He who said it cannot be treated has not mastered the skills. 21

8 针灸治疗中风的误区 1. 错过最佳时机 2. 针灸治疗方法失当 3. 治疗量不足 4. 忽略对并发症及早防治 Errors in acupuncture treatment for stroke 1. WHEN? - time 2. HOW? - quality 3. HOW MUCH? - quantity 4. WHAT ELSE? - other issues 22 Error 误区 #1 错过最佳时机 Missing the best window Time is of the Essence 時間最關鍵 23 Time is Brain If a stroke is left untreated, 1.9 million neurons destroyed per minute 14 billion synapses destroyed per minute 12km (7.5 miles) of myelinated fibers per minute Ischemic brain ages 3.6 years per hour compared with normal brain aging 24

9 Pathophysiology of ischemic infarct - Penumbra The occlusion of a cerebral vessel is followed by formation of a central irreversible tissue necrotic lesion, where the brain blood flow is reduced < 15% (<20 ml/100gr/min), with a peripheral zone, the Penumbra (20-30 ml/100gr/min), where tissue is viable and functional disturbance is reversible due to partial preservation of blood supply via emissary vessels, if ischemia reverses on time Depending on the grade of blood flow reduction and its duration, after an ischemic interval, Penumbra becomes necrotic Experimental studies report that the infarct ιs formed 3-12 h after initiation of ischemia and continues to develop even after 24h, although in a much slower rate (24-72h <30% increase) Infarct Penumbra 25 Pathophysiology of ischemic stroke Neuronal disturbances Decreased energy supply to the cerebral parenchyma with simultaneous decrease in Ο 2, Glucose and ATP production (25% of normal levels in the central area, 50-70% in Penumbra) Anaerobic glycolysis and metabolic acidosis Release of excitative amino acids (glutaminoacid) and inflammatory mediators in extracellular space, decreased energy production, ions and water intracellular entrance, increase of catabolic enzymes and free radicals neuron cells oedema, cellular membrane injury and cytolysis Disturbance of regional blood flow autoregulation (regional vasodilation) and as a consequence it s absolute dependency from systemic BP (thus when BP reduces, ischemia worsens) Angiogenic oedema around the ischemic area because of blood-brain barrier destruction (endothelial cell connections, 1-4 days after ischemia), may cause compressive effect and necrotic area expansion 26 Pathophysiology of ischemic stroke Large hemispheric strokes (10-20% in the total of ischemic strokes) are due to middle cerebral artery occlusion Several mechanisms contribute to ischemic stroke evolution, the main being the clot expansion Other possible mechanisms during the first h after ischemic stroke initiation are: - cerebral oedema development and space occupational action, - metabolic disturbances like hyperglycemia, hyponatremia, - hemorrhagic transformation, - fever (infection) aggravating ischemic neuron metabolism 27

10 最佳治疗时机 The Best Treatment window 功能康复率 Chance of Functional Recovery <3h 90 <3d <7d <1m <3m <6m >6m Time lapsed after onset 中风后时间 28 Stages of Stroke 中风的分期 Chronic or Sequele Stage 后遗症期 > 3 months Subacute or Recovery Stage 恢复期 ~3months Acute Stage 急性期 脑梗塞 Ischemic: 7-15 days 脑出血 Hemorrhagic: days Number of Days after onset 中风后时间 ( 天 ) 29 Treatment Principles for First 3 Days 首三天的治療原則 维持生命指征 normalize vital signs 止血化瘀, 改善供血 remove blood clots, stop bleeding, improve circulation 抑制脑水肿形成 inhibit cerebral edema 缩小半暗带范围 reduce penumbra 醒腦開竅 restore consciousness 30

11 Treatment Principles on Day 3-7 第 3-7 天的治療原則 维持生命指征 normalize vital signs 消退脑水肿 reduce cerebral swelling 降低顱內壓 depress intracranial pressure 抑制半暗带扩大 limit increase in penumbra 缩短脑休克期 shorten cerebral shock 帮助度过危险期 survive the critical period 改善症状 alleviate symptoms 31 Treatment Principles in Subacute Stage 恢復期的治療原則 消退脑水肿 lessen edema 缩小周边伤害 reduce surrounding damage 缩短脑休克期 shorten cerebral shock 改善症状 alleviate symptoms 恢复功能 restore functions 32 Treatment Principles in Chronic Stage 后遗症期的治疗原则 增加肌体活动能力 Increase physical capacity 纠正姿势步态 改善生活质量 恢复生活自理 Correct postures and gait Improve quality of life Regain daily independence 33 33

12 Acupuncture has NO blood-brain barrier! 34 Error 误区 #2 针灸治疗方法失当 Using improper treatment methods 35 Advantages of Zhu s Scalp Acupuncture 朱氏头皮针之优点 Least invasive, least pain 微创, 最少疼痛 Safe and convenient 安全方便 Not interfere with daily activities 不影响活动 All channels meet in the head 头为诸阳之会 Direct action on the brain 直接作用于脑 Highly effective 高疗效 Fast and long-lasting results 效果快而持续 36

13 37 急性中风之最佳针刺疗法 Best Acupuncture Treatment for Acute Stroke 朱氏头皮针 Zhu s Scalp Acupuncture 带气行针 Manipulate needles with Qi 结合导引 Integrate with Daoyin 38 导引 Daoyin 导气令和 引体令柔 To harmonize qi and soften body 39

14 瑜伽 物理治疗 舞蹈 语言训练 作业治疗 唱歌体针 放松功 推拿按摩 吐纳 运动 五禽戏 气功 心理辅导 打坐 整骨 朱氏头皮针的导引 40 Yoga Physical Activities Dancing Speech Training Functional Activities Massage Singing Exercises Body Acupuncture Breathing Relaxation Adjustment Qigong Counseling Meditation Modern Daoyin in ZSA 41 缺血性中风治疗要點 Treatment Emphasis for Ischemic Stroke 活血化瘀, 行气通络以动为主, 以静为辅 improve circulation, dissolve clots, move qi, unblock channels mainly moving exercises, augmented with calming activities 42

15 出血性中风治疗要點 Treatment Emphasis for Hemorrhagic Stroke < 3 days: 止血通络, 以静为主 stop bleeding, unblock channels, mainly calming > 3 days: 行瘀通络, 以静带动 remove stasis, unblock channels, calming + movements 43 Error 误区 #3 治疗量不足 Inadequate treatment doses 44 急性期导引康复量 Amount of Daoyin in Acute Stage continuous for days 持续 天 no less than 3 hours daily 每天不少于 3 小时 short but frequent 时间短, 次数多 until slightly sweat but not exhausted 不太累, 微汗为度 45

16 Error 误区 #4 忽略对并发症及早防治 Failure to prevent & treat complications 46 其他注意事项 Other Precautions 尽早治疗失语 吞咽障碍调整情志纠正姿势, 预防痉挛 挛缩 Treat aphasia and dysphagia promptly Manage emotions Correct postures and gait, prevent spasms and contracture 47 其他注意事项 Other Precautions Should not stay in bed all day 不宜绝对卧床 Should not lower blood pressure too much 血压不宜降得太低 Should not overuse blood thinner 稀血药不宜过量 Should not use the 3 tubes if possible (NG tube, tracheal tube, catheter) 三管尽可能不用 ( 鼻饲管 喉管 尿管 ) 48

17 并发症的防治 控制癫痫, 宜针不宜药中枢性发热, 宜通便退热针刺预防脑萎缩痴呆 帕金森综合症 Prevent and Manage Complications control seizures w/ acupuncture (better than meds) lower central fever by purging bowels prevent dementia and Parkinsonism w/ acupuncture 49 朱氏头皮针第一时间治疗中风减少后遗残而不废生活自理 Use Zhu s Scalp Acupuncture Therapy Immediately after a stroke Can minimize deficits Restore functions Regain independence 50 51

18 Upcoming workshop Basics of ZSA September 5-6, 2015 Bad Zurzach 52 Basics of Zhu s Scalp Acupuncture August 29-30, 2015 Workshop Regular Fee $579 Early Bird Discount $539 (By 6/30/15) Beverly Heritage Hotel Milpitas CA Introduction to Zhu s Scalp Acupuncture 16 CEUs A foundation class & prerequisite for the certification program. You will learn: History of Scalp Acupuncture ZSA Treatment Zones, Locations, Functions & Indications Procedures, Techniques, Daoyin, Basic Applications, Precautions and Contra-indications Demonstrations & Hands-On Training (408) Technology Dr. Ste 225 San Jose, CA 53