中医杂志

基于少阳经络脏腑与脑、咽在结构与功能上的密切关联，认为中风后吞咽障碍的病机为中风后枢机郁滞、痰瘀互结、相火妄动、神机失协，终致咽窍失用。确立以调枢通窍为核心的针刺疗法，取少阳经穴风池、完骨、翳风、外关调枢治本，取督任经穴风府、廉泉、天突通窍治标。同时可分期辨治，急性期痰浊壅盛加丰隆、阴陵泉、金津、玉液化痰利窍；恢复期相火灼咽加足临泣、照海泄火滋阴，相火扰神加通里、内关宁心安神；慢性期血虚络瘀加足三里、三阴交养血通络。临证时根据不同阶段吞咽障碍调节针刺角度与深度，配合芒针、药灸以增效。

Based on the close structural and functional associations of the Shaoyang（少阳） channel and related zang-fu（脏腑） organs with the brain and the pharynx,this paper proposes that the pathogenesis of post-stroke dysphagia involves constraint and stagnation of the pivot mechanism,binding of phlegm and stasis,frenetic stirring of ministerial fire,and incoordination of the spirit mechanism,ultimately leading to loss of pharyngeal function.An acupuncture therapy centered on regulating the pivot and unblocking the orifice is established.Acupoints of the Shaoyang channel,including Fengchi(GB 20),Wangu(GB 12),Yifeng(SJ 17),and Waiguan(SJ 5),are selected to regulate the pivot and treat the root; acupoints of the Du（督） and Ren（任） channels,including Fengfu(GV 16),Lianquan(CV 23),and Tiantu(CV 22),are used to unblock the orifice and treat the branch.In addition,staged treatment can be applied according to syndrome differentiation.In the acute stage with predominant phlegm turbidity,Fenglong(ST 40),Yinlingquan(SP 9),Jinjin(EX-HN 12),and Yuye(EX-HN 13) are added to resolve phlegm and facilitate orifice function.During the recovery stage with excess ministerial fire scorching the pharynx,Zulinqi(GB 41) and Zhaohai(KI 6) are added to drain fire and nourish yin; when ministerial fire disturbs the spirit,Tongli(HT 5) and Neiguan(PC 6) are added to calm the spirit and the heart.During the chronic stage with blood deficiency and collateral stasis,Zusanli(ST 36) and Sanyinjiao(SP 6) are added to nourish blood and unblock collaterals.In clinical practice,the angle and depth of needling are adjusted based on the stage of dysphagia,with the combination of elongated needles and medicinal moxibustion are used to enhance the therapeutic effect.