It can be combined with more than 10 diseases, especially cerebrovascular ischemic diseases. Swallowing disorder is the main symptom of medullary palsy, and is a key link in the development and prognosis of the patient’s condition. The author from 96 years, a combination of experience and acupuncture points about two scientific and technological achievements, using acupuncture electroacupuncture treatment 37 cases with good results, reported as follows
1, clinical data
All cases are from our hospital, the treatment group is 1996 to the present my department on the hospital consultation patients. The control group was patients who were hospitalized in the Department of Neurology during the same period. The diagnosis of cerebrovascular disease was confirmed by cranial CT or MRI examination according to the diagnostic criteria of the literature [3].
In the treatment group, there were 15 males and 6 females; age ranged from 49 to 82 years old, with an average of 68.7 years; duration of disease ranged from 10 to 30 days, with an average of 16 days. In the control group, there were 26 cases, 19 males and 7 females; age ranged from 52 to 77 years old, average 66.5 years old; disease duration ranged from 6 to 20 days, average 13 days. The general conditions of the two groups were statistically processed, and the differences were not significant (P0.05) and were comparable. See Table 1.
Comparison of the conditions of the two groups ————————————————————————————————————-
Group Number of cases Mean age Duration of disease (days) Bilateral multifocal cerebral infarction/prolonged medullary infarction
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Treatment group 27 68.7 10~30 16 / 5
Control group 26 66.5 6~20 19 / 7
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2. Treatment method
2.1.1 Treatment group, electroacupuncture treatment points taken
①Clamp Lianquan double acupuncture point; Kaiyin acupuncture point double acupuncture point.
② Fengchi acupuncture point double acupuncture point; blood supply point double acupuncture point. Combined with conventional medication as the control group treatment.
2.1.2 Electroacupuncture treatment operation method.
①Clamp Lianquan point is located 0.5 cm to the left and right of Lianquan point, and 0.25×40~60 mm milli-needle is selected according to the patient’s fatness, with the tip of the needle pointing to the root of the tongue and stabbing straight [1]. The Kaiyin point[2] is located one transverse finger below the angle of the mandible and one transverse finger in front. With a 0.25×5 mm milli-needle, avoiding the carotid artery, the tip of the needle is pointed at the root of the tongue and stabbed obliquely. The two acupuncture points on the left and right sides are connected to the electroacupuncture connection.
②The Fengchi point is in the depression between the sternocleidomastoid muscle and the superior aspect of the rhomboid muscle. Use a 0.25×50mm milli-needle with the needle tip pointing straight at the root of the tongue. The blood supply point is 2 cm below the Fengchi point along the flat mouth angle with a 0.25×50mm milli-needle, with the tip of the needle pointing straight to the laryngeal node. The two acupuncture points on the left and right sides are connected to the electroacupuncture connection. Electroacupuncture G6805 with sparse wave, stimulation intensity, with the doctor’s index finger to feel the muscle between the two points mild contraction as degree, each treatment 25-30 minutes, once a day, 6 times for a course of treatment.
2.2 In the control group, cerebral vasodilators and neurophilic nutrients were routinely administered intravenously by the neurology department once a day for one week.
Both groups were observed for 3 courses and then the efficacy was counted.
3.Efficacy observation
3.1 Efficacy criteria Clinical cure: resume normal diet, no choking and coughing when drinking water; apparent effect: normal diet, occasional choking and coughing when drinking water; ineffective: no change before and after treatment.
3.2 Treatment results (see Table 2)
See Table 2 Comparison of the therapeutic effect between the two groups
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Group Number of cases Clinical cure Significant ineffective Effective rate (%)
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Treatment group 21 17(81) 3(14.2) 1(4.8) 97.2
Control group 26 10(38.5) 6(23) 10(38.5) 61.5
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As can be seen from Table 2, the differences in clinical cure rates and efficiency rates between the treatment and control groups were highly significant (all P0.01), indicating that the efficacy of the treatment group was significantly better than that of the control group.
The ineffective cases, de-cortical waking coma, dementia state.
4. Typical case
Patient’s surname is Zhu, male, 78 years old, hospitalization number: 712380. medical history: the patient had hypertension for 7 years; type 2 diabetes mellitus for 5 years, recurrent “double vision” in recent half months. on May 1, 2008, he suddenly had unfavorable speech with weakness of limbs for 9 hours, and was diagnosed by MIR as “cerebral infarction “He was admitted to hospital for treatment.
After 20 days, his condition was stabilized, but he still could not eat even after removal of the nasal feeding tube, and his MRI showed multiple speckle-like long T1 and long T2 abnormal signals in the paraventricular, basal ganglia and brainstem on both sides. After reinsertion of the nasal feeding tube, he was referred to our department for consultation. Physical examination: the patient had symptoms of strong crying and strong laughing, good eye movements, limited uplift of the soft palate, disappearance of the gag reflex, incomplete tongue extension, right-sided, muscle strength of the left upper and lower extremities IV, muscle strength of the right upper extremities grade 0, muscle strength of the lower extremities grade I, double palmar jaw reflex (+).
He was able to eat after removing the nasal feeding tube after 5 times of electroacupuncture treatment, but still had occasional choking and coughing when drinking, and continued to eat and drink normally after 6 times of treatment, followed by limb rehabilitation treatment.
5. Discussion
Medullary palsy, also known as bulbar palsy, includes true medullary palsy and pseudo medullary palsy. True medullary palsy is caused by a lesion of the nerve nucleus of the medulla oblongata itself or the nerves emanating from it, and the function of the transverse pharyngeal muscle innervated by it is impaired.
The one case that did not work in the treatment group in this paper was a progressive medullary paralysis type, i.e., motor neuron disease, most often seen in brainstem infarction. Pseudomyelination palsy, on the other hand, is caused by lesions of the superior motor neurons innervating the motor nuclei of the medulla oblongata, with bilateral functional paralysis of the pharyngeal muscle groups, which is more common with bilateral cerebrovascular onset and is not directly related to the medulla oblongata itself. However, the clinical symptoms of both are very similar, and the main symptom is dysphagia.
The main symptom is swallowing disorder, the symptom is in the pharynx, and the location of the disease is in the brain. The acupuncture points taken in this article are located in the cervical collar and were developed after analyzing the experience and acupuncture principles of the two scientific and technological achievements of Gao and Feng.
The acupuncture (electroacupuncture) treatment acts directly on the tongue and throat to open the meridians and open the pharynx, and indirectly energize the brain and benefit the marrow. From the aspect of modern medicine, electroacupuncture local bilateral acupuncture points in the neck, stimulate bilateral linguopharyngeal, vagus and sublingual nerves, whose excitation can be transmitted to the periphery of the central area of bilateral stroke lesions, i.e., the semi-affected area, to promote the recovery of brain cells (neurons) in a state of electrical failure, or/and to promote the residual part of neural progenitors through functional reorganization to compensate for the loss of function of nerves in a new way, thus forming a new conduction pathway and improving flexibility of the impaired swallowing reflex.
To promote the recovery of the patient’s feeding and swallowing functions, thus avoiding misaspiration, preventing pulmonary complications and, more importantly, ensuring that the patient’s organism can receive adequate nutritional supplements in a timely manner.
In summary, acupuncture treatment of swallowing disorder in medullary palsy is based on solid neurophysiology and pathology, and the treatment with this method can receive the effect of treating both the symptoms and the root cause with half the effort.