Syncope (syncope) is a transient loss of consciousness due to sudden onset of transient widespread cerebral insufficiency of blood supply, which causes reticular inhibition of hemorrhage. Patients show loss of muscle tone and fall, which can be recovered in a short period of time, and convulsions can occur if the duration of loss of consciousness exceeds 10 to 20 seconds. There are many causes of syncope, and clinically syncope is often divided into four categories: reflex syncope, cardiogenic syncope, cerebral syncope, and other syncope. Reflex syncope is caused by damage to the reflex arc that regulates blood pressure and heart rate in the body. The reflex arc includes afferent stimulation of the carotid sinus and aortic arch, regulation of the vasodilatory center in the medulla oblongata, and sympathetic and parasympathetic efferent impulses to the cardiovascular system. Mental activity in the cerebral cortex can affect vasomotor centers via the subthalamus, and somatic and visceral pain can also be an afferent stimulus, so pain and emotional instability can induce syncope. The common ones are vascular decompression syncope, upright hypotensive syncope, carotid sinus syncope, urinary syncope, cough syncope, swallowing syncope, and pain syncope. Cerebrogenic syncope is caused by ischemia due to lesions of arteries such as the internal carotid system, vertebrobasilar system, aortic arch and its branches, resulting in luminal narrowing, spasm, and obstruction. Or it is caused by neck diseases or artificial compression of blood vessels. The common ones are transient ischemic attack, aortic arch syndrome, hypertensive encephalopathy, and basilar artery type migraine. Cardiogenic syncope occurs as a result of heart disease with reduced cardiac transfusion bleeding or cardiac arrest, leading to ischemia of brain tissue. Common disorders include severe arrhythmias, Q-T time prolongation syndrome, aortic valve stenosis, and certain congenital heart diseases. Other syncope includes blood component abnormalities seen in hypoglycemia, severe anemia hyperventilation syndrome, and crying. Reflex syncope is the most common, and this section mainly deals with reflex syncope. Other types of syncope can be treated with acupuncture by referring to this section.
This disease is called “syncope” in Chinese medicine, and is characterized by sudden fainting, unconsciousness, and cold extremities. In mild cases, the fainting time is short, and the patient will gradually wake up without sequelae such as hemiplegia, aphasia and slanting of the mouth and eyes after waking up. In severe cases, the syncope will not wake up and lead to death. It is mainly caused by the sudden reversal of the qi flow, the rise and fall, and the malfunction of qi and blood.
Diagnostic criteria
1, mostly in young and frail women.
2. there are obvious mental, somatic and environmental triggers before the onset of the attack.
3, transient prodromal symptoms may appear before the onset, such as dizziness, pallor, sweating, nausea, blurred vision, tinnitus, abdominal pain, general weakness, and confusion.
4. Sudden onset, feeling black in front of the eyes, unstable standing, and brief loss of consciousness and falling to the ground. Loss of consciousness for about several seconds to tens of seconds.
5. occurring mostly in the standing position, especially when standing for too long.
6. The attack may be accompanied by a drop in blood pressure, slow and weak pulse, dilated pupils, and reduced muscle tone.
7, rapid recovery, after a few seconds to tens of seconds, without sequelae.
P.S. The mild and severe stages of syncope, Henri Gastant divided the symptoms of syncopal episode into 3 mild and severe stages.
Stage 1: Blurred consciousness accompanied by vertigo, vomiting, waxy pallor, weakness of the limbs, shaking to fall, and head hanging low on the chest.
Stage 2: Following the above period, lasting about 10 seconds, complete loss of consciousness, loss of generalized muscle tone, the patient falls, back straightens, and eyes turn white up.
The third stage: also known as convulsive syncope, lasts for a maximum of 10 seconds. At this time, tonic spasms appear, corkscrewing, double fist clenching, rarely more than 1 to 2 seconds, the patient’s pupils are extremely dilated, sometimes with nystagmus, salivation, bite through the tongue, urine vivid. Sometimes there is apnea with mild cyanosis, which rarely occurs.
Criteria for identification
1. Gas syncope: actual evidence is sudden fainting, unconsciousness, silence of the mouth and fist, coarse breathing, or cold extremities, thin white coating, pulse volatile or sunken string. Deficient evidence of dizziness and fainting, pale face, weak breathing, sweating limbs cold, light tongue, sunken pulse.
2, blood syncope: actual evidence for sudden fainting, unconsciousness, teeth closed, face red lips purple, tongue red, pulse sunken string. Deficiency evidence for sudden fainting, pale face, mouth and lips, limbs trembling, eyes trapped mouth open, sweating skin cold, weak breathing, light tongue, pulse hollow or thin and weak.
3, phlegm syncope: sudden fainting, sound of phlegm in the throat, or vomiting saliva, coarse breathing, white and greasy coating, sunken and slippery pulse.
4, food syncope: sudden fainting after overeating, with stuffy breath, distended abdomen, thick and greasy moss, and smooth pulse.
Treatment principles and selection of acupuncture points
1. The main therapeutic principle of this disease is to open the orifices and awaken the brain, to open and close the mind.
2. The selection of acupuncture points is based on the theory that the Governor’s Vessel supervises all the yang and enters the brain; the pericardium is the external guard of the heart, which receives evil on behalf of the heart and carries out orders on behalf of the heart, which is the master of the mind; the pericardium is superimposed on the Sanjiao meridian; and the Yangming meridian is a meridian with more qi and blood.
①The brain is the house of the spirit; the Governor’s Vessel enters the upper pinnacle, and the Renzhong point is located at the junction of the Governor’s Vessel, so it is taken to connect the yin and yang, to open the orifice and awaken the spirit, and to take the Su s to open the orifice and clear the heat, to raise the yang and save the rebellion; the heart is the master of the spirit, so the Heart meridian points Shenmen and Shaochong are taken, and the pericardium meridian points Zhongchong, Daling and Neiguan are taken to open the orifice and awaken the spirit and regulate the qi. The Yangming meridian is a meridian of Qi and Blood, and the foot Sanli is a joint point of the Yangming meridian. It can warm and disperse the cold evil of Qi and Blood.
②Selecting points for identification of evidence: for those with actual evidence who are physically strong and faint due to a momentary rebellion of the meridian qi, use well points and Neiguan to strengthen the enlightening effect.
The deficient patient has weak vital energy, disorders of the meridian qi, the 12 meridians cannot be rushed up to the head, and the yang qi cannot reach the four ends.
③Symptomatic selection of acupuncture points: in the concurrent evidence of occlusion, if the teeth are tightly closed, take the local acupuncture point method, take the cheek car and the lower guan to unblock the local
If you see closed teeth, take the cheek car and lower guan to release the local meridian qi, and take the hegu and tai chong points to open the teeth. For phlegm in the throat, add local acupuncture points to Tiantu, and take Hegu and Foot Sanli points farther along the meridian, and use Fenglong point to open up phlegm and depression; for dysuria, add Tianshu, Daheng, and Zhongji points in the abdomen, and use Zhigou, Sanyinjiao, and Yinlingquan distally to clear heat and open up the bowels. For limb twitching, hegu, tai-chong, houxi, and sinew points are used to soothe the tendons and open the channels. The concurrent evidence of decompensation is mainly seen in rebellious coldness of the extremities and incontinence of the second stool. In the former case, Taixi, Sanyinjiao, Spleen Yu and Kidney Yu are added and acupuncture is used to ventilate Yang Qi; in the latter case, Huiyin, Changqiang, Zhongji, Sanyinjiao and Kidney Yu are used to unblock the Qi of the Ren and Du channels.
Acupuncture prescriptions
Recommended prescription 1
Main acupuncture points: Renzhong (⊥) (invigorates Shenqi, awakens the brain and opens the orifices)
Neiguan (⊥), Zhongchong (⊥) (invigorates and awakens the mind, regulates the qi flow)
Foot San Li (Τ + ×) (regulates the spleen and stomach, warms yang and disperses cold)
Taichong (⊥), Yanglingquan (⊥) (dredges the liver, regulates qi and relieves depression)
Supporting points: for deficiency add Shen Que (△), Guan Yuan (Τ), Qi Hai (Τ); for blood syncope add Blood Sea (│), He Gu (│), San Yin Jiao (│); for food syncope add Zhong Gu (⊥), Xi Gu (⊥), Tian Shu (⊥); for obvious heat symptoms add Twelve Wells (↓), Shi Xuan (↓), Shang Yang (↓), Dazhi (↓), Qu Chi (⊥), Nei Ting (⊥).
Operation: strong stimulation of the main acupuncture point, routine operation of the remaining acupuncture points.
Recommended prescription 2
Treatment: Tonify the mind and open the orifices, and sue the syncope.
Main acupoints: Baihui (│), Shuigou (⊥) (awakening the brain and opening the orifices)
Neiguan (⊥) (tonifies the mind and opens the orifices)
Hegu (⊥) (regulates Qi and blood)
Operation: Immediately lie flat with the head slightly lowered and enter the needle with a quick twist or a quick stab. Except for the Baihui point, all other points can be rapidly and substantially lifted and twisted to produce a short sensation of soreness, distension, pain or electric shock until the patient awakens.
Criteria for assessing the efficacy of treatment
1.Cure: Eliminate the cause of the syncope of qi, phlegm and food, the patient wakes up, the other symptoms disappear and the consciousness returns to normal.
2.Improvement: The cause is eliminated, coma is awakened, and then there are recurrent attacks, but the number of attacks is reduced, the interval is long, the duration is short, and the degree is light.
Analysis of therapeutic effect
1, factors affecting the efficacy of acupuncture
①position: because of the lack of oxygen supply to the brain during syncope, acupuncture should make the patient lying down, such as low blood pressure, head down 45 °, to ensure the supply of blood oxygen to the cerebral vessels is the key, which is also an important factor to improve the acupuncture suction.
②Operation: acupuncture treatment for syncope should be applied in a timely manner, and must use strong stimulation techniques to give continuous stimulation until the patient has a delirious response, so that the patient quickly recovers from the coma, thus stopping the development of the disease.
③Etiology: acupuncture is effective for reflex syncope; for cardiogenic syncope, the link is to improve circulation and cardiac function, which can achieve certain results, but the cause should be actively searched for, and targeted treatment should be carried out by the specialist; cerebral syncope, while actively treating the primary cause, early acupuncture treatment can reduce the harm caused by ischemia and hypoxia to brain cells.
2.Links and mechanisms of acupuncture treatment
The normal cerebral blood flow is 45-50 ml/(100 g of brain tissue? min) or so. When the cerebral blood flow is suddenly reduced to 30 ml/(100 g of brain tissue? minutes), syncope occurs. The causes of sudden decrease in cerebral blood flow are: (1) a sharp drop in blood pressure; (2) a sudden decrease in cardiac bleeding; and (3) acute ischemia of the intracranial arteries supplying blood to the brain. Factors such as hunger, fatigue, insomnia, pain, mental tension, etc., stimulate the vagal reflex, causing transient peripheral vasodilatation, lowered resistance, reduced cardiac output, and thus reduced cerebral blood flow, resulting in transient, widespread ischemia and hypoxia of brain cells and causing syncope. The links and mechanisms of acupuncture to resuscitate syncope may include.
① excitation of the central: for the conditions of motor, sensory, endocrine function decline and super-liminal inhibition of the cerebral cortex, through stronger needle sensory stimulation, lifting the excessive inhibition of the cerebral cortex, excite the central nervous system, stimulate and promote the normal functioning of the body, to achieve the rescue purpose of timely wake-up.
② Heart-strengthening and respiratory stimulation: Acupuncture points such as Neiguan can regulate the function of the heart and have an obvious pressure-raising effect. It can improve the circulation of the body and increase the blood oxygen content, thus increasing the supply of cerebral blood oxygen and improving cerebral circulation. Acupuncture in Renzhong can raise blood pressure and enhance pulmonary gas exchange, the principle of which is related to improving blood flow to internal organs and cardiac function, promoting adrenal secretion, etc. It also strengthens the autoregulatory movements of the cerebral microvasculature, which can excite the brainstem reticular upward activating system and improve cerebral circulation. Acupuncture of Su s points can elevate blood sugar in shock patients, enhance posterior pituitary function to raise blood pressure, cause enhanced respiratory promptness, and excite respiration. Studies have shown that myocardial contraction is enhanced after Guan Yuan application of moxibustion, which in turn leads to an increase in blood transfusion per heart beat, has a significant elevating effect on systolic blood pressure, and has a moderating effect on norepinephrine.
Prognosis
The prognosis of syncope depends on the etiology. Reflex syncope is generally transient and can recover on its own without medication, with a good prognosis, no life threatening and no sequelae, but can be recurrent; cardiogenic syncope should be actively defined as the cause, and targeted treatment should be carried out by specialists; cerebral syncope should be actively treated as the primary cause. If syncope is not treated timely and correctly, it may develop into coma and convulsions and endanger life. Cardiogenic syncope is the most serious and can lead to sudden death. The method of acupuncture to open the orifice and awaken the spirit is an extremely important method of first aid in Chinese medicine in the case of emergency, which is more convenient and faster than the method of western medicine in first aid syncope, and has its own uniqueness because it does not choose the environment and place of administration.