巨刺法结合康复训练对缺血性脑卒中后神经可塑性的影响研究
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摘要
目的：
探讨巨刺法结合康复训练对缺血性脑卒中患者肢体功能的影响。同时,通过动物实验,探讨应用巨刺法结合康复训练对脑缺血再灌注损伤大鼠运动功能以及海马区和梗塞灶周围神经生长相关蛋白-43(GAP-43)和突触素(SYP)表达的影响。
方法：
本课题研究分为临床研究及动物实验研究两个方面：
(1)临床研究
将符合纳入标准的49例缺血性脑卒中患者随机分为两组,其中治疗组27例,对照组22例。
治疗组应用巨刺法结合康复训练进行治疗,具体治疗方法如下：
巨刺法：软瘫期选穴：头部取双侧颞三针,上肢取双侧肩髃、曲池、手三里、合谷；下肢取双侧髀关、梁丘、足三里、解溪；痉挛期选穴：头部取双侧颞三针,上肢取双侧肩髎、臑会、天井、外关、后溪；下肢取双侧居骼、殷门、阳陵泉、跗阳、解溪。
康复训练法：弛缓阶段(Brunnstrom Ⅰ阶段)：体位摆放；被动运动；床上运动；桥式运动等；痉挛阶段(BrunnstromⅡ～Ⅲ阶段)：床上与床边训练；坐位训练；站立训练；平行杠内行走训练；步行训练等；分离阶段(BrunnstromⅣ～Ⅴ阶段)：行走训练；上肢功能训练。所有患者在按照上述不同训练方法进行肢体运动功能训练的同时,还按照不同患者的不同功能缺陷,进行日常生活活动能力的康复训练；口、面部、语言功能训练。
对照组应用常规针刺法结合康复训练进行治疗,具体治疗方法如下：
常规针刺法：软瘫期选穴：头部取病灶侧颞三针,上肢取瘫痪侧肩髃、曲池、手三里、合谷；下肢取瘫痪侧髀关、梁丘、足三里、解溪；痉挛瘫选穴：头部取病灶侧颞三针,上肢取瘫痪侧肩髎、臑会、天井、外关、后溪；下肢取瘫痪侧居髎、殷门、阳陵泉、跗阳、解溪。
本组康复训练法同巨刺康复组。
经过4周治疗后,评定各组患者神经功能缺损、运动功能、日常生活能力等方面的变化。
(2)动物实验研究：采用线栓法栓塞实验大鼠大脑中动脉致局灶性脑缺血模型,造模成功后2h,拔除栓线,造成脑缺血再灌注损伤,将造模成功后的实验大鼠随机分组：模型组(9只)、康复组(8只)、常规针刺康复组(8只)、巨刺康复组(9只),增加一组空白对照组(6只),共5组。造模成功24h后,康复组开始进行滚笼、平衡木、转棒、网屏等训练；巨刺康复组开始给予巨刺针法,取穴百会、双侧曲池、足三里,同时又给予康复训练；常规针刺康复组给予常规针刺,取穴百会、瘫侧曲池、足三里,同时又给予康复训练,空白对照组及模型组不做任何干预。各组分别在造模后7d,14d时进行行为学评估综合评分,造模14d后,经灌注固定后断头取脑,用免疫组织化学方法检测海马区及缺血周围区神经生长相关蛋白-43(GAP-43)、突触素(SYP)表达。
结果：
(1)NDS评分
两组患者治疗前后的比较,两组治疗后的NDS评分均显著低于治疗前的NDS评分,差异均有统计学(P<0.05),经治疗后两组病例的NDS评分相比,治疗组显著低于对照组,差异有统计学意义(P (2)MAS评分
两组患者治疗前后的比较,两组治疗后的MAS评分均显著高于治疗前的MAS评分,差异均有统计学(P<0.05),经治疗后两组病例的MAS评分相比,治疗组显著高于对照组,差异有统计学意义(P<0.05)。
(3)MBI评分
两组患者治疗前后的比较,两组治疗后的MBI评分均显著高于治疗前的MBI评分,差异均有统计学(P<0.05),经治疗后两组病例的MBI评分相比,治疗组显著高于对照组,差异有统计学意义(P<0.05)。
(4)实验大鼠神经行为学评分
术后7d,巨刺康复组大鼠的神经行为学评分显著低于其余三组,差异有统计学意义(P<0.05),其余三组之间无明显差异(P>O.05)；术后14d,巨刺康复组大鼠的神经行为学评分显著低于其余三组,差异有统计学意义(P0.05)。
(5)GAP-43阳性蛋白的表达
与空白对照组相比较,模型组、巨刺康复组、常规针刺康复组、康复组大鼠脑组织GAP-43表达IOD值均明显增加,差异有统计学意义(P<0.05)；康复组与模型组相比较,两组大鼠脑组织GAP-43表达IOD值无明显差异,经统计学分析,差异无统计学意义(P>0.05)；常规针刺康复组与康复组及模型组相比较,常规针刺康复组大鼠脑组织GAP-43表达IOD值明显增加,差异有统计学意义(P (6)SYP表达
与空白对照组相比较,模型组、巨刺康复组、常规针刺康复组、康复组大鼠脑组织SYP表达IOD值均明显增加,差异有统计学意义(P<0.05)；康复组与模型组相比较,两组大鼠脑组织SYP表达IOD值无明显差异,经过统计学分析,差异无统计学意义(P>0.05)；常规针刺康复组与康复组及模型组相比较,常规针刺康复组大鼠脑组织SYP表达IOD值明显增加,差异有统计学意义(P<0.05)；巨刺康复组与常规针刺康复组与康复组及模型组相比较,巨刺康复组大鼠脑组织SYP表达IOD值明显增加,差异有统计学意义(P<0.05)。
结论：
(1)巨刺及常规针刺结合康复训练均能促进缺血性脑卒中患者运动功能、日常生活能力的改善,但巨刺法结合康复训练较常规针刺结合康复训练疗效更显著。
(2)针刺治疗、康复训练均能在一定程度上促进MCAO大鼠神经功能的恢复,但是针刺结合康复训练较单纯康复训练疗效显著。而针刺方法上,巨刺法结合康复训练较常规针刺结合康复训练能更快更好地促进MCAO大鼠的恢复。模型组大鼠在造模后存在一定程度上的自然恢复。
(3)针刺治疗、康复训练均能促进神经生长相关蛋白-43(GAP-43)及突触素(SYP)的表达,但针刺结合康复训练较单纯康复训练疗效显著,进一步促进了突触重建和突触联系。而在针刺方法上,巨刺法结合康复训练较常规针刺结合康复训练能更快更好地促进MCAO大鼠的中枢神经系统的重塑。
Objective
To observe the effects of opposing needling combined with rehabilitation training on the functional improvement of ischemic stroke patients. At the same time, by animal experiment study, To explore the effects of opposing needling combined with rehabilitation training on motor function and the expression of GAP-43, SYP in the hippocampus and around the cerebral infracted area of rats after cerebral ischemia damage.
Methods
This research is divided into two parts:clinical study and animal experimental study:
(1) Clinical study49ischemic stroke patients were assigned to the treatment group and control group according to the principle of random, control and blindness. There were29patients in the treatment group and22patients in the control group.
The treatment group received opposing needling combined with rehabilitation training, The specific treatment methods are as follows:
opposing needling:Flaccid paralysis:the acup-points are the temporal3-needle, Jianyu, Quchi, Shousanli, Hegu, Biguan, Liangqiu, Zusanli, Jiexi on both sides; Spastic paralysis:the acup-points are the temporal3-needle, Jianniao, Naohui, Tianjing, Waiguan, Houxi, Juniao, Yinmen, Yanglingquan, Fuyang, Jiexi on both sides.
The rules of rehabilitation:Relaxation phase (Brunnstrom I phase): Keeping normal limbs in good position, Passive movement, Moving on the bed, Bridge-style movement, and so on. Spasticity phase (BrunnstromⅡ-Ⅲ phase): activities on bed and bedside, training on sitting position. training on stand position, walk training and walk inside parallel bars. Separation phase (BrunnstromⅣ-Ⅴphase):Walk training and upper limb function training. All patients in accordance with the different training methods for extremity motor function in training, at the same time, also in accordance with the different patients with different functional defects, to carry out activities of daily living ability, mouth rehabilitation training; language training.
The control group received routine needling combined with rehabilitation training, routine needling:Flaccid paralysis:the acup-points are the temporal3-needle, Jianyu, Quchi, Shousanli, Hegu, Biguan, Liangqiu, Zusanli, Jiexi in their paralyzed part of the bodies. Spastic paralysis:the acup-points are the temporal3-needle, Jianniao, Naohui, Tianjing, Waiguan, Houxi, Juniao, Yinmen, Yanglingquan, Fuyang, Jiexi in the paralyzed part of the bodies. The rules of rehabilitation are the same as the treatment group.
After4weeks of treatment, all of the patients were evaluated through the Neurologic Deficit Scale (NDS), Motor Assessment Scale (MAS), Modified Barthel Index (MBI).
(2) Animal experimental study
Establishing the animal model of focal cerebral ischemia by using suture method in mature SD rats,2hours later, the thread was withdrawn to resume perfusion, and resulted in cerebral ischemia reperfusion injury. All MCAO models were randomly divided into4groups:model group (n=9), rehabilitation group (n=8), routine needling combined with rehabilitation group (n=8), opposing needling combine with rehabilitation group (n=9). The rats of rehabilitation group were received motor training programs, including balancing, grasping, rotating and walking exercise. The rats of opposing needling combine with rehabilitation group were received motor training programs and opposing needling, the main points were Baihui, Quchi, Zusanli on the both sides. The rats of routine needling combined with rehabilitation group were received motor training programs and routine needling, the main points were Baihui, Quchi and Zusanli in the paralyzed part of the bodies. The behavioral tests of every group were evaluated at the7th,14th day after operation. The animals were decapitated14th day after operation, and immunohistochemistry staining method was used to detect the immune positive expression of Growth Associated Protein43(GAP-43) and Synaptophysin(SYP) of peri-ischemia cortex and hippocampal.
Results
(1) NDS
After4weeks therapies, compared with scores before the treatment, there were significant differences in NDS in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(2) MAS
After4weeks therapies, compared with scores before the treatment, there were significant differences in MAS in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(3) MBI
After4weeks therapies, compared with scores before the treatment, there were significant differences in MBI in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(4) The scores of neuroethology assessment
7th day after operation, there were significant difference between opposing needling combine with rehabilitation group and the other three groups (P＜0.05).14th day after operation, there were significant difference between opposing needling combine with rehabilitation group and the other three groups (P＜0.05). Compared rehabilitation group with routine needling combined with rehabilitation group, there were significant difference between the two groups (P＜0.05)
(5) The immune positive expression of GAP-43
Compared with the blank group, the immune positive expression of GAP-43of the four experiment groups was obviously increased. Compared model group with rehabilitation group, there were no significant difference between the two groups (P>0.05). Compared routine needling combined with rehabilitation group with routine model group and rehabilitation group, there were significant difference between the two groups (P＜0.05). Compared with model group, rehabilitation group and routine needling combined with rehabilitation group, the immune positive expression of GAP-43of the opposing needling combine with rehabilitation group was obviously increased (P＜0.05)
(6) The immune positive expression of SYP
Compared with the blank group, the immune positive expression of SYP of the four experiment groups was obviously increased. Compared model group with rehabilitation group, there were no significant difference between the two groups (P>0.05). Compared routine needling combined with rehabilitation group with routine model group and rehabilitation group, there were significant difference between the two groups (P＜0.05). Compared with model group, rehabilitation group and routine needling combined with rehabilitation group, the immune positive expression of SYP of the opposing needling combine with rehabilitation group was obviously increased (P<0.05)
Conclusion
(1) The therapies of routine needling combined with rehabilitation and opposing needling combine with rehabilitation are can promote the motor function of patients with ischemic stroke, improve the activities of daily living. The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation.
(2) Acupuncture therapy, rehabilitation training can promote the recovery of neural function of the animal model of focal cerebral ischemia in some extent. But the acupuncture combined with rehabilitation is much more effective than simple rehabilitation training. About the acupuncture methods, The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation. There is some spontaneous recovery in those rats of model group.
(3) Acupuncture therapy, rehabilitation training can promote the immune positive expression of SYP.of the animal model of focal cerebral ischemia in some extent. But the acupuncture combined with rehabilitation is much more effective than simple rehabilitation training, acupuncture can promote the rebuilding of synapses and synaptic connections obviously. About the acupuncture methods, The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation.
探讨巨刺法结合康复训练对缺血性脑卒中患者肢体功能的影响。同时,通过动物实验,探讨应用巨刺法结合康复训练对脑缺血再灌注损伤大鼠运动功能以及海马区和梗塞灶周围神经生长相关蛋白-43(GAP-43)和突触素(SYP)表达的影响。
方法：
本课题研究分为临床研究及动物实验研究两个方面：
(1)临床研究
将符合纳入标准的49例缺血性脑卒中患者随机分为两组,其中治疗组27例,对照组22例。
治疗组应用巨刺法结合康复训练进行治疗,具体治疗方法如下：
巨刺法：软瘫期选穴：头部取双侧颞三针,上肢取双侧肩髃、曲池、手三里、合谷；下肢取双侧髀关、梁丘、足三里、解溪；痉挛期选穴：头部取双侧颞三针,上肢取双侧肩髎、臑会、天井、外关、后溪；下肢取双侧居骼、殷门、阳陵泉、跗阳、解溪。
康复训练法：弛缓阶段(Brunnstrom Ⅰ阶段)：体位摆放；被动运动；床上运动；桥式运动等；痉挛阶段(BrunnstromⅡ～Ⅲ阶段)：床上与床边训练；坐位训练；站立训练；平行杠内行走训练；步行训练等；分离阶段(BrunnstromⅣ～Ⅴ阶段)：行走训练；上肢功能训练。所有患者在按照上述不同训练方法进行肢体运动功能训练的同时,还按照不同患者的不同功能缺陷,进行日常生活活动能力的康复训练；口、面部、语言功能训练。
对照组应用常规针刺法结合康复训练进行治疗,具体治疗方法如下：
常规针刺法：软瘫期选穴：头部取病灶侧颞三针,上肢取瘫痪侧肩髃、曲池、手三里、合谷；下肢取瘫痪侧髀关、梁丘、足三里、解溪；痉挛瘫选穴：头部取病灶侧颞三针,上肢取瘫痪侧肩髎、臑会、天井、外关、后溪；下肢取瘫痪侧居髎、殷门、阳陵泉、跗阳、解溪。
本组康复训练法同巨刺康复组。
经过4周治疗后,评定各组患者神经功能缺损、运动功能、日常生活能力等方面的变化。
(2)动物实验研究：采用线栓法栓塞实验大鼠大脑中动脉致局灶性脑缺血模型,造模成功后2h,拔除栓线,造成脑缺血再灌注损伤,将造模成功后的实验大鼠随机分组：模型组(9只)、康复组(8只)、常规针刺康复组(8只)、巨刺康复组(9只),增加一组空白对照组(6只),共5组。造模成功24h后,康复组开始进行滚笼、平衡木、转棒、网屏等训练；巨刺康复组开始给予巨刺针法,取穴百会、双侧曲池、足三里,同时又给予康复训练；常规针刺康复组给予常规针刺,取穴百会、瘫侧曲池、足三里,同时又给予康复训练,空白对照组及模型组不做任何干预。各组分别在造模后7d,14d时进行行为学评估综合评分,造模14d后,经灌注固定后断头取脑,用免疫组织化学方法检测海马区及缺血周围区神经生长相关蛋白-43(GAP-43)、突触素(SYP)表达。
结果：
(1)NDS评分
两组患者治疗前后的比较,两组治疗后的NDS评分均显著低于治疗前的NDS评分,差异均有统计学(P<0.05),经治疗后两组病例的NDS评分相比,治疗组显著低于对照组,差异有统计学意义(P
两组患者治疗前后的比较,两组治疗后的MAS评分均显著高于治疗前的MAS评分,差异均有统计学(P<0.05),经治疗后两组病例的MAS评分相比,治疗组显著高于对照组,差异有统计学意义(P<0.05)。
(3)MBI评分
两组患者治疗前后的比较,两组治疗后的MBI评分均显著高于治疗前的MBI评分,差异均有统计学(P<0.05),经治疗后两组病例的MBI评分相比,治疗组显著高于对照组,差异有统计学意义(P<0.05)。
(4)实验大鼠神经行为学评分
术后7d,巨刺康复组大鼠的神经行为学评分显著低于其余三组,差异有统计学意义(P<0.05),其余三组之间无明显差异(P>O.05)；术后14d,巨刺康复组大鼠的神经行为学评分显著低于其余三组,差异有统计学意义(P
(5)GAP-43阳性蛋白的表达
与空白对照组相比较,模型组、巨刺康复组、常规针刺康复组、康复组大鼠脑组织GAP-43表达IOD值均明显增加,差异有统计学意义(P<0.05)；康复组与模型组相比较,两组大鼠脑组织GAP-43表达IOD值无明显差异,经统计学分析,差异无统计学意义(P>0.05)；常规针刺康复组与康复组及模型组相比较,常规针刺康复组大鼠脑组织GAP-43表达IOD值明显增加,差异有统计学意义(P
与空白对照组相比较,模型组、巨刺康复组、常规针刺康复组、康复组大鼠脑组织SYP表达IOD值均明显增加,差异有统计学意义(P<0.05)；康复组与模型组相比较,两组大鼠脑组织SYP表达IOD值无明显差异,经过统计学分析,差异无统计学意义(P>0.05)；常规针刺康复组与康复组及模型组相比较,常规针刺康复组大鼠脑组织SYP表达IOD值明显增加,差异有统计学意义(P<0.05)；巨刺康复组与常规针刺康复组与康复组及模型组相比较,巨刺康复组大鼠脑组织SYP表达IOD值明显增加,差异有统计学意义(P<0.05)。
结论：
(1)巨刺及常规针刺结合康复训练均能促进缺血性脑卒中患者运动功能、日常生活能力的改善,但巨刺法结合康复训练较常规针刺结合康复训练疗效更显著。
(2)针刺治疗、康复训练均能在一定程度上促进MCAO大鼠神经功能的恢复,但是针刺结合康复训练较单纯康复训练疗效显著。而针刺方法上,巨刺法结合康复训练较常规针刺结合康复训练能更快更好地促进MCAO大鼠的恢复。模型组大鼠在造模后存在一定程度上的自然恢复。
(3)针刺治疗、康复训练均能促进神经生长相关蛋白-43(GAP-43)及突触素(SYP)的表达,但针刺结合康复训练较单纯康复训练疗效显著,进一步促进了突触重建和突触联系。而在针刺方法上,巨刺法结合康复训练较常规针刺结合康复训练能更快更好地促进MCAO大鼠的中枢神经系统的重塑。
Objective
To observe the effects of opposing needling combined with rehabilitation training on the functional improvement of ischemic stroke patients. At the same time, by animal experiment study, To explore the effects of opposing needling combined with rehabilitation training on motor function and the expression of GAP-43, SYP in the hippocampus and around the cerebral infracted area of rats after cerebral ischemia damage.
Methods
This research is divided into two parts:clinical study and animal experimental study:
(1) Clinical study49ischemic stroke patients were assigned to the treatment group and control group according to the principle of random, control and blindness. There were29patients in the treatment group and22patients in the control group.
The treatment group received opposing needling combined with rehabilitation training, The specific treatment methods are as follows:
opposing needling:Flaccid paralysis:the acup-points are the temporal3-needle, Jianyu, Quchi, Shousanli, Hegu, Biguan, Liangqiu, Zusanli, Jiexi on both sides; Spastic paralysis:the acup-points are the temporal3-needle, Jianniao, Naohui, Tianjing, Waiguan, Houxi, Juniao, Yinmen, Yanglingquan, Fuyang, Jiexi on both sides.
The rules of rehabilitation:Relaxation phase (Brunnstrom I phase): Keeping normal limbs in good position, Passive movement, Moving on the bed, Bridge-style movement, and so on. Spasticity phase (BrunnstromⅡ-Ⅲ phase): activities on bed and bedside, training on sitting position. training on stand position, walk training and walk inside parallel bars. Separation phase (BrunnstromⅣ-Ⅴphase):Walk training and upper limb function training. All patients in accordance with the different training methods for extremity motor function in training, at the same time, also in accordance with the different patients with different functional defects, to carry out activities of daily living ability, mouth rehabilitation training; language training.
The control group received routine needling combined with rehabilitation training, routine needling:Flaccid paralysis:the acup-points are the temporal3-needle, Jianyu, Quchi, Shousanli, Hegu, Biguan, Liangqiu, Zusanli, Jiexi in their paralyzed part of the bodies. Spastic paralysis:the acup-points are the temporal3-needle, Jianniao, Naohui, Tianjing, Waiguan, Houxi, Juniao, Yinmen, Yanglingquan, Fuyang, Jiexi in the paralyzed part of the bodies. The rules of rehabilitation are the same as the treatment group.
After4weeks of treatment, all of the patients were evaluated through the Neurologic Deficit Scale (NDS), Motor Assessment Scale (MAS), Modified Barthel Index (MBI).
(2) Animal experimental study
Establishing the animal model of focal cerebral ischemia by using suture method in mature SD rats,2hours later, the thread was withdrawn to resume perfusion, and resulted in cerebral ischemia reperfusion injury. All MCAO models were randomly divided into4groups:model group (n=9), rehabilitation group (n=8), routine needling combined with rehabilitation group (n=8), opposing needling combine with rehabilitation group (n=9). The rats of rehabilitation group were received motor training programs, including balancing, grasping, rotating and walking exercise. The rats of opposing needling combine with rehabilitation group were received motor training programs and opposing needling, the main points were Baihui, Quchi, Zusanli on the both sides. The rats of routine needling combined with rehabilitation group were received motor training programs and routine needling, the main points were Baihui, Quchi and Zusanli in the paralyzed part of the bodies. The behavioral tests of every group were evaluated at the7th,14th day after operation. The animals were decapitated14th day after operation, and immunohistochemistry staining method was used to detect the immune positive expression of Growth Associated Protein43(GAP-43) and Synaptophysin(SYP) of peri-ischemia cortex and hippocampal.
Results
(1) NDS
After4weeks therapies, compared with scores before the treatment, there were significant differences in NDS in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(2) MAS
After4weeks therapies, compared with scores before the treatment, there were significant differences in MAS in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(3) MBI
After4weeks therapies, compared with scores before the treatment, there were significant differences in MBI in two group (P＜0.05). After treatment, there were significant difference between treatment group and control group (P＜0.05)
(4) The scores of neuroethology assessment
7th day after operation, there were significant difference between opposing needling combine with rehabilitation group and the other three groups (P＜0.05).14th day after operation, there were significant difference between opposing needling combine with rehabilitation group and the other three groups (P＜0.05). Compared rehabilitation group with routine needling combined with rehabilitation group, there were significant difference between the two groups (P＜0.05)
(5) The immune positive expression of GAP-43
Compared with the blank group, the immune positive expression of GAP-43of the four experiment groups was obviously increased. Compared model group with rehabilitation group, there were no significant difference between the two groups (P>0.05). Compared routine needling combined with rehabilitation group with routine model group and rehabilitation group, there were significant difference between the two groups (P＜0.05). Compared with model group, rehabilitation group and routine needling combined with rehabilitation group, the immune positive expression of GAP-43of the opposing needling combine with rehabilitation group was obviously increased (P＜0.05)
(6) The immune positive expression of SYP
Compared with the blank group, the immune positive expression of SYP of the four experiment groups was obviously increased. Compared model group with rehabilitation group, there were no significant difference between the two groups (P>0.05). Compared routine needling combined with rehabilitation group with routine model group and rehabilitation group, there were significant difference between the two groups (P＜0.05). Compared with model group, rehabilitation group and routine needling combined with rehabilitation group, the immune positive expression of SYP of the opposing needling combine with rehabilitation group was obviously increased (P<0.05)
Conclusion
(1) The therapies of routine needling combined with rehabilitation and opposing needling combine with rehabilitation are can promote the motor function of patients with ischemic stroke, improve the activities of daily living. The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation.
(2) Acupuncture therapy, rehabilitation training can promote the recovery of neural function of the animal model of focal cerebral ischemia in some extent. But the acupuncture combined with rehabilitation is much more effective than simple rehabilitation training. About the acupuncture methods, The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation. There is some spontaneous recovery in those rats of model group.
(3) Acupuncture therapy, rehabilitation training can promote the immune positive expression of SYP.of the animal model of focal cerebral ischemia in some extent. But the acupuncture combined with rehabilitation is much more effective than simple rehabilitation training, acupuncture can promote the rebuilding of synapses and synaptic connections obviously. About the acupuncture methods, The efficacy of opposing needling combine with rehabilitation is more significant than the efficacy of routine needling combined with rehabilitation.
引文
[1]谭斌.浅谈祖国医学对中风病的认识[J].中外医疗,2009,33：91.
[2]李红香,戴慎.中风病名探源[J].辽宁中医药大学学报,2011,13(4)：158-159.
[3]许玉皎.中风病名分析及现代中风病诊断[J].中医药导报,2011,17(5)：6-8.
[4]唐·孙思邈.备急千金要方[M].宋·林亿,注,刘更生,校正.北京：华夏出版社,1993：122.
[5]宋·赵佶.圣济总录[M].北京：人民卫生出版社,1962：220.
[6]元·王履.医经溯洄集[M].左言福,点注.南京：江苏科学技术出版社,1985：46.
[7]明·楼英.医学纲目[M].高登瀛,点校.北京：人民卫生出版社,1987：293.
[8]明·张介宾.景岳全书[M].夏之秋,校注.北京：中国中医药出版社,1994：128.
[9]清·叶天士.临证指南医案[M].华岫石,编订.北京：华夏出版社,1995：1-3.
[10]张锡纯.医学衷中参西录[M].王石凯,重校.石家庄：河北科学技术出版社,2002：192.
[11]郜峦,王键.中风病病因病机的源流及发展[J].中国中医急症,2009,18(8)：1279-1281.
[12]何华.中风先兆丸对椎-基底动脉系短暂性脑缺血发作患者血流动力学的影响[J].陕西中医,2006,27(11)：1334-1335.
[13]刘淑霞,杨秀洁,白宇望,等.醒脑通络片治疗缺血性中风63例[J].陕西中医,2005,26(7)：661-662.
[14]缪峰.化瘀通脉汤治疗缺血性中风恢复期114例[J].陕西中医,2007,28(10)：1311-1312.
[15]杨劲松,罗治华,钟妙文,等.降纤酶结合益气活血化瘀通络中药治疗进展性缺血性中风的临床研究[J].中西医结合心脑血管病杂志,2007,5(1)：26-27.
[16]罗萌,宋志宙.脑梗死的中医药治疗研究进展[J].中国中医急症,2008,17(7)：982-984.
[17]尹文姬,金香淑.通脉化瘀汤治疗血瘀型缺血性脑血管病74例[J].陕西中医,2009,30(2)：162-163.
[18]汪宁,刘青石,彭代银,等.通窍活血汤对小鼠脑缺血缺氧保护作用的研究[J].中国中药科技,2003,10(6)：933-934.
[19]尹思远,廖慧玲,杨思进,等.化瘀通络胶囊对脑缺血大鼠血管内皮细胞的影响[J].辽宁中医杂志,2008,35(3)：456-458.
[20]李玉芳,陈立平,范玲.开窍化痰通瘀法治疗脑梗死的临床观察[J].中华医学实践杂志,2007,6(1)：41-42.
[21]李京,曹锐,胡文忠,等.化痰祛瘀汤对脑梗死急性期组织型纤溶酶元激活物及其抑制物影响的临床观察[J].中国中西医结合急救杂志,2007,14(6)：333-336.
[22]张春燕.补肾活血汤对缺血性脑卒中治疗的临床观察[J].山西中医学院学报,2005,6(3)：21.
[23]张树泉,徐西元.补肾活血化痰方对大鼠脑缺血再灌注损伤的保护作用[J].中西医结合心脑血管病杂志,2005,3(6)：515-516.
[24]常富业,王永炎.中风病毒邪论[J].北京中医药大学学报,2004,27(1)：3-6.
[25]刘轲,徐江雁.益气活血、解毒降浊治疗缺血性脑卒中的理论探讨[J].北京京中医药大学学报,2004,27(2)：9-11.
[26]陈隐漪.黄连解毒汤对急性脑梗死患者的血清IL-6、TNF-a的影响[J].首都医药,2007,4：35-36.
[27]乔晓莉,肖学凤,高岚,等.黄连解毒汤中栀子苷在缺血性脑血管病模型大鼠体内的药动学研究[J].时珍国医国药,2008,19(10)：2462-2463.
[28]张勇.温胆汤加味治疗缺血性脑中风80例[J].河南中医,2005,25(9)：63-64.
[29]颜建云,吴伟康.四逆汤抗脑缺血的作用及其机制的研究[J].中山大学,2003.
[30]王青,马聪敏,刘倩玲.银杏达莫注射液治疗脑梗死的疗效观察[J].中国实用神经疾病杂志,2007,10(9)：69-71.
[31]李茯梅,段小毛,王俊杰,等.银杏叶提取物对脑缺血再灌注大鼠线粒体ATP敏感性钾通道的影响[J].中华中医药学刊,2008,26(7)：1462-1463.
[32]李世泽,白宏英,史振军,等.灯盏细辛对急性脑梗死患者sICAM-1和TNF-a的影响[J].中国实用神经疾病杂志,2007,10(5)：49-50.
[33]刘钦华,林小娟,王梅平.灯盏细辛注射液对脑梗死患者认知功能的影响[J].福建中医药,2007,38(6)：8-9.
[34]尉娜,杨纯生,李素芳.川芎嗪对急性脑梗死患者个血黏度及血红细胞聚集指数的影响[J].新乡医学院学报,2007,24(6)：588-589.
[35]王芳.川芎嗪对脑栓塞血浆、溶血磷脂酸水平的影响[J].中国实用神经疾病杂志,2007,10(4)：12-13.
[36]张奕文,牛建文,宋叶华.三七总皂苷对急性脑梗死患者血浆溶血磷脂酸的影响[J].临床荟萃,2006,,21(21)：1572-1573.
[37]韦羡华,黄春,曾祥发,等.三七总皂苷对急性脑梗死患者血清C反应蛋白水平的影响[J].福建中医药,2007,38(3)：4-6.
[38]孙振杰.手足十二针治疗脑梗死150例疗效观察[J].中医中药.2009,16(17)：81-83.
[39]叶信画.醒脑开窍针刺法治疗脑梗死35例[J].山东中医杂志,2009,28(7)：479-480.
[40]王颖.针刺风池、风府穴对中风后遗症患者脑血流速度的影响[J].中医药临床杂志,2005s,17(3)：251-252.
[41]王格红,郝重耀,贾运滨.针灸治疗中风后遗症60例临床观察[J].中西医结合心脑血管病杂志.2005,3(8)：741.
[42]张俊英,张海龙,付正良,等.分期辨证取穴针刺法治疗中风后遗症临床观察[J].中医中药,2007,4(27)：76-77.
[43]江丰,李常度,孟晓丹,等.针刺五志穴治疗中风后抑郁症的临床疗效观察[J]针灸临床杂志,2006,22(12)：25-26.
[44]潘永清.针刺八脉交会穴治疗中风后抑郁56例[J].陕西中医,2007,28(2)：199-200.
[45]揭子慧.针刺八脉交会穴治疗中风语言不利临床观察[J].天津医药.2007.35(9)：677.
[46]王顺,蔡玉颖,胡丙成,等.透穴刺法治疗中风后小脑性共济失调临床观察[J]中国针灸,2006,26(1)：75-77.
[47]张雅丽,倜,蔡玉颖.透穴刺法治疗中风后足内翻疗效观察[J],中国针灸,2006,26(1)：15-17.
[48]李永堂,周志华,吴洲红.脑出血患者的中西医结合治疗回顾分析[J].中国中医急症,2004,13(11)：774.
[49]谈福强.头针治疗中风24例临床观察[J].湖北中医杂志,2001,23(6)：44.
[50]张红星,张唐法.头针治疗中风病33例疗效观察[J].湖北中医杂志,2001,23(8)：41.
[51]杨秋汇.头针治疗急性期缺血性中风194例血液流变学观察[J].山西中医,2007,23(4)：54-56.
[52]杨富强.头针治疗急性缺血性卒中120例[J].中国实用神经疾病杂志,2009,12(11)：58-59.
[53]单丽华,周正国,曲芳,等.头皮针体针并用治疗急性脑梗死偏瘫76例[J].实用中医内科杂志,2008,22(4)：90-91.
[54]韩冰雪,唐强.头针配合十二井穴刺络放血治疗急性脑梗塞[J].辽宁中医杂志,2008,35(1)：120-121.
[55]梅晓明,孙利,刘淑美,等.头针加体针治疗中风后遗症69例[J].中国民间疗法,2005,13(5)：13-14.
[56]许佳年,贾怡蓓,韩天雄,等.针药结合对脑梗塞患者血脂和血液流变学的影响[J].辽宁中医杂志,2006,33(12)：1528-1529.
[57]李宗桥,韩永,陈会君,等.针药结合对急性脑梗死患者神经功能恢复的影响[J].针灸临床杂志,2006,22(10)：25-26.
[58]郝宏华.电针配合中药治疗中风后遗症[J].中西医结合心脑血管病杂志,2004,2(8)：492-493.
[59]曹银香,白炜玮,冯金萍,等.眼针治疗脑梗死半身不遂156例临床观察[J].河北中医,2008,30(3)：286-287.
[60]曹荣禄,杨改琴,黄丽萍,等.舌三针及人迎穴为主治疗脑卒中后吞咽功能障碍[J],陕西中医,2010,31(1)：89-90.
[61]史术峰.项针结合吞咽康复训练治疗脑卒中后吞咽困难[J].针灸临床杂志,2009,25(8)：18-19.
[62]陈丽贤,丁晓虹.腹针治疗脑梗死50例[J]中国临床康复,2004,8(19)：3823-3824.
[63]徐振华,符文彬,刘健华.腹针治疗脑卒中后感觉障碍15例[J].江西中医药,2009,5(40)：58-59.
[64]曹晶晶,陈英.电针联合巨刺法穴位注射治疗脑血管病引起的顽固性呃逆100例[J].河南职工医学院学报,2011,23(1)：53-55.
[65]万娇,李波,陈向阳等.巨刺导引复合针法对中风偏瘫运动功能康复的疗效观察[J].上海针灸杂志,2011,30(3)：160-161.
[66]武丹,娄必丹.巨刺法为主治疗中风后肩手综合征临床观察[J].新中医,2011,43(7)：117-119.
[67]杜伟.巨刺加电针疏密波治疗中风偏瘫疗效观察[J].上海针灸杂志,2010,29(2)：86-87.
[68]邹玮庚,徐远红,李海峰等.巨刺阳经法治疗缺血性脑卒中后上肢痉挛的临床观察[J].天津中医药,2010,27(4)：294-296.
[69]倪克锋,骆燕宁,王延武等.巨刺法结合持续静力牵张治疗中风后肌张力增高的临床观察[J].浙江中医药大学学报,2009,33(4)：576-577.
[70]宋维健.巨刺与刺络放血法治疗脑卒中后丘脑痛29例[J].针灸临床杂志,2009,25(10)：34-35.
[71]毕臻.巨刺配合患肢推拿治疗中风偏瘫60例[J].辽宁中医学院学报,2004,6(5)：410..
[72]王为凤.巨刺郄穴配合推拿治疗粘连期肩关节周围炎疗效观察[J].上海针灸杂志,2011,30(2)：110-112.
[73]张保球.运用巨刺及龙虎交战法的针刺手法合并温针灸治疗致密性髂骨炎50例[J].中国当代医药,2011,18(12)：97-98.
[74]旷秋和.火针巨刺治疗肱骨外上髁炎48例[J].中国民间疗法,2011,19(5)：21.
[75]张官印,张盈,闫凌.巨刺法配合拔火罐治疗落枕100例[J].光明中医,2010,25(12)：2270-2271.
[76]邢俊标.巨刺滞针法治疗急性肩周炎30例[J].现代中西医结合杂志,2007,16(35)：5307.
[77]朱维升.应用针灸巨刺法治疗痹证700例疗效观察[J].中国民族医药杂志,2007,11(11)：36.
[78]刘亚丽.巨刺法结合电针治疗原发性坐骨神经痛40例[J].针灸临床杂志,2004,20(9)：34.
[79]景宽,刘春,王雪峰.巨刺配合运动治疗肩周炎50例临床观察[J].吉林中医药,2004,27(7)：42.
[80]王舰,阙庆辉,林宇凡.肩三针巨刺治疗肩周炎100例[J].福建中医药,2003,34(6)：6.
[81]赵金奉,赵军,李长君.巨刺治疗周围性面神经炎并发症26例[J].针灸临床杂志,2011,27(6)：22-23.
[82]曹晓滨,秦毅,王倩.巨刺和温针法治疗面神经炎116例[J].陕西中医,2010,31(7)：890-891.
[83]张晓阳.巨刺法治疗顽固性周围性面瘫疗效观察[J].安徽中医学院学报,2008,27(6)：33-34.
[84]魏丽洁,宋玉明.巨刺、透刺与毛刺分期治疗周围性面瘫疗效观察[J].现代中西医结合杂志,2004,13(20)：2691.
[85]李进华.以巨刺透穴为主治疗周围性面瘫的临床观察[J].中国针灸,2004,S1：60-61.
[86]陈永平.巨刺法治疗面神经麻痹36例[J].江苏中医药,2003,24(9)：48.
[87]刘蓉.毛刺加巨刺治疗面肌痉挛35例[J].上海针灸杂志,2010,29(2)：73.
[88]孙盛,王瑛,安丽萍.止痉穴结合巨刺远取法治疗面肌痉挛临床观察[J].河北中医,2007,29(3)：241.
[89]罗文舒.针刺任脉加巨刺对脑卒中上肢体感诱发电位的影响[J].河南中医,2009,29(1)：84-85.
[90]罗文舒.针刺任脉加巨刺对脑卒中恢复期正中神经F波的影响[J].中国现代医生,2009,47(33)：1-2.
[91]刘光亭, 肖永俭.电针巨刺对中风偏瘫患者甲皱微循环的影响[J].针刺研究,1990,15(1)：40-43.
[92]刘光亭.巨针巨刺法对脑梗死患者脑血流图、血液流变学和血脂的影响[J]中国针灸,2004,24(10)：701-703.
[93]李连生,汤德安,徐汤萍等.巨刺对90例脑梗塞患者脑血流图的影响[J].天津中医学院学报,19892：27-29.
[94]吴钢,郑依勇.应用TCD研究巨刺法对脑血流动力学的影响[J].中国中医药科技,1997,4(1)：59-60.
[95]方剑乔,刘元亮.电针巨刺与患侧针刺镇痛的临床与实验研究[J].中国中西医结合杂志,1994,14(10)：579-582.
[96]朱丽霞,黎春元,莫孝荣,等.针刺镇痛选穴原则的探讨[J].生理科学.1984,4(5,6)：73-74.
[97]黄坤厚,戎象棣,徐文斌等.不同侧穴位电针对外周神经伤害性传入冲动影响的比较[J].针刺研究,1986 1：50-53.
[98]匡培根,吴爱华,张凤英.巨刺对穴位灌流液中乙酰胆硷含量的影响[J]针刺研究,19802：147-149.
[99]刘光亭,王淑敏,王力健.巨刺阳陵泉穴对胆道系统的影响[J].中国针灸,2003,23(1)：29-30.
[100]刘光亭.巨刺内关穴对冠心病病人左心功能的影响[J].中西医结合心脑血管病杂志,2005,3(7)：595-596.
[101]陈泽斌,熊迎春,吴昌清,等.电针刺激大鼠“肾俞”穴对下丘脑室旁核功能状态的影响[J].湖北中医学院学报,1999,1(1)：30-32.
[102]Morgen K, Kaclom N, Sawaki A, et al. Kinematic specificity of cortical reorganization associated with motor training [J]. Neuro image,2004,21:1182-1187.
[103]Rossini PM, Calautti C, Pauri F, et al. Post-stroke plastic reorganization in the adult brain[J]. Lancet Neurol,2003,2:493-502
[104]缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(二)[J].中国康复理论与时间1996,1-5.
[105]Glees P, Cole J, Whiny CW, et al. The effects of lesions in the cingular gyrus and adjacent areas in monkeys=[J]. Journal of Neurology, Neuro surgery & Psychiatry,1950, 13 (3):178-190.
[106]王茂斌,主编.脑卒中的康复医疗[M].北京：中国科学技术出版社,2006.22-29.
[107]Fabisch W, Glees P,Macmillan AL. Hemispherectomy for the treatment of epilepsy in infantile hemiplegia; a review and a case report [J]. Monatsschrift fur Psychiatric and Neurologie,1955,130(6):385-405.
[108]Cao Y, D'Olhaberriague L, Vikingstad EM, et al. A pilot study of subjects recovered from hemiparetic stroke [J]. Stroke,1997,28:2518-2527.
[109]Von Voigtlander PF, Moore KE. Turning behavior of mice with unilateral 6-hydroxydopamine lesions in the striatum:effects of apomorphine, L-DOPA, amanthadine, amphetamine and other psychomotor stimulants [J]. Neuropharmacology,1973,12 (5): 461-462.
[110]Mishra RK, GardnerEL, Katzman R, et al. Enhancement of dopamine stimulated adenylate cyclase activity in rat caudate after lesions in substantia nigra:evidence for denervation supersensitivity [J]. Proceedings of the National Academy of Sciences of the United States of America,1974,71(10):3883-3887.
[111]Kalisker A, Rutledge, Perkins JP. Effect of nerve degeneration by 6-hydroxydopamine on catecholamine-stimulated adenosine 3',5'-monophosphate formation in rat cerebral cortex[J]. Molecular Pharmacology,1973,9(5):619-629.
[112]Huang M, Ho AK, Daly JW. Accumulation of adenosine cyclic 3',5'-monophosphate in rat treatment with 6-hydroxydopamine,2,3,5-trihydroxyphenethylamine, and dihydroxytryptamines [J]. Molecular Pharmacology,1973,9(6):711-717.
[113]许绍芬,主编.神经生物学[M].第2版.上海：复旦大学出版社.1999.88-94,99-111.457-463.
[114]Mitchell PJ, Tjian R. Transcriptional regulation in mammalian cells by sequence-specific DNA binding proteins [J]. Science,1989,245(4916):371-378.
[115]Gonzalez GA, Montminy MR, Cyclic AMP stimulates somatostatin gene transcription by phosphorylation of CREB at serine 133[J]. Cell,1989,59(4):675-680.
[116]Agnes F, Leonardo GC. Translational studies in neuro rehabilitation:From Bench to Bedside[J]. Cog Behav Neurol,2006,19:1-10.
[117]寿天德,主编.神经生物学[M].第2版,北京：高等教育出版社2006,184-185.
[118]Stroke Unit Trialists'Collaboration. Collaborative systematic review of the randomized trials of organized in patient (stroke unit) case after stroke[J]. BMJ,1997, 314:1151-1159.
[119]Argye E. Hillis. The right place at the right time [J]. Brain,2006,129:1351-1356
[120]Musso M, Weiller C, Kiebel, et al. Training-induced brain plasticity in aphasia[J]. Brain,1999,122 (pt9):1781-1790.
[121]De Boissezon X, Demonet JF, Puel M, et al. Subcortical aphasia:a longitudinal PET study [J]. Stroke,2005,36:1467-1473
[122]Pulvermuller F, Hauk 0, Zohsel K, et al. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia[J]. Neuroimage,2005,28:481-489.
[123]Winhuisen L, Thiel A, Schumacher B, et al. Role of the contralateral inferior frontal gyms in recovery of language frmction in post stroke aphasia:a combined repetitive transcranial magnetic stimulation and positron emisson tomography study [J]. Stroke,2005,36:1759-1763.
[124]ohansen Berg H, Rushwoith M, Bogdanovic MD, et al. The role of ipsilateral premotor cortex in hand movement after stroke[J]. Proc Natl Acad Sci USA 2002,99:14518-14523.
[125]Butehsch CM. Plasticity in the human cerebral cortex:lessons from the normal brain and from stroke[J]. Neuroscientist,2004,10:163-173.
[126]Ward NS, Brown MA, Thompson AJ, et al. Neural correlates of motor recovery after stroke:a longitudinal fMRI study[J]Brain,2003,26(ptll):2476-2496.
[127]Serrien DJ, Strens LH, Cassidy MJ, et al. Functional significance of the ipsilateral hemisphere during movement of the affected hand after stroke[J]. Exp Neurol, 2004,190:425-432.
[128]Calautti C, Leroy F, Guincestre JY, et al. Sequential activation brain mapping after subcoitical stroke; Changes in hemispheric balance and recovery [J]. Neuro report,2001, 12:3883-3886.
[129]Heiss WD, Kessler J, Thiel A, et al. Differential capacity of left and right hemispheric areas for compensation of post stroke aphasia[J]. Ann Neuro 1999,45430-438.
[130]Kurland J, Naeser MA, Baker EH, et al. Test-retest reliability of fMRI during nonverbal semantic decisions in moderate- severe non fluent aphasia patients [J]. Behav Neurol,2004,15:87-97.
[131]Martin PI, Naeser MA, Theoret H, et al. Transcranial magnetic stimulation as a complementary treatment for aphasia [J]. Semin Speech Lang,2004,25:181-191.
[132]Naeser MA, Martin PI, Nicholas M, et al. Improved picture naming in chronic aphasia after TMS to part of right Broca' area:an open-protocol study[J]. Brain Lang,2005,93: 95-105.
[133]Frogni F, Boggio PS, Mansur CG, et al. Transcranial direct current stimulation of the unaffected hemisphere in stroke patients[J]. Neuro report,2005,16:1551-1555.
[134]Mansur CG, Frogni F, Boggio PS, et al. A sham stimulation controlled hemisphere in stroke patients[J]. Neurology,2005,64:1802-1804.
[135]吕佳,海英.巨刺法治疗中风后偏瘫的作用机制探析[J].中医研究,2011,24(1)：69-70.
[136]邹成永.浅谈“维筋相交”[J].实用中医药杂志,2000,16(7)：44.
[137]解秸萍.巨刺法神经解剖学机制探讨[J].上海针灸杂志,1997,16(2)：28-29.
[138]徐振华,许能贵,易玮,等.不同针刺量对大鼠脑缺血后突触可塑性的影响[J].广州中医药大学学报,2009,26(1)：32-37.
[139]徐振华,许能贵,易玮,等.针刺对大鼠脑缺血后海马突触可塑性的促进作用[J].安徽中医学院学报,2007,26(3)：18-20.
[140]关建军,姬军风,吴世卫等.针灸益气活血方对血管性痴呆大鼠突触可塑性的实验研究[J].陕西中医,2008,29(10)：1416-1417.
[141]高家林,黄彬,罗素元等.吗啡依赖戒断焦虑大鼠海马突触结构的可塑性[J].解剖学杂志,2008,31(1)：40-42.
[142]张敏,图娅.电针对慢性应激抑郁模型大鼠海马糖皮质激素受体和N-甲基-D-天冬氨酸受体2B表达的影响[J].中国中医药信息杂志,2008,15(2)：25-27.
[143]卢峻.电针影响慢性应激抑郁模型大鼠神经可塑性的分子机制研究[D].北京：北京中医药大学,2004.
[144]汪芳俊,闵苏.突触可塑性的调节及生理学功能研究进展[J].中国老年学杂志,2006,26(1)：141-143..
[145]余曙光,罗松,韩婷等.电针对老年性痴呆大鼠海马神经元突触形态可塑性的影响研究[J].中华神经医学杂志,2006,5(4)：369-371.
[146]卢圣锋,邵欣,唐勇,等.电针促进阿尔茨海默病模型小鼠(SAMP8)海马神经元突触可塑性的神经细胞粘附机制[J].中国康复医学杂志,2008,23(12)：1057-1060.
[147]邵欣,余曙光,卢圣锋,等.电针对快速老化小鼠海马神经元突触超微结构的影响[J].中国老年学杂志,2009,29(4)：780-782.
[148]卢圣锋,唐勇,尹海燕,等.电针对SAMP8小鼠海马NCAM和NF-kB表达的影响[J].中华神经医学杂志,2009,8(3)：266-269.
[149]孙树敏.神经生长相关蛋白与突触可塑性[J].天津医科大学学报.2007,13(1)：118-121.
[150]严恒林.生长相关蛋白(GAP-43)与神经发育和再生[J],神经解剖学杂志,1993,9(2)：155.
[151]Gamby C, Waage MC, Allen RG, et al. Growth-associated protein 43(GAP-43) facilitates peptide hormone secretion in mouse anterior pituitary AtT-20 cells [J].J Biol. Chem, 1996,271(17):10023.
[152]管兴志,匡培根.脑缺血后生长相关蛋白43基因表达变化[J].国外医学脑血管疾病分册,2000：8(1)：9.
[153]Stewart HJ, Cowen T, Curtis R, et al. GAP-43 immnunoreactivity is widespread in the autonomic neurons and sensory neurons of the rat [J]. Neuroscience,1992,47(3):673.
[154]Qin H, Dent EW, Meiri KF. Modulation of action filament behavior by GAP-43 (neuromodulin) is dependent on the phosphorylation status of Ser41, the protein kinase C site[J]. J Neurosci,1997,17(10):3515.
[155]O'Driscoll CM,Gorman AM. Hypoxia induces neurite outgrowth in PC12 cells that is mediated through adenosine A2A receptors [J]. Neurosience,2005,131(2):321.
[156]Gomez-Pinilla F, Ying Z, Roy RR, et al. Afferent input modulates neurotrophins and synaptic plasticity in the spinal cord [J]. J Nerophysiol,2004,92(6):3423.
[157]Luque JM, Puign N, Mattinez JM, et al. Glutamate N-methy L-D-aspartate receptor blockade prevents induction of GAP-43 after focal ischemia in rats[J]. Neurosci Lett,2001, 305(2):87-90.
[158]Kotulska K, Marcol W, Larysz-Brysz M, et al. Impaired regeneration of bcl-2-lacking peripheral nerves [J]. Neurol Res,2005,27(8):843.
[159]王守彪.早期康复训练对大鼠脑缺血半影区GAP-43和P38mRNA表达的影响[J].青岛大学医学院学报,2003,39(27)：137-139.
[160]雷万龙,袁群芳,姚志彬.大鼠脑梗塞灶周围区GAP-43免疫组化反应的观察[J].解剖学研究,1999,21(1)：2225.
[161]Janh R, Schiebler W, Quimet C, et al. A-38000 Dal ton membrane protein (p38) present in synaptic vesicle[J]. Proc Natl Acad Sci USA,1985,82:4137-4141.
[162]Janz R, Sudhof TC, Hammer RE, et al. Essention roles in synaptic plascity for synaptogyrin I and synaptophysin[J]. Neuron,1999,24:687-700.
[163]Stroemer RP, Kent TA, Hulsebosch CE. Enhanced nerocortical neural sprouting, synaptogenesis, and behavioral recovery with damphetamine therapy after neocortical infarction in rats[J]. Stroke,1998,29:2381-2395.
[164]Stroemer RP, Kent TA, Hulsebosch CE, et al. Neocortical neural sprouting synaptogenesis and behavioral recovery after neocortical infarction in rats[J]. Stroke,1995,26:2135-2144.
[165]Stroemer RP, Kent TA, Hulsebosch CE. Increase in synaptophysin immunoreactivity following cortical infarction[J]. Neurosci Lett,1992,147:21-24.
[166]Martinez G, Di Giacomo C, Carnazza ML, et al. MAP2 synaptophysin immunostaining in rat brain and behavioral modifications after cerebral postischemic reperfusion[J]. Dev Neurosci,1997,19:457-464.
[167]黄如训,张艳,方燕南,等.大鼠脑梗死后运动功能可塑性物质基础及发生机制[J].中华医学杂志,2000,8：769-772.
[2]李红香,戴慎.中风病名探源[J].辽宁中医药大学学报,2011,13(4)：158-159.
[3]许玉皎.中风病名分析及现代中风病诊断[J].中医药导报,2011,17(5)：6-8.
[4]唐·孙思邈.备急千金要方[M].宋·林亿,注,刘更生,校正.北京：华夏出版社,1993：122.
[5]宋·赵佶.圣济总录[M].北京：人民卫生出版社,1962：220.
[6]元·王履.医经溯洄集[M].左言福,点注.南京：江苏科学技术出版社,1985：46.
[7]明·楼英.医学纲目[M].高登瀛,点校.北京：人民卫生出版社,1987：293.
[8]明·张介宾.景岳全书[M].夏之秋,校注.北京：中国中医药出版社,1994：128.
[9]清·叶天士.临证指南医案[M].华岫石,编订.北京：华夏出版社,1995：1-3.
[10]张锡纯.医学衷中参西录[M].王石凯,重校.石家庄：河北科学技术出版社,2002：192.
[11]郜峦,王键.中风病病因病机的源流及发展[J].中国中医急症,2009,18(8)：1279-1281.
[12]何华.中风先兆丸对椎-基底动脉系短暂性脑缺血发作患者血流动力学的影响[J].陕西中医,2006,27(11)：1334-1335.
[13]刘淑霞,杨秀洁,白宇望,等.醒脑通络片治疗缺血性中风63例[J].陕西中医,2005,26(7)：661-662.
[14]缪峰.化瘀通脉汤治疗缺血性中风恢复期114例[J].陕西中医,2007,28(10)：1311-1312.
[15]杨劲松,罗治华,钟妙文,等.降纤酶结合益气活血化瘀通络中药治疗进展性缺血性中风的临床研究[J].中西医结合心脑血管病杂志,2007,5(1)：26-27.
[16]罗萌,宋志宙.脑梗死的中医药治疗研究进展[J].中国中医急症,2008,17(7)：982-984.
[17]尹文姬,金香淑.通脉化瘀汤治疗血瘀型缺血性脑血管病74例[J].陕西中医,2009,30(2)：162-163.
[18]汪宁,刘青石,彭代银,等.通窍活血汤对小鼠脑缺血缺氧保护作用的研究[J].中国中药科技,2003,10(6)：933-934.
[19]尹思远,廖慧玲,杨思进,等.化瘀通络胶囊对脑缺血大鼠血管内皮细胞的影响[J].辽宁中医杂志,2008,35(3)：456-458.
[20]李玉芳,陈立平,范玲.开窍化痰通瘀法治疗脑梗死的临床观察[J].中华医学实践杂志,2007,6(1)：41-42.
[21]李京,曹锐,胡文忠,等.化痰祛瘀汤对脑梗死急性期组织型纤溶酶元激活物及其抑制物影响的临床观察[J].中国中西医结合急救杂志,2007,14(6)：333-336.
[22]张春燕.补肾活血汤对缺血性脑卒中治疗的临床观察[J].山西中医学院学报,2005,6(3)：21.
[23]张树泉,徐西元.补肾活血化痰方对大鼠脑缺血再灌注损伤的保护作用[J].中西医结合心脑血管病杂志,2005,3(6)：515-516.
[24]常富业,王永炎.中风病毒邪论[J].北京中医药大学学报,2004,27(1)：3-6.
[25]刘轲,徐江雁.益气活血、解毒降浊治疗缺血性脑卒中的理论探讨[J].北京京中医药大学学报,2004,27(2)：9-11.
[26]陈隐漪.黄连解毒汤对急性脑梗死患者的血清IL-6、TNF-a的影响[J].首都医药,2007,4：35-36.
[27]乔晓莉,肖学凤,高岚,等.黄连解毒汤中栀子苷在缺血性脑血管病模型大鼠体内的药动学研究[J].时珍国医国药,2008,19(10)：2462-2463.
[28]张勇.温胆汤加味治疗缺血性脑中风80例[J].河南中医,2005,25(9)：63-64.
[29]颜建云,吴伟康.四逆汤抗脑缺血的作用及其机制的研究[J].中山大学,2003.
[30]王青,马聪敏,刘倩玲.银杏达莫注射液治疗脑梗死的疗效观察[J].中国实用神经疾病杂志,2007,10(9)：69-71.
[31]李茯梅,段小毛,王俊杰,等.银杏叶提取物对脑缺血再灌注大鼠线粒体ATP敏感性钾通道的影响[J].中华中医药学刊,2008,26(7)：1462-1463.
[32]李世泽,白宏英,史振军,等.灯盏细辛对急性脑梗死患者sICAM-1和TNF-a的影响[J].中国实用神经疾病杂志,2007,10(5)：49-50.
[33]刘钦华,林小娟,王梅平.灯盏细辛注射液对脑梗死患者认知功能的影响[J].福建中医药,2007,38(6)：8-9.
[34]尉娜,杨纯生,李素芳.川芎嗪对急性脑梗死患者个血黏度及血红细胞聚集指数的影响[J].新乡医学院学报,2007,24(6)：588-589.
[35]王芳.川芎嗪对脑栓塞血浆、溶血磷脂酸水平的影响[J].中国实用神经疾病杂志,2007,10(4)：12-13.
[36]张奕文,牛建文,宋叶华.三七总皂苷对急性脑梗死患者血浆溶血磷脂酸的影响[J].临床荟萃,2006,,21(21)：1572-1573.
[37]韦羡华,黄春,曾祥发,等.三七总皂苷对急性脑梗死患者血清C反应蛋白水平的影响[J].福建中医药,2007,38(3)：4-6.
[38]孙振杰.手足十二针治疗脑梗死150例疗效观察[J].中医中药.2009,16(17)：81-83.
[39]叶信画.醒脑开窍针刺法治疗脑梗死35例[J].山东中医杂志,2009,28(7)：479-480.
[40]王颖.针刺风池、风府穴对中风后遗症患者脑血流速度的影响[J].中医药临床杂志,2005s,17(3)：251-252.
[41]王格红,郝重耀,贾运滨.针灸治疗中风后遗症60例临床观察[J].中西医结合心脑血管病杂志.2005,3(8)：741.
[42]张俊英,张海龙,付正良,等.分期辨证取穴针刺法治疗中风后遗症临床观察[J].中医中药,2007,4(27)：76-77.
[43]江丰,李常度,孟晓丹,等.针刺五志穴治疗中风后抑郁症的临床疗效观察[J]针灸临床杂志,2006,22(12)：25-26.
[44]潘永清.针刺八脉交会穴治疗中风后抑郁56例[J].陕西中医,2007,28(2)：199-200.
[45]揭子慧.针刺八脉交会穴治疗中风语言不利临床观察[J].天津医药.2007.35(9)：677.
[46]王顺,蔡玉颖,胡丙成,等.透穴刺法治疗中风后小脑性共济失调临床观察[J]中国针灸,2006,26(1)：75-77.
[47]张雅丽,倜,蔡玉颖.透穴刺法治疗中风后足内翻疗效观察[J],中国针灸,2006,26(1)：15-17.
[48]李永堂,周志华,吴洲红.脑出血患者的中西医结合治疗回顾分析[J].中国中医急症,2004,13(11)：774.
[49]谈福强.头针治疗中风24例临床观察[J].湖北中医杂志,2001,23(6)：44.
[50]张红星,张唐法.头针治疗中风病33例疗效观察[J].湖北中医杂志,2001,23(8)：41.
[51]杨秋汇.头针治疗急性期缺血性中风194例血液流变学观察[J].山西中医,2007,23(4)：54-56.
[52]杨富强.头针治疗急性缺血性卒中120例[J].中国实用神经疾病杂志,2009,12(11)：58-59.
[53]单丽华,周正国,曲芳,等.头皮针体针并用治疗急性脑梗死偏瘫76例[J].实用中医内科杂志,2008,22(4)：90-91.
[54]韩冰雪,唐强.头针配合十二井穴刺络放血治疗急性脑梗塞[J].辽宁中医杂志,2008,35(1)：120-121.
[55]梅晓明,孙利,刘淑美,等.头针加体针治疗中风后遗症69例[J].中国民间疗法,2005,13(5)：13-14.
[56]许佳年,贾怡蓓,韩天雄,等.针药结合对脑梗塞患者血脂和血液流变学的影响[J].辽宁中医杂志,2006,33(12)：1528-1529.
[57]李宗桥,韩永,陈会君,等.针药结合对急性脑梗死患者神经功能恢复的影响[J].针灸临床杂志,2006,22(10)：25-26.
[58]郝宏华.电针配合中药治疗中风后遗症[J].中西医结合心脑血管病杂志,2004,2(8)：492-493.
[59]曹银香,白炜玮,冯金萍,等.眼针治疗脑梗死半身不遂156例临床观察[J].河北中医,2008,30(3)：286-287.
[60]曹荣禄,杨改琴,黄丽萍,等.舌三针及人迎穴为主治疗脑卒中后吞咽功能障碍[J],陕西中医,2010,31(1)：89-90.
[61]史术峰.项针结合吞咽康复训练治疗脑卒中后吞咽困难[J].针灸临床杂志,2009,25(8)：18-19.
[62]陈丽贤,丁晓虹.腹针治疗脑梗死50例[J]中国临床康复,2004,8(19)：3823-3824.
[63]徐振华,符文彬,刘健华.腹针治疗脑卒中后感觉障碍15例[J].江西中医药,2009,5(40)：58-59.
[64]曹晶晶,陈英.电针联合巨刺法穴位注射治疗脑血管病引起的顽固性呃逆100例[J].河南职工医学院学报,2011,23(1)：53-55.
[65]万娇,李波,陈向阳等.巨刺导引复合针法对中风偏瘫运动功能康复的疗效观察[J].上海针灸杂志,2011,30(3)：160-161.
[66]武丹,娄必丹.巨刺法为主治疗中风后肩手综合征临床观察[J].新中医,2011,43(7)：117-119.
[67]杜伟.巨刺加电针疏密波治疗中风偏瘫疗效观察[J].上海针灸杂志,2010,29(2)：86-87.
[68]邹玮庚,徐远红,李海峰等.巨刺阳经法治疗缺血性脑卒中后上肢痉挛的临床观察[J].天津中医药,2010,27(4)：294-296.
[69]倪克锋,骆燕宁,王延武等.巨刺法结合持续静力牵张治疗中风后肌张力增高的临床观察[J].浙江中医药大学学报,2009,33(4)：576-577.
[70]宋维健.巨刺与刺络放血法治疗脑卒中后丘脑痛29例[J].针灸临床杂志,2009,25(10)：34-35.
[71]毕臻.巨刺配合患肢推拿治疗中风偏瘫60例[J].辽宁中医学院学报,2004,6(5)：410..
[72]王为凤.巨刺郄穴配合推拿治疗粘连期肩关节周围炎疗效观察[J].上海针灸杂志,2011,30(2)：110-112.
[73]张保球.运用巨刺及龙虎交战法的针刺手法合并温针灸治疗致密性髂骨炎50例[J].中国当代医药,2011,18(12)：97-98.
[74]旷秋和.火针巨刺治疗肱骨外上髁炎48例[J].中国民间疗法,2011,19(5)：21.
[75]张官印,张盈,闫凌.巨刺法配合拔火罐治疗落枕100例[J].光明中医,2010,25(12)：2270-2271.
[76]邢俊标.巨刺滞针法治疗急性肩周炎30例[J].现代中西医结合杂志,2007,16(35)：5307.
[77]朱维升.应用针灸巨刺法治疗痹证700例疗效观察[J].中国民族医药杂志,2007,11(11)：36.
[78]刘亚丽.巨刺法结合电针治疗原发性坐骨神经痛40例[J].针灸临床杂志,2004,20(9)：34.
[79]景宽,刘春,王雪峰.巨刺配合运动治疗肩周炎50例临床观察[J].吉林中医药,2004,27(7)：42.
[80]王舰,阙庆辉,林宇凡.肩三针巨刺治疗肩周炎100例[J].福建中医药,2003,34(6)：6.
[81]赵金奉,赵军,李长君.巨刺治疗周围性面神经炎并发症26例[J].针灸临床杂志,2011,27(6)：22-23.
[82]曹晓滨,秦毅,王倩.巨刺和温针法治疗面神经炎116例[J].陕西中医,2010,31(7)：890-891.
[83]张晓阳.巨刺法治疗顽固性周围性面瘫疗效观察[J].安徽中医学院学报,2008,27(6)：33-34.
[84]魏丽洁,宋玉明.巨刺、透刺与毛刺分期治疗周围性面瘫疗效观察[J].现代中西医结合杂志,2004,13(20)：2691.
[85]李进华.以巨刺透穴为主治疗周围性面瘫的临床观察[J].中国针灸,2004,S1：60-61.
[86]陈永平.巨刺法治疗面神经麻痹36例[J].江苏中医药,2003,24(9)：48.
[87]刘蓉.毛刺加巨刺治疗面肌痉挛35例[J].上海针灸杂志,2010,29(2)：73.
[88]孙盛,王瑛,安丽萍.止痉穴结合巨刺远取法治疗面肌痉挛临床观察[J].河北中医,2007,29(3)：241.
[89]罗文舒.针刺任脉加巨刺对脑卒中上肢体感诱发电位的影响[J].河南中医,2009,29(1)：84-85.
[90]罗文舒.针刺任脉加巨刺对脑卒中恢复期正中神经F波的影响[J].中国现代医生,2009,47(33)：1-2.
[91]刘光亭, 肖永俭.电针巨刺对中风偏瘫患者甲皱微循环的影响[J].针刺研究,1990,15(1)：40-43.
[92]刘光亭.巨针巨刺法对脑梗死患者脑血流图、血液流变学和血脂的影响[J]中国针灸,2004,24(10)：701-703.
[93]李连生,汤德安,徐汤萍等.巨刺对90例脑梗塞患者脑血流图的影响[J].天津中医学院学报,19892：27-29.
[94]吴钢,郑依勇.应用TCD研究巨刺法对脑血流动力学的影响[J].中国中医药科技,1997,4(1)：59-60.
[95]方剑乔,刘元亮.电针巨刺与患侧针刺镇痛的临床与实验研究[J].中国中西医结合杂志,1994,14(10)：579-582.
[96]朱丽霞,黎春元,莫孝荣,等.针刺镇痛选穴原则的探讨[J].生理科学.1984,4(5,6)：73-74.
[97]黄坤厚,戎象棣,徐文斌等.不同侧穴位电针对外周神经伤害性传入冲动影响的比较[J].针刺研究,1986 1：50-53.
[98]匡培根,吴爱华,张凤英.巨刺对穴位灌流液中乙酰胆硷含量的影响[J]针刺研究,19802：147-149.
[99]刘光亭,王淑敏,王力健.巨刺阳陵泉穴对胆道系统的影响[J].中国针灸,2003,23(1)：29-30.
[100]刘光亭.巨刺内关穴对冠心病病人左心功能的影响[J].中西医结合心脑血管病杂志,2005,3(7)：595-596.
[101]陈泽斌,熊迎春,吴昌清,等.电针刺激大鼠“肾俞”穴对下丘脑室旁核功能状态的影响[J].湖北中医学院学报,1999,1(1)：30-32.
[102]Morgen K, Kaclom N, Sawaki A, et al. Kinematic specificity of cortical reorganization associated with motor training [J]. Neuro image,2004,21:1182-1187.
[103]Rossini PM, Calautti C, Pauri F, et al. Post-stroke plastic reorganization in the adult brain[J]. Lancet Neurol,2003,2:493-502
[104]缪鸿石.中枢神经系统(CNS)损伤后功能恢复的理论(二)[J].中国康复理论与时间1996,1-5.
[105]Glees P, Cole J, Whiny CW, et al. The effects of lesions in the cingular gyrus and adjacent areas in monkeys=[J]. Journal of Neurology, Neuro surgery & Psychiatry,1950, 13 (3):178-190.
[106]王茂斌,主编.脑卒中的康复医疗[M].北京：中国科学技术出版社,2006.22-29.
[107]Fabisch W, Glees P,Macmillan AL. Hemispherectomy for the treatment of epilepsy in infantile hemiplegia; a review and a case report [J]. Monatsschrift fur Psychiatric and Neurologie,1955,130(6):385-405.
[108]Cao Y, D'Olhaberriague L, Vikingstad EM, et al. A pilot study of subjects recovered from hemiparetic stroke [J]. Stroke,1997,28:2518-2527.
[109]Von Voigtlander PF, Moore KE. Turning behavior of mice with unilateral 6-hydroxydopamine lesions in the striatum:effects of apomorphine, L-DOPA, amanthadine, amphetamine and other psychomotor stimulants [J]. Neuropharmacology,1973,12 (5): 461-462.
[110]Mishra RK, GardnerEL, Katzman R, et al. Enhancement of dopamine stimulated adenylate cyclase activity in rat caudate after lesions in substantia nigra:evidence for denervation supersensitivity [J]. Proceedings of the National Academy of Sciences of the United States of America,1974,71(10):3883-3887.
[111]Kalisker A, Rutledge, Perkins JP. Effect of nerve degeneration by 6-hydroxydopamine on catecholamine-stimulated adenosine 3',5'-monophosphate formation in rat cerebral cortex[J]. Molecular Pharmacology,1973,9(5):619-629.
[112]Huang M, Ho AK, Daly JW. Accumulation of adenosine cyclic 3',5'-monophosphate in rat treatment with 6-hydroxydopamine,2,3,5-trihydroxyphenethylamine, and dihydroxytryptamines [J]. Molecular Pharmacology,1973,9(6):711-717.
[113]许绍芬,主编.神经生物学[M].第2版.上海：复旦大学出版社.1999.88-94,99-111.457-463.
[114]Mitchell PJ, Tjian R. Transcriptional regulation in mammalian cells by sequence-specific DNA binding proteins [J]. Science,1989,245(4916):371-378.
[115]Gonzalez GA, Montminy MR, Cyclic AMP stimulates somatostatin gene transcription by phosphorylation of CREB at serine 133[J]. Cell,1989,59(4):675-680.
[116]Agnes F, Leonardo GC. Translational studies in neuro rehabilitation:From Bench to Bedside[J]. Cog Behav Neurol,2006,19:1-10.
[117]寿天德,主编.神经生物学[M].第2版,北京：高等教育出版社2006,184-185.
[118]Stroke Unit Trialists'Collaboration. Collaborative systematic review of the randomized trials of organized in patient (stroke unit) case after stroke[J]. BMJ,1997, 314:1151-1159.
[119]Argye E. Hillis. The right place at the right time [J]. Brain,2006,129:1351-1356
[120]Musso M, Weiller C, Kiebel, et al. Training-induced brain plasticity in aphasia[J]. Brain,1999,122 (pt9):1781-1790.
[121]De Boissezon X, Demonet JF, Puel M, et al. Subcortical aphasia:a longitudinal PET study [J]. Stroke,2005,36:1467-1473
[122]Pulvermuller F, Hauk 0, Zohsel K, et al. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia[J]. Neuroimage,2005,28:481-489.
[123]Winhuisen L, Thiel A, Schumacher B, et al. Role of the contralateral inferior frontal gyms in recovery of language frmction in post stroke aphasia:a combined repetitive transcranial magnetic stimulation and positron emisson tomography study [J]. Stroke,2005,36:1759-1763.
[124]ohansen Berg H, Rushwoith M, Bogdanovic MD, et al. The role of ipsilateral premotor cortex in hand movement after stroke[J]. Proc Natl Acad Sci USA 2002,99:14518-14523.
[125]Butehsch CM. Plasticity in the human cerebral cortex:lessons from the normal brain and from stroke[J]. Neuroscientist,2004,10:163-173.
[126]Ward NS, Brown MA, Thompson AJ, et al. Neural correlates of motor recovery after stroke:a longitudinal fMRI study[J]Brain,2003,26(ptll):2476-2496.
[127]Serrien DJ, Strens LH, Cassidy MJ, et al. Functional significance of the ipsilateral hemisphere during movement of the affected hand after stroke[J]. Exp Neurol, 2004,190:425-432.
[128]Calautti C, Leroy F, Guincestre JY, et al. Sequential activation brain mapping after subcoitical stroke; Changes in hemispheric balance and recovery [J]. Neuro report,2001, 12:3883-3886.
[129]Heiss WD, Kessler J, Thiel A, et al. Differential capacity of left and right hemispheric areas for compensation of post stroke aphasia[J]. Ann Neuro 1999,45430-438.
[130]Kurland J, Naeser MA, Baker EH, et al. Test-retest reliability of fMRI during nonverbal semantic decisions in moderate- severe non fluent aphasia patients [J]. Behav Neurol,2004,15:87-97.
[131]Martin PI, Naeser MA, Theoret H, et al. Transcranial magnetic stimulation as a complementary treatment for aphasia [J]. Semin Speech Lang,2004,25:181-191.
[132]Naeser MA, Martin PI, Nicholas M, et al. Improved picture naming in chronic aphasia after TMS to part of right Broca' area:an open-protocol study[J]. Brain Lang,2005,93: 95-105.
[133]Frogni F, Boggio PS, Mansur CG, et al. Transcranial direct current stimulation of the unaffected hemisphere in stroke patients[J]. Neuro report,2005,16:1551-1555.
[134]Mansur CG, Frogni F, Boggio PS, et al. A sham stimulation controlled hemisphere in stroke patients[J]. Neurology,2005,64:1802-1804.
[135]吕佳,海英.巨刺法治疗中风后偏瘫的作用机制探析[J].中医研究,2011,24(1)：69-70.
[136]邹成永.浅谈“维筋相交”[J].实用中医药杂志,2000,16(7)：44.
[137]解秸萍.巨刺法神经解剖学机制探讨[J].上海针灸杂志,1997,16(2)：28-29.
[138]徐振华,许能贵,易玮,等.不同针刺量对大鼠脑缺血后突触可塑性的影响[J].广州中医药大学学报,2009,26(1)：32-37.
[139]徐振华,许能贵,易玮,等.针刺对大鼠脑缺血后海马突触可塑性的促进作用[J].安徽中医学院学报,2007,26(3)：18-20.
[140]关建军,姬军风,吴世卫等.针灸益气活血方对血管性痴呆大鼠突触可塑性的实验研究[J].陕西中医,2008,29(10)：1416-1417.
[141]高家林,黄彬,罗素元等.吗啡依赖戒断焦虑大鼠海马突触结构的可塑性[J].解剖学杂志,2008,31(1)：40-42.
[142]张敏,图娅.电针对慢性应激抑郁模型大鼠海马糖皮质激素受体和N-甲基-D-天冬氨酸受体2B表达的影响[J].中国中医药信息杂志,2008,15(2)：25-27.
[143]卢峻.电针影响慢性应激抑郁模型大鼠神经可塑性的分子机制研究[D].北京：北京中医药大学,2004.
[144]汪芳俊,闵苏.突触可塑性的调节及生理学功能研究进展[J].中国老年学杂志,2006,26(1)：141-143..
[145]余曙光,罗松,韩婷等.电针对老年性痴呆大鼠海马神经元突触形态可塑性的影响研究[J].中华神经医学杂志,2006,5(4)：369-371.
[146]卢圣锋,邵欣,唐勇,等.电针促进阿尔茨海默病模型小鼠(SAMP8)海马神经元突触可塑性的神经细胞粘附机制[J].中国康复医学杂志,2008,23(12)：1057-1060.
[147]邵欣,余曙光,卢圣锋,等.电针对快速老化小鼠海马神经元突触超微结构的影响[J].中国老年学杂志,2009,29(4)：780-782.
[148]卢圣锋,唐勇,尹海燕,等.电针对SAMP8小鼠海马NCAM和NF-kB表达的影响[J].中华神经医学杂志,2009,8(3)：266-269.
[149]孙树敏.神经生长相关蛋白与突触可塑性[J].天津医科大学学报.2007,13(1)：118-121.
[150]严恒林.生长相关蛋白(GAP-43)与神经发育和再生[J],神经解剖学杂志,1993,9(2)：155.
[151]Gamby C, Waage MC, Allen RG, et al. Growth-associated protein 43(GAP-43) facilitates peptide hormone secretion in mouse anterior pituitary AtT-20 cells [J].J Biol. Chem, 1996,271(17):10023.
[152]管兴志,匡培根.脑缺血后生长相关蛋白43基因表达变化[J].国外医学脑血管疾病分册,2000：8(1)：9.
[153]Stewart HJ, Cowen T, Curtis R, et al. GAP-43 immnunoreactivity is widespread in the autonomic neurons and sensory neurons of the rat [J]. Neuroscience,1992,47(3):673.
[154]Qin H, Dent EW, Meiri KF. Modulation of action filament behavior by GAP-43 (neuromodulin) is dependent on the phosphorylation status of Ser41, the protein kinase C site[J]. J Neurosci,1997,17(10):3515.
[155]O'Driscoll CM,Gorman AM. Hypoxia induces neurite outgrowth in PC12 cells that is mediated through adenosine A2A receptors [J]. Neurosience,2005,131(2):321.
[156]Gomez-Pinilla F, Ying Z, Roy RR, et al. Afferent input modulates neurotrophins and synaptic plasticity in the spinal cord [J]. J Nerophysiol,2004,92(6):3423.
[157]Luque JM, Puign N, Mattinez JM, et al. Glutamate N-methy L-D-aspartate receptor blockade prevents induction of GAP-43 after focal ischemia in rats[J]. Neurosci Lett,2001, 305(2):87-90.
[158]Kotulska K, Marcol W, Larysz-Brysz M, et al. Impaired regeneration of bcl-2-lacking peripheral nerves [J]. Neurol Res,2005,27(8):843.
[159]王守彪.早期康复训练对大鼠脑缺血半影区GAP-43和P38mRNA表达的影响[J].青岛大学医学院学报,2003,39(27)：137-139.
[160]雷万龙,袁群芳,姚志彬.大鼠脑梗塞灶周围区GAP-43免疫组化反应的观察[J].解剖学研究,1999,21(1)：2225.
[161]Janh R, Schiebler W, Quimet C, et al. A-38000 Dal ton membrane protein (p38) present in synaptic vesicle[J]. Proc Natl Acad Sci USA,1985,82:4137-4141.
[162]Janz R, Sudhof TC, Hammer RE, et al. Essention roles in synaptic plascity for synaptogyrin I and synaptophysin[J]. Neuron,1999,24:687-700.
[163]Stroemer RP, Kent TA, Hulsebosch CE. Enhanced nerocortical neural sprouting, synaptogenesis, and behavioral recovery with damphetamine therapy after neocortical infarction in rats[J]. Stroke,1998,29:2381-2395.
[164]Stroemer RP, Kent TA, Hulsebosch CE, et al. Neocortical neural sprouting synaptogenesis and behavioral recovery after neocortical infarction in rats[J]. Stroke,1995,26:2135-2144.
[165]Stroemer RP, Kent TA, Hulsebosch CE. Increase in synaptophysin immunoreactivity following cortical infarction[J]. Neurosci Lett,1992,147:21-24.
[166]Martinez G, Di Giacomo C, Carnazza ML, et al. MAP2 synaptophysin immunostaining in rat brain and behavioral modifications after cerebral postischemic reperfusion[J]. Dev Neurosci,1997,19:457-464.
[167]黄如训,张艳,方燕南,等.大鼠脑梗死后运动功能可塑性物质基础及发生机制[J].中华医学杂志,2000,8：769-772.