陰陽辨證合併肉毒桿菌注射，指引針刺治療中風後上肢痙攣病例報告

A Case Report of Acupuncture Treatment in Upper Limb Spasticity in Stroke Patients Based on Differential Diagnostics of Yin-yang Combined with Botulinum Toxin Injection Guide

本病例為63歲男性腦中風上肢痙攣患者。此病患就診時左上肢手肘屈曲、拳頭緊握、無法伸展。思考如何選擇穴位來緩解此病患的上肢痙攣程度。醫者依據陰陽辨證並參考肉毒桿菌注射指引選取相近之穴位，對病患施予中醫針刺的治療。經過5個月的中醫針刺和復健治療，病患Modified Ashworth Scale從3分進步到1分，患者左上肢痙攣狀況獲得改善。中風患者施打肉毒桿菌素治療肢體痙攣，每次花費新台幣1萬元至2萬元之間，相對昂貴且需要重複治療。此病患在無施打肉毒桿菌的情形下，進行中醫針刺和復健的治療。針刺的選穴方式採用中醫的陰陽辨證並參考西醫的肉毒桿菌注射指引所建議之肌肉注射部位進行取穴，結果可緩解此病患上肢痙攣。中醫針刺以根據陰陽辨證合併肉毒桿菌注射指引取穴，將可提供中風痙攣患者便宜有效的治療選擇。

This is a 63-year-old male with upper limb spasticity caused by stroke. At the time of consultation, the elbow of the left upper limb was flexed, the fist was clenched, and the elbow and fingers were difficult to extend. Consider how to choose acupuncture points to relieve the upper limb spasticity of this patient. We select the acupoint points based on the yin-yang differentiation and refer to botulinum toxin injection guide. After 5 months of acupuncture and rehabilitation treatment, the patient's left upper limb spasticity improved and the Modified Ashworth Scale improved from 3 to 1. A stroke patient's limb spasticity is treated with botox, which each time costs NT10,000 to NT20,000, which is relatively expensive and requires repeated treatment. The patient underwent acupuncture and rehabilitation without botox injection. The method of acupoint selection is based on yin-yang differentiatal diagnostics and refer to the botox injection guidelines to select similar acupoints. Acupuncture based on the differential diagnostics of yin-yang combined with botulinum toxin injection guide will provide a cheap and effective treatment option for stroke patients.