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目的:观察温针经筋刺法联合点刺井穴放血对中风后肩手综合征(SHS)患者甲襞微循环、血液流变学及降钙素基因相关肽(CGRP)、血清P物质(SP)的影响.方法:将72例患者按随机数字表法分为观察组和对照组,每组36例.对照组给予肢体康复锻炼,观察组在此基础上加用温针经筋刺法和点刺井穴放血治疗,疗程均为4周.治疗后比较两组临床疗效,观察肩手综合征评估量表(SHSS)、简化Fugl-Meyer上肢运动功能评定量表(FMA-UE)、视觉模拟量表(VAS)、日常生活能力(ADL)评分、中医证候评分、甲襞微循环、血液流变学指标[全血黏度(高切、低切)、红细胞比容、红细胞沉降率(ESR)]、CGRP及SP水平变化.结果:观察组总有效率86.1％,高于对照组的63.9％(P<0.05),观察组整体疗效优于对照组(P<0.05).治疗后,两组SHSS中的痛觉、水肿、臂部外转及外旋评分和总分均较治疗前显著降低(均P<0.05),且观察组各项评分均低于对照组(均P<0.05).治疗后,两组VAS和中医证候评分均较治疗前显著降低(均P<0.05),FMA及ADL评分均显著升高(均P<0.05),且观察组VAS和中医证候评分均低于对照组(均P<0.05),而FMA和ADL评分均高于对照组(均P<0.05).治疗后,两组全血黏度(高切和低切)和红细胞比容均较治疗前明显下降(均P<0.05),ESR均较治疗前明显升高(均P<0.05),且观察组全血黏度(高切和低切)和红细胞比容均低于对照组(均P<0.05),而ESR高于对照组(P<0.05).治疗后两组甲襞微循环中的管周状态、管袢形态、血流形态评分及总分均较治疗前显著下降(均P<0.05),且观察组各项评分均低于对照组(均P<0.05).治疗后,两组SP均较治疗前明显降低(均P<0.05),CGRP均较治疗前明显升高(均P<0.05),观察组SP水平低于对照组(P<0.05),而CGRP水平高于对照组(P<0.05).结论:相较于常规肢体康复锻炼,温针经筋刺法联合点刺井穴放血治疗SHS能显著减轻临床症状,促进肢体功能恢复,改善甲襞微循环和血液流变学指标,调节CGRP和SP等细胞因子水平.“,”Objective: To observe the effect of muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in improving nail fold microcirculation in the patients with shoulder-hand syndrome (SHS) after stroke, and the effects on hemorrheology, calcitonin gene-related peptide (CGRP) and serum substance P (SP). Methods: A total of 72 patients were randomized into an observation group and a control group by the random number table method, with 36 cases in each group. The control group was treated with physical rehabilitation training, and the observation group was treated with additional muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment. The treatment course lasted for 4 weeks. After treatment, the clinical efficacy of the two groups was compared. The changes in shoulder-hand syndrome scale (SHSS), simplified Fugl-Meyer assessment-upper extremity (FMA-UE), visual analog scale (VAS), activities of daily living (ADL), traditional Chinese medicine (TCM) syndrome score, nail fold microcirculation hemorheology indictors [whole blood viscosity (high-shear, low-shear), hematocrit, erythrocyte sedimentation rate (ESR)], CGRP and SP levels were observed. Results: The total effective rate in the observation group was 86.1％, higher than 63.9％ in the control group (P<0.05). The overall curative effect in the observation group was better than that in the control group (P<0.05). After treatment, the scores of pain sensation, edema, external turn and rotation of the arm in SHSS, and the total score were significantly decreased in both groups (all P<0.05), and each score in the observation group was lower than that in the control group (all P<0.05). After treatment, the scores of VAS and TCM syndrome in both groups decreased significantly (all P<0.05), and the scores of FMA-UE and ADL increased significantly (all P<0.05). The scores of VAS and TCM syndrome in the observation group were lower than those in the control group (both P<0.05), and the scores of FMA-UE and ADL were higher than those in the control group (both P<0.05). After treatment, the whole blood viscosity (high-shear and low-shear) and hematocrit in both groups decreased obviously (all P<0.05), and ESR increased obviously (both P<0.05), and the whole blood viscosity (high-shear and low-shear) and hematocrit in the observation group were lower than those in the control group (all P<0.05), and ESR was higher than that in the control group (P<0.05). After treatment, the peritubular state, loop shape, blood flow and total score of nail fold microcirculation in both groups decreased significantly (all P<0.05), and each score in the observation group was lower than that in the control group (all P<0.05). After treatment, SP in both groups decreased obviously (both P<0.05), CGRP increased obviously (both P<0.05), and SP in the observation group was lower than that in the control group (P<0.05), CGRP was higher than that in the control group (P<0.05). Conclusion: Compared with conventional physical rehabilitation training, muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment can significantly reduce the clinical symptoms of SHS, promote the recovery of physical functions, improve the nail fold microcirculation and hemorrheology indictors, and regulate the serum cytokine levels such as CGRP and SP.