本文關(guān)鍵詞： 腧穴配伍 結(jié)腸 效應(yīng)差異 內(nèi)臟大神經(jīng) 迷走神經(jīng) 脊髓側(cè)角 交感中樞　出處：《南京中醫(yī)藥大學(xué)》2017年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究目的:本研究以大鼠升結(jié)腸、橫結(jié)腸、降結(jié)腸的運(yùn)動(dòng)為觀察目標(biāo),觀察單穴與雙穴調(diào)節(jié)大鼠不同結(jié)腸段運(yùn)動(dòng)的效應(yīng)差異,并觀察針刺過(guò)程中左側(cè)內(nèi)臟大神經(jīng)、左側(cè)迷走神經(jīng)及左側(cè)脊髓側(cè)角神經(jīng)元的放電變化,以探索不同部位雙穴配伍的效應(yīng)規(guī)律及其可能的神經(jīng)生物學(xué)整合機(jī)制,為臨床合理應(yīng)用腧穴配伍提供科學(xué)依據(jù)。研究方法:1.在不同結(jié)腸段置入壓力感受水囊,觀察針刺單穴(左右天樞、左右上巨虛、左右曲池)與雙穴配伍(左右配伍:雙側(cè)天樞、雙側(cè)上巨虛、雙側(cè)曲池;上下配伍:曲池+上巨虛;遠(yuǎn)近配伍:天樞+上巨虛、天樞+曲池)對(duì)大鼠不同結(jié)腸段(升結(jié)腸、橫結(jié)腸、降結(jié)腸)腸內(nèi)壓的影響。2.通過(guò)引導(dǎo)電極記錄左側(cè)內(nèi)臟大神經(jīng)、左側(cè)迷走神經(jīng)的電活動(dòng),觀察針刺單穴與雙穴配伍對(duì)自主神經(jīng)自發(fā)放電的影響。3.通過(guò)玻璃微電極記錄左側(cè)脊髓側(cè)角神經(jīng)元的放電活動(dòng),觀察針刺單穴與雙穴配伍對(duì)脊髓側(cè)角神經(jīng)元自發(fā)放電的影響。實(shí)驗(yàn)結(jié)果:實(shí)驗(yàn)一:1.手針腹部單穴天樞抑制升結(jié)腸、橫結(jié)腸運(yùn)動(dòng),對(duì)降結(jié)腸作用不明顯;手針上下肢單穴曲池、上巨虛可興奮各結(jié)腸段運(yùn)動(dòng);2.手針左右天樞均對(duì)升結(jié)腸抑制效應(yīng)最明顯,手針左上巨虛對(duì)橫結(jié)腸興奮效應(yīng)最明顯,手針左曲池對(duì)降結(jié)腸、右曲池對(duì)升結(jié)腸興奮效應(yīng)最明顯;3.手針左右天樞對(duì)降結(jié)腸有效應(yīng)差異,手針左右上巨虛對(duì)升結(jié)腸有效應(yīng)差異,手針左右曲池對(duì)升結(jié)腸、降結(jié)腸有效應(yīng)差異;4.左右配穴對(duì)各腸段的效應(yīng)量及效應(yīng)方向均無(wú)明顯差異;上下配穴對(duì)升結(jié)腸的抑制效應(yīng)最強(qiáng),對(duì)降結(jié)腸的興奮效應(yīng)最強(qiáng);遠(yuǎn)近配穴對(duì)升結(jié)腸、橫結(jié)腸均有抑制趨勢(shì),對(duì)降結(jié)腸的興奮作用最強(qiáng);5.配穴效應(yīng)量均小于至少某一單穴效應(yīng)量,效應(yīng)方向與單穴效應(yīng)方向基本一致;6.配穴效應(yīng)總與某側(cè)單穴效應(yīng)呈正相關(guān)關(guān)系。實(shí)驗(yàn)二:1.手針天樞對(duì)內(nèi)臟大神經(jīng)放電的興奮作用最強(qiáng),手針曲池、上巨虛對(duì)迷走神經(jīng)放電的興奮作用最強(qiáng);2.手針左側(cè)天樞對(duì)內(nèi)臟大神經(jīng)的興奮作用強(qiáng)于右側(cè),手針右側(cè)曲池對(duì)迷走神經(jīng)的興奮作用強(qiáng)于左側(cè);手針左右上巨虛對(duì)自主神經(jīng)的放電均有興奮趨勢(shì);3.左右配伍中,對(duì)于內(nèi)臟大神經(jīng)放電的調(diào)節(jié),雙天樞的興奮效應(yīng)量小于左天樞、雙曲池的興奮效應(yīng)量大于單曲池、雙上巨虛的興奮效應(yīng)量與單穴相比無(wú)差異;對(duì)于迷走神經(jīng)放電的調(diào)節(jié),雙天樞、雙曲池、雙上巨虛的效應(yīng)量與單穴相比均無(wú)明顯差異;4.上下配伍中,雙穴與單穴對(duì)自主神經(jīng)放電的調(diào)節(jié)效應(yīng)均無(wú)明顯差異;5.遠(yuǎn)近配伍中,對(duì)于內(nèi)臟大神經(jīng)放電的調(diào)節(jié),雙穴的效應(yīng)量均小于天樞;對(duì)于迷走神經(jīng)神經(jīng)放電的調(diào)節(jié),雙穴的效應(yīng)量均小于上下肢單穴;6.不同部位單穴對(duì)內(nèi)臟大神經(jīng)放電、迷走神經(jīng)放電的調(diào)節(jié)效應(yīng)均有顯著差異;雙穴配伍對(duì)內(nèi)臟大神經(jīng)放電、迷走神經(jīng)放電的調(diào)節(jié)效應(yīng)大致無(wú)明顯差異。實(shí)驗(yàn)三:1.手針天樞對(duì)脊髓側(cè)角神經(jīng)元放電的興奮效應(yīng)最強(qiáng),總有效率達(dá)87.5%;手針曲池對(duì)脊髓側(cè)角神經(jīng)元放電的興奮效應(yīng)最小;2.單穴與雙穴配伍對(duì)脊髓側(cè)角神經(jīng)元的放電變化均有興奮效應(yīng)。結(jié)論:1.不同部位單穴的效應(yīng)差異與自主神經(jīng)系統(tǒng)關(guān)系密切,腹部單穴天樞主要通過(guò)興奮脊髓交感中樞-內(nèi)臟大神經(jīng)通路抑制結(jié)腸運(yùn)動(dòng);上肢單穴曲池主要通過(guò)迷走神經(jīng)通路興奮結(jié)腸的運(yùn)動(dòng);下肢單穴上巨虛可同時(shí)興奮內(nèi)臟大神經(jīng)通路及迷走神經(jīng)通路,對(duì)結(jié)腸運(yùn)動(dòng)的調(diào)節(jié)為無(wú)效或興奮。2.左右腧穴效應(yīng)差異可能與左右腧穴對(duì)自主神經(jīng)自發(fā)放電的效應(yīng)差異有關(guān)。左天樞對(duì)內(nèi)臟大神經(jīng)的興奮作用最強(qiáng),對(duì)結(jié)腸運(yùn)動(dòng)抑制效應(yīng)最強(qiáng);右曲池對(duì)迷走神經(jīng)的興奮作用最強(qiáng),對(duì)結(jié)腸運(yùn)動(dòng)興奮效應(yīng)最強(qiáng)。3.左右配伍與上下配伍出現(xiàn)較單穴效應(yīng)量減低的現(xiàn)象可能與腧穴配伍后興奮相拮抗的自主神經(jīng)有關(guān):四肢部單穴以興奮迷走神經(jīng)為主,而雙曲池、雙上巨虛、曲池+上巨虛均出現(xiàn)了興奮內(nèi)臟大神經(jīng)的效應(yīng),內(nèi)臟大神經(jīng)與迷走神經(jīng)效應(yīng)相拮抗,因此配穴效應(yīng)量均小于某側(cè)單穴或任一單穴。4.遠(yuǎn)近配伍、左右配伍、上下配伍出現(xiàn)較單穴效應(yīng)量減低的現(xiàn)象可能與配穴效應(yīng)在脊髓側(cè)角交感中樞的會(huì)聚有關(guān):天樞對(duì)脊髓側(cè)角神經(jīng)元放電變化的興奮效應(yīng)較強(qiáng),與曲池、上巨虛配伍使用后,脊髓側(cè)角神經(jīng)元放電變化率減小,相應(yīng)配穴效應(yīng)量也降低;左天樞對(duì)脊髓側(cè)角神經(jīng)元放電變化的興奮效應(yīng)最強(qiáng),與右天樞配伍使用后脊髓側(cè)角神經(jīng)元放電變化率減小,相應(yīng)配穴效應(yīng)量也降低。綜上所述,應(yīng)用不同部位單穴可以興奮不同的自主神經(jīng),從而引起不同效應(yīng)方向的結(jié)腸運(yùn)動(dòng);應(yīng)用不同部位雙穴配伍可以通過(guò)脊髓側(cè)角交感中樞的匯聚整合與自主神經(jīng)的相互拮抗作用,從而產(chǎn)生效應(yīng)量比較均衡的結(jié)腸運(yùn)動(dòng)。本次研究結(jié)果提示臨床中可以應(yīng)用單穴針對(duì)性治療某一腸段疾病,也可以應(yīng)用腧穴配伍進(jìn)行全身調(diào)節(jié)。
[Abstract]:Objective: in this study, rat ascending colon, transverse colon, descending colon movement as the observation target, observe the difference effect of single point and double cavity adjusting different rat colon movement, and to observe the left splanchnic nerve during acupuncture, the left vagus nerve and left lateral horn of spinal cord nerve discharge in yuan, in effect to explore different parts of two acupoints and nerve biology possible integration mechanism, provide scientific basis for the clinical application of acupoints compatibility. Methods: 1. different pressure in the implantation of colon segment feel the water sac, observation of single point acupuncture (left and right Tianshu, around about double and Shangjuxu, Quchi acupoints (left and right) with bilateral Tianshu bilateral, bilateral Shangjuxu, Quchi; upper and lower compatibility: Quchi Shangjuxu; distance compatibility: Tianshu Shangjuxu, Tianshu) of rat Quchi + colon (colon, transverse colon, descending colon) effect of enteral pressure.2. Through the guide electrodes to record the left splanchnic nerve, vagus nerve electrical activity, and observation of single point acupuncture and acupoints in spontaneous discharge discharge effect of.3. by glass microelectrode recording of left lateral horn of spinal cord neurons of the autonomic nervous system, acupuncture single point and double hole combined effects on the spontaneous discharge of neurons in lateral horn of spinal cord of experimental. Results: experiment one: 1. hand needle abdominal single point Tianshu inhibit transverse movement, ascending colon, descending colon is not obvious on the effect of hand acupuncture on the lower extremity; single acupoint Quchi, each can be excited Shangjuxu colon segment movement; 2. hand needle pivot on the ascending day about the most obvious inhibitory effect, the left hand acupuncture Shangjuxu on transverse effect is the most exciting obviously, the left hand needle Quchi of descending colon, right on the ascending excitatory effect most obvious Quchi; 3. hand needle on the left and right Tianshu descending colon effect difference, hand acupuncture has effect on the ascending difference about 37, Left and right hand needle Quchi of ascending colon, descending colon effect difference; there were no significant difference between the 4. points on the effect of various intestinal segments and the effect direction; on the coordination of the inhibitory effect of acupuncture on the ascending of the strongest of the strongest excitatory effect of the descending colon; distal acupoints on the ascending colon, transverse colon inhibited the trend of excitement the strongest effect of descending colon; 5. acupoints effect quantity were less than at least one single point effect, effect and direction effect of single point direction; 6. points total effect was positively correlated with a single point side effect relationship. Experiment two: 1. the strongest excitatory effect of hand acupuncture to Tianshu splanchnic nerve discharge, hand needle Quchi, Shangjuxu excited the strongest effects on excitatory effect of vagus nerve discharge; 2. hand needle on the left Tianshu splanchnic nerve on the right side of the strong, the excitatory effect of vagus nerve on the right hand needle Quchi is stronger than the left hand needle; around the giant virtual independent of God The trend of the discharge are excited; about 3. compatibility, for the regulation of splanchnic nerve discharge, the amount of excitatory effect is less than the left double Tianshu Tianshu, the amount of excitatory effect is greater than the single hyperbolic pool pool, the amount of excitatory effect and single point double 37 compared with no difference; the vagal discharge regulation, double Tianshu, double pool, double the amount and effect of Shangjuxu single point showed no significant difference; 4. on compatibility, there were no significant difference between the effects of double point and single point of autonomic nerve discharge; 5. distance formula, for the regulation of splanchnic nerve discharge, the effect of amount of acupoints were less than Tianshu for regulating; the effect of vagus nerve discharge, amount of double points are less than the upper and lower limbs of single point; 6. different parts of a single point on the splanchnic nerve discharge, there was significant difference in regulating effect of vagus nerve discharge; double acupoints on visceral Bryant after discharge, discharge of vagus nerve Generally no significant difference between the moderating effect of electricity. Experiment three: 1. hand acupuncture Tianshu excitement effect on lateral horn of spinal cord neurons was the strongest, the total effective rate was 87.5%; excitatory effect of hand acupuncture Quchi on lateral horn of spinal cord neurons with 2. minimum; single point and double hole on the discharge change has the excitatory effect of lateral horn of spinal cord nerve yuan. Conclusion: the close relationship between the 1. different parts of the single point and the effect of autonomic nervous system, abdomen single point Tianshu mainly through the spinal cord - the central sympathetic splanchnic nerve pathway inhibition of colon movement; upper limb single acupoint Quchi mainly through vagal pathway excited colon movement; lower extremity single point simultaneously excited Shangjuxu splanchnic nerve pathway and vagal pathway, regulation of colonic motility is invalid or excited about.2. acupoint effect difference may be related to differences and effects about acupoints on the spontaneous discharge of autonomic nerve. Days left Most of the excitatory effects of pivot splanchnic nerve, the strongest inhibitory effect on colonic motility; the strongest excitatory effect of vagus nerve right Quchi, autonomic nerve excitatory effect on colonic motility strongest about.3. compatibility and lower compatibility compatibility may appear than single acupoint effect decreased after the combination of acupoints phenomenon and excited about: single limb acupuncture point to excite vagus nerve, while the double double Quchi, Shangjuxu, Quchi Shangjuxu appeared excited effect of splanchnic nerve and splanchnic nerve and vagus nerve effect combination of acupoints, so the effect of the volume were less than a single point or either side of single point.4. is about compatibility, compatibility, compatibility may appear upper and lower than single acupoint effect decreased with the effect of acupoints on the phenomenon of convergence in lateral horn of spinal cord: central sympathetic excitatory effect on Tianshu lateral horn of spinal cord neurons change strong, and Quchi, with 37 Wu after use, lateral horn of spinal cord neurons change rate decreases, the corresponding acupoints effect also decreased; left Tianshu excitatory effect on lateral horn of spinal cord neurons change the strongest, and the use of the right combination of spinal cord lateral horn neurons at the rate of change is reduced, the corresponding acupoints effect quantity is reduced. In summary, the application of different parts of a single points of autonomic nervous excited, which caused different effects of colonic motion direction; different parts of application of double acupoints by lateral horn of spinal cord and the integration of convergence of central sympathetic autonomic antagonism, resulting in the effect of a more balanced colonic motility. The results of this study suggest that the application of targeted therapy in a single point bowel disease can be clinically, can also be used for general acupint compatibility regulation.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R245

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