本文選題：針灸 + 肝膽��； 參考：《廣州中醫(yī)藥大學(xué)》2013年博士論文

【摘要】：為了更清楚的定義中醫(yī)學(xué)的偏頭痛診斷標(biāo)準(zhǔn)以及如何與西醫(yī)的診斷相關(guān),為中醫(yī)學(xué)現(xiàn)代化發(fā)展以及更為廣泛地在歐美國家被接受,本課題力圖通過理論及臨床資料的探討與分析,明確偏頭痛在中、西醫(yī)兩個(gè)醫(yī)學(xué)體系中的臨床標(biāo)志性特征以及肝膽在其發(fā)病機(jī)理中所起的重要作用,為針灸臨床診斷和治療偏頭痛提供堅(jiān)實(shí)的中西醫(yī)理論和臨床依據(jù)。本課題的研究目的在于探討以下問題：基于中醫(yī)理論和臨床觀察基礎(chǔ)上的偏頭痛與和肝膽相關(guān)性的探討；西醫(yī)對(duì)偏頭痛的理解及其與中醫(yī)理論中肝、膽關(guān)系的探討；針灸調(diào)理肝膽法治療偏頭痛的理論基礎(chǔ)和臨床依據(jù)探討。 方法與內(nèi)容 一.方法 本課題運(yùn)用文獻(xiàn)研究的方法,從中、西醫(yī)角度分析、探討肝膽與偏頭痛病理生理及治療之間的關(guān)系。 二.內(nèi)容 1.從中醫(yī)理論及臨床角度探討肝膽與偏頭痛的關(guān)系 1.1偏頭痛的中醫(yī)發(fā)病機(jī)制 陽氣的生理和病理在內(nèi)經(jīng)中是一個(gè)重要問題。綜合來說,內(nèi)經(jīng)認(rèn)為,腦為髓海,是人體手、足陽經(jīng)及督脈會(huì)聚的地方,亦是人體精氣會(huì)聚之處。五藏六腑之氣血皆上注于頭,正因如此,當(dāng)陽氣功能亢進(jìn)或陰陽失調(diào)時(shí),頭部就很容易受到影響。比如,《黃帝內(nèi)經(jīng)·素問》曰：“故春氣上于頭”,這里的春氣即指肝氣。肝主疏泄,表現(xiàn)為肝氣向上、向外的運(yùn)動(dòng),其自然屬性就是運(yùn)行到人體的最高點(diǎn),即頭部。也就是說,一旦肝氣的運(yùn)動(dòng)方式出現(xiàn)問題,就容易影響到頭部功能,這對(duì)偏頭痛來說是一個(gè)重發(fā)病因素的。 1.2正常的肝膽關(guān)系 肝膽之間通過它們各自所連屬的經(jīng)脈形成了表里關(guān)系,這使得二者之間不可能獨(dú)立發(fā)揮各自的功能,二者在生理和病理方面均相互影響。中醫(yī)理論中,肝的生理功能和特征有：儲(chǔ)存血液、疏泄氣機(jī)、主筋、其華在爪甲、開竅于目、主魂；膽的主要功能是儲(chǔ)存和分泌由充盛的肝氣所化生的膽汁,滿足身體的需求。肝膽相表里,命門之火和膽共同協(xié)助肝臟行氣。 1.3偏頭痛與肝膽關(guān)系的臨床研究 Blackwell、Facco等學(xué)者報(bào)道,臨床上80%的偏頭痛患者因肝陽上亢引發(fā)；Flaws、Sionneau、學(xué)者尹氏、劉氏等也認(rèn)為,偏頭痛患者常因肝陽上亢引發(fā)；Flaws和Sionneau的研究也認(rèn)為,中醫(yī)理論中,偏頭痛通常由肝功能紊亂引起,尤其是肝陽上亢。學(xué)者陳氏、Coeytaux等人研究發(fā)現(xiàn),46%的偏頭痛患者存在肝血淤滯的情況；肝血淤滯引起的疼痛一般為固定痛,具體稱為掣痛或燒灼痛；血淤型偏頭痛發(fā)生的一般原因?yàn)轭^部經(jīng)絡(luò)之氣的運(yùn)行不暢,進(jìn)而造成淤血,這種情況的產(chǎn)生多由于肝陽上亢后造成膽經(jīng)之氣血運(yùn)行受阻,引發(fā)刺痛、掣痛等偏頭痛特有的癥狀,這些疼痛一般位于眼后或太陽穴附近,由此可推斷淤血發(fā)生在膽經(jīng)及其旁絡(luò),也有可能涉及三焦經(jīng)及其旁絡(luò)；臨床上,淤血一般是由于氣滯逐漸加重引起,多引起于慢性偏頭痛。 2.西醫(yī)對(duì)于偏頭痛的認(rèn)識(shí)及與中醫(yī)理論中肝膽的關(guān)系 2.1西醫(yī)偏頭痛的臨床表現(xiàn) 典型的偏頭痛表現(xiàn)為間斷性發(fā)作的、嚴(yán)重的、跳動(dòng)性的一側(cè)頭痛,常伴有神經(jīng)系統(tǒng)功能障礙的表現(xiàn)如惡心、聲音恐懼癥(對(duì)噪音敏感)或畏光(對(duì)光線敏感)等。 2.2偏頭痛發(fā)作時(shí)常見的疼痛部位 疼痛的部位通常沿三叉神經(jīng)和顳區(qū)的上頸神經(jīng)根附近分布；研究顯示,疼痛更常出現(xiàn)的在顳區(qū)而不是巔頂或枕骨下區(qū)域；而從中醫(yī)經(jīng)絡(luò)理論的角度來看,在大腦顳區(qū)(太陽穴)疼痛處,我們可看到三叉神經(jīng)路徑和膽經(jīng)及其旁絡(luò)之間的相互關(guān)系；膽經(jīng)和三焦經(jīng)之間的相互關(guān)系更解釋了這一點(diǎn),即二者都穿過太陽穴,與三叉神經(jīng)的路徑非常相似；肝經(jīng)支絡(luò)與目周圍組織的聯(lián)系與三叉神經(jīng)在眼區(qū)的分布十分相似。 2.3偏頭痛的病理生理學(xué) 偏頭痛是一種復(fù)雜的腦部功能紊亂,一種其發(fā)病的病理生理學(xué)基礎(chǔ)尚不十分清楚的血管神經(jīng)性頭痛。曾經(jīng),血管功能改變被認(rèn)為是其發(fā)病的唯一原因,但目前,理論研究認(rèn)為,偏頭痛的發(fā)生原因與神經(jīng)系統(tǒng)功能異常有關(guān),并隨之激活三叉神經(jīng)血管系統(tǒng),被激活的這個(gè)系統(tǒng)會(huì)增加神經(jīng)肽的釋放,并導(dǎo)致頭部的疼痛,而腦血流量的變化本身并不會(huì)導(dǎo)致疼痛的產(chǎn)生�？磥�,導(dǎo)致偏頭痛產(chǎn)生的主要原因是神經(jīng)肽而不是血管管徑的改變。這個(gè)有關(guān)偏頭痛的發(fā)病機(jī)理的新理論推動(dòng)了對(duì)偏頭痛發(fā)病機(jī)理的認(rèn)識(shí)。 科技的進(jìn)步已經(jīng)使得人們對(duì)理解腦血管收縮和擴(kuò)張和由此產(chǎn)生的神經(jīng)肽級(jí)聯(lián)在偏頭痛發(fā)病過程中所扮演的完整角色。有中醫(yī)學(xué)者認(rèn)為,血管直徑的改變是受營氣和衛(wèi)氣支配的,營衛(wèi)之間的協(xié)調(diào)平衡共同調(diào)節(jié)著血管的管徑。營主血管擴(kuò)張,衛(wèi)主血管收縮的過程與血管內(nèi)皮有關(guān),學(xué)者們把營氣和衛(wèi)氣的功能分別等同于一氧化氮和降鈣素基因相關(guān)肽。他們認(rèn)為,經(jīng)絡(luò)氣血郁滯引起偏頭痛是源于營衛(wèi)之氣失衡。 3.針灸調(diào)理肝膽法治療偏頭痛的理論基礎(chǔ)及臨床依據(jù) 3.1針灸穴位治療效果觀察 研究證實(shí),針刺太沖穴15分鐘后,鼻、顳側(cè)睫狀后短動(dòng)脈阻力指數(shù)(P0.05)比基線明顯下降,研究者得出結(jié)論：針刺太沖穴對(duì)降鈣素基因相關(guān)肽、一氧化氮以及神經(jīng)源性血管擴(kuò)張有效；從中醫(yī)理論的角度來看,太沖穴可用于偏頭痛引起的視覺功能異常的治療,這項(xiàng)研究為中醫(yī)理論的正確性作了充分的論證；針刺百會(huì)穴后,在安靜的情況下,大腦中動(dòng)脈、大腦前動(dòng)脈的血流量顯著升高,該研究顯示針刺百會(huì)穴能有效提高腦血流量。從中醫(yī)理論的角度來看,我們知道當(dāng)人體陽氣上升到頂點(diǎn)時(shí)就是人體的百會(huì)穴,百會(huì)也是人體內(nèi)風(fēng)上升后到達(dá)之處,同時(shí),百會(huì)穴還有使膽經(jīng)之氣下降的功能。這項(xiàng)研究對(duì)百會(huì)穴在中醫(yī)臨床中常用于治療相關(guān)癥狀的理論提供了有利的實(shí)驗(yàn)研究依據(jù)；針刺風(fēng)池穴能有效調(diào)節(jié)人體的免疫系統(tǒng)及減輕血管內(nèi)皮損傷。通過調(diào)節(jié)肝膽氣機(jī),風(fēng)池穴在降低肝陽上亢型偏頭痛患者的血清白細(xì)胞介素-6水平方面起重要作用；針刺合谷穴、太沖穴(四關(guān)穴)后,血一氧化氮升高；大腦額葉、枕骨腦葉、顳葉處的血流量均升高；該研究同時(shí)認(rèn)為,太沖穴(四關(guān)穴)的作用機(jī)理在于,肝膽經(jīng)均到達(dá)頭部,而無論穴位在該經(jīng)的哪個(gè)位置,這些穴位都可治療該經(jīng)運(yùn)行路線上所有部位的癥狀,盡管選穴的位置離癥狀所在位置很遠(yuǎn)。具體表現(xiàn)在針灸理論中,就是遠(yuǎn)端取穴�？偟膩碚f,這些穴位能調(diào)節(jié)腦部血管的收縮和擴(kuò)張、提高腦部血流量、調(diào)節(jié)炎癥反應(yīng)。 3.2針灸與西醫(yī)藥物治療的臨床療效比較 某項(xiàng)研究將針灸的治療效果與偏頭痛的非處方藥物的治療效果進(jìn)行了比較。針灸治療組選用的穴位有：合谷、太沖、百會(huì)、率谷、風(fēng)池、外關(guān)、足臨泣、三陰交、印堂,治療原則是疏理肝膽、平抑肝陽、止痛。統(tǒng)計(jì)結(jié)果顯示,與西藥治療對(duì)照組比較,針灸治療組每位患者的偏頭痛的疼痛程度都比治療前有明顯下降(P.014)；與西藥治療對(duì)照組比較,針灸治療組患者偏頭痛發(fā)生的平均頻率均明顯下降(P0.006)；實(shí)驗(yàn)結(jié)果顯示,針灸治療對(duì)偏頭痛效果顯著,且無副作用。 結(jié)果 肝陽上亢是引起偏頭痛的最常見的原因,而肝氣郁結(jié)又是引起肝陽上亢的重要原因,二者也可同時(shí)引起偏頭痛,肝血淤是引發(fā)偏頭痛的第三個(gè)主要原因。情緒因素又是引發(fā)肝陽上亢的重要原因,憤怒、沮喪、長期擔(dān)憂等都會(huì)造成肝氣郁滯并進(jìn)而演變成肝陽上亢。 西醫(yī)中的偏頭痛與中醫(yī)中的肝陽上亢型偏頭痛(疼痛沿膽經(jīng)分布)最為接近,針灸調(diào)理肝膽法治療偏頭痛與西藥、安慰劑等的療效相比是十分成功的。 結(jié)論 一.偏頭痛常見發(fā)病部位在膽經(jīng)運(yùn)行路線上,尤其是太陽穴附近,而很少發(fā)生在足厥陰肝經(jīng)所屬的巔頂。 二.偏頭痛的發(fā)生與肝膽氣機(jī)損傷有關(guān)。從偏頭痛發(fā)作時(shí)疼痛的位置、性質(zhì)、間隔時(shí)間、伴見癥狀等來看,都充分論證了肝膽及它們所屬的經(jīng)絡(luò)在該病的發(fā)病原因中所起的重要作用。 三.針灸調(diào)理肝膽法治療偏頭痛的生理學(xué)研究能填補(bǔ)西醫(yī)模型的不足,同時(shí)更好地解釋中醫(yī)理論。目前,中醫(yī)對(duì)偏頭痛的發(fā)病機(jī)制和治療原則方面比西醫(yī)有更完整和深入的理解。未來中西醫(yī)在偏頭痛的研究方面如果有更深入的研究和交流,將對(duì)肝膽在偏頭痛發(fā)病中所扮演的角色及確立最佳的針灸治療策略發(fā)揮更好的作用。
[Abstract]:In order to define more clearly the diagnostic criteria of migraine in traditional Chinese medicine and how to be related to the diagnosis of Western medicine, for the modernization of Chinese medicine and more widely accepted in European and American countries, this topic tries to make clear the clinical indications of two medical systems in migraine and Western medicine through the discussion and analysis of theoretical and clinical data. The important role of the syndrome and the liver and gallbladder in its pathogenesis provides a solid Chinese and Western medicine theory and clinical basis for the clinical diagnosis and treatment of migraine by Acupuncture and moxibustion. The purpose of this study is to discuss the following problems: a study of the correlation between migraine and liver and gallbladder based on the theory of traditional Chinese medicine and clinical observation; and migraine in western medicine. To understand the relationship between liver and gallbladder in TCM theory, and explore the theoretical basis and clinical basis of acupuncture and moxibustion for liver and gallbladder therapy.
Method and content
One. Method
In this study, the relationship between liver and gallbladder and pathophysiology and treatment of migraine is discussed from the perspective of Chinese and Western medicine.
Two. Content
1. discuss the relationship between liver and gallbladder and migraine from TCM theory and clinical point of view.
1.1 pathogenesis of migraine in traditional Chinese Medicine
The physiology and pathology of Yang Qi is an important problem in the inner meridian. In general, the inner meridian is thought that the brain is the medullary sea, the human hand, the place where the foot Yang Meridian and the supervision pulse gather together. It is also the place where the human body is concentrated. The Qi and blood of the five Hans and the six Fu organs are all injected into the head, and the head is easily affected when the function of Yang Qi is hyperactive or the Yin and yang imbalance. For example, "the Huangdi Neijing" said, "so the spring gas is on the head", the spring gas here refers to the liver qi. The liver main discharge is manifested as the liver Qi upward, outward movement, its natural property is to run to the highest point of the human body, that is, the head function is easy to affect the head function once the liver qi movement has problems, this is a headache to migraine. It is a serious cause of disease.
1.2 normal relationship of liver and gallbladder
Between the liver and gallbladder through their respective meridians formed a relationship, which makes it impossible for the two to perform their own functions independently, and the two in both physiological and pathological aspects. The physiological functions and characteristics of the liver are: the storage of blood, the drain machine, the main tendons, its claw a, the head, the soul; the gall. The main function is to store and secrete the bile that is filled with liver qi to meet the needs of the body. In the liver and gallbladder form, the fire and the bile of the life of the life together assist the liver.
Clinical study on the relationship between 1.3 migraine and liver and gallbladder
Blackwell, Facco and other scholars reported that 80% of the clinical migraine patients were caused by hyperactivity of liver Yang; Flaws, Sionneau, scholar Yin's, Liu's, etc. also believed that migraine patients were often caused by hyperactivity of liver Yang; Flaws and Sionneau studies also believed that migraine was often caused by liver dysfunction, especially liver yang hyperactivity in TCM theory. Coeytaux and other studies have found that 46% of migraine patients have liver blood stasis; the pain caused by liver blood stasis is usually fixed pain, which is called pain or burning pain. The general cause of migraine in the blood stasis type is that the operation of the Qi of the head meridian is not smooth, and then the blood is caused by the hyperactivity of the liver after hyperactivity of the liver. The symptoms of migraine, such as stinging and pain, are caused by the obstruction of the Qi and blood circulation, which are usually located near the eye or near the temples. Thus, it is possible to infer that the congestion occurs in the bile meridians and their collateral channels, and may also involve the tri - focal meridian and its collateral channels. A headache.
2. western medicine's understanding of migraine and its relationship with liver and gallbladder in TCM theory
Clinical manifestation of migraine in 2.1 Western Medicine
Typical migraine is characterized by intermittent episodes, severe, beating side headaches, often accompanied by nervous system dysfunction such as nausea, sound phobia (noise sensitive) or photophobia (light sensitivity).
2.2 common painful parts of a migraine attack
The site of pain usually distributes near the trigeminal nerve and the upper cervical nerve root in the temporal region; the study shows that pain is more often occurring in the temporal region rather than the top of the top or the inferior occipital region; and from the point of view of the meridian theory of traditional Chinese medicine, in the temporal region of the brain (temples), we can see the phase between the trigeminal nerve and the bile meridians and their collateral channels. Interrelationship; the relationship between the bile meridian and the tri - focal meridian explains this more, that is, the two all cross the temples, which are very similar to the path of the trigeminal nerve; the connection of the hepatic meridian collateral to the surrounding tissue is very similar to the distribution of the trigeminal nerve in the eye area.
2.3 pathophysiology of migraine
Migraine is a complex brain disorder, a kind of vascular neurogenic headache that is not very clear on its pathophysiological basis. Once, changes in vascular function are considered the only cause of its disease. But, at present, theoretical studies suggest that the cause of migraine is associated with abnormal function of the nervous system and then activates the trigeminal. Neurovascular systems, which are activated by the system, increase neuropeptide release and lead to pain in the head, and the change in brain blood flow itself does not cause pain. It appears that the main cause of migraine is neuropeptides rather than vascular diameter changes. This new theory of migraine pathogenesis is a new theory. The understanding of the pathogenesis of migraine.
Advances in science and technology have led to a complete role in understanding the cerebral vasoconstriction and dilatation and the resulting cascade of neuropeptides in the pathogenesis of migraine. The process of vasoconstriction of the main blood vessel is related to the vascular endothelium, and the scholars equate the function of camp Qi and Wei Qi to the nitric oxide and calcitonin gene related peptide respectively. They believe that the migraine caused by Qi and blood stasis caused by the meridians and blood is derived from the imbalance of the gas in the camp.
3. theoretical basis and clinical basis for treating migraine by acupuncture, regulating liver and gallbladder
Observation on the effect of 3.1 acupuncture points for acupuncture and acupoint treatment
The research confirmed that after 15 minutes of acupuncture at Tai Chung acupoint, the short artery resistance index (P0.05) of the nasal and temporal ciliary arteries was significantly lower than that of the baseline. The researchers concluded that the acupuncture at the acupuncture point was effective for the calcitonin gene related peptide, nitric oxide and neurovascular dilatation; from the viewpoint of TCM theory, Tai Chung point could be used in the view caused by migraine. After the acupuncture at Baihui Point, the blood flow of the middle cerebral artery and the anterior cerebral artery increased significantly after acupuncture at the Baihui Point. The study showed that the acupuncture point can effectively improve the blood flow of the brain. From the perspective of TCM theory, we know when the body Yang is the human body. When the gas rises to the apex, it is the Baihui acupoint of the human body. Baihui is also the place where the human body's internal wind rises. At the same time, Baihui acupoint has the function of reducing the Qi of the bile. This study provides a favorable experimental research basis for the theory of Baihui acupoint used in the treatment of related symptoms in the clinic of traditional Chinese medicine; the acupuncture point can effectively regulate the human body. The level of serum interleukin -6 in patients with liver yang hyperactivity migraine has an important role in reducing the level of serum interleukin (ILC) in the patients with hyperactivity of liver yang hyperactivity by regulating the liver and bile duct. The study also suggests that the mechanism of the Tai Chi (four point) is that the liver and gallbladder meridians reach the head, and no matter where the point is located in the meridian, these points can be used to treat the symptoms of all parts of the route, although the location of the acupoints is far from the position of the symptoms. These acupoints can regulate the contraction and expansion of the blood vessels in the brain, increase the blood flow of the brain, and regulate the inflammatory response.
3.2 comparison of clinical efficacy between acupuncture and Western Medicine
A study compares the therapeutic effect of acupuncture and moxibustion with the non prescription drugs of migraine. The acupoints of the acupuncture treatment group are as follows: Hegu, Tai Chi, Baihui, rate Valley, wind pond, outer customs, foot and face sobs, Sanyinjiao, and Tang Dynasty. The principle of treatment is to dredge the liver and gallbladder, suppress liver Yang and relieve pain. The statistical results show that the comparison group is compared with the control group of Western medicine. The pain degree of migraine in the acupuncture treatment group was significantly lower than that before the treatment (P.014). Compared with the western medicine control group, the average frequency of migraine in the acupuncture and moxibustion treatment group decreased significantly (P0.006). The experimental results showed that acupuncture treatment had a significant effect on migraine and had no side effects.
Result
Hyperactivity of liver Yang is the most common cause of migraine, and liver qi stagnation is an important cause of hyperactivity of liver yang. The two can also cause migraine at the same time. The liver blood stasis is the third main cause of migraine. Emotional factors are also important causes of hyperactivity of liver Yang, anger, depression, long worry and so on will cause liver qi stagnation. And then evolved into a hyperactivity of liver yang.
The migraine in western medicine is most close to the liver yang hyperactivity type migraine in traditional Chinese medicine (pain along the bile duct). The treatment of migraine with acupuncture and regulating liver and gallbladder method is very successful compared with western medicine and placebo.
conclusion
1. The common location of migraine is on the operative route of the gallbladder meridian, especially near the temple, and rarely occurs on the top of the liver meridian of foot Yin Yin.
Two. The occurrence of migraine is related to the injury of the liver and gallbladder. The position, nature, interval time and symptoms of the migraine are fully demonstrated, and the important role of the liver and gallbladder and their meridians in the cause of the disease is fully demonstrated.
Three. The physiological study of treating migraine with acupuncture and regulating liver and gallbladder can fill the deficiency of the western medicine model and explain the theory of traditional Chinese medicine better. At present, Chinese medicine has a more complete and deeper understanding of the pathogenesis and treatment principles of migraine than western medicine. It will play a better role in the role of liver and gallbladder in the pathogenesis of migraine and the establishment of the best acupuncture and moxibustion strategy.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R245

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 ;Acupuncture at the San Jiao meridian affects brain stem tissue G protein content in a rat migraine model[J];Neural Regeneration Research;2008年09期

2 胡靜;吳中朝;王京京;焦s，

本文編號(hào)：2029529