【作者】 周俊亮；

【导师】 刘友章；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2005， 博士

【摘要】 目的:脾主运化是脾胃学说的重要理论之一。人体营、卫、气、血、津液等的化生是个复杂的过程,它涉及五藏六腑、先天、后天等多方面因素,但都有赖于脾胃运化水谷精微来完成。可见脾主运化的功能正常,人体才能正常进行物质代谢、能量代谢以维持正常活动。 中医的所谓脏腑蕴藏着整体观念,脏腑的功能活动,是一系列综合性的整体活动,它既是统一的,又是相互联系、相互制约、相互依存的系统功能活动。现代研究发现,中医“脾”不仅是指西医学的整个消化系统,而是多系统、多功能单位,与神经、内分泌、血液循环、免疫、泌尿、生殖、运动等各系统均有密切联系。刘友章教授早在八十年代,就率先提出了脾主肌肉与细胞线粒体有密切的关系,在进行国家“七五”攻关课题“脾虚证候机理研究”中,对脾虚证患者胃粘膜细胞线粒体变化进行电镜观察,首先报道了脾虚病人胃粘膜壁细胞线粒体数目减少、超微结构受损、能量代谢障碍,提出了中医脾-线粒体相关学说,提出中医脾主运化,不仅仅是指食物在胃肠的消化吸收,更重要的是营养物质在线粒体的生物氧化产能过程,首先把脾胃研究深入到亚细胞水平。 细胞色素氧化酶,即呼吸链复合物Ⅳ,位于呼吸链的末端,催化细胞色素的氧化,同时驱动ATP的合成,是线粒体的标志酶,其酶活性的发挥对于维持线粒体结构和功能以及细胞能量的产生有非常重要的意义。能量代谢是生物体内物质代谢过程中所伴随的能量的释放、转移和利用,它与中医“脾主运化”理论都有着密切的关系。本研究就是针对脾主运化与细胞线粒体及细胞色素氧化酶之间的关系进行研究,以揭示出二者之间的关系。 方法:研究分为文献研究和实验研究。在基础文献研究中,首先对于脾主运化的功能特点、对机体的影响与病理变化进行了研究,进一步探讨脾主运化与线粒体、细胞色素氧化酶的关系,明确了脾主运化与机体能量代谢之间的关系;其次,对于痿证的历史渊源、发病特点、致病因素、病理机制、辨证要点与治疗关键进行综述,明确了痿证与脾虚之间的特殊关系;同时,对于痿病患者超微结构的病理变化特点亦进行了概述。 在动物实验研究中,为了探讨脾主运化与线粒体、细胞色素氧化酶之间的关系,通过建立大鼠慢性脾虚模型,检测动物的骨骼肌、肝、胃与心组织的细胞线粒体、细胞色素氧化酶含量、活性以及细胞色素氧化酶的基因变化。在痿证患者肌肉病理检查研究中,为了明确痿证患者脾虚状态时肌肉组织的病理特点,能过对16例患者肌肉组织取材,进行常规光镜检查与电镜下观察。 结果:动物实验研究结果显示,脾虚大鼠在不同程度上存在着骨骼肌、肝、胃与心组织的细胞线粒体总体量的减少(P<0.05或P<0.01),骨骼肌、肝、胃与心组织的各种类色素氧化酶含量减少与活性降低(P<0.05或P<0.01),脾虚组及自然复健组大鼠细胞线粒体DNACOXIA、COXⅡ和COXⅢ亚基基因损伤。结果表明,脾虚证动物在其脾主运化的功能下降的状态下,存在着各组织的线粒体与细胞色素氧化酶的功能下调,它们之间存在着密切的关系。临床实验研更多还原

【Abstract】 Objetcive : The theories of spleen governing movement and transformation is an important part of the Spleen - stomach Doctrines .It is a complicated process that transform and create the nutrient qi , defensive qi, qi, blood, the fluid ...etc in human body, it involve five zang viscera and six fu viscera, inborns, acquired., but all depend on stomach and spleen to carries the essence of food and drink .Therefore only the spleen governing movement and transformation runs well, can the human body make material metabolism, energy metabolism to maintain normal activity.The so-called internal organs of the Chinese medicine contains the idea of the whole, the function activity of the internal organs, is a series to synthetical activities of the whole. The modern research discovers, the " spling" of the Chinese medicine is not only whole digestive system to of Western medicine, but also multi-systems, multi-function unit, having close contact with nerve, endocrine, blood circulation, immunity, urinary, procreation , sport system etc. As early as 80’s, professor Liu you zhang, take the lead to put forward that the spleen governing muscles haves close relation with cell chondriosome. In proceed National"75" Studying task "syndrome of deficiency of spleen mechanism research", observed the variety proceed of gastric mucosa cell chondriosome of sufferers with syndrome of deficiency of spleen by electron microscope. Firstly reports the gastric mucosa cell chondriosome of sufferers with syndrome of deficiency of spleen reduced the ultrastructure is damaged, and energy metabolism is blocked, put forward the theory of spling in Chinese medicine with cell chondriosome. Putting forward the spleen governing movement and transformation, is not only digesting food in the stomach and intestines to absorb , more important is that nourishment material be oxidized to produce energy in chondriosome, making the appetite research into the second cell level firstly.The cytochrome oxidizing enzyme , is the respiratory chain complex IV , locating the bitter end of respiratory chain, catalyze the oxidation of cytochrome, driving at the same time synthesizing the ATP , is the indicating enzyme of chondriosome, its activity is very important to maintain the construction and function of chondriosome and cell energy creation. The energy metabolism is the process of the energy releasing, transfering and using of the material metabolism in organism , it has closely relation with the theories of "spleen governing movement and transformation* of Chinese medicine. This research aims at the relation between ’spleen governing movement and transformation* and chondriosome and the cytochrome oxidizing enzyme to post out such relations.Method: The research consists of two parts: literature review and experiment study. In foundation literature research, firstly study on the function characteristics of *spleen governing movement and transformation* and its influence to the organism and the pathologic diversification, further study on the relation between *spleen governing movement and transformation* and and the cytochrome oxidizing enzyme, demonstrate the relation of ’spleen governing movement and transformation* and energy metabolism in organism;Secondly, overview the history origin, the coming on characteristics, the cause of disease, pathologic mechanism, dialectical point and treatment key of spleen flaccidity-syndrome;define the special relation of spleen flaccidity-syndrome and ’spleen governing movement and transformation* ;At the same time, summarize the characteristics of the ultra structural pathologic variety of flaccidity-syndrome patient.In animal experiment research, for inquirying into the relations between and chondriosome and the cytochrome oxidizing enzyme , set up the rat medel of chronic spleen deficiency, detect chondriosome of animals’ skeletal muscle , liver> stomach and heart, cytochrome oxidase’s content and activity and its genie change.In research on pathologic check to muscle of patient with flaccidity-syndrome, to make clear the pathologic characteristics of the muscular tissue of the patient with flaccidity-syndrome when they are spleen flaccid, we make specimen of muscle tissue of patient with spleen flaccidity, observe by normal light microscope and electron microscope.Effect: In animals experiment study, the results shows, the rat with spleen deficiency’s cell chondriosome ,the content and activity of cytochrome oxidase of skeletal muscle , liver-, stomach and heart decline in different degree (P<0. 05orP<0. 01) .It shows that when animal with spleen deficiency and spleen governing movement and transformation go wrong, the animal’s organ’s chondriosome and cytochrome oxidase go wrong,更多还原