中国和欧洲两个耳针体系中定位和诊疗程序的比较研究

【作者】 王磊；

【导师】 赵百孝；

【作者基本信息】 北京中医药大学 ， 针灸推拿学， 2016， 博士

【摘要】 耳穴诊治法(又称为耳针、耳穴疗法、耳医学)是以耳郭为诊断施治部位来调整全身的针灸疗法,具有突出的临床疗效和广泛的应用范围。在耳穴定位方面,主要分为中国和欧洲两个耳穴体系。自从法国Paul Nogier的胚胎倒置于耳郭的学说传入我国,我国针灸耳穴专家进行了广泛而深入的研究。由于文化差异、思维模式的不同,耳针在研究和临床应用中向不同的方向发展,逐步形成了各自自己独立的体系,即现有的中国耳穴体系和欧洲耳穴体系。在法国,耳穴的研究和应用主要基于法国Paul Nogier的发现,如三相学说理论指导下的耳医学体系。在德国,Bahr基于Nogier的研究,但对三相学说提之甚少,而是以干扰场(或病灶)理论和血管自主神经信号下为主导,使耳穴疗法成为耳医学体系。本研究选择在欧洲影响较大的Bahr耳穴体系进行研究。在我国耳穴国家标准制定方面,我国已经形成了较为完善的耳穴国家标准《耳穴名称与定位》。在国际标准制定方面,以我国2008年国家标准《耳穴名称与定位》为主导而制定的世界针灸学会联合会针灸行业国际标准《耳穴》已于2013年在世界针灸杂志上公开。为了推动耳穴国际标准化进程,使中国和欧洲耳穴界专家同仁相互之间增加了解,彼此认识两个耳穴体系,本着求同存异的理念,来进行两个耳穴体系的比较研究。目的本研究为理清中国耳穴体系和欧洲耳穴体系的在定位方面的相似点和在诊疗程序和定位方面的不同点,并从阳性反应率的角度来比较两个耳穴心区的定位的合理性。方法通过对比最新世界针灸学会联合会出版的针灸行业国际标准《耳穴》(以我国国家标准《耳穴名称与定位》为蓝本制定)和欧洲耳针,包括中文、英文和德文版的《基于Nogier和Bahr工作的精确袖珍图谱》；通过理论学习和临床实践,本人被派往瑞士巴塞尔乡村州Reinach 市 Medi-China中医药中心跟随欧洲中医药学会副主席Wirz-Ridolfi教授进行基于Nogier和Bahr的欧洲耳针的理论学习和临床实践,分析挖掘出这两个系统在定位方面的相似点和不同点,以及在诊疗程序方面的不同点；通过在中国和瑞士冠心病心绞痛患者的两个耳穴心区定位的比较研究(探索性研究)来比较两个耳穴心区的定位的合理性。结果1.中国耳针系统和欧洲Nogier-Bahr耳医学系统在定位方面的相似点世界针联国际耳针系统(以我国国家标准《耳穴名称与定位》为蓝本制定)与欧洲Nogier-Bahr耳针系统,共有24个耳穴有共同的耳穴名称和耳穴定位。另外有25个分区或耳穴,虽然其代表的身体部位和作用都不同,但可以推荐其采用耳郭解剖名称来命名。2.中国耳针系统和欧洲Nogier-Bahr耳医学系统在诊疗程序和定位方面的不同点(1)诊疗程序从诊疗程序和耳穴定位两个方面,中国耳穴系统和欧洲Nogier-Bahr耳针系统都有较大的不同。中国耳穴系统主要从视诊、触诊、电测结合中医辨证进行诊断和治疗,欧洲Nogier-Bahr耳穴系统主要从消除干扰场的角度,利用血管自主神经信号的方法进行诊断和治疗。(2)耳穴定位耳穴定位方面,下肢、脊柱中下段、心、呼吸系统、胃肠系统(包括直肠和肛门)、脾、扁桃体、泌尿生殖系统(包括肾、子宫、卵巢/睾丸、阴茎/阴蒂)、内分泌系统(肾上腺)、头部(包括颌、牙、鼻、耳)、脑干的定位不同。3.不同耳穴心区在中国和瑞士冠心病心绞痛患者的定位比较(探索性研究)从不同耳穴心区在中国冠心病心绞痛患者(52个病例)的定位的比较研究(后文简称前者研究)和不同耳穴心区在瑞士冠心病心绞痛患者(40个病例)的定位的比较研究中(后文简称后者研究)得出：在视诊变色方面,同侧耳穴心区1的缺血程度比耳穴心区2的缺血程度严重。在视诊变色方面,前者研究说明不同侧耳穴心反应率区1(或2),左侧比右侧的缺血程度差异不大。而在后者研究中得出,不同侧耳穴心区1(或2),左侧比右侧的缺血程度严重。在触诊时水肿发生率方面,前者研究中,耳穴心区1常出现较高的阳性发生率,耳穴心区2常不发生；中国冠心病心绞痛患者急性发作期或围手术期的左侧耳穴心区1的阳性水肿发生率是94.2%,右侧为78.8%。而在后者研究中,在触诊方面,水肿发生率方面,耳穴心区1常出现较高的阳性发生率,耳穴心区2常不发生。瑞士冠心病心绞痛患者冠心病心绞痛手术后恢复期,左耳耳穴心区1的阳性水肿发生率为93.75%,右侧为78.125%。在触诊发生条索方面,前者研究中,不同侧耳穴心区1的条索发生率,左侧比右侧高；在后者研究中,耳穴心区1常出现较低的阳性发生率,左侧比右侧高,耳穴心区2常不发生条索。在触诊压痛方面,前者研究中,不同侧的两个耳穴心区均表现较强的阳性发生率。而在后者研究中,不同侧的两个耳穴心区均表现较低的阳性发生率。在生物电值方面,在前者研究和后者研究中,同侧耳穴心区1的生物电值的阳性反应比同侧耳穴心区2敏感。左侧耳穴心区1(或2)的生物电值的阳性反应比右侧耳穴心区1(或2)敏感。在不同侧的同—耳穴心区(耳穴心区1或2)的生物电值比较中,前者研究表现出左侧耳穴心区1(或2)的生物电值的阳性反应比右侧耳穴心区1(或2)敏感。而后者研究不同侧耳穴心区1(或2)的生物电值无统计学差异。结论在定位和诊疗程序方面,中国耳针系统和欧洲Nogier-Bahr耳针系统,有相似点也有不同点。从视诊、触诊、电测和生物电值方面,耳穴心区1(耳甲15区)比耳穴心区2(对耳轮8区与对耳轮9区之间)的阳性反应率高。左侧耳穴心区1(或者2)比右侧耳穴心区1(或2)敏感。从视诊、触诊和电测生物电值的阳性反应率方面,将心区定位在左侧耳甲腔更为合理。更多还原

【Abstract】 Auricular acupuncture, or ear acupuncture, or auriculotherapy, or auriculomedicine, or auricular diagnosis and treatment, is a therapy in the subject of acupuncture-moxibuston, in which the auricle is selected to be stimulated to regulate the whole body. It has excellent clinical effect and extensive scope of clinical application. From the perspectives of the localizations of auricular acupuncture points (AAPs), there are two systems of auricular acupuncture points, including Chinese and European systems of AAPs. Since the discovery of the inverted fetus reflexed on the auricle by the French physician, Paul Nogier, was introduced into China, Chinese acupuncturists carried out deep and extensive the study of auricular acupuncture. Due to possible great differences in aspects of culture and thinking model, auricular acupuncture goes toward different directions during research and application, and gradually develops into their individual sytems, the Chinese system and European system of AAPs. In France, the application of AAPs is most based on Nogier’s original findings, the theory of three phases. In Germany, Austria and Switzerland, the theory of three phases was little mentioned. Instead, auricular therapy is integrated into Bahr’s new findings, the theory of focus, making auriculotherapy into auriculomedicine. This paper, only Bahr’s system of auriclomedicine is studied. For developing standard of AAPs, Chinese national standard, Nomenclature and location of AAPs, was also published in 2008. For developing international standards, an international standard of AAPs mainly according to the Chinese national standard, Nomenclature and location of AAPs was published in 2013 in the World Journal of Acupuncture-Moxibstion (WJAM). In order to promote the work of international standardization of AAPs, to help the experts, doctors, researchers in the field of AAPs understand each other know the two systems, based on the idea of seeking common ground while reserving differences, this paper was to undergo the comparative study of the two systems.Objectives:To calrify the similarities and disparities of Chinese system of auricular acupuncture points and European auriculotherapy according to Nogier and Bahr from perspectives of localization and procedure of diagnosis and treatment, and to compare the rationality of the localizations of the two heart ear-reflexed points.Methods:Based on the knowledge of the Chinese and European systems of auricular acupuncture points (AAPs), the similarities and disparities of the two systems were clarified through comparison of the latest published international standard of auricular acupuncture points, mainly according to the Chinese national 2008 standard, Nomenclature and Location of Auricular Acupuncture Points(AAPs), by the World Federation of Acupuncture-Moxibustion Societies and the three books on the European auriculotherapy (Chinese, English and German editions of "A Precise Pocket Atlas Based on the works of Nogier/Bahr"). Through theory study and clinical practice, the author was sent to study with Dr. Wirz-Ridolfi, Medi-China center for Traditional Chinese Medicine, Reinach, Switzerland, the theory and clinical practice of European auriculotherapy according to Nogier/Bahr. Through a pilot study of the comparison of the positive reaction rates of the two heart ear reflexed points on Chinese and Swiss patients with angina pectoris due to coronary heart disease, the rationality of the localizations of the two heart ear reflexed points was compared.Results:1. The similarities of Chinese system of AAPs and European system of auriculomedicine according to Nogier/Bahr from perspective of localization Between the standard of the World Federation of Acupuncture-Moxibustion Societies and European system of auriculotherapy accoding to Nogier/Bahr, there were twenty-four AAPs sharing the same name and similar locations, and other twenty-five subzones or points were recommended to share the auricular name with different anatomical names with different reflexed parts of the body and different therapeutical effects.2. The disparities of Chinese system of AAPs and European system of auriculomedicine according to Nogier/Bahr from perspectives of procedure of diagnosis and treatment, and localizationFrom perspectives of the procedure of diagnosis and treatment and location of AAPs, there are great disparities between the two systems. Inspection, palpation and electrical examination and pattern identification in traditional Chinese medicine were integrated together during diagnosis and treatment of Chinese auricular acupuncture. The elimination of focus and feeling the vascular autonomic signal were combined together during European auriculotherapy/auriculotmedicine.For the localizations of AAPs, the localizations of the lower limb, the middle and lower segment of the spine, heart, respiratory, gastrointestinal sytem (including rectum and anus), spleen, tonsil, urogenital system (including kidney, uterus, ovary/testis, penis/clitoris), endorcrine system (adrenal gland), head region (including jaw, teeth, nose and ear) and brain stem.3. A pilot study of the comparative study on the localizations of the two heart ear-reflexed points on Chinese and Swiss patients with angina pectoris due to coronary heart diseaseFrom perspectives of whitening discoloration, the comparative study on the localization of the two heart ear-reflexed points on Chinese patients with angina pectoris due to coronary heart disease (in the text it is called "the former study"), and the comparative study on the localization of the two heart ear-reflexed points on Swiss patients with angina pectoris due to coronary heart disease (in the text it is called "the latter study") demonstrated that the whitening discoloration rate of heart ear-reflexed point No.1 (in the concha) was much more higher than the other heart ear-reflexed point No.2 (on the antihelix). The former study showed that there was no significant difference between the heart ear-reflexed point No.1 (or No.2) on the left and the right auricle. However, the latter study showed the whitening discoloration of the heart ear-reflexed point No.1 (or No.2) on the left auricle was more serious than on the right auricle.From perspectives of edema during palpation, the former study showed that there was a high positive reaction rate, on the heart ear-reflexed point No.1. However, the former study demonstrated that there was no edema during palpation on the heart ear-reflexed point No.2. The edema rate of the heart ear-reflexed point No.1 on the left auricle of the Chinese patients during acute attack or perioperative period of angina pectoris was 94.2%, and 78.8% on the heart ear-reflexed point No.1 of the right auricle. The latter study demonstrated that there was a high positive reaction rate on the heart ear reflexed point No.1. Similar to the former study, the latter study also demonstrated that there was no edema during palpation on the heart ear-reflexed point No.2. The edema rate of the heart ear-reflexed point No.l on the left auricle of the Chinese patients during acute attack or perioperative period of angina pectoris was 93.75% and 78.125% on the heart ear-reflexed point No.1 of the right auricle.From perspectives of cord during palpation, the former study showed that there was a higher positive reaction rate on the heart ear-reflexed point No.1 on the left auricle than on the right auricle. The latter study demonstrated that there was a low positive reaction rate on the heart ear reflexed point No.1, and there was a higher positive reaction rate on the heart ear-reflexed point No.1 on the left auricle than on the right auricle. The latter study also demonstrated that there was no cord during palpation on the heart ear-reflexed point No.2.From perspectives of pain during palpation, the former study showed that there were high positive reaction rates on the heart ear-reflexed point No.1 (or No.2) on the left auricle and on the right auricle. The latter study demonstrated that there were low positive reaction rates on the heart ear reflexed point No.1 or No.2 on the left auricle and on the right auricle.From perspectives of biological electrical value, both the former study and the latter study showed that it was more sentive on the heart ear-reflexed point No.1 than No.2 on the same side of the auricle, and that it was more sentive on the heart ear-reflexed point No.1 (or No.2) on the left auricle than on the right auricle. The former study demonstrated that the heart ear-reflexed point No.1 (or No.2) on the left auricle was more sensitive than the relevant point on the right auricle. However, the latter study concluded that there was no signifiancant difference between the heart ear-reflexed point No.1 (or No.2) on the left auricle and the relevant point on the right auricle.Conclusions:From perspectives of localization and procedure of diagnosis and treatment, there are both similarities and disparities between the Chinese system of AAPs and European auriculotherapy/auriculomedicine. From perspectives of inspection, palpitation and electrical biliogical value, the positive reaction rates of the heart ear-reflexed point in the concha are higher than the heart ear-reflexed point on the antihelix. The heart ear-reflexed point on the left auricle is more sensitive than the relevant point on the right auricle. From perspectives of positive reaction rates of inspection, palpitation and electrical biliogical value, the heart ear-reflexed point in the concha on the left auricle is more rational than other relevant points.更多还原