【作者】 邹军；

【导师】 张家维；

【作者基本信息】 广州中医药大学 ， 针灸学， 2000， 博士

【摘要】 “中风”即现代医学所称的急性脑血管病，包括脑出血、脑血栓形成、蛛网膜下腔出血等。世界各地临床流行病学调查表明急性脑血管病是目前致死率最高的疾病之一。急性脑血管病是老年人的常见病，并呈现死亡率、致残率均高的特点，严重影响患者与亲属的身心健康和日常生活。其缺血性中风的发病率约为出血性中风的3倍。针灸治疗中风疗效确切，为了进一步探讨针灸治疗缺血性中风的作用机制，本文从以下几个方面进行了研究： 一、文献研究 1、中医对脑缺血引起的中风的病名、病因、病机的研究都有较为明确的结论。中风又名“卒中”。多由忧思恼怒、饮食不节、恣酒纵欲等因，以致阴阳失调、脏腑气偏、气血错乱所致。临床表现以猝然昏仆、口眼喎斜、半身不遂者。因本病起病急剧，变化迅速，与自然界善行而数变之风邪特性相似，故古人以此类比，名为中风。其病理因素为火、气、痰湿、瘀血阻络等。临床辨证而灵活运用滋阴潜阳、平肝熄风、通腑化痰、活血通络、清热除痰健脾利湿、益气养血等治则。而活血化瘀治则，为清代王清任以后许多医家所共同推崇，近代运用这一治则治疗本病总结出不少的好经验。针灸治疗中风疗效确切，方法众多。取穴方法有辨证辨病辨症取穴、单穴、风府哑门针刺法、上下配穴法、从阳引阴十二透穴法、夹脊穴法或背部俞穴法、醒脑开窍法等；针灸方法有头针、眼针、腹针、手针、穴位埋线、皮肤针、刺血、分期巨刺、子午流注纳甲法、艾灸等。从多角度、多层次对获效机制进行了研究，认为针灸治疗中风是从以下几方面起作用的：改善血液流变学及四肢甲皱循环；改善脑血流量及脑血流图；调节组织电生理；调节神经生化免疫；对缺血大脑组织形态学的影响。 二、中风与现代医学的脑卒中大体相同。脑卒中包括出血性脑血管病和缺血性脑血管病两大类。出血性脑血管病主要有高血压性脑出血；缺血牲脑血管病主要有脑血栓形成、脑栓塞和暂时性脑缺血发作等，率、致残率、复发率都很高。急 ，性缺血性脑血管病的西药治疗，迄今尚无重大突破，方法虽多，疗效尚不肯定，有些还在研究中，如陇疗滞，腕在不同看法，需待抛。然而，超早期恢复血供，改善血液循环状态，配合针灸对缺血后神经元死亡不同机制的综合干预及治疗，无疑将是治疗的关键。脑缺血后的病理机制包括基本病理变化、与缺血相关物质的释放及相踢因锄、炎症、细胞凋亡、损伤级联反应等，渊机制之间还有相互作用和影响，其中许多问题坯 楚。 二、实验研究 1、本研究以不开颅可逆大脑中动脉阻塞（MCA）建立局灶性脑缺血模型，观察了电针“百会”、“素谬”对急性缺血性大鼠的胶组织超微结构、凋 激因子－一兴奋性氨基酸、细胞凋亡及凋亡相关基因蛋白表达等的影响，其结果如下： O）虽 察到典型神经元细胞凋亡的各个时期，但研究表明电针可促进缺血早期神经元功能恢复。表现为神经元线粒体水肿消退，线粒体数量增加，核糖体密集。这些为缺血性中风急性期的顺治疗提供了理论依据。 Q）电针使大脑皮层梗塞区内凋聊胞数明显减少，提示栅…神经元凋亡的发生而达到脑保护日的，对缺血后神经元细胞的保护、防止神经元细胞丢失有重要意义。 幻）电针能明显降低脑缺血后异常升高的脑组织GIU、挪怨，从而哪EAAs神经毒性，在一定程度上减轻了细棚亡的诱因。 N）帆顺局部缺血后ofor蛋白脯脯明显抑制作用。ofOS表达产物 2 作为细鹏息传递通路上的“第 3雕”，测－反应基因（b一 po） 表达，包括与凋亡有关基因，如belZ、P53等，从而使细胞发生凋亡。故电针可能 通过了抑制r蛋白的表达进而调控其后发的凋亡相关基因，发挥抑制细胞凋亡的 作用。 （5）电针对脑局部脑缺血后 belZ蛋白的表达有明显升高作用，提示电针抑制t 神经元凋亡的发生从可能通过了升高beFZ表达途径，其沏筛可能与以下因素有关： ①通过影响早期反应基因途径来影响belZ的表达。②电针保存合成beLZ蛋白的选 择性合成能力③防止再灌注损伤对蛋白合成环节的抑制。 “）电针可使脑局部缺血后升高的 p53蛋白的表达有所下降，但与缺血组蜘 怨异显靴。提示 p53蛋白的高表达虽膨与细胞凋亡的发生，但帆对 p53蛋 白的高表达无明显的u作用，所以其桔抗脑缺血后的细胞凋亡的作用，可能不是 通过抑制p53基因蛋白高表达鳅的。 三、结论 察电针对脑缺血后超微结构、细胞凋亡及相关基因表达的影响，我们观 察到：①电针能改善脑缺血后脑细胞更多还原

【Abstract】 Stroke is belonged to acute cerebral vascular diseases in modem medicine. It includes cerebral hemorrhage, cerebral thrombosis and subarachnoid hemorrhage, etc. The epidemic data collected from various areas all over the world show that acute cerebral vascular disease is one of the diseases which have the highest mortality. Acute cerebral vascular disease is very common in aged people. And it has the characteristics of high mortality and high disablement rate. It severely affects the physical and mental health and daily lives of patients and their family members. The morbidity of ischemk; stroke is two times higher than that of hemorrhagic stroke. The therapeutic effectiveness of acupuncture and moxibustion in treating stroke is definite. In order to further investigate the action mechanism of acupuncture and moxibustion in treating ischemic stroke, studies on the following aspects have been carried out in this article.1.Literature research(l)Definite conclusions have been made in studies on the term, etiology and pathogenesis of ischemic stroke in traditional Chinese medicine. Stroke has another name of apoplectic stroke. Melancholy, anxiety, improper diet, alcohol addiction and excessive sexuality are its main causes. Imbalance of yin and yang, qi and blood disturbance of zang and fu are its pathogenesis. Its main clinical features include sudden coma, distorsion of eye and mouth and hemiparah/sis. This disease occurs suddenly and changes quickly. It is quite similar to the characteristics of wind in nature. So it is called "stroke" by ancient Chinese.4Fire, qi, phlegm-dampness and ecchymosis are its pathogenic factors. The principles of clinical differentiation and treatment are as follows: nourishing yin and suppressing yang hyperactivity, calming liver and calming the endopathic wind, clearing fa-organs and resolving phlegm, promoting blood circulation to remove observation in the channels, clearing heat and removing phlegm, invigorating the spleen for eliminating dampness, supplementing qi and activating blood circulation. The treatment principle of "activating blood flow and removing blood stasis" has been adopted by Qingren Wang, a famous medical expert of Qing dynasty and his descendants. Many good experiences have been achieved in treating diseases under the guidance of this principle in recent decades. The therapeutic effectiveness of acupuncture and moxibustion in treating stroke is definite. And the therapy methods are quite different from each other according to different therapy syndromes of traditional Chinese medicine. There are many point-selecting methods, such as syndrome differentiation, disease distinguish, one-point method, acupuncture at feng fu and ya men, point-matching with upward and downward point, twelve point-penetrating from yang to inducing yin, jia ji point method or back points method, the method of enlivening brain and opening the hole. The acupuncture methods include sca^> acupuncture, eye acupuncture, abdomen acupuncture, hand acupuncture, thread embedding on the points, skin acupuncture, blood vessel acupuncture, acupuncture the opposite side of the disease as a treatment, zi wu Uu zhu na jia and moxibustioalts action mechanism has been investigated from multiple aspects and multiple levels. Most medical workers consider that the action mechanism of acupuncture and moxibustion include: improving patients’ blood theology and microctrculation of nail matrix, improving cerebral blood flow and rheoencephalogram, regulating tissue etectrophysiology, regulating neurological biochemistry and immunity, effecting on histobgical morphology of ischemk cerebral tissue.5(2)Stroke is similar to cerebral sudden death of modem medicine. Cerebral sudden death includes hemorrhagjc cerebral vascular disease and ischemk cerebral vascular disease. Cerebral hemorrhage caused by hypertension is the majority of hemorrhagic cerebral vascular disease. Ischemic cerebral disease mainly includes cerebral thrombosis, cerebral embolism and temporal cerebral ischemia seizure,更多还原