针刺跷脉腧穴治疗老年性痴呆的探讨

【作者】 徐立鹏；

【导师】 谷世喆；

【作者基本信息】 北京中医药大学 ， 针灸学， 2002， 硕士

【摘要】 随着社会人口老龄化的加重，世界各国老年性痴呆（SD）的发病率正在呈上升趋势。目前,在西方国家及我国大城市，SD已成为仅次于心脏病、肿瘤、中风的第四位死亡原因。如何预防和治疗SD已经成为世界各国，特别是发达国家医学界普遍关注的课题。奇经八脉中阴阳跷脉与脑有着特殊的联系，所以，作为八脉交会穴中与跷脉相通的照海、申脉在治疗精神情志病方面，如失眠、痫证等，经常为诸家所采用。导师谷世哲教授亦常选用此二穴治疗癫痫。但在实际的临床应用中，此二穴绝少单独应用。从现代针灸文献研究来看，目前临床治疗SD所取的腧穴亦是以督脉与十二经腧穴为主，未见有单独选用跷脉的报道。为了研究跷脉及照海、申脉对于中医脑病和SD是否存在临床价值，本课题从理论与实验两个方面进行了探讨。针灸文献研究首先通过对《针灸甲乙经》、《灵枢》中关于跷脉的记载和现代循经感传研究的考证、分析，确认跷脉有其独立的经脉循行；照海、申脉在《针灸甲乙经》中不仅定位于十二正经循行线之外，而且主治病候亦非常确切地归属跷脉。因此，针刺照海、申脉二穴对脑的作用途径是阴阳跷脉，而不是其他经脉。其次，根据《灵枢·脉度》和《难经·二十八难》中关于跷脉循行的论述，结合卫气与跷脉功能的联系，认为阴阳跷脉实为一体，皆起于跟中，二者最终上合于脑中，由此，提出了“跷脉——脑环状通路”的观点，认为此环状通路的意义在于通过阴阳跷脉的协调平衡维持正常的脑功能，从而产生对SD等中医脑病的治疗作用。实验研究主要观察了针刺跷脉腧穴照海、申脉对SD模型小鼠脑内胆碱能系统及学习记忆能力的影响。在模型复制方法的选择上，着眼于SD的慢性发病过程、中医的“整体观”和公认的“胆碱能假说”，采用了以D-gal项后皮下注射作为造模的方法。经过预实验与正式实验的证明，此模型复制是成功的。在研究思路上，通过直接和间接两个方面的指标来反映针刺对脑内胆碱能系统功能水平和学习记忆能力的影响：以普遍公认的皮层AChE水平（羟胺比色法测定）来直接反映胆碱能神经元的功能状态；以海马SOD（黄嘌呤氧化酶法）、MDA（硫代巴比妥钠法）反映脑内抗脂质过氧化的情况，间接反映胆碱能系统ACh的合成水平；以水迷宫测试从行为学方面观察针刺治疗对模型小鼠学习记忆能力的变化。实验结果显示，针刺跷脉组小鼠的照海、申脉两穴，可以升高皮层因D-gal皮下注射所造成的AChE水平降低；显著升高SOD活性，减少MDA的含量；缩短水迷宫学习时间，减少水迷宫记忆测试中进入盲端的错误次数，改善学习记忆能力。通过本课题的理论与实验研究，确认了照海、申脉归属于跷脉，有其特异基础。实验结果亦证明，针刺跷脉能够促进脑内胆碱能神经元活性，增强脑内抗脂质过氧化机制的功能，提高ACh的合成，有助于受损胆碱能系统的功能恢复，从而显著改善学习记忆的能力。所以，针刺跷脉腧穴照海、申脉确实对SD的恢复具有良性作用，临床应用此二穴治疗精神情志病是有意义的，值得进行进一步的临床研究。更多还原

【Abstract】 More and more old people have got a longer life expectancy, with which, however, the incidence of Alzheimer’s Disease (AD) increases. The nations and medical organizations all over the world are paying more attention to the prevention and therapeutic treatment of AD. China has the biggest population in the world, so the domestic development of AD will certainly be highlighted.The project focuses on the effect of the acupoints, Zhaohai and Shenmai, to treat AD through Heel Meridians, and puts forword the hypothesized pathological pathway on the basis of the relationship between Heel Meridians and Brain. Experimental and theoretical studies are carried out.The theorctical study of TCM involves three sections: the independence of Heel Meridians, the belonging of Zhaohai and Shenmai, and the role Heel Meridians play in modulating the function of brain. The study on the ancient records about Heel Meridians proves that Yin Heel Meridian goes in the midst of Foot Taiyin Meridian and Foot Shaoyin Meridian, and Yang Heel Meridian goes in the midst of Foot Taiyang Meridian and Foot Shaoyang Meridian, which means Heel Meridians are independent in the Meridian System. The review insight of the position of acupoints around Zhaohai and Shenmai in ancient books indicates that these two acupoints don’t respectively belong to Foot Shaoyin Meridian/Foot Taiyang Meridian, but to Yin/Yang Heel Meridian. In the last section, the pathological structure of AD, “Circuit of Heel Meridians” is proposed, which plays an important part in balancing the function of brain’s Yin and Yang if Zhaohai and Shenmai are stimulated. The experimental study includes the influence of needling Zhaohai and Shenmai on the cholinergic system in CNS and on the learning & memory ability. The animal models are made by injecting D-galactose under skin of mice at nape, in view of the chronic process of AD, the Wholism of TCM and the recognized Cholinergic Hypothesis. And the method of making animal models proves reasonable and credible by the result of pre-experiment and formal experiment. We select the direct and indirect indice to observe the effect of needling: the direct index is acytel-cholinesterase in cortex, which reflects the conditions of cholinergic neurons; the indirect indice are SOD and MDA in hippocampus, which reflect the function of antioxidation and thereby the synthesis of acytelcholine; another index is from the Water Maze Test, which shows the learning & memory ability of the models. Results: by needling Zhaohai and Shenmai, the concentration of acytel-cholinesterase in cortex and the activity of SOD increase, and the <WP=5>concentration of MDA and Errors in Water Maze Test decrease meanwhile. The results are significantly different from the controls, which means that the needling contributes to the restore of the impaired cholinergic system, the antioxidaton in CNS and the improvement of learning & memory ability, and has therapeutic effects for AD.Altogether, the acupuncture in the acupoints of Zhaohai and Shenmai, is able to treat AD experimentally and theoretically, and the pathological structure, "Heel Meridians—Brain Pathway" is a new one for AD’s therapeutic strategy, worthy of further studies in the future.更多还原