【作者】 许辛寅；

【导师】 江钢辉；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 目的：我们在挖掘祖国传统中医理论的基础上,经过归纳与整理,在“脾胃为后天之本”,“脾主运化”,“脾为生痰之源”等中医传统经典理论的指导下,不断深化对高脂血症病因病机的认识。我们认为：升高的血脂属于中医无形之痰的范畴,病变主要在脾胃二脏,虚以脾虚为主,实以痰滞为标。在本次研究中,先观察艾灸足三里、丰隆穴、足三里合丰隆穴对高脂血症模型大鼠血脂的影响,再将动物实验得的成果运用到临床中,观察艾灸足三里、丰隆穴、足三里合丰隆穴在动物研究与临床研究是否有差别。方法：本论文第一部分是关于高脂血症的文献研究,阐述了现代医学和祖国医学对高脂血症的认识、治疗、以及临床上遇到的问题,重点说明了针灸在这方面的优势。在第二部分动物研究中,SD大鼠60只,雌雄各半,普通饲料喂养2天后,根据体重按随机数字表,将大鼠随机分为空白对照组8只,模型对照组11只,足三里组13只,丰隆组14只、足三里合丰隆组14只。以高脂饲料喂养模型对照组、足三里组、丰隆组、足三里合丰隆组,四周后,检测各组的血清学指标,以确定造模成功,再在接下来的8周里,都用普通饲料喂养,治疗组给予艾灸相关穴位,模型对照组只抓取动物,而不进行治疗,以观察艾灸足三里、艾灸丰隆、艾灸足三里合丰隆对高脂血症模型大鼠血脂、血液流变学的影响。在第三部分,先选取75名高脂血症患者,以随机分组的方式分到足三里组25例、丰隆组23例、足三里合丰隆组27例,后共脱落9例,观察患者的血脂指标、体型、临床症状的变化。结果：1.模型大鼠血脂及AI水平比较：在艾灸治疗8周后,与模型组比较,足三里组、丰隆组、足三里合丰隆组血清TG、TC、LDL-C水平、AI指数都显著降低,差异具有显著性(P<0.01)；HDL-C水平都显著升高。其中足三里组、足三里合丰隆组在降TC方面更具有优势；丰隆组、足三里合丰隆组在降LDL-C方面更具有优势。2.血液流变学比较：与模型组比较,足三里组、丰隆组、足三里合丰隆组的高切变率、低切变率、血浆粘度、红细胞压积、红细胞电泳时间、红细胞聚集指数都显著下降,差异具有显著性。3.临床患者血脂水平比较：足三里组、丰隆组、足三里和丰隆组皆可降血脂,其中足三里合丰隆组更有效。4.临床患者体型比较：治疗后三组患者体型无明显改变。5.临床患者症状积分比较：足三里组、丰隆组、足三里和丰隆组皆可有效降低高脂血症患者的症状积分,其中足三里合丰隆组更有效。结论：1.艾灸足三里、丰隆穴、足三里合丰隆穴,可以有效地降低高脂血症模型大鼠的血清TC、TG、LDL-C、AI指数,升高HDL-C。2.艾灸足三里、足三里合丰隆穴在降低高脂血症模型大鼠血清TC明显,艾灸丰隆、足三里合丰隆穴在降低高脂血症模型大鼠血清LDL-C明显。3.艾灸足三里、丰隆穴、足三里合丰隆穴,可以有效地降低高脂血症模型大鼠血液流变学各项指标。4.艾灸足三里、丰隆穴、足三里合丰隆穴可有效治疗患者的高脂血症,而且两穴合用效果更好。5.艾灸足三里、丰隆穴、足三里合丰隆穴可有效降低高脂血症患者的临床积分、改善患者的临床症状,而且两穴合用效果更好,但改善患者体型作用不明显。6.为“脾主运化”“脾胃为后天之本”“脾为生痰之源”的中医基础理论提供了一定的实验室和临床依据。更多还原

【Abstract】 ObjectiveMining the basis of the traditional Chinese medicine theory, after induction and consolidation, under the guidance of the classical theory that including" the stomach and the spleen are acquired","spleen governs the transportation","the spleen is the source of phlegm", and constantly deepen the understanding of the etiology and pathogenesis of hyperlipidemia. We believe that:elevated blood lipids belong to the scope of TCM invisible sputum, lesions in the spleen and stomach two dirty,virtual Spleen-based,real phlegm stagnation as the standard.In this study, the first observation of the moxibustion Zusanli point, the moxibustion Fenglong point,the moxibustion Zusanli together Fenglong point on serum lipids of hyperlipidemic model,then the animal experiments of the results of use in the clinical,observation Observe whether the animal studies and clinical research makes a difference.MethodsThe first part of this paper is a literature study on hyperlipidemia on the understanding and treatment of modern medicine and the tradition medicine hyperlipidemia, and clinical problems encountered, highlighting the advantages of acupuncture in this respect.In the second part of the animal studies, SD rats60, male and female in half, fed with normal diet after2days according to body weight according to the random number table, the rats were randomly divided into the blank control group of8, the model control group of10, the Zusanli group Of13, the Fenglong of14, the Zusanli together Fenglong group of13. the High fat diet model group, the Zusanli group, the Fenglong group, Zusanli together Fenglong group, four weeks after the detection of serological markers in each group to determine the model was successful,and then in the next eight weeks,fed with normal diet, the treatment group received moxibustion related points,just crawl animal model control group without treatment, to observe moxibustion at Zusanli, moxibustion Leong, moxibustion Zusanli together Fenglong the hyperlipidemic disease model of serum lipids and hemorheology.In the third section, first select the75patients with hyperlipidemia, randomized25cases assigned to the Zusanli group, the Fenglong group of23cases, the Zusanli together Fenglong group of27patients,after shedding nine cases,observationthe patient’s serum lipids, body, changes in clinical symptoms.Results1.A rat model of blood lipids and AI levels:8weeks after the moxibustion treatment,compared with model group, the Zusanli group, the Fenglong group,Zusanli together Fenglong serum TG,TC and LDL-C level,AI Index significantly lower difference(P<0.01),HDL-C levels were significantly elevated.the Zusanli group and the Zusanli together Fenglong group have more advantages in lowering TC,the Fenglong group and the Zusanli together Fenglong group have more advantages in lowering LDL-C.2.Hemorheology:Compared with the model group, the Zusanli group, the Hong Leong group,the Zusanli together Fenglong group of high shear and low shear rate,plasma viscosity,hematocrit,erythrocyte electrophoresis time, erythrocyte aggregation index were significantly decreased,the difference was significant.3.Clinical lipid levels in patients with:the Zusanli group, the Hong Leong group, the Zusanli together Fenglong group can be lowering blood pressure,which together Hong Leong group Zusanli more effective4.Body of clinical patients:no significant change after treatment,three groups of patients with body size.5.clinical symptoms points:the Zusanli group, the Fenglong group, the Zusanli together Fenglong group can be effective to reduce the symptom score of patients with hyperlipidemia, in which the Zusanli together Fenglong group more effective.Conclusion1.the moxibustion Zusanli point,Fenglong point,Zusanli together Fenglong point,and hyperlipidemia model rats can effectively reduce serum TC, TG and LDL-C,AI index,elevated HDL-C.2.Moxibustion at Zusanli point, Zusanli together Fenglong point significantly reduce hyperlipidemia model serum TC, the moxibustion Fenglong, Zusanli together Fenglong point in reducing hyperlipidemia model of serum LDL-C obvious.3.The moxibustion Fenglong point,Zusanli together Fenglong point,can effectively reduce the hyperlipidemia model rats hemorheological parameters.4. Moxibustion Zusanli point,Fenglong point,Zusanli together Fenglong point can be effective in treating patients with hyperlipidemia, and the combination of the two points better.5.Moxibustion Zusanli point,Fenglong point,Zusanli together Fenglong point can effectively reduce the clinical integration of the patients with hyperlipidemia, to improve the patient’s clinical symptoms, and the combination of the two points better, but to improve the patients body is not obvious. 6.The basic theory of Chinese medicine as the"the stomach and the spleen are acquired","spleen governs the transportation","the spleen is the source of phlegm" certain laboratory and clinical evidence.更多还原