【作者】 张幼美；

【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】 痹证是临床的常见病证，其防治仍是目前的攻关难题，由于发病率高，病情复杂，反复发作，治疗上有一定难度，积极探索其有效的治疗方法及研究其获效的作用机理以进一步提高临床疗效是医学界共同努力的方向。近年来，针灸，尤其是电针治疗痹证在提高临床疗效，改善预后等方面取得了一定成绩，为进一步探讨其获效的作用机理，本论文在以下几个方面作了一些初步的探讨。 一.文献研究 从古代中医对痹证的认识、针灸治疗痹证的现代研究概况及针灸治疗痹证的实验研究等方面进行了系统的理论探讨，认为： 1.痹证是指由于风、寒、湿邪侵袭机体，使经脉气血运行不畅，出现肢体关节肿胀、屈伸不利、活动受限或麻木不仁的一组症候，包括现代医学风湿性关节炎、类风湿性关节炎、痛风性关节炎、坐骨神经痛、肩周炎等范畴。 2.痹证可分为躯体痹证和“五痹”，躯体痹包括“风痹”、“寒痹”、“着痹”、“热痹”、“麻痹”；“五痹”包括“脉痹内合于心”、“筋痹内 张幼荧博士毕业论文于肝”丸“肌痹内合于脾”、“鹏内合于肺”、“髓内肝肾”。 3．不同痹证的治疗采用不同的针刺方法。针灸治疗痹证常用的取穴方法包括：局部取椭、邻近取椭、远道取阳、远近取雌、对应取穴法及多经取九法等。 4．现代针灸治疗痹证的临床研究主要是针对不同针法＊ 床疗效及作用晌u的研究。而实验研究主要恻重于娜动物模型的建立、针灸治疗觎的作用机制的研究；其中针灸治疗痹证作用机理的研究主要从以下几个方面开展：针灸治疗痹证抗炎、止痛机理的研究：针灸调节痹证患者免疫功能的研究；针灸治疗对痹证患舢蝴汕液流变学的影响；针灸治疗湘证患者抗氧化作用的影响及不同针灸施旗是不同频率电针对痹证患甜炎、牌作用机理的研解。 二．l③硼究 本部锨颐例80例，包括痛痹37例、着痹22例，鹏15例和热痹6例。随机分为电针ZHZ组27例、踉ltollZ 组26例及体针27例。三组间性别、年龄、病程、中医辩证及主要临床症状之间具有可比性。研究结果表明： ＊ZHz及100HZ电针治疗可明显缓狮网剖匝患者的临床瞅，其效果明显优于体针组。在临床疗效方面，ZHZ与 100HZ电针之间临床疗效无显著性差异，但均优于体针组，特别是在治疗痊愈率上ZHZ、10the电针两组均明显高于体针治疗组，表明电针治疗风湿痹证的临床疗效明显优于体针泊疗，电针阳陵泉、肛里、阿是穴及其它配穴治疗痹证是非常有效的。A 2．电针治疗痹证患者可升高其血清补体含量，阅氏免疫球蛋自水平，抑制其觎的栅免疫，从碗到治疗作用。其中又以100HZ电针治疗效果为最佳。 3．100HZ r治能OKW明显下降，而offi／OI（1’r比值明显升高。 2 电针治疗痹证的临床疗效和实验研究 电针治疗通过调节wt／OIQS比值及免疫球蛋白失衡来调 思者免疫 功g编田L，恢复体液和细胞免疫的动态平衡。 4．ZHz、100HZ电针治疗后几七水平均明显升高，并接近正常人的 水平，提示电针可提高机体的兔疫功能。 5．ZHz、100HZ电针治疗后哪患者血浆LOP含量和觑胞SOD活 性均见明显阅民提示电针对氧自由基的释放有抑制作用，从而减少体 内自由基的酗反应，使原来代偿陇高的血浆LOP含量和觑胞SOD 活性哪，使炎症减轻，关节功能得以改善。 三．实验研究 通过对实验性风湿性关节炎大鼠徽娜究发现： 1．急性模型大鼠痛敏感状态存在，炎症局部肿胀度显著增加；电 针治疗后 阈升高、炎症局部肿胀度减轻，尤以100Hi电针治疗组效 果明显。 2．电针治疗可明显改善急性模型大鼠的血液鞭鲫…。 3．电针治疗可明显抑制急性模型大鼠海马中即早基因C－fOS的蛋 白表达。 4．帆能哪急性模型大鼠炎症局部组织中的吗及组织避冶量， 以100HZ电针作用较强。ZHz、100HZ电针和阶均可哪炎脯部组织l 中54fi’的缩。附和附治疗均可啊氏炎娥织中NE的沮，但电 针和体针对DA颇明显影响。电针可使AA大鼠炎症局部Ep中8EP、 LEK＃tJS加。这些实验结果提示电针及体针治疗对AA大鼠均有镇痛作 用，且以100H电针疗效为优，其夕周镇痛机制可能是通脓炎症组织 中致痛物质腻沙，镇痛物质增加而挪作用的。 5．电针对慢性类M性关节炎模型大鼠关节病理形态学有明显的 改善作用。更多还原

【Abstract】 Bi Zheng", traslated "Bi Syndrome", a common disease in clinic, is being paid close attention to on its treatment and prevention measure recently as a result of its high incidence, complex condition, frequent recurrence as well as the difficulty in complete recovery. The researches on an certain effective therapeutic method and the related action mechanism is being urged around the whole medical field for the sake of improving treatment result. At present, acupuncture especially the electric acupuncture applied to the treatment of Bi syndrome has achieved some success to promote clinical effect and prevent relapse. This article covers some primary researches which have been done in order to further investigate the action mechanism of electric acupuncture respectively in the following aspects. 1. Literature researchthrough a wide review on the ancient record in traditional Chinese medicine along with current experimental and clinical researches on Bi syndrome, it is concluded that:(l)Bi syndrome is a group of syndrome including swollen joint,numbness and impaired or fixed flexion and extension which is attributed to the obstruction of qi and blood circulation in channels primarily resulting from wind, cold and damp evil attack. This syndrome in TCM is generally equal to a variety of disease in modern medicine such as rheumatic arthritis, rheumatoid arthritis, gouty arthritis, sciatica and scapulohumeral periarthritis.(2)Bi syndrome can also be separated into "Qu Ti Bi"(body Bi) and "Wu Bi"(five Bi)two types. The body Bi syndrome is composed of "FengBi"(windBi), "Man Bi"(cold Bi), "Zhuo Bi"(Adhesive Bi),"Re Bi"(Heat Bi) and "Ma Bi"(Numbness Bi), while five Bi syndrome includes vessel Bi connecting heart, tendon Bi connecting liver, muscle Bi connecting spleen, skin Bi connecting lung and bone Bi connecting kidney.(3)Contemporary clinical study on the acupuncture therapy for this disease major emphasizes on the survey of clinical efficacy and the related active principles in the treatment with different puncturing manipulations. And experimental researches mostly focuses on the foundation of animal models and the discovery of the action mechanism. As for the inquiry on the action mechanism of acupuncture, great work on the anti-inflammation and analgesia, immunity adjustment, circulatory and rheological promotion on blood, and anti-oxidative effect are under way, in addition to a specific research on the contrast of anti-inflammation and pain-killing influence by various types of puncturing method especially on the electric acupuncture with different electricfrequency.2. Clinical research:80 cases were observed in this part of research, among them, 37 were of pain Bi, 22 of adhesive Bi, 15 of wandering Bi and 6 of heat Bi. They were randomly assigned into 2Hz electric group of 27 cases, 100Hz electric group of 26 cases and body acupuncture group of 27 cases, sex, age, illness course as well as mian complaints and pattern differentiation in TCM of the all three groups were absolutely compatible. The results were as follows:(1)2Hz and lOOHz electric acupuncture groups have significantly relieved the clinical symptoms of Bi syndrome patients, superior to the body acupuncture group, however, they perform no difference between these two electric acupuncture groups. 2Hz and lOOHz electric acupuncture also take advantage over the body acupuncture in obtaining better curative rate, manifesting that the clinical effect of electric acupuncture is better than that of body acupuncture. Electric acupuncture on Yanglingquan, Zusanli and Ashi points together with some other supplementary points is particularly helpful in treating Bi syndrome.(2)Electric acupuncture treating Bi syndrome did made its work by increasing the serum complement concentration, reducing immunoglobin level, inhibiting the hyperactive humoral immunity. What’s more, lOOHz electric acupuncture turned out to be of the best effect.(3)As OKT8 dropped obviously after the treatment with lOOHzelectric acupunctur更多还原