【作者】 刘洁；

【导师】 袁肇凯；

【作者基本信息】 湖南中医药大学 ， 中医诊断学， 2006， 博士

【摘要】 一、不完全性截瘫的文献研究通过对文献杂志的系统整理探讨了各医家对不完全性截瘫（痿证）的中医针灸辨治规律（一）临床辨证规律共检索2000～2005年国内中医、西医、中西医结合正式刊物及书籍等62篇,不完全性截瘫临床辨证为气滞血瘀证、脾肾阳虚证、肝肾阴虚证三个主要证型。（二）临床用药规律统计了使用方剂总数,方剂中各类药物使用频率及组合数、用药总数、用药分类,各药的使用频率,主要治法用药情况及成方使用情况。结果:使用方剂总数55首,方剂中以活血化瘀类药使用频率最高,补血药为次,说明不完全性截瘫的用药指南以活血补血（治血）为第一要义。55首方剂中辨病论治即专病专方加减者18首方,辨证论治者37首方,无论是辨病论治还是辨证论治,活血化瘀药均为处方的主要选择。用药频率在10次以上共25味,使用频率最高的五5味药是当归、牛膝、熟地、土鳖虫、鹿角胶,提示“活血补血法”在不完全性截瘫证治中的使用频率最高,“活血补血,通阳（督）起废”是治疗本病的关键。（三）针灸辨治规律检索论文58篇,总结取穴规律:①治痿首取督脉;②辅以华佗夹脊穴;③佐以五脏俞加膈俞;④佐以膀胱经和胆经穴;⑤治痿不忘阳明;⑥治痿常灸井穴。总结针法灸法运用规律:①督脉针刺法;②矩阵式针灸法;③神经干刺激法;④华佗夹脊针刺法;⑤十联电针针刺法;⑥醒脑开窍针刺法;⑦排针疗法;③局部断面九针穴刺激法;⑨动针法;⑩长针透穴法;（11）七星针扣刺;（12）灸法;（13）穴位注射法,提示针刺督脉是治疗本病的关键。二、不完全性截瘫肝肾阴虚证针刺治疗的临床研究采用多医院疗效观察的方法对外伤性截瘫（痿证）的证治进行了规范化临床研究,在湖南中医学院第一附属医院、湖南省中医研究院附属医院、长沙市第四医院等3家医院观察督脉针刺合神经干刺激疗法、督脉针刺法、神经干刺激疗法对外伤性截瘫的总体疗效和小便功能改善情况,并用I¹²⁵放射免疫测量法测定治疗前后血液、脑脊液,神经肽包括β-内啡肽（β-EP）强啡肽A（DYNA）精氨酸加压素（AVP）含量,探讨针灸治瘫的机理。结果:共观察178例患者,发现3种疗法均能治疗外伤性截瘫,但以督脉针刺合神经干刺激疗法疗效显著,明显优于单纯督脉针法、神经干刺激疗法,对不完全性截瘫的痊愈率可达70%以上,导尿管拔除率达100%,可显著的缩短疗程,提高疗效,降低成本。是一种简单实用、安全有效、值得推广的中医针灸疗法。治疗前后神经肽含量明显变化。针灸疗效与降低DYNA,β-EP、AVP含量有关。三、针刺对兔不完全性截瘫不同证候阶段影响的实验研究动物实验研究中探讨了不完全性截瘫三个证候阶段,针灸疗效的实质。采用压迫法造模,观察针灸治疗在三个证候阶段脊髓光镜、电镜结构改变,神经肽含量变化,神经、血管生长因子阳性表达。结果,脊髓损伤后6小时内气滞血瘀期,脊髓损伤出血、水肿最严重。与损伤脊髓血管内皮细胞生长因子（VEGF）阳性信号数呈高峰状态相一致,针灸一次即可降低VEGF的阳性表达信号数,可减少脊髓水肿减少出血与渗出,可维持细胞核体密度正常状态。维持线粒体有效功能面积及有效个数,促进线粒体能量代谢,促进神经原恢复。脾肾阳虚期（约在伤后7d-15d以后）,针灸能有效地利用成纤维细胞生长因子（bFGF）促神经再生作用,增加bFGF阳性表达;又能清除炎细胞聚集,抑制bFGF合成释放,有效地达到抗瘢痕抗粘连的作用。肝肾阴虚期（约在伤后15d以后）能促进神经营养因子（NGF）阳性表达。神经营养成分增加,对神经元维护与修复起到至关重要的作用。针灸在脊髓损伤后三个不同证候阶段可调整靶细胞神经肽含量,通过纤维突触的运转致神经元参与脊髓损伤的修复,主要有:调整血管升压素（AVP）含量,加快抗原抗体结合,减轻由AVP升高导致的脊髓水肿;调整β-内啡肽（β-EP）含量;加快DYNA降解弥散,及与受体结合过程,从而减轻对脊髓的继发损伤。更多还原

【Abstract】 1.According the systematic sorting of the literature and magazine to explore the regulation of syndrome differ classification that each docter cures incomplete paraplegia using acupuncture。(1) The regulation of syndrome differ classification in Traditional Chinese Medicine:Consulting 62 literature of Chinese medicine,western medicine,combine traditional Chinese and western medicine in 2000-2005 years,the dilectical classification in incomplete paraplegia can be divided into syndrome of Qi - stagnated and blood - stasis,syndrome of deficiency of spleen- yang and kindey- yang,syndrome of deficiency of liver- yin and kindey- yin.(2) The regulation of clinic medicine usage:Statisticsed a total amount,the frequency of each kind of medicine used,the number combined and the medicine used in the square total amount,the medicine categorized,the usage frequency of each medicine,the main method of treatment with the medicine and the usage of all prescriptions.Results:Use 55 prescriptions,the tallest usage frequency is a kind of prescription that can promote blood circulation and remove blood stasis in these prescriptions。Second is the kind of prescription that can increase blood。This can be explained that it is the most important that using prescription that can promote blood and increase the blood in the treatment of incomplete paraplegia。In the 55 prescriptions,the theory cure namely particularly the disease is 18,37 prescriptions are the ones that based on differentiation of symptoms and signs。The function of all the two kinds are mainly promoting blood circulation and removing blood stasis.The total number of usage frequency more than 10 times is about 25,in which the tallest usage frequency includes danggui,niuxi,shudi, tubiecong,lujiaojiao。Thus,it is the most that the usage of those prescriptions that can promote blood and increase blood in the treatment of incomplete paraplegia."promoting blood and increasing blood, calefaction positive gas(Du meridian) and stimulate paralysis" is the key method in the treatment of incomplete paraplegia。(3) The regulation of syndrome differentiation of acupuncture:we referred to 58 dissertations,summarizing six laws about how to select aperture:①to take Du meridian at first when treating the impotence syndromes;②to take Huatuo Jiaji acupoint as supplement;③to take Wuzhang acupoint and Ge acupoint as adjuvant;④the meridian of urinary bladder and gallbladder can also be used as assistance;⑤to take Yangming meridian when treating the impotence syndrome;⑥to take Jin acupoint as usual when treating the impotence syndrome.The summarization of 13 laws about how to use the method of acupuncture and moxibustion:①the method of pricking Du meridian;②to choose acupoints by matrix form;③the method of stimulating nerve stem;④the method of pricking Huatuo Jiaji acupoint;⑤to use ten-joint electrical needles;⑥the method of awaking brain and opening aperture for acupuncture;⑦therapy of needles-in-line;⑧stimulating the nine-needle acupoint of certain part§ion;⑨the method of needle-movement;⑩the method of long needle penetrating the acupoint;(11)to take seven-star needle for pricking;(12) moxibustion;(13) the method of acupoint-injection.2.The clinic study of "liver and kidney-yin-weak "syndrome of incomplete paraplegia with acupuncture.The standardization clinic study was explored on the regulation of syndrome differ classification incomplete paraplegia with curative effect observing of many hospitals.Collectivity curative effect and condition of urinate function improving were observed with acupuncture on Du meridian and nerve trunk,acupuncture on Du meridian,stimulating on nerve trunk in the frist hospital of Hunan college of tradition Chinese medicine,The hospital of hunan tradition Chinese medicine academy, The fourth hospital of Changsha.The content of neuropeptides(B-EP,DYNA,AVP) in blood and cerebrospinal fluid before and after therapy,to explore mechanism of acupuncture on paraplegia.Result:through the observation of 178 patients,the result is all the three therapies can treat traumatic paraplegia,but the therapy of Du meridian and nerve trunk is better than others,which can get to 70%of recovery rate on incomplete paraplegia and 100%of removing rate of catheter.It can significantly shorten period of treatment,improve curative effects,decrease cost,so it is an easy,safe,effective and recommendable therapy of acupuncture.The content of neuropeptides changed distinctly before and after therapy.The effect of acupuncture is related to decreasing the content of DYNA,B-EP,AVP.3.The experiment study on the regulation of syndrome differ classification incomplete paraplegia of rabbit with acupuncture.Three syndrome phase of incomplete paraplegia and the essence of effect of acupuncture were explored in the animal experiment study.The animal experiment adopts the pressing model of rabbit,adopts photoelectrical scope to observe spine and positive expression of neuropeptides,NGF and VEGF.Result:The status that Spinal cord was scathed to bleeding and dropsy was the best severity were same as that the pinnacle status of positive signal number of VEGF within syndrome of Qi - stagnated and blood- stasis afer the spinal trauma in 6 hours.Taking acupuncture one time after the spinal trauma can maintein the positive signal number of VEGF,reduce the dropsy,bleeding and effusion,maintein the normal density nucleus,maintain the functional area and number of mitochondria, can promoe energy metabolismof mitochondria and neuron recovery. Acupuncture can promote the expression of BFGF to regenerate the traumatic neuron,can clean the inflammatory cells and inhibit the release of NGF(the increase of neurotrophins is important to defence and repair of impaired neuron).Morever,acupuncture can adjust the level of some neutopeptides,can carry them into neuron to participate in the repair of tranmatic spinal cord:adjust the content of AVP,B-EP,accelerate the degeneration and diffusion DYNA and the combination with receptor so as to alleviate the secondary impair of spinal cord.更多还原