【作者】 释传根；

【导师】 王玲玲；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 抑郁症是一种患病率、复发率、自杀率三高的身心病症。目前传统西药治疗虽然具有肯定的疗效,但这类药物具有突出的抗胆碱能副作用和中枢毒性以及心血管、胃肠道等系统的不良反应,限制了其对老年伴躯体疾病的抑郁症患者的使用。目前临床使用的各种抗抑郁药物都存在一定的局限性。因此研制慈经音乐电针仪疗法,优化治疗方案,为临床提供一个疗效较好的治疗方案及措施。本课题的研究分成理论研究,慈经音乐电针仪研制及临床研究三部分内容。第一部分理论研究：1.明确抑郁症是中西医病名的定义。2.明确历代中医学对于抑郁症的认识及渊源：即抑制症起源于秦汉,发展于唐宋,完善于金元,而鼎盛于明清,统一於近代。3.明确抑郁症病位在脑,并与脑、心的损害或功能紊乱有关,气机失调时,脑神紊乱而使五脏功能失调,引致郁证发生。所以治郁必先治脑,脑气通调,心血充足,则郁自解,神自宁。4.明确抑郁症的病因是情志不遂,气机郁滞、气血阴阳失调、脏腑功能失常、精神异常；其病机核心是“气机失调,脑神失控”,导致血瘀、痰蕴、精亏、气虚、血虚、阴虚、阳虚等病态链的病理反应,形成机体“气机失调,脑神失控”。5.明确西医对抑郁症发病机制主要集中在心理社会因素、遗传学因素、神经生化、神经内分泌以及免疫机制研究几个方面。6.探讨慈经音乐电针疗法概念及优势。并简叙对抑郁症的治疗机理。7.剖析佛家慈经音乐电针治疗抑郁症的机理：(1)因感于佛法即是解脱宇宙生命的各种生灭现象。佛陀以弘扬佛法之法,开悟众生,了脱苦恼之束缚以佛家慈经音乐电针治疗此症,借助佛法的智慧,体会佛法看破放下的真义,通过幽美宁静的音律蕴含佛学精神的词句,使低潮郁闷的情绪霍然开朗,用每个音符,每句话语,抚平受创的心灵,祛除内在的虚妄执着,进而调适身心灵的括静,平和,当心调意摄,自然达到安乐自在,清净无忧的境界(2)慈经的文献综述资料很少,也末曾有人作过临床研究,所以对它的研究及发展是有特殊的学术价值和意义。8.明确佛学与医疗关系及佛教音乐医疗的特征,具有修行性、感化性、传承性的特性。《慈经》是来自释迦牟尼的教示,是有关于对宇宙众生无限爱心的启示。(1)“大悲为首”,“慈悲喜舍”。(2)“诸恶莫作,诸善奉行”(3)“自利利他”,“自觉觉人”。(4)正念而住的特奌。配合音乐治疗作用具有一定的感化性及心理疏导作用。9.慈经音乐电针疗法的介绍及探究。10.慈经电针特点与优势。11.中医角度分析慈经疗法的作用,慈经音乐电针具有舒心活血、镇静催眠、解痉止痛、抗炎消肿、蠲痹降压、预防肌肉的痿缩等功效第二部分慈经音乐电针仪研制的设计,参数及原理第三部分临床研究1.2008年10月～2009年10月随机选取60例新加坡菩提施诊所,新加坡佛教施诊所,门诊病人。(均由西医精神科医生诊断为抑郁症)。2.随机对照性分为2组,治疗组与对照组各30例。两组病人治疗前性别、年龄、病程基本相同,具有可比性(P＞0.05)治疗组为慈经电针1组：选主穴：百会、印堂。基本配穴：风池(双)、大椎、神门、神道、三阴交(双)。灵活配穴：临床针灸医生根据患者病情特点及体质状态结合个人临床经验灵活配穴1-2个。每次电针30min,并播放慈经音乐,音量在60贝,播放前说明慈经含意,每星期二次,共治疗6周。对照组为慈经2组：播放慈经音乐,音量在60贝,播放前说明慈经含意,连续时间30分钟,每星期二次,共治疗6周。(并由专人进行操作及评估)两组于治疗前治疗后第6周观察汉密顿(HAND)量表、自评抑郁量表(SDS)。经过6周治疗后,慈经电针治疗组的汉密尔顿(HAMD)显效5例,有效24例,无效1例,有效率达到96.67%。单只听慈经音乐的对照组显效1例,有效13例,无效16例,有效率达到46.67%。说明慈经音乐结合电针的治疗组优于单只听慈经音乐的对照组。(X2=19.172,P＜0.01)经过6周治疗后,慈经电针治疗组的自评抑郁量表(SDS)完全改善无抑郁17例,轻度抑郁12例,中至重度抑郁1例,有效率达到96.67%。单只听慈经音乐的对照组完全改善无抑郁4例,轻度抑郁18例,中至重度抑郁8例,有效率达到73.33%。说明自评量表(SDS),慈经音乐结合电针的治疗组优于单只听慈经音乐的对照组。(X~2=14.692,P＜0.01)结论1.慈经音乐结合电针刺督脉百会印堂等穴具有调整阴阳、醒脑开窍、宁心安神之功。针刺此穴能改善脑组织血液供应及血管弹性,并能通过大脑皮层的反射调节自主神经,进而对神经系统疾病起到治疗你用,电针刺百会穴能抑制脑的异常兴奋,使紊乱的脑功能恢复平衡、协调疗效优于单纯播放慈经音乐组2.慈经音乐结合电针抑郁症的患者,初期接受电针时紧张感所具备的舒缓情绪,放松身心的作用在抗焦虑、抑郁情绪等方面,慈经音乐起到了促进作用,而电针仪可弥补音乐不能达到的作用,两者可互为补充提高优化治疗,值得临床进一步的推广应用。更多还原

【Abstract】 Mental illness such as depression has a high chance being contracted; it also has a high relapse rate and results in high suicide rate. Although at present, modern medicine has effective measures against depression, but those drugs in use do have prominent anti-cholinergic side effects, CNS toxicity, as well as causing adverse reactions on cardiovascular, gastrointestinal and other systems. This restricts the use of such drugs on both elderly patients and patients who are stricken with both physical and mental diseases concurrently. Therefore, current clinical uses of anti-depressant drugs are limited. As such, a study on the use of electro-acupuncture with Metta music therapy is implemented so as to investigate how it can increase clinical efficacy of depression treatment, and eventually enhance treatment programs for patients stricken with depression.PURPOSE AND ITS SIGNIFICANCE(1) Theoretical Research1 Depression is a modern disease name in the traditional Chinese and Western medicine.2 To affirm that studies made on depression in TCM literature and its originality were first found in Qin and Han dynasties, developed during Tang and Song dynasties, fully established in Ming and Qing dynasties and finally unified recently.3 To affirm that the location of illness of depression are related to brain and heart functional deficiencies and disorders. When disorder in qi flow and brain spirit results in disorder of visceral functions, and consequently depression syndromes manifest. As such, the treatment for depression starts with treating the disorder in brain and heart. When the brain’s spirit is ordered and heart’s blood is sufficient, depression shall subside and spirit shall be calmed.4 To affirm that the depression’s pathogenic factors comprises of emotional upsets and qi stagnation, which in turn causes qi, blood, yin and yang disorder, and resulting in visceral function disorder, brain spirit abnormality. The mechanism of illness is thus:qi mechanism disorder resulting in brain spirit disorder, causing blood stasis, phlegm accumulation, essence insufficiency, qi, blood, yin and yang asthenia, such a series of chain reactions along the way, resulting in brain spirit disorder" shall be invoked as depression evolves with time.5 To affirm that current medical against into depression are focused on several areas: psychological and societal factors, genetic factors, nervous biochemical factors, nervous endocrinological factors and immunological factors.6 To study the effectiveness and advantage of electro-acupuncture with Metta music Therapy.7 Analysis of Buddhist Metta chant as electrotherapy for depression:i. Buddhism is the perfect education about us and the universe we live in. It is the teaching beyond worldly knowledge-of the highest wisdom that leads to the realization of true happiness. Buddha dharma is the wisdom of all people and the light of the world. It is a method to enable all sentient beings to attain perfect virtue and wisdom, and become the Enlightened One. Thus, Metta chant is used to propagate the Dharma, by employing graceful and enchanting melodies of Metta chant to eject to stream of miraculous medicine in the turbulent sea of emotional ups and downs.ii. The chant of Metta literature traces out little information, but also clinical studies have not been made, thus this is a special value and significant research. 8 To affirm the relation between Buddhism teaching and medical treatment and also the characteristics of Buddhism music used in musical therapy with its main characteristics being cultivating of embodying nature, probational nature, transmissive nature. Metta music based on Buddha’s teaching with relation to his exposition of boundless love to universal beings have three characteristics:i. Loving Kindness; Compassion; Sympathetic joy; Equanimityii. Cease all evil deeds; to be heedful in wholesome deedsiii. On self reliance and helping others on the same path; self realization and lead others on the path of realization.iv. To move on with right mindfulness.9 Introduction and exploration of Metta music electro-acupuncture.10 The characteristics and advantage of Metta music electro-acupuncture11 From TCM perspective, such musical signal is able to tranquilize and hypnotize, relieves convulsion and pain, has anti-inflammation effect and reduces swelling, reduces numbness and is anti-hypertensive, prevents muscle atrophy etc.(2) Equipment Research and Design(3) Clinical Research1. Random selection of 60 depression cases from the period starting October 2008 to October 2009 in Puti Free Clinic and Singapore Buddhist Free Clinic outpatient records.2. Randomly divide the 60 patients into 30 patients in a treatment group and 30 patients in the placebo group. These 60 patients are of the same sex, belonging to the same age group, has similar course of depression illness and are all being diagnosed with depression by qualified doctors specializing in mental illnesses.In the treatment group, electro-acupuncture with Metta chant excitation are performed at the volume of 60dB on the following acu-points while Metta chant was playing, in the background for 30 minutes. Such treatment will be twice a week and will take 6 weeks to complete course.Primary acu-points:Bahui (GV20), Yintang (EX-HN3) Secondary acu-points:Dazhui (GV14), Shendao (GV11), Fengchi-both (GB20), Shenmen-both (HT7), Sanyinjiao (SP6)Flexible acu-points:Physician’s choice of one to two extra acu-points in accordance with the syndromes manifested during treatment. The duration of treatment is 30 minutes, done at a frequency of twice a week for a course of 6 weeks.In the placebo group, only Metta chant is being played at a volume of 60dB with explanation of the meaning of Metta chant before the treatment begins. The duration of treatment is 30 minutes, done at a frequency of twice a week for a course of 6 weeks.At both the beginning and end of treatment in both groups, a 17-item Hamilton Rating Scale for Depression (HAMD) is being assessed by the physician and the standard questionnaire for self-rating depressive scale is done by the patient.(4) ConclusionFrom clinical research, after 6 weeks of Metta music electro-acupuncture theraphy, based on the Hamilton Rating Scale for Depression (HAMD), these results are achieved.●patients with obvious effectiveness●24 patients with some effectiveness ●1 patient with no effect I.e. effective rate of 96.67%For treatment with only Metta musical Theraphy, the following results are achived.●1 patient with obvious improvement●13 patients with some improvement●16 patient with new improvement I.e. effective rate of 46.67%The above results show that there is superior effectiveness of Metta musical theraphy combined with electro acupuncture treatment against treatment with just Metta music (x2=19.172,P<0.01)1. In conclusion, Metta musical threaphy combined with electroaccupuncture on governor vessels such as Bai Hui (GV20), Yin Tang (EX-NW3) etc serves to achieve ying-yang balance, enlighten thoughts and smoothen emotions. Applying acupuncture on Bai Hui acu-point can improve blood supply to the brain and elasticity of the blood vessel; reflex regulation of autonomous nerve via the skin layer of the brain and with healing effects on nerve system disease, suppress the unusual excitement to recover and regulate the troubled brain to a balanced state.2. Metta musical theraphy combined with electro-accupuncture have a soothing effects on the patients suffering from depression. With the metta musical theraphy complementing the electro-accupuncture and increasing the effectiveness of the treatment. Therefore, it is worthwhile to explore further these combined treatment through more clinical researches.更多还原