针刺提插补泻法对血虚证模型家兔血清铁蛋白、总铁结合力的影响

【作者】 徐敏；

【导师】 睢明河；

【作者基本信息】 北京中医药大学 ， 针灸推拿学， 2011， 硕士

【摘要】 针刺提插与捻转手法是针刺的两大基本补泻手法,被广泛运用于临床中。但补泻手法究竟是否存在,决定补泻效果的因素有哪些,是否与针刺时的深度、角度、力度、频率、刺激量存在着关系,至今仍然存在着很大的争论。针刺手法有着很大的主观性而使得其缺少临床规范,导致在很多实验中难以达到较高的可重复性。因此,建立一个针刺手法规范的量化就显得尤其重要,从而为今后的临床及实验研究提供操作基础。第一部分文献综述文献综述共两篇。第一篇介绍了关于针刺提插补泻手法的古代文献及理论研究,提插深度、角度、频率、刺激量等客观指标的研究及提插补泻手法的实验研究概况。第二篇论述中医对血虚证病因、病机等方面的古代、现代的认识,研究概况及治疗方案。第二部分动物实验研究目的：通过研究提插“补”、“泻”手法对血虚证家兔所产生的补泻效果,观察对于血虚证家兔：①针刺提插补法与泻法所产生的补泻效果是否不同；②针刺提插补法的效果是否优于提插泻法；③其研究结果将为提插补泻手法提供客观科学依据,也为临床针刺治疗血虚证提供客观依据。实验方法：将60只家兔随机分为5组：A组(空白组)、B组(模型对照组)C组(留针组)、D组(提插补法组)、E组(提插泻法组),每组12只,后三组统称为治疗组。A组不进行任何处理,正常同步喂养,其余四组均采用放血加适当限食的方法制备血虚证模型。造模成功后,B组：只做捆绑固定,不进行任何治疗,让其自然恢复；C组：针刺家兔双侧足三里进行治疗,不做补泻手法,进针得气后,留针15分钟；D组：针刺家兔双侧足三里进行治疗,按预先录制好的操作口令行提插补法；E组：针刺家兔双侧足三里进行治疗,按预先录制好的操作口令行提插泻法。间日治疗一次,共计10次。分别于造模前、造模后、治疗结束后的第2天、第17天、第32天在耳缘静脉取血,检测家兔外周血中的血清铁蛋白及总铁结合力。采用SAS软件对数据进行统计分析。结果：一、造模前后结果对比1.造模前各组间家兔的SF、TIBC值对比无差异；2.造模后B、C、D、E组的SF值与造模前对比明显下降,TIBC值与造模前对比明显升高；③造模后B、C、D、E组的SF、TIBC值在同一时间段与空白组对比有显著差异,而四组间对比无明显差异。从以上两个指标来看可以判定血虚证模型家兔造模成功。二、治疗前后结果对比1.治疗后第2天,各组家兔的SF值及TIBC值与针刺前相比无明显差异；各组与A组(空白组)比较SF值仍偏低,TIBC值仍偏高。2.治疗后第17天：(1)SF值：①D、E两组(补法组、泻法组)的SF值与针刺前相比明显升高；在此时间点,E组的SF值(泻法组)明显高于B组(模型组)(P<0.05),而D组与B组比较虽无统计学意义,但由于其基础值较低,因此SF值上升的趋势也很明显。②C组(留针组)的SF值与治疗前相比有所上升,其上升幅度要高于B组(但无统计学意义),其与A、B两组相比较均无统计学差异,说明C组有一定升高SF值的效果,但不如D、E两组明显。③D、E两组间比较无统计学意义(P>0.05),说明补法组与泻法组升高SF值的补泻效果无明显区别。(2) TIBC值：①D、E两组(补法组、泻法组)的TIBC值与针刺前相比明显下降,且要低于此时的B组(模型组),与A组(空白组)比较已无明显差异。②C组(留针组)的TIBC值与针刺前相比有所降低(但无统计学意义),其与A、B两组相比较均无统计学差异,说明C组有一定降低TIBC值的效果,但不如D、E两组明显。③D、E两组相比无统计学意义(P>0.05),说明补法组与泻法组降低TIBC值的补泻效果无明显区别。3.治疗后第32天,各组的TIBC及SF值与治疗前相比均明显恢复,各组与A组(空白组)比较已无明显差异(P<0.05)。结论：1.针刺治疗后第17天,D、E两组(补法组、泻法组)家兔的SF值比治疗前明显升高(P<0.05),C组虽无统计学意义,但其SF值升高趋势也较明显,说明针刺治疗可有效升高失血后家兔的SF值。2.针刺治疗后第17天,D、E两组(补法组、泻法组)家兔的TIBC值比治疗前明显降低(P<0.05),C组虽无统计学差异,但其SF值也有降低的趋势,说明针刺可有效纠正失血后异常升高的TIBC值。3.本实验中针刺提插补法与泻法对于治疗血虚证家兔降低的SF与升高的TIBC均有较好的疗效,其效果要优于静留针法。4.本实验中的提插补法对比提插泻法,改善SF及TIBC值的差异不明显,无统计学意义,因而不能推断提插补法的治疗效果要优于提插泻法。更多还原

【Abstract】 As two basic reinforcing and reducing methods of acupuncture, lting-thrusting method and whirling method are widely used in clinic. There are still many different points of view about them:whether the reinforcing and reducing effect really exists, which factors affect the reinforcing and reducing effect, whether reinforcing and reducing effect has relation with the depth, angle, force and frequency of needle insertion. Because the subjectivity of acupuncture manipulation, it’s hard to standardized in clinic and leads to low repeatability in experiments. Therefore, it is very important to establish the quantization of acupuncture manipulation, which will provide with a base for the clinical and experimental research in future.Section one:Literature SummaryThere are two literature reviews. The first article is involved in the study about antique literature and theories; the depth, angle, force and frequency of the lting-thrusting method; and the research profile about experimental study. Section two:animal experimentObjective:To observe the effectiveness of reinforcing and reducing by lifting and thrusting to blood deficiency rabitts:①To study whether the effect is different between lifting-thrusting reinforcement method and lifting-thrusting reduction method on blood-deficiency rabbits;②To study whether the effect of lifting-thrusting reinforcement method is better than lifting-thrusting reduction method on blood-deficiency rabbits;③To evaluate objectively acupuncture manipulation of lifting-thrusting reinforcement and reduction.Methods:60 Rabitts were divided into five groups randomly:Blank Group(Group A), Model Group (Group B), quiet stay needle group (Group C), reinforcing group(Group D) and reducing group (Group E),12 rabitts per group. Drew blood from central veins and central artery and ear margin vein of rabit ears except Blank Group, once per two days and 10 ml per time, totally 5 times, (the volume of withdraw blood is 10% of the whole body blood). Change their normal fed rules since the date of building model, with adequate food and restriction alternately. Drew periphery blood of the rabitts after model built 2 days,17 days and 32 days, test serum ferritin and total iron binding capacity of blood serum after Centrifugal. Data analyze in SAS software.Results:Results contrasting between pre-modeling and post-modeling1. There are no differences in the SF and TIBC indexs among the five groups before modeling.2. Contrast with pre-modeling, the SF index of Group B, C, D,E are sharply decreased, the TIBC index are obviously increased.3. After modeling, the SF and TIBC index of Group B, C, D, E are significantly different with the blank group at the same time, and there are no differences among the four groups. Therefore we could concluded that the model is successfully established.Results contrasting between pre-treatment and post-treatment1.2 days after treatment, there are no differences in the SF and TIBC indexs compared with pre-treatment every group, compared with the blank group, the SF index are still lower and the TIBC index are still higher in Group B, C,D,E.2.17 days after treatment:SF index:①Group D and E are much higher than pre-treatment, Group E is significantly higher than Group B (P<0.05), though there is no statistic difference between Group D and B, the SF index of Group D are also obvious because of the relatively lower basic index.②The SF index of Group C are higher than pre-treatment,it is also higher than Group B(not statistically), which showed Group C could increase the SF index, but not so obviously as Group D and E.③There are no statistic differences between Group D and E, which showed no difference between reinforcing and reducing effect for the SF index.TIBC index:①Group D and E are much lower than pre-treatment, and also much lower than Group B at this time.②The TIBC index of Group C are relatively lower than pre-treatment, it is also lower than Group B(not statistically), which showed Group C could decrease the TIBC index, but not so obviously as Group D and E.③There are no statistic differences between Group D and E, which showed no difference between reinforcing and reducing effect for the TIBC index.3.32 days after treatment:the SF and TIBC index of group B,C,D,E are obviously recovered, and no more significant differences compared with Blank Group. (P<0.05)。Conclusion:1. Acupuncture treatment could effectively increase the index of SF of blood loss rabitts.2. Acupuncture treatment could effectively lower the index of SF of blood loss rabitts.3. the treatment of reinforcing and reducing by lifting and thrusting is good for the index of decreasing SF and increasing TIBC of blood deficiency rabitts and better than quiet stay needle treatment.4. there is no difference between reinforcing and reducing by lifting and thrusting for improving the index of SF and TIBC, no difference statistically between them, so we can not draw a conclusion that the method of strongly thrusting and lightly lifting is better than and lightly thrusting and strongly lifting.更多还原