针灸从肝胆论治偏头痛的理论探讨

发布时间：2018-06-17 03:46

本文选题：针灸 + 肝胆　；参考：《广州中医药大学》2013年博士论文

【摘要】：为了更清楚的定义中医学的偏头痛诊断标准以及如何与西医的诊断相关,为中医学现代化发展以及更为广泛地在欧美国家被接受,本课题力图通过理论及临床资料的探讨与分析,明确偏头痛在中、西医两个医学体系中的临床标志性特征以及肝胆在其发病机理中所起的重要作用,为针灸临床诊断和治疗偏头痛提供坚实的中西医理论和临床依据。本课题的研究目的在于探讨以下问题：基于中医理论和临床观察基础上的偏头痛与和肝胆相关性的探讨；西医对偏头痛的理解及其与中医理论中肝、胆关系的探讨；针灸调理肝胆法治疗偏头痛的理论基础和临床依据探讨。方法与内容一.方法本课题运用文献研究的方法,从中、西医角度分析、探讨肝胆与偏头痛病理生理及治疗之间的关系。二.内容 1.从中医理论及临床角度探讨肝胆与偏头痛的关系 1.1偏头痛的中医发病机制阳气的生理和病理在内经中是一个重要问题。综合来说,内经认为,脑为髓海,是人体手、足阳经及督脉会聚的地方,亦是人体精气会聚之处。五藏六腑之气血皆上注于头,正因如此,当阳气功能亢进或阴阳失调时,头部就很容易受到影响。比如,《黄帝内经·素问》曰：“故春气上于头”,这里的春气即指肝气。肝主疏泄,表现为肝气向上、向外的运动,其自然属性就是运行到人体的最高点,即头部。也就是说,一旦肝气的运动方式出现问题,就容易影响到头部功能,这对偏头痛来说是一个重发病因素的。 1.2正常的肝胆关系肝胆之间通过它们各自所连属的经脉形成了表里关系,这使得二者之间不可能独立发挥各自的功能,二者在生理和病理方面均相互影响。中医理论中,肝的生理功能和特征有：储存血液、疏泄气机、主筋、其华在爪甲、开窍于目、主魂；胆的主要功能是储存和分泌由充盛的肝气所化生的胆汁,满足身体的需求。肝胆相表里,命门之火和胆共同协助肝脏行气。 1.3偏头痛与肝胆关系的临床研究 Blackwell、Facco等学者报道,临床上80%的偏头痛患者因肝阳上亢引发；Flaws、Sionneau、学者尹氏、刘氏等也认为,偏头痛患者常因肝阳上亢引发；Flaws和Sionneau的研究也认为,中医理论中,偏头痛通常由肝功能紊乱引起,尤其是肝阳上亢。学者陈氏、Coeytaux等人研究发现,46%的偏头痛患者存在肝血淤滞的情况；肝血淤滞引起的疼痛一般为固定痛,具体称为掣痛或烧灼痛；血淤型偏头痛发生的一般原因为头部经络之气的运行不畅,进而造成淤血,这种情况的产生多由于肝阳上亢后造成胆经之气血运行受阻,引发刺痛、掣痛等偏头痛特有的症状,这些疼痛一般位于眼后或太阳穴附近,由此可推断淤血发生在胆经及其旁络,也有可能涉及三焦经及其旁络；临床上,淤血一般是由于气滞逐渐加重引起,多引起于慢性偏头痛。 2.西医对于偏头痛的认识及与中医理论中肝胆的关系 2.1西医偏头痛的临床表现典型的偏头痛表现为间断性发作的、严重的、跳动性的一侧头痛,常伴有神经系统功能障碍的表现如恶心、声音恐惧症(对噪音敏感)或畏光(对光线敏感)等。 2.2偏头痛发作时常见的疼痛部位疼痛的部位通常沿三叉神经和颞区的上颈神经根附近分布；研究显示,疼痛更常出现的在颞区而不是巅顶或枕骨下区域；而从中医经络理论的角度来看,在大脑颞区(太阳穴)疼痛处,我们可看到三叉神经路径和胆经及其旁络之间的相互关系；胆经和三焦经之间的相互关系更解释了这一点,即二者都穿过太阳穴,与三叉神经的路径非常相似；肝经支络与目周围组织的联系与三叉神经在眼区的分布十分相似。 2.3偏头痛的病理生理学偏头痛是一种复杂的脑部功能紊乱,一种其发病的病理生理学基础尚不十分清楚的血管神经性头痛。曾经,血管功能改变被认为是其发病的唯一原因,但目前,理论研究认为,偏头痛的发生原因与神经系统功能异常有关,并随之激活三叉神经血管系统,被激活的这个系统会增加神经肽的释放,并导致头部的疼痛,而脑血流量的变化本身并不会导致疼痛的产生。看来,导致偏头痛产生的主要原因是神经肽而不是血管管径的改变。这个有关偏头痛的发病机理的新理论推动了对偏头痛发病机理的认识。科技的进步已经使得人们对理解脑血管收缩和扩张和由此产生的神经肽级联在偏头痛发病过程中所扮演的完整角色。有中医学者认为,血管直径的改变是受营气和卫气支配的,营卫之间的协调平衡共同调节着血管的管径。营主血管扩张,卫主血管收缩的过程与血管内皮有关,学者们把营气和卫气的功能分别等同于一氧化氮和降钙素基因相关肽。他们认为,经络气血郁滞引起偏头痛是源于营卫之气失衡。 3.针灸调理肝胆法治疗偏头痛的理论基础及临床依据 3.1针灸穴位治疗效果观察研究证实,针刺太冲穴15分钟后,鼻、颞侧睫状后短动脉阻力指数(P0.05)比基线明显下降,研究者得出结论：针刺太冲穴对降钙素基因相关肽、一氧化氮以及神经源性血管扩张有效；从中医理论的角度来看,太冲穴可用于偏头痛引起的视觉功能异常的治疗,这项研究为中医理论的正确性作了充分的论证；针刺百会穴后,在安静的情况下,大脑中动脉、大脑前动脉的血流量显著升高,该研究显示针刺百会穴能有效提高脑血流量。从中医理论的角度来看,我们知道当人体阳气上升到顶点时就是人体的百会穴,百会也是人体内风上升后到达之处,同时,百会穴还有使胆经之气下降的功能。这项研究对百会穴在中医临床中常用于治疗相关症状的理论提供了有利的实验研究依据；针刺风池穴能有效调节人体的免疫系统及减轻血管内皮损伤。通过调节肝胆气机,风池穴在降低肝阳上亢型偏头痛患者的血清白细胞介素-6水平方面起重要作用；针刺合谷穴、太冲穴(四关穴)后,血一氧化氮升高；大脑额叶、枕骨脑叶、颞叶处的血流量均升高；该研究同时认为,太冲穴(四关穴)的作用机理在于,肝胆经均到达头部,而无论穴位在该经的哪个位置,这些穴位都可治疗该经运行路线上所有部位的症状,尽管选穴的位置离症状所在位置很远。具体表现在针灸理论中,就是远端取穴。总的来说,这些穴位能调节脑部血管的收缩和扩张、提高脑部血流量、调节炎症反应。 3.2针灸与西医药物治疗的临床疗效比较某项研究将针灸的治疗效果与偏头痛的非处方药物的治疗效果进行了比较。针灸治疗组选用的穴位有：合谷、太冲、百会、率谷、风池、外关、足临泣、三阴交、印堂,治疗原则是疏理肝胆、平抑肝阳、止痛。统计结果显示,与西药治疗对照组比较,针灸治疗组每位患者的偏头痛的疼痛程度都比治疗前有明显下降(P.014)；与西药治疗对照组比较,针灸治疗组患者偏头痛发生的平均频率均明显下降(P0.006)；实验结果显示,针灸治疗对偏头痛效果显著,且无副作用。结果肝阳上亢是引起偏头痛的最常见的原因,而肝气郁结又是引起肝阳上亢的重要原因,二者也可同时引起偏头痛,肝血淤是引发偏头痛的第三个主要原因。情绪因素又是引发肝阳上亢的重要原因,愤怒、沮丧、长期担忧等都会造成肝气郁滞并进而演变成肝阳上亢。西医中的偏头痛与中医中的肝阳上亢型偏头痛(疼痛沿胆经分布)最为接近,针灸调理肝胆法治疗偏头痛与西药、安慰剂等的疗效相比是十分成功的。结论一.偏头痛常见发病部位在胆经运行路线上,尤其是太阳穴附近,而很少发生在足厥阴肝经所属的巅顶。二.偏头痛的发生与肝胆气机损伤有关。从偏头痛发作时疼痛的位置、性质、间隔时间、伴见症状等来看,都充分论证了肝胆及它们所属的经络在该病的发病原因中所起的重要作用。三.针灸调理肝胆法治疗偏头痛的生理学研究能填补西医模型的不足,同时更好地解释中医理论。目前,中医对偏头痛的发病机制和治疗原则方面比西医有更完整和深入的理解。未来中西医在偏头痛的研究方面如果有更深入的研究和交流,将对肝胆在偏头痛发病中所扮演的角色及确立最佳的针灸治疗策略发挥更好的作用。
[Abstract]:In order to define more clearly the diagnostic criteria of migraine in traditional Chinese medicine and how to be related to the diagnosis of Western medicine, for the modernization of Chinese medicine and more widely accepted in European and American countries, this topic tries to make clear the clinical indications of two medical systems in migraine and Western medicine through the discussion and analysis of theoretical and clinical data. The important role of the syndrome and the liver and gallbladder in its pathogenesis provides a solid Chinese and Western medicine theory and clinical basis for the clinical diagnosis and treatment of migraine by Acupuncture and moxibustion. The purpose of this study is to discuss the following problems: a study of the correlation between migraine and liver and gallbladder based on the theory of traditional Chinese medicine and clinical observation; and migraine in western medicine. To understand the relationship between liver and gallbladder in TCM theory, and explore the theoretical basis and clinical basis of acupuncture and moxibustion for liver and gallbladder therapy.
Method and content
One. Method
In this study, the relationship between liver and gallbladder and pathophysiology and treatment of migraine is discussed from the perspective of Chinese and Western medicine.
Two. Content
1. discuss the relationship between liver and gallbladder and migraine from TCM theory and clinical point of view.
1.1 pathogenesis of migraine in traditional Chinese Medicine
The physiology and pathology of Yang Qi is an important problem in the inner meridian. In general, the inner meridian is thought that the brain is the medullary sea, the human hand, the place where the foot Yang Meridian and the supervision pulse gather together. It is also the place where the human body is concentrated. The Qi and blood of the five Hans and the six Fu organs are all injected into the head, and the head is easily affected when the function of Yang Qi is hyperactive or the Yin and yang imbalance. For example, "the Huangdi Neijing" said, "so the spring gas is on the head", the spring gas here refers to the liver qi. The liver main discharge is manifested as the liver Qi upward, outward movement, its natural property is to run to the highest point of the human body, that is, the head function is easy to affect the head function once the liver qi movement has problems, this is a headache to migraine. It is a serious cause of disease.
1.2 normal relationship of liver and gallbladder
Between the liver and gallbladder through their respective meridians formed a relationship, which makes it impossible for the two to perform their own functions independently, and the two in both physiological and pathological aspects. The physiological functions and characteristics of the liver are: the storage of blood, the drain machine, the main tendons, its claw a, the head, the soul; the gall. The main function is to store and secrete the bile that is filled with liver qi to meet the needs of the body. In the liver and gallbladder form, the fire and the bile of the life of the life together assist the liver.
Clinical study on the relationship between 1.3 migraine and liver and gallbladder
Blackwell, Facco and other scholars reported that 80% of the clinical migraine patients were caused by hyperactivity of liver Yang; Flaws, Sionneau, scholar Yin's, Liu's, etc. also believed that migraine patients were often caused by hyperactivity of liver Yang; Flaws and Sionneau studies also believed that migraine was often caused by liver dysfunction, especially liver yang hyperactivity in TCM theory. Coeytaux and other studies have found that 46% of migraine patients have liver blood stasis; the pain caused by liver blood stasis is usually fixed pain, which is called pain or burning pain. The general cause of migraine in the blood stasis type is that the operation of the Qi of the head meridian is not smooth, and then the blood is caused by the hyperactivity of the liver after hyperactivity of the liver. The symptoms of migraine, such as stinging and pain, are caused by the obstruction of the Qi and blood circulation, which are usually located near the eye or near the temples. Thus, it is possible to infer that the congestion occurs in the bile meridians and their collateral channels, and may also involve the tri - focal meridian and its collateral channels. A headache.
2. western medicine's understanding of migraine and its relationship with liver and gallbladder in TCM theory
Clinical manifestation of migraine in 2.1 Western Medicine
Typical migraine is characterized by intermittent episodes, severe, beating side headaches, often accompanied by nervous system dysfunction such as nausea, sound phobia (noise sensitive) or photophobia (light sensitivity).
2.2 common painful parts of a migraine attack
The site of pain usually distributes near the trigeminal nerve and the upper cervical nerve root in the temporal region; the study shows that pain is more often occurring in the temporal region rather than the top of the top or the inferior occipital region; and from the point of view of the meridian theory of traditional Chinese medicine, in the temporal region of the brain (temples), we can see the phase between the trigeminal nerve and the bile meridians and their collateral channels. Interrelationship; the relationship between the bile meridian and the tri - focal meridian explains this more, that is, the two all cross the temples, which are very similar to the path of the trigeminal nerve; the connection of the hepatic meridian collateral to the surrounding tissue is very similar to the distribution of the trigeminal nerve in the eye area.
2.3 pathophysiology of migraine
Migraine is a complex brain disorder, a kind of vascular neurogenic headache that is not very clear on its pathophysiological basis. Once, changes in vascular function are considered the only cause of its disease. But, at present, theoretical studies suggest that the cause of migraine is associated with abnormal function of the nervous system and then activates the trigeminal. Neurovascular systems, which are activated by the system, increase neuropeptide release and lead to pain in the head, and the change in brain blood flow itself does not cause pain. It appears that the main cause of migraine is neuropeptides rather than vascular diameter changes. This new theory of migraine pathogenesis is a new theory. The understanding of the pathogenesis of migraine.
Advances in science and technology have led to a complete role in understanding the cerebral vasoconstriction and dilatation and the resulting cascade of neuropeptides in the pathogenesis of migraine. The process of vasoconstriction of the main blood vessel is related to the vascular endothelium, and the scholars equate the function of camp Qi and Wei Qi to the nitric oxide and calcitonin gene related peptide respectively. They believe that the migraine caused by Qi and blood stasis caused by the meridians and blood is derived from the imbalance of the gas in the camp.
3. theoretical basis and clinical basis for treating migraine by acupuncture, regulating liver and gallbladder
Observation on the effect of 3.1 acupuncture points for acupuncture and acupoint treatment
The research confirmed that after 15 minutes of acupuncture at Tai Chung acupoint, the short artery resistance index (P0.05) of the nasal and temporal ciliary arteries was significantly lower than that of the baseline. The researchers concluded that the acupuncture at the acupuncture point was effective for the calcitonin gene related peptide, nitric oxide and neurovascular dilatation; from the viewpoint of TCM theory, Tai Chung point could be used in the view caused by migraine. After the acupuncture at Baihui Point, the blood flow of the middle cerebral artery and the anterior cerebral artery increased significantly after acupuncture at the Baihui Point. The study showed that the acupuncture point can effectively improve the blood flow of the brain. From the perspective of TCM theory, we know when the body Yang is the human body. When the gas rises to the apex, it is the Baihui acupoint of the human body. Baihui is also the place where the human body's internal wind rises. At the same time, Baihui acupoint has the function of reducing the Qi of the bile. This study provides a favorable experimental research basis for the theory of Baihui acupoint used in the treatment of related symptoms in the clinic of traditional Chinese medicine; the acupuncture point can effectively regulate the human body. The level of serum interleukin -6 in patients with liver yang hyperactivity migraine has an important role in reducing the level of serum interleukin (ILC) in the patients with hyperactivity of liver yang hyperactivity by regulating the liver and bile duct. The study also suggests that the mechanism of the Tai Chi (four point) is that the liver and gallbladder meridians reach the head, and no matter where the point is located in the meridian, these points can be used to treat the symptoms of all parts of the route, although the location of the acupoints is far from the position of the symptoms. These acupoints can regulate the contraction and expansion of the blood vessels in the brain, increase the blood flow of the brain, and regulate the inflammatory response.
3.2 comparison of clinical efficacy between acupuncture and Western Medicine
A study compares the therapeutic effect of acupuncture and moxibustion with the non prescription drugs of migraine. The acupoints of the acupuncture treatment group are as follows: Hegu, Tai Chi, Baihui, rate Valley, wind pond, outer customs, foot and face sobs, Sanyinjiao, and Tang Dynasty. The principle of treatment is to dredge the liver and gallbladder, suppress liver Yang and relieve pain. The statistical results show that the comparison group is compared with the control group of Western medicine. The pain degree of migraine in the acupuncture treatment group was significantly lower than that before the treatment (P.014). Compared with the western medicine control group, the average frequency of migraine in the acupuncture and moxibustion treatment group decreased significantly (P0.006). The experimental results showed that acupuncture treatment had a significant effect on migraine and had no side effects.
Result
Hyperactivity of liver Yang is the most common cause of migraine, and liver qi stagnation is an important cause of hyperactivity of liver yang. The two can also cause migraine at the same time. The liver blood stasis is the third main cause of migraine. Emotional factors are also important causes of hyperactivity of liver Yang, anger, depression, long worry and so on will cause liver qi stagnation. And then evolved into a hyperactivity of liver yang.
The migraine in western medicine is most close to the liver yang hyperactivity type migraine in traditional Chinese medicine (pain along the bile duct). The treatment of migraine with acupuncture and regulating liver and gallbladder method is very successful compared with western medicine and placebo.
conclusion
1. The common location of migraine is on the operative route of the gallbladder meridian, especially near the temple, and rarely occurs on the top of the liver meridian of foot Yin Yin.
Two. The occurrence of migraine is related to the injury of the liver and gallbladder. The position, nature, interval time and symptoms of the migraine are fully demonstrated, and the important role of the liver and gallbladder and their meridians in the cause of the disease is fully demonstrated.
Three. The physiological study of treating migraine with acupuncture and regulating liver and gallbladder can fill the deficiency of the western medicine model and explain the theory of traditional Chinese medicine better. At present, Chinese medicine has a more complete and deeper understanding of the pathogenesis and treatment principles of migraine than western medicine. It will play a better role in the role of liver and gallbladder in the pathogenesis of migraine and the establishment of the best acupuncture and moxibustion strategy.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R245

【参考文献】