脾胃为五脏藏神关键及针刺足三里干预抑郁症的理论与实验研究

发布时间：2018-08-22 20:34

【摘要】：目的：五脏藏神是中医学脏腑与神志关系的重要理论之一。本研究从基础理论分析、临床文献研究、动物实验的角度对脾胃与神志的关系进行探讨,揭示脾胃与五脏整体的关系以及脾胃对于神志活动的调节作用,分析调理脾胃改善神志异常的机理,对探讨脾胃与神志活动之间的作用机制及丰富五脏藏神理论具有重要的意义,同时对研究调理脾胃防治神志异常具有一定的临床价值。方法：梳理脾胃为五脏整体之中心的理论基础,探讨脾胃在生理及病理状态下对神志活动产生的影响。以当今社会的高发神志异常抑郁症为例,搜集常用医学数据库中的针刺治疗抑郁症的临床文献,统计选取经脉以及穴位的数据并且加以分析。从细胞信号传导通路角度以CREB为指标,探索足三里穴、神门穴对抑郁症大鼠的发病影响与否及其作用机理。动物实验方法以孤养加慢性不可预见性应激方法建立大鼠抑郁症模型,运用电针手少阴心经穴(神门)、足阳明胃经穴(足三里),通过与西药组盐酸氟西汀对照,运用开野行为测定法检测大鼠行为学指标,运用HE常规染色观察海马CA3区神经元细胞排列与细胞形态变化及Western Blot法测定海马组织中CREB的表达水平,采用免疫组织化学方法检测海马CA3区CREB的表达。结果：五行之中以土为尊,脾因属土而位重。古人崇尚中正之位,因人体脾胃居中,表现而出的现象为化生水谷精微以供养全身,即具有“气血生化之源”的重要功能而受尊崇。人体全身之气升降出入须臾离不开脾胃的转枢,脾胃实为一身气机升降之枢轴。生理上,脾胃具有滋养五脏、助五脏调和之功。病理上,脾胃一病可以直接导致五脏失和；阴阳之气不相顺接导致五脏整体气机逆乱；经脉气血运行失调亦可致周身气机不畅,五脏难安,整体配合不协调从而影响神志活动。脾胃调节五脏整体影响神志活动的机理,不论是脾胃配合失宜、脾胃主持五脏整体气机失调,还是脾胃对气血津液代谢、脾经胃经的影响等,病机关键均离不开气血、阴阳。临床文献研究的结果反映,治疗抑郁症选取阳经的频率远远高于阴经,说明抑郁症在病性上属于阴病,亦表明抑郁症不是单独一脏一腑之病。提示诊治抑郁症时应把握其气血逆乱的本质,在整体观的指导下,以调理气血、转枢气机为治病关键,注意“首调阳经,五脏重脾”的治疗思路。电针足三里组、神门组抑郁症大鼠水平活动和垂直活动次数增加明显。盐酸氟西汀组、电针足三里穴组、电针神门穴组在糖水消耗实验上与模型组比较,糖水消耗量明显增加。电针足三里组、电针神门组两组之间并无显著性统计学差异。在体重的变化上,发现电针足三里穴与神门穴组抑郁大鼠的体重较其他组相对减轻。HE常规染色观察大鼠海马神经元结构,模型组大鼠海马CA3区神经元细胞排练紊乱。电针神门穴组、电针足三里穴组、盐酸氟西汀组海马CA3区神经元变性明显减少,胞体排列较整齐,细胞层次较清晰,结构较清楚。但电针神门穴组、电针足三里穴组与盐酸氟西汀组比较细胞情况稍好,两者并无明显差异。免疫组化法观察大鼠海马CA3区CREB的表达,模型组明显低于其他实验组,电针神门组明显高于足三里组;Western Blot(?)去测定抑郁模型大鼠海马CREB的表达,模型组海马CREB的表达量最低,电针足三里组高于神门组。在海马CA3区电针神门穴增强CREB表达能力强于电针足三里穴,而从整个海马组织CREB的表达来看,电针足三里穴的调节作用优于电针神门穴。结论： 1.五脏藏神理论的内涵为五脏整体主神,脾胃是五脏整体的中心,是五脏整体主神的关键。 2.脾胃影响五脏整体调节神志活动的机理离不开气血、阴阳。 3.抑郁症属于神志异常疾病,在病性上属于阴病,亦表明抑郁症不是单独一脏一腑之病。提示抑郁症的病机实质为阴阳失衡、气血逆乱,在整体观的指导下,以调理气血、转枢气机为治病关键,注意“首调阳经,五脏重脾”的治疗思路。 4.电针足阳明胃经足三里穴、手少阴心经神门穴均可改善抑郁症大鼠病理状态,具有防治抑郁症的作用。提示以《内经》“五脏藏神理论”与“心主神明”理论为依据,指导治疗神志异常疗效确切。 5.电针足三里穴、神门穴调节抑郁症发病的机理与海马CREB含量增加有关,推测CREB含量增加,保护神经的作用加强。其中电针足三里穴对整个海马组织CREB含量增加的影响强于电针神门穴。考虑其原因可能是针刺足阳明胃经,直接调节中焦脾胃,产生调畅气机、运化气血的作用。这一调控神志活动的过程发生机制可能与神经-内分泌-免疫网络的变化有关,其中脑肠轴有极大的可能性参与了这一系列的反应。
[Abstract]:Objective:The five zang-zang-shen is one of the important theories of the relationship between the zang-fu and the mind in traditional Chinese medicine.This study explores the relationship between the spleen and the stomach and the mind from the angles of basic theory analysis,clinical literature study and animal experiment,reveals the relationship between the spleen and the stomach and the five zang-zang as a whole,and the regulating effect of the spleen and the stomach on mental activities,and analyzes the improvement of the mind by regulating the spleen and The mechanism of abnormality is of great significance for exploring the mechanism of action between spleen and stomach and mental activity and enriching the theory of five zang-zang-shen. It also has certain clinical value for studying the regulation of spleen and stomach to prevent and treat mental abnormality.
Methods: Combing the theoretical basis of the spleen and stomach as the center of the five Zang-organs and discussing the influence of the spleen and stomach on mental activities under physiological and pathological conditions. From the point of view of cellular signal transduction pathway, the effect of Zusanli point and Shenmen point on depression in rats and its mechanism were explored. In Zusanli, compared with fluoxetine hydrochloride, open-field behavior test was used to detect the behavioral indexes of rats, HE routine staining was used to observe the changes of neuron arrangement and cell morphology in hippocampal CA3 area, Western Blot method was used to detect the expression of CREB in hippocampal CA3 area, and immunohistochemical method was used to detect CREB in hippocampal CA3 area. Expression.
The ancient people advocated the center of the spleen and stomach, and the manifestation of the phenomenon was that the essence of the metagenetic valley was used to support the whole body, that is, it had the important function of "the source of Qi and blood biochemistry". The whole body of the human body must be inseparable from the pivot of the spleen and stomach. Physically, the spleen and stomach can nourish the five Zang-organs and help the five Zang-organs harmonize. Pathologically, one disease of the spleen and stomach can directly lead to the disharmony of the five zang-organs; the inconsistency between yin and Yang leads to the disorder of the whole Qi of the five zang-organs; the disorder of the circulation of the meridians, Qi and blood can also lead to the disorder of the whole body Qi and the disturbance of the five zang-organs, which affects the mind. Activities. The mechanism of the spleen and stomach regulating the five Zang-organs affecting mental activities as a whole, whether it is the inappropriate coordination of the spleen and stomach, the disorder of the spleen and stomach presiding over the five Zang-organs as a whole, or the effect of the spleen and stomach on the metabolism of qi, blood and fluid, the spleen and stomach meridians and so on, is inseparable from Qi and blood, Yin and yang. Higher than Yin meridian, indicating that depression is a disease of Yin, but also that depression is not a single viscera-viscera disease. Suggest that the diagnosis and treatment of depression should grasp the essence of Qi and blood disorders, under the guidance of the overall view, to regulate Qi and blood, the pivot Qi for the treatment of the key, pay attention to the "first regulation of Yang meridian, five Zang heavy spleen" treatment ideas.
Electroacupuncture at Zusanli group and Shenmen group significantly increased the number of horizontal and vertical activities in rats with depression.Fluoxetine hydrochloride group,electroacupuncture at Zusanli point group and electroacupuncture at Shenmen point group showed a significant increase in sugar consumption compared with the model group.There was no significant difference between electroacupuncture at Zusanli group and electroacupuncture at Shenmen point group. HE routine staining was used to observe the structure of hippocampal neurons in rats, and the rehearsal of hippocampal neurons in CA3 area was disordered in model group. The expression of CREB in CA3 area of hippocampus of rats was observed by immunohistochemical method, and the expression of CREB in model group was significantly lower than that in other experimental groups, and that in electroacupuncture Shenmen group was significantly higher than that in fluoxetine hydrochloride group. The expression of CREB in hippocampus of depression model rats was the lowest in the model group, and the expression of CREB in hippocampus was higher in the electroacupuncture group than in the Shenmen group. It is better than electroacupuncture at Shen men point.
Conclusion:
1. The connotation of the theory of five zang-zang-shen is that the five zang-zang-shen is the main spirit of the whole, and the spleen and stomach are the center of the five zang-zang-shen and the key to the five zang-zang-shen.
2. the mechanism of spleen and stomach affecting the five zang organs to regulate mental activity is inseparable from Qi, blood, yin and Yang.
3. Depression is a mental disorder, which is a kind of yin disease in nature, and also indicates that depression is not a single viscera-fu disease.
4. Electroacupuncture at Zusanli point of Foot-Yangming stomach meridian and Shenmen point of Hand-Shaoyin heart meridian can improve the pathological state of depressive rats and have the effect of preventing and treating depression.
5. Electroacupuncture at Zusanli point and Shenmen point is related to the increase of CREB content in the hippocampus, and it is speculated that the increase of CREB content and the protective effect on the nerve are strengthened. The effect of electroacupuncture at Zusanli point on the increase of CREB content in the whole hippocampus is stronger than that of electroacupuncture at Shenmen point. The spleen and stomach produce the function of regulating qi and transporting Qi and blood.The mechanism of regulating mental activity may be related to the changes of nerve-endocrine-immune network.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R223.1

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