基于肢端微循环血流变化探讨针刺“阳陵泉”的循经感传特征研究

发布时间：2018-08-14 15:22

【摘要】：目的:利用激光散斑血流成像系统和问卷调查开展对循经感传经脉现象及特点的研究,观察记录针刺“阳陵泉”穴、经脉非穴以及非经非穴时循经感传伴随的远端穴位血流灌注变化以及循经感传主观感觉的情况,探索整理循经感传的散斑微循环变化与主观感觉特征。方法:本研究以健康志愿者为研究载体,所有受试者全部来自辽宁中医药大学2012级-2013级的本科学生,选取受试者28例,纳入24例。分别针刺受试者的阳陵泉穴,经脉非穴以及非经非穴,每次针刺间隔时间最短为24小时。针刺过程中应用循经感传的调查问卷记录受试者出现感传的主观感觉以及各种感觉的VAS评分,同时利用激光散斑血流成像系统观察循经感传伴随的远端腧穴的血流变化。结果:1.根据调查问卷的结果,将循经感传度分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四个等级,Ⅰ级:局部针感明显,但并未出现循经感传;Ⅱ级:局部针感明显,同时出现循经感传,向下传至光明穴处,约为外踝尖上5寸,或向上感传至膝阳关穴,约为阳陵泉上3寸;Ⅲ级:局部针感明显,循经感传向下传至外踝尖处,或向上感传至风市穴,约为乆横纹上7寸处;Ⅳ级:局部针感明显,感传向下至脚趾或脚背,或向上感传至环跳穴,约为股骨大转子最凸点与骶管裂孔连线的外1/3与中1/3交点处。若感传未传到下一级则将循经感传度归为上一级。针刺阳陵泉组的循经感传度明显优于经脉非穴组与非经非组(P0.05)。2.针刺阳陵泉穴与经脉非穴,其感传基本循经传导;针刺非经非穴其感传路线不明确,其中疑似胆经感传2例,疑似胃经感传8例,感传路线不明确者10例。3.针刺过程中出现酸、麻、胀、痛四种主观感觉,各种针感出现的频率以及VAS评分均无统计学差异。将Ⅰ、Ⅱ、Ⅲ级感传视为低级感传、Ⅳ级感传视为高级感传,阳陵泉组高级感传VAS评分高于低级感传,差异具有统计学意义(P0.05);经脉非穴组低级感传与高级感传VAS评分比较没有统计学差异(P0.05)。4.比较针刺阳陵泉穴、经脉非穴与非经非穴出针前后肢端穴位的血流微循环变化,阳陵泉组窍阴、侠溪、足临泣、丘墟出针后的血流值均较进针前升高,差异具有统计学意义(P0.05);经脉非穴组与非经非穴组出针前后肢端穴位血流降低,差异没有统计学意义(P0.05)。5.阳陵泉组在出针后窍阴穴的血流值与循经感传度呈正相关(P0.01),经脉非穴组与非经非穴组出针后各穴的血流值与循经感传度无相关性(P0.05)。6.比较分析阳陵泉组与经脉非穴组低、高等级感传与肢端穴位血流相关性。阳陵泉组低级感传与各穴血流无相关性,高级感传在井穴窍阴与原穴丘墟处的血流值呈正相关;经脉非穴组低、高级感传,与其远端各穴血流值均无相关性。结论:1.针刺胆经阳陵泉穴、经脉非穴与非经非穴均能激发感传,阳陵泉组循经感传度明显优于经脉非穴组与非经非穴组,说明循经感传具有经穴特异性。2.针刺阳陵泉穴,出针后肢端穴位的血流值均较进针前升高;针刺经脉非穴与非经非穴,出针后肢端穴位血流值无改变,进一步论证经穴的特异性。3.针刺阳陵泉穴引起循经感传并且伴随肢端穴位血流值的升高,其循经感传度越高,伴随的肢端穴位血流值越高,说明循经感传具有循经特异性,提示皮肤表面微循环可作为循经感传的机理进一步探讨。
[Abstract]:Objective: To study the phenomenon and characteristics of meridian transmission by laser speckle blood flow imaging system and questionnaire survey, observe and record the changes of blood perfusion of distal acupoints accompanied by sensory transmission along meridian when acupuncture at "Yanglingquan", non-meridian acupoints and non-meridian acupoints, and explore the situation of sensory transmission along meridian. Methods: A total of 28 subjects from Liaoning University of Traditional Chinese Medicine (Liaoning University of Traditional Chinese Medicine, Grade 2012-2013) were enrolled in this study. They were acupunctured at Yanglingquan point, non-acupoints of meridians and non-acupoints of non-meridians. The shortest time was 24 hours. The subjective sensation and VAS scores of various sensations were recorded by the questionnaire of sensory transmission along meridians. The hemorheological changes of distal acupoints accompanied by sensory transmission along meridians were observed by laser speckle flow imaging system. Results: 1. Sensory transmission along meridians was divided into two groups according to the results of the questionnaire. Grade I, II, III, IV, Grade I: Local needle sensation is obvious, but there is no transmission along the meridian; Grade II: Local needle sensation is obvious, at the same time, there is transmission along the meridian sensation, down to the bright point, about 5 inches above the outer malleolus tip, or up to the knee Yangguan point, about 3 inches above Yanglingquan; Grade III: Local needle sensation is obvious, down to the outer malleolus tip. Or upward sensation to Fengshi acupoint, about 7 inches above the horizontal lines; Grade IV: Local sensation of needle is obvious, sensory transmission down to toe or toe back, or upward sensation to Huantiao acupoint, about the most salient point of the greater trochanter of the femur and sacral canal hiatus hiatus connecting the outer 1/3 and 1/3 intersection point. Acupuncture of Yanglingquan and non-meridian acupoints has a basic sensory transmission along meridians; acupuncture of non-meridian acupoints has an unclear route of sensory transmission, including 2 cases of suspected gallbladder channel sensory transmission, 8 cases of suspected gastric channel sensory transmission, 10 cases of unclear route of sensory transmission. There was no significant difference in the frequency and VAS score among the four kinds of subjective sensations. Regarding grade I, II and III sensory transmission as low-level sensory transmission, grade IV sensory transmission as high-level sensory transmission, the VAS score of Yanglingquan group was higher than that of low-level sensory transmission, and the difference was statistically significant (P 0.05). There was no statistically significant difference (P 0.05). 4. Compared with the changes of blood microcirculation at the extremity points before and after acupuncture at Yanglingquan, non-acupoints and non-acupoints, the blood flow values of Qiaoyin, Xiaxi and Zulin in Yanglingquan group were higher than those before acupuncture (P 0.05). There was no significant difference (P 0.05). 5. There was a positive correlation between the blood flow of Qiaoyin acupoints and the sensory transmission along meridians in Yanglingquan group (P 0.01). There was no correlation between the blood flow of non-acupoint group and non-acupoint group (P 0.05). There was no correlation between the low-grade sensory transmission and the blood flow of the extremity acupoints in Yanglingquan group, and the high-grade sensory transmission was positively correlated with the blood flow of the orifice-yin of Jing acupoints and the hilly ruins of the original acupoints. Yanglingquan group is superior to non-acupoint group and non-acupoint group, indicating that sensory transmission along meridians has meridian specificity. 2. Acupuncture Yanglingquan point, the blood flow value of limb acupoints after needling is higher than that before needling. Acupuncture non-acupoint and non-acupoint of meridian has no change in blood flow value of limb acupoints after needling. 3. Acupuncture at Yanglingquan points leads to sensory transmission along the meridian and increases the blood flow value of the limb acupoints. The higher the sensory transmission along the meridian, the higher the blood flow value of the limb acupoints accompanied by the sensory transmission along the meridian, which indicates that sensory transmission along the meridian is specific, suggesting that skin surface microcirculation can be used as a mechanism for sensory transmission along the meridian.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246

【参考文献】