针刺加推拿对去卵巢模型大鼠干预作用的研究
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摘要
背景
随着社会的发展,科技的进步,人类的健康维护越见完善,老年人口的比例显着增加。根据上海市统计年鉴的调查报告,2002年上海市女性的平均期望寿命已经达到81.63岁,这显示女性一生中将有1/3以上的时间在绝经期后度过,显然地,对更年期的中年妇女健康的关注,正迅速成为公共卫生优先考虑的项目。
更年期综合症是女性随着自然老化的趋势,生殖器官逐渐萎缩的生理过程,雌激素分泌逐渐衰竭而产生的如:潮热、心悸、盗汗、头晕、失眠、易怒、抑郁、记忆力减退等许多不适的症状。女性的更年期涵盖生殖器官开始衰竭至完全绝经的期间,通常始于40岁左右,期间月经紊乱甚至会停经,一般约在50岁左右完全绝经。更年期症状严重的时候,甚至于会造成骨质疏松、功能失调性子宫出血、心血管疾病、乳腺疾病和生殖泌尿道疾病等不良后果。
更年期综合症有不同的型态、病情和发作的时间,一般都以患者体内的雌激素和孕激素的水平来评估治疗方法。上世纪80年代和90年代时,医学界曾提出雌激素补充疗法,来保障妇女免于罹患心脏病或其他严重不适症状的困扰。美国妇女健康协会曾对一批年龄自50岁至79岁(平均年龄63.2岁)的更年期妇女举行一项大规模的临床试验,目的是要评估雌激素或孕激素疗法,是否可以防止心脏病或老人痴呆症等的慢性病。结果发现雌激素与黄体素疗法可能会增加乳腺癌的机率,并且会增加妇女产生血栓症,中风和心脏病的发病机会,所以这个评估试验提早叫停。这些发现让人注意到用雌激素治疗更年期症状的安全问题,许多妇女立即停止了雌激素替代疗法,并寻求其他更好的治疗方式,因此,中医的针刺和推拿等治疗方法,也成为寻求的替代医疗方案之一。
更年期综合症除了像激素替代疗法之类的药物治疗外,还有许多其他的补救措施如;适当的补充钙,磷,维生素D等生化物质,对预防骨质疏松症与心血管心脏病是非常重要的。经常运动也有益于心脏和骨骼,帮助调节体重,有助利于建立良好的体质和改善情绪。饮食也是一个可以帮助控制更年期症状的重要工具,减少食用含大量咖啡因的食品和含磷的碳酸饮料能防止骨质丢失。
中医对更年期综合症的认识久远,中医对更年期的记载始于《黄帝内经》,但对于更年期种种不适症状的叙述,则是散见于中国古籍中所谓的:“天癸竭”、“崩漏”、“脏躁”、“郁证”、“潮热”、“月经不调”、“心悸”、“不寐”等证候。其病因病机首系于“先天虚损致病”,肾为先天之本,女性至七七以后“天癸竭,任脉虚,太冲脉衰少”,这是肾阴不足的征象。肾阴不足削弱肾脏产生骨髓功能,减弱造骨和补益大脑能力,产生头晕,耳鸣,健忘,腰膝酸软和关节疼痛。阴虚产生内热,引致五更潮热,颧红,盗汗,口干,尿黄和便秘。内热瘀积造成梦遗及失眠等不适症状。
更年期综合症的次要发病因素为“后天失养致病”,脾胃为后天之本,脾虛意味着运化失常,气血来源不足,表現出臉色苍白,疲倦和少氣懶言。脾气虛表示脾不統血,血行無常,从而引起紫癜,便血,经血过多和子宮出血等症狀。刘完素在《素问病机气宜保命·妇人胎产论》中提出了著名的三期调经方论,说明青春期的妇女当注重补肾,育龄期的妇女当注重调肝,更年期的妇女当注重健脾。这些理论成为后世采用健脾法治疗更年期综合征的主要基础。中医并通过辩证论治,对更年期综合症的治疗采用包括中药、针灸、推拿及其他疗法如:拔罐、耳针等,均取得良好的医疗效果。
临床和实验研究证明,针刺治疗更年期综合症能达到调节内分泌、改善神经的微循环、消除组织的炎症反应、影响神经通路及递质、调节免疫系统等多方面的效果。
按摩推拿是中医的一种治疗方法,它以不同的手法刺激人体经络,改善血液循环,促进新陈代谢,达到祛病强身、延年益寿的目的。按摩能够调节内分泌系统,改善自主神经功能,并消除全身或局部不适的症状。
目的
从现代医学的角度,腹部有丰富的神经细胞,别称“第二大脑”,腹部的自律神经支配内脏系统的运作,五脏六腑功能都透过腹部神经回馈脑部中枢系统,调配气血运行。妇女更年期时的许多不适症状如:胸闷、心悸、心跳加速、手抖、头痛、盗汗、腹泻或便秘、肠胃不适、频尿等,或许与腹部内分泌失调有关,但这些现象如透过腹部推拿以舒缓自律神经方式,来强化中枢神经的调节性,还是可以起到医疗的作用。
针刺对更年期诸症有良好的医疗效果,惟众多报告,独少见针刺与推拿并用之医疗效果研究。鉴于推拿医疗有简单方便之功效,而针刺又能起到调理经络、运行气血的医疗效果,兼以对现代医学腹部神经效应的认识,拟以针刺加腹部推拿之方法,对阴虚型绝经大鼠施以治疗,观察其成效,作为日后反映到实际妇女更年期综合症医疗之参考。研究针刺加推拿治疗对去卵巢大鼠的干预作用,评价其对治疗更年期综合症的效果,并探讨其作用机理。
方法
建立动物实验模型,作为更年期综合症的治疗观察指标。任选50只SPF级大鼠,区分为5组。第一组为正常组,养入后不作任何处理,正常生活及进食及饮水。其余4组为摘除卵巢的模型组,分别命名为对照组:正常生活及进食及饮水,供作治疗成效比较参考。西药组:灌服七日人工合成雌激素己烯雌酚。推拿组:每日作二次推拿治疗,推拿部位为腹部及下肢相关穴位。针刺加推拿组:除前述推拿治疗外,每日加作一次针刺治疗。
观察大鼠实验前后症状改变的情况,观察指标包括大鼠的形体及生化水平如体重、饮水量、食量、雌激素水平、黄体素水平、促卵泡激素水平及促性腺释放激素水平。
结果
观察大鼠外显型态的体重、食量及饮水量,及内蕴生化型态的E、LH、GnRH等水平的整体指标显示:针刺与推拿对于去卵巢大鼠均有显著的治疗效果。
结论
针刺与腹部推拿结合的治疗方式对更年期综合征的临床疗效具有正面意义,显示相关的理论基础对临床治疗女性更年期综合症具重要的指导意义,不仅开创未来透过腹部经络理论的了解深化治疗更年期综合症的坚实基础;而且更由于治疗方法简单,操作方便,及成本低廉的优点,减低基层民众的医疗支出,对改善广大妇女同胞的生活质量有极大的帮助,将会产生很大的社会经济效益。
现代免疫学及内分泌学知识的建立,使医学界对包括更年期综合症在内的慢性病本质掌握得更清楚,并了解如何以中医传统的“治未病”及“扶正祛邪”等观念,去做先行的防护与调养,妇女更年期所发生的现象,其实也是人体自我治疗、调适的一个过程,当身体老化造成卵巢功能衰竭时,雌激素水平的变异,也挑战到人体下丘脑—垂体调控系统的应变能力,内分泌系统必须为应付这些功能变化而作一些动荡的平衡。依现代医疗的观念,更年期综合症不属于脏器或组织器质性受损的重大疾病,很少需要超强药物或手术治疗,只要增强人体自我治疗、修复的能力,消弭系统动荡所产生的冲击,就可以去除更年期综合症所滋生的困扰,因此中医针灸透过刺激免疫系统、影响血液流通、调整心律和心搏量、分泌胃酸、增生红白血球。刺激激素释放,舒缓精神压力等方式,对更年期的防治是一项适宜的选择。
根据经络学,腹部容纳三焦、脾胃、肝胆等重要经脉,于腹部方面的理解尚有许多不足之处,如《难经·二十八难》说:“冲脉者,起于气冲,并足阳明之经,夹脐上行,至胸中而散也。”关于其中的“并足阳明之经”《难经通解》认为应是“少阴之经”。《难经本义》:“当从《内经》。”而《难经经释》则认为:“虽阳明与少阴经文互异,然两经不甚相远,皆冲脉所过,义无害也。”而人体腹部与背部的经脉条数不相等,也是启人疑窦之处。此外,中医古籍称任脉可连通肾经、胃经,督脉可连通肾经与膀胱经,但并无指明其路径走向的相关文献报告。脾经的“属脾络胃”;肝经的“夹胃属肝络胆”;肾经的“属肾络膀胱”;甚或小肠经的“抵胃属小肠”都形容得过于笼统,无法指明其贯属方式。本项研究致力于腹部生理的探讨,面对如大脑一般的“腹脑”结构,虽因腹部神经分布过于复杂,又有自律神经交织其间,致使经络认知的因素错综复杂,若能藉助本研究的开端,在近代解剖生理学、神经电学、内分泌学的协助下,填补古代经络学说之间的空白,当为深富意义之举。
Introduction
With the progress of human society,the development of science and technology,and gradually improved human health maintenance systems,the proportion of the elderly population increased significantly.According to the investigation of Shanghai Statistical Office,the life expectancy of Shanghai women has increased to an average age of 81.63.This means that most women can expect to live another third of their lives after menopause.Clearly, the health concerns of menopause-aged women are rapidly becoming a larger public health priority.
Climacterium,a complicated biological process with versatile symptoms like:hot flashes,palpitation,night sweats,dizziness,insomnia, irritability,depression and memory recession,is associated with the gradual dying out of the hormonal activity of ovaries on the background of a general aging of the female organism.Menopausal transition usually began in 40s,the transition from female' s reproductive years to menopause,and the length of cycles will start to vary and begin to skip periods,the average age of the final menstrual period is around 50s.The worst situation of Climacteric syndrome sometimes will leads to the happening of Osteoporosis,Dysfunctional uterine bleed,Cardiovascular disease,Breast disease and Urology reproductive diseases.
The Traditional Chinese Medicine(TCM) have long awareness of the Climacteric syndromes,in the early record of Nei Jing(Classics of Internal Medicine) already describes the syndromes,etiology and pathogenesis of Climacterium.After the Differential Diagnosis,the TCM recommend many treating methods including Medications,Acupuncture and Moxibustion,Massage, Cupping,Auricular points sticking and pressing,are all proved to be a safe and effective treatments.
Menopausal symptoms vary in combination,intensity,and duration,and we assess the evidence for these as well.Estrogen,either by itself or with Progestins,has been the therapy of choice for decades for relieving menopause related symptoms.Epidemiologic studies in the 1980s and 1990s suggested that estrogen-containing therapy might protect women from heart disease and other serious medical problems.The Women' s Health Initiative(WHI) was a large clinical trial of postmenopausal women(age range,50 to 79 years[mean,63.2 years]) that was designed to see whether estrogen with or without progestin therapy could prevent chronic conditions,such as heart disease and dementia. The estrogen with progestin portion of the trial ended early because of increased incidence of breast cancer.There were increases in blood clots, stroke,and heart disease among women who received this treatment as well. These findings raised serious questions about the safety of estrogen to treat symptoms of menopause.Many women stopped hormone replacement therapy,and some searched for alternative therapies.As the result,the acupuncture and massage treatment of Traditional Chinese medicine has become one of the alternative options to seeking the cure of Climacteric syndromes.
Except Hormone Replacement Treatment,there are many alternative remedies for Climacteric Symptoms;the use of Calcium,phosphorus,vitamin D supplementation are very important for prevention of Osteoporosis and Cardiovascular Heart Disease.Regular exercise benefits the heart and bones, helps regulate weight,and contributes to a sense of overall well-being and improvement in mood.the diet is an important tool that you can use to help control the menopausal symptoms.Reduce the amounts of caffeine in any foods, and carbonated beverages which contain phosphorous can prevent bone loss.
The Traditional Chinese Medicine(TCM) had long awareness of the Climacteric syndromes,thought the descriptions of the syndromes are exist in the early record of Nei Jing(Classics of Internal Medicine),but the details of Climacterium are separately list in different name like "Menopause"、"Metrorrhagia"、"Bipolar disorder"、"Depression"、"Hot Flashes"、"Irregular Menstruation"、"Palpitation"、"Insomnia".Climacteric syndromes mainly caused by Kidney deficiency,kidney is the foundation of congenital essence,at the age of forty-night,sexual energy begins to decline, the Ren meridian becomes deficient,and the Chong meridian becomes scanty, deficiency of kidney yin weakens the kidney in its function of producing marrow, dominating bones and nourishing the brain,the result is dizziness,tinnitus, poor memory,soreness and weakness of the lumbar region and knee joints. Deficiency of yin produces endogenous heat,hence afternoon fever,malar flush, night sweating,dryness of the mouth,yellow urine and constipation, disturbance in the interior by heat of the deficiency type is the cause of nocturnal emission and insomnia.
Another etiology and pathogenesis of Climacterium is spleen deficiency, spleen is the foundation of postnatal essence.Deficiency of the spleen implies inpairment of its function in transportation and transformation,which produces an insufficient source of Qi and blood,that explains pale complexion, lassitude,and dislike of speaking,weakness of the spleen qi indicates inability of the spleen to control blood,which leaks from the vessels and thus elicits purpura,bloody stools,excessive menstrual flow and uterine bleeding.Wansu Liu announce the theory "three stages of menstrual control" on his book Theory of Obstetric:adolescent women should pay attention to nourish the kidney,pregnant women should pay attention to manipulate the liver, menopausal women should pay attention to nourish the spleen,these theories has become the basis of climacteric syndrome treatment.
After the Differential Diagnosis,the TCM recommend many treating methods including Medications,Acupuncture and Moxibustion,Massage,Cupping, Auricular points sticking and pressing,are all proved to be a safe and effective treatments.
Many clinical and experimental researches show,to cure Climacteric syndromes with acupuncture can reaches the benefit of regulate the endocrine system,improve the microcirculation of nerve system,eliminate the inflammatory response of tissues,influence the neural pathways and neurotransmitters,adjust the immune system.
Massage is one kind of the Chinese Medical treatments.With different ways of practices,it can stimulate the meridian of the body,improve the circulation of blood,and promote the metabolism,so as to cure the disease and strengthen the body,inhibits the process of aging.By using massage treatment,people can adjust the function of endocrine system and autonomic nervous system,and eliminate systemic or local symptoms.
Objective
Observed from the perspective of modern medicine,medical research has proven that there is a second brain in the body and it's located in the belly, the belly consists of more neurons than are contained in the entire spine. The abdominal autonomic nervous control the operation of visceral system,and sends signals to the brain by talking to a small number of "command neurons," which in turn send signals to the abdomen,control the circulation of qi and blood.Many symptoms of middle age women include Chest tightness、Tremor、palpitation、Rapid heart beat、headache、sweating、diarrhea、Constipation、Gastrointestinal discomfort、Urinary frequency are attribute to Abdominal endocrine disorders,through the treatment of abdominal massage will release these phenomena,and strengthen the regulation of central nervous system, achieve the effect of medical care.
Many studies had shown acupuncture is an effective method to control climacteric syndromes,but seldom study focus on the effectiveness of combine acupuncture and massage therapies.In view of medical massage has the benefits of simple、cheap and efficacy,and considering both of acupuncture and massage have proved very effective for climacteric syndromes,combined acupuncture and massage therapy may be a reasonable option for patients.
This study is to observe the effect of acupuncture and massage treatment on the model of ovariectomized rats,evaluate its effect of cure Climacteric syndromes,and explore its active mechanism.
Method
To established an animal experiment model for the indicator of Climacteric syndromes treatment.Fifty SPF grade rats were randomly divided into 5 groups-1 normal group and 4 model groups(remove ovarian),4 model groups are separately named control group,medicine group,massage group and acupuncture plus massage group,each group contains 10 rats.The normal group is only used for observation reference,the control group is used for treatment comparison,the medicine group is feed with artificial estrogen -Diethylstilbestrol. the massage group is treated with massage in the Abdomen and lower extremities acu-points twice a day,the acupuncture plus massage group is treated with acupuncture and massage at the same places as massage group.
The ameliorative rates of syndromes before and after treatment was compared with physical and biological index including:weight,water intake,food intake, estrogen level(E),luteinizing hormone(LH) level,follicle stimulating hormone(FSH)level,Besides serum endocrine hormone,follicle stimulating hormone(FSH) and estradiol were determined before and after treatment in the study group.
Results
Observing model' s physical conditions of weight,food intake and water intake,and biological index of Estrogen level(E),Luteinizing hormone(LH) level,Follicle Stimulating Hormone(FSH) level and Gonadotropin Releasing Hormone(GnRH) level shows,the acupuncture and Massage have significantly effect in the treating of climacteric syndromes of ovariectomized rats.
Conclusion
Combined acupuncture and abdominal massage therapy on the treatment of Climacteric syndromes demonstrate many beneficial meaning,the first,it shows the traditional Chinese meridian has offer solid theoretical basis on Climacteric syndromes treatment,the second,it is the simple,effective and easy way to cure long-lasting refractory disease,the third,it reduces the cost of people' s medical expense.
The advance of modern immunology and endocrinology knowledge help the medicine practitioners grasp the concept of treating chronic diseases like Climacteric syndrome with better insight,and learn how to adopt the philosophy of traditional Chinese medicine on "preventing the disease before get sick" and "strengthen the Physical power,dispel the pathogens" to maintain human health.Typical menopause symptoms such as hot flash or night sweat are caused by changing hormonal level in the female reproductive system.It is part of women nature self-healing process to deal with the change of their body due to aging.
Based on these new knowledge and insight,most medical practitioners in major hospitals in the world do not treat climacteric syndrome as a serious disease that require heavy dose of medicine or intervention of surgery procedures;Instead most doctors now prescribe alternative medicine for menopause.Such as herbal medicine with compound that will produce progestational and estrogenic effects on humans and reduce the severeness of the syndrome.Other compound will increase body immune system which will help body heal itself and fight off the climacteric syndrome.
In addition,some practitioners also discovered that acupuncture is another good alternative because the acupuncture has been shown to stimulate the immune system.It also has affects the circulation,blood pressure, rhythm and stroke volume of the heart,secretion of the gastric acid,and production of red and white cells.It also stimulates the release of a variety of hormones that help body to respond to injury and stress that cause by menopause.
With this new knowledge,Traditional Chinese Medical treatments such as homeopathy and acupuncture become a new trend in modern medicine to fight climacteric syndrome.
According to theory of traditional meridian,the study of abdominal cavity which contains the most organs in the body such as the digest tract,the liver and pancreas,the spleen the adrenal gland and the kidneys is not sufficient. This study of Chinese medicine is focus on physiological structure of the abdomen,it is an extensive and highly complicated structure that actually consists of more neurons than the brain,however,the deficiency of study abdominal anatomy is concerning.We should revelation of this study and hopefully will lead to more understanding of meridian mystery of abdomen with help from modern Anatomy,Electroneurophysiology,Endocrinology,and it will benefit significantly to the Traditional Chinese Medicine.
随着社会的发展,科技的进步,人类的健康维护越见完善,老年人口的比例显着增加。根据上海市统计年鉴的调查报告,2002年上海市女性的平均期望寿命已经达到81.63岁,这显示女性一生中将有1/3以上的时间在绝经期后度过,显然地,对更年期的中年妇女健康的关注,正迅速成为公共卫生优先考虑的项目。
更年期综合症是女性随着自然老化的趋势,生殖器官逐渐萎缩的生理过程,雌激素分泌逐渐衰竭而产生的如:潮热、心悸、盗汗、头晕、失眠、易怒、抑郁、记忆力减退等许多不适的症状。女性的更年期涵盖生殖器官开始衰竭至完全绝经的期间,通常始于40岁左右,期间月经紊乱甚至会停经,一般约在50岁左右完全绝经。更年期症状严重的时候,甚至于会造成骨质疏松、功能失调性子宫出血、心血管疾病、乳腺疾病和生殖泌尿道疾病等不良后果。
更年期综合症有不同的型态、病情和发作的时间,一般都以患者体内的雌激素和孕激素的水平来评估治疗方法。上世纪80年代和90年代时,医学界曾提出雌激素补充疗法,来保障妇女免于罹患心脏病或其他严重不适症状的困扰。美国妇女健康协会曾对一批年龄自50岁至79岁(平均年龄63.2岁)的更年期妇女举行一项大规模的临床试验,目的是要评估雌激素或孕激素疗法,是否可以防止心脏病或老人痴呆症等的慢性病。结果发现雌激素与黄体素疗法可能会增加乳腺癌的机率,并且会增加妇女产生血栓症,中风和心脏病的发病机会,所以这个评估试验提早叫停。这些发现让人注意到用雌激素治疗更年期症状的安全问题,许多妇女立即停止了雌激素替代疗法,并寻求其他更好的治疗方式,因此,中医的针刺和推拿等治疗方法,也成为寻求的替代医疗方案之一。
更年期综合症除了像激素替代疗法之类的药物治疗外,还有许多其他的补救措施如;适当的补充钙,磷,维生素D等生化物质,对预防骨质疏松症与心血管心脏病是非常重要的。经常运动也有益于心脏和骨骼,帮助调节体重,有助利于建立良好的体质和改善情绪。饮食也是一个可以帮助控制更年期症状的重要工具,减少食用含大量咖啡因的食品和含磷的碳酸饮料能防止骨质丢失。
中医对更年期综合症的认识久远,中医对更年期的记载始于《黄帝内经》,但对于更年期种种不适症状的叙述,则是散见于中国古籍中所谓的:“天癸竭”、“崩漏”、“脏躁”、“郁证”、“潮热”、“月经不调”、“心悸”、“不寐”等证候。其病因病机首系于“先天虚损致病”,肾为先天之本,女性至七七以后“天癸竭,任脉虚,太冲脉衰少”,这是肾阴不足的征象。肾阴不足削弱肾脏产生骨髓功能,减弱造骨和补益大脑能力,产生头晕,耳鸣,健忘,腰膝酸软和关节疼痛。阴虚产生内热,引致五更潮热,颧红,盗汗,口干,尿黄和便秘。内热瘀积造成梦遗及失眠等不适症状。
更年期综合症的次要发病因素为“后天失养致病”,脾胃为后天之本,脾虛意味着运化失常,气血来源不足,表現出臉色苍白,疲倦和少氣懶言。脾气虛表示脾不統血,血行無常,从而引起紫癜,便血,经血过多和子宮出血等症狀。刘完素在《素问病机气宜保命·妇人胎产论》中提出了著名的三期调经方论,说明青春期的妇女当注重补肾,育龄期的妇女当注重调肝,更年期的妇女当注重健脾。这些理论成为后世采用健脾法治疗更年期综合征的主要基础。中医并通过辩证论治,对更年期综合症的治疗采用包括中药、针灸、推拿及其他疗法如:拔罐、耳针等,均取得良好的医疗效果。
临床和实验研究证明,针刺治疗更年期综合症能达到调节内分泌、改善神经的微循环、消除组织的炎症反应、影响神经通路及递质、调节免疫系统等多方面的效果。
按摩推拿是中医的一种治疗方法,它以不同的手法刺激人体经络,改善血液循环,促进新陈代谢,达到祛病强身、延年益寿的目的。按摩能够调节内分泌系统,改善自主神经功能,并消除全身或局部不适的症状。
目的
从现代医学的角度,腹部有丰富的神经细胞,别称“第二大脑”,腹部的自律神经支配内脏系统的运作,五脏六腑功能都透过腹部神经回馈脑部中枢系统,调配气血运行。妇女更年期时的许多不适症状如:胸闷、心悸、心跳加速、手抖、头痛、盗汗、腹泻或便秘、肠胃不适、频尿等,或许与腹部内分泌失调有关,但这些现象如透过腹部推拿以舒缓自律神经方式,来强化中枢神经的调节性,还是可以起到医疗的作用。
针刺对更年期诸症有良好的医疗效果,惟众多报告,独少见针刺与推拿并用之医疗效果研究。鉴于推拿医疗有简单方便之功效,而针刺又能起到调理经络、运行气血的医疗效果,兼以对现代医学腹部神经效应的认识,拟以针刺加腹部推拿之方法,对阴虚型绝经大鼠施以治疗,观察其成效,作为日后反映到实际妇女更年期综合症医疗之参考。研究针刺加推拿治疗对去卵巢大鼠的干预作用,评价其对治疗更年期综合症的效果,并探讨其作用机理。
方法
建立动物实验模型,作为更年期综合症的治疗观察指标。任选50只SPF级大鼠,区分为5组。第一组为正常组,养入后不作任何处理,正常生活及进食及饮水。其余4组为摘除卵巢的模型组,分别命名为对照组:正常生活及进食及饮水,供作治疗成效比较参考。西药组:灌服七日人工合成雌激素己烯雌酚。推拿组:每日作二次推拿治疗,推拿部位为腹部及下肢相关穴位。针刺加推拿组:除前述推拿治疗外,每日加作一次针刺治疗。
观察大鼠实验前后症状改变的情况,观察指标包括大鼠的形体及生化水平如体重、饮水量、食量、雌激素水平、黄体素水平、促卵泡激素水平及促性腺释放激素水平。
结果
观察大鼠外显型态的体重、食量及饮水量,及内蕴生化型态的E、LH、GnRH等水平的整体指标显示:针刺与推拿对于去卵巢大鼠均有显著的治疗效果。
结论
针刺与腹部推拿结合的治疗方式对更年期综合征的临床疗效具有正面意义,显示相关的理论基础对临床治疗女性更年期综合症具重要的指导意义,不仅开创未来透过腹部经络理论的了解深化治疗更年期综合症的坚实基础;而且更由于治疗方法简单,操作方便,及成本低廉的优点,减低基层民众的医疗支出,对改善广大妇女同胞的生活质量有极大的帮助,将会产生很大的社会经济效益。
现代免疫学及内分泌学知识的建立,使医学界对包括更年期综合症在内的慢性病本质掌握得更清楚,并了解如何以中医传统的“治未病”及“扶正祛邪”等观念,去做先行的防护与调养,妇女更年期所发生的现象,其实也是人体自我治疗、调适的一个过程,当身体老化造成卵巢功能衰竭时,雌激素水平的变异,也挑战到人体下丘脑—垂体调控系统的应变能力,内分泌系统必须为应付这些功能变化而作一些动荡的平衡。依现代医疗的观念,更年期综合症不属于脏器或组织器质性受损的重大疾病,很少需要超强药物或手术治疗,只要增强人体自我治疗、修复的能力,消弭系统动荡所产生的冲击,就可以去除更年期综合症所滋生的困扰,因此中医针灸透过刺激免疫系统、影响血液流通、调整心律和心搏量、分泌胃酸、增生红白血球。刺激激素释放,舒缓精神压力等方式,对更年期的防治是一项适宜的选择。
根据经络学,腹部容纳三焦、脾胃、肝胆等重要经脉,于腹部方面的理解尚有许多不足之处,如《难经·二十八难》说:“冲脉者,起于气冲,并足阳明之经,夹脐上行,至胸中而散也。”关于其中的“并足阳明之经”《难经通解》认为应是“少阴之经”。《难经本义》:“当从《内经》。”而《难经经释》则认为:“虽阳明与少阴经文互异,然两经不甚相远,皆冲脉所过,义无害也。”而人体腹部与背部的经脉条数不相等,也是启人疑窦之处。此外,中医古籍称任脉可连通肾经、胃经,督脉可连通肾经与膀胱经,但并无指明其路径走向的相关文献报告。脾经的“属脾络胃”;肝经的“夹胃属肝络胆”;肾经的“属肾络膀胱”;甚或小肠经的“抵胃属小肠”都形容得过于笼统,无法指明其贯属方式。本项研究致力于腹部生理的探讨,面对如大脑一般的“腹脑”结构,虽因腹部神经分布过于复杂,又有自律神经交织其间,致使经络认知的因素错综复杂,若能藉助本研究的开端,在近代解剖生理学、神经电学、内分泌学的协助下,填补古代经络学说之间的空白,当为深富意义之举。
Introduction
With the progress of human society,the development of science and technology,and gradually improved human health maintenance systems,the proportion of the elderly population increased significantly.According to the investigation of Shanghai Statistical Office,the life expectancy of Shanghai women has increased to an average age of 81.63.This means that most women can expect to live another third of their lives after menopause.Clearly, the health concerns of menopause-aged women are rapidly becoming a larger public health priority.
Climacterium,a complicated biological process with versatile symptoms like:hot flashes,palpitation,night sweats,dizziness,insomnia, irritability,depression and memory recession,is associated with the gradual dying out of the hormonal activity of ovaries on the background of a general aging of the female organism.Menopausal transition usually began in 40s,the transition from female' s reproductive years to menopause,and the length of cycles will start to vary and begin to skip periods,the average age of the final menstrual period is around 50s.The worst situation of Climacteric syndrome sometimes will leads to the happening of Osteoporosis,Dysfunctional uterine bleed,Cardiovascular disease,Breast disease and Urology reproductive diseases.
The Traditional Chinese Medicine(TCM) have long awareness of the Climacteric syndromes,in the early record of Nei Jing(Classics of Internal Medicine) already describes the syndromes,etiology and pathogenesis of Climacterium.After the Differential Diagnosis,the TCM recommend many treating methods including Medications,Acupuncture and Moxibustion,Massage, Cupping,Auricular points sticking and pressing,are all proved to be a safe and effective treatments.
Menopausal symptoms vary in combination,intensity,and duration,and we assess the evidence for these as well.Estrogen,either by itself or with Progestins,has been the therapy of choice for decades for relieving menopause related symptoms.Epidemiologic studies in the 1980s and 1990s suggested that estrogen-containing therapy might protect women from heart disease and other serious medical problems.The Women' s Health Initiative(WHI) was a large clinical trial of postmenopausal women(age range,50 to 79 years[mean,63.2 years]) that was designed to see whether estrogen with or without progestin therapy could prevent chronic conditions,such as heart disease and dementia. The estrogen with progestin portion of the trial ended early because of increased incidence of breast cancer.There were increases in blood clots, stroke,and heart disease among women who received this treatment as well. These findings raised serious questions about the safety of estrogen to treat symptoms of menopause.Many women stopped hormone replacement therapy,and some searched for alternative therapies.As the result,the acupuncture and massage treatment of Traditional Chinese medicine has become one of the alternative options to seeking the cure of Climacteric syndromes.
Except Hormone Replacement Treatment,there are many alternative remedies for Climacteric Symptoms;the use of Calcium,phosphorus,vitamin D supplementation are very important for prevention of Osteoporosis and Cardiovascular Heart Disease.Regular exercise benefits the heart and bones, helps regulate weight,and contributes to a sense of overall well-being and improvement in mood.the diet is an important tool that you can use to help control the menopausal symptoms.Reduce the amounts of caffeine in any foods, and carbonated beverages which contain phosphorous can prevent bone loss.
The Traditional Chinese Medicine(TCM) had long awareness of the Climacteric syndromes,thought the descriptions of the syndromes are exist in the early record of Nei Jing(Classics of Internal Medicine),but the details of Climacterium are separately list in different name like "Menopause"、"Metrorrhagia"、"Bipolar disorder"、"Depression"、"Hot Flashes"、"Irregular Menstruation"、"Palpitation"、"Insomnia".Climacteric syndromes mainly caused by Kidney deficiency,kidney is the foundation of congenital essence,at the age of forty-night,sexual energy begins to decline, the Ren meridian becomes deficient,and the Chong meridian becomes scanty, deficiency of kidney yin weakens the kidney in its function of producing marrow, dominating bones and nourishing the brain,the result is dizziness,tinnitus, poor memory,soreness and weakness of the lumbar region and knee joints. Deficiency of yin produces endogenous heat,hence afternoon fever,malar flush, night sweating,dryness of the mouth,yellow urine and constipation, disturbance in the interior by heat of the deficiency type is the cause of nocturnal emission and insomnia.
Another etiology and pathogenesis of Climacterium is spleen deficiency, spleen is the foundation of postnatal essence.Deficiency of the spleen implies inpairment of its function in transportation and transformation,which produces an insufficient source of Qi and blood,that explains pale complexion, lassitude,and dislike of speaking,weakness of the spleen qi indicates inability of the spleen to control blood,which leaks from the vessels and thus elicits purpura,bloody stools,excessive menstrual flow and uterine bleeding.Wansu Liu announce the theory "three stages of menstrual control" on his book Theory of Obstetric:adolescent women should pay attention to nourish the kidney,pregnant women should pay attention to manipulate the liver, menopausal women should pay attention to nourish the spleen,these theories has become the basis of climacteric syndrome treatment.
After the Differential Diagnosis,the TCM recommend many treating methods including Medications,Acupuncture and Moxibustion,Massage,Cupping, Auricular points sticking and pressing,are all proved to be a safe and effective treatments.
Many clinical and experimental researches show,to cure Climacteric syndromes with acupuncture can reaches the benefit of regulate the endocrine system,improve the microcirculation of nerve system,eliminate the inflammatory response of tissues,influence the neural pathways and neurotransmitters,adjust the immune system.
Massage is one kind of the Chinese Medical treatments.With different ways of practices,it can stimulate the meridian of the body,improve the circulation of blood,and promote the metabolism,so as to cure the disease and strengthen the body,inhibits the process of aging.By using massage treatment,people can adjust the function of endocrine system and autonomic nervous system,and eliminate systemic or local symptoms.
Objective
Observed from the perspective of modern medicine,medical research has proven that there is a second brain in the body and it's located in the belly, the belly consists of more neurons than are contained in the entire spine. The abdominal autonomic nervous control the operation of visceral system,and sends signals to the brain by talking to a small number of "command neurons," which in turn send signals to the abdomen,control the circulation of qi and blood.Many symptoms of middle age women include Chest tightness、Tremor、palpitation、Rapid heart beat、headache、sweating、diarrhea、Constipation、Gastrointestinal discomfort、Urinary frequency are attribute to Abdominal endocrine disorders,through the treatment of abdominal massage will release these phenomena,and strengthen the regulation of central nervous system, achieve the effect of medical care.
Many studies had shown acupuncture is an effective method to control climacteric syndromes,but seldom study focus on the effectiveness of combine acupuncture and massage therapies.In view of medical massage has the benefits of simple、cheap and efficacy,and considering both of acupuncture and massage have proved very effective for climacteric syndromes,combined acupuncture and massage therapy may be a reasonable option for patients.
This study is to observe the effect of acupuncture and massage treatment on the model of ovariectomized rats,evaluate its effect of cure Climacteric syndromes,and explore its active mechanism.
Method
To established an animal experiment model for the indicator of Climacteric syndromes treatment.Fifty SPF grade rats were randomly divided into 5 groups-1 normal group and 4 model groups(remove ovarian),4 model groups are separately named control group,medicine group,massage group and acupuncture plus massage group,each group contains 10 rats.The normal group is only used for observation reference,the control group is used for treatment comparison,the medicine group is feed with artificial estrogen -Diethylstilbestrol. the massage group is treated with massage in the Abdomen and lower extremities acu-points twice a day,the acupuncture plus massage group is treated with acupuncture and massage at the same places as massage group.
The ameliorative rates of syndromes before and after treatment was compared with physical and biological index including:weight,water intake,food intake, estrogen level(E),luteinizing hormone(LH) level,follicle stimulating hormone(FSH)level,Besides serum endocrine hormone,follicle stimulating hormone(FSH) and estradiol were determined before and after treatment in the study group.
Results
Observing model' s physical conditions of weight,food intake and water intake,and biological index of Estrogen level(E),Luteinizing hormone(LH) level,Follicle Stimulating Hormone(FSH) level and Gonadotropin Releasing Hormone(GnRH) level shows,the acupuncture and Massage have significantly effect in the treating of climacteric syndromes of ovariectomized rats.
Conclusion
Combined acupuncture and abdominal massage therapy on the treatment of Climacteric syndromes demonstrate many beneficial meaning,the first,it shows the traditional Chinese meridian has offer solid theoretical basis on Climacteric syndromes treatment,the second,it is the simple,effective and easy way to cure long-lasting refractory disease,the third,it reduces the cost of people' s medical expense.
The advance of modern immunology and endocrinology knowledge help the medicine practitioners grasp the concept of treating chronic diseases like Climacteric syndrome with better insight,and learn how to adopt the philosophy of traditional Chinese medicine on "preventing the disease before get sick" and "strengthen the Physical power,dispel the pathogens" to maintain human health.Typical menopause symptoms such as hot flash or night sweat are caused by changing hormonal level in the female reproductive system.It is part of women nature self-healing process to deal with the change of their body due to aging.
Based on these new knowledge and insight,most medical practitioners in major hospitals in the world do not treat climacteric syndrome as a serious disease that require heavy dose of medicine or intervention of surgery procedures;Instead most doctors now prescribe alternative medicine for menopause.Such as herbal medicine with compound that will produce progestational and estrogenic effects on humans and reduce the severeness of the syndrome.Other compound will increase body immune system which will help body heal itself and fight off the climacteric syndrome.
In addition,some practitioners also discovered that acupuncture is another good alternative because the acupuncture has been shown to stimulate the immune system.It also has affects the circulation,blood pressure, rhythm and stroke volume of the heart,secretion of the gastric acid,and production of red and white cells.It also stimulates the release of a variety of hormones that help body to respond to injury and stress that cause by menopause.
With this new knowledge,Traditional Chinese Medical treatments such as homeopathy and acupuncture become a new trend in modern medicine to fight climacteric syndrome.
According to theory of traditional meridian,the study of abdominal cavity which contains the most organs in the body such as the digest tract,the liver and pancreas,the spleen the adrenal gland and the kidneys is not sufficient. This study of Chinese medicine is focus on physiological structure of the abdomen,it is an extensive and highly complicated structure that actually consists of more neurons than the brain,however,the deficiency of study abdominal anatomy is concerning.We should revelation of this study and hopefully will lead to more understanding of meridian mystery of abdomen with help from modern Anatomy,Electroneurophysiology,Endocrinology,and it will benefit significantly to the Traditional Chinese Medicine.
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[27]缪兴财.推拿治疗女性更年期综合症180例的临床体会 中国临床医药研究杂志2008年总第190期:39-40
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[34]陈成巧.三穴六针治疗更年期综合征33例 浙江中西医结合杂志2005年第15卷第4期:250-251
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[23]李晓泓、解秸萍 逆灸关元穴对自然更年期大鼠下丘脑雌激素受体OL和促肾上腺激素释放激素及血浆促肾上腺激素的调节料 中国临床康复第10卷第7期2006,02,20:118-119
[24]王璐.耳压治疗更年期综合征30例 上海针灸杂志1996年第15卷第4期:10-11
[25]杨清芳.耳压治疗更年期综合征31例 云南中医杂志1993年第14卷第5期:27-28
[26]朱江.耳穴贴压对妇女更年期综合征患者植物神经功能状态的影响 上海针灸杂志1996年第15卷第4期:9-10
[27]缪兴财.推拿治疗女性更年期综合症180例的临床体会 中国临床医药研究杂志2008年总第190期:39-40
[28]龚小琦.推拿腹部穴位治疗内科腹痛38例效果观察 齐鲁护理杂志2008年第14卷第14期:46-47
[29]蒋振亚.循经走罐治疗更年期综合征48例中国针灸杂志2001年第21卷第9期:558-559
[30]余少辉.走罐为主治疗女性更年期综合征20例 新中医2006年12月第38卷第12期:55-56
[31]徐智.捏脊针灸补肾益脑胶囊治疗女性更年期综合征100例疗效观察 按摩与导引2004年10月第20卷第5期:12-13
[32]李晓清.梅花针治疗妇女更年期失眠50例上海针灸杂志2000年第19卷第4期:27
[33]姜守信.穴位埋线治疗妇女更年期综合症60例临床观察 针灸临床杂志2000年第16卷第7期:46-47
[34]陈成巧.三穴六针治疗更年期综合征33例 浙江中西医结合杂志2005年第15卷第4期:250-251
[35]袁志太.五脏俞加膈俞针刺治疗更年期综合征 上海针灸杂志1999年第18 卷第6期:19
[36]刘国富.人工蜂粮与蜂针结合治疗更年期综合症 蜜蜂杂志月刊1997年第7期:16-17
[37]慕化民.以流注八穴为主治疗更年期综合征87例 新中医1996年第2期:32-33
[38]孙远征.俞募通经针法治疗围绝经期综合征26例疗效观察 中国中医药科技2005年3月第12卷第2期:116-117
[39]汤敏华.腕踝针治疗妇女更年期不寐32例广西中医大学学报2001年第4卷第3期:26
[40]何宇峰.腹针治疗女性更年期抑郁症疗效观察 上海针灸杂志2008年4月第27卷第4期:25-26
[41]沈晓明.调神益肾针法对更年期大鼠中脑5-羟色胺神经元形态功能的影响.中国针灸,2002;22(10):693
[42]张慧.逆针关元穴对自然更年期大鼠超氧化物歧化酶和一氧化氮合酶活性的调节 中国临床康复2005年第9卷第37期:147-148
[43]杨丹红.头针结合体针治疗妇女更年期忧郁症 浙江中医学院学报1996年3月号:131
[44]李忠仁主编 实验针灸学 中国中医药出版社2003年1月第一版
[45]张绍芬主编 绝经-内分泌与治疗 人民卫生出版社2005年7月第一版
[46]汪强.保健推拿治疗失眠症疗效观察 现代中西医结合杂志2008 Jun,17(16):2453-2454
[47]缪兴财.拿治疗女性更年期综合症180例的临床体会 中国临床医药研究杂志2008年总第190期:39-40
[48]赵洁敏、徐宾 推拿治疗更年期综合征36例临床总结 按摩与导引2005年2月第21卷第2期:37-38
[49]高晓冬.推拿点穴辨证治疗不寐116例 实用中医内科杂志 May.2008 Vol 220.5:102-103
[50]王鹰雷.更年期综合征按摩手法的辨证施治附32例病例报告 按摩与导引1996年第六期:14-15
[51]黄克强.更年期综合征的手法治疗 按摩与导引2000年8月第16卷第4期:64-65
[52]童玉霞.浅谈按摩治疗妇女更年期综合征 按摩与导引1996年第二期15-17
[53]骆仲达.初论腹部推拿手法的特殊性《按摩与导引》2007年8月第23卷第8期:10-11
[54]孙艳红、金若敏.女性更年期综合征动物模型制备的研究进展 时珍国医国药2005年第16卷第7期 657-658
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