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針灸治療骨質疏松癥有潛力

醫案(an)日(ri)記 2023-06-16 08:13:58

骨(gu)(gu)(gu)質(zhi)疏松(song)癥(zheng)(zheng)(zheng)(OP)是一(yi)(yi)種以骨(gu)(gu)(gu)組織(zhi)顯微(wei)結構受損的(de)全身(shen)代謝障礙的(de)疾病,因其常引起骨(gu)(gu)(gu)痛、骨(gu)(gu)(gu)折等(deng)繼發性癥(zheng)(zheng)(zheng)狀或疾病,嚴重影響了老年(nian)人(ren)的(de)健(jian)康(kang)和生活質(zhi)量,因此作為中(zhong)老年(nian)退行性主要疾病之一(yi)(yi)的(de)骨(gu)(gu)(gu)質(zhi)疏松(song)癥(zheng)(zheng)(zheng)備(bei)受各國(guo)醫學(xue)學(xue)者的(de)關注。針(zhen)灸作為一(yi)(yi)種具有中(zhong)醫特色的(de)療法在該病的(de)防治方(fang)面有很大(da)的(de)潛力,并取(qu)得了一(yi)(yi)定的(de)成果,且應用前(qian)景廣(guang)闊。

腎虛是產生(sheng)骨質疏松(song)癥的原因

在(zai)(zai)中(zhong)醫(yi)文獻中(zhong)無骨(gu)(gu)(gu)質疏(shu)松癥(zheng)(zheng)這一(yi)病名,從其(qi)發病部位及(ji)臨床癥(zheng)(zheng)狀(zhuang)來看(kan),隸屬(shu)于祖(zu)國(guo)醫(yi)學(xue)的“骨(gu)(gu)(gu)痹”、“骨(gu)(gu)(gu)痿(wei)”范疇(chou),中(zhong)醫(yi)認為(wei)“腎主骨(gu)(gu)(gu),藏精(jing)(jing),精(jing)(jing)生(sheng)(sheng)(sheng)(sheng)髓(sui)以(yi)養骨(gu)(gu)(gu)”,腎精(jing)(jing)充足,則(ze)骨(gu)(gu)(gu)骼生(sheng)(sheng)(sheng)(sheng)化有源(yuan),堅(jian)固充實(shi),強健(jian)有力;因此腎虛(xu)是本(ben)病的根本(ben)原(yuan)因。“脾(pi)(pi)主四肢肌肉,統(tong)血(xue)”,同(tong)時(shi)(shi)骨(gu)(gu)(gu)質疏(shu)松癥(zheng)(zheng)與沖任(ren)二脈及(ji)天癸有關(guan),天癸乃生(sheng)(sheng)(sheng)(sheng)殖(zhi)之精(jing)(jing),源(yuan)于先天,受(shou)后天的滋(zi)養,若脾(pi)(pi)胃之氣(qi)(qi)不(bu)充,陽明精(jing)(jing)衰(shuai)則(ze)氣(qi)(qi)血(xue)生(sheng)(sheng)(sheng)(sheng)化無源(yuan),經(jing)(jing)脈空虛(xu),沖任(ren)失養,腎精(jing)(jing)衰(shuai)敗,天癸竭止,則(ze)無以(yi)生(sheng)(sheng)(sheng)(sheng)髓(sui)充骨(gu)(gu)(gu)則(ze)骨(gu)(gu)(gu)痿(wei)。因此此病乃本(ben)虛(xu)標實(shi),虛(xu)實(shi)相(xiang)兼之癥(zheng)(zheng),以(yi)脾(pi)(pi)腎痿(wei)虛(xu),骨(gu)(gu)(gu)枯髓(sui)痿(wei)為(wei)本(ben),邪(xie)阻經(jing)(jing)絡為(wei)標。現代研(yan)究表明腎虛(xu)時(shi)(shi)發生(sheng)(sheng)(sheng)(sheng)內分泌系(xi)統(tong)紊亂,免疫功能下降,微量元素(su)發生(sheng)(sheng)(sheng)(sheng)改變(bian)等(deng)一(yi)系(xi)列的內環境(jing)的改變(bian),同(tong)時(shi)(shi)血(xue)淤是骨(gu)(gu)(gu)質疏(shu)松癥(zheng)(zheng)的促進因素(su),在(zai)(zai)脾(pi)(pi)虛(xu)基(ji)礎上形(xing)成的血(xue)淤,痹阻經(jing)(jing)絡,中(zhong)醫(yi)理論認為(wei)淤不(bu)去則(ze)新不(bu)生(sheng)(sheng)(sheng)(sheng),從而(er)加重(zhong)骨(gu)(gu)(gu)質疏(shu)松癥(zheng)(zheng)的病情。

現代醫學中研究最為常見的是絕經后的骨(gu)(gu)質(zhi)(zhi)疏(shu)松癥(zheng),它(ta)與內分泌(mi)(mi)紊(wen)亂,鈣、磷、蛋白質(zhi)(zhi)的攝(she)入不(bu)足及戶外運動減少(shao)有關,由于(yu)卵巢功能衰退,雌激素水平(ping)下(xia)降,它(ta)直接抑制(zhi)骨(gu)(gu)細胞(bao),使(shi)骨(gu)(gu)形成(cheng)減少(shao),同是一(yi)些(xie)鈣調節激素(降鈣素、甲狀腺(xian)激素)分泌(mi)(mi)紊(wen)亂,對(dui)骨(gu)(gu)質(zhi)(zhi)的重建也有一(yi)定的影響,從而使(shi)骨(gu)(gu)代謝(xie)紊(wen)亂,骨(gu)(gu)重建處于(yu)平(ping)衡(heng)狀態,導致骨(gu)(gu)質(zhi)(zhi)疏(shu)松。另(ling)外還有一(yi)些(xie)疾(ji)病繼發性的引(yin)起骨(gu)(gu)質(zhi)(zhi)疏(shu)松癥(zheng),如(ru)皮質(zhi)(zhi)醇增(zeng)多癥(zheng)、甲狀腺(xian)機能亢(kang)進等引(yin)起骨(gu)(gu)質(zhi)(zhi)疏(shu)松癥(zheng)。

針灸(jiu)可改善(shan)骨(gu)質(zhi)疏松癥(zheng)癥(zheng)狀

在骨(gu)(gu)質(zhi)疏(shu)松(song)(song)癥(zheng)(zheng)(zheng)的(de)(de)(de)(de)實(shi)驗(yan)研(yan)究(jiu)中,建立一個(ge)理(li)想的(de)(de)(de)(de)骨(gu)(gu)質(zhi)疏(shu)松(song)(song)癥(zheng)(zheng)(zheng)實(shi)驗(yan)動物(wu)模(mo)型(xing)是其(qi)研(yan)究(jiu)的(de)(de)(de)(de)基(ji)礎。目前普遍采用(yong)的(de)(de)(de)(de)是大鼠去(qu)勢(shi)法,即切大大鼠雙(shuang)側卵巢,止血(xue)縫合后飼養3個(ge)月即能形(xing)成絕經后骨(gu)(gu)質(zhi)疏(shu)松(song)(song)癥(zheng)(zheng)(zheng)模(mo)型(xing)。此模(mo)型(xing)與臨床絕經后骨(gu)(gu)質(zhi)疏(shu)松(song)(song)癥(zheng)(zheng)(zheng)極為相似且成功率高,穩定可(ke)靠,主(zhu)要用(yong)于的(de)(de)(de)(de)絕經后骨(gu)(gu)質(zhi)疏(shu)松(song)(song)癥(zheng)(zheng)(zheng)研(yan)究(jiu)。另外還有維甲(jia)酸法等。造模(mo)的(de)(de)(de)(de)方法有多種,根據(ju)不同的(de)(de)(de)(de)實(shi)驗(yan)目的(de)(de)(de)(de)選取不同的(de)(de)(de)(de)實(shi)驗(yan)模(mo)型(xing)是實(shi)驗(yan)研(yan)究(jiu)的(de)(de)(de)(de)前提(ti)。

近年來(lai)對針(zhen)(zhen)灸(jiu)治療(liao)(liao)骨質疏(shu)松癥的(de)(de)報道有很(hen)(hen)多,治療(liao)(liao)方法上也(ye)趨向(xiang)多極(ji)化,從(cong)傳統(tong)的(de)(de)針(zhen)(zhen)刺、艾灸(jiu)、天灸(jiu)、耳針(zhen)(zhen)、穴(xue)位(wei)(wei)敷貼到(dao)現代創新手法如電針(zhen)(zhen)、穴(xue)位(wei)(wei)注射、紅(hong)外(wai)灸(jiu)療(liao)(liao)儀等。同(tong)(tong)(tong)時治療(liao)(liao)手法也(ye)多元化,用上了提(ti)、插、捻、轉,呼吸補瀉,開闔(he)補瀉等手法,在(zai)治療(liao)(liao)方案(an)上也(ye)偏(pian)向(xiang)于綜合療(liao)(liao)法,把(ba)針(zhen)(zhen)與(yu)灸(jiu)相結(jie)合,針(zhen)(zhen)與(yu)藥,針(zhen)(zhen)與(yu)罐(guan),針(zhen)(zhen)灸(jiu)與(yu)推拿相合,這些(xie)療(liao)(liao)法的(de)(de)療(liao)(liao)效(xiao)都很(hen)(hen)好。同(tong)(tong)(tong)時蔡紅(hong)等研究還發現不(bu)同(tong)(tong)(tong)頻次的(de)(de)針(zhen)(zhen)刺,療(liao)(liao)效(xiao)也(ye)有不(bu)同(tong)(tong)(tong),即針(zhen)(zhen)刺發揮效(xiao)應有一個療(liao)(liao)效(xiao)累積的(de)(de)過程。

在用針(zhen)灸(jiu)(jiu)療(liao)(liao)(liao)法(fa)治(zhi)(zhi)療(liao)(liao)(liao)骨(gu)(gu)質疏(shu)松癥的(de)(de)研究(jiu)中,趙英(ying)俠(xia)等研究(jiu)人員選(xuan)用12月齡雌性Wistar大鼠(shu)40只,分(fen)為(wei)(wei)假手術組(zu)(zu)(zu)(zu)、模型(xing)組(zu)(zu)(zu)(zu)、針(zhen)刺(ci)組(zu)(zu)(zu)(zu)、艾灸(jiu)(jiu)組(zu)(zu)(zu)(zu)和(he)西藥組(zu)(zu)(zu)(zu),建立模型(xing)后對(dui)后三組(zu)(zu)(zu)(zu)實(shi)行(xing)不同的(de)(de)治(zhi)(zhi)療(liao)(liao)(liao)方法(fa)來比較其療(liao)(liao)(liao)效(xiao)。針(zhen)刺(ci)組(zu)(zu)(zu)(zu)取命門、脾俞(yu)、足三里、大椎等穴,實(shi)行(xing)提插捻轉平(ping)(ping)補平(ping)(ping)瀉的(de)(de)手法(fa),留(liu)針(zhen)30分(fen)鐘隔日治(zhi)(zhi)療(liao)(liao)(liao)1次,12天(tian)(tian)(tian)為(wei)(wei)1個(ge)(ge)療(liao)(liao)(liao)程(cheng)(cheng)(cheng),療(liao)(liao)(liao)程(cheng)(cheng)(cheng)間(jian)間(jian)隔7天(tian)(tian)(tian),再行(xing)下(xia)1個(ge)(ge)療(liao)(liao)(liao)程(cheng)(cheng)(cheng);艾灸(jiu)(jiu)組(zu)(zu)(zu)(zu)選(xuan)穴與針(zhen)刺(ci)組(zu)(zu)(zu)(zu)相同,溫(wen)和(he)灸(jiu)(jiu),每次灸(jiu)(jiu)15分(fen)鐘;吳明霞等研究(jiu)人員在分(fen)組(zu)(zu)(zu)(zu)基礎上,增加(jia)了正常對(dui)照(zhao)組(zu)(zu)(zu)(zu),其取穴為(wei)(wei)大椎、大杼、命門,配穴為(wei)(wei)懸鐘、膈(ge)俞(yu)、足三里,用補腎藥條(tiao)(艾絨、羊藿、補骨(gu)(gu)脂、黃芪(qi)、刺(ci)五加(jia)、當(dang)歸尾等)溫(wen)和(he)灸(jiu)(jiu),每次灸(jiu)(jiu)15分(fen)鐘,1次/天(tian)(tian)(tian),10天(tian)(tian)(tian)為(wei)(wei)1個(ge)(ge)療(liao)(liao)(liao)程(cheng)(cheng)(cheng),療(liao)(liao)(liao)程(cheng)(cheng)(cheng)間(jian)間(jian)隔5天(tian)(tian)(tian),共灸(jiu)(jiu)6個(ge)(ge)療(liao)(liao)(liao)程(cheng)(cheng)(cheng)。其實(shi)驗結果(guo)經過生化(hua)檢測,礦(kuang)物質密度(BMD)測定(ding),激(ji)素測定(ding)均顯(xian)(xian)示了針(zhen)灸(jiu)(jiu)組(zu)(zu)(zu)(zu)、艾灸(jiu)(jiu)組(zu)(zu)(zu)(zu)與西醫(yi)治(zhi)(zhi)療(liao)(liao)(liao)組(zu)(zu)(zu)(zu)的(de)(de)療(liao)(liao)(liao)效(xiao)無明顯(xian)(xian)差距,針(zhen)灸(jiu)(jiu)療(liao)(liao)(liao)法(fa)能提高雌激(ji)素水平(ping)(ping),抑制骨(gu)(gu)吸收,促進骨(gu)(gu)形(xing)成,糾正骨(gu)(gu)代謝的(de)(de)負平(ping)(ping)衡狀態,對(dui)治(zhi)(zhi)療(liao)(liao)(liao)骨(gu)(gu)質疏(shu)松癥有一定(ding)療(liao)(liao)(liao)效(xiao)。

李學(xue)武等研究人員應(ying)用天(tian)灸(jiu)(jiu)(jiu)療(liao)法選用10月(yue)齡(ling)Wistar大鼠,造模后分為對(dui)照組(zu)(zu)(zu)、模型(xing)組(zu)(zu)(zu)、服藥(yao)組(zu)(zu)(zu)、天(tian)灸(jiu)(jiu)(jiu)組(zu)(zu)(zu)、天(tian)灸(jiu)(jiu)(jiu)加(jia)(jia)藥(yao)組(zu)(zu)(zu)。天(tian)灸(jiu)(jiu)(jiu)組(zu)(zu)(zu)取(qu)背部右側的背俞(yu)穴,每穴外敷0.5克的天(tian)灸(jiu)(jiu)(jiu)藥(yao)膜(淫(yin)羊(yang)藿、刺五加(jia)(jia)、丹參、辣椒等)24~26小時后自然干落,每周兩次,連敷6個月(yue)。其療(liao)效(xiao)與(yu)對(dui)照組(zu)(zu)(zu)相比有(you)(you)顯著性差(cha)異,且天(tian)灸(jiu)(jiu)(jiu)與(yu)西藥(yao)鈣劑有(you)(you)正(zheng)協(xie)同作(zuo)用,天(tian)灸(jiu)(jiu)(jiu)加(jia)(jia)藥(yao)組(zu)(zu)(zu)組(zu)(zu)(zu)療(liao)效(xiao)最好。天(tian)灸(jiu)(jiu)(jiu)的療(liao)效(xiao)同時與(yu)治(zhi)療(liao)時機(ji)有(you)(you)關(guan),病程(cheng)越短(duan),療(liao)效(xiao)越好,在摘(zhai)除(chu)卵巢后立即天(tian)灸(jiu)(jiu)(jiu)其療(liao)效(xiao)是最好的。

在用(yong)(yong)(yong)穴(xue)(xue)(xue)位敷貼(tie)法治療骨質疏(shu)松(song)癥(zheng)的(de)(de)研究(jiu)中(zhong)武密山等研究(jiu)人員用(yong)(yong)(yong)三月齡Wistar大(da)鼠60只,用(yong)(yong)(yong)地塞米松(song)誘發(fa)骨質疏(shu)松(song)癥(zheng)造模,在用(yong)(yong)(yong)穴(xue)(xue)(xue)位敷貼(tie)的(de)(de)三組(zu)(zu)(zu)中(zhong),一組(zu)(zu)(zu)選用(yong)(yong)(yong)太(tai)溪穴(xue)(xue)(xue)和(he)大(da)鐘穴(xue)(xue)(xue),另一組(zu)(zu)(zu)用(yong)(yong)(yong)腎(shen)俞和(he)飛揚穴(xue)(xue)(xue),還(huan)有一組(zu)(zu)(zu)是非(fei)經非(fei)穴(xue)(xue)(xue),治療3個月后顯示穴(xue)(xue)(xue)位敷貼(tie)的(de)(de)兩組(zu)(zu)(zu)有很(hen)好(hao)的(de)(de)療效,從“穴(xue)(xue)(xue)位-經絡-絡屬臟腑-所(suo)主靶器官”的(de)(de)關系上證(zheng)實了穴(xue)(xue)(xue)位敷貼(tie)治療骨質疏(shu)松(song)癥(zheng)的(de)(de)療效。

針灸的(de)(de)(de)(de)實驗及臨床研(yan)究(jiu)均證實了針灸作為一(yi)種獨特(te)的(de)(de)(de)(de)治療手段,對骨(gu)質疏松(song)有較好的(de)(de)(de)(de)療效,對其(qi)作用機(ji)制(zhi)的(de)(de)(de)(de)研(yan)究(jiu)就(jiu)更(geng)為顯得(de)重要。骨(gu)質疏松(song)屬中醫“骨(gu)痹”的(de)(de)(de)(de)范疇(chou),它(ta)的(de)(de)(de)(de)發(fa)病與肝腎(shen)腎(shen)密切相(xiang)關,與任督脈也(ye)息息相(xiang)關。針刺或(huo)艾(ai)灸的(de)(de)(de)(de)穴(xue)(xue)(xue)位主要選取(qu)的(de)(de)(de)(de)是背俞穴(xue)(xue)(xue)及一(yi)些(xie)特(te)定穴(xue)(xue)(xue)位。趙英俠(xia)取(qu)“主一(yi)身之(zhi)陽”的(de)(de)(de)(de)督脈上的(de)(de)(de)(de)“大椎”、“命門”,胃(wei)之(zhi)合穴(xue)(xue)(xue)“足三里”,還有背俞穴(xue)(xue)(xue)脾俞,通過補(bu)法(fa)能(neng)培元(yuan)補(bu)腎(shen)、健脾和(he)胃(wei)、散寒溫經之(zhi)功(gong),能(neng)起到先后天同補(bu),強筋健骨(gu)的(de)(de)(de)(de)功(gong)能(neng),可從根本(ben)上治療骨(gu)質疏松(song)。

實驗(yan)證明針(zhen)(zhen)(zhen)灸是治療骨(gu)(gu)(gu)質(zhi)(zhi)疏(shu)(shu)松(song)(song)癥方法之一,可(ke)緩解臨床癥狀(zhuang)、調節骨(gu)(gu)(gu)代謝(xie)(xie)和提高(gao)骨(gu)(gu)(gu)密度。針(zhen)(zhen)(zhen)灸治療骨(gu)(gu)(gu)質(zhi)(zhi)疏(shu)(shu)松(song)(song)癥的(de)(de)(de)作用(yong)(yong)(yong)具有雙向性(xing)(xing)(xing)和整體(ti)(ti)性(xing)(xing)(xing)的(de)(de)(de)特征,既能(neng)促(cu)(cu)進骨(gu)(gu)(gu)形(xing)成,又能(neng)抑制骨(gu)(gu)(gu)吸(xi)收(shou)。它的(de)(de)(de)作用(yong)(yong)(yong)機理主(zhu)要是通(tong)過以(yi)下(xia)途徑(jing)來實現:大(da)量研究(jiu)表(biao)明針(zhen)(zhen)(zhen)刺后雌(ci)激(ji)素(su)(su)(su)水平提高(gao),這可(ke)能(neng)就(jiu)是通(tong)過下(xia)丘腦-垂(chui)體(ti)(ti)-性(xing)(xing)(xing)腺軸的(de)(de)(de)功能(neng)來發(fa)揮作用(yong)(yong)(yong)的(de)(de)(de),針(zhen)(zhen)(zhen)刺后性(xing)(xing)(xing)腺上(shang)雌(ci)激(ji)素(su)(su)(su)的(de)(de)(de)受(shou)體(ti)(ti)敏感性(xing)(xing)(xing)或雌(ci)激(ji)素(su)(su)(su)的(de)(de)(de)受(shou)體(ti)(ti)數(shu)量增加(jia),從(cong)而重建骨(gu)(gu)(gu)平衡(heng);針(zhen)(zhen)(zhen)灸的(de)(de)(de)作用(yong)(yong)(yong)是全面的(de)(de)(de),它能(neng)促(cu)(cu)進腸道對鈣(gai)離子作用(yong)(yong)(yong),使去(qu)勢大(da)鼠血(xue)鈣(gai)水平上(shang)升,從(cong)而抑制了甲狀(zhuang)旁腺素(su)(su)(su)(PTH)、促(cu)(cu)進鈣(gai)吸(xi)收(shou);針(zhen)(zhen)(zhen)灸能(neng)調節內環境微量元素(su)(su)(su)的(de)(de)(de)平衡(heng),促(cu)(cu)進礦物(wu)質(zhi)(zhi)在骨(gu)(gu)(gu)中的(de)(de)(de)沉積,進而發(fa)揮抗(kang)骨(gu)(gu)(gu)質(zhi)(zhi)疏(shu)(shu)松(song)(song)癥的(de)(de)(de)作用(yong)(yong)(yong);針(zhen)(zhen)(zhen)灸可(ke)促(cu)(cu)進局(ju)部許(xu)多細胞因子等一系(xi)列的(de)(de)(de)改變,能(neng)影響骨(gu)(gu)(gu)組織的(de)(de)(de)微環境而提高(gao)成骨(gu)(gu)(gu)細胞的(de)(de)(de)活性(xing)(xing)(xing),促(cu)(cu)進骨(gu)(gu)(gu)形(xing)成,抑制骨(gu)(gu)(gu)吸(xi)收(shou),糾正骨(gu)(gu)(gu)代謝(xie)(xie)的(de)(de)(de)負平衡(heng)狀(zhuang)態(tai),防止(zhi)骨(gu)(gu)(gu)質(zhi)(zhi)的(de)(de)(de)進一步(bu)丟(diu)失。

研究表明,針灸治療(liao)(liao)骨質疏松癥(zheng)與西(xi)(xi)藥(yao)組、中(zhong)(zhong)藥(yao)治療(liao)(liao)組間的療(liao)(liao)效無明顯差別,而(er)西(xi)(xi)藥(yao)治療(liao)(liao)有(you)其不(bu)可避免的副(fu)作用,中(zhong)(zhong)藥(yao)的治療(liao)(liao)療(liao)(liao)效較慢(man),相對而(er)言,針灸治療(liao)(liao)更為方(fang)便快(kuai)捷(jie),經濟安(an)全,更能被患(huan)者所接(jie)受,是(shi)一種很有(you)潛力的治療(liao)(liao)方(fang)法,有(you)待進一步發掘(jue)。

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