目的 探讨糖尿病前期的中医证型及证素分布特点.方法 检索中国知网、万方及维普三大数据库中收录的自建库以来有关糖尿病前期证型的临床研究文献,对中医证型进行规范整理,建立数据库,提取证素,运用数据挖掘技术中的关联分析、聚类分析探究证素分布规律.结果 共纳入10篇文献,总有效病例1620例,证型经规范处理后整理为18个,主要证型为脾虚痰湿证.共提取证素13个,主要病位证素为脾,主要病性证素为气虚、湿和痰,关联分析显示脾—湿支持度和置信度最高,聚类分析结果可得到3个聚类组.结论 糖尿病前期病位在脾,气虚、脾、痰、湿是常见证素,临床诊治糖尿病前期应注重从脾论治,需辨证施治.

目的:使用荧光照相法观察电针对小型猪前肢外侧循经低电阻线(LILM)注射荧光素钠(SF)后产生的迁移轨迹的影响,并对电针调节经脉之气运行的机制进行探讨.方法:将小型猪分为电针组和对照组,将SF分别注入小型猪的前肢外侧中央LILM腕部上约4.5 cm一点,电针组选择原注射点作为进针点,将针灸针与皮肤呈60°角刺入,随后接入电针仪,参数6～9 mA,持续30 min,以肉眼可见肌肉出现持续的节律性收缩为度;对照组仅注射SF不做任何干预.随后使用荧光照相法对比观察两组SF的迁移规律.结果:电针组和对照组SF迁移轨迹的平均长度分别为(4.50±0.89)cm、(2.51±0.51)cm;平均宽度分别为(1.79±0.37)cm、(1.05±0.18)cm.两组迁移长度占前肢长度的百分比分别为33.3％±66.3％、18.6％±36.5％,电针组的长度百分比相对于对照组增加了近1倍.电针组SF迁移轨迹的长度和宽度与对照组比较均极显著延长(P<0.01).电针组和对照组总例数一半以上的SF迁移轨迹方向皆表现为离心迁移,除此之外,电针组有3例呈双向迁移;对照组里各有2例呈向心迁移和双向迁移.结论:电针可促进组织液的流动,其机制可能与肌肉活动,产生推动组织液流动的压力有关.

目的:测算健康人十二经原穴经皮二氧化碳释放率(TCER)及其左右失衡度(IBD-LRM)、表里失衡度(IBD-EIM)、手足失衡度(IBD-HFM),为经络诊断奠定基础.方法:使用激光多普勒及经皮氧分压监测仪测量30例健康受试者十二经原穴的经皮二氧化碳分压曲线,用MATLAB程序对该曲线最小值之后的一段线性曲线进行最小二乘法线性拟合,以拟合直线的斜率作为TCER,再分别计算3种失衡度IBD-LRM、IBD-EIM和IBD-HFM及失衡度绝对值.结果:1)十二经TCER IBD-LRM均值为(-0.71±8.00)％,左右侧TCER分别为(2.21±0.56)和(2.24±0.59)mm Hg(1 mm Hg=0.133 kPa)/s,差异无统计学意义(P>0.05);IBD-LRM绝对值在(14.04±9.66)％至(40.63±23.36)％之间,均值为(25.86±6.40)％.2)IBD-EIM均值为(-6.18±14.35)％,表里经TCER均值分别为(2.18±0.61)和(2.27±0.59)mm Hg/s,差异无统计学意义(P>0.05);IBD-EIM绝对值在(20.26±14.82)％至(58.37±20.19)％之间,均值为(38.50±8.64)％.3)IBD-HFM均值为(13.63±16.93)％;手足同名经的TCER均值分别为(2.35±0.63)mm Hg/s和(2.10±0.64)mm Hg/s,手经显著高于足经(P<0.05);IBD-HFM绝对值在(26.68±20.69)％到(56.55±18.29)％之间,均值为(41.12±7.19)％.结论:健康人十二经原穴左右侧的TCER十分接近,表里经之间也比较接近,但手经高于足经;TCER的左右失衡度较小,表里失衡度和左右失衡度较大.

Objective. To explore the dynamic changes recorded in pulse graph related to the changes in the severity of pain before and after electroacupuncture (EA) intervention among young women suffering from primary dysmenorrhea (PD). Methods. A total of 147 female college students were recruited in this study. Based on participants’ symptoms associated with menstruation, they were divided into the PD group and the healthy control group. In addition, participants in the PD group were further sorted into the Cold Coagulation and Blood Stasis Pattern (CCBSP) and Qi Stagnation and Blood Stasis Pattern (QSBSP) based on TCM diagnoses and their pulses differences. Participants in the PD group received EA at maximal pain during menstruation. The primary acupuncture points selected were SP 6 and RN 3, additional RN 4 for CCBSP, and LR 3 for QSBSP. Four observation time points were 7–10 days before menstruation (T0), maximal pain during menstruation (T1), immediately after EA (T2), and 30 mins after EA (T3). The severity of pain was assessed by a visual analog scale (VAS) along with a pulse analyzer to record the variations of the pulse graph throughout the changes of pain level. Results. (1) The average VAS score in the PD group decreased from 5.44 ± 1.46 at T1 to 1.72 ± 1.27 at T2 and 1.59 ± 1.30 at T3. The average VAS score in participants of CCBSP at T1, T2, and T3 was higher than that of QSBSP. (2) At T1, h2, h3, h4, and w1/t were all significantly increased, compared with those at T0. At T2, t and t5 were both significantly increased, and w1/t, t1, and t1/t were all significantly decreased, compared with those at T1. At T3, w1/t, t1, and t1/t were all significantly increased, and t and t5 were both significantly decreased, compared with those at T2. (3) Comparing the pulse graphs between the healthy control and the PD groups, h1 was significantly lower at T0; w1/t was significantly higher at T1; t was significantly higher at T2; and t1 and t1/t were both significantly higher at T3 in PD group. (4) When comparing the pulse graphs between QSBSP and CCBSP, t4/t5 was significantly higher at T0 and t1 was significantly higher at T1 in the CCBSP group. Conclusion. EA is effective in relieving primary dysmenorrhea. Our results showed the opposite changing of the pulse graph recorded before the onset of pain to the maximum pain and that from maximum pain to pain relief. Indeed, there were differences in the recorded pulse graphs between CCBSP and QSBSP (two patterns of PD) as described in traditional Chinese pulses diagnosis. The study has been registered in the Chinese Clinical Trial Registry (registered number: ChiCTR2000040065; registered date: 2020/11/19).

《黄帝内经》提出了"平人"的概念,代表人体的健康态,特指人的阴阳平衡,是《黄帝内经》健康思想的总纲.应四时、俱往来、不结动、相守司和必相称是书中衡量"平人"的客观标准;"平人""阴平阳秘,精神乃治"意为属于营卫之气的精气和属于血的神气得到控制."平人"主要指人体内在阴阳的平衡,特别是五脏、五脏和六腑、阴经与阳经的平衡.依据平人健康思想,从阴阳平衡的角度评估人的健康状态,通过脉象、皮肤的寒温与滑涩等客观指标的测量,对阴经与阳经、上下经脉、深浅经脉的气的平衡进行计算,可知人体是否处于健康态.

目的:从肌筋膜链角度,探讨足三阴经筋的解剖基础,为临床经筋疗法提供理论支撑.方法:分析足三阴经筋的分布、病候,并与肌筋膜链前深线解剖、功能对比,阐释足三阴经筋的解剖结构.结果:足三阴经筋的线性分布呈现混合分布趋势.在足踝小腿部,长屈肌及肌腱可视为足太阴经筋,趾长屈肌及肌腱可视为足少阴经筋.在阴股部,股内侧肌及股内收肌群的股骨止点可被视为足太阴经筋,股内收肌群结合体可被视为足厥阴经筋,大收肌后部及半腱肌半膜肌可被视为足少阴经筋.在躯干部,足太阴经筋与腰大肌筋膜密切相关,足少阴经筋与脊柱椎体前筋膜更为切合.从功能上,足厥阴经筋突出了股内收肌群与耻骨的解剖关系,足少阴、足太阴经筋突出了下肢内侧与腰腹的关系.结论:足三阴经筋分布与下肢内侧及腹腔后壁肌筋膜密切相关,由于经筋的功能性,需要进一步从解剖、功能、生物力学和病候等方面对足三阴经筋深入探讨.

目的:观察第二课堂教学对针灸推拿专业临床前课程教学效果的影响.方法:校内专业教师与校外特聘临床专家共同形成第二课堂教学团队,设计筋骨脉理论及实操第二课堂教学方案,将2017级针灸推拿专业五年制整班学生分为自愿参加筋骨脉理论及实操第二课堂的试验组和不参加筋骨脉理论及实操第二课堂的对照组,第二课堂开设时段为本科第四学期至第七学期,同步观察比较两组临床前课程成绩并进行统计学分析.结果:试验组和对照组大一《人体解剖学》课程成绩没有统计学差异(P>0.05),两组具有可比性.第二课堂开设期间,试验组和对照组的《针灸推拿临床解剖》《刺法灸法学》《推拿学》《针灸推拿综合实训》课程成绩差异没有统计学意义(P>0.05).结论:针灸推拿专业相关理论及技能第二课堂对针灸推拿本科临床前教学专业课程成绩无影响.作为本科专业课教学的有益补充,第二课堂教学对专业课教学及人才培养的促进作用评估是一长期系统工程.教育教学研究需要严格的试验设计,教学效果评价方法仍然是教学研究的重点.

Objective: The resonance frequency (Fr) of twelve meridians was observed by means of sweep frequency of weak constant current, and a method of evaluating Fr was explored. Method: Four-electrode bioimpedance spectroscopy was used in the study. Constant current of 1~100Hz was applied from a phase-locked amplifier through the excitation electrode to the twelve meridians of 30 healthy subjects. Data were collected by the test electrode and the Fr of the twelve meridians was obtained by data fitting in Matlab. Result: Among the twelve meridians, the Fr of the small intestine meridian is the lowest, and the gallbladder meridian is the highest, which are 23.18±0.99Hz and 28.27±1.39 Hz, respectively. The mean resonance frequencies of meridians of the same name on hand and foot are 24.80±1.34Hz and 26.22±1.17Hz, respectively. The Fr of the Shao Yin meridian of the hands and feet is basically equal, the other five pairs of foot meridians are all higher than the hand meridian, and the difference of the Yang meridian of the same name is greater than the Yin meridian of the same name, the Fr of hand Shao Yang meridian, hand Tai Yang meridian and hand Yang Ming meridian were lower than those of foot meridians. The mean value of 6 pairs of yin and yang meridians are 25.59 ± 1.97Hz and 25.42 ± 0.70Hz, respectively. Conclusion: The resonance frequencies of the twelve meridians ranged from 23 to 28Hz approximately.

目的:探讨耳针疗法治疗糖尿病前期的中医证治规律及作用机制.方法:通过对近10年针灸治疗糖尿病前期文献的统计,梳理其选穴规律及刺灸方法,特别是对耳针疗法进行总结,探讨耳针疗法治疗糖尿病前期的中西医学机制.结果:耳针疗法是临床常见的降糖方法,其治疗糖尿病前期疗效显著且优势独特,临床取穴以内分泌、胰、三焦、胃、脾为主,通过影响神经系统和内分泌系统达到降糖的效果.结论:耳针疗法作为针灸中常用防治糖尿病的方法,其独特的优势值得临床推广,但对糖尿病前期的治疗方案尚须完善和优化.

On the base of the analysis on the original text in Huangdi Neijing (The Yellow Emperor ¢s Inner Classic) and in association with the meridian tracing experiment results in transparent fish, rats and human body, the routes of conception vessel and governor vessel were recognized de novo. The starting site of conception vessel has been described as "the center of uterus" and "the inferior part of Zhongji (CV 3)", which refer to the same region. The running course of conception vessel includes 3 routes, named the deep abdominal route, the deep dorsal route and the superficial abdominal route. The governor vessel starts at Qugu (CV 2) on the pubis and its running course includes 4 routes, named the buttock-spine ascending route, the head-back descending route, the abdomen-face ascending route and the head-back midline route. Both the conception vessel and the governor vessel distribute on the anterior and the posterior aspects of the trunk, head and face, but they are in deep and shallow layers respectively, forming two cycles internally and externally. Such recognition is really not the pattern, known by the people, that conception vessel distributes in the front, while the governor vessel on the back.

目的 分析原发性痛经寒凝血瘀证患者脉图参数的动态变化及其与疼痛程度的相关性.方法 以原发性痛经寒凝血瘀证患者为原发性痛经组,健康者为对照组.在痛经典型发作时予以电针治疗,形成4个观测时点(T0:经前7～10 d,T1:经期痛经典型发作时,T2:针刺镇痛治疗30 min结束即刻,T3:针刺镇痛治疗结束后30 min).运用道生DS01-C型脉象仪采集脉图参数,包括幅度(h)、时值(t)、宽度(w)、幅度比、时值比、宽度与时值比、心率(HR)等,并用视觉模拟评分(VAS)评定疼痛程度.统计方法采用重复测量的方差分析、Pearson积差相关系数、Spearman相关系数及均值、标准差等描述性分析的方法.结果 原发性痛经组纳入35例,对照组纳入32例.在疼痛程度的变化上,痛经发作前后,即4个时点的VAS比较结果,T1、T2、T3与T0比较均显著升高(P<0.05),T2、T3与T1比较均显著降低(P<0.05).在脉图参数的变化上,痛经发作前后,即4个时点的脉图参数变化为:T1与T0比较,h2、h4、t1均显著升高(P<0.05);T2与T1比较,t5显著升高(P<0.05),h3/h1、w1/t、t1/t、t1、HR均显著降低(P<0.05);T3与T2比较,h3/h1、w1/t、t1/t、t1均显著升高(P<0.05).同一时点与对照组比较:T0时点,原发性痛经组h2、h4均显著低于对照组(P<0.05);T1时点,h3/h1、w1/t、t1、t1/t均显著高于对照组(P<0.05);T3时点,t1、t1/t均显著高于对照组(P<0.05).在脉图参数与疼痛程度的相关性上,与VAS呈显著正相关的脉图参数是:h2、h3、h4、h3/h1、h4/h1、w1(P<0.05);与VAS呈显著负相关的脉图参数是:h5、h5/h1(P<0.05).结论 原发性痛经寒凝血瘀证患者的脉图参数在痛经发作时较痛经发作前、缓解后及健康人群有一定程度改变,且其脉图参数的变化与疼痛程度有一定的相关性.

原发性痛经是中医妇科常见的一种病症,指生殖器官无器质性病变的一类痛经,临床上多发于青年女性.由于目前还未制定出用于判定原发性痛经中医证型的诊断标准,因而多使用痛经证型的诊断标准,但二者在发病人群、病因病机、证型分布、证候要素、辨证内容上都有明显不同.原发性痛经中医证型诊断标准多以权威部门或单位制定为主,常见辨证分型以实证居多,血瘀、湿滞、寒凝最为多见,不同证型之间具体诊断内容有所差异.同时,原发性痛经中医证型的诊断标准尚缺乏具有可操作性的判定标准.故课题组通过研究近5年现代文献中关于原发性痛经中医证型的诊断标准及其辨证内容,并分析其应用现状,为其相关理论和临床研究提供一定的参考依据.

OBJECTIVE:To display the low hydraulic resistance channel along the running course of the Conception Vessel (CV) by using in vivo fluorography, so as to provide evidence for the existence of meridians of traditional Chinese medicine from the aspect of interstitial fluid channel. METHODS:A total of 24 male SD rats were randomly divided into 3 groups, namely CV-low impedance spots (CV-LIS), CV-low hydraulic resistance points (CV-LHRP) and non-meridian points (NMP) groups (n＝8 in each group). The CV-LIS (the imaged line between the xiphoid process and symphysis pubis), CV-LHRP (lateral and parallel to LIS) and NMP (lateral and parallel to CV-LHRP) were detected by using meridian detector and biofluid resistance meter, respectively. Sodium fluorescein solution (1%) was injected into the spot (A-spot, upper 1/5 of the CV-LIS), and one of the NMP (about 1 cm lateral and parallel to the A-spot, and the mid-point between the Kidney and Stomach meridian running courses) by using a microsyringe for observing the migration trace of sodium fluorescein. RESULTS:After injection of fluorescein, the migration trace of fluorescein appeared along the CV-LIS and CV-LHRP lines, and only local diffusion was found in the NMP group. The migration trace lengths along the CV-LIS and CV-LHRP were significantly longer than that of the NMP group (P<0.01), and the migration width of CV-LIS and CV-LHRP groups was significantly smaller than that of the NMP group (P<0.01). The migration speed of CV-LIS and CV-LHRP groups was significantly higher than that of the NMP group (P<0.01). CONCLUSION:Fluorography is able to be used to display the running course of CV, possibly supporting the existence of meridians from the interstitial fluid channel and providing a new method for visualization of meridians.

《黄帝内经》中的十二经水有时指自然界的十二条河流水系,可称自然经水;有时指人体十二经脉中气的通道,称为人体经水.后者位于血脉之外,与血脉和五脏六腑相互影响.经脉之气相应于人体组织液,与水的性质相似,故古人把经脉之气比喻为经水.

OBJECTIVE:To calculate the imbalance degree (IBD) of left-right meridian (IBD-LRM), IBD of exterior-interior meridian (IBD-EIM) and IBD of hand-foot meridians (IBD-HFM) of impedance in extracellular fluid of cells in twelve meridians of healthy subjects, so as to provide foundation for meridian diagnosis.METHODS:A total of 31 healthy volunteers were enrolled and bioelectrical impedance spectroscopy (BIS) was applied. The constant current (from 1 to 100 kHz, 200 μA) was connected into the bilateral twelve meridians through two excitation electrodes with a distance of 10 cm. Two measuring electrodes, with an interval of 5 cm, were set in between the two excitation electrodes to collect the voltage amplitude and phase. The Cole-Cole curve fitting was used to calculate the impedance of extracellular fluid of cells in the twelve meridians; the IBD-LRM, IBD-EIM and IBD-HFM as well as their absolute values were calculated.RESULTS:The impedance of extracellular fluid in the left side was higher than that in right side in the large intestine meridian, the small intestine meridian and the bladder meridian (P<0.05, P<0.01). The mean value of IBD-LRM of extracellular fluid was (4.0±1.4) %; the mean value of absolute value of IBD-LRM was (15.0±1.1) %; the maximum absolute value of IBD-LRM was the bladder meridian. The mean value of IBD-EIM was (3.3±1.0) %; the mean value of absolute value of IBD-EIM was (17.9±1.6) %; the maximum absolute value of IBD-EIM was the bladder meridian and the kidney meridian. The impedance of extracellular fluid of hand jueyin meridian, hand taiyin meridian and hand shaoyin meridian were lower than those of foot meridians. The mean value of IBD-HFM was (-2.6±1.1) %; the mean value of absolute value of IBD-HFM was (19.7±1.7) %; the maximum absolute value of IBD-HFM was shaoyang meridian; the imbalance of yin meridians was greater than yang meridians. There were significant differences in impedance of extracellular fluid between left and right and between hands and feet (P<0.05, P<0.01).CONCLUSION:The extracellular fluid of left-right meridians of healthy subjects is different, but the absolute value of IBD is low; the mean value of exterior meridian and interior meridian is very close, and the absolute value of IBD is medium; the impedance of the foot meridians are greater than the hand meridians, and the absolute value of IBD is relatively high.

In previous studies, it was found that blocking the low hydraulic resistance channel (LHRC) along meridian in minipigs could lead to the hyperalgesia, a series of abnormal behavioral changes, traditional Chinese medicine (TCM) syndromes and abnormal autopsy in internal organs. The objective of this paper is to investigate the pathology of these changes. Mini-pigs were randomly divided into a stomach meridian blocking group (SBG, n=8), a kidney meridian blocking group (KBG, n=8) and a control group (CG, n=6). The hydraulic gel was injected separately into LHRCs along the stomach meridian and the kidney meridian. The pigs were then fed 7 to 9 weeks, and several indexes were observed. The results showed that the blood serum creatinine increased extremely in all 3 groups and the level in the KBG was lower than that in the SBG by 13.76% (P<0.05) and in the CG by 14.51% (P<0.01). HE staining results showed that more than half of the pigs had the heart abnormalities in the CG, the liver abnormalities in the SBG and the kidney and testicles abnormalities in the KBG. Intestinal sections in the SBG showed that the intestinal crypt depth of the duodenum and the colon, and the total mucosal thickness of the large intestine were significantly higher than those of the CG. The jejunal V/C and the ileal crypt depth were significantly lower than those of the KBG, and the ileal V/C was significantly higher than that of the KBG. Compared with the CG, intestinal sections of the KBG showed that the duodenal crypt depth and the thickness of the colon was significantly higher than that of the CG. The GAS in the KBG was significantly higher than those of the CG and the SBG. The results verify that the blockage of LHRC along the stomach meridian and the kidney meridian can lead to different pathological phenomena, which provided a scientific basis for the syndromes induced by meridian stasis.

目的 研究《灵枢》卷首《九针十二原》针刺补泻法对小型猪皮下组织液压(interstitial fluid pressure,IFP)的作用,探讨其调节组织液的生物力学机制.方法 在9只健康实验用小型猪腹部随机取点行补法(提/按法)和泻法(摇大针孔),观察正常状态(normal state,NS)、抽取组织液的低组织液量(low volume,LV)状态和注入生理盐水的高组织液量(high volume,HV)状态下针刺前后IFP.结果 NS下提/按法可极显著升高IFP;泻法可极显著降低IFP,针后5 min泻法组IFP降低较快.LV状态提/按法均能升高IFP,针后10 min二者IFP下降较慢.HV状态下泻法可极显著降低IFP,针后5 min与对照组变化趋势不同.结论 该补泻法可升高或降低IFP,证明其对IFP有相反方向的调节作用.研究结果为针灸临床使用补泻手法提供新的科学依据.

This paper discusses the existing classification of acupoints and puts forward a new classification method of acupoints. Through the definition of 3 kinds of acupoints and the analysis of the original meaning of ashi points, it is pointed out that the existing classification of acupoints has overlapping among different categories. The acupoints are reclassified based on the characteristics of acupoints in reflecting and treating disease as well as the application of acupoints in clinic. Acupoints can be divided into traditional acupoints and modern holographic acupoints, among which traditional acupoints can be divided into meridian system points and extra points. According to their structure and function features, meridian system points can be divided into meridian points, collateral points, meridian-muscles points and cutaneous region points. The new classification method of acupoints highlights the importance of channel-collateral theory in acupuncture clinic and the feature of acupuncture in the diagnosis and treatment of disease.

《黄帝内经》中“膀胱”在结构上是指下焦之下、以腹膜为其外壁的盆腔空间,其中包括含尿液的尿脬和腹腔液.“膀胱”所藏津液主要指腹腔液,它来自大肠、小肠分泌的水液,通过三焦特别是下焦的网膜结构聚积于盆腔的间隙空间中,再通过内脏的温度、压力等作用,变成小水颗粒,从腹膜等途径渗入膀胱经,最后通过膀胱经的气化作用转运全身.故不应把《黄帝内经》中的“膀胱”与西医解剖同名之“膀胱”混为一谈.

目的 运用静息态功能磁共振(rsfMRI)技术,观察针刺风池穴即刻后脑效应,探索其调制视觉中枢的脑功能机制.方法 招募11名健康志愿者,均先后接受左侧风池穴手法针刺及表皮触觉对照刺激,以随机数字表法决定受试者接受2种刺激的先后顺序.每次刺激时间为30 s,频率60次/min.刺激前、即刻后均行6 min脑rsfMRI扫描.采用DPABI4.3软件对rsfMRI数据进行统计学分析,包括比率低频振幅(fALFF)、局部一致性(ReHo)、度中心(DC)分析局部脑活动变化;种子点双侧后扣带皮质(PCC)、腹内侧前额叶(VMPFC)分析全脑功能连接,观察针刺风池穴后的即刻脑功能及全脑功能连接的变化.结果 与表皮触觉刺激比较,针刺左侧风池穴视觉相关脑区右侧楔叶、楔前叶局部活动增强(体素水平P＜0.01,簇水平P＜0.05),双侧种子点PCC与左侧顶下小叶脑功能连接增强,种子点VMPFC与右侧楔前叶脑功能连接降低(体素水平P＜0.01,簇水平P＜0.05).结论 风池穴可以调节视觉中枢及邻近脑区功能活动,调制默认网络脑功能连接,可能是其治疗眼部疾病等临床适应证的重要脑功能基础.