| 523 | 4 | 138 |
| 下载次数 | 被引频次 | 阅读次数 |
“经脉-脏腑相关”理论解释了体表经脉穴位与内在脏腑之间的双向联系，是中医经络理论的核心内容。脏腑的生理功能失常，可通过经络的传导而反映于体表穴位。当体表感受一定刺激时，经络可将信息传导于脏腑。该理论为针刺调理经络以治疗肠易激综合征（IBS）提供了理论支持。IBS的基础病机为脾虚湿浊内蕴，大肠传导失司。针灸在缓解和改善IBS患者的临床症状上具有显著疗效，以益气健脾、渗湿止泻为原则，临床根据其不同分型选用合适腧穴。肝脾不调治宜疏肝解郁，健脾止泻；脾肾阳虚治宜温补脾肾，固肠止泻；虚实夹杂治宜寒热平调，祛湿止泻；肺失宣降，大肠腑气不通之便秘型IBS(IBS-C)，治宜宣发肺气，化浊通腑。针灸治疗时应调理足太阴经、足阳明经、任脉，针刺其腧穴，并根据实际情况加用足厥阴经、足太阳经、手太阴经之腧穴。
Abstract：The theory of “meridian-viscera correlation” explains the bidirectional relationship between the superficial meridian acupoints and the internal viscera,constituting the core content of traditional Chinese medicine(TCM) meridian theory. Physiological dysfunction of the viscera can be reflected on superficial acupoints through meridian conduction.When certain stimuli are applied to the body surface,the meridians can transmit information to the viscera. This theory provides theoretical support for using acupuncture to regulate meridians in the treatment of irritable bowel syndrome(IBS). The underlying pathogenesis of IBS is spleen deficiency with dampness accumulation and dysfunction of colon transmission.Acupuncture significantly alleviates and improves clinical symptoms in IBS patients by benefiting qi,invigorating the spleen,and addressing dampness to stop diarrhea. Differentiating treatment according to subtype involves selecting appropriate acupoints. Treatment strategies include soothing the liver and resolving depression strengthening the spleen and stopping diarrhea for liver-spleen disharmony,tonifying the spleen and kidney yang for spleen-kidney deficiency,and regulating cold and heat for mixed deficiency and excess syndromes.For irritable bowel syndrome with constipation(IBS-C) with lung qi failing to descend and colon obstruction,treatment focuses on promoting the dissemination of lung qi and clearing turbidity to facilitate bowel movements. Acupuncture treatment should regulate the Foot Taiyin meridian,Foot Yangming meridian,and Ren meridian,needling their respective acupoints,and additional acupoints of Foot Jueyin meridian,Foot Taiyang meridian,and Hand Taiyin meridian may be used based on individual circumstances.
[1] FORD A C,LACY B E,TALLEY N J. Irritable bowel syndrome[J]. N Engl J Med,2017,376(26):2566-2578.
[2] LIU M,YE Z,WU Q,et al. Healthy sleep,mental health,genetic susceptibility,and risk of irritable bowel syndrome[J]. J Affect Disord,2023,331:25-32.
[3]宋怡然，梁笑楠，李忱阳，等.《2020年中国肠易激综合征专家共识意见》解读[J].临床荟萃，2021,36(7):628-631.
[4] LI C Y,AIN MOHD TAHIR N,LI S C. A systematic review of integrated traditional Chinese and western medicine for managing irritable bowel syndrome[J].Am J Chin Med,2015,43(3):385-406.
[5]赵尔樱，周佳玮，褚海云，等.肠易激综合征流行病学与致病因素研究进展[J].中国公共卫生，2021,37(4):764-768.
[6] BLACK C J,FORD A C. Global burden of irritable bowel syndrome:trends,predictions and risk factors[J].Nat Rev Gastro Hep,2020,17(8):473-486.
[7] HUANG K Y,WANG F Y,LV M,et al. Irritable bowel syndrome:epidemiology,overlap disorders,pathophysiology and treatment[J]. World J Gastroenterol,2023,29(26):4120-4135.
[8] WANG S S,WANG X R,YANG R Y,et al. Efficacy and mechanism of acupuncture combined with Tongxieyaofang for diarrhea-type irritable bowel syndrome of liver depression and spleen deficiency[J]. Chin Acupunct and Moxibust,2020,40(6):605-609.
[9]石智尧，房致永，孙佩飞，等.国医大师王晞星从肝脾肾论治肠易激综合征经验[J].上海中医药杂志，2024,58(4):26-29.
[10] DAI Y K,WU Y B,LI R L,et al. Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults[J]. World J Gastroenterol,2020,26(41):6488-6509.
[11]张粲，单娥仙，徐娜，等.基于红外热成像技术对脑瘫五脏背俞穴温度敏化规律的研究[J].云南中医药大学学报，2024,47(2):40-44.
[12] CHANG L,BERMAN S,MAYER E A,et al. Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia[J]. Am J Gastroenterol,2003,98(6):1354-1361.
[13]胡瑞斌，刘永斌，杨雪，等.心肌缺血小鼠体表穴位敏化与垂体腺苷酸环化酶激活多肽的针刺研究[J].针刺研究，2024,49(3):1-9.
[14]赖宁源，兰蕾，罗阿呷，等.针灸对肠易激综合征患者脑区激活的磁共振成像研究：一项基于激活似然估计的分析[J].针灸临床杂志，2024,40(4):60-67.
[15]邓桂花.肠易激综合征患者力敏腧穴分布规律及针刺临床疗效观察[D].南昌：江西中医药大学，2023.
[16]林俊言，何金霞，郑千姿，等.电针干预慢性炎性痛及其焦虑情绪与海马不同区域GABA相关机制研究[J].浙江中医药大学学报，2022,46(9):945-956.
[17] ZHANG F,MA Z,WENG Z,et al. P2X(3)receptor in primary afferent neurons mediates the relief of visceral hypersensitivity by electroacupuncture in an irritable bowel syndrome rat model[J]. Gastroenterol Res Pract,2020,2020:8186106.
[18] JONES M P,TACK J,VAN OUDENHOVE L,et al.Mood and anxiety disorders precede development of functional gastrointestinal disorders in patients but not in the population[J]. Clin Gastroenterol H,2017,15(7):1014-1020.
[19]张维波，王燕平，李宏彦.《黄帝内经》经脉脏腑相关解析[J].针刺研究，2018,43(7):424-429.
[20]韩铁军.阴阳“开、合、枢”理论的运气学原理和临床应用[C]//中华中医药学会.中医理论临床应用学术研讨会论文集，武汉市医学科学研究所，2007:68-70.
[21]鞠苏岚，张怡，孙倩倩，等.基于宣补通降法论治便秘型肠易激综合征[J].中医临床研究，2024,16(10):138-142.
[22]张小虎，古继红，区永欣，等.肺主肃降与“肺与大肠相表里”相关性的实验研究及其应用探讨[J].中华中医药学刊，2008(9):2059-2062.
[23]赵立波，王迎寒，刘玉玲，等.肠易激综合征发病机制研究进展[J].河北医学，2014,20(6):1052-1054.
[24] WU J,CHENG Y,ZHANG R,et al. P2Y1R is involved in visceral hypersensitivity in rats with experimental irritable bowel syndrome[J]. World J Gastroenterol,2017,23(34):6339-6349.
[25]庞希军.针灸治疗腹泻型肠易激综合征的中医理论研究[J].智慧健康，2024,10(2):29-32,40.
[26]张宁康，郑薇薇.腹泻型肠易激综合征的中西医研究进展[J].中国中西医结合消化杂志，2024,32(4):351-356.
[27]牛冰玉，魏薇，王慧芬，等.腹泻型肠易激综合征患者炎症因子水平变化及与中医证型的关系[J].世界中西医结合杂志，2024,19(4):822-826.
[28]王姣姣，罗慧君，蔺晓源.中医经方治疗腹泻型肠易激综合征的研究进展[J].中医药学报，2024,52(4):112-116.
[29]刘婷婷，陈少宗，赵香顺，等.电针天枢、上巨虚对肠易激综合征大鼠模型结肠功能的影响[J].针灸临床杂志，2023,39(11):61-65.
[30]张冠林，向晶，焦子远，等.基于天枢与上巨虚穴经皮神经电刺激观察对溃疡性结肠炎模型大鼠结肠组织TLR9/MyD88/NF-κB蛋白表达的影响[J].湖南中医药大学学报，2024,44(1):128-134.
[31]覃颖，郭孟玮，蓝莹，等.电针不同穴位对肠易激综合征大鼠肠道动力和敏感性的影响[J].针刺研究，2020,45(4):293-298.
[32]吴帆，唐丽娜，王华，等.标本配穴针灸对IBS-D大鼠肠黏膜机械屏障的影响[J].时珍国医国药，2022,33(3):756-760.
[33] WANG X Y,LI C Y,ZHANG Y N,et al. Effect of electroacupuncture on 5-HT7R in gastric antrum and colon tissues of functional diarrhea rats[J]. Acupunct Res,2021,46(7):549-554.
[34]王楷，侯雨君，王路，等.培土抑木针法调节CRF/CRFR1通路修复腹泻型肠易激综合征大鼠肠黏膜屏障的针刺研究[J].针刺研究，2024,49(5):472-479.
[35]何鹏庆，曹熙，梁雪，等.天牖穴探析[J].中国民间疗法，2023,31(16):35-39.
[36]韩李莎，盛茹雅，鲁海，等.颈项部“上入”穴应用刍议[J].中国中医基础医学杂志，2019,25(9):1270-1272.
[37]周源子，马晓娟，薄雨扬，等.命门穴考[J].中华中医药杂志，2024,39(1):99-102.
[38]刘静，廖金玲，覃婧，等.背俞温针灸法治疗脾胃虚寒型胃脘痛的临床疗效观察[J].时珍国医国药，2018,29(7):1667-1668.
[39]张笑.朱琏兴奋Ⅱ型针法结合温和灸治疗脾肾阳虚型IBS-D的临床研究[D].南宁：广西中医药大学，2023.
[40]张子晶.针刺联合阴阳调理灸改善脾肾阳虚腹泻型肠易激综合征的临床研究[D].武汉：湖北中医药大学，2023.
[41]王志磊.基于脑-肠轴和5-HT通路研究隔药灸脐法治疗IBS-D的机制[D].济南：山东中医药大学，2023.
[42]齐琳婧，苏同生，刘志顺，等.针刺曲池上巨虚治疗功能性肠病临床观察[J].陕西中医，2014,35(2):224-225.
[43]邵晓雪.电针曲池、上巨虚对慢传输型便秘大鼠结肠M2及VIP影响的研究[D].沈阳：辽宁中医药大学，2021.
[44]马克.针刺手三里足三里建里组穴治疗脾胃虚弱型痞满临床观察[J].光明中医，2023,38(3):512-515.
[45]周颖.“心胃同治”电针对腹泻型肠易激综合征大鼠结肠NGF、TrkA的影响[D].武汉：湖北中医药大学，2023.
[46]符奇飞，段碧锋，张倩，等.殷克敬教授独取公孙穴温针治疗腹部术后腹胀[J].世界针灸杂志，2017,27(2):74-76.
[47]陈盼碧，侯天仙，陈艺，等.穴位埋线治疗便秘型肠易激综合征的疗效观察及对血清SP含量的影响[J].上海针灸杂志，2024,43(1):40-46.
[48]何婷. TEAS对IBS-C模型大鼠内脏痛敏和结肠动力的调控作用及机制研究[D].延安：延安大学，2024.
[49]王冠，林叶青.太渊穴治疗便秘的临床研究及其机理探讨[C]//中国针灸学会年国际针灸技法及临床应用学术研讨会论文集.北京，2005:178-180.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2024.08.002
中图分类号:R246.1
引用信息:
[1]吴静怡,杨晨曦,包洁,等.基于“经脉-脏腑相关”理论探讨针刺治疗肠易激综合征的机制与临床应用[J].山东中医杂志,2024,43(08):788-794.DOI:10.16295/j.cnki.0257-358x.2024.08.002.
基金信息:
国家重点研发计划项目（编号：2022YFC3500401,2022YFC3500402）; 浙江省中西医协同创新基金项目（编号：ZS22XTC X06）
2024-08-05
2024-08-05