艾灸治疗炎症性肠病的古代文献与现代研究的思考及展望

Thinking and Prospects of Ancient and Modern Researches on Moxibustion Treatment for Inflammatory Bowel Disease (IBD)

目的:通过对古、现代文献的梳理,探讨炎症性肠病的病因病机,总结艾灸治疗炎症性肠病(Inflammatory Bowel Diseases,IBD)的选穴规律和实验机制,为临床应用与研究提供选穴、灸法依据和理论支持。方法:古代文献检索"中国中医药数据库检索系统",现代文献检索Pubmed、中国知网(CNKI)和维普数据库2005年1月-2016年1月的文献。筛选符合的文献进行综合分析。结果:中医学认为本病的病因多与外邪、饮食、情志或久病体虚有关,针灸治疗IBD当标本兼顾,既要疏调肠腑气机,也要温养脾胃,选取胃经经穴既可健脾益胃、升清降浊,又可调理肠腑、强身止泻。在此中医理论指导下进行的现代研究提示,艾灸对穴区局部可刺激温度感受器,提高穴区的肥大细胞脱颗粒率;对靶器官肠道具有通过调控转录因子影响免疫相关因子的表达,以及促受损的肠黏膜屏障修复而发挥抗炎作用;艾灸还具有防治肠纤维化的作用。结论:艾灸温养脾胃、疏调肠腑气机的治疗方法对防治IBD有效,基于该理论的机制研究已取得一定进展,但具体机制有待于进一步深入研究。

By means of searching the ancient and modern literature, this study mainly investigated the etiology and pathogenesis of IBD, summarized the rules of acupoint selection and the experimental mechanism of the moxibustion treatment for IBD, providing the basis and theoretical evidence of acupoint selection and moxibustion therapy for clinical practice and studies. Ancient literatures were retrieved in TCM database system, while modern literatures in Pubmed, CNKI and VIP database from January, 2005 to January, 2016. Finally, comprehensive analysis was implemented among the selected literatures. It was found that the pathogenesis of IBD was associated with exogenous evils, diet, emotion, and fatigue during chronic diseases in TCM. The treatments of acupuncture and moxibustion for IBD should consider both the primary symptoms and root causes by regulating functional activity of Zang and Fu and also warming and nourishing the spleen and stomach. On this basis, acupoint selection mainly focused on the stomach meridian with the functions of invigorating spleen and stomach, elevating clear qi and descending turbid, recovering the bowel function and strenthening the body and antidiarrhea. Modern research upon the scientific basis of TCM indicated that moxibustion stimulated the thermoreceptors around the acupoints leading to the increased degranulation of mast cells. Immune factors were impacted with the regulation of transcriptional activators in the bowel for repairing mucosal barrier and preventing intestinal fibrosis in IBD. In conclusion, moxibustion was effective on warming and nourishing spleen and stomach and regulating the function activity of bowel for the prevention and treatment of IBD. Achievements were made in the mechanism researches on IBD based on the TCM theory. However, some profound mechanisms need in-depth exploring.