神经节段效应对泌尿生殖系统疾病取穴的影响初探

Influence of Neuro Segment Effect to the Regularity of Acupoint Selection of Urogenital System Diseases

目的:回顾并整合针灸治疗泌尿生殖系统适宜症的现有证据,并对现代针灸学理论进行有力补充。方法:选取泌尿生殖系统疾病的针灸优势病种(更年期综合征、功能性子宫出血、痛经、泌尿系结石、尿潴留),运用临床流行病学和循证医学的方法对收录于中国期刊全文数据库的文献进行分析,统计整理符合纳入标准的文献(CCT、RCT文献)的穴位使用频次、使用穴位的相关经脉归属、相关穴位的局部解剖特征,对针灸治疗适宜疾病的取穴规律进行初步研究。结果:针灸泌尿生殖系统疾病的治疗中存在诸多问题,每个病种往往涉及几十个乃至上百个穴位,临床取穴多依靠个人经验和心得;通过循证研究,常用穴位有94%与调节器官有密不可分的神经生物学联系,针刺穴位与调节对象处于相同或相关的神经节段支配区时能够获得更好疗效;少部分穴位与相关神经节段之间无密切的神经解剖及生理学联系。结论:针灸对泌尿生殖系统疾病有良好的疗效,但临床医生在具体选穴时多缺乏规律性指导,针刺的节段性及整体性效应可作为取穴理论的有力补充。

Objective: To review and integrate the existing evidence of acupuncture and moxibustion in treating suitable diseases of the urogenital system, and to supplement the theory of modern acupuncture and moxibustion. Methods: The clinical literature included in the full text database of Chinese periodicals was analyzed by selecting the dominant urogenital diseases treated by acupuncture and moxibustion(menopausal syndrome, functional uterine bleeding, dysmenorrhea, urinary stones, urinary retention). The frequency of the use of acupoints, the attribution of related meridians, and the local anatomical characteristics of related acupoints in the literatures of CCT and RCT which met the inclusion standards were statistically arranged, and the rule of acupoint selection was preliminarily studied. Results: There were many problems in the treatment of urogenital diseases by acupuncture and moxibustion. Each disease often involved dozens or even hundreds of acupoints, and clinical selection of acupoints was mainly relying on personal experience. Through evidence-based research, it was found that 94% of commonly used acupoints were closely linked with regulating organs. Acupoints could achieve better results when they were in the same or related ganglion regions. Only a small number of acupoints were not closely related to the neurotomy and physiology. Conclusion: Acupuncture and moxibustion has a good effect on the diseases of the genitourinary system, but clinicians has less regular guidance to refer to when selecting points. The segmental and holistic effects of acupuncture can be used as a powerful supplement to the theory of acupoint selection.