新安医家针灸诊治泄泻特点分析

新安医学起源于皖南新安地域,在针灸领域具有独特的学术特色。新安医家认为,泄泻病因包括感受外邪、饮食所伤、情志失调、素体脾虚,病机为脾胃运化不利、肠腑分清泌浊及传导功能失常。针灸选穴以俞募配穴为特色,多取天枢和脾俞为主穴,并遵循辨证取穴原则;推崇用灸法治疗泄泻,善于从肾论治,以灸法治疗久泻;同时重视饮食调护,强调忌食生冷之物。

《黄帝内经》灸法辨析

《黄帝内经》灸法辨析张家口医学院孙洪生关键词：《黄帝内经》，灸补，灸泻《黄帝内经》（以下简称《内经》）的辨治思想，一直指导着后世医家的临证治疗，是书以针灸为主要论治方法的理论和实践，也成为后世针灸学发达的契机。但核考《内经》对于灸治疗法的论述，笔者认...

Diarrhea

Institute of Acupuncture and Moxibustion,China Academy of Traditional Chinese Medicine Beijing 100700

EFFECTS OF ELECTRO ACUPUNCTURE AND TWIRLING REINFORCING-REDUCING MANIPULATIONS ON VOLUME OF MICROCIRCULATORY BLOOD FLOW IN CEREBRAL PIA MATER

Effects of electroacupuncture (EA) and routine acupuncture with twirling reinforcing and reducing manipulation of the needle (RA) both at Zusanli point (St 36) on volume of microcirculatory blood flow in the cerebral pia mater were observed by fenestration of the cranial bone and laser Doppler microcirculatory blood flow analyser. Results showed that both RA and EA could increase the volume of microcirculatory blood flow in the cerebral pia mater; and that the increase in the EA group was superior to that in RA group. This suggests that a moderate and effective stimulation is a key to the production of a regulative effect on the organism.

Research on laws of effect of different acupuncture-moxibustion therapies based on data mining

Different acupuncture-moxibustion therapies can produce different clinical effects, that is, the effect has specificity, which is significantly important in obtaining acupuncture-moxibustion efficacy. In this study, the clinical application laws of fire needle, acupoint injection, catgut embedment, acupoint application, moxibustion therapy and filiform needle acupuncture were summarized in the aspects of category of disease, efficacy and related prescriptions （such as medication and acupoint selection） based on the result of data mining, and the general applicable categories of disease of acupuncture-moxibustion treatment methods were further screened, so as to guide the clinical application and give play to the best efficacy.

Observations on the therapeutic effiect of acupuncture with left ascending and right descending method for 52 cases of chronic diarrhea

Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.

Therapeutic observation of acupuncture plus turtle-shell-partitioned moxibustion for diarrhea-predominant irritable bowel syndrome

Objective： To observe the clinical efficacy of acupuncture plus turtle-shell-partitioned moxibustion in treating diarrheapredominant irritable bowel syndrome（IBS-D）. Methods： Seventy-six patients were randomized into two groups： 39 cases in the observation group were intervened by acupuncture plus turtle-shell-partitioned moxibustion, while 37 cases in the control group by the same acupuncture treatment, once a day, 10 d as a treatment course, for 2 courses in total. The improvements of symptoms were observed at the end of the intervention in both groups. Results： The total effective rate was 89.7% in the observation group versus 67.6% in the control group, and the difference was statistically significant（P〈0.05）. Conclusion： Acupuncture plus turtle-shell-partitioned moxibustion can significantly improve the symptoms of IBS-D, and can produce a more significant efficacy than acupuncture alone.

Clinical Observation on Moxa Cone Moxibustion Treatment for Chronic Diarrhea

Objective： To observe the therapeutic effect of moxa cone moxibustion for chronic intractable diarrhea. Methods： Sixty cases in conformity with the inclusion criteria were divided into two groups randomly. Thirty cases in the treatment group were treated by moxa cone moxibustion on Pishu （BL 20） and Shenshu （BL 23）, while 30 cases in the control group were treated by oral administration of herbal medicine. The therapeutic effects were compared after one treatment course. Results： The total effective rate was higher in the treatment group than that in the control group, and the difference between the two groups was statistically significant （P0.05）. Conclusion： Moxa cone moxibustion is better than oral administration of herbal medicine in treatment of chronic intractable diarrhea.

Clinical Research of Ulcerative Colitis Treated with Herbal Cake-partitioned Moxibustion

Objective： To observe the effects of herbal cake-partitioned moxibustion and bran-partition moxibustion in improving symptoms of ulcerative colitis （UC） and the TNF-α and its receptor of colon mucosa. Method： 67 UC cases were randomly allocated into herbal cake-partition moxibustion group of 35 cases and bran-partitioned moxibustion group of 32 cases, to compare the improvement and detect the TNF-α and its receptor with immunohistochemical method in both groups. Result： Herbal cake-partitioned moxibustion is prior to bran-partitioned moxibustion in improving of diarrhea, flatus, lassitude, tenesmus and lumbar soreness; The expression of TNF-α,TNF-αR1, and TNF-αR2 are significantly decreased after treatment in herbal cake-partitioned moxibustion group, while in bran-partitioned moxibustion group only TNF-αR1 expression is significant decreased after treatment. Conclusion： Moxibustion can well improve the syndromes of UC, Herbal cake-partitioned Moxibustion is prior to bran-partitioned moxibustion in the improvement of diarrhea and flatus; Herbal cake-partitioned moxibustion could down-regnlate the expression of TNF-α,TNF-αR1, and TNF-αR2, while bran-partitioned moxibustion could only down-regulate the expression of TNF-αR1.

Moxibustion on Shenque(CV 8) Improves Effect of Acupuncture for Diarrhea-predominant Irritable Bowel Syndrome

Objective: To observe the clinical effect of acupuncture and moxibustion on diarrhea-predominant irritable bowel syndrome(IBS-D). Methods: A total of 60 IBS-D patients were randomly allocated into a treatment group and a control group, 30 in each group. Patients in the treatment group were treated with acupuncture combined with ginger and salt-partitioned moxibustion on Shenque(CV 8), whereas patients in the control group only received acupuncture treatment. Six days made up a course of treatment, and the clinical effects were statistically analyzed after 4 courses. Results: The overall response rate in the treatment group was 96.7%, versus 76.7% in the control group, showing a statistical significance(P<0.05). In the intra-group comparison of the symptom scores after treatment, there were statistical differences in both groups(both P<0.01), and in the inter-group comparison, the difference was statistically significant(P<0.05). Conclusion: Acupuncture combined with ginger and salt-partitioned moxibustion on Shenque(CV 8) can obtain better effect for ISB-D than acupuncture alone.

Irritable bowel syndrome with diarrhea (IBS-D) treated with moxibustion on heat-sensitive acupoints: a randomized controlled trial

Objective To compare the effects between acupuncture combined with moxibustion on heat-sensitive acupoints and acupuncture on irritable bowel syndrome with diarrhea （IBS-D）. Methods Sixty-four cases were randomly divided into an acupuncture and moxibustion group （n=32） and an acupuncture group （n=32）. Conventional acupuncture at Tiānshū （天枢 ST 14）, Zúsānlǐ （足三里 ST 36）, Gōngsūn （公孙 SP 4） and other acupoints was used in the two groups, and moxibustion on heat-sensitive acupoints was added in the acupuncture and moxibustion group. The treatment frequency was 5 times a week, and 4 weeks were a course. After 2 courses, the therapeutic effect was evaluated. Results The clinical symptom scores after treatment in two groups decreased obviously than those before treatment （both P〈0.01）. The cured and markedly effective rate in the acupuncture and moxibustion group was 87.5% （28/32）, and that in the acupuncture group was 37.5% （12/32）, so the effect in the acupuncture and moxibustion group was better than that in the acupuncture group （P〈0.01）. The improvement of all kinds of symptom scores in the acupuncture and moxibustion group was all better than that in the acupuncture group （all P〈0.05）. Conclusion The clinical effect of acupuncture combined with moxibustion on heat-sensitive acupoints on IBS-D is better than that of acupuncture.

Metrological Analysis and Evaluation of Acupuncture-Moxibustion Treatment for Diarrhea in Modern Literature

Objective： To review year 1957-2005 literature on acupuncture and moxibustion and explore point selection and methods for acupuncture-moxibustion treatment of diarrhea in order to provide objective and reliable data for research on acupuncture and moxibustion standardization. Methods： A comprehensive analysis was made by a method of metrological analysis according to the data from ＂China modem acupuncture-moxibustion information database＂. Results： Points Zusanli （ST 36）, Tianshu （ST 25） and Shenque （CV 8） were the most frequently used and the optimal combination for acupuncture-moxibustion treatment of diarrhea. Chronic adult diarrhea was often treated by moxibustion. Acute childhood diarrhea was often treated by point application and injection. Conclusion： Diarrhea is often treated by needling and moxaing methods in acupuncture-moxibustion treatment. It is proposed to use Zusanli （ST 36） and Tianshu （ST 25） as a basic prescription for acupuncture-moxibustion treatment of diarrhea and to select points according to the syndrome.

Acupuncture Combined with Tuina Treatment for Infantile Diarrhea

Objective： To observe the effect of acupuncture combined with Tuina for nfantile diarrhea. Methods： One hundred and twenty patients met the inclusion criteria were randomly divided into two groups at the ratio of 2：1, and there were 80 cases in the treatment group while 40 cases in the control group. The patients in the treatment group were treated with acupuncture combined with tuina, while those in the control group were treated with medication. The effects of two groups were compared after a 3-day treatment. Results： The total effective rate was 97.5% in the treatment group, versus 87.5% in the control group, and the difference was statistically significant （P〈0.05）. After 48-hour treatments, the antidiarrheal effect of the treatment group was better than that of the control group （P〈O.05）. Conclusion： Acupuncture combined tuina treatment is effective for nfantile diarrhea and works fast.

Ginger-partitioned moxibustion plus pediatric massage for treating infantile diarrhea due to spleen deficiency:a randomized controlled clinical trial

Objective:To observe the clinical efficacy of ginger-partitioned moxibustion plus pediatric massage(tuina)in treating infantile diarrhea due to spleen deficiency.Methods:Ninety infants were randomly divided into a massage plus moxibustion group,a massage group and a drug group by the random number table method,with 30 cases in each group.The intervention was conducted for two consecutive courses.The infants in the massage plus moxibustion group were treated with pediatric massage and ginger-partitioned moxibustion at Shenque(CV 8).The infants in the massage group were treated with pediatric massage alone,while those in the drug group were treated with smecta.The primary and secondary symptom scales were assessed before and after treatment and at the follow-ups,and the total effective rate was evaluated after treatment.Results:The total effective rate in the massage plus moxibustion group was significantly different from that in the massage group and drug group(both P<0.05).After treatment,the scores of primary and secondary symptoms decreased in all three groups,with statistically significant intra-group differences(all P<0.05);the scores of primary symptoms were significantly different between the massage plus moxibustion group and the drug group(P<0.05);the scores of secondary symptoms in the massage plus moxibustion group and the massage group were significantly different from that in the drug group(both P<0.05).The differences in the time to recover normal bowel movement frequency among the three groups were not statistically significant(P>0.05).Conclusion:Ginger-partitioned moxibustion plus pediatric massage compared with pediatric massage or smecta monotherapy shows superior clinical efficacy in treating infantile diarrhea due to spleen deficiency,and has the advantages of appetite improvement,physique strengthening and short course.

Effect of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV 6) for the treatment of diarrhea-dominant irritable bowel syndrome： a patient-blinded pilot trial with orthogonal design

OBJECTIVE: To investigate the effects of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV6) in patients with diarrhea-dominant irritable bowel syndrome(D-IBS) by assessing predominant factors, and determining the best factor combinations and their interactions. To identify the optimal quantity of warming moxibustion Tianshu(ST 25, bilateral) and Qihai(CV 6) to achieve optimal efficacy.METHODS: An L9(3~4) orthogonal design was applied to 233 confirmed subjects based on the three most influential factors and the three most frequently used levels. Nine programs were designed.Subjects were assigned to four subgroups according to age and gender; each subject underwent one of the nine programs randomly. We selected Tianshu(ST 25, bilateral) and Qihai(CV 6). The scores of symptoms and the IBS Quality of Life(IBS-QOL) were evaluated after the final treatment.RESULTS: After treatment, clinical symptoms of all patients were significantly improved(P = 0.001).Quality of life also improved significantly(P < 0.05).For all the participants, frequency was the dominating factor regarding symptoms(P = 0.01). Duration was the dominating factor for quality of life(P =0.0001). The best combination for improving symptoms in 30-40-year-old male and female patients was two courses of 10 min each once a day, and for41-50-year-old male and female patients it was three courses of 10 min(males) or 30 min(females)twice a day. The best combination for quality of life was three courses of 20 min once a day. No interaction was found between frequency and course, or frequency and duration.CONCLUSION: Warming moxibustion Tianshu(ST25, bilateral) and Qihai(CV 6) is a promising therapy for D-IBS. To acquire optimal efficacy, the three main factors(duration, frequency and treatment course) of the warming moxibustion should reach a specific quantity and be combined appropriately.

Acupuncture treatment for depressive symptom in diarrhea-predominant irritable bowel syndrome:a randomized controlled study

Objective:To observe the clinical efficacy of acupuncture treatment for depressive symptom in diarrhea-predominant irritable bowel syndrome(IBS-D).Methods:A total of 70 patients with IBS-D accompanied by depressive symptom were randomized into a control group and an observation group,with 35 cases in each group.The control group was treated with oral intake of pinaverium bromide tablets,and the observation group was treated with regulating liver and spleen acupuncture treatment.The two groups were treated for 4 weeks.The scores of IBS symptom severity scale(IBS-SSS)and self-rating depression scale(SDS)were assessed before and after treatment.Results:After treatment,there were statistical significant differences in the scores of abdominal pain degree,abdominal pain frequency and defecation satisfaction level and the total score between the two groups(all P<0.05).The SDS score of the observation group was obviously decreased,and the improvement was significantly superior to that in the control group(P<0.05).Conclusion:Acupuncture treatment can significantly improve gastrointestinal symptom and depressive symptom in patients with IBS-D.

Observation on the effects of different partitioned moxibustion in treating ulcerative colitis

Objective：To observe the clinical effect and syndrome scores improvements of herbal cake-partitioned moxibustion（HPM） and ginger-partitioned moxibustion（GPM） in treating ulcerative colitis（UC）.Methods：A total of 65 eligible cases were randomly divided into a HPM group（n=32） and a GPM group（n=33） according to their visiting order.Bilateral Tianshu（ST 25） and Dachangshu（BL 25） were selected for the HPM or the GPM treatment once daily,12 d as a treatment course with a 3-day interval,6 courses in all.The clinical effect,syndrome scale and Mayo scale were evaluated and compared between the two groups.Results：Of the 65 cases enrolled,2 cases dropped out in the HPM group and 3 cases dropped out in the GPM group,30 cases of each group finished the treatment courses.The total effective rate is 93.3% in HPM group and 86.7% in the GPM group,there was no statistically significant difference in the total effective rate between the two groups（P〉0.05）;there were statistically significant differences between the two groups in score evaluation of lasting time of abdominal pain and frequency of diarrhea,HPM is prior to GPM（P=0.032,P=0.044）.There are no statistical significant differences between the two groups in scores evaluation of general symptom,three main symptoms,quality of life（QOL）,frequency and severity of abdominal pain,times,and pattern of diarrhea（all P〉0.05）.There was a statistical significant difference in the improvement of Mayo score between the two groups,and HPM was superior to GPM（P=0.048）.Conclusion：HPM and GPM are both promising ways to treat UC,and the total effect is quite similar.HPM is superior to GPM in the improvement of lasting time of abdominal pain and frequency of diarrhea,and also the Mayo score.

Introduction to LU Shou-yan's Acupuncture Theory

LU considers that correct manipulations are essential to the therapeutic effect. Reinforcing and reducing manipulations are especially important for zang-fu problems. He summarized the typical reinforcing-reducing manipulations： mountain-fire burning and heaven-penetrating cooling method as follows.

Effects of moxibustion on miRNA-133b,Pitx3/TH,and neurotransmitters in the midbrain of rats with diarrhea-predominant irritable bowel syndrome

Objective:To investigate the mechanism of moxibustion in the treatment of diarrhea-predominant irritable bowel syndrome(IBS-D),by observing the effects of moxibustion at Tianshu(ST25)and Shangjuxu(ST37)on microRNA-133b(miRNA-133b),pituitary homeobox family factor 3(Pitx3)/tyrosine hydroxylase(TH),and neurotransmitters in the brain tissue of IBS-D rats.Methods:Healthy Sprague-Dawley rats were randomly divided into a normal group,a model group,a moxibustion group,and a Western medicine group,with 12 rats in each group.Except for the normal group,the IBS-D rat model was established by mother-offspring separation and acetic acid enema combined with restraint stress stimulation in all the other groups.No intervention was performed in the normal and model groups.Mild moxibustion was applied to both Tianshu(ST25)and Shangjuxu(ST37)in the moxibustion group.Rifaximin was given by gavage in the Western medicine group.The physical status of rats in each group was observed at different periods.After the intervention,hematoxylineosin staining was performed to observe the histopathological morphology of rat colon;enzyme-linked immunosorbent assay was used to measure the levels of dopamine(DA),noradrenaline(NE),and 5-hydroxytryptamine(5-HT)in plasma,colon,and midbrain tissue of rats;the relative expression levels of miRNA-133b,Pitx3 mRNA,and TH mRNA in the midbrain tissue were measured by real-time fluorescence quantitative polymerase chain reaction,and the relative expression levels of Pitx3 and TH proteins in the midbrain tissue were measured by Western blotting and immunofluorescence.Results:The body weights of rats among groups and at different time points were statistically different(P<0.01).The body weight of the normal group was higher than that of the other groups over time(P<0.01).After modeling,the minimum volume threshold of abdominal withdrawal reflex(AWR)was significantly lower(P<0.01)and the loose stool rate was significantly higher(P<0.01)in the model,moxibustion,and Western medicine groups compared with the normal group;the miRNA-133b expression in the midbrain tissue was significantly lower(P<0.01),the expression levels of Pitx3 and TH in the midbrain tissue were significantly higher(P<0.01),and the levels of DA,NE,and 5-HT in plasma,colon and midbrain tissue were significantly higher(P<0.01).After the intervention,the minimum volume threshold of AWR was significantly higher(P<0.01),the loose stool rate was significantly lower(P<0.01),the miRNA-133b expression was significantly increased(P<0.01 or P<0.05)and the expression levels of Pitx3 and TH were significantly decreased(P<0.01)in the midbrain tissue,the levels of DA,NE,and 5-HT in plasma,colon,and midbrain tissue were significantly reduced(P<0.01)in the moxibustion and Western medicine groups compared with the model group;the levels of 5-HT in the colon and midbrain tissue of the moxibustion group were significantly lower than those in the Western medicine group(P<0.05),and there was no statistical difference compared with the remaining groups(P>0.05).Linear correlation analysis showed that miRNA-133b was negatively correlated with Pitx3(r<0,P<0.01);Pitx3 with TH,TH with DA,and NE with 5-HT were positively correlated(r>0,P<0.01).Conclusion:Moxibustion at Tianshu(ST25)and Shangjuxu(ST37)improves diarrhea symptoms and visceral hypersensitivity in IBS-D rats.The mechanism may be related to up-regulating miRNA-133b,inhibiting Pitx3/TH,and reducing neurotransmitter expression levels in the midbrain tissue.