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樊蓥、魏辉、田海河, 全美中医药学会 美国中医校友联合会

【新闻快递】

上海中医药大学、南京中医药大学和广州中医药大学三所中医药大学被列入美国新闻周刊(U.S. News& World Report) 2020年度全球最好大学排名;北京中医药大学被列入上海交大(ARWU 2018-2019世界大学学术排名

美国新闻周刊于2019年10月22日以大学学术水平为主要依据,发表了2020年全球最好大学排名 (2020 Best Global Universities Rankings)。本年度共有81个国家和地区1500所大学被列入,比以往75个国家和地区1250 所有所扩大。(https://www.usnews.com/info/blogs/press-room/articles/2019-10-22/us-news-announces-2020-best-global-universities-rankings

从大学整体学术实力而言,上海中医药大学 (Shanghai University of Traditional Chinese Medicine)、南京中医药大学(Nanjing University of Chinese Medicine) 和广州中医药大学(Guangzhou University of Chinese Medicine)入选,分别位列第1376、1390和1440名。

在临床医学方面,全球共750个大学最强,哈佛大学位列第1;而中国有40个大学入选,这方面最好的北京大学,位列全球第92名。南京中医药大学、上海中医药大学、广州中医药大学分别位于第688、734和738名。

在药理与毒理学方面,全球共250个大学最强,哈佛大学位列第1;中国有29个大学入选,这方面最好的大学是中国药科大学,位列全球第18名。南京中医药大学位列全球第209名。

在肿瘤学方面,全球共250个大学最强,哈佛大学位于第1;中国有25个大学入选,这方面最好的大学是上海交通大学,位列全球第57名。南京中医药大学位列全球第243名。

这是美国新闻周刊第2次将中医药大学列入全球最好大学。上一次是2018年度,上海中医药大学位列第1231名、南京中医药大学,位列第1249名。北京中医药大学则是2018年度和2019年度被上海交大世界大学学术排名ARWU列为第901-1000名的著名大学。

【背景】

美国新闻周刊2020年度全球最好大学排名中,具有最好大学最多的前五个国家是美国、中国、英国、日本和德国,分别有249、188、86、82、66个大学入选。

前十名最好的大学,毫无悬念地被美国和英国的大学占具,他们是:

  1. 哈佛大学 (Harvard University, U.S.);
  2. 麻省理工学院 (Massachusetts Institute of Technology, U.S.)
  3. 斯坦福大学 (Stanford University, U.S.)
  4. 加州大学伯克莱分校 (University of California—Berkeley, U.S.)
  5. 牛津大学 (University of Oxford, U.K.)
  6. 加州理工学院 (California Institute of Technology, U.S.)
  7. 哥伦比亚大学 (Columbia University, U.S.)
  8. 普林斯顿大学 (Princeton University, U.S.)
  9. 剑桥大学 (University of Cambridge, U.K.)
  10. 华盛顿大学 (University of Washington, U.S.)

中国最好大学的前三名是:清华大学(Tsinghua University, 位列全球第36位)、 北京大学(Peking University, 位列第59位)、中国科技大学( University of Science and Technology of China, 位列第128位)。

我们知道,大学排名与分析和计算积分的方法学有关。本次美国新闻周刊的全球最好大学排名,主要依据了Web of Science (发布SCI杂志名录的公司)学术信息,包括了13个方面:全球研究信誉(Global research reputation,       占12.5%)、地区研究信誉(Regional research reputation, 12.5%)、发表论文(Publications, 10%)、出版书籍(Books, 2.5%)、会议论文(Conferences, 2.5%), 正态化引用影响因子(Normalized citation impact,10%)、总引用数(Total citations,7.5%)、10%最高引用的论文数(Number of publications that are among the 10% most cited, 12.5%)、10%最高引用的论文数的百分比 (Percentage of total publications that are among the 10% most cited, 10%)、国际合作论文(International collaboration, 5%)、Percentage of total publications with international collaboration(国际合作总论文百分比,5%)、该领域最高1%引用的论文数(Number of highly cited papers that are among the top 1% most cited in their respective field, 5%)以及该领域最高1%引用的论文百分比(Percentage of total publications that are among the top 1% most highly cited papers)。https://www.usnews.com/education/best-global-universities/articles/methodology

【评论】

本次排名,可能会有许多因素影响分析和计算的客观性,包括分析的视角、文化及文字差异、发表论文是否在SCI杂志,都可以显著地影响到全球最好大学排名的客观性。这个美国新闻周刊大学排名中没有中医药学校的专属排名,可能会遗漏大型西医院校或综合院校里中医学院、中药学院;同时,这个分析、计算的方法学,似乎更偏向学术、或者说以英文发表的SCI杂志论文更受到重视,这会更有利于欧美英语国家的大学;中国的非西方传统性质的学科、比如中医药学的大学实际实力会被大打折扣。

国际上有四个著名的机构评定全球最好大学排名,他们是英国的QS (Quacquarelli Symonds, https://www.topuniversities.com/university-rankings),英国的THE (https://www.timeshighereducation.com/world-university-rankings), 美国的U.S. News & World Report,       以及中国上海交通大学的ARWU(Academic Ranking of World Universities, http://www.shanghairanking.com/ARWU2019.html)。各个排名的入选大学数量是不一样的。前两个只列入全球800所大学名单;美国新闻周刊大学排名去年之前,一般只列入1250所大学名单,而今年扩大为1500所;ARWU 2017年之前只包括500-800所大学名单,自2018年,扩大为1000所。包括名单数量多少,也决定了是否有中医药大学被列入。可以断定的是,目前最好的中医药大学整体实力来说,在国际上排名,应处于901-1500之间。

总的来说,中医药大学列入全球最好大学排名,意味者中医药大学的学术已经位于了主流之列,特别是临床医学、药理与毒理学研究、肿瘤学的研究与临床也有中医药大学进入排名,意义更是重大。

 

 

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我国首次发布中医药发展白皮书《中国的中医药》

http://www.xinhuanet.com/health/2016-12/06/c_1120063254.htm
2016年12月06日 12:21:51 来源: 新华网
    新华网北京12月6日电(刘映)12月6日,国务院新闻办发布《中国的中医药》白皮书,这也是我国首次发布中医药发展状况的白皮书。据了解,白皮书从中医药的历史发展脉络及其特点、中国发展中医药的国家政策和主要措施、中医药的传承与发展、中医药国际交流与合作等方面对我国中医药的发展情况进行了概述。全文约9000余字,由前言、正文、结束语三部分组成,以中、英、法、俄、德、西、日、阿等语种发表,中文版和英文版已分别由人民出版社和外文出版社出版。

    国家卫生计生委副主任、国家中医药管理局局长王国强表示,在推进“健康中国”建设过程中,中医药在普及健康生活方式,在“治未病”、重大疾病防治、康复以及完善健康保障方面都能发挥重要作用,在建设健康环境方面,中医药也具有优势。

    中医药“整体化、个体化、治未病”等理念意蕴深远

国务院新闻办新闻发言人袭艳春表示,中医药作为中华文明的杰出代表,是中国各族人民在几千年生产生活实践和与疾病做斗争中逐步形成并不断丰富发展的医学科学,不仅为中华民族繁衍昌盛做出了卓越贡献,也对世界文明进步产生了积极影响。

白皮书显示,中医药在历史发展进程中,兼容并蓄、创新开放,形成了独特的生命观、健康观、疾病观、防治观,实现了自然科学与人文科学的融合和统一,蕴含了中华民族深邃的哲学思想。随着健康观念变化和医学模式转变,中医药越来越显示出独特价值,并形成了鲜明的特点,包括重视整体,注重“平”与“和”,强调个体化,突出“治未病”,使用简便等。

从历史上看,中华民族屡经天灾、战乱和瘟疫,却能一次次转危为安,人口不断增加、文明得以传承,中医药做出了重大贡献。近些年来,抗疟药物“青蒿素”的发明,拯救了全球特别是发展中国家数百万人的生命。2015年,中国中医科学院研究员屠呦呦因“青蒿素的发现”而获得诺贝尔生理学或医学奖,更是让世界见证了传统中医药的魅力。

    中医药传承与发展提速,中医医疗服务体系覆盖城乡

中国历来高度重视中医药事业发展,近年来,更是出台了一系列推动中医药发展的政策文件。比如2003年,国务院发布实施《中华人民共和国中医药条例》,2009年,国务院颁布实施了《关于扶持和促进中医药事业发展的若干意见》,逐步形成了相对完善的中医药政策体系。2015年国务院常务会议通过《中医药法(草案)》,并将提请全国人大常委会审议,将为中医药事业发展提供良好的政策环境和制度保障。2016年,国务院印发了《中医药发展战略规划纲要(2016-2030年)》,这是把中医药发展上升为国家战略的具体体现,是新时期推进我国中医药事业发展的纲领性文件。

近期举行的全国卫生与健康大会强调,要“着力推动中医药振兴发展”。

在中医药的传承与发展方面,王国强表示,目前,我国已基本建立起覆盖城乡的中医医疗服务体系。在城市,形成了以中医(民族医、中西医结合)医院、中医类门诊部和诊所以及综合医院中医类临床科室、社区卫生服务机构为主的城市中医医疗服务网络。在农村,形成了由县级中医医院、综合医院(专科医院、妇幼保健院)中医临床科室、乡镇卫生院中医科和村卫生室为主的农村中医医疗服务网络,提供基本中医医疗预防保健服务。截至2015年底,全国有中医类医院3966所,其中民族医医院253所,中西医结合医院446所。中医类别执业(助理)医师45.2万人(含民族医医师、中西医结合医师)。全国有中医类门诊部、诊所42528个,其中民族医门诊部、诊所550个,中西医结合门诊部、诊所7706个。2015年全国中医类医疗卫生机构总诊疗人次达9.1亿,全国中医类医疗卫生机构出院人数2691.5万人。

中医药除在常见病、多发病、疑难杂症的防治中贡献力量外,在重大疫情防治和突发事件医疗救治中也发挥重要作用。中医、中西医结合治疗传染性非典型肺炎,疗效得到世界卫生组织肯定;中医治疗甲型H1N1流感,取得良好效果,成果引起国际社会关注。同时,中医药在防治艾滋病、手足口病、人感染H7N9禽流感等传染病,以及四川汶川特大地震、甘肃舟曲特大泥石流、江苏昆山爆炸等突发事件医疗救治中,都发挥了独特作用。

此外,中医药在预防保健、文化建设等多个方面取得快速发展。白皮书显示,中国政府重视和保护中医药的文化价值,积极推进中医药传统文化传承体系建设,已有130个中医药类项目列入国家级非物质文化遗产代表性项目名录,“中医针灸”被列入联合国教科文组织人类非物质文化遗产代表作名录,《黄帝内经》和《本草纲目》入选世界记忆名录。

此外,中医药标准化工作也取得积极进展。制定实施了《中医药标准化中长期发展规划纲要(2011—2020年)》,中医药标准体系初步形成,标准数量达到649项,年平均增率29%。中医、针灸、中药、中西医结合、中药材种子种苗5个全国标准化技术委员会及广东、上海、甘肃等地方中医药标委会相继成立。

    中医药已成最具代表性的中国元素

从里约奥运会、G20杭州峰会,以及最近在上海举行的全球健康促进大会等国际重大活动和会议中,都“不约而同”地出现了中医药热现象。

对此,王国强表示,今年,中国外文局对外传播研究中心开展了第四次中国国家形象全球调查。此次调查引用LightSpeed Research全球样本库中覆盖G20中除欧盟外的19个成员国9500个样本,并严格执行Online在线调查的国际标准。调查结果显示,与2012年第一次调查相比,中医药首次被认为是最具代表性的中国元素,选择比例达50%,中国整体形象稳步提升,并呈现新特点。与中医密不可分的武术列居第二,远超书法、戏曲、饮食等元素。

白皮书显示,目前,中医药已传播到183个国家和地区。据世界卫生组织统计,目前103个会员国认可使用针灸,其中29个国家和地区设立了法律法规,18个国家和地区将针灸纳入医疗保险体系。中药逐步进入国际医药体系,已在新加坡、古巴、越南、阿联酋和俄罗斯等国以药品形式注册。有30多个国家和地区开办了数百所中医药院校,培养本土化中医药人才。总部设在中国的世界针灸学会联合会有53个国家和地区194个会员团体,世界中医药学会联合会有67个国家和地区251个会员团体。

王国强表示,中国政府一直致力于推动国际传统医药发展,与世界卫生组织保持密切合作关系,为全球传统医学发展做出贡献。目前,中国政府与相关国家和国际组织签订专门的中医药合作协议86个,中国政府已经支持在海外建立了10个中医药中心。

此外,为促进中医药在全球范围内的规范发展,保障安全、有效、合理应用,中国推动在国际标准化组织(ISO)成立中医药技术委员会(ISO/TC249),秘书处设在中国上海,目前已发布一批中医药国际标准。在中国推动下,世界卫生组织将以中医药为主体的传统医学纳入新版国际疾病分类(ICD-11)中。推动传统药监督管理国际合作,保障传统药安全有效。

    我国将建全国中药资源动态监测网,提升中药安全性

    一图读懂中国的中医药

【纠错】

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冬雪春雨4296952 [中国浙江省杭州市 ]2016年12月06日 19:04 发表

中国的传统中医医务工作者,中国的中药材质量,中国的中药产品的质量,中国新闻有关中国中医的报道质量,中国的医务工作者,中药材,中药产品检验质量到底怎么样?有多少真实性?有多少被污染了?

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悲欢离合4294282 [中国贵州省黔西南布依族苗族自治州 ]2016年12月06日 07:55 发表

中国药助中华民族人数众多,人材济济,繁荣昌盛、就是最明显的疗效。

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There are six papers in http://www.PubMed.gov, a NIH database for Modified Huo Luo Xiao Ling Dan, Dr.Arthur Yin Fan involved in most of these studies, included in pre-clinical studies for safety evaluation and efficacy tests, mechanism explorations. This project was a NIH funded studies conducted in University of Maryland Harvard University.

Lao L, Fan AY, Zhang RX, Zhou A, Ma ZZ, Lee DY, Ren K, Berman B.

Am J Chin Med. 2006;34(5):833-44.

PMID:17080548 [PubMed – indexed for MEDLINE]Related citations

Zhang RX, Fan AY, Zhou AN, Moudgil KD, Ma ZZ, Lee DY, Fong HH, Berman BM, Lao L.

J Ethnopharmacol. 2009 Jan 30;121(3):366-71. Epub 2008 Nov 28.

PMID: 19100323 [PubMed – indexed for MEDLINE] Free PMC ArticleRelated citations

Rajaiah R, Lee DY, Ma Z, Fan AY, Lao L, Fong HH, Berman BM, Moudgil KD.

J Ethnopharmacol. 2009 May 4;123(1):40-4. Epub 2009 Mar 4.

PMID: 19429337 [PubMed – indexed for MEDLINE] Free PMC ArticleRelated citations

Fan AY, Lao L, Zhang RX, Zhou AN, Berman BM.

Zhong Xi Yi Jie He Xue Bao. 2010 May;8(5):438-47.

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Yang YH, Rajaiah R, Lee DY, Ma Z, Yu H, Fong HH, Lao L, Berman BM, Moudgil KD.

Evid Based Complement Alternat Med. 2011;2011:642027. Epub 2010 Oct 19.

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Nanjundaiah SM, Lee DY, Ma Z, Fong HH, Lao L, Berman BM, Moudgil KD.

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The best way to choose a TCM doctor is to ask questions.

First ask friends whether they have a herbalist, and if so, would they recommend him/her? Using Chinese medicine practitioner’s website is usually the best way to get detail information about TCM doctor and his / her personality, as well as practice.

There are also many online registries of Chinese medicine practitioners, such as NCCAOM— the national board for acupuncture and Chinese medicine in USA,  which handles national examinations and issues certificates which are required for licensing in most of States to practice of acupuncture, Chinese herbal medicine, tuina – Chinese therapeutic massage in the USA. Currently, there are over 10,000 professionally qualified TCM practitioners registered with NCCAOM ,which provides Chinese medicine practitioners contact information by state.

You should ask the provider some questions to decide how helpful the TCM doctor is.

For example:

*Does this TCM doctor assure you that the body heals itself and that the Chinese medicine give opportunity to heal?

*Does this TCM doctor make you feel that you can trust him or her?

*Can this TCM doctor answer your questions to your satisfaction?

*Does this TCM doctor teach you why you might be ill in the first place?

*Does this TCM doctor listen to you or understand you ( Some Chinese may be  poor in spoken English)?

*Do you feel uncomfortable with your TCM doctor?

Remember–lack of trust can hinder the healing.

Remember–any healthcare professional, that offers a quick fix to all problems, is not offering healthcare. There are no magic bullets or miracle cures. Take care!

And if a provider’s fee schedule is very low (based on your common sense ), you should question the quality of his / her practice.

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A Chinese Doctor’s Office in Los Angeles ca. 1890

http://www.history.la.ca.us/hdphotos.htm[photo] – from the CHS/TICOR Collection (US)

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From: National Institute of Health, National Center for Complementary and Alternative Medicine (NCCAM)

NCCAM Clearinghouse

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China moe than 2,000 years ago, acupuncture became widely known in the United States in 1971 when New York Times reporter James Reston wrote about how doctors in Beijing, China, used needles to ease his abdominal pain after surgery. Research shows that acupuncture is beneficial in treating a variety of health conditions.

In the past two decades, acupuncture has grown in popularity in the United States. In 1993, the U.S. Food and Drug Administration (FDA) estimated that Americans made 9 to 12 million visits per year to acupuncture practitioners and spent as much as $500 million on acupuncture treatments.1 In 1995, an estimated 10,000 nationally certified acupuncturists were practicing in the United States. By the year 2000, that number is expected to double. Currently, an estimated one-third of certified acupuncturists in the United States are medical doctors.2

The National Institutes of Health (NIH) has funded a variety of research projects on acupuncture that have been awarded by its National Center for Complementary and Alternative Medicine (NCCAM), National Institute on Alcohol Abuse and Alcoholism, National Institute of Dental Research, National Institute of Neurological Disorders and Stroke, and National Institute on Drug Abuse.

This information and resource package provides general information about acupuncture, summaries of NIH research findings on acupuncture, information for the health consumer, a list of additional information resources, and a glossary that defines terms italicized in the text. It also lists books, journals, organizations, and Internet resources to help you learn more about acupuncture and traditional Chinese medicine.

Acupuncture Theories

Traditional Chinese medicine theorizes that the more than 2,000 acupuncture points on the human body connect with 12 main and 8 secondary pathways, called meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi, between the surface of the body and internal organs.

Qi regulates spiritual, emotional, mental, and physical balance. Qi is influenced by the opposing forces of yin and yang. According to traditional Chinese medicine when yin and yang are balanced they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind.

Traditional Chinese medicine practices (including acupuncture, herbs, diet, massage, and meditative physical exercises) all are intended to improve the flow of qi.3

Western scientists have found meridians hard to identify because meridians do not directly correspond to nerve or blood circulation pathways. Some researchers believe that meridians are located throughout the body’s connective tissue;4 others do not believe that qi exists at all.5,6Such differences of opinion have made acupuncture a source of scientific controversy.

Preclinical Studies

Preclinical studies have documented acupuncture’s effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.7,8,9,10,11,12

Mechanisms of Action

Several processes have been proposed to explain acupuncture’s effects, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (the brain and spinal cord) to release chemicals into the muscles, spinal cord, and brain. These chemicals either change the experience of pain or release other chemicals, such as hormones, that influence the body’s self-regulating systems. The biochemical changes may stimulate the body’s natural healing abilities and promote physical and emotional well-being.13 There are three main mechanisms:

  • Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points an strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at it greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals such as endorphins and of immune system cells to specific sites that are injured or vulnerable to disease.14,15
  • Activation of opioid systems: research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.16
  • Changes in brain chemistry sensation, and Involuntary body functions: studies have shown that acupuncture may alter brain chemistry by changing the release ofneurotransmitters and neurohormones in a good way. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person’s blood pressure, blood flow, and body temperature are regulated.3,17,18
Conditions Appropriate for Acupuncture Therapy
Digestive
Abdominal pain
Constipation
Diarrhea
Hyperacidity
Indigestion
Emotional
Anxiety
Depression
Insomnia
Nervousness
Neurosis
Eye-Ear-Nose-Throat
Cataracts
Gingivitis
Poor vision
Tinnitis
Toothache
Gynecological
Infertility
Menopausal symptoms
Premenstrual syndrome
Miscellaneous
Addiction control
Athletic performance
Blood pressure regulation
Chronic fatigue
Immune system tonification
Stress reduction
Musculoskeletal
Arthritis
Back pain
Muscle cramping
Muscle pain/weakness
Neck pain
Sciatica
Neurological
Headaches
Migraines
Neurogenic
Bladder dysfunction
Parkinson’s disease
Postoperative pain
Stroke
Respiratory
Asthma
Bronchitis
Common cold
Sinusitis
Smoking cessation
Tonsilitis
Source: World Health Organization United Nations. “Viewpoint on Acupuncture.” 19 19 (revised).23

Clinical Studies

According to an NIH consensus panel of scientists, researchers, and practitioners who convened in November 1997, clinical studies have shown that acupuncture is an effective treatment for nausea caused by surgical anesthesia and cancer as well as for dental pain experienced after surgery. The panel also found that acupuncture is useful by itself or combined with conventional therapies to treat addiction, headaches, menstrual cramps, tennis elbow,fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome, and asthma; and to assist in stroke rehabilitation.19

Increasingly, acupuncture is complementing conventional therapies. For example, doctors may combine acupuncture and drugs to control surgery related pain in their patients.20 By providing both acupuncture and certain conventional anesthetic drugs, doctors have found it possible to achieve a state of complete pain relief for some patients.16 They also have found that using acupuncture lowers the need for conventional pain-killing drugs and thus reduces the risk of side effects for patients who take the drugs.21,22

Outside the United States, the World Health Organization (WHO), the health branch of the United Nations, lists more than 40 conditions for which acupuncture may be used.23 The table (above) lists these conditions.

Currently, one of the main reasons Americans seek acupuncture treatment is to relieve chronic pain, especially from conditions such as arthritis or lower back disorders.24,25 Some clinical studies show that acupuncture is effective in relieving both chronic (long-lasting) and acute or sudden pain,26 but other research indicates that it provides no relief from chronic pain.27Additional research is needed to provide definitive answers.

FDA’s Role

The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires manufacturers of acupuncture needles to label them for single use only.28 Relatively few complications from the use of acupuncture have been reported to the FDA when one considers the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. When not delivered properly acupuncture can cause serious adverse effects, including infections and puncturing of organs.1

NCCAM-Sponsored Clinical Research

Originally founded in 1992 as the Office of Alternative Medicine (OAM), the NCCAM facilitates the research and evaluation of unconventional medical practices and disseminates this information to the public. The NCCAM established in 1998, supports 13 Centers, where researchers conduct studies on complementary and alternative medicine for specific health conditions and diseases. Scientists at several Centers are investigating acupuncture therapy.

Researchers at the NCCAM Center at the University of Maryland in Baltimore conducted arandomized controlled clinical trial and found that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo.20 Other scientists at the Center found that older people with osteoarthritis experienced significantly more pain relief after using conventional drugs and acupuncture together than those using conventional therapy alone.29

Researchers at the Minneapolis Medical Research Foundation in Minnesota are studying the use of acupuncture to treat alcoholism and addiction to benzodiazepines, nicotine, and cocaine. Scientists at the Kessler Institute for Rehabilitation in New Jersey are studying acupuncture to treat a strokerelated swallowing disorder and the pain associated with spinal cord injuries.

The OAM, now the NCCAM, also funded several individual researchers in 1993 and 1994 to conduct preliminary studies on acupuncture. In one small randomized controlled clinical trial, more than half of the I I women with a major depressive episode who were treated with acupuncture improved significantly.30

In another controlled clinical trial, nearly half of the seven children with attention deficit hyperactivity disorder who underwent acupuncture treatment showed some improvement in their symptoms. Researchers concluded that acupuncture was a useful alternative to standard medication for some children with this condition.31

In a third small controlled study, eight pregnant women were given moxibustion to reduce the rate of breech births, in which tile fetus is positioned for birth feet-first instead of the normal position of head-first. Researchers found the treatment to be safe, but they were uncertain whether it was effective.32 Then, rescarchers reporting in the November 11, 1998, issue of theJournal of the American Medical Association conducted a larger randomized controlled clinical trial using moxibustion. They found that moxibustion applied to 130 pregnant women presenting breech significantly increased the number of normal head-first births.33

Acupuncture and You

The use of acupuncture, like many other complementary and alternative treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be safe and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not substantiate the anecdotal reports.

Lifestyle, age, physiology, and other factors combine to make every person different. A treatment that works for one person in, y not work for another who has the very same condition. You, as a health care consumer (especially if you have a preexisting medical condition), should discuss acupuncture with your doctor. Do not rely on a diagnosis of disease by an acupuncturist who does not have substantial conventional medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture might help.

Finding a Licensed Acupuncture Practitioner

Doctors are a good resource for referrals to acupuncturists. Increasingly, doctors are familiar with acupuncture and may know of a certified practitioner. In addition, more medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture, traditional Chinese medicine, and other alternative and complementary therapies. Friends and family members may be a source of referrals as well. In addition, national referral organizations provide the names of practitioners, although these organizations may be advocacy groups for the practitioners to whom they refer. See “Acupuncture Information Resources” for a list of these organizations.

Check a practitioner’s credentials.

A practitioner who is licensed and credentialed may provide better care than one who is not. About 30 states have established training standards for certification to practice acupuncture, but not all states require acupuncturists to obtain a license to practice. Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients with acupuncture.

The American Academy of Medical Acupuncture can give you a referral list of doctors who practice acupuncture. The National Acupuncture and Oriental Medicine Alliance lists thousands of acupuncturists on its Web site and provides the list to callers to their information and referral line. The Alliance requires documentation of state license or national board certification from its listed acupuncturists. The American Association of Oriental Medicine can tell you the state licensing status of acupuncture practitioners across the United States as well. To contact these and other organizations, see “Acupuncture Information Resources.”

Check treatment cost and insurance coverage.

Reflecting public demand, an estimated 70 to 80 percent of the nation’s insurers covered some acupuncture treatments in 1996. An acupuncturist may provide information about the number of treatments needed and how much each will cost. Generally, treatment may take place over a few days or several weeks. The cost per treatment typically ranges between $30 and $100 but it may be more. Physician acupuncturists may charge more than nonphysician practitioners.13

Check treatment procedures.

Find out about the treatment procedures that will be used and their likelihood of success. You also should make certain that the practitioner uses 1 new set of disposable needles in a sealed package every time. The FDA requires the use of sterile, nontoxic needles that bear a labeling statement restricting their use to qualified practitioners. The practitioner also should swat, the puncture site with alcohol or another before inserting the needle.

Some practitioners may use electroacupuncture; others may use moxibustion. These approaches are part of traditional Chinese medicine, and Western researchers are beginning to study whether they enhance acupuncture’s effects.

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to the condition. This holistic approach is typical of traditional Chinese medicine and many other alternative and complementary therapies. Let the acupuncturist, or any doctor for that matter, know about all treatments or medications you are taking and whether you have a pacemaker, are pregnant, or have breast or other implants. Acupuncture may be risky to your health if you fail to tell the practitioner about any of these matters.

The Sensation of Acupuncture

Acupuncture needles arc metallic, solid, and hair-thin, unlike the thicker, hollow hypodermic needles used in Western medicine to administer treatments or take blood samples. People experience acupuncture differently, but most feel minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. 34 Some patients may fear acupuncture because they are afraid of needles. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.35 This is why it is important to seek treatment only from a qualified acupuncture practitioner.

As important research advances continue to be made on acupuncture worldwide, practitioners and doctors increasingly will work together to give you the best care available.

For More Information

For more information about acupuncture research sponsored by different parts of NIH contact the respective Information Office or Clearinghouse. Call the NIH operator for assistance at 301-490-4000.

For more information about research on acupuncture, contact the NIH National Library of Medicine (NLM), which has published a bibliography of more than 2,000 citations to studies conducted on acupuncture. The bibliography is available on the Internet athttp://www.nlm.nih.gov/pubs/cbm/acupuncture.html or by writing the NLM, 8600 Rockville Pike, Bethesda. MD 20894. The NLM also has a toll-free telephone number: 1-888-346-3056.

For a database of research on complementary and alternative medicine, including acupuncture access the CAM Citation Index on the NCCAM Web site at http://altmed.od.nih.gov/nccam.

 

Glossary of Terms

Acupuncture – An ancient Chinese health that involves puncturing the skin with hair-thin needles at particular locations, called acupuncture points, oil the patient’s body. Acupuncture is believed to help reduce pa in or change a body function. Sometimes tile needles are twirled given a slight electric charge (see electroacupuncture) or warmed (see moxibustion).

Attention deficit hyperactivity disorder – A syndrome primarily found in children and teenagers that is characterized by excessive physical movement, impulsiveness, and lack of attention.

Clinical studies (also clinical trials, clinical outcomes studies, controlled trials, case series, comparative trials, or practice audit evidence) – Tests of a treatment’s effects in humans. Treatments undergo clinical studies only after they have shown promise in laboratory studies of animals. Clinical studies help researchers find out whether a treatment is safe and effective for people. They also tell scientists which treatments are more effective than others.

Electroacupuncture – A variation of traditional acupuncture treatment in which acupuncture or needle points are stimulated electronically.

Electromagnetic signals – The minute electrical impulses that transmit information through and between nerve calls. For example, electromagnetic signals convey information about pain and other sensations within the body’s nervous system.

Fibromyalgia – A complex chronic condition having multiple symptoms, including muscle pain, weakness, and stiffness, fatigue; metabolic disorders, allergies and headaches.

Holistic – Describes therapies based on facts about the “whole person,” including spiritual and mental aspects, not only the specific part of the body being treated. Holistic practitioners may advise changes in diet, physical activity, and other lifestyle factors to help treat a patient’s condition.

Merldians – A traditional Chinese medicine term for the 14 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.

Moxibustion – The use of dried herbs in acupuncture. The herbs are placed on top of acupuncture needles and burned. This method is believed to be more effective at treating some health conditions than using acupuncture needles alone.

Neurohorinones – Chemical substances made by tissue in the body’s nervous system that can change the structure or function or direct the activity of an organ or organs.

Neurological – A term referring to the body’s nervous system, which starts, oversees, and controls all body functions.

Neurotransmitters – Biochemical substances that stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations, such as pain.

Opioids – Synthetic or naturally occurring chemicals in the brain that may reduce pain and induce sleep.

Placebo – An inactive substance given to a participant in a research study as part of a test of the effects of another substance or treatment. Scientists often compare the effects of active and inactive substances to learn more about how the active substance affects participants.

Preclinical studies – Tests performed after a treatment has been shown in laboratory studies to have a desirable effect. Preclinical studies provide information about a treatment’s harmful side effects and safety it different doses in animals.

Qi (pronounced “chee”) – The Chinese term for vital energy or life force.

Randomized controlled clinical trials – A type of clinical study that is designed to provide information about whether a treatment is safe and effective in humans. These trials generally use two groups of people, one group receives the treatment and the other does not. The participants being studied do not know which group receives the actual treatment.

Traditional Chinese medicine – An ancient system of medicine and health care that is based on the concept of balanced qi or vital energy that flows throughout the body. Components of traditional Chinese medicine include herbal and nutritional therapy restorative physical exercises, medication acupuncture, acupressure, and remedial massage.

Yang – The Chinese concept of positive energy and forces in the universe and human body Acupuncture is believed to remove yang imbalances and bring the body into to balance.

Yin – The Chinese concept of negative energy and forces in the universe and human body. Acupuncture is believed to remove yin imbalances and bring the body into balance.

References

  • Lytle, C.D. An Overview of Acupuncture. 1993, Washington, DC: United States Department of Health and Human Services, Health Sciences Branch, Division of Life Sciences, Office of Science and Technology, Center for Devices and Radiological Health, Food and Drug Administration.
  • Culliton, RD. “Current Utilization of Acupuncture by United States Patients.” National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts (Bethesda, MD, November 3-5,1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications Research. Bethesda, MD: National Instittites of Health, 1997.
  • Beinfield, H. and Korngold, E.L. Between Heaven and Earth: A Guide to Chinese Medicine. New York, NY: Ballantine Books, 1991.
  • Brown, D. “Three Generations of Alternative Medicine: Behavioral Medicine, Integrated Medicine and Energy Medicine.” Boston University School of Medicine Alumni Report, Fall 1996.
  • Senior, K. “Acupuncture: Can It Take the Pain Away?” Molecular Medicine Today. 1996. 2(4):150-3.
  • Raso. J. Alternative Health Care: A Comprehensive Guide. Buffalo, NY Prometheus Books, 1994.
  • Eskinazi, D. P. “National Institutes of Health Technology Assessment Workshop on Alternative Medicine Acupuncture.” Journal of Alternative and Complementaty Medicine. 1996. 2(1):1-253
  • Tang, N.M., Dong, H.W., Wang, X. M., Tsui, Z.C., and Han, J.S. “Cholecystokinin Antisense RNA Increases the Analgesic Effect Induced by Electroacupuncture or Low Dose Morphine: Conversion of Low Responder Rats into High Responders.” Pain. 1997. 71(1)-.71-80.
  • Cheng, X.D., Wu, G. C., He, Q. Z., and Cao, X. D. “Effect of Electroacuptuncture on the Activities ol Tyrosine Protein Kinasc in Subcellular Fractions of Activited T Lymphocytcs from the Traumatized Rao;.” Immunopharmacology. Forthcoming.
  • Chen, L.B. and Li, S.X. “The Effects of Electrical Acupuncture of Neiguan in the PO2 of the Border Zone Between Ischemic and Non-Ischemic Myocardium in Dogs.” Journal of Traditional Chinese Medicine. 1983, 3(2):8 1-8.
  • Lee, H.S. and Kim, J.Y. “Effects on Blood Pressure and Plasma Renin Activity in Two Kidney One Clip Goldblatt Hypertensive Rats.” American Journal of Chinese Medicine. 1994. 22(3-4):215-9.
  • Okada, K_ Oshima, M., and 1 Kawakita, K. “Examination of the Afferentnt Fiber Responsible for the Suppression of Jaw-Open Reflex in Heat, Cold and Manual Acupuncture Stimulation in Anesthetized Rats.” Brain Research. 1996 740(1-2):201-7.
  • National Institutes of Health. Frequently. Asked Questions About Acupuncture. Bethesda, MD: National Institutes of Health, 1997.
  • Dale, R.A. “Demythologizing Acupuncture Part 1. The Scientific Mechanisms and the Clinical Uses.” Alternative & Complementary Therapies Journal. April 1997. 1(2)-.125-31.
  • Takeshige, C. “Mechanism of Acupuncture Analgesia Based on Animal Experiments.”Scientific Bases of Acupuncture. Berlin, Germany: Springere-Verlag, 1989.
  • Han, J.S. “Acupuncture Activates Endogenous Systems of Analgesia.” National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts (Bethesda, MD. November 3-5, 1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda, MD: National Institutes of Health, 1997.
  • Wu, B., Zhou, R.X., and ZI M.S. “Effect of Acupuncture on Interleukin-2 Level and NK Cell Immunoactivity of Peripheral Blood of Malignant Tumor Patients.” Chung Kyo Chung Hsi I Chieh Ho Tsa Chich. 1994.14(9):537-9.
  • Wit, B. “Effect Of Acupuncture on the Regulation of Cell-Mediated Immunity in Patients with Malignant Tumors.” Chen Tzu Yen Chiu. 1995, 20(3):67-71.
  • National Instituties of Health Consensus Panel. Acupuncture National Institutes of Health Consensus Development Statement November 3-5, 1997). Sponsors: Office of Alternaive Medicine –ind Office of Medical Application., of Research Bethesda, MD: N ational Institutes of, Health, 1997.
  • Lao, L., Bergman, S., Langenherg, P, Wong, R., and Berman, B. “Efficacy of Chinese Acupuncture on Postoperative Oral Surgery Pain,” Oral Surgery, Oral Medicine, Oral Pathology. 1995.79(4):423-8.
  • Lewith, G.T. and Vincent, C. “On the Evaluation of the Clinical Effects of Acupuncture: A Problem Reassessed and a Framework for Future Research.” Journal of Alternative and Complementary Medicine. 1996. 2(1):79-90.
  • TsibuIiak,VN., Alisov, A.P, and Shatrova,V.P. “Acupuncture Analgesia and Analgesic Transcutaneous Electroneurostimulation in the Early Postoperative Period,”Anesthesiology and Reanimatology 1995. 2:93-8,
  • World Health Organization. Viewpoint on Acupuncture. Geneva, Switzerland: World Health Organization, 1979.
  • Bullock, M.L., Pheley.A.M., Kiresuk.T.J., Lenz, S.K., and Culliton, PD. “Characteristies and Complaints of Patients Seeking Therapy at a Hospital-Based Alternative Medicine Clinic.” Journal of Alternative Medicine 1997-30):31-7.
  • Diehl, D.L., Kaplan, G., Coulter, I., Glik, D.,and Hurwitz, E.L.” Use of Acupuncture by American Physicians.” Journal of Alternative and Complementary Medicine. 1997, 3(2):119-26.
  • Levine, J.D., Gormley, J., and Fields, H.J., “Observatins on the Analgesic Effects of Needle Puncture (Acupuncture).” Pain. 1976.2(2):149-59.
  • Ter Reit, G., Kleijnen, J., and Knipschild, P. “Acupuncture and Chronic Pain: A Criteria-Based Meta-Analysis.” Clinical Epidemiology 1990 43:1191-9.
  • U.S. Food and Drug Administration. “Acupuncture Needles No Longer Investigational”FDA Consumer Magazine June 1996.30(5).
  • Berman, B., Lao, L., Bergman, S., Langenberg, P, Wong, R., Loangenberg, P, and Hochberg, M. “Efficacy of Traditional Chinese Acupuncture in the Treatment of Osteoarthritis: A Pilot Study.” Osteoarthritis and Cartilage 1995. (3):139-42.
  • Allen, J.J.B. “An Acupuncture Treatment Study for Unipolar Depression.” Psychological Science. 1998. 9:397-401.
  • Sonenklar, N. Acupuncture and Attention Deficit Hyperactivity Disorder. National Institutes of Health, Office of Alternative Medicine Research Grant *R21 RR09463. 1993.
  • Milligan, R. Breech Version by Acumoxa. National Instituties of Health, Office of Alternative Medicine Research Grant #R21 RR09327. 1993.
  • Cardini, F. and Weixin, H. “Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial..” Journal of the American Medical Association. 1998. 280:1580-4
  • American Academy of Medical Acupuncture “Doctor, What’s This Acupuncture All About? Brief Explanation for Patients.“Los Angeles. CA: American Academy of Medical Acupuncture, 1996.
  • Lao, L. “Safety Issues in Acupuncture.” Journal of Alternative and Complementary Medicine. 1996, 2(1):27-9.

  • Go to NCCAM Resource List Go to NCCAM web site for more current information
  • www.ChineseMedicineDoctor.US

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Sometimes TCM doctors treat patients mainly according to his or her illness/disorder, in other words, treating each illness/disorder the same. But most of the time, the treatments are individualized, especially when it involves using herbology or dietary adjustment. The same disease or condition may be treated differently depending on the individual’s constitutions and/or the individual’s illness stage; such that acute, chronic, and recovery stages all receive different treatments. Some patients may also have additional conditions to their primary condition, which would alter the formula recipe for the herbal tea.

Because Chinese Medicine uses more than one way to treat conditions or illnesses, one patient may receive acupuncture and Herbology, some may only receive Herbology, while others may receive just acupuncture, or other therapies such as Tui-na, Chinese therapeutic massage or bone-setting. Treatment is also dependent upon a patient’s preference and the provider’s training. For example, some providers may have only received training in acupuncture or herbology alone, while others may have had more extensive training within the whole context of TCM therapies. Therefore, some providers may have additional choices in applying suitable therapies to achieve quick, satisfactory results.

Patients with the same condition may have varied recovery times. When receiving treatment through herbology, it is beneficial to acknowledge that every person has a different constitution. The concept of a constitution in Chinese Medicine infers that every person has different organ function, structure, metabolism, and diverse personalities. Based on one TCM perspective, there are five main types of constitutions: Yang/hot type, Yin/cold type, Phlegm/damp type, Dry type, Neutral Type. Note that an individual usually does not maintain just one constitution; in actuality, people may have mixed physical and mental constitutions.  With TCM doctors’ guidance, each patient is capable of choosing the correct diet for their type, along with prescribed herbal teas, to aim for a neutral constitution and maintain a balanced life.

However, just because two people have the same constitution or pattern, does not mean they will be treated the same. For example, two women may exhibit the same blood-deficiency type; also known was anemia in Western medical terms. Yet one of the two ladies is on her period, and one is not menstruating. The woman menstruating will receive a different herbal tea formula because her body is in a different state. In this sense Dr. Fan says that even if two people have the same illness, but one has a different pattern, you do not treat the two patients the same. Yet even though two people may have a different illness, if their pattern is the same, it is possible treat them both alike. However because many people have other issues in addition to their main illness, it is sensible to treat each individual differently; everything depends on a patient’s specific condition at that particular time.

Personality also plays a role in determining the correct treatment for an individual. Dr. Fan is excellent at noticing a patient’s personality type and then basing a treatment plan off that observation. For example, for those of us who have drunk the herbal tea, we know it doesn’t always taste delicious. Despite the many who do not mind, there are those that prefer not to. Dr. Fan finds alternative means to treat these sensitive patients by either informing them of diet restrictions/additions, or providing them with herbal pills, which are quite easy to swallow and do not bother the stomach like most Western pharmaceuticals. Also for many children, it may be difficult for them to drink the herbal tea because of the taste, so the herbal pills are very convenient for that reason. Sometimes Dr. Fan may use herbs with less bitter or pungent smell/taste to substitute the herbs used in the original formula to make the aroma and taste more acceptable.

Based on the cultural differences, Asian cultures such as China, Korea, and Japan consist of doctors and patients that use more herbology in their treatment plans. In Western countries such as America, doctors and patients are more hesitant to use herbology as a treatment, and lean toward more acupuncture treatment instead. It is beneficial for the doctor-patient relationship to be as open about this as possible to create a happy and positive experience for the patient. Some cultures or societies have specific habits or preferences which they do not wish to change. TCM doctors attempt to understand these cultural differences and respect. In doing so, their treatment or dietary guidance will cater to those who do convey different cultural or societal ideals.

Written and edited by Arthur Fan and Julia Rosenthal.

For more information, visit: www.ChineseMedicineDoctor.US,  www.VITCM.org

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Here I post a doctor’s suggestion to his patient. I feel he is correct.
“I was just thinking why you may not have
taken advantage of your consultation.

You’re probably like many others who
suffer from back pain, headache, neck pain,
soreness, or any type of physical ache or pain…
the pain comes and goes and now you’re feeling
pretty good…am I right?

Sometimes even our patients often feel
better after the first few treatments,
and although this may seem good, the opposite
can sometimes be true as well.

Patients often mistake this feeling for a total
cure of their condition. They simply do not
realize that a relief of the symptoms DOES
NOT indicate a correction of the condition.

The smart patients never discontinue treatment
before their actual complaint has been corrected,
and if they do so, further complications are
bound to develop.

Even if you feel better, get checked out.

Prevent future problems.

We’ll extend our offer for a consultation,
but you have to call our office .
We’re standing by to hear from you and hopefully
help you prevent future problems.”

My phone number: 703-499-4428;

website: www.ChineseMedicineDoctor.US

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中国生命科学论坛杂志—TILS, Trends In Life Sciences
肾阳虚证临床及实验研究回顾 刘尚全1
自从1959年上海医科大学脏象研究组从肾阳虚入手,开始对肾虚、肾本质进行研究以来,人们应用多种现代的研究技术手段,从功能到形态,从宏观到微观,从组织细胞水平到分子水平对肾阳虚证进行更加广泛而深入的研究。各方面的研究表明,肾阳虚证与神经、内分泌、免疫系统的功能改变密切相关。中医的肾不同于解剖学上的肾,远远超出了西医肾脏的范畴,涉及的范围很广,是多系统和器官功能的综合表现。现对肾阳虚证的临床及实验研究作一回顾。
1.肾阳虚证实验动物模型的研究
用动物模型进行证的中医药研究,可以弥补中医单靠临床研究的不足,从形态和功能等多方面阐述中药治疗的效果和原理,揭示中医理论的本质,并在此基础上产生新的理论和治疗方法,关于肾阳虚实验动物模型,文献已有详尽总结[1]。
2.肾阳虚证中枢改变
海马是脑内参与记忆贮存功能的重要部分,而海马CA3区是学习记忆的关键部位,并对衰老较为易感。益气补肾药物在提高大鼠海马、额叶去甲肾上腺素 (NE)、多巴胺 (DA)、五羟色胺(5-HT)含量的同时改善了Alzheimer 病肾阳虚模型大鼠学习记忆力[2][3],进一步对大鼠海马CA3 区超微结构进行研究[4]发现老年肾虚AD鼠在亚细胞水平的变化主要表现为脂褐质数量异常增多,神经元核膜内陷形成皱褶,核内出现空泡,神经元胞浆内线粒体数目减少,形态不规则,嵴变短,部分嵴缺失和线粒体内絮状斑块。主要细胞器如高尔基体、粗面内质网有明显的变形、增宽、脱颗粒等。温阳药物则可以逆转上述变化,表现为抑制脑内脂
褐质的形成和积累、促进脑细胞蛋白质的合成和改善脑部血液循环作用。使神经元内线粒体数目增多,防止线粒体嵴肿胀及变性等。精氨酸升压素(Argipressin,AP)具有增强学习记忆功能的作用[5],生长抑素(Somatostatin,SS)是体内具有广泛抑制作用的神经肽[6],有文献报告[7]下丘脑组织中SS神经元和 AP神经元之间有共存的树突,它们之间有直接形态学的联系,而在功能上则相互影响,研究证实[8]肾阳虚动物学习记忆成绩明显下降的同时下丘脑和血浆中SS和AP 水平均异常,表现为AP降低而SS升高;用药后学习记忆成绩提高,同时AP升高而SS下降。 郑里翔等[9]研究了肾阳虚模型单氨类递质及胆碱酯酶的变化,除5-HT无明显差以外,NE/DA/ACHE均有显著差异,外周NE/DA也出现类似情况。NA与警觉、睡眠、情绪等调节有关。5-HT与睡眠精神活动密切相关。5-HT、NE、DA共同维持体温恒定,参与睡眠及内分泌调节,ACHE在智力活动和记忆中起着关键作用。
3.内分泌系统改变
沈自尹教授曾对“肾阳虚”的本质进行了系统的研究[10],认为肾阳虚证不仅可引起下丘脑—垂体—肾上腺皮质轴 (HPA)功能紊乱,而且对于不同靶腺轴 (如下丘脑—垂体—甲状腺轴)的不同环节,均有不同程度的功能紊乱和退行性病变。
3.1 下丘脑
下丘脑激素的作用是通过胞内信号传导系统来实现的,反之胞内信号传导系统的改变就可能影响激素分泌,从而导致下丘脑 -垂体轴的神经内分泌功能紊乱。PKA,PKC通过底物磷酸化参与许多生理活动如神经递质释放、细胞增殖分化等,它们是许多外在刺激因子如激素、神经递质、生长因子等发挥作用的重要信号调节因子[11][12]。研究结果表明[13],肾阳虚大鼠下丘脑组织中 PKA,PKC 活性均明显降低。下丘脑组织细胞胞液 PKA 活性的变化更为明显。PKC 的活性胞膜大于胞液,但胞液的下降幅度大于胞膜,提示胞液中的 PKA和 PKC活性可能对下丘脑神经内分泌功能变化影响更大。生理条件下,下丘脑将从大脑传来的神经信息转变成激素信息,如分泌TRH、GnRH、CRF等。这些神经肽作用于垂体,使之分泌相应的激素而作用于各自的靶器官。在下丘脑-垂体-靶腺体轴中,各环节分泌的激素又反馈调节上一环节。这些激素与靶器官上的受体结合,通过信号传导系统发挥作用。NO在中枢神经系统有广泛的分布,是近年来认识到的一种新型神经信使因子,具有多种生物效应,有调节神经内分泌的功能。NO 参与下丘脑-垂体神经肽的释放,通过 cGMP 信号传导途径抑制下丘脑 GnRH 分泌与表达,NOS抑制剂可阻断神经递质的释放[14]。通过[15]对肾阳虚证神经内分泌功能受损状态下NO系统的变化的研究发现肾阳虚证时大鼠下丘脑 nNOS 表达增强。下丘脑组织 NOS 活性升高,血清和下丘脑组织中 NO 水平也明显升高,但下丘脑组织升高幅度明显高于血清,由此推测,肾阳虚证时影响了下丘脑nNOS 表达,并引起NOS活性增强,被激活的NOS催化L-精氨酸生成过量的NO。NO水平的升高可能对GC的刺激作用增强,导致cGMP生成量增大,cGMP 作为第二信使作用于 cGMP 依赖的蛋白激酶而发挥生物效应,抑制下丘脑的神经内分泌功能,导致肾阳虚证的发生。 Ca2+广泛分布于人体细胞内和体液中,Ca2+作为胞内信使“主动”参与一切外来信号调控细胞功能的信号传导过程。胞内游离钙的改变,可触发一系列生理、生化反应。许多病理或疾病现象的发生都伴随着细胞内 Ca2+浓度的异常升高,如脑缺血、癫痫、糖尿病等[16]。细胞内钙离子超载、钙离子内环境失衡是导致细胞死亡的最后的共同途径[17]。宋春风等采用[18]灵敏度高特异性强的第三代 Ca2+荧光探针 Fluo3AM 对下丘脑-垂体-肾上腺轴和血淋巴细胞 [Ca2+]i进行了测定,同时测定了血清钙。结果表明,肾阳虚大鼠下丘脑、血淋巴细胞中 [Ca2+]i及血清钙显著升高,补肾中药右归饮能够抑制肾阳虚大鼠下丘脑、血淋巴细胞Ca2+及血清钙的升高。由于 [Ca2+]i具有第二信使的功能,且作用广泛,因此 [Ca2+]i的升降对调节细胞活动起着决定的作用。在生理状态下,细胞膜内外存在极大的Ca2+电化学梯度,细胞内钙浓度为0.1umol/L~1.0umol/L,而细胞外钙浓度比 [Ca2+]i高 1 万倍,约为 1.0mmol/L 。细胞维持如此大的浓度梯度,保证
细胞内钙稳定,主要靠细胞膜 Ca2+极低的通透性、钙结合蛋白 (如钙调素 )的缓冲以及依赖质膜两侧钙泵Ca2+-Mg2+-ATP 酶、Na+- Ca2+交换系统将 Ca2+主动排出,或通过细胞内 Ca2+库如线粒体、内质网等摄取与贮存Ca2+。其中线粒体是胞内最重要的钙库之一。当 [Ca2+]i>1.0mmol/L 时,线粒体摄钙明显增加,但 [Ca2+]i的调控均有一定限度,超过极限将导致 [Ca2+]i升高,引起细胞和线粒体钙超载,从而触发一系列有害的病理生理过程[19],使一些依赖Ca2+的酶如NO合成酶、磷脂酶、蛋白水解酶及核酸酶的活性增加。通过“瀑布”式连锁反应使线粒体氧化磷酸化脱偶联,线粒体功能下降或衰竭,细胞呼吸抑制,同时影响细胞的基本代谢功能。一些研究表明,脑老化伴随着神经细胞内钙稳态的失调和细胞钙调节能力的降低,随着年龄的增加,[ Ca2+]i呈渐进性增加[20]。细胞内钙的增加主要通过细胞膜上钙通道开放和细胞内钙库的释放而引起。细胞内游离钙病理性增加后,则需要细胞内的 Ca2+调控机制发挥作用,以维持细胞内钙稳态。但研究发现,随着老龄化的发生,细胞内Ca2+调控能力逐渐衰退,如细胞膜Ca2+泵活性随年龄增加而显著降低,外排 Ca2+的能力明显下降,线粒体摄钙能力也随着年龄增长逐渐衰退[21]。有研究表明,机体老化是一种生理性肾阳虚,肾阳虚是未老先衰的一种表现。因此肾阳虚时下丘脑、血淋巴细胞的 [Ca2+]i及血清钙升高,可能是细胞外大量Ca2+顺浓度梯度进入细胞内,细胞膜钙泵功能降低,排出Ca2+的功能受损,胞内钙库线粒体、内质网等摄取、贮钙能力下降,钙代谢紊乱的结果。由于肾阳虚时下丘脑、血淋巴细胞 [Ca2+]i升高,激活 NOS 等多种酶,引起线粒体等细胞结构和功能的损伤,使细胞功能下降,特别是下丘脑、血淋巴细胞与机体的基本代谢,激素的分泌和调控以及免疫功能密切相关,下丘脑、血淋巴细胞的 [Ca2+]i的升高,破坏了其钙代谢的平衡,影响了下丘脑和血淋巴细胞功能,使机体的基本代谢紊乱,免疫力下降,出现一系列的肾阳虚症状。补肾中药能够调整机体的 Ca2+稳态失衡,可能与其具有降低血清钙,调整细胞膜的钙泵活性,升高胞内钙库摄钙、贮钙能力,及抑制NOS等酶的作用有关。正中隆起位于下丘脑内侧基底部,通过垂体柄与垂体相连。其正上方为第三脑室,额状面上为第三脑室底部膨大的三角形结构,由内到外分为内中外三层,外层为栅状带,较宽含有丰富的毛细血管,下丘脑神经分泌细胞的促垂体激素大多运输到此,再通过垂体门脉系统进入垂体前叶,中层为神经纤维,主要为下丘脑垂体束,参与垂体后叶的调控,内层即为第三脑室腔面的室管膜细胞[22]。下丘脑的许多神经分泌核团的含有神经分泌颗粒的神经末梢中终止于正中隆起,并且正中隆起本身也存在着一些促垂体神经分泌细胞,从正中隆起的神经联系和血管分布来看,它是下丘脑 -垂体 -内分泌轴上传下达的关键部位,与多种激素及其他信息的传递和调控有关。近年来中医肾本质的研究表明,肾阳虚证与下丘脑 -垂体 -内分泌腺轴的功能紊乱有关[23],推测主要发病环节在下丘脑[24], 宋春风等[25]运用扫描电镜观察了糖皮质激素醋酸可的松致肾阳虚大鼠下丘脑正中隆起室管膜细胞超微结构的变化发现肾阳虚大鼠下丘脑 -垂体 -肾上腺轴功能受抑制,室管膜细胞分泌功能下降,微绒毛分布改变,结构异常,分泌颗粒样结构几乎消失。细胞出现孔洞,这可能是室管膜细胞功能下降,细胞走向凋亡的一种形态表现。而温补肾阳中药能够直接作用于下丘脑,改善肾阳虚大鼠或老年大鼠下丘脑促肾上腺皮质激素释放激素 (CRF)神经元和神经纤维免疫活性[26]、CRFm RNA表达水平[27]及下丘脑双氢睾酮 (DHT)受体的亲和力[28],进而提高 HPA轴功能。同时可以改善下丘脑正中隆起室管膜细胞超微结构的损伤 。
右归饮是温补肾阳的经典名方,可拮抗肾阳虚大鼠体重增长受抑和饮食摄水的减少,改善动物下丘脑单胺类递质的含量[29];并可通过提高下丘脑CRFmRNA和CaMmRNA的表达以缓解肾阳虚证的阳虚状态[30][31] 。
3.2垂体改变
垂体是机体内最重要的内分泌腺之一,它分泌多种激素,调控其他许多内分泌腺和器官的功能,并以神经和血管与下丘脑相连,因此垂体在神经与内分泌两大整合系统的相互关系中居枢纽地位。近年来,随着对中医肾本质研究的逐步深入初步,认为肾阳虚证与下丘脑 -垂体 -靶腺轴的功能改变密切相关[32];宋春风等的试验[33]则从超微结构的角度,进一步证明肾阳虚大鼠垂体前叶五种内分泌细胞,除催乳激素细胞因雄性大鼠很少,未见明显变化以外,其他四种内分泌细胞 -生长激素细胞、促性腺激素细胞、促甲状腺激细胞、促肾上腺皮质激素细胞都有不同程度的粗面内质网扩张,线粒体肿胀、空化,细胞变形,核变形、
固缩,而益气补肾中药能够改善这种超微结构的损伤。
超微病理学认为,具有分泌功能或蛋白质合成旺盛的细胞粗面内质网较多,并多呈平行片排列,粗面内质网池也多呈狭隙状。当细胞受到缺氧、中毒等各种损伤时,粗面内质网和滑面内质网的形态改变表现为池的非特异性扩张和裂解。在损伤较轻时,内质网较轻度扩张,粗面内质网膜上的核糖体常部分脱落于胞浆中 ;当细胞损伤较重时,内质网高度扩张并裂解为大泡状。与此同时,高尔基体和线粒体等其他细胞器也发生类似的扩张[34]。从细胞的结构与功能分析,出现这些形态变化的原因可能有两个 :第一,缺氧等细胞损伤首先使敏感的细胞器线粒体肿胀、空化,使线粒体的氧化磷酸化作用受到影响,致使钠泵失效,Na+和水分进入细胞的内质网、高尔基体,使内质网扩张、脱颗粒,高尔基体扩张。第二,细胞合成或分泌蛋白质的过程受阻,排出困难而使分泌物堆积在这些细胞器中,引起其扩张或肿胀。但不管哪种原因,最终都将导致蛋白质的分泌减少,细胞功能的下降。因此,垂体内分泌细胞超微结构的改变,必然使其功能受到严重的影响,特别是各种多肽类促激素的合成,主要是通过粗面内质网完成的,这些细胞的粗面内质网扩张和脱颗粒,说明其蛋白质合成的精确性降低,酶的结构和活性发生种种改变,激素的合成减少。再加上线粒体的肿胀、核的固缩,影响了氧化磷酸化和 DNA 的转录复制,致使能量供应不足,DNA 的转录复制功能降低,而导致整个细胞的功能低下。宋春风等研究[35]的结果提示肾阳虚与垂体细胞超微结构的改变及其细胞功能下降有关,益气补肾中药对肾阳虚垂体超微结构的损伤有明显的改善作用,能够恢复其细胞功能,表明益气补肾中药能够通过影响垂体的形态结构,进而调整肾阳虚的种种表征,使机体恢复正常状态。试验中还发现,五种内分泌细胞超微结构损伤程度依次为促性腺激素细胞、生长激素细胞、促甲状腺激素和促肾上腺皮质激素细胞。
3.3甲状腺改变
下丘脑 -垂体 -甲状腺轴在人体的生命活动中起着重要的作用,与能量代谢、物质代谢及信息传递密切相关。有研究表明[36],肾阳虚大鼠血清中甲状腺激素 T3 、r T3 、T4 浓度明显低于正常大鼠,同时腺垂体分泌的 TSH也明显低于正常大鼠。补肾壮阳中药能恢复肾阳虚大鼠血清 T3 、r T3 、T4和 TSH水平  。宋春风等[37]以大剂量醋酸可的松造成大鼠肾阳虚模型,取其垂体、甲状腺制成超薄切片,进行电镜观察。发现肾阳虚大鼠垂体促甲状腺激素(TSH)细胞、甲状腺滤泡上皮细胞出现内质网、高尔基体扩张,线粒体空化,细胞变形,核的形态改变等超微结构的损伤。由于肾阳虚大鼠垂体 TSH细胞、甲状腺滤泡上皮细胞细胞核降解,线粒体肿胀,嵴空化,内质网扩张,而使核的 DNA复制、转录,线粒体的氧化磷酸化,内质网的蛋白质合成等功能受到影响,致使细胞的功能下降,合成和分泌激素的能力减弱,能量代谢率降低,最终导致多种器官的功能下降,而产生一系列的肾阳虚的症状,给予益气补肾中药能够减轻肾阳虚大鼠垂体超微结构的损伤,但对甲状腺细胞超微结构损伤的保护作用甚微。因此认为肾阳虚证与垂体 -甲状腺轴功能密切相关,而益气补肾中药则通过减轻垂体的超微结构损伤,调节垂体 -甲状腺轴的功能,而达到纠正肾阳虚证的效应。
3.4肾上腺改变
HPAA是神经内分泌网络的重要组成部分,对于调节机体的内稳态和各种功能都起着不可忽视的作用。中医学中的“肾”和肾上腺皮质功能的关系长期以来为中西医结合研究所重视。临床研究[38] [39]发现肾阳虚患者的垂体前叶一肾上腺皮质轴处于功能低下和混乱状态,糖皮质激素水平降低,并推测肾阳虚患者的糖皮质激素水平下降是由于垂体前叶功能低下。实验研究也发现[40]动物长期应用大剂量糖皮质激素,会由于糖皮质激素的反馈抑制作用而使肾上腺皮质功能受抑制,使血浆糖皮质激素水平降低,用醋酸氢化可的松复制的肾阳虚模型大鼠的血浆皮质醇降低,测定血浆中的ACTH浓度发现肾阳虚模型大鼠垂体前叶分泌的 ACTH 浓度降低。给予拮抗醋酸氢化可的松对肾上腺皮质功能的反馈抑制作用的药物后,P 和 ACTH 显著著升高,钟历勇[41]等的研究从分子水平表明,肾阳虚大鼠下丘脑促肾上腺皮质激素释放因子(CRF)mRNA显著受抑制,补肾中药能够提高下丘脑CRFmRNA的表达量与HPAA的功能,使受抑的CRFmRNA水平在一定程度上得以恢复。对作用广泛的Ca2+-CaM信号系统与肾阳虚的关系进行研究发现,在糖皮质激素所致的肾阳虚大鼠下丘脑中,CaMmRNA有较高的表达,在正常大鼠下丘脑中表达不明显,温补肾阳中药能抑制肾阳虚下鼠下丘脑中CaMmRNA的过度表达。在肾上腺中,肾阳虚组与正常
组相比,CaMmRNA亦显著上升。在垂体组织,肾阳虚组与正常组相比,CaMmRNA表达有上升的趋势,但没有显著的统计学意义。垂体和肾上腺组织中,补肾中药组CaMmRNA的表达均略低于肾阳虚组,亦没有统计学意义。已有研究表明,在CaM基因的 5′端非编码区有糖皮质激素的受体位点[42]。糖皮质激素能够抑制垂体促肾上腺皮质细胞ACTH的释放,这种抑制的早期 (< 2h),能够诱导出新的mRNA和蛋白。在T淋巴细胞中发现CaM,这种多功能的 Ca2 +受体蛋白,是加入糖皮质激素地塞米松后 2h内产生的几种蛋白之一[43]。在小鼠垂体促肾上腺皮质激素肿瘤细胞AtT2 0D1 6 :1 6 细胞中,人工合成的糖皮质激素地塞米松能够迅速诱导CaMmRNA的产生,而且在加入类固醇激素的同时加入CRF,能够显著地减少这种mRNA的产生以及糖皮质激素对ACTH释放的抑制。因此,CRF能够抑制糖皮质激素对ACTH释放的抑制作用及对CaMmRNA的诱导作用[44]。在祛除肾上腺的大鼠中,海马和皮质中的CaMmRNA显著减少。在祛除肾上腺的同时,每天给以皮质酮,则能阻碍CaMmRNA的减少[45]。可见,CaM对HPAA的调控起着重要的作用。因此认为糖皮质激素对HPAA的抑制与CaMmRNA的产生有关。肾阳虚时下丘脑CaMmRNA的诱导,与CaRFmRNA表达抑制有着直接或间接的关系。早在60年代邝安KUN等就发现助阳药能够对抗大剂量肾上腺皮质激素引起的耗竭作用[46]。随后的临床实验发现,肾阳虚患者血清中 17-羟皮质酮降低[47];垂体前叶-肾上腺皮质轴功能低下,糖皮质激素水平降低[48]。实验研究[49]也表明,糖皮质激素所致肾阳虚大鼠血浆糖皮质激素水平降低,并直接证明了肾阳虚大鼠血浆糖皮质激素水平降低是由于垂体前叶功能受损所致。任何器官或组织机能不足必然有其物质基础,这就是细胞的形态结构的改变,严重时引起细胞的萎缩、变性或坏死。本实验结果表明,肾阳虚大鼠垂体ACTH细胞 ,存在着内质网扩张 ,线粒体肿胀、空化等超微结构损伤。肾上腺则出现束状带、网状带严重萎缩,细胞萎缩变小,束状带脂滴分布异常或消失。这些超微结构的损伤是导致肾阳虚大鼠垂体 -肾上腺功能低下的重要原因 ,补肾中药能够改善垂体ACTH细胞的超微结构损伤 ,但对肾上腺皮质的改善不明显。肾上腺皮质三个区带分泌醛固酮 ,主要受血管紧张素Ⅱ和血浆 Na+、K+浓度调控 ,束状带分泌糖皮质激素 ,网状带分泌性激素 ;后两带主要受垂体分泌的ACTH调控。ACTH 不但促进糖皮质激素的合成与分泌 ,而且是维持束状带和网状带正常结构的决定因素[50]。本实验中发现 ,肾阳虚大鼠垂体ACTH细胞存在着内质网、线粒体等超微结构的损伤 ,而 ACTH细胞中内质网是合成ACTH的场所,线粒体是细胞进行氧化磷酸化、产生能量的场所。因此,这些超微结构的损伤,使得ACTH的合成和分泌受抑制,进而导致肾上腺结构的损伤,表现为肾上腺束状带和网状带细胞的萎缩,而最终导致糖皮质激素分泌受抑。由此可见,垂体 -肾上腺的超微结构的异常是肾阳虚证的原因之一,补肾中药能够通过改善垂体ACTH细胞超微结构的损伤而调整垂体 -肾上腺的功能,而最终改善肾阳虚症状。 c-Fos 是一种存在于正常细胞核内的原癌基因,广泛存在于真核细胞基因组内,对正常细胞的分裂、生长、分化及信息识别起重要作用[51]。c-Fos的功能是通过它所编码的核内磷蛋白Fos实现的,Fos 是真核细胞内调控因子,在细胞信号传导过程中起重要作用。研究证实,至少有 3 种明确的第二信使能激活c-Fos,即依赖甘油二脂的蛋白激酶C(PKC),cAMP和Ca2+钙调素复合物 (Ca
2+-CaM) [ 5 2 ]。这些第二信使通过激活c-Fos等一些原癌基因,生成多种多样的核蛋白,把第一和第二信使传来的信息与靶基因表型的改变耦连起来,进而调节靶基因的表达和转录速率,因此又称 c-Fos 为第三信使,它在第二信使和靶基因的表达中起着桥梁作用。c-Fos是即刻早期基因 (immediate early gene)家族中的一种,它的蛋白产物Fos参与多种形式的急性刺激[53],虽然肾阳虚是一种慢性虚损症状,但由于 c-Fos 基因蛋白产物在复杂的细胞信号传导过程中起着重要作用,特别是 c-Fos 基因上端调控序列含有若干个转录调控元件,其中位于 c-Fos 启动子上游60个碱基对处的钙反应元件 (CaRE)决定了细胞钙可调节c-Fos表达[54]。一些研究还表明,细胞内Ca2+增加可能是不同刺激诱发c-Fos基因表达的共同机制,凡可使胞内Ca2+增高的因素均可诱导c-Fos基因的表达[55]。除此之外有研究表明,慢性重复性刺激亦可引起 Fos 表达[56],并且慢性应激可以诱导 c-Fos 持续表达[57]。肾阳虚大鼠下丘脑、肾上腺细胞中Ca2+浓度升高,补肾中药右归饮能够抑制这种Ca2+浓度的升高,鉴于肾阳虚证与 Ca2+浓度的密切关系。原癌基因 c-Fos 被认为是细胞核内信号传导的第三信使,在信号传导中通过调节某些特殊基因的表达而将外界信号和基因表型改变耦连起来,各种细胞外信号通过三磷酸肌醇 (IP3 )、Ca2+、cAMP 等第二信使,诱导 c-Fos 的表达,其产物 Fos 蛋白与核蛋白 Jun 通过亮氨酸拉链形成异源二聚体蛋白激活因子 1 (AP1 ),AP1 可特异性地结合某些基因的特异位点,即 AP1DNA 结合位点 TGACTA,诱导靶基因的表达,从而将细胞外信号转变为细胞内基因表达的刺激信号,起到调控基因表达的作用[58]。进一步研究与 Ca2+-CaM 信号密切相关的 c-Fos 基因产物 Fos 蛋白的表达。发现肾阳虚时下丘脑视交叉上核和肾上腺皮质中 Fos 蛋白表达增强,补肾中药右归饮能够抑制这些细胞中 Fos 蛋白的表达。但垂体中均未见 Fos蛋白表达。Fos 异常表达的确切机制尚不清楚,但许多研究表明,胞内Ca2+浓度的升高均能够诱导c-Fos基因的表达,胞内升高的 Ca2+浓度,能够激活 CaM 形成 Ca2+CaM 复合物,对转录因子进行磷酸化修饰,进而.启动 c-Fos 等即早基因的转录[59]。有文献报道, c-Fos/c-Jun 二聚体结合到 DNA 的特殊位点上是蛋白激酶调控系统的重要作用点[60], c-Fos 启动子含有一个经 CaMPKⅡ激活的第二顺式作用元件,这个 DNA 序列被认为是CaMPKⅡ反应元件 (CaMRE) [ 6 1 ]。因此,CaMPKⅡ能够诱导Fos蛋白的表达。Fos蛋白的表达和许多生理反应有关,下丘脑室旁核区域 c-Fos 调控着心率及皮质醇的变化[62]。其能够抑制糖皮质激素 (GC)对CRF基因表达的影响,其表达与糖皮质激素在血液中的浓度有关[63];肾上腺切除后可加强c-Fos和CRF基因的表达[64]。因此,fos蛋白的过度表达与Ca2+浓度的改变密切相关,包括与Ca2+信号传递密切相关的CaMmRNA及 CaMPK,并与其所在细胞的特定功能密切相关,能够反映其所在细胞某种特定功能的变化。肾阳虚时下丘脑视交叉上核和肾上腺Fos蛋白的过度表达,与肾阳虚大鼠Ca2+浓度的升高、CaMmRNA表达及CaMPK活性的升高,具有因果关系,提示肾阳虚时某种因素可能诱发 Ca2+在胞内聚集,增高的 Ca2+又与 CaM 结合形成Ca2+CaM复合物,激活CaM依赖的蛋白激酶,引起一系列的生理改变。同时由于Ca.2+,CaM第二信使的改变.诱导 c-Fos 基因的表达,其表达产物 Fos 蛋白又作用于特定的靶基因而影响这些基因的表达,从而导致相
应的功能改变。下丘脑视交叉上核位于视交叉背侧,细胞小而密集,其传出纤维还到达下丘脑的其他核团,如结节区的室周核、腹内侧核、背内侧核、弓状核、漏斗核及正中降起。其中视交叉上核至正中隆起的投射,参与腺垂体激素的分泌调节,如肾上腺皮质激素分泌的昼夜节律变化。肾阳虚大鼠下丘脑视交叉上核 Fos 蛋白表达的增加,说明肾阳虚时下丘脑 垂体 肾上腺轴的功能紊乱可能与下丘脑视交叉上核 Fos 蛋白表达改变有关。肾阳虚时下丘脑视交叉上核 Fos 蛋白表达的增加,影响了下丘脑对垂体和肾上腺激素的分泌功能的调控,从而导致下丘脑-垂体-肾上腺轴的功能紊乱。另有研究表明,急性应激 24h 后即观察不到 c-Fos 阳性细胞,而慢性应激可以诱导 c-Fos 持续存在[65]。Smeyne 等[66]用 Foslac Z 转基因小鼠证明, c-Fos 持续过度表达与细胞的凋亡有关。肾阳虚时肾上腺组织中Fos过度表达,以及Ca2+、CaMmRNA的升高等因素可能诱导了肾上腺组织的细胞凋亡,而出现肾阳虚的一系列症状。补肾中药可能通过抑制肾阳虚大鼠下丘脑视交叉上核和肾上腺 Fos 蛋白的表达,调整肾阳虚大鼠下丘脑 垂体 肾上腺轴的功能,抑制肾上腺细胞的凋亡,从而改善肾阳虚的症状。国内对肾虚的研究中巳注意到肾阳虚患者主要表现为糖皮质激素的减少,而盐皮质激素的变化不大。盐皮质激素以醛固酮为代表.它不象糖皮质激素那样主要受垂体前叶分泌的ACTH的调节,而主要受肾素一血管紧张素系统的调节”,尚未见肾阳虚模型大鼠的肾素一血管紧张素一醛固酮系统发生改变的报告。
3.5性腺轴改变
杨明等[66]用流式细胞仪分析男性肾阳虚不育症患者精液 DNA,从 DNA 的单倍体量、二倍体量及多倍体数量发现患者精子以异常的二倍体和多倍体为主,经益气补肾治疗后 DNA 单倍体数目则明显增多。病理研究发现[67]“肾阳虚”模型组大鼠睾丸呈萎缩状态,曲细精管退化变性,管腔内生殖上皮变薄,精子数目明显减少 ;正常对照组及益气补肾组睾丸组织未见异常改变,曲细精管内精子发生完全,各级生精细胞排列规则。
4.其他
4.1 免疫系统
白细胞介素Ⅱ(IL-2),它是由 TH细胞分泌的一种淋巴因子,具有促进并维持T淋巴细胞在体内外的生长,参与B淋巴细胞抗体产生,诱导NK细胞增殖分化及产生干扰素等,是体内重要的免疫调节物质[68]。白细胞介素Ⅱ的产生受神经内分泌的影响[69] [70] [71],同时也对神经内分泌系统产生一定的作用[72] [73]。检测白细胞介素Ⅱ活性能从分子水平反映体内免疫功能状态。章建民[74]等检测了皮质酮“肾阳虚”小鼠的有关免疫指标,结果表明模型小鼠的 NK活性、 T淋转、 IL-2水平及 r-IFN活性均明显降低。 [75]实验性“肾阳虚”大鼠红细胞 C3b受体花环率明显下降,红细胞免疫复合物花环率则显著上升。 童光东等[76]以温补培元方剂治疗后,动物巨噬细胞功能、脾细胞自然杀伤 (NK)细胞活性及刀豆素A(ConA)刺激的淋巴细胞掺入率(LIR)、红细胞免疫以及白细胞介素2(IL-2)含量均有显著改善。 有文献报道脂肪酸具有改变淋巴细胞膜的结构和 /或改变淋巴细胞的功能,参与T-淋巴细胞的磷脂代谢等作用[77]。观察皮质酮所致肾阳虚模型小鼠免疫功能低下与红细胞膜磷脂脂肪酸和血浆磷脂脂肪酸含量的变化的关系,结果显示[78]:皮质酮所致肾阳虚模型小鼠的脂肪酸百分含量变化很大,尤其是不饱和脂肪酸显著降低,甚至缺乏(血浆和红细胞膜磷脂脂肪酸均未检出二十碳四烯酸 )。从另一角度来讲,说明脂肪酸水平的高低直接影响机体的免疫功能活动。
4.2 微量元素变化
微量元素在生物体内的生物代谢过程中有着特定的作用,它们通过构成关键酶、或作为关键酶的激动剂或抑制剂、或构成其他物质调节生物代谢而发挥作用。马威等[79]通过用非线性映射方法分析肾阳虚模型组、益气补肾组及对照组的血液微量元素浓度。肾阳虚模型动物全血铜、铁、锌等元素含量与造模前相比均显著降低 (P<0.05),皮质醇降低 ;益气补肾治疗后,与肾阳虚模型相比,肾阳虚症状缓解,同时全血微量元素铜、铁、锌、锰、镉、镍等元素均显著性增高。锌是人体内作用最广泛的微量元素,这是因为锌作为酶的辅助因子,参与细胞内核酸的合成,转录和翻译过程。柴立等[80]通过统计对比,发现造成肾虚的病因与引起微量元素锌锰缺乏的病因有 95%相同,提出锌锰是中医肾的物质基础;刘锐[81]测定了38例阳虚病人血中微量元素锌的含量发现,它们都不同程度的低于正常人,同时,血锌的降低符合五脏虚损的情况,即血锌含量为正常人 >脾阳虚 >肾阳虚 >脾肾阳虚 ;管竞环[82]研究发现,在常用的 8味补肾中药中,锌、锰的含量高低与其提高“肾阳虚”小鼠的 DNA合成率的作用强弱呈正相关关系,同时分析慢性肾衰脾肾阳虚患者体内微量元素变化,发现均表现为血锌、锰、铁、磷缺乏。
4.3 脂质过氧化与抗氧化指标
中医理论认为 :肾主人体生长发育,肾虚是衰老的重要原因。现代医学研究表明,自由基损伤是衰老的重要原因之一。由此推论,中医肾虚证与自由基代谢紊乱可能存在某种对应关系。临床研究发现[83],肾阳虚证患者红细胞 LPO 明显升高,SOD 活性明显降低,提示红细胞脂质过氧化反应增强,而清除氧自由基能力降低,抗氧化能力降低。过多的超氧阴离子自由基可攻击细胞膜上的多元不饱和脂肪酸,产生多种脂质过氧化物,进而造成细胞膜的脂质过氧化损伤 ;而超氧化物歧化酶活性降低,又不足以催化超氧阴离子自由基的歧化反应,不能有效清除生物氧化产生的超氧阴离子自由基,使细胞和组织免受损害。肾阳虚患者红细胞抗氧化能力降低将会影响红细胞的变形性及膜的流动性、通透性,使细胞内外钠、钾、镁、钙离子浓度失衡,引起机体功能障碍。吕爱平等[84]采用经典方法复制肾阳虚证动物模型脂质过氧化物 (LPO)含量增加,谷胱甘肽过氧化物酶 (GSH-Px)活性以及 GSH-Px/LPO(抗氧化能力的重要参数 )比值下降。温补脾肾药物具有降低 LPO含量,提高 GSH-Px活性及抗氧化能力的作用。 [85]肾阳虚大鼠晶体sod活性降低,lpo活性升高。
4.4 线粒体磷脂变化
吕爱平等观察[86]并对比了肾阳虚证动物模型大鼠治疗前后神经鞘磷脂(SM)、磷脂酰胆碱 (PC)、磷脂酰乙醇胺(PE)和磷脂酰甘油(CL)的含量变化。肾阳虚模型大鼠SM升高,PC 下降,SM/PC比值升高。药物治疗后SM降低,PC升高。 还有一些学者从红细胞钠泵[87]、耳蜗电位及毛细胞血管纹琥珀酸脱氢酶(SDH)[ 8 8 ]、甲皱和皮肤微循环、能量代谢、水盐代谢、自由基等[89]方面对肾阳虚进行了研究,均发现有异常。这些研究无疑开阔了肾阳虚证的研究思路,丰富了肾阳虚证的研究资料,为进一步研究肾阳虚证的本质奠定了基础。总之,由于中医的肾在五脏中居主要地位,不同于西医的肾,涉及的面又非常广,因此有关肾阳虚证的研究也非常广泛而丰富,目前主要集中在神经内分泌免疫系统,但要真正揭示肾阳虚证的本质,还需要作长期不懈的努力。
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1作者简介:刘尚全,男,上海第二医科大学03级博士研究生,研究方向内分泌代谢。

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Sometime, patient, who has tried to conceive, asked me the question–“Dr.Fan, for infertility treatments, do you think it is necessary to use different acupuncture points, based on different period phases?”

Similar question we could ask–“Dr.Fan, using Chinese herbology, what do you comment to using different herbs according to women period phases?”

My answer is:

TCM treatments based on period phases, either acupuncture or Chinese herbology in Chinese Gynecology, actually was based on my two teachers, Dr.Xia Gui Cheng (some books published in western countries in recent years  in English language may reflect Dr. Xia’s experiences and theories) and Dr. Sun Ning Quan (he died in early of 1990s), who clearly mentioned the relationship between women period phases and Yin-Yang cycle in 1970s.  They clearly mentioned using different Chinese herbs/ formula to treat the illness/disorders which are related to women’s period cycle, or adjust the irregular period to reach the aim of conceiving.  Before them, almost all Chinese medicine doctors use traditional Pattern differeciation (Bian Zheng Lun Zhi) to treat female patients.

So, we could have two different ways / strategies to handle same problem, i.e.infertility–either traditional Bian Zheng Lun Zhi or according to period phases(actually another style Bian Zheng Lun Zhi).  For teaching in class or writing / publishing a book, the practitioners (TCM doctors, teachers) may prefer to using different methods to treat patients in different period phases.  Such as in period flow time, using certain methods; in estrogen phase, using certain methods; during ovulation, using certain methods; and during progestrone phase, using certain methods.

In theory, we prefer that, but we need to consider the real practice condition.  This rule/method could adjust according to fit different conditions.

Using only one set of treatment strategy may not fit to everyone, esp. to patient who has some experience from other practitioners’ office or reading some books. However, sometime, we have to use it, of course, still need modify accordingly.

Talking acupuncture first.

For fertility issue, we, indeed,could do different “menu” for different phases of period, however, some patients are not like certain positions or some points.  I mean we face some challenge sometime. So we have to use equievlant points in a patient’s confortable position.

Second, we find it is not uncommon–when patients come to see me, sometime they forget the exact days in their period cycle. When I ask– “today, what day is in your period cycle?” Patients may reply–” Oop! I need ask my husband”, or ” I need look for my calender” (today I met two!).

And it is very common–” I have/had a travelling”, “I am/was busy…..”, “I am sorry to miss the appointments”.  So it seems we could not do something in real time in some patients.

Sometime, doing acupuncture according to patients’ period cycle seems very difficult.

So, based on 25 years of my clinical experience, I feel basing on traditional strategy sometime is also a good option.  I use one bigger acupuncture formula to adjust according to specific condition, which includes a few things (here, we use conventional words / terms, although we do consider it in TCM theory and terms, the original thinking style):

1. Adjusting the energy level to handle the stress or mental issue, which affects gynecological function;

2. Adjusting hypothalamus and pitutary function which is upper center for ovaries and uterus functions;

3. Adjusting the local function of ovaries and uterus functions, and circulation of pelvic area.

Total how many needles for this formula? 25-30 per time.

Each time, we basically do not want to adjust the formula totally, may be adjusting 3-5 needles based on new condition or phases issue.  One reason is about half of our patients don’t like to use less needles (“why last time used 25, today use 21?”)–they paid, so they want to use more, at least same amount needles; And, explanation takes too much time. However, we do adjust if different patterns, or patients’ different reactions occur.

The results from our center for fertility is good, over 40 ladies got pregnant, either acupuncture alone or with IVF, IUI since 2007.

Talking about Chinese herbology.

In China, the herbology for infertility treatments has been a main therapy since 2000 years ago.  Before my teachers, “the great master”, Dr. Xia Gui Cheng (who helped Chinese president Hu Jing Tao to get his grandchild) and his former colleague Dr. Sun Ning Quan (he was the first one who mentioned using TCM herbs to adjust patients’ period based on patient’ s period phases), in history, TCM gynecologists almost all using single method to treat infertility, such as adjusting Live Qi, Regulating the Blood, or Tonifying the Kidney and Spleen…… Since my teachers, the rule has been changed–adjusting women’s period according to period phases.  It is sure, I am their “good student”.

However, in United States, the culture is very different.  Using herbs meet some challenges in present time.

No.1 issue is patients seem not like the tastes, and using too much time to cook; and it is not uncommon–forgot to take in time.  “Too busy” is one of their stories.

No.2. FDA still treats herbs as food, so any side or adverse effect is not allowed for herbs.  And, conventional MDs are not welcome new remedies which may have a competition with them–they have no training in herbology too, so they might always give negative advices to patients for herbs.

So, 2/3 patients could not use herbal tea regularly, 1/2 patients could not use herbal pills in time.

For getting more positive results, I have been working on more herbal application combining with acupuncture.

Following the Big Tao(Dao), Making Everything Real Simple” (Da Dao Zhi Jian).  Using one set of treatment plan to modify in fertility treatment is my current main method.

I heard famous TCM gynecologist Dr. Bei Run Fu in California also has simplified his treatment strategies. In China(15 years ago), he prefered the Dr.Xia’s theory and published many papers; but when he came in USA, he gradually comes back to the traditional Bian Zheng Lun Zhi, to use one strategy to modify the formula in fertility Chinese herbology practice today.

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Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial.

Country: Germany

Institute: Department of Sports Medicine, Goethe-University Frankfurt, Ginnheimer Landstrasse 39, 60487, Frankfurt, Germany, m.huebscher@sport.uni-frankfurt.de.

Author(s): Hübscher M, Vogt L, Ziebart T, Banzer W.

Journal: Eur J Appl Physiol. 2010 May 25

Abstract:

The present study investigated the immediate efficacy of acupuncture compared to sham acupuncture and placebo laser acupuncture on strength performance. A total of 33 recreational athletes (25.2 +/- 2.8 years; 13 women) were randomized to receive acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser acupuncture (deactivated laser device) in a double-blind crossover fashion with 1 week between trials. Assessment included bipedal drop jumps for maximum rebound height and quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface electromyography (EMG) was used to measure the EMG activity of the rectus femoris muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF) analysis was applied to characterize muscular endurance. Measurements were performed at baseline and immediately after treatment by a blinded investigator. Repeated measures ANOVA and post hoc paired-sample t test with Bonferroni-Holm correction were used for statistical analysis.

The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N). ANOVA did not show statistically significant treatment effects for drop jump height or MPF.

The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performance enhancement, but also for rehabilitation programs aimed at restoring neuromuscular function.

Full text:

Click here for the full article text.  

Pubmed ID: 20499248

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http://www.aaaomonline.info/aom_in_us.pdf

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Acupuncture and Oriental Medicine (AOM), i.e.Traditional Chinese Medicine (TCM)’s definition, scope, research, education and license requirements.

Special report of SAR. Article from the official Journal of AAAOM, Acupuncturist.March 31, 2009.

http://www.aaaomonline.info/aom_in_us.pdf

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Asking

From: A…. C
Subject: gender prediction
To: ArthurFan@ChineseMedicineDoctor.us
Date: Wednesday, September 22, 2010, 12:53 PM

Hi –

I just read your post on the internet regarding determining pregnancy thru pulse reading. My Acupuncturist recently told me the gender of my baby thru pulse reading (only 6 days after and IVF transfer). Is there any merit to this, and if so, how early can it be done? He mentioned about the left side stronger, and not detecting the babies female hormone in my body, therefore it must be a boy. There’s not much about it on the internet, but what I could find says that it can be about 80% accurate.

Thank you.

A….C.

A reply from Dr. Arthur Fan

Hi, A….,

The pulse diagnosis should be one of testing methods, which gives a trend of something (just a potential) and need other tests to confirm it.

My main concern is in “modern days”, there are too much interfering stuff which could affect the pulse and make the pulse diagnosis inaccurate some time (I mean the “sham pulse”). For example, using too much of progesterone may cause the pulse bigger and slippery, some providers may think the woman may get pregnant.

For your case, the pulse could be affected by the hormone or drugs you used during IVF.

At this moment, only 6 days after the embryo transferred, it is a bit too soon to tell –is boy or girl.

Let say, 10 women got pregnant only for 6 days, if the provider says 10 all boys. At last, if at half (5 are boys, 5 are girls), or as you said 80% chance, say 8 are boys, 2 girls, then some women will treat the provider “magic”(if at last they get boys), and other will treat him “nonsense”(if get the girls).

I mean, we use the pulse diagnosis as one of testing methods, which give us some trends, not the last diagnosis. We must combine some other methods to make last diagnosis. I strongly against the way–only use pulse diagnosis to tell something.

I did see some patients had bad experience from our “colleagues”.

Arthur Yin Fan, PhD,CMD,LAc
McLean Center for Complementary and Alternative Medicine, PLC
8214 Old Courthouse Road, Tysons Square Office Park,
Vienna, VA 22182.
Phone:(703)499-4428; Fax:(703)547-8197
Web: http://www.ChineseMedicineDoctor.US
Blogs: www.arthuryinfan.wordpress.com

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