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主题:【原创】关于针灸问题的基点说明 -- 虽远必诛

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    • 家园 中医院已经西医化

      我母亲血脂高,脑血管硬化,8年来用药不断。这病也不是疑难杂症,为了方便和良好的服务,因为她的本家侄子是中医学院的教授,所以到一家省中医学院的附属医院就诊,间或住院治疗。用的药没有一剂是重要,全是西药。我不知道中医疗效如何,如果中医的疗效与西医相当,至少接近。那么中医学院是断不会用西药的。而血脂高和脑血管硬化,是现在的常见病,多发病。还请中医学院的各位高人拿出振奋民族精神,至少振兴中医的研究成果。

    • 家园 楼主说自己临床二十多年了,您是中医从业者还是西医从业者?
    • 家园 一篇關於針灸的文章最近發表在《自然神經科學》上

      以下引用一段相關的新聞報導(Discovery News)。

      Acupuncture Releases Natural Painkiller

      我摘一段,

      Studies have shown a clear link between acupuncture and pain relief in animals, but research on people has offered more confusing results,said Richard Harris, who studies chronic pain and acupuncture at the University of Michigan, Ann Arbor. Many large trials have found that pretend acupuncture works just as well as -- and sometimes even better than -- real acupuncture.

      我想主要原因大概在於:因為動物跟人類不會溝通,因此在人類中出現的暗示現象(這裡是shame acupuncture)不會出現在動物身上。因此在小鼠身上針灸鎮痛反而獲得了非常明確的關聯。但是在人類身上,不僅針灸可以鎮痛,假動作也可以鎮痛。但是,針灸不能止痛則沒有提及。

      全文見

      http://news.discovery.com/human/acupuncture-pain.html

      Acupuncture Releases Natural Painkiller

      2010年5月31日下午05:30:00

      When they get acupuncture, mice release a natural pain-relieving

      molecule that scientists have never linked with the treatment before.

      While it’s not clear yet whether the finding will apply to humans,

      unraveling the biological secrets of acupuncture could help the

      therapy become a mainstream way to tackle pain.

      “I think it’s important that the Western world take acupuncture

      seriously,” said Maiken Nedergaard, a neuroscientist at the University

      of Rochester in New York. “Many patients have unnecessary pain. I hope

      this can improve pain treatment.”

      Acupuncture has been around for thousands of years, and the World

      Health Organization has endorsed it for more than 20 conditions, but

      Western medicine continues to be skeptical about the practice.

      For managing pain, sessions last about 30 minutes and involve

      inserting small needles into specific acupuncture points, then

      periodically rotating the needles, using electrical stimulation or

      adding heat.

      Studies have shown a clear link between acupuncture and pain relief in

      animals, but research on people has offered more confusing results,

      said Richard Harris, who studies chronic pain and acupuncture at the

      University of Michigan, Ann Arbor. Many large trials have found that

      pretend acupuncture works just as well as -- and sometimes even better

      than -- real acupuncture.

      “The acupuncture community feels that acupuncture is doing something,

      but differentiating that from the effects of sham acupuncture is more

      difficult to do,” Harris said, partly because pain is so complicated

      in people, and the placebo effect is powerful.

      “When a patient complains of chronic pain, there’s not just the

      intensity of painful stimulation,” Harris said. “There are also

      issues about whether the person can still work and provide for their

      family, whether there is a disability or they are under litigation to

      receive money to compensate them for their illness. A lot of factors

      go into pain.”

      In his own studies, Harris and his group have found that sham

      acupuncture works by increasing levels of endorphins and other feel-

      good chemicals in the brain, while true acupuncture works by targeting

      the receptors for those chemicals, increasing the number of receptors

      that are activated or helping them bind more tightly.

      Still other studies have shown that certain parts of the brain get

      turned off during acupuncture therapy, leading to analgesic effects.

      In the new study, just published in the journal Nature Neuroscience,

      Nedergaard and colleagues looked instead at adenosine, a molecule that

      influences inflammation, sleep and the heart, and also acts as a

      natural painkiller. Using mice with injured paws, the scientists first

      demonstrated that adenosine was released during acupuncture.

      Next, they found that acupuncture reduced the amount of pain that the

      mice felt by two-thirds. The researchers measured pain levels by how

      quickly the animals moved their legs away when touched. In mice that

      didn’t have adenosine receptors and so couldn’t benefit from any of

      the molecule’s effects, there was no relief from pain.

      Finally, the researchers gave the mice an approved leukemia drug that

      lengthens the amount of time that adenosine sticks around. With the

      drug, the animals experienced relief for three times as long: three

      hours instead of an hour.

      If the same strategy worked in people, it might be possible to treat

      chronic pain more effectively with, say, a combination of acupuncture

      and drugs that enhance acupuncture’s benefits. One hope is that

      acupuncture could cut into the amount of medicine people need to take,

      Nedergaard said. That could reduce side effects and lower the chances

      of addiction to narcotics.

      That’s a big if, Harris warned. These kinds of pain studies in rodents

      often don’t translate to humans, and the new study didn’t compare

      needle pricks at specific acupuncture points with pricks in other areas.

      Still, he said, by pinpointing the science of how acupuncture works,

      studies like this give legitimacy to acupuncture and help move the

      field forward.

      “There are definitely people out there that are suffering from chronic

      pain that could get better if they had access to treatment and if

      their insurance companies covered it,” Harris said. “I really do

      think that acupuncture offers hope for some people.”

      • 家园 翻译一下,看不懂
        • 家园 試譯一下

          Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture

          腺苷A1型受體介導了針灸的局部抗神經毒作用

          Abstract

          摘要

          Acupuncture is an invasive procedure commonly used to relieve pain.

          針灸是一種通常用於止痛的侵入性療法。

          Acupuncture is practiced worldwide, despite difficulties in reconciling its principles with evidence-based medicine.

          儘管難於將其理論與實證醫學折沖調和,針灸依然在世界範圍內被廣泛應用。

          We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression.

          我們發現,在對小鼠的針灸過程中,腺苷(adenosine)作為一種神經調製因子被釋放(於神經細胞間隙)並用來拮抗神經毒的作用;這種拮抗神經毒的作用需要神經細胞表達一種被稱為腺苷A1型受體Adora1的蛋白。

          Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture.

          在小鼠中身體上直接注射Adora1這個受體的激活劑,這個實驗再現了針灸的鎮痛效應。

          Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture-elicited increase in adenosine, as well as its anti-nociceptive effect.

          反之,抑制參與降解腺苷的酶則促進了(針灸產生的)腺苷的積累;同樣,腺苷對神經毒的拮抗也增加了。

          These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.

          這些觀察結果表明,腺苷介導了針灸鎮痛的功能;而且,針灸在臨床應用中或許更會得益於進一步干擾腺苷的代謝。

          关键词(Tags): #針灸#腺苷#Adenosine A1 recepto
      • 家园 这个应当不是很新的内容

        另外shame needle 分很多种。

        有乱扎一气的,有体外用针的,有用TENs的。

        文章没有给出到底用的那种。

        placebo effect 在针灸作用中是非常强大的,但不是全部。

        针灸对慢性疼痛有效,比TENs作用时间长。但是无法解决疼痛根本问题。

        • 家园 發表在五月三十號的Nature Neuroscience

          Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture

          Journal name:

          Nature Neuroscience

          Year published:

          (2010)

          DOI:

          doi:10.1038/nn.2562

          Received

          16 March 2010

          Accepted

          27 April 2010

          Published online

          30 May 2010

          Abstract

          Acupuncture is an invasive procedure commonly used to relieve pain. Acupuncture is practiced worldwide, despite difficulties in reconciling its principles with evidence-based medicine. We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression. Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture. Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture-elicited increase in adenosine, as well as its anti-nociceptive effect. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.

          • 家园 我是说内容

            针灸可以刺激内啡肽的水平,下行抑制, 可以激活gate control,节段性抑制等。

            加上安慰剂效应。

            这些可能是目前认可的针灸机理。

            • 家园 确切点说是套路化的针灸机理

              针灸可以刺激内啡肽的水平,下行抑制, 可以激活gate control,节段性抑制等。

              NATURE上的文章也没有脱离从单一机理确认针灸作用的套路。不知道虽远必诛兄说的内容老是不是这个意思。

              但是如果把这些作用联合起来,在各环节作用都不强的情况下,能否产生超出单环节作用水平极限的整体作用。这方面的研究还基本是空白。

              大多数人认为,不过是扎针,能产生如此多的作用已经可以了。虽远大夫觉得应当更高更快更强。

              慢慢来吧。

              未来的事情很难讲。

              毕竟组学的研究才刚刚开始。

    • 家园 常识主义者的思考

      中医是否有效、效果达到什么程度要用事实来说,国内中医药有很多杂志,每年也毕业很多博士、硕士,他们的文章也要用现代科学的方法来统计疗效,而且结论大多数不可能是“中医是锦上添花、可有可无,靠撞大运”,而应该是有效,否则他们也不用混这口饭了。具体论文结论可以在网上搜索到。如果他们是可信的,那么中医的效果就是可以被科学证明的;如果他们是不可信的,那就是中医界在集体严重造假。

      是不是造假要有根据。虽远大夫说如果中医有效那么外文期刊也应该发表很多,外文期刊不发表所以不可信、没得到学术界认可。这个值得商榷,某种期刊发表哪方面的文章有倾向性,或者说学术界有倾向性,对你的东西不感兴趣就不登,而不是看文章正确与否。至于有什么发现了就可以拿诺贝尔奖,我们知道有些诺贝尔奖是颁发给十几年几十年前的成果的,更有甚者,有的科学家都没能活着看到自己的成果被广为关注或者接受,这不是理论本身正确与否的问题,爱因斯坦获得诺贝尔奖名义上就不是因为相对论。科学理论还是应该让事实来证明。大夫曾经讨论过一个关于中医治疗感冒无效的外文文章,其实那篇文章主要讨论的是统计程序上的不正确,而不是中医本身,关注点还是西方的统计学。

      国内的论文在讨论中医的问题中经常被正反两方忽略,倒是个奇怪的现象。随便说一句,关中药的研究不只是植物提取,还有汤剂、组方、中成药等,这些和中医理论有关。

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