针灸及针灸联合中药治疗骨质疏松症的进展
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摘要
目的分析针灸及针灸联合中药治疗骨质疏松症的研究进展,以期为骨质疏松症临床治疗和基础研究提供思路。方法以骨质疏松症、针灸、中药等为关键词,检索CNKI、维普、万方等国内医学文献数据库自2014年1月至2018年8月发表的有关针灸及针灸联合中药治疗骨质疏松症的文献,分析文献的类型,总结基础研究及作用机制、临床疗效标准与治疗结果,并对常用穴位及中药复方进行总结。结果自2014年1月至2018年8月共检索到136篇相关文献。其中针灸治疗骨质疏松症有94篇,常用穴位有:阿是穴、肾俞、命门、关元、气海、腰阳关、脾俞、足三里、三阴交等,基础和临床研究均表明针灸能显著提高骨质疏松大鼠和病人的骨密度。针灸联合中药治疗骨质疏松症的文献有42篇,常用的复方有补肾壮骨汤、补肾健脾汤、补肾化瘀汤等,但缺乏相应的动物实验研究。结论针灸能在一定程度上抑制骨质疏松发展,其联合中药有助于增强临床疗效。但针灸治疗骨质疏松的作用机制研究相对滞后,选穴及用药没有统一标准,缺乏长期临床疗效观察及不良反应研究,这些问题需要在未来的研究中加以解决。
Objective To review the efficacy of acupuncture and acupuncture combined with traditional Chinese medicine(TCM) in the treatment of osteoporosis, which may help to provide new ideas for clinical treatment and basic research of osteoporosis. Methods The literatures in the China domestic medical literature databases(CNKI, VIP and Wanfang) published from January 2014 to August 2018 were retrieved with the key words such as osteoporosis, acupuncture, and TCM. The type of articles was analyzed. The basic research, mechanism of action, clinical curative standard, treatment results, and acupuncture points, as well as the formulas of TCM were summarized in the current study. Results A total of 136 articles have been recorded in the databases. Of those, 94 were focused on studying the effects of acupuncture treatments on osteoporosis. The commonly used acupoints were A'shi points, Shenshu, Mingmen, Guanyuan, Qihai, Yaoyangguan, Pishu, Zusanli, and Sanyinjiao, etc. The clinical and preclinical results demonstrated that acupuncture significantly increased bone mineral density in osteoporotic patients and ovariectomized rats. In addition, 42 articles were dealt with the combination of acupuncture with TCM formula. Nourishing kidney and strong bone decoction, nourishing kidney and invigorating spleen decoction, and nourishing kidney and expelling blood stasis decoction were frequently prescribed. However, there was a lack of animal experimental study to reveal the mechanism. ConclusionAcupuncture treatment can prevent the development of osteoporosis. Moreover, the combination of acupuncture and TCM helps to enhance its clinical efficacy. However, the investigation on the mechanism of acupuncture treatment for osteoporosis is needed. In addition, there is no unified standard for acupoint selection and TCM medication. Also, there is no clinical observation of long-term efficacy and side effects of acupuncture. It needs to be further improved and developed.
Objective To review the efficacy of acupuncture and acupuncture combined with traditional Chinese medicine(TCM) in the treatment of osteoporosis, which may help to provide new ideas for clinical treatment and basic research of osteoporosis. Methods The literatures in the China domestic medical literature databases(CNKI, VIP and Wanfang) published from January 2014 to August 2018 were retrieved with the key words such as osteoporosis, acupuncture, and TCM. The type of articles was analyzed. The basic research, mechanism of action, clinical curative standard, treatment results, and acupuncture points, as well as the formulas of TCM were summarized in the current study. Results A total of 136 articles have been recorded in the databases. Of those, 94 were focused on studying the effects of acupuncture treatments on osteoporosis. The commonly used acupoints were A'shi points, Shenshu, Mingmen, Guanyuan, Qihai, Yaoyangguan, Pishu, Zusanli, and Sanyinjiao, etc. The clinical and preclinical results demonstrated that acupuncture significantly increased bone mineral density in osteoporotic patients and ovariectomized rats. In addition, 42 articles were dealt with the combination of acupuncture with TCM formula. Nourishing kidney and strong bone decoction, nourishing kidney and invigorating spleen decoction, and nourishing kidney and expelling blood stasis decoction were frequently prescribed. However, there was a lack of animal experimental study to reveal the mechanism. ConclusionAcupuncture treatment can prevent the development of osteoporosis. Moreover, the combination of acupuncture and TCM helps to enhance its clinical efficacy. However, the investigation on the mechanism of acupuncture treatment for osteoporosis is needed. In addition, there is no unified standard for acupoint selection and TCM medication. Also, there is no clinical observation of long-term efficacy and side effects of acupuncture. It needs to be further improved and developed.
引文
[1] 郭鱼波,马如风,王丽丽,等. 骨质疏松动物模型及其评价方法的研究进展[J]. 中国骨质疏松杂志, 2015,21(9):1149-1154.
[2] 张智海,刘忠厚,李娜,等. 中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J]. 中国骨质疏松杂志, 2014,20(9): 1007-1010.
[3] 郭鱼波,王丽丽,马如风,等. 骨质疏松的中医病因病机分析及其中医药治疗的前景探讨[J]. 世界科学技术-中医药现代化, 2015,17(4): 768-772.
[4] 王珊玺,谢菊英,谢玉英,等. 针灸治疗原发性骨质疏松症腧穴选取的研究[J]. 中医研究, 2017(3): 57-58.
[5] 周德祥,王东岩. 骨质疏松症的针灸治疗概况及述评[J]. 针灸临床杂志, 2000(1): 56-57.
[6] 乔思雨,赵英侠. 针灸治疗绝经后骨质疏松症的实验研究进展[J].中国骨质疏松杂志, 2015,21(10): 1258-1262.
[7] 康轶鑫,王道全,刘忠厚. 针灸治疗骨质疏松症的临床研究进展[J]. 中国骨质疏松杂志, 2010,16(9): 701-708.
[8] 鲍圣涌.“双固一通”针法治疗绝经后骨质疏松症模型大鼠的机理研究[D].武汉:湖北中医学院, 2005.
[9] 范怀玲,纪峰,林莺,等. 电针“关元”穴对绝经后骨质疏松症大鼠Wnt信号通路的影响[J]. 针刺研究, 2015(2): 87-93.
[10] 黄永南.“双固一通”针法对绝经后骨质疏松症模型大鼠的骨密度、免疫球蛋白及RANKLmRNA表达水平的影响[D]. 武汉:湖北中医学院, 2005.
[11] 刘永兵. 针罐合用治疗骨质疏松症患者的临床疗效分析[J]. 现代诊断与治疗, 2014,25(17): 3903-3904.
[12] 马道南,范远俊. 联用中药内服和针灸疗法治疗骨质疏松症的效果研究[J].当代医药论丛, 2018,16(7): 58-59.
[13] 石卫华. 针灸联合补肾健脾汤治疗骨质疏松症骨痛的临床疗效研究[J]. 中国实用医药, 2014,9(30):169-170.
[14] 吴余粮,谢少龙. 补肾化瘀汤加减结合针灸治疗骨质疏松症腰背痛的效果评价[J]. 中医临床研究, 2018,10(10): 34-35.
[15] 章振林,金小岚,夏维波. 原发性骨质疏松症诊疗指南(2017版)要点解读[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017,23(5): 411-412.
[2] 张智海,刘忠厚,李娜,等. 中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J]. 中国骨质疏松杂志, 2014,20(9): 1007-1010.
[3] 郭鱼波,王丽丽,马如风,等. 骨质疏松的中医病因病机分析及其中医药治疗的前景探讨[J]. 世界科学技术-中医药现代化, 2015,17(4): 768-772.
[4] 王珊玺,谢菊英,谢玉英,等. 针灸治疗原发性骨质疏松症腧穴选取的研究[J]. 中医研究, 2017(3): 57-58.
[5] 周德祥,王东岩. 骨质疏松症的针灸治疗概况及述评[J]. 针灸临床杂志, 2000(1): 56-57.
[6] 乔思雨,赵英侠. 针灸治疗绝经后骨质疏松症的实验研究进展[J].中国骨质疏松杂志, 2015,21(10): 1258-1262.
[7] 康轶鑫,王道全,刘忠厚. 针灸治疗骨质疏松症的临床研究进展[J]. 中国骨质疏松杂志, 2010,16(9): 701-708.
[8] 鲍圣涌.“双固一通”针法治疗绝经后骨质疏松症模型大鼠的机理研究[D].武汉:湖北中医学院, 2005.
[9] 范怀玲,纪峰,林莺,等. 电针“关元”穴对绝经后骨质疏松症大鼠Wnt信号通路的影响[J]. 针刺研究, 2015(2): 87-93.
[10] 黄永南.“双固一通”针法对绝经后骨质疏松症模型大鼠的骨密度、免疫球蛋白及RANKLmRNA表达水平的影响[D]. 武汉:湖北中医学院, 2005.
[11] 刘永兵. 针罐合用治疗骨质疏松症患者的临床疗效分析[J]. 现代诊断与治疗, 2014,25(17): 3903-3904.
[12] 马道南,范远俊. 联用中药内服和针灸疗法治疗骨质疏松症的效果研究[J].当代医药论丛, 2018,16(7): 58-59.
[13] 石卫华. 针灸联合补肾健脾汤治疗骨质疏松症骨痛的临床疗效研究[J]. 中国实用医药, 2014,9(30):169-170.
[14] 吴余粮,谢少龙. 补肾化瘀汤加减结合针灸治疗骨质疏松症腰背痛的效果评价[J]. 中医临床研究, 2018,10(10): 34-35.
[15] 章振林,金小岚,夏维波. 原发性骨质疏松症诊疗指南(2017版)要点解读[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017,23(5): 411-412.