針刺足三里穴對第一型糖尿病大鼠腸蠕動影響之研究; The Effect of Zusanli (ST-36) Acupuncture on Intestinal Transit in Type I Diabetic Rats

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题名:	針刺足三里穴對第一型糖尿病大鼠腸蠕動影響之研究;The Effect of Zusanli (ST-36) Acupuncture on Intestinal Transit in Type I Diabetic Rats
作者:	簡宗保;Tsung-Pao Chien
贡献者:	中國醫藥大學中西醫結合研究所
关键词:	糖尿病;胃腸蠕動;足三里穴;針灸;Acupuncture;Zusanli acupoint（ST-36）;Diabetic mellitus;Charcoal meal;Intestinal Transit
日期:	2004
上传时间:	2010-01-18 11:43:20 (UTC+8)
摘要:	糖尿病可以引起全身各個系統的併發症，當然也包括胃腸系統。糖尿病合併胃腸蠕動異常，雖然不至於導致患者生命上的威脅，但它的高發生率、對患者生活品質的影響及社會成本的付出，卻不容小覷。目前對於糖尿病合併胃腸蠕動異常，在葯物治療上並無重大進展，而傳統的針灸治療對於腸胃道具有雙向調節的作用，在臨床試驗和動物實驗中，已得到許多印證。對於糖尿病合併胃腸蠕動異常的患者，針灸治療能不能有所助益？本研究以動物模式來探討針刺足陽明胃經的合穴『足三里』對於糖尿病大鼠腸蠕動的影響。本研究以大白鼠為實驗對象，以腹腔內注射鏈尿佐菌素（Streptozotocin，STZ)的方法，製造出第一型糖尿病大白鼠的動物模型。在不麻醉的狀態下，針刺足三里穴並捻針30秒後，剪斷露出皮膚的針身及針柄，以模仿傳統針刺手法及留針方式。並以餵食不被腸吸收的活性碳液，來進行腸蠕動的觀察。首先以正常控制組、糖尿病組、糖尿病加針刺組，進行觀察比較；再進一步以納洛酮（Naloxone）腹腔內注射方式來觀察針刺效應能否被阻斷。結果顯示，以腹腔內注射Streptozotocin(STZ) 誘導一週後的糖尿病大鼠，其腸蠕動的平均值雖較正常大鼠快，但在統計學上並無明顯的差異（p＝0.068），表示短期的糖尿病並沒有明顯的影響腸蠕動。而手針雙側足三里穴可以使糖尿病大鼠的腸蠕動變慢，在統計上確實有明顯的差異（p＝0.035）。至於血糖在針刺後都有上昇，可能因實驗是在未麻醉的狀態下進行，使老鼠必須面臨壓力（stress），但此並無統計上的意義；進一步實驗先以納洛酮（Naloxone）腹腔內注射糖尿病大鼠以阻斷內生性鴉片受體後，再針刺足三里穴，結果針刺組的糖尿病大鼠腸蠕動與未針刺的控制組無顯著差異，這顯示針刺足三里可能是透過內生性鴉片（endogenous opioids）來影響腸蠕動。結論：手針雙側足三里穴可以抑制，未經麻醉的STZ誘導第一型糖尿病大鼠腸的蠕動，其作用機轉與內生性鴉片有關。; The Effect of Zusanli Acupuncture on Intestinal Transit in Type Ι Diabetic Rats Many organ systems including gastrointestinal tract can be involved in diabetes-associated complications. Gastrointestinal motility disorders in diabetic mellitus are not life-threatening problems, but they are high prevalence, high morbidity and with high costs-of-illness. There is no impressive progression in drugs to treat motility disorders in recent decade. Acupuncture has been used for various gastrointestinal conditions and many literatures support its efficacy in the regulation of gastrointestinal motor activity. What is the role for acupuncture to treat gastrointestinal motility disorders in diabetic mellitus? The present study was designed to explore the acupuncturing Zusanli acupoint effect of foot-Yang Ming (stomach channel) on intestinal transit of diabetic rats. In this study, typeΙ diabetic rats were induced by intraperitoneal injection of streptozotocin (STZ, 100 mg/kg). All the studied rats were kept in the conscious state and administered with 0.6 ml charcoal meal into the stomach through a metal feeding tube. The stimulation group rats were treated by manual acupuncture on Zusanli acupoint (ST-36). After being inserted at a depth of 5 mm at ST-36, the needle was manipulated manually by twisting right and left once every second for 30 seconds. Then the needle-body was cut from the skin and left the needle-point in the leg till 30 minutes. Initially, we studied the three groups including normal rats, diabetic rats and diabetic rats with acupuncture treatment. Then after pretreatment with naloxone (3 mg/kg, i.p.), diabetic rats with or without acupuncture treatment were studied. Results: After one week, the diabetic rats were induced successfully by STZ injection, although a small increase in the mean intestinal transit was seen in diabetic rats, the difference between diabetic and normal rats’ intestinal transit was not significant. It meant that there was no obviously dysmotility in the short-term typeΙdiabetic rats. Decreasing in mean intestinal transit was seen after manual acupuncture, and the difference of intestinal transit was significant between diabetic rats with and without acupuncture. Elevating glucose after study was found but there was no statistical significance. It might be associated with stress because all the studied rats were kept in the conscious state. After diabetic rats being pretreated with naloxone, the decreased intestinal transit effect of acupuncture was abolished. It indicated that this effect was from endogenous opioid peptides. In conclusions, the present data suggested that manual acupuncture at Zusanli acupoint could inhibit intestinal transit, and endogenous opioid peptides played an important role as neurotransmitter in the mediation of acupuncture on intestinal transit of STZ (typeΙ) diabetic rats.
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