| 摘要: | 針灸學是以針刺與艾灸來防治疾病的一門臨床科學,針刺常與艾灸並用,故有針灸之合稱,針灸發源於我國的原始社會,已有數千年的歷史,為中國醫學的重要組成部分。由於針灸具有治療廣泛、取效迅速、療效顯著、操作簡便與經濟安全等優點,故數千年來仍為廣大民眾所接受,目前正在世界各國快速的推廣與發展,深受醫學界之矚目。針灸在臨床實踐與實驗研究方面都有了長足的進展,而發展的深度與廣度也在不斷的提升,隨著針灸療效的提高與科研成果的不斷出現,至今已有百餘國家應用針灸治病,而世界衛生組織(WHO)也承認針灸可以治療43種疾病,使針灸療法正式納入現代之醫療體系。黃疸是臨床上常見的現象之一,根據古代針灸文獻記載,針灸具有治療黃疸的效果,為了探討針刺與艾灸對大白鼠實驗性高膽紅素血症與膽管炎之影響,以及探索其作用機理,進而為臨床選穴,提供實驗依據,乃作此研究。 本研究採用Alpha-naphthylisothiocyanate (ANIT)急性中毒作為黃疸之實驗模型,將ANIT溶於1.5% Carboxy Methyl Cellulose Sodium Salt(CMC)中製成懸浮液,以體重200-250gm之Sprague-Dawley系雄性大白鼠為實驗對象。雄性大白鼠43隻分為5組:第一組為正常組,不作任何治療處理。第二組為CMC組,以胃管餵食1.5% CMC溶液(10ml/kg)。第三組為ANIT對照組,以胃管餵食ANIT(100mg/kg/10ml)誘發實驗性高膽紅素血症及膽管炎。第四組為針刺治療組,在餵食ANIT(100mg/kg)之前18、12、6小時及餵食ANIT(100mg/kg)之後6、12、18小時,分別施予針刺治療共六次。第五組為艾灸治療組,在餵食ANIT(100mg/kg)之前18、12、6小時及餵食ANIT(100mg/kg)之後6、12、18小時,分別施予艾灸治療共6次。所有大白鼠在餵食ANIT之後36小時禁食,餵食ANIT之後48小時,以乙醚麻醉,由腹腔動脈抽血,測定Total bilirubin、Direct bilirubin、SGOT和SGPT之生化值,並切一小塊肝臟組織,置於10% Formalin液中固定,按常規方法製片及Hematoxylin-Eosin染色後,再以顯微鏡觀察組織學之變化。實驗組先將大白鼠固定於木製固定架上,選取相當於人體雙側之足三里、三陰交、太衝及正中線之中脘等穴,以32號不銹鋼毫針正對所取之點直刺,進針深度因穴而異,大約2-5mm,每6小時針刺一次,共6次,每次留針15分鐘,每隔5分鐘手提插捻轉一次。將艾絨捻成比麥粒稍大的艾炷,以電動天秤稱得每粒約重8mg,每灸一粒艾炷謂之一壯。實驗組將大白鼠固定於木製固定架上,先將背毛剪除,選取相當於人體背部雙側之肝俞、膽俞、脾俞及正中線之至陽等穴區,將艾炷以線香點燃後直接置於穴區,待艾炷燃至接近皮膚時換壯,每次連續施灸6壯,每6小時施灸一次,共6次。Bilirubin、SGOT與SGPT以Hitachi 736-15 Automatic Analyzer測定。並以Student's T test求其平均值差異之顯著性。 結果顯示:大白鼠在中毒48小時後,血清Total bilirubin、Direct bilirubin、SGOT和SGPT等生化值都急據升高至最高值。針刺治療組對Total bilirubin、Direct bilirubin與SGOT皆有顯著降低作用(p<0.05、p<0.001、p<0.01)。艾灸治療組對Total bilirubin、Direct bilirubin與SGOT亦均有顯著降低作用(p<0.01、p<0.001、p<0.05)。由此觀之,針刺與艾灸對肝損傷皆有防治作用。大白鼠餵食ANIT之後,誘發之肝組織病變,可由病理切片觀察到膽管上皮細胞有明顯增加及發炎現象,經針刺或艾灸治療後,膽管上皮細胞之增生與發炎現象有輕度減少。 綜此觀之,針刺治療與艾灸治療對大白鼠實驗性高膽紅素血症與膽管炎均有抑制作用。
The effects of moxibustion on experimental hyperbilirubinemia and cholangitis were studied in male rats (n=33). The experimental group were treated with moxibustion, 18, 12 and 6 hours prior to and 6, 12 and 18 hours after challenge with oral .alpha.-napthylisothiocyanate (ANIT, 100mg per kg). Rats were sacrificed 48 hours after challenge. Serum and liver samples were taken for biochemical and histological analysis, respectively. The results revealed that rats treated with ANIT exhibited elevations in bilirubin, SGOT and SGPT as well as cholangitis. In rats receiving moxibustion and ANIT, biochemical and morphological parameters of liver injury were significantly reduced. Thus, this study shows that moxibustion therapy may be able to prevent ANIT-induced hyperbilirubinemia and cholangitis. Moxibustion, the stimulation of acupuncture points by burning moxa wool, is an important part of Chinese traditional acupuncture (Zhu 1984). Recently, moxibustion has been used in treating allergic, malignant, inflammatory and infectious diseases. The effect of moxibustion on hormonal or immunological reactions has also been observed (Hau, 1981; Rogers and Bossy, 1981; Odozaki and Sakamoto, 1983; Chen, 1987; Sternfeld et al, 1988; Hau et al, 1989). It has been reported that acute administration of ANIT to rats produce cholangitis and obstructive jaundice (Mclean and Rees, 1958; Eliakim et al, 1959; Griffiths et al, 1961; Goldfarb et al, 1962; Becker and Plaa, 1965). These effects have led to the use of ANIT as an experimental tool for the investigation of liver injury in rats. Previous studies showed that some drug and Chinese herbs effectively protect the rat against ANIT induced liver injury (Batzinger et al, 1981; Ruwart et al, 1984; Traiger et al, 1984; Jeng, 1985). In the present study, we try to determine whether moxibustion therapy could protect the liver from ANIT-induced injury in rats. Male Sprague-Dawley rats (200-250mg) from the animal center of China Medical College were used throughout the present study. Water and food (produced by Fu-Sao Ind. Co.) were fully supplied. A total of 33 rats were randomly divided into four groups: Group A, normal control; Group B, the CMC (Carboxy Methyl Cellulose) group, received 10ml per kg of CMC (1.5% Carboxy Methyl Cellulose Sodium Salt, Sigma); Group C, the experimental control, liver injury was induced by a single oral administration of 100mg per kg of ANIT dissolved in 10ml of CMC; Group D, the experimental group, was treated with moxibustion 18, 12 and 6 hrs before ANIT administration, and 6, 12 and 18 hrs afterward. Rats were fixed on a wood plate, and the acupoints similar to human's Gan-Shu (B18), Dan-Shu (B19), Pi-Shu (B20) (bilaterally) and Zhi-Yang (GV 9) were selected. These points were stimulated with ignited moxa cones (8mg, 5 cones per animal per time). Burned moxa was put directly on their skin every 6 hours for 6 administrations. These particular acupoints, bilateral to vertebral column, were chosen because previous reports showed that they are "useful" points for stimulating the hepatic system (Watari et al, 1977; Yang and Tsai 1989). We, therefore, selected these acupoints for the study of hepatic protective effect. Forty-eight hours after ANIT administration, all rats were anesthetized with ether and sacrificed. Blood samples were collected for serum analysis and liver samples were taken for light microscopy examination. All serum biochemistry measurements were done by the China Medical College Hospital's Clinical Research Laboratories. Bilirubin, SGOT and SGPT were measured spectrophotometrically on the Hitachi 736-15 Automatic Analyzer System. For histological examination, slices of liver tissue were fixed in 10% formalin and embedded in paraffin. Sections were stained with Haematoxylin and Eosin dye and examined under photomic |
