从《黄帝内经》“聚沫则为痛”理论探析推拿干预疼痛及痛情绪的作用机制

程艳彬; 陆萍; 朱清广; 孔令军; 吴志伟; 房敏

doi:10.3969/j.issn.1006-2157.2023.11.005

您当前的位置：

首页 >

文章列表页 >

从《黄帝内经》“聚沫则为痛”理论探析推拿干预疼痛及痛情绪的作用机制

理论研究 | 更新时间：2023-12-08

- 从《黄帝内经》“聚沫则为痛”理论探析推拿干预疼痛及痛情绪的作用机制
- Exploring the mechanism of tuina intervention for pain and painful emotions from the theory of "pain is caused by accumulation of body fluids" in Huangdi Neijing
- 北京中医药大学学报 2023年46卷第11期页码：1510-1516
- 作者机构：
  
  1.上海中医药大学附属岳阳中西医结合医院　上海　200437
  2.上海市中医药研究院中医推拿研究所
  3.上海中医药大学针灸推拿学院
  4.上海中医药大学附属曙光医院
- 作者简介：
  
  程艳彬，男，博士，主治医师
  # 房敏，男，博士，教授，主任医师，博士生导师，主要研究方向：推拿治疗骨关节病生物学效应研究，E-mail：fm-tn0510@shutcm.edu.cn
- 基金信息：
  
  国家自然科学基金项目(82030121;82004493;82205302;81973974);国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-C-202008);上海市促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2022CRT018);上海市青年科技英才扬帆计划项目(20YF1450900);上海市浦江人才计划项目(21PJD071)
- DOI：10.3969/j.issn.1006-2157.2023.11.005
  中图分类号： R244.15
- 收稿：2023-05-08，
  
  网络首发：2023-10-24，
  
  纸质出版：2023-11-30
- 稿件说明：
移动端阅览
程艳彬, 陆萍, 朱清广, 等. 从《黄帝内经》“聚沫则为痛”理论探析推拿干预疼痛及痛情绪的作用机制[J]. 北京中医药大学学报, 2023,46(11):1510-1516.

CHENG Yanbin, LU Ping, ZHU Qingguang, et al. Exploring the mechanism of tuina intervention for pain and painful emotions from the theory of "pain is caused by accumulation of body fluids" in Huangdi Neijing[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1510-1516. DOI: 10.3969/j.issn.1006-2157.2023.11.005.
程艳彬, 陆萍, 朱清广, 等. 从《黄帝内经》“聚沫则为痛”理论探析推拿干预疼痛及痛情绪的作用机制[J]. 北京中医药大学学报, 2023,46(11):1510-1516. DOI： 10.3969/j.issn.1006-2157.2023.11.005.

CHENG Yanbin, LU Ping, ZHU Qingguang, et al. Exploring the mechanism of tuina intervention for pain and painful emotions from the theory of "pain is caused by accumulation of body fluids" in Huangdi Neijing[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1510-1516. DOI: 10.3969/j.issn.1006-2157.2023.11.005. DOI：

摘要

慢性疼痛迁延难愈，常伴随抑郁、焦虑等痛情绪的发生，严重影响患者生活质量，给个人、家庭、社会造成巨大伤害，因此备受关注。本文基于《黄帝内经》“聚沫则为痛”理论对慢性疼痛的病因病机进行阐释，阐明推拿治疗慢性疼痛的中医学内涵，并对推拿治疗慢性疼痛和痛情绪“身心同治”的独特优势进行总结，以期通过对骨关节疾病“聚沫则为痛”理论的探讨为相关基础研究和临床诊疗提供思路。

Abstract

Chronic pain is persistent

difficult to treat

and often accompanied by pain emotions

such as depression and anxiety

seriously affecting patients’ quality of life and substantially harming individuals

families

and society. Therefore

chronic pain has received considerable attention. This article explains the etiology and pathogenesis of chronic pain according to the "pain is caused by accumulation of body fluids" theory in

Huangdi Neijing

and clarifies the traditional Chinese medicine connotation of tuina treatment for chronic pain. The unique advantages of tuina treatment for chronic pain and pain emotions through the "treatment for both the body and mind" approach are summarized. It is hoped that the exploration of the "pain is caused by accumulation of body fluids" theory here will provide ideas for relevant basic research

clinical diagnosis

and treatment.

关键词

Keywords

references

WU MW , CHEN YQ , SHEN Z , et al . Electroacupuncture alleviates anxiety-like behaviors induced by chronic neuropathic pain via regulating different dopamine receptors of the basolateral amygdala [J]. Mol Neurobiol , 2022 , 59 ( 9 )： 5299 - 5311 .

王帅，曹祖懋，李志刚 . 痛情绪相关神经递质及神经环路研究进展 [J]. 世界科学技术—中医药现代化， 2022 , 24 ( 1 )： 252 - 257 .

张海艳，朱怡霖，吴泽民，等 . 痛情绪相关神经递质的研究进展 [J]. 中国药理学与毒理学杂志， 2020 , 34 ( 6 )： 460 - 465 .

程艳彬，朱清广，孔令军，等 . 推拿调控腰椎间盘突出症神经损伤的外周-中枢镇痛机制探讨 [J]. 中华中医药杂志， 2022 , 37 ( 4 )： 2186 - 2190 .

姚重界，孔令军，程艳彬，等 . 骨关节疾病中“聚沫”致痛说刍议 [J]. 中医杂志， 2022 , 63 ( 8 )： 706 - 709 .

赵志斌，李伟红，刘世敏 . 《灵枢·周痹》中“迫切而为沫”的含义探析 [J]. 风湿病与关节炎， 2021 , 10 ( 9 )： 62 - 64 .

谢曾，肖京，曹昺焱，等 . 《黄帝内经》“分肉之间”理论与经筋痹痛分层治疗 [J]. 中国针灸， 2023 , 43 ( 5 )： 569 - 573 .

罗迪，乔海法，王强，等 . 从针刺治神角度谈针刺镇痛 [J]. 中国针灸， 2023 , 43 ( 3 )： 265 - 268 .

张幻真，林志刚，陈乐春，等 . 基于形神一体观探析推拿五脏背俞穴干预疼痛的优势 [J]. 山东中医杂志， 2023 , 42 ( 4 )： 309 - 312 .

刘欣蕊 . 基于“神”理论探讨疼痛与负性情绪共病的治疗 [J]. 中国民间疗法， 2023 , 31 ( 1 )： 33 - 36 .

梁志刚，李瑞，邓成哲 . 从“心”理解“诸痛痒疮皆属于心” [J]. 中国中医基础医学杂志， 2011 , 17 ( 4 )： 370 - 371 .

SHAH JP , DANOFF JV , DESAI MJ , et al . Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points [J]. Arch Phys Med Rehabil , 2008 , 89 ( 1 )： 16 - 23 .

曹奔，张帅攀，周鑫，等 . 基于炎性微环境探析推拿干预腰椎间盘突出症的镇痛机理 [J]. 中医杂志， 2022 , 63 ( 24 )： 2321 - 2325 .

张帅攀，朱清广，孔令军，等 . 推拿易筋经防治膝骨关节炎疼痛的临床探讨 [J]. 中华中医药杂志， 2021 , 36 ( 12 )： 7425 - 7428 .

宋学军，樊碧发，万有，等 . 国际疼痛学会新版疼痛定义修订简析 [J]. 中国疼痛医学杂志， 2020 , 26 ( 9 )： 641 - 644 .

娄金鹏，詹逸珺，裴建．从疼痛新定义到针刺干预神经性疼痛机制探讨 [J]. 上海针灸杂志， 2022 ， 41 ( 2 )： 198 - 202 .

TREEDE RD , RIEF W , BARKE A , et al . Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11) [J]. Pain , 2019 , 160 ( 1 )： 19 - 27 .

华洁，王丽娜，金晓红，等 . 慢性疼痛患者伴发抑郁焦虑情绪的观察及相关性分析 [J]. 广东医学， 2019 , 40 ( 20 )： 2853 - 2856 .

周利君，信文君，庞瑞萍，等 . 慢性疼痛的细胞因子微环境假说 [J]. 中国疼痛医学杂志， 2013 , 19 ( 11 )： 679 - 684 .

MAUCERI D . Role of Epigenetic Mechanisms in Chronic Pain [J/OL]. Cells , 2022 , 11 ( 16 )： 2613 [ 2023-03-15 ]. https://www.mdpi.com/2073-4409/11/16/2613 .

GOESLING J , CLAUW DJ , HASSETT AL . Pain and depression: an integrative review of neurobiological and psychological factors [J/OL]. Curr Psychiatry Rep , 2013 ， 15 ( 12 )： 421 [ 2023-03-15 ]. https://link.springer.com/article/10.1007/s11920-013-0421-0 .

陈国良，王梅，路桂军，等 . 慢性疼痛患者焦虑、抑郁状况调查及相关因素分析 [J]. 中国疼痛医学杂志， 2014 , 20 ( 4 )： 226 - 230 .

ZIS P , DASKALAKI A , BOUNTOUNI I , et al . Depression and chronic pain in the elderly: links and management challenges [J]. Clin Interv Aging , 2017 , 12 : 709 - 720 .

SARANGI A , MCMAHON T , GUDE J . Benzodiazepine misuse: an epidemic within a pandemic [J/OL]. Cureus , 2021 , 13 ( 6 )： e15816 [ 2023-03-15 ]. https://www.cureus.com/articles/60414-benzodiazepine-misuse-an-epidemic-within-a-pandemic#!/ .

SCARPIGNATO C , LANAS A , BLANDIZZI C , et al . Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis：an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks [J/OL]. BMC Med , 2015 ， 13 ： 55 [ 2023-03-15 ]. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0285-8 .

WEI XL , TIAN J , JIA SH ， et al . Acupuncture for the relief of chronic pain：regulating negative emotions and reward/motivation circuits based on the theory of “spirit-regulation with acupuncture” [J]. World J Acupunct Moxibustion , 2023 , 33 : 28 - 33 .

陈雪丽，贾晓丽，陈峥 . 对标疼痛新定义，浅谈慢性疼痛管理的现状和未来 [J]. 华西医学， 2022 ， 37 ( 8 )： 1253 - 1256 .

KERNS RD , SELLINGER J , GOODIN BR . Psychological treatment of chronic pain [J]. Annu Rev Clin Psychol , 2011 ， 7 ： 411 - 434 .

ALI A , ARIF AW , BHAN C , et al . Managing Chronic Pain in the Elderly: An Overview of the Recent Therapeutic Advancements [J/OL]. Cureus , 2018 ， 10 ( 9 )： e3293 [ 2023-03-15 ]. https://www.cureus.com/articles/14819-managing-chronic-pain-in-the-elderly-an-overview-of-the-recent-therapeutic-advancements#!/ .

KNOERL R , GIOBBIE-HURDER A , BERFIELD J , et al . Yoga for chronic chemotherapy-induced peripheral neuropathy pain: a pilot, randomized controlled trial [J]. J Cancer Surviv , 2022 , 16 ( 4 )： 882 - 891 .

YAN B , ZHU SB , WANG Y , et al . Effect of Acupuncture on Chronic Pain with Depression: A Systematic Review [J/OL]. Evid Based Complement Alternat Med , 2020 ， 2020 ： 7479459 [ 2023-03-15 ]. https://www.hindawi.com/journals/ecam/2020/7479459/ .

PRITCHARD KT , BAILLARGEON J , LEE WC , et al . Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019 [J/OL]. JAMA Netw Open , 2022 , 5 ( 11 )： e2240612 [ 2023-03-15 ]. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798134 .

WEN YR , SHI J , HU ZY , et al . Is transcranial direct current stimulation beneficial for treating pain, depression, and anxiety symptoms in patients with chronic pain? A systematic review and meta-analysis [J/OL]. Front Mol Neurosci , 2022 ， 15 ： 1056966 [ 2023-03-15 ]. https://www.frontiersin.org/articles/10.3389/fnmol.2022.1056966/full .

JIANG W , ZHANG LX , TAN XY , et al . Inflammation and histone modification in chronic pain [J/OL]. Front Immunol , 2022 , 13 : 1087648 [ 2023-03-15 ]. https://www.frontiersin.org/articles/10.3389/fimmu.2022.1087648/full .

ALHALAL EA , ALHALAL IA , ALAIDA AM , et al . Effects of chronic pain on sleep quality and depression: a cross-sectional study [J]. Saudi Med J , 2021 , 42 ( 3 )： 315 - 323 .

KOBAYASHI K , IMAGAMA S , OHGOMORI T , et al . Minocycline selectively inhibits M1 polarization of microglia [J/OL]. Cell Death Dis , 2013 , 4 ( 3 )： e525 [ 2023-03-13 ]. https://www.nature.com/articles/cddis201354 .

宋苏蒙，王丽琨，伍国锋 . 小胶质细胞极化M1/M2表型在脑出血后继发性损伤中的作用 [J]. 中风与神经疾病杂志， 2021 , 38 ( 2 )： 165 - 168 .

WATKINS LR , MILLIGAN ED , MAIER SF . Glial activation: a driving force for pathological pain [J]. Trends Neurosci , 2001 , 24 ( 8 )： 450 - 455 .

WAXMAN SG . The molecular pathophysiology of pain: abnormal expression of sodium channel genes and its contributions to hyperexcitability of primary sensory neurons [J]. Pain , 1999 , Suppl ( 6 )： S133 - S140 .

FRANCO R , FERNÁNDEZ-SUÁREZ D . Alternatively activated microglia and macrophages in the central nervous system [J]. Prog Neurobiol , 2015 , 131 : 65 - 86 .

EYRE H , BAUNE BT . Neuroimmunological effects of physical exercise in depression [J]. Brain Behav Immun , 2012 , 26 ( 2 )： 251 - 266 .

MAES M , YIRMYIA R , NORABERG J , et al . The inflammatory & neurodegenerative (I&ND) hypothesis of depression: leads for future research and new drug developments in depression [J]. Metab Brain Dis , 2009 , 24 ( 1 )： 27 - 53 .

CAO P , CHEN CM , LIU A , et al . Early-life inflammation promotes depressive symptoms in adolescence via microglial engulfment of dendritic spines [J]. Neuron , 2021 ， 109 ( 16 )： 2573 - 2589 .

KIMURA LF , NOVAES LS , PICOLO G , et al . How environmental enrichment balances out neuroinflammation in chronic pain and comorbid depression and anxiety disorders [J]. Br J Pharmacol , 2022 , 179 ( 8 )： 1640 - 1660 .

KLAWONN AM , FRITZ M , CASTANY S , et al . Microglial activation elicits a negative affective state through prostaglandin-mediated modulation of striatal neurons [J]. Immunity , 2021 , 54 ( 2 )： 225 - 234 .

LI BJ , YANG W , GE TT , et al . Stress induced microglial activation contributes to depression [J/OL]. Pharmacol Res , 2022 , 179 : 106145 [ 2023-03-15 ]. https://linkinghub.elsevier.com/retrieve/pii/S1043661822000901 .

RAJKOWSKA G , MIGUEL-HIDALGO JJ . Gliogenesis and glial pathology in depression [J]. CNS Neurol Disord Drug Targets , 2007 , 6 ( 3 )： 219 - 233 .

ZHANG JQ , HE H , QIAO Y , et al . Priming of microglia with IFN-γ impairs adult hippocampal neurogenesis and leads to depression-like behaviors and cognitive defects [J]. Glia , 2020 , 68 ( 12 )： 2674 - 2692 .

HAN KM , HAM BJ . How inflammation affects the brain in depression: a review of functional and structural MRI studies [J]. J Clin Neurol , 2021 , 17 ( 4 )： 503 - 515 .

CHEN G , ZHANG YQ , QADRI YJ , et al . Microglia in pain: detrimental and protective roles in pathogenesis and resolution of pain [J]. Neuron , 2018 , 100 ( 6 )： 1292 - 1311 .

WON E , KIM YK . Neuroinflammation-associated alterations of the brain as potential neural biomarkers in anxiety disorders [J/OL]. Int J Mol Sci , 2020 , 21 ( 18 )： 6546 [ 2023-03-15 ]. https://www.mdpi.com/1422-0067/21/18/6546 .

OSIMO EF , PILLINGER T , RODRIGUEZ IM , et al . Inflammatory markers in depression: a meta-analysis of mean differences and variability in 5, 166 patients and 5, 083 controls [J]. Brain Behav Immun , 2020 , 87 : 901 - 909 .

NGUYEN KT , DEAK T , OWENS SM , et al . Exposure to acute stress induces brain interleukin-1beta protein in the rat [J]. J Neurosci , 1998 , 18 ( 6 )： 2239 - 2246 .

薛爱荣，宋薛艺，徐鹏，等 . 理筋调脊通络法对腰椎间盘突出症患者SF-MPQ、Owestry、JOA评分及中医症状评分的研究 [J]. 时珍国医国药， 2019 , 30 ( 9 )： 2169 - 2171 .

张幻真，陈乐春，陈进城，等 . 通督调神推拿手法干预神经根型颈椎病合并焦虑状态的临床研究 [J]. 光明中医， 2020 , 35 ( 24 )： 3932 - 3935 .

马驰，姚斌彬，于天源，等 . 拨法对CCI大鼠脊髓中IL-6及SOCS3的影响 [J]. 南京中医药大学学报， 2017 , 33 ( 4 )： 399 - 402 .

HIDALGO B , HALL T , BOSSERT J , et al . The efficacy of manual therapy and exercise for treating non-specific neck pain: a systematic review [J]. J Back Musculoskelet Rehabil , 2017 , 30 ( 6 )： 1149 - 1169 .

LIU ZF , WANG HR , YU TY , et al . A review on the mechanism of Tuina promoting the recovery of peripheral nerve injury [J/OL]. Evid Based Complement Alternat Med , 2021 , 2021 : 6652099 [ 2023-03-15 ]. https://www.hindawi.com/journals/ecam/2021/6652099/ .

LIU ZF , WANG HR , YU TY , et al . Tuina for peripherally-induced neuropathic pain: a review of analgesic mechanism [J]. Front Neurosci , 2022 , 16 : 1096734 [ 2023-03-15 ]. https://www.frontiersin.org/articles/10.3389/fnins.2022.1096734/full .

张若冰 . 推拿改善颈型颈椎病员工焦虑状态：疼痛缓解的中介作用 [J]. 中国疼痛医学杂志， 2018 , 24 ( 12 )： 927 - 931 .

龙抗胜，叶勇，孙梦龙，等 . 针刺激痛点结合脏腑推拿治疗慢性腰背肌筋膜疼痛综合征伴焦虑临床研究 [J]. 针灸临床杂志， 2022 , 38 ( 9 )： 16 - 20 .

赵培，崔学记，王文丽 . 推拿点穴治疗痛经疗效观察及对患者负面情绪的影响 [J]. 新中医， 2022 ， 54 ( 6 )： 181 - 184 .

CHENG ZJ , ZHANG SP , GU YJ , et al . Effectiveness of Tuina therapy combined with yijinjing exercise in the treatment of nonspecific chronic neck pain: a randomized clinical trial [J]. JAMA Netw Open , 2022 , 5 ( 12 )： e2246538 [ 2023-03-15 ]. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799438 .

浏览量

679

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

从神经肌肉信号传导途径探究“三法三穴”推拿改善坐骨神经损伤大鼠运动功能的机制

督脉推法激活PI3K/AKT信号通路改善孤独症谱系障碍大鼠行为学的机制研究

基于NMDAR1/cGMP通路探究“三法三穴”对轻度慢性压迫性神经损伤大鼠脊髓背角的镇痛启动机制

基于IL-17F/IL-17RC信号通路及M1小胶质细胞探讨“三法三穴”推拿手法即刻镇痛作用的机制

对颈椎病推拿的“筋骨评估”推广模式的探讨