一种基于活动形状模型算法的耳郭穴区定位方法

目的耳穴疗法是中医的重要组成部分,而耳穴定位是治疗的前提。由于耳郭面积较小、耳穴众多导致自动寻穴困难,本文提出一种基于图像处理技术的耳郭穴区定位方法。方法通过对来自于北京科技大学USTB人耳图像库和自行采集图像共30幅构建训练集,在最新耳穴国家标准GB/T13734-2008的基础上,选取包含耳郭边缘点、曲率极大值点、等分点等在内的65个特征点构建点分布模型(point distribution model,PDM),采用基于活动形状模型(active shape model,ASM)的图像处理方法,对待测人耳图像搜索匹配后,通过分别连接构成耳郭穴区的特征点,实现对人耳图像的穴区定位。最后通过计算定位后与人工标定的特征点之间的欧几里得距离,对定位的精度进行评估。结果该方法能初步实现耳郭的穴区定位,欧几里得平均距离为6.246±0.429。结论基于ASM的耳郭穴区定位方法能初步实现人耳图像的穴区定位,有利于耳穴疗法的穴区定位、耳穴自动化仪器的开发和中医耳穴示教等。     

Antiallodynic effects of acupuncture in neuropathic rats

Peripheral nerve injury often results in abnormal neuropathic pain such as allodynia or hyperalgesia. Acupuncture, a traditional Oriental medicine, has been used to relieve pain and related symptoms. However, the efficiency of acupuncture in relieving neuropathic pain is not clear. The aim of this study was to investigate the anti-allodynic effects of acupuncture through behavioral and electrophysiological examinations. Male Sprague-Dawley rats were subjected to neuropathic surgery consisting of a tight ligation and transection of the left tibial and sural nerves, under pentobarbital anesthesia. The acupuncture experiment consisted of four different groups, one treated at each of three different acupoints (Zusanli (ST36), Yinlingquan (SP9), and a sham-acupoint) and a control group. Behavioral tests for mechanical allodynia and cold allodynia were performed for up to two weeks postoperatively. Extracellular electrophysiological recordings were made from the dorsal roots using platinum wire electrodes. Mechanical and cold allodynia were significantly reduced after acupuncture treatment at the Zusanli and Yinlingquan acupoints, respectively. Electrophysiological neural responses to von Frey and acetone tests were also reduced after acupuncture at the same two acupoints. These results suggest that acupuncture may be beneficial in relieving neuropathic pain.     

Research status and prospects of acupuncture for prevention and treatment of chemo- and radiotherapy-induced salivary gland dysfunction in head and neck cancer

Salivary gland dysfunction (SGD) induced by chemo- and radiotherapy for head and neck cancer (HNC) has always been a difficult problem in modern medicine. The quality of life of a large number of HNC patients is severely impaired by SGD such as xerostomia and dysphagia. In recent years, several studies have found that acupuncture can improve patients' salivary secretion, but it has not yet been approved as an alternative therapy for SGD. For this reason, we collected the clinical study reports on acupuncture in the treatment of SGD induced by chemo- and radiotherapy in HNC patients in the past 20 years, and analyzed and discussed the advantages and disadvantages of these studies with respect to tumor types, group setting, intervention modality, acupoints selection, outcome evaluation, and safety. We believed that acupuncture is beneficial for SGD, but the existing objective evidence is insufficient to support its effectiveness. Therefore, improving the Standards for Reporting Interventions in Clinical Trials of Acupuncture, selecting the optimal combination of acupoints through scientific and rigorous study design, and exploring the potential mechanism of acupuncture in the treatment of diseases combined with the meridian theory may be effective ways to promote the acceptance of acupuncture as an alternative therapy for SGD in future. The significance of this review is to provide a reference for researchers to carry out high-quality clinical trials of acupuncture in the treatment of SGD in future from the perspective of the combination of modern medicine and traditional Chinese medicine.     

Acupuncture,from the ancient to the current

Acupuncture is characterized by the insertion of a fine metal needle through the skin of the human body at an acupuncture point (acupoint) in Traditional Chinese Medicine (TCM). It is an ancient form of therapy, and has a long history of prosperity and decline. Due to the persistent efforts of TCM practitioners, a number of well-designed clinical trials regarding acupuncture have been published in the past decade. Besides, numerous basic researches aiming to reveal the mechanisms of acupuncture have also been conducted. Several scientific explanations have been obtained to interpret the arcane TCM theory. This review provides brief information of acupuncture, including its history, status, evidence, and mechanisms.     

Neural mechanism underlying acupuncture analgesia

Acupuncture has been accepted to effectively treat chronic pain by inserting needles into the specific "acupuncture points" (acupoints) on the patient's body. During the last decades, our understanding of how the brain processes acupuncture analgesia has undergone considerable development. Acupuncture analgesia is manifested only when the intricate feeling (soreness, numbness, heaviness and distension) of acupuncture in patients occurs following acupuncture manipulation. Manual acupuncture (MA) is the insertion of an acupuncture needle into acupoint followed by the twisting of the needle up and down by hand. In MA, all types of afferent fibers (Abeta, Adelta and C) are activated. In electrical acupuncture (EA), a stimulating current via the inserted needle is delivered to acupoints. Electrical current intense enough to excite Abeta- and part of Adelta-fibers can induce an analgesic effect. Acupuncture signals ascend mainly through the spinal ventrolateral funiculus to the brain. Many brain nuclei composing a complicated network are involved in processing acupuncture analgesia, including the nucleus raphe magnus (NRM), periaqueductal grey (PAG), locus coeruleus, arcuate nucleus (Arc), preoptic area, nucleus submedius, habenular nucleus, accumbens nucleus, caudate nucleus, septal area, amygdale, etc. Acupuncture analgesia is essentially a manifestation of integrative processes at different levels in the CNS between afferent impulses from pain regions and impulses from acupoints. In the last decade, profound studies on neural mechanisms underlying acupuncture analgesia predominately focus on cellular and molecular substrate and functional brain imaging and have developed rapidly. Diverse signal molecules contribute to mediating acupuncture analgesia, such as opioid peptides (mu-, delta- and kappa-receptors), glutamate (NMDA and AMPA/KA receptors), 5-hydroxytryptamine, and cholecystokinin octapeptide. Among these, the opioid peptides and their receptors in Arc-PAG-NRM-spinal dorsal horn pathway play a pivotal role in mediating acupuncture analgesia. The release of opioid peptides evoked by electroacupuncture is frequency-dependent. EA at 2 and 100Hz produces release of enkephalin and dynorphin in the spinal cord, respectively. CCK-8 antagonizes acupuncture analgesia. The individual differences of acupuncture analgesia are associated with inherited genetic factors and the density of CCK receptors. The brain regions associated with acupuncture analgesia identified in animal experiments were confirmed and further explored in the human brain by means of functional imaging. EA analgesia is likely associated with its counter-regulation to spinal glial activation. PTX-sesntive Gi/o protein- and MAP kinase-mediated signal pathways as well as the downstream events NF-kappaB, c-fos and c-jun play important roles in EA analgesia.     

基于虚拟现实技术构建蒙医针刺手法的上肢仿真系统

背景:蒙医针刺手法的训练是蒙医针灸理论联系实际的一个重要步骤。目的:在虚拟环境中,建立表达不同上肢穴位蒙医针刺手法涉及的力学模型,以多层次展示蒙医上肢针灸穴位的针刺过程。方法:①由内蒙古医科大学蒙医药学院1名在职研究人员针对蒙医针刺疗法在前臂特定穴位的直刺法(垂直刺入皮肤)、斜刺法(倾斜45°刺入皮肤)、十字刺法(刺入皮肤后四方旋转)进行演示实验,使用ATP-IV型针刺信息采集系统的光学位置传感器和附带的记录软件,记录自行针开始10 s内的各个传感器数据;②扫描条件为电压9 V,电流250 mA,其余各项参数选择手法参数测定仪的默认值。将针刺手法参数测定仪的X、Y、Z轴采样信息分别绘制电压-时间关系图,参照文献记载建立针刺过程模型;③对蒙医针刺过程的建模进行生物力学分析;④研究方案的实施符合内蒙古医科大学的相关伦理要求。结果与结论:①通过ATP-IV针刺参数测定仪实际测定的直刺、斜刺手法模拟参数,可见在针尖接触到软组织表面后针受到的轴向力会迅速上升,在刺破软组织表皮后急剧下降,形成了落空感,并在此后由于软组织弹性和摩擦力的作用,针受到的阻力趋于平缓,与Okamura的生物力学实验结果基本一致;②相对于中医复杂的针刺手法,蒙医文献载述的针刺手法只有与手感结合的进针三步法和与穴位结合的8种针刺手法,具有操作简便、用具简单的特点。     

Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence

Stress urinary incontinence leads to the involuntary loss of urine during abdominal strain caused by sneezing, laughing, and coughing. Acupuncture has been widely used for the treatment and prevention of a variety of diseases in traditional medicine. Acupuncture has also been used to relieve the symptoms of functional disorders of the lower urinary tract. In the present study, we investigated the effect of acupuncture at the Sanyinjiao (SP6) acupoint on stress urinary incontinence in rats. The present results showed that abdominal leak point pressure was decreased in rats with stress urinary incontinence, while acupuncture at the SP6 acupoint significantly enhanced the abdominal leak point pressure. The expression of c-Fos in the pontine micturition center (PMC), ventrolateral periaqueductal gray (vlPAG), and medial preoptic nucleus (MPA) regions was increased by the induction of stress urinary incontinence, and acupuncture at the SP6 acupoint significantly decreased c-Fos expression in these areas. In the present study, we showed that acupuncture has therapeutic effect on the symptoms of stress urinary incontinence, and this effect of acupuncture is associated with modulation of c-Fos expression in the brain.     

Acupuncture therapy for Alzheimer's disease: The effectiveness and potential mechanisms

Alzheimer's disease (AD) is a common neurodegenerative disease that accounts for approximately 70% of dementia. Following the global escalation of the aging process, the morbidity of AD is increasing rapidly. The current treatment for AD is mainly limited to medications, such as acetylcholinesterase inhibitors. However, the efficacy of acetylcholinesterase inhibitors in improving memory and cognitive functions is not satisfactory. It is a challenge to find an effective alternative therapy for ameliorating AD symptoms. As an important therapeutic technique in traditional Chinese medicine, acupuncture has been proved effective in treating many neurologic diseases including AD. The efficacy of acupuncture is also acknowledged by the National Institutes of Health of the United States. Here, we summarized the effectiveness of acupuncture for treating AD. Especially, the role of acupuncture at certain acupuncture points in modulating the brain function through meridians activity based on Chinese meridian theory is discussed. How acupuncture at a certain acupoint can improve AD symptoms is also described. Furthermore, the possible molecular mechanisms of acupuncture for AD are reviewed, and the role of acupuncture in modulating signaling molecules in neural protection and homeostasis is highlighted. This study may help to understand the theoretical basis and potential molecular mechanisms of acupuncture therapy for AD.     

磁刺激穴位镇痛诱发的脑电信号特征成分及源定位

背景：针灸是中国传统医学的重要组成部分。穴位治疗作用是否具有生理基础或者只是心理作用一直是争议的焦点。目前临床中常用的穴位刺激方式为手针和电针,很少有关于磁刺激穴位引起脑电活动的文献发表。 目的：利用诱发电位来研究磁刺激合谷穴对大脑皮质功能区的影响,探讨磁刺激穴位镇痛机制。 方法：18名被试(男13名,女5名)自愿参加实验,选取右侧合谷穴作为靶点目标,距离合谷穴约3 cm处的非穴位点作为对照点。磁刺激频率为1Hz,刺激强度为1.76T,实验分别采集磁刺激前、中、后的脑电信号。 结果与结论：磁刺激穴位140~170 ms后,在F3,F1,FZ,F2,F4,FC3,FC1,FCZ,FC2,FC4 等电极处记录到诱发电位晚成分P150。对该成分进行偶极子源定位分析发现P150定位于前扣带回后部,之前的研究已经证明前扣带回不仅参与痛觉认知,还参与痛觉的调制。结果揭示了磁刺激穴位可能的镇痛机制。     

同一经络上穴位的脑功能磁共振成像研究

目的:手针针刺同一经络上但被同一神经阶段支配的不同穴位的核磁共振功能成像研究。方法:对33名志愿者进行手针针刺,每一位志愿者会随机地接受一个点的针刺:太冲穴,中都穴,太冲穴旁的非穴位点和中都穴旁的非穴位点,在针刺同时用1.5T核磁共振扫描仪进行扫描,得到针刺穴位相对于非穴位的激活脑区。结果:相对于刺激假穴组,刺激真穴组都激活了额内侧面、前扣带回(ACC,BA24/32/25);对侧中央后回、顶叶BA7/31、额中回;还有同侧的BA19和小脑。针刺太冲穴特异地激活了两侧额中回和颞下回,对侧颞中回、岛叶、小脑和同侧额中回、尾状核;针刺中都穴特异地激活了对侧颞上回、顶下小叶、同侧的中央前回和额上回。结论:针刺同一经络上的不同穴位会引起相似的大脑反应,而针刺同一经络上不同穴位所引起的特异性激活也表明了穴位特异性的存在。     

腹针治疗周围性面瘫选穴规律研究

目的 研究腹针治疗周围性面瘫的选穴规律。方法 通过计算机及手工检索,选取近15年有关腹针治疗周围性面瘫的相关文献,以临床研究、疗效观察、现代对比实验研究为依据,进行分析归纳,探讨腹针的选穴规律。结果 腹针治疗周围性面瘫主要取任脉、肾经、胃经及脾经上的穴位及腹部新穴,使用频率依次为55.70%、15.44%、14.09%、2.68%、12.08%;腹针治疗周围性面瘫选用的标志性穴位组合规律:主要有引气归元、腹四关、天地针、调脾气,其使用频率依次为48.48%、27.27%、12.12%、12.12%。结论 合理运用腹针,遵循其选穴规律,可有效治疗周围性面瘫。     

Role of Collagen Fibers in Acupuncture Analgesia Therapy on Rats

Acupuncture, a traditional Chinese therapeutic technique, has been put into practice for more than 4000 years and widely used for pain management since 1958. However, what is the mechanism underlying the acupuncture for analgesia effects by stimulation of acupoints, what substances receive the original mechanical acupuncture signals from the acupoints, or what transforms these signals into effective biological signals are not well understood. In this work, the role of collagen fibers at acupoints during acupuncture analgesia on rats was investigated. When the structure of the collagen fibers at Zusanli (ST36) was destroyed by injection of type I collagenase, the needle force caused by the acupuncture declined and the analgesic effects of rotation or lift-thrusting manipulations was attenuated accompanying the restraint of the degranulation ratios of mast cells. We propose that collagen fibers play an important role in acupuncture-induced analgesia, and they participate in signal transmission and transform processes.     

Acupuncture for psychiatric illness: a literature review

The use of complementary and alternative medicine (CAM) is on the rise, especially among psychiatric patients. Acupuncture is considered a safe and effective treatment modality, and traditional Chinese medicine teaches that acupuncture harmonizes the body's energies. Scientific research has found that acupuncture increases a number of central nervous system hormones (ACTH, beta-endorphins, serotonin, and noradrenaline) and urinary levels of MHPG-sulfate, an adrenergic metabolite inversely related to the severity of illness in schizophrenics. Acupuncture can have positive effects on depression and anxiety, although evidence is still lacking as to its true efficacy for these conditions. To the authors' knowledge, no trials have been conducted for schizophrenia, and researchers evaluating acupuncture in cases of substance abuse have found conflicting results. Further research is warranted.     

针灸联合多种方法治疗骨质疏松的网状Meta分析

文题释义： 网状 Meta 分析：是传统Meta分析的扩展,可以同时比较3个或者3个以上的干预措施的疗效。但是目前对网状Meta分析的定义相对混乱,按照“国际药物经济学和结果研究协会”的报告,网状Meta分析包括调整间接比较和混合治疗分析。混合治疗分析是在直接比较的基础上合并间接比较的证据,从而提高分析结果的精确性,但是这种方法主要是应用于干预措施可以形成具有闭合环路(loop)时。网状Meta分析的最大优势就是可以对治疗同类疾病的不同干预措施进行量化比较,并按照某一结果指标效果好坏进行排序,进而选择最优治疗方案。 针灸：是一门独具特色的传统医学学科。临床上,常将针灸作用于经络腧穴以防治疾病的方法和技术,称之为针灸疗法。针灸具有适应证广、疗效明显、应用方便、经济安全等优点。 背景：针灸及其联合其他疗法与标准西医疗法之间比较治疗骨质疏松有效性的研究结论存在争议,现有的原始研究和 Meta 分析多为单一针灸治疗、针灸联合西药治疗与标准西医疗法间的比较,缺乏针灸联合其他疗法之间的直接比较,使人们难以对针灸疗效有较清晰、全面的认识。 目的：采用网状Meta分析技术,比较针灸联合其他疗法治疗骨质疏松疗效的差异。 方法：在CNKI、维普、万方、SinoMed、PubMed、Cochrane Library数据库上进行检索,纳入不同针灸疗法对比治疗骨质疏松的临床随机对照试验(RCT)。根据相关纳入与排除标准对文献进行筛选后提取相关资料,并对纳入文献进行质量评价。运用Stata 14.0软件进行文献数据分析及作图。 结果与结论：最终纳入34篇随机对照试验,共涉及7种干预措施,包括：单一针灸治疗,单一西药治疗,单一中药治疗,针灸+西药联合治疗,针灸+中药联合治疗,中药+西药治疗,针灸+中药+西药联合治疗。①在治疗有效率上,针灸+中药的疗效最佳,且针灸+中药、针灸+西药以及针灸+中药+西药,均显著比中药+西药治疗的有效率高(P < 0.05);②在增加患者骨密度方面,针灸+中药、针灸+西药以及针灸+中药+西药,均优于单一中药或西药组(P < 0.05);③在缓解患者疼痛方面,与单一西药治疗相比,针灸+西药治疗能缓解患者的疼痛(P < 0.05),但其余治疗方式之间,并无明显的差异(P > 0.05)。在纳入的研究中,有极少数患者出现针刺后穴位瘀血现象,但均未出现晕针或未报道,也未发现其他毒副作用。提示：针灸联合其他疗法,可以提高有效率、增加骨密度、缓解患者疼痛。 ORCID: 0000-0001-7755-5563(岑卓灏) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

电针对骶髓损伤后神经源性膀胱容量及其组织形态学的影响

背景：骶段的脊髓和腰椎病变导致脊髓损伤使骶髓初级排尿中枢受损或其周围神经(副交感和体神经)病变引起逼尿肌无反射,会导致尿潴留,进而导致膀胱组织细胞形态学也发生了病理性变化。 目的：观察电针次髎、中极、三阴交穴对骶髓损伤后尿潴留模型大鼠最大膀胱容量及其组织形态学的影响。 方法：SD雌性大鼠40只,随机抽取10只为空白组,其余制备骶髓损伤模型后随机摸球法均分为模型组、电针穴位组和电针对照点组。模型组大鼠只捆绑不针刺,穴位组取大鼠“次髎”、“中极”、“三阴交”,对照点组取非穴对照点,针刺后加电针,均治疗20 min。且所有大鼠在治疗后第14天和第22天行膀胱容量检测,治疗结束后取膀胱组织行苏木精-伊红染色观察大鼠膀胱组织形态学变化。 结果与结论：①电针穴位组最大膀胱容量较治疗前明显降低(P < 0.01),并且较对照点组疗效更明显(P < 0.05),穴位组膀胱容量差值(d值)较对照点组差异更明显(P < 0.05)。②电针穴位组膀胱组织形态学较模型组及对照点组有明显改善。说明电针次髎、中极、三阴交穴可有效降低骶髓损伤后尿潴留大鼠最大膀胱容量并使受损的膀胱组织细胞得到一定程度修复。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Acupoint-specific fMRI patterns in human brain

Specific central nervous system (CNS) responses to acupuncture have recently attracted attention. It is important to understand the differences in fMRI images of the brain evoked by acupuncture at an acupoint and at a nearby "sham" point. Here, we report analyses of fMRI images of the brains of 37 healthy volunteers in response to acupuncture at Liv3 (Taichong) and LI4 (Hegu) versus their sham points. We found common activation areas in response to Liv3 or LI4 acupuncture in the middle temporal gyrus and cerebellum, along with deactivation areas in the middle frontal gyrus and inferior parietal lobule, compared with the effects of acupuncture at sham points. Acupuncture at Liv3 evoked specific activation at the postcentral gyrus, posterior cingulate, parahippocampal gyrus, BA 7, 19 and 41, but deactivation at the inferior frontal gyrus, anterior cingulate, BA 17 and 18, compared with acupuncture at its sham point. Acupuncture at LI4 evoked specific activation at the temporal pole, but deactivation at the precentral gyrus, superior temporal gyrus, pulvinar and BA 8, 9 and 45, compared with acupuncture at its sham point. These observations reveal that acupuncture at acupoints induces specific patterns of brain activity, and these patterns may relate to the therapeutic effects of acupuncture.     

背部腧穴穴位定位仪器的设计

目的：针对当前电子医疗设备领域缺乏自动化程度高的中医穴位定位辅助仪器的状况,设计了一种背部腧穴穴位定位的电子仪器。方法：仪器整体由四部分组成：搭载Android系统的智能移动终端、蓝牙通信模块、以ARIVl为核心的控制系统及二维机械运动平台。其中,搭载Android系统的智能移动终端负责接收用户在应用界面的操作指令、蓝牙通信模块负责用户指令的无线传输、以ARM为核心的控制系统根据用户指令控制二维机械运动平台精准的运动,从而达到穴位定位的效果。结果：Android操作系统下编写的用户界面美观流畅,用户体验良好。主控制系统性能稳定,能处理各种复杂的穴位定位指令。经过测试,在室内环境下蓝牙通信模块正常工作的有效距离为7m,能满足仪器的实际应用需求。结论：仪器的整体设计遵循高内聚低耦合的设计原则,使得系统具有很好的维护性和扩展性。本仪器能够辅助中医医师实现对背部穴位的定位。提高医师在治疗过程中的工作效率。同时,为中医穴位相关的医疗保健器械提供可靠的解决方案,有利于传统的针灸穴位疗法推广。     

光子中医学研究概况

本文简要地论述了中医药学的基本特点及其优势,将现代光子学理论与技术纳入到中医学体系,提出了光子中医学的概念,对光子中医学的学科建设、研究领域及其前景进行了论述.在中医基础理论方面,光子中医学就阴阳的属性及判断、五行的划分及向五色的延伸、经络系统的穴位特征与效应特点等方面进行阐述;在中医临床应用上,研究了光生物效应的中医作用机理,对低强度激光照射治疗及激光针灸进行了初步临床疗效观察;在中药研究方面,对中药有效成分与药理分析提出了光子药理学分析.最后,总结了中医学现代化建设的光子学设备研究方向以及中医药学的现代建设的光子学方向.