食蟹猴左足三里穴针刺fMRI研究

目的 对食蟹猴进行左侧足三里穴针刺的fMRI研究,探讨左侧足三里穴针刺所引起的脑功能活动.方法 食蟹猴6只,采用3.0T MR扫描仪,动物麻醉后进行左侧足三里穴磁共振功能成像扫描.针刺fMRI采用"静息-刺激-静息"设计模式.fMRI-BOLD扫描16层,128 phase.采用SPM2软件处理fMRI实验数据,采用t检验来分析特定任务刺激下脑激活的状态.结果 针刺左侧足三里穴可以观察到左侧中央前回、右侧中央后回、双侧岛叶、楔前叶、右侧颞叶激活;额叶、顶叶、枕叶、扣带回有负激活点.结论 可以在临床使用的MRI设备上对非人灵长类动物进行脑fMRI的研究.针刺食蟹猴左侧足三里穴,fMRI可以显示不同脑组织区域的正激活和负激活.针刺的作用机理可能与中央前回、岛叶及颞上回有较密切关系.针刺足三里穴引起的负激活定位性较差,扣带回的负激活在针刺机理及针灸止痛中可能有重要作用.     

Effects of Acupuncture on Alzheimer’s Disease: Evidence from Neuroimaging Studies

As the worldwide population ages, the prevalence of Alzheimer''s disease (AD) increases. However, the results of promising medications have been unsatisfactory. Chinese acupuncture has a long history of treating dementia, but lack of evidence from well-designed randomized controlled trials that validate its efficacy and safety, as well as its lack of clear underlying mechanisms, contribute to its limited application in clinical practice. In recent years, brain imaging technologies, such as functional magnetic resonance imaging and positron emission tomography, have been used to assess brain responses to acupuncture in a dynamic, visual, and objective way. These techniques are frequently used to explore neurological mechanisms of responses to acupuncture in AD and provide neuroimaging evidence as well as starting points to elucidate the possible mechanisms. This review summarizes the existing brain imaging evidence that explains the effects of acupuncture for AD and analyzes brain responses to acupuncture at cognitive-related acupoints [Baihui (GV 20), Shenmen (HT 7), Zusanli (ST 36), Neiguan (PC 6), and Taixi (KI 3)] from perspectives of acupoint specificity and acupoint combinations. Key issues and directions to consider in future studies are also put forward. This review should deepen our understanding of how brain imaging studies can be used to explore the underlying mechanisms of acupuncture in AD.     

针刺脑功能磁共振成像的可重复性研究

目的 探讨功能性磁共振成像(fMRI)针刺引起的脑功能活动区域信号变化的可重复性。方法 选择无任何中枢神经系统症状及体征的健康志愿者12名(针刺组),利用fMRI技术分别针刺足三里穴(ST36)、太溪穴(KI3)及非穴位对照点进行5次完全相同的功能磁共振扫描,以右手对指运动作为对照组,通过计算组内相关系数来对比针刺与对指运动fMRI的可重复性。结果 12名志愿者中,10名完成了全部扫描过程,对数据完整的10名志愿者的数据进行分析。针刺足三里穴(ST36)、太溪穴(KI3),针刺组中脑功能区活动平均信号变化有着相似的模式,针刺非穴位点引起的脑功能区激活模式与针刺上述两穴位点明显不同;定量比较对指运动及针刺三点引起的脑功能信号变化的可重复性,对照组组内相关系数明显高于针刺组(P<0.05)。结论 与对指运动对照组比较,针刺fMRI引起的脑功能活动区域信号变化可重复性较差。     

Regional homogeneity analysis on acupoint specificity with resting-state functional magnetic resonance imaging

Background  The mechanism of acupuncture analgesia in craniotomy has been widely studied. However, the theoretical basis for selection of acupoints has not been examined. In this study, we used the regional homogeneity method blood oxygen level-dependent (BOLD) signals to determine changes in brain activity in response to transcutaneous electrical stimulation on acupoints and non-acupoints in resting state functional magnetic resonance imaging (fMRI).

Methods  Twelve healthy volunteers were enrolled in this study. BOLD fMRI scanning of the brain was performed for 306 seconds before and 30 minutes after transcutaneous electrical stimulation on acupoints UB63 (Jinmen), LV3 (Tai chong), ST36 (Zusanli), and GB40 (Qiuxu). The procedure was repeated after one week with stimulation on non-acupoints (one was 9 above BL67, the second was 12 above BL67 (Kunlun), the third was 7 above KI3, and the fourth was 10 above KI3 (Taixi)).

Results  The regional homogeneity in the acupoint group was increased in the left thalamus, caudate, putamen, lentiform nucleus (BA19, 30, 39), postcentral gyrus, precentral gyrus (BA3, 4, 30, 32), calcarine fissure, middle temporal gyrus (BA30), right superior temporal gyrus, inferior temporal gyrus (BA38), cuneus, and precuneus (BA7, 19) when compared to the non-acupoint group. The regional homogeneity of the acupoint group was decreased in the left cerebellum posterior lobe, middle frontal gyrus (BA10), double-side precuneus (BA7), and the postcentral gyrus (BA40).

Conclusions  The brain region activated following acupoint stimulation is the ipsilateral pain-related brain region, which may relate to the therapeutic effect of acupuncture on pain relief. Further acupoint stimulation causes different central nervous responses compared to non-acupoint stimulation.

     

Altered Brain Regional Homogeneity Following Contralateral Acupuncture at Quchi (LI 11) and Zusanli (ST 36) in Ischemic Stroke Patients with Left Hemiplegia: An fMRI Study

Objective: To study the effect of contralateral acupuncture (CAT) at acupoints of Quchi (LI 11) and Zusanli (ST 36) on the unaffected limbs of ischemic stroke patients with left hemiplegia based on regional homogeneity (ReHo) indices. Methods: Ten ischemic stroke patients with left hemiplegia received CAT on right side at LI 11 and ST 36. Functional magnetic resonance imaging (fMRI) was performed before and after acupuncture. A ReHo analytical method was used to compare brain responses of patients before and after CAT operated by REST software. Results: The stimulation at both LI 11 and ST 36 on the unaffected limbs produced significantly different neural activities. CAT elicited increased ReHo values at the right precentral gyrus and superior frontal gyrus, decreased ReHo value at right superior parietal lobule, left fusiform gyrus and left supplementary motor area. Conclusions: Acupuncture at one side could stimulate bilateral regions. CAT could evoke the gyrus which was possibly related to motor recovery from stroke. A promising indicator of neurobiological deficiencies could be represented by ReHo values in post-stroke patients.     

针灸治疗肠易激综合征取穴规律初探

搜集近10年来针灸治疗肠易激综合征的临床报道近50篇,总结其取穴规律,发现天枢、足三里、中脘为使用率最高的主穴;局部取穴以腹部穴位及相关脏腑背俞穴为主;循经取穴以足阳明胃经经穴为主,肝脾两经穴位不可忽视;配穴多以八纲、脏腑辨证取穴,并注重宁心安神。并对取穴规律从中西医角度进行了分析,为针灸治疗IBS的临床取穴提供了理论依据。     

针刺促进猫脊髓Ⅱ板层可塑性变化的穴位特异性——电镜定量…

为了解针否刺穴位可促进脊髓的可塑性变化这一效应有无穴位特异性，采用针刺单侧后肢备根猫术侧Ｌ６脊神经支配范围的“足三里”和“悬钟”、“伏兔”和“三阴交”两组穴位及与它们对应的非穴位，于３０天时用电镜定量方法计数穴位经且与非穴位组脊髓Ⅱ板层内突触性终末之数量。结果：两组动物非背根来源的简单终末（ＳＴ）数无显著性差异（ｐ〉０．０５），针刺非穴位组的ＣＴ数仅为穴位组的５３％，表明针刺非穴位对ＣＴ数量无明显     

针刺"醒神益智"组穴对脑静息态功能的影响

目的 应用功能磁共振成像(fMRI)技术研究针刺穴位、非穴位对大脑静息态功能网络的影响,从而为进一步阐释针刺的神经机制提供科学依据.方法 选取健康大学生20名,随机分为穴位组和非穴位组,穴位组针刺百会、双侧风池、双侧内关,非穴位组针刺上述各穴位旁开1.5~2.0 cm非穴位处.针刺30 min后,受试者即刻接受磁共振扫...     

Involvement of connexin 43 in acupuncture analgesia

Background Connexin 43 （Cx43） is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli （ST36） acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia.
Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.     

磁刺激穴位干预的临床应用新进展

在传统中医经穴理论治疗体系中,以针刺、灸法等作用于穴位的中医治疗疾病的方式,已被广为熟知和应用。磁刺激是一种新型刺激疗法,具有无痛、无创、操作简便、易重复、能进行深部刺激等优点,以前大多用于脑功能区或刺激外周的神经、肌肉,取得了较好的效果,是四大脑技术之一。近年来磁刺激技术也在逐步应用于穴位干预中,取得了一定的成效,为此,本文对近十年的国内外文献进行了综述。在睡眠障碍、脑疲劳状态、抑郁症、脑卒中后偏瘫、腰椎手术失败综合征、肌肉疲劳等疾病的临床治疗中,磁刺激穴位有一定的作用,能代替或部分代替常规治疗。但目前大多数研究的样本量偏小,多中心前瞻性的随机对照研究缺少,循证医学证据还不足,需要以后的更高质量的临床研究。在机制方面,大多数研究主要围绕在不同穴位、不同参数、不同状态下的磁刺激干预的大脑皮层变化来进行探讨,目前的主要手段大多聚焦于脑电诱发电位、脑网络,并探讨了如何优化磁刺激系统来达到更好地效果。研究者除了中医针灸专业之外,还有不少的工科研究人员,存在多学科的交叉。综述表明将现代磁刺激技术和传统经穴理论相结合,是磁刺激技术在医学领域的新开拓,对传统中医针灸学的临床应用起到了推动作用,也利于经穴治疗在全科医疗中的推广。      

针刺对严重脑损害昏迷患者疗效的量化研究

目的 应用SPECT观察针刺治疗改善严重脑损害昏迷患者脑血流灌注和脑功能活动的可行性和价值，为针刺促醒及功能的康复治疗提供依据。方法 严重脑损害继发脑梗死（DCI）昏迷患者39例。随机分为观察组（针刺组，17例）和对照组（22例）。以韩氏穴位神经刺激仪电针患肢合谷、曲池穴、足三里和三阴交穴。使用Siemens ECAM/ICON SPECT系统，同一患者同体位下，40min之内连续接受针刺前和电针状态下2次SPECT脑灌注显像。用BFCR％数学模型定量分析，并在同样针刺1周后比较对照组临床指标。结果 17例严重脑损害昏迷患者针刺治疗前SPECT皆显示脑内大片放射性分布稀疏区或缺损区。电针治疗时，诸患者脑血流灌注和脑功能活动增高，所有病灶都有不同程度的缩小。BFCR％增高差异有非常显著性（P＜0．01），较对照组有明显的促醒和防治DCI作用。结论 针刺治疗确实可以改善病灶区的脑血流灌注和脑细胞的功能，激发脑细胞活性，可以作为严重脑损害患者综合治疗的方法之一。     

基于数据挖掘探讨国内外针灸治疗阿尔茨海默病的选穴规律*

目的 运用数据挖掘技术分析国内外针灸治疗阿尔茨海默病的选穴规律。方法 检索建库至2020年12月31日中国期刊全文数据库（CNKI）、维普中文期刊服务平台（VIP）、万方数据知识服务平台（Wanfang）、Web of Science、Pubmed、Embase、Cochrane Library数据库收录的针灸治疗阿尔茨海默病的相关文献,采用Microsoft Excel 2019建立针灸处方数据库,对腧穴、经脉进行频数统计,并运用IBM SPSS Modeler 18.0软件对腧穴、经脉进行关联规则分析。结果 共纳入182篇文献,包括308个针灸处方、96个腧穴,腧穴使用总频次为1 928次。其中,主要选取的经脉为督脉及足三阳经;腧穴主要分布于头面、下肢和上肢;累计应用频次最高的腧穴为百会、四神聪、足三里;特定穴多使用交会穴;腧穴配伍以大椎→百会最为常见。结论 国内外针灸治疗阿尔茨海默病重视督脉及足三阳经的使用;取穴以近部取穴及远近配穴为主;重视特定穴使用,尤其是交会穴。     

Nitric Oxide Signaling Molecules in Acupoints: Toward Mechanisms of Acupuncture

Recent clinical trial studies have demonstrated that the effects of acupuncture on pain improvement are small and no difference between acupoints and non-points. Whether acupuncture needles must be inserted in specific points depends on whether acupoint specificity exists that is still not resolved, and is now urgent. Previous anatomical studies have demonstrated that acupoints exist higher number of nerve fibers/trunks, blood vessels, hair follicles, and sweat glands as well as density of the gap junction. Recent evidence shows that nitric oxide(NO) level is elevated in the acupoints/meridians and is associated with an enhanced expression of NO synthase endowed with transient receptor potential vanilloid type-1. There is growing evidence from international groups showing that acupuncture induces NO-mediated vasodilatation, which increases local blood flow and allows for a flush of algesic or sensitizing substances, leading to pain relief. Previous studies, using a novel biocapture system, have demonstrated that NOx–(total nitrite and nitrate) and cyclic guanosine monophosphate(c GMP) concentrations are consistently increased over skin acupoints compared to non-meridian control regions(NMCR) in humans. Dermal microdialysis in humans showed that NO-c GMP releases in the subcutaneous tissue of acupoint are higher than those in NMCR and increased by electroacupuncture(EA). Recent studies have demonstrated that low-frequency electrical stimulation and manual acupuncture with low stimulating force and rate produce an elevation of NO release predominantly over acupoints. In contrast, NO levels over the areas of the skin regions are moderately reduced by high-frequency EA stimulation. The results from anatomical and biochemical studies consistently show that acupoints exist higher levels of NO signaling molecules, and stimulus-evoked NO release is also with a higher level at acupoints. Results suggest that NO signaling molecules contribute to the specificity of acupoints, and selecting well-trained acupuncturetists for using correct acupoints and appropriate parameters should improve acupuncture clinical trial studies.     

Effect of stimulating the acupoints Feishu (BL 13) and Dazhui (GV 14) on transdermal uptake of sinapine thiocyanate in asthma gel

Objective

To investigate the effect of stimulating the acupoints Feishu (BL 13) and Dazhui (GV 14) on the transdermal uptake of sinapine thiocyanate contained in a gel used for the management of asthma.

针灸刺激对健康人及中风患者功能磁共振显像脑活动的影响

Objective

To investigate brain activity patterns during acupuncture in stroke patients, and to compare the result with normal subjects using functional magnetic resonance imaging (fMRI).

Methods

A total of 11 stroke patients with motor weakness and 10 healthy subjects were studied. fMRI was performed during acupuncture on the left side at points Quchi (LI11) and Zusanli (ST36). Data were analyzed using statistical parametric maps of brain activation induced by acupuncture stimulation.

Results

The results showed that stimulation of both LI11 and ST36 produced significantly different brain activation patterns between the two groups. The normal group showed a greater overall activation than the stroke group. In the normal group, parts of the frontal lobe, parietal lobe, sub-lobar, cerebellum and midbrain regions were activated by acupuncture at the left LI11. On the other hand, only the right side of the inferior parietal lobule region was activated in the stroke patients. When the left ST36 was stimulated in the normal group, both sides of the frontal lobe, parietal lobe, temporal lobe, and sub-lobar, and the left side of occipital lobe, and the right side of cerebellum and midbrain regions were activated. For the same stimulation in the stroke group, only both sides of the inferior parietal lobule and cerebellum regions were activated (P<0.05, cluster level). Deactivation pattern was not noted during any acupuncture stimulation in both groups.

Conclusion

Brain signal activations during the same acupuncture were different between the healthy and the stroke patients, and the effects showed a correlation of different acupuncture points.     

治疗不安腿综合征的穴位干预方法及取穴组方规律研究

目的 统计近年来治疗不安腿综合征（RLS）的主要穴位干预方法，分析相应干预方法的取穴组方规律。方法 运用文献计量学的方法，检索中国知网（CNKI）、维普数据网（VIP）、万方数据库(WF)近40年来刺激穴位治疗RLS的临床文献，统计分析其穴位干预方法和取穴组方规律。结果 治疗RLS的穴位干预方法主要是普通针刺（占59.26%）。普通针刺方法中以足三里、三阴交、阳陵泉、承山为主要选穴，足三里、三阴交穴配伍支持度最高。其他穴位刺激疗法也是足三里、三阴交、阳陵泉、承山为主要选穴，足三里、阳陵泉穴配伍支持度最高。结论 普通针刺方法相较于其他穴位刺激疗法在治疗RLS方面相对成熟、可靠。普通针刺方法与其他穴位刺激疗法的选穴主要集中在下肢，取穴组方有规律可循，不同的干预方法取穴组方大致相同。     

针刺胃经下肢段及非经非穴点对胃电的影响

目的探讨足阳明胃经对胃功能调控的相对特异性。方法静脉持续输入盐酸山莨菪碱制作胃电节律规整性下降的异常状态背景。针刺胃经穴位足三里、梁丘以及穴位旁开1．5cm的非经非穴点，比较足三里、梁丘及其穴位旁开对照点对胃电节律的调整作用。结果足三里、梁丘及其穴位旁开对照点均能对抗盐酸山莨菪碱引起的胃电节律规整性下降。足三里、梁丘穴较其旁开对照点对胃电节律的调整作用好。结论足阳明胃经下肢段对胃功能调控具有相对特异性。     

壮医药线点灸联合针刺对失眠患者血浆Orexin及HPA轴的影响

目的观察失眠患者血浆Orexin、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)含量的变化,讨论壮医药线点灸联合针刺治疗失眠的机制。方法 50例失眠患者为针灸组,54例作为健康对照组,针灸组予以壮医药线点灸足三里联合针刺百会、神门治疗,健康对照组予以指压按摩百会、神门、足三里。记录疗效,ELISA法检测血浆Orexin、CRH、ACTH的含量。结果①治疗前针灸组和对照组比较,针灸组Orexin(112.02±8.95)pg/ml升高(P<0.05),CRH(0.88±0.13)ng/L、ACTH(15.32±4.56)ng/L均显著升高(P<0.01)。②与本组治疗前比较,针灸组治疗后血浆Orexin含量(62.01±6.22)pg/ml降低(P<0.05),CRH(0.41±0.09)ng/L、ACTH(8.01±4.02)ng/L均显著降低(P<0.01)。结论壮医药线点灸联合针刺治疗失眠的起效环节在于抑制Orexin、CRH、ACTH合成和分泌,恢复下丘脑-垂体-肾上腺轴(HPA轴)的正常功能。     

针刺治疗短暂性脑缺血发作的组穴规律研究*

目的 探讨临床针刺治疗短暂性脑缺血发作的组穴应用规律。方法 检索中国知网、万方、维普、PubMed电子数据库，筛选文献建立数据库。应用Excel进行描述性统计分析，运用SPSS Clementine 12.0进行关联规则分析，应用SPSS 26.0进行聚类分析。结果 共纳入60个针刺处方，47个腧穴，使用频次前5位的腧穴为百会、风池、颈夹脊、大椎、风府，督脉上的腧穴最多，多集中在头颈部，重视交会穴等特定穴的选用。关联度排名前4位的腧穴组合为百会-风府、大椎-哑门、百会-哑门、百会-哑门-大椎，并将高频腧穴聚为5类。结论 临床针刺治疗TIA取穴以头部为主，多采用近端取穴、循经取穴联合远端取穴的取穴原则，腧穴配伍重视调动阳气、醒脑开窍、滋补气血。     

访学有感

编者按:该文是孟红教授访学的中期总结报告,反映了作者的亲身体验和学习收获,充满激情和感叹.更多的是结合天津中医药大学实际,联系自身工作的反思与谋划.将该文发表,与全校师生分享她的喜悦和经验.也让大家结合自己工作去思考,改善教师自身的学习和工作.并期盼其他访学进修的教师也能写出亲身体验与思考,本刊将优先发表,以惠读者.