针刺镇痛机制的多样性及问题分析

从针刺镇痛神经机制（神经生理学、神经化学、神经解剖学）及非神经机制（结缔组织、局部生化改变）等方面,对复杂、多样的针刺镇痛机制进行总结,对多样性机制个体的不足之处、多样性机制间的矛盾之处及其原因进行初步分析,并提出了相应的建议。     

时间节律与针刺镇痛机制相关研究

大量的临床和实验研究证实,人和实验动物的痛阈都具有明显的昼夜节律。与针刺镇痛各环节相关的神经递质、激素分泌水平、神经元活动也同样具有昼夜节律,针刺在发挥镇痛功效的同时,也具有整复节律的作用。从时间节律特征来探索针刺镇痛机制提供了崭新的视角和思路,可望取得新的重要进展。     

基于结缔组织探讨针刺镇痛的机制

疼痛主要是由神经介导的,因此,针刺镇痛机制的研究相对集中在神经系统方面。不少研究认为,神经反应在针刺镇痛中起主要作用,但是以神经系统为主导的学说,不能解释一些临床现象。例如,很多患者在接受针刺治疗过程中感觉是轻松的、舒适的,并非一定要感受到剧痛才有效;     

针刺穴位的镇痛机制研究进展

针刺能够通过激活人体的穴位来减轻疼痛,因穴位包含肥大细胞、神经纤维等特殊成分,故有利于针刺信号的激活.在脊髓中电针可以通过下调趋化因子并增加抗炎细胞因子来抑制神经胶质细胞活化,从而减少肿瘤坏死因子α、白介素1β、白介素6、前列腺素E2等释放参与即时与长期镇痛.即时镇痛通过抑制P38丝裂原激活蛋白激酶(p38MAPK)和...     

针刺镇痛机制的研究进展

针灸在我国有着2000多年的历史，早在《黄帝内经》中就有详细的记载，是祖国医学的重要组成部分。上世纪50年代末，我国医学家在针灸可以缓解疼痛的临床基础上，发展了一种新的麻醉方法一针刺麻醉(acupuncture anesthesia)，从而推动了针刺镇痛(acupuncture analgesia)机制的研究。50多年来，我     

催眠镇痛和针刺镇痛的机制是否有区别

催眠和针刺均可缓解实验性疼痛，但二者的镇痛机制尚不清楚，对8名男性志愿受试者，用冷加压试验引起实验性疼痛。在用双盲交叉法施也安慰剂和催眠镇痛和针刺镇痛的效应进行测定。结论：1、催眠和针刺均能显著减弱冷加压试验引起的疼痛，前者经后者的作用更强；2、催眼镇痛和针刺镇痛主要不是由阿片内啡肽系统传递的；3、无论催眠或针刺，给纳洛酮或安慰剂对血浆β-内啡素水平均无明显影响。     

针刺镇痛机制研究的过去与未来

<正> Acupuncture is known as an age-old healing art originated and developedin China,It has constituted one of the major means to protect the health ofthe people for many years,and it is regarded as important as as herb medicinein combating diseases in china,However,acupuncture suffered a serious set-back during the Ching Dynasty when acupuncture was denounced as beingharmful to the human body and was p(?)ohibited by the Manchu rulers,Althoughwidely used privately among the general population,acupuncture was not acce-     

脑内GABA参与针刺镇痛的受体机制

脑室注射γ 氨基丁酸 (ＧＡＢＡ)Ａ受体的拮抗剂荷包牡丹碱 (Ｂｉｃｕｃｕｌｌｉｎｅ,Ｂｉｃ)未能阻断针刺镇痛效应 ,说明脑内ＧＡＢＡ不参与或不通过激活Ａ受体参与针刺镇痛效应。为阐明脑内ＧＡＢＡ在针刺镇痛中的作用及其受体机制 ,本文比较观察了脑室注射 (ｉｃｖ)和蛛网膜下腔注射 (ｉｔｈ)ＧＡＢＡＢ受体的拮抗剂ＣＧＰ 55845对针刺镇痛效应的影响。以辐射热照射大鼠尾部引起甩尾反射潜伏期作为痛阈的指标 ,以脑室注射 5μＬ、蛛网膜下腔注射 1 0 μＬ药液加 5μＬ生理盐水后、或电针“次”穴后痛阈变化百分率的最大值判断镇痛效应 …     

从针刺镇痛原理看安慰针刺设置的问题

本文回顾了针刺镇痛的神经机制及规律,即针刺镇痛的特异性与广泛性取决于刺激强度与刺激部位,当刺激部位与痛源处于同一神经节段时,不论弱刺激或强刺激均可产生镇痛效应;当刺激部位与痛源处于非同一神经节段的远端时,强刺激才能产生镇痛效应。在此基础上指出当前针对疼痛类疾病临床研究中安慰针刺对照设置存在的问题,提出在疼痛类疾病临床研究中,合理的安慰针刺的设置应当在与痛源部位处于非同一神经节段的远端部位进行弱刺激。     

针刺对神经病理性疼痛的镇痛机制

通过分析近年来国内外有关针刺镇痛的研究进展,总结针刺对神经病理性疼痛的镇痛机制。分别从外周和中枢水平阐述了针刺对神经病理性疼痛的镇痛机制,包括外周敏化与免疫炎性反应、离子通道的改变、中枢敏化、细胞信号通路的调节、脊髓胶质细胞的活化等方面。认为借助多组学技术开展体外试验,检测针刺前后神经病理性疼痛患者体内相关代谢物质及各级信号通路分子的变化情况,进一步明确针刺的镇痛机制,应是今后研究的重点。     

Acupuncture analgesia: a review of its mechanisms of actions

The mechanism of acupuncture analgesia (AA) has been widely explored since the 1970s. Early studies investigated the relationship between acupuncture and endogenous opiates (beta-endorphin, enkephalin, endomorphin and dynorphin). Before the 1990s, most experts agreed on the concept that in normal animal models, lower frequency electroacupuncture (EA) stimulates the release of beta-endorphin, enkephalin and endomorphin, which in turn activates the mu- and delta-opioid receptors, and that higher frequency EA stimulates dynorphin which activates the kappa-opioid receptor. Besides endogenous opiates, our studies have focused on serotonin. The serotoninergic descending inhibitory pathway is suggested to be an important mechanism of acupuncture analgesic, collaborating with endogenous opiates. Many efforts have been made to clarify these mechanisms, but to date no satisfactory consensus has been reached. In the late 1990s, researchers began to focus on the different analgesic effects of EA between normal and hyperalgesic animal models. Published data from these studies imply that normal and hyperalgesic animals respond differently to EA. Results from experiments on the anti-hyperalgesia effect of EA have raised a new issue about the influences of EA on receptors to excitatory amino acid in the spinal cord level. Results from various studies have shown that these receptors play a role in the mechanism of AA. Recently, research on the autonomic nervous system (ANS) seem to indicate its connection with acupuncture. The inflammatory reflex (via the ANS) might be a crucial part of anti-hyperalgesia elicited by acupuncture, and this reflex, which regulates the immune system in the organism, can elucidate not only the mechanism of AA but also the mechanism of acupuncture applied to other inflammatory conditions. Innovation of functional image study enables us to analyze the responses of cortex on living human body to acupuncture. However, results of these experiments are still controversial. After 30 years of acupuncture research, there are still many puzzles left to be solved regarding the mechanism of AA.     

Acupuncture mechanisms: anesthesia, analgesia andprotection on organ functions

Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and of its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles, lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.     

针刺方向、角度、深度与针刺镇痛的关系

从疼痛病症、针刺进针点、针刺工具及针刺方向、角度、深度等不同角度,对近30年针刺镇痛文献进行分析,初步优化针刺方向、角度、深度与针刺镇痛的关系,以提高针刺镇痛疗效.结果表明,针刺方向、角度及深度是影响针刺镇痛疗效的关键因素,但目前对此研究非常薄弱.应用多因素分析法,系统分析针刺方向、角度、深度等因素与镇痛效应、镇痛机制...     

针刺方向、角度、深度与针刺镇痛的关系

从疼痛病症、针刺进针点、针刺工具及针刺方向、角度、深度等不同角度,对近30年针刺镇痛文献进行分析,初步优化针刺方向、角度、深度与针刺镇痛的关系,以提高针刺镇痛疗效.结果表明,针刺方向、角度及深度是影响针刺镇痛疗效的关键因素,但目前对此研究非常薄弱.应用多因素分析法,系统分析针刺方向、角度、深度等因素与镇痛效应、镇痛机制的关系,既可提高针刺镇痛疗效,又可全方位探索针刺镇痛机制.     

Acupuncture for allergic rhinitis: a systematic review and meta analysis

Objective

To analyze and review the clinical efficacy of acupuncture (including electroacupuncture) alone for allergic rhinitis (AR) and to compare its efficacy with antihistamines and Chinese patent medicine Bi Yan Kang Tablet.

Methods

The search strategy, inclusion and exclusion criteria were made according to the principle of evidence-based medicine. We performed a systematic search on China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), Chinese Biomedical Literature Database (CBM), PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Library, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) of acupuncture for allergic rhinitis between January 1990 and December 2015. The quality was evaluated by Cochrane Handbook for Systematic Reviews of Interventions Version 5.1, and the meta-analysis was conducted by RevMan 5.3 version.

Results

Twenty eligible RCTs were included into the meta-analysis after selection. Compared with antihistamines, the meta-analysis showed RR=1.24>1, 95%CI[1.15, 1.33], P<0.00001, indicating that acupuncture achieved a better total effective rate for AR than antihistamines; MD = –0.93<0, 95%CI[–1.22,–0.63], P<0.00001, indicating that acupuncture is better than antihistamines in decreasing the total nasal symptom score (TNSS) in AR patients; and MD = 1.46>0, 95%CI[–10.84, 13.75], P = 0.82, indicating that there was no statistical difference between acupuncture and antihistamines in regulating immunoglobulin E (IgE) in AR patients. Compared with Bi Yan Kang Tablet, the meta-analysis has shown RR = 1.50>1, 95%CI[1.30, 1.73], P<0.00001, indicating that acupuncture achieved a better total effective rate for AR than Chinese patent medicine Bi Yan Kang Tablet.

Conclusion

Acupuncture alone can achieve a better total effective rate for AR than antihistamines and Bi Yan Kang Tablet. It is also better than antihistamines in improving clinical symptom scores; however, whether acupuncture is better than Bi Yan Kang Tablet needs further proof. As far as current data are concerned, there was no statistical difference between acupuncture and antihistamines in improving serum IgE; further study is needed in this regard. The risk of bias due to absent randomization methods or blinding implementation decreased the evidence level of the overall conclusion.

     

论针刺深浅之“刺皮”

从《黄帝内经》开始就已有刺皮针法的相关记载,现代刺皮针法更是因其安全有效、患者痛苦少而被更多地运用到临床中。刺皮针法的理论基础包括皮部理论、卫气理论、五脏理论,刺皮针法常用针具有鑱针、鍉针、锋针、毫针,刺皮针法衍生出的针法包括经皮刺激、皮内刺激,刺皮针法的主治范围等方面,阐述刺皮针法的特点并分析所存在的问题,以为今后刺皮针法的临床研究提供理论基础。     

针灸辨证治疗偏头痛的效果分析

目的观察针灸辨证治疗偏头痛的效果。方法对我院收治的80例偏头痛患者采用针灸辨证治疗。结果经过治疗,肝阳上亢型总有效率为95．2％,痰浊上扰型总有效率为94．1％,瘀血阻络型总有效率为100．0％,气血亏虚型总有效率为85．7％,肝肾阴虚型总有效率为90．0％,总有效率为93．7％。结论采用针刺辨证治疗偏头痛标本兼治,内外齐施,从而达到“通则不痛”、“荣则不痛”的目的。     

Introduction to Professor HUA Yan-ling's Acupuncture Experience: Ⅱ .Paravertebral Acupuncture, Sacroiliac Acupuncture and Sacral Acupuncture

Pro. HUA had practiced traditional Chinese medicine and acupuncture for about 50 years, borne excellent medical skills and was then highly respected by his colleagues and patients. In his large amount of practice, he combined syndrome differentiation in Chinese medicine and disease differentiation in western medicine in order to work hard on acupuncture indications and some stubborn diseases. With the time going on and medical cases accumulating, some unique treatment styles had been formed, such as Jiaji (paravertebral) acupuncture, sacroiliac acupuncture and sacral acupuncture. They are briefly introduced as follows.     

腹腔镜术后采用喷他佐辛镇痛的临床分析

目的：腹腔镜手术术后采用喷他佐辛进行镇痛效果评价.方法：随机抽取我院2008-2010年经腹腔镜手术患者52例,随机分为28人观察组和24人对照组;观察组按照术前8-12h给药喷他佐辛1-2粒,200mg/粒,手术结束后待患者可以正常进食后6h给喷他佐辛1例,之后连续两日早晚个给药1例,注意观察用药期间患者镇痛效果、不良反应、体征、和睡眠状况.结果：对比两组镇痛效果,观察组与对照组比较疼痛明显减轻;待清醒后观察组VAS值为1.43±0.26VS对照组VAS值为2.79±1.44（P〈0.05）,但术后6h,12h,24h两组VAS值无显著差异.结论：喷他佐辛用于术后镇痛疗效和安全性均值的肯定适于经腹腔镜手术后镇痛使用.