三叉神经系统在颜面部针刺镇痛过程中的作用及其实验形态学的研究

<正> 祖国的医学实践表明,针刺头面部穴位有明显的镇痛效应,且可用于治疗某些疾思。近年来大量的临床资料证明,针刺颜面部穴位既能产生明显的镇痛效应又能抑制内脏牵拉反应;头面部针刺麻醉还能作远隔部位的手术。神经解剖学记载:颜面部痛觉是由三叉神经传入到三叉神经脊束核的。脊束核的尾段内可记录出“痛”细胞放电,这就更加说明三叉神经及其尾侧脊束核与颜面部痛觉有关。     

三叉神经脊束核及其纤维联系在针剌镇痛中的作用

哺乳类动物的三叉神经脊束核有相似的形态结构。其尾侧与颈段脊髓后角尖端灰质相连续。根据细胞构筑的特点,该核可分为尾侧脊束核、极间脊束核和咀侧脊束核。家兔的三叉神经脊束核只包括咀侧与尾侧两部分。三叉神经尾侧脊束核又分为带状亚核、胶状质亚核和巨细胞亚核,它们分别与脊髓后角灰质的RexedⅠ、Ⅱ和ⅢⅣ层相当。三叉神经尾侧脊束核主要与头面部的痛、温觉有关,并参与了头面部的针刺镇痛过程。三叉神经尾侧脊束核接受三叉神经、面神经、舌咽神经、迷走神经、脑干网状结构、中缝大核、兰斑、大脑皮质和脊髓的传入纤维。该核的传出纤维投射至丘脑的腹后内侧核及板内核、内侧膝状体、脑干网状结构、某些脑神经核(孤束核、三叉神经感觉主核、前庭核、舌下神经核、迷走神经背核、疑核、三叉神经运动核、面神经核和动眼神经核)、非脑神经核(中缝大核、中脑顶盖与中央灰质、楔核、楔外核和内侧橄榄副核等)和上颈段脊髓。三叉神经传入纤维及其尾侧脊束核与中枢内的许多核团发生联系,并在那里与来源于不同部位的躯体或内脏的传入纤维发生会聚,这种直接的会聚可能为颜面部针刺冲动与来自躯体或内脏的痛冲动在同一部位相互作用提供了解剖学基础。三叉神经尾侧脊束核与脊髓、巨细胞网状核、中缝大核和丘脑板内核的纤维联系可能为颜面部针刺镇痛以及颜面部针刺麻醉能进行身体其他部位手术提供了神经学基础。三叉神经尾侧脊束核与巨细胞网状核、孤束核和延髓背外侧网状结构的纤维联系可能为颜面部针刺抑制内脏痛和内脏牵拉反应提供了解剖学基础,这对支持体表内脏相关学说也是很重要的。     

颜面部针刺镇痛效应传入途径的实验形态学研究——(一)三叉神经一级传入纤维的投射

<正> 临床实践和实验性研究表明:颜面部针刺具有镇痛、抑制内脏牵拉反应和调整内脏功能等特点.当切断和封闭三叉神经(第二支)时,此类效应明显减弱或消失,它提示颜面部针刺镇痛和调整内脏效应是通过三叉神经传入中枢的.文献记载,颜面部痛觉与三叉神经尾侧脊束核有关。我们也曾部分损坏家兔的三叉神经尾侧脊束核,观察过在此核损坏前、后的针刺镇痛效应和内脏调整效应,结果显示:颜面部针刺镇痛和针刺对内脏调整效应有可能通过不同途径传至不同的中枢部位.因而,进一步研究三叉神经一级传入纤     

颜面部针刺镇痛效应传入途径的实验形态学研究 (二)三叉神经尾侧脊束核的纤维投射

<正> 祖国医学实践证明,头面部刺镇痛和针刺治病效果显著;近年来开展的头面部针剌麻醉也取得了较为满意的效果。神经解剖学记载,颜面部痛、温觉是经三叉神经传入到同侧三叉神经脊束核的。电生理学研究表明:在此核的尾段可记录到“痛”细胞放电.可见,三叉神经和三叉神经尾侧脊束核     

足三阳经下肢穴位传入纤维向脊髓和延髓的投射

<正> 下肢穴位传入纤维大部分经过腰,骶节段后根进入脊髓,足三阳经(足阳明胃经、足太阳膀胱经和足少阳胆经)在下肢的穴位主要位于下肢的外侧及背侧,其传入纤维主要由骶丛的分支由腰4至骶2节段后根进入脊髓,切断腰4至骶2节段的后根,可取消针刺“足三里”的效应,腰4至骶2节段后根纤维进入脊髓后在中枢投射的部位,能反映出足三阳经在下肢穴区传人纤维向中枢投射的范围,而腰4至骶2节段后根纤维在脊髓和延髓内的投射的研究资料很少,至于到延髓的一些核团如三叉神经脊束核、巨细胞网状孩和小细胞网状     

针刺镇痛的下行作用途径探讨

<正> 现有大量临床及实验材料证明,尾核、丘脑的束旁核、三叉神经脊束核、脊髓背角等核团与针刺镇痛有密切关系。据我们观察,这些核团都接受大脑皮质的传出纤维,即在大脑皮质与核团间存在着直接的下     

“面口合谷收”的机制研究概况

对运用现代医学手段解释"面口合谷收"的机制研究文献进行了归纳总结,以理清面口部与合谷之间的联系,用经络以外的理论来道明其所以然。口面部的感觉传入与合谷穴区的感觉传入在脊髓背根节、孤束核、网状结构、丘脑及大脑皮质的投射终止区相邻或重叠,都有可能发生会聚而互相作用,实现功能上的整合。此外,面口部、合谷穴与大脑之间的信息传入传出的神经活性物质也多种多样,这些均成为"面口合谷收"的物质基础。     

Implication of the spinal nucleus of the trigeminal nerve in acupuncture

This voluminous nucleus extends from the upper part of the medulla oblongata to the 4th cervical segment of the spinal cord. This topography puts it in relation with numerous other spinal and cerebral centers = ventral and dorsal horns of the spinal cord, including spinal nucleus of the accessory nerve, nucleus solitarius, motor dorsal nucleus of the vagus nerve, reticular formation, etc... Even if the longitudinal aspect of this nucleus is not uniform, it must be pointed out that the three branches of the trigeminal nerve are represented along this course through the trigeminal spinal tract. These relations explain the straight reciprocal action of the nerve areas of the trigeminal branches with the first four cervical nerves and the related autonomic links. These direct elementary reflexes may explain: many referred symptoms; etiologic or triggering factors of neuralgias in the entire cervico-cephalic region; the treatment of the cervico-cephalic diseases (of cerebrospinal or autonomic type) by stimulation of the various cervico-cephalic structures: acupuncture points, articular manipulations, massages, etc... an important part of auriculopuncture effects; the possibility to use points localized in various nerve areas to get the same action.     

中枢乙酰胆碱与针刺镇痛关系的研究

<正> 乙酰胆碱(Ach)不论在种系发生或个体发生上都是最早出现的神经递质,在某些低等动物感觉传入神经全部是胆碱能的,高等动物痛觉的神经通路有一部分也和上行胆碱能网状激活系统一致;脑内一些重要的与痛和镇痛有关的结构是胆碱能的;因此我们认为 Ach 可能是研究针刺镇痛中枢神经化学原     

针刺镇痛时脊髓后角和脊神经节内Ach代谢的变化

<正> 针刺穴位所产生的信息,如何传入中枢,引起镇痛,发挥治病作用,一直是针灸原理研究者十分关心和感兴趣的课题。本文以针刺镇痛时,脊髓背角和脊神经节内ACh含量及其合成酶(ChAc)与降解酶(AchE)的变化为中心,对ACh与“针感”一级传入的关系进行一些探讨。     

耳针作用的形态学基础―来自HRP神经示踪法的证据

目的 观察支配耳甲区迷走神经在延髓水平中枢的投射情况,探讨耳针作用机理.方法 健康成年SD大鼠10只,外耳道口方向分离耳甲皮肤与皮下组织,微量注射器缝内注射40 μl 浓度为30%的HRP神经示踪剂,神经示踪技术观察标记细胞在延脑水平核团分布情况.结果 除了在三叉神经脊束核外,在孤束核和迷走神经运动背核以及其他核团也发现了标记神经元或神经纤维.结论 耳甲区迷走神经分支与迷走初级中枢有神经联系,耳甲穴位针刺效应很可能是通过耳-迷走反射途径实现的.     

NEURONS DISCHARGE AND C-FOS EXPRESSION IN NTS FOLLOWING ELECTROACUPUNCTURE AT ACUPOINTS OF STOMACH MERIDIAN OF FOOTYANGMING

The nucleus of solitary tract(NTS) is a primary center for both visceral afferents and somatic afferents.Previous experiments demonstrated that NTS is associated with the connection of the stomach and acupoints in Stomach Meridian of Foot-Yangming(ST Meridian).In this study, extracellular recording and immunochemistry method were used to analyze the discharging neurons and c-Fos protein expression in NTS after electroacupuncture at different acupoints and non-acupoint.A total of 104 discharging neurons were detected in the NTS of 52 rats, of which, 86 were provided with complete data.After acupuncturing at Sibai(ST2), Zusanli(ST36), Neiting(ST44), Quanliao(SI18) and non-acupoint, the response neuron occurring rates(RNORs) in NTS were 65.12%, 51.16%, 46.51%, 34.88% and 31.40% respectively.For RNORs, there was a significant difference among Sibai(ST2), Zusanli(ST36), Neiting(ST44), Quanliao(SI18) and nonacupoint(P0.01 or P0.05).Accordingly, in other 48 rats, the number of c-fos immunoreactive(c-fos-IR) neurons in the NTS after electroacupuncture(EA) at Sibai(ST2) was significantly higher than that of at other acupoints and non-acupoint(P0.05 or P0.01).Both EA at Zusanli(ST36) and Neiting(ST44) increased c-fos-IR neurons significantly compared with that of at Quanliao(SI18) and non-acupoint(P0.05 or P0.01), while there was no difference between EA at Quanliao(SI18) and nonacupoint(P0.05).The experiments demonstrated that the afferent convergence in NTS is different by body surface point stimulus, which suggested that NTS might be a primary center in the central nervous system(CNS) which received acupoint stimulus from ST Meridian.     

微电泳导入纳洛酮对中缝大核刺激抑制脊髓背角神经元伤害性反应的影响

<正> 全身注射纳洛酮可阻断电针镇痛作用,说明内源性吗啡样物质参与针刺镇痛,进而我们又在脊髓背角伤害感受神经元胞体附近微电泳导入纳洛酮可以明显阻断电针对脊髓背角伤害性反应的抑制效应,进一步说明脊髓水平脑啡肽参与电针阻抑痛信息的传递。脊髓是外周各种传入冲动进入中枢的第一站,在此初步加工过程中,受着来自脊上水平的下行性调控。以往工作毁损中缝大核(NRM)可减弱针刺镇痛效应,电针穴位可激活中缝大核,电刺激模拟激活可产生与针刺穴位相似的明显镇痛效应,而此效应可被全身注射纳洛酮所阻断说明5-HT能下     

NEURON DISCHARGE AND C-FOS EXPRESSION IN NUCLEUS OF THE SOLITARY TRACT FOLLOWING ELECTROACUPUNCTURE AT ACUPOINTS OF STOMACH MERIDIAN OF FOOT-YANGMING

Objective: The nucleus of the solitary tract(NTS) is a primary center for both visceral afferents and somatic afferents.Previous experiments demonstrated that NTS is associated with connection of the stomach and acupoints in the Stomach Meridian of Foot-Yangming(ST Meridian).In this study, an extracellular recording and immunochemistry method was used to analyze the neuron discharge and c-fos protein expression in the NTS following acupuncture at different acupoints and non-acupoint.Methods: A total of 104 discharging neurons were detected in the NTS of 52 rats, of which, 86 were provided with complete data.Results: After acupuncture at Sibai(ST2), Zusanli(ST36), Neiting(ST44), Quanliao(SI18) and non-acupoint, the response neuron occurring rates(RNORs) in the NTS were 65.12%, 51.16%, 46.51%, 34.88% and 31.40%, respectively.For RNOR,there was a significant difference among ST2, ST36, ST44, SI18 and non-acupoint(P0.01 or P0.05).Accordingly, in other 48 rats, the number of c-fos immunoreactive(c-fos-IR) neurons in the NTS after electroacupuncture(EA) at ST2 was significantly higher than at other acupoints and non-acupoint(P0.05 or P0.01).Both EA at ST36 and at ST44 increased c-fos-IR neurons significantly as compared with EA at SI18 and non-acupoint(P0.05 or P0.01), while there was no difference between EA at SI18 and at non-acupoint groups(P0.05).Conclusion: The experiment demonstrated that the afferent convergence in the NTS was different by body surface point stimulus, which suggested that NTS might be a primary center in the central nervous system receiving acupoint stimulus from ST Meridian.     

“合谷”穴和口面部联系的解剖学基础

目的 :用形态学的方法探讨“合谷”穴与口面部的传入联系。方法 :本实验分神经生物素示踪和fos蛋白表达两部分 ,每部分均选用雌性Wistar大鼠 2 4只。将神经束路示踪剂神经生物素分别注射于“合谷”穴区和口面部 ,观察标记纤维在颈段脊髓和低位脑干的分布。电针“合谷”穴和口面部 ,利用免疫组织化学的方法 ,观察其二者的传入信息在颈髓和低位脑干诱导的fos样免疫反应阳性神经元的分布。结果 :“合谷”穴区的初级传入纤维主要止于颈髓 5～ 8节段 ;来自口面部的初级传入纤维主要止于同侧三叉神经脊束核 ,尚有少量分支直接投射至同侧孤束核和网状结构。电针“合谷”穴的传入信息除主要到达颈部脊髓背角外 ,也可到达孤束核和网状结构 ;而电针口面部的传入信息主要抵达同侧三叉神经脊束核、孤束核和网状结构 ,也可影响到颈髓背角等结构的神经元。结论 :“合谷”穴和口面部均与孤束核有着直接或间接的纤维联系 ,这可能是“合谷”穴和口面部联系的形态学基础。     

中缝核与针刺镇痛关系的研究概况

<正> 由延髓下端到中脑头端、脑干中缝两旁,有相对集中的中缝核。人、猫、兔和鼠的中缝核,由尾侧向头端均可分成下述八个核团:中缝隐核、中缝苍白核、中缝大核、中缝桥脑核、中央上核、中缝背核、线形中核和线形上核。在中枢神经内,5-羟色胺(5-HT)神经元主要分布在中缝核及其邻近的网状结构内。中缝核的联系相当广泛,共机能是多方面的。近来研究表明,它在针刺镇痛中起重要作用。 (一)损毁或电刺激中缝核对针刺镇痛的影响无论以电针刺激大鼠尾部引起嘶叫反应测痛,还是以刺激大鼠牙髓诱发的皮层     

针刺大鼠“四白”传入信息对孤束核神经元放电的影响

目的:比较足阳明经中远近腧穴及手太阳小肠经腧穴和非经非穴点的传入信息在孤束核(NTS)的差异。方法:采用细胞外记录方法,以足阳明胃经“四白”穴为刺激点,并以同名经的“地仓”和“内庭”、手太阳小肠经的“颧”、非经非穴“四白”旁开点为对照,在刺激点上用手针施以捻转手法刺激30 s,在NTS寻找对来自体表刺激点有反应的神经元。结果:52只大鼠记录到资料完整的86个NTS神经元中,针刺“四白”后NTS有反应神经元出现的机率(含兴奋和抑制性神经元)为65.12%,而针刺“地仓”“内庭”“颧”“四白”旁开点有反应神经元出现的机率分别为50.00%、46.51%、34.88%、31.40%。统计表明,针刺“四白”后NTS有反应神经元出现的机率均极显著地高于针刺“地仓”“内庭”“颧”“四白”旁开点后有反应神经元出现的机率(P<0.01);针刺“地仓”和“内庭”后NTS有反应神经元出现的机率均显著高于刺激“颧”和“四白”旁开点的有反应神经元出现机率(P<0.05)。针刺上述穴和非穴区,NTS神经元主要是以兴奋为主。针刺“四白”“地仓”“内庭”“颧”“四白”旁开点,其兴奋性神经元频率变化率分别为(35.08±4.80)%、(28.25±5.46)%(、27.57±4.87)%、(20.02±4.23)%(、18.55±2.49)%,“四白”与各组之间有显著性或极显著性差异(P<0.05或P<0.01),“地仓”“内庭”与“颧”“四白”旁开点亦有显著性或极显著性差异(P<0.05或P<0.01)。结论:与手太阳小肠经穴以及非经非穴点比较,足阳明经穴与NTS的关系更密切;足阳明经中远近腧穴的信息传入在NTS亦存在着一定的差异,这提示腧穴均有一定的特异性。     

新生大鼠注射谷氨酸钠对针刺镇痛和下丘脑弓状核β—内啡肽免疫反应细胞的影响

<正> 本实验室以往研究表明,下丘脑弓状核参与各种镇痛)并认为可能与胞体密集于下丘脑弓状核内的β-内啡肽(β-EP)能神经元活动有关。本实验对新生大鼠腹腔注射谷氨酸钠(Monosodium Glu-tamate,MSG)破坏弓状核神经元,并采用免疫细胞化学技术对β-EP 细胞进行     

Neuron Discharge and c-Fos Expression in the Nucleus of the Solitary Tract Following Electroacupuncture at Acupoints of the Yangming Stomach Meridian of Foot

The nucleus of the solitary tract (nucleus tractus solitarii; NTS) is a primary center for both visceral afferents and somatic afferents. Previous experiments have demonstrated that the NTS is closely connected to the stomach and acupoints in the Yangming Stomach Meridian of Foot (ST Meridian). In this study, extracellular recording and immunochemistry methods were used to analyze the discharge of neurons and c-Fos protein expression in the NTS following acupuncture at different acupoints and a nonacupoint. A total of 104 discharging neurons were detected in the NTS of 52 rats, of which 86 provided complete data. After acupuncture at Sibai (ST 2), Zusanli (ST 36), Neiting (ST 44), Quanliao (SI 18), and the nonacupoint, the neuron response rate in the NTS was 65.12%, 51.16%, 46.51%, 34.88% and 31.40% respectively. For neuron response rate, there was a significant difference among Sibai (ST 2), Zusanli (ST 36), Neiting (ST 44), Quanliao (SI 18), and the nonacupoint (p < 0.01 or p < 0.05). In the other 48 rats, the number of c-Fos immunoreactive neurons in the NTS by electroacupuncture (EA) at Sibai (ST 2) group was significantly higher than that EA at other acupoints and the nonacupoint (p < 0.05 or p < 0.01). EA at both Zusanli (ST 36) and Neiting (ST 44) increased c-Fos immunoreactive neurons significantly over EA at Quanliao (SI 18) and the nonacupoint (p < 0.05 or p < 0.01), while there was no difference between EA at Quanliao (SI 18) and the nonacupoint group (p > 0.05). The experiments demonstrated that the afferent convergence in NTS are different by body surface points stimulus, which suggests that the NTS might be a primary center in the central nervous system receiving acupoints stimulus from the ST Meridian.     

深刺局部穴治疗三叉神经痛疗效观察

目的:寻找提高三叉神经痛疗效的有效方法.方法:将90例原发性三叉神经痛患者随机分为深刺组(45例)、常规针刺组(45例).常规针刺组以局部近取浅刺和循经远取手足阳明经穴位为主,深刺组在此基础上对局部穴位采用深刺达神经干的方法.治疗3个疗程后统计疗效.结果:两组均收到明显疗效,深刺组临床治愈12例,显效24例,好转7例,无效2例,有效率为95.6%;而常规针刺组分别为7例、15例、12例、11例、75.6%.深刺组疗效优于常规针刺组(P＜0.05).结论:针刺治疗三叉神经痛,局部穴位深刺加循经远取手足阳明经穴位,能明显提高疗效.