Neurobiology of Acupuncture: Toward CAM

Sheng-Xing Ma. Departments of Obstetrics and Gynecology, Harbor–UCLA Medical Center, David Geffen School of Medicine at University of California at Los Angeles, Torrance, CA, USA. eCAM 2004; 1:41–97, http://www.ecam.oupjournals.org/cgi/content/full/1/1/41It has long been accepted that acupuncture, puncturing and scraping needles at certain points on the body, can have analgesic and anesthetic effects, as well as therapeutic effects in the treatment of various diseases. This therapy, including acupuncture anesthesia, has drawn the attention of many investigators and become a research subject of international interest around the world. Numerous studies have demonstrated that the nervous system, neurotransmitters, endogenous substances and Jingluo (meridians) may respond to needling stimulation and electrical acupuncture. An abundance of information has now accumulated concerning the neurobiological mechanisms of acupuncture, in relation to both neural pathways and neurotransmitters/hormonal factors that mediate autonomic regulation, pain relief and other therapeutics. Early studies demonstrated that the analgesic effects of electroacupuncture (EA) are mediated by opioid peptides in the periaqueductal gray. Recent evidence shows that nitric oxide plays an important role in mediating the cardiovascular responses to EA stimulation through the gracile nucleus-thalamic pathway. Other substances, including serotonin, catecholamines, inorganic chemicals and amino acids such as glutamate and -aminobutyric acid (GABA), are proposed to mediate certain cardiovascular and analgesic effects of acupuncture, but at present their role is poorly understood. The increased interest in acupuncture health care has led to an ever-growing number of investigators pursuing research in the processes of the sense of needling touch, transduction of needling stimulation signals, stimulation parameters and placebos. In this Review, the evidence and understanding of the neurobiological processes of acupuncture research have been summarized with an emphasis on recent developments of nitric oxide mediating acupuncture signals through the dorsal medulla-thalamic pathways.     

不同机体状态下针刺对神经递质的调控

针刺效应的产生与神经系统结构完整性和功能正常密切相关,神经递质是针刺效应产生的物质基础。本文在梳理针刺效应神经生物学机制的基础上,就不同机体状态下针刺对神经递质的调控机制作一总结。神经递质在腧穴局部参与针刺信号的启动,在中枢层次参与针刺信息的传导与整合,在效应器官参与疾病的调控。针刺对神经递质的调控与机体状态密切相关,具有趋正常化调节效应特点。神经递质在穴位局部产生的针刺效应是非特异性作用;在特定机体状态下,神经递质参与靶器官、效应器官的功能调控,体现了针刺的特异性作用。     

“头项寻列缺”的机制研究概况

从有关"头项寻列缺"的针灸理论基础、生理解剖基础、现代机理等方面分别进行探讨,从不同方面证实针刺列缺穴可以有效治疗头项部疾病。列缺穴为八脉交会穴之一,通于任脉,而任督二脉经气相通,督脉的循行路线过头项部,针刺列缺穴可疏通任督二脉的经气,能够有效治疗头项部的疾患,其机制可能与神经递质抑制疼痛信号的传递、筋膜通路相关。现代机理研究涉及穴位敏化机制、红外热像机制、血流动力学机制等多个方面。     

针刺内关穴对大鼠心肌缺血再灌注损伤后HMGB1表达的影响

目的:探讨针刺内关穴对大鼠心肌缺血再灌注后HMGB1表达的影响。方法:建立心肌缺血再灌注模型,实验分为假手术组、模型组、针刺治疗组,针刺治疗组造模前7天电针内关穴。动物心超检测心室前壁厚度、后壁厚度、左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)及左室射血分数(LVEF)、短轴缩短率(FS)等指标,HE染色,光镜观察心肌组织病理变化,Western blots检测心肌HMGB1蛋白的表达。结果:与模型组比较,针刺组大鼠心室前壁厚度、FS、LVEF均明显升高,LVDs、LVDd明显下降;光镜观察心肌病理学变化减轻,心肌细胞HMGB1蛋白表达减少。结论:针灸预处理可减轻大鼠心肌缺血再灌注损伤,其机制可能与减少HMGB1表达有关。     

针刺治疗血管性痴呆机制的研究进展

血管性痴呆是一种由脑血管病所导致的严重认知功能障碍综合征,是仅次于阿尔茨海默病的第二位常见的痴呆类型。西医对于血管性痴呆缺乏有效的针对性治疗,而针刺作为治疗血管性痴呆的一种有效手段,在临床广泛应用。目前,针刺的机制尚未完全阐明,现对近年来针刺治疗血管性痴呆的动物实验机制进行回顾,为探索针刺治疗血管性痴呆的机制提供依据和思路。     

针刺研究的困惑与假说

近年来西方用现代临床试验方法研究针灸引出一些令传统针灸界十分困惑的难题,其中包括如何确认针灸适应症,穴位是否有特异性,为何东方临床经验同西方研究结果迥异等问题。笔者试图以“针灸愈合作用”、“泛穴现象”及“硬针灸和软针灸”3个假说解释西方报道的大量临床研究数据同中国传统针灸理论和实践的差异。相信,采用科学方法对这些假说的证实或否定,将促进对传统针灸的重新认知和现代针灸理论的成熟。     

针灸治疗抑郁症随机对照试验的临床进展

现代研究发现,针灸刺激作用可通过网状结构上行激动系统使大脑皮层兴奋性增强,调节兴奋与抑制过程的平衡,从而恢复中枢神经系统的平衡状态。并能改善椎动脉供血情况,使脑血流速度加快,从而改善脑细胞的代谢。针灸亦可通过改善大脑皮质抑制状态,增强代偿功能,而提高皮质细胞的基本电活动。以此达到改善并治疗抑郁症患者的各种症状的目的。近年来针灸治疗抑郁症随机对照试验运用较为普遍的是头针、体针、腹针,而耳针、眼针与腕踝针的应用较少或仅作为配合治疗。     

周围性面神经麻痹的针刺时机探析

周围性面神经麻痹是临床常见的多发病,在治疗上多采用针刺治疗,而针刺的时机异同,会直接影响病患的恢复效果。现代医学研究普遍认为,急性期面瘫,面神经炎症,多发生水肿,不应尽快针刺治疗;而针灸临床多数报道表明,早期给予针刺,能有效提高临床有效率。因此,对于针刺时机则需进一步加强其标准化。本文则主要通过对近几年文献的检索,探索最佳针刺时机在面神经麻痹中的临床应用。     

针灸对AD大鼠血清内Aβ含量变化的影响

探讨针灸对AD大鼠血清内Aβ含量的影响。方法：将60只Wistar大鼠随机分为正常组、模型组、假手术组及针灸治疗组,对模型组和针灸治疗组大鼠海马注射A131-42制备AD模型,假手术组大鼠海马注射等量生理盐水;对针灸治疗组大鼠采用针刺加艾灸百会穴和肾俞穴进行治疗,其余组大鼠不进行任何治疗;以酶联免疫分析法检测各组大鼠血清中Aβ含量。结果：与正常组比较,模型组Aβ含量显著上升,差异有统计学意义（P〈0．01）;与模型组比较,假手术组、针灸治疗组Aβ含量显著降低,差异有统计学意义（P〈0．05,P〈0．01）;假手术组与针灸治疗组比较,差异无统计学意义（P〉0．05）。结论：针灸AD大鼠百会与肾俞穴可降低AD大鼠血清内Aβ含量,但其作用机制尚待进一步研究。     

针刺调神组方对慢性失眠症患者过度觉醒状态的影响

目的:观察针刺调神组方治疗慢性失眠症的临床疗效及对过度觉醒状态的影响,并探讨其可能机制.方法:将60例慢性失眠症患者随机分为针刺组(30例,脱落1例)和假针刺组(30例,脱落1例).两组均予基础睡眠健康宣教.针刺组采用针刺调神组方治疗,穴取百会、神庭、印堂、神门、三阴交;假针刺组采用非有效穴浅刺治疗.两组均隔日治疗1次...     

针刺郄门穴治疗35例慢性浅表性胃炎临床疗效观察

目的:观察针刺郄门穴治疗慢性浅表性胃炎的临床疗效,为临床提供一个简捷、安全、有效的治疗方案。方法:将70例慢性浅表性胃炎的患者随机分为治疗组(针刺双侧郄门穴)35例和对照组(针刺双侧内关、中脘、足三里)35例,观察比较两组临床疗效。结果:治疗组总有效率为97.14%,对照组为91.42%,两组比较差异无统计学意义(P0.05)。结论:针刺郄门穴治疗慢性浅表性胃炎疗效确切,远端取穴,简单、安全便于临床运用推广。     

平衡针治疗急性咽炎咽痛即时疗效分析

目的:探讨平衡针治疗急性咽炎咽痛的即时疗效。方法:74例病人按就诊号随机分为治疗组和对照组,其中治疗组36人给予平衡针针刺"咽痛穴"治疗,对照组38人给予假穴位针刺,评价治疗后1min视觉模拟评分(VAS)及安全指标。结果:治疗后1min治疗组及对照组VAS分别为(2.11±1.88)分和(3.39±1.94)分,治疗组优于对照组(P<0.05)。治疗组愈显率为44.4%(16/36),优于对照组的10.5%(4/38)。结论:平衡针治疗及假穴位针刺治疗皆能迅速缓解急性咽炎咽痛症状,平衡针疗效优于假穴位针刺疗效。     

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.     

“针灸只是安慰剂”之质疑——以国内外针灸文献对比研究为讨论基础

[目的]探讨国外SCI源期刊对针灸治疗腰背痛的研究方向,并与国内针灸核心期刊进行对比。通过对比,对“针灸只是安慰剂”之说进行深入探讨与思考。[方法]通过搜集近10年国外SCI源期刊和国内核心期刊所收录的针灸治疗腰背痛的临床研究文献进行统计和分析,探讨国内外研究者对针灸治疗腰背痛的研究方向之差异,从而进一步对“针灸只是安慰剂”之说进行剖析。[结果]国外研究对针灸治疗腰背痛的研究目标设立较为广泛,国内研究则是集中于探索针灸治疗腰背痛的疗效观察与评估。但国外研究中涉及了国内研究中所不见的假针灸对照试验研究。可是,基于假针灸对照组的设立存有争议并且未达到共识,“针灸只是安慰剂”之说仍有争议。[结论]国内和国外研究者对针灸治疗腰背痛存在着研究方向上的分歧。“针灸只是安慰剂”之说仍存有争议。     

针灸疗法治疗男性不育症的近况

综合近10年中医药文献可知：针灸疗法在治疗男性不育症的研究方面取得了一定进展，主要从针刺疗法、针药并用以及穴位注射三个方面进行探讨，方法简便，毒副作用小，充分显示了针灸治疗疑难病症方面的优势。但在基础理论方面还存在诸多不足之处。我们既要加强临床的经验探索，又要开展基础理论研究，使针灸疗法更好地为男性不育患者服务。     

国外假针刺对照的针灸临床试验研究现状分析

对国外开展的假针刺对照的针灸临床试验研究进行总结梳理,包括:1假针刺的概念背景,2假针刺对照的针灸临床试验在各国的发展现状,3德国假针刺对照的针灸临床试验研究概况,4国外大样本针灸临床试验中关于假针刺对照试验的研究概况。对假针刺对照试验的未来发展趋势进行总结分析,提出目前针灸研究存在的问题。     

眼针对局灶脑缺血再灌注大鼠脑组织及血液肿瘤坏死因子含量的影响

目的探讨眼针疗法治疗缺血性脑血管病的可能机制。方法采用随机分组将大鼠分为假手术组、模型组与眼针组,改良的线栓方法制作大鼠局灶性脑缺血再灌注模型;取上焦区、下焦区、肝区、肾区为施加因素;采用ELISA法检测大鼠脑组织及血液TNF-α含量。结果眼针组与模型组脑组织及血液TNF-α含量比较,差异有统计学意义（P〈0.01）。结论眼针可降低缺血半暗区皮层脑组织及血液中TNF-α含量。这可能是眼针治疗缺血脑血管病机制之一。     

ANALYSIS OF THE SHAM AND VERUM ACUPUNCTURE TECHNIQUES EMPLOYED IN THE ACUPUNCTURE RANDOMIZED TRIALS FOR TENSION TYPE HEADACHE:A REEVALUATION OF THE THEORETICAL BASIS AND LOGIC FOR ACUPUNCTURE PRACTICE AND RESEARCH

Analysis of the sham and verum acupuncture techniques employed in the acupuncture randomized trial for tension type headache: a reevaluation of the theoretical basis and logic for acupuncture practice and research.A number of research studies over the last decade have suggested that sham acupuncture technique may be as efficacious as true acupuncture.These findings are apparently at odds with traditional theories regarding acupuncture point specificity and needling technique and call into question someideas which are commonly held by many practicing acupuncturists.These research results were identified as one of the "provocative paradoxes" or special research challenges at the 2007 SAR Conference marking the 10 th anniversary of the 1997 United States National Institutes of Health Consensus Conference on Acupuncture.In this paper, the author examines the sham and verum technique used in the 2005 German Acupuncture Randomized Trial for Tension Type Headache, one of the most often cited of these provocative research studies.The author applies a detailed evaluation of traditional Chinese acupuncture theory and a review of historical literature on theory and clinical practice.This analysis explains and demonstrates that the presumed sham technique, which was employed in this important clinical trial,in fact utilized an acupuncture approach that was theoretically as well suited as the named verum technique to treat the clinical problem under study.This paper's analysis serves as the foundation for a reevaluation of the theoretical basis and logic for acupuncture practice and research.The use of placebo in acupuncture research is examined and the application of comparative effectiveness trials as the most appropriate format for acupuncture research is proposed.     

针刺治疗颈性眩晕27例疗效观察

[目的]观察针刺穴位治疗颈性眩晕的临床疗效。[方法]将52例疗颈性眩晕患者随机分为两组,治疗组予针刺穴位治疗,对照组单纯口服药物治疗。[结果]治疗组治愈率为62.96%,总有效为85.18%,对照组治愈率为52%,总有效为72%,两组治愈率比较P<0.01,总有效率P<0.05,差异有统计学意义。[结论]针刺治疗颈性眩晕取得良好的临床疗效。     

针灸疗法对中风后康复的临床有效性及其作用机制研究

中风为临床常见病,严重危害人类健康。本文对近年来针灸治疗中风后遗症的临床应用情况和疗效进行总结,并对其作用机制研究进行总结。结果表明,近年来针灸治疗中风后遗症疗效确切,针灸通过多种途径和机制对脑组织的保护作用,是针灸治疗起效的机制之一。对其机制研究方面有待于继续深入。