针刺三阴交对痛经患者脑葡萄糖代谢的影响

目的：探讨针刺三阴交治疗痛经的中枢作用机制。方法：对6例痛经患者行经疼痛时行右侧三阴交假针刺和针刺，用数字疼痛强度分级法比较刺激前后疼痛情况，并在假针刺和针刺时利用正电子发射断层摄影技术（positron emission tomograph，PET）对痛经患者行埔F—FDG脑功能成像，用SPM软件分析，获得针刺激活的脑解剖功能区。结果：假针刺前后疼痛值差异无显著性意义（P〉0．05），针刺三阴交后疼痛值比针刺前明显降低（P〈0．01）。针刺右侧三阴交引起痛经患者多个与疼痛相关脑区被激活，针刺使同侧豆状核（苍白球、壳）、同侧小脑、同侧岛叶、双侧背侧丘脑、同侧中央旁小叶、双侧杏仁体、对侧中脑黑质、双侧第Ⅱ躯体感觉区、同侧海马回、同侧扣带回前部、对侧下丘脑乳头体葡萄糖代谢增强，大脑皮质小区域葡萄糖代谢降低。结论：针刺三阴交能明显缓解痛经患者疼痛，其机理为针刺三阴交可激活皮质、皮质下边缘系统和小脑与疼痛相关脑区，可能通过平衡与疼痛有关的中枢网络而减轻疼痛，神经内分泌也可能在治疗中起作用。     

经皮穴位电刺激诱发的大脑fMRI信号与镇痛的关系

针刺主要是通过激发内源性阿片达到镇痛的目的。不同个体针刺镇痛效果的差异 ,与胆囊收缩素 (ＣＣＫ)等抗阿片物质的个体水平有关 ,那么 ,ＣＣＫ是通过何种通路来影响针刺镇痛的呢 ?我们应用功能性磁共振成像 (ｆＭＲＩ)针对这个问题进行了研究。实验采用两种频率 (2Ｈｚ,1 0 0Ｈｚ)的经皮穴位电刺激 (ＴＥＡＳ)模拟针灸的不同手法 ,其优点是镇痛效果肯定 ,刺激参数可以量化。以前的研究表明 ,不同的脑内神经通路分别介导低频和高频ＴＥＡＳ镇痛 ,中脑、丘脑和下丘脑的某些核团起着关键性的作用。 2 5名健康被试者随机分成两组 ,分别接受高…     

ACUPUNCTURE MODULATES THE FUNCTIONAL CONNECTIVITY OF PRIMARY SOMATOSENSORY CORTEX ONLY IN CERTAIN PATHOLOGICAL STAGES OF BELL'S PALSY

Objective: Bell's palsy(BP) is a common peripheral idiopathic facial nerve palsy and acupuncture is a popular treatment.The aim of this study is to investigate acupuncture effect on primary somatosensory cortex(SI) functional connectivity(FC) in different pathological stages of BP.Methods: Three runs of fMRI data(before, during and after acupuncture treatment) were acquired in healthy control(normal group, n=35) and patients with BP.Patients were classified into three groups according to disease duration(DD) and House Brackmann score(HB) of BP, including early group(n=39, HBI, DD14 d), later group(n=36, HBI, DD14 d), andhealed group(n=37, HB=I).Seed point of SI from the lesion side was first decided by analysis of fMRI data during acupuncturing at Hegu(LI4), and then FC of SI was performed.The FC changes between post-acupuncture and pre-acupuncture were analyzed with pair t-test.Results: By comparing FC of post-acupuncture with that of pre-acupuncture, significantly decreased FC of SI was found in early stage in left primary somatosensory cortex, secondary somatosensory cortex, primary motor cortex, middle insula and posterior insula and increased connectivity was found in later stage in bilateral primary motor cortex, motor cingulate cortex, supplement motor area, premotor, cuneus, precuneus, lingual gyrus and right occipital gyrus.No significant differences in FC changes between pre-acupuncture and post-acupuncture were found in the normal group and in the healed group.Conclusion: Although the same paradigm of acupuncture stimulation was applied to the four groups, changes in FC of SI were only found in early and later stages of BP while no changes were found in healthy control and healed patients.It was concluded that acupuncture induced changes of FC of SI depending on the pathological status in patients with BP which is consistent with the acupuncture role in homeostasis.     

DISSOCIATION OF THE ACUPUNCTURE EFFECT OF SOMATOSENSORY NEEDLING AND NEEDLING CREDIBILITY ON LOW BACK PAIN PATIENTS USING fMRI

Background: Sham acupuncture as well as real acupuncture, a specific form of needling, is known to reduce low back pain(LBP), but the brain mechanism of placebo effect in sham acupuncture has not been clearly understood.We devised a novel form of sham acupuncture, so called phantom acupuncture which induces needling credibility without somatosensory needling.And we aimed to dissociate the brain correlates with somatosensory needling and needling credibility effect.Methods: Thirty LBP patients were randomized into the real(REAL, n=15) and phantom acupuncture(PHNT, n=15) groups.Sensory threshold and LBP intensity(VAS) were measured before and after the fMRI scanning.During the scanning, two steady state pain sessions were scanned before and after acupuncture stimulation(using low-back extension pain-model) and pain intensity(PAIN) induced by the pain model was collected.In acupuncture session, the REAL group got real acupuncture, while the PHNT group got only the visual stimulation(recorded needling manipulation video) to create needling credibility.Autonomic response of heart rate(HR) and skin conductance(SC), and acupuncture sensation were measured.Results: There was greater SC response, acupuncture sensation, signal increase in sensorimotor network(SMN), periaqueductal grey(PAG) and nucleus accumbense(NAC), and greater signal decrease in default mode network(DMN) in the REAL group.Also increase in vibration detection threshold and decrease in PAIN were observed.The HR decrease and signal increase in salience network(SLN), as well as the decrease in pressure pain threshold and unpleasantness of PAIN were observed both in the REAL and PHNT group.In the PHNT group, decrease in VAS was found.Different correlation between the change in outcome measure and the change in resting state network connectivity was found.Conclusion: Physical information processing and placebo/analgesic brain area were involved in somatosensory needling effect, while cognitive processing was related to the needling credibility effect.     

LATERALIZATION OF BRAIN RESPONSE TO ACUPUNCTURE:A FUNCTIONAL MRI STUDY

Objective: Previous studies have found that lateralization of brain function exists in many aspects, but lateralization of brain response to acupuncture has not been explored yet.In this study, brain responses to acupuncture at left and right side of Hegu(LI4) were analyzed in order to find out the laterality of brain response to acupuncture.Methods: Thirty-eight volunteers were randomly divided into two groups(the left group and the right group) according to the side of acupoint selected for acupuncture.Acupuncture fMRI data were acquired in both groups with a block design.Group analysis of both groups was done first.In order to find the difference in brain response to different side of acupuncture, intergroup analysis was done by comparing the data from the left group with the vertically flipped data from the right group.Results: The group analysis demonstrated that activated areas in the left group included signal increased in right insula, right lentiform nucleus and right superior temporal gyrus, and signal decreased in left inferior temporal gyrus, while activated areas in the right group included signal decreased in right postcentral gyrus, right inferior temporal gyrus and right parahippocampal gyrus.Intergroup analysis between the left and the flipped right found significant difference in the areas of the left inferior temporal gyrus, right insula, right fusiform gyrus, and left middle temporal gyrus.Conclusion: In this study, we found lateralizing features of brain response to acupuncture.Dominancy of right hemispheres responses was found both in the left- and right-side acupuncture groups, therefore right cerebral cortex may play an important role in the acupuncture therapeutic effects.     

针刺心包经腧穴对健康人静息态脑功能磁共振成像低频振幅的影响

目的观察针刺手厥阴心包经全经腧穴对健康人静息态（rest1,R1）脑功能磁共振成像低频振幅的影响。方法对16名健康受试者依次进行结构像T1、T2扫描和功能像磁共振成像扫描,功能像包括第1次R1扫描,扫描时间为8 min 6 s和针刺手厥阴心包经全经腧穴后留针状态（acupuncture,AP）扫描,扫描时间为8 min 6 s。对采集的结构像和功能像fMRI数据都进行格式转换和统计分析。结果 R1状态下,ALFF信号活跃的脑区：双侧额上回、额内侧回、枕中回、楔前叶、颞上回、扣带回。AP状态下ALFF信号活跃的脑区：双侧额上回、额内侧回、颞中回、左侧梭状回、楔前叶、后扣带回、小脑山坡部。与R1状态比较,针刺心包经使得ALFF信号明显差异的脑区：双侧楔叶、楔前叶、左侧后扣带回、右侧枕中回、右侧枕叶舌回。结论针刺手厥阴心包经全经腧穴后会显著改变大脑皮层固有活动状态,尤其是双侧额上回、额内侧回、楔前叶的激活。     

针刺穴位与非穴位激活不同脑区的效应观察

目的：观察穴区与非穴区对大脑功能区影响的差异，以探讨相关的针刺理论基础。方法：以视力正常的健康志愿者18人作为受试对象，随机分为A、B组。两组先分别接受针刺假穴治疗，然后A组针刺穴位光明和太冲，B组针刺穴位丰隆和陷谷。所有成像技术均采用1．5T磁共振扫描仪（西门子Erlangen）。结果：在试验中，丘脑及红核的激活、大脑外侧沟与顶颞皮质的激活证明了针刺真穴位与假穴位在激活类型上有显著差异。结论：通过针刺与视觉有关的穴位发现针刺对于视皮质并没有确切的影响，但对其他皮质区，如脑岛、外侧沟、顶颞皮质等与疼痛及躯体感觉刺激有关的皮质有激活作用。     

Differential localization of pain-related neural responses during acupuncture stimulation using Blood Oxygen Level Dependent (BOLD) fMRI in a canine model

The objective of this study was to differentiate the neuronal responses, which was related or unrelated, to pain associated with acupuncture stimulation, and to localize the brain regions with response to stimulation that is unrelated to pain by using Blood Oxygen Level Dependent (BOLD) functional MRI (fMRI). BOLD fMRI was performed in six normal healthy beagle dogs, during placebo and verum acupuncture stimulations, at the right side of BL60 (KunLun) acupoint before and after local anesthesia of the acupoint. The order of the four sessions was placebo; verum acupuncture stimulation; before local anesthesia; and followed by the same stimulation after local anesthesia. One-sample t-test analysis was performed to localize the activated or deactivated areas, during both pre-anesthesia and post-anesthesia. In order to compare the pre-anesthesia to post-anesthetic responses, and placebo to verum acupuncture stimulation, within-subject analysis was performed. The post-anesthetic verum acupuncture stimulation resulted in increased activations in the left somatic afferent area I and II, right visual and auditory association area, and the descending reticular activating system of the brainstem. In addition, differential areas during post-anesthesia compared to that of the pre-anesthesia were in the left olfactory peduncle and descending reticular activating system of the brainstem. These results indicate that the areas of specific neural pathway are considered to be unrelated to the pain response during acupuncture stimulation.     

Acupuncture stimulation for motor cortex activities: a 3T fMRI study

The acupoint, GB34, located in the back of the knee, is known to be effective in recovering motor function after a stroke. This study uses a functional magnetic resonance imaging (fMRI) study with 3T scanner to investigate whether or not acupuncture of GB34 produces a significant response of the modulation of somatomotor areas. A fMRI of the whole brain was performed in ten normal healthy subjects during two task stimulations of acupuncture manipulation on GB34 and sham points, inserting and twisting the needle for 25 seconds at a rate of approximately 120 times per minute; the needle manipulation was paused for a duration of 25 seconds as a control state. The process was repeated four times to have four epochs of stimulation. Bilateral sensorimotor areas (BA 3, 4, 6 and 7) showed approximately 6% of stimulation-related BOLD signal contrast, whereas very few areas were activated when sham stimulation was given. Acupuncture stimulation in GB34 modulates the cortical activities of the somatomotor area in humans. The present findings may shed light on the CNS mechanism of motor function by acupuncture, and form a basis for future investigations of motor modulation circuits in stroke patients.     

Carryover effects alter FMRI statistical analysis in an acupuncture study

Carryover effects can contaminate ON/OFF BOLD contrasts designated in an fMRI experiment. Yet, the ON/OFF contrasts are essential to facilitate statistical analysis based on the significance of contrast levels. Here, we conducted an fMRI experiment with acupuncture stimulation applied on ST42 acupoint as well as with tactile stimulation on its skin surface. Experiment consisted of three two-block acupuncture and one two-block tactile fMRI runs. Each block started with 26-sec OFF period followed by either 26-sec needle manipulation in the acupuncture runs or by scratching skin surface with sand paper in the tactile. To test if carryover effects could alter the BOLD contrasts, we analyzed different portions of fMRI data using GLM method. Our results showed analyses on different portions of acupuncture fMRI data gave significantly different results. Statistical parametric maps of group random effects resulted from the analysis on the very first fMRI trial formed the broadest coverage of the active brain areas. BOLD model time course also best explained the adjusted raw time course at peak active voxel (coefficient of determination = 0.88). Analyses on other portions of fMRI data only selected subset of the active brain areas delineated by the analysis on the very first data trial and the BOLD model only mildly accounted for the adjusted raw time courses. In tactile runs, results were more consistent across analyses. Therefore, in fMRI experiments with strong carryover effects, a single-block experimental design with multiple repetitions, separated by long enough periods of time, should be more suitable to extract task BOLD effects.     

基于ERP探讨头针治疗脑卒中偏瘫即刻效应机制的研究

摘 要：目的：采用事件相关电位（Event-Related Brain Potential, ERP）探讨头针顶颞前斜线中2/5治疗脑卒中的即刻效应机制。方法:选取符合纳入标准的脑卒中患者30例,健康人25例,两组均予头针刺激,均选取右侧顶颞前斜线中2/5。两组分别于针刺前,针刺10 min后进行ERP检测,脑卒中组还需进行肌力评级及神经功能缺损评分。全部试验结束后,从ERP里提取受试者左右手的运动皮层相关电位（（movement-related cortical potentials,MRCPs）。结果：头针刺激10 min后,脑卒中组运动神经功能缺损评分较前降低（P<0.05）;肌力评级较前升高（P<0.05）;针刺前后脑卒中组患侧手MRCPs波幅较前明显下降(P<0.05)。结论：头针治疗脑卒中患者肢体偏瘫的即刻效应明确,其作用机制可能是针刺顶颞前斜线时刺激皮层运动功能区,降低了大脑运动执行策划的能量损耗,激活了受损脑区与运动相关皮层区域的神经元,提高了大脑对运动过程的处理效率,从而促进偏瘫肢体运动功能的即刻改善。并且我们观察到,健侧脑具有代偿性作用,这提示我们临床中进行头针针刺时,进行双侧刺激可能疗效更佳。     

RESPONDING BRAIN AREAS TO DE-QI REDUCED BY LOCAL ANESTHESIA AT ST36

Objective: Recently, researchers have paid more attention to sensation of De-qi, especially at ST36.However, little is known of the responding brain areas if the sensation of De-qi is suppressed.So, this study aims at detecting the brain response when De-qi was inhibited by local anesthesia at ST36.Methods: Forty healthy volunteers were recruited in this study.They all received two rounds of functional magnetic resonance imaging(fMRI) scans.One was accompanied with manual acupuncture at ST36(DQ group), and another was associated with local anesthesia and manual acupuncture at the same acupoint(LA group).At end of each scan, subjects were asked to quantify their stimulating sensations using a 10-point visual analogue scale.Results: Compared with the DQ group, most of De-qi sensations reduced by local anesthesia were soreness(94%), numbness(96%), fullness(92%), spreading(96%) and dull pain(98%).In the DQ group a lot of areas displayed significant fMRI signal intensity changes.The mainly activated regions were bilateral inferior frontal gyrus, S1, M1, inferior parietal lobule, thalamus, insula, claustrum, cingulate gyrus, putamen, superior temporal gyrus, and cerebellum.Surprisingly only cerebellum showed significant activation in the LA group.In the two groups, bilateral S1, insula, ipsilateral IFG, IPL, claustrum and contralateral ACC were remarkably activated.Conclusion: The responding brain areas to De-qi would bereduced following local anesthesia at ST36     

针刺阳陵泉穴脑功能磁共振成像研究进展

搜集并总结针刺阳陵泉穴脑功能磁共振成像(fMRI)研究的文献,发现目前研究内容主要集中在:1)不同针刺深度、生理状态等因素对针刺阳陵泉穴激活脑区的影响;2)针刺阳陵泉穴所激活脑区的特异性;3)阳陵泉穴与其他穴位配伍所激活脑区的差异对比。通过对研究结果的分析可以看出,针刺阳陵泉穴可激活特定的脑区,如双侧颞上回、双侧中央前回等及双侧眶回、右侧颞下回等区,从而起到疏肝利胆、舒筋活络的功效,在治疗胆系疾病及中风等病症中具有积极有效的作用。     

Effects of three needling manipulations of the right-side Zusanli(ST 36) on brain using functional magnetic resonance imaging

OBJECTIVE: To investigate the effects on the brain using three needling manipulations(twirling, lifting-thrusting, and twirling plus lifting-thrusting)when the right-side Zusanli(ST 36) acupoint was stimulated with needles.METHODS: Seventeen healthy subjects accepted three needling manipulations stimulating the right Zusanli(ST 36) over separate days. Functional magnetic resonance imaging was used to detect changes in the brain during the manipulations, and then the needling sensations were recorded using the MGH acupuncture sensation scale(MASS) after each scan. f MRI data were processed using Statistical Parametric Mapping 8 to analyze the positiveand negative activation in the brain induced by different acupuncture manipulations.RESULTS: The individual needling sensations showed no statistically significant differences among the three manipulations. However, the MASS index showed that lifting-thrusting twirling plus lifting-thrusting twirling. Lifting-thrusting activated left premotor cortex, left postcentral,right middle frontal gyrus, left inferior frontal gyrus,right lingual gyrus, left insula, right putamen, bilateral cingulate gyrus and right cerebellum; and deactivated bilateral hippocampus and left caudate.Twirling activated bilateral orbital middle frontal gyrus, left opercular and triangular inferior frontal gyrus, and right middle occipital gyrus; and deactivated bilateral precuneus, right amygdala, left anterior cingulate gyrus, right inferior temporal gyrus,right middle frontal gyrus, right supplementary motor gyrus, and left postcentral. Twirling plus lifting-thrusting activated bilateral postcentral, left inferior occipital gyrus, left insula, left thalamus, left cingulate gyrus, and right putamen; and deactivated right superior frontal gyrus, right superior parietal gyrus, right temporal gyrus, right middle occipital gyrus, right insula, and left lingual gyrus. Pairwise comparisons of the three manipulations showed that signals induced by lifting-thrusting were the strongest, especially in the limbic system,followed by twirling plus lifting-thrusting; twirling alone was the weakest.CONCLUSION: Three methods of needling manipulations similarly activated areas associated with the somatosensory system, vision, cognition, and emotional regulation. This may have significant implications for acupuncture in clinical practice.     

针刺大陵穴对大脑皮质的影响——MRI研究

目的:探讨针刺大陵穴治疗精神性疾病的中枢神经系统机制.方法:采用功能磁共振成像技术,观察针刺大陵后脑功能区变化.纳入8名健康志愿者作为受试对象,每名受试者在大陵穴接受针刺刺激,刺激模式为"休息-刺激-体息-刺激-休息",最终所获得的数据采用SPM 2软件包分析其作用部位.结果:针刺大陵穴所获得的脑激活区主要位于额下回的Brodmann 46/47/44/9区,额中回的Brodmann 6区,颞上回的Brodmann 22区,中央后回和顶下小叶的Brodmann 40区.结论:额颞叶损伤、额叶功能低下或激活程度不够与精神性疾病的发病密切相关.针刺大陵穴对精神性疾病治疗作用的起效途径之一可能是通过激活中枢神经系统端脑额颞叶皮质完成的.     

ADVANCE IN ACUPOINT SPECIFICITY STUDY BASED ON NEUROIMAGING TECHNIQUES

Objective: To reveal the central mechanism of acupoint specificity.Methods: The research was conducted on patients with functional dyspepsia(FD) and migraine(MIG) undergoing acupuncture by applying functional magnetic resonance imaging and positron emission computed tomography.Results: FD patients:(1) Significant difference in cerebral glucometabolism between FD patients and healthy subjects(HS) was found and some brain areas were negatively correlated with NDI scoring.(2) Different acupoint selection methods had different impacts on brain functions of FD patients.Migraine patients:(1) Compared with HS, decreased gray matter density of right insula, cerebral glucose metabolism and resting functional connectivity in MIG were detected.(2) Compared with non-acupoint group and non-involved-meridian group, Shaoyang meridian group showed relative specificity on cerebral glucose metabolism after acupuncture.(3) After acupuncture on the acupoints along Shaoyang meridian, the functional connectivity network of right insula in MIG became similar with that in healthy subjects.(4) The change of functional connectivity in right insula-DLPFC was negatively correlated with comprehensive score improvements in Shaoyang meridian group.(5) With fMRI data prior acupuncture, 2 weeks and 4 weeks after acupuncture, compared with non-acupoints, the persistent or alternative rise was witnessed in the pain-related brain regions of MIG in the group of specific acupoints of Shaoyang meridian, meanwhile the functional connectivity network of anterior cingulated cortex was in the process of dynamic modulation.Conclusion: Compared with healthy subjects, the brain functions of the patients with FD or MIG were significantly different; acupuncture on the involved meridian has a relative specificity on central response characteristics.     

针刺对缺血性中风患者食指运动激活脑功能区的影响

目的：观察针刺对运动状态下缺血性中风患者脑功能区的影响。方法：15例缺血性中风患者分别在基础和针刺状态下食指运动采集脑功能区功能性磁共振成像图像，测量激活的区域、大小及信号强度。结果：基础状态下食指运动可见对侧初级运动区、运动前区以及第一感觉区的激活，针刺状态下食指运动除见上述区域激活外，还可见同侧初级运动区，病灶部位及对侧顶上小叶、颞上回、岛叶等部位的激活。针刺状态下激活面积及最小信号强度方面均大于基础状态。结论：针刺对缺血性中风的康复与改善大脑皮层功能区血液循环有关。     

头皮针短暂调解皮质应激性与动作准备电位的作用

根据10位正常志愿者皮质兴奋和动作准备电位探讨头针短期调节机制。经由对其皮下脑皮质相关治疗区域的刺激,头皮针能改变此相关皮质的功能已达到有效的治疗,这是头皮针的基本原理。根据本神经生理基础研究所提供数据,显示头皮针乃调节后期动作准备电位,主要分布在针刺激对侧的运动和感觉皮质。此外,在成对的脉冲磁场刺激实验中,从通过头皮针之体感刺激输入对侧感觉皮层,头皮针显现抑制作用主要引向长间时的皮质应激性反应。本研究中于针刺穴位得气后仅留针,之后并无使用手法加强,可能因此没有达到足够刺激的强度,进而无法产生更强针灸抑制作用。     

针刺穴位和非穴位对脑功能连接影响的MR研究

目的:观察穴区与非穴区对脑功能连接的影响,以探讨腧穴作用特异性的基础.方法:选择21名健康志愿者,随机分为穴位组(12例)和非穴位组(9例),分别针刺受试者双侧足三里和足三里外侧3～4 mm处,采用捻针手法,分别于针刺前、出针后25 min进行功能磁共振扫描,以双侧扣带回作为种子点,分析穴位组和非穴位组脑功能连接情况.结果:穴位组和非穴位组均能产生广泛的脑功能连接,穴位组与非穴位组相比,穴位组在双侧小脑扁桃体、右侧小脑齿状核、双侧小脑悬雍垂、左侧小脑山坡、右侧小脑结节、左侧额下回、双侧颞中回、双侧旁中央小叶、左侧扣带回、右侧颞上回、右侧前扣带回等区域与后扣带回存在功能连接增强,而穴位组双侧额内侧回、右侧额下回与后扣带回的脑功能连接强度较非穴位组减弱.结论:穴位和非穴位所引发脑功能连接的脑区大部分相同,但穴位组在脑内的脑功能连接强度总体上高于非穴位组.     

针刺申脉穴的fMRI脑功能成像研究

目的:研究针刺申脉穴脑功能变化的规律和激活脑区的定位信息。方法:利用血氧依赖性磁共振成像技术,获得健康志愿者的申脉穴在行针及留针不同针刺状态下的脑功能变化图像,利用SPM信号处理系统,对比分析不同针刺状态下脑功能变化的规律。结果:针刺申脉穴主要激活边缘系统(丘脑、扣带回、海马旁回)和额叶、颞叶等脑区,在行针和留针过程中激活的脑区存在较为明显的规律性变化,在行针过程中首先激活对侧脑区,留针后逐渐由对侧延伸到双侧。结论:激活的脑区可能在申脉穴治疗失眠等心境障碍性疾病时起一定作用。