针刺真、假穴位不同脑区激活效应的功能性磁共振成像评估

背景:人们从大脑的不同功能区着手,试着用功能性磁共振来阐释其与经络穴位的相关性。目的:运用功能性磁共振观察针刺真、假穴位与大脑功能区的关系,以及针刺真、假穴位不同脑区激活效应的差异。设计:随机对照的验证性观察。单位:成都中医药大学附属医院,弗莱堡大学医学院环境和自然医学系针灸科以及放射医疗中心。对象:本实验于2000-10在弗莱堡大学医学院放射医疗中心完成。以视力正常的健康志愿者(弗莱堡大学医学院医学生)18人作为受试对象,随机分为2组:针刺假穴 有治疗作用穴位组和针刺假穴 无治疗作用穴位组,每组9人。均签定知情同意书。方法:两组先接受浅刺(假穴)后观测出针。然后针刺假穴 有治疗作用穴位组针刺双侧光明穴和太冲穴,针刺假穴 无治疗作用穴位组针刺双侧丰隆穴和陷谷穴。为得到强烈的针感(酸麻胀重的感觉),每30s进行捻转(每穴先左后右),每次持续10s,持续4min后静息2min为1个周期,共持续4个周期25min后出针。采用1.5T磁共振扫描仪(西门子Erlangen)进行功能成像检测。并对所有的受试者及单个受试者交叉关系分析。主要观察指标:①针刺假穴以及针刺有治疗作用穴位组对象视皮质的反应。②针刺对两组对象不同脑区的激活情况。结果:因刺激程序的错误运用,2例受试者(两组各1例)在进一步的数据分析时被剔除。①针刺与视觉有关的穴位对视皮质无确切影响,但在实验过程中,而在其他皮质区(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)有轻微血氧合水平依赖性成像法信号转换,即在这些皮质区针刺真穴及假穴均有激活反应。②针刺具有治疗视力障碍作用与不具有治疗视力障碍作用的穴位,其激活类型无明显差异。③单个受试者交叉关系分析(CC>0.3)发现,针刺假穴过程中仅2/8的受试者出现了丘脑的激活。两组均出现了丘脑、红核、大脑外侧沟的激活。针刺假穴 有治疗作用穴位组3/8和针刺假穴 无治疗作用穴位组4/8的受试者出现可观察到后外侧中脑导水管周围灰质的激活反应,两组还出现了顶颞皮质的激活。说明针刺真穴与假穴在激活类型上有显著差异。结论:①通过针刺与视觉有关的穴位发现针刺对于视皮质无确切影响,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。②针刺真穴与假穴在激活类型上有显著差异,但针刺具有治疗视力障碍作用与不具有治疗视力障碍作用的穴位激活类型差异则不明显。

Effect of acupuncturing at true and sham points on the activation of various cerebral areas assessed with functional nuclear magnetic resonance

BACKGROUND: From the different function of the brain, functional magnetic resonance (fMRI) was used to explain the correlation with acupoints of meridian. OBJECTIVE: To discuss the effect of aeupuncturing at true and sham points on activating effect in various cerebral areas through fMRI. DESIGN: Randomized-controlled verificated study. SETTING: Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Acupuncture Section of Environment and Physio-medical Science Department of Medical College and the Radiation Medical Center of University of Freiburg. PARTICIPANTS: The experiment was completed in the Radiation Medical Center of University of Freiburg in Germany in October 2000. In our present study, altogether 18 healthy volunteers with normal vision were selected from Medical College of Freiburg University. All volunteers were divided into two groups. Sham acupuncture + treating acupuncture group (group A) and sham acupuncture + non-treating acupuncture group (group B) with 9 in each group. METHODS: During the experiment, all volunteers first received sham acupuncture (shallow needling on a non-acupoint), then withdraw the needles. Second, cases in group A were needled on Guangming (GB37) and Taichong (LI3) of both sides; cases in group B received acupuncture on Fenglong (ST40) and Xiangu (ST43). In order to achieve a strong De Qi (a characteristic sensation manifesting as numbness, soreness, heaviness, distension), a manual twisting manipulation of the needles (10 s each, left and right in turn) was performed every 30 s. After a period of 4 minutes, the needles were maintained for 2 minutes regarded as a course. Needles were removed after 25 minutes, 4 courses. All imagings were performed on 1.5 Tesla Vision Scanner (Siemens, Erlangen). Then make the cross-correlation analysis on all volunteers and each volunteer. MAIN OUTCOME MEASURES: ① The effect of acupuncture of group A on the vision-related cortex. ② The activation on different area of the cortex by acupuncture in the two groups. RFSULTS: Two subjects (either has one) had to be excluded from further data analysis due to incorrect application of the stimulation procedure. ① We did not find any BOLD-response to acupuncture in the visual cortex through acupuncture of Guangming (GB 37), which was described as an effective acupoint directly influencing vision-related disorders, but during the experiment, some of the areas reproducibly showing BOLD-contrast in all experiments e.g. Insula, sulcus lateralis and the parieto-temporal cortex had been shown to be involved in the cortical processing of painful and somatosensory stimuli. ② No obvious difference of the activation patterns were found in response to acupuncture on points with a specific therapeutic potencial in contrast to acupoints without that specific potential. ③ Activation in the Alamus could be observed for only 2/8 volunteers during acupuncture on sham acupuncture by cross-correlation-analysis (CC ＞ 0.3). Both of the two groups were found activation in the thalamus, nucleas rubber, the suleus lateralis. And activation in the posterolateral PAG could be observed for 3/8 (group A) and 4/8 (group B) volunteers. Activation in the parieto-temporal cortex was also found in both of the two groups. These proved significant contrasting between true acupuncture and sham acupuncture.CONCLUSION: ① Trough acupuncture on the acupoints related to the vision, we found no activation on the vision cortex. But on other cortex, e.g.insula, sulcus lateralis and the parieto-temporal cortex, the cortical processing of painful and somatosensory stimuli, we found the activation. ②There is difference of the activation pattern in response to true acupuncture in contrast to sham acupuncture detectable, but seldom difference of t he activation pattern in response to acupuncture on points with specific potential in contrast to acupoints without that specific potential.