世界中医药

基金项目:国家重点基础研究发展计划（“973”计划）项目：病理状况下面口部与合谷穴区联系的脑功能和突触可塑性研究（编号：2010CB530505）；国家自然科学基于多模态功能性磁共振成像针刺穴位脑机制偏侧性研究（编号：81202768）；安徽省教委重大科研项目：设备场强等关键因素对针刺脑功能成像的影响（编号：KJ2011ZD05）；安徽省自然科学针刺脑功能成像个体差异及其与中医体质类型的关系研究（编号：1208085MH147）

作者	单位
杨骏1 李传富2 徐春生2 张庆萍3 陈东晓3 汪林英3 朱一芳2 张威2 武媛媛3 黄建军2 卢琦2	1 安徽中医药大学第一附属医院针灸科，合肥，230031； 2 安徽中医药大学第一附属医院影像中心、数字化影像技术实验室，合肥，230031； 3 安徽中医药大学，合肥，230038

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中文摘要:

目的：利用fMRI探讨针刺合谷穴和后溪穴主治疾病的中枢神经生理学机制及两穴功能的相对特异性。方法：共募集40名健康志愿者，均为右利手。分为针刺合谷穴组与针刺后溪穴组，每组各20名。采用改良后的组块设计方案，用相同的磁共振扫描序列采集针刺两组健康志愿者左侧合谷穴或后溪穴任务态fMRI数据。利用AFNI程序分析脑激活区，对所有的功能数据进行组分析和组间分析，并利用Monte Carlo方法对分析结果进行多重比较校正(P=0.002，α≤0.05)。结果：针刺左侧合谷穴激活脑区包括：双侧中央前回、顶上小叶、颞上回、豆状核、壳核、小脑，右侧中央后回、顶下小叶、额中回、颞中回、缘上回、丘脑、丘脑底核、尾状核、扣带回，左侧额下回、枕中回和脑岛；针刺左侧后溪穴激活脑区包括：双侧脑岛、小脑，右侧中央前回、额中回、尾状核头和体，左侧扣带回、丘脑和腹后内侧核；针刺左侧合谷穴和后溪穴，组间分析结果有统计学意义，合谷穴组较后溪穴组右侧额中回、额下回激活减弱，左侧扣带回、左侧中央前回激活增强。结论：本研究为“面口合谷收”“后溪通督脉”理论提供了客观的证据，一定程度上解释了合谷穴治疗汗症、后溪穴治疗颈项腰背部疾病以及两穴的镇痛作用的中枢神经机制；并进一步从中枢神经层面表明了部位相近的穴位存在功能相对特异性。

English Summary:

To explore the neurophysiological mechanisms of acupuncture on Hegu(LI4) and Houxi(SI3) curing diseases and the functional specificity of them based on the technique of fMRI.Methods:Forty healthy right-handed volunteers，divided into Hegu(LI4) point group and Houxi(SI3) point group，20 cases in each group.The experiment took the modified block design.All healthy volunteers were stimulated at left Hegu(LI4) or Houxi(SI3)，acquiring the fMRI data with the same scanning sequences.All fMRI data were analyzed by AFNI program and the results were corrected with Monte Carlo method(P=0.002，α≤0.05).Results: 1) Many brain areas were actived with increased signal by stimulating at the left Hegu(LI4) which included：bilateral cerebellum，right thalamus and subthalamic nucleus，bilateral lentiform nucleus and putamen，right caudate，right cingulate gyrus，bilateral precentral gyrus，right posterior central gyrus，bilateral superior parietal lobule，right inferior parietal lobule，left inferior frontal gyrus，right middle frontal gyrus，right middle temporal gyrus，bilateral superior temporal gyrus，right supramarginal gyrus，left middle occipital gyrus，left insula. 2) As well as many brain areas were actived with increased signal by stimulating at the left Houxi(SI3) which included：bilateral cerebellum，left thalamus and ventral posterior medial，right caudate，right precentral gyrus，right middle frontal gyrus，left cingulate gyrus，bilateral insula. 3)It showed significant defferences between the Intergroup analysis results of stimulating at Hegu(LI4) vs Houxi(SI3)：the increased signal in left cingulated，precentral gyrus and decreased signal in right middle frontal gyrus，inferior frontal gyrus of Hegu(LI4) than Houxi(SI3).Conclusion:Present research directly illustrated the link of Hegu(LI4) with the face and mouth，as well as Houxi(SI3) with the neck and torso at the levels of central nervous system.And it also offered the objective neurophysiological evidence to the traditional Chinese medical theory-“fall and hand controlled by Hegu” and “Houxi associating with the governor vessel”.In addition，it explained the mechanism of Hegu treatment to hyperhidrosis，Houxi(SI3) treatment to neck lumbar diseases，and the analgesic function of both acupoints in some degree.Nevertheless，it provided the objective basis of functional specificity of the acupoints which were closed in location.

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