不同手法针刺足三里穴的得气针感及脑功能效应的差异研究

发布时间：2018-04-28 22:28

本文选题：针刺手法 + 得气针感　；参考：《中国中医科学院》2017年硕士论文

【摘要】：研究背景“得气”是针灸学科特有的专业术语,一方面是指患者主观感觉的酸、麻、胀、重、压等,另一方面是指施针者手下沉紧感。得气是针刺取得疗效的关键,也是正确定穴、判定患者经气盛衰和病候预后以及选择行针方法的依据。过去国内外研究人员从“得气”的定性定量、“得气”与临床疗效的关系以及运用功能性磁共振成像(Functional Magnetic Resonance Imaging,fMRI)技术观察“得气”的脑中枢效应等方面展开了一些研究,然而得出的结果还是比较初步,有的方面还存在颇多争议。对于针刺得气的机制,过去也做过一些工作。有相关报道表明,与不得气相比,针刺得气更能增加局部皮肤和肌肉的血流量;有研究指出,针刺得气针感可能与穴区下结缔组织缠绕有关;而另有研究则表明,得气针感可能与肌肉组织关系密切;另外,多数研究表明得气效应是穴区多个组织结构共同参与的结果,而非单一组织,但具体机制尚无定论。“行针”是指针刺入穴后,为使患者获得或增强针感,或使针感向某个方向传导而采取的操作方法。行针手法是影响针刺得气的重要因素之一,是针刺过程的重要组成部分,也是维持和加强得气针感的重要方法,与针刺疗效密切相关。其基本手法包括捻转法和提插法。针灸临床表明,应用手法的疗效常优于不运用手法,不同的针刺手法产生的临床效应也有差异。研究表明不同行针手法下,针体的受力情况差异显著,说明针体在不同手法操作下对人体的作用是不同的,由此产生的得气针感可能也有所不同。但是目前对于何种手法更容易产生针感,何种手法对应何种针感,尚缺乏确切证据。脑中枢是针刺起效的重要途径。随着脑功能检测方法的不断创新发展,目前基于脑科学的得气研究相当热门,采用的检测方式有脑电图、脑磁图、电子计算机X射线断层扫描技术、正电子发射断层扫描等。尤其是近20年来,fMRI技术快速发展,由于其无创、无辐射、空间分辨力高、功能和形态同时成像等优点,在针刺脑中枢机制的研究中应用越来越广,并取得了一定成果。但不同手法及复合手法的脑中枢效应是否存在差异尚未明确。本研究以健康受试者为试验对象,以表面肌电图(Surface Electromyography,sEMG)和fMRI为技术手段,选取右足三里穴为代表腧穴,以捻转法、提插法及其复合手法为干预方法,观察不同针刺手法下施针者和受针者的得气针感、穴区表面肌电及脑功能效应,比较分析其异同,为选择不同针刺手法治疗疾病的生物学机制研究打下基础。研究目的通过比较捻转法、提插法、提插捻转法三种不同的行针手法针刺右侧足三里穴的得气针感、穴区表面肌电和脑功能区激活情况的异同,探讨不同针刺手法(提插、捻转等)在引起不同得气针感(受针者得气感与施针者手下针感)中的作用及其与穴区表面肌电和fMRI脑功能变化的关系,为针刺得气针感理论提供科学解释,并藉此为其临床应用、提高临床疗效提供科学依据。研究方法招募45位健康志愿者,针刺右侧足三里穴,每隔一周随机接受一种行针手法:捻转法、提插法、提插捻转法,于针刺结束后由针灸师和受试者共同填写一份得气针感量表(MGH Acupuncture Sensation Scale,MASS)。随机抽取其中13位受试者,用生理记录仪记录进针前、行针期间、留针期间及出针后的穴区表面肌电。随机抽取另外17位受试者,在行针同时,扫描头颅fMRI。采用SPSS23.0软件分析得气针感的强度和频率,LabChart8.0软件计算积分肌电值(Integrated Electromyogram,IEMG)、平均功率频率(Mean Power Frequency,MPF)、中位频率(Median Frequency,MF),并以SPSS23.0进行统计分析,统计参数图软件包(Statistical Parametric Mapping,SPM8)处理分析 fMRI 数据,比较不同行针手法干预下得气针感、穴区表面肌电以及脑功能区激活与负激活的差别。研究结果1、不同手法对得气针感的影响三种手法引起的各针感强度和频率无显著性差异,均以胀满感、酸感明显,针感综合指数(MASS index)显示:提插组提插捻转组捻转组。捻转组和提插捻转组受试者的胀满感与施针者手下沉紧感呈正相关,提插组受试者的胀满感与施针者手下沉紧感呈正相关趋势。2、不同手法对穴区表面肌电的影响行针及留针期间,三种手法的IEMG值均较针前显著升高(P0.05),提插法最明显(P0.01);出针后,提插法的IEMG值仍较针前高(P0.05),捻转法和提插捻转法恢复针前水平(P0.05)。组间比较显示,各针刺时间段的IEMG值差异无明显统计学意义(P0.05)。行针期间,三种手法的MPF值均较针前显著降低(P0.05),提插法更明显(P0.01);留针期间及出针后,三中手法的MPF值均恢复针前水平(P0.05)。组间比较显示行针期间提插法分别与捻转法、提插捻转法相比差异有统计学意义(P0.05),其他时间段三种手法的MPF值差异均无统计学意义(P0.05)。行针期间,提插法和提插捻转法的MF值均较针前显著降低(P0.05),提插法更明显(P0.01),捻转法较针前无显著变化(P0.05);留针期间及出针后,三种手法的MF值均恢复针前水平(P0.05)。组间比较显示,各针刺时间段的MF值差异无明显统计学意义(P0.05)。3、不同手法对脑功能效应的影响提插组激活左侧前运动皮层、左侧中央后回、右侧额中回、左侧额下回、右侧舌回、左侧脑岛、右侧壳核、双侧扣带回、右侧小脑等,负激活双侧海马、左侧尾状核;捻转组激活双侧眶部额中回、左侧岛盖部和三角部额下回、右侧枕中回等,负激活双侧楔前叶、右侧杏仁核、左侧扣带回前部、右侧颞下回、右侧额中回、右侧补充运动区、左侧中央后回等;提插捻转法激活双侧中央后回、左侧枕下回、左侧脑岛、左侧丘脑、左侧扣带回、右侧壳核等;负激活右侧额上回、右侧顶上回、右侧颞回、右侧枕中回、右侧脑岛、左侧舌回等。三种手法的两两比较结果显示:提插法信号最强,主要集中在边缘系统;提插捻转法次之,捻转法最弱。研究结论:1、不同手法针刺足三里穴得气针感的强度和频率基本相似,均以胀满感、酸感明显,MASS指标提示:提插法针感最强,捻转法最弱。2、施针者手下沉紧感、受试者胀满感与肌电活动可能存在一定联系,不同手法针刺足三里穴均能引发肌电,提示:肌肉组织可能是引发医者和受试者针刺足三里穴产生得气针感的主要组织结构之一,但不同手法的刺激强度不一,由此激活的肌纤维类型可能也不一。提插法的刺激强度可能最大,并可能更多地激活了慢肌纤维。3、三种手法针刺足三里穴均不同程度及范围地激活了体感区、视觉区、认知、情绪等脑区,体现了针刺对大脑功能网络的复杂调控作用,此种复杂脑功能作用为针刺足三里穴的广泛性效应提供一定的证据;提插法对脑区激活最明显,捻转法对脑区负激活明显,主要集中在边缘系统,体现了手法脑效应的相对特异性。从脑区信号强度看,提插组的刺激强度可能更大,捻转组最弱;而刺激量大时,脑区激活可能更明显;刺激量小时,负激活可能更明显。
[Abstract]:Research background "Qi" is a special term in the subject of acupuncture and moxibustion. On the one hand, it refers to the patients' subjective feeling of acid, hemp, swelling, weight, pressure and so on. On the other hand, it refers to the tight feeling of the needles. The researchers at home and abroad have carried out some research from the qualitative and quantitative analysis of "Qi", the relationship between "Qi" and the clinical effect, and the application of functional magnetic resonance imaging (Functional Magnetic Resonance Imaging, fMRI) to observe the brain central effect of "Qi". However, the results are still relatively preliminary and some aspects still exist. There have been a lot of controversy. Some work has been done on the mechanism of needling gas. Some reports show that acupuncture is more capable of increasing the blood flow of local skin and muscles compared with no gas. In addition, the flesh tissue is closely related; in addition, most studies have shown that the effect of gas is the result of the joint participation of multiple tissue structures in the acupoint, not a single organization, but there is no definite mechanism for the specific mechanism. One of the important factors to get gas with acupuncture is an important part of the process of acupuncture. It is also an important way to maintain and strengthen the sense of air needle. It is closely related to the effect of acupuncture. Its basic techniques include twisting and inserting. The clinical effect of the acupuncture and moxibustion is often superior to that of the needling manipulation. There should be differences. The study shows that there is a significant difference in the force of the needle body under different manipulations. It shows that the effect of the needle body on the body is different under different manipulations, and the sensation of the needle may be different. Evidence. The brain center is an important approach to the effect of acupuncture. With the continuous innovation and development of the method of brain function detection, the research of gas producing based on brain science is quite popular. The methods of detection are electroencephalogram, magnetoencephalogram, computer X ray tomography, positron emission tomography, etc. especially in the past 20 years, fMRI technology is fast Development, because of its non invasive, non radiation, high spatial resolution, functional and morphological imaging, it has been used more and more widely in the research of acupuncture brain central mechanism, and has achieved certain results. However, there is no clear difference in the brain central effect of different manipulations and complex manipulation. Surface Electromyography (sEMG) and fMRI were used as the technical means to select the right Zusanli acupoint as the acupoint, with twisting and turning method, the insertion method and its compound technique as the intervention method, to observe the needle sensation of the needling and the needles under different acupuncture manipulation, the muscle electricity and the brain function effect on the surface of the acupoint area. The purpose of this study is to study the biological mechanism of the acupuncture manipulation in the treatment of diseases. The purpose of this study is to explore the difference of the sensation of gas needling, the electromyography of the acupoint surface and the activation of the brain function in the right Zusanli point by three different needle manipulation methods, such as twisting and twisting, and inserting twisting and twisting. The function of the feeling of air needle (the feeling of needling and the needling of the needling) and the relationship with the changes of the surface electromyography and fMRI brain function of the acupoint area, provide a scientific explanation for the theory of acupuncture for the sense of Qi needle, and provide a scientific basis for its clinical application and the improvement of the clinical effect. 45 healthy volunteers were recruited and the right Zusanli was needled. Acupoints were randomly selected every other week: twisting, inserting, lifting and twisting. After the end of the needle, a MGH Acupuncture Sensation Scale (MASS) was filled in by the acupuncturist and the subjects. The 13 subjects were randomly selected and recorded by the physiological recorder, during the needle period, during the needle retention period and out of the needle. Electromyography on the surface of the point after the needle. 17 other subjects were randomly selected at the same time. At the same time, the scanning head fMRI. used SPSS23.0 software to analyze the intensity and frequency of the gas needle sensation. The LabChart8.0 software calculated the integral electromyography (Integrated Electromyogram, IEMG), the average power frequency (Mean Power Frequency, MPF), and the median frequency (Median Frequency). A statistical analysis was carried out with SPSS23.0, and the Statistical Parametric Mapping (SPM8) was used to analyze the fMRI data, and the difference between the gas needle sensation, the surface electromyography of the acupoint surface and the activation of the brain function area was compared with the difference between the activation and the negative activation of the brain function area under the intervention of different needle manipulation methods. 1, the effects of different manipulations on the feeling of gas needle were caused by different manipulations. There is no significant difference in the intensity and frequency of the needle sensation, all of which are flatulence and acid sense, and the needle sense synthesis index (MASS index) shows that the flatulence of the subjects in the twisting group and the lifting and twisting group is positively related to the feeling of the tightenness of the needles. The correlation trend.2, the effect of different manipulations on the surface electromyography of the acupoint surface, the IEMG value of the three methods increased significantly (P0.05) and the extraction method was most obvious (P0.01). After the needle, the IEMG value of the method was still higher than that before the needle (P0.05). The twist method and the lifting and twisting method restored the level of the needle (P0.05). The comparison between the groups showed that each acupuncture time was the time. There was no significant statistical significance (P0.05) for the difference in the IEMG value of the segment. The MPF values of the three methods were significantly lower than those before the needle (P0.05), and the insertion method was more obvious (P0.01). The MPF values of the three middle techniques were all restored before the needle (P0.05). The comparison between the groups showed that the insertion method was compared with the twisting and twisting method. The difference was statistically significant (P0.05), and there was no significant difference in the MPF value of the three methods in other time periods (P0.05). During the needle, the MF values were significantly lower than those before the needle (P0.05), and the insertion method was more obvious (P0.01). The twist method was not significantly changed before the needle (P0.05). The MF values of the three methods were both during and after the needle retention. The results showed that there was no significant difference in the pre needle level (P0.05). There was no significant difference in the MF value between the acupuncture time periods (P0.05).3. The effect of different manipulations on the function of the brain was activated by the left anterior motor cortex, the left central posterior gyrus, the right frontal gyrus, the left inferior frontal gyrus, the right lingual gyrus, the left insula, right putamen, bilateral cingulate gyrus, right side Cerebellum, negative activation of bilateral hippocampus, left caudate nucleus, twisting group activating bilateral orbital frontal gyrus, left Island cover and lower frontal gyrus, right occipital gyrus, right occipital gyrus, negative activation of bilateral anterior lobe, right amygdala, left cingulate gyrus, right inferior temporal gyrus, right medial frontal gyrus, right supplementary motor area, left central posterior gyrus, etc. Bilateral central posterior gyrus, left occipital gyrus, left cerebral Island, left thalamus, left cingulate gyrus, right putamen, etc.; negative activation of right upper frontal gyrus, right top upper gyrus, right temporal gyrus, right occipital gyrus, right insula, left lingual gyrus, etc.. The results of the 22 comparison between the three methods showed that the signal was strongest, mainly in the edge system; put in twisting and twisting. 1, the intensity and frequency of the needle feeling of acupuncture at Zusanli point are basically similar, all of which are filled with feeling of flatulence and acid sense. The MASS index indicates that the feeling of the needle is the strongest, the twisting method is the weakest.2, the needle holder is heavy, the subjects may have a certain connection with the electromyography and the different manipulation needles. Acupoints of Zusanli can cause electromyography, suggesting that muscle tissue may be one of the main tissue structures that trigger the sense of gas needle in the Zusanli point of the doctor and the subject, but the stimulation intensity of different manipulations is different, and the activation of the muscle fibers may be different. The stimulation intensity of the extraction method may be the greatest and may be more activated. The slow muscle fiber.3, the three methods of acupuncture at Zusanli point activate the somatosensory area, visual area, cognition, emotion and other brain regions, which reflect the complex regulation effect of acupuncture on the brain function network. This complex brain function provides certain evidence for the extensive effect of acupuncture at Zusanli point; the extraction method is most active in the activation of the brain area. Obviously, the negative activation of the brain region is obvious with the twist method, which mainly concentrates on the edge system, which reflects the relative specificity of the manipulative brain effect. From the signal intensity of the brain region, the stimulation intensity of the extract group may be greater and the twisting group is the weakest; while the stimulation is large, the activation of the brain area may be more obvious; the negative activation may be more obvious when the stimulus amount is hours.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246

【参考文献】