3篇論文/綜述，根據具體的實驗結果，從西醫角度揭示了自主神經係統在針灸機理中的重要地位。

來源: 欲千北於 2022-06-03 08:24:47 [檔案] [博客] [舊帖] [給我悄悄話] 本文已被閱讀：次 (9357 bytes)

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回答: 經絡治療疾病的原理由 kylelong 於 2022-06-03 05:24:32

A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis，Shenbin Liu，Nature 2021 Oct; https://pubmed.ncbi.nlm.nih.gov/34646018/

（機器翻譯）摘要

體感自主反射允許電針刺激 (ES) 在遠處調節身體生理 1-6（例如，抑製嚴重的全身炎症 6-9）。自 1970 年代以來，關於這些反射的新興組織規則是身體區域特異性 1-6 的存在。例如，後肢 ST36 穴位的 ES 而不是腹部 ST25 穴位的 ES 可以驅動小鼠的迷走腎上腺抗炎軸10, 11。然而，這種體細胞組織的神經解剖學基礎是未知的。在這裏，我們展示了 PROKR2Cre 標記的感覺神經元，它支配深後肢筋膜（例如，骨膜）而不是腹部筋膜（例如，腹膜），對於驅動迷走神經 - 腎上腺軸至關重要。具有消融 PROKR2Cre 標記的感覺神經元的小鼠 ST36 位點的低強度 ES 未能激活後腦迷走神經傳出神經元或驅動腎上腺釋放兒茶酚胺。結果，ES 不再抑製由細菌內毒素引起的全身炎症。相比之下，ST25 和 ST36 部位的高強度 ES 誘發的脊髓交感神經反射不受影響。我們還表明，通過 ST36 位點對 PROKR2Cre 標記的神經末梢進行光遺傳學刺激足以驅動迷走神經-腎上腺軸，但不能驅動交感神經反射。此外，PROKR2Cre 神經纖維的分布模式可以回顧性地預測低強度 ES 將或不會有效產生抗炎作用的身體區域。我們的研究為穴位在驅動特定自主神經通路中的選擇性和特異性提供了神經解剖學基礎。

Abstract

Somatosensory autonomic reflexes allow electroacupuncture stimulation (ES) to modulate body physiology at distant sites^1-6 (for example, suppressing severe systemic inflammation^6-9). Since the 1970s, an emerging organizational rule about these reflexes has been the presence of body-region specificity^1-6. For example, ES at the hindlimb ST36 acupoint but not the abdominal ST25 acupoint can drive the vagal-adrenal anti-inflammatory axis in mice^10,11. The neuroanatomical basis of this somatotopic organization is, however, unknown. Here we show that PROKR2^Cre-marked sensory neurons, which innervate the deep hindlimb fascia (for example, the periosteum) but not abdominal fascia (for example, the peritoneum), are crucial for driving the vagal-adrenal axis. Low-intensity ES at the ST36 site in mice with ablated PROKR2^Cre-marked sensory neurons failed to activate hindbrain vagal efferent neurons or to drive catecholamine release from adrenal glands. As a result, ES no longer suppressed systemic inflammation induced by bacterial endotoxins. By contrast, spinal sympathetic reflexes evoked by high-intensity ES at both ST25 and ST36 sites were unaffected. We also show that optogenetic stimulation of PROKR2^Cre-marked nerve terminals through the ST36 site is sufficient to drive the vagal-adrenal axis but not sympathetic reflexes. Furthermore, the distribution patterns of PROKR2^Cre nerve fibres can retrospectively predict body regions at which low-intensity ES will or will not effectively produce anti-inflammatory effects. Our studies provide a neuroanatomical basis for the selectivity and specificity of acupoints in driving specific autonomic pathways.

Somatotopic Organization and Intensity Dependence in Driving Distinct NPY Expressing Sympathetic Pathways by Electroacupuncture，Shenbin Liu， et al. Neuron ( IF 14.415 ) : 2020-08-12 , https://www.sciencedirect.com/science/article/pii/S0896627320305328

（機器翻譯）摘要

針灸實踐背後的神經解剖學基礎仍然知之甚少。在這裏，我們使用交叉遺傳策略來消融 NPY+ 去甲腎上腺素能神經元和/或腎上腺嗜鉻細胞。使用內毒素誘導的全身炎症作為模型，我們發現電針刺激 (ES) 以體細胞和強度依賴性方式驅動交感神經通路。後肢區域的低強度 ES 驅動迷走腎上腺軸，產生依賴於 NPY+ 腎上腺嗜鉻細胞的抗炎作用。腹部高強度 ES 通過脊髓交感軸激活 NPY+ 脾去甲腎上腺素能神經元；這些神經元通過激活不同的腎上腺素能受體 (ARs) 參與不連貫的前饋調節回路，並且由於 AR 譜的疾病狀態依賴性變化，它們的 ES 誘發激活產生抗炎或促炎作用。在驅動不同的自主神經通路中體細胞組織和強度依賴性的揭示可以形成優化刺激參數的路線圖，以提高使用針灸作為治療方式的療效和安全性。

Abstract

The neuroanatomical basis behind acupuncture practice is still poorly understood. Here, we used intersectional genetic strategy to ablate NPY⁺ noradrenergic neurons and/or adrenal chromaffin cells. Using endotoxin-induced systemic inflammation as a model, we found that electroacupuncture stimulation (ES) drives sympathetic pathways in somatotopy- and intensity-dependent manners. Low-intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on NPY⁺ adrenal chromaffin cells. High-intensity ES at the abdomen activates NPY⁺ splenic noradrenergic neurons via the spinal-sympathetic axis; these neurons engage incoherent feedforward regulatory loops via activation of distinct adrenergic receptors (ARs), and their ES-evoked activation produces either anti- or pro-inflammatory effects due to disease-state-dependent changes in AR profiles. The revelation of somatotopic organization and intensity dependency in driving distinct autonomic pathways could form a road map for optimizing stimulation parameters to improve both efficacy and safety in using acupuncture as a therapeutic modality.

Acupuncture and Neural Mechanism in the Management of Low Back Pain—An Update

Tiaw-Kee Lim, et al. Medicines (Basel). 2018 Sep; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164863/

很好的綜述，有各種對針灸效果的理論假設，包括神經作用。非常好。

（機器翻譯）摘要

在過去 10 年中，腰痛 (LBP) 患病率增加了 18%。 LBP 的管理和高成本給醫療保健係統帶來了巨大的負擔。已經確定了許多危險因素，例如生活方式、創傷、退化、姿勢障礙和職業相關因素；然而，高達 95% 的 LBP 病例是非特異性的。目前，LBP 采用藥物治療。大約 25% 到 30% 的患者會出現嚴重的副作用，例如嗜睡和藥物成癮。脊柱手術通常不會顯著改善疼痛緩解。因此，正在將補充方法整合到康複計劃中。這些包括整脊療法、物理療法、按摩、運動、草藥和針灸。針灸治療腰痛是最常用的非藥物鎮痛技術之一。這是由於其低副作用和成本效益。目前，許多隨機對照試驗和臨床研究已經產生了可喜的結果。本文綜述了 LBP 對全球醫療保健的原因和發生率。考慮到針灸治療的重要性。綜述了揭示穴位與解剖特征之間聯係的努力以及導致針刺鎮痛作用的神經機製。

Abstract

Within the last 10 years, the percentage of low back pain (LBP) prevalence increased by 18%. The management and high cost of LBP put a tremendous burden on the healthcare system. Many risk factors have been identified, such as lifestyle, trauma, degeneration, postural impairment, and occupational related factors; however, as high as 95% of the cases of LBP are non-specific. Currently, LBP is treated pharmacologically. Approximately 25 to 30% of the patients develop serious side effects, such as drowsiness and drug addiction. Spinal surgery often does not result in a massive improvement of pain relief. Therefore, complementary approaches are being integrated into the rehabilitation programs. These include chiropractic therapy, physiotherapy, massage, exercise, herbal medicine and acupuncture. Acupuncture for LBP is one of the most commonly used non-pharmacological pain-relieving techniques. This is due to its low adverse effects and cost-effectiveness. Currently, many randomized controlled trials and clinical research studies have produced promising results. In this article, the causes and incidence of LBP on global health care are reviewed. The importance of treatment by acupuncture is considered. The efforts to reveal the link between acupuncture points and anatomical features and the neurological mechanisms that lead to acupuncture-induced analgesic effect are reviewed.