穴位敏化现象及其生物学意义
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摘要
机体在病理过程中通过神经源性牵涉反应诱发体表对应部位产生感觉异变,反应部位就是"穴位"。这种感觉异变称之为"敏化"现象,其在生物学上具有重要意义。穴位是动态的,其"开/合"状态和功能强弱会随着内脏功能的变化而改变;穴位是反映和调节内脏功能状态的特定部位,具有诊断及治疗内脏病变的双重作用。穴位从"沉寂"(生理状态)到"唤醒"(病理状态)的过程即为穴位敏化,主要表现为穴位位置、大小及其理化环境的动态变化,也是机体自稳态调控的触发点。
In the pathological conditions, the human body induces somatic sensory exchanges and takes neurogenic inflammatory reactions according to referred visceral organ. Acupoint possesses both diagnosing and treating functions according to the acupuncture theory. The sensitization of acupoint refers to a pathophysiological dynamic change which is manifested predominately as a neurogenic inflammatory reaction in the specific area(s) of the body surface under pathological conditions. Furthermore, the process of acupoint from "silent"(physiological status) to "active"(pathological status) is generally represented by the dynamic changes of acupoint location, size and physicochemical environment. These responses of acupoint sensitization simultaneously activate self-healing system in the body and eventually induce the curative effects.
In the pathological conditions, the human body induces somatic sensory exchanges and takes neurogenic inflammatory reactions according to referred visceral organ. Acupoint possesses both diagnosing and treating functions according to the acupuncture theory. The sensitization of acupoint refers to a pathophysiological dynamic change which is manifested predominately as a neurogenic inflammatory reaction in the specific area(s) of the body surface under pathological conditions. Furthermore, the process of acupoint from "silent"(physiological status) to "active"(pathological status) is generally represented by the dynamic changes of acupoint location, size and physicochemical environment. These responses of acupoint sensitization simultaneously activate self-healing system in the body and eventually induce the curative effects.
引文
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[2]北京医学院基础医学系针麻原理研究形态组.家兔耳廓皮肤电阻变化与内脏疾病的关系[M]//中医研究院.针灸研究进展.北京:科学出版社, 1981.
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[16] Dorsher PT. Can classical acupuncture points and trigger points be comparedinthetreatmentofpaindisorders?Birch’sanalysis revisited[J]. J Altern Complement Med, 2008, 14(4):343-345.
[17] WoolfCJ,MaQ.Nociceptors--noxiousstimulusdetectors[J].Neuron, 2007, 55(3):353-364.
[18] WoolfCJ,SalterMW.Neuronalplasticity:increasingthegainin pain[J]. Science, 2000, 288(5472):1765-1769.
[19] Lechner SG, Lewin GR. Peripheral sensitisation of nociceptors via G-protein-dependentpotentiationofmechanotransduction currents[J]. J Physiol, 2009, 587(Pt 14):3493-3503.
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[25] He W, Wang XY, Shi H, et al. Cutaneous neurogenic inflammation inthesensitizedacupointsinducedbygastricmucosalinjuryin rats[J]. BMC Complement Altern Med, 2017, 17:141.
[26] WoolfCJ.Evidenceforacentralcomponentofpost-injurypain hypersensitivity[J]. Nature, 1983, 306(5944):686-688.
[27] JensenTS,FinnerupNB.Allodyniaandhyperalgesiain neuropathicpain:clinicalmanifestationsandmechanisms[J].Lancet Neurol, 2014, 13(9):924-935.
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[32]荣培晶,李霞,李亮,等.延髓背柱核在穴位敏化现象中的作用[J].世界中医药, 2013, 8(3):249-254.
[33] YuLL,LiL,BenH,etal.Changesinresponsesofneuronsin spinalandmedullarysubnucleusreticularisdorsalistoacupoint stimulationinratswithvisceralhyperalgeisa[J].EvidBased Comlement Altern Med, 2014, 2014:768634.
[34]余玲玲,李亮,秦庆广,等.内脏伤害性传入易化穴位对大鼠脊髓广动力型神经元的激活效应[J].针刺研究,2014,39(5):390-395.
[35]李亮,荣培晶,罗曼,等.内脏伤害性传入易化体表穴区功能的中枢机制[J].中国针灸, 2015, 35(11):1187-1191.
[36]朱兵.系统针灸学[M].北京:人民卫生出版社, 2015.
[2]北京医学院基础医学系针麻原理研究形态组.家兔耳廓皮肤电阻变化与内脏疾病的关系[M]//中医研究院.针灸研究进展.北京:科学出版社, 1981.
[3]李宇清,荣培晶,徐卫东,等.条件刺激引起脊髓神经元外周感受野的变化[J].中国神经科学杂志, 1999, 15(4):316-319.
[4]喻晓春,朱兵,高俊虹,等.穴位动态过程的科学基础[J].中医杂志,2007, 48(11):971-973.
[5]施静,王健,王渊,等.心绞痛牵涉痛与穴位敏化的关系[J].针刺研究, 2018, 43(5):277-284.
[6]陈日新,康明飞.腧穴热敏化艾灸新疗法[M].北京:人民卫生出版社, 2006.
[7]盖国才.穴位压痛诊断法[M].北京:科学技术文献出版社, 1978.
[8]吴秀锦.穴位的病理性反应[M]//中医研究院.针灸研究进展.北京:人民卫生出版社, 1981.
[9]FarmerAD,AzizQ.Mechanismsandmanagementoffunctional abdominal pain[J]. J R Soc Med, 2014, 107(9):347-354.
[10] Li S, Melton DH, Li S. Tactile, thermal, and electrical thresholds inpatientswithandwithoutphantomlimbpainaftertraumatic lower limb amputation[J]. J Pain Res, 2015, 8:169-174.
[11]Chang L, Berman S, Mayer EA, et al. Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia[J]. Am J Gastroenterol, 2003, 98(6):1354-1361.
[12]曹东元,牛汉璋,杜剑青,等.穴位电刺激经大鼠初级传入反射引起内脏的神经源性炎症反应[J].针刺研究, 2002, 27(1):45-49.
[13] Miranda A, Peles S, Rudolph C, et al. Altered visceral sensation in responsetosomaticpainintherat[J].Gastroenterology,2004,126(4):1082-1089.
[14] MelzackR,StillwellDM,FoxEJ.Triggerpointsandacupuncture points for pain:correlations and implications[J]. Pain, 1977, 3(1):3-23.
[15] Birch S. Trigger point--acupuncture point correlations revisited[J].J Altern Complement Med, 2003, 9(1):91-103.
[16] Dorsher PT. Can classical acupuncture points and trigger points be comparedinthetreatmentofpaindisorders?Birch’sanalysis revisited[J]. J Altern Complement Med, 2008, 14(4):343-345.
[17] WoolfCJ,MaQ.Nociceptors--noxiousstimulusdetectors[J].Neuron, 2007, 55(3):353-364.
[18] WoolfCJ,SalterMW.Neuronalplasticity:increasingthegainin pain[J]. Science, 2000, 288(5472):1765-1769.
[19] Lechner SG, Lewin GR. Peripheral sensitisation of nociceptors via G-protein-dependentpotentiationofmechanotransduction currents[J]. J Physiol, 2009, 587(Pt 14):3493-3503.
[20] HuangJ,ZhangX,Mc NaughtonPA.Modulationof temperature-sensitiveTRPchannels[J].SeminCellDevBiol,2006, 17(6):638-645.
[21] HenrichF,MagerlW,KleinT,etal.Capsaicin-sensitiveC-and A-fibrenociceptorscontrollong-termpotentiation-likepain amplification in humans[J]. Brain, 2015, 138(Pt 9):2505-2520.
[22] Rong PJ, Li S, Ben H, et al. Peripheral and spinal mechanisms of acupointsensitizationphenomenon[J].EvidBasedComplement Alternat Med, 2013, 742195.
[23]何伟,吴美玲,景向红,等.穴位的本态:穴位组织细胞化学的动态变化[J].中国针灸, 2015, 35(11):1181-1186.
[24]石宏,程斌,李江慧,等.肥大细胞和P物质参与急性胃黏膜损伤大鼠体表穴位的敏化过程[J].针刺研究,2010,35(5):323-329.
[25] He W, Wang XY, Shi H, et al. Cutaneous neurogenic inflammation inthesensitizedacupointsinducedbygastricmucosalinjuryin rats[J]. BMC Complement Altern Med, 2017, 17:141.
[26] WoolfCJ.Evidenceforacentralcomponentofpost-injurypain hypersensitivity[J]. Nature, 1983, 306(5944):686-688.
[27] JensenTS,FinnerupNB.Allodyniaandhyperalgesiain neuropathicpain:clinicalmanifestationsandmechanisms[J].Lancet Neurol, 2014, 13(9):924-935.
[28] KunerR.Centralmechanismsofpathologicalpain[J].NatMed,2010, 16(10):1258-1266.
[29] Meng F, Ge HY, Wang YH, et al. A afferent fibers are involved in thepathologyofcentralchangesinthespinaldorsalhorn associated with myofascial trigger spots in rats[J]. Exp Brain Res,2015, 223(11):3133-3143.
[30] LatremoliereA,WoolfCJ.Centralsensitization:ageneratorof painhypersensitivitybycentralneuralplasticity[J].JPain,2009,10(9):895-926.
[31] LuzLL,FernandesEC,SivadoM,et al.Monosynaptic convergenceofsomaticandvisceralC-fiberafferentson projectionandlocalcircuitneuronsinlaminaI:asubstratefor referred pain[J]. Pain, 2015, 156(10):2042-2051.
[32]荣培晶,李霞,李亮,等.延髓背柱核在穴位敏化现象中的作用[J].世界中医药, 2013, 8(3):249-254.
[33] YuLL,LiL,BenH,etal.Changesinresponsesofneuronsin spinalandmedullarysubnucleusreticularisdorsalistoacupoint stimulationinratswithvisceralhyperalgeisa[J].EvidBased Comlement Altern Med, 2014, 2014:768634.
[34]余玲玲,李亮,秦庆广,等.内脏伤害性传入易化穴位对大鼠脊髓广动力型神经元的激活效应[J].针刺研究,2014,39(5):390-395.
[35]李亮,荣培晶,罗曼,等.内脏伤害性传入易化体表穴区功能的中枢机制[J].中国针灸, 2015, 35(11):1187-1191.
[36]朱兵.系统针灸学[M].北京:人民卫生出版社, 2015.