针感灸感及其感传机制的研究进展
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摘要
古代文献中均有关于针感和灸感的记载,主要提出了气至的概念,分析了气至与治疗效应的相关性,针感与灸感的产生是针灸气至病所的标志之一。笔者查阅近十年关于针感、灸感及其感传的文献,进行分析总结,包括以下4个方面的内容:针感和灸感的表现形式、解剖生理结构、针感及其感传的神经体液机制和灸感及其感传的神经体液机制。
There are some records about the needling and moxibustion sensations in Chinese ancient medical literature,in which,the concept of Deqi(qi arrival)and its relationship with the production of therapeutic effects were put forward.The generation of needling or moxibustion sensations is one of the symbol for qi reaching the affected site during the manipulation and is also related to the treatment outcomes.In the present paper,we reviewed current situations about the mechanisms of acupuncture and moxibustion stimulation induced sensations and their relation to the propagated sensation(PS)published in recent 10 years from the following four aspects:1)the patterns of manifestation of needling sensations(including general sensations,and specific sensations,as well as the practitioner's hand felt heavy,tight,hard-going senses,etc.)and moxibustion sensations(local superficial and deep warmth);2)modern anatomical and physiological basis(skin,loose and dense connective tissue,free nerve ending,various receptors);3)neurohumoral mechanism of acupuncture stimulation induced PS phenomenon(mechanical receptors,afferent and efferent nerve fibers,neural center,various neurotransmitters/modulators,chemical substances,etc.);4)neurohumoral mechanism of moxibustion stimulation induced channel transmission(transient receptor potential vanilloid receptors-heat sensitive receptors,heat-shock protein,immunocytes,etc.).Additionally,the authors also put forward some suggestions about future researches on acupuncture-moxibustion sensations.
There are some records about the needling and moxibustion sensations in Chinese ancient medical literature,in which,the concept of Deqi(qi arrival)and its relationship with the production of therapeutic effects were put forward.The generation of needling or moxibustion sensations is one of the symbol for qi reaching the affected site during the manipulation and is also related to the treatment outcomes.In the present paper,we reviewed current situations about the mechanisms of acupuncture and moxibustion stimulation induced sensations and their relation to the propagated sensation(PS)published in recent 10 years from the following four aspects:1)the patterns of manifestation of needling sensations(including general sensations,and specific sensations,as well as the practitioner's hand felt heavy,tight,hard-going senses,etc.)and moxibustion sensations(local superficial and deep warmth);2)modern anatomical and physiological basis(skin,loose and dense connective tissue,free nerve ending,various receptors);3)neurohumoral mechanism of acupuncture stimulation induced PS phenomenon(mechanical receptors,afferent and efferent nerve fibers,neural center,various neurotransmitters/modulators,chemical substances,etc.);4)neurohumoral mechanism of moxibustion stimulation induced channel transmission(transient receptor potential vanilloid receptors-heat sensitive receptors,heat-shock protein,immunocytes,etc.).Additionally,the authors also put forward some suggestions about future researches on acupuncture-moxibustion sensations.
引文
[1]HUI K K,NIXON E E,VANGEL M G,et al.Characterization of the“deqi”response in acupuncture[J].BMC Complement Altern Med,2007,7(1):33.
[2]KONG J,GOLLUB R,HUANG T,et al.Acupuncture de qi,from qualitative history to quantitative measurement[J].J Altern Complement Med,2007,13(10):1059-1070.
[3]WHITE P,BISHOP F,HARDY H,et al.Southampton needle sensation questionnaire:development and validation of a measure to gauge acupuncture needle sensation[J].J Altern Complement Med,2008,14(4):373-379.
[4]谢丁一.陈日新教授论灸感[J].中国针灸,2016,36(8):789-792.
[5]王桂英,王耀帅,卢开信,等.不同灸温对高脂血症小鼠胆固醇及“神阙”穴皮肤的影响[J].中国针灸,2016,36(1):59-63.
[6]WANG G Y,WANG L L,XU B,et al.Effects of moxibustion temperature on blood cholesterol level in a mice model of acute hyperlipidemia:role of TRPV1[J].Evid Based Complement Alternat Med,2013,2013:871704.
[7]杨雪艳,王永霞,郑成强,等.艾灸温度与提高艾灸疗效的探讨[C]∥中国针灸学会临床分会.中国针灸学会临床分会2014年年会暨第二十一次全国针灸临床学术研讨会论文集.2014:157-159.
[8]郭义,方剑乔.实验针灸学[M].3版,北京:中国中医药出版社,2012.
[9]董泉声,董新民,先茂全,等.揭示灸法作用的穴位物质基础与阐明灸法退热机理的研究[J].四川中医,2013,31(7):151-160.
[10]白丽敏,李亚东.神经解剖学[M].北京:中国中医药出版社,2003.
[11]郑嘉太,陈波,郭永明,等.影响腧穴配伍效应差异的因素分析[J].中国针灸,2015,35(7):719-722.
[12]赵彦芬,赵峰,毛轲.针刺镇痛作用机制的探索[C]∥中国中西医结合学会、江苏省中西医结合学会.中国中西医结合麻醉学会年会暨第二届全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会论文汇编,2015:122-123.
[13]贾建平,陈生弟.神经病学[M].7版,北京:人民卫生出版社,2013.
[14]李鑫举,赵雪,郭义,等.试论针刺反应与针刺效应的关系[J].中医学报,2017,32(1):155-158.
[15]陆凤燕.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[D].北京:中国中医科学院,2017.
[16]周丹,潘萍,郭义,等.针刺引起的炎性反应是针效产生始动环节之一[J].中国针灸,2009,29(1):32-34.
[17]裴莹,赵雪,李忠正,等.钙离子与肥大细胞在针刺效应产生中作用的研究[J].临床和实验医学杂志,2017,16(12):1145-1148.
[18]NELISSEN S,LEMMENS E,GEURTS N,et al.The role of mast cells in neuroinflammation[J].Acta Neuropathol,2013,125(5):637-650.
[19]白杨,郭义.针刺效应/信号调节网络初探[J].针刺研究,2013,38(4):330-333.
[20]胡吴斌,吴子建,汪克明.中枢5-羟色胺在针刺效应中的作用研究进展[J].针刺研究,2012,37(3):247-251.
[21]陈波,李明月,赵雪,等.P物质与针灸效应的研究进展[J].上海针灸杂志,2014,33(1):82-87.
[22]石田寅夫,张秀玉,郭义,等.组织胺功能对针刺效应影响的研究[C]∥世界卫生组织.世界卫生组织传统医学大会卫星研讨会---针灸与人类健康论文摘要汇编.2008:115-116.
[23]GOLDMAN N,CHEN M,FUJITA T,et al.Adenosine A1receptors mediate local anti-nociceptive effects of acupuncture[J].Nat Neurosci,2010,13(7):883-888.
[24]陈宇杰.艾灸温热刺激与人体温度感受器的关系[C]//中国针灸学会实验针灸分会.第十七届针灸对机体功能的调节机制及针灸临床独特经验研讨会会议论文集.2014:83-86.
[25]黄凯裕,梁爽,孙征,等.艾灸温通效应的启动机制分析[J].中国针灸,2017,37(9):1023-1026.
[26]张会芳.不同灸温调脂通脉效应及TRPV1介导灸法“以温促通”效应机制研究[D].南京:南京中医药大学,2013.
[27]卢圣锋,尹海燕,唐勇,等.瞬时感受器电位及其与艾灸温热效应机制研究结合的思考[J].针刺研究,2012,37(2):151-154.
[28]李亮,杨金生,荣培晶,等.不同表面积和不同温度的热灸样刺激对大鼠延髓背侧网状亚核神经元的激活作用[J].针刺研究,2011,36(5):313-320.
[29]KOBAYASHI K.Induction of heat-shock protein(hsp)by moxibustion[J].Am J Chin Med,1995,23(3-4):327.
[30]刘慧荣,王乾瑶,吴焕淦,等.艾灸增强溃疡性结肠炎大鼠穴区HSP72和IL-6的表达[J].中华中医药学刊,2010,28(4):745-748.
[31]余曙光,尹海燕,罗玲,等.穴位局部分子靶点与艾灸作用机理[J].成都中医药大学学报,2015,38(4):1-5.
[32]郁洁,易受乡,常小荣,等.艾灸足三里、梁门穴对大鼠不同组织器官HSP70表达的影响[J].湖南中医药大学学报,2009,29(4):67-69.
[33]罗玲.艾灸免疫调节的局部作用机制研究[D].成都:成都中医药大学,2010.
[34]郑松,高兴华.皮肤的免疫功能[J].实用医院临床杂志,2015,12(2):3-8.
[2]KONG J,GOLLUB R,HUANG T,et al.Acupuncture de qi,from qualitative history to quantitative measurement[J].J Altern Complement Med,2007,13(10):1059-1070.
[3]WHITE P,BISHOP F,HARDY H,et al.Southampton needle sensation questionnaire:development and validation of a measure to gauge acupuncture needle sensation[J].J Altern Complement Med,2008,14(4):373-379.
[4]谢丁一.陈日新教授论灸感[J].中国针灸,2016,36(8):789-792.
[5]王桂英,王耀帅,卢开信,等.不同灸温对高脂血症小鼠胆固醇及“神阙”穴皮肤的影响[J].中国针灸,2016,36(1):59-63.
[6]WANG G Y,WANG L L,XU B,et al.Effects of moxibustion temperature on blood cholesterol level in a mice model of acute hyperlipidemia:role of TRPV1[J].Evid Based Complement Alternat Med,2013,2013:871704.
[7]杨雪艳,王永霞,郑成强,等.艾灸温度与提高艾灸疗效的探讨[C]∥中国针灸学会临床分会.中国针灸学会临床分会2014年年会暨第二十一次全国针灸临床学术研讨会论文集.2014:157-159.
[8]郭义,方剑乔.实验针灸学[M].3版,北京:中国中医药出版社,2012.
[9]董泉声,董新民,先茂全,等.揭示灸法作用的穴位物质基础与阐明灸法退热机理的研究[J].四川中医,2013,31(7):151-160.
[10]白丽敏,李亚东.神经解剖学[M].北京:中国中医药出版社,2003.
[11]郑嘉太,陈波,郭永明,等.影响腧穴配伍效应差异的因素分析[J].中国针灸,2015,35(7):719-722.
[12]赵彦芬,赵峰,毛轲.针刺镇痛作用机制的探索[C]∥中国中西医结合学会、江苏省中西医结合学会.中国中西医结合麻醉学会年会暨第二届全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会论文汇编,2015:122-123.
[13]贾建平,陈生弟.神经病学[M].7版,北京:人民卫生出版社,2013.
[14]李鑫举,赵雪,郭义,等.试论针刺反应与针刺效应的关系[J].中医学报,2017,32(1):155-158.
[15]陆凤燕.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[D].北京:中国中医科学院,2017.
[16]周丹,潘萍,郭义,等.针刺引起的炎性反应是针效产生始动环节之一[J].中国针灸,2009,29(1):32-34.
[17]裴莹,赵雪,李忠正,等.钙离子与肥大细胞在针刺效应产生中作用的研究[J].临床和实验医学杂志,2017,16(12):1145-1148.
[18]NELISSEN S,LEMMENS E,GEURTS N,et al.The role of mast cells in neuroinflammation[J].Acta Neuropathol,2013,125(5):637-650.
[19]白杨,郭义.针刺效应/信号调节网络初探[J].针刺研究,2013,38(4):330-333.
[20]胡吴斌,吴子建,汪克明.中枢5-羟色胺在针刺效应中的作用研究进展[J].针刺研究,2012,37(3):247-251.
[21]陈波,李明月,赵雪,等.P物质与针灸效应的研究进展[J].上海针灸杂志,2014,33(1):82-87.
[22]石田寅夫,张秀玉,郭义,等.组织胺功能对针刺效应影响的研究[C]∥世界卫生组织.世界卫生组织传统医学大会卫星研讨会---针灸与人类健康论文摘要汇编.2008:115-116.
[23]GOLDMAN N,CHEN M,FUJITA T,et al.Adenosine A1receptors mediate local anti-nociceptive effects of acupuncture[J].Nat Neurosci,2010,13(7):883-888.
[24]陈宇杰.艾灸温热刺激与人体温度感受器的关系[C]//中国针灸学会实验针灸分会.第十七届针灸对机体功能的调节机制及针灸临床独特经验研讨会会议论文集.2014:83-86.
[25]黄凯裕,梁爽,孙征,等.艾灸温通效应的启动机制分析[J].中国针灸,2017,37(9):1023-1026.
[26]张会芳.不同灸温调脂通脉效应及TRPV1介导灸法“以温促通”效应机制研究[D].南京:南京中医药大学,2013.
[27]卢圣锋,尹海燕,唐勇,等.瞬时感受器电位及其与艾灸温热效应机制研究结合的思考[J].针刺研究,2012,37(2):151-154.
[28]李亮,杨金生,荣培晶,等.不同表面积和不同温度的热灸样刺激对大鼠延髓背侧网状亚核神经元的激活作用[J].针刺研究,2011,36(5):313-320.
[29]KOBAYASHI K.Induction of heat-shock protein(hsp)by moxibustion[J].Am J Chin Med,1995,23(3-4):327.
[30]刘慧荣,王乾瑶,吴焕淦,等.艾灸增强溃疡性结肠炎大鼠穴区HSP72和IL-6的表达[J].中华中医药学刊,2010,28(4):745-748.
[31]余曙光,尹海燕,罗玲,等.穴位局部分子靶点与艾灸作用机理[J].成都中医药大学学报,2015,38(4):1-5.
[32]郁洁,易受乡,常小荣,等.艾灸足三里、梁门穴对大鼠不同组织器官HSP70表达的影响[J].湖南中医药大学学报,2009,29(4):67-69.
[33]罗玲.艾灸免疫调节的局部作用机制研究[D].成都:成都中医药大学,2010.
[34]郑松,高兴华.皮肤的免疫功能[J].实用医院临床杂志,2015,12(2):3-8.