针刺镇痛作用原理.ppt
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1、针刺镇痛研究 40年回顾,北京大学 神经科学研究所,韩济生,历史回顾,1958年出现了“针刺麻醉”新事物 周总理通过卫生部指示:研究针麻原理 全国100余座医学院校参与研究 1965年9月我接受国家任务主持此项目,至今40年 回顾40年历程,从科研方向、方法、结果进行总结,可能有一定意义,从 “是什么” What? 针刺真的镇痛吗? 到 “为什么” Why? 针刺为什么会镇痛?,Acupucture-induced analgesia Human Observation:,7,足三里,合谷穴,对照组,合谷 优于 足三里,合谷 - 足三里,合谷穴,对照组,合谷-足三里 双穴 优于 单穴,对照组,
2、合谷穴,非经穴,针刺非经穴也有镇痛效果,合谷穴,Site specificity,Meridine/channel (morphological evidence?) Acupoints (precise to mm level?) Body points (Chinese original) or Ear points (French scholars) Bio-electrically sensitive sites, or densely innervated sites relative rather than absolute specificity,12,14,留针,留针,捻针,捻
3、针,耳针镇痛:规律相似 捻针有效,留针效差,同一天 重复电针,不同天 重复电针,电针镇痛有个体差异,具有可重复性,大 鼠 实 验,测痛是否能预测针麻效果?,外科手术时 针麻效果,术前测定针刺镇痛效果,合谷穴内注射局麻药procaine阻断针刺镇痛,针刺合谷穴,针刺,穴位注射局麻药 加 针刺,Procaine infiltration in the acupoint abolishes the effect of AA,0,20,40,60,80,-20,0,20,40,60,80,100,120,(n=10),Acupuncture at Heku point,Pain threshold c
4、hange (%),Time in minutes,Procaine infiltration + Acupuncture,Analgesic effect produced by peripheral nerve Stimulation,8,Decay of the Effect of Acupuncture Analgesia After the termination of acupuncture stimulation Half life (T1/2) = 16 min,9,Rabbit experiment: cross infusion of CSF,Evidence showin
5、g a neurochemical basis for AA,TFL, % change,Time, min,AA + CSF perfusion,200,100,150,aCSF,Doner rabbit,Lat ventricle,III ventricle,perfusate,Infusion of CSF,Acupuncture,Control,50,0,10,Recipient rabbit,从 “是什么” What? 针刺真的镇痛吗?是的! 到 “为什么” Why? 针刺为什么会镇痛?,机制研究从何入手?,从神经生理(电生理)入手? 从神经化学(物质基础)入手? 神经冲动是电活动
6、到突触末端是化学活动,针刺镇痛的神经化学机制,小分子神经递质 5-羟色胺(5-HT), 去甲肾上腺素(NA), 乙酰胆碱(ACh), etc 神经肽 鸦片肽,非鸦片肽,Tail flick latency, % change,The role of CNS 5-HT in EA analgesia,ICV inj,ITH inj,The role of CNS NA in EA analgesia,The role of CNS NA in EA analgesia,Tail flick latency, % change,DOPS 前体物质 Phentol受体阻断,中枢神经递质在脑的不同部位
7、 发挥不同作用,2Hz EA increases Enk release 100Hz EA increases Dyn release,12,0,500,1000,1500,2000,10,15,0,5,0,500,1000,1500,2000,0,5,10,15,2Hz Enk,100Hz Dyn,fmol / ml CSF,Frequency dependence of peptide release Human Study,Mek-Arg-Phe,Dynorphin A,MEK-Arg-Phe,Dynorphin A,A study in collaboration with Dr. L
8、ars Terenius,13,15,大鼠脊髓中脑啡肽和强啡肽的作用: 低频:脑啡肽 高频:强啡肽,电针不同频率 发挥不同作用,放电频率,Response / Release,神经递质,神经肽,Thomas Hokfelt, 1991, Neuron 7:867-879,4,低频刺激释放神经递质,高频释放神经肽,2 Hz,100 Hz,1997,EA accelerates the release of endogenous opioids,Synergistic Interaction between neuropeptides,19,The optimal cycle of DD wave
9、,The optimal cycle seems to be 6 second (3 low, 3 high),1 mA 2 mA 3 mA,Trends in Neuroscience, 2003; 26: 17-22,电针方法 是否有改进余地?,穴位接受什么刺激?,机悈刺激: 机悈压迫(砭),针刺 温度刺激:温针(经针),灸(经皮) 电刺激 :经针(电针),经皮(TENS),电刺激穴位:两种方式,经针 (电针, EA) 0.5 - 3.0 mA 经皮 (经皮电刺激,TENS) 5 - 15 mA,15,必须应用恒流(constant current)电刺激仪,Equal potency o
10、f the analgesic effects produced by EA and TENS in rats,EA TENS,EA TENS,2 Hz,15 Hz,100 Hz,Placebo,TFL, % change,16,Cross tolerance between EA and TENS,电针和TENS的比较,相同点:镇痛效果相似,镇痛机制相同,TENS使用方便。,HANS for the treatment of autism自闭症、孤独症,The HANS unit and the skin electrodes,An autism patient is treating hi
11、mself with a HANS unit.,18,ShenZhen Hospital,电针镇痛的神经通路,经典神经生物学方法 脑影像方法 必须与针刺治疗效果相关者才有意义,Nerve pathways for low and high frequency EA analgesia,100 Hz,2 Hz,-end,Enk,Dyn,PBN,Arcuate N. Hypoth.,PAG,Medulla,DHN,Nerve pathways for low and high frequency EA analgesia,27,Rat experiment,Brain imaging and fu
12、nctional correlates,Acupuncture may activate many brain areas. But which is related with the given functional change? It is advisable to find the correlation between the BOLD signals and the therapeutic effects produced by acupuncture,28,http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/
13、 http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:
14、/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ http:/ and non-responders in acupuncture analgesia,30,Zhang WT, et al: Brain Res 2003; 982:168-178,Pos
15、itive correlation,31,Zhang WT, et al: Brain Res 2003; 982:168-178,从原理研究 返回临床实际,Hans Acupoint Nerve Stimulator (HANS) 韩 氏 穴 位 神 经 刺 激 仪,NeiGuan (Pe6),Heku (LI 4),21,HANS,Electrical stimulation parameters,Frequency (Hz, 1-100) Intensity (mA, 0.5-3.0) Pulse width (ms, 0.1-0.6),20,急性痛 (创伤,手术,术后,生育),慢性痛
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- 针刺 镇痛 作用 原理
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