与胃溃疡相关的督脉背段敏化穴位特异性研究

The specificities of acupoints have been met with incredulity in recently years even if they are making component parts of acupuncture treatment. There were obvious debate about the effectiveness among acupoints and non- acupoints according some large sample randomized controlled trial in clinical research, and it will become a major scientific problem in the field of acupuncture and moxibustion. Some defects of the research about the specificities of acupoints were: the substance and structure of acupoints were break away from its function during the procedure of study, on the other hand, the contrary program is exist，and therefore cannot find the key factors about function matching substance and structure of acupoints. The sensitized function of acupoints accompanying the specific changed about the substance and structure in acupoints simultaneously during the body is at the statement of diseases, then, we can say that the acupoints having the specificities. Some phenomenon was observed that sensitized acupoints on back section of governor vessel in patients with stomach ulcer according to the basis of our previous work. We will take advantage of the characteristics of sensitized acupoints to locate it at governor vessel related to stomach ulcer, and we will study the specificities of its function by effects of acupuncture. To discern the essence of the specificities of sensitized acupoints related to stomach ulcer of governor vessel by the principle of function matching substance and structure, it is necessary for measuring the threshold of pain of sensitized acupoints by mechanical pressure, testing the temperature of surface of sensitized acupoints, observing the microcirculation perfusion、substance P and PGE2 of its deep tissue, all this will be conducive to solve the scientific key issue about the specificities of acupoints by evidence provided from our experiments.

作为针灸基础的穴位，其特异性在近年来却屡遭质疑，一些大样本的临床随机对照研究也对穴位与非穴位的疗效是否有差异存在较大的争议，成为目前困扰针灸界的重要科学问题。当前关于穴位特异性的研究存在明显的不足：一是脱离穴位的物质结构研究穴位功能，二是脱离穴位的功能研究其物质结构，结果无法探明穴位功能与物质结构相匹配的关键因素。我们认为，穴位的特异性表现在于机体病态时穴位出现功能敏化的同时伴随物质结构的特异性改变。根据我们的工作基础，胃溃疡患者在督脉背段存在穴位敏化现象，本研究先以穴位敏化的特征进行精确定位，再观察督脉敏化穴位的针刺效应以确定其功能的特异性；进一步测定敏化穴位机械压痛阈、体表温度和深部组织微循环灌注量、穴位深部组织致痛物质（P物质、PGE2）的含量以确定敏化穴位的生物物理化学特性，以功能和物质结构相匹配的原则研究敏化穴位特异性的实质，为解决穴位是否具有特异性的科学问题提供有益的实验依据。

作为针灸基础的穴位，其特异性在近年来却屡遭质疑，成为目前困扰针灸界的重要科学问题。我们认为，穴位的特异性表现在于机体病态时穴位出现功能敏化的同时伴随物质结构的特异性改变。本项目从以下五个方面开展研究，并取得了一些结果：（1）以机械压力测定痛阈的方法定位了胃溃疡病态时在督脉背段的敏化穴位或部位，确定了最优敏化穴位或部位为T4、T5（神道）、次优为T6（灵台）3个胸椎节段；（2）以红外成像方法观察了督脉敏化穴位的体表温度、体表红外辐射成像特征，确定了胃溃疡患者督脉背段T4-T6段温差和红外辐射轨迹均具有特异性表现，且较健康者的督脉背段红外辐射轨迹更易显示、更完整；（3）总结了督脉敏化穴位的体表微循环特征和规律：胃溃疡督脉背段棘突下T4-T6水平的微循环灌注量高于健康组，也高于自身的非敏化对照部位L3棘突下水平；（4）对比胃溃疡大鼠相应的督脉敏化穴位和非敏化穴位深部组织的致痛物质含量的差异：胃溃疡大鼠督脉敏化穴位深部组织中ｐ物质和PGE2升高；（5）以胃黏膜损伤指数（UI）、胃组织病理形态为指标，观察运用敏化穴位治疗胃溃疡大鼠的针刺效应研究：采用火针治疗，与模型组大鼠比较，敏化组和传统组大鼠胃黏膜损伤指数降低，但未见显著差异，其原因可能是治疗时间不足或例数过少造成抽样误差，后续研究将延长治疗时间和增加样本量，以进一步观察其针刺效应。结果表明：胃溃疡患者在督脉背段敏化穴位的机械压痛阈、体表温度、红外辐射轨迹和皮肤组织微循环灌注量、胃溃疡大鼠穴位深部组织致痛物质（P物质、PGE2）含量均具有特异性，证实了敏化穴位具有独特的生物物理化学特性。本研究的应用前景有助于弄清督脉背段敏化穴位与胃病的特异对应关系，形成有特色的经络穴位诊断，为胃病的针灸治疗提供全新的有别于传统的取穴依据或针灸刺激部位的定位；有助于为解决困扰针灸界的重要科学问题——穴位的特异性提供有益的实验依据。