本文選題：針刺手法 + 得氣針感　； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：研究背景“得氣”是針灸學(xué)科特有的專業(yè)術(shù)語,一方面是指患者主觀感覺的酸、麻、脹、重、壓等,另一方面是指施針者手下沉緊感。得氣是針刺取得療效的關(guān)鍵,也是正確定穴、判定患者經(jīng)氣盛衰和病候預(yù)后以及選擇行針方法的依據(jù)。過去國內(nèi)外研究人員從“得氣”的定性定量、“得氣”與臨床療效的關(guān)系以及運(yùn)用功能性磁共振成像(Functional Magnetic Resonance Imaging,fMRI)技術(shù)觀察“得氣”的腦中樞效應(yīng)等方面展開了一些研究,然而得出的結(jié)果還是比較初步,有的方面還存在頗多爭議。對于針刺得氣的機(jī)制,過去也做過一些工作。有相關(guān)報(bào)道表明,與不得氣相比,針刺得氣更能增加局部皮膚和肌肉的血流量;有研究指出,針刺得氣針感可能與穴區(qū)下結(jié)締組織纏繞有關(guān);而另有研究則表明,得氣針感可能與肌肉組織關(guān)系密切;另外,多數(shù)研究表明得氣效應(yīng)是穴區(qū)多個(gè)組織結(jié)構(gòu)共同參與的結(jié)果,而非單一組織,但具體機(jī)制尚無定論�！靶嗅槨笔侵羔槾倘胙ê�,為使患者獲得或增強(qiáng)針感,或使針感向某個(gè)方向傳導(dǎo)而采取的操作方法。行針手法是影響針刺得氣的重要因素之一,是針刺過程的重要組成部分,也是維持和加強(qiáng)得氣針感的重要方法,與針刺療效密切相關(guān)。其基本手法包括捻轉(zhuǎn)法和提插法。針灸臨床表明,應(yīng)用手法的療效常優(yōu)于不運(yùn)用手法,不同的針刺手法產(chǎn)生的臨床效應(yīng)也有差異。研究表明不同行針手法下,針體的受力情況差異顯著,說明針體在不同手法操作下對人體的作用是不同的,由此產(chǎn)生的得氣針感可能也有所不同。但是目前對于何種手法更容易產(chǎn)生針感,何種手法對應(yīng)何種針感,尚缺乏確切證據(jù)。腦中樞是針刺起效的重要途徑。隨著腦功能檢測方法的不斷創(chuàng)新發(fā)展,目前基于腦科學(xué)的得氣研究相當(dāng)熱門,采用的檢測方式有腦電圖、腦磁圖、電子計(jì)算機(jī)X射線斷層掃描技術(shù)、正電子發(fā)射斷層掃描等。尤其是近20年來,fMRI技術(shù)快速發(fā)展,由于其無創(chuàng)、無輻射、空間分辨力高、功能和形態(tài)同時(shí)成像等優(yōu)點(diǎn),在針刺腦中樞機(jī)制的研究中應(yīng)用越來越廣,并取得了一定成果。但不同手法及復(fù)合手法的腦中樞效應(yīng)是否存在差異尚未明確。本研究以健康受試者為試驗(yàn)對象,以表面肌電圖(Surface Electromyography,sEMG)和fMRI為技術(shù)手段,選取右足三里穴為代表腧穴,以捻轉(zhuǎn)法、提插法及其復(fù)合手法為干預(yù)方法,觀察不同針刺手法下施針者和受針者的得氣針感、穴區(qū)表面肌電及腦功能效應(yīng),比較分析其異同,為選擇不同針刺手法治療疾病的生物學(xué)機(jī)制研究打下基礎(chǔ)。研究目的通過比較捻轉(zhuǎn)法、提插法、提插捻轉(zhuǎn)法三種不同的行針手法針刺右側(cè)足三里穴的得氣針感、穴區(qū)表面肌電和腦功能區(qū)激活情況的異同,探討不同針刺手法(提插、捻轉(zhuǎn)等)在引起不同得氣針感(受針者得氣感與施針者手下針感)中的作用及其與穴區(qū)表面肌電和fMRI腦功能變化的關(guān)系,為針刺得氣針感理論提供科學(xué)解釋,并藉此為其臨床應(yīng)用、提高臨床療效提供科學(xué)依據(jù)。研究方法招募45位健康志愿者,針刺右側(cè)足三里穴,每隔一周隨機(jī)接受一種行針手法:捻轉(zhuǎn)法、提插法、提插捻轉(zhuǎn)法,于針刺結(jié)束后由針灸師和受試者共同填寫一份得氣針感量表(MGH Acupuncture Sensation Scale,MASS)。隨機(jī)抽取其中13位受試者,用生理記錄儀記錄進(jìn)針前、行針期間、留針期間及出針后的穴區(qū)表面肌電。隨機(jī)抽取另外17位受試者,在行針同時(shí),掃描頭顱fMRI。采用SPSS23.0軟件分析得氣針感的強(qiáng)度和頻率,LabChart8.0軟件計(jì)算積分肌電值(Integrated Electromyogram,IEMG)、平均功率頻率(Mean Power Frequency,MPF)、中位頻率(Median Frequency,MF),并以SPSS23.0進(jìn)行統(tǒng)計(jì)分析,統(tǒng)計(jì)參數(shù)圖軟件包(Statistical Parametric Mapping,SPM8)處理分析 fMRI 數(shù)據(jù),比較不同行針手法干預(yù)下得氣針感、穴區(qū)表面肌電以及腦功能區(qū)激活與負(fù)激活的差別。研究結(jié)果1、不同手法對得氣針感的影響三種手法引起的各針感強(qiáng)度和頻率無顯著性差異,均以脹滿感、酸感明顯,針感綜合指數(shù)(MASS index)顯示:提插組提插捻轉(zhuǎn)組捻轉(zhuǎn)組。捻轉(zhuǎn)組和提插捻轉(zhuǎn)組受試者的脹滿感與施針者手下沉緊感呈正相關(guān),提插組受試者的脹滿感與施針者手下沉緊感呈正相關(guān)趨勢。2、不同手法對穴區(qū)表面肌電的影響行針及留針期間,三種手法的IEMG值均較針前顯著升高(P0.05),提插法最明顯(P0.01);出針后,提插法的IEMG值仍較針前高(P0.05),捻轉(zhuǎn)法和提插捻轉(zhuǎn)法恢復(fù)針前水平(P0.05)。組間比較顯示,各針刺時(shí)間段的IEMG值差異無明顯統(tǒng)計(jì)學(xué)意義(P0.05)。行針期間,三種手法的MPF值均較針前顯著降低(P0.05),提插法更明顯(P0.01);留針期間及出針后,三中手法的MPF值均恢復(fù)針前水平(P0.05)。組間比較顯示行針期間提插法分別與捻轉(zhuǎn)法、提插捻轉(zhuǎn)法相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),其他時(shí)間段三種手法的MPF值差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。行針期間,提插法和提插捻轉(zhuǎn)法的MF值均較針前顯著降低(P0.05),提插法更明顯(P0.01),捻轉(zhuǎn)法較針前無顯著變化(P0.05);留針期間及出針后,三種手法的MF值均恢復(fù)針前水平(P0.05)。組間比較顯示,各針刺時(shí)間段的MF值差異無明顯統(tǒng)計(jì)學(xué)意義(P0.05)。3、不同手法對腦功能效應(yīng)的影響提插組激活左側(cè)前運(yùn)動(dòng)皮層、左側(cè)中央后回、右側(cè)額中回、左側(cè)額下回、右側(cè)舌回、左側(cè)腦島、右側(cè)殼核、雙側(cè)扣帶回、右側(cè)小腦等,負(fù)激活雙側(cè)海馬、左側(cè)尾狀核;捻轉(zhuǎn)組激活雙側(cè)眶部額中回、左側(cè)島蓋部和三角部額下回、右側(cè)枕中回等,負(fù)激活雙側(cè)楔前葉、右側(cè)杏仁核、左側(cè)扣帶回前部、右側(cè)顳下回、右側(cè)額中回、右側(cè)補(bǔ)充運(yùn)動(dòng)區(qū)、左側(cè)中央后回等;提插捻轉(zhuǎn)法激活雙側(cè)中央后回、左側(cè)枕下回、左側(cè)腦島、左側(cè)丘腦、左側(cè)扣帶回、右側(cè)殼核等;負(fù)激活右側(cè)額上回、右側(cè)頂上回、右側(cè)顳回、右側(cè)枕中回、右側(cè)腦島、左側(cè)舌回等。三種手法的兩兩比較結(jié)果顯示:提插法信號最強(qiáng),主要集中在邊緣系統(tǒng);提插捻轉(zhuǎn)法次之,捻轉(zhuǎn)法最弱。研究結(jié)論:1、不同手法針刺足三里穴得氣針感的強(qiáng)度和頻率基本相似,均以脹滿感、酸感明顯,MASS指標(biāo)提示:提插法針感最強(qiáng),捻轉(zhuǎn)法最弱。2、施針者手下沉緊感、受試者脹滿感與肌電活動(dòng)可能存在一定聯(lián)系,不同手法針刺足三里穴均能引發(fā)肌電,提示:肌肉組織可能是引發(fā)醫(yī)者和受試者針刺足三里穴產(chǎn)生得氣針感的主要組織結(jié)構(gòu)之一,但不同手法的刺激強(qiáng)度不一,由此激活的肌纖維類型可能也不一。提插法的刺激強(qiáng)度可能最大,并可能更多地激活了慢肌纖維。3、三種手法針刺足三里穴均不同程度及范圍地激活了體感區(qū)、視覺區(qū)、認(rèn)知、情緒等腦區(qū),體現(xiàn)了針刺對大腦功能網(wǎng)絡(luò)的復(fù)雜調(diào)控作用,此種復(fù)雜腦功能作用為針刺足三里穴的廣泛性效應(yīng)提供一定的證據(jù);提插法對腦區(qū)激活最明顯,捻轉(zhuǎn)法對腦區(qū)負(fù)激活明顯,主要集中在邊緣系統(tǒng),體現(xiàn)了手法腦效應(yīng)的相對特異性。從腦區(qū)信號強(qiáng)度看,提插組的刺激強(qiáng)度可能更大,捻轉(zhuǎn)組最弱;而刺激量大時(shí),腦區(qū)激活可能更明顯;刺激量小時(shí),負(fù)激活可能更明顯。
[Abstract]:Research background "Qi" is a special term in the subject of acupuncture and moxibustion. On the one hand, it refers to the patients' subjective feeling of acid, hemp, swelling, weight, pressure and so on. On the other hand, it refers to the tight feeling of the needles. The researchers at home and abroad have carried out some research from the qualitative and quantitative analysis of "Qi", the relationship between "Qi" and the clinical effect, and the application of functional magnetic resonance imaging (Functional Magnetic Resonance Imaging, fMRI) to observe the brain central effect of "Qi". However, the results are still relatively preliminary and some aspects still exist. There have been a lot of controversy. Some work has been done on the mechanism of needling gas. Some reports show that acupuncture is more capable of increasing the blood flow of local skin and muscles compared with no gas. In addition, the flesh tissue is closely related; in addition, most studies have shown that the effect of gas is the result of the joint participation of multiple tissue structures in the acupoint, not a single organization, but there is no definite mechanism for the specific mechanism. One of the important factors to get gas with acupuncture is an important part of the process of acupuncture. It is also an important way to maintain and strengthen the sense of air needle. It is closely related to the effect of acupuncture. Its basic techniques include twisting and inserting. The clinical effect of the acupuncture and moxibustion is often superior to that of the needling manipulation. There should be differences. The study shows that there is a significant difference in the force of the needle body under different manipulations. It shows that the effect of the needle body on the body is different under different manipulations, and the sensation of the needle may be different. Evidence. The brain center is an important approach to the effect of acupuncture. With the continuous innovation and development of the method of brain function detection, the research of gas producing based on brain science is quite popular. The methods of detection are electroencephalogram, magnetoencephalogram, computer X ray tomography, positron emission tomography, etc. especially in the past 20 years, fMRI technology is fast Development, because of its non invasive, non radiation, high spatial resolution, functional and morphological imaging, it has been used more and more widely in the research of acupuncture brain central mechanism, and has achieved certain results. However, there is no clear difference in the brain central effect of different manipulations and complex manipulation. Surface Electromyography (sEMG) and fMRI were used as the technical means to select the right Zusanli acupoint as the acupoint, with twisting and turning method, the insertion method and its compound technique as the intervention method, to observe the needle sensation of the needling and the needles under different acupuncture manipulation, the muscle electricity and the brain function effect on the surface of the acupoint area. The purpose of this study is to study the biological mechanism of the acupuncture manipulation in the treatment of diseases. The purpose of this study is to explore the difference of the sensation of gas needling, the electromyography of the acupoint surface and the activation of the brain function in the right Zusanli point by three different needle manipulation methods, such as twisting and twisting, and inserting twisting and twisting. The function of the feeling of air needle (the feeling of needling and the needling of the needling) and the relationship with the changes of the surface electromyography and fMRI brain function of the acupoint area, provide a scientific explanation for the theory of acupuncture for the sense of Qi needle, and provide a scientific basis for its clinical application and the improvement of the clinical effect. 45 healthy volunteers were recruited and the right Zusanli was needled. Acupoints were randomly selected every other week: twisting, inserting, lifting and twisting. After the end of the needle, a MGH Acupuncture Sensation Scale (MASS) was filled in by the acupuncturist and the subjects. The 13 subjects were randomly selected and recorded by the physiological recorder, during the needle period, during the needle retention period and out of the needle. Electromyography on the surface of the point after the needle. 17 other subjects were randomly selected at the same time. At the same time, the scanning head fMRI. used SPSS23.0 software to analyze the intensity and frequency of the gas needle sensation. The LabChart8.0 software calculated the integral electromyography (Integrated Electromyogram, IEMG), the average power frequency (Mean Power Frequency, MPF), and the median frequency (Median Frequency). A statistical analysis was carried out with SPSS23.0, and the Statistical Parametric Mapping (SPM8) was used to analyze the fMRI data, and the difference between the gas needle sensation, the surface electromyography of the acupoint surface and the activation of the brain function area was compared with the difference between the activation and the negative activation of the brain function area under the intervention of different needle manipulation methods. 1, the effects of different manipulations on the feeling of gas needle were caused by different manipulations. There is no significant difference in the intensity and frequency of the needle sensation, all of which are flatulence and acid sense, and the needle sense synthesis index (MASS index) shows that the flatulence of the subjects in the twisting group and the lifting and twisting group is positively related to the feeling of the tightenness of the needles. The correlation trend.2, the effect of different manipulations on the surface electromyography of the acupoint surface, the IEMG value of the three methods increased significantly (P0.05) and the extraction method was most obvious (P0.01). After the needle, the IEMG value of the method was still higher than that before the needle (P0.05). The twist method and the lifting and twisting method restored the level of the needle (P0.05). The comparison between the groups showed that each acupuncture time was the time. There was no significant statistical significance (P0.05) for the difference in the IEMG value of the segment. The MPF values of the three methods were significantly lower than those before the needle (P0.05), and the insertion method was more obvious (P0.01). The MPF values of the three middle techniques were all restored before the needle (P0.05). The comparison between the groups showed that the insertion method was compared with the twisting and twisting method. The difference was statistically significant (P0.05), and there was no significant difference in the MPF value of the three methods in other time periods (P0.05). During the needle, the MF values were significantly lower than those before the needle (P0.05), and the insertion method was more obvious (P0.01). The twist method was not significantly changed before the needle (P0.05). The MF values of the three methods were both during and after the needle retention. The results showed that there was no significant difference in the pre needle level (P0.05). There was no significant difference in the MF value between the acupuncture time periods (P0.05).3. The effect of different manipulations on the function of the brain was activated by the left anterior motor cortex, the left central posterior gyrus, the right frontal gyrus, the left inferior frontal gyrus, the right lingual gyrus, the left insula, right putamen, bilateral cingulate gyrus, right side Cerebellum, negative activation of bilateral hippocampus, left caudate nucleus, twisting group activating bilateral orbital frontal gyrus, left Island cover and lower frontal gyrus, right occipital gyrus, right occipital gyrus, negative activation of bilateral anterior lobe, right amygdala, left cingulate gyrus, right inferior temporal gyrus, right medial frontal gyrus, right supplementary motor area, left central posterior gyrus, etc. Bilateral central posterior gyrus, left occipital gyrus, left cerebral Island, left thalamus, left cingulate gyrus, right putamen, etc.; negative activation of right upper frontal gyrus, right top upper gyrus, right temporal gyrus, right occipital gyrus, right insula, left lingual gyrus, etc.. The results of the 22 comparison between the three methods showed that the signal was strongest, mainly in the edge system; put in twisting and twisting. 1, the intensity and frequency of the needle feeling of acupuncture at Zusanli point are basically similar, all of which are filled with feeling of flatulence and acid sense. The MASS index indicates that the feeling of the needle is the strongest, the twisting method is the weakest.2, the needle holder is heavy, the subjects may have a certain connection with the electromyography and the different manipulation needles. Acupoints of Zusanli can cause electromyography, suggesting that muscle tissue may be one of the main tissue structures that trigger the sense of gas needle in the Zusanli point of the doctor and the subject, but the stimulation intensity of different manipulations is different, and the activation of the muscle fibers may be different. The stimulation intensity of the extraction method may be the greatest and may be more activated. The slow muscle fiber.3, the three methods of acupuncture at Zusanli point activate the somatosensory area, visual area, cognition, emotion and other brain regions, which reflect the complex regulation effect of acupuncture on the brain function network. This complex brain function provides certain evidence for the extensive effect of acupuncture at Zusanli point; the extraction method is most active in the activation of the brain area. Obviously, the negative activation of the brain region is obvious with the twist method, which mainly concentrates on the edge system, which reflects the relative specificity of the manipulative brain effect. From the signal intensity of the brain region, the stimulation intensity of the extract group may be greater and the twisting group is the weakest; while the stimulation is large, the activation of the brain area may be more obvious; the negative activation may be more obvious when the stimulus amount is hours.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246

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