电针对抑郁症大脑半球功能偏侧化的影响及其与“气机升降”关系的研究

It is a great significance to reveal the essences and relations between Qi activity and emotions for development of traditional Chinese medicine(TCM). Lateralization of development inter-hemisphere promoted the dextromanuality and the lateralization of the left/right hemispheric positive /negative emotion processing advantages. It is an important link of mental disturbance that hemispheres lateralizated too much more or less. The left hemisphere hypofunction and/or the right hemisphere hyperfunction associated with lowering positive emotional experience and increasing negative emotional experience in major depressive disorder(MDD) .Cerebral functional lateralization hypothesis happened to coincide with TCM theory of Qi Activity and Emotions. It is too much more or less of Qi activity ascending from the left and descending from the right in human body brought about risk of emotional disease.Emotional disturbance and stagnation of liver qi are the basic pathogenesis of MDD.It was definited that acupuncture had the curative effect on MDD.Also,acupuncture could correct abnormal cerebral lateralization for MDD.Furthermore, the effects of unilateral limbs or body acupuncture on hemispheric functions were accordance with the direction of Qi activity ascending and descending in TCM theory.Basing upon the hypothesis for the relations of “Emotional Activity—Qi Activity Ascending And Descending—Cerebral Functional Lateralization ”,the project research the therapeutic effects of acupuncture of the left body,the right body and the bilateral symmetry body on MDD with syndrome of liver-qi stagnation by evaluating TCM syndrome combining with the depressive symptoms .The cortical excitability and inhibitory which responses Qi Activity ascending and descending will be detected by the techniques of transcranial magnetic stimulation.The changes of people’s emotions will be detected by the techniques of affective priming experimental paradigm combining with multi-lead electroencephalogram. It could concretize the concepts of Emotions and Qi Activity by those experiments. It could ascertain the mechanism of acupuncture treatment for MDD,and the essences and relations between Qi activity and Emotions by discussing the regulation way of acupuncture on emotions and Qi Activity.

探明气机与情志的实质和关系对中医发展意义重大。人脑半球间偏侧化进化促进了右利手和正、负性情绪在左、右半球的加工优势偏向。半球功能偏侧太过或不及与精神障碍发病有关,左脑功能降低和/或右脑功能亢进与抑郁症正性情绪体验降低和/或负性情绪体验增强有关。脑功能偏侧化假说与中医气机和情志理论不谋而合,气机左升右降太过或不及均导致情志病。情志失调和肝气郁结是抑郁症的基本病机,针刺疗效明确,可纠正其异常脑偏侧,且单侧经穴刺激影响半球功能与气机升降方向一致。本课题提出“情志活动—气机升降—脑功能偏侧化”相关性假说,采用证候和症状评定探讨左、右侧针刺和对称针刺治疗肝郁气滞证抑郁症的疗效,采用经颅磁刺激皮层兴奋性和抑制性检测技术反映气机的升和降，采用情绪启动多导脑电图检测技术反映情志变化，拟将中医情志和气机概念具体化，通过探讨针刺对气机和情志的调节途径，阐明针刺治疗抑郁症的机理,并探明情志和气机的实质与关系。

情志失调和气机升降失调是中医针刺治疗抑郁症的重要理论依据，但其科学内涵有待深入阐述。脑功能偏侧化假说认为半球功能偏侧太过或不及与精神障碍发病有关，这与中医气机和情志理论不谋而合。本项目采用单侧针刺和双侧对称针刺对比研究，整合中医证候评定、汉密尔顿抑郁量表（HAMD）评定、经颅磁刺激（TMS）联合运动皮层兴奋性（MCE）与脑电图（EEG）（TMS-MCE、TMS-EEG）、国际情绪图片系统（IAPS）启动多导事件相关电位（ERP）（IAPS-ERP）等神经电生理技术，将中医“情志”和“气机”理论概念具体化，验证了“情志失调——气机升降失调——左右半球功能异常偏侧化”假说的科学性与客观性。. 研究发现，与健康对照者相比，抑郁症患者优势半球皮层抑制功能受损，在情绪处理加工过程中存在大脑半球功能异常偏侧化，并且大脑半球功能异常偏侧化与抑郁症状严重程度相关。针刺前后的临床疗效指标及神经电生理指标分析结果表明，左、右针刺和对称针刺治疗均有抗抑郁作用，其抗抑郁作用机制可能与改善抑郁症患者大脑半球功能偏侧化有关。其中，TMS-MCE分析结果表明，针刺可纠正抑郁症者大脑兴奋功能异常偏侧化，左、右针刺可分别增高和降低抑郁症患者半球兴奋性，其效应与经穴调节气机左升右降方向一致。TMS-EEG和IAPS-ERPs分析结果表明，单侧针刺和双侧针刺均可改善抑郁症患者脑功能连接异常，纠正大脑半球情绪处理功能异常偏侧化。. 本研究从神经电生理角度初步阐述了针刺对“气机”和“情志”的调节途径，深化了对抑郁症病理机制和针刺抗抑郁作用机制的理解，为阐明气机的实质及其与情志病的关系寻求了新的研究方法，为物理辅助诊断技术在中医的应用提供科学依据。