体质影响针刺镇痛的脑功能连接网络整合机制

Constitution consideration is of importance in the Traditional Chinese Medicine which labeled by emphasizing individualized treatment. It's also one of the potentially powerful factors that influents the efficacy of acupuncture. The ancient classic Huangdi Neijing put forward the theory that various constitution of different sensitivity could have an influence on the Deqi effects of acupuncture, and it has been confirmed by acupuncturist' clinic experiences. However, the modern research on acupuncture has rarely touch upon it, the relative mechanisms of action is remaining unclear and needs to be probe into. Modern brain neuroimaging technique has provided revolutionary tools to monitor the dynamic response of the whole brain to acupuncture with specific regional activation. It could detect the whole action of central nerve system without invade into the brain, and we can analyze the data of the functional connectivity of complicated brain network. Our previous study has indicated that the efficacy of acupuncture is modulated by a distributed network of brain areas involved in sensory, cognitive/affect，so we raise a hypothesis based on pervious results that the effects' diversity due to distinct constitutions of acupuncture has its modulation mechanisms in central nervous network. According to the principle of acupuncture-constitution relevancy theory, three typical constitutions of various sensitivities would be selected from healthy volunteers. The blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) is used to monitor the activity in brain functional areas in the course of acupuncturing both in normal state and in acute experimental pain state respectively. We use functional connectivity analyses to probe into the modulation mechanism of different efficacy in various constitutions exerted by acupuncture. We expect that the data could offer scientific evidence to the theory that constitution-acupuncture relationship, provide particular idea to the present research on acupuncture's theory and by which to promote the inheritance and development of acupuncture.

体质是中医个体化治疗的重要考量因素，也是针刺疗效的重要影响因素,已被针灸临床实践所证实。然而针灸现代研究对此却少有涉及，亟待对其机制作深入探讨。应用脑功能成像技术研究显示针刺效应受到脑内特定神经网络的调控作用，可对中枢神经活动特征进行整体、无创的检测，数据分析方法已深入复杂神经网络的"功能连接"层次，为针刺效应机制研究提供了有力工具。在预实验结果基础上，本课题提出"不同敏感度体质的针刺镇痛效应不同，有相应的脑功能连接网络整合基础"的假说，在《内经》针灸体质理论指导下，严格筛选对针刺敏感度不同的3类典型体质的受试者，观察针刺对不同体质的急性实验痛的镇痛效应；并运用脑功能磁共振fMRI-BOLD成像技术，采集针刺干预急性实验痛的脑功能成像数据。引入"功能连接网络"分析方法进行数据分析，探求不同体质影响针刺镇痛效应的中枢神经整合机制，为针刺体质相关理论提供科学依据，促进针灸理论的传承和发展。

研究背景:体质是中医个体化治疗的重要考量因素，是针刺疗效的重要影响因素,已被针灸临床实践所证实，亟待对其机制作深入探讨。本课题在前期实验基础上提出“不同敏感度体质的针刺镇痛效应不同，有相应的脑功能连接网络整合基础”的假说。在《内经》针灸体质理论指导下，筛选对针刺敏感度不同的典型体质受试者，观察针刺对不同体质的镇痛效应差异及其中枢神经整合机制。. 主要研究内容:①以《内经》不同敏感度体质“得气”理论为指导，筛选对针刺敏感度不同的典型体质。对针刺体质与中医体质学、社会心理学、生理行为学作相关性分析。②观察针刺不同敏感度体质人群的镇痛效应差异；③采集受试者针刺时及针刺前后的脑功能磁共振BOLD成像数据，引入“功能连接网络”分析方法，结合现代医学对情绪、认知、疼痛等中枢调控网络的研究，探求不同敏感体质影响针刺效应差异的脑功能连接网络特征。. 重要结果及关键数据: ①针刺足三里穴的镇痛作用在九种不同体质人群中具有差异性；中医“五态人格”具有不同的中医体质特征，而不同的针刺敏感度体质人群有不同的（大五）人格倾向。②针刺敏感组较不敏感组得到了更优的针刺镇痛效果，验证了传统针灸理论。③针刺时敏感组和不敏感组激活的差异脑区为后扣带回、中央前回和角回，以后扣带回为ROIs分析与全脑的功能连接图谱发现,两组受试者针刺后较针刺前与PCC功能连接增强的脑区大都位于疼痛矩阵、LPNN、默认功能网络，功能连接均降低的脑区位于角回，在敏感组中增强而在不敏感组中降低的脑区位于颞中回。上述脑区与PCC功能连接的差异可能是不同敏感度体质人群针刺镇痛效果差异的脑内调控基础。. 科学意义:本研究证实了不同敏感度体质是影响针刺效应的重要因素，有相应的脑内神经信息调控基础，并进一步明确了针刺效应调控中枢的相关脑网络。该结果为针刺体质相关理论提供了科学依据，为深入理解和研究大脑对针刺的调控模式做出了有益探索。