神门、三阴交的穴位配伍效应及其安神机制研究

The study of acupoint group is great significance to promote the development of acupuncture and moxibustion.Acupuncture and moxibustion has an advantage in the treatment of insomnia,Shenmen and Sanyinjiao are the most commonly used acupoints.Further research on the mechanism and the effect of acupoint combination of this sedative “paired acupoints” has favourable clinical value.In the project of the National Natural Science Foundation of China(No.81273851,No.30973800),we found that electro acupuncture has a great effect on psychological stress and circadian rhythm.According to the “weak nutrient Qi and disturbance of mind”pathogenesis of insomnia,we put forward the research hypothesis that Shenmen and Sanyinjiao work on acupoint compatible effect through nourishing nutrient Qi and clamming the nerves.Basing on previous studies we further explore the effect and the mechanism to sedation of acupoint combination of Shenmen and Sanyinjiao.We will randomly divide 120 cases of insomniac patients into insomnia control group, EA Shenmen group(electroacupuncture on Shenmen), EA Sanyinjiao group(electroacupuncture on Sanyinjiao), EA Shenmen and Sanyinjiao group(electroacupuncture on Shenmen and Sanyinjiao).Meanwhile we will multidimensional evaluate the effect of acupoint combination by using a number of commonly used scale and insomnia symptom scale based on patient reports.We will explore the nerve electrophysiological mechanism of acupoint combination of nourishing nutrient Qi and clamming the nerves by using polysomnogram,screen out the biomarkers by metabonomics and discover the mechanism of neurotransmitter by enzyme linked immunosorbent assay.The conclusion will provide the basis for the effect and mechanism of acupoint group research.

穴位组学研究对于推动针灸学科发展具有重要意义。失眠症是针灸优势病种，神门和三阴交是取穴频次最多的穴位，深入研究这一安神“穴对”的穴位配伍效应及其作用机制，具有良好的临床价值。我们前期自然基金课题（81273851、30973800）研究发现，电针对心理应激和昼夜节律都有良好调整作用。本课题在此基础上，根据失眠症“营虚神扰”病机，提出“神门和三阴交通过养营安神发挥穴位配伍效应”的研究假说，探索神门、三阴交的穴位配伍效应及其安神机制。课题将失眠症患者分为失眠对照组、电针神门组、电针三阴交组、电针神门+三阴交组，电针组电针相应腧穴，采用多个常用量表和基于患者报告的失眠症症状量表，进行穴位配伍效应的多维度评价；以健康者为对照，采用多导睡眠图、代谢组学和酶免法检测，探索穴位配伍产生养营安神作用的神经电生理机制、生物学标记物以及睡眠相关神经递质调控机制，研究结论可为穴位组学研究提供效应及机制依据。

研究采用匹兹堡睡眠质量指数、失眠程度指数以及睡眠障碍等级量表、Epworth思睡量表、焦虑自评量表、抑郁自评量表观察神门、三阴交单穴及双穴配伍对失眠症临床症状的影响，评价神门、三阴交穴位配伍安神效应。通过多导睡眠检测，探索神门、三阴交改善失眠症患者睡眠质量的穴位配伍效应，进一步进行血清代谢组学检测分析以及神经递质检测探索神门、三阴交治疗失眠症的穴位配伍作用机制。课题阐释了失眠症“营虚神扰”的中医病机以及神门、三阴交养营安神穴位配伍效应的中医针灸机理，发表论文10篇。研究发现神门和三阴交在改善失眠症患者睡眠、情绪、日间嗜睡等临床症状方面双穴配伍优于单穴作用，穴位配伍具有协同增效作用。三阴交在改善失眠症患者睡眠、缓解日间嗜睡等临床症状方面起到主要作用；神门在改善失眠症患者焦虑、抑郁情绪方面起到主要作用。多导睡眠监测发现，神门-三阴交双穴配伍较单穴神门在延长失眠症患者总睡眠时间，缩短睡眠潜伏期，缩短失眠症患者入睡后清醒时间，提高睡眠效率方面具有明显优势，为神门-三阴交双穴配伍改善失眠症患者夜间睡眠质量提供了客观依据。通过检测失眠症患者以及健康受试者血清，分析代谢产物发现，神门、三阴交穴位配伍协同增效的机制与下调失眠症患者血清甘油磷酸丝氨酸以及Schidigerasaponin B1的水平有关。检测失眠症患者以及健康受试者的血清神经递质含量发现，神门-三阴交双穴配伍通过升高血清5-HT、GABA、MT含量，降低NE含量发挥改善失眠症患者睡眠质量、调整焦虑抑郁情绪、缓解日间嗜睡的穴位配伍效应。本研究证实了“神门和三阴交通过神经递质调控代谢水平产生养营安神的穴位配伍效应”的研究假说，为穴位组学研究提供效应及机制依据。