巨刺阳明经穴治疗缺血性卒中偏瘫的功能可塑性机制研究

A large amount of researches have shown that opposing needling is beneficial for treating hemiplegia patients after ischemic stroke, but the underlying mechanism still remains unknown. Therefore, according to the classical theory of opposing needling that those patients with lesions in the left cerebral hemisphere should choose acupuncture points on the right side of the body and vise versa, which came from the Miraculous Pivot: GuanZhen, Combining with frontier researches of human cerebral plasticity, starting with opposing needling at acupoints of yangming meridians to cure hemiplegia after ischemic stroke, in this study, magnetic resonance imaging(MRI),transcranial magnetic stimulation(TMS), neuroimaging navigation system,electromyography (EMG) recording system and so on will be used. Moreover, three aspects of researches listed as follows will be carried out: Effects of opposing needling at acupoints of yangming meridians on the excitability of M1 region in healthy subjects,on the activation and reconstruction of M1 region of patients with hemiplegia after ischemic stroke in healthy brain and to predict the recovery potential of movements on patients with hemiplegia after stroke. After clearing the best electro-acupuncture frequency of opposing needling at acupoints of yangming meridians to activate and reconstruct the M1 region, the mechanism of those on the functional plasticity on patients with hemiplegia after ischemic stroke can be illustrated. Accordingly, a scientific hypothesis that opposing needling at acupoints of yangming meridians may be one of the key mechanisms of activating the M1 region in the healthy brain of people and starting cerebral functional reconstruction. On one hand, the scientific content inside the classical acupuncture theory of opposing needling can be explained deeply; On the other hand, this research will exert an important and far reaching influence on the clinical treatment of acupuncture.

大量研究表明巨刺疗法治疗缺血性卒中偏瘫具有较好的临床疗效，但其内在机制不甚明了。因此，基于《灵枢•官针》：“巨刺者左取右，右取左。”的经典理论，结合脑可塑性这一生命科学的前沿研究，以巨刺阳明经穴治疗缺血性卒中偏瘫为切入点，采用核磁共振技术、经颅磁刺激技术、神经影像导航定位技术、四通道肌电诱发电位技术等，从巨刺阳明经穴对健康受试者M1脑区兴奋性的作用，对缺血性卒中偏瘫患者健侧M1脑区激活与重塑的作用，以及预测缺血性卒中偏瘫患者运动功能恢复潜力三方面开展研究，在明确巨刺阳明经穴激活与重塑M1脑区的最佳电针频率的基础上，阐明巨刺阳明经穴对缺血性卒中偏瘫患者的功能可塑性机制。从而归纳提出“巨刺阳明经穴是激发人类健侧M1脑区，进而启动脑功能重塑是其可能的关键机制之一”的科学假说。一方面可深入地诠释巨刺疗法这一针灸经典理论的科学内涵，另一方面也将对针灸临床治疗有着重要的指导意义。

大量研究表明巨刺疗法治疗缺血性卒中偏瘫具有较好的临床疗效，但其内在机制不甚明了。因此，基于《灵枢•官针》：“巨刺者左取右，右取左。”的经典理论，结合脑可塑性这一生命科学的前沿研究，以巨刺阳明经穴治疗缺血性卒中偏瘫为切入点，采用核磁共振技术、经颅磁刺激技术、神经影像导航定位技术、四通道肌电诱发电位技术等，从电针阳明经穴对健康受试者M1脑区兴奋性的作用，对缺血性卒中偏瘫患者双侧M1脑区激活与重塑的作用，以及预测缺血性卒中偏瘫患者运动功能恢复潜力三方面开展研究，研究表明：生理状态下不同频率（2Hz、50Hz、100Hz）电针左侧肢体阳明经穴对健康受试者M1脑区所支配的大鱼际肌的兴奋性均有一定的促进作用，并获得了2Hz是该促进作用的最佳电针频率，且采用2Hz电针阳明经穴对M1脑区所支配的大鱼际肌的兴奋性作用可能存在左、右脑区的差异性，而50Hz、100Hz电针阳明经穴对M1脑区所支配的大鱼际肌的兴奋性作用不存在左、右脑区的差异性；进而病理状态下巨刺阳明经穴对缺血性卒中偏瘫患者健侧M1脑区的激活与重塑具有一定的促进作用，确证了“巨刺阳明经穴是激发人类健侧M1脑区，进而启动脑功能重塑是其可能的关键机制之一”的科学假说；此外研究发现巨刺阳明经穴后的缺血性卒中偏瘫患者量表指标Barthel指数、Fugl-meyer评分与其的健侧M1脑区所支配的大鱼际肌的MEP波幅有很强的相关性，因此表明患者的健侧M1脑区所支配的大鱼际肌的MEP波幅可预测巨刺阳明经穴治疗缺血性卒中偏瘫患者运动功能恢复的潜力。该研究在一定程度上阐明巨刺阳明经穴对缺血性卒中偏瘫患者的功能可塑性机制，从而诠释巨刺疗法这一针灸经典理论的科学内涵，同时也将对针灸临床治疗有着重要的指导意义。