基于经络穴位的筋膜及其内微细神经的多模态超声观测及机制研究

The essence of acupoints and meridians is one of the hotspots in the research of traditional Chinese medicine. Many theories have been put forward, but they still fail to provide a convincing objective basis for the structure and function of the human body. With the development of high frequency ultrasound, it has been able to display the soft tissue structures such as fine nerves. We observed the soft tissue structure of acupoint at “shou san li” by ultrasound. We found that the strongest sensation of “deqi” would appear when the needle tip was located in the most concentrated part of the fine nerves in the fascia, and the fascia bound the rotating needle. Based on these findings, we assume that acupoints and meridians are closely related to the fine nerves in the deep fascia network. Acupuncture may activate the neurohumoral regulation by stimulating the central nervous system through the fine nerve. The purpose of this project is to study the fascia and the fine nerve image and anatomy of the acupoints in the human hand - Yangming large intestine meridian by high frequency ultrasound and magnetic resonance and to explore the interaction between the deep fascia and the fine nerve at the acupuncture point. The changes in microcirculation of acupoints and distal soft tissues and the changes in the central functional area of the brain were studied by ultrasonography and functional magnetic resonance. We want to clarify the structure and function of acupoints and the related mechanism of acupuncture and to provide an objective imaging basis for the research of the essence of acupoints and meridians.

穴位、经络的本质是中医学界的持续性研究热点之一。人们提出了多种学说，但仍未能提供令人信服的基于人体结构和功能的客观依据。随着高频超声的发展，已能实现微细神经等软组织结构的显像。前期团队应用超声动态观测了针刺人体手三里等穴位时的软组织结构，发现得气感最强的部位位于筋膜中微细神经最集中的地方，并发现捻针时的筋膜缠绕现象。基于这些发现，我们大胆假设“穴位、经络与深筋膜网络内的微细神经密切相关，针刺穴位时，可能通过微细神经兴奋中枢神经特异性功能区实现神经-体液调节”。本项目拟通过高频超声与磁共振研究人体手阳明大肠经各主要穴位筋膜与微细神经分布的影像解剖学共同点，探索针刺穴位时深筋膜与微细神经的相互作用关系，通过超声造影和脑功能性磁共振研究穴位及远端软组织的微循环变化及大脑中枢性功能区的变化等，以期阐明穴位的影像学结构和功能特点及相关的针炙作用机制，为穴位、经络的本质研究提供客观的影像学依据。

经络学说是针灸理论的基础和核心。传统理论认为，经络是人体气血运行的通路，穴位是气血在经络运行的窗口，是对经络本质和针灸机制研究的关键抓手。深入研究穴位、经络的本质（物质基础），提高针灸治疗的准确性和规范性，探索针灸作用机制将成为今后研究的重中之重。对于经络、穴位的本质，目前以筋膜学说和神经学说占据主流，但是两者都不能完全解释针灸治疗的一些问题和现象。我们的研究通过对人体手阳明大肠经、手厥阴心包经、手太阴肺经各穴位超声声像图特征提取，对穴位处组织分布规律进行总结；通过对人体手阳明大肠经、手厥阴心包经、手太阴肺经各穴位针刺时动态超声观察，分析受试者“得气”感最明显时组织与针体、针尖位置关系与特征发现，经络的本质是深筋膜网络及其内分布的微细神经分支，深筋膜与其中的微细神经构成经络整体，在针灸治疗中发挥作用。通过超声观察委中穴、足三里等常用腧穴针刺的实时动态观测，进一步验证经络、穴位的神经、筋膜学说，并观察了其针刺效应, 针刺对血浆ET-1和PGI-2具有双向调节作用；通过兴奋局部微细神经，改善经络效应区微循环。我们的研究为针灸理论科学化提供客观依据，为针灸治疗规范化提供可视化解决方案。