【作者】 张毅；

【导师】 田捷；

【作者基本信息】 西安电子科技大学 ， 模式识别与智能系统， 2009， 博士

【摘要】 针灸是中国传统医学的精华,是中国人民长期与疾病作斗争的经验和总结,它作为中华民族的宝贵文化遗产在中国已有数千年的临床实践史。针刺作为针灸疗法的重要组成部分可以治疗多种疾病,如关节炎、肥胖、中风后遗症、哮喘、药物成瘾等,也可以缓解各种疼痛。其显著的疗效和很少的副作用,使得针刺疗法得到了推广和普及并逐步被国际医学界认可。然而,尽管目前已经有140多个国家和地区采用了针刺疗法,其作用机理却始终不明确。如何明确的阐述针刺的作用机理已经成为制约其理论发展的重要因素。作为针刺疗法的发源地,中国具有先天的优势率先揭开针刺治病的机理,以便把针刺更好的应用于医疗实践中,从而弘扬祖国医学,推广祖国优秀的传统文化。现代医学影像技术的发展使得研究针刺的方法和手段越来越多,近十余年来,功能磁共振成像(fMRI)技术因其具有非侵入的特点以及可实时反映大脑特定功能区域在外部刺激下的活动状态的特性,被国内外广泛应用于视觉、听觉方面以及思维、情绪等高级认知方面的研究,各种研究成果已获得国际上的普遍认可。本论文以传统中医理论为指导,运用现代医学的观点和功能磁共振成像技术,从实验设计模式和数据处理方法等方面对针刺作用的神经机制进行了初步探索。本文的创新工作如下:根据以往的实验设计模式,研究了传统的基于多组块设计的针刺机理。通过分析传统多组块针刺实验过程中各阶段(捻针与静息)包含的效应,发现不同阶段存在差异;创新的将独立分量分析这种数据驱动方法引入针刺足三里的磁共振成像研究中,将针刺时捻针状态下及针刺后静息状态下的大脑功能网络分别与针刺前静息状态下的大脑功能网络进行对比,发现大脑功能网络的变化,从而得到针刺过程中针刺效应存在时变特性的结论。以上述研究为基础,本文引入了非重复事件相关实验设计模式,综合种子点相关的功能连接度分析及独立分量分析这两种方法研究了静息状态下针刺视觉相关穴位(光明穴)和非视觉相关穴位(交信穴)对大脑功能网络的调节,发现针刺上述两个不同的穴位点虽然能够使得相似的大脑视觉皮层区域被激活,但表现出的时域特性却反向相关。也就是说针刺这两个不同的穴位点会诱发相似的空间激活模式,而引起的时域调节模式却存在着显著的差异。本文同时还研究了针刺对静息态下大脑功能网络的调节,发现针刺足三里穴主要调节了静息态下大脑网络群中“空间注意”网络以及视觉网络,而针刺光明和交信穴均调节了静息态下的“缺省模式”网络,发现最强的两个激活脑区位于后扣带回和楔前叶。同时还发现前扣带回与“缺省模式”网络的功能连接显著增强。从而推测这两个核团在针刺神经调节作用中发挥着重要的作用。更多还原

【Abstract】 Acupuncture, as a valuable aspect of the cultural heritage of the Chinese nation, and the essence of Traditional Chinese Medicine (TCM), has a history of several thousand years in clinical practice. It can be used to treat a variety of diseases such as arthritis, obesity, stroke, asthma, drug addiction, and it can also mitigate chronic pain with very few side effects. Due to these advantages, acupuncture has been popularized and promoted, and also has been gradually recognized by the international community. There are currently over 140 countries and regions using acupuncture. However, along with the popularization and promotion of acupuncture, its scienctific validity has been questioned. Setting forth a clear mechanism of how acupuncture works has become a primary constraint in its development. Hence, it is a way for China to be the proponent of acupuncture and aid in the necessary research in revealing its mechanism. Modern medical imaging technology enables a more mechanistic approach to acupuncture: the emergence of functional magnetic resonance imaging (fMRI) technology has provided new ways and effective means for deeper exploration in the field of acupuncture. Due to its non-invasiveness and real-time capability to map the activity of specific brain regions induced by external stimulation, this technology has been widely used in vision, hearing, as well as other high-level cognitive research. In this paper, we used fMRI technology to study and analyze the brain response to acupuncture and combined the theory of TCM and modern medical means to explore neural regulating mechanisms. Specific aims included the following:Studied the acupuncture mechanism based on a multiple-block experimental design via analyzing the different effects included in the distinct experimental stage of the process (stimulation and restingstates). We found there existed discrepancies in different stages of acupuncture. The data-driven approach of independent component analysis was innovatively introduced into the fMRI study of acupuncture at ST 36 (Zusanli), and we compared the stimulation states with different resting states in the brain functional networks. Therefore, we concluded that there existed time variability during the course of acupuncture.Based on the research above, we introduced a novel experimental paradigm using a non-repeated event-related (NRER) design, combined the methods of seed correlated functional connectivity and ICA to study the brain functional network during resting state after acupuncture at vision-related acupoint GB 37 (Guangming) and nonvision-related acupoint KI 8 (Jiaoxin). We discovered that stimulation at these two acupoints induced the same activations in the occipital cortical areas (BA 17/18/19) in spatial distribution, but their temporal characteristics were negative. Our results support the proposition that acupuncture at vision and nonvision-related acupoints can induce similar activations in the visual cortex of the spatial domain, but have different modulation patterns in the temporal domain.This article also focused on the study of the brain functional network during the resting state under the regulation of acupuncture. Results showed that acupuncture at ST 36 mainly regulated the spatial attention and vision-related networks of the resting state networks (RSNs); meanwhile, stimulation at GB 37 activated the post cingulate cortex (PCC) and precuneus of the‘default-mode’network. The study also found that acupuncture at the two acupoints activated both the PCC and precuneus; these two nuclei are the core regions that reflect the neural regulation of acupuncture.更多还原