【作者】 李江山；

【导师】 严洁；

【作者基本信息】 湖南中医药大学 ， 针灸推拿学， 2006， 博士

【摘要】 目的:通过比较针刺内关、足三里等穴对正常及模型大鼠孤束核(NTS)神经元放电、c-fos表达及胃内压、ST_Ⅱ的影响,探讨多病症一经(穴)司控,一脏(腑)多经(穴)调控的经脉—脏腑相关理论,阐明NTS可能是内关、足三里穴共同调节心胃功能的一个重要的延髓初级中枢。方法:运用细胞外记录神经电生理学方法,研究针刺内关、足三里等穴对NTS神经元放电及对NTS胃扩张或心律失常敏感神经元放电的影响。运用免疫组织化学技术观察电针内关、足三里等穴对胃扩张或心肌缺血模型大鼠NTS内c-fos表达的影响。结果:1、针刺足三里、内关、偏历、合阳穴各组,NTS内神经元主要以呈兴奋性反应为主。针刺足三里、内关穴组,NTS内兴奋性神经元出现率与针刺偏历、合阳穴组比较有显著性差异(P＜0.01)。选取对针刺腧穴呈兴奋性反应的NTS神经元,比较针刺前后神经元放电频率变化。针刺足三里、内关、偏历、合阳穴组,其针刺后放电频率均显著高于针刺前(P＜0.01),表明针刺对NTS神经元有明显的激活作用;针刺足三里穴组、内关穴组兴奋性神经元频率变化率显著高于针刺偏历、合阳穴组(P＜0.01)。2、①149个NTS神经元中对胃扩张刺激起反应的有65个,其中44个神经元(44/65)被胃扩张刺激所兴奋,21个神经元(21/65)被胃扩张刺激所抑制,NTS神经元对胃扩张刺激以呈兴奋性反应为主。针刺足三里、内夭、偏历、合阳穴各组,NTS胃扩张兴奋性神经元主要呈抑制性反应。针刺足三里、内关穴组,NTS胃扩张兴奋性神经元呈抑制反应的出现率显著高于针刺偏历、合阳穴组(P＜0.01或P＜0.05)。针刺足三里、内关、偏历、合阳穴组,均可使胃扩张模型大鼠NTS兴奋性神经元放电频率显著降低(P＜0.01)。针刺足三里、肉关穴组NTS胃扩张兴奋性神经元频率变化率显著高于针刺偏历、合阳穴组(P＜0.01)。②116个NTS神经元中对心律失常刺激起反应的有54个,其中46个神经元(46/54)被心律失常刺激所抑制,8个神经元(8/54)被心律失常刺激所兴奋。NTS神经元对乌头碱造成心律失常刺激以呈抑制性反应为主。针刺足三里、内关、偏历、合阳穴各组,NTS心律失常抑制性神经元主要呈兴奋性反应。针刺内关穴组,NTS心律失常抑制性神经元呈兴奋反应的出现率显著高于针刺偏历、合阳穴组(P＜0.05)。针刺足三里、内关、偏历、合阳穴组,均可使心律失常模型大鼠NTS抑制性神经元放电频率显著增加(P＜0.01)。针刺足三里、内关穴组NTS心律失常抑制性神经元频率变化率显著高于针刺偏历、合阳穴组(P＜0.01)。3、①造成大鼠胃扩张模型后,能显著诱导NTS内c-fos的表达;电针足三里、内关穴组与胃扩张模型组比较,NTS内Fos阳性细胞数均有显著性降低(P＜0.01);电针足三里、内关穴组NTS内Fos阳性细胞数显著低于电针偏历、合阳穴组(P＜0.01)。②造成大鼠心肌缺血模型后,能显著诱导NTS内c-fos的表达;电针足三里、内关穴组与心肌缺血模型组比较,NTS内Fos阳性细胞数均有显著性降低(P＜0.01);电针足三里、内关穴组NTS内Fos阳性细胞数显著低于电针偏历、合阳穴组(P＜0.01)。4、①电针足三里、内关穴组能显著升高胃扩张模型大鼠胃内压(P＜0.01),其胃内压升高程度高于电针偏历、合阳穴组(P＜0.01)。②电针足三里、内关穴组能显著降低心肌缺血模型大鼠ST_Ⅱ电位值(P＜0.01),其电位降低值大于电针偏历、合阳穴组(P＜0.01)。结论:1、针刺内关、足三里穴区的躯体感觉传入和心胃的内脏伤害性刺激传入在NTS发生汇聚。2、NTS是针刺内关、足三里穴共同调节心胃功能的整合中枢之一。3、多病症一经(穴)司控,一脏(腑)多经(穴)调控具有相对的特异性。更多还原

【Abstract】 Objective:To explore the mechanism of "one meridian or acupoint controlling many diseases and many acupoints controlling one viscus" and clarify that nucleus of the solitary tract(NTS) may be an important primary nervous center in the medulla oblongata of "Neiguan" and "Zusanli" acupoints regulating cardiac and gastric functions,differences between acupuncture at "Neiguan" and "Zusanli" acupoints on neuronal discharges and c-fos expression in the NTS,and gastric pressure,as well as STⅡof electrocardiogram were observed in the normal and model rats.Method:Effects of acupuncture at "Neiguan" and "Zusanli" acupoints on discharges of neurons in the NTS sensitive or not sensitive to gastric distension or arrhythmia and on c-fos expression in the NTS in gastric distension and myocardial ischemia rats were respectively observed by extracellular recording and immunohistochemistry techniques.Results:1.neurons in the NTS was mainly excitatory response after acupuncture at Zusanli,Neiguan,Pianli and Heyang acupoints,however, there was significant difference between Zusanii and Neiguan groups and Pianli and Heyang groups in the ratio of appearance of those excitatory neurons(P＜0.01).Furthermore,discharge frequency of those excitatory neurons in four groups after acupuncture was higher than that before acupuncture(P＜0.01),showing that acupuncture has an obvious activation on neurons in the NTS.The percentage changes of the frequency of excitatory neurons in Zusanli and Neiguan groups were also obvious higher than those in Pianli and Heyang groups(P＜0.01).2.①In 149 neurons in the NTS,65 neurons were responsive to gastric distension,in which 44 neurons were excited and 21 neurons were inhibited to the stimulation,showing neurons in the NTS were mainly excited to gastric distension.After acupuncture at Zusanli,Neiguan, Pianli and Heyang acupoints,those excitatory neurons mentioned above were inhibited,moreover,the ratio of inhibitory neurons in the Zusanli and Neiguan groups was obvious higher than that in the Pianli and Heyang groups(P＜0.01,P＜0.05).Acupuncture at Zusanli,Neiguan, Pianli and Heyang acupoints all produced remarkable decreases in discharge ratio of excitatory neurons in rats induced by gastric distension (P＜0.01),furthermore,the percentage changes of the frequency in the Zusanli and Neiguan groups were noticeably higher than those in the Pianli and Heyang groups(P＜0.01).②In 116 neurons in the NTS,54 neurons were responsive to arrhythmia, in which 46 neurons were inhibited and 8 neurons were excited to the stimulation,showing that neurons in the NTS were mainly inhibited to arrhythmia.After acupuncture at Zusanli,Neiguan,Pianli and Heyang acupoints,those inhibitory neurons mentioned above were excited, moreover,the ratio of excitatory neurons in the Neiguan groups was obvious higher than that in the Pianli and Heyang groups(P＜0.05). Acupuncture at Zusanli,Neiguan,Pianli and Heyang acupoints all produced remarkable increases in discharge ratio of inhibitory neurons in rats induced by arrhythmia(P＜0.01),furthermore,the percentage changes of the frequency in the Zusanli and Neiguan groups were noticeably higher than those in the Pianli and Heyang groups(P＜0.01).3.①The number of fos-immunoreactive(fos-IR) neurons in the NTS in Zusanli and Neiguan groups was significantly lower than that in the gastric distension group(P＜0.01) and obviously higher than that in Pianli and Heyang groups(P＜0.01).②A similar phenomenon was observed in the arrhythmia rats.The number of fos-immunoreactive(fos-IR) neurons in the NTS in Zusanli and Neiguan groups was significantly lower than that in the arrhythmia group(P＜0.01) and obviously higher than that in Pianli and Heyang groups(P＜0.01).4.②Acupuncture at Zusanli and Neiguan acupoints increased significantly gastric pressure(P＜0.01),which was obviously higher than that after acupuncture at Pianli and Heyang acupoints(P＜0.01).②In the myocardial ischemia rats,acupuncture at Zusanli and Neiguan acupoints decreased significantly the value of STⅡof myocardiogram(P＜0.01), which was more obvious than that after acupuncture at Pianli and Heyang acupoints(P＜0.01).Conclusion:1.Somatic afferent information induced by acupuncture at Neiguan and Zusanli acuponts and noxious visceral stimuli from the heart and stomach may converge in the NTS.2.NTS may be one of integrated nervous center of Neiguan and Zusanli acuponts in together regulating both the cardiac and gastric functions.3."One meridian or acupoint controlling many diseases and many acupoints controlling one viscus" is relative specificity.更多还原