摘 要
慢性疼痛是一种常见的健康问题，严重影响患者的生活质量。传统中医针灸疗法在缓解慢性疼痛方面具有悠久的历史和丰富的临床经验。然而，其神经机制尚不完全清楚。本研究旨在探讨针灸治疗慢性疼痛的神经机制，通过结合现代神经科学技术和传统中医理论，揭示针灸效应的生物学基础。研究采用随机对照试验设计，招募了120名慢性疼痛患者，随机分为针灸组和对照组。针灸组接受标准化的针灸治疗，对照组则接受假针灸治疗。通过功能性磁共振成像（fMRI）和脑电图（EEG）技术，监测两组患者在治疗前后的脑活动变化。结果显示，针灸组患者的疼痛评分显著降低，且与疼痛相关的脑区活动明显减弱。特别是前扣带回和岛叶皮层的活动变化与疼痛缓解程度呈正相关。此外，血清中内源性阿片肽水平的检测结果表明，针灸治疗后患者的内啡肽水平显著升高。这些发现提示针灸可能通过激活内源性镇痛系统来发挥作用。本研究的创新点在于首次将现代神经影像技术与传统中医理论相结合，系统地探讨了针灸治疗慢性疼痛的神经机制。主要贡献在于提供了科学证据支持针灸疗法的有效性和潜在的生物学机制，为未来进一步研究和临床应用奠定了基础。
关键词：慢性疼痛；针灸疗法；神经机制；功能性磁共振成像；内源性阿片肽
Abstract
Chronic pain is a common health problem that seriously affects the quality of life of the patients. Traditional Chinese acupuncture therapy has a long history and rich clinical experience in relieving chronic pain. However, the neural mechanisms are not fully understood. This study aims to investigate the neural mechanisms of acupuncture in the treatment of chronic pain, and to reveal the biological basis of acupuncture effects by combining modern neuroscience techniques and traditional Chinese medicine theories. The study used a randomized controlled trial design with 120 chronic pain patients randomized to acupuncture and control groups. The acupuncture group received standardized acupuncture treatment, while the control group received sham acupuncture treatment. Monitoring of brain activity before and after treatment by functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) techniques. The results showed that patients in the acupuncture group had significantly lower pain scores and pain. In particular, changes in activity in the ACC and insular cortex were positively correlated with the degree of pain relief. Moreover, the detection of endogenous opioid peptide levels in serum indicated that endorphin levels were significantly increased in patients after acupuncture treatment. These findings suggest that acupuncture may function through the activation of the endogenous analgesic system. The innovation of this study lies in the first combination of modern neuroimaging techniques with traditional TCM theory to systematically explore the neural mechanism of acupuncture for chronic pain. The main contribution lies in providing scientific evidence to support the effectiveness and potential biological mechanisms of acupuncture therapy, laying the foundation for further research and clinical applications in the future.
Keywords：Chronic pain; Acupuncture therapy, Neural mechanisms, Functional magnetic resonance imaging; Endogenous opioid peptide
目 录
引 言 1
第一章 针灸对慢性疼痛的初步效应机制 2
1.1 针灸刺激的生理反应 2
1.2 神经递质在针灸治疗中的作用 2
1.3 针灸对疼痛阈值的影响 3
1.4 初步临床试验结果分析 3
第二章 针灸与中枢神经系统的关系 4
2.1 针灸对大脑皮层活动的调节 4
2.2 脊髓水平上的神经传导变化 4
2.3 针灸与脑内阿片系统的互动 5
2.4 中枢神经系统内的信号传递机制 5
第三章 针灸在外周神经系统的效应 7
3.1 外周神经纤维的激活与抑制 7
3.2 局部炎症反应的调控机制 7
3.3 神经肌肉接头的变化分析 8
3.4 外周神经再生与修复的研究进展 8
第四章 针灸治疗慢性疼痛的综合模型构建 10
4.1 多层次神经网络模型的建立 10
4.2 模型验证与临床应用前景 10
4.3 针灸治疗效果的长期追踪研究 11
4.4 未来研究方向与挑战探讨 11
结 论 13
参考文献 14
致 谢 15
慢性疼痛是一种常见的健康问题，严重影响患者的生活质量。传统中医针灸疗法在缓解慢性疼痛方面具有悠久的历史和丰富的临床经验。然而，其神经机制尚不完全清楚。本研究旨在探讨针灸治疗慢性疼痛的神经机制，通过结合现代神经科学技术和传统中医理论，揭示针灸效应的生物学基础。研究采用随机对照试验设计，招募了120名慢性疼痛患者，随机分为针灸组和对照组。针灸组接受标准化的针灸治疗，对照组则接受假针灸治疗。通过功能性磁共振成像（fMRI）和脑电图（EEG）技术，监测两组患者在治疗前后的脑活动变化。结果显示，针灸组患者的疼痛评分显著降低，且与疼痛相关的脑区活动明显减弱。特别是前扣带回和岛叶皮层的活动变化与疼痛缓解程度呈正相关。此外，血清中内源性阿片肽水平的检测结果表明，针灸治疗后患者的内啡肽水平显著升高。这些发现提示针灸可能通过激活内源性镇痛系统来发挥作用。本研究的创新点在于首次将现代神经影像技术与传统中医理论相结合，系统地探讨了针灸治疗慢性疼痛的神经机制。主要贡献在于提供了科学证据支持针灸疗法的有效性和潜在的生物学机制，为未来进一步研究和临床应用奠定了基础。
关键词：慢性疼痛；针灸疗法；神经机制；功能性磁共振成像；内源性阿片肽
Abstract
Chronic pain is a common health problem that seriously affects the quality of life of the patients. Traditional Chinese acupuncture therapy has a long history and rich clinical experience in relieving chronic pain. However, the neural mechanisms are not fully understood. This study aims to investigate the neural mechanisms of acupuncture in the treatment of chronic pain, and to reveal the biological basis of acupuncture effects by combining modern neuroscience techniques and traditional Chinese medicine theories. The study used a randomized controlled trial design with 120 chronic pain patients randomized to acupuncture and control groups. The acupuncture group received standardized acupuncture treatment, while the control group received sham acupuncture treatment. Monitoring of brain activity before and after treatment by functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) techniques. The results showed that patients in the acupuncture group had significantly lower pain scores and pain. In particular, changes in activity in the ACC and insular cortex were positively correlated with the degree of pain relief. Moreover, the detection of endogenous opioid peptide levels in serum indicated that endorphin levels were significantly increased in patients after acupuncture treatment. These findings suggest that acupuncture may function through the activation of the endogenous analgesic system. The innovation of this study lies in the first combination of modern neuroimaging techniques with traditional TCM theory to systematically explore the neural mechanism of acupuncture for chronic pain. The main contribution lies in providing scientific evidence to support the effectiveness and potential biological mechanisms of acupuncture therapy, laying the foundation for further research and clinical applications in the future.
Keywords：Chronic pain; Acupuncture therapy, Neural mechanisms, Functional magnetic resonance imaging; Endogenous opioid peptide
目 录
引 言 1
第一章 针灸对慢性疼痛的初步效应机制 2
1.1 针灸刺激的生理反应 2
1.2 神经递质在针灸治疗中的作用 2
1.3 针灸对疼痛阈值的影响 3
1.4 初步临床试验结果分析 3
第二章 针灸与中枢神经系统的关系 4
2.1 针灸对大脑皮层活动的调节 4
2.2 脊髓水平上的神经传导变化 4
2.3 针灸与脑内阿片系统的互动 5
2.4 中枢神经系统内的信号传递机制 5
第三章 针灸在外周神经系统的效应 7
3.1 外周神经纤维的激活与抑制 7
3.2 局部炎症反应的调控机制 7
3.3 神经肌肉接头的变化分析 8
3.4 外周神经再生与修复的研究进展 8
第四章 针灸治疗慢性疼痛的综合模型构建 10
4.1 多层次神经网络模型的建立 10
4.2 模型验证与临床应用前景 10
4.3 针灸治疗效果的长期追踪研究 11
4.4 未来研究方向与挑战探讨 11
结 论 13
参考文献 14
致 谢 15
