CAJ | 학술논문

目的：利用 fMRI 探讨针刺合谷穴和后溪穴主治疾病的中枢神经生理学机制及两穴功能的相对特异性。方法：共募集40名健康志愿者，均为右利手。分为针刺合谷穴组与针刺后溪穴组，每组各20名。采用改良后的组块设计方案，用相同的磁共振扫描序列采集针刺两组健康志愿者左侧合谷穴或后溪穴任务态 fMRI 数据。利用 AFNI 程序分析脑激活区，对所有的功能数据进行组分析和组间分析，并利用 Monte Carlo 方法对分析结果进行多重比较校正（P ＝0.002，α≤0.05）。结果：针刺左侧合谷穴激活脑区包括：双侧中央前回、顶上小叶、颞上回、豆状核、壳核、小脑，右侧中央后回、顶下小叶、额中回、颞中回、缘上回、丘脑、丘脑底核、尾状核、扣带回，左侧额下回、枕中回和脑岛；针刺左侧后溪穴激活脑区包括：双侧脑岛、小脑，右侧中央前回、额中回、尾状核头和体，左侧扣带回、丘脑和腹后内侧核；针刺左侧合谷穴和后溪穴，组间分析结果有统计学意义，合谷穴组较后溪穴组右侧额中回、额下回激活减弱，左侧扣带回、左侧中央前回激活增强。结论：本研究为“面口合谷收”“后溪通督脉”理论提供了客观的证据，一定程度上解释了合谷穴治疗汗症、后溪穴治疗颈项腰背部疾病以及两穴的镇痛作用的中枢神经机制；并进一步从中枢神经层面表明了部位相近的穴位存在功能相对特异性。
목적：이용 fMRI 탐토침자합곡혈화후계혈주치질병적중추신경생이학궤제급량혈공능적상대특이성。방법：공모집40명건강지원자，균위우리수。분위침자합곡혈조여침자후계혈조，매조각20명。채용개량후적조괴설계방안，용상동적자공진소묘서렬채집침자량조건강지원자좌측합곡혈혹후계혈임무태 fMRI 수거。이용 AFNI 정서분석뇌격활구，대소유적공능수거진행조분석화조간분석，병이용 Monte Carlo 방법대분석결과진행다중비교교정（P ＝0.002，α≤0.05）。결과：침자좌측합곡혈격활뇌구포괄：쌍측중앙전회、정상소협、섭상회、두상핵、각핵、소뇌，우측중앙후회、정하소협、액중회、섭중회、연상회、구뇌、구뇌저핵、미상핵、구대회，좌측액하회、침중회화뇌도；침자좌측후계혈격활뇌구포괄：쌍측뇌도、소뇌，우측중앙전회、액중회、미상핵두화체，좌측구대회、구뇌화복후내측핵；침자좌측합곡혈화후계혈，조간분석결과유통계학의의，합곡혈조교후계혈조우측액중회、액하회격활감약，좌측구대회、좌측중앙전회격활증강。결론：본연구위“면구합곡수”“후계통독맥”이론제공료객관적증거，일정정도상해석료합곡혈치료한증、후계혈치료경항요배부질병이급량혈적진통작용적중추신경궤제；병진일보종중추신경층면표명료부위상근적혈위존재공능상대특이성。
Objective:To explore the neurophysiological mechanisms of acupuncture on Hegu(LI4)and Houxi(SI3)curing diseases and the functional specificity of them based on the technique of fMRI.Methods:Forty healthy right-handed volunteers,divided into Hegu (LI4)point group and Houxi(SI3)point group,20 cases in each group.The experiment took the modified block design.All healthy vol-unteers were stimulated at left Hegu(LI4)or Houxi(SI3),acquiring the fMRI data with the same scanning sequences.All fMRI data were analyzed by AFNI program and the results were corrected with Monte Carlo method(P =0.002,α≤0.05).Results:1)Many brain areas were actived with increased signal by stimulating at the left Hegu(LI4)which included:bilateral cerebellum,right thalamus and subthalamic nucleus,bilateral lentiform nucleus and putamen,right caudate,right cingulate gyrus,bilateral precentral gyrus,right posterior central gyrus,bilateral superior parietal lobule,right inferior parietal lobule,left inferior frontal gyrus,right middle frontal gyrus,right mid-dle temporal gyrus,bilateral superior temporal gyrus,right supramarginal gyrus,left middle occipital gyrus,left insula.2)As well as many brain areas were actived with increased signal by stimulating at the left Houxi(SI3)which included:bilateral cerebellum,left thala-mus and ventral posterior medial,right caudate,right precentral gyrus,right middle frontal gyrus,left cingulate gyrus,bilateral insula.3) It showed significant defferences between the Intergroup analysis results of stimulating at Hegu(LI4)vs Houxi(SI3):the increased signal in left cingulated,precentral gyrus and decreased signal in right middle frontal gyrus,inferior frontal gyrus of Hegu(LI4)than Houxi (SI3).Conclusion:Present research directly illustrated the link of Hegu(LI4)with the face and mouth,as well as Houxi(SI3)with the neck and torso at the levels of central nervous system.And it also offered the objective neurophysiological evidence to the traditional Chi-nese medical theory-“fall and hand controlled by Hegu”and “Houxi associating with the governor vessel”.In addition,it explained the mechanism of Hegu treatment to hyperhidrosis,Houxi(SI3)treatment to neck lumbar diseases,and the analgesic function of both acu-points in some degree.Nevertheless,it provided the objective basis of functional specificity of the acupoints which were closed in loca- <br> tion.