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1、手针与电针调制边缘叶-旁边缘叶-新皮层网络,手针与电针调制边缘叶-旁边缘叶-新皮层网络,传统望诊技术-Traditional Inspection,传统望诊技术-Traditional Inspection,Telescope 望远镜,Microscope 显微镜,X-Ray Body 人体透视,现代望诊技术-Modern Tech for Inspection,Telescope 望远镜Microscope 显微,The transparent image of Body,4,The transparent image of Body6,RADIOLOGY TOOLS-Instruments
2、,5,X-RAY DSA CT gamma camera MRI,RADIOLOGY TOOLS-Instruments7,Modern Imaging Techniques in TCM Clinical practice and Research现代影像技术在针刺机制研究中的应用,针刺为具有3000年历史的我国传统体表刺激治疗方法，其脑效应不清，适合fMRI研究。1994-2009，共发表各种文章700余篇，主要在中国、美国、韩国、德国、日本；SCI论文140余篇，40篇左右有较高的学术价值。Huang W.J.,park K.et al Plos One 2012,6,Modern Im
3、aging Techniques in T,针刺穴位fMRI脑效应研究,经过近二十年的国内外fMRI针刺研究探索，对针灸脑机理产生了新的认识，初步形成了新的多学科边缘研究领域。SCI 论文 140余篇：HBM，NeuroImage，Journal of Neuroscience PNAS-Hui et al HBM 2000 Neuroimage 2005-Cho et al PNAS 1998，2006-Wu et al Radiology 1999-Kong et al Journal of Neuroscience 2009,针刺穴位fMRI脑效应研究,Basic Questions 基
4、本问题,Do Manual and Electro acupuncture modulate the relative specific brain network?手针、电针脑效应有何特点，有何不同？,8,Basic Questions 基本问题 Do Ma,Hypothesis 假说,The Salient Characteristics of the Central Effects of Acupuncture Needling:Limbic-Paralimbic-Neocortical Network Modulation 针刺捻针的显著特征：调制边缘叶-旁边缘叶-新皮层网络 Manu
5、al and Electro acupuncture modulating the relative specific brain network 电针和手针各有特点,9,Hypothesis 假说The Sali,First experiment-Manual acupuncture 实 验 一-手针脑效应研究,10,First experiment,The Salient Characteristics of the Central Effectsof Acupuncture Needling:Limbic-Paralimbic-Neocortical Network Modulation
6、 捻针的显著特征：调制边缘叶-旁边缘叶-新皮层网络,Fang Jiliang,Hui KKS et al.Human Brain mapping 2009,The Salient Characteristics of,Methods,Subjects:Healthy adult volunteers,right-handed,N=10Acupoints:LV3,LV2,ST44,Sham 3rd metatarsal spaceManual acu:needle rotation,even motion,160/minParadigm:Block Design R1,2,3,4 Needle
7、in place Current Off,S1,2,3 EA Current On 30s.6 min fMRI:1.5 T GE Signa MRI EPI:TE 30ms,TR 2500ms,slice thickness 3.0/0.5 mm,41 Slices,paralleled by AC-PC line Data analysis:SPM2Interview for sensations after each procedure,MethodsSubjects:Heal,Needling sensation Intensity 四穴位 捻针针感强度比较,T-test Aching
8、*LV3 vs.LV2 p 0.05,Needling sensation I,Results,1.General Response for LV3,LV2,ST44&Sham pointActivation areas，激活脑区:Thalamus 丘脑 SII 体感二区 Insula 岛叶 Antero-middle cingulate cortex(aMCC)中扣带回前部Deactivation areas，负激活脑区:Anterior medial prefrontal cortex 前内侧前额叶皮层 Mesial temporal lobe 内侧颞叶 Posterior medial
9、parietal cortex 后内侧顶叶皮层,Results,Activation Network n=10,p=0.001,Activation Network n=10,Deactivation network n=10 p=0.001,Deactivation network n=10 p=0.,Published paper,17,Published paper19,Second experiment-Electro acu 实 验 二-电针研究,18,Second experiment,METHODS,Subjects:21 healthy adults,acupuncture-n
10、ave,F/M,20-55 y.o.Acupuncture:Electro acupuncture at CV4,CV12 separately.Paradigms:Block Design R1,2,3,4 Needle in place Current Off,S1,2,3 EA Current On 30s.fMRI:1.5 T GE Signa MRI EPI:TE 30ms,TR 2500ms,slice thickness 3.0/0.5 mm,41 Slices,paralleled by AC-PC line Interview for sensations after eac
11、h procedure.,ME,20,任脉：关元穴（CV4），中脘穴（CV12）,22任脉：关元穴（CV4），中脘穴（CV12）,Data Processing,SPM 2 for GLM analysis:activation and deactivation areas.SPM2分析脑激活及负激活区。Network analysis:local and distance functional connectivity：Degree centrality(or degree)is a network measure that quantifies the number of links or
12、 edges connected to a node.短程和长程“中心度”方法。对全脑内所有体素与其12mm半径内的球形邻域内的其他体素时间强度变化曲线作相关分析，相关系数超过0.25 的所有体素为短程中心度值。通过Z变换标准化，行个体和组平均及比较。Sepulcre J,Liu H,PLoS Computational Biology 2010,21,Data Processing SPM 2 for,Electroacupuncture Sensations 电针针感研究,22,fullness was stronger in CV4 than CV12(P=0.02).,Electroa
13、cupuncture Sensations,Activated and Deactivated Areas by EA at CV4、CV12 电针关元、中脘穴的激活、负激活脑区图,23,CV4(n=20)versus CV12(n=18)，P=0.05,corrected 5 voxel,MNI coordinates.Strong and prevalent deactivation in ventral medial prefrontal cortex and anterior cingulate cortex was observed for both conditions.No di
14、fference,Activated and Deactivated Ar,Sham stimulation induced moderate changes in local functional connectivity 留针时 脑短程功能连接的变化,24,for CV4,n=20,for CV12,n=18,r 0.25,P 0.05,Sham stimulation induced,EA stimulation induced significant changes in local functional connectivity 电针诱导显著短程连接变化,25,for CV4,n=2
15、0,for CV12,n=18,r 0.25,P 0.05,EA stimulation induced sig,Post-EA Effects for CV4 and CV12（6min）拔针后6分钟内更强的脑短程连接效应,26,Resting state,n=21,r 0.25,P 0.05,Post-EA Effects for CV4 and CV,The Limbic-Prefrontal Network Modulated by Electro-acupuncture at CV4 and CV12Jiliang Fang,XiaolingWang,Hesheng Liu,YinW
16、ang,Kehua Zhou,Yang Hong,Jun Liu,LeiWang,Chao Xue,Ming Song,Baoyan Liu,and Bing ZhuEvidence Based Complementary and Alternative Medicine Epub 2012.2,27,The Limbic-Prefrontal Network,28,30,Discussion 讨 论,29,Discussion,Limbic paralimbic Neocortical 网络 边缘叶-旁边缘叶-新皮层网络,Adapted from Carpenter M.B.Core Tex
17、t of Neuroanatomy,4th Ed.,Hyp,Fennix,MPC,MPFC,Limbic paralimbic Neocorti,Manual acupuncture modulatingLimbic-paralimbic-neocortical network（LPNN）,MFC BA11,10,25 MPC BA7Amgy,H,1 frontal pole 2 VMPFC 3 pregen cingulate 4 subgen cingulate5 post cingulate 6 hypothalamus 7 cerebellar vermis8 substantia n
18、igra 9 reticular formation,2,9,8,6,4,3,5,7,Signal decrease,The Generalized Integrated Signal Decrease Response in the Limbic-paralimbic-neocortical system Courtesy by Dr.Kathleen Hui,11,1,1 frontal pole 29864357Signal,Electro acupuncture modulating Limbic-prefrontal network电针调制边缘叶-前额叶网络,Electro acup
19、uncture modulating,Neural Circuitry of Mood 情感调制神经环路,Adapted from Carpenter M.B.Core Text of Neuroanatomy,4th Ed.,Neural Circ,References for LPNN,Group in Martinos center MGH,Harvard medical School（1994-2009）Hui 2000,2005,2009Wu 1999,2002Napadow 2005These results support the LPNN modulation,35,手针调制脑
20、网络既往研究,References for LPNNGroup,Hui et al Human Brain Mapping 2000,Neuroimaging 2005,Brain Research 2009,Hui et al Human Brain Mappin,METHODS,Subjects:48 healthy adults,acupuncture-nave,F/M,20-55 y.o.Acupuncture:manual rotation 60/min at right LI4,ST36,LV3 on same subjectParadigms:M1,M2 needle manip
21、ulation,R1,R2,R3 needle in place Control:tactile stimulation with 0.55 von Frey filamentInterview for sensations after each procedure:grouping of datasets into deqi and mixed(deqi mixed with sharp pain)Courtesy by Dr.Kathleen Hui,S,METH,合谷 足三里 太冲,Hui,Fang,Brain Research 2009,Courtesy by Dr.Kathleen
22、Hui,ST36,right run,p,Hippocampus,right,Task-negative Network,CCA:Acupuncture deqi,P 0.005,.,Courtesy by Dr.Kathleen Hui,pP 0.001RAX 6-2-10-18-26-3,Wu et al 1999 Radiology,40,Wu et al 1999 Radiology42,Napadow 2005 HBM,41,Napadow 2005 HBM43,LPNN(Hui,et al 2000,2005,2009 Fang et al 2009),LPNN(MPFC-Limb
23、ic)(Fang 2012),DMN,Overlap networkbetween LPNN in acupuncture and DMN of resting brain,(Biswal 1997Buckner et al,2006),Resting Brain,Manual Acu,Electro Acu,LPNN(MPFC-Limbic)DMN,The are different effects between manual and electro acupuncture at the Brain LPNN.手针调制：边缘叶-旁边缘叶-新皮层网络电针调制：边缘叶-前额叶皮层网络 It i
24、s overlapped with the functional circuits associated with emotional and cognitive regulation.针刺调制的脑网络与脑情绪及认知调节明显相关 The antipain,antianxiety,and other modulatory effects of acupuncture may be mediated by this intrinsic neural system.针刺可能通过此脑内在网络产生抗焦虑、止痛及其他治疗效应。,Conclusion,Conclusion,44,Acknowledge Ou
25、r Brain Imaging Research Team in China：王寅，王小玲，刘军，洪洋，周科华，王雷，薛超，林诗智,石凤祥，汪平宋明，蒋田仔刘保延，朱兵 Martinos center MGH Harvard Medical School USA：Kathleen Hui，Hesheng Liu，Kenneth K Kwong，Phoebe S T Chen，Erika Nikson，Jing Liu，Nikos Markris,Vitaly Napadow,46 Acknowledge,Grants fMRI study on Neuromechanism of Acupun
26、cture,1.美国国立卫生研究院（NIH）课题 2005-2009 针刺不同穴位脑中枢效应的fMRI研究 PI:Central Effects of Acupuncture:Acupoint Specificity(NIH/NCCAM)F05-AT003022-01-04)(2005.12-2009.12)2.国家自然基金课题 2009-2011 针刺调制脑边缘叶旁边缘叶新皮层环路的fMRI研究 PI:Acupuncture modulating the limbic-paralimbic-neocortical circuit(NSFC:30870668)（2009.1-2011.12）3.国家中医药管理局中医药留学回国人员课题 2004-2005 针刺正常人太冲穴 及其临近穴 的脑功能成像,Grants,Hi，Everyone，Cooperation,Radiologist 影像专家,Experts in TCM中医针灸临床科研专家,Hi,感谢聆听,感谢聆听,
