3篇论文/综述，根据具体的实验结果，从西医角度揭示了自主神经系统在针灸机理中的重要地位。

A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis，Shenbin Liu，Nature 2021 Oct;  https://pubmed.ncbi.nlm.nih.gov/34646018/

（机器翻译）摘要

体感自主反射允许电针刺激 (ES) 在远处调节身体生理 1-6（例如，抑制严重的全身炎症 6-9）。自 1970 年代以来，关于这些反射的新兴组织规则是身体区域特异性 1-6 的存在。例如，后肢 ST36 穴位的 ES 而不是腹部 ST25 穴位的 ES 可以驱动小鼠的迷走肾上腺抗炎轴10, 11。然而，这种体细胞组织的神经解剖学基础是未知的。在这里，我们展示了 PROKR2Cre 标记的感觉神经元，它支配深后肢筋膜（例如，骨膜）而不是腹部筋膜（例如，腹膜），对于驱动迷走神经 - 肾上腺轴至关重要。具有消融 PROKR2Cre 标记的感觉神经元的小鼠 ST36 位点的低强度 ES 未能激活后脑迷走神经传出神经元或驱动肾上腺释放儿茶酚胺。结果，ES 不再抑制由细菌内毒素引起的全身炎症。相比之下，ST25 和 ST36 部位的高强度 ES 诱发的脊髓交感神经反射不受影响。我们还表明，通过 ST36 位点对 PROKR2Cre 标记的神经末梢进行光遗传学刺激足以驱动迷走神经-肾上腺轴，但不能驱动交感神经反射。此外，PROKR2Cre 神经纤维的分布模式可以回顾性地预测低强度 ES 将或不会有效产生抗炎作用的身体区域。我们的研究为穴位在驱动特定自主神经通路中的选择性和特异性提供了神经解剖学基础。

Abstract

Somatosensory autonomic reflexes allow electroacupuncture stimulation (ES) to modulate body physiology at distant sites^1-6 (for example, suppressing severe systemic inflammation^6-9). Since the 1970s, an emerging organizational rule about these reflexes has been the presence of body-region specificity^1-6. For example, ES at the hindlimb ST36 acupoint but not the abdominal ST25 acupoint can drive the vagal-adrenal anti-inflammatory axis in mice^10,11. The neuroanatomical basis of this somatotopic organization is, however, unknown. Here we show that PROKR2^Cre-marked sensory neurons, which innervate the deep hindlimb fascia (for example, the periosteum) but not abdominal fascia (for example, the peritoneum), are crucial for driving the vagal-adrenal axis. Low-intensity ES at the ST36 site in mice with ablated PROKR2^Cre-marked sensory neurons failed to activate hindbrain vagal efferent neurons or to drive catecholamine release from adrenal glands. As a result, ES no longer suppressed systemic inflammation induced by bacterial endotoxins. By contrast, spinal sympathetic reflexes evoked by high-intensity ES at both ST25 and ST36 sites were unaffected. We also show that optogenetic stimulation of PROKR2^Cre-marked nerve terminals through the ST36 site is sufficient to drive the vagal-adrenal axis but not sympathetic reflexes. Furthermore, the distribution patterns of PROKR2^Cre nerve fibres can retrospectively predict body regions at which low-intensity ES will or will not effectively produce anti-inflammatory effects. Our studies provide a neuroanatomical basis for the selectivity and specificity of acupoints in driving specific autonomic pathways.

 

Somatotopic Organization and Intensity Dependence in Driving Distinct NPY Expressing Sympathetic Pathways by Electroacupuncture，Shenbin Liu， et al. Neuron ( IF 14.415 ) : 2020-08-12 , https://www.sciencedirect.com/science/article/pii/S0896627320305328

（机器翻译）摘要

针灸实践背后的神经解剖学基础仍然知之甚少。在这里，我们使用交叉遗传策略来消融 NPY+ 去甲肾上腺素能神经元和/或肾上腺嗜铬细胞。使用内毒素诱导的全身炎症作为模型，我们发现电针刺激 (ES) 以体细胞和强度依赖性方式驱动交感神经通路。后肢区域的低强度 ES 驱动迷走肾上腺轴，产生依赖于 NPY+ 肾上腺嗜铬细胞的抗炎作用。腹部高强度 ES 通过脊髓交感轴激活 NPY+ 脾去甲肾上腺素能神经元；这些神经元通过激活不同的肾上腺素能受体 (ARs) 参与不连贯的前馈调节回路，并且由于 AR 谱的疾病状态依赖性变化，它们的 ES 诱发激活产生抗炎或促炎作用。在驱动不同的自主神经通路中体细胞组织和强度依赖性的揭示可以形成优化刺激参数的路线图，以提高使用针灸作为治疗方式的疗效和安全性。

Abstract

The neuroanatomical basis behind acupuncture practice is still poorly understood. Here, we used intersectional genetic strategy to ablate NPY⁺ noradrenergic neurons and/or adrenal chromaffin cells. Using endotoxin-induced systemic inflammation as a model, we found that electroacupuncture stimulation (ES) drives sympathetic pathways in somatotopy- and intensity-dependent manners. Low-intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on NPY⁺ adrenal chromaffin cells. High-intensity ES at the abdomen activates NPY⁺ splenic noradrenergic neurons via the spinal-sympathetic axis; these neurons engage incoherent feedforward regulatory loops via activation of distinct adrenergic receptors (ARs), and their ES-evoked activation produces either anti- or pro-inflammatory effects due to disease-state-dependent changes in AR profiles. The revelation of somatotopic organization and intensity dependency in driving distinct autonomic pathways could form a road map for optimizing stimulation parameters to improve both efficacy and safety in using acupuncture as a therapeutic modality.

 

Acupuncture and Neural Mechanism in the Management of Low Back Pain—An Update

Tiaw-Kee Lim, et al. Medicines (Basel). 2018 Sep; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164863/

很好的综述，有各种对针灸效果的理论假设，包括神经作用。非常好。

（机器翻译）摘要

在过去 10 年中，腰痛 (LBP) 患病率增加了 18%。 LBP 的管理和高成本给医疗保健系统带来了巨大的负担。已经确定了许多危险因素，例如生活方式、创伤、退化、姿势障碍和职业相关因素；然而，高达 95% 的 LBP 病例是非特异性的。目前，LBP 采用药物治疗。大约 25% 到 30% 的患者会出现严重的副作用，例如嗜睡和药物成瘾。脊柱手术通常不会显着改善疼痛缓解。因此，正在将补充方法整合到康复计划中。这些包括整脊疗法、物理疗法、按摩、运动、草药和针灸。针灸治疗腰痛是最常用的非药物镇痛技术之一。这是由于其低副作用和成本效益。目前，许多随机对照试验和临床研究已经产生了可喜的结果。本文综述了 LBP 对全球医疗保健的原因和发生率。考虑到针灸治疗的重要性。综述了揭示穴位与解剖特征之间联系的努力以及导致针刺镇痛作用的神经机制。

Abstract

Within the last 10 years, the percentage of low back pain (LBP) prevalence increased by 18%. The management and high cost of LBP put a tremendous burden on the healthcare system. Many risk factors have been identified, such as lifestyle, trauma, degeneration, postural impairment, and occupational related factors; however, as high as 95% of the cases of LBP are non-specific. Currently, LBP is treated pharmacologically. Approximately 25 to 30% of the patients develop serious side effects, such as drowsiness and drug addiction. Spinal surgery often does not result in a massive improvement of pain relief. Therefore, complementary approaches are being integrated into the rehabilitation programs. These include chiropractic therapy, physiotherapy, massage, exercise, herbal medicine and acupuncture. Acupuncture for LBP is one of the most commonly used non-pharmacological pain-relieving techniques. This is due to its low adverse effects and cost-effectiveness. Currently, many randomized controlled trials and clinical research studies have produced promising results. In this article, the causes and incidence of LBP on global health care are reviewed. The importance of treatment by acupuncture is considered. The efforts to reveal the link between acupuncture points and anatomical features and the neurological mechanisms that lead to acupuncture-induced analgesic effect are reviewed.