针灸治疗肠易激综合征的神经生物学机制研究进展及问题

Research progress and problems of neurobiological mechanisms of acupuncture underlying improvement of irritable bowel syndrome

近年来研究证实,针灸治疗肠易激综合征(IBS)有肯定的疗效,并对针灸治疗本病的神经生物学机制进行了大量探索。本文对此进行了综述,一是回顾了针灸调控IBS内脏高敏痛的神经生物学机制的研究,涉及外周水平的机制、脊髓水平的机制、脑水平的机制;二是回顾了针灸调节IBS肠运动功能的神经生物学机制的研究,涉及迷走神经和肠神经—Cajal间质细胞—平滑肌细胞网络发挥的作用。同时,本文还就针灸治疗IBS的神经生物学机制研究存在的问题进行了讨论,针对这一领域的研究所存在的碎片化问题和既往相关机制研究所依赖的还原论方法的局限性,提出针灸治疗IBS的神经生物学机制的研究有必要借鉴系统科学的研究方法。

In recent years, many studies have confirmed the positive effect of acupuncture and moxibustion in the treatment of irritable bowel syndrome(IBS), and a lot of researches have been made to explore its neurobiological mechanisms. The neurobiological mechanisms include two aspects 1) remission of visceral hypersensitivity via peripheral and central pathways(spinal cord and brain), and 2) improvement of intestinal motility via vagus nerve and enteric nervous system(ENS)-interstitial cells of Cajal(ICC)-smooth muscle cells(ENS-ICC-SMC) network, and 5-HT, vasoactive intestinal peptide(VIP), neuropeptide Y, etc.. At the same time, we also discussed the existing problems in the research of the underlying neurobiological mechanisms of acupuncture and moxibustion for IBS. The existing problems in this field mainly include 1) fragmentization or lack of integrity in researches, and 2) limitation of the reductionism method. For this reason, we should draw lessons from the research methods of systematic science to study the neurobiological mechanisms of acupuncture and moxibustion in the treatment of IBS, including the detailed links of peripheral and central nervous transmission of acupoint stimulation signals, and the interactive action modes(two-way benign regulation, multi-target regulation, saturation regulation, etc.).