Cheng Ling, Li Peng, Tjen-A-Looi Stephanie Cheeyee, Longhurst John Charles
Department of Acupuncture, East Hospital, Shanghai, China.
Susan-Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, USA.
Chin Med. 2015 Nov 30;10:36. doi: 10.1186/s13020-015-0070-9. eCollection 2015.
The outcome of acupuncture on hypertension treatment is inconclusive. This study aims to evaluate the influence of acupuncture on hypertension, based on findings from mechanistic studies over the course of decades particularly those conducted at the University of California, Irvine. Low-current and low-frequency electroacupuncture (EA) at P5-6 (overlying the median nerve) and S36-37 (overlying the deep peroneal nerve) reduced high blood pressure in a subset of patients (~70 %) with mild-to-moderate hypertension, in a slow-onset (4-8 weeks) but long-lasting (1-2 months) manner. EA inhibited cardiovascular sympathoexcitatory neurons through activation of neurons in the arcuate nucleus of the hypothalamus, the ventrolateral periaqueductal gray in the midbrain and the nucleus raphe pallidus in the medulla, through inhibiting the activity of premotor sympathetic neurons in the rostral ventrolateral medulla (rVLM). Several neurotransmitters such as glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids were involved in this EA-induced hypotensive response. The long-lasting inhibition of hypertension induced by EA was related to opioids and GABA in the rVLM, neural circuitry between the arcuate and ventrolateral periaqueductal gray, and prolongation of the increase in preproenkephalin mRNA levels and enkephalin levels in the rVLM and arcuate. Moreover, the long-lasting inhibition of sympathetic activity by EA was confirmed in EA-treated hypertensive patients with decreased levels of norepinephrine, renin and aldosterone.
针刺治疗高血压的效果尚无定论。本研究旨在基于数十年来的机制研究结果，尤其是加利福尼亚大学欧文分校开展的研究，评估针刺对高血压的影响。在P5 - 6（正中神经上方）和S36 - 37（腓深神经上方）进行低电流、低频电针（EA）治疗，可使一部分（约70%）轻度至中度高血压患者的血压降低，呈现起效缓慢（4 - 8周）但持续时间长（1 - 2个月）的特点。电针通过激活下丘脑弓状核、中脑腹外侧导水管周围灰质和延髓中缝苍白核中的神经元，抑制延髓头端腹外侧（rVLM）中运动前交感神经元的活动，从而抑制心血管交感兴奋神经元。谷氨酸、乙酰胆碱、阿片类物质、γ-氨基丁酸（GABA）、孤啡肽、5-羟色胺和内源性大麻素等几种神经递质参与了电针诱导的降压反应。电针诱导的高血压长期抑制与rVLM中的阿片类物质和GABA、弓状核与腹外侧导水管周围灰质之间的神经回路以及rVLM和弓状核中前脑啡肽原mRNA水平和脑啡肽水平升高的持续时间延长有关。此外，在接受电针治疗的高血压患者中，去甲肾上腺素、肾素和醛固酮水平降低，证实了电针对交感神经活动的长期抑制作用。
