中医杂志

目的 观察推拿“委中”穴对慢性背根神经节压迫（CCD）模型大鼠机械痛敏行为的影响，并初步探讨“委中”穴区相关神经传入及中枢投射的解剖学分布特征。方法 30只SD大鼠随机分为假手术组、模型组、推拿组，每组10只。模型组和推拿组大鼠均通过在右侧腰椎第4/5节段和第3/4节段椎间孔植入不锈钢钢棒，建立CCD模型，假手术组仅暴露手术伤口。推拿组自造模后第4～28天，每天持续推拿右侧“委中”穴（压力5 N，频率2 Hz，每次10 min）。假手术组和模型组仅固定。在造模前及造模第3、7、14、21、28天分别评估各组大鼠机械缩足阈值（MWT）。造模第29天，在模型组大鼠的右侧“委中”穴注射逆行跨多级突触病毒（PRV）,120 h后经心脏灌注固定，取大鼠“委中”穴局部组织、造模同节段背根神经节、腰段脊髓以及大脑，观察以上组织中PRV阳性信号分布特征。结果 与假手术组同时间比较，模型组和推拿组大鼠造模第3、7、14、21、28天MWT均降低（P<0.05）；与模型组同时间比较，推拿组大鼠造模第21、28天MWT均升高（P<0.05）。荧光成像结果显示，PRV阳性信号主要分布于大鼠“委中”穴局部肌肉中深筋膜层，腰椎第4、5节段的背根神经节以及脊髓背角和中央管区域，大脑初级感觉皮层（S1）、次级运动皮层（M2）和前扣带回皮层（ACC），其中M2阳性神经元数量最多。结论 推拿“委中”穴可缓解CCD模型大鼠机械痛敏，“委中”穴区局部深部组织与相关腰段背根神经节、脊髓背角及部分皮层区域之间存在可示踪的神经解剖学联系。

Objective To determine the effects of tuina at "Weizhong(BL 40)" on mechanical pain hypersensitivity in a rat model of chronic dorsal root ganglion(CCD),and to preliminarily explore the anatomical distribution characteristics of neural afferents associated with "Weizhong(BL 40)" acupoint and their central projections.Methods Thirty SD rats were randomly assigned to a sham operation group,a model group,and a tuina group,with 10 rats in each group.In the model group and the tuina group,a chronic compression of CCD model was established by implanting stainless-steel rods into the right L4/5 and L3/4 intervertebral foramina.Rats in the sham operation group underwent surgical exposure only.From day 4 to day 28 after modeling,rats in the tuina group received daily manipulation at the right "Weizhong(BL 40)"(pressure: 5 N; frequency: 2 Hz; duration: 10 min/session).Rats in the sham operation group and the model group were subjected only to fixation.Mechanical withdrawal threshold(MWT) was assessed before modeling and on day 3,7,14,21,and 28 after modeling.On day 29 after modeling,pseudorabies virus(PRV),a retrograde trans-multisynaptic tracer,was injected into the right "Weizhong(BL 40)" acupoint in rats from the model group.After 120 h,rats were perfusion-fixed through the heart,and local tissues surrounding the "Weizhong(BL 40)" acupoint,corresponding lumbar dorsal root ganglia,lumbar spinal cord,and brain tissues were collected for fluorescence imaging of PRV-positive signals.Results Compared to the sham operation group,rats in the model group and the tuina group showed significantly reduced MWT on day 3,7,14,21,and 28 after modeling(P<0.05).Compared to the model group,rats in the tuina group exhibited significantly increased MWT on day 21 and 28 after modeling(P<0.05).Fluorescence imaging revealed PRV-positive signals in the deep fascial layer of local muscle tissue at "Weizhong(BL 40)",the L4 and L5 dorsal root ganglia,the dorsal horn and central canal region of the spinal cord,as well as the primary somatosensory cortex(S1),secondary motor cortex(M2),and anterior cingulate cortex(ACC).Among the examined cortical regions,M2 contained the largest number of PRV-positive neurons.Conclusion Tuina at "Weizhong(BL 40)" alleviates mechanical hyperalgesia in rats with the chronic compression of CCD model.A traceable neuroanatomical connection exists between the linking deep tissues within "Weizhong(BL 40)" region and the corresponding lumbar dorsal root ganglia,the spinal dorsal horn,and specific cortical areas.