| 摘要: | 根據中醫理論，針刺不同俞穴能產生不同治療效果，透過經絡學說取穴的方法有局部取穴、遠部取穴及循經取穴等。本研究主要目的是：利用2 Hz電針分別刺激中脘關元及兩側足三里穴，以血糖變化為指標證實此一理論，同時比較兩者降血糖作用機轉的差異。方法是將雄性實驗動物隨機分為，去腎上腺組及假手術組作為對照，以2 Hz電針中脘關元穴或兩側足三里穴，比較大鼠與小鼠之血糖之變化，同時以 ELISA 測量大白鼠血清腦內啡 (β-endorphin) 及胰島素 (Insulin) 的含量變化，探討與血糖變化的關係，並藉由比較大鼠小腿外側非穴區與兩側足三里穴，證實穴位的特殊性；同時以鏈尿佐菌素 (Streptozotocin，STZ) 誘導之糖尿病大鼠，探討胰島素在電針足三里之角色。接著，使用嗎啡受體之阻斷方法，比較在不同俞穴降血糖的機轉，如果無法完全被阻斷，則加入p-chlorophenylalanine (PCPA) 尋找內生性嗎啡以外的影響。結果顯示：2 Hz電針刺激中脘關元穴或兩側足三里穴，無論是大鼠或小鼠都有顯著降血糖作用，同時增加大鼠血清腦內啡和胰島素的濃度。電針中脘關元穴其降血糖作用因去腎上腺而消失，而兩側足三里穴則仍有部份的降血糖作用；唯兩穴區都無法改變去腎上腺大鼠血清腦內啡及胰島素濃度。進一步，電針大鼠非穴區與足三里比較確有穴位的特殊性。另一方面，電針STZ誘導糖尿病大鼠之足三里穴亦無法得到顯著的降糖作用。接著，使用嗎啡受體阻斷方法可完全阻斷正常大鼠及小鼠電針中脘關元穴降血糖作用，卻僅部份阻斷足三里穴降血糖作用。因此，加入PCPA前處理後則可完全阻斷電針大鼠與小鼠之足三里穴降血糖作用。進一步也觀察到足量的naloxonazine可完全阻斷電針大鼠中脘關元穴的降血糖作用，且naloxonazine及納洛酮皆可阻斷電針促進血清中胰島素上升的作用。 根據上述結果，結論是2 Hz 電針中脘關元穴可刺激來自腎上腺的腦內啡經由活化μ1 —嗎啡受體刺激胰島素的分泌而導致血糖下降。兩側足三里穴的電針所引致的降血糖作用，僅部份來自腎上腺，除藉由腦內啡來刺激胰島素的分泌外，還涉及血清素參與其中。本研究證實了傳統中醫理論針刺不同俞穴確能產生不同的效果，且有穴位的特殊性，也說明了針灸治療學的遠部取穴與循經取穴，確有實際意義。; According to the theory of Traditional Chinese Medicine (TCM), different acupoints have different effects. Through the meridian theory, Chinese physician can get the acupoints for disease treatment via following the meridian and/or far from the focus of disease. Aim of this study is to compare 2 Hz electro-stimulating Zhongwan/Gwanyuan with bilateral Zusanli acupoints, using the change of plasma glucose as an indicator to prove the theory of acupuncture, and compare the differences of the hypoglycemic mechanism between both areas of electro acupuncture (EA) moreover. In this study, male experimental animals were divided into adrenalectomy (ADX) group and sham group as control randomly. They were stimulated by 2 Hz EA to observe the changes of plasma glucose at Zhongwan/Gwanyuan or bilateral Zusanli acupoints in rats and mice. ELISA was applied to detect the change of plasma β-endorphin and insulin of rats for exploring the relationship with the changed plasma glucose simultaneously. To investigate the specific character in acupoint, we compared bilateral Zusanli with nonacupoint of lateral lower leg, and used the change of plasma glucose level, β-endorphin and insulin as indicator. Streptozotocin (STZ) induced diabetic rats were applied to investigate the role of insulin in Zusanli EA. To continue, the blocking methods of opioid receptor were applied to contrast the mechanism of different acupoints. If the hypoglycemic effect of acupoint had not been blocked completely, it would be added p-chlorophenylalanine (PCPA) to search the influence beside endogenous opioid peptides (EOP).As a result, Regardless of rats and mice, there was a significant hypoglycemic effect in Zhongwan/Gwanyuan and bilateral Zusanli acupoints by 2 Hz EA, and plasma β-endorphin and insulin increased remarkably. The hypoglycemic effect disappeared after electro stimulating Zhongwan/Gwanyuan with 2 Hz EA, and partial lowering plasma glucose effect was observed at bilateral Zusanli due to adrenalectomy, But plasma β-endorphin and insulin no significant change after stimulating both sites. However, we compared nonacupoint with Zusanli that showed acupoint specific character. No significant lowering plasma glucose effect was also observed in STZ-induced diabetc rats stimulated by Zusanli EA. The blocking methods on opioid receptors can make to vanish the hypoglycemic effect in Zhongwan/Gwanyuan completely, but only partially block in Zusanli stimulated by 2 Hz EA. Therefore adding PCPA pretreated, that can be totally blocked the hypoglycemic effect of Zusanli EA in rats and mice. Further sufficient naloxonazine also can block the hypoglycemic effect of Zhongwan/Gwanyuan with 2 Hz EA, and naloxone or naloxonazine can block the encouraged plasma insulin also. According to our results, we suggest that we can challenge large amount of plasma β-endorphin coming from adrenal gland and activating μ1-opioid receptor to stimulate plasma insulin secretion, leading to the hypoglycemic effect after 2 Hz |
