功能性磁共振造影(fMRI-Functional Magnetic Resonance Imaging)自1992 年問世以來為腦神經功能性研究研究提供了有效的方法,亦成為人研究腦功能圖譜之新利器。1998 年,Dr. Cho 首度嘗試以功能性磁振造影探究針灸在腦功能性上的機轉。2000 年再度發表第二篇關於針灸腦功能性研究的結果。Dr. Cho 的發現引發一連串針灸在腦功能性上的研究風潮,相關的論文也陸續被發表。這些早期的研究前輩雖然利用腦功能性磁振造影觀察到針灸在大腦所引發的活動反應,然而綜觀這些研究,各團隊所規劃的對照組實驗設計都採用偏離穴位一公分或針刺不得氣的方式來進行。然而,這種對照組設計方式,是針對臨床療效評估設計的,是否可以適用於腦功能性實驗上,是一個非常值得探討的問題,同時,到目前為止,全球亦尚無任何團隊對腦功能性磁振造影在針灸研究的方法學上的正確性作一個徹底的探究,同時對於對照組的刺激方式也沒有經過有系統的測試與證實。我們過去的研究也顯示出目前針灸刺激在腦功能性實驗上能表現出最正確的對照組實驗仍未被定義出來。沒有正確的對照組設計導致不易正確的抽離出針灸特有的大腦活動區域,這使得針灸的腦功能性研究上受到非常大的阻礙,也使得近年來在針灸在大腦中存在獨特的反應腦區的問題受到越來越多的質疑。雖然針灸影響身體機能的獨特功效究竟是否經過高等的神經系統,也就是大腦,來達成,至今仍未能定論,但是我們認為,若以目前為止所的研究去否定功能性磁振造影觀察針灸效應的可行性並不正確,原因是我們認為最佳的研究方法學還沒有人經過有效的實驗去比較與評估。因此,建立最具對比性的對照組是一件非常基礎卻重要的工作。同時對於中國傳統醫學-針灸的研究亦有著非常重大的影響。本研究計畫以三年的時間進行,分別以砂紙摩擦、熱痛刺激、針刺非經非穴及針刺大陵穴四種方式與刺激衝陽穴四個項目進行比較。每個項目將收集二十位受試者,在1.5T MRI 下進行此研究。四種對照組實驗的意義為砂紙摩擦將可精確標出該刺激穴位活化之腦區;熱痛刺激為現在國際間標準慢性疼痛(chronic pain)之刺激方法; 針刺非經非穴則為針灸實驗常用之對照組,而且此為尖銳疼痛(sharp pain)之刺激方式; 另外,再與其他穴道之比較,將可清楚定義出腦中實際活化之腦區。
Functional Magnetic Resonance Imaging (fMRI) were developed at 1992 and providing an effective way to approach brain function study. In 1998, Dr. Cho published the first paper about acupuncture mechanism by using functional MRI. And soon, his second paper also published in 2000. Functional MRI soon became a new important approach for acupuncture research. Mostly, these previous studies using puncturing area beside the real acupoint 1cm as their control study. However, this method was originally designed for the estimating of clinical curative effect. There are no researches for building the standard control- model of acupuncture fMRI. Also, no effective evidences for proving the validity of this design until present day. Through our experience, the 「beside acupoint 1cm 」 method may not the best control study for acupuncture fMRI research, this control design also procure difficulty to defining the specific active brain area caused by acupuncture stimulation. In this three- year NSC project, we will compare four different control methods: sand-paper sensory stimulation, thermal-pain stimulation, beside acupoint 1cm puncturing stimulation and acupuncturing the Da-Ling acupoint (PC7), 20 healthy subjects will be clued for each sub-study (which means 80 subjects will be clued in total). All study will perform in a 1.5T MR unit and using SPM2 for data analysis. This research will provide a important guideline for acupuncture fMRI research. Also, more significant active brain area should be observed through a correct control study design.