中西方医学的桥梁——以治疗慢性呼吸障碍肺病为目的，详细探讨刺激肺经穴位与现代体感神经反射过程的关系

Bridging Medicine East and West—Pursuit on the Relation between Biomedical Consequence of Stimulating the Acupoints of the Lung Meridian and Somatosensory Reflexes, Aiming to Treat Chronic Obstruction Pulmonary Diseases

摘要: 肺在整个生命过程中不停地工作。1) 呼吸起搏器系统位于脑干中，沿著称为皮质脊髓神经束的数束路径(Bulbospinal tracts)向脊髓多节发放出节律性讯号。其中红核神经束启动从脊髓C3-C5输出的运动神经元(形成膈交感神经)，令膈收缩。还有网状脊髓神经束通过胸椎中间神经元，引起肋间肌收缩。2) 另一方面，刺激肺经的穴位会引起体感反射，并由脑皮层及脊髓传出数组不同的讯号启动膈及有关吸气肌肉。3) 此外，最近发现在脑干–脊柱上存在一组运动–呼吸耦合系统：“总部”在脑干而两个“分站”在脊髓(名为膈核及斜角肌核)。在运动期间，此系统为调节呼吸提供了输入讯号。4) 膈神经本身也存有感觉神经元；其轴突进入C3-C5背角的中间神经元，自然调整呼吸强度、节律性。基于现代神经生理学，本文提供了以上所有四个调节过程的详细分析，解释了最近三队不同研究小组使用针刺11组不同经络的穴位治疗慢性阻塞性肺疾病(COPD)疗效的机制。除肺经二穴位外，刺激其他经络的穴位归因于呼吸肌肉及运动–呼吸耦合系统的启动。在每一则重要立论都提供实验证据；因为内容牵涉范围很广，本文辅以十八绘图解䆁。这项详细的分析为了解肺经筋在中医学中的功能提出了新见解，并为将来发展不同的针刺，砭石疗法和艾灸技术作为治疗COPD的方式铺路。据预测，到2030年，COPD将成为世界第三大疾病死因。

Abstract: The lungs work non-stop throughout life. 1) The respiratory pacemaker system is in the brain stem, generating pre-sympathetic neurons to the spinal cords along the bulbospinal tracts. Neurons of these tracts activate motor neurons of spinal cords C3-C5 (forming the sympathetic part of the phrenic nerves), and thoracic spinal cords in humans to cause contraction of the diaphragm and intercostal muscles respectively. 2) On the other hand, stimulating acupoints of the Lung Meridian causes two somatosensory reflexes, sending efferent neurons to activate the phrenic nerves and respiratory muscles via the brain cortex and spinal cords C3-C5. 3) A locomotion-respiratory coupling system with “local centers” has been found to exist from the brain stem along the spine, supplying inputs to regulate respiration. Two local centers have been confirmed—the phrenic nu-cleus was confirmed in 2009 and the scalene nucleus was found some months ago. 4) The dia-phragm itself also has sensory neurons entering the dorsal horns of C3-C5. Based on modern neu-rophysiology, we provide a detailed analysis of all the above four regulatory processes, explaining the efficacy of acupuncture employed recently by three different groups using the same 11 sets of acupoints of different Meridians to treat chronic obstructive pulmonary diseases (COPD). The acupoints of Meridians other than that of the Lung are attributed to the activation of respiratory muscles and the locomotion-respiration coupling system. This detailed analysis gives new insights to the understanding of the function of the Lung Sinew Channels in TCM, and sheds light on devel-oping different techniques of acupuncture, moxibustion, hot Bian stone treatment as modalities to treat COPD in the future. Note that it has been projected that by 2030, COPD likely becomes the third leading cause of death.