摘要
推拿镇痛作用明确,广泛用于治疗疼痛类疾病,其镇痛机制是推拿领域关注的重点问题。通过回顾并综述近十年有关推拿镇痛机制的文献,发现推拿可通过下调白细胞介素-1(interleukin-1,IL-1)、白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)等炎性介质的表达,抑制外周及中枢敏化过程;通过下调P物质(substance P,SP)、N-甲基-D-天冬氨酸(N-methyl-D-aspartic acid,NMDA)、嘌呤受体-(purinoceptors,P)亚型P 2X3等兴奋性神经递质的表达,抑制初级神经元的去极化;通过上调γ-氨基丁酸(γ-aminobutyric acid,GABA)、5-羟色胺(5-hydroxy tryptamine,5-HT)受体亚型5-HT 2A等抑制性神经递质的表达,减轻中枢去抑制作用;通过调节丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)、Toll样受体4(toll-like receptor 4,TLR4)等信号通路,进一步抑制IL-1β等细胞因子的表达;通过抑制β-内啡肽(β-endorphin,β-EP)等镇痛物质的表达,抑制胶质细胞活化;上调细胞自噬,发挥镇痛作用。推拿镇痛机制主要涉及外周、脊髓、脑水平,通过MAPK、TLR4等途径,来影响炎性因子、神经递质、神经肽等物质,具有“多水平—多通路—多物质”的作用特点。
Tuina,with a good analgesic effect,has been widely used in the treatment of pain diseases.Its analgesic mechanism is the focus of attention.By reviewing the literatures about the analgesic mechanism of Tuina in recent ten years,we found that Tuina can inhibit peripheral and central sensitization by down-regulating the expression of IL-1,IL-1β,IL-6,and TNF-α,inhibiting the depolarization of primary neurons by down-regulating the expression of excitatory neurotransmitters,such as SP,NMDA and P 2X3.It can decrease the central disinhibition by up-regulating the expression of GABA,5-HT 2A and other inhibitory neurotransmitters,and regulate MAPK and TLR4 signaling pathways.What’s more,Tuina can play an analgesic role by inhibiting the expression ofβ-EP and the activation of glial cells,up-regulating the autophagy.The analgesic mechanism of massage mainly involves the levels of peripheral,spinal and brain,the pathways of MAPK,TLR4 and others,the substances of inflammatory mediators,neurotransmitters and others,manifesting as characteristics of multi-level,multi-pathway and multi-substance.
作者
刘志凤
焦谊
于天源
张英琦
刘迪
官乾
徐亚静
王厚融
LIU Zhifeng;JIAO Yi;YU Tianyuan;ZHANG Yingqi;LIU Di;GUAN Qian;XU Yajing;WANG Hourong(Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《环球中医药》
CAS
2022年第3期526-530,共5页
Global Traditional Chinese Medicine
基金
国家自然科学基金(81674094、82074573)。
