經絡實質、針刺機制及其對神經科學基本信念之挑戰(The Essence of Meridians, Mechanism of Acupuncture and Its

Challenges to the Basic Tenets in Neuroscience)

張翔 教授(Prof. Shyang Chang)

國立清華大學電機工程系(Department of Electrical Engineering

National Tsing Hua University)

研究目的 (Motivation)

• 自西學東漸，西方近代科學以雷霆萬鈞之勢席捲天下，較之漢唐以來之佛學，有過之而無不及。 (Western modern sciences have been very dominating since its

introduction to the East. They are more influential than the Buddhism imported since the Han and Tang dynasties.)

• 目前，西方之自然科學已一統天下，唯獨西方之醫學仍未能定於一尊，實因傳統中醫療效確切，故尚能與之抗衡。但是中醫存廢之爭，始終未停。 (At present, the western natural sciences have been ecumenical

but not the medicine. It is simply because the traditional Chinese medicine (TCM) has proved it to be clinically effective. However, it is never short of critics.)

.

研究目的 (Motivation)

• 欲廢者認為中醫 (一 ) 不能以儀器實驗檢驗之， (二 ) 無數學描述， (三 ) 無邏輯推理，應此不科學。 (The critics think the theory of TCM are 1) not verifiable via

modern instruments, 2) not mathematized, and 3)no logical reasoning. Hence, it is not scientific.

• 欲興者則必須以實証求真之精神，認真而積極面對批評。 (For us the believers, we should face the critics seriously and

try to verify the truth contained in TCM.)

.

研究目的 (Motivation)

• 本講演將結合個人研究經驗所得，以中醫理論為基礎、實驗為主、數學及邏輯推理為輔，並以跨學科的方式探討傳統中醫之經絡實質、針刺機制以及其對西方神經科學基本信念之挑戰。 (In this talk, I will use the theory of TCM as the basis and

combine it with the human experiments, mathematics, and sound logic reasoning to investigate the essence of meridians, mechanism of acupuncture, and its challenges to the basic tenets in western neurosciences.)

研究目的 (Motivation)

• 深信中醫比西醫更合乎真理。如果世界上祗能有一種醫學存在，那將是中醫而非西醫。 (It is my sincere belief that TCM is much more closer to truth

than western medicine. If there is only one ecumenical medicine can exist in the world, it must be TCM and not the others.)

目錄 (Table of Contents)

I. 簡介 (Introduction)– 西方神經科學基本信念 (Basic tenets in

neurosciences)– 針灸和傳統中醫之功能觀 (Functional view of TCM)

II. 數學基礎 (Mathematical foundation)III. 實驗結果 (Experimental results)IV. 結論 (Conclusion)

I. 簡介 (Introduction)

西方神經科學基本信念 (Basic Tenets in Neuroscience )

• 神經元學說 (Neuron Doctrine, on Structure: Cajal and Golgi,1906 Nobel Laureates)

• 神經纖維有損耗之傳導 (Leaky or Lossy Nerve Fibers of Conduction, on Function: Hodgkin and Huxley, 1963 Nobel Laureates)

• 交互抑制 (Mutual Inhibition, on Function: Sherrington and Eccles, 1932 and 1963 Nobel Laureates)

I. 簡介 (Introduction)

針灸和傳統中醫之功能觀 (Functional View of Acupuncture and TCM)

• 農業社會，日往夜來、潮起潮落、四季變化皆節律也。 (In an agrarian society, night follows day; the tides ebb and flow; seasons change. Visible and invisible rhythms underlie the world around us.)

• 人亦處於此周行不殆之節律中。 (Hence, man’s place is only a humble part of the periodic time cycle ).

I. 簡介 (Introduction)

針灸和傳統中醫之功能觀 (Functional View of Acupuncture and TCM)

• 一般有日、月、季、年、節律 (In concert with our planet, we have circadian, monthly, seasonal, and annual rhythms. )

• 節律有長如上述、亦有短如血脈、呼吸…者。 (In addition to the long cycles, short physiological rhythms

are also important, for instance, the blood pressure, pulse, respiration, ….)

I. 簡介 (Introduction)

針灸和傳統中醫之功能觀 (Functional View of Acupuncture and TCM)

• 生理節律彼此作用並與外界交互影響。 (Physiological rhythms usually interact with one another

and probably have an overall integration with the outside environment.)

• 一陰一陽之謂道，偏陰偏陽之謂疾。 (Diseases occur if the normal rhythms break down or they

are replaced by abnormal ones. )

II. 數學基礎 (Mathematical foundation)

以振幅、頻率、及相位來刻劃節律 (To characterize rhythms in physiological functions, we need to

calculate the collective amplitudes and frequencies for various systems. )

• 布朗運動 (Brownian motion (BM) )• 分形布朗運動 (Fractional Brownian motion (FBM) )• 分形高斯噪聲 (Fractional Gaussian noise (FGN) )• 譜測度 (Spectral measure (SM) )

布朗運動 (Brownian motion)

• 定義 (Definition: The integral of an infinite series of oscillations with random amplitudes

where is a sequence of independent, identically distributed standard Gaussian random variables. )

n

分形布朗運動 (FBM)

• 1968 B. Mandelbrot popularized the FBM with correlated increments (proposed by A. Kolmogorov in 1940s) for applications in real environment.

• 定義 (Definition: The FBM with the Hurst parameter H (0<H<1) with was defined by and

分形維度之生理意義(Physiological meaning of FD in FBM )

• If H is greater than 0.5, the interpretation is that the collective amplitudes of the FBM can be categorized as positively correlated or persistent .

HH ttB 22 ~)(

分形維度之生理意義(Physiological meaning of FD in FBM )

• If H is less than 0.5, the interpretation is that the collective amplitudes of the FBM can be categorized as negatively correlated or anti-persistent.

HH ttB 22 ~)(

譜測度之生理意義 (Spectral measure for the frequencies)

• Bochner’s theorem

2( ) ( )iHr e F d

III. 實驗結果 (Experimental results)

– III.a 排尿與膀胱氣化之動物實驗 (Micturition of Lower Urinary Tract (Rats))

– III.b 曲肘和旋前臂 (Elbow Flexion and Forearm Pronation (Humans) )

– III.c 針刺心包經內關穴 (Effects of Acupuncture at Neiguan (Humans) )

第一挑戰 : 交互抑制(1st challenge: to the reciprocal inhibition)

• 在我們前兩個實驗中，衹見到節律之協同、及協和，而未 見拮抗、 及抑制。

(In the first two experiments, we have only seen the synergic and cooperative coactivations of rhythms instead of antagonism or mutual inhibition in our experiments.)

III.C 針刺心包經內關穴之效應(Effects of Acupuncture at Neiguan )

• 內關 (Neiguan (PC 6) is, with the hand supine, located about 2 inches directly above the midpoint of the transverse crease of the wrist, between the two tendons.)

• 解剖位置 (Anatomically, below the PC 6 is the median nerve, artery and veins.)

• The value of A corresponds to “舒張壓” “ diastolic” pressure.

• The value of P corresponds to “收縮壓” “ systolic” pressure.

• The value of V corresponds to peripheral compliance and resistance. “平均血壓”

控制組 (Sham control, A in green, V in red, P in blue)

針刺可 “升壓” (“Blood Pressures” rise after Acupuncture)

(A in green, V in red, P in blue)

針刺可 “降壓” (“Blood Pressures” fall after Acupuncture)

(A in green, V in red, P in blue)

心率變異度Heart Rate Variability (HRV)

腦波頻率 : 對照組 (Frequencies of Brain waves: Sham control)

針刺前腦波頻率 (Brain waves before acupuncture)

針刺中腦波頻率同步共振 (Synchronization of brain oscillations during acupuncture of

12 channels)

針刺中腦波頻率同步共振 (Synchronization of brain oscillations during acupuncture of

12 channels)

針刺中腦波頻率同步共振 (Synchronization of brain oscillations during acupuncture of 12

channels)

針刺後腦波頻率仍同步共振 (Synchronization of brain oscillations after acupuncture)

腦波 : 阿爾伐頻段 (The dominant frequency (Hz) of alpha band in 12-channels)

• Before During After• Fp1 8.394 8.203 8.008• F3 8.203 8.203 8.008• C3 8.203 8.203 8.008• P3 8.203 8.203 8.008• O1 8.594 8.203 8.008• T3 8.398 8.203 8.008• Fp2 8.203 8.203 8.008• F4 8.203 8.203 8.008• C4 8.203 8.203 8.008• P4 8.398 8.203 8.008• O2 8.594 8.389 8.008• T4 8.008 8.008 8.008• Mean8.300 8.202 8.008• Std 0.176 0.081 2.03E-07

針刺前腦波電位 (Electrical potential before acupuncture)

針刺中腦波電位 (Electrical potential during acupuncture)

電功率 (The power (dB) of dominant frequencies in alpha band for all

12-channels)

• Before During After• Fp1 14.83 17.48 18.94• F3 17.62 20.01 21.48• C3 16.45 19.14 20.64• P3 16.86 19.28 20.99• O1 18.56 19.43 21.34• T3 13.02 15.27 16.76• Fp2 15.02 17.62 18.77• F4 18.12 20.38 21.53• C4 17.34 19.96 21.16• P4 13.67 18.09 19.90• O2 18.04 18.90 20.70• T4 12.71 15.27 16.52

針刺效應 (Effects of Acupuncture)

• 全身血流、 HRV、 EEG 變化快速以秒計。 (Acupuncture has modified the blood pressure, HRV and EEG in

seconds.) • 全腦變化，不分區。 (The brain functions are more likely to be hologramic rather than

modularly organized.) • 唯有感應能解釋。生物化學、內分泌速度太慢！ (The brain functions are more likely to electromagnetic and less likely to

be of biochemical or endocrinal origins.)

解釋針刺效應 (To explain the effects of acupuncture)

兩個關鍵問題 : Two key questions:

• 問題一 :經絡是什麼？ What are the meridians?

• 問題二 :針刺機制為何？ How does the acupuncture work?

左前臂示意圖Transverse Section through the Middle of the Left Forearm

(Gray’s Anatomy 39th ed.)

問題一 :經絡是什麼？ What are the meridians?

• 在肘膝以下，每一主動脈旁有二衛星靜脈及主要神經四者全部包於結締組織之內。經絡便是此神經血管叢。動脈及運動神經之傳導方向是離心的，而靜脈和感覺神經之傳導方向是向心的，一往一返，電磁效應幾乎抵消而呈電磁中性。因此，屍體解剖學無法顯示其功能，活體之功能稍失常態亦極難偵查出。 (Meridians below the elbow and knees are actually the neurovascular bundles. The neurovascular bundles contain the arteries and motor nerves that are centrifugal and two satellite veins and sensory nerves that are centripetal. Hence, they are almost electromagnetically neutralized. Their functions cannot be revealed via anatomy and even difficult for minor physiological dysfunction.)

如何定量刻劃經絡？How to characterize the meridians quantitatively?

• 經絡是神經血管叢。而神經叢多與氣相關而血管叢多與血相關。两者可以容抗、及感抗刻劃二者陰陽之多寡。 The (Neurovascular bundle can be characterized by the electromagnetic dynamical variables of resistance (R) ( 電阻 ), inductance (L) (容抗 ), capacitance (C) (感抗 ), and conductance (G) ( 電導 ) which can be used to generate or respond to rhythms.)

• 目前，血管叢可以有容抗及感抗，但是神經叢祗有容抗，並無感抗。西方理論有偏陰偏陽之慮。 It is known that the

vascular vessels have L and C, but not the the nerve bundles in the Hodgkin and Huxley’s theory. The theory has no place for inductance.)

()

大腦皮質(Visual, and Acoustic Cortex of Man) (Schafer’s Essentials of

Histology)

腦中之神經纖維(Nerve Fibers in Brain: Von Hagens’ Body Worlds)

神經軸突之感抗(Squid Axon’s Inductive Impedance in K. Cole’s “Membranes,

Ions and Impulses”)

經絡的模型(Models of meridians)

必須符合• < 靈樞 . 海論 >“夫十ニ經脈者內屬于腑臟外絡于肢節”• < 靈樞 . 本臟 >“經脈者所以行氣血營陰陽濡筋骨利關節者也”• 經絡之標本、根結見於 < 靈樞 .根結篇 > 及 < 靈樞 .衛氣篇 > 根、本在四肢而標、結位於頭、胸、腹。它形成一複雜之通信網路，其傳輸線即為經絡。

• The model of meridians we propose are conformable to the

cannons of the yellow emperor and they are modeled as transmission lines in a complex communication networks.

經絡模型 ( 經絡臟腑肢節均以阻抗表示 )(The limbs, meridians and the associated visceral organs can be

characterized by their corresponding impedances)

Generator

Zg

Z3

Z3N

Z2

Z3N-1

問題二 :針刺機制為何？ How does the acupuncture work?

injury current

問題二 :針刺機制為何？ How does the acupuncture work?

injury current

• < 靈樞 . 九針十二原 > “欲以微針通其經脈，調其血氣…”

• 調其血氣之陰陽 ( 即針刺後引起局部組織輕微受傷，其受傷電流改變了局部容抗和感抗之大小，但由於網路是位及全身，故可調整全身之氣血。 )

• The injury current will change the impedances of neurovascular bundles locally. However, the network is global and the effects of acupuncture will be global.

受傷電流之效應Effects of Injury Current

(K. Cole’s Membranes, Ions and Impulses)

問題二 :針刺機制為何？ How does the acupuncture work?

• 阻抗之匹配，即陰陽之調和 The relevant impedances will be matched or mismatched to

achieve its effects. • 駐波、行波於標、本、根、結之間 In case of mismatching or matching in the impedances, the

neurovascular flow will have standing wave, or traveling waves, otherwise.

阻抗圖 Impedance diagram

血壓之双向變化On the rise and fall of blood pressure

• V=IZ

• 中醫不談血壓 V衹談血流或氣血之通塞即 I與 Z 。 In TCM, there is no such term as blood pressure. It is the

blood flow I that is important and is adjusted via the increase or decrease of the impedance Z of neurovascular bundles (meridians).

• 一般 V 變化 大，正常血流 I 可由調整 Z 經絡之通與塞而取得。 In general, the mean blood pressure does not change that much. The normal neurovascular flow I can be achieved mainly through adjusting Z (instead of V) as in our case.

血壓之双向變化On the rise and fall of blood pressure

止痛之機制On the mechanism of pain relief

• 針刺適當之經穴後，改變了經絡之阻抗 ( 或氣血之通塞 ) ，疼痛之信號波，部份反射，因而疼痛之感受降低。腦電位升高也有類似效應。

The acupuncture has changed the impedance, hence pain signal has been partially reflected. The brain will receive less intensity of pain signal. Brain electric potentials are elevated after acupuncture according to our experiment.

• 總結是因為阻抗不匹配，引起波反射，信號降低，而有止痛效果。神經化學作用倒是次要的。 Hence, the afferent pain signals from the generator are

partially reflected back and pain relief can be achieved.

臟腑治病之機制On the therapy of visceral disorders

• 例如 Z3 增加，臟腑稱疾，正常之神經血管流因阻抗之不匹配，而有反射，無法有正常之濡養。在經絡之適當穴位針刺，使兩端阻抗重新匹配，神經血管流恢復正常。 For instance, the visceral disorder is due to an increase of load impedance, say Z3. Consequently, the normal neurovascular flow to the Z3 will be reflected due to mismatch of impedance between say Z3 &Z2 . Acupuncture at proper sites will induce injury current that can reduce the capacitance of the neurovascular bundle and then the reflection coefficient near Z1 & Z2 will be complex conjugately matched with that near Z3 &Z2 and there is no more standing wave. Normal fow will then be resumed.

第二挑戰 : 神經元及神經傳導學說2nd challenge: to the neuron doctrine

and leaky cable theory of axon • 神經元理論無法解釋針刺現象 So far we cannot find a model based on synaptic connections

in a pool of 100 billions neurons (neuron doctrine) to explain the experimental results in seconds.

Serial model: too long for synchronization to occur Parallel model: no synchronization of brain rhythms

• 神經傳導學說沒有感抗是永遠無法阻抗匹配的。 Only capacitance, resistance, conductance and no inductance

in nerves can never have impedance matched. (unthinkable in electrophysiology)

IV. 結論 Conclusions

• 以實驗實証 Instead of antagonism or mutual inhibition in physiology and medicine, we have only seen the synergic and cooperative coactivations of rhythms

• 及數學基礎 FBM, FGN, and spectral measures have been used to quantitatively characterize the physiological rhythms.

• 提出經絡實質、針刺機制並對西方神經、血管生理提出挑戰。 A model of the meridians and the mechanism of acupuncture (instead of neuron doctrine) have been proposed for this ancient medicinal art of acupuncture.

参考論文References (partial list)

• 1. Chang, S. Physiological rhythms, dynamical diseases and acupuncture. Chinese J. Physiol. 53: 77-90, 2010.

• 2. Chang, S., Chang, Z.G., Li, S.J., Chiang, M.J., Ma, C.M., Cheng, H.Y. and Hsieh, S.H. Effects of acupuncture at Neiguan (PC 6) on electroencephalogram. Chinese J. Physiol. 52: 1-7, 2009.

• 3. Chang, S., Chiang, M.J., Li, S.J., Hu, S.J., Cheng, H.Y., Hsieh, S.H. and Cheng, C.L. The cooperative phenomenon of autonomic nervous system in urine storage. Chinese J. Physiol. 52: 72-80, 2009.

• 4. Chang, S., Li, S.J., Hu, S.J., Cheng, H.Y., Hsieh, S.H. and Cheng, C.L. Dynamic performance evaluation on the synergy of micturition in spinal cord-injured female rats under pharmacological effects. Chinese J. Physiol. 52: 81-92, 2009.

• 5. Chang, S., Hsyu, M.C., Cheng, H.Y. and Hsieh, S.H. Synergic co-activation of muscles in elbow flexion via fractional Brownian motion. Chinese J. Physiol. 51: 376-386, 2008.

• 6. Chang, S., Hsyu, M.J., Cheng, H.Y., and Hsieh, S.H. Synergic co-activation in forearm pronation. Ann. Biomed. Eng. 36: 2002-2018, 2008.

参考論文References (partial list)

• 7. Chang, S., Chao, W.L., Chiang, M.J., Li, S.J., Lu, Y.T., Ma, C.M., Cheng, H.Y. and Hsieh, S.H. Effects of acupuncture at Neiguan (PC 6) of the pericardial meridian on blood pressure and heart rate variability. Chinese J. Physiol. 51: 167-177, 2008.

• 8. Chang, S., Li, S.J., Chiang, M.J., Hu, S.J. and Hsyu, M.C. Fractal dimension estimation via spectral distribution function and its application to physiological signals. IEEE Trans. Biomed. Eng. 53: 1895-1898, 2007.

• 9. Chang, S., Hu, S.J. and Lin, W.C. Fractal dynamics and synchronization of rhythms in urodynamics of female Wistar rats. J. Neurosci. Meth. 139: 271-279, 2004.

• 10. Chang, S., Mao, S.T., Hu, S.J., Lin, W.C. and Cheng, C.L. Studies of detrusor-sphincter synergia and dyssynergia during micturition in rats via fractional Brownian motion. IEEE Trans. Biomed. Eng. 47: 1066-1073, 2000.

• 11. Chang, S., Mao, S.T., Kuo, T.P., Hu, S.J., Lin, W.C. and Cheng, C.L. Fractal geometry in urodynamics of lower urinary tract. Chinese J. Physiol. 42: 25-31, 1999.

合作者Coworkers

• Wei-Lun (Aaron) Chao1, Meng-Ju Chiang1, Shiun-Jeng Li1, Yu-Tsung Lu1, Chia-Mei Ma2, Hsiu-Yao Cheng3, Sheng-Hwu Hsieh4, Chen-Li Cheng5 and Chen-Chiang Lin6

• 1Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan 300, ROC.

• 2Department of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, P.R. China.

• 3Department of Chemistry, Tunghai University, Taichung, Taiwan 400, ROC.

• 4Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan, ROC.

• 5Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC

• 6Department of Orthopedic Surgery, National Taiwan University Hospital, Yunling Branch, Yunling, Taiwan, ROC

謝謝大家！並高度期待中醫之風華再現！(Thank you ! and the renaissance of TCM is highly expected.)