針刺神門（HT7）-通里（HT5）和神門-內關（PC6）對正常人心率變異度有不同的效應

Different Effects of Acupuncture at Shenmen (HT7)-Tongli (HT5) and Shenmen-Neiguan (PC6) Points on Heart Rate Variability in Healthy Subjects

針灸常用配穴來產生協同作用促進療效。神門（HT7）和通里（HT5）屬於心經，而內關（PC6）屬於心包絡經。這些穴位之間都非常的靠近而且都與心臟功能有關。心率變異度（heart rate variability，HRV）分析是一種簡單無侵犯性的技術被使用於自律神經系統的功能評估。本研究的目的是觀察單獨針刺神門，神門加通里，以及神門加內關對HRV作用之區別。我們對20名健康自願者設計一個交叉性（crossover）的研究，所有的受試都接受假針刺（shamacupuncture）、針刺神門、針刺神門加通里、針刺神門加內關等四種試驗。針刺前、針刺中以及針刺取針後分別做HRV分析紀錄。結果顯示針刺神門和針刺神門加通里試驗之HRV的lnLF（low frequency）和lnVariance成分在針刺取針後20分鐘時比假針刺試驗低；神門加內關試驗則沒有相似的結果。單獨針刺神門和針刺神門加通里兩者對HRV的lnLF和lnVariance成分產生相似的作用，針刺神門的作用可以被附加針刺內關抵銷，如此推測神門和內關對交感迷走神經之平衡產生互相拮抗的作用。因此為了增進配穴的效用建議不要選擇相同以及相鄰經絡互相接近的穴位。Point combinations are commonly used in acupuncture to produce synergistic effects to enhance therapeutic benefits. Shenmen (HT 7) and Tongli (HT 5) are located on the heart meridian, while Neiguan (PC 6) lies on the pericardium meridian. These acupoints lie close together and are all closely related to heart function. Heart rate variability (HRV) analysis is a simple noninvasive technique used to evaluate the function of the autonomic nervous system. The present study sought to investigate the differences in HRV among patients stimulated at HT 7 alone; HT 7 and HT 5; and HT 7 and PC 6. We designed a crossover clinical study and recruited a total of 20 healthy volunteers. All subjects received 4 experimental sessions that included sham acupuncture (SA); verum acupuncture at HT 7; verum acupuncture at HT 7 + HT 5; and verum acupuncture at HT 7 + PC 6. HRV analysis was recorded before, during, and after each acupuncture session. Results indicated that the lnLF and lnVariance components of HRV were lower at 20 min post acupuncture in the HT 7 and HT 7 + HT 5 sessions than in the SA session; no similar results were noted in the HT 7 + PC 6 session. Both acupuncture at HT 7 alone and at HT 7+ HT 5 produce similar effects on the lnLF and lnVariance components of HRV. The effects of acupuncture at HT 7 may be counteracted by adding PC 6, suggesting that HT 7 and PC 6 may have antagonistic effects on sympathovagal balance. In order to enhance the efficacy of point combinations, the points selected should not lie close together along the same meridian and also should not lie close along neighboring meridians.