晕针的神经机制、分型与利弊权衡  

Acupuncture Syncope’s Neural Mechanism,Classification and the Tradeoff of Its Safety and Efficacy

作　　者：金观源 JIN Guanyuan(International Institute of Systems Medicine,WI 53045,USA)

机构地区：[1]美国国际系统医学研究所,美国威斯康星州53045

出　　处：《中华中医药学刊》2025年第1期24-34,I0008,共12页Chinese Archives of Traditional Chinese Medicine

摘　　要：长期以来,晕针一直被视作不良事件加以防范,但几乎所有患者在适当处置后都会快速复原,而且部分患者甚至晕针后“获大效”,对晕针及其起效的机制未曾深究。通过回顾迄今为止的大量晕针文献(个案、调查与系统评论)及血管迷走性晕厥的最新研究,支持晕针虽属不良反应但“不伤人”的认知,赞同晕针属于血管迷走性晕厥,而非休克。患者的晕厥易感性,动脉压力感受性反射障碍或不稳定性,心理应激、体位应激尤其合并针灸(躯体神经刺激)激发的血管迷走性反应,是晕针的病理生理学基础。按其神经机制,晕针可分为三种类型:Ⅰ型(心理应激型),在进针前后立即发生。Ⅱ型(交感触发型),它进而分为渐进性交感神经激活型(Ⅱa型)与抑制型(Ⅱb型)。该型的交感兴奋性较高,在针刺作用下进一步提高再突然或逐渐下降,导致晕针。Ⅲ型(迷走触发型),针刺一些特殊部位(如耳甲区)激发迷走传入诱导的晕针。进一步提出晕针患者(主要是Ⅱ、Ⅲ型)“获大效”的原理离不开针灸刺激(多半为强刺激)乃至晕针本身强烈激发下丘脑-垂体-肾上腺轴、胆碱能迷走抗炎机制,以及对疾病稳定态的再设置。由此,一方面对晕针易感人群可特别关注,包括消除紧张情绪,治疗取卧位,轻刺激;出现晕针先兆时,以防范跌倒损伤为首位;除非晕厥持续,无须再施针,但也可以继续留针。另一方面,对于敏感性低、久治无效的患者,则可以有意在身体敏感部(穴)位采取较强的刺激手段,同时取容易晕针的直立(坐)体位,寻求转机。换言之,应该在保证晕针“不伤人”与期待“获大效”目标之间作出临床权衡。Acupuncture syncope(commonly know as needle fainting),long considered an adverse event to be prevented,has been found to result in rapid recovery for almost all patients with appropriate management.Some patients even experience“significant”therapeutic effects after fainting.Though the mechanism of acupuncture syncope and its potential benefits have not been thoroughly investigated,this article,based on reviews of extensive literature on acupuncture syncope(case reports,surveys,and systematic reviews)and recent research on vasovagal syncope,supports the notion that acupuncture syncope is not harmful.It raises a novel point that acupuncture syncope is actually a form of vasovagal syncope rather than shock.The pathophysiological basis of acupuncture syncope includes patient susceptibility to syncope,arterial baroreflex dysfunction or instability,and vasovagal responses triggered by psychological stress,postural stress,and particularly acupuncture(somatic nerve stimulation).Based on its neurological mechanism,acupuncture syncope can be classified into three types.TypeⅠ(psychological stress type)occurs immediately before and after the needle is inserted.TypeⅡ(sympathetic triggering type)is further divided into progressive sympathetic activation type(TypeⅡa)and inhibitory type(TypeⅡb).The sympathetic excitability of this type is initially high,which further increases under needle stimulation before suddenly or gradually decreasing,leading to fainting.TypeⅢ(vagus-triggered type)is induced by directly stimulating vagal afferent at some special parts of the body(e.g.,the auricular region).The article proposes that the significant therapeutic effects experienced by some fainting patients(mainly TypesⅡandⅢ)are related to the strong stimulation of acupuncture and the fainting itself,which strongly activate the hypothalamic-pituitary-adrenal axis,cholinergic vagal anti-inflammation pathways,and reset disease homeostasis.For patients susceptible to syncope,clinicians should mitigate psychological stress and a

关 键 词：晕针 血管迷走性晕厥 神经机制 分型 不良反应 安全性 疗效 临床权衡 

分 类 号：R245-0[医药卫生—针灸推拿学]