43 1,3 1,3 2 DAVID M. NIDDAM 2 2,3 1 2 3 1976 Gunn 1 70 motor point of a muscle 12 9 22.9+2.7 8 1 2-6 92-06-01A 7,24 8 extensor carpi radialis longus muscle Figure 1 brachioradialis muscle
44 4 10-20 64 20 mm 13R27, 5 KΩ 1000 28G, Dantec, Denmark 3mm Hz with band-pass of 0.1-50 Hz (Neuroscan version 4.0, Herndon, USA) 100ms 350 ms 300 epoches 20mm + 0.5 Student t-test p<0.05 plot (Herndon, USA) 3HZ 5 1.4+0.2 ma 86.9+5.2 ms 4.9+2.4 v Fc2 Fz Cz Figure 2 Figure 1. The location of acupuncture point (Quchi, LI-11), motor point of extensor carpi radialis longus (MP) and non-motor point of extensor carpi radialis longus (MM) Figure 2. The somatosensory evoked potentials SEPs and activated sites were elicited by electro-acupuncture of LI-11.Color means degree of activation. Deep color means that more SEPs were generated.
45 90.3+4.8 ms p=0.56 2.5+0.8 v p=0.02 Fc2 Fz Cz Figure 3 Figure 4 A C fiber 9 A Figure 3. The somatosensory evoked potentials SEPs and activated sites were elicited by electro-acupuncture of the motor point of extensor carpi radialis longus muscle. Color means degree of activation. Deep color means that more SEPs were generated. Figure 4. The comparison of peak latency and amplitude of somatosensory evoked potentials between acupuncture point (Quchi, LI-11), motor point of extensor carpi radialis longus (MP) and non-motor point of extensor carpi radialis longus (MM). The peak latency and pattern of waveform were similar between LI-11 and MP.
46 Gunn 1 70 1/3 2/3 spasticity 17-18 19 6 20 21 28 9 27 22 24-26 (motor endplate) 10 A Ia 11-12 13-15 gate control theory 16 VGH92-153
47 2001. 9. Pomeranz, B. Scientific basis of acupuncture. In: Stux G editor. Basics of acupuncture. 3rd eds. Spring-Verlag, New York, 21-24, 1995. 10. Simons DG, Travell JG, Simons LS, eds. 1. Gunn CC, Ditchburn FG, King MH, Myofascial pain and dysfuction: The Renwick GJ. Acupuncture loci: a trigger point manual, Vol. 1, 2 nd ed. proposal for their classification Wiliams & Wilkins, pp.1-235, 1999. according to their relationship to known neural structures. Am J Chin Med 4:183-195, 1976 11. Starr A, Mckeon B, Skuse N, Burke D. Cerebral potentials evoked by muscle stretch in man. Brain 104, 149-166, 1981 2.. 12. Fukuda M, Kameyama S, Tanaka R. pp.1-40 1999 3. Cho ZH, Chung SC, Jones JP et al. New findings of the correlation between Thalamic potentials evoked by motor point stimulation. Muscle & Nerve 23:246-251, 2000. acupoints and corresponding brain 13. Mense S. Nociception from skeletal cortices using fmri. Proc Natl Acad Sci USA 95:2670-3, 1998 4. Wu MT, Hsieh JC, Xiong J et al. Central muscle in relation to clinical muscle pain. Pain 54:241-89, 1993 14. Shimojo M, Svensson P, Arendt-Nielsen nervous pathway for acupuncture L, Chen ACN. Dynamic brain stimulation: localization of processing topography of somatosensory evoked with functional MRI of potentials and equivalent dipoles in brain preliminary experience. response to graded painful skin and Radiology 212:133-41, 1999 muscle stimulation. Brain topogr 5. Hui KKS, Liu J, Makris N et al. 13:43-58, 2000. Acupuncture modulates the limbic 15. Niddam DM, Graven-Nielsen T, system and subcortical gray structures of Arendt-Nielsen L, Chen ACN. the human brain: evidence from fmri studies in normal subjects. Human Brain Non-painful and painful surface and intramuscular electrical stimulation at Mapping 9:13-25, 2000 the thenar and hypothenar sites: 6. Hsieh JC, Tu CH, Chen FP et al. Brain differential cerebral dynamics of early to activation by acupuncture with De-Qi : late latency SEPs. Brain topogr a poitron emission tomography study. Neuroscience Lett 307:105-8, 2001 13:283-92, 2001. 16. 7. pp.991-995 1992 pp.1-106 2002 17. Yoo WK, Chung IH, Park CI. Anatomic 8. motor point localization for treatment of 25:54, gastronemius muscle spasticity. Yonsei
48 Medical Journal 43:627-30, 2002. 18. Albert T, Yelnik A, Colle F, Bonan I, 23. Kendall FP, McCreary EK, Provance PG: Muscles: Testing and Function. ED4. Lassau JP. Anatomic motor point Williams Wilkins, Baltimore, 1993. localization for partial quadriceps block 24. Craig AD. How do you feel? in spasticity. Arch Physical Med & Interoception: the sense of the Rehabilitation 81:285-7, 2000. 19. Bossy J. Morphological data concerning the acupuncture points and channel physiological condition of the body. Nature Review 3:655-667, 2002. 25. network. Acupuncture 45-53, 1998. Electro-Therapeutics Res 19:79-106, 26. 1984. 61-67, 1998. 20. 27. Dung HC. Anatomical features pp.220 2000 contributing to the formation of 21. acupuncture points. Am J Acupunct 12: 17:18, 2001. 139-143, 1984. 22. Shen, J. Research on the 28. MPS neurophysiological mechanisms of 45-58, acupuncture: review of selected studies 1999. and methodological issues J Altern Complement Med vol.7 S121-7, 2001.
49 The Role of Motor Point in Acupuncture Point And Therapy Yen-Ying Kung 1,3, Fang-Pey Chen 1,3, Shu-Guan Chen 2, David M. Niddam 2, Jen-Chuen Hsieh 2,3 1 Center for Traditional Medicine, Taipei Veterans General Hospital 2 Integrated Brain Research Laboratory, Taipei Veterans General Hospital 3 National Yang-Ming University Abstract Motor points of a muscle are one of the basic structures in acupuncture point, but their role and function are seldom investigated. In this study, we investigated this issue by recording the somatosensory evoked potentials (SEPs) elicited by electrical needling in acupuncture point (Quchi, LI-11), motor point (MP) and non-motor point of extensor carpi radialis longus muscle (MM). The results showed that the peak latency and pattern of SEPs elicited by electrical needling in LI-11 and MP were similar. The amplitude of SEPs elicited by electrical needling in LI-11 was higher than that of MP. There was no obvious SEPs generation when MM was electrical needling. It implied that motor points actually were one of the important structures composing some acupuncture points. The roles of motor points in acupuncture therapy were postulated to have analgesic and anti-spastic effect. Key words: motor point, acupuncture, somatosensory evoked potentials
50