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Why Can Acupuncture at ST36 Activate the Vagus Nerve?

Why Can Acupuncture at ST36 Activate the Vagus Nerve?
為什麼針灸足三里（ST36）能「激活迷走神經」？
Important clarification｜重要澄清：
The vagus nerve does not anatomically pass through ST36. When studies state that “electroacupuncture at ST36 activates the vagus nerve,” they are referring to a reflex neural circuit, not direct anatomical contact.

迷走神經在解剖學上並不經過足三里（ST36）。 當研究指出「電針 ST36 可激活迷走神經」時，所指的是反射性神經迴路，而非直接刺激迷走神經本身。
The Core Concept｜核心概念
ST36 → Peripheral sensory input → Central integration → Vagal output

ST36 functions as a somatic stimulation site on the lower limb. Signals generated at this site first travel through peripheral sensory nerves, are integrated within the central nervous system, and only then result in downstream activation of the vagus nerve.

足三里是一個體表刺激點。 其刺激訊號會先經由下肢周邊感覺神經向上傳入，在中樞神經系統整合後，才引發迷走神經的輸出反應。

How the Reflex Circuit Works｜反射性神經迴路如何運作
  • Input (Afferent)：
    Sensory nerves in the lower limb transmit signals generated by acupuncture at ST36.
    輸入端（傳入）：腿部的感覺神經將足三里刺激產生的訊號向上傳遞。
  • Central Integration (CNS)：
    Signals enter the spinal cord and ascend to brainstem regions involved in autonomic regulation.
    中樞整合：訊號進入脊髓，並上行至與自律神經調控相關的腦幹區域。
  • Output (Efferent)：
    The brainstem activates parasympathetic output via the vagus nerve, modulating inflammation and organ function.
    輸出端（傳出）：腦幹啟動迷走神經的副交感輸出，進而調節發炎反應與臟器功能。
A Simplified Anatomical Pathway｜簡化的解剖路徑理解
  1. Sensory afferents in the ST36 region (commonly associated with branches of the deep peroneal and tibial nerves).
    足三里區域的感覺神經（常與腓深神經、脛神經分支相關）。
  2. Convergence into proximal nerve trunks and lumbar–sacral spinal segments.
    訊號向近端匯入神經幹，進入腰骶段脊髓。
  3. Ascension to brainstem autonomic centers.
    上行至腦幹自律神經中樞。
  4. Activation of vagal parasympathetic output.
    啟動迷走神經副交感輸出。
Why This Matters: The Anti-Inflammatory Reflex

Through this vagus-mediated reflex—often described as the cholinergic anti-inflammatory pathway—immune cells reduce the release of pro-inflammatory cytokines such as TNF-α and IL-6, helping to control excessive inflammation in conditions like sepsis and intestinal barrier injury.

透過這條由迷走神經介導的反射性路徑（常稱為膽鹼能抗炎途徑），免疫細胞可降低 TNF-α、IL-6 等促炎細胞因子的釋放，從而協助控制敗血症或腸道屏障損傷中的過度炎症反應。

Take-home message｜重點帶走：
Acupuncture at ST36 does not stimulate the vagus nerve directly. Instead, it engages a well-defined somato–autonomic reflex circuit, translating peripheral sensory input into central autonomic regulation.

足三里並非「直接刺激迷走神經」，而是透過體感－自律神經反射迴路，將周邊刺激轉化為中樞與自律神經層級的調控。
🔽 References｜參考文獻 Click to expand｜點擊展開
  1. Tracey KJ. The inflammatory reflex. Nature. 2002;420(6917):853–859.
    （提出膽鹼能抗炎反射的經典理論）
  2. Borovikova LV, Ivanova S, Zhang M, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000;405(6785):458–462.
    （迷走神經刺激抑制全身性發炎反應的關鍵實驗）
  3. Hu S, et al. Electroacupuncture at Zusanli (ST36) prevents intestinal barrier and remote organ dysfunction following gut ischemia through activating the cholinergic anti-inflammatory-dependent mechanism. Evid Based Complement Alternat Med. 2013;2013:592127.
    （ST36 → 迷走神經依賴性抗炎反射 → 腸道屏障）
  4. Du MH, et al. Electroacupuncture improves gut barrier dysfunction in prolonged hemorrhagic shock rats through vagus anti-inflammatory mechanism. World J Gastroenterol. 2013;19(36):5988–5999.
    （證實迷走神經切斷會消除電針的腸道保護效果）
  5. Liu JH, Yan SY, Chen JDZ. Somatic afferent nerve stimulation activates vagal efferent pathways and suppresses inflammation. Autonomic Neuroscience. 2017;205:70–76.
    （體感神經 → 中樞 → 迷走神經輸出的反射性神經迴路）
  6. Li Y, Yu L, Chen Y, et al. Revealing the biological mechanism of acupuncture in alleviating excessive inflammatory responses and organ damage in sepsis: a systematic review. Frontiers in Immunology. 2023;14:1242640.
    （系統性整理針灸—體感—自律神經—免疫調控機制）

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