[Acupuncture and biological resilience].

Abstract

This paper systematically elaborates the theories of stress, biological resilience and hormesis. Mild low-dose stress induces organismic overcompensation via preconditioning, activates nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated antioxidant, autophagy, DNA repair and other pathways, and presents an inverted U-shaped biphasic dose-response relationship. Preconditioning is categorized into local and remote types, which exerts long-term protective effects on systemic organs via metabolic reprogramming as well as neuro-humoral and immune pathways, with 2 distinct protective time windows (early and delayed). Numerous clinical trials have validated that remote ischemic preconditioning improves the prognosis of organ transplantation, stroke, hypertension and other diseases, yet its clinical application is limited by the requirement to predict injuries in advance. It proposes that somatic stimulation therapies including acupuncture, scraping and cupping act as mild stress-like interventions that fully conform to the six core characteristics of hormesis. By regulating oxidative stress, inflammatory response, mitochondrial function and DNA repair pathways, these therapies elevate systemic biological resilience, consistent with the evolutionary law that "mild stress confers benefits" and the traditional Chinese medicine health-preserving philosophy of tempering vitality through hardship as recorded in ancient texts. Acupuncture can be applied to perioperative care, chronic disorders, neurological diseases and full-life-cycle health management. Nevertheless, current research on acupuncture modulating resilience-related pathways remains insufficient, and in-depth exploration of its underlying basic mechanisms and clinical translation is still warranted. 本文系统阐释应激、生物抗逆性与“亢强效应”（hormesis）理论，低剂量温和应激可通过预适应诱导机体过度补偿，激活核因子E2相关因子2（Nrf2）抗氧化、自噬、DNA修复等通路，形成倒“U”形双向剂量效应;预适应分为局部与远程两类，依托代谢重塑、神经-体液-免疫通路实现全身脏器长效保护，存在长短两个保护时间窗。远程缺血预适应已经被大量临床试验证实，可改善器官移植、卒中、高血压等疾病预后，但存在需提前预判损伤的局限。提出针灸、刮痧、拔罐等体表刺激属于类应激温和干预，完全契合“hormesis”的6大特征，可通过调控氧化应激、炎性反应、线粒体及DNA修复通路提升全身生物抗逆能力，契合“小害有益”的进化规律与中医“苦其心志”的抗逆养生思想。针灸可应用于围手术期、慢性病、神经疾病及全生命周期健康管理;但目前针灸调控抗逆通路相关研究尚缺乏，基础机制与临床转化仍有待深入探索。.