医疗行为作为一种本能伴随于动物的整个生命过程中，而一切医学的起源最初也是本能医学。本文从生物进化的角度阐释针灸等体表刺激疗法的作用机制。体表形成的这些特殊结构与针灸为代表的刺激疗法密切相关：1）皮肤应激刺激能够诱发角质细胞等分泌糖皮质激素等多种内分泌物质，发挥广泛的生物学效应；2）皮肤的各种感觉传入能够激活控制疼痛信号的闸门，产生良好的镇痛作用；3）体表传入能够与内脏传入在神经系统的多个水平发生相互作用，触发对各功能系统的调节作用。
Medicine originates from instinctive behavior and lives of animals are maintained by self-healing. We put forward the somatic stimulation as acupuncture from the perspective of biological evolution in that acupuncture is related to specific structures on the surface of human body:Skin stressor may induce keratinocytes to secrete glucocorticoid and other endocrine substances, to generate diffused bioeffects; Somatic inputs may stimulate pain control gate to produce analgesia; Somato-visceral afferents may integrate at different levels and activate multiple functional regulation.
[1] Zouboulis C C.The skin as an endocrine organ[J].Dermatoendocrinol,2009,1:250-252.
[2] Roosterman D,Goerge T,Schneider S W,et al.Neuronal control of skin function:The skin as a neuroimmunoendocrine organ[J].Physiological Reviews,2006,86:1309-1379.
[3] Fichtelius K E,Groth O,Liden S.The skin,a first level lymphoid organ[J].International Archives of Allergy and Immunology,1970,37:607-620.
[4] Streilein J W.Lymphocyte traffic,T-cell malignancies and the skin[J].Journal of Investigative Dermatology,1978,71:167-171.
[5] Bos J D,Zonneveld I,Das P K,et al.The skin immune system (SIS):distribution and immunophenotype of lymphocyte subpopulations in normal human skin[J].Journal of Investigative Dermatology,1987,88:569-573.
[6] Paus R,Theoharides T C,Arck P C.Neuroimmunoendocrine circuitry of the ‘brain-skin connection’[J].Trends Immunology,2006,27:32-39.
[7] Melzack R,Wall P D.Pain mechanisms:a new theory[J].Science,1965,150:971-979.
[8] Avery D G,Thomas J H.Feeding and defecation[C]//C.elegans Ⅱ.Riddle D L,Blumenthal T,Meyer B J,et al.New York:Cold Spring Harbor Lab Press,1997:679-716.
[9] Jellies J,Kopp D M,Bledsoe J W.Development of segment-and target-related neuronal identify in the medicinal leech[J].Journal of Experimental Biolo-gy,1992,170:71-92.
[10] Muller K J,Nicholls J G,Stent G S.Neurobiology of the Leech[M].Long Island,New York:Cold Spring Harbor Lab Press,1981:51-78.
[11] Loer C M,Jellies J,Kristan W B Jr,et al.Segment-specific morphogenesis of leech retzius neurons requires particular peripheral targets[J].Journal of Neuroscience,1987,7:2630-2638.
[12] Raible D W,Eisen J S.Restriction of neural crest cell fate in the trunk of the embryonic zebrafish[J].Development,1994,120:495-503.
[13] Fye W B.Carl Ludwig[J].Clin Cardiol,1991,14:361-363.
[14] Cervero F,Tattersall J E.Somatic and visceral sensory integration in the thoracic spinal cord[J].Progress in Brain Research,1986,67:189-205.
