Editor's Choice—Specificity of acupuncture acupoints:observation by functional magnetic resonance imaging

Acupuncture at certain acupoints （specific sites for needle insertion） can induce the activation of specific regions of the brain. This activated brain region influences the target organ or tissue in order to treat the disease. Acupoint specificity is the basis of acupuncture therapy.

Mechanism of acupoint penetration acupuncture therapy regulating chondrocyte autophagy via the PI3K/Akt-mTOR pathway in KOA rats

Objective:To investigate whether acupoint penetration acupuncture(APA)could regulate chondrocyte autophagy and apoptosis via the PI3K/Akt-mTOR signaling pathway to reduce cartilage degeneration in knee osteoarthritis(KOA)rats.Methods: KOA was induced in rats via intra-articular injection of sodium iodoacetate resolution.Forty male Sprague-Dawley rats were randomly assigned to blank control,model,APA,electro-acupuncture(EA),and sham model groups(n=8)and those in the APA and EA groups received their respective therapies.Following completion of the treatment course,histological examinations of cartilage and muscle were conducted.Levels of apoptosis-and autophagy-related factors,including Bax,Bcl-2,mTOR,ULK-1,and Beclin-1 protein,and mRNAs were assessed.Additionally,β-endorphin(β-EP)concentrations in the brain and serum were measured.Results: Histological analysis revealed that APA alleviated cartilage and muscle damage compared with the model group.APA inhibited cartilage degeneration by modulating the expression of apoptosis-and autophagy-related proteins and mRNA,thus preventing chondrocyte apoptosis.In the APA group,Bax and mTOR protein levels were significantly lower than those in the model group(both P=.024).Conversely,the Bcl-2 expression level was significantly higher than that in the EA group(P=.035).Additionally,ULK-1 expression was significantly lower than that in the EA group(P=.045).The mRNA level of Bax was significantly higher than that in the blank control group(P<.001).However,Beclin-1 levels were significantly higher than those in both the model and EA groups(both P<.001).ELISA results showed a significant decrease in the concentration ofβ-EP in the brains of the rats in the APA group compared with those in the model group(P=.032).Conclusions: APA reduced osteoarthritis-related pain and alleviated cartilage damage by upregulating chondrocyte autophagy and down-regulating apoptosis via signaling pathways involving PI3K/Akt-mTOR in KOA rats.

COMBINED TREATMENT OF 198 CASES OF INSOMNIA WITH ACUPUNCTURE OF BODY ACUPOINTS PLUS PELLET PRESSING OF OTOPOINTS

Objective: To observe the therapeutic effect of acupuncture of body acupoints plus otopoint pellet-pressing for treatment of insomnia. Methods: A total of 198 cases of insomnia patients were observed. Straight inserted the filiform needles into Shenmen (HT 7), Neiguan (PC 6), Zhaohai (KI 6) and Zusanli (ST 36) and manipulated the needles with uniform reinforcing-reducing method, then otopoints as Ershenmen (MA-TF 1), Shen (MA-SC), Gan (MA-SC 5), etc. were stimulated by pressing the stuck vaccaria seeds. Ten treatments were considered as a therapeutic course. Results: Of the 198 cases, 65 (32%) were cured, 76 (38%) had remarkable improvement, 53 (26%) had improvement and 4 (2%) had no effect, with the total effective rate being 97%. Conclusion: Acupuncture of body acupoints plus otopoint pellet pressing works well in treatment of insomnia.

RELATIONSHIP OF ACUPOINTS AND MERIDIANS TO CONNEXIN 43

Objective To explore the relationship between connexin 43 and acupoints and meridians. Methods we detected one major skin gap junction connexin （connexin43, Cx43） in meridians and acupoints, and studied the expression of Cx43 in Zusanli （足三里 ST 36） acupoints compared with control non-acupoint regions in rats after acupuncture treatments. The expression of Cx43 was detected by using immunohisto- chemistry, immunoblotting, and RT-PCR for Cx43 protein and mRNA level. Results The results showed much more abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat at ST 36 acupoints and bladder and kidney meridians than that of in the controls. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those of in the control points in non-acupuncture groups and even more so after acupuncture treatments. Conclusion Our research implied that connexins and gap junctions could have a close relationship to acupoints and meridians, and gap junctional intercellular communication might play an important role in the effect of acupuncture.

Mechanisms of electroacupuncture effects on acute cerebral ischemia/reperfusion injury:possible association with upregulation of transforming growth factor beta 1

Electroacupuncture at the head acupoints Baihui（GV20） and Shuigou（GV26） improves recovery of neurological function following ischemic cerebrovascular events,but its mechanism remains incompletely understood.We hypothesized that the action of electroacupuncture at these acupoints is associated with elevated serum levels of transforming growth factor beta 1（TGF-β1）.To test this,we established a rat model of cerebral ischemia by middle cerebral artery occlusion.Electroacupuncture was performed at Baihui and Shuigou with a “dispersedense” wave at an alternating frequency of 2 and 150 Hz,and at a constant intensity of 3 m A.Each electroacupuncture session lasted 30 minutes and was performed every 12 hours for 3 days.Neurological severity scores were lower in injured rats after acupuncture than in those not subjected to treatment.Furthermore,serum level of TGF-β1 was greater after electroacupuncture than after no treatment.Our results indicate that electroacupuncture at Baihui and Shuigou increases the serum level of TGF-β1 in rats with acute cerebral ischemia/reperfusion injury,and exerts neuroprotective effects.

Central neuromechanisms underlying control of intragastric pressure through acupuncture at Zusanli(ST36) in rats: the upper cervical cord is the key link between the ascending and descending pathways

Sensory inputs stimulated by Zusanli（ST36） acupuncture in the abdomen are known to converge in the upper cervical cord. However, it is unclear whether these inputs are subsequently conveyed to the hypothalamic paraventricular nucleus and what kind of afferent fibers are involved. We focused on the upper cervical cord, where afferent inputs converge, and detected c-fos expression in oxytocinergic neurons. We found that Zusanli acupuncture therapy effectively elevated intragastric pressure, but inhibited expression of c-fos in oxytocinergic neurons of the paraventricular nucleus in upper cervical cord injured rats. These Zusanli acupuncture effects remained even after complete dorsal cord transection. However, after complete transection of the spinal cord or dorsolateral funiculus, the effects were significantly attenuated and even disappeared. These findings suggest that the paraventricular nucleus is responsible for pooling and integrating signals from the Zusanli acupuncture and sensory information from the intragastric pressure variation, thereby contributing to the regulation of intragastric pressure. The upper cervical cord serves as the key link between ascending and descending pathways, which conveys afferent inputs to the paraventricular nucleus through the dorsolateral funiculus.

THEORY OF OPPOSITE ACUPOINTS AND ITS CLINICAL APPLICATION

In the light of the position character, acupoints situating on the corresponding medial and lateral sides of the limbs or in the front and back parts of the body trunk are called as “opposite acupoints”. In the present paper, the author expounds its theoretical basis from yin-yang theory, investigates its origin from the location of acupoints and ancient clinical application, and introduces its current application in clinical practice. In addition, the author lists 4 typical cases about treatment of hysteric convulsion, pregnant hypertension, child bed-wetting and leucorrhagia with opposite acupoints. Clinical practice demonstrates that opposite acupoints therapy is fewer in taking acupoints for one session of treatment, simple in operation, and good in the therapeutic effect for treatment of various diseases of different systems in the human body.

OBSERVATION OF THERAPEUTIC EFFECT ON TREATMENT OF THE GREATER OCCIPITAL NEURALGIA WITH ACUPUNCTURE

To compare the differences in therapeutic effects on treatments of the greater occipital neuralgia between acupuncture and western medicine. Method. Sixty cases of the greater occipital neuralgia were randomized into acupuncture group （30 cases） and western medicine group （30 cases）. In acupuncture group, acupuncture was applied on Fengchi （ 风池 GB 20）, Chengling （承灵 GB 18）, Xuanzhong （悬钟 GB 39） and Ashi （阿是穴）, once everyday. In western medicine group, carbamazepine was administrated orally, 100 mg, Bid × 10 days. Results： In acupuncture group, 25 cases （83.3%） were cured, 4 cases （13.3%） remarkably effective, 1 case （3.4%） effective and 0 case ineffective. In western medicine group, 16 cases （53.3%） were cured, 7 cases （23.3%） remarkably effective, 2 cases （6.7%） effective and 5 cases （ 16.7 % ） ineffective. The cured-markedly effective rates of two groups were 96.6 % and 76.6 % respectively, indicating significant difference between two groups （P 〈 0.05）. Conclusion： The therapeutic effect with acupuncture on the greater occipital neuralgia was significant compared with that with carbamazepine.

A REPORT ON THE TREATMENT OF STEROID RESISTANT ASTHMA WITH ACUPUNCTURE-MOXIBUSTION AND ACUPOINT INJECTION

In the present paper, the authors report their results of treatment of 5 cases of steriod resistant asthma with acupoint-injection, body acupuncture, moxibustion and cupping. Bilateral Zusanli (ST 36) are used for acupoint injection of mixture solution of placenta tissue injectio (2 mL), Danggui (Radix Angelicae Sinesis) injectio (2 mL) and Huangqi (Radix Astragli seu Hedysari) injectio (4 mL), with 4 mL for each acupoint. Acupoints used for puncturing are bilateral Yuji (LU 10), Dingchuan (EX-B 1), Feishu (BL 13), Fengmen (BL 12), Gaohuangshu (BL 43), Taiyuan (LU 9), Fenglong (ST 40), Shenshu (BL 23), Zusanli (ST 36), etc.. Dazhui (GV 14), Tanzhong (CV 17), and Zhongwan (CV 12) are moxibustioned after insertion of acupuncture needles and achieving needling sensations. Cupping is applied to bilateral Dingchuan (EX-B 1) after removing acupuncture needles with a little blood out. Following 3 days’ treatment, these 5 asthma patients who have no apparent response to conventional medication treatment are relieved strikingly in the attack frequency, till the 7th day of the treatment, they have no any asthmatic onset again. One month’s follow-up shows no recurrence. Results indicate that acupuncture with moxibustion and cupping is fairly effective in relieving steriod resistant asthma patients who have no effect in responding to glucocorticoid treatment.

TREATMENT OF NINETY-FIVE CASES OF MULTIPLESCLEROSIS WITH ACUPUNCTURE

From December of 1998 to August of 2002, the author treated 95 cases of multiple sclerosis with acupuncture. The observation has confirmed that acupuncture is a very effective method for treating this disease, especially to sclerosis patients in the early stage; and furthermore it can slow down the development of the pathological conditions of the patients. Thus it is an important therapeutic method worthy of the choice by European and American clinical doctors.

EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n=11), acupoint skin electrical stimulation combined with epidural anesthesia (B) group (n=11) and simple epidural anesthesia (C) group (n=11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2～3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before, during and 3 days after operation for detecting plasma NE, E and DA contents. Results: ① During operation, plasma NE of group A and B lowered in comparison with pre operation, particularly group A (P<0.01), while in group C, plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre operation (P< 0.01). Plasma DA in the 3 groups all raised during operation. ② Three days after operation, plasma NE, E and DA levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effect has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. Conclusion: Acupuncture or acupoint surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE OF JIAJI (EX-B2) IN THE TREATMENT OF APOPLECTIC SPASTIC HEMIPLEGIA

Objective: To compare the therape utic effects of acupuncture of different acupoints in the treatment of spast ic hemiplegia of apoplexy. Methods: Eighty stro ke patients with spastic hemiplegia were evenly randomized into control grou p and treatment group. Forty cases of treatment group were given with acupun cture of Jiaji (夹脊 EX-B2) from T1 to L5, while forty cases of control gro up were treated with conventional acupoints as Jianyu (肩NFDA1 LI 15), Quchi (曲池 LI 11), Huantiao (环跳 GB 30), Zusanli (足三里 ST 36), Kunlun (昆仑 BL 60), etc. o n the diseased side, once daily, with 10 sessions being one therapeutic course, and 3 courses all together. The modified Ashworth Scale (MAS) and neurological d eficit grading scale (NDS) were used as the indexes to assess the therapeutic ef fects. Results: After treatment, the scores of NDS of both treat ment and control groups reduced and the difference value between post- and pre-treatment of tr ea tment group was significantly bigger than that of control group. MAS showed a si milar tendency in both groups. Of the 40 cases in treatment and control groups, 6 and 1 were cured, 20 and 15 had marked improvement, 9 and 11 had improvement, 4 and 8 failed, 1 and 5 got worse, with the total effective rates being 87.5% an d 67.5% respectively. The therapeutic effect of treatment group was significantl y superior to that of control group (P<0.01). Conc lusion: Acupuncture of Jiaji ( EX-B2) is superior to acupuncture of conventional acupoints in alleviating the state of spastic hemiplegia of apoplexy.

COMMENTS ON THE STUDY OF ACUPOINT COMBINATION AND REMEDIES FOR TREATMENT OF DIABETES MELLITUS WITH ACUPUNCTURE AND MOXIBUSTION

In the present paper, the author reviews the progresses in the study on acumoxi (acupuncture-moxi-bustion) treatment of diabetes mellitus (DM) from Chinese ancient classical works, Chinese and foreign journals. The therapeutic results reveal that acupuncture treatment of DM is effective in improving DM patients' symptoms via vagal-nerve reflex, regulation of neuroendocrine and immune functions. The author holds that ① correct selection of acupoints in accordance with syndrome differentiation and the related meridians and combined application of acupuncture and Chinese herbal medicines (for oral administration) are the key points for raising the therapeutic effect; and ② acupoint combination and curative methods need to be researched further.

Magnetic stimulation at Neiguan(PC6) acupoint increases connections between cerebral cortex regions

Stimulation at specific acupoints can activate cortical regions in human subjects.Previous studies have mainly focused on a single brain region.However,the brain is a network and many brain regions participate in the same task.The study of a single brain region alone cannot clearly explain any brain-related issues.Therefore,for the present study,magnetic stimulation was used to stimulate the Neiguan（PC6） acupoint,and 32-channel electroencephalography data were recorded before and after stimulation.Brain functional networks were constructed based on electroencephalography data to determine the relationship between magnetic stimulation at the PC6 acupoint and cortical excitability.Results indicated that magnetic stimulation at the PC6 acupoint increased connections between cerebral cortex regions.

Nitric Oxide Signaling Molecules in Acupoints:Toward Mechanisms of Acupuncture

Recent clinical trial studies have demonstrated that the effects of acupuncture on pain improvement are small and no difference between acupoints and non-points. Whether acupuncture needles must be inserted in specific points depends on whether acupoint specificity exists that is still not resolved, and is now urgent. Previous anatomical studies have demonstrated that acupoints exist higher number of nerve fibers/trunks, blood vessels, hair follicles, and sweat glands as well as density of the gap junction. Recent evidence shows that nitric oxide（NO） level is elevated in the acupoints/meridians and is associated with an enhanced expression of NO synthase endowed with transient receptor potential vanilloid type-1. There is growing evidence from international groups showing that acupuncture induces NO-mediated vasodilatation, which increases local blood flow and allows for a flush of algesic or sensitizing substances, leading to pain relief. Previous studies, using a novel biocapture system, have demonstrated that NOx–（total nitrite and nitrate） and cyclic guanosine monophosphate（c GMP） concentrations are consistently increased over skin acupoints compared to non-meridian control regions（NMCR） in humans. Dermal microdialysis in humans showed that NO-c GMP releases in the subcutaneous tissue of acupoint are higher than those in NMCR and increased by electroacupuncture（EA）. Recent studies have demonstrated that low-frequency electrical stimulation and manual acupuncture with low stimulating force and rate produce an elevation of NO release predominantly over acupoints. In contrast, NO levels over the areas of the skin regions are moderately reduced by high-frequency EA stimulation. The results from anatomical and biochemical studies consistently show that acupoints exist higher levels of NO signaling molecules, and stimulus-evoked NO release is also with a higher level at acupoints. Results suggest that NO signaling molecules contribute to the specificity of acupoints, and selecting well-trained acupuncturetists for using correct acupoints and appropriate parameters should improve acupuncture clinical trial studies.

ACUTE WAIST SPRAIN TREATED BY ACUPUNCTURING DONGSHI ACUPOINT

Acute waist sprain is a local injury of themuscle, fascia and ligament in the waist due tosudden overstretch by external force beyond thenormal physiological limit. Acute waist spraincan lead to cicatrix adhesion, loss of normal tis-sue function and chronic waist pathologicalchanges without timely and effecthe treatment.Long time treatment without cure will affectboth work and daily life.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPOINT INJECTION FOR TREATMENT OF GOUTY ARTHRITIS

In the present paper, 60 cases of gouty arthritis patients were randomly divided into acupuncture group (n=30) and acupoint injection group (n=30). In these two groups, the tender point was used as the main acupoint, combined with Taichong (LR 3), Yinbai (SP 1), Sanyinjiao (SP 6), Juegu (GB 39), Xuehai (SP 10), etc. 10% Chishao (Radix Paeoniae Rubra) Injection and dexamethasone were used for acupoint injection. Results indicated that in acupoint injection and acupuncture groups, 15 (50.0%) and 9 (30.0%) cases had marked improvement, 12 (40.0%) and 10 (33.3%) were effective, and 3 (10.0%) and 11(36.7%) failed in treatment, with the total effective rats being 90.0% and 63.3% respectively. Statistical analysis shows that acupoint injection is significantly superior to simple acupuncture in the therapeutic effect (P<0.05).

Influence of cluster needling at scalp acupoints combined with rehabilitation training on balance functions of children with cerebral palsy

Objective To observe therapeutic effects of scalp acupuncture at close acupoints combined with rehabilitation training on balance functions of children with cerebral palsy （CP）. Methods Sixty children with CP were randomly divided into a scalp acupuncture combined with rehabilitation training group （group SA＋RT） and a rehabilitation training group （group RT） with 30 cases in each group. Conventional rehabilitation therapy and balance training were applied in group RT, and scalp acupuncture at close acupoints in the parietal region and sub-occipital region was added besides rehabilitation training in group SA＋RT. Balance functions were evaluated by using Berg rating scale, and abilities of daily living were estimated by using rating scale for activities of daily living （ADL）. Results After treatment, both Berg scores for balance and ADL scores were significantly improved in both groups （all P0.05）, and the improvement in group SA＋RT was more obvious than that in group RT （ both P0.05）. Conclusion Combination of scalp acupuncture at close acupoints with rehabilitation training is superior to simple rehabilitation training in improving balance functions and activities of daily living in children with cerebral palsy.