The modulation of brain functional connectivity with manual acupuncture in healthy subjects:An electroencephalograph case study

Manual acupuncture is widely used for pain relief and stress control.Previous studies on acupuncture have shown its modulatory effects on the functional connectivity associated with one or a few preselected brain regions.To investigate how manual acupuncture modulates the organization of functional networks at a whole-brain level,we acupuncture at ST36 of a right leg to obtain electroencephalograph（EEG） signals.By coherence estimation,we determine the synchronizations between all pairwise combinations of EEG channels in three acupuncture states.The resulting synchronization matrices are converted into functional networks by applying a threshold,and the clustering coefficients and path lengths are computed as a function of threshold.The results show that acupuncture can increase functional connections and synchronizations between different brain areas.For a wide range of thresholds,the clustering coefficient during acupuncture and postacupuncture period is higher than that during the pre-acupuncture control period,whereas the characteristic path length is shorter.We provide further support for the presence of ＂small-world＂ network characteristics in functional networks by using acupuncture.These preliminary results highlight the beneficial modulations of functional connectivity by manual acupuncture,which could contribute to the understanding of the effects of acupuncture on the entire brain,as well as the neurophysiological mechanisms underlying acupuncture.Moreover,the proposed method may be a useful approach to the further investigation of the complexity of patterns of interrelations between EEG channels.

Hepatoprotective effect of manual acupuncture at acupoint GB34 against CCl_4-induced chronic liver damage in rats

AIM： To investigate the hepatoprotective effect of manual acupuncture at Yanglingquan （GB34） on CCl4-induced chronic liver damage in rats. METHODS： Rats were injected intraperitoneally with CCh （1 mL/kg） and treated with manual acupuncture using reinforcing manipulation techniques at left GB34 （Yanglingquan） 3 times a week for 10 wk. A nonacupoint in left gluteal area was selected as a sham point. To estimate the hepatoprotective effect of manual acupuncture at GB34, measurement of liver index, biochemical assays including serum ALT, AST, ALP and total cholesterol, histological analysis and blood cell counts were conducted. RESULTS： Manual acupuncture at GB34 reduced the liver index, serum ALT, AST, ALP and total cholesterol levels as compared with the control group and the sham acupuncture group. It also increased and normalized the populations of WBC and lymphocytes. CONCLUSION： Manual acupuncture with reinforcing manipulation techniques at left GB34 reduces liver toxicity, protects liver function and liver tissue, and normalizes immune activity in CCh-intoxicated rats.

Pretreatment of emulational manual acupuncture versus electroacupuncture against visceral traction pain in rats

BACKGROUND： Acupuncture and moxibustion against visceral noxious stimulation present different mechanisms in the peripheral and central nervous systems, involving release of neurotransmitter substance P, acetylcholine esterase, leucine-enkephalin, and c-Fos protein expression. However, there are few reports addressing changes in neurotransmitter expression following manual acupuncture and electroacupuncture against visceral traction pain.OBJECTIVE： To explore changes in neurotransmitter expression in the ileum and protein expression in the medullary visceral zone of visceral traction pain rats undergoing pretreatment of emulational manual acupuncture, and to investigate the differences between emulational manual acupuncture and electroacupuncture.DESIGN, TIME AND SETTING： The randomized, controlled study was performed at the Biomedical Engineering Laboratory, Shanghai University of Traditional Chinese Medicine, Shanghai, China from August 2008 to July 2009.MATERIALS： G6805 electroacupuncture apparatus （Shanghai Medical Electronic Machine Factory, China） and ZSF-I acupuncture manipulation simulation therapeutic system （Chinese Medical Engineering Room, Shanghai University of Traditional Chinese Medicine, Shanghai China） were used in the present study.METHODS： A total of 40 male Sprague Dawley rats were equally and randomly assigned to sham surgery, model, emulational manual acupuncture and electroacupuncture groups. In the emulational manual acupuncture and electroacupuncture groups, emulational manual acupuncture and electroacupuncture were applied at bilateral Zusanli （ST 36） acupoints for 30 minutes, and models of visceral traction pain were established immediately.MAIN OUTCOME MEASURES： Substance P expression, c-Fos and glial fibrillary acidic protein expression were measured using immunohistochemistry. Acetylcholine esterase activity was examined utilizing a colorimetric method. Leucine-enkephalin content was detected using a radioimmune assay. Degree of pain in rats was assessed by pain score.RESULTS： Pain score, substance P expression in the ileum, acetylcholine esterase activity, expression of c-Fos protein and glial fibrillary acidic protein in the medullary visceral zone were significantly decreased following pretreatment of emulational manual acupuncture and electroacupuncture in rats with visceral traction pain （P〈0.05）. Compared with the electroacupuncture group, the leucine-enkephalin content was significantly increased, and pain score was significantly diminished in the emulational manual acupuncture group （P〈0.05）.CONCLUSION： Emulational manual acupuncture pretreatment decreases acetylcholine esterase activity, increases leucine-enkephalin release, downregulates expression of c-Fos protein and glial fibrillary acidic protein and ultimately inhibits visceral traction pain by reducing substance P release. The effectiveness in inhibiting visceral traction pain is greater when using emulational manual acupuncture compared with electroacupuncture. This is because emulational manual acupuncture effectively increases leucine-enkephalin release.

Modulation of electroencephalograph activity by manual acupuncture stimulation in healthy subjects:An autoregressive spectral analysis

To investigate whether and how manual acupuncture（MA） modulates brain activities,we design an experiment where acupuncture at acupoint ST36 of the right leg is used to obtain electroencephalograph（EEG） signals in healthy subjects.We adopt the autoregressive（AR） Burg method to estimate the power spectrum of EEG signals and analyze the relative powers in delta（0 Hz-4 Hz）,theta（4 Hz-8 Hz）,alpha（8 Hz-13 Hz）,and beta（13 Hz-30 Hz） bands.Our results show that MA at ST36 can significantly increase the EEG slow wave relative power（delta band） and reduce the fast wave relative powers（alpha and beta bands）,while there are no statistical differences in theta band relative power between different acupuncture states.In order to quantify the ratio of slow to fast wave EEG activity,we compute the power ratio index.It is found that the MA can significantly increase the power ratio index,especially in frontal and central lobes.All the results highlight the modulation of brain activities with MA and may provide potential help for the clinical use of acupuncture.The proposed quantitative method of acupuncture signals may be further used to make MA more standardized.

MANUAL ACUPUNCTURE PRODUCES LONG TERM INHIBITION OF THE NOCICEPTIVE TRANSMISSION TO WIDE DYNAMIC RANGE NEURONS IN THE SPINAL CORD OF THE RAT

singe unit discharge recordings were made from 42 WDR neurons in spinal dorsal horn in the rat. These neurons could he driven by electrical stimull activiting innocuous and noxious afferent fibres in the ipsilateral plantar nerve. Traditional manual acupuncture delivered at the local acupoints Zusanli, Chengshan, Kunlun and Yongquan induced a strong inhibition or the C-fiber response. in 19 of 42 neurons obtained but did not after the A-fibre response of the neurons. The inhibition of the fibre response outlasted the period of acupuncture for more than 30 min. Neither Anor C-fibre responses in the remaining 23 neurous could be affected by manual acupuncture. These results suggest that the acupuncture stimulation specifically influences nociceptive nociceptive transmission,maybe through a presynaptic action,Furthermore, the fact that the inhibitory effect outlasts the stimulation by more than 30 min indicates that either a neuromodulatory ,presumably peptidergic action is at hand or that a temporary synaptic modification occurs in the spinal dorsal horn.

Initiation of Acupoint Molecular Mechanisms for Manual Acupuncture Analgesia—Nuclear FactorκB Signaling Pathway

Objective To identify the prominent molecular signaling in acupoints and explore their roles in initiating the analgesia effect of manual acupuncture(MA).Method A three-step study was conducted,the experiment 1 was a genome-wide analysis of the tissue at acupoint Zusanli(ST 36),including 12 Wistar rats which were divided into control,control+MA1,and control+MA7 groups.In the experiment 2,the paw withdrawal latency(PWL),immunohistochemistry and Western blot analysis of phospho-nuclear factor kappa B(NFκB)p65(p-p65),phospho-NFκB p50(p-p50)at ST 36 were performed on rats of saline,saline+MA,and complete Freund’s adjuvant(CFA)+MA groups(n=6).In experiment 3,24 rats were divided into saline+DMSO,CFA+DMSO,CFA+DMSO+MA,and CFA+BAY 11–7082+MA groups,the PWL and immunofluorescence assay of NFκB p65 at ST 36 was conducted.Result(1)The gene:inhibitor of NFκB(Nfkbia),interleukin-1β(Il1b),interleukin-6(Il6),chemokine c-x-c motif ligand 1(Cxcl1),monocyte chemoattractant protein-1(MCP-1/Ccl2)expressions in the control+MA7 group were significantly increased(P<0.05 or P<0.01),and the expression of NFκB p65(Rela),NFκB p50(Nfkb1)were increased in the control+MA7 group(P<0.05).(2)CFA+MA groups showed increased PWL from day 1 to 7(P<0.01 vs.CFA),and the Western blot results were consistent with immunohistochemistry,the expression of NFκB p-p65 and NFκB p-p50 were significantly increased in the MA-related groups compared with control and CFA groups(P<0.05).(3)Compared with the CFA+DMSO+MA group,the PWL of the CFA+BAY 11–7082+MA group decreased significantly and continued until day 5 and 7(P<0.05 and P<0.01,respectively),and the NFκB p65 expression of CFA+BAY 11–7082+MA was significantly reduced compared with CFA+DMSO+MA(P<0.01).Conclusion Local NFκB signaling cascade in acupoint caused by MA is an important step in initiating the analgesic effect,which would provide new evidence for the initiation of MA-effect and improve the understanding of the scientific basis of acupuncture analgesia.

Peripheral Nerve Discharge Elicited by Manual Acupuncture at Zusanli (ST 36) Regulates Blood Pressure in Anesthetized Rats

Objective： To investigate target organ response by recording mean arterial blood pressure （MAP） fluctuation corresponding to nerve-tract discharges from the nerve innervating acupoint of Zusanli （ST 36） in the hind limb evoked by MA in anesthetized rats. Methods： Male SD rats anesthetized with chloral hydrate were randomly divided into 3 groups which were treated with manual acupuncture （MA）, injection of lidocaine followed by MA and injection of normal saline （NS） followed by MA, respectively. The right carotid artery was canulated for persistent measurement of the blood pressure and meanwhile nerve discharges from the nerve-tract were recorded for analysis with amplitude spike counts for every 5 s. Results： The results showed that there were significant nerve discharges recorded from the nerve-tract when applying MA at Zusanli （ST 36） and simultaneous decrease in the MAP, while there was no response when inserting a needle into the Zusanli （ST 36） without manipulation （P〈0.05）. Furthermore, the reduction of MAP during MA could be completely abolished after blockade of peripheral nerve discharges with an injection of lidocaine into the tissue around Zusanli （ST 36） but not with that of normal saline （NS）. Conclusion： These results indicate that MA at Zusanli （ST 36） can elicit the peripheral nerve discharges from the nerve innervating the acupoint; such kind of nerve discharges may contain acupuncture signal regulating blood pressure via somato-cardiovascular reflex.

Memory response to manual acupuncture in chronic insomniacs: evidence from event-related potentials

Objective:To investigate the effectiveness and safety of manual acupuncture for memory loss and sleep quality in chronic insomniacs.Methods:A total of 60 eligible participants were enrolled and randomized into either a treatment group or a control group,with 30 cases in each group.The treatment group was intervened by manual acupuncture whereas the control group was given sham acupuncture.In the two groups,the interventions were offered once every other day and three times a week,for 8 weeks in total.Before and after the treatment,Pittsburgh sleep quality index (PSQI) and eventrelated potentials (ERPs) were used to assess the patients' sleep quality and memory,respectively.Meanwhile,adverse events were monitored and recorded.Results:After 8-week treatment,both the treatment group and the control group showed a significant decrease in the PSQI global score (P<0.001,P<0.01),and the decrease in the treatment group was more significant than that in the control group (P<0.001).The intra-group comparisons of ERPs indicated that,the latencies of N1 and P3 were shortened and the amplitudes of N1 and P3 were increased in the treatment group after the intervention,and the differences were statistically significant (P<0.05,P<0.001);in the control group,there were no significant changes in the latency and amplitude after the treatment (P>0.05).The between-group comparisons of ERPs showed that the treatment group was more effective than the control group in shortening the latency of P3 (P<0.01).Conclusion:Acupuncture can be a safe and effective treatment option for chronic insomnia coupled with memory impairment.

The effect of manual acupuncture and electroacupuncture on lower limb muscle strength

Objective： To determine whether six weeks＇ of acupuncture has a positive effect on plantar flexion muscle strength and whether electroacupuncture （EA） has a greater effect than manual acupuncture （MA） on plantar flexion, so that the most beneficial method of acupuncture can be established for strengthening muscles. Methods： A randomized controlled trial with parallel groups. A total of 20 participants were randomly assigned to three groups： a control/non-acupuncture group （n=6）, a manual acupuncture group （MAG） （n=8） and an electroacupuncture group （EAG） （n=6）. MAG and EAG received three 25-minute treatments per week for 6 weeks. The control group continued with their normal training activity and received no treatment. The maximal voluntary contraction （MVC） of the ankle plantar-flexors at 30~ per second was measured using Biodex system 3, Results： Both MA and EA had a positive effect in increasing plantar flexion strength. The likelihood for this happening was high; 69% for MA and 92% for EA when compared with the control group. However the effect size was small for both groups. There was only a trivial difference in the effect size between the EAG and the MAG in regards to average plantar flexion torque. Conclusion： EA and MA have a beneficial effect on plantar flexion muscle strength compared with the control group in healthy population.

Labor Pain Treated with Acupuncture or Acupressure

Opioid-dependent women have an 80% to 90% unintended pregnancy rate, almost double the overall unintended pregnancy rate: 40% globally and 51% in north America. The prescription drug abuse milieu increases the possibility opioid abusing laboring patients. In 2012, neonatal abstinence syndrome occurred in 5.8 per 1000 hospital births. Non-pharmacological labor pain management (NPLPM) is especially recommended for laboring patients with a history of substance abuse. Therefore, literature review was performed to elucidate the efficacy and safety of acupuncture, noninvasive electro-acupuncture (EA), and acupressure in labor pain management. Compared to standard intrapartum controls, bilateral EA at JiaJin or Sanyinjiao significantly reduced visual analog scale (VAS) pain scores 30-minutes post intervention (p < 0.01) and Stage 1 active phase labor length (p < 0.05). EA achieves shorter Stage 2 labor than patient-controlled epidural analgesia (p = 0.05);and 10-point lower VAS pain scores and reduced cesarean delivery rate than no-analgesia controls, p < 0.05. Current evidence indicates that EA should have a role in NPLPM, and that acupressure may have a role in NPLPM. Nevertheless, future RCTs could strengthen the argument for increased EA and acupressure use in NPLPM.

Different Effects and Peripheral Mechanism between Manual-acupuncture and Electroacupuncture on Mast Cell Function and Acupuncture Analgesia by Nerve Block in Acupionts

Objective： To observe the effects of nerve block on MA and EA analgesia and mast cells degranulation in adjuvant arthritis rats in order to analyze the difference between the underlying peripheral mechanism of MA and EA analgesia. Methods： Zusanli （ST 36） was chosen as the acupuncturing point on adjuvant arthritis rats. Eighty SD rats were randomized into 10 groups, including control, model, normal＋Lido, EA, Lido＋EA, DLido＋ZEA, Xlido＋ZEA, MA, Lido＋MA, Dlido＋ZMA groups, with 8 rats in each group. Paw Withdraw Latencies and mast cells degranulation ratios were recorded and computed. Results： Compared with model group, the pain threshold （PT） and mast cells degranulation ratios of EA and MA groups were obviously increased （P〈0.05 or P〈0.01）. The analgesia effects of both MA and EA were obviously attenuated after nerve block by pretreated with Lidocaine hydrochloride at the acupuncturing point or at the acupiont of proximal end in the same neural stem while they were not by the same manipulations at the acupoint of distal end. Degranulation ratios of mast cells caused by MA or EA were not obviously affected by nerve block. Conclusion： The effective signal of nerve conduction of MA analgesia is generated after the degranulation of mast cells in the process of acupoints activation or needle sense and it is the direct cause of generation of nerve signal. In the condition of EA, the acupoints activation is caused by the stimulation of electric signal on nerve receptor while the degranulation of mast cells is concomitant or feedback effect.

De-qi,Not Psychological Factors,Determines the Therapeutic Efficacy of Acupuncture Treatment for Primary Dysmenorrhea

Objective： To study the impact of De-qi （得气%, obtaining qi） and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea, with an attempt to explore the relationship among De-qi, psychological factors, and clinical efficacy. Methods： The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation （manipulation group, n=67） and an acupuncture group without manipulation （non-manipulation group, n=64）. Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment. De-qi, the sensations a patient experienced during the acupuncture treatment, was scored on a 4-point scale by the subjects. In addition, the psychological factors, including belief in acupuncture, the level of nervousness, anxiety, and depression, were quantitatively assessed. The personality of the subject was assessed using the Eysenck personality questionnaire （EPQ） and 16 personality factor questionnaire （16PF）. Results： Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity （W=2410.0, P〈0.01 ） and pain duration （W=3181.0, P〈0.01） between the two groups. The number of De-qi acupoints （W=1150.5, P〈0.01） and the average intensity of De-qi （W=1141.0, P〈0.01） were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy. Conclusions： Compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

Effects of Acupuncture Pretreatment on Ischemic Cardiac Muscle Cell Apoptosis and Gene Expression in Ischemia-reperfusion Rats

Objective： To investigate the protective effects of acuptmcture pretreatment on ischemic myocardium, the protective mechanism of acupuncture pretreatment on ischemic myocardium was explored by observing the cardiac muscle cell apoptosis and the expression of HSP70 mRNA of ischemia-reperfusion injury rats treated with acupuncture pretreatment. Methods： Sixty-four Wistar rats were randomly divided into eight groups： control group, sham surgery group, ischemia-reperfusion group, ischemia pretreatment group, manual acupuncture pretreatment group （once a day）, electroacupuncture pretreatment group （once a day）, manual acupuncture pretreatment group （twice a day）, and electroacupuncture pretreatment group （twice a day）. The reperfusion model of rat myocardial ischemia was made. Expression of HSP70 mRNA was assayed by in situ hybridization, and cell apoptosis by TUNEL. Results： Compared with those in the control group and the sham surgery group, the apoptosis and the expression of HSP70 mRNA were increased in the ischemia-reperfusion group. Compared with those in the ischemia-reperfusion group, the cardiac muscle cell apoptosis was decreased and the HSP70 mRNA was increased in the rats treated with acupuncture pretreatment; meanwhile, acupuncture pretreatment twice a day had stronger effects than acupuncture pretreatment once a day and ischemia pretreatrnent. Conclusion： Acupuncture pretreatment can inhibit the cardiac muscle cell apoptosis, and up-regulate the expression of HSP70 mRNA in ischemia-reperfusion rats. Acupuncture pretreatment twice a day has stronger effects than pretreatment once a day.

Investigation of acupuncture in improving sleep,cognitive and emotion based on attenuation of oxidative stress in prefrontal cortex in sleep-deprived rats

Objective To explore whether acupuncture can improve sleep disturbance,cognitive impairment and emotional disorders caused by sleep deprivation,and its association with the attenuation of oxidative stress injury in prefrontal cortex.Methods Fifty-two male Sprague-Dawley rats were randomly divided into a control group(n=10),a model group(n=14),a manual acupuncture(MA)group(n=14),and a sham-MA group(n=14).All the groups were established as sleep deprivation models via the modified multiple platform method,except for the control group.Rats in both the MA group and the sham-MA group received corresponding intervention,respectively.After modeling and intervention,the four groups received three behavioral tests,namely sleep monitoring,by comprehensive lab animal monitoring system(CLAMS),Morris water maze(MWM)test and open-field test(OFT),followed by oxygen free radical level test and Western blot(WB)detection for the expression levels of Bax and Bcl-2.Results The MA group derived more sleep time within 24 h than either the model group or the sham-MA group(both P<0.05).On MWM orientation navigation test day 1,there were no significant differences in escape latency among the control,MA and sham-MA groups(P>0.05),and the escape latency was significantly shorter in these three groups than that in the model group(all P<0.05).On test day 4,the escape latency was markedly shorter in the MA group than that in either the model group or the sham-MA group(both P<0.05);meanwhile,the MA group showed significantly better performance compared with these two groups in space probe test(both P<0.05).In OFT,compared with the control group,there was a significant decline in the horizontal movement score in the other three groups(all P<0.05),and the decrease was more significant in the model group and the sham-MA group than that in the MA group(both P<0.05).The superoxide dismutase(SOD)content was markedly higher and the malondialdehyde(MDA)content was markedly lower in the MA group than those in the model group and the sham-MA group(all P<0.05).Compared with the model group and the sham-MA group,the expression of Bax was significantly lower and the expression of Bcl-2 was significantly higher in the MA group(all P<0.05).Conclusion MA therapy can lengthen the sleep time in sleep-deprived rats and improve learning and memory impairments induced by sleep deprivation,and the underlying mechanism may be associated with the enhancement of antioxidant capacity in the prefrontal cortex and the inhibition of hippocampal neuronal apoptosis.

Acupuncture Enhances Signalsat Sensitized Acupoints to Elevate Pressure Pain Thresholdin Knee Osteoarthritis Patients

Objective:To observe the pressure pain threshold(PPT),skin conductance(SC)and blood perfusion(BP)of the sensitized acupoints in patients with knee osteoarthritis(KOA),and explore the mechanism of acupuncture at the sensitized acupoints for treating diseases.Methods:Eleven healthy subjects and 11 unilateral KOA patients were recruited from July 2020 to March 2021 in this study.The PPT,SC and BP of control acupoints in healthy controls,and non-sensitized and sensitized acupoints in KOA patients were measured and compared between baseline and after manual acupuncture(MA)treatment.Results:Before MA treatment,lower PPT was observed at the sensitized acupoints comparedwith non-sensitized andcontrol acupoints(P<0.05).After MA treatment,PPT at the sensitized acupoints increased significantly in KOA patients(P<0.05).Before MA treatment,there was no statistical difference in SC and BP among control,non-sensitized and sensitized acupoints(P>0.05).Compared with the control and non-sensitized acupoints,there were significant increases of SC and BP in sensitized acupoints of KOA patients after MA treatment(P<0.05 or P<0.01).Conclusion:MA at sensitized acupoints could elevate PPT of KOA patients,which may be associated with the increment of SC and BP.

Post-schizophrenia comorbid depressive disorder and insomnia treated by acupuncture combined with Chinese medicine:A retrospective case series based on JBI reporting checklist

Background:Acupuncture combined with Chinese herbal medicine was performed on 24 patients with post-schizophrenia comorbid depressive disorder and insomnia admitted to the Psychiatry Department,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine from 2016 to 2020,and provided satisfactory results.Considering post-schizophrenia comorbid depressive disorder and insomnia is not a common clinical disorder in hospital of traditional Chinese medicine,the treatment and follow-up cycle is long,and the dropout rate is high,a retrospective case series based on Joanna Briggs Institute(JBI) reporting checklist were conducted instead of a randomized controlled trial.Objective:To retrospectively summary the short-,mid-and long-term effects of acupuncture combined with Chinese herbal medicine for post-schizophrenia comorbid depressive disorder and insomnia,and analyze the principles of the prescriptions.Methods:A retrospective analysis based on case series JBI reporting checklist were performed to investigate effects of 24 patients with post-schizophrenia comorbid depressive disorder and insomnia undergoing 12-week combined acupuncture and Chinese herbal medicine treatment(patients did not receive full dosage treatments,or received western medicine or other physical and psychological therapies during the treatment period were excluded).The psychotic symptoms,depression,insomnia,and self-care ability for daily living were measured by the Positive and Negative Syndrome Scale(PANSS),Calgary Depression Scale for Schizophrenia(CDSS),Pittsburgh Sleep Quality Index(PSQI),and Activity of Daily Living Questionnaire(ADL-Q),respectively.Follow-ups were conducted at 8 and 16 weeks after treatment.Meanwhile,Acupuncture Beliefs Scale(ABS) was assessed at pre-and post-treatment as well as 16-week follow-up to investigate patients’ beliefs and expectations for acupuncture treatment.Results:(1) compared with pre-treatment,the PANSS global scores did not decrease significantly at posttreatment and follow-up periods(P> 0.05).(2) compared with pre-treatment,the global scores of CDSS and PSQI decreased significantly at post-treatment and follow-up periods(both P<0.05).The PSQI global scores at the 16-week follow-up were even significantly lower than at port-treatment(P<0.05).(3) after treatment,the ADL-Q.global scores decreased significantly(P<0.05),and continued to decrease during the follow-ups(P<0.05).(4) effective treatment improved patients’ beliefs and expectations of acupuncture therapy.Conclusions:Acupuncture combined with Chinese herbal medicine can significantly improve the insomnia and depressed mood following schizophrenia,with satisfactory short-,medium-and long-term effects;effective treatment experience can increase patients’ beliefs and expectations for acupuncture therapy.

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.

Quantity-effect Relationship of Electroacupuncture for Urge Incontinence:A Multicenter Randomized Controlled Trial

Objective：To investigate the quantity-effect relationship of electroacupuncture in treating urge incontinence （UI）.Methods：A clinical multicenter randomized controlled trial was carried out.One hundred and ninety-nine UI patients meeting the inclusion criteria were randomly allocated,at a ratio of 2：1,to acupuncture and medication groups.The acupuncture group of 199 patients was treated with electroacupuncture plus manual acupuncture,and the medication group of 68 patients was treated with oral administration of Tolterodine Tartrate tablets.Results：The total scores of international consultation on incontinence questionnaire-short form （ICIQ-SF） score plus the international prostatic symptom score （I-PSS） were significantly lower in both groups at each follow-up visit （after 3,6 and 9 treatments） than before treatment.The effect was accumulated with an increase in the number of treatments.The improving effect was significantly better at each follow-up visit in the acupuncture group than that in the medication group （P0.05）.Conclusion：The improvement degree of urinary symptoms and the number of treatments are positively correlated in the treatment of UI by electroacupuncture plus manual acupuncture and by oral administration of Tolterodine Tartrate tablets.Acupuncture has a more marked effect.

Effects of Different Acupuncture Stimulations on NO Content in Acupoint Areas

Objective:To study the effects of different acupuncture stimulation on nitric oxide(NO) content in acupoint areas.Methods:The experiment was performed in 47 healthy volunteers providing informed consents.Both males and females were included in each group:11 cases in electro-acupuncture group,13 cases in manual-acupuncture group,16 cases in warm-moxibustion group,and 7 cases in control group.Stimulations were given at Jianshi(PC 5) of the Pericardium Meridian and Chengshan(BL 57) of the Bladder Meridian with manual-acupuncture,electro-acupuncture and warm-moxibustion respectively.NO was collected from Ximen(PC 4) and Chengjin(BL 56) areas on the ipsilateral meridians,and the content was detected.Results:The content of NO in the warm-moxibustion group was higher than that in the electro-acupuncture group,the content in electro-acupuncture group was higher than that in the manual acupuncture group(P<0.05) . Conclusion:All the three stimulations can raise NO levels on acupoint areas significantly,and the effect moxibustion is superior to that of electro-acupuncture and manual acupuncture.

单盲双模拟针灸临床试验设计思路与实践——以“手针和电针治疗绝经烘热疗效比较”研究为例

Randomized controlled trial(RCT)is the golden standard for evaluation of clinical evidence.To assess the effect of acupuncture,due to the specificity of acupuncture intervention,the blinding and control methods are the difficulties in study design.It is not practical to blind investigators,participants and evaluators simultaneously.At present,blinding is generally conducted for the participants and evaluators in clinical trial.We took a comparative study of manual acupuncture and electroacupuncture for menopausal hot flush as an example to explore a new way with the reference of double-dummy design in new drug study.A single-blind and double-dummy clinical trial model of acupuncture was established.Based on individual acupuncture intervention in each group,the placebo intervention was combined to ensure the form consistency of two groups.Such a study design may eliminate non-specific effect of acupuncture,and can be conductive to comparing the specific effect of acupuncture and can provide the references and regimens for study design.