Efficacy of acupuncture on acute tonsillitis:a systematic review and meta-analysis

OBJECTIVE To systematically assess the efficacy and safety of acupuncture in treating acute tonsillitis,providing a reference for clinical decision-making.METHODS We searched PubMed,CENTRAL,Embase,Web of Science,China National Knowledge Infrastruc⁃ture,China Biomedical,clinical research registra⁃tion platforms,grey literature,and the reference lists of the selected studies from inception to Oct.30,2022.The risk of bias assessment used Rev⁃Man.Meta-analysis was performed using STATA with Hedges′g value.In addition,we performed subgroup analysis,meta-regression,and publica⁃tion bias detection with Harbord′s and Egger′s tests.RESULTS We included 19 randomized controlled trials comprising 1701 patients,of which 1 study was assessed high risk of bias.The primary outcome,the response rate,revealed that acupuncture was more effective than antibi⁃otics.The secondary outcomes showed that the difference in the reduction of the VAS scores,sore throat time,and white blood cell counts was statistically significant with acupuncture compared to antibiotics.However,the difference in modulat⁃ing neutrophil percentage and C-reactive protein was not statistically significant.Besides,acupuncture treatments showed a lower incidence of adverse events than antibiotics.CONCLUSION Acupuncture therapy on acute tonsillitis is safe,and the response rate is superior to antibiotics.For alleviating sore throat symptoms,shortening sore throat time,and improving immune in fl am mation index,acupuncture has positive signi fi cance.Nevertheless,because of the limitations of this study,our conclusions should be inter⁃preted with caution.Future efforts still need more high-quality trials to improve the methodology and reporting quality.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND During anesthesia administration for cataract surgery,low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing,with the use of additional drops intraoperatively increasing the risk of complications.Accordingly,there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study.Patients were divided into the proparacaine surface anesthesia(SA)group(65 cases)and the compound acupuncture-medicine anesthesia group(CAMA group,65 cases).Patients in the CAMA group were provided acupuncture analgesia in addition to SA.Preoperative anxiety[Self-Rating Anxiety Scale(SAS)score and state anxiety inventory(SAI)score],intraoperative stress,vital signs,analgesia,and cooperation,as well as postoperative adverse events,were compared between groups.RESULTS More marked reductions in anxiety were observed among patients in the CAMA group,with corresponding reductions in SAS and SAI scores.During the operation,no change in the secretion of E,NE,or Cor group compared to the preoperative period was observed in the CAMA,which was markedly lower than that in the SA group.Heart rate,blood pressure,and respiratory rate were more stable intraoperatively in the CAMA group.In addition,the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group.Accordingly,patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery.Furthermore,marked reductions in intraoperative adverse effects were observed in the CAMA group,indicating greater overall safety.CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

THE ROLE OF CONNEXIN 43 GENE IN ACUPUNCTURE ANALGESIA

Objective To and connexin 43. Methods investigate the possible relationship between the analgesic effect of acupuncture Connexin 43 gene knock-out mice were randomly divided into 4 groups： a wide type （WT） control group, a WT acupuncture group, a heterozygous （HT） control group and HT acupuncture group. Hot-plate test and writhing response induced by acetic acid were used for investigating the different analgesic effect of acupuncture on HT and WT mice. Results There was no significant difference in the basic pain threshold value between HT and WT mice （P 〉0.05）. Acupuncture could significantly increase the pain threshold value, prolong the latency period of writhing body and decrease the number of writhing body as compared with pre-acupuncture in WT and HT mice （P 〈 0.01 or P 〈 0.05）. The pain threshold, latency period of writhing and number of writhing body in HT mice were less than WT mice post-acupuncture （P〈0.05）. Conclusion Connexin 43 gene knock-out might partially inhibit the analgesic effect of acupuncture, suggesting that connexin 43 is possibly related with meridians and the effect of acupuncture.

RELATIONSHIP BETWEEN ACUPUNCTURE ANALGESIA AND MET-ENKEPHALIN OR DYNORPHIN

subjective: The effect of 4～5 Hz electroacupuncture (EA) on alterations of both met enkephalin (MEK) and dynorphin (Dyn) in the patient plasma or mouse spinal cord and its relation with analgesic effect were studied.Methods: In acupuncture clinic 10 patients with acute pain were treated with 4 Hz EA at Zusanli(ST 36) and/or Hegu(LI 4) acupoints for 30 min. 20 BALB/C mice were randomly divided into 2 groups: a. EA group(n=10), treated with 4～5 Hz EA at bilateral “Zusanli"(ST 36) for 15 min; b. control group(n=10) treated with no EA, but also restrained for 15 min. Before and after EA or restraining acupoints, the pain threshold of the patients or mice was detected. 10 μl of the patient plasma before and after EA and each mouse spinal cord suspension, of the 2 groups were blotted onto nitrocellulose membrane (NCM) respectively. The protein dot blot signals were detected by immunoreactivity (IR) and using Shimadu TLC Scanner and analyzed statistically. Results: The results showed that an increase in patient plasma MEK IR or Dyn IR and a decrease in mouse spinal MEK IR or Dyn IR could be detected, and the alteration of plasma or spinal MEK IR was more significant than that of plasma or spinal Dyn IR. There was a positive correlation in alteration between plasma or spinal MEK IR and plasma or spinal Dyn IR with respective parallel levels in individuals. The increased plasma MEK IR or the decreased spinal MEK IR was positively or negatively correlated with the analgesic effect, while the correlation between plasma or spinal Dyn IR and analgesic effect was insignificant. Conclusion: The results suggest that under lower frequency EA the met enkephalin may play an important role in analgesia.

WRIST-ANKLE ACUPUNCTURE FOR ANALGESIA IN TREATING SOME COMMON DISEASES IN ATHLETES

With gradual generalization of acupuncture-moxibustion therapy in developed countries, an increasing attention has been paid to its application in the athletic field. Wrist-ankle acupuncture is a kind of shallow acupuncture, by which 6 points in the wrist and ankle regions are selected and punctured for treating diseases related to individual parts of the body. It is a kind of information therapy concerning biological hologram regularities. The analgesic effects of the therapy in treating some common diseases in 64 athletes are reported as follows.

Correlation between the cumulative analgesic effect of electroacupuncture intervention and synaptic plasticity of hypothalamic paraventricular nucleus neurons in rats with sciatica

In the present study, a rat model of chronic neuropathic pain was established by ligation of the sciatic nerve and a model of learning and memory impairment was established by ovariectomy to investigate the analgesic effect of repeated electroacupuncture stimulation at bilateral Zusanfi （ST36） and Yanglingquan （GB34）. In addition, associated synaptic changes in neurons in the paraventricular nucleus of the hypothalamus were examined. Results indicate that the thermal pain threshold （paw withdrawal latency） was significantly increased in rats subjected to 2-week electroacupuncture intervention compared with 2-day electroacupuncture, but the analgesic effect was weakened remarkably in ovariectomized rats with chronic constrictive injury. 2-week electroacupuncture intervention substantially reversed the chronic constrictive injury-induced increase in the synaptic cleft width and thinning of the postsynaptic density. These findings indicate that repeated electroacupuncture at bilateral Zusanfi and Yanglingquan has a cumulative analgesic effect and can effectively relieve chronic neuropathic pain by remodeling the synaptic structure of the hypothalamic paraventricular nucleus.

The cumulative analgesic effect of repeated electroacupuncture involves synaptic remodeling in the hippocampal CA3 region

In the present study, we examined the analgesic effect of repeated electroacupuncture at bilateral Zusanfi （ST36） and Yanglingquan （GB34） once a day for 14 consecutive days in a rat model of chronic sciatic nerve constriction injury-induced neuropathic pain. In addition, concomitant changes in calcium/calmodulin-dependent protein kinase II expression and synaptic ultrastructure of neurons in the hippocampal CA3 region were examined. The thermal pain threshold （paw withdrawal latency） was increased significantly in both groups at 2 weeks after electroacupuncture intervention compared with 2 days of electroacupuncture. In ovariectomized rats with chronic constriction injury, the analgesic effect was significantly reduced. Electroacupuncture for 2 weeks significantly diminished the injury-induced increase in synaptJc cleft width and thinning of the postsynaptJc density, and it significantly suppressed the down-regulation of intracellular calcium/ calmodulin-dependent protein kinase II expression in the hippocampal CA3 region. Repeated electroacupuncture intervention had a cumulative analgesic effect on injury-induced neuropathic pain reactions, and it led to synaptic remodeling of hippocampal neurons and upregulated calcium/calmodulin-dependent protein kJnase II expression in the hippocampal CA3 region.

EFFECT OF ACUPUNCTURE STIMULATION AT SANYINJIAO (SP 6) ON CEREBRAL GLUCOSE METABOLISM IN DYSMENORRHEA PATIENTS

To study the central mechanism of acupuncture stimulation of Sanyinjiao （三阴交 SP 6） in relieving dysmenorrhea. Methods： A total of 6 dysmenorrhea volunteer patients were subjected into this study. On the first positron emission tomography （PET） scan examination, they were assigned to pseudoacupuncture group by using the acupuncture needle just to prick the skin of Sanyinjiao （SP 6） ; while on the second PET scans, they were assigned to acupuncture group by inserting the needle into the same acupoint. 18F fluorodeoxyglucose （;SF-FDG） PET of the whole brain was performed during pseudo-acupuncture and real acupuncture of Sanyinjiao （SP 6）. The acquired PET data were analyzed by using statistical parametric mapping （SPM） software to determine changes of glucose metabolism in different cerebral regions. The patient＇s pain intensity was rated by using 0-10 numerical pain intensity scale. Results： After pseudo-acupuncture stimulation of Sanyinjiao （SP 6）, no significant changes were found in the pain intensity （ P 〉0.05）, while after real-acupuncture stimulation, the pain intensity declined significantly （ P〈0.01 ）. Following acupuncture of the right Sanyinjiao （SP 6）, multiple cerebral regions involving pain were activated （increase of glucose metabolism）, including ipsilateral lenticular nucleus （globus palliclus, putamen）, ipsilateral cerebellum and insular lobe, bilateral dorsal thalamus, ipsilateral paracentral Iobule, bilateral amygdaloid bodies, contralateral substantia nigra of the midbrain, bilateral second somatosensory （S Ⅱ ） areas, ispsilateral hippocampal gyms, frontal part of the ipsilateral cingulated gyrus, and bilateral mammary bodies of the hypothalamus. In addition, fewer regions of the cerebral cortex responded with decrease of the glucose metabolism after real acupuncture.

EFFECTS OF ACUPUNCTURE ON IMMUNE RESPONSE RELATED TO OPIOID-LIKE PEPTIDES

Experimental research has recently shown that acupuncture induces the formation of opioid-like peptides (OLPs) in animals. In order to provide further evidence, we tested the beta-endorphin levels and other parameters (VIP, lymphocyte subsets, NK cells and monocyte phagocytosis) in a group of 90 patients suffering from various painful disorders treated with acupuncture. Zusanli (St 36) and Hegu (LI 4) acupoints were selected. A homogeneous group of 30 subjects was used as control. Evaluation of the above parameters was made with 3 series of blood tests before treatment, 30 minutes and 24 hours after acupuncture treatment. In the acupuncture group, the following results were achieved: 1) A considerable increase in beta-endorphin levels remained high even 24 hours after acupuncture treatment. In addition, we demonstrated an inverted correlation between beta-endorphins and VIP; 2) 30 minutes after acupuncture session, 80% of the treated patients showed a significant increase of CD3 and CD4 values and an increase of CD8 24 hours after stimulation; 3) Monocyte phagocytosis was increased in 45% of the treated subjects 30 minutes from starting treatment, and in 100% of them after 24 hours. The percentage of NK cells was also increased in 40% of cases after 30 minutes, and in 50% after 24 hours. However, in the control group, no such significant changes in immune parameters were found.

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF STOMACH CARCINOMA PAIN

Clinical observation on 48 cases of stomach carcinoma pain indicated that acupuncture including filiform needle group and point-injection group had better therapeutic effects in treatment of stomach carcinoma pain when patient's mind was concentrated at the site of disease. After treatment for 2 months, the long-term effective rates of analgesia in both the filiform needle group and the point-injection group were similar to that in the western medicine group, all being about 81%. While the long-term markedly effective rates in the two groups were superior to that in the western medicine group. Life quality of the patients in all the groups were improved. The toxic action and side effects caused by chemotherapy were prevented, the high viscous state showed by indexes of blood rheology was improved, and the lowered Cu-Zu-SOD activity in erythrocytes in patients of stomach carcinoma was increased in the filiform needle group and the point-injection group. Based on the results of clinical study, we consider that acupuncture analgesic effect on stomach carcinoma is related to the increase of PLEK, improvement of cellular immune function and the elevation of life quality after acupuncture.

ACUPUNCTURE TREATMENT OF MIGRAINE IN GERMANY

1. The fact that 25% of the German population have the problem of headache, or migraine is uniquely characteristic of Germany. The administration of analgesics which used to be their local treatment for the problem can neither give a radical cure nor avoid certain side effects. 2. It can be seen from the therapeutic result of a 80% effective rate in 89 cases of migraine that acupuncture treatment is an effective therapy for 'German migraine' without any side effects. 3. Since 10% of the migraine cases were related to the improper sleeping posture, due attention should be paid and appropriate measures be taken to prevent occurrence of headache. 4. While receiving acupuncture treatment, the cases of migraine related to menstruation should also try to regulate their emmeniopathy. 5. It seems somewhat difficult for acupuncture treatment to give good effects in those with migraine related to psychological pressures and in those given long-term administration of contraceptives. This needs to be further studied.

Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory disease characterized by ankylosis of the spine and sacroiliac joints.The continuous development of this disease can cause damage to multiple organs.At present,modern medical treatment programs generally focus on symptomatic treatment such as analgesia and anti-inflammatory,which can relieve pain and inflammation to a certain extent,but there are many problems such as adverse drug reactions,and cannot be completely cured.Modern medical treatment of ankylosing spondylitis focuses on relieving symptoms,controlling disease activity,slowing disease progression,and reducing disability rates.As an important part of traditional Chinese medicine,acupuncture therapy,compared with modern medicine,has obvious advantages in the treatment of ankylosing spondylitis,such as good curative effect,quick effect,safety and low price,and no toxic and side effects.By reviewing the literature,it is found that there are a large number of clinical studies on the treatment of ankylosing spondylitis by acupuncture and moxibustion in recent years,and it is concluded that acupuncture and moxibustion has unique advantages in reducing local pain,alleviating inflammatory symptoms,improving joint function,preventing spinal deformity,and improving quality of life.Therefore,this study summarizes and reviews the relevant literature on different acupuncture and moxibustion therapy for ankylosing spondylitis,in order to provide ideas and solutions for the effective treatment of this disease.

Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy:A randomized controlled trial

Objective:To evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy.Methods:This randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture.The patients were randomized into two groups.The electroacupuncture analgesia(EA)group received EA stimulation at five acupuncture points:Hegu(LI 4),Neiguan(PC 6),Shuitu(ST 10),Quepen(ST 12),and Yifeng(SJ 17),while the control group received a bilateral superficial cervical plexus block.Primary outcomes included the level of analgesia and perioperative vital signs in both groups.Additionally,pain thresholds and serum b-endorphin levels were measured before and after electroacupuncture in the EA group.Results:Complete analgesia(Level A)was attained in 86%and 76%of the patients in the EA and control groups,respectively,with no significant difference between the two groups(P=1.00).In the EA group,the mean pain threshold after receiving EA doubled(648.7(77.4)g/s vs.305.3(45.3)g/s,P<.001),and the mean serum b-endorphin level increased by approximately 13.5 pg/mL(P<.001).All patients remained hemodynamically stable throughout the surgery.Conclusion:EA,in conjunction with additional medications that stimulate five acupuncture points,LI 4,PC 6,ST 10,ST 12,and SJ 17,was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

Acupuncture analgesia: diversity and analysis

The complex and diverse mechanisms of acupuncture analgesia are summarized from the following two aspects： the neural mechanisms （neurophysiology mechanism, neurochemistry mechanism and neuroanatomy mechanism） and the non-nerve mechanisms （connective tissue mechanism and local biochemical change mechanism）. Initial analysis are also carried out on the individual deficiencies of diverse mechanisms, the contradictions among different diverse mechanisms as well as the causing factors, and suggestions are proposed accordingly.

Observation on acupuncture at Nèimádin (内麻点 Extra) for abdominal postoperative analgesia

Objective To observe the analgesia effectiveness and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery. Methods One hundred and twenty patients with routine abdominal surgery were randomly divided into an acupuncture group and a medication group, 60 cases in each group. The acupuncture group was treated with electroacupuncture at Neimadian （内麻点 Extra）, which was located on the medial side of lower leg, 7 cun above the medial malleolus and about 0.5 cun from post edge of tibia. The medication group was treated with patient-controlled intravenous analgesia （PCIA） with Sufentanil. After the treatment, the Visual Analogue Scale （VAS）, the security, the analgesic effect and plasma β-endorphin content in the two groups were compared.Results The postoperative VAS scores at 2, 4, 8, 16, 24 and 48 h in the acupuncture group were lower than those in the medication group （all P〈0.05）. The analgesic effects at 2, 4, 16 and 24 h after surgery in the acupuncture group were superior to those in the medication group （P〈0.05, P〈0.01）. The plasma β-endorphin contents at 0, 8, 16 and 48 h after surgery in both groups were increased, and the acupuncture group was superior to the medication group （all P〈0.05）. The security class after surgery in the acupuncture group was higher than that in the medication group （P〈0.05）. Two cases in acupuncture group stopped treatment due to overstress and fear of needling, 24 cases in medication group presented adverse reactions, among them, 3 cases stopped the treatment due to nausea, vomiting. Conclusion The analgesic effect and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery are superior to those of the PCIA with Sufentanil.

Acupuncture analgesia and the direction,angle and depth of needle insertion

Literatures on acupuncture analgesia of the recent 30 years are analyzed through the target pain syndromes, points and tools selected for needling as well as the chosen direction, angle and depth of insertion. The relationship between effect of acupuncture analgesia and needling direction, angle as well as depth is initially optimized to enhance the analgesic effect. The result shows that the 3 factors are the key influences. However, studies on the above mentioned relation are still far from enough. Aiming at enhancing the effect of acupuncture analgesia and exploring the relative mechanism, it is held that multivariate analysis should be adopted to do systematic analysis on relationship between effect and mechanism of acupuncture analgesia and direction, angle and depth of the needle insertion.

Research Progress of Acupuncture Analgesia for Labor

Labor pain is a kind of severe pain the lying-in women of natural childbirth must undergo. The labor quality is decided by the tolerance to pain. Acupuncture analgesia for labor pain has been increasingly concerned and applied by more and more clinical workers because of its safety and efficacy. By summarizing and analyzing the choice and applications of various factors of acupuncture analgesia for labor pain such as acupoint selection, instrument analgesic coefficient, and the needling techniques in acupuncture analgesia for labor pain in the recent 12 years, this study aims to provide a theoretical foundation for the clinical application of acupuncture analgesia for labor pain.

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.

Involvement of connexin 43 in acupuncture analgesia

Background Connexin 43 （Cx43） is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli （ST36） acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia.Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

Acupuncture Mechanisms: Anesthesia, Analgesia and Protection on Organ Functions

Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles,lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.