Comparative Study of the Specificities of Needling Acupoints DU20, DU26 and HT7 in Intervening Vascular Dementia in Different Areas in the Brain on the Basis of Scale Assessment and Cerebral Functional Imaging

Objective： Using methods of clinical scale assessment and cerebral functional imaging to compare the relative specificity of needling acupoints Baihui （DU20）, Shuigou （DU26） and Shenmen （HTT） in intervening vascular dementia （VD） in different areas in the brain. Methods： Fifty patients with VD were randomized into 5 groups. Needling on conventionally used acupoints of hand and foot three Yang-meridians aiming at hemiplegia was applied to the patients in Group A, and needling on DU20 to Group B, on DU26 to Group C, on HT7 to Group D and on all the three to Group E was applied additionally. Assessments of Mini Mental State Examination （MMSE）, Activities of Daily Living （ADL） and Family Attitude Questionnaire （FAQ） were made. And the positron emission computerized tomography （PET） and single photon emission computerized tomography （SPECT） examinations were conducted in 5 selected patients from each group before and after treatment. Results： Needling on conventional acupoints plus DU20 could effect the inner temporal system, thalamencephalon system and prefrontal cortical system to improve memory and executive capacity of VD patients; conventional acupoints plus DU26 could effect more to the prefrontal cortical system to obviously elevate the executive capacity; that plus HT7 would reveal an effect similar to but rather weaker than plus DU20, and effect more to memory; and that plus all the three simultaneously could effect rather roundly multiple aspects of the nervous system related to intellectual activities, to elevate the recognition and enhance the executive capacity. Conclusion： Needling on various acupoints like DU20, DU26 and HT7 have effects on different brain areas.

Needling at the Waiguan (SJ5) in healthy limbs deactivated functional brain areas in ischemic stroke patients A functional magnetic resonance imaging study

Deactivation is common in cerebral functional imaging. However, the physiological mechanisms responsible for this phenomenon remain poorly understood. The present study analyzed 12 ischemic stroke patients, who were randomly assigned to two groups： one group underwent sham needling and true needling at the Waiguan （SJ 5） in the healthy upper limb and the other group underwent sham and true needling at a sham point. Functional magnetic resonance imaging results showed no activation points in brain tissues following needling at SJ 5. However, compared with sham needling at SJ 5, true needling at SJ 5 deactivated Broadmann 4, 6, 24, and 32 areas. In addition, compared to needling at the sham point, true needling at SJ 5 deactivated bilateral hypothalamus. Results demonstrated that SJ 5 needling in the healthy upper limb resulted in specific directional brain action, as manifested by deactivation of cerebral areas related to motor （Broadmann 4 and 6）, emotion （hypothalamus）, and cognition （Broadmann 24, 32）.

Acupoints combination correlates with activation of cerebral areas A functional MRI study

Acupoint combination is a method used for acupoint treatment of patients. Traditionally, acupoints are matched along the meridian distribution, which is a common rule in clinical practice, but the underlying mechanism remains unclear. Cerebral scans with functional magnetic resonance imaging （fMRI） have been used in the study of acupuncture and acupoint specifically. In this study, fMRI was used to detect the activation of the brain areas under different acupoints, matched along different meridians, to elucidate the acupoint combination via a modern medical approach. Forty healthy volunteers were randomly divided into the following groups： Waiguan point （SJ 5）, Waiguan （SJ 5） ＋ Zhigou （SJ 6） （2 acupoints come from the same meridian）, Waiguan （SJ 5） ＋ Neiguan （PC 6） （2 acupoints come from 2 meridians with the relationship of interior-exterior）, Waiguan （SJ 5） ＋ Yanglingquan （GB 34） （2 acupoints come from 2 meridians with the same name-Shaoyang Meridian）, and sham point groups （needling in different points on the right hand）. A real-time cerebral fMRI scan was simultaneously performed. The cerebral activation rate, and the number and strength of different regions of interest were compared among the groups. The fMRI cerebral imaging confirmed that there were some differences in the activation of cerebral areas by the needlings in SJ 5, and in combination with other acupoints. Needling at SJ 5 alone greatly activated the right cerebellum, while needling at both SJ 5 and different co-needling points activated different cerebral functional areas.

Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan （TE5）. In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamiilary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11,20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.

Positron emission tomography study of the specificity of Waiguan (SJ 5) acupoint

Functional brain imaging studies of the specificity of acupoint stimulation have revealed that needling at particular acupoints can induce activation of corresponding brain areas, examined in physiological and pathological states. The present study examined Waiguan （SJ 5） as the acupoint of interest. We tested five conditions： a true needling at true acupoint group, a sham needling at true acupoint group, a true needling at sham acupoint group, a sham needling at sham acupoint group, and a healthy control group. We examined changes in glucose metabolism in different functional cortical regions to determine the specific brain activation elicited by acupuncture at Waiguan. The results revealed that true and sham acupuncture at the same acupoint activated different brain regions. In addition, applying acupuncture at a genuine acupoint and a neighboring sham acupoint activated different brain regions. These findings suggest that acupuncture at Waiguan causes activation in some brain regions.

Specific Effects of Needling Different Acupoints of Patients with Vascular Dementia

Objective： To observe the effects of needling Baihui （GV 20）, Shuigou （GV 26） and Shenmen （HT 7） on cerebral glucose metabolism in patients with vascular dementia （VD） by cerebral functional imaging technique. Methods： Twenty-five patients with VD were divided into 5 groups （Group A, B, C, D and E） randomly. Patients in the Group A were treated by needling routine acupoints for hemiplegia （Acupoints of the three yang meridians of hand and foot）, and besides the routine acupoints, patients in the Group B were treated by needling Baihui（GV 20）, the Group C by Shuigou（GV 26）, the Group D by Shenmen（HT 7）, and the Group E by Baihui（GV 20）, Shuigou（GV 26）, and Shenmen（HT 7）. All the patients were examined by Positron Emission Tomography （PET） to detect the cerebral glucose metabolism in the bilateral frontal lobes（orbital gyri）, parietal lobes, temporal lobes（hippocampus and hippocampal gyrus）, occipital lobes, thalamus, lentiform nucleus, caudate nuclei, cingulate gyrus and cerebellum before treatments and after treatments. Results： After needling the routine acupoints for hemiplegia, glucose metabolism increased in lentiform nucleus and temporal lobe; needling Baihui（GV 20）, increased in frontal lobe, temporal lobe and lentiform nucleus; needling Shuigou（GV 26）, increased in frontal lobe, thalamus and lentiform nucleus; needling Shenmen（HT 7）, increased in parietal lobe and lentiform nucleus; and needling these three acupoints, increased in frontal lobe, temporal lobe, thalamus and lentiform nucleus. Conclusion： Needling Baihui（GV 20）, Shuigou（GV 26） and Shenmen（HT 7） affect glucose metabolism in different functional regions of the brain, and Baihui（GV 20）, Shuigou（GV26） and Shenmen（HT 7） relate to different functional regions of the brain.