Acupuncture Research Research Articles

Symptom effects and central mechanism of acupuncture in patients with functional gastrointestinal disorders: a systematic review based on fMRI studies

BackgroundFunctional gastrointestinal disorders (FGIDs) are closely related to disorders of brain-gut interaction. FGIDs are the dominant disease of acupuncture treatment, which can improve the symptoms and emotional state.AimTo evaluate the results and quality of the available clinical evidence and to summarize the central mechanism and effect of acupuncture on FGIDs.MethodsPubMed, EMBASE, Web of science, Cochrane Library, China National Knowledge Infrastructure (CNKI) were searched by computer to collect the randomized controlled trials (RCTs), which contained central mechanisms via fMRI research of acupuncture in the treatment of FGIDs patients. The search time limit was from the establishment of the database to June 22, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality.ResultsTen RCTs involving fMRI data were included in this study, including 4 Functional dyspepsia (FD) studies, 3 irritable bowel syndrome (IBS) studies, and 3 functional constipation (FC) studies. The score of improvements in both gastrointestinal symptoms and psychological symptoms showed that acupuncture could significantly improve the clinical symptoms of FGIDs patients, including abdominal pain, abdominal distension, frequency of defecation, and stool characteristics, and could relieve anxiety and depression symptoms of patients. Acupuncture could regulate brain functional connections and functional activity in FGIDs patients, mainly including insula, anterior cingulate cortex, prefrontal cortex, thalamus, hippocampus, amygdala and other brain regions.ConclusionAcupuncture can improve gastrointestinal symptoms and psychological status in FGIDs patients, and regulate functional connectivity and activity of brain regions such as insula, ACC, PFC, thalamus, HIPP, amygdala, etc. These changes in brain activity may related to visceral sensation, pain regulation, emotion, but further studies of high quality are still necessary.

A Conversation with Professor Ted Kaptchuk, a Key Architect of Modern TCM in the West

Abstract The interview was conducted on November 20th, 2022 by Ioannis Solos and Charles Buck. Ted Kaptchuk (泰开阳) is a Professor of Medicine and a Professor of Global Health & Social Medicine at Harvard Medical School. In 1975, he graduated from the Macau Institute of Chinese Medicine, Macau, China. After returning to the West, Ted taught Chinese medicine throughout the States, Europe, Latin America, and Australia. Ted’s book, The Web that Has No Weaver: Understanding Chinese Medicine is a groundbreaking explanation of East Asian medicine that continues to shape the discourse of the Chinese medicine profession in the West and has been translated into 13 languages. In 1990, Ted was recruited in Harvard Medical School to help research Chinese medicine. After encountering high placebo responses in multiple acupuncture clinical trials, Ted decided to switch his career to primarily studying placebo. He has published over 300 peer-reviewed articles. He has been awarded the Lifetime Achievement Award from the Society of Acupuncture Research (2015), the Lifetime Achievement Award from the Society for Interdisciplinary Placebo Studies (2021), and the William Silen Lifetime Achievement Award in Mentoring from Harvard Medical School (2022).

Introduction to the Meta-analysis method of functional magnetic resonance imaging research and the exploration of its application in the field of acupuncture.

In recent years, the number of functional magnetic resonance imaging (fMRI) research in acupuncture grows increasingly. However, due to the differences in acupoint selection, acupuncture technique and sample size, the problems get more prominent in terms of the diverse results and the lack of common rules of acupuncture among researches. By taking the fMRI research for post-stroke motor dysfunction (PSMD) treated with acupuncture as the example, this paper introduces the fMRI Meta-analysis technology for integrating the relevant research results and extracting the common rules, namely image-based Meta-analysis (IBMA) and coordinate-based Meta-analysis (CBMA). Considering the higher feasibility of CBMA, three available CBMA methods are explained specially, including activation likelihood estimation (ALE), kernel density analysis (KDA), and seed-based d mapping (SDM). Focusing on the precautions and operation procedure of CBMA, the review is conducted systematically on the type of fMRI research, task design, analytical method, and the thinking integrity of fMRI Meta-analysis, and the review findings are collated in charts. It aims to assist readers to understand the abstract and complex theories and practical information of this technology efficiently, conveniently and systematically, and hopes to provide the references for the future learning and the application.

Application and thinking of musculoskeletal ultrasound in diagnosis and treatment of musculoskeletal diseases with acupuncture and moxibustion.

Musculoskeletal ultrasound (MSUS) is characterized as the dynamic, real-time and continuous visualization, the quantitative and qualitative localization,the simple operation and the absence of use contraindication. As a tool for auxiliary examination, treatment, evaluation and research, in acupuncture and moxibustion, MSUS may improve the accuracy of acupoint location, guide the direction and depth of needle insertion, monitor the reactions of deqi, guarantee the safety of operation and quantify the effect evaluation. Hence, it may provide an objective basis for acupuncture and moxibustion research and be conductive to display the operation techniques of acupuncture and moxibustion by means of objective approaches such as imaging and data.

Standardization studies of acupuncture prescriptions: a new approach to translational medicine in acupuncture.

This paper explores the relationship between the standardization studies of acupuncture prescriptions and translational medicine, elucidating the translational medical concepts in the standardization of acupuncture prescriptions. It emphasizes that the standardization of acupuncture prescriptions is a pivotal link in the transformation of foundational acupuncture research. Considering the current clinical status of acupuncture prescriptions, the paper proposes the elements for standardizing prescriptions to promote the translation of foundational acupuncture research into clinical practice. These elements encompass prescription structure, precise acupoint number, orderly techniques of acupuncture, quantification of procedures, and clarity in efficacy. The goal is to provide a new perspective for the development of translational medicine in acupuncture.

Acupuncture in Sports Medicine.

Acupuncture is gaining popularity and wider acceptance as a treatment modality within the field of sports medicine. Our objective was to provide a comprehensive review of the existing literature pertaining to acupuncture in sports medicine to shed light on approaches utilized in acupuncture while revealing its personalized nature and its impact on athletes' preparation, performance, and recovery. We evaluated acupuncture research in the context of medicine and sports-related injury treatment, assessing its impact on athletic performance across demographics of athletes. Athletes participating in most sports have shown positive outcomes from acupuncture interventions. Acupuncture improves peak oxygen levels, maximum heart rate, delayed-onset muscle soreness, pain, swelling, explosive force production, and joint mobility. Furthermore, the efficacy of acupuncture appears to be similar regardless of age and sex. Lastly, the acceptance of acupuncture is influenced by cultural factors, with Western and traditional East Asian cultures exhibiting distinct perspectives on its rationale and mechanisms of action. Traditional East Asian acupuncturists typically employ qi and meridian theories in their acupuncture practices, with the recent incorporation of Western concepts. Acupuncture shows promise as an effective treatment for musculoskeletal pain and neuropathies in athletes across different age groups and for addressing injuries in various sports. Our comprehensive review will enhance our understanding of acupuncture's potential as a complementary or distinct therapeutic approach compared to conventional therapies. Additionally, our review explores its specific applications within different sports and delves into the cultural dimensions involved in integrating this practice into modern sports medicine.

Research progress of acupuncture in the regulation of surgery stress response.

In clinical practice, operative stress varies from surgeries, which may lead to many injuries such as ischemia-reperfusion injury (IRI), hyperactivation of sympathetic nervous system (SNS), post-traumatic immunosuppression (PTI), hypercoagulation and inflammation. Acupuncture is effective and advantageous in regulating the stress response to surgery. The great progress has been made in recent years of acupuncture research in postoperative visceral IRI, SNS hyperactivation, PTI, hypercoagulation and inflammation. By collecting the relevant evidences of acupuncture in this field, the application value of acupuncture involved in modulating surgical stress response and the progress of mechanism research are explored and summarized.

Knowledge mapping of acupoint sensitization and acupoint specificity: a bibliometric analysis.

The relationship between acupoint sensitization and acupoint specificity is a topic of significant interest in acupuncture research. Numerous clinical studies have demonstrated that needling pain sensitive acupoints yields superior therapeutic outcomes compared to traditional acupoints, particularly in the context of pain disorders. However, there is a lack of bibliometric analysis in acupuncture area. Therefore, the objective of this study is to offer a comprehensive overview of the knowledge structure and research hotspots pertaining to acupoint sensitization and acupoint specificity. The search for publications pertaining to acupoint sensitization and acupoint specificity was conducted in the Web of Science Core Collection (WoSCC) database from its inception until August 11, 2023. Subsequently, bibliometric analyses were carried out using VOSviewer, CiteSpace, R software (Bibliometrix package), and GraphPad Prism software. This study includes 4,940 articles from 72 countries, with China and the United States being the leading countries. The number of publications related to acupoint sensitization and specificity has been increasing annually. Major research institutions involved in this field include the Shanghai University of Traditional Chinese Medicine, Kyung Hee University, Beijing University of Chinese Medicine, Chinese Academy of Chinese Medical Sciences, and China Medical University, among others. "Evidence-based Complementary and Alternative Medicine" is the most popular journal in acupuncture field, and "PAIN" is the most co-cited journal. Publications are contributed by 20,325 authors from all over the world, with Wu Huangan, Fang Jianqiao, Lin Yi-Wen, Liu Huirong, and Chen Rixin having published the most articles. Han Ji-Sheng is the most cited author in this research area. The main directions include the study of temperature specificity of acupoints, the diagnosis of acupoint sensitization diseases, and the study of the mechanism of acupoint sensitization. The most listed keywords in recent years are "TRPV1," "signaling pathway," and "diagnosis." This is the first bibliometric study to comprehensively summarize research trends and advances in acupoint sensitization and acupoint specificity, and the information highlights recent research preliminary and main directions that serve as a reference for acupoint sensitization and acupoint specificity research.

Perspectives and Ideas to Advance Integrative Medicine and Healthcare: Proceedings of the 4th Annual Jaseng Academic Conference

The 4<sup>th</sup> Annual Jaseng Academic conference (August 13, 2023) in Seoul, South Korea, was a pivotal event in the realm of integrative medicine. Cohosted by Jaseng Hospital of Korean Medicine and Michigan State University College of Osteopathic Medicine, over 500 professionals including Korean medicine doctors, medical doctors, doctors of osteopathic medicine, acupuncturists, researchers, and students gathered at the conference. The theme, “Perspectives on Integrative Medicine,” marked a departure from previous conference themes and embraced a multidisciplinary approach to healthcare. The event highlighted the importance of holistic patient care and cross-disciplinary collaboration within healthcare. It offered a comprehensive overview of the current state of integrative medicine approaches in manual medicine, evidence-based acupuncture treatment, and acupuncture research. The Annual Jaseng Academic conference continues to serve as a platform for healthcare professionals to exchange ideas and perspectives, and bridges the gap between diverse medical systems to promote improved patient outcome and wellbeing.

Acupuncture as an adjunctive therapy for gastric ulcer: A modified Delphi consensus study

BackgroundAcupuncture is often used as an adjunctive therapy for gastric ulcer (GU). However, there is still a lack of evidence on the appropriate and optimal interventions for acupuncture. This study aimed to optimize the acupuncture treatment of gastric ulcers based on expert consensus for guiding acupuncturists in clinical practice. MethodsTo conduct this study, research evidence was gathered from databases in both Chinese and English. After discussion, preliminary clinical questions were developed. Following three rounds of multidisciplinary clinical expert consultation, the initial consensus questionnaire was formed after testing and modification by team members. A Delphi consensus was ultimately reached to answer the questionnaire and develop guidance for acupuncture treatment. A 9-point Likert-type scale was used to measure the agreement of expert consensus, where a score of 80% between 7 and 9 was defined as “agreement.” ResultsAfter two rounds of Delphi voting, a total of 35 items reached an agreement. These items can be roughly divided into 6 domains. According to expert consensus, the application of acupuncture for gastric ulcer should follow a semistandardized approach. Based on the syndrome differentiation, the main acupoints recommended are Zusanli (ST36), Zhongwan (CV12), Neiguan (PC6), and Sanyinjiao (SP6), while the adjunct acupoints include Taichong (LR3), Guanyuan (CV4), Xuehai (SP10), and Taixi (KI3). In the experience of experts, adverse events associated with acupuncture are typically mild and often manifest as subcutaneous hematomas. ConclusionThere is a lack of definitive acupuncture guidelines that can effectively determine the optimal therapeutic approach for the treatment of gastric ulcer. This expert consensus provides recommendations for clinical research and practice of acupuncture, with a particular focus on the selection of acupoints. However, further exploration through rigorous studies is necessary due to the limited availability of clinical evidence.

Examining the Current State of Acupuncture Research and Education

Examining the Current State of Acupuncture Research and Education

Hotspots and emerging trends in acupuncture research during 2012–2022: A bibliometric analysis: 2012至2022年针灸领域热点和趋势研究:一项文献计量学分析

ObjectiveTo find the hotspots of acupuncture research in the last decade and predict future trends. MethodsThe Web of Science Core Collection was used to retrieve articles published on the topic of acupuncture from January 1, 2012, to August 31, 2022. CiteSpace 6.1.R3, VOSviewer 1.6.18, SCImago Graphics and other tools were used to visualize and analyze the number of publications, countries, authors, journals, institutions, keywords, and cited articles. ResultA total of 10,942 articles published from January 2012 to August 2022 were analysed. A total of 97 countries and regions have conducted acupuncture research, with the highest number of research conducted in China. Furthermore, 8,056 institutions were involved in acupuncture research. In addition, 1,823 journals have published articles related to acupuncture research, with the highest number published by the journal Evid-Based Compl Alt (1,096 articles). The hotspots of acupuncture research are acupuncture analgesia (low back pain, knee osteoarthritis, headache, shoulder pain, neck pain, cancer pain, migraine), acupuncture anti-inflammatory (allergic rhinitis [AR], inflammatory pain), female-related diseases (polycystic ovary syndrome and breast cancer), cerebrovascular diseases (stroke and hemiplegia), rehabilitation treatment (postoperative nausea and vomiting, postoperative pain, and trauma pain in veterans), resting functional magnetic resonance imaging (fMRI), nervous system diseases (nerve regeneration and neuroprotection), depression, insomnia, Alzheimer's disease (AD), evidence-based researches, etc. ConclusionFrom the analysis of acupuncture research hotspots, acupuncture research was mainly focused on acupuncture mechanisms, clinical efficacy, and acupuncture standards. The emerging trends for the future include the standardization of acupuncture research and the treatment of chronic diseases with a clinical basis and more efficacy through the use of acupuncture in internal medicine.

Improved Suspension Fixation Using Rat Jacket in Rat Acupuncture Experiments.

In basic experimental acupuncture research, rats are commonly used as laboratory animals. However, it is difficult for them to maintain a fixed posture. During electroacupuncture procedures, proper immobilization of rats is essential. Various methods of rat fixation are currently used, including anesthesia fixation, high-platform fixation, binding fixation, and fixation with a self-made rat coat. However, these methods have their limitations, which may affect the efficiency and operability of the experiment to some extent. This protocol introduces a method of suspending and fixing rats using rat clothes. Firstly, rats are clothed with rat jackets that match their body shape, taking advantage of their preference for darkness and burrowing. The needling operation can then be carried out after the rats have worn rat clothes. When suspended, the rats are relatively still, as their limbs cannot move. This fixation method offers not only economical and user-friendly benefits but also ensures a stable and reliable fixation of the rats in a comfortably relaxed position. It also effectively minimizes time consumption, experimental space, and manpower resources. Additionally, this method allows for the exposure of most acupoints used for acupuncture in rats. This article primarily concentrates on the device's composition, encompassing a specially designed rat jacket, an elevated fixation rack, and their connecting structures. Additionally, an illustrative example will be presented to demonstrate the application of the rat clothing-based suspension fixation method in rat electroacupuncture procedures.

Acupuncture out, dogma in: The U.K. National Institute for Health and Care Excellence guideline for osteoarthritis 2022

The recently published National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis (NG226) does not recommend acupuncture. However, high-quality evidence exists that indicates acupuncture is effective for osteoarthritis and not simply a placebo. NICE clinical guidelines, such as NG226, provide recommendations for the National Health Service (NHS) in the U.K. In this opinion article the author examines the rationale and evidence set out in the Guideline NG226 and the supporting documentation. Two interrelated issues are identified: problems of interpretation and problems of definition. The problems of interpretation have been discussed in relation to previous NICE guidelines, these include: the evidence review erroneously analyses sham acupuncture as inert; the minimal important difference criterion for efficacy trials is not applied consistently; insufficient weight is given to pragmatic comparative effectiveness evidence. The problems of definition have not been discussed to the same degree. The evidence review employs no operational definitions of acupuncture or sham acupuncture. As a result, highly similar procedures are classified as sham in one trial but verum in another. This is illogical and unscientific. The guideline rationale fails to engage with the scientific debate regarding acupuncture research and repeats the mistakes of earlier guidelines. The interpretation of the evidence is erroneous as it is based on the dogma that sham acupuncture is inert. This is compounded by a failure to have clear definitions for acupuncture or sham acupuncture. The committee's interpretation of the acupuncture evidence will have negative consequences for patients in practice and for those enrolled in future clinical trials.

Sham acupuncture and placebo acupuncture in clinical trials

The commonly used terms "sham acupuncture" and "placebo acupuncture" in clinical acupuncture research is compared and analyzed in this article. In terms of their respective characteristics, sham acupuncture has a wider scope, including various types of acupoints, needle insertion at non-acupoint or non-insertion at acupoints, while placebo acupuncture mainly focuses on non-insertion at acupoints. Sham acupuncture mainly emphasizes the appearance similarity to real acupuncture, while placebo acupuncture emphasizes both similarity in appearance and the absence of therapeutic effects. Properly distinguishing and applying sham acupuncture and placebo acupuncture can help standardize their usage in terminology. Considering the difficulty in setting up qualified placebo acupuncture, it is suggested that researchers use the term "sham acupuncture" to describe the acupuncture control methods used in clinical research.

Dr. Lian Zhu: A Founder of Contemporary Acupuncture Medicine.

As an inseparable part of Traditional Chinese Medicine (TCM), acupuncture has been used in more than 196 countries or regions and has played an increasingly important role in health care. This article introduces Dr. Lian Zhu, MD, who made great contributions to acupuncture development. Dr. Zhu was a medical doctor, a military physician in her early life, and a high-ranking officer in the health care system of the Chinese government. She became famous as an acupuncturist after learning acupuncture in 1945. She was highly influenced by Zhijun Lu, MD, who learned acupuncture from Zuotian Ren, a TCM doctor in Yan'an, who had cured Chairman Mao Zedong's intractable shoulder pain. Dr. Zhu was one of the 2 earliest acupuncture trainers in the Chinese military health system, helping the Chinese communist military overcome resource shortages during the Chinese Civil War. She was one of China's most-influential acupuncture educators, having taught many acupuncture classes that trained many acupuncturists from 1945 to 1955. She was also an officer and policy maker in the Health Department of the central government, where she established such policy initiatives as training content for TCM doctors' reeducation schools. Dr. Zhu was ones of the earliest acupuncture researchers and administrators with a government-endorsed background. She created the first public acupuncture university in history in 1976 as well as 2 key acupuncture institutes in China and was director of both. She played a crucial role in promoting acupuncture research through TCM and biomedical methods, and was the first scholar in China to publish a thorough book on medical acupuncture using Western-biomedical language, which was highly praised by Chairman Mao. Dr. Zhu's acupuncture theory objectively promoted acceptance of medical acupuncture by the general public, medical doctors, government officials, and international medical societies.

Progress of mechanism research on the neurotransmitters in treatment of insomnia with acupuncture by regulating sleep architecture

Low-quality sleep in patients with insomnia is closely related to sleep architecture imbalance and neurotransmitter impairment. Acupuncture may reduce the duration of light sleep and its proportion, increase the time of deep sleep and rapid- eye-movement sleep as well as their proportions so as to modulate the sleep architecture for insomnia. The paper summarized the related studies of acupuncture for improving sleep architecture through regulating serotonin, norephinephrine, dopamine, γ-aminobutyric acid, acetylcholine and orexin; and explored the effects of acupuncture on the neurotransmitters and their specific performance in regulating sleep architecture. It is anticipated that the review may provide the literature evidences of acupuncture for improving sleep quality in patients with insomnia, and the approaches to the mechanism research of acupuncture for regulating sleep architecture.

Acupuncture treatment for functional gastrointestinal disorders: Identification of major acupoints using network analysis

BackgroundUsing network analysis, we sought to determine the acupoints most commonly used to treat functional gastrointestinal disorders (FGIDs), particularly functional dyspepsia (FD) and irritable bowel syndrome (IBS). MethodsTo explore the acupoint patterns used for FGID, data on acupoint combinations for FD and IBS were gathered from systematic reviews. Network analysis was used to determine the degree, closeness centrality, betweenness centrality, and eigenvector centrality of each acupoint. The most common acupoint combinations for FD and IBS were examined based on the eigenvector centrality. ResultsNetwork analysis revealed that CV12, ST25, ST36, CV10, and LR3, which had the highest eigenvector centrality values, were the main acupoints for treating FGID. CV12 was the main acupoint for treating FD, while ST25 was the hub acupoint for treating IBS in the abdomen. ST36, LR3, and PC6 were the key peripheral acupoints for FD and IBS. ConclusionsUsing network analysis, we provided data that will aid the selection of both general and specific acupoints for FD and IBS, along with spatial information (i.e., the positions of acupoints on a body map). These findings could be applied in future acupuncture research on therapy for gastrointestinal system dysfunction. They may also help bridge the gap between the traditional meridian theory, which assumes that there is a link between diseases/symptoms and the specific body region being treated, and real-world clinical evidence.

Construction of a core outcome set in clinical research of acupuncture and moxibustion for treatment of adhesive capsulitis

This study aims to construct the core outcome set for the clinical trials of adhesive capsulitis treated with acupuncture and moxibustion. Using systematic review, semi-structured interview, Delphi questionnaire survey, analytic hierarchy process and expert consensus meeting, the primary outcomes are obtained, i.e. local tenderness, pain degree during movement, range of motion, changes in range of motion, function score, and score of local symptoms of shoulder joint. The secondary outcomes are myofascial thickness, thickness of the inferior wall of the joint capsule, health status, activity of daily living, incidence of adverse events, laboratory indexes, vital signs, cost-effectiveness, total effective rate, and patient satisfaction. It is expected to provide a reference for the outcome selection in clinical trials and the generation of medical evidences in the treatment of adhesive capsulitis with acupuncture and moxibustion.

Research trends from 1992 to 2022 of acupuncture anesthesia: a bibliometric analysis.

Acupuncture anesthesia is a significant technical development that originated in China in 1958 and was introduced to the West in the early 1970s. Due to its relative novelty, it has been the subject of intense scrutiny and contestation. Since the early 1970s, the use of acupuncture as a complementary treatment for opioid analgesics has been accepted. Research on acupuncture anesthesia has helped to reduce clinical opioid abuse. However, only a few articles have focused on previous publications that reflect the trend of the study, the main investigators, reciprocal collaboration, and other information in this field. In view of this, we utilized bibliographic analysis methods to objectively analyze current trends and research hotspots in this field, aiming to provide a foundation and reference for future studies. The Web of Science database was searched for publications related to acupuncture anesthesia between 1992 and 2022. The CiteSpace and VOSviewer were used to analyze the annual publications, authors, Co-cited authors, and their countries (regions) and institutions, co-occurrence keywords, burst keywords, Co-citation references and Co-citation journals. A total of 746 eligible publications were retrieved from the database for the analysis, including 637 articles and 109 reviews. And the trend of annual publications continued to grow. Aashish J. Kumar, Daniel I. Sessler, Baoguo Wang, and Paul F. White published the most papers in this field (7), and all authors, had a very low centrality (<0.01). China (252) and the University of California System (21) were the most productive country (region) and institution, respectively, while the United States (0.62) and University of California System (0.16) had the highest centrality. After removing keywords related to the search strategy, the three most frequent were pain (115), electroacupuncture (109), and stimulation (91). The six most recent burst keywords were recovery, transcutaneous electrical acupoint stimulation, systematic review, quality, general anesthesia, and surgery. Wang et al.'s article had the highest co-citation count (20), whereas Zhang et al.'s articles had the highest centrality (0.25). The Journal of Anesthesia and Analgesia was the most influential one (408 co-citations). This research provides valuable information for the study of acupuncture anesthesia. In recent years, frontier topics in acupuncture anesthesia research have been the promotion of perioperative rehabilitation, anesthesia management, and quality improvement.