Central Mechanism Of Acupuncture 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.

Multidimensional Pain Modulation by Acupuncture Analgesia: The Reward Effect of Acupuncture on Pain Relief.

Pain is an intrinsically unpleasant experience with features that protect an organism by promoting motivation and learning. Pain relief, a negative reinforcement of pain, is considered a reward and activates the brain's reward system. The reward circuit in the brain involves reward and pain. Acupuncture has a multidimensional and comprehensive regulating effect on chronic pain. However, the reward effect of acupuncture in relieving chronic pain and the mechanism of the brain reward circuit involved in acupuncture analgesia are not thoroughly studied. In this article, we have reviewed the definition of pain abnormalities and negative emotions in patients with chronic pain, the conceptual characteristics of analgesic reward, and the new progress in studying brain reward circuits and functions. Moreover, we have expounded on the critical clinical and scientific significance of studying the reward effect of acupuncture analgesia and related brain reward circuits, the pain mechanism obtained from human neuroimaging studies, and the survey results on the effects of acupuncture on reward/motivation circuits. Some viewpoints and suggestions on the reward effect of acupuncture analgesia and related reward circuits have been put forward to clarify the multidimensional characteristics and benign regulation of acupuncture analgesia. Studies on the reward effect of acupuncture in relieving chronic pain and the regulating effect of the brain reward loop on acupuncture analgesia help to deepen the clinical understanding of acupuncture analgesia, innovate the research concept of acupuncture analgesia, and provide help for further studies on the central mechanism of acupuncture in improving chronic pain in the future.

Therapeutic effects and central mechanism of acupuncture and moxibustion for treating functional dyspepsia: study protocol for an fMRI-based randomized controlled trial

BackgroundFunctional dyspepsia (FD) is one of the most common functional gastrointestinal disorders, with a high prevalence and significant influence on the quality of life (QoL). Either acupuncture or moxibustion is effective for dyspepsia, which is confirmed by both ancient documents and modern research. However, the therapeutic advantage and underlying mechanism between acupuncture and moxibustion for FD remain unclear.MethodsThis randomized controlled fMRI trial aims to (i) evaluate the therapeutic advantages of acupuncture and moxibustion treatment for FD, (ii) investigate the similarities and differences in cerebral activity elicited by acupuncture and moxibustion, and (iii) analyze the possible correlations between brain responses and clinical variables thus to explore the potential central mechanism of acupuncture and moxibustion for treating FD. Ninety-two FD patients will be randomly assigned to either the acupuncture group or the moxibustion group in a 1:1 ratio. Twenty sessions of acupuncture or moxibustion treatment over 4 weeks will be performed on each patient. The short form Leeds Dyspepsia Questionnaire, the Nepean Dyspepsia Index, etc., are used to evaluate the therapeutic effects. The heart rate variability will be analyzed to investigate the autonomic nerve function. Thirty-six FD patients in each group will be randomly selected for the fMRI scan to detect cerebral activity changes.DiscussionWe expect the results will deepen our knowledge on the clinical value and underlying mechanism of acupuncture and moxibustion and provide a reference for a better selection of interventions for treating FD.Trial registrationChinese Clinical Trial Registry (www.chictr.org.cn) ChiCTR2100049496. Registered on 2 August 2021

Immediate Analgesic Effect of Acupuncture in Patients With Primary Dysmenorrhea: A fMRI Study.

Primary dysmenorrhea (PDM) is a common gynecological disease characterized by lower abdominal pain. Acupuncture is considered a good alternative therapy for PDM. However, the central mechanism of the analgesic effect of acupuncture is largely unknown. In this study, eligible patients were randomized into the real and sham acupuncture groups using a computer-generated, permuted block randomization method. The study cohort comprised 34 patients: 19 in the real acupuncture group and 15 in the sham acupuncture group. The clinical characteristics of the patients during their menstrual period were collected, and imaging scans were performed during the first 3 days of the patients’ menstrual period. We analyzed task and resting functional magnetic resonance imaging (fMRI) data to investigate the potential central mechanism of the immediate effect of acupuncture intervention on the intensity of PDM pain. The task fMRI study found that the rostral anterior cingulate cortex (rACC) and right supplemental motor area were activated during real acupuncture. Using the resting-state functional connectivity (FC) method, we found a post- versus pre-treatment change in the FC of the rACC and left precentral gyrus in the comparison of real acupuncture versus sham acupuncture. In addition, the FC of the rACC–left precentral gyrus at baseline was negatively correlated with short-term analgesia, while the change in the FC of the rACC–left precentral gyrus was positively correlated with short-term analgesia after acupuncture treatment. These findings support the importance of rACC–left precentral gyrus resting-state FC in the modulation of the intensity of PDM pain through acupuncture, which may shed light on the central mechanism of acupuncture in the treatment of PDM.

Is dorsal vagal complex the key nucleus of acupuncture regulation of gastric function？

Acupuncture has remarkable effects on treating functional gastrointestinal diseases, but its central mechanism is not clear. At present, the research has mainly focused on several central nuclei, such as the dorsal vagus complex (DVC), nucleus raphe magnus (NRM), locus coeruleus (LC), subnucleus reticularis dorsalis (SRD), hypothalamic paraventricular nucleus (PVN), cerebellar fastigial nucleus (FN), central amygdala (CeA), etc. It is not clear whether the nuclei are involved in acupuncture regulation of gastric function through certain interrelation. A further summary of related literature indicates that many brain regions or nuclei in the central nervous system are closely related to gastric function, such as DVC, NRM, parabrachial nuclei (PBN), LC, periaqueductal gray (PAG), cerebellum, PVN, arcuate nucleus (Arc), hippocampus, CeA, etc. Most of these nuclei have certain fiber connections with each other, in which DVC is the basic center, and other nuclei are directly or indirectly involved in the regulation of gastric function through DVC. Is DVC the key target in acupuncture regulation of gastric function? Does other nuclei have direct or indirect neural circuit with DVC to participate in the regulation of gastric function by acupuncture, such as the possibility of CeA-DVC neural loop in acupuncture regulating gastric function. Therefore, more advanced techniques such as photogenetics, chemical genetics should be introduced and the central mechanism of acupuncture on regulating gastric function with DVC as center, from the view of nerve loop, will become the focus of further research, which could explain the central integration mechanism of acupoint compatibility by modern neuroscience technology.

Acupuncture at Waiguan (SJ5) and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study.

Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group (true acupuncture at right Waiguan (SJ5)) and sham point group (sham acupuncture). Results of functional magnetic resonance imaging revealed activation in right parietal lobe (Brodmann areas 7 and 19), the right temporal lobe (Brodmann area 39), the right limbic lobe (Brodmann area 23) and bilateral occipital lobes (Brodmann area 18). Furthermore, inhibition of bilateral frontal lobes (Brodmann area 4, 6, and 45), right parietal lobe (Brodmann areas 1 and 5) and left temporal lobe (Brodmann area 21) were observed in the true point group. Activation in the precuneus of right parietal lobe (Brodmann area 7) and inhibition of the left superior frontal gyrus (Brodmann area 10) was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex (Brodmann area 5) is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.

Acupuncture effect and omics studies.

The current special issue is the 2013 issue which includes 12 interesting manuscripts. According to the World Health Organization, acupuncture is useful as adjunct therapy in more than 50 disorders; however, the mechanisms by which acupuncture acts are unclear. In recent years, the omic technologies including genomics, transcriptomics, proteomics, metabolomics/metabonomics, and brain connectomics have been extensively used in acupuncture studies. With these techniques, it seems possible to explore the physiological mechanism of acupuncture in various diseases. This special issue contains 12 manuscripts, of which 4 systematic reviews are related to the recent advances on human body and diseases under the guidance of holistic view, which will be an utmost important way for developing acupuncture. One manuscript studies the activity of the brachioradialis muscle along the large intestine meridian of hand Yangming by electromyography (sEMG) technology. One manuscript studied the validity of a “Streitberger” needle as a valid approach in a population with experience of acupuncture. Three manuscripts are related to the mechanism of acupuncture. These papers suggested that acupuncture may result from antioxidation, anti-inflammation, and antiapoptosis effects in kinds of diseases. In traditional Chinese medicine, the holistic view not only means the harmonious unity of the whole body, but also includes the unison between man and environment. One manuscript is related to the effect of acupuncture on endometrial immune microenvironment. Two overviews focus on omics application in acupuncture research, which provides an important approach for further exploring the central mechanism of acupuncture. Omics and systems biology approaches should be particularly good at generating new hypotheses on mechanisms for acupuncture effects, and more research is required to reveal physiological mechanism of acupuncture at the holistic view level. Cun-Zhi Liu Fan-Rong Liang Jaung-Geng Lin Sven Schroder Tiina Rekand Li Zhu

Neurobiological Mechanisms of Acupuncture

Acupuncture, an age-old healing art, has been accepted to effectively treat various diseases, particularly chronic pain and neurodegenerative diseases. Since its public acceptance and good efficacy, increasing attention has been now paid to exploring the physiological and biochemical mechanisms underlying acupuncture, particularly the brain mechanisms. Basic and clinical acupuncture studies on neurobiological mechanisms of acupuncture are crucial for the development of acupuncture. This issue compiles 32 exciting papers, most of which are very novel and excellent investigations in this field. The neural mechanism underlying acupuncture analgesia was addressed in four articles. J. Wang et al. established a postincisional pain model of rats and investigated electroacupuncture effect on the brain oscillations involving postoperative pain. B.-S. Lim et al., using interesting bee venom acupuncture, explored whether it can relieve oxaliplatin-induced cold allodynia and which endogenous analgesic system is implicated. The paper by Yumi Maeda et al. aimed to evaluate this linkage between brain response to acupuncture and subsequent analgesia in chronic pain patients with carpal tunnel syndrome. Since many articles aimed to assess the effect of electroacupuncture induced analgesia, W. Kim et al. systemically conducted a review to assess the efficacy and clarify its mechanism on neuropathic pain. In addition, as a great challenge in acupuncture analgesia and treatment evaluations, D. Zhu et al. outlined the advantages and disadvantages of kinds of acupuncture controls and highlighted how the differences among placebo devices can be used to isolate distinct components of acupuncture treatment. Five papers deal with potential neural mechanism underlying acupuncture treatments on the stroke, hypertension, and mild cognitive impairments. The paper by L. Liu and R.T.F. Cheung aimed to investigate whether the combination of melatonin and electroacupuncture therapies could be beneficial against transient focal cerebral ischemia in a rat model of transient middle cerebral artery occlusion. W. Qin et al. accompanied by L. Liu and R.T.F. Cheung's paper explored the importance of anti-inflammatory acupuncture treatment for the focal cerebral ischemia/reperfusion by inhibiting the NF-κB signaling pathway. Another two papers mainly focused on the acupuncture modulation of neural mechanism for hypertension regulation with long-term as well as short-term treatments. The paper by G.-H. Tian et al. addressed the long-term electroacupuncture on cerebral microvessels and neurons in CA1 region of hippocampus in spontaneously hypertensive rats. H. Chen et al. aimed to explore the hypothalamus-anchored resting brain network underlying primary hypertension patients after short-term acupuncture treatments. Moreover, for mild cognitive impairments, S. Chen et al. have pointed out that acupuncture at KI3 at different cognitive states and with varying needling depths may induce distinct reorganizations of effective connectivity of brain networks. The neuroendocrine system involving acupuncture has been addressed by the following three papers. Z. Yu et al. has suggested that TRPV1 receptor is partially involved in the electroacupuncture-mediated modulation of gastric motility. The paper by C.-C. Kuo et al. explored the mechanism of electroacupuncture (EAc) induced antinociception involved opioid receptors and the serotonergic system. Q.-Q. Li et al. conducted a systemic review about the central mechanism of acupuncture in modulating various autonomic responses. Moreover, other papers focused on the relatively acupoint specificity from wide aspects. One of the studies by L. Li et al. suggested that both the size and function of the acupoints comply with the functionality of the internal organs; thus the sensitive degree of acupoints changed according to malfunction of internal organs. C.-Y. Chen et al. implied that somatoparasympathetic neuronal connection (groin-spinal dorsal horn-NTS/DMX-uterus) and a somatosympathetic neuronal connection (groin-spinal dorsal horn-NTS-PVN-uterus) could be the prerequisites to the neuronal basis of the somatovisceral reflex and also the neuronal mechanism of acupuncture. Z. Wang et al. advanced that the modulatory effects of different needling sensations induced by relatively different acupoints contribute to acupuncture modulations of limbic-paralimbic-neocortical network. Although the acupoints were spatially adjacent, there was also relatively functional specificity inflected by brain networks. By gathering these papers, we hope to enrich our readers and researchers with respect to the underlying neurological mechanism of acupuncture, and we look forward to an increasing number of both clinical trials and experimental studies to further promote the development of understanding the neurological mechanism involving acupuncture. Lijun Bai Richard E. Harris Jian Kong Lixing Lao Vitaly Napadow Baixiao Zhao

Acupuncture Effect and Central Autonomic Regulation

Acupuncture is a therapeutic technique and part of traditional Chinese medicine (TCM). Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. This review focused on the central mechanism of acupuncture in modulating various autonomic responses, which might provide neurobiological foundations for acupuncture effects.

Central mechanism of electric-acupuncture at Zusanli (ST36) for gastric mucous membrane protection with FMRI

To explore the central mechanism of acupuncture in protecting gastric mucous membrane by a composite analysis of gastric mucous membrane related indices in peripheral blood and functional MRI (fMRI) signal changes after electric-acupuncturing Zusanli (ST36) acupoint. Sixteen healthy adult volunteers were divided into true acupoint group (A) and sham acupoint group (B). Zusanli acupoint was used for Group A. Peripheral blood was drawn 5 min before and 5, 15, 25, 30 min after needle-removal for the detection of gastric mucous membrane related indices. fMRI was performed during acupuncture and the acquired fMRI data were analyzed by SPM2 (P < 0.001). The levels of calcitonin gene related peptide (CGRP) and prostaglandin E2 (PGE2) increased while those of endothelin (ET) and gastrin (GAS) decreased significantly after acupuncture in Group A (P < 0.01). And there was no significant change in Group B (P > 0.05). Acupuncturing Zusanli activated the bilateral middle frontal gyrus, caudate, left precentral and postcentral gyri, hypothalamus, anterior cingulate cortex, right hippocampus, insula and cerebellar hemisphere. But acupuncturing the sham acupoint only activated the paracentral lobule and cerebellar hemisphere. Acupuncturing Zusanli acupoint activates certain cortex areas and multiple systems to stimulate the release of neurotransmitters and regulate the peripheral humoral factors to achieve the protection of gastric mucous membrane.

Acupuncture effects on levels of Excitatory amino acids in brain of SAM-P/8

Objective: To reveal the central mechanism of acupuncture on the central nervous system. Methods: Excitatory amino acids (EAAs) were determined in cerebral cortex, hippocampus and striate body of left side by Shimadzu LC-6A HPLC. Results: Metabolic disorder existed in excitatory amino acids: The content of Glu, Gln, Asp and Asn in hippocampus and striate body were generally increased (P < 0.05, orP < 0.01), the content of Asn in cerebral cortex was also increased (P < 0.01). The changes of inhibited amino acids (IAAs) to certain extent also existed in the three regions but without regularity. Xingnao Kaiqiao acupuncture method could obviously reduce the levels of Glu, Asp, Gln and Asn in hippocampus and striate body and the levels of Asn and Gln in cerebral cortex of senescence accelerate mouse P/8 (SAM-P/8). The non-acupoint acupuncture method did not exert obvious effects on Glu and Asp which was quite different from Xingnao Kaiqiao acupuncture effects. Conclusions: (1) The hypermetabolism of EAAs existed in the brain of SAM-P/8, which could be regarded as the important pathological mechanism of disorder in study and memory and cerebral atrophy. (2) Xingnao Kaiqiao acupuncture method could obviously regulate the abnormal metabolism of cerebral EAAs, which could be regarded as one of the mechanisms of acupuncture effects on improving brain function. (3) Acupuncture effect has remarkable’ specificity of acupoint.