The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI

Clinical and experimental data indicate that most acupuncture clinical results are mediated by the central nervous system, but the specific effects of acupuncture on the human brain remain unclear. Even less is known about its effects on the cerebellum. This fMRI study demonstrated that manual acupuncture at ST 36 (Stomach 36, Zusanli), a main acupoint on the leg, modulated neural activity at multiple levels of the cerebro-cerebellar and limbic systems. The pattern of hemodynamic response depended on the psychophysical response to needle manipulation. Acupuncture stimulation typically elicited a composite of sensations termed deqi that is related to clinical efficacy according to traditional Chinese medicine. The limbic and paralimbic structures of cortical and subcortical regions in the telencephalon, diencephalon, brainstem and cerebellum demonstrated a concerted attenuation of signal intensity when the subjects experienced deqi. When deqi was mixed with sharp pain, the hemodynamic response was mixed, showing a predominance of signal increases instead. Tactile stimulation as control also elicited a predominance of signal increase in a subset of these regions. The study provides preliminary evidence for an integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 that correlates with the psychophysical response.     

基于fMRI技术探讨电针与手针中枢机制响应差异

目前功能磁共振技术在针刺（电针与手针）中枢机制研究取得了一定进展,但不同针刺参数及形式的刺激在大脑的响应不同。本文收集了“功能磁共振与针刺”相关的国内外文献,以针刺“刺激-响应”模式为切入点,对电针刺激量及电针与手针的的中枢响应差异作一初步的论述。结果表明,在功能磁共振技术观测中,不同电针参数存在不同的中枢响应机制,并应将多个参数联合研究;其次,电针与手针在传入途径、作用机制、靶点、临床疗效等方面存在差异,也有着各自的优势病种。      

Acupuncture in migraine: investigation of autonomic effects

OBJECTIVE: A dysregulation of the autonomic nervous system is discussed as a pathogenetic factor in migraine. As acupuncture has been shown to exhibit considerable autonomic effects, we tested whether the clinical effects of acupuncture in migraine prophylaxis are mediated by changes of the autonomic regulation. METHODS: We simultaneously monitored changes of heart-rate variability (HRV) as an index of cardiac autonomic control and clinical improvement during an acupuncture treatment in 30 migraineurs. HRV was derived from spectral analysis of the electrocardiogram, which was performed before, during, and after the first and the last session of a series of 12 acupuncture sessions. Migraineurs were randomly allocated to 2 groups receiving either verum acupuncture (VA) or sham acupuncture (SA) treatment. RESULTS: Across the combined VA and SA groups, the clinical responders (with at least 50% reduction of migraine attacks) exhibited a decrease of the low-frequency (LF) power of HRV in the course of the treatment, which was not be observed in patients without clinical benefit. VA compared with SA induced a stronger decrease of high-frequency power. The mode of acupuncture, however, did not have an impact on the LF component of HRV or the clinical outcome. DISCUSSION: The data indicate, that VA and SA acupuncture might have a beneficial influence on the autonomic nervous system in migraineurs with a reduction of the LF power of HRV related to the clinical effect. This might be due to a reduction of sympathetic nerve activity. VA and SA induce different effects on the high-frequency component of HRV, which seem, however, not to be relevant for the clinical outcome in migraine.     

A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods

OBJECTIVES: To characterize the brain activation patterns evoked by manual and electroacupuncture on normal human subjects. DESIGN: We used functional magnetic resonance imaging (fMRI) to investigate the brain regions involved in electroacupuncture and manual acupuncture needle stimulation. A block design was adopted for the study. Each functional run consists of 5 minutes, starting with 1-minute baseline and two 1-minute stimulation, the interval between the two stimuli was 1 minute. Four functional runs were performed on each subject, two runs for electroacupuncture and two runs for manual acupuncture. The order of the two modalities was randomized among subjects. During the experiment, acupuncture needle manipulation was performed at Large Intestine 4 (LI4, Hegu) on the left hand. For each subject, before scanning started, the needle was inserted perpendicular to the skin surface to a depth of approximately 1.0 cm. Electroacupuncture stimulation was delivered using a continuous rectangular wave form (pulse width 30 ms) at a frequency of 3 Hz. For manual acupuncture, the needle was rotated manually clockwise and counterclockwise at a rate of about 180 times per minute (3 Hz). SUBJECTS: Eleven right-handed, normal, healthy volunteer adults, 6 male and 5 female, ages 21-64 participated in the experiment. RESULTS: Results showed that electroacupuncture mainly produced fMRI signal increases in precentral gyrus, postcentral gyrus/inferior parietal lobule, and putamen/insula; in contrast, manual needle manipulation produced prominent decreases of fMRI signals in posterior cingulate, superior temporal gyrus, putamen/insula. CONCLUSION: These results indicate that different brain networks are involved during manual and electroacupuncture stimulation. It suggests that different brain mechanisms may be recruited during manual and electroacupuncture.     

针刺足阳明胃经两相邻穴位脑功能磁共振成像研究

目的研究针刺足阳明胃经两相邻穴位所引起的脑功能变化情况。方法将27名健康右利手志愿者随机分为3组,分别针刺右侧陷谷穴、内庭穴以及二者附近的假穴,针刺同时进行全脑功能核磁共振成像,运用统计参数图软件（SPM）加以处理。结果针刺两个穴位激活的相同脑区包括双侧第一感觉/运动区（SI/MI）,同侧小脑和第二感觉区（SII）。针刺陷谷穴特异性激活了同侧额内侧回,额下回内侧,扣带回前部（ACC）和丘脑腹外侧核;针刺内庭穴特异性激活了双侧扣带回后部（PCC）,对侧额中回,额下回,楔前叶,同侧舌回,枕中回,豆状核。结论从影像学角度验证了针刺同一经络上位置相近功能相似的腧穴可以引起与治疗作用相关的中枢神经系统响应。     

Acupuncture mechanisms for clinically relevant long-term effects--reconsideration and a hypothesis

From the author's direct involvement in clinical research, the conclusion has been drawn that clinically relevant long-term pain relieving effects of acupuncture (>6 months) can be seen in a proportion of patients with nociceptive pain. The mechanisms behind such effects are considered in this paper. From the existing experimental data some important conclusions can be drawn: 1. Much of the animal research only represents short-term hypoalgesia probably induced by the mechanisms behind stress-induced analgesia (SIA) and the activation of diffuse noxious inhibitory control (DNIC). 2. Almost all experimental acupuncture research has been performed with electro-acupuncture (EA) even though therapeutic acupuncture is mostly gentle manual acupuncture (MA). 3. Most of the experimental human acupuncture pain threshold (PT) research shows only fast and very short-term hypoalgesia, and, importantly, PT elevation in humans does not predict the clinical outcome. 4. The effects of acupuncture may be divided into two main components--acupuncture analgesia and therapeutic acupuncture. A hypothesis on the mechanisms of therapeutic acupuncture will include: 1. Peripheral events that might improve tissue healing and give rise to local pain relief through axon reflexes, the release of neuropeptides with trophic effects, dichotomising nerve fibres and local endorphins. 2. Spinal mechanisms, for example, gate-control, long-term depression, propriospinal inhibition and the balance between long-term depression and long-term potentiation. 3. Supraspinal mechanisms through the descending pain inhibitory system, DNIC, the sympathetic nervous system and the HPA-axis. Is oxytocin also involved in the long-term effects? 4. Cortical, psychological, "placebo" mechanisms from counselling, reassurance and anxiety reduction.     

近20年激光针灸脑效应研究进展

激光针灸作为社会科技进步的时代产物，是一种将低水平激光应用于经络系统的治疗方法，拓宽了传统针灸技术的应用及发展，其脑效应研究于近20年兴起，本文从当前应用较多的功能磁共振成像、脑电图和经颅多普勒超声3种技术层面对激光针灸脑效应的研究进展及未来展望加以论述。研究表明激光针灸在刺激不同穴位时产生的脑效应能够体现穴位的特异性且与其主治存在关联，同时有相似作用的穴位产生的脑效应存在一定的相关性。目前激光针灸作用机制仍未探查清楚，脑效应研究为探索其治疗以疼痛为代表的某些疾病的疗效机制提供了新的视角，虽然仍面临着许多挑战，但未来有着广阔的发展前景。      

Acupuncture modulation of capsaicin-induced inflammation: effect of intraperitoneal and local administration of naloxone in rats. A blinded controlled study

OBJECTIVE: It is believed that acupunctural stimulation induces an analgesic response mainly through a central mechanism: that is, through an increase in the production of opioid peptides and their release at different levels in the nervous system. We sought to establish whether the modulating effect of acupuncture on experimental neurogenic edema can be attributed to a central mechanism only or whether a peripheral mechanism could also exist. Intraperitoneal administration was compared to local administration in the same paw in rats that were injected with capsaicin and in the same dermatome of the acupunctural stimulation. MATERIALS AND METHODS: Experimentation was conducted on 105 male Sprague-Dawley rats weighing 180-220 g, divided into 7 groups as follows: group 1, control; groups 2-4 (15 animals), stimulated with manual acupuncture; group 3 also treated with intraperitoneal naloxone 1 mg/kg; group 4 also treated locally with naloxone (20 microg); groups 5-7 (15 animals), stimulated with 5 Hz and 5 mA electroacupuncture (EAP); group 6 also treated with intraperitoneal naloxone, 1 mg/kg, group 7 also treated locally with naloxone (20 microg). RESULTS: The results indicate that the administration of 1 mg/kg of naloxone intraperitoneally can inhibit the modulating effect of acupunctural stimulation. Equally effective in inhibiting the modulating effect of acupunctural stimulation, although not having a systemic effect, is a 20-microg dose of naloxone administered peripherally on the site of edema induction. CONCLUSION: It is possible to conclude that both systemic and peripheral mechanisms seem to be implicated in the modulating effect of acupuncture on the neurogenic inflammation mechanism.     

针药合用对大鼠局灶性脑缺血预后的影响

目的研究针药合用对脑缺血大鼠的治疗作用。方法阻断大鼠一侧大脑中动脉(MCA)造成局灶性脑缺血模型(MCAO),观察针药合用对神经病学症状、被动性条件反向、血液流变性、脑梗死面积及脑组织病理学的影响,并与单纯针刺和单纯药物组比较。结果3组均能改善脑缺血大鼠神经症状,提高学习记忆能力,降低血液黏度,缩小脑梗死面积,促进坏死灶内血管和胶质细胞增生修复,减少脑组织水肿和炎性细胞浸润。结论针药组在提高学习记忆能力及降低血液黏度方面明显优于针刺和药物组。     

Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation

Segmental neurological modulation, neural hysteresis and biomechanical effects have been proposed as mechanisms underpinning the effects of manual therapy. An increasing number of studies hypothesise activation of the central nervous system resulting in a non-segmental hypoalgesic effect with concurrent activation of other neural pathways as a potential mechanism of action. Whether this model is consistent with the current literature is unknown. This systematic review aims to assess the consistency of evidence supporting an involvement of supraspinal systems in mediating the effects of passive cervical joint mobilisation. We searched randomised trials in three electronic databases from inception to November 2007, without language restriction, and checked reference lists of included studies. We assessed study validity and extracted salient features in duplicate. Fifteen studies met our inclusion criteria. The overall quality was high. We found consistency for concurrent hypoalgesia, sympathetic nervous system excitation and changes in motor function. Pooling of data suggested that joint mobilisation improved outcomes by approximately 20% relative to controls. This specific pattern suggests that descending pathways might play a key role in manual therapy induced hypoalgesia. Our review supports the existence of an alternative neurophysiological model, in which passive joint mobilisation stimulates areas within the central nervous system.     

Neuroimaging acupuncture effects in the human brain

Acupuncture is an ancient East Asian healing modality that has been in use for more than 2000 years. Unfortunately, its mechanisms of action are not well understood, and controversy regarding its clinical efficacy remains. Importantly, acupuncture needling often evokes complex somatosensory sensations and may modulate the cognitive/affective perception of pain, suggesting that many effects are supported by the brain and extending central nervous system (CNS) networks. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans and may be used to help map the neurophysiological correlates of acupuncture. In this review, we will summarize data from acupuncture neuroimaging research and discuss how these findings contribute to current hypotheses of acupuncture action.     

电刺激的fMRI的初步研究

目的研究不同频率的电刺激在大脑产生的激活,为理解和发展电刺激治疗疾病的方法提供依据和方向.方法对健康被试者的手腕和肘部内侧进行不同频率的低频电刺激,采用功能磁共振仪进行脑部激活图像的采集.结果表明不同频率的电刺激在大脑中的激活具有差异性,引起了运动皮层和躯体感觉区的明显激活.结论提示不同频率的电刺激可能激活了不同的神经通路,这些神经通路可能服务于中枢神经系统的不同功能,对于在电刺激的康复治疗中,选择恰当的刺激频率有一定的指导意义.     

Acupuncture analgesia for temporal summation of experimental pain: A randomised controlled study

Background: Temporal summation of pain, a phenomenon of the central nervous system (CNS), represents enhanced painful sensation or reduced pain threshold upon repeated stimulation. This pain model has been used to evaluate the analgesic effect of various medications on the CNS. Aims: The present study aimed to evaluate the effects and characteristics of analgesia induced by electroacupuncture (EA), manual acupuncture (MA) and non‐invasive sham‐acupuncture (SA) in healthy humans on temporal summation of pain. Methods: Thirsty‐six pain‐free volunteers were randomised into one of the three groups EA (2/100 Hz), MA or SA. Acupuncture intervention was on ST36 and ST40 on the dominant leg delivered by an acupuncturist blinded to the outcome assessment. Both subjects and the evaluator were blinded to the treatment allocation. Pain thresholds to a single pulse (single pain threshold, SPT) and repeated pulses electrical stimulation (temporal summation thresholds, TST) were measured before, 30 min after and 24 h after each treatment. Results: The baseline values of three groups were comparable. Compared to SA, EA significantly increased both SPT and TST immediately after the treatment on the treatment leg as well as 24 h after on both the treatment and non‐treatment legs (ANOVA, p < 0.05). MA also increased SPT and TST, but the changes were not significantly different from those induced by SA. Conclusion: EA induces bilateral, segmentally distributed and prolong analgesia on both SPT and TST, indicating a non‐centrally specific effect. This effect needs to be verified with heat or mechanical model and in pain patients.     

针刺正常老年人"四关穴"的脑功能MRI研究

目的采用脑功能磁共振成像(fMRI)探讨针刺正常老年人“四关穴”(双侧太冲穴和合谷穴)的中枢神经机制。方法针刺13例正常老年人“四关穴”,同时进行全脑fMRI扫描。为避免针刺后效应的影响,实验采用单组块设计。数据采用SPM99进行分析。图像中每个体素的t值形成统计参数图,以P<0.05(经比较修正后)的体素作为激活体素。结果针刺正常老年人“四关穴”激活双侧小脑半球、小脑蚓部、左侧额中回、双侧额下回、双侧中央旁小叶、双侧丘脑、后扣带回和前扣带回。针刺“四关穴”所激活的脑区,并非是单独针刺太冲穴和合谷穴所激活脑区的简单叠加。结论针刺正常老年人“四关穴”激活后扣带回和额叶,这可能是该组合穴治疗精神类疾病的中枢神经机制。fMRI是一种客观显示针刺治疗脑改变的方法。     

红细胞生成素:新的神经营养和神经保护因子

红细胞生成素(erythropoietin，EPO)是由肾脏产生的特异性刺激红细胞生成的造血生长因子。近年来的研究发现EPO不仅仅只作用于造血系统，作为一种多功能的营养因子，它还对整个机体稳态的维持发挥作用。在中枢神经系统和脑脊液中均发现有特殊的EPO及EPO受体系统，该系统独立于造血系统中的EPO及其受体系统而存在。EPO在不同种类的神经损伤(如脑缺血、缺氧及蛛网膜下腔出血等)中具有神经营养和保护功能，重组人红细胞生成素(recombinant human erythropoietin，rhEPO)疗法将很快用于临床实践去修复上述疾病引起的神经损伤。     

针刺对肥胖大鼠纹状体组织一氧化氮含量和一氧化氮合酶活性的作用

背景已知针灸减肥机制涉及神经及神经体液调节.考虑到纹状体参与了对下丘脑摄食中枢、植物神经中枢、体温调节中枢等的调控.针刺对肥胖大鼠纹状体组织一氧化氮含量和一氧化氮合酶(nitric oxide syn-thase,NOS)活性的调整作用如何?目的探讨针刺对肥胖大鼠纹状体组织一氧化氮和NOS含量的影响,进一步深化针刺减肥的中枢神经作用机制.设计以自身对照、相互对照为主的实验研究.单位南京中医药大学第二临床医学院针灸研究所、南京人口管理学院生殖医学教研室.材料本实验在南京中医药大学第二临床医学院针灸研究所完成.1月龄刚断乳SD雄性大鼠,体质量50～70 g,由南京军区总医院实验动物中心提供,动物级别为清洁级.干预以普通全价鼠饲料喂养的大鼠作为正常组,将造模成功的实验性肥胖大鼠随机分为对照组和针刺组,每组6只.针刺组大鼠给予针刺治疗14 d,正常组和对照组大鼠分别每天放入大鼠固定器中适应15 min,持续14 d.采用神经生化技术观察针刺治疗前后肥胖大鼠体质量、体脂及纹状体组织一氧化氮和NOS含量的变化.主要观察指标①针刺对实验性肥胖大鼠肥胖指标及对心包、肾周和附睾脂肪量的影响.②针刺对各组大鼠纹状体组织一氧化氮含量和一氧化氮合酶活性的影响.③大鼠纹状体组织一氧化氮含量和NOS活性与体质量和Lee's指数的相关性.结果肥胖大鼠体质量和体脂均显著高于正常大鼠水平,差异均有显著性意义(t=8.86,9.99,8.31,P均＜0.01);纹状体组织一氧化氮和NOS水平均显著低于正常大鼠水平,差异均有显著性意义(t=5.48,4.37,P均＜0.01);大鼠纹状体组织一氧化氮和NOS水平与体质量和Lee's指数呈负相关(r=-0.78,-0.71;P＜0.01).针刺治疗能使肥胖大鼠纹状体组织一氧化氮和NOS水平明显回升,与针刺前比较,差异均有显著性意义(t=3.74,3.48,P均＜0.01).结论纹状体组织一氧化氮和NOS水平异常可能是肥胖发病的因素;针刺对肥胖机体纹状体组织一氧化氮和NOS水平的良性调整作用可能是实现减肥效应的中枢作用机制之一.     

Glucocorticoid therapy in neurologic critical care

BACKGROUND: The pivotal role of inflammation and edema across the spectrum of central nervous system injury has driven extensive investigation into the therapeutic potential of glucocorticoids. OBJECTIVE: To review the experimental and clinical data relating to the efficacy and adverse effects of glucocorticoids in conditions encountered in critical neurologic and neurosurgical illness. DATA SOURCE: Search of MEDLINE and Cochrane databases, manual review of article bibliographies. DATA SYNTHESIS AND CONCLUSIONS: The efficacy of glucocorticoids is well established in ameliorating edema associated with brain tumors and in improving outcome in subsets of patients with bacterial meningitis. Despite frequently encouraging experimental results, clinical trials of glucocorticoids in ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury have not shown a definite therapeutic effect. The evidence supporting glucocorticoid therapy for spinal cord injury is controversial; however methylprednisolone continues to be widely employed in this setting.     

针刺对小儿脑瘫作用机制的初步探讨

为总结针刺对小儿脑瘫的疗效并探讨其机理，收集脑瘫患儿资料195例，年龄3个月～11岁，分为观察组119例和对照组76例。观察组予针刺、药物治疗及功能康复锻炼；对照组不予针刺，其余相同，并对部分患儿进行了血流流变学和脑SPECF检查。结果观察组有效率73．95％，对照组为58．24％（标准化后），差别有统计意义（P＜0．05）；而且年龄、治疗时间和脑瘫类型不同对疗效有影响。血液流变学和脑SPECT检查结果也支持针刺对本病的治疗作用（P＜0．05或0．01）。提示脑瘫应早期诊断，早期治疗。从现代系统论观点出发，针刺通过神经调节和体液调节作用于中枢神经和血液循环等系统，改善了患儿脑部病灶的血供和营养，促进了脑瘫尤其是痉挛型患儿的康复。     

手法针刺合谷穴得气与脑功能激活关系的探讨

目的 探讨针灸"得气"与脑功能激活的关系.方法 13例健康右利手受试者,由针灸医师先后进行右手合谷穴"浅表刺激"与传统手法捻针刺激两种任务,利用fMRI-BOLD技术获得脑功能图像,用感兴趣区(ROI)分析方法,比较两种任务下的平均信号变化情况.结果 针灸"得气"存在个体差异,相应脑功能的激活情况也有所不同,前额区、丘...     

Does acupuncture help patients with spasticity? A narrative review

Spasticity is a motor disorder encountered after upper motor neuron lesions. It adversely affects quality of life in most patients and causes long-term burden of care and has significant financial implications. The effect of conventional therapies for spasticity including physical therapy, surgery, and pharmacotherapy are not always satisfying because of the short-term effects or side effects in some patients. Acupuncture is a part of traditional medicine originating from China. It has been used to resolve functional recovery problems after central nervous system injury for many years in Asian countries and is increasingly popular in western countries. Some researches suggest that acupuncture has therapeutic potential to help improve limb movement function and decrease the severity of spasticity. This review synthesizes studies involving stroke, brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis to give an overall picture of the effect and potential mechanisms of acupuncture on spasticity occurring after upper motor neuron lesions. Moderate-quality evidence suggests that electroacupuncture combined with conventional routine care (pharmacological/rehabilitation) could reduce spasticity and improve motor function and activities in daily living after stroke. However, there is not enough evidence to conclude that acupuncture (including electroacupuncture) could reduce spasticity with other central nervous system diseases.