Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study

Recent neuroimaging studies have revealed that acupuncture stimulation modulates human central nervous system including cerebral limbic/paralimbic and subcortical structures. Due to the wide and intricate connections with cerebrum, we hypothesized that anatomically specific areas in human cerebellum are also modulated by acupuncture stimulation beyond classical involvement of cerebellum in motor coordination. Functional MRI (fMRI) was used to investigate neural substrates responding to the acupuncture stimulation of Pericardium 6 (PC6, Neiguan), an acupoint relevant for the management of nausea including vestibular-related motion sickness. Sham stimulation near the acupoint and tactile stimulation on the skin of the acupoint were given as separate conditions. Psychophysical scores as well as the heart and respiratory rates were measured during each condition. Acupuncture manipulation on PC6, in comparison to the sham acupuncture and tactile stimulation conditions, selectively activated left superior frontal gyrus, anterior cingulate gyrus, and dorsomedial nucleus of thalamus. Acupuncture-specific neural substrates in cerebellum were also evident in declive, nodulus, and uvula of vermis, quadrangular lobule, cerebellar tonsil, and superior semilunar lobule. Negative MR signal changes, often seen during the acupuncture of analgesic points, were not observed in the present study. Our data suggest that cerebellum serves as important activation loci during the acupuncture stimulation of PC6, and clinical efficacy of PC6 may be mediated by the cerebellar vestibular neuromatrix.     

针刺中都穴的fMRI研究

目的采用功能MRI(fMRI)方法研究针刺中都穴(Liv6)有关的大脑激活。方法16例健康志愿者随机分为两组。8例接受右侧中都穴针刺,8例接受右侧中都穴附近的假针刺。实验采用单组块设计。每个被试只接受一次针刺,即中都穴或中都穴附近。在针刺时进行全脑图像扫描,最后对全脑图像采用统计参数图(SPM99)进行统计分析。结果相对于刺激假穴组,刺激中都穴激活了对侧额内侧、对侧中央后回、小脑、额上回、同侧前扣带回、同侧枕叶、对侧顶叶和对侧颞上回。结论针刺Liv6激活了视区、小脑、边缘系统和皮下灰质结构,这些脑区有可能是中都穴的特异性脑区。这将为解释针灸和大脑之间的关系提供进一步的证据。     

针刺真、假穴位不同脑区激活效应的功能性磁共振成像评估

背景:人们从大脑的不同功能区着手,试着用功能性磁共振来阐释其与经络穴位的相关性。目的:运用功能性磁共振观察针刺真、假穴位与大脑功能区的关系,以及针刺真、假穴位不同脑区激活效应的差异。设计:随机对照的验证性观察。单位:成都中医药大学附属医院,弗莱堡大学医学院环境和自然医学系针灸科以及放射医疗中心。对象:本实验于2000-10在弗莱堡大学医学院放射医疗中心完成。以视力正常的健康志愿者(弗莱堡大学医学院医学生)18人作为受试对象,随机分为2组:针刺假穴 有治疗作用穴位组和针刺假穴 无治疗作用穴位组,每组9人。均签定知情同意书。方法:两组先接受浅刺(假穴)后观测出针。然后针刺假穴 有治疗作用穴位组针刺双侧光明穴和太冲穴,针刺假穴 无治疗作用穴位组针刺双侧丰隆穴和陷谷穴。为得到强烈的针感(酸麻胀重的感觉),每30s进行捻转(每穴先左后右),每次持续10s,持续4min后静息2min为1个周期,共持续4个周期25min后出针。采用1.5T磁共振扫描仪(西门子Erlangen)进行功能成像检测。并对所有的受试者及单个受试者交叉关系分析。主要观察指标:①针刺假穴以及针刺有治疗作用穴位组对象视皮质的反应。②针刺对两组对象不同脑区的激活情况。结果:因刺激程序的错误运用,2例受试者(两组各1例)在进一步的数据分析时被剔除。①针刺与视觉有关的穴位对视皮质无确切影响,但在实验过程中,而在其他皮质区(如脑岛、外侧沟、顶颞皮质等与疼痛及躯体感觉刺激有关的皮质)有轻微血氧合水平依赖性成像法信号转换,即在这些皮质区针刺真穴及假穴均有激活反应。②针刺具有治疗视力障碍作用与不具有治疗视力障碍作用的穴位,其激活类型无明显差异。③单个受试者交叉关系分析(CC>0.3)发现,针刺假穴过程中仅2/8的受试者出现了丘脑的激活。两组均出现了丘脑、红核、大脑外侧沟的激活。针刺假穴 有治疗作用穴位组3/8和针刺假穴 无治疗作用穴位组4/8的受试者出现可观察到后外侧中脑导水管周围灰质的激活反应,两组还出现了顶颞皮质的激活。说明针刺真穴与假穴在激活类型上有显著差异。结论:①通过针刺与视觉有关的穴位发现针刺对于视皮质无确切影响,但对其他皮质区,如脑岛、外侧沟、顶颞皮质等与疼痛及躯体感觉刺激有关的皮质有激活作用。②针刺真穴与假穴在激活类型上有显著差异,但针刺具有治疗视力障碍作用与不具有治疗视力障碍作用的穴位激活类型差异则不明显。     

Inserting Needles Into the Body: A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10 tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network, including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbic neocortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker patterns of brain responses were detected in areas similar to those stated above. The activation and deactivation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain.PerspectiveThis article facilitates a better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the multiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture.     

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。     

针刺太冲、合谷两穴位引起的小脑响应的差异:fMRI研究

目的应用fMRI研究针刺太冲、合谷两穴位所致小脑响应的差异。方法37例健康志愿者随机分为4组,9例接受在太冲针刺,8例接受右侧太冲附近的假穴针刺,10例接受在合谷的针刺,10例接受右侧合谷附近的假穴针刺。在针刺时进行全脑功能成像扫描,用SPM2处理图像。结果发现针刺两穴位激活了小脑的不同区域:针刺太冲的激活了对侧小脑前叶,同侧小脑后叶下半月小叶;针刺合谷激活了对侧小脑后叶下半月小叶及同侧小脑后叶上半月小叶。两穴位针刺均未引起小脑的负激活。结论不同穴位引起的小脑激活区域不同,提示小脑在针灸不同穴位作用机制中具有特异性;小脑后叶可能是不同穴位作用的共同神经通路。     

功能磁共振成像观察补法、泻法针刺足三里穴对大脑作用的中枢机制

目的 用功能磁共振成像(fMRI)方法观察补法和泻法针刺足三里穴对大脑作用的中枢机制. 方法 选取32名健康右利手志愿者,对11名受检者用补法电针刺激右侧足三里穴(ST36)、11名用泻法电针刺激ST36、10名电针刺激右侧足三里穴同一水平向外2～3 cm处.同时行全脑fMRI扫描;用SPM2软件进行图像后处理. 结果 电针结束后5 min,泻法组的脑区激活不明显,而补法组平均信号升高的脑区主要有双侧尾状核头部、丘脑、左侧岛叶、扣带回及小脑齿状核.电针结束后20～30 min期间两组脑区的激活最为明显,均激活左侧的丘脑、中央旁小叶、中央前回、颞中回、额中回、岛叶、双侧尾状核头部、小脑半球、前、后扣带回;两组激活区域大致相同,但补法组激活的脑区范围更广、强度更大.针刺假穴组只激活中央旁小叶及小脑半球. 结论 补、泻手法针刺足三里穴均能激活边缘系统、辅助运动区、灰质结构等脑区,而应用补法能更早、更强烈地激活上述脑区.     

Involvement of Spinal Neurotrophin-3 in Electroacupuncture Analgesia and Inhibition of Spinal Glial Activation in Rat Model of Monoarthritis

Although electroacupuncture (EA) has been proven to effectively relieve pain associated with arthritis, the underlying mechanism of EA analgesia requires further investigation. Here, the involvement of spinal neurotrophin-3 (NT-3) in EA’s analgesic effects on complete Freund’s adjuvant (CFA)-induced inflammatory pain was examined. The present study demonstrated that: 1) repeated EA stimulation of ipsilateral GB30 and GB34 acupoints remarkably suppressed CFA-induced hyperalgesia; 2) EA treatment markedly enhanced the upregulation of spinal NT-3 mRNA and protein levels following CFA injection; 3) antisense oligodeoxynucleotides (ODN) specifically against NT-3 intrathecally administered during EA treatment for 7 days significantly attenuated the EA analgesia; and 4) the suppressed expression of spinal GFAP (astrocytic marker), OX-42 (microglial marker) as well as proinflammatory cytokines, interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α by EA treatment was significantly attenuated following NT-3 antisense ODN delivery. These results suggested that endogenous NT-3 may be involved in the analgesic effect of EA on inflammatory pain in rats, mediated through the inhibition of spinal glial activity as well as proinflammatory cytokine production.

Perspective

The present study may initiate a discussion on the possible roles of NT-3/glia/cytokines in the therapeutic effects of acupuncture and provide insight on the mechanism underlie the analgesic effects of acupuncture on pain associated with arthritis.     

Local electrical stimulation: Effective needling points for suppressing jaw opening reflex in rat

Effects of electroacupuncture on the jaw opening reflex after tooth pulp stimulation were investigated in lightly anesthetized rats. Electroacupuncture stimulation (45 Hz, 5 msec) was delivered to 8 meridian points and 6 nonmeridian ones for 15 min so as to compare the degree of suppression elicited from each point. Significant suppressive effects on the reflex were observed in the cases of Yin-Hsiang, Ho-Ku and Shou-Sanli stimulation and these effects were antagonized by naloxone. However, stimulation of Hsia-Kuan, Chu-Chih, Neiting and Taichi, although these points were reported to suppress oro-facial or dental pain in man, scarcely produced suppressive effects. On the other hand, stimulation of some nonmeridian points produced moderate analgesic effects as gauged by the jaw opening reflex. The present study revealed that specificity of the meridian points is not absolute, but relative and that Yin-Hsiang, Ho-Ku and Shou-Sanli points were fairly effective in suppressing pulp-evoked jaw opening reflex in rat, which is presumably a noxious reflex. When the jaw opening reflex was evoked by non-pulpal stimulation, electroacupuncture was less effective on the reflex.     

Discrimination of Real and Sham Acupuncture Needles Using the Park Sham Device: A Preliminary Study

Tan C-W, Christie L, St-Georges V, Telford N. Discrimination of real and sham acupuncture needles using the Park sham device: a preliminary study.

Objective

To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles.

Design

The design was a yes-no experiment. Judgments were made on whether the real or sham acupuncture needle was administered.

Setting

University laboratory.

Participants

Healthy, acupuncture-naive university students and staff (N=20; median age, 22y; range, 18–48y) recruited through convenience sampling.

Interventions

Participants made yes-no judgments on whether the real or sham needle was administered to 8 acupoints (4 traditional and 4 nontraditional) along the Pericardium meridian (Pericardium 3 to Pericardium 6) on the dominant forearm.

Main Outcome Measures

The accuracy index, d′, of participants' ability to discriminate between the real and sham needles (discriminability) was computed for the traditional alone, the nontraditional alone, and a combination of both types of acupoints.

Results

The participants' d′ between the real and sham needles was not statistically significant from d′ equal to 0 for the combined traditional and nontraditional acupoints comparison and the nontraditional acupoints alone comparison (combined, t₁₉=1.20, P=.25; nontraditional, t₁₉=.16, P=.87). However, the participants' d′ was statistically significant from d′ equal to 0 for the traditional acupoints comparison (t₁₉=2.096, P=.049).

Conclusions

The Park sham acupuncture device appears to be effective in blinding participants to real acupuncture intervention when it is applied to the nontraditional acupoints and when traditional and nontraditional acupoints are combined on the forearm along the pericardium meridian. However, the sham device does not appear to blind participants effectively when traditional acupoints alone are used for the same context.     

孤啡肽基因敲除小鼠电针镇痛作用增强

目的：孤啡肽是阿片受体样受体（ORL1）的内源性配基,蛇能调节疼痛与镇痛反应以及针刺镇痛反应,但各个实验室所得结果各不相同。本文利用OFQ基因敲除的小鼠为工具,观察内源性OFQ在针刺镇痛中的作用。方法：采用本实验室建立的小鼠电针方法,选用穴位足三里（SP36）与三阴交（SP6）,电针参数采用韩氏仪恒流方波输出,强度1.0-1.2-1.4 mA,每10min递增一级。痛阈的改变以热辐射甩尾来评价。结果：与野生型小鼠相比,OFQ基因高除小鼠基础痛阈明显延长,对100Hz电针镇痛反应显著增强,但不影响2Hz电针镇痛。结论：在整体情况下,内源性OFQ有紧张性的致痛敏作用,并对100Hz针刺镇痛有拮抗作用。     

Research on the neurophysiological mechanisms of acupuncture: review of selected studies and methodological issues

This presentation reviews studies that contribute to an understanding of the neurophysiological mechanisms of acupuncture. A 1973 study, using volunteer medical students, looked into acupuncture's analgesic effect on experimentally induced pain and suggests that humoral factors may mediate acupuncture-induced analgesia. In a study of the possible role of the cerebrospinal fluid transmission of pain suppression effects of acupuncture, cerebrospinal fluid from acupuncture-treated rabbits was infused into recipient rabbits. The analgesic effect was observed in the recipient rabbits, suggesting that acupuncture-induced analgesia may be mediated by substances released in the cerebrospinal fluid. Studies of electroacupuncture in rats revealed that both low-frequency and high-frequency stimulation could induce analgesia, but that there are differential effects of low- and high-frequency acupuncture on the types of endorphins released. In another study, low-frequency electroacupuncture, given as median nerve stimulation in cats, was shown to protect the myocardium by inhibiting sympathetic pressor response and increasing myocardial oxygen demand. The development of neuroimaging tools, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), make noninvasive studies of acupuncture's effects on human brain activity possible. Studies using PET have shown that thalamic asymmetry present among patients suffering from chronic pain was reduced after the patients underwent acupuncture treatment. Other studies, using fMRI, have pointed to relationships between particular acupoints and visual-cortex activation. These powerful new tools open the possibility to new scientific studies of this ancient therapy.     

Neurobiology of Acupuncture: Toward CAM

It has long been accepted that acupuncture, puncturing and scrapingneedles at certain points on the body, can have analgesic andanesthetic effects, as well as therapeutic effects in the treatmentof various diseases. This therapy, including acupuncture anesthesia,has drawn the attention of many investigators and become a researchsubject of international interest around the world. Numerousstudies have demonstrated that the nervous system, neurotransmitters,endogenous substances and Jingluo (meridians) may respond toneedling stimulation and electrical acupuncture. An abundanceof information has now accumulated concerning the neurobiologicalmechanisms of acupuncture, in relation to both neural pathwaysand neurotransmitters/hormonal factors that mediate autonomicregulation, pain relief and other therapeutics. Early studiesdemonstrated that the analgesic effects of electroacupuncture(EA) are mediated by opioid peptides in the periaqueductal gray.Recent evidence shows that nitric oxide plays an important rolein mediating the cardiovascular responses to EA stimulationthrough the gracile nucleus-thalamic pathway. Other substances,including serotonin, catecholamines, inorganic chemicals andamino acids such as glutamate and -aminobutyric acid (GABA),are proposed to mediate certain cardiovascular and analgesiceffects of acupuncture, but at present their role is poorlyunderstood. The increased interest in acupuncture health carehas led to an ever-growing number of investigators pursuingresearch in the processes of the sense of needling touch, transductionof needling stimulation signals, stimulation parameters andplacebos. In this Review, the evidence and understanding ofthe neurobiological processes of acupuncture research have beensummarized with an emphasis on recent developments of nitricoxide mediating acupuncture signals through the dorsal medulla-thalamicpathways.     

磁刺激穴位镇痛诱发的脑电信号特征成分及源定位

背景：针灸是中国传统医学的重要组成部分。穴位治疗作用是否具有生理基础或者只是心理作用一直是争议的焦点。目前临床中常用的穴位刺激方式为手针和电针,很少有关于磁刺激穴位引起脑电活动的文献发表。目的：利用诱发电位来研究磁刺激合谷穴对大脑皮质功能区的影响,探讨磁刺激穴位镇痛机制。方法：18名被试（男13名,女5名）自愿参加实验,选取右侧合谷穴作为靶点目标,距离合谷穴约3cm处的非穴位点作为对照点。磁刺激频率为1Hz,刺激强度为1.76T,实验分别采集磁刺激前、中、后的脑电信号。结果与结论：磁刺激穴位140～170ms后,在F3,F1,FZ,F2,F4,FC3,FC1,FCZ,FC2,FC4等电极处记录到诱发电位晚成分P150。对该成分进行偶极子源定位分析发现P150定位于前扣带回后部,之前的研究已经证明前扣带回不仅参与痛觉认知,还参与痛觉的调制。结果揭示了磁刺激穴位可能的镇痛机制。     

正常人体针灸效应功能性磁共振成像的研究

目的评价针刺体表穴位对脑部相应区域的功能性磁共振成像(fMRI)表现。方法17例健康志愿者，在1，5TMRI仪上进行针刺足三里(S36)、阳陵泉(G34)的实时动态fMRI检查，观察并分析针刺效果明显者的脑部功能变化情况，判断针刺效果及其意义。结果17例志愿者中13例检查成功，可见躯体感觉运动区(SMC)、运动前区(PMC)、副运动区(SMA)激活明显，额叶前部、扣带回、尾状核头部、豆状核及丘脑、岛叶、岛盖皮质大多有大面积明显激活，小脑和桥脑也可见有激活，在左侧丘脑、SMA、SMC、PMC激活区附近有信号减低的现象，但激活的像素数不多；信号减低区包括两侧额叶内侧面皮质，双侧扣带回前部皮质，两侧海马区，右侧眶回、基底节、尾状核头部等。结论针刺对脑部相关穴位的治疗效应显著，可产生广泛而复杂的脑功能变化，fMRI可清楚显示针刺效应引起的脑部功能变化，是针刺机制及效应良好且直观的评价途径。     

Evaluating the Effects of Acupuncture Using a Dental Pain Model in Healthy Subjects – A Randomized,Cross-Over Trial

Acupuncture is a complementary and nonpharmacological intervention that can be effective for the management of chronic pain in addition to or instead of medication. Various animal models for neuropathic pain, inflammatory pain, cancer-related pain, and visceral pain already exist in acupuncture research. We used a newly validated human pain model and examined whether acupuncture can influence experimentally induced dental pain. For this study, we compared the impact of manual acupuncture (real acupuncture), manual stimulation of a needle inserted at nonacupuncture points (sham acupuncture) and no acupuncture on experimentally induced dental pain in 35 healthy men who were randomized to different sequences of all 3 interventions in a within-subject design. BORG CR10 pain ratings and autonomic responses (electrodermal activity and heart rate variability) were investigated. An initial mixed model with repeated measures included preintervention pain ratings and the trial sequence as covariates. The results showed that acupuncture was effective in reducing pain intensity when compared to no acupuncture (β = −.708, P = .002), corresponding to a medium Cohen's d effect size of .56. The comparison to the sham acupuncture revealed no statistically significant difference. No differences in autonomic responses between real and sham acupuncture were found during the intervention procedures.PerspectiveThis study established a dental pain model for acupuncture research and provided evidence that experimentally induced dental pain can be influenced by either real acupuncture or manual stimulation of needles at nonacupuncture points. The data do not support that acupoint specificity is a significant factor in reducing experimental pain.     

Acupuncture in migraine prevention: a randomized sham controlled study with 6-months posttreatment follow-up

OBJECTIVE: To assess the efficacy of acupuncture in migraine prophylaxis. METHODS: Thirty-seven patients with migraine were enrolled in a randomized control trial at the Headache clinic located in a University Hospital. Real and sham acupuncture groups received 16 acupuncture sessions over 3 months. Treatment was individualized in the real acupuncture group and minimal acupuncture was used in the sham group. The primary end point was the percentage of patients with a >or=50% reduction in their migraine attack frequency in the second, third, fourth, fifth, and sixth (months) compared with the first one (baseline period). Primary and secondary end points were measured comparing headache diaries. RESULTS: Real acupuncture group showed improvement with significant differences compared with the sham acupuncture group in the primary efficacy end point (P=0.021) at the second month of the treatment. Differences also appeared in 2 secondary end points: number of days with migraine per month (P=0.007) in the second month and the percentage of patients with >or=40% reduction in migraine attack frequency in the first (P=0.044) and second months (P=0.004) of the treatment. These differences disappeared in the third (last) month of the treatment as a consequence of the high improvement of the sham acupuncture group. Comparisons within each group showed that several migraine parameters evaluated improved significantly in both groups. CONCLUSIONS: Individualized treatment based on traditional Chinese medicine plays a role in preventing migraine attacks. Nevertheless, sham acupuncture had similar effects. Major conclusions were limited by the small sample sizes however the observed trends may contribute to design future trials.     

电针廉泉穴和风府穴对吞咽相关脑区c-Fos特异性的影响

目的 观察电针廉泉穴和风府穴对吞咽相关脑区（孤束核、臂旁核、初级运动皮质和初级感觉皮质）c-Fos的特异性的影响。 方法 选用C57小鼠20只,将其分为空白组（不做电针干预）、电针廉泉穴组（仅电针廉泉穴）、电针风府穴组（仅电针风府穴）和电针廉泉穴+风府穴组（电针风府穴和廉泉穴）,每组5只小鼠。电针廉泉穴组、电针风府穴组和电针廉泉穴+风府穴组均接受对应穴位的电针治疗15 min,空白组不做电针干预。4组小鼠均于电针廉泉穴组、电针风府穴组和电针廉泉穴+风府穴组电针干预结束50 min后取材,进行免疫荧光染色,通过共聚焦显微镜观察并统计各个脑区（孤束核、臂旁核、初级运动皮质和初级感觉皮质）即刻早基因c-Fos的表达。 结果 在孤束核中,电针廉泉穴组的c-Fos阳性细胞数为（445.1±43.14）个/mm2高倍镜视野,显著高于电针风府穴组的（297.47±25.54）个/mm2高倍镜视野,差异有统计学意义（P＜0.001）。在臂旁核中,电针廉泉穴组、电针风府穴组和电针廉泉穴+风府穴组三组的c-Fos阳性细胞数组间差异均无统计学意义（P＞0.01）。在初级运动皮质中,电针风府穴组的c-Fos阳性细胞数与电针廉泉穴组和电针廉泉穴+风府穴组比较,差异均有统计学意义（P＜0.05）。在初级感觉皮质中,电针廉泉穴+风府穴组的c-Fos阳性细胞数比电针廉泉穴组和电针风府穴组高,差异均有统计学意义（P＜0.01）。 结论 在生理状态下,与电针风府穴、电针廉泉穴+风府穴相比,电针廉泉穴对孤束核的c-Fos激活更强;与电针廉泉穴、电针廉泉穴+风府穴相比,电针风府穴对初级运动皮质的c-Fos激活更强;与电针廉泉穴、电针风府穴相比,电针廉泉穴+风府穴对初级感觉皮质的c-Fos激活更强。     

Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial

OBJECTIVES: To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness (Japanese: katakori) with those of sham acupuncture. DESIGN: Randomized-controlled trial. METHODS: Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness, who had no arm symptoms and gave informed consent, were randomly allocated to acupuncture or sham groups. Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks. In the acupuncture group the acupuncture needle was inserted to the muscle, then the sparrow pecking technique was applied five times. Sham acupuncture was done without insertion of the needle. Dull pain and stiffness were evaluated by visual analog scale (VAS) before, and every 2 days after the first needling for 1 month. Pressure pain threshold on the tender points was measured before and after each treatment. RESULTS: There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment. However, the acupuncture group showed significant reduction of VAS scores immediately after and/or 1 day after the real acupuncture treatments (P<0.01). The effect tended to be prolonged after repeated treatment. Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture. CONCLUSIONS: Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness, but this study was unable to demonstrate any long-term superiority over sham acupuncture.     

Acupuncture compared with placebo in post-herpetic pain

A single blind randomised controlled study of auricular and body acupuncture compared with placebo (mock transcutaneous nerve stimulation) was performed in 62 patients with post-herpetic neuralgia. There was no difference in the amount of pain relief recorded in the two groups during or after treatment; 7 patients in the placebo group and 7 patients in the acupuncture group experienced significant improvement in their pain at the end of treatment. This suggests that acupuncture is of little value as an analgesic therapy for post-herpetic neuralgia. However the study method and the use of a mock transcutaneous nerve stimulator as a placebo may be of value when assessing the effects of acupuncture in other conditions.