Autonomic and subjective responses to real and sham acupuncture stimulation

This study compared verum acupuncture (VA) and sham acupuncture (SA) stimulation by assessing autonomic and subjective responses. Autonomic responses such as skin conductance response (SCR) and heart rate (HR) were measured. Subjective pain ratings were collected and evaluated. A correlation analysis was performed for SCR and HR changes and subjective pain ratings. In both VA and SA sessions, SCR increased, and HR decreased. Subjective responses were different for VA and SA. The SCR changes correlated with subjective responses for VA, but not SA. The present results suggest that VA and SA do not fundamentally differ in their autonomic response patterns.     

Effects of electroacupuncture on gastric myoelectrical activity in healthy humans

The acupuncture point of the wrists (PC6) and the lower legs (ST36) are common points for the treatment of gastric symptoms. However, it remains unclear whether these two acupoints have different effects on gastric myoelectrical activity. We compared the effect of electroacupuncture (EAP) between PC6 and ST36 on gastric myoelectrical activity using surface electrogastrography (EGG). EAP (1 Hz, for 30 min) was applied at either ST36, or PC6, or both acupoints in eight healthy volunteers. EAP at both PC6 and ST36 did not change the percentage of normal slow waves and tachygastria. While EAP at either PC6 or ST36 did not change period dominant frequency (PDF), EAP at both PC6 and ST36 significantly decreased PDF to 78.1 +/- 8.4% of baselines. EAP at PC6 reduced period dominant power (PDP) to 47.2 +/- 5.3% of baselines, while EAP at ST36 increased PDP to 153.6 +/- 28.3% of baselines. EAP at shoulders (sham acupuncture) did not affect the gastric myoelectrical activity. EAP at either PC6 or ST36 shows an opposite effect on PDP, whereas EAP at both PC6 and ST36 has a synergistic effect on PDF. Understanding site-specific effects of acupuncture may contribute to the selection of appropriate acupoints for treating functional GI disorders.     

Fos-CreER-based genetic mapping of forebrain regions activated by acupuncture

Acupuncture increasingly is accepted as a potential therapy for many diseases in the Western world. However, the mechanism of acupuncture is not well understood mechanistically. We have established that manual acupuncture (MA) at the Neiguan (P6) acupoint inhibits excitatory cardiovascular reflex responses through modulation of the autonomic nervous system in the brainstem. It is unclear whether P6 MA activates neurons in the brain regions beyond the brainstem. Thus, we mapped P6 specific neural activation by MA in the forebrain using the Fos-CreER; Ai9 mice model, which allows for enhanced sensitivity and efficiency compared to conventional immunohistochemical staining. Compared to sham-MA control without manual stimulation, we find that MA at P6 markedly increases c-Fos positive neurons in a number of the forebrain regions (n = 5 in each group). These activated regions include accumbens nucleus, caudate putamen, claustrum, bed nucleus of the stria terminalis, amygdaloid nucleus, ventral posterior division of the thalamic nucleus, paraventricular hypothalamic nucleus, arcuate hypothalamic nucleus, primary and secondary somatosensory cortex, ectorhinal cortex, and dorsolateral entorhinal cortex. As MA at P6 activates neurons in relatively broad brain networks beyond the brainstem, our data suggest that acupuncture at this acupoint has the potential to influence physiological functions associated with autonomic and non-autonomic nervous systems through its effects on multiple brain regions.     

Investigation of specificity of auricular acupuncture points in regulation of autonomic function in anesthetized rats

Auricular acupuncture has been used for various autonomic disorders in clinical practice. It has been theorized that different auricular areas have distinct influence on autonomic functions. The present study aims to examine the effects of acupuncture stimulation at different auricular areas on cardiovascular and gastric responses. In male Sprague-Dawley rats anesthetized with pentobarbital sodium, five auricular areas, which were located at the apex of the helix (A(1)), the middle of the helix (A(2)), the tail of the helix (A(3)), the inferior concha (A(4)) and the middle of the antihelix (A(5)), had been selected for stimulation with manual acupuncture (MA) and different parameters of electroacupuncture (EA). A mild depressor response (6%-12% decrease from baseline) was evoked from A(1), A(3) and A(4) by MA and from all five areas by EA (100 Hz-1 mA). The biggest depressor response (-18.4+/-3.1 mmHg, p<0.001) was evoked from A(4). A small bradycardia was evoked by MA from A(4) and by EA at A(3), A(4) and A(5.) Increase in intragastric pressure (8-14 mmH(2)O) was evoked by MA from A(1), A(3) and A(4) and by EA at A(2.) These results show that similar patterns of cardiovascular and gastric responses could be evoked by stimulation of different areas of the auricle. The present results do not support the theory of a highly specific functional map in the ear. Rather, there is a similar pattern of autonomic changes in response to auricular acupuncture, with variable intensity depending on the area of stimulation.     

Visceral perceptions and gastric myoelectrical activity in healthy women and in patients with bulimia nervosa

Bulimia nervosa remains a common eating disorder in young women. Little is known about upper gastrointestinal symptoms or gastric motility in patients with bulimia nervosa. The aim of this study was to measure gastric myoelectrical activity and hunger/satiety and stomach emptiness/fullness before and after a non-nutrient water load and solid-phase gastric emptying in hospitalized patients with bulimia nervosa (n = 12) and in healthy women (n = 13). Gastric myoelectrical activity was measured by means of cutaneous electrodes; visual analogue scales were used to measure perceptions of hunger/satiety and stomach emptiness/fullness. Before and after a standard water load the bulimia patients reported significantly greater stomach fullness and satiety compared with control subjects (P < 0.01). The percentage of gastric myoelectrical power in the normal 3 cpm range was significantly less in bulimics compared with controls. Power in the 1–2 cpm bradygastria range was significantly greater in bulimia patients before and after the water load compared with the control subjects (P < 0.05). Solid-phase gastric emptying studies using radio-isotope-labelled scrambled eggs showed the lag phase was shortened in the bulimic patients (16 ± 4 min vs 31 ± 4 min in controls, P < 0.01), but the percentage of meal emptied at 2 h was similar to control values. In conclusion: bulimia patients had exaggerated perceptions of stomach fullness and satiety in response to water; and abnormal gastric myoelectrical activity and accelerated lag phase of gastric emptying were objective stomach abnormalities detected in hospitalized patients with bulimia nervosa.     

Autonomic nervous system response to a solid meal and water loading in healthy children: its relation to gastric myoelectrical activity

The aim of this study was to investigate the correlation of gastric myoelectrical and autonomic activities in healthy children. Simultaneous recordings of electrogastrography (EGG) and electrocardiogram (ECG) were performed in healthy children before and after a solid meal and water loading respectively. The autonomic activity was assessed by spectral analysis of the heart rate variability (HRV). The solid meal resulted in an increase in EGG-dominant frequency (2.92 cpm vs 3.16 cpm, P < 0.05), dominant power (46.9 dB vs 53.7 dB, P < 0.05) and percentage normal slow waves (81.9%vs 89.0%, P < 0.05), while only dominant power increased following water loading. Power in the low-frequency band of HRV (LF) was significantly increased and power in the high-frequency band of HRV (HF) significantly decreased following the solid meal. Postprandial LF was positively and HF negatively correlated with the postprandial increase in EGG-dominant power. Water loading was not associated with any significant changes in HRV parameters. These results suggest that both vagal and sympathetic pathways are involved in modulation of gastric myoelectrical activity.     

Neuroprotection effects of retained acupuncture in neurotoxin-induced Parkinson's disease mice

The aim of this study was to investigate the role of retained acupuncture (RA) in neurotoxin-induced Parkinson’s disease (PD) mice. Male C57BL/6 mice were injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to induce the PD model. The mice were divided into four groups, namely, (1) normal; (2) MPTP + retained acupuncture (RA); (3) MPTP + electroacupuncture (EA); (4) MPTP + sham acupuncture (SA). After mice being manipulated with/without acupuncture at acupoints (Daling, PC 7), groups 2–4 were injected with MPTP (15 mg/kg/d). The mice were evaluated for behavioral changes, in terms of time of landing, after acupuncture treatment. The animals were sacrificed and their brains assayed for dopamine and its metabolites and tyrosine hydroxylase (TH) expression by using HPLC and immunohistochemistry/Western blotting, respectively. [¹²³I] IBZM-SPECT imaging between SA and RA groups were compared. The results showed that the time of landing of the three groups with treatment was significant longer than group 1 (normal) (4.33 ± 0.15 s). Nonetheless, group 2 (RA) (7.13 ± 0.20 s) had a shorter time of landing than group 4 (SA) (7.89 ± 0.46 s). The number of TH (+) neurons and the expression of TH proteins were significantly higher in the RA group than in the SA/EA groups. RA also increased the uptake of [¹²³I] IBZM into the triatum compared to the SA group. We conclude that RA possibly attenuates neuronal damage in MPTP-induced PD mice, which suggests RA may be useful as a complementary strategy when treating human PD.     

Effects of intracranial hypertension on gastric myoelectrical activity evaluated by using clinical and radiological symptoms

BACKGROUND AND PURPOSE: Acute and chronic increases in intracranial pressure (ICP) cause a dramatic autonomic dysfunction. The aim of the study is to evaluate effects of acute and chronic ICP on gastric myoelectrical activity. MATERIAL AND METHODS: We studied 80 patients hospitalized in the Department of Neurotraumatology of the Jagiellonian University Medical College. The control group included 16 healthy volunteers matched with gender and age. Gastric myoelectrical activity was captured with cutaneous electrodes and Synectics (Sweden) system of storing and analyzing the data. RESULTS: Results of the study were analyzed in the Department of Pathophysiology of the Jagiellonian University Medical College. Most significant changes on gastric myoelectrical activity were observed in patients after a severe head injury with acute intracranial hypertension (Glasgow Coma Scale: 4-7 points). The percentage of bradygastria timing increased up to 50%. In this group of patients the increase in amplitude of the signal was observed. Significant dysrhythmias up to 40% occurred in patients with chronic increase of intracranial pressure caused by brain tumors. CONCLUSIONS: Most significant changes on gastric myoelectrical activity were observed in patients after a severe head injury with acute intracranial hypertension (Glasgow Coma Scale: 4-7 points). The percentage of bradygastria timing increased up to 50%. Gastric dysmotility was caused by stimulation of both arms of the autonomic nervous system.     

Pretreatment of emulational manual acupuncture versus electroacupuncture against visceral traction pain in rats

BACKGROUND: Acupuncture and moxibustion against visceral noxious stimulation present different mechanisms in the peripheral and central nervous systems, involving release of neurotransmitter substance P, acetylcholine esterase, leucine-enkephalin, and c-Fos protein expression. However, there are few reports addressing changes in neurotransmitter expression following manual acupuncture and electroacupuncture against visceral traction pain.OBJECTIVE: To explore changes in neurotransmitter expression in the ileum and protein expression in the medullary visceral zone of visceral traction pain rats undergoing pretreatment of emulational manual acupuncture, and to investigate the differences between emulational manual acupuncture and electroacupuncture.DESIGN, TIME AND SETTING: The randomized, controlled study was performed at the Biomedical Engineering Laboratory, Shanghai University of Traditional Chinese Medicine, Shanghai, China from August 2008 to July 2009.MATERIALS: G6805 electroacupuncture apparatus (Shanghai Medical Electronic Machine Factory, China) and ZSF-I acupuncture manipulation simulation therapeutic system (Chinese Medical Engineering Room, Shanghai University of Traditional Chinese Medicine, Shanghai China) were used in the present study.METHODS: A total of 40 male Sprague Dawley rats were equally and randomly assigned to sham surgery, model, emulational manual acupuncture and electroacupuncture groups. In the emulational manual acupuncture and electroacupuncture groups, emulational manual acupuncture and electroacupuncture were applied at bilateral Zusanli (ST 36) acupoints for 30 minutes, and models of visceral traction pain were established immediately.MAIN OUTCOME MEASURES: Substance P expression, c-Fos and glial fibrillary acidic protein expression were measured using immunohistochemistry. Acetylcholine esterase activity was examined utilizing a colorimetric method. Leucine-enkephalin content was detected using a radioimmune assay. Degree of pain in rats was assessed by pain score.RESULTS: Pain score, substance P expression in the ileum, acetylcholine esterase activity, expression of c-Fos protein and glial fibrillary acidic protein in the medullary visceral zone were significantly decreased following pretreatment of emulational manual acupuncture and electroacupuncture in rats with visceral traction pain (P＜0.05). Compared with the electroacupuncture group, the leucine-enkephalin content was significantly increased, and pain score was significantly diminished in the emulational manual acupuncture group (P＜0.05).CONCLUSION: Emulational manual acupuncture pretreatment decreases acetylcholine esterase activity, increases leucine-enkephalin release, downregulates expression of c-Fos protein and glial fibrillary acidic protein and ultimately inhibits visceral traction pain by reducing substance P release. The effectiveness in inhibiting visceral traction pain is greater when using emulational manual acupuncture compared with electroacupuncture. This is because emulational manual acupuncture effectively increases leucine-enkephalin release.     

Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial

ObjectiveThe objective of this study was to evaluate the efficacy and safety of acupuncture treatment for primary insomnia.MethodsWe conducted a single-center, single-blinded, and randomized controlled clinical trial. Seventy-two patients with primary insomnia were randomly assigned into two groups – the acupuncture group, who received acupuncture treatment, and the control group, who received sham acupuncture treatment. The treatment was given three times a week for four weeks. Patients were asked to wear sleep monitors and complete questionnaires every two weeks for a total of eight weeks. The primary outcome was the Insomnia Severity Index (ISI). The secondary outcomes were sleep parameters including sleep efficiency (SE), sleep awakenings (SA) and total sleep time (TST) recorded by the Actigraphy, as well as scores of the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS).ResultsCompared with pretreatment baseline, patients in both groups had varying degrees of improvements in their sleep conditions. Paired t-test showed that there was a significant difference in all indicators in the acupuncture group before and after acupuncture treatment. One-way analysis of covariance adjusted for baseline scores indicated that the ISI improved dramatically in the acupuncture group at two weeks post-treatment (F = 11.3, p = 0.001), four weeks post-treatment (F = 33.6, p < 0.001), 2 weeks follow-up (F = 39.4, p < 0.001) and four weeks follow-up (F = 34.1, p < 0.001). Similar significant improvements can also be observed in the SE, TST and SDS scores. Although no differences in SA and SAS were shown between the two groups until the end of the treatment, remarkable decrements in SA and SAS were found in the acupuncture treatment group after the two-week and four-week follow-ups.ConclusionAcupuncture treatment is more effective than sham acupuncture treatment in increasing insomnia patients' sleep quality and improving their psychological health.Trial RegistrationChinese Clinical Trial Registry: Chi CTR-TRC-14004859.     

25The effect of lipase supplementation on upper gastrointestinal symptoms and gastric myoelectrical activity induced by a high fat meal in healthy volunteers.

Background/Aims: Dyspepsia symptoms of abdominal discomfort, fullness, early satiety, and nausea occur after ingestion of meals in 20–30% of the population. Gastric dysrhythmias are exhibited by approximately 55% of dyspepsia patients. Currently there are limited therapies to reduce these symptoms. Gastric and pancreatic lipases are key enzymes in fat digestion, and hydrolyze fat into fatty acids and monoglycerides. The aims of this study were to characterize the effects of a high fat meal on upper gastrointestinal symptoms and gastric myoelectrical activity, and to evaluate the effect of acid‐resistant lipase supplementation on the same outcomes. Methods: Sixteen healthy volunteers enrolled in a double‐blind, placebo controlled, cross‐over trial were given a high fat meal (Pulmocare^®) that was 55% fat, 28% carbohydrates, and 17% protein (237 ml; 355 Kcal). A capsule containing 280 mg of acid‐resistant lipase (Amano Enzyme USA) or placebo was administered immediately before ingestion of the meal. The order of conditions was counterbalanced, and visits were separated by at least one week. At each visit, individuals completed a Visual Analog Scale (VAS) concerning symptoms of nausea, stomach fullness, hunger, bloating, and abdominal discomfort at baseline, immediately after the meal, and at 10, 20, 30, 45, and 60 minutes after the meal. Electrogastrograms (EGGs) were recorded throughout each visit to assess gastric myoelectrical activity. Results: Nausea, bloating, and stomach fullness were significantly increased 10 min after ingestion of the meal (ps < 0.05), and hunger was significantly decreased (p < 0.001); there was also a significant decrease in normal gastric myoelectrical activity (3 cycles min^?1), and a significant increase in tachygastria (3.7–10 cycles min^?1) at 10 min after the meal (ps < 0.05). By 45 min after the meal, dyspepsia symptoms and tachygastria had decreased significantly from immediately after the meal, and normal gastric myoelectrical activity had increased significantly (ps < 0.05). Stomach fullness was significantly lower with lipase supplementation than with placebo condition at 20 and 30 min after the meal (p < 0.05); no effect of lipase supplementation on gastric myoelectrical activity was detected. Conclusions: (1) The high fat meal induced dyspepsia symptoms and gastric dysrhythmias, suggesting the meal may be a useful test for assessing gastric neuromuscular disorders; and (2) Acid‐resistant lipase supplementation decreased stomach fullness after ingestion of the meal, and warrants further study in individuals with functional dyspepsia.     

Two‐channel gastric pacing in patients with diabetic gastroparesis

Background Our primary goals were to investigate the effects of two‐channel gastric pacing on gastric myoelectrical activity, and energy consumption with the secondary intent to monitor gastric emptying and symptoms in patients with severe diabetic gastroparesis. Methods Four pairs of temporary pacing wires were inserted on the serosa of the stomach at the time of laparotomy to place the Enterra? System in 19 patients with severe gastroparesis not responding to standard medical therapies. Two of the pairs were for electrical stimulation and the other two for recording. Five days after surgery the optimal pacing parameters for the entrainment of gastric slow waves in each patient were identified by serosal recordings. Two‐channel gastric pacing was then initiated for 6 weeks using a newly developed external multi‐channel pulse generator. Electrogastrogram (EGG), Total Symptom Score (TSS), and a 4‐h gastric emptying test were assessed at baseline and after 6 weeks of active gastric pacing. Enterra? device was turned OFF during the duration of this study. Key Results Two‐channel gastric pacing at 1.1 times the intrinsic frequency entrained gastric slow waves and normalized gastric dysrhythmia. After 6 weeks of gastric pacing, tachygastria was decreased from 15 ± 3 to 5 ± 1% in the fasting state and from 10 ± 2 to 5 ± 1% postprandially (P < 0.05), mean TSS was reduced from 21.3 ± 1.1 to 7.0 ± 1.5 (P < 0.05) and mean 4‐h gastric retention improved from 42 to 28% (P = 0.05). Conclusions & Inferences Two‐channel gastric pacing is a novel treatment approach which is able to normalize and enhance gastric slow wave activity as well as accelerate gastric emptying in patients with diabetic gastroparesis with a goal safety profile.     

Revised spectral metrics for body surface measurements of gastric electrophysiology

Background

Electrogastrography (EGG) non-invasively evaluates gastric function but has not achieved common clinical adoption due to several technical limitations. Body Surface Gastric Mapping (BSGM) has been introduced to overcome these limitations, but pitfalls in traditional metrics used to analyze spectral data remain unaddressed. This study critically evaluates five traditional EGG metrics and introduces improved BSGM spectral metrics, with validation in a large cohort.

Methods

Pitfalls in five EGG metrics were assessed (dominant frequency, percentage time normogastria, amplitude, power ratio, and instability coefficient), leading to four revised BSGM spectral metrics. Traditional and revised metrics were compared to validate performance using a standardized 100-subject database of BSGM tests (30 min baseline; 4-h postprandial) recorded using Gastric Alimetry® (Alimetry).

Key Results

BMI and amplitude were highly correlated (r = −0.57, p < 0.001). We applied a conservative BMI correction to obtain a BMI-adjusted amplitude metric (r = −0.21, p = 0.037). Instability coefficient was highly correlated with both dominant frequency (r = −0.44, p < 0.001), and percent bradygastria (r = 0.85, p < 0.001), in part due to misclassification of low frequency transients as gastric activity. This was corrected by introducing distinct gastric frequency and stability metrics (Principal Gastric Frequency and Gastric Alimetry Rhythm Index (GA-RI)^TM) that were uncorrelated (r = 0.14, p = 0.314). Only 28% of subjects showed a maximal averaged amplitude within the first postprandial hour. Calculating Fed:Fasted Amplitude Ratio over a 4-h postprandial window yielded a median increase of 0.31 (IQR 0–0.64) above the traditional ratio.

Conclusions & Inferences

The revised metrics resolve critical pitfalls impairing the performance of traditional EGG, and should be applied in future BSGM spectral analyses.     

Oxyntomodulin and glicentin are potent inhibitors of the fed motility pattern in small intestine

Glicentin (GLIC) and oxyntomodulin (OXM or GLIC 33-69) are gut hormones which regulate digestion. They are known to reduce digestive secretions and to delay gastric emptying. Their biological activities on intestinal motility are still unknown. The effect of a systemic GLIC or OXM increase was investigated in rats on the food intake, the postprandial myoelectrical activity of small intestine and the orocaecal transit. An OXM or GLIC i.v. infusion was applied during the 5 min preceding food onset and during the first 15 min of food intake. This determined a three- to fourfold increase of the preprandial OXM-GLIC level. The OXM or GLIC plasma increase did not modify food intake. OXM infusion slowed down gastric emptying when the stomach contained 3/4 of the ingested food (before T 3 h). The quantity of food delivered in jejunum was subsequently smaller (P < 0.05). In the small intestine, the duration of postprandial myoelectrical activity (50-60 min g(-1) of ingested food) was reduced by 70% (P < 0.001) on duodenum or jejunum and by 54% (P < 0.01) on ileum in OXM-treated rats. An interdigestive motility profile was settled and an acceleration of both gastric emptying and transit rate was thereafter evidenced (after T 3 h). GLIC also reduced the duration of the postprandial myoelectrical activity on duodenum and jejunum (65 and 63% respectively, P < 0.05), but was not as efficient as OXM on ileum. In pathological states such as acute adult gastroenteritis, OXM and GLIC exhibit a two- to fivefold increase in their plasma concentrations. The present findings suggest that OXM and GLIC could, in that disease, contribute to exclude pathogens, due to their joined action on gut motility.     

Effects of acupuncture at Sibai （ST 2） acupoint on neuronal discharge in rat nucleus tractus solitarius

BACKGROUND： Electrophysiology can prove the integration of afferent information from the stomach meridian of Foot-Yangming in the nucleus tractus solitarius （NTS） and objectively describe the specific association between meridian vessels and Zang Fu organs. OBJECTIVE： To investigate the effects of afferent information from acupuncture at Sibai （ST 2） acupoint on neuronal discharge in rat NTS. DESIGN, TIME AND SETFING： A randomized, controlled, animal experiment was performed at the Key Laboratory of Meridian-Vessels and Zang Fu Organs, Traditional Chinese Medicine University of Hunan, State Administration of Traditional Chinese Medicine, and Key Laboratory of Acupuncture, Moxibustion, and the Biological Information of Hunan Higher Education Institutes, between December 2005 and October 2008. MATERIALS： A total of 52 Sprague Dawley rats, of either gender, aged 4 months, were included in this study. Acupuncture needles of 0.32 mm （diameter） x 40 mm （length） were used. METHODS： An extracellular recording protocol was applied. The Sibai （ST 2） acupoint in the stomach meridian of Foot-Yangming was used as an acupuncture point （acupoint）. Simultaneously, Dicang （ST 4） and Neiting （ST 44） acupoints in the stomach meridian of Foot-Yangming, Quanliao （S118） acupoint in the small intestine meridian of Hand-Taiyang, and a non-acupoint lateral to Sibai （ST 2） acupoint, were selected as controls. The Sibai （ST 2） acupoint was stimulated for 30 seconds by hand acupuncture through twirling and rotating, to determine the neurons responding to body surface stimulation in the NTS. MAIN OUTCOME MEASURES： Frequency of responding NTS neurons after acupuncture at four acupoints including Sibai （ST 2）, Dicang （ST 4）, Neiting （ST 44） and Quanliao （SI 18） and one non-acupoint. RESULTS： The frequency of responding NTS neurons was significantly higher after acupuncture at Sibaithan at control sites including the Dicang （ST 4）, Neiting （ST 44） and Quanliao （S118） acupoints and at the non-acupoint （P 〈 0.01）. The frequency of responding NTS neurons at Dicang （ST 4） and Quanliao （SI 18） was significantly higher than at Quanliao （SI 18） and the non-acupoint （P 〈 0.05）. The rate of frequency change of responding NTS neurons for the Sibai （ST 2）, Dicang （ST 4）, Neiting （ST 44）, and Quanliao （S118） acupoints as well as the non-acupoint was （35.08±4.80） %, （28.25± 5.46） %, （27.57± 4.87） %, （20.02 ±4.23） %, and （18.55 ±2.49） % respectively. Simultaneously, significant differences existed between Sibai （ST 2） and the other acupoints （P 〈 0.05 or P〈 0.01）. CONCLUSION： Compared with the Dicang （ST 4） and Neiting （ST 44） acupoints in the stomach meridian of Foot-Yangming, Quanliao （SI 18） acupoint in the small intestine meridian of Hand-Taiyang, and the non-acupoint lateral to Sibai （ST 2） acupoint, the Sibai （ST 2） acupoint in the stomach meridian of Foot- Yangming is more closely related to the NTS. In the stomach meridian of Foot- Yangming, afferent information is different in distant and near Shu acupoints, indicating that each Shu acupoint has its own specificity.     

针刺及艾灸足三里穴缓解大鼠运动疲劳作用的比较

背景：已有诸多实验证实针灸足三里穴能够有效地缓解运动疲劳。 目的：观察毫针针刺及艾灸足三里穴(ST36)对运动疲劳大鼠的运动耐力、骨骼肌微循环及抗氧化酶活性的影响,探讨针刺及艾灸两种不同疗法缓解运动疲劳作用的差异。 设计、时间及地点：随机动物实验,于2008-06/07在华南师范大学光子中医学实验室完成。 材料：SPF级雄性成年SD大鼠24只,体质量220~260 g。 方法：SD大鼠24只,适应性游泳后被随机分为正常对照组、模型组、艾灸组及针刺组,每组6只。采用无负重游泳方式建立大鼠运动疲劳模型,艾灸组及针刺组在游泳运动的同时,分别采用毫针及艾灸刺激足三里穴,1次/d,共10 d。末次力竭运动结束后检测指标。 主要观察指标：大鼠骨骼肌微循环及线粒体内超氧化物歧化酶、谷胱甘肽过氧化酶的活性。 结果：实验第9天,艾灸组大鼠的运动耐力显著高于同时间点模型组的运动耐力(P < 0.05);实验第11天,艾灸组和针刺组的大鼠的运动耐力均显著高于模型组的大鼠同时间点的运动耐力(P < 0.05),艾灸组和针刺组相比差异无显著性意义 (P > 0.05)。艾灸组双侧胫骨前肌的血流灌注量均显著高于模型组(P < 0.05);针刺组腹直肌的血流灌注量显著高于模型组(P < 0.05)。艾灸组双侧胫骨前肌线粒体内的超氧化物歧化酶、谷胱甘肽过氧化物酶活性显著高于模型组(P < 0.05); 针刺组双侧胫骨前肌线粒体内的超氧化物歧化酶、谷胱甘肽过氧化物酶活性显著低于艾灸组(P < 0.05)。 结论：艾灸足三里穴能够有效地提高运动疲劳大鼠骨骼肌线粒体抗氧化酶活性、增加骨骼肌血流灌注,缓解外周骨骼肌的运动疲劳,提高运动耐力,其效应优于针刺足三里穴。     

The salient characteristics of the central effects of acupuncture needling: limbic-paralimbic-neocortical network modulation

Human and animal studies suggest that acupuncture produces many beneficial effects through the central nervous system. However, the neural substrates of acupuncture actions are not completely clear to date. fMRI studies at Hegu (LI4) and Zusanli (ST36) indicated that the limbic system may play an important role for acupuncture effects. To test if this finding applies to other major classical acupoints, fMRI was performed on 10 healthy adults during manual acupuncture at Taichong (LV3), Xingjian (LV2), Neiting (ST44), and a sham point on the dorsum of the left foot. Although certain differences could be observed between real and sham points, the hemodynamic response (BOLD signal changes) and psychophysical response (sensory experience) to acupuncture were generally similar for all four points. Acupuncture produced extensive deactivation of the limbic-paralimbic-neocortical system. Clusters of deactivated regions were seen in the medial prefrontal cortex (frontal pole, pregenual cingulate), the temporal lobe (amygdala, hippocampus, and parahippocampus) and the posterior medial cortex (precuneus, posterior cingulate). The sensorimotor cortices (somatosensory cortices, supplementary motor cortex), thalamus and occasional paralimbic structures such as the insula and anterior middle cingulate cortex showed activation. Our results provide additional evidence in support of previous reports that acupuncture modulates the limbic-paralimbic-neocortical network. We hypothesize that acupuncture may mediate its antipain, antianxiety, and other therapeutic effects via this intrinsic neural circuit that plays a central role in the affective and cognitive dimensions of pain as well as in the regulation and integration of emotion, memory processing, autonomic, endocrine, immunological, and sensorimotor functions.     

Effect of rikkunshito on gastric sensorimotor function under distention

Background The herbal medicine rikkunshito is effective for the treatment of gastrointestinal symptoms in patients with functional dyspepsia. Although some basic studies on the effects of rikkunshito have been reported in rats, its effects on human gastric function have not yet been clarified. Psychosocial stress induces visceral hypersensitivity and elements of rikkunshito may reasonably affect or suppress this process. We conducted a study to verify the hypothesis that rikkunshito improves stress‐induced gastric hypersensitivity and/or changes in gastric wall tone. Methods Nine healthy volunteers (five males, four females) participated in the study. The counterbalanced regimen consisted of a 2‐week period of oral administration of 7.5 g day^?1 rikkunshito, then a 2‐week period without treatment. Fundic sensorimotor function was examined using a gastric barostat twice on the day after each period. Virtual reality stress was imposed during the measurements of gastric tone and electrocardiogram. Key Results Stress induced a significant increase in heart rate (P = 0.041), gastric volume (P = 0.008), and phasic volume events (P = 0.049) and a decrease in sensory (P = 0.038), discomfort (P = 0.011), and pain (P = 0.041) thresholds of the stomach. Rikkunshito significantly reduced epigastric fullness (P = 0.037) and perceived stress (P = 0.034) following stimulation of the pain threshold, regardless of stress without the drug. Stress reduced gastric volume at the sensory threshold and increased anxiety at the discomfort threshold, and these responses were significantly inhibited by rikkunshito (P = 0.026, P = 0.022, respectively). Conclusions & Inferences These findings suggest that rikkunshito may improve symptoms and impaired gastric accommodation under distention stimuli of the proximal stomach superimposed by stress.     

Impact of stimulation dose and personality on autonomic and psychological effects induced by acupuncture

Acupuncture has been shown to exhibit distinct effects on the autonomic nervous system. We tested whether the autonomic and psychological response to acupuncture depends on the stimulation dose and the personality of the treated subjects. 52 healthy subjects were randomized to receive either low dose (one needle at point Hegu bilaterally) or high dose (additional 4 needles at non-acupoints bilaterally) acupuncture stimulation after stratification according to their personality to "reduce" or "augment" incoming stimuli. Outcomes were changes of electrodermal activity (EDA), high frequency component of heart rate variability, heart rate, mean arterial blood pressure, respiration rate and subjective parameters for psychological well being and perceived intensity of needling. Electrodermal activity increased during needle insertion and decreased under baseline when subjects were resting with the needles in the body for 20min. The initial EDA increase was significantly (GEE ANCOVA p<0.001) more pronounced during high dose stimulation and independent of personality. All other physiological parameters did not show any significant group effect. Strong stimulated augmenters perceived acupuncture most painful and increased with their psychological activation after the acupuncture session in contrast to the other groups, which showed a decrease of activation in the pre-post comparison (overall group effect p=0.032). The data indicate that during needle insertion high dose acupuncture stimulation leads to a higher increase of sympathetic nerve activity than low dose stimulation independent of personality. After needle insertion subjects who tend to augment incoming stimuli might show a lack of psychological relaxation when receiving high dose stimulation.     

The role of substance P in acupuncture signal transduction and effects

BackgroundAcupuncture has been used to treat a wide variety of diseases, disorders, and conditions for more than 2500 years. While the anatomical structures of acupuncture points (or acupoints) are largely unknown, our previous studies have suggested that many acupoints can be identified as cutaneous neurogenic inflammatory spots (neurogenic spots or Neuro-Sps), arising from the release of neuropeptides from activated small diameter sensory afferents at topographically distinct body surfaces due to the convergence of visceral and somatic afferents. In turn, the neuropeptides released during neurogenic inflammation may play important roles in the effects of acupuncture as well as the formation of active acupoints. Thus, the present study has focused on the role of substance P (SP) in acupuncture signal transduction and effects.MethodsNeuro-Sps were detected by using in vivo fluorescence imaging after intravenous injection of Evans blue dye (EBD) and compared with traditional acupoints. Stimulatory effects of the Neuro-Sps were examined in a rat model of immobilization-induced hypertension (IMH). The roles of increased SP in Neuro-Sps were also investigated by using immunohistochemistry, in vivo single-fiber peripheral nerve recordings, and in vivo midbrain extracellular recordings.ResultsNeurogenic inflammation quickly appeared at acupoints on the wrist and was fully developed within 15 min in IMH model. The Neuro-Sps showed an increased release of SP from afferent nerve terminals. Mechanical stimulation of these Neuro-Sps increased cell excitability in the midbrain (rostral ventrolateral medulla) and alleviated the development of hypertension, which was blocked by the local injection of the SP receptor antagonist CP-99994 into Neuro-Sps prior to acupuncture and mimicked by the local injection of capsaicin. Single fiber recordings of peripheral nerves showed that increased SP into the Neuro-Sps elevated the sensitivity of A- and C-fibers in response to acupuncture stimulation. In addition, the discharge rates of spinal wide dynamic response (WDR) neurons significantly increased following SP or acupuncture treatment in Neuro-Sps in normal rats, but decreased following the injection of CP-99994 into Neuro-Sps in IMH rats.ConclusionsOur findings suggest that SP released during neurogenic inflammation enhances the responses of sensory afferents to the needling of acupoints and triggers acupuncture signaling to generate acupuncture effects.