Auditory influence on stickiness perception: an fMRI study of multisensory integration.

This study explored how the human brain perceives stickiness through tactile and auditory channels, especially when presented with congruent or incongruent intensity cues. In our behavioral and functional MRI (fMRI) experiments, we presented participants with adhesive tape stimuli at two different intensities. The congruent condition involved providing stickiness stimuli with matching intensity cues in both auditory and tactile channels, whereas the incongruent condition involved cues of different intensities. Behavioral results showed that participants were able to distinguish between the congruent and incongruent conditions with high accuracy. Through fMRI searchlight analysis, we tested which brain regions could distinguish between congruent and incongruent conditions, and as a result, we identified the superior temporal gyrus, known primarily for auditory processing. Interestingly, we did not observe any significant activation in regions associated with somatosensory or motor functions. This indicates that the brain dedicates more attention to auditory cues than to tactile cues, possibly due to the unfamiliarity of conveying the sensation of stickiness through sound. Our results could provide new perspectives on the complexities of multisensory integration, highlighting the subtle yet significant role of auditory processing in understanding tactile properties such as stickiness.

Graded brain fMRI response to somatic and visual acupuncture stimulation.

Increased stimulation can enhance acupuncture clinical response; however, the impact of acupuncture stimulation as "dosage" has rarely been studied. Furthermore, acupuncture can include both somatic and visual components. We assessed both somatic and visual acupuncture dosage effects on sensory ratings and brain response. Twenty-four healthy participants received somatic (needle inserted, manually stimulated) and visual (needle video, no manual stimulation) acupuncture over the leg at three different dosage levels (control, low-dose, and high-dose) during functional magnetic resonance imaging (fMRI). Participants reported the perceived deqi sensation for each acupuncture dose level. Blood-oxygen-level dependent imaging data were analyzed by general linear model and multivariate pattern analysis. For both somatic and visual acupuncture, reported deqi sensation increased with increased dosage of acupuncture stimulation. Brain fMRI analysis demonstrated that higher dosage of somatic acupuncture produced greater brain responses in sensorimotor processing areas, including anterior and posterior insula and secondary somatosensory cortex. For visual acupuncture, higher dosage of stimulation produced greater brain responses in visual-processing areas, including the middle temporal visual areas (V5/MT+) and occipital cortex. Psychophysical and psychophysiological responses to both somatic and visual acupuncture were graded in response to higher doses. Our findings suggest that acupuncture response may be enhanced by the dosage of needling-specific and nonspecific components, represented by different neural mechanisms.

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

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

A prospective observational study of optimal acupoint selection on patients with functional gastrointestinal disorders.

INTRODUCTION: Functional gastrointestinal disorders (FGIDs), which include irritable bowel syndrome (IBS) and functional dyspepsia (FD), are common gastrointestinal (GI) diseases that have a large financial impact on patients' quality of life (QoL). Traditional Korean medicine has a particular diagnostic pattern for treating FGIDs. However, FGIDs have not been thoroughly explored because of their complexity. In this proposed study, we will investigate the acupoint selection pattern for FGID patients with various disease patterns, and further determine the best acupoints for treating FGID patients using a machine-learning algorithm. METHODS: We will collect clinical data from 15 multi-center Korean medical clinics that treat FGID as part of an observational study registry. Patients who meet the criteria will be added to the registry after screening. They will receive a maximum 4-week treatment, and they will respond 3 times to a series of questions. We will investigate how doctors of FGID patients with diverse disease patterns choose the acupoints, and we will use a machine learning technique to identify the best acupoints for treating FGID patients. DISCUSSION: This will be the first multi-center observational registry study to assess how traditional Korean medical practitioners diagnose and treat patients in the real world. The findings will shed light on how traditional Korean medicine treats FGIDs and demonstrate the rationale for the diagnostic and acupuncture treatment flow.

Acupuncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis.

Acupuncture has been used as a therapeutic intervention for the treatment of numerous diseases and symptoms for thousands of years, and low back pain has been studied and treated the most in acupuncture clinics. Traditional theory strongly suggests that the selection of acupoints will influence their clinical effects and combinations (e.g., the clinical effects of a particular acupoint or combination on reducing pain), but this idea was not considered in earlier systematic reviews and meta-analyses. We performed a systematic review, meta-analysis, and network analysis to evaluate the magnitude of the effects of acupoints used to treat low back pain in randomized controlled clinical trials. We found that acupuncture significantly reduced pain in patients with low back pain compared with the control group. The most frequently prescribed acupoints were BL23, GV3, BL20, BL40, and BL25, whereas the acupoints with the highest average effect size scores were BL20, GV3, GB30, GB34, and BL25. Further, the combinations of BL23-BL40, BL23-B25, and BL23-BL60 were the most frequently prescribed, while BL23-GV3, BL40-GV4, and BL23-BL25 showed the largest average effect size. By calculating clinical outcomes based on average effect sizes, we found that the most popular acupoints might not always be associated with the best results. Although a more thorough investigation is necessary to determine the clinical effects of each acupoint and combination on patients, we suggest that our approach may offer a fresh perspective that will be useful for future research.

Comparison of the acupuncture manipulation properties of traditional East Asian medicine and Western medical acupuncture.

Background: Acupuncture treatments frequently use manipulation techniques. The therapeutic advantages of acupuncture differ depending on the acupuncture manipulation. The purpose of this article was to compare manipulation techniques in traditional East Asian medicine (TEAM) and Western medical acupuncture (WMA). Methods: Manipulation techniques in TEAM and WMA were compared according to purpose, modulating parameters, and indications. The practical understanding of manipulation in terms of acupuncture stimulation intensity was also explored. The TEAM manipulation techniques of twirling and lifting and thrusting are discussed in terms of the objectives of tonification and sedation. Results: The main therapeutic effect of WMA is mediated through activation of the nervous system, which is achieved with adequate intensity of needling. The TEAM tonification and sedation techniques were designed to produce mild or intense stimulation, respectively, to elicit varying degrees of deqi sensation. Conclusions: Further research is needed to clarify the differences between the TEAM and WMA practices, and to determine whether different needling manipulations affect treatment outcomes.

The role of visual expectations in acupuncture analgesia: A quantitative electroencephalography study.

Acupuncture is a complex treatment comprising multisensory stimulation, including visual and tactile sensations and experiences of body ownership. The purpose of this study was to investigate the role of these three components of acupuncture stimulation in acupuncture analgesia. 40 healthy volunteers participated in the study and received acupuncture treatment under three different conditions (real-hand, rubber-hand synchronous, and rubber-hand asynchronous). The tolerance for heat pain stimuli was measured before and after treatment. Brain oscillation changes were also measured using electroencephalography (EEG). The pain tolerance was significantly increased after acupuncture treatment under all three conditions. Noticeable deqi (needle) sensations in response to acupuncture stimulation of the rubber hand were found under both rubber-hand synchronous and rubber-hand asynchronous conditions. Deqi sensations were significantly correlated with acupuncture analgesia only under the rubber-hand synchronous condition. Increased delta and decreased theta, alpha, beta, and gamma waves were observed after acupuncture treatment under all three conditions. Our findings clarified the role of cognitive components of acupuncture treatment in acupuncture analgesia through the rubber-hand illusion. This study is a first step toward separating various components of acupuncture analgesia, i.e. visual, tactile, and body ownership, and utilizing those components to maximize analgesic effects.

Exploring Acupuncture Actions in the Body and Brain.

Acupuncture's actions have been explained by biomedical research. However, the meridian system used in acupuncture needs further clarification. This review describes how acupuncture affects the body and brain. From the perspective of traditional East Asian medicine, the meridian system is closely connected with acupuncture's treatment effects. In the body, the indications of acupoints, primarily established based on the meridian system, have spatial symptom patterns. Spatial patterns of acupoint indications are distant from the stimulated sites and strongly associated with the corresponding meridian's route. Understanding how acupuncture works based on the original meridian system is important. From a neuroscience perspective, an acupuncture-induced sensation originates from the bottom-up action of simple needling in the peripheral receptor and the reciprocal interaction with top-down brain modulation. In the brain, enhanced bodily attention triggered by acupuncture stimulation can activate the salience network and deactivate the default mode network regardless of the actual stimulation. The application of data science technology to acupuncture research may provide new tools to uncover the principles of acupoint selection and enhance the clinical efficacy of acupuncture treatment in various diseases.

Diachronic analysis of major acupoints used in ancient and current acupuncture treatments: Changes in main acupoints over time.

Background: Over time, a large body of knowledge on acupoint selection patterns has accumulated. This study compared the main acupoint selection patterns between ancient and current acupuncture treatments. Methods: Data on the 10 most frequently used acupoints were obtained from a current medical database, the Cochrane Database of Systematic Reviews, and the ancient medical text Donguibogam. Network analysis was used to identify the most commonly used major points across various diseases. Results: The most commonly used acupoints in both ancient and current acupuncture were ST36, SP6, LR3, LI4, and GV20. Acupoints CV3, CV4, CV6, CV8, and CV12 were more widely used in ancient acupuncture, while in current acupuncture, HT7, PC6, KI3, GB34, and EX-HN3 were more prevalent. Conclusions: Ancient and current acupuncture practice had similar and distinct acupoint selection patterns. Diachronic analysis sheds light on how patterns of acupoint selection have changed.

The efficacy and safety of Laminaria japonica for metabolic syndrome: A protocol for systematic review.

BACKGROUND: Metabolic syndrome is a pathological condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Conventional treatments for metabolic syndrome have limitations due to their nonselectivity, drug resistance, and low bioavailability. The brown seaweed Laminaria japonica (LJP) is a traditional medicine and food in Asia that has shown pharmacological and biochemical properties favorable to the prevention and treatment of lifestyle-related diseases. We will systematically review randomized controlled trials and in vivo preclinical studies evaluating the efficacy and safety of LJP as a useful treatment for metabolic syndrome. METHODS: The following databases will be searched from inception to September 2021: MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science. Randomized controlled trials and in vivo preclinical studies that analyzed LJP for the prevention and treatment of metabolic syndromes will be included. The outcome measures will include body composition, dietary habit scores, serum lipid profiles, daily nutrient intake, quality of life, number of microbiomes, gastrointestinal symptoms, and bowel function. Studies comparing LJP with any type of control intervention will be included. Data extraction using Review Manager version 5.3 and risk of bias assessment using the Cochrane Collaboration's tool for assessing risk of bias will be performed by 2 independent assessors. RESULTS AND CONCLUSION: This systematic review will provide evidence confirming the efficacy and safety of LJP in the treatment of metabolic syndrome. ETHICS AND DISSEMINATION: Ethical approval was not required, as this study protocol does not include any personal information of the participants. TRIAL REGISTRATION NUMBER: DOI 10.17605/OSF.IO/G2BQK (https://osf.io/g2bqk).

Antiobesity and Hepatoprotective Effects of Protein Hydrolysates Derived from Protaetia brevitarsis in an Obese Mouse Model.

Background: Obesity induced by excessive nutrients can cause fatty liver and metabolic dysfunction, which leads to hepatic dysfunction and local/systemic inflammatory responses. Previously, we analyzed the antioxidant, antilipotoxicity, and anti-inflammatory effects of protein hydrolysates in vitro. The aim of the present study is to investigate the antiobesity and hepatoprotective effects of protein hydrolysates derived from Protaectia brevitas (PHPB) in an obese mouse model. Methods: For this in vivo study, 40 mice were included and divided into four groups: (1) normal diet group, (2) high-fat-diet (ctrl(-)) group, (3) high-fat-diet and silymarin-treated (ctrl(+)) group, and (4) high-fat-diet and PHPB-treated group. After 6 weeks of treatment, body weight and the amount of daily food intake were observed. Moreover, the major organs and blood of animals were collected for the analysis of serum chemistry, histopathological examination, and obesity- and inflammation-related gene expressions. Results: The body weight and the amount of daily food intake significantly decreased in the PHPB-treated group compared with those in the ctrl(-) group. The levels of serum ALT, AST, ALP, creatinine, blood urea nitrogen, glucose, bilirubin, total cholesterol, TG, low-density lipoprotein, IL-6, TNF-α, and IGF-1 significantly reduced in the PHPB-treated group, whereas the serum free fatty acid, albumin, high-density lipoprotein, and adiponectin concentrations increased. In the analysis of weight of the liver, kidney, lungs, spleen, and fat tissues (from epididymal, perirenal, and mesentery tissues), the PHPB-treated group showed decreased values compared with the ctrl(-) group. In the histopathological analysis, the PHPB-treated group showed significantly reduced macrovesicular fatty change and inflammatory cell infiltration in the liver, and the size of the adipocyte in the epididymis also significantly decreased. The obesity- and inflammation-related gene (IL-6, TNF-α, IGF-1, leptin, AP2/FABP4, AMPK-α2, ß3AR, and PPAR-γ) expressions in the liver and epididymal adipose tissue were reduced in the PHPB-treated group. Conclusions: Overall, the results of this study suggest that the protein hydrolysates that derived from Protaectia brevitas produce antiobesity and hepatoprotective effects via anti-inflammatory activities.

Identifying Dose Components of Manual Acupuncture to Determine the Dose-Response Relationship of Acupuncture Treatment: A Systematic Review.

The dose-response relationship is a hallmark of pharmacological studies. However, this relationship has not been fully established in acupuncture research. This systematic review aims to provide the characteristics of the dose-response relationship in acupuncture research. We further summarized the differences in acupuncture effects according to dose components. Dose components of acupuncture were categorized into three groups: number of needles, stimulation intensity, and total number/frequency of treatments. The PubMed database was used to identify studies examining the effects of different doses of acupuncture from the establishment of the database to August 13, 2020. Dose components and responses were extracted from each study, and the results of low- and high-dose conditions were compared. Fourteen studies were included in this study. Of the included studies, 37.5% showed statistically significant enhanced responses to acupuncture treatment under high-dose conditions compared to low-dose conditions. Significant differences between high- and low-dose conditions were observed most frequently in studies that used various stimulation intensities (four out of six studies), followed in order by studies that used various numbers of needles (two out of seven studies), and those that used various numbers or frequencies of treatment (none of the three studies). Responses were categorized into symptom changes, physiological changes, experimentally induced pain/stimuli perception, and needling sensation. Stimulation intensity, which is considered one of the most important needling components, might indeed have a great impact on clinical responses to acupuncture.

Open-Label Placebo Treatment for Experimental Pain: A Randomized-Controlled Trial with Placebo Acupuncture and Placebo Pills.

Objective: An open-label placebo (OLP) is a placebo treatment in which the patient is aware that the treatment is a placebo. OLPs are considered effective for reducing pain, and previous studies have shown a stronger placebo effect for placebo acupuncture than for placebo pills. In this study, the authors compared the analgesic effects of OLP pills, OLP acupuncture, and a no treatment condition in healthy participants, and then examined the factors contributing to the OLP effect. Design: Randomized controlled crossover trial. Settings/Location: College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea. Subjects: 34 healthy participants. Intervention: Participants received three different treatments ("OLP-pill," "OLP-acupuncture," and "no treatment") on three separate days in random order. Outcome Measurements: Before and after the treatment, heat pain stimuli were applied to the participants' hands, and pain tolerance, intensity, and unpleasantness were measured using a visual analog scale (range, 0-10). Results: Data of 31 participants were included in the analysis. The authors found significant analgesic effects of the placebo pill and placebo acupuncture in the OLP condition. Regression analyses revealed that expectations regarding treatment and practitioner identity influenced the analgesic effects of OLP acupuncture. There was no adverse event. Conclusions: Expectations regarding treatment and practitioner identity influenced the analgesic effect of placebo acupuncture without deception. These findings provide new information regarding the cognitive factors underlying pharmacologic and nonpharmacologic treatments. Clinical Trial Registration Number: KCT0004928.

Effect of Acupuncture on Gut-Brain Axis Parameters in Patients with Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial.

Atopic dermatitis (AD) is a relapsing and remitting chronic inflammatory skin disease for which a variety of etiological factors are involved. Treatment strategies should be multifaceted and have few side effects. In this respect, acupuncture has become increasingly popular as a safe, consistently effective, and drug-free therapy that treats multiple AD symptoms. We aim to not only verify the effectiveness of acupuncture but also suggest patient-specific response determinants and a new underlying mechanism implicating the gut-brain axis. We have designed a randomized, participant-blinded, sham-controlled clinical trial for 60 mild to moderate AD patients. In a previous study, we observed that the clinical skin symptoms of AD were closely associated with gastrointestinal (GI) symptoms. From these findings, we developed an intervention with six acupuncture points: three for AD symptoms and three for GI symptoms. Also, since high responders and low responders to the acupuncture treatment could be identified in the previous study, we now aim to explore response-determining factors, with a particular focus on GI symptoms. Therefore, we will precisely evaluate not only AD symptoms using the SCORAD, EASI, and DLQI tools, but also GI symptoms using the GSRS, TDS, BSFS, and AR tools and abdominal examination. AD develops in association with complicated pathophysiological factors, such as skin barrier function, genetic susceptibility, and immunological factors. Moreover, the underlying mechanism by which acupuncture treatment works has not been clearly elucidated. We, therefore, will conduct a simultaneous cross-sectional study with a sample of 40 healthy individuals, wherein potential indicators, such as fMRI, gut microbiota, and serum TARC and ATX, will be investigated to determine the gut-brain axis-associated mechanism of acupuncture. We expect that the results of this study could provide important clinical evidence for the effects of acupuncture and help elucidate the therapeutic mechanisms that underlie acupuncture's efficacy in AD treatment. This trial is registered with https://clinicaltrials.gov/ct2/show/KCT0005422 (Trial registration: Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0005422); date of registration: September 23, 2020).

Prescription patterns of herbal medicine for menopausal disorders in major Korean medicine hospitals: a multicenter retrospective study.

BACKGROUND: This study aimed to obtain the symptom, prescription and therapeutic patterns for the treatment of patients with menopausal syndrome in major Korean medicine (KM) hospitals. METHODS: We used a retrospective chart review of climacteric disorder and postmenopausal syndrome patients by examining medical records (ICD-10, menopausal and female climacteric states: N95.1, Menopausal and perimenopausal disorder, unspecified: N95.9) from eight university KM hospitals in South Korea. RESULTS: The main symptoms of 1,682 patients with menopausal disorders visiting eight college-affiliated oriental medicine hospitals were hot flush, hyperhidrosis, fatigue, insomnia, and chest tightness. Guipi decoction, Si-wu guipi decoction, Qing-xin lianzi-yin, Jiawei xiao-yao-san and Guipi wen-dan decoction were the most commonly prescribed treatments for menopausal disorders. Patients were most often treated with a combination of herbal medicine and acupuncture. CONCLUSION: Our study shows that the current prescribed herbal medicines were used for treating menopausal disorders in Korean medicine hospitals. However, the objectivity of the efficacy assessment should be studied further.

Exploring traditional acupuncture point selection patterns for pain control: data mining of randomised controlled clinical trials.

BACKGROUND: The underlying principles of traditional acupuncture point selection for pain control are complex. Analysis of acupuncture treatments from clinical studies may provide us with a potential rule when selecting traditional acupuncture points (hereafter abbreviated as "points") in treatment protocols for pain control. The aim of this study was to investigate which points were most commonly used to treat pain in randomised controlled clinical trials (RCTs). METHODS: We searched acupuncture treatment regimens in RCTs included in the Cochrane Database of Systematic Reviews for pain management. We analysed information on point selection (more than 10 RCTs included) from seven eligible systematic reviews on pain control. The frequency of the points used was calculated and visualised using a human body template. RESULTS: The points most commonly used across diseases were SP6, ST36, LI4 and LR3. However, the most frequently used points varied across individual conditions. For example, the most frequently used points to treat migraine were GB20, LR3, GV20, Taiyang, LI4 and TE5, while the most frequently used points to manage dysmenorrhoea were SP6, CV4, SP8, LR3 and BL32. Both regional and distal points were used for pain management with acupuncture. CONCLUSIONS: Our findings suggest that local and segmental/extra-segmental neuromodulation appear to be the most common phenomena for pain control in acupuncture research. Analysis of information on point selection using a data-driven approach may unveil the hidden patterns of traditional acupuncture point utilisation in clinical practice.

Attentional Bias Toward Cupping Therapy Marks: An Eye-Tracking Study.

OBJECTIVE: Despite the many medical benefits, cupping therapy can be difficult for some patients due to unpleasant marks on the skin. As patients are afraid of the potential painful sensation from cupping therapy, the skin reactions might produce vigilance for treatment as pain-related information. We investigated whether individuals show negative emotions and attentional bias toward pain-related residual marks from cupping therapy on the body using an eye-tracking method. METHODS: Fifty pain-free volunteers were presented with four different kinds of visual stimulation, such as the back or face region and with or without cupping marks on the skin. A cupping and a control image were presented on one screen with one image on the left side of the screen and the other on the right (locations of the images were counterbalanced across participants). The eye movements of the participants were measured while they viewed the pictures. They completed the Empathy Quotient questionnaire before the experiment and evaluated the unpleasantness level to each image during the task. RESULTS: Images of the back and face with cupping marks were rated significantly more unpleasant and showed a significant attentional bias (significantly longer percentage fixation time) than the control images (attentional bias score: Back + cupping: 48.1 ± 2.8%; Back: -0.7 ± 3.4%; Face + cupping: 34.5 ± 2.5%; Face: -2.2 ± 2.9%). Individuals with greater empathy exhibited significantly higher unpleasantness (r = 0.323, p < 0.05) and less attentional bias (r = -0.279, p < 0.05) to the images with cupping marks. CONCLUSION: The skin reactions caused by cupping therapy evoked negative emotional responses as well as attentional bias to the reaction sites. Our findings suggest that the emotional and attentional responses to cupping therapy might reflect potential reluctance to this therapy.