[Discussion on "sugar needle - comfortable acupuncture and moxibustion"].

The cases of feeling comfort during acupuncture and moxibustion treatment in literature were summarized and its biological basis was explored. A simple classification of comfort was made, and the importance of obtaining comfort in acupuncture treatment was pointed out. Considering the pursuit of less pain and harmlessness in modern clinical treatment, sugar needle should be advocated and popularized in current clinical practice of acupuncture and moxibustion.

[Challenges and choices: translational acupuncture research spectrum-a proposal].

For more than half a century，the modern bioresearch in acupuncture has made remarkable advancements, proving scientific basis underlying the traditional, intuitive treatment, as well as leading to some new discoveries with the potential to enhance the effectiveness of acupuncture as we know it. Meanwhile, the clinical researches have started to shift its paradigm from traditional individual observation to modern evidence-based medicine. However, there is little interaction between basic and clinic researches, which are like two separate worlds, not benefiting each other. Also the education and training of acupuncture are still traditional style, little combining with modern studies. To bridging the large gap, we need translational science involving in. In this article, with a critical reviews of the limitations of the traditional methods of acupuncture, the challenges faced by clinic practices and placebo-control studies, and the advantages and disadvantages of basic research, we propose a methodological paradigm of the translational research, Translational Acupuncture Research Spectrum, that meets the current situation of acupuncture researches, hoping to give insights into this field and to promote modern acupuncture to move towards a new stage.

[The path of translational medicine for neuroimmunological anti-inflammation and its enlightenment to acupuncture].

Neuroimmunological anti-inflammation is one of the most successful areas of translational medicine in the past 50 years, leading directly to the success of anti-TNF biologics and vagal nerve stimulation therapy for anti-inflammation. The latter has many similarities with traditional acupuncture therapy and further research may reveal more intertwining and enlightenment to acupuncture. This paper briefly reviews the discovery and translational process of Cachectin/TNF, anti-TNF therapy, neural inflammatory reflex arc, vagus nerve stimulation therapy, and Stimulating Peripheral Activity to Relieve Condition (SPARC) project, and also summarizes the experience and lessons learned from the path of translational medicine in this field. The two key steps in the translational process are discussed in details. The purpose is to provide reference for the development of translational medicine in acupuncture. "Minimal injury with significant healing" should be considered as the principal hypothesis to further study the biological mechanism of acupuncture and it may result in more clinical translation in the future.

Song's Mast Cell Theory of Acupuncture.

Professor. Jimei Song (1924-1987), from the Liaoning College of Traditional Medicine, first proposed the hypothesis that cutaneous mast cells (MCs) may be responsible for some of the phenomena associated with activation of meridians, acupoints, and De Qi in acupuncture. This was in 1977 and she subsequently published the first investigative report on human subjects. Supported by hundreds of extensive research reports later on, now Song's Mast Cell Theory of Acupuncture is one of the leading theories in acupuncture research. As a scientist and mother, Professor Song belonged to a special generation of female professionals in China. These women were living in a very unique and challenging era. Called "half of the sky" or "bourgeoisie intellectuals," they faced unbearable difficulties in their lives and their work. The contribution of Professor Song to acupuncture is as significant as the contribution of Ms. Youyou Tu to Chinese herbal medicine. The difference is that Professor Song did not receive any award or significant recognition before she died in 1987. This review provides some background about her life, her contributions, and related publications, as well as a brief review of recent advances on MC mapping and acupuncture based on her MC theory.

[The significance of "A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis" published in Nature for acupuncture research].

October 2021, Nature published an original research article entitled A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis, which draws great attention and arouses extensive discussion in the acupuncture field. Based on previous findings, this study demonstrates that the abundant innervation of PROKR2-Cre neurons in deep fascia tissues mediates the anti-inflammatory effect induced by low-intensity electroacupuncture stimulation at "Zusanli"（ST36） or "Shousanli"(LI10) via the "vagal-adrenal axis". This study is one of milestones in the field of acupuncture basic research and represents a great achievement generated by multi-discipline integration of acupuncture and neuro-immunology. It reveals partial contributing factors involved in acupuncture's effect and the relative specificity of the neuroanatomical basis of acupoints in the context of immune modulation. This study is both very informative and instructive for the innovation and clinical translation of future acupuncture research. Acupuncture researchers are recommended to attach great importance to this study in terms of its research strategy,methods and findings.

[Anatomical basis of transition from eleven to twelve meridians in Han dynasty].

The discovery of modern evolutionary anatomy shows that the persistent median artery in the upper arm is a common variant with an increasing trend. This phenomenon can explain well the transition from the eleven meridians described in the Han silk and bamboo slips to the twelve meridians finalized in Neijing and the addition of the hand- jueyin meridian in Han dynasty. After systematic analysis and comparison, the author proposes the hypothesis that "yin meridians are arteries, and yang meridians are nerve-like structures" to explain the meridian theory prior to acupuncture and acupoints in the Qin and Han dynasties. It is clear that over two thousand years ago, Chinese physicians already described the distribution, physiology, and pathology of the six main arteries and six important nerves in the human extremities. The finding suggests that it was the addition of acupuncture and acupoints that had changed the direction of TCM development in Neijing or later and promoted the maturation of qi and blood, meridians, and zangfu theories.

[In the search of mobile target for acupuncture: why is mast cell?]

Both clinical practice and basic research of acupuncture have pointed out that acupuncture treatment has specific tissue and cellular targets. In addition to the known fixed tissue targets such as nerves and blood vessels, the author analyzes the biological characteristics of other skin resident cells in the skin and concludes that cutaneous mast cells are the most suitable candidate for the cellular target of acupuncture. A hypothesis of the bionic acupuncture is proposed to explain the biological principles by which the innate immunity and healing system respond to acupuncture. The distribution of mast cells in the human skin is characterized by "approaching to the terminals and gathering at the orifices", and the cell density is highly correlated with the density of acupoints and the micro-acupuncture systems. These evidences all support that mast cells are the mobile target cells for acupuncture, which can explain some clinical phenomena and principles of acupuncture, and suggest mast cells as one of the tissue markers for acupoints.

[Discussion on Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial published in JAMA Internal Medicine].

Professor LIANG Fan-rong's team from Chengdu University of TCM published Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial in JAMA Internal Medicine on July 29, 2019, which demonstrates that acupuncture as an adjunctive therapy is safety and effective for mild and moderate chronic stable angina. Sixteen experts at home and abroad conducted serious discussions on the research design, evaluation methods, principles and mechanisms, clinical significance and enlightenment of future acupuncture research, and provided practical suggestions for acupuncture and moxibustion to go global and gain international recognition.

Persistent median artery may explain the transition from 11 to 12 meridians in ancient Chinese medicine.

Persistent median artery (PMA) has been recognized as a major arterial variant of the forearm in about 30% adults and it also shows a continuously increasing trend in the last two hundred years. This may explain well the mystery why a "new meridian" was added to the older 11-meridian system over two thousand years ago in Chinese medicine. The 12th meridian, Hand Jue Yin Meridian, happens to run along the same pathway as PMA.

Dry Needling: Is It Derived From Acupuncture? How Did Nonacupuncturists Start Using It?

CONTEXT: In the United States. and other Western countries, dry needling (DN) has been a disputed topic in both the academic and legal fields. OBJECTIVE: The research team intended to examine whether DN is a technique independent from acupuncture and also how nonacupuncturists, such as physical therapists (PTs), started practicing DN. DESIGN: The research team completed research, examined critical issues related to DN, and published a white paper in 2017 that discussed evidence and expert opinions from academic scholars, for health care professionals, administrators, policy makers, and the general public that demonstrate that DN is acupuncture. This article continues that endeavor. RESULTS: DN is not merely a technique but a medical therapy that is a simplified form of acupuncture practice. To promote DN theory and business, some commercial DN educators have recruited a large number of nonacupuncturists, including PTs, athletic trainers, and nurse practitioners, in recent years. PTs did not initiate the practice of DN and DN does not fit into the practice scope for PTs because it is an invasive practice. The national organizations of the PT profession, such as the American Physical Therapy Association and the Federation of State Boards of Physical Therapy, began to support the practice of DN by PTs in approximately 2010. Currently, more PTs are involved in DN practice and are teaching than any other specialty. CONCLUSIONS: Acupuncturists and physicians must complete extensive acupuncture training in accredited programs and pass national examinations to become licensed or certified to practice acupuncture. However, a typical DN course runs only 20-30 h, often in the course of 1 weekend, and the participants may receive a DN certificate without any national examination being required. For the safety of patients and professional integrity, the research team strongly suggests that all DN practitioners and educators should have to meet the same basic standards as those required for licensed acupuncturists or physicians.

The Neuroimmune Basis of Acupuncture: Correlation of Cutaneous Mast Cell Distribution with Acupuncture Systems in Human.

The hypothesis that cutaneous mast cells (MCs) are responsible for skin phenomena in acupuncture was proposed 40 years ago, but very little is known about the correlation of MC distribution with acupuncture systems in human. The aim of this study is to quantify cutaneous mast cells at different body sites and compare them with the distributions of classical acupuncture points and micro-acupuncture systems. Skin biopsies from dermatological practice were evaluated under microscope with H&E or CD117 stains. Dermal MCs were counted and expressed as MCs per high power field. Densities of classical acupuncture points at different body sites were also calculated and expressed as points per dm2. MC densities at special sites of the body were compared with micro-acupuncture systems. After examining 285 skin biopsies, MC enriched special sites (MESS) were found at peripheral parts of the body and around orifices of body surfaces. Comparative mapping showed that patterns of MC distribution are highly correlated with the distributions of classic acupuncture points in 14 classic acupuncture meridians, with the exception of the trunk areas. Mapping also revealed that all micro-acupuncture systems were established at MESS, including ear, scalp, hand, foot, eye, face, and umbilicus. The conclusion is that the densities of cutaneous MCs are highly correlated with classical acupuncture points and micro-acupuncture systems. These findings provide tissue evidence of neuroimmune basis of acupuncture and suggest that MC is a tissue target for acupuncture stimulation and may serve as a tissue marker for acupuncture points.

[The Incorrect Translation, Misinterpretation and Misunderstanding of "Superficial Fascia" in Acupuncture].

The "superficial fascia" is often interpreted as "tendon-membrane like structure" in acupuncture field and it is speculated that acupuncture stimulation-induced structural alteration of the superficial fascia may contribute to the alleviation of many medical conditions. The fact is that the superficial fascia mainly consists of subcutaneous adipose tissue and fibrotic network (which function in storing, supporting and buffering external pressure and are not responsible for producing "Deqi" or "needling sensations"), and has no typical tendon or membrane structure in hypodermis. In the present paper, the author tries to clarify its incorrect translation, misinterpretation, and misunderstanding in acupuncture and propose that the target of acupuncture stimulation is probably not only the subcutaneous soft tissue per se, but also the contents in subcutaneous soft tissue network as the nerves, blood vessels, lymph-vessels, cutaneous accessory structures, mast cells, multiple movable cells, related receptors, etc.

Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017.

The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.

Evidence and expert opinions: Dry needling versus acupuncture (II) : The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016.

In the United States and other Western countries, dry needling has been a topic in academic and legal fields. This White Paper is to provide the authoritative information of dry needling versus acupuncture to academic scholars, healthcare professionals, administrators, policymakers, and the general public by providing the authoritative evidence and expertise regarding critical issues of dry needling and reaching a consensus. We conclude that Dr. Travell, Dr. Gunn, Dr. Baldry and others who have promoted dry needling by simply rebranding (1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using "fascia" hypothesis) in replace of their equivalent Chinese medical terms. Dry needling is an over-simplified version of acupuncture derived from traditional Chinese acupuncture except for emphasis on biomedical language when treating neuromuscularskeletal pain (dry needling promoters redefined it as "myofascial pain"). Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of manual therapy. Dr. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture's local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients' safety, dry needling practitioners should meet standards required for licensed acupuncturists and physicians.

[Three Waves of Arsenic Therapy for Leukemia and Related Innovations].

There were three waves of arsenic therapy for leukemia in the history and every time, it started with a particular medical innovation. German doctor first found that Fowler arsenic solution might improve symptoms of leukemia patients in 1865 but the therapy was never popular due to uncertainty. In 1931, American hematologists reported a series of chronic myeloid leukemia cases successfully managed by arsenic solutions , and published the pathological data supporting the specificity of arsenic action on leu- kemic cells. Not until late 1970s, after the publication of new FAB classification of leukemia, Chinese doctors from Harbin Medical University who had been exploring novel applications of traditional Chinese medi- cines, discovered that the new leukemic entity, acute promyelocytic leukemia (APL) was the best indica- tion for arsenic containing remedy. The theory was supported by many APL survivors and later trials with As2Ο3, as a monotherapy. The Harbin Protocol was soon repeated successful in China and in the West, and As2Ο3, became a FDA approved new drug for APL in 2001. The discovery of arsenic therapy for APL was ap- parently not an incidental finding, but a timely advance following medical innovation. The continuing efforts in the research of traditional Chinese medicine and the teamwork of specialists in Chinese medicine, hema- tology, pathology, and pharmacology made this innovative discovery possible.