A review of neuroendocrine immune system abnormalities in IBS based on the brain-gut axis and research progress of acupuncture intervention.

Irritable bowel syndrome (IBS) is a common digestive disorder observed in clinics. Current studies suggest that the pathogenesis of the disease is closely related to abnormal brain-gut interactions, hypokinesia, visceral sensory hypersensitivity in the gastrointestinal tract, and alterations in the intestinal microenvironment. However, it is difficult for a single factor to explain the heterogeneity of symptoms. The Rome IV criteria emphasized the holistic biologic-psycho-social model of IBS, suggesting that symptoms of the disease are closely related to neurogastroenterology and various abnormalities in brain-gut interaction. This study comprehensively reviewed the relationship between the brain-gut axis and IBS, the structure of the brain-gut axis, and the relationship between the brain-gut axis and intestinal microenvironment, and discussed the relationship between the abnormal regulation of the nervous system, endocrine system, and immune system and the incidence of IBS on the basis of brain-gut axis. In terms of treatment, acupuncture therapy can regulate the neuroendocrine-immune system of the body and improve the intestinal microenvironment, and it has the advantages of safety, economy, and effectiveness. We study the pathogenesis of IBS from local to global and micro to macro, and review the use of acupuncture to treat the disease as a whole so as to provide new ideas for the treatment of the disease.

Efficacy of moxibustion in diarrhea-predominant irritable bowel syndrome model rats: a systematic review and meta-analysis.

Objective: To systematically evaluate the efficacy of moxibustion in diarrhea-predominant irritable bowel syndrome (IBS-D) model rats. Methods: A comprehensive search was conducted in the China National Knowledge Infrastructure, WanFang Data, VIP, PubMed, Embase, and Web of Science databases from their inception to June 30, 2023. Relevant animal experiments investigating moxibustion for treating IBS-D in model rats were included. Two independent researchers screened the literature, extracted data, and evaluated the risk of bias in the selected studies. The meta-analysis was performed using RevMan 5.3 software. Results: In total, 21 animal studies comprising 680 model rats were included. The meta-analysis results demonstrated that moxibustion enhanced the threshold capacity of the abdominal withdrawal reflex (AWR) [standardized mean difference (SMD) = 1.84; 95% confidence interval (CI): 1.09, 2.60; p < 0.00001], ameliorated the rate of loose stool (SMD = -4.03; 95% CI: -5.76, -2.30; p < 0.00001), and decreased the colon 5-hydroxytryptamine (SMD = -3.67; 95% CI: -5.33, -2.01; p < 0.00001), serum interleukin-1ß (SMD = -3.24, 95% CI: -4.06, -2.41; p < 0.00001), serum tumor necrosis factor-α (SMD = -2.35, 95% CI: -4.12, -0.58; p < 0.00001), and serum substance P (SMD = -5.14, 95% CI: -8.45, -1.83; p = 0.002) concentrations. Moxibustion did not affect the blood calcitonin gene-related peptide level compared to the blank model group (p = 0.15). Conclusion: Moxibustion modulated the brain-gut interaction, reduced visceral hypersensitivity, inhibited intestinal inflammation, and regulated the immune balance, improving the rate of loose stool and increasing the AWR threshold capacity in IBS-D model rats, achieving good analgesic and antidiarrheal effects. However, these conclusions require further validation due to limitations in the quantity and quality of the included studies.

A Comparison Study of the Effect on IBS-D Rats among Ginger-Partitioned Moxibustion, Mild Moxibustion, and Laser Moxibustion.

BACKGROUND: Diarrhea-predominant irritable bowel syndrome (IBS-D) is a functional gastrointestinal disorder that severely affects patients' life. Moxibustion is believed to be an effective way to treat IBS-D. However, the therapeutic effects and the underlying mechanisms in symptom management of IBS-D by different moxibustion therapies remain unclear. METHODS: IBS-D model rats were divided into groups and treated with ginger-partitioned moxibustion (GPM), mild moxibustion (MM), and laser moxibustion (LM) at a temperature of 43°C, respectively. The temperature curves of acupoints were recorded during interventions. The therapeutic effects were evaluated on the basis of general condition, stool, and hematoxylin-eosin staining of the colon tissue. Moreover, the expression of transient receptor potential vanilloid 1 (TRPV1) receptors in both acupoint tissue and colon tissue was analyzed by immunohistochemistry. RESULTS: After moxibustion treatment, the symptoms were improved. The expression of TRPV1 was increased in acupoint tissue and decreased in colon tissue. GPM and MM showed a more significant influence on IBS-D rats compared with LM. The temperature profile of GPM and MM was wave-like, while LM had an almost stable temperature curve. CONCLUSION: GPM, MM, and LM could improve the symptoms in IBS-D rats. Moxibustion might activate TRPV1 channels in the acupoint tissue and induce acupoint functions, which in turn inhibit the pathological activation state of the colon's TRPV1, followed by improvements in abdominal pain and diarrheal symptoms. LM with stable temperature might lead to the desensitization of TRPV1 receptors and the tolerance of acupoint. GPM and MM provided dynamic and repetitive thermal stimulations that perhaps induced acupoint sensitization to increase efficacy. Therefore, dynamic and repetitive thermal stimulation is recommended in the application of moxibustion.

The thermal performance of biological tissue under moxibustion therapy.

An understanding of the thermal performance of biological tissue under moxibustion with ash cleaning and distance adjustment (ACDA) is helpful for the optimization and standardization of moxibustion clinical treatment. This study compared surface temperature distribution of burning moxa stick with and without ash cleaning. The experimental of moxibustion treatment on in-vitro tissue and human abdomen were conducted and corresponding numerical models were developed. The effect of ACDA on thermal performance of biological tissue under moxibustion therapy were analyzed. The results show that the surface temperature of burning moxa stick with ash cleaning maintained at a higher range compared to that without ash cleaning. During moxibustion with ACDA process in in-vitro tissue experiment, the temperature increase (ΔT) at skin surface almost fluctuated in the same temperature range, and the ΔT in subcutaneous tissue (>11 mm) kept increasing. Relatively, these ΔT under moxibustion treatment without ACDA showed different trends and these values were all much smaller than those with ACDA. In addition, the position of maximum temperature of tissue under moxibustion with and without ACDA was fixed on treatment acupoint and moved away from treatment acupoint, respectively. Besides, the surface temperature of human abdomen tissue under moxibustion treatment with ACDA can be maintained at 46 °C-50 °C for a longer time compared to that under moxbustion without ACDA. In conclusion, moxibustion with ACDA can create a larger and more durable thermal effect on biological tissue. The results also suggest that ACDA may be helpful to improve moxibustion therapy efficacy in clinic treatments.

The Effect of Moxibustion Stimulation on Local and Distal Skin Temperature in Healthy Subjects.

The aim of this study is to investigate the response of local and distal skin temperature to moxibustion stimulation (MS) and explore the effects of MS on sympathetic nerve activity. The distal skin temperatures of fingertips, as an indicator for sympathetic reflex response, were recorded using infrared camera during resting period (10 min), MS period (10 min), and natural cooling period (15 min), respectively. The MS without ash cleaning (AC) was applied to acupoints Quze (PC3) (Group I) and Lao Gong (PC8) (Group II), respectively. In Group III, the MS with the operation of AC was performed on PC8. The temperature responses of the local stimulation points and corresponding control points were also investigated. At the beginning of MS period, a significant increase of temperature on the stimulation point accompanied by a simultaneous reduction of temperature on fingertips was observed. A marked negative correlation was also obtained between temperature changes in the stimulation point and in the fingertips. At the end of natural cooling period (t = 34 min), the temperature of stimulation point was obviously higher than baseline values. In contrast, the temperatures of fingertips increased and then returned to the baseline levels during the second minute of MS period. In Group III, the temperature of stimulation point increased every time with the operation of AC, accompanied by the temperature decrease of middle fingertip. The findings suggest that moxibustion may trigger the sympathetic nervous system and induce the reduction of microcirculation, accompanied by a reduction of fingertip temperature. In addition, the operation of AC caused repeated cycles of thermal stimulation on the stimulation point, which may repetitively activate cutaneous sympathetic nerve fibres and evoke the temperature reduction of fingertips.

The protective effects of acupoint gel embedding on rats with myocardial ischemia-reperfusion injury.

AIMS: Prevention and treatment of myocardial ischemia-reperfusion (I/R) injury has for many years been a hot topic in treating ischemic heart disease. As one of the most well-known methods of complementary and alternative medicine, acupuncture has attracted increasing interest in preventing myocardial I/R injury due to its remarkable effectiveness and minimal side effect. However, traditional acupuncture approaches are limited by cumbersome execution, high labor costs and inevitable pain caused by frequent stimulation. Therefore, in this work, we aimed to develop a novel acupoint gel embedding approach and investigated its role in protecting against myocardial I/R injury in rats. MAIN METHODS: Gels were embedded at bilateral Neiguan (PC6) points of rats and their protective effects against myocardial I/R injury evaluated in terms of changes in histomorphology, myocardial enzymology, antioxidant capacity, anti-inflammatory response, and anti-apoptosis of cells. KEY FINDINGS: We found that the approach of acupoint gel embedding could significantly reduce myocardial infarcted size, repair pathological changes, mitigate oxidative stress damage and inflammatory response, as well as inhibit apoptosis of cardiomyocytes. Such cardioprotective effects were found to be associated with Notch-1/Jagged-1 signaling pathway. SIGNIFICANCE: The proposed approach of acupoint gel embedding has advantages in continuous acupoint stimulation, dosing controls, and no side effects in the course of treatment, as well as in reducing the pain caused by frequent acupuncture. It can form an alternative therapy to not only protect against myocardial I/R injury but also hold great potential in treating other diseases in the future.

An In Vitro and Numerical Study of Moxibustion Therapy on Biological Tissue.

OBJECTIVE: Moxibustion therapy achieves satisfactory therapeutic effects largely depending on the heat stimulation of burning moxa. Understanding the thermal characteristics of heating process is an effective way to reveal the underlying mechanisms of moxibustion therapy. METHODS: This paper performs experimental study on temperature distributions of burning moxa sticks and fresh in vitro porcine abdominal tissue using an infrared camera and thermocouples. Meanwhile, a moxibustion model incorporating moxa stick burning model and tissue heat transfer model was established with consideration of radiation propagation and water evaporation. RESULTS: The burning features of moxa sticks were acquired and the radiation energy generated by the burning moxa stick was absorbed and scattered in biological tissue, resulting in a large temperature gradient in the skin layer. And the water evaporation led to a mass loss and reduced skin surface temperature. The numerical model was verified by experimental results and the effects of moxibustion treatment distance and duration can be quantified based on model calculation. CONCLUSION: The detailed heat transfer process of moxibustion was obtained experimentally and numerically. During moxibustion, the radiation attenuation and water evaporation have a significant influence on the energy transport in biological tissue which cannot be ignored. The treatment distance of 3 cm is the recommended value to achieve the treatment efficacy without thermal damage and pain. SIGNIFICANCE: This research would reveal the underlying mechanisms of moxibustion therapy. Besides, the developed models are expected to establish a guideline for moxibustion clinical treatment.

[Clinical value of cupping spot effect].

The cupping spot is considered as one kind of skin change due to cupping treatment. With literature regarding cupping spot, the influencing factors and value of cupping spot in clinical diagnosis and treatment were analyzed, which could make a further exploration on the action mechanism of cupping treatment. The literature showed that the formation of cupping spot was related with cupping temperature, pressure, cup-retaining time, cupping area, individual difference and health condition, etc; cupping spot had the ability to assist diagnosis, prevent disease, cure disease and evaluate clinical efficacy. Previous studies on cupping spot have already made some progress, and played a positive significance on finding cupping rule and studying its mechanism. However, the research for this area is still in the primary stage, which needed deeper study to reveal scientific connotations of cupping spot.